The New York herald., 1879-03-15
OUR INSANE ASYLUMS.

.
CLANS, LAWYERS AND OTHER CITIZENS OF
NEW YoRK-AN INVESTIGATION PROPOSED AND
IT'S CHARACTER.
The management OF our insane asylums and the
treatment of their unfortunate inmates constitute
subject in which public interest Ia at all times
great. though it is spasmodic in its expression or
late Massachusetts, and Pennsylvania have been
aroused on this question. and the physicians
and other citizens Of New York, with . view of
remedylng the many wrongs known to exist and
prevent their recurrence in the future have sd-
dressed the following petition to the Legislature Of
the State:-
To THE LEGIsLATuRE OF THE STATE OF NEW YoRK:-
The petition of the undersigned physicians. law
yers aud other citizens OF the state OF New York.
There has lately sprung mp general and marked
discomfort in the public mind with regard to the
management of our insane asylums. From the ma
of the CASE the internal mechanism OF these in
stitutions being more or less secluded from public
scrutiny. it not to be expected that the popular
feeling could point to any special fault in the system
its cause. Like most popular movements the
sgsaton o. the sna nas
abuse rather than the great systemic defects OF
which these instances were but the outcome.
cal profession whose studies led them to investigate
asylums without bias or prejudice, purely in the in
have made public charges against the system Of
asylum supervision and asylum management in this
state which are deserving OF notice.
They merit special attention for the single reason,
IL there other reasons that those at the
head Of asylums have been either unable or un-
willing to answer their arguments or to disprove
their allegations.
Many OF these defects medical and administrative
have been admirably and fully set forth by Dr. h. b.
Wilbur in his Report on the Management of the
Insane in Great Britain. published in 1876 and 1877
This writer institutes comparison between the
management of the insane in the two countries
which is as humiliating as it is instructive.
The following points are among the most promi-
them rest upon exact EVIDENCE others can be-
stantated by responsible members OF the medical
profession, and regarding still others strong cir
cumstantlal evidence be adduced 1t is the pur-
pose OF the projected investigation to discern how
many of the questions herein set forth be salts
factorly answered under oath. We also believe that
the points referred to by these queries are Of the
highest Importance for the welfare or the unfortu
/. How many days in the year is the superintend-
ent actually and really on duty in his Office or IN the
q How many days in the year is the superintend
ent away from his asylum engaged in private busi-
tending upon courts without an order from the At
torney General or other proper authority?
g. Does not the State for cityl, in giving the super
intendent fair large salary. make contract for
the of his whole time. usual vacation excepted?
4. How often in q week does the superintendent
see and speak to every patient under his charge?
s. How many patients in the asylum are seen only
once month. or less often by the superintendent
unexpected visits to his wards? How often does he
make tours between midnight and morning to OBJ
the symptoms of some patients and to see how
nurses and watchmen perform their duties?
Z. How many patients are actually and really un-
der the superintendent's own medical treatment?
8. Does the superintendent see and examine every
immediately after admission, and Is he re-
sponsble for the registered diagnosis and general
o. Does the asylum possess. and do its medical off,
GERS really use, such common instruments as the
thermometer. ophthalmoscope asthesiometer. dyna.
afA nh mo
galvanc electrical batteries the speculum and uterine
sound, chemicals for the analysis of urine. &C.?
TO- Is feeding by forco always done by o medical
officer or in his presence. as it should be?
H. Is the superintendent consulted whenever
manner and result Of this mechanical restraint duly
recorded in book kept for the inspection Of the
Commissioner in Lunacy and of the courts?
himself, for the beneht of his patients of consulta-
tions with general physicians and surgeons and gen.
tlemen eminent in the several departments of med-
Is, Do you ever employ the barbarons and injuri-
Gus means of restraint known as "crib?"
IA. Are undergraduates in medicine ever employed
in your asylum assistant physcians or acting as-
sstant physicians?
/. Does the Commissiouer in Lunacy give any
notice Of hts coming to the officials OF an asylum he
is about to inspect?
q Has the Commissioners ever visited asylums at
unusual hours as in the middle of the night or in
the very early morning. in order TO determine the
usual condition Of their wards2
3. Does the Commissioner ever 60 about an insti-
tuition without company. or at any rate without
medical other officer. whose presence prevent
speaking the part of attendants and patientsi
4. How frequently are inspections made in the
various asyluns. and how many days in the year is
business not legtimately appertaining to his Officer
s. Does not the State. in paying the Commissioners
q fair salary, make contract for his whole time,
customary vacation excepted?
6. Was the present Commissioner appointed in
strict accordance with the law which requires the
candidate for this position to have been 'physi,
clan of exporienceT'
Besides your petitioners believe the following
statements to be well founded. They refer to more
strictly medical matters than the above recited ques
tions, yet consider that IL these evils exist the
State and the patients IN our asylums highly in
terested in their eradicaton:-
!. Superntcndents of insane asylums are, nearly
without exception. not chosen from among medical
men who have pursued special studies in neurology
at home and abroad, and who are we'll trained ply
sicians but from among assistant physicians OF asy
lums who. after having been badly chosen tride
institution.
2. Assistant physicians of asylums (future candi-
dates for the position OF superintendent nearly
always men just issued from too elementary med
ical schools: who have not served in civil hos
ptals (which can be entered only by severe
to any test when in the institution they not
furnished with means of study medical journals.
books and instruments) and, inevitably. years go
by. they forget what general medicine they knew
graduating.
and wretchedly paid. Their time is taken up by
visiting too many patients. by writing interninabe,
useless histories OF cases. and by various oflical'
duties, such talking by the hour with friends Of
patients, receiving visitors &c. The largest asylum
under state management lin this State) has only four
assistant ply sicans for between six and hun
dred patients In general hospital, like bellevue
the New York Hospital, every division Of from forty
to eighty patients Is ofcered by one attending physi
clan (who really his patients daily aud three
assistants. all graduates. selected from among .
crowd Of the best men by o severe competitive
examination. And il must be borne in mind that
in general hospitals there as in insane asyums
very many chronic cases requiring minimum OF
care. From this comparative statement it is at
once evident that in spite Of enormous outays Of
money insane ssyfums indifferently ofhccred
L. Superintendcnts and their assistants with
hardly exception. not versed in the anat
omy and physiology of the nervous system, the
part chiefly concerned In insanity t
5. Superintendents and their assistants, with
hardly exception not believed to be skilled in
the modern methods OF diagnosis and Of post-mor-
TEN examination. Few of them able to read in
the original the invaluable contributions insanity
and its treatment which we owe to German and
French scientific physicians for tho insane.
g. The little pathological work which has been
done in our asylums ut enormous cost has been Of