Vermont phÅ“nix. [volume] (Brattleboro, Vt.) 1834-1955, 1876-11-17

in view Of the fact Just stated regarding
the durability of insanity, the charge that
the chronic insane cared for in tho Yer
mont Asylum are "of its own making"
falls to the ground OF its own weight, and
could hardly have been ma de by any care
ful, candid and unprejudiced mind.
Accepting as s"well established truths
and principles" that "Insanity is a disease
ofthe BRAIN" and that II sis disease amen
able TO proper treatment in a large proper
ton Of cases for its cure, and in many 9TH
err cases for lis amelioration," and that "In-
stitutions Of proper size and under good
management, and with all the necessary
appliances and appurienances have an adj
vantage in the treatment Of insane patients
over those treated at their own homes, both
in economy and success in the way OF cure"
the three points made by the Commission
or, we pass TO the inquiry "Does this Asy-
lum apply these well. established truths
and principles in the care and treatment OF
its patients, and does 1t meet the require
ments Of well regulated institution in the
care OF the insane ?"
In the "opinion" Of the Commissioner
''it does not now, and has not since the first
ten years." Here we take issue. The ca
pacty OF the Institution is complained Of,
as being Gar beyond the size capable of
tho best success in the euro OF insanity
This lisa point that has been much discuss
ed by those engaged in the management of
such establishments, and the Association
of Superntendents Of the Insane Asylums
of the United States, has twice placed itself
on record in this matter. Formerly the
durability Of insanity was regarded as much
greater than at present. and acting upon
this belief, it was the expression OF that
body that 1.-TWO hundred and fifty was the
highest desirable number to he treated in
one institution" This was twenty-five
years ago. Fileen years elapsed and dur,
ing that time the pressure upon all the Asy-
lums in the country greatly increased.
New institutions were not created as rapid
ly as they were demanded. This led 10 the
adoption OF the policy quite universally of
discharging the chronic 10 make room for
the acute cases. This filed the almshouses
with incurables, and entailed manifold
evils. Then arose the question of separate
provision for the two classes. Institutions
exclusively for the incurables were opposed
by the Association, on the ground that
where curative agencies were not deemed
Indispensable, the character of Asylums
would tend to degenerate into that of aims
houses-the question of dollars and cents
cling uppermost, and the policy of rrovid-
ing for all in a uniform manner, whatever
might be their prospect OF recovery, was
favored, as having on its side the best in
te rests OF the insane. The Willard Asy-
lum, New York, already alluded to, is the
only real exception yet tried, and this,
whatever may be its advantages or disad-
vauta ges, has not been any saving 10 ex-
pense. In 1868, therefore, the same body
expressed the opinion that institutions "em-
bracing the usual proportions of durable
and incurable inaane, in particular COM
munity, may be properly carried to the ex-
tent of accommodating six hundred pa
tients," and such is the capacity of many of
the Asylums since erected or in process OF
erection at the present time, and others in
existence previously, have been enlarged
to correspond with the latter conclusions.
1t will be seen therefore, that The trustees
Of the Vermont Asylum have not pursued
policy contradictory 10 the views which
have shaped State policy throughout this
country.
Again, the Commissioner urges that this
Institution "has put upon its superintend-
ents such burden and so much labor, that
they have little time TO use, and improve
those high qualifications of medical skill
and experience, for which they were main
ly selected" and further, that ''they are re-
duced by this pressure upon their time and
energies TO mere superintendent compar-
s,.l.
ment Of patients is impossible"
1t is true that the responsibilities, attach
ing to such positions are onerous enough.
The Commissioner, however, fully agrees
that in the organization of an establish
ment Of this kind, its practical working
"must be under the control OF one man, to
act both as superintendent and physician"
hence 1t follows that the efficiency of all
such establishments must depend upon the
systematic carrying out of the working
plan in its practical details. 1t is not ex-
pected that the physician in chief of hos
pital will perform all the medical and surg
ical duties incident 10 his charge PERSONAL
ly, although the responsibility is his but
that he will be the counsellor of his med
ical assistants, an d the director Of the work.
ing corps, in every department.
In respect TO the number of assistants
and subordinates necessary for the efficient
administration of the internal economy he
is expected to be the Judge and if the SUI
perintendents OF the Vermont Asylum
have had any cause TO complain of inabili-
ty to exercise in the most efficient manner
their prerogatives, ii has not been from any
Limitation on the part of those having the
oversight and direction of its affairs, but
solely from tho lack of means and certain
1y no person practically acquainted with
The management OF Asylums, would con-
slider the professional duties incident TO the
care OF household of the proportions OF re-
cent and chronic cases which at present
compose the numbers under treatment,
more difficult than would be the care of
half the number composed largely Of acute
cases.
Again the Commissioner asserts that "the
Institution has not increased its appliances
and facilities for cure, as the size increased"
In WORD the reader is led TO infer that the
Institution saw its best days before it had
existed ten years, and has been gradually
declining for the last:thirty years, until 1t
has now reached IFS lowest ebb.
We note with special establishment the
remarks of the Commissioner relative to
religious exercises, and amusements. Al
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