as a civilized community, and by the simplest considerations of sound policy, to make due provision for their safe keeping, care, and treatment, that so their grievous and disabling malady may, if possible, be cured, and themselves restored to activity and usefulness; or, if incurable, that they may be kept under such kind restraint as the public safety requires, and enjoy such comforts as humanity demands. If cared for at all, these must be cared for at the public expense. For all these the State should provide asylums or hospitals, that none may be left to the inhuman outrage of being incarcerated with felons in prisons, or to the unutterable wretchedness of languishing or raving their lives away under the ignorant and unfeeling treatment of the almshouse. These hospitals or asylums should be placed under the charge of the most skilful superintendents, to be men not only of the most thorough medical training as specialists, but of the best common sense and administrative ability, of humane instincts, and of large and ripe experience. The hopelessly incurable may better be provided for in an entirely separate establishment under simpler and cheaper arrangements.

For the quasi-criminal class there would seem to be no need of any special establishment. Why should they not be distributed to their appropriate places in the ordinary asylum or hospital? I think there is no sufficient reason to exclude them. Perhaps for patients of this class, who, after treatment for a longer or shorter period, recover their soundness of mind, some special legal provision needs to be made.

For insane convicts, the properly criminal class, the State might provide either an entirely separate establishment or a separate department attached to the ordinary hospital, as economy and convenience should dictate. But no man acknowledged to be really insane should be kept in prison or in any department of a prison, especially after his prescribed term of imprisonment has expired. This was no part of his sentence. The State, having deprived him of his self-control and become his absolute master and guardian, may not leave him in bodily sickness to languish and die without the use of the proper medical remedies, and what is a necessary adjunct-proper care and nursing. Neither may she leave him to rave or mope himself into incurable madness or idiocy for the want of the treatment. which the best medical skill and other alleviating provision

could furnish, and which cannot be had in the cells or purlieus of a prison.

There remains another important branch of the subject, to which the attention must now be turned, namely, the general supervision of all the institutions and hospitals for the insane, and of the processes of committing persons to their charge, and of determining when their detention should cease.

It is not enough to have good laws, and wise and generous provisions. As much depends upon their faithful and judicious administration as upon the laws themselves. The gentlemen of the medical profession deserve the highest credit and the meed of lasting gratitude for their share in the modern reformation of the treatment of the insane, and in the amelioration of their condition by means of well appointed public asylums and hospitals. But they have sometimes shown quite too much sensitiveness at any suggestion of having their own administration submitted to supervision, especially on the part of laymen. But no man and no class of men can safely be entrusted with absolute and irresponsible control of their fellow men for an indefinite length of time; and experience has often shown the sad effect of such want of responsibility upon the character of excellent men in charge both of public and private institutions for the care of the weak and helpless. Besides, there is need of constant watchfulness against the negligence, the recklessness, the self-will, the cruelties, the abuse of their immediate power, their "little brief authority," on the part of the subordinates and attendants in such institutions. And as for supervision, any board or commission for the visitation of such institutions should be constituted chiefly of laymen. On considering the disagreement of a commission of "experts" recently appointed by the Governor of this State to determine the mental condition of a convict, with a view to commute his sentence if insane, an eminent physician said, that in all such cases, the commission should be composed of laymen with the exception of one able physician, who could advise as to the question whether the person to be examined was afflicted with a bodily malady, which might induce insanity. His impression was clear, that intelligent, conscientious business men, who had constant dealings with men, and whose judgment would necessarily be more clear as to the mental balance of a man, should be pre

ferred to physicians, whose profession gave them comparatively but little opportunity of testing actually or by comparison, a person's mental soundness. Professional esprit du corps, too, needs to be guarded against; and laymen, while more surely impartial, are in fact not less competent judges than medical men of most matters to be submitted to official examination and inspection. This is indicated in the English as well as certain American laws.

The insane in hospitals exist in such unmitigated seclusion that the eyes of the community never rest upon them to any appreciable extent. They receive little or no recognition from the public, who may be quick to extend their sympathy and aid to the wronged and suffering of all other classes. This indifference not unfrequently extends itself even to those who are set over these unhappy beings, from the chief to the lowest attendant of the hospital. Rarely or never can injuries be so exposed as to come to the public eye, and are never considered, much less believed, upon the testimony of the suffering patient; who in a large majority of cases is quite capable of clearly and truthfully presenting the facts. It is unnecessary to say, for it has been recently exposed to the public in a most aggravated manner, that brutality even to the extent of causing death may obtain immunity even in a court of justice.

Such things could not be, if the community recognized the condition of these wards of the State and appreciated their infirmity, their needs, and the measure and character of the attention and relief which they require.

Few members of any community ever visit a hospital for the insane. Few strangers in a city make such an institution one of the objects which they desire or expect to investigate.

If in either case, there are exceptions, the show wards alone are open to inspection, or at most a hurried walk is made. through the corridors, where the quiet patients lounge or saunter in unvaried depression or ennui. While the hospitals of all other descriptions, the asylums for the blind, the mute, the feeble-minded, the houses of refuge and even the prisons, are always open to the unrestrained inspection of all respectable people, this asylum for the mentally discased is practically closed against such "intrusion." The necessity does not exist at all, in the degree alleged.

I am not ignorant of the fact that unguarded and indis

criminate visiting at all times and under all circumstances would be injurious to some of the patients, and would derange the administration of the hospitals. Such license would be mischievous anywhere, and more especially where the inmates, in large proportion, require freedom from disquieting influences. On the other hand, however, the social experiences of the inmates of almost all hospitals for the insane, are of a nature to induce insanity, where it does not exist, to intensify it, where it does exist, and to drag down to irremediable madness the unhappy victims of such companionship as they are consigned to, in these institutions. It becomes, therefore, all parties in authority in these institutions, in the State and in the community, to mitigate this fundamental evil, and remove as far as possible this chief hindrance to recovery or amendment, by a relaxation of the system of isolation from all companionship or familiar intercourse, outside the ranks of their fellow-sufferers and their keepers; the one always suggestive of an indefinite imprisonment, the other of unrelieved misery and distress. I speak, of course, of the general condition of a class and not of exceptional cases.

Not only public asylums and hospitals, but also private houses and institutions for the care of the insane need visitation and thorough inspection, both for the protection of their inmates, and for the protection of the community. Care must be taken lest, through the malice of relatives or guardians, and the incompetence or collusion of (so-called) physicians, they become places for the hopeless incarceration or detention of perfectly sane and innocent persons, who, being forced helplessly into such a condition, and surrounded by such associations, may, after no very long time, be actually reduced to a state of real and remediless insanity or idiocy. The degree of M.D., even though the prescribed course of study has been thoroughly mastered-which is far from being always the case-does not of itself qualify a man to decide upon the question of the sanity or insanity of an individual. There is no good reason why as great care should not be taken that no sane person should be incarcerated in an asylum or hospital, whether public or private, as that no innocent person should be subjected to punishment with the guilty.

For a further and very complete exposition of all this part

of the subject-at least in relation to the legislation of one State-reference is here made to the Appendix, containing the Report of a Commission appointed by Governor Hoyt, of Pennsylvania, in 1882, "to consider the question of the care of the insane in this Commonwealth, the mode of their introduction into public and private asylums, the general scope of their treatment, the mode of their supervision and release, which are believed now to be inadequately guarded and provided for; to examine into the present system, and inquire into the legislation of other States and countries, and report the result of their investigations, conclusions, and recommendations, for the further protection and amelioration of the insane."

To this report is appended the draft of a law submitted by the commission. It will be seen by reference to the laws of Pennsylvania on this subject, that, with some changes, this draft was adopted by the Legislature and enacted into a statute. As I cannot regard these changes in the light of amendments, the draft of the commission is here printed at the end of the report, and is commended to the careful consideration of future legislatures in the several States.

I cannot claim the right to name the best examples of lunacy laws in the different States; but as some references may be convenient, I will state that I consider those of Massachusetts, Wisconsin, New York, Iowa and Pennsylvania worthy of commendation. There are, no doubt, others of equal merit.

The compilation of this volume has been a work of much labor and difficulty. Exactness has been necessary throughout all its pages, and great embarassment has been experienced both in obtaining access to the required legislation and in extracting from the mass of laws on the subject in every State, precisely what was actually in force at a given date.

I had the good fortune to obtain the assistance of Albert B. Roney, Esq., a very intelligent lawyer of Philadelphia, and his brother, W. S. Roney, Esq., whose industry and appreciation of accuracy have been of the greatest value in the production of this work. I have also received valuable assistance from Dr. Ourt, Secretary of the Penna. Lunacy Committee.

JANUARY, 1884.

G. L. H.

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