New-York tribune., 1876-12-20
WHO SHALL KEEP THE KEEPERSf

THE NECESSITY OF HAVING MORE sKIrLFUL AT
TESDANTs IN LUNATIC AsYLUMs-THE PRESENT
| SYSTEM A FAILURE.
| To the Editor or The Tribune.
| SIR Your editorial this morning on tho Blooming
dale Asylum, and the general subject Of attendants
for lunatic patients puts the question: Who shall
| keep the keepers Ia question which may well be
asked. which inevitably will be asked in course OF
time, in regard TO every asylum and hospital in the
country. No one can have any knowledge Of the
admirable head of the institution mentioned with
out feeling entire confidence in his integrity OF mind
and purpose, and in his Skill wisdom. and humanity;
while the very mention Of the names of the mana
gers is token that no wrong-doing would be toll
Grated by them. What more can we do for our help
less people One thing more: Organize the hos
pital service. There question here of the COM
potency and character of the managers and chief
officers. Is not tho question rather one OF imper-
feet organization 7
In most establishments Of the kind mentioned the
presiding officers are overworked. while in the
nursing corps itself of many of our asylums and hos
pitals las may easily be learned by inquiry there
are no intermediate grades no head nurse, no COM
petent subaltern officers, the nurses, each one, re-
porting directly to the superintendent or the
physician in charge. Many professional men have
the desire to keep every detail of management in
their hands-a plan clearly impossible, in fact,
and which breaks down at some point or other from
tho mere nature Of things What should we say OF
a railroad steamship company or Of any largo city
business organized in such wayf certain amount
of authority must be delegated Is it not safer to
have that authority graded itstead of deegatng it
at once to the lowest rank of attendantsf body
of nurses without organization and without trained
supervisors will at best only scramble along work
ing hospital very much as a regiment might fight
q battle without its company commanders.
Trained keepers, nurses and servants are not to
be had in sufficient numbers to supply all our instl-
tutons at Once but each hospital may make be-
ginning, and by the appointments OF competent
head of its nursing corps, and by system OF care
full oversight, with rewards and promotions may do
its own training and gradually supply its own need
of compact graded, orderly, intelligent service
The condition of things complained of has come
gradually. Our hospitals have outgrown simpler
system which might have suited their earlier days
and their smaller number Of patients. But III the
growth and consequent increasing complexity OF the
machinery essentials have sOmctimesbeen lost sight
of III nOn-essentials. We do not, for instance pay
salaries adequate to command the skill and intelli-
gence and the high sharacter, which are are
necessary for subordinate officers. Money has TOO
frequently been spent for monuments" rather than
for men, The condition of the insane especially
that of the insane poor, is pit9ble indeed 1hey are
even more helpless than children Their word goes
for nothing; they have literally, in one sense, no
friends. They need every safeguard which can be
thrown around them. Ignorance is cruel. Fear is
cruel And this most helpless Of all classes may not
infrequenty suffer from Ignorance and fear rather
than from deliberate cruelty. 1t is but year or
two since a clergyman of this city. on visiting
poorhouse IN a neighbOrng State, found in its barn
a harmless lunatic chained like Wild beasc, a
brutality committed no doubt through ignorance
and fear TO keep the man secure aud save the cost
of an attendant. But in our best asyuIns and
with a good class of attendants the service can
never be of the best quality without organization
and without intelligent and hgh-grade oversight.
Nelc- York, Dec. 10, 1876. K