New-York tribune., 1893-12-24
PART II.
DEC. "a, 1893.
CARE OF THE INSANE.
THE DUTY OF THE STATE POINTED OUT.
CURABLE CASES SHOULD BE ISOLATED AND HOS
PITAL PHYSICIANS SHOULD BE SPECIALLY
ASSIGNED TO THEM.

cURABLE CASES SHOULD BE ISOLATED AND HOS
PITAL PHYSICIANS SHOULD BE SPECIALLY
ASSIGNED TO THEM.
To the Editor of The Tribune
Sir: THE duty OF the State is such provision -
to accomplish the largest result In the restoration
TO health of durable cases, the element OF expense
being here subordinate one, and Tor the re-
mander such comfortable provision as shall N
sure safety the community and humane care %
the sufferer" This quotation from an ADDRESS ~
Dr. Godding of the Government Hospital for the
Insane at Washington, ID. c., is made use OF ~
DR.. Andrew MacFarane in an article In the Octo-
ber number OF THE Popular Science Monthly, N
which he offers useful suggestion relating to the
better accomplishment by our State hospitals OK
the objects referred The steady advance maoe
by this State in the manner OF taking care Of In
sane people is referred to at length after which =
Is shown that further steps are necessary II the
benefcent legislation OF the last few years 10 -
accomplish fully its expected ends.
The word hospital has been substituted for asy.
um in the titles OF these institutions but they
SILL remain places for refuge. rather than places
for cure 1t is true that s4 % per week Is allowed
during the first three years Of residence Of each
patient against s. so eky for the remaining pc
riod. This, Dr. MacFarlane says, is OF benefit 70
the durable patient only by raising the general
standard Of care large proportion OF the cases
admitted already in hopeless condition Of
y,
hospital belong the class. Under present
conditions 81 % is allowed for the recently admit
ted chronic incurable well as for the acute cur
able case and at the time the construction
and management of the hospital provide no ade'
quate special arrangement for the treatment OF the
latter. In fact the who has broken down IN
business. has beer temporarily overcome by the
storms of life, must be placed in the same ward ~
the chronic unatic.
The recent State Care act provides for the re-
moval OF large number of insane people from the
county houses to the State hospitals. Most Of them
are suffering from chronic insanity, there being
the slightest hope of their recovery. 1t Is In
tended to provide accommodations for tfem by
erecting number of cheap buildings in the hos
pta grounds DR.. MacFarlane suggests that first
of all the huge. antiquated main buildings be given
up to them, and that small, homelike structures b
provided for the administration of vigorous hos
pita treatment the acute Here" he
says "the real work OF the hospital should be
done and no labor should be spared which would
in any way tend to the recovery OF a patient, or
help solve any of the unknown problems of insan-
ity" Many Of the acute insane very sick peo-
ple requiring close medical attention and skilful
nursing. Such could here receive the benefit
of the modern methods and apparatus for nvesti-
eating diseased conditions and for promoting their
restoration A high order of nursing could also be
provided, nurses trained m general hospitals being
associated with the special nurses in order that the
purey physical ASPECT Of each case might receive
every attention
The custom of congregating durable and incur.
able cases of insanity in ,he same ward Is an un.
mitigated evil II mas the chance Of recovery or
many promising cases. Constant association with
the insane is far from wholesome TO the sane and
its effect on the morbii fancies depressed feelings
and half-fxed deusions o. a man recently become
insane or corvalescng cannot fail to be perniclous
Recovered patients speak OF IL frequently, and one
of my acquaintance has written Of It in the public
press The lack of wholesome self-contro, the ex-
preston Of delusions and rrCrtd fanc.es mostly or
an unpleasant nature. the righteousness, the de-
pressed spirits and the general ideness and spir'
itess Indifference characteristic OF ward OF
chronic insane people must have struck any one
who has visited a large hospital.
The preponderance of chronic cases in our state
HOSPITALS must affect the character of the medi-
cal work II is d deploribe fact. perhaps not gen.
orally known that the medical spirit or these insti-
tutons is not what 1t ought TO be. Many a young
physician enters them ambitious and enthusiastic
in scientific matters only TO find in a few years
that he has been dstanced by his contemporaries
in other lines Of medical work, and that he Is al
most out of touch with them. The reason for this
Is simple. He has not been able to direct his ener-
gies 10 the nvestiga ton and cure Of limited number
OF prominent cases but has been Obliged to employ
himself endless rounds among helpless chronics de-
pendent upon him for devising means for their em-
ploymen; and amuser ent whose frequently monot-
onous histories he must record. and whose corre-
spondence and friends lay Claim 10 his attention.
So rlany non-medical matters engage him that his
medical zeal dies OF inantion. The majority or
his cases require humane custodial care only, su-
perysed by intelligent medical observation Tor Sc.
lection of cases showing promise Of recovery ana
the proper claSslilcdslOn ana uispoSioh VI the
remainder
In hospital containing thousand patients NOT
moro than 100 and probably as few as 90. can
be considered durable Su III a hospital In this state
would he equipped with staff OF seven physicians.
Two or three OF these Or MacFarlane says, would
be sufficient for the necessities Of the incurables the
rest could thus be lc free 10 attend 10 the promis-
ing cases in the homelike annexes. Close observa.
ton anu study of these cases and the application
OF an energetic plan OF treatment would anoro
them ample occupation. The benefits TO patients,
nurses and physicians and TO the community
would more than repay any extra expense ana
trouble entailed. The number OF durable cases.
however. is unfortunately small that the expense
of the plan suggested would not De much greater
than under present conditions DR.. MacFarlane
substantates his views by extensive quotations
from numerous auth )ri.les. collective and individ-
ual medical and lay. He adds. too that such a
plar as he suggests is in practical operation IN
SON. European and British fcspitas, ana tnat It's
extension Is contemplated.
Under the high pressure of modern lie, insanity
of those temporarily overcome are imperative.
People Yet got over the, feeling that the
commitment of a relative or friend to hospitals for
the insane is attended by certain disgrace. Any
change that Will tend to make these places hos
pIfals indeed and to remove this prejudice, Is de.
srahle and il Is to be hoped that those having
thority or influence in the matter will read Dr,
MacFarlanes article and promote the adoption Of
his suggestion. W. L. IL
New York. Dec. is, 1893.