June 27, 1848 — US Senate and House of Representatives, Washington DC

 

Your memorialist respectfully asks permission to lay before you what seem to be just and urgent claims in behalf of a numerous and increasing class of sufferers in the United States. I refer to the great and inadequately relieved distresses of the insane through out the country.

Upon the subject to which this memorial refers, many to whose justice and humanity it appeals are well-informed; but the attention of many has not been called to the subject, and a few, but a. very few, have looked upon some features of this sad picture as revealed in private dwellings, in poor-houses, and in prisons.

Your memorialist hopes to place before you substantial reasons which shall engage your earnest attention, and secure favorable action upon the important subject she advocates.

It is a fact, not less certainly substantiated than it is deplorable, that insanity has increased in an advanced ratio with the fast increasing population in all the United States. For example, according to the best received methods of estimate five years since, it was thought correct to count one insane in every thousand inhabitants throughout the Union. At the present, my own careful investigations are sustained by the judgment and the information of the most intelligent superintendents of hospitals for the insane, in rendering the estimates not less than one insane person in every eight hundred inhabitants at large, throughout the United States.

There are, in proportion to numbers, more insane in cities than in large towns, and more insane in villages than among the same number of inhabitants dwelling in scattered settlements.

Wherever the intellect is more excited, and health lowest, there is an increase of insanity. This malady prevails most widely, and illustrates its presence most commonly in mania, in those countries whose citizens possess the largest civil and religious liberty ; where, in effect, every individual, however obscure, is free to enter upon the race for the highest honors and most exalted stations; where the arena of competition is accessible to all who seek the distinctions which acquisitions and possession of wealth assures, and the respect accorded to high literary and scholastic attainments. Statesmen, politicians, and merchants, are peculiarly liable to insanity. In the United States, therefore, we behold an illustration of my assertions. The kingdoms of Western Europe, excepting Portugal, Spain, and the lesser islands dependent on Great Britain, rank next to this country in the rapid development of insanity. Sir Andrew Halliday, in a letter to Lord Seymour, states that the number of insane in England has become more than tripled in the last twenty years. Russia in Europe, Turkey, and Hungary, together with the most of the Asiatic and African countries, exhibit but little insanity. The same is remarked by travellers, especially by Humboldt, of a large part of South America. Those tracts of North America inhabited by Indians, and the sections chiefly occupied by the negro race, produce comparatively very few examples. The colored population is more liable to attacks of insanity than the negro.

This terrible malady, the source of indescribable miseries, does increase, and must continue fearfully to increase, in this country, whose free, civil, and religious institutions create constantly various and multiplying sources of mental excitement. Comparatively but little care is given in cultivating the moral affections in proportion with the intellectual development of the people. Here, as in other countries, forcible examples may be citied to show the mischiefs which result alike from religious, social, civil, and revolutionary excitements. The Millerite delusions prepared large numbers for our hospitals; so also the great conflagrations in New York, the Irish riots and firemen’s mobs in Philadelphia; and the last presidential elections throughout the country levied heavily on the mental health of its citizens. Abroad, discontents in Scotland, civil and religious; agitations in Wales, social and civil; wide-spread disturbances in the manufacturing and agricultural districts of England; tumultuous and riotous gatherings in Ireland — all have left abiding evidence of their mischievous influence upon the records of every hospital for the insane. France, too, unfolds a melancholy page of hospital history. Subsequent to the bloody revolution which marked the close of the eighteenth century, the hospitals for the insane were thronged, showing that where the effect of exalted mental excitement failed to produce insanity in the parents, it was developed in the children. and children’s children — a fearful legacy, and sure!

The political disturbances which convulsed Canada, several years since, were followed by like results.

In law, idiots are ranked with the insane. I have remarked, throughout our country, several prevailing causes of organic idiocy; of these the most common, and the most surely traced, is intemperance of parents, and the marriage and intermarriage of near relatives and kindred. Abounding examples exist on every side throughout the land.

In calculating the statistics of mental aberration, from the best authorities, it is found impossible to arrive at exactly correct results; approximation to facts is all that can be attained.

There is less maniacal insanity in the southern than in the northern States, for which disparity various causes may be assigned. Two leading causes, obvious to every mind, is the much larger amount of negro population, and much less influx of foreigners, in the former than in the latter. While the tide of immigration sets towards the north Atlantic States with almost overwhelming force, one cannot witness the fact and not note its sequence.

Our hospitals for the insane are already receiving a vast population of uneducated foreigners ; and most of these, who become the subjects of insanity, present the most difficult and hopeless, because the least curable cases. Take for example the following records, which are gathered from the city hospitals for the insane poor, passing by for the present all the State and general hospitals:

In 1846, the Boston City Hospital for the insane poor received 169 patients; 90 of which were foreigners, 35 natives of other States, and 44 alone residents of the city. Of the 90 foreigners, 70 were Irish. The New York City Hospital for the insane poor, on Blackwell’s island, which went into operation in 1839, had, in the autumn of 1843, about 300 patients. Of 284 admitted the following year, 176 were foreigners, viz: 112 Irish, 21 English, 27 Germans; and besides these, were 38 natives of New York. On the first of January, 1846, there were in the institution 356 patients, of whom 228 Were foreigners. In January, 1847, there were 410 insane patients, 329 of whom were foreigners. The cost to the city of supporting this institution, in 1846, was 24,179 dol. 67 c.

In the Philadelphia poorhouse hospital, at Blockley, there were received in one year 395 insane patients; at the present time there are actually resident there 350 idiots, epileptics, and insane. At the Baltimore city almshouse, there are at the present time more than 85 individuals in various stages of insanity, the whole number of inmates reported being 1,726; of whom 873 are Americans, and 853 Europeans. In the Charity Hospital at New Orleans, in 1845-346, were above 73 insane; in 1847 — ’48 there were above 80, chiefly foreigners, and presenting mostly chronic cases. The whole number of patients received at this institution the past year was 8,044; of these 7,173 were Americans by birth, 6,150 were foreigners, and 121 were not recorded.

The report of the Commercial Hospital at Cincinnati shows, for 1844-‘45, that of 1,579 patients, 85 were insane and idiotic. The report of 1846 exhibits the following summary: “ Of 2,028 patients, 102 were insane.” The last return shows yet an increase of this afflicted class, notwithstanding the enlarged accommodations in the State Hospital at Columbus, and the new buildings for the insane at the excellent asylum for persons in necessitous circumstances in the same city. I might adduce additional records, but believe the above are sufficient to establish the correctness of my position.

Allowing at the present time 22,000,000 inhabitants in the United States, (which is below the estimated number,) and supposing only one in every thousand to be insane or idiotic, we have then 22,000 to take charge of; a majority of whom are in needy or necessitous circumstances. Present Hospital provision relieves (if we do not include those institutions not considered remedial), less than 3,700 patients. Where are the remainder, and what is their condition? More than 18,000 are unsuitably placed in private dwellings, in jails, in poorhouses, and other often most wretched habitations.

Dr. Kirkbride, who has carefully reviewed this subject, writes as follows: “ In regard to whole numbers, my own enquiries lead me to believe that one in every six or seven hundred inhabitants would be a nearer approximation to correct estimate than one in every thousand, which has heretofore been assumed as the common rule.” According to the latest Parliamentary returns taken with the report of the Metropolitan Commissioners in Lunacy, which give the numbers of all classes of insane in the hospitals of England and Wales, it is ascertained that in these two countries “there is one insane pauper to every one thousand inhabitants alone.”

The liability of communities to insanity should not, I suppose, be estimated by the number of existing cases at at any one time; for insanity does not usually hasten the termination of life. Take for example Massachusetts, New York, and Virginia, where are found so large numbers of established, long-existing cases. These are counted again and again, every year, every five, or every ten years. A fairer test of the liability of communities to insanity is to be found in the occurring cases in corresponding given periods.

There are twenty State hospitals, besides several incorporated hospitals, for the treatment of the insane, in nineteen States of the Union, Virginia alone having two government institutions of State incorporated hospitals. The following is a correct list, omitting several small establishments conducted by private individuals, and several pretty extensive poorhouse and prison departments, which cannot properly be classed with regularly organized hospitals, being usually deficient in remedial appliances.

The first hospital for the insane in the United States was established in Philadelphia, as a department of the Penn Hospital, in the year 1752. This has been transferred to a fine district near the village of Mautua, in the vicinity of Philadelphia, since 1832: number of patients 188.

The second institution receiving insane patients, and the first exclusively for their use, was at Williamsburg, Virginia, in 1773: number of patients 164. 

The third was the Friends’ Hospital, at Frankfort, near Philadelphia, in 1817: number of patients 95.

The next was the McLean Hospital, at Charlestown, (now Summerville,) in Massachusetts, in 1818. This valuable institution is second to none in America. Number of patients 180.

Bloomingdale Hospital, near the city of New York, was established in 1821; number of patients 145: South Carolina Hospital, at Columbia, in 1822; number of patients 74: Connecticut Hospital at Hartford: patients 122: and Kentucky Hospital, at Lexington, patients 247, in 1824.

In 1845-46, the legislature of Kentucky passed a bill to establish a second State institution in the Green River country.

Virginia Western Hospital was opened at Staunton in 1828  number of patients 217. Massachusetts State Hospital, at Worcester, was opened in 1833, and enlarged in 1843; it has 370 patients. Maryland Hospital, at Baltimore, was founded in 1834; it has in the present year 109 patients. Vermont State Hospital, at Brattleborough, was opened for patients in 1837, and enlarged in in 1846-47 it has at present 320 patients. New York City Hospital for the-poor, on Blackwell’s island, was occupied in 1838; it is now being considerably enlarged; above 400 patients.

The grand jury this month (June, 1848,) have made the following presentment in relation to the Blackwell’s island hospital for the insane poor: “We found no less than 425 afflicted children of humanity suffering under the most terrible of all privations, and, we observed with regret, less adequately cared for than their situation and the dictates of humanity require.”

The same document places before the public the concurrent testimony of Drs. Macdonald, Williams, and Ogden, who in a. clear and true report show that “the accommodations for the insane poor of New York city are at present inadequate and miserable; and the imperfect manner of their treatment is such as to be a dis grace to the city, which otherwise is deservedly famed for its liberal benevolent institutions. In the present state of affairs: it is useless to attempt the recovery of any patients here.”

The same remark holds good of the department for the insane connected with the commercial hospital in Cincinnati.

Well organized hospitals are the only fit places of residence for the insane of all classes; ill-conducted institutions are worse than none at all. The New York City Hospital for the insane, and the State hospitals of Georgia and Tennessee, cannot take at present respectable rank as curative or comfortable hospitals.

Tennessee State Hospital, at Nashville, was opened in 1839. According to an act of the legislature the present year, this hospital is to be replaced by one of capacity to receive 250 patients. In the old hospital are 64 patients. Boston City Hospital for the indigent, which has 150 patients, and Ohio State Hospital at Columbus, were severally opened in 1839. The latter has been considerably enlarged, and has now 329 patients. Maine State Hospital, at Augusta, 1840; patients 130. New Hampshire State Hospital, at Concord, was opened in 1842, and has 100 patients. New York State Hospital, at Utica, was established in 1843, and has since been largely extended, and has 600 patients. Mount Hope Hospital, near Baltimore, 1844-’45  has 72 insane patients. Georgia has an institution for the insane at Milledgeville, and at present 128 patients. Rhode Island State Hospital opened, under the able direction of Dr. Ray, early in 1848. New Jersey State Hospital, at Trenton, 1848. Indiana State Hospital, at Indiana polis, will be opened in 1848. State Hospital of Illinois, at Jacksonville, will be occupied before 1849. The Louisiana State Hospital will be occupied perhaps within a year.

I repeat that these institutions, liberally sustained as are most of them, cannot accommodate the insane population of the United States who require prompt remedial care.

It may be suggested that though hospital treatment is expedient, perhaps it may not be absolutely necessary, especially for vast numbers whose condition may be considered irrecoverable, and in whom the right exercise of the reasoning faculties may be looked upon as past hope. Rather than enter upon a philosophical and abstract argument to prove the contrary to be the fact, I will ask permission to spread before you a few statements gathered, without special selection, from a mass of records made from existing cases, sought out and noted during eight years of sad, patient, deliberate investigation. To assure accuracy, establish facts beyond controversy, and procure, so far as possible, temporary or permanent relief, more than sixty thousand miles have been traversed, and no time or labor spared which fidelity to this imperative and grievous vocation demanded. The only States as yet unvisited are North Carolina, Florida, and Texas. From each of these, however, I have had communications, which clearly prove that the conditions of the indigent insane differ in no essential degree from those of other States.

I have myself seen more than nine thousand idiots, epileptics, and insane, in these United States, destitute of appropriate care and protection; and of this vast and most miserable company, sought out in jails, in poorhouses, and in private dwellings, there have been hundreds, nay, rather thousands, bound with galling chains, bowed beneath fetters and heavy iron balls, attached to drag-chains, lacerated with ropes, scourged with rods, and terrified beneath storms of profane execrations and cruel blows; now subject to gibes, and scorn, and torturing tricks — now abandoned to the most loathsome necessities, or subject to the vilest and most outrageous violations. These are strong terms, but language fails to convey the astounding truths. I proceed to verify this assertion, commencing with the State of Maine. I will be ready to specify the towns and districts where each example quoted did exist, or exists still.

In B___., a furious maniac confined in the jail; case doubtful from long delay in removing to an hospital; a heap of filthy straw in one corner served for a bed; food was introduced through a small aperture, called a slit, in the wall, through which also was the sole source of ventilation and avenue for light.

Near C___., a man for several years in a narrow filthy pen, chained; condition loathsome in the extreme.

In A___, insane man in a small damp room in the jail; greatly excited; had been confined many years; during his paroxysms, which were aggravated by every manner of neglect, except want of food, he had torn out his eyes, lacerated his face, chest, and arms, seriously injured his limbs, and was in a state most shocking to behold. In P___., nine very insane men and women in the poorhouse, all exposed to neglect in every species of injudicious treatment; several chained, some in pens or stalls in the barn, and treated less kindly than the brute beasts in their vicinity. At 0___., four furiously crazy; ill treated, through the ignorance of those who held them in charge, 47 cases in the middle district, either scattered in poorhouses, jails, or in private families, and all inappropriately treated in every respect; many chained, some bearing the marks of injuries self-inflicted, and many of injuries received from others. In New Hampshire, on the opening of the hospital for the reception of patients, in 1842; many were removed from cages, small unventilated cells in poorhouses, private houses, and from the dungeons of county jails. Many of these were bound with cords, or confined with chains; some bore the marks of severe usage by blows and stripes. They were neglected and filthy; and some, who yet remain in remote parts of the State, through exposure to cold in inclement seasons, have been badly frozen, so as to be maimed for life. Details in many cases will not bear recital.

In New Hampshire, a committee of the legislature was named in 1832, whose duty it was to collect and report statistics of the insane. Returns were received from only one hundred and forty one towns: in these were returned the names of one hundred and eighty-nine persons bereft of their reason, and incapable of taking care of themselves; ninety men and ninety-nine women. The number confined was seventy-six, twenty five of whom were in private houses, seven in cells and cages, six in chains and irons, and four in the jails. Of the number at liberty, many had at various times been confined. Many of the facts represented by this committee are too horrible to repeat, and would lead many to the belief that they could not be correct, were they not so undeniably authenticated. The committee remark that from many towns no returns had been made, and conclude their report with the declaration “that they could not doubt that the numbers of the insane greatly exceeded the estimates rendered.”

Where were these insane? “Some were in cells or cages; some in outbuildings, garrets, or cellars; some in county jails, shut up with felons and criminals; some in almshouses, in brick cells, never warmed by fire, nor lighted by the rays of the sun.” The facts presented to this committee not only exhibit severe unnecessary suffering, but utter neglect, and in many cases actual barbarity.

Most of the cases reported, I could authenticate from direct investigation. One very insane woman was confined all winter in a jail without fire; and from the severity of the cold, and her fixed posture, her feet were so much injured that it was deemed necessary to amputate them at the ankle, which was accordingly done.

“Another female was confined in a garret, where, from the lowness of the roof, and the restrained position, she grew double, and is now obliged to walk with her hands, as well as her feet, upon the floor.” I recollect eight cases corresponding with this, produced from similar causes, in other States. A man was con fined in a cellar for many years without clothing, and couching in a heap of wet straw, which was from time to time renewed: another in a similar condition is chained in an out-building; another is at this time (1846)’chained to the floor in an out-building, glad to pick the bones thrown into his kennel, like a beast: one with sufficient property, and formerly correct in life, active and happy. This case was reported to the committee in 1832, who, summing up their report, state, that’ “in the extremity of disease, the maniac is withdrawn from observation, and is forgotten. His voice, in his raving, grates not upon the ear of the happy. They who have the custody of the wretched being are too prone to forget their duty, and his claims upon them for kindness and forbearance. Their sympathy is exhausted, and their kindness becomes blunted by familiarity with misery. They give up the feelings of the friend for the apathy of the jailer.” They adopt a common error, that the maniac is insensible to suffering; that he is incurable; and therefore there is no use in rendering the cares his situation demands.

A committee reported (in 1836) to the legislature of New Hamp shire, that their whole number of returns was 312: the number of towns returned having insane, was 141; the whole number of inhabitants in all the towns returned, was 193,569. The number returned as confined, including all in cages, jails, close rooms, by chains and hand-cuffs, &c., was 81. From these statistics, carefully collected, it appears that one in every six hundred and twenty is insane. The committee of 1936 conclude their report as follows: “ Neither the time nor the occasion requires us to allude to instances of the aggravated and almost incredible suffering of the insane poor which have come to our knowledge. We are convinced that the legislature require no high wrought pictures of the various gradations of intense misery to which the pauper lunatic is subjected; extending from his incarceration in the cold, narrow, sunless, and fireless cell of the almshouse, to the scarcely more humane mode of ‘selling him at auction,’ as it is called, by which he falls into the hands, and is exposed to the tender mercies, of the most worthless of society, who alone could be excited by cupidity to such a revolting charge. Suffice it on this point, your committee are satisfied that the horrors of the present condition of the insane poor of New Hampshire are far from having been exaggerated; and of course they find great unwillingness on the part of those having charge of them to render correct accounts, or to have these repeated to the public.”

The report of the nine trustees for the hospital, for 1847, states, that from authentic sources they are informed that “in eight of the twenty-four towns of Merrimack county, having an aggregate population of twelve thousand, there are eighteen insane paupers; part supported upon the town farms, and part set up and bid off at auction from year to year, to be kept and maintained by the lowest bidder.” According to the data afforded above, there must be in the State several hundred insane supported on the poor-farms, or put up at auction, annually.

In Vermont, the same neglect, ignorance, and sometimes brutal severity, led to like results. Dr. Rockwell, his assistant physicians, and the whole corps of hospital nurses, bear accordant testimony to the sufferings of patients formerly brought to that institution from all parts of the State , and many even now arrive under circumstances the most revolting and shocking, subject to the roughest treatment or the most inexcusable and extreme neglects.

I have seen many of these afflicted persons, men of hardy frames, and women of great capacity for endurance, bowed and wasted till almost all trace of humanity was lost in grovelling habits, and injuries through severities and privations, which those cannot comprehend who have never witnessed similar cases of misery.

Not many counties, if indeed any towns or parishes, but have their own tales of various woe, illustrated in the miseries of the insane.

In the eighth annual report of the Vermont hospital for 1844 is the following record, which being a repetition in fact, if not almost literal expression of my own notes, I adopt in preference: “One case was brought to the hospital four and a half years ago, of a man who had been insane more than twelve years. During the four years previous to his admission he had not worn any article of clothing, and had been caged in a cellar, without feeling the in fluence of a fire. A nest of straw was his only bed and covering. He was so violent that his keeper thought it necessary to cause an iron ring to be riveted about his neck, so that they could hold him when the)r changed his bed of straw. In this miserable condition he was taken from the cellar and conveyed to the hospital. The ring was at once removed from his neck. He has worn clothing, has been furnished with a comfortable bed, and has come to the table, using a knife and fork ever since he was admitted. He is most of the time pleasantly and usefully employed about the institution.” “Another man, insane for twenty-four years, for the last six years had worn no clothing, and had been furnished with no bed except loose straw. He had become regardless of every thing that was decent. In less than three months after his admission, he so improved that he wore clothing constantly, kept his bed and room neat, and worked on the farm daily.”

“Another man, insane more than thirty years, was sold to the lowest bidder. For many years he was caged, and had his feet frozen so that he lost his toes, and endured cruel sufferings which no person in a natural state could have supported. He was five months in the hospital, wore his clothing, was furnished with a comfortable bed, and sat at table with other patients. He was a printer by trade, and for a long time employed himself in setting up type for the newspaper printed at this institution.”

Another patient, a woman 61 years of age, was taken to the hospital. She had been confined for several years in a half sub terranean cage, &c., which was nothing other than a cave excavated in the side of a hill near the house, and straw thrown in for a bed; no warmth was admitted save what the changing seasons supplied. Her condition in all respects was neglected and horrible in the extreme.”

Examples here, as in every State of the Union, might be multiplied of the insane caged and chained, confined in garrets, cellars, corn houses, and other out-buildings, until their extremities were seized by the frost, and their sufferings augmented by extreme torturing pain.

In all the States where the cold of winter is sufficient to cause freezing of the human frame by exposure, I have found many mutilated insane, deprived either of the hands or the feet, and sometimes of both. In Massachusetts we trace repetition of like circumstances. In the fifth annual report of the State hospital, it is stated that “many patients have been received into the institution who have been badly frozen; some in such manner as to have lost their limbs — others a part of them.” “Within a week from the date of this report, a man was sent who had been confined three years in a cage, where he had been repeatedly badly frozen, and in the late severe weather so much so, that his extremities were actually in a state of mortification when he arrived. He survived but two days.” In 1841 and 1842, I traced personally the condition of more than five hundred insane men and women in Massachusetts wholly destitute of appropriate care. In one county jail alone there were twenty-eight, more than half of whom were furious maniacs. In another jail, in an adjoining county, were twenty-two neglected creatures. It was to this jail — just presented by the grand jury as a nuisance, a place totally unfit for even temporary use, that a female patient was hastily removed from the poorhouse of D___, in order, as was said, that she might be more comfortable — in reality to evade searching investigations entered upon by strong authority.

Said the keeper of one county prison, in which were many insane, committed “not for crime or misdemeanor,” but for safe keeping, or because dangerous to be at large, and in default of sufficient hospital provision for the same, “ My prison resembles more the infernal regions than any place on the earth!” Almost without interval might be heard furious exclamations, blasphemous language, and the wildest ravings, howls, and shrieks. In three towns of one county alone (Essex) I found sixty neglected cases. The returns of 1842 exhibited an aggregate of one hundred and thirty-five in that county. On the 24th of December, the thermo meter below zero, I visited a poorhouse ; found one of the insane inmates, a woman, in a small apartment entirely unfurnished: no chair, table, nor bed — neither bundle of straw nor a lock of bay. The cold was intense. On the bare floor crouched the wretched occupant of this dreary place, her limbs contracted, the chin resting immovably upon her knees. She shuddered convulsively, and drew, as well as she was able, more closely about her fragments of garments which constituted her sole protection against unfit exposure and the biting cold. But the attendant, as I passed out from this den, remarked that they used “ to throw some blankets over her at night.”

Inquiring my way to another almshouse which I had heard was greatly neglected, I was shown the road, and told that there were “ plenty of insane and idiot people there.” “Well taken care of?” I asked. “Well enough for such sort of creatures.” “ Any violently insane?” “Yes; my sister’s son is there — a real tiger  I kept him a while, but it was too much trouble; so I carried him there.” “ Is he comfortably provided for? “Well enough.” “Has he decent clothes?” “ Good enough.” “And food ?” “ Good enough — good enough.” “One word more: has he the comfort of a fire?’” “Fire, indeed, fire! What does a crazy man want of fire? he’s hot enough — hot enough without fire!”

At another poorhouse I found three confined in stalls, in an out building. The vicissitudes which had marked the life of one of these desolate beings were singular, and may bring instruction to those whose reason now “is the strength of their life,” but who are not exempt from the great calamity.

H____ belonged to a respectable family, possessed good abilities, and was well educated. He removed from I___ , in Massachusetts, to Albany, N.Y., where for a considerable period he conducted with ability a popular newspaper. In time, he was elected senator in the State legislature, and was a judge in the court of errors. As a public man he was upright and respected. Insanity was developed while be filled public stations  he was conveyed to the hospital at Worcester; his property was consumed; and he was finally discharged as altogether incurable; and being very violent most of the time, he was placed, “for safety,” first in the jail at S___ , finally removed to that in I___ , and thence transferred to the almshouse where I found him. He had even then periods of partial restoration to reason, so as to comprehend where he was, and how cared for: inhabiting an unfurnished, dreary, narrow stall, in a. dreary building of an almshouse!

In a prison which I visited often, was an idiot youth. He would follow me from cell to cell with eager curiosity, and for a long time manifested no appearance of thought.~ Cheerful expressions, a smile, frequent small gifts, and encouragement to acquire some improved personal habits, at length seemed to light up his mind to a limited power of perception. He would claim his share in the distribution of books, though he could not read, examine them with delight, and preserve them with singular care. If I read from the Scriptures, he was reverently attentive: if I con versed, he listened earnestly, with half conscious aspect. One morning I passed more hurriedly than usual, and did not speak to him. “Me book! me book!” he exclaimed, eagerly thrusting his hand through the iron bars of the closed door of his cell. “ Take this, and be careful,” I said. Suddenly stooping, be seized the bread which had been brought for his breakfast, and pushing it eagerly through the bars, he exclaimed, in more connected speech than was known before, “Here’s bread; an’t you hungry?” How much might be done to develop even the minds of idiots, if we but knew how to touch the instrument with a skilful hand!

Attempts to cultivate the higher faculties of these creatures, seemingly the merest animals, have been successfully adopted to a moderate extent in France, Germany, and Switzerland, and in the United States the subject has been discussed. Dr. Ray, of the Rhode Island hospital, not long since visited a school for idiots which has been established at the Bicetre, near Paris. He writes, that “as early as the year 1828, Femes made the first attempt in France to develop the powers of idiots, which attempt has resulted in the present school of Voisin, and which exhibits to the astonished spectator a triumph of perseverance and skill in the cause of humanity, that does infinite credit to the heart and under standing of that gentleman.” This testimony is supported by Dr. Conolly, who, visiting the hospitals near Paris, said, “I was conducted to a school exclusively established for the improvement of these cases, and of the epileptic, and nothing more extraordinary can be well imagined.” Dr. Hayward, of Boston, who visited last year, the schools for idiots above referred to, expresses the opinion that the great benefits to the unfortunate classes whose good they are designed to promote can hardly be appreciated, and that no pains should be spared to establish similar institutions in the United States.

I visited the poorhouse in W___. In a cage, built under a wood shed, fully exposed to all passers upon the public road, was a miserable insane man, partially enveloped in a torn coverlet.“ My husband,” remarked the mistress of the house, “clears out the cage and puts in fresh straw, once a week; but sometimes it’s hard work to master him. You see him now in his best estate!”

In the adjacent town, at the poorhouse, was a similar case; only, if possible, more revolting, more excited, and more neglected. There were also other persons there in different stages of insanity.

In a county jail not far distant was a man who had been confined in a close apartment for many years; a wreath of rags invested his body and his neck; he was filthy in the extreme; there was neither table, seat, nor bed; and a heap of noxious straw defiled one corner of the room.

One case more must suffice for this section: I would that no others could be adduced even more revolting than are these so briefly referred to. In G___, distant from the poorhouse a. few rods, was a small wooden building, constructed of plank, affording a single room; this was unfurnished, save with a bundle of straw. The occupant of this comfortless abode was a young man, declared to be incurably insane. He was chained, and could move but a little space to and fro; the chain was connected to the floor by a heavy staple at one end — the other was attached to an iron collar which invested his neck — the device, it seemed, of a former keeper.

In summer the door was thrown open, but during winter it was closed, and the room was in darkness. Some months after I saw this poor patient, and after several individuals also had witnessed his sufferings, the authorities who directed the affairs of the poor house reluctantly consented that he should be placed under the care of Dr. Bell. The man who was charged to convey the patient the distance of rather more than forty miles, having bound and chained him, (I have the impression that, by the aid of a blacksmith, he was released at this time from the torturing iron ring,) conveyed him as far as East Cambridge, arriving at dusk. Instead of proceeding with the patient at once to the hospital, which was distant less than a mile, in Somerville, he chained him for a night to a post in the stable. After breakfast he was released and carried to the hospital, in a state of much exhaustion. While the careful attend ants and humane physician were busied in removing the strong bands which chafed his limbs, and lacerated the flesh in many places, he continually endeavoured to express his gratitude — embracing them, weeping, and exclaiming, “Good men! kind men! Ah, good, kind men, keep me here.”

After some months of careful nursing, he was so much improved that strong hopes were entertained of his complete restoration. These were crushed by an absolute decision of the overseers of the poor, remanding him to his old prison. Remonstrance was ineffectual. The last account stated an entire relapse, not only to the former state, but to still more hopeless condition. He had become totally idiotic.

In November I visited the poorhouse in F___; weather severe for the season; no mode of warming the insane. I was conducted to an out-building, so enclosed as to secure the closest solitude to the patient. He had been returned from the hospital as incurable. He was said to be neither violent nor dangerous, but shut up lest he should run away. The door was opened, disclosing a narrow, squalid, dark, unfurnished cell. In one corner was a heap of straw, in which the insane man was nestled. He raised himself slowly and advanced with unsteady steps. His look was calm and gentle.

“Give me those books! Oh, give me those books! ” he exclaimed, eagerly reaching his hands for some books I carried. “DO give them to me, do!” he exclaimed, with kindling earnestness. “You could not use them; it is dark with you here.” “Oh, give them, do give them! and he drew a little nearer, lowering his voice to a whisper: “Give them, and I’ll pick a hole in the plank, and let in some of God’s light! ” Just then the master arrived; he said that he purposed getting an iron collar and chain—then he could fasten him in the air sometimes outside. “I had,” he added, “a cousin up in Vermont, crazy as a tiger cat; I got a collar made for him. After this, I kept the poorhouse at Gronton, and I fastened up a crazy man there  he was fast then. I mean to have one for this fellow. I know how to manage your crazy men.”

In Connecticut, the estimated number of insane, nearly eight years since, was 542; a number even then below the actual amount, and now very much below the true estimate. Of these, not one sixth were under hospital treatment five months since: in fact, it is believed that not a ninth part will be found receiving suitable care. The sad case of Rubello is too well known to require repetition. The insane patients in M___ no longer drag their heavy chains abroad, when at labor laying stone walls, nor are they in other respects as much abused and abased as formerly. But no county is free from the reproach of having within its limits insane patients needing humane and judicious care.

Of the most miserable neglects in the case of large numbers carried for successive years to the Hartford Retreat, Drs. Brigham, Woodward, and Butler can, even now, hear sad testimony; and to the observations of medical men may be added the evidence of that good man and true friend of sufferers, Rev. T. H. Gallaudit.

Rhode Island has nearly or quite four hundred insane, idiots, and epileptics. About 90 recently were receiving the benefit of hospital care, under the enlightened administration of Dr. Ray. In no State, however, have I found more terrible examples of neglect and suffering, from abuse, or ignorance, than existed there in the year 1843, and some cases in 1845-‘47. In the jails were many pining in narrow, damp, unventilated dungeons. In the poorhouses were many examples of misery and protracted distress. In private families these conditions were less frequent; but the suffering, through ill-directed aims at securing the patients from escape, was in many instances equally revolting and shocking. Here, as in the five States first referred to, hundreds of special cases might be cited, did time permit. I offer but a single well-known example.

In the yard of a poorhouse, in the southern part of the state, I was conducted by the mistress of the establishment to a small building constructed of plank ; the entrance into a small cell was through a narrow passage bare and unlighted. The cell was destitute of every description of furniture, unless a block of wood could be called such; and on this was seated a woman —clothed, silent, and sad. A small aperture, opening upon a dreary view, and this but a few inches square, alone admitted light and air. The inmate was quiet, and evidently not dangerous in her propensities. In reply to my remonstrances in her behalf the mistress said that she was directed to keep her always close; that otherwise she would run away, or pull up the flowers! How is she warmed in winter? I inquired. “Oh, we just heat a stone and give her,” was the laconic reply. Your other patient — where is he? “You shall see; but stay outside till I get a lantern.” Accustomed to exploring cells and dungeons in the basements and cellars of poorhouses and prisons, I concluded that the insane man spoken of was confined in some such dark, damp retreat. Weary and oppressed, I leaned against an iron door which closed the sole entrance to a singular stone structure, much resembling a tomb, yet its use in the court yard of the poorhouse was not apparent. Soon, low smothered groans and moans reached me, as if from the buried alive. At this moment the mistress advanced, with keys and a lantern. “He’s here,” said she, unlocking the strong, solid iron door. A step down and short turn through a narrow passage to the right, brought us, after a few steps, to a second iron door parallel to the first, and equally solid. In like manner, this was unlocked and opened; but so terribly noxious was the poisonous air that immediately pervaded the passage, that a considerable time elapsed before I was able to return and remain long enough to investigate this horrible den. Language is too weak to convey an idea of the scene presented. The candle was removed from the scene, and the flickering rays partly illuminated a spectacle never to be forgotten. The place when closed had no source of light or of ventilation. It was about seven feet by seven, and six and a half high. All, even the roof, was of stone. An iron frame, interlaced with rope, was the sole furniture. The place was filthy, damp, and noisome; and the inmate, the crazy man, the helpless and dependent creature, cast by the will of Providence on the cares and sympathies of his fellow man — there he stood, near the door, motionless and silent; his tangled hair fell about his shoulders; his bare feet pressed the filthy, wet stone floor; he was emaciated to a shadow, etiolated, and more resembled a disinterred corpse that any living creature. Never have I looked upon an object so pitiable, so woe struck, so imaging despair. I took his hands and endeavored to warm them by gentle friction. I spoke to him of release, of liberty, of care, and kindness. Notwithstanding the assertions of the mistress that he would kill me if I persevered, a tear stole over the hollow cheek, but no words answered to my importunities; no other movement indicated consciousness of perception or of sensibility. In moving a little forward I struck against something which returned a sharp metallic sound: it was a length of ox-chain, connected to an iron ring which encircled a leg of the insane man. At one extremity it was joined to what is termed a solid chain — namely, bars of iron 18 inches or 2 feet long, linked together, and at one end connected by a staple to the rock overhead. “My husband,” said the mistress, “in winter rakes out sometimes, of a morning, half a bushel of frost, and yet he never freezes; ” referring to the oppressed and life stricken maniac before us. “Sometimes he screams dreadfully,” she added, “and that is the reason we had the double wall, and two doors in place of one: his cries disturbed us in the house!” “How long has he been here?” “Oh, above three years; but then he was kept a long while in a cage first: but once he broke his chains and the bars, and escaped  so we had this built, where he can’t get off.” Get off! No, indeed; as well might the buried dead break through the sealed gates of the tomb, or upheave the mass of binding earth from the trodden soil of the deep grave. I forbear comment. Many persons, after my investigations here, visited this monument of the utter insensibility and ignorance of the community at whose expense it was raised. Brutal, willfully cruel, I will not call them, black, as in the case, and fatal as were the results of their care! But God forbid that such another example of suffering should ever exist to be recorded.

New York, according to the census of 1840, had 2,340 idiots and insane. I am convinced that this estimate was below the certain number by many hundreds. In 1841, the Secretary of State reported 803 supported at public charge. In 1842, the trustees of poorhouses estimated the number of insane poor then confined in the jails and poorhouses at 1,430. In 1843 I traversed every county in the State, visiting every poorhouse and prison, and the insane in many private families. The hospital for the insane at Utica was opened in January, 1843, and during the year received 276 patients, all with the exception of six being residents of the State of New York. On Blackwell’s island were above 300; at Bloomingdale more than 100: 26 were at Bellevue. Besides these, I found, chiefly in the poorhouses, more than 1,500 insane and idiots, 500 of whom were west of Cayuga bridge. In the poorhouse at Flatbush were 26 insane not counting idiots; in that at White plains were 30 insane; at Albany between 30 and 40 ; at Ghent, 18; in Greene county, 46. In Washington county poorhouse, besides “simple, silly, and idiotic,” 20 insane. Nearly ever poor house in the State had, and still has, its “crazy house,” “crazy cells,” “ razy dungeons,” or “crazy hall; ” and in these, with rare exceptions, the inevitable troubles and miseries of the insane are sorely aggravated.

At A___ , in the cell first opened, was a madman. The fierce command of his keeper brought him to the door, a hideous object; matted locks, an unshorn beard, a wild, wan countenance, disfigured by vilest uncleanness; in a state of nudity, save the imitating incrustations derived from that dungeon, reeking with loathsome filth. There, without light, without pure air, without warmth, without cleansing, absolutely destitute of everything securing comfort or decency, was a human being — forlorn, abject, and disgusting, it is true, but not the less a human being — nay more, an immortal being, though the mind was fallen in ruins, and the soul was clothed in darkness. And who was he — this neglected brutalized wretch? A burglar, a murderer, a miscreant, who for base foul crimes had been condemned, by the justice of outraged laws and the righteous indignation of his fellow men, to expiate offences by exclusion from his race, by privations and sufferings extreme, yet not exceeding the measure and enormity of his misdeeds? No; this was no doomed criminal, festering in filth, wearing wearily out the warp of life in dreariest solitude and darkness. N 0, this was no criminal  — “only a crazy man.” How, in the touching language of Scripture, could he have said: “My brethren are far from me, and mine acquaintance are verily estranged from me: my kinsfolk have failed, and my familiar friends have forgotten me : my bone cleaveth unto my skin and my flesh. Have pity upon me, have pity upon me, for the hand of God hath touched me ! ”

I turned from this sickening scene only to witness another yet more pitiable. In the far corner of a damp, dark dungeon, on the right was a human creature — “a woman dreadful bad,” said the attendant, who summoned her in harsh tones to  “come out;” but she only moved feebly amidst the decaying mass of straw, uttering low moans and cries, expressive both of physical pain and mental anguish. There she lay, seemingly powerless to rise. She, too, was unclothed; and in this dungeon alone, in want, and pain, and misery; no pure air, no pleasant light, no friendly hand to chafe the aching limbs, no kind voice to raise and cheer; she dragged out a troubled existence. I know nothing of her history — whether forsaken by able kindred, or reluctantly given over to public charity by indigent parents, or taken in, a wandering demented creature. I only know that I found and left her reduced to a condition upon which not one who reads this page could look but with unmitigated horror. Do you turn with inexpressible disgust from these details? It is worse to witness the reality. Is your refinement shocked by these statements? There is but one remedy; the multiplication of well-organised hospitals ; and to this end, creating increased means for their support. In the same poorhouse, in the “crazy cellar,” were men chained to their beds, or prostrate on the ground, fettered, and painfully confined in every movement. There were women, too, in wretched, unventilated, crowded rooms, exhibiting every horrible scene their various degrees of insanity could create.

In B___ , the cells in the crazy cellar admitted neither light not pure air.

In T___ , the cells for the insane men were in a shocking condition.

In A____  were above twenty insane men and women in the poorhouse, mostly confined with chains and balls attached to fetters. “By adopting this plan,” said the master of the poorhouse, “ I give them light and air, preventing their escape; otherwise I should have to keep them always in the cells.” A considerable number of women, mostly incurables. were “behind the pickets,” in an out building. There was a passage sufficiently lighted and warmed, and of width for exercise. There was no classification; the noisy and the quiet mutually vexed each other. One woman was restrained by a barbarous apparatus to prevent rending her clothes. It consisted of an iron collar investing the throat, through which, at the point of closing in front, passed a small belt or bar, from which depended an iron triangle, the sides of which might measure sixteen or eighteen inches. To the corners of the horizontal side were attached iron wristlets; thus holding the hands confined, and as far apart as the length of the base line of the triangle. When the hands and arms were suddenly elevated. pressure upon the apex of the triangle, near the point of connexion at the throat, produced a sense of suffocation; and why not certain strangulation, it was not easy to show.

Not distant from the poorhouse, I found a woman in a private dwelling, supported by two invalid sisters. She was in the highest state of phrenzy, and nearly exhausted the patience of love in those who toiled laboriously for her and their own scanty maintenance. She had once been transferred to the poorhouse ; but patience was never there exercised in behalf of the unruly; and, bearing the marks of harsh blows, she was taken again by her sisters, to share  “the little they could earn so long as they or she should live.”

 In E___, the insane, as usual, were unfitly disposed of. To adopt the language of a neighbouring farmer, “Those damp, dreary cells were not fit for a dog to house in, much less for crazy folks.”

At R___, and M___, and L___, and B___, were repetitions of the like dismal cells, heavy chains and balls, and hopeless sufferings. After my visit to L___,  I found one of the former inmates at the hospital in charge of Dr. Brigham. He bore upon his ankles the deep scars of fetters and chains, and upon his feet evidence of expo sure to frost and cold.

In B-—, several idiots occupied together a portion of a most comfortless establishment. One gibbering, senseless creature, was the mother of an infant child. ‘

At A , the most furious were in narrow cells, which were neither cleaned, warmed, nor ventilated. In 0___ was an insane man, so shockingly neglected and abused that his limbs were crippled, so that he could neither stand nor walk. He was extended on a miserable dirty pallet, untended and little cared for.

At E , the insane were confined in cells crammed with coarse, dirty straw, in the basement, dark and damp. “ They are,” said the keeper, “taken out and washed (buckets of water thrown over them,) and have clean straw, once every week.”

In H___ were many furiously crazy. Several of the women were said to be the mothers of infants, who were in an adjoining room pining with neglect, and unacknowledged by their frantic mothers.

I pass over hundreds of desperate cases, and quote a few examples from my notes in New Jersey; altogether omitting Canada East and West, as being without the limits of the United States, though corresponding examples with those in New York were found in almost every direction. In 1841, there were found in New Jersey, upon a rather cursory survey, two hundred and fifty-two insane men, one hundred and sixty-three insane women, and one hundred and ninety-six idiots, of both sexes. I traversed the State in 1844; the numbers in every county were increased, and their miseries were also increased. Sixty patients had been placed in the hospitals in New York and Pennsylvania, but hundreds still occupied the wretched cells and dungeons of almshouses and of prisons. In the winter of 1845, several froze to death, and several perished through severe exposure and alarm at a fire which consumed a populous poorhouse. At S___, of eight insane patients, several were heavily chained, and two were furiously mad.

In one poorhouse was a man who had been chained by the leg for more than twenty years, and the only warmth introduced into his cell was derived from a small stove-pipe carried through one corner.

On a level with the cellar, in a basement room, tolerably decent, but bare of comforts, lay upon a narrow bed a feeble, aged man, whose few grey locks fell tangled over the pillow. As I entered he addressed one present, saying, “ I am all broken up — broken up!” “ Do you feel much weaker, Judge?” “ he mind, the mind is going — almost gone,” responded he, in tones of touching sadness. This feeble, depressed old man, in a lone room in the poorhouse — who was he“.l I answer as I was answered. In his young and vigorous years he filled various offices of honour and trust in his county. His ability as a lawyer raised him from the bar to the bench. As a jurist he was distinguished for uprightness, clearness, and impartiality. He was also judge of the orphans’ court, and was for many years a member of the legislature. He was somewhat eccentric, but his habits were always correct. I could learn no thing remembered to his discredit, but much which commends men to honor and respect. He had passed the meridian of a useful and active life. The property, honestly acquired, on which he had relied for comfortable support in his declining years, was lost by some of those fluctuations in monetary affairs which so often pro cure unanticipated reverses. He became insane: soon, insanity took the form of furious mania: he was chained, “for safety;” and finally, for greater security, committed to the county jail — a most wretched place — dreary, damp, and unfurnished. Time passed: a more quiet state supervened. He was placed at board in a private family, till the remnant of his once sufficient property was consumed, and then he was removed to the poorhouse. Without vices and without crimes, he was at once the victim of misfortunes and the prey of disease. A few months subsequent to my visit the almshouse was consumed by fire. The inmates, barely rescued, were hastily removed, and such cares rendered as the emergency demanded. Fires were kindled in the court-house, and a portion of the poor removed thither. Of this number was Judge S. His pallet was laid within the bar, below the bench were he had once presided. The place perhaps revived painful memories: he was conscious of his condition; spoke of his trials; languished a few days ; and, in the good providence of God, was then released from the pains and afflictions of this mortal life, and, it is believed, passed to that state of existence where tears are wiped from all eyes, and where troubles are unknown.

In P___, the cells in the cellar for the insane were in a most wretched condition. In M___, the insane, and many imbeciles were miserably housed, fed, and clothed. In the vicinity of the main building was one of brick, containing the poor cells, from eight to nine feet square. A straw bed and blanket on the floor constituted the furniture, if I except the ring-bolts and iron chains for securing the patients. In P___, I found the insane, as usual, ill provided for. One madman was chained, clothed only with a straight jacket, laced so as to impede the motion of the arms and hands: cold, exposed, and offensive to the last degree, his aspect, wild and furious, was as shocking as his language was coarse and blasphemous. Such care was bestowed as the keepers of the poor house best could render; but an hospital alone could afford fit treatment for one so dangerous and so unmanageable.

At M___ were five idiots and insane, ill kept, and very turbulent most of the time. Said one poor maniac, whose fetters and manacles I had ordered to be removed, and whose aching, bruised limbs I was bathing, “Ah, now I am a human creature again : God is good—he sends you to free me: I will pray for you for ever, and bright days shall shine for you.” One woman, whose limbs bore marks of the cankering iron, worn for many years, said, “I could curse those who chained me, but the aft voice says, ‘Pray for your enemies ;’ but, alas! my soul is dark, and the thoughts are black .”

In the western part of the State I found a young man chained near his father’s house, his bleeding limbs cut by the iron rings which confined the ankles; he moaned, and howled, and cursed, and raved, so that horror filled the neighbourhood.

A middle-aged woman, who was often greatly excited, was for months at a time confined in a smoke-house. Her condition was filthy to the last degree; she had neither change of raiment, nor water for bathing, for months. “She’ll be found frozen to death some of these nights, I reckon,” said the “care-taker.” Ten miles distant I found another case similar, but if possible more miserable.

In Pennsylvania, in 1839, careful inquiry, followed by authentic reports. placed the number of insane and idiots at over twenty-three hundred: of these it was computed that more than twelve hundred were in the county poorhouses and prisons. I visited every county and considerable town in the State in the summer and autumn of 1844, and am satisfied that the number was much above the estimate of 1839.

In L___ I found above fifty insane, not counting idiots. The cells in the poorhouse, forty-four in number, measured four feet by seven, and twelve feet high; “chains and hobbles” were in constant use.

In Y___ were above thirty insane: those in the basement of the poorhouse occupied cells of sufficient dimensions, being four feet by ten, and ten feet high; hobbles and chains were in constant use. The physician estimated the number of insane in the county at more than one hundred, and added that cases of exceeding neglect and suffering often came to his knowledge. Sufficient provision in hospitals might save thousands of honest citizens from becoming a life-long burden to themselves and others, through permanent insanity. In this county above one hundred insane were found ; there probably were other cases. In the poorhouse at G___ the insane were exposed and suffering; the basement cells measured eight by eight feet, and eight feet high. Chains, hobbles, and the miscalled “ tranquilizing chain,” were in use. There were more than forty insane in the county.

In C___, above twenty insane and idiots in the poorhouse ; one was chained near the fireplace of a small room; a box filled with straw was near, in which she slept. Above 60 insane and idiots in this county. In B___ I found nearly forty; some chained, others confined in narrow cells. In S___, several insane in the jail; one, heavily ironed, had been in close confinement there six years—another for eleven months. In this county the insane and idiots were estimated to be 76 in 1840. I heard of more than 100. One woman has for months wandered in the woods and fields in a state of raving madness.     

At G , several cases in the jail; one chained: above forty in the county.

I N___, in the jail, two madmen in chains; no furniture or   decent care. One was rolling in the dust, in the highest excitement: he had been in close confinement for fifteen years. On one occasion he became exasperated at the introduction of a drunken prisoner into his cell, who perhaps provoked him. No one knows ; ‘but the keeper, on entering, found the insane man furious, covered with the blood of the other, who was murdered and mutilated in the most shocking manner. Another insane man had been in confinement seven years, and both are to this day in the same prison. In the poorhouse were above twenty insane and idiots; four chained to the floor. In the adjacent county were above fifty insane and epileptics; several cases of misery through brutal usage, by “kicks and beating,” in private families.

In W___ ere seven very crazy, and above twenty simple, insane, and idiotic. One, who was noisy, was in a small building in a field. The condition of all was degraded and exposed. In P , the insane in the jail were subject to great miseries. Many in the county were harshly confined; some wandering at liberty, often dangerous to the safety of all they met. The twelve counties next visited afforded corresponding examples. The nine next traversed had fewer insane, and fewer, in proportion tov whole numbers, in chains. In H___, one case claimed special sympathy. Adjacent to a farm-house was a small shanty, slightly constructed of thin boards, in which lies an old feeble man, with blanched hair, not clad either for protection or decency;  “fed,” as said a poor neighbour very truly, “fed like the hogs, and treated worse.” He is exposed to the scorching heats of summer, and pinching cold of the inclement winter; no kind voice cheers_ him, no sympathizing friend seeks to mitigate his sufferings. He is an outcast, a crazy man, almost at the door of his once cheerful comfortable home. I pass by without detail nearly one hundred examples of insane men and women in filthy cells, chained and hobbled, together with many idiots and epileptics wandering abroad. Some were confined in low, damp, dark cellars  some wasted their wretched existence in dreary dungeons, deserted and neglected. It would be fruitless to attempt describing the sufferings of these unhappy beings for a day even. What must be the accumulation of the pains and woes of years, consigned to prisons and poorhouses, to cells and dungeons, enduring every variety of privation—helpless, deserted of kindred, tortured by fearful delusions, and suffering indescribable pains and abuses. These are no tales of fiction. I believe that there is no imaginable form of severity, of cruelty, of neglect, of every sort of ill-management for mind and body, to which I have not seen the insane subject in all our country, excepting the three sections already defined. As a general rule, ignorance procures the largest measure of these shocking results; but while of late years much is accomplished, and more is pro posed, by far the largest part of those who suffer remain unrelieved, and must do so, except the general government unites to assist the several States in this work.

In Maryland, large numbers are at this hour in the lowest state of misery to which the insane can be reduced. At four different periods I have looked into the condition of many cases, counting hundreds there. Chains, and want, and sorrows, abound for the insane poor in both the western and eastern districts, but especially in the western.

In Delaware, the same history is only to be repeated, with this variation: as the numbers are fewer, so is the aggregate of misery less.

In the District of Columbia, the old and new jails, and the alms houses, had, till very recently, their black, horrible histories. I witnessed abuses in some of these in 1838, in 1845, and since, from which every sense recoils. At present, most of these evils are mitigated in this immediate vicinity, but by no means relieved to the extent that justice and humanity demand.

In Virginia, very many cases of extreme suffering now exist. The most observing and humane of the medical profession have repeatedly expressed the desire for additional hospital provision for the insane. Like cases of great distress to those in Maryland and Pennsylvania were found in the years 1844 and ’45. In every county through which I passed were the insane to be found — some times chained, sometimes wandering free. In the large populous poorhouse nearby were spectacles the most offensively loath some. Utter neglect and squalid wretchedness surrounded the insane. The estimate of two thousand insane idiots and epileptic patients in this State is thought to be below the actual number. The returns in 1840 were manifestly incorrect.

In the report upon the Western State Hospital of Virginia, at Staunton, for the year 1847, Dr. Stribling feelingly remarks upon the very insufficient means at command for the relief of the insane poor throughout the State. “We predicted,” he says, “ that during the present year, those seeking the benefits of this institution would far exceed our ability to receive. This anticipation, we regret to say, has been painfully realised, and we are now called upon to report the fact, that within the last nine months, one hundred .and twenty-three applications have been received, whilst only thirty-nine could be admitted. What has become of the remaining eighty-four it is impossible for us to report.” I regret to say there is but one conclusion deducible from this statement. The rejected patients are suffering privations and miseries in different degrees, in the narrow rooms or cells of poorhouses, or in the equally wretched sheds, stalls, or pens, attached to private dwellings, while some have been temporarily detained, for security, in the jails. The laws of Virginia forbid a protracted detention of the insane in the county prisons, at this period. Formerly, I have traced the most cruel sufferings in the confined apartments, uncleansed and unventilated, and in the still more neglected dungeons, into which the insane have been cast. The hospital physicians report patients often sent to their care painfully encumbered with cords and chains.

North Carolina has more than twelve hundred insane and idiots. I do not know by personal observation what is their condition; but within a few months, sad details have been communicated from respectable and reliable sources.

South Carolina records the same deplorable abuses and necessities as New York. I have found there the insane in pens, and bound with cords and chains, and suffering no less than the same class in States already referred to at the north, except through exposure to the cold in winter, the climate in the southern States sparing that aggravated misery. One patient was removed to the hospital after being confined in a jail more than twenty years. Another had for years been chained to a log; another had been confined in a hut ten feet square, and was destitute of clothing and of every comfort of life. A young girl was confined in a dismal cabin, filthy, and totally neglected. Her hair was matted into a solid foul mass; her person emaciated and uncleansed; nothing human could be imagined more entirely miserable, and more cruelly abandoned to want.

Georgia has, so far as I have been able to ascertain, fewer insane in proportion to population, than either North or South Carolina; but there is not less injudicious or cruel management of the violent cases throughout the State. Chains and ropes are employed to increase security from escapes, in addition to closed doors, and the bolts and bars which shut the dreary cells and dungeons of jails and other receptacles. I have seen the deep scars of former wounds produced by chains and blows ; and those who have received patients transported to the State hospitals, are as much at a loss for any decent language for describing the condition of these unfortunate beings as myself. Their condition is indeed indescribable. Patients have not seldom been transported to the hospital in open carts, chained and bound with heavy cords. Alabama reveals in her jails, and in many poor dwellings, corresponding scenes. In 1846 and 1848, I traced there poor creatures in situations truly revolting and horrible. To record cases is but to repeat sad histories differing only in time and place, not in degrees of misery. So also in Louisiana and Mississippi, in. the same years. There are not, at the lowest estimate, less than fourteen hundred in these three last-named States.

In Texas it is said insanity is increasing. I have seen several patients brought hence for hospital treatment, bound with cords and sorely bruised.

In Arkansas, the insane and idiots are scattered in remote districts. I found it often exceedingly difficult to ascertain precisely their circumstances. These were no better—and worse they could not be—than were the indigent, and not seldom the affluent, in other States.

In Tennessee, the insane and idiotic population, as in Kentucky, is numerous and increasing. The same methods of confinement to cabins, pens, cells, dungeons, and the abandonment to filth, to cold, and exposure, as in other States.

In Kentucky, I found one epileptic girl subject to the most brutal treatment, and many insane in perpetual confinement. Of the idiots alone, supported by the State at a cost of 17,500 dols. 62 0., in indigent private families, and of which class there were in 1845 four hundred and fifty, many were exposed to severest treatment and heavy blows from day to day, and from year to year. In a dreary block-house was confined for many years a man whose insanity took the form of mania. Often the most furious paroxysms prevented rest for several days and nights in succession. N o alleviation reached this unhappy being; without clothes, without fire, without care or kindness, his existence was protracted amidst every horror incident to such circumstances. Chains in common use.

In Ohio, the insane population, including idiots, has been greatly underrated, as I am fully satisfied by repeated but interrupted in uiries in different sections of the State. The sufferings of a great number here are very distressing, corresponding with those re erred to in New York and in Kentucky. Cells and dungeons, unventilated and uncleansed apartments, severe restraints, and multiplied neglects abound.

Michigan, it was stated, had sixty-three insane in 1840. I think it a moderate estimate, judging from :my investigations, reaching no further north than Jackson and Detroit, that the number in 1847 exceeded two hundred and fifty. I saw some truly afflicted and lamentable cases.

Indiana, traversed through its whole length and breadth in 1846, exhibits the usual forms of misery wherever the insane are found; and of this class there cannot be, including idiots and epileptics, less than nine hundred. I found one poor woman in a smoke-house, in which she had been confined more than twenty years. In several poorhouses, the insane, both men and women, were chained to the floors, sometimes all in the same apartment. Several were confined in mere pens, without clothing or shelter; some furious, others for a time comparatively tranquil. The hospital now about to be opened, when finished, will not receive to its care one patient in ten of existing cases.

Illinois, visited also in its whole extent in 1846, has more than four hundred insane, at the most moderate estimate. Passing into a confined room in the poorhouse at G___, I saw a cage constructed upon one side of the room, measuring six feet by three. “There,” exclaimed the keeper, with emotion, “ there is the best place I have to keep a madman, a place not fit for a. dog, a place where they grow worse and worse. and, in defiance of such care as I can give, become a nuisance to themselves and every one in the neighbourhood. We want hospitals, Miss; we want hospitals; and more means for the crazy everywhere.” I found crazy men and women in all sorts of miserable conditions; sometimes, as in Georgia, &c., &c., strapped upon beds with coarse hard strips of leather; some times chained to logs, or to the floor of wretched hovels; often exposed to every vicissitude of the climate. But I limit myself to one more example. It was an intensely hot day when I visited F. He was confined in a roofed pen, which enclosed an area of about eight feet by eight. The interstices between the unhewn logs ad mitted the scorching rays of the sun then, as they would open way for the fierce winds, and drenching rains, and frosts of the later seasons. The place was wholly bare of furniture — no bench, no bed, no clothing. His food, which was of the coarsest kind, was pushed through spaces between the logs; “fed like the hogs, and no better,” said a stander-by. His feet had been frozen by exposure to cold in the winter past. Upon the shapeless stumps, aided by his arms, he could raise himself against the logs of the pens. In warm weather this wretched place was cleansed once a week or fortnight; not so in the colder seasons. “ We have men called,” said his sister, “ and they go in and tie him with ropes, and throw him out on the ground, and throw water over him, and my husband cleans out the place.” But the expedient to prevent his freezing in winter was the most strangely horrible. In the centre of the pen was excavated a pit, six feet square and deep : the top was closed over securely ; and into this ghastly place, entered through a trap door, was cast the maniac, there to exist till the returning warm weather induced his care-taker to withdraw him: there, without heat, without light, without pure air, was left the pining, miserable maniac, whose piteous groans and frantic cries might move to pity the hardest heart.

In Missouri, visited in 1846 and 1847, multiplied cases were found in pens, in stalls, in cages, in dungeons, and in cells ; men and women alike exhibited the most deplorable aspects. Some are now dead, others still live only to experience renewed troubles of mind, and tortures of the flesh.

Let these examples suffice; others daily occur. Humanity requires that every insane person should receive the care appropriate to his condition, in which the integrity of the judgment is destroyed, and the reasoning faculties confused or prostrated.

Hardly second to this consideration is the civil and social obligation to consult and secure the public welfare; first, in affording protection against the frequently manifested dangerous propensities of the insane ; and second, by assuring seasonable and skilful remedial cares, procuring their restoration to usefulness as citizens of the republic, and as members of communities.

Under ordinary circumstances, and where there is no organic lesion of the brain, no disease is more manageable or more easily cured than insanity; but to this end special appliances are necessary, which cannot be had in private families, nor in every town and city; hence the necessity for hospitals, and the multiplication, not enlargement, of such institutions. The citizens of many States have readily submitted to increased taxation, and individuals have contributed liberal gifts, in order to meet these imperative wants. Hospitals have been constructed, and well organized. The important charge of these has been in most instances confided to highly responsible and skilful physicians; men whose rank in morals and in intellect, while commanding the public confidence, has wrought immeasurable benefits for hundreds and thousands of those in whom, for a time, the light of reason had been hidden.

But while the annual reports emanating from these beneficent institutions record eminent successes in the cure of recently developed cases, the provision for the treatment of this malady in the United States is found wholly insufficient for existing necessities, as has been already demonstrated in preceding pages.

To confide the insane to persons whose education and habits do not qualify them for this charge, is to condemn them to a mental death. The keepers of prisons, the masters of poorhouses, and most persons in private families, are wholly unacquainted with bodily and mental diseases, and are therefore incapable of the judicious application of such remedial measures, moral, mental, and medical, as are requisite for the restoration of physical and mental health. Recovery, even of recent cases, not submitted to hospital charge, is known to be very rare ; a fact readily demonstrable by examples, and by figures, if necessary. It may be more satisfactory to show the benefits of hospital treatment, rather than dilate upon the certain evils of prison and almshouse neglects or abuses, and domestic mismanagement.

Under well-directed hospital care, recovery is the rule — incurable permanent insanity the exception. Dr. Luther V. Bell, in one of his reports, shows that “all cases certainly recent, whose origin does not date back, directly or obscurely, more than one year, recover under a fair trial.” And, again, in his report of 1843—’44, he remarks, that “in regard to the curability of insanity, in its different manifestations, there can be no general rule better established than that this is in direct ratio of the duration of the symptoms.”

Dr. Ray repeats and confirms these opinions.

Dr. Chandler stated, in 1843, that his experience proved that the earlier the patient was placed under hospital treatment, the more sure and speedy was the recovery.

Dr. Brigham repeatedly states, in his reports, that more than eight out of ten recent cases recover, while not more than one in six of the old cases are cured. Dr. Rockwell’s reports corroborate these views.

Dr. Butler states that delay of appropriate treatment rapidly diminishes the chances of recovery.

Dr. Kirkbride declares that the general proposition that “ truly recent cases of insanity are speedily curable, and chronic only occasionally, ought to be everywhere understood.”

Dr. Awl, writing on this subject, says: “Public safety, equity, and economy, alike require that this should be so.”

Dr. Earle shows that “there are few acute diseases from which so large a per centage of the persons attached are restored. ”

Drs. Woodward, Stribling, Parker, Allen, Buttolph, Stedman, and others, also support, in this country, the same opinions; while the long list of able and well-known distinguished writers on insanity, and the physicians of the hospitals, on the other side of the Atlantic, place the question beyond doubt.

The following tables, prepared from the records of one hospital, afford a single illustration of the views above advanced, and show the duration of insanity before the admission of the 280 patients received in five consecutive years

An author of profound research and high intellectual endowments, in a work which was first published some years since in several foreign languages, and has since been reproduced in this country, states that “the general certainty of curing insanity in its early stage is a fact which ought to be universally known, and then it would be properly appreciated and acted upon by the public.”

Dr. Ellis, director of the West Riding Lunatic Hospital, England, stated in 1827, that of 312 patients admitted within three months after their first attack, 216 recovered; while, in contrast with this. he adds that of 318 patients admitted, who had been insane for upwards of one year to thirty, only 26 recovered. In La. Salpètriere, near Paris, the proportion of cures of recent cases was, in 1806-’7, according to Dr. Veitch’s official statement, as nearly two to three cured, while only five out of 152 old cases recovered. Dr. Burrows stated, in 1820, that of recent cases under his care, 91 in 100 recovered ; and in 1828, that the annual reports of other hospitals, added to his own larger experience, confirmed these observations. Dr. Willis made to Parliament corresponding statements. At the Senavra hospital, near Milan, the same results appeared upon the annual records.

But cure alone, manifestly, is not the sole object of hospital care: secondary indeed, but of vast importance, is the secure and comfortable provision for that now large class throughout the country, the incurable insane. Their condition, we know, is susceptible of amelioration, and of elevation to a state of comparative comfort and usefulness.

Insanity prevails, in proportion to numbers, most among the educated, and, according to mere conventional distinctions, in the highest classes of society. But those who possess riches and a liberal competency are few, compared with the toiling millions; therefore the insane who are in necessitous circumstances greatly out-number those whose individual wealth protects them usually from the grossest exposures and most cruel sufferings.

I have seen very many patients who had been confined for years in stalls, cages, and pens, and who are reduced to the most abject moral, physical, and mental prostration, removed to the hospitals, divested of chains, fetters, and filthy garments; bathed, clothed, nursed, and nourished with careful kindness; whose improvement was, according to constitution and the nature of the disease, more or less rapid, and who in a few months became the most able laborers, under constant direction, upon the hospital farms, in the gardens, shops, and barns; and while these labors engaged the men, the women were no less busily occupied in the washing and ironing rooms, in the seamstress and dress-making apartments, and about various household daily recurring labors. These might never recover the right exercise of reason — might never be able to bear the excitement of society and the vicissitudes of life abroad; but, subject to judicious direction, be as cheerful and comfortable as the malady permits ; occasional recurrence of paroxsyms sometimes disqualifying from the exercise of ordinary employments. A few examples may not be without interest. A young man who for ten years had been confined in an out-building of a poorhouse, in Rhode Island, who was chained and neglected, by the interposition of a. visitor was released and removed to the Mc Lean Asylum, in Massachusetts. In a few weeks he recovered the use of his limbs, so as to adopt a little voluntary exercise. Gradually he improved so as to follow the gardener; at first merely as an observer, but after a time as an efficient laborer, always cheerful and ready for employment; but he was never restored to mental health. In the same institution a young lady, insane for several years, and classing with the incurables, supports her own expenses, by. the use of her needle, making the most tasteful and beautiful articles which find a ready sale. Many besides are employed variously; several draw very beautifully, observing the proportions and rules of art with great exactness.

In 1836, a raving maniac was conveyed to the State Hospital; he refused to be clothed, committed every sort of extravagance, and months passed before he was sufficiently composed to address himself to any useful employment. Gradually, however, he resorted to the carpenter’s shop, amused himself with the tools, but finally applied to useful work, and, with few intervals, has since been able to accomplish a. large amount of productive labor.

Another patient, who was confined nearly four years in a county prison, had several violent paroxysms: his mind is never entirely free from delusion; he speaks of his excitements — knows he is insane, and unsafe to be at large : is now ordinarily quiet, pleasant, and good tempered. He is an ingenious mechanic; makes correct observations on common things, but exhibits strange fancies and delusions upon all spiritual concerns. He labors diligently and profitably most of the time.

I do not recollect a. more satisfactory illustration of the benefit of hospital care upon large numbers of incurable patients, brought under improving influences at one and the same time, than is afforded in the first opening of the hospital for the insane poor at South Boston. Prior to 1839, the insane poor of Suffolk county were confined in a receptacle in rear of the almshouse ; or rather all those of this class who were furiously mad, and considered dangerous to be abroad upon the farm grounds. This receptacle revealed scenes of horror and utter abomination such as language is powerless to represent. These wretched creatures, both men and women, exhibit cases of long standing, regarded past recovery, their malady being confirmed by the grossest mismanagement.

The citizens were at length roused to a sense of the enormity and extent of these abuses, matched only, it is believed, (except in individual cases,) by the vile condition of the English private madhouse, as thrown open to the inspection of Parliamentary commissioners, within the last thirty years. The monstrous injustice and cruelty of herding these maniacs in a hall filled with cages, behind the bars of which, all loathsome and offensive, they howled, and gibbered, and shrieked, and moaned, day and night, like infuriated wild beasts, moved the kindling sensibilities of those heretofore ignorant or indifferent. The most sanguine friends of the hospital plan expected no more for these wretched beings than to procure for them greater decency and comfort; recovery of the mental faculties, for such as these, was not anticipated.

The new buildings were completed, opened, and a system of discipline adopted by Dr. Butler, the results of which I witnessed with profound interest and surprise. The insane were removed, disencumbered of their chains, freed from the remnants of foul garments, bathed, clothed, fed decently, and placed by kind nurses in comfortable apartments. Remedial means, medical and moral, were judiciously applied. Behold the result of a few ‘months’ care, in their recovered physical health, order, general quiet, and well-directed employments. Now, and since, visit the hospital when you may, at neither set time nor season, you will find this class of incurable patients exercising in companies or singly, reading the papers of the day, or books loaned from the library ; some busy in the vegetable, some in the flower gardens, while some are found occupied in the washing and ironing rooms, in the kitchen and in the sewing rooms. Less than one-sixth of those who were removed from the almshouse recovered their reason; but, with the exception of three or four individuals, they regained the decent habits of respectable life, and a capacity to be useful, to labor, and to enjoy occupation.

No hospital in the United States but affords abundant evidence of the capacity of the insane to work under direction of suitable attendants, and of recovery from utter helplessness to a considerable degree of activity and capacity for various employments.

I have seen the patient attendants, in many institutions, per severe day by day in endeavors to rouse, and interest, and instruct the demented .in healthful occupations; and these efforts after a time have found reward in the gradual improvement of the objects of their care, and their acquisition of power to attend to stated healthful labors.

While the interests of humanity, those first great obligations, are consulted by the establishment of well regulated hospitals for the insane, political economy and the public safety are not less insured. The following table exhibits the advantage of largely extended and seasonable hospital care for the insane. I am indebted chiefly to the reports of Drs. Woodward and Awl for these carefully prepared records.

It will be said by a few, perhaps, that each State should establish and sustain its own institutions ; that it is not obligatory upon the general government to legislate for the maintenance of State charities, by supplying the means of relief to individual sufferers. But may it not be demonstrated as the soundest policy for the federal government to assist in the accomplishment of great moral obligations, by diminishing and arresting wide-spread miseries, which mar the face of society, and weaken the strength of com munities?

Should your sense of moral responsibility seek support in precedents for guiding present action, I may be permitted to refer to the fact of liberal grants of common national property made, in the light of a wise discrimination, to various institutions of learning; ~ also to advance in the new States common school education, and to aid two seminaries of instruction for the deaf and dumb, viz., that in Hartford, Connecticut, and the school at Danville, in Kentucky, &c.

But it is not for one section of the United States that I solicit benefits, while all beside are deprived of direct advantages. I entertain no sectional prejudices, advance no local claims, and propose the advancement of no selfish aims, present or remote.

I advocate the cause of the much suffering insane throughout the entire length and breadth of my country. I ask relief for the east and for the west, for the north and the south; and for all I claim equal and proportionate benefits.

I ask of the Senate and House of Representatives of the United States, with respectful but earnest importunity, assistance to the several States of the Union in providing appropriate care and support for the curable and incurable, indigent insane.

I ask of the representatives of a whole nation, benefits for all their constituents. Annual taxation for the support of the insane in hospitals is felt to be onerous, both in the populous maritime States, and in the States and Territories west of the Alleghanies. Much has been done, but much more remains to be accomplished, as I have endeavored to demonstrate in the preceding pages, for the relief of the sufferings and oppressions of that large class of the distressed for whom I plead, and upon whose condition I am solicitous to fix your attention.

I ask for the people that which is already the property of the people; but possessions so holden, that it is through your action alone they can be applied as is now urged.

The whole public good must be sought and advanced through those channels which most certainly contribute to the moral elevation and true dignity of a great people.

Americans boast much of superior intelligence and sagacity; of power and influence; of their vast resources possessed and yet undeveloped; of their free institutions and civil’ liberty; of their liberally endowed schools of learning, and their far-reaching commerce: they call themselves a mighty nation; they name themselves a great and wise people. If these claims to distinction above most nations of the earth are established upon undeniable premises, then will the rulers, the political economists, and the moral philosophers of other and remote countries, look scrutinizingly into our civil and social condition for examples to illustrate the greatness of our name. They will seek not to measure the strength and extent of the fortifications which guard our coast; they will not number our vessels, of war, or of commerce; they will not note the strength of our armies; they will not trace the course of the thousands eager for self-aggrandizement, nor of the tens of thousands led on by ambition and vain glory: they will search after illustrations in those God-like attributes which sanctify private life, and in that incorruptible integrity and justice which perpetuates national existence. They will note the moral grandeur and dignity which leads the statesman to lay broad and deep the foundations of national greatness, in working out the greatest good for the whole people;“ in effect, making paramount the interests of mind to material wealth, or mere physical prosperity. Primarily, then, in the highest order of means for confirming the prosperity of a people and the duration of government must be the education of the ignorant, and restoring the health and maintaining the sick mind in its natural integrity.

I will not presume to dictate to those in whose humane dispositions I have faith, and whose wisdom I cannot question.

I have approached you with self-diffidence, but with confidence in your impartial and just consideration of the; subject submitted to your discussion and righteous etfective decision.

I confide to you the cause and the claims of the destitute and of the desolate, without fear or distrust. I ask, for the thirty States of the Union, 5,000,000 acres of land, of the many hundreds of millions of public lands, appropriated in such a manner as shall assure the greatest benefits to all who are in circumstances of extreme necessity, and who, through the Providence of God, are wards of the nation, claimants on the sympathy and care of the public, through the miseries and disqualifications brought upon them by the sorest afflictions with which humanity can be visited.

Respectfully submitted.

D. L. Dix

 

 

Source: The Journal of Mental Science: Published by Authority of the Association of Medical Officers of Asylums and Hospitals for the Insane, ed. John Charles Bucknill, MD, Vol. 4, (London: Longman, Green, Longmen & Roberts, 1858), pp. 129-164.