REPORT

OE THE

PHYSICIAN

OB THE

NEW-YORK

LUNATIC ASYLUM,,

ADDRESSED TO A

COMMITTEE OF ITS GOVERNORS,

AND

PUBLISHED AT THEIR. REQUEST

New- York:PRINTED BY SAMUEL WOOD & SONS,

1818.

To Thomas Franklin, Jacob Slurred, andCornelius Dubois, Esquires, chairman,

and members of the committee of theNew-York Lunatic Asylum.

Gentlemen,

AS your monthly records exhibitregular returns of the patients, and you haveby long and assiduous attention become fa-miliar with the management of the asylum

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and its dependencies, it can hardly be ex-pected, that under a more general view ofthe institution, I shall be able to add to yourknowledge of its important interests. Butas with the privilege of your example, andof co-operating with you in your benevo-lent design, there cannot, it is hoped, be anymisconception of the motives which governme, I beg leave to lay before you, in theform of tables, a statement of cases admittedfrom the 13th of September last to this date.

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(a period of eight months) with their results,and of others received prior to that month,and within the same time discharged ; refer-ring you, for a more particular account, tothe accompanying volume, which containstheir histories, in so far as it has been prac-ticable to obtain them, and their medicaltreatment. I shall take the liberty to addsome general observations on lunatic asy-lums, and on the treatment of insanity, hav-ing an exclusive reference to the comfort,convenience, and cure of the unfortunatepersons labouring under that most awfulmalady.

The number of admissions in the periodrefered to, is thirty-eight, of which twenty-eight were males, and ten females. Of theformer, there have been discharged cured,thirteen, improved three ; two by request,and two have died. Of the eight remainingin the house, four are much improved, threehave been recently admitted, and one is aman sixty-eight years of age, labouring un-der that species of insanity, which sometimesoccurs in advanced life, from a diminu-tion of perception and memory, and is ter-med amentia senilis. It is to be observed,

that T. H. who, on the 25th of October, wasentered on the minutes of the committeeas relieved only, was discharged cured. Ofthe ten female patients, one has been dis-charged cured, one an improper object, threeby request, and one has died. Of the re-maining four, one was admitted the 18th, onethe 27th of March, one the 24th of April,one the 12th instant; and they are all nearlyin the state in which they came in. Duringthe time stated, of patients who were in thehouse previous to the first of September,there have been cured one male, and one fe-male ; four males and one female have died,three males and two females have been dis-charged by request, and one male as an im-proper object; the females and two of themales, improved. The cases which endedfatally were of long standing, connectedwith palsy, epilepsy,consumption and dropsy.

The whole number cured since the 13thof September, is fourteen, twelve of whomwere males, and two females. In the sametime, there have been relieved, and muchimproved, five; discharged by request,twelve; as improper objects, two; and eighthave died.

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The number of patients now in the houseis seventy-seven, of whom forty-nine aremales, and twenty-eight females. Fourteenmales, and nine females are variously andusefully employed in such occupations asappear to be the best adapted to their severalcases, deriving in this manner, more benefitperhaps, than the establishment, under itspresent arrangements, could otherwise affordthem.

It is desirable that early measures shouldbe taken to discharge C. H. whose case youare acquainted with, and to enable him toreturn to his connections in Scotland, who,lam informed, are respectable people. Hisconfinement appears to have a tendency torevive, and it may perpetuate the disorderfrom which he is fast recovering, and which,for its entire cure, may require nothing buthis enlargement. Should he, from his pre-sent restraint, unfortunately relapse into thedreadful state in which he was admitted, itis not difficult to foretel to what a series ofpainful reflections so deplorable an eventwould give rise.

W. M. a custom house patient, as he iscalled, labouring under palsy, is an improper

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object of our attention. The means adap-ted to his cure, would be more advantageous-?ly applied in the hospital.

There are several old cases of both sexesin the house, of whose recovery there existsbut a faint probability; and there are othersin a course of improvement.

Accompanying the tables of cases, is alist of names, showing, annexed to each, asnearly perhaps as the difficulty and obscuri-ty of the subject admits, their supposedcauses. How far such an exposition mayor may not be useful, it is not pretended todetermine. I shall hazard one remark onthe occasion, that religious terror, arisingfrom erroneous perceptions, is much morefrequently the effect than a cause of men-tal derangement.

It will be evident to you, that from anypharmaceutical course that has been pursuedin the treatment of our patients, there is butlittle to boast. Medicine indeed, has beenrarely given, except when strongly indica-ted by such symptoms of bodily disease, aswere supposed instrumental in exciting, orhad been connected with the disorder of themind. Under such circumstances chiefly.

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do we rely on its efficacy: but we do notbelieve in the specific power of any drugin curing madness. Although mercury hasbeen given to a number of our patients, thereis but one instance in which it was consider-ed that the recovery was the result of itsuse, and that was the case of J. L. G. dis-charged the 31st of March.

Mild cathartics, and warm bathing, havelong appeared to me of more general utilitythan any other means employed as phys-ical agents, in the treatment of insanity, andthe latter, in an especial manner, in melan-cholic cases. Drastic purges, unless whenparticularly demanded, have been of far lessbenefit.

Blood-letting, judiciously used, in violentparoxysms, has on many occasions been ofgreat efficacy, but is of far less generalapplication than is often supposed; and,without the most accurate discrimination,will be productive of much mischief. 80far as I have been able to judge, local bleed-ing, as it is termed, has not that advantageover the general operation, as to justify thetrouble of performing it; and lam almostled to pronounce it a more than useless resort-

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Incases of mental disorder. Very ampleexperience does not dispose me to thinkmore favourably of setons in the neck.

Blistering the head, the back of the neck,or between the shoulders, has also been of

<»

doubtful effect; and more dependence hasbeen placed on the same operation on remot-er parts.

In three old cases, the actual cautery hasbeen applied in its fullest extent, to thehead, in the manner proposed and practisedby Monsieur Valentin, a French surgeon,of reputation, as I am told ; and al-though succeeded by exfoliations of theouter table of the scull, the result has notjustified a repetition of so severe a remedy.

As a means of temporary mitigation, un-der a furious paroxysm, accompanied bystrong arterial action and increased heat, theshower bath has been usefully applied.Though it is not to be supposed that anycase of madness is to be removed by its ope-ration, as has often occurred in certainstatesof febrile disease, much advantage maybe derived from its proper application.

The means of safe keeping by bars andbolts, and cords and chains, are abundant.

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and easily obtained; but it should be thesupreme object of those who have assumedthe responsibility of governing the insane,to restore to their reason, and to society, thegreatest possiye number of these afflictedbeings : and we have no hesitation in be-lieving, that this will be the most certainlyaccomplished by stiict attention to a moralregimen. The greatest improvements inthe treatment of madness have been of thisnature; and the most approved physicalagents of modern times were familiar to ourremotest ancestors. With such views, therecovery of the deranged is not to beforgotten in the mazes of abstract research,nor in those wild speculations on the natureof the reasoning faculty, under the influenceof which, it is often difficult to determine,where the greatest degree of mental alien-ation exists, whether in the patient, or inhim who has the care of him.

The order and internal economy and go-vernment of the New-York Lunatic Asy-lum, have justly placed it in the highest rankamong the best institutions of our country ;

and the most improved establishments of thekind in Europe, do not afford a source of

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higher congratulation on the benefits theyhave afforded to the most afflicted of ourrace. The period is not remote, when a va-riety of circumstances conspired to renderthe very name of a mad house a subject ofterror and dismay. The prevailing opinionof the friends of its. unhappy tenants was,that they were placed within its walls, notas in a situation, where they might, by lenityand kind treatment, be restored to the bles-sings of health and reason, but as in a placeof safe keeping, disabled from injuring them-selves and others ; where, from the supposednature of their disorder, they neither deserv-ed, nor would receive the compassion oftheir keepers, and where they would inevita-bly languish and die. Thanks to the wisdomand humanity of the times in which we live,lunatic asylums have not only excited theattention of the benevolent every where,but have also been a subject of legislativeinvestigation in one of the most enlightenedcountries of Europe. It was on inquirydiscovered in England, that the contribu-tions which had been made with a liberalhand towards their support, both in town andcountry, where shamefully misapplied, and

12lavished on those, who, by neglect and cruel-ty, had merited and received the severestreprehensions of an abused public. Undertheir former structure, every thing that metthe view of the exiled sufferer , about to en-ter them, was suited to convey the idea ofconfinement, and restraint, and that he wasto be immured in, and subject to thehardships of a prison ; an impression oflasting and pernicious tendency. Hewas indeed there shut up from the world, se-parated from his friends,and covered from thelight of day ; and, amidst the aggravated hor-rors of a dungeon, the chains which rivettedbis ghastly figure to the ground, bound alsoin everlasting night, the distinguishing attri-bute of his being. In such a situation, with-out an effort to revive the suspended en-ergies of his mind, with nothing to awakenhim to a sense of his human nature, withouta ray of consolation, of affection, or of sym-pathy to beam upon him, he remained a neg-lected, forgotten, and abandoned prison-er. Thus forlorn, the whole plan and sys-tem of bis custody, were of a nature to drivehim to despair, and to the hopeless, the aw-

ful condition of irremediable madness.

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Asylums for the insane ought no longer tobe viewed as places of personal securitymerely, but the temporary abode of a classoffellow beings, having the strongest claimsto our sympathy and regard ; furnished withthe means of comfort, amusement, and em-ployment, adapted to the circumstances oftheir condition, and the nature oftheir dis-ease.

In the superior and general superintend-ence of such an institution, I would takethe liberty to recommend, for the most ob-vious reasons, permanency of appointment,when justified by the qualifications of theelected. The appointed should be reasona-ble, humane, moral and religious, possessingstability and dignity of character ; mild andgentle in their temper and deportment, butresolute in their purposes, and of great selfcommand ; never attempting by ill directedefforts ofsuperior strength, to subdue theunconscious violence of their charge ; ofjust and sagacious observation, and endued,with clear and unclouded minds ; so compas-sionate, and of such intelligence, as not onlyto take an interest in the unhappy lot oftheobjects of their trust, but to be able to as-sist them in the recovery of their reason.

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In their ordinary visits, they should ap-proach the insane with an air of gentle-ness and kindness, expressive of concern fortheir unhappy condition, a deportment,which will not fail to augment their respectand confidence, on occasions requiring amore stern and distant intercourse. Theyshould watch, with discriminating and un-wearied attention, those favourable mo-ments of drawing them from their halluci-nations, their fantasies and wanderings,which frequently occur in the intermissionsof many cases, both of madness and melan-choly. The blunders of the ignorant andunskilful in the treatment of bodily disease,are generally of rapid effect, and may soonend in the death of their victim ; but in themanagement of the insane, they are of slow,deep, and lasting consequence.

In the arrangement and structure of theasylum now erecting, whether as connectedwith this house, or as a separate establish-ment, I beg leave to suggest, that while itis of much importance that it be so con-structed as to convey no idea but that ofcomfort, it may also admit of a classifica-tion of the patients during the day, accord-ing to their sexes, condition of life, and va-

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rious states of derangement, in separate a-partments of convenient dimensions. Thisis an object of such moment, that althoughrequiring an additional number of attend-ants, appears to be deserving of serious con-sideration ; and it is confidently believed,that its advantages would amply repay anyadditional expence which might arise from avariation of form. It is also recommended,that a distinct building be provided for themost raving and noisy, who should be con-stantly under the inspection of a faithful,humane and discreet attendant.

A convalescent should at all times be se-parated from the more insane. While per-mitted to see in the countenances and con-duct of those who are around him, multipli-ed examples of the deplorable state fromwhich he is emerging, what can be more a-dapted to overthrow his feeble and yet tot-tering intellect I

The furious maniac, who from occasional,but remote acts of violence, may have re-quired the most rigid restraint, ought attimes to be released from his chain and hiscell; to be led forth to the refreshing influ-ence of an untainted air, and the liberty of

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such exercise, as may promote so free andequal a circulation, as shall counteract thatmorbid structure and disorganization, what-ever their nature, which confirm and pro-long his disease, and finally render it incu-rable. When released, it is advised that heshould not associate with the deranged, butcontinue under the eye of an attendant, bothcapable and willing to improve every ad-vantage of his meliorated condition. It isonly by thus extending the freedom of theviolent, that we can ascertain the changestheir malady may have undergone. Neglectin performing so imperious a duly, is a ne-gative act of unpardonable cruelty, which,there are strong reasons to believe, has oftendoomed to immeasurable suffering, many awretched inmate of a lunatifc asylum. Whatmust be the feelings of that being, who,month after month, and year after year, fet-tered with chains, and shut up in darkness,yet possessing the powers of intellect, is in-capable of rousing the sympathy of his keep-ers, and can contemplate in the grave only,the termination of his suffering ? Withwhat an aggravated sense of horror mustwe view his forsaken condition, if at the

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same time, he is cut off from the cheeringlight and consolations of the Gospel, theblessed refuge of the afflicted ? It is sta*ted, that at the house of correction at Ken-dal in England, a maniac, who had lucidintervals of nine or ten months duration, wasconfined in a solitary cell for ten wholeyears, without occupation, and without see-ing a human being but those who broughthim food.

In the arrangements of the new asylum,it is presumed that considerable advantagewould be derived from an exclusive appro-priation of two large apartments for the sickof the two sexes, having allowed to each anattendant, who should remain with themduring the night as well as the day. Withsuch a provision, the sufferer, in whose mindthe light of reason had been long extin-guished, might, during that gleamof intellect,which frequently attends the closing sceneof life, be made to know that he is a humanbeing, meriting and receiving the compas-sion and kind offices of his fellows. With-out such accommodation, many do, andmust unavoidably die unseen.

There is perhaps nothing of more realimportance to the comfort and recovery of

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the sick and insane, as respects the internalprovisions of the house, than a plentifulsupply of water. At this establishment,some difficulty and delay have attended theprescriptions for tepid bathing, an applica-tion not only of great utility in many casesof mental disorder, but essential also forwashing and purify ing the skin, and promo-ting that cleanliness which is so necessary tohealth, as well as comfort, in every situation.Where the quantity of this most necessaryarticle is abundant, conveniences, under theusual calls of nature, may be so constructedand arranged in some ofthe apartments, andespecially in those of the sick, as that theircontents may be removed by a stream ofwater, conveyed by pipes in the walls of thebuilding, passing constantly through them.

It appears to me that the marble floor ofthe hall of the basement story of this house,without possessing any particular advantagefrom its material, produces a degree ofdampness, not only uncomfortable, but.hurtful to the persons who daily occupy itIn our colder seasons.

The expediency, propriety, and utility, ofpublic worship, cannot be too strongly in-

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culcated, under proper regulations andrestrictions, in every building appropriatedto the reception of persons labouring undermental disease.

With respect to the amusements and vari-ous occupations of the deranged, as a meansof arresting their wanderings, and therebycontributing to their recovery, many usefulremarks may be found in some of the pub-lications on insanity. I would recommend,that in all their recreations, whether otlabour, of skill, or amusement, they shouldbe separated from each other, and classed,as far as circumstances will admit, with thesane, engaged in similar amusements andpursuits. It has been found that such em-ployments and recreations as require themost bodily exertion, have been the mostbeneficial.

It is submitted to the committee, if a fullsupply of the succulent vegetables of theseason, would not be a reasonable, as it isconsidered a proper and salutary indul-gence, to the patients of this institution.

I cannot. Gentlemen, close this long re-port, without an apology for so great a

trespass on your time, and expressing to youmy high sense of the support afforded me

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in the arduous duties of my appointment, aswell by your example, as by a prompt acqui-escence in the means which have been occa-sionally proposed for the benefit and com-fort of the patients of the asylum. Foryour uniform tokens of personal respectand kindness, I beg you to receive mywarmest acknowledgments.

To Mr. Wilson, the superintendent, I ammuch indebted for his faithful attendance,and ready co-operation with me under thevarious circumstances in which his serviceshave been required. To Doctor JoshuaFisher, for his able assistance in every de-partment of duty claiming my attention, weare under the highest obligations; and forthe polite and friendly aid, on various emer-gencies, of Doctor Campbell, the house phy-sician, I cannot adequately express mythankfulness : and it is with no ordinaryemotions that I acknowledge the respectfulcivilities of the superior and subordinate of-ficers generally, of the New-York Hospital.

I am with much respect,Gentlemen, your obliged,

and obedient servantWILLIAM HANDY.

Asylum 15th May, 1818,