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THE INSTITUTIONAL CARE
OF THE INSANE

IN THE

UNITED STATES AND CANADA



HENRY M. KURD, WILLIAM F. DREWRY, RICHARD DEWEY,

CHARLES W. PILGRIM, G. ALDER BLUMER

AND T. J. W. BURGESS

EDITED BY

HENRY M. HURD, M.D., LL.D.

Emeritus Professor of Psychiatry, The Johns Hopkins University ;

formerly Medical Superintendent of the Pontiac State

Hospital; Secretary, The Johns Hopkins Hospital



VOLUME I



ILLUSTRATED




THE JOHNS HOPKINS PRESS

BALTIMORE, MD.

1916



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BALTIMOKK, Ml)., V. S. A.



COMMITTEE OF THE AMERICAN MEDICO-PSYCHOLOGICAL
ASSOCIATION ON A HISTORY OF THE INSTITU-
TIONAL CARE OF THE INSANE, 1908-1916.

Henrv M. Hurd, M. D., LL. D., Chairman,
Baltimore, Md.

William Francis Drewry, M. D.,

Medical Superintendent Central State Hospital,

Petersburg, Va.

Richard Dewey, A. M., M. D.,

Formerly Medical Superintendent Kankakee State Hospital,

Superintendent Milwaukee Sanitarium,

Wauwatosa, Wis.

Charles W. Pilgrim, M. D.,
Ex-President New York Commission in Lunacy,
Medical Superintendent Hudson River State Hospital,
Poughkeepsie, N. Y.

G. Alder Blumer, M. D., L. R. C. P.,

Formerly Superintendent Utica State Hospital,

Physician and Superintendent Butler Hospital,

Providence, R. I.

T. J. W. Burgess, M. D., F. R. S. C,

Medical Superintendent Protestant Hospital,

Professor of Mental Diseases McGill University,

Montreal, Que.



PREFACE.

The preparation of the "History of the Institutional Care of the
Insane," of which this forms the first volume, has been much
delayed by an unexpected broadening of the original scope of the
work. It was originally undertaken to give in detail histories of
every institution in the United States and Canada with special
reference to their foundation and development. Early in the
course of the work, however, it became evident that such a com-
pilation would not present in a concise and accessible form many
important facts which were considered worthy of record for future
use, and certain general chapters were added. The extended plan
has involved a considerable increase in the labor of compiling the
volumes and consequent delay in publication. The change of plan
necessitated an extensive correspondence with state boards, state
officers, superintendents of institutions, philanthropists and others
in every part of the country; and from these various sources
valuable information has been obtained which could not otherwise
have been gathered.

The thanks of the committee are due to Dr. Spencer L. Dawes,
the Commissioner of Immigration ; to the New York State Hos-
pital Commission ; to Dr. J. Montgomery Mosher ; to Mr. T. E.
McGarr, formerly Secretary of the Lunacy Commission and later
of the State Hospital Commission, all of Albany, N. Y. ; to
Dr. T. Wood Clarke, of Utica, N. Y. ; to the Boards of Control
of Minnesota, Illinois, Kansas, Iowa, Kentucky, Ohio, Nebraska,
Colorado, Oregon and South Dakota ; to Dr. S. E. Smith, of
Richmond, Ind., for invaluable assistance in connection with
procuring histories of institutions in Indiana ; to the State Libra-
rians of Oregon, Washington, New York, Pennsylvania and
Maryland for information and access to original documents ; to
Dr. Frank Woodbury, Secretary of the Pennsylvania Committee
in Lunacy ; to Dr. C. Eugene Riggs, of St. Paul, for copies
of the Minnesota statutes ; to the late Dr. H. A. Tomlinson, of St.
T*eter State Hospital, Minn., for valuable documents ; to Dr. F. W.
Hatch, of Sacramento, for many histories of the hospitals of



VI PREFACE

California ; to Drs. Owen Copp and C. E. Thompson, formerly
of the Massachusetts Board of Insanity, for much assistance ; to
Dr. L. Vernon Briggs, of the Massachusetts Board of Insanity,
for kind co-operation and assistance ; to Dr. Geo. A. Zeller, of the
Board of Administration in Illinois, for many favors ; to Dr.
Charles P. Bancroft, of Concord, N. H., for valuable documents
relating- to the early history of the hospitals in New Hampshire ;
to Dr. Edward Cowles, of Boston, Mass., for material in refer-
ence to the establishment of training schools for nurses, and also
for the history of the development of laboratories in connection
with insane hospitals ; to Dr. John B. Chapin, of Canandaigua,
N. Y., for valuable historical notes upon the care of the chronic
insane in New York, and for biographies ; to Dr. Charles W.
Page, of Hartford, Conn., for the early history of the Hartford
Retreat, and of the remarkable work of Dorothea L. Dix between
the years 1840-1860; to Dr. B. D. Evans, of the New Jersey
State Hospital at Morris Plains, for valuable copies of original
documents relating to the care of the insane in New Jersey during
the past century' ; to Dr. E. L. Bullard, of Rockville, Md., for an
extended sketch of the so-called Wisconsin method of caring for
the insane ; to Dr. J. W. Babcock, of Columbia, S. C, for permis-
sion to use extracts from his " Public Charities of South Caro-
lina," and for valuable assistance and suggestions ; and to Dr.
W. W. Richardson, of Mercer, Pa., for painstaking assistance in
gathering the histories of private institutions for the insane. Also
to Mr. A. D. Eraser, Librarian of Parliament, Charlottetown, P.
E. I., for sketch of the hospital and copies of early laws relating
to its foundation ; to Dr. W. H. Hattie, formerly Medical Super-
intendent of the Nova Scotia Hospital and now Inspector of
Humane and Penal Institutions of Nova Scotia, for account of
hospital and copies of early acts ; to Dr. David Young, formerly
Medical Superintendent of Selkirk xA.sylum, Manitoba, for much
valuable information regarding its early history ; to Dr. D. Low
and Messrs. Storey and Van Egmond, for copies of acts and plans
of the Battleford Hospital ; to Mr. Erank Scholes, Bursar of
Ponoka Hospital, and Mr. A. M. Jeffers, architect, of Edmonton,
for valuable information and plans of Ponoka Hospital, Alberta ;
to Professor Hill-Tout, of Victoria, B. C, and Judge Howay, of
New Westminster, B. C, for information regarding insanity



PREFACE VU

among the Indians of the Pacific Coast ; to Z. T. Wood, Assistant
Commissioner R. N. W. Mounted PoHce, Regina, Sask., Law-
rence Fortescue, Comptroller of the Force, Ottawa, Ont., and Dr.
A. J. Gillis, Speaker Territorial Council, Dawson City, for informa-
tion concerning the care of the insane in the Yukon and North-
west Territories ; to Dr. C. K. Clarke, formerly Medical Superin-
tendent of Kingston and Toronto Asylums, now Superintendent
of the Toronto General Hospital, for sketches of those institu-
tions ; to Dr. R. W. Bruce Smith and Edwin R. Rogers, Inspect-
ors of Asylums, for information regarding Ontario institutions ;
to the late Reuben G. Thwaites, Secretary of the Wisconsin State
Historical Society and editor of " The Jesuit Relations," for
information as to insanity among the eastern tribes of Indians ;
to Dr. A. G. Doughty, Dominion Archivist, Ottawa, Ont., and his
assistant, Mr. David W. Parker, Mr. Crawford Lindsay, chief
English translator for Quebec Legislature, Mr. E. Z. Massicotte,
Archivist of the District of Montreal, Miss M. Charlton, Libra-
rian McGill University, and Miss M. L. Meiklejohn, Stanley Insti-
tute, Ottawa, Ont., for researches relating to insanity during the
period of the French regime in Canada, and copies of documents ;
to Mr. H. P. Biggar, of Welwyn, England, for researches at the
library of the Louvre, Paris, France; to Brother Superior Casi-
mir, for an interesting sketch of the Retraite St. Benoit-Joseph ;
to Dr. E. Tremblay for a sketch of L'Hospice Bale St. Paul and
biographical notices of its founders ; to Lady Superioress, Mother
M. A. Piche, of the Grey Nunnery, Montreal, for information
regarding the early care of the insane in that institution ; to James
Douglas, LL. D., New York City, and P. B. de Crevecoeur,
Librarian, Eraser Institute, Montreal, thanks are specially due
for the loan of rare works relating to the French regime in
Canada ; to Dr. C. A. Porteous, Assistant Superintendent, Verdun
Hospital, Montreal, for invaluable service in the revision of manu-
scripts and in other ways ; to Mr. E. Dyonnet, Secretary Royal
Canadian Academy of Arts, for assistance in the translation
of old French documents ; to Dr. P. H. Bryce, Commissioner of
Emigration, Ottawa, Ont., for many courtesies ; and to Dr. W. ]\I.
English, of Hamilton, for valuable assistance.

The obHgations of the committee to the individual superinten-
dents of nearlv two hundred institutions in the United States and



Vlll PREFACE

Canada are very great ; in fact, without their co-operation it would
have been impracticable to prepare any adequate history of the
movements in the various states and provinces.

It is evident from a careful study of all the material which has
come into the hands of the committee that a gradual evolution has
occurred in the care of the insane in America during the past half
century, which bids fair to change materially the discouraging
views as to the hopelessness of their cure which have prevailed for
many years in the United States and Canada.

The movement towards the prompt treatment of curable cases
without the formality of legal commitment and under the same
conditions as in admission to a hospital for general bodily disease,
gives every hope that at an early day cases of recent attack may be
received everywhere promptly, and that greatly increased numbers
can be cured. Cases of a chronic nature are also now much more
satisfactorily dealt with in institutions on the cottage plan, with out-
lying colonies for the employment of patients, and have a cor-
respondingly better opportunity to attain self-support. These
movements promise to make material changes in future methods
of caring for the insane.

Special personal obligations are due by the Editor to R. G.
Hazard, of Peace Dale, R. I., and to C. C. Harrison, of Phila-
delphia, for generous assistance by loaning books not otherwise
obtainable. His thanks are also due to Dysart McMullen, of Balti-
more, for invaluable aid in the compilation of histories and the
arrangement of material, and to Miss Mary Brinkley, his secretary,
who has assisted in the correction of manuscripts and proof-
reading.



CONTENTS.
SECTION CHAPTER I. page

I. Introduction 5

II. The Association of Medical Superintendents of American In-
stitutions for the Insane, 1844-1893 11

III. The American Medico-Psychological Association, 1893-1913... 53

IV. The American Journal of Insanity 75

CHAPTER II.

I. Early and Colonial Care of the Insane 81

II. The Era of Awakening 93

CHAPTER III.
I. Dorothea Lynde Dix and Her Work loi

CHAPTER IV.

I. Evolution of Institutional Care in the United States 139

II. County Care of the Insane 144

III. Chronic and Incurable Insane 147

IV. The Colony System 156

V. State Care 163

VI. The Wisconsin System of County Care 168

CHAPTER V.

I. Evolution of the Administration of Hospitals I79

II. Present Government of Institutions for the Insane 183

HI. Methods of Investigation of Public Institutions 196

IV. Development of Hospital Architecture 204

CHAPTER VI.

I. The Propositions 217

II. Reforms in Caring for the Insane 223

III. Medical Treatment of the Insane 230

IV. Non-Medical Treatment of the Insane 234

V. Emploj-ment for the Insane 242

VI. Asylum Periodicals 250

VII. Individual Treatment 254

VIII. Experimental Removals 256

IX. Origin of the Psychopathic Hospital in the United States 258

X. State Psychopathic Hospital at the University of Michigan. ... 266

XL Boston Psychopathic Hospital 276

XII. Research Work in Hospitals 281



X CONTENTS

SECTION CHAPTER VIT.

I. Training Schools for Nurses and the First School in McLean

Hospital 289

H. First Training School for Attendants at the Buffalo State Hos-
pital (Asylum), 1883-1886 301

CHAPTER Vni.
I. Private Care of the Insane 313

CHAPTER IX.

I. Growth of the Law of Insanity 321

II. Commitment of the Insane 331

III. Conditions of Discharge 338

IV. Admission of Voluntary Patients 344

V. Care of the Criminal Insane 348

CHAPTER X.

I. Immigration and the Care of the Insane 355

H. The Alien-Born in Relation to the Cost of State Care 362

CHAPTER XI.

I. Insanity among the Negroes 371

II. Insanity among the North American Indians 381

ill. Insanity among Indians in Soutli Dakota 386

IV. The Chinese and Japanese Insane in the United States 393

CHAPTER XII.

I. Institutional Population 399

II. Census of the Insane 411

III. Feeble-Minded in Institutions 421

CHAPTER XIII.

I. Laws for the Commitment of the Insane in Canada 427

II. Care of the Insane in Canada Previous to the Establishment

of Provincial Institutions 446

HI. Establishment of Provincial Institutions 454

IV. System of Care in the Provinces of Canada, and Government

and Inspection of Provincial Institutions 458

V. The Contract System in the Province of Quebec 467

VI. Immigration and the Care of the Insane in Canada 472

VII. Census of the Insane in Canada 478

VIII. The Chinese and Japanese in Institutions in British Columbia

between the Years 1871 and 1913 480

IX. Dorothea L. Dix and Canadian Institutions 481



ILLUSTRATIONS.

PAGE

Eastern Lunatic Asylum, Williamsburg, Va., the Oldest State

Institution Frontispiece

Dr. William McClay Awl 12

Dr. Luther V. Bell 14

Dr. Amariah Brigham 16

Dr. John S. Butler 20

Dr. Nehemiah Cutter 24

Dr. Pliny Earle 28

Dr. John Minson Gait ^2

Dr. Thomas Story Kirkbride 36

Dr. Isaac Ray 38

Dr. Charles Harrison Stedman 42

Dr. Francis T. Stribling 44

Dr. Samuel White 46

Dr. Samuel Bayard Woodward 50

The Eastern Lunatic Asylum, Williamsburg, Ya., about 1774 84

New York Hospital (Lunatic Asylum), 1806-1821 86

Lunatic Asylum — Ground Plan of Building to Left of General Hospital. 87

Friends' Asylum, 1818 88

Bloomingdale Asylum, 1821 90

The Hartford Retreat, 1824 92

Friends' Asylum, Frankford, 1828 94

Maryland Hospital for the Insane, 1832 96

Friends' Asylum, 1835 106

Brattleboro Retreat (Vermont Asylum), 1836 no

Western Virginia Lunatic Asylum, 1838 120

Brattleboro Retreat (Vermont Asylum) , 1844 130

Butler Hospital, Providence, R. I., 1848 140

New York State Lunatic Asylum, about 1850 152

Provincial Lunatic Asylum, Toronto, Ont., 1850, North View 428

Provincial Lunatic Asylum, Toronto, Ont., 1850, South View 432



PART I

GENERAL HISTORY IN THE
UNITED STATES



CHAPTER I
THE ORGANIZED ACTIVITIES OF ALIENISTS







I.

INTRODUCTION.

At the meeting of the American Medico-Psychological Associa-
tion in Baltimore in 1897, Dr. Theophilus O. Powell, superinten-
dent of the Georgia Sanitarium at ]\Iilledgeville, Ga., at that time
president of the Association, presented as a presidential address
a sketch of psychiatr}^ in the Southern states, which was received
with marked attention by all the members present.

In the following year, at the meeting of the Association in St.
Louis, a paper was presented from Dr. J. W. Babcock, of Colum-
bia, S. C, who was absent, entitled " A History of the Insane in
America, Shall the Association Have one Prepared?" Unfor-
tunately no copy of this paper can be found nor any record of the
disposition made of it.

Although no record was made, it is evident that a committee on a
history of the Association was appointed, because in the following
year in New York Dr. Babcock recommended that the committee
appointed the previous year be dropped, and that the whole matter
be referred to the Council with power to act. In the discussion
which followed appropriate reference was made to the philan-
thropic work of those who had labored to develop insane hospitals
in the different sections of the country, and the consensus of
opinion was general that the Council of the Association should
take charge of the preparation and publication of an adequate
account of their work in behalf of the insane during the previous
century and of accompanying biographical sketches of the men
who had been concerned in the movement. It was also agreed that
the Council should employ an historian to compile whatever
material was obtained for such history. These suggestions were
adopted and the Council was empowered to employ an historian
and to do everything required to advance the work.

The project, however, slumbered until the Cincinnati meeting in
1908, when the matter was again considered and a committee of
five was authorized to assume charge of the project and to report
at the next meeting of the Association. The president. Dr. Charles
P. Bancroft, of Concord, N. H., appointed as such committee.



6 INSTITUTIONAL CARE OF THE INSANE

Henry M. Hurd, chairman, Baltimore, Md. ; William F. Drewry,
Petersburg, Va. ; Richard Dewey, Wauwatosa, Wis. ; Charles W.
Pilgrim, Potighkeepsie, X. Y. ; G. Alder Blumer, Providence, R.
I. ; and T. J. W. Burgess, Montreal, Canada, to organize the work.

In 1910 at the meeting of the Association in Washington, the
first report of the committee was read, and a plan of action was
outlined. The Association adopted the plan and appropriated a
continuing annual sum of $300 to be used as a publication fund.

In the summer of 191 1 a systematic effort was made to interest
all members of the Association in the project and to secure from
every section of the United States and Canada adequate co-oper-
ation in the effort to collect historical material.

The older states like Massachusetts, Rhode Island, Connecticut,
New York, Pennsylvania, Virginia and South Carolina were found
to have fairly complete records of the earlier institutions. The
Hartford Retreat had served as a model for nearly all institutions
in New England for patients of the private class. The Worcester
State Hospital in Massachusetts, the Utica State Hospital in New
York, and the Pennsylvania Hospital for the Insane in Philadel-
phia had in like manner influenced to a marked degree the erection
of similar institutions in all sections of the United States. The
Worcester Hospital had many imitators in New England and
Canada ; while the Utica State Hospital and the Pennsylvania
Hospital had been generally copied by new institutions in the
South and West ; the former for its organization and mode of
management, and the latter as furnishing an example of substan-
tial, durable and inexpensive construction.

Several publications were found which gave interesting details
respecting some earlier institutions. Among these were the reports
of the Worcester State Hospital and of the Brattleboro Retreat,
especially the volume known as the " Annals of the Vermont Asy-
lum," prepared by Dr. Joseph Draper on the occasion of the fiftieth
anniversary of the founding of the Retreat. The reports of the
McLean Asylum, the gathered papers of the New Hampshire State
Hospital, at Concord, the history of the Bloomingdale Hospital by
Earle and continued by Lyon, J. B. Chapin's portion of Morton's
History of the Pennsylvania Hospital, Babcock's History of the
Charities of .South Carolina, the Report of the Worcester State
Hospital for 1828, the Centennial Report of the Williamsburg, Va.,



INTRODUCTION 7

Hospital, and Burgess' paper before the Royal Society of Canada,
were also of great value.

The committee found it difficult to get any adequate or satis-
factory account of the condition of the insane in many of the states
prior to the establishment of state institutions. The conclusion is
forced upon the student of history that the insane as a class at that
period were universally neglected, and little or no effort was made
to provide anything beyond shelter for them, and sometimes even
shelter was lacking. It is also saddening to find that the optimism
of the earlier philanthropic movements which culminated in the
Hartford Retreat, the Worcester State Hospital, the Brattleboro
Retreat, the Utica State Hospital and other kindred institutions
was doomed to disappointment. These movements owed their
origin largely to the mistaken idea that insanity was a curable dis-
ease and that all forms of mental disease, if taken at an early stage,
could be quickly cured. Hence the erection of a single institution
in states like New York, New Jersey, Pennsylvania, Ohio, Indiana
and other Western and Southern states, which soon proved to be
wholly inadequate to meet the needs of such rapidly growing com-
monwealths. Consequently the condition of the insane in these
states soon became as bad as before any institution had been built ;
although unquestionably the erection of institutions improved the
standard of public care, and did much to keep before the people
the need of increased care and further provision. Whether pioneer
states with scanty resources, imperfect means of communication
and a general indifference to humanitarian calls could have made
more speedy or more liberal provision for the insane, remains a
question. All good citizens were struggling for a living and no
community had any surplus funds to undertake a work which
involved the erection of buildings and the elaborate administrative
and professional machinery required for adequate care and proper
treatment. For many reasons it has seemed advisable to trace the
history of these early pioneer institutions with care and to give
comparatively full details as to their organization, hopes, successes
and failures.

In each state there arose public-spirited, self-sacrificing, devoted
men, who labored faithfully and zealously with scanty resources
to develop an interest in the proper care of the insane. In many
pioneer states their efforts, however, would have failed had it not



8 INSTITUTIONAL CARE OF THE INSANE

been for the wonderful initiative of Dorothea L. Dix, who year
after year visited the newer states to urge the need of better care
for the dependent and helpless. The committee accordingly feels
that it has been justified in devoting a long chapter to her work,
because when viewed after the lapse of more than fifty years it
seems more faithful and ef^cient than that of any other person
during the nineteenth century.

The committee early in its work found it prerequisite to suc-
cessful work to divide the United States and Canada into districts
and as far as possible to ask the individual members to be responsi-
ble for these districts. Dr. Blumer assumed the responsibility of
New England; Dr. Pilgrim, of New York, New Jersey and Penn-
sylvania ; Dr. Dewey of Wisconsin and Illinois ; Dr. Drewry of
the Southern states ; Dr. Burgess undertook the collection of his-
tories from Canada ; and the chairman that of the other states in
addition to the general editorial work.

The scheme of the enterprise has grown in the hands of the com-
mittee. Besides securing historical data covering the early and
colonial times, it has been thought wise to trace the evolution of
laws of commitment in each of the United States and the provinces
of Canada. This has required a large amount of correspondence
and investigation. In fact had it not been for the publication by
Dr. Salmon, formerly of the Public Health and Marine Hospital
Service, now detached for service in connection with the Society of
Mental Hygiene, of a compilation of the laws of each state in the
Union, it would have been difficult to present a satisfactory abstract
of the laws of commitment. The Canadian laws show less diver-
sity, and the task of collecting them has been less onerous.

It also seemed desirable to treat of different methods of care
in the various states. This has led the committee to include early
care by counties and townships or charitable institutions, prior to
any state care. Chapters on county care of the insane have been
prepared ; also on the care of chronic and acute cases ; on the Wis-
consin and Pennsylvania systems where institutions have been sub-
sidized by the state ; and finally on state care.

Chapters on the administration of hospitals, the immigration
problem and the care of the Indian, colored and foreign insane
have been inserted.



INTRODUCTION 9

Under the heading, Treatment of the Insane, considerable pains
have been taken to give adequate sketches of the estabhshment of
training schools for nurses in connection with hospitals ; the
methods of government of hospitals ; reforms in methods of caring
for the insane; and the development of hospital architecture.

The treatment of the insane by non-medicinal means, such as
amusements, industries, etc., and the influence of experimental re-
movals and individual treatment, have been carefully considered.

The long contest which occurred in the Medico-Psychological



Online LibraryHenry Mills HurdThe institutional care of the insane in the United States and Canada (Volume 1) → online text (page 1 of 44)