C75!v> isai # '•'tfu ?mw Mm. Vffl& ■•flj)*: •>■■ NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service REPORT OP A COMMITTEE OF THE CONNECTICUT MEDICAL SOCIETY, f RESPECTING AN V ASYLUM FOR THE INSANE, WITH THE CONSTITUTION OP THE SOCIETY FOR THEIR RELIEF. ACCEPTED BY THE MEDICAL CONVENTION, OCTOBER 3, 1821, AND BY THEM ORDERED TO BE PUBLISHED. HARTFORD. BOWLES AND FRANCIS, PRINTERS. 1821. Note.—In May last, the attention of the President and Fel- lows of the Medical Society was directed to the hapless condition of the insane, and their families. The subject was referred to a committee, who recommended the establishment of an Asylum for their relief The Convention having approved of this proposition, again referred the subject to a committee,and adjovrned till the 3d of October. The journal of the adjourned Convention, and the report of the Committee, are published for the benefit of those who feel an interest in the accomplishment of an object so desirable. C75/X- Proceedings of the President and Fellows of the Connecticut Me- dical Society, at their adjourned Convention in Hartford on the 3d of October, 1821. Voted, To accept and approve of the report of the Committee, appointed at the annual Convention in May last, on the subject of the establishment of an Asylum for the Insane in this State. Voted, To accept of the Constitution for the organization of a Society for their relief, reported by the same Committee, as altered and amended by this Convention. Voted, That Drs. Thomas Miner, Eli Todd, Samuel B. Wood- ward William Tully, George Sumner, Jonathan Knight, and Eli Ives, be a Committee of Correspondence, to carry into imme- diate effect the plan laid down in the aforesaid Constitution ; and that the following persons be County Committees to co-operate with them, viz. M. F. Cogswell, M. D. ^ Rev. Thomas Robbins, > Hartford. Samuel Tudor, Esq. ) Rt. Rev. Dr. Brownell, } Joseph Foot, M. D. > New-Haven. Hon. Simeon Baldwin, j Hon. Elias Perkins, ~) John O. Miner, M. D. > New-London. Richard Adams, Esq. ) PI on. R. M. Sherman, ~) Dr. Jonathan Knight. > Fairfield. Rev. M. R. Dutton, ) Thomas Hubbard, M. D. ~) Hon. Zephaniah Swift, > Windham. Daniel Putnam, Esq. ) His Ex. Oliver Wolcott, } Joseph Battell, Esq. > Litchfield. William Buel, M. D. ) Hon. S. T. Hosmer, 1 Hon. Joshua Stow, > Middletown. J. R. Watkinson, Esq. ) John S. Peters, M. D. ^ Rev. A. Bassett, D. D. £ Tolland. Benning Mann, Esq. ) The Committee of Correspondence shall cause to be printed such documents as seem suited to promote the object in view. They shall meet monthly ; appoint agents to solicit subscriptions in every part of the State ; and by correspondence with the County Commit- 4 tees, and by their own observation, they are to see that their agents are faithful and upright. They are also to transmit to the County Committees a subscription, to be opened in each town in the State, which subscription shall be returned to the Committee of Corres- pondence, at or before their meeting in May next. They are also to deposit with the County Committees,documents for distribution in the several counties. The members of the several County Committees will receive such communications, as may, from time to time, be addressed to them for distribution. The} are requested frequently to consult with each other, and to communicate to the Corresponding Committee and to the public, whatever information may by them be deemed ex- pedient. There shall bea joint meeting of the Committee of Correspondence, and of the County Committees, at the State-House in New-Haven, on the Tuesday preceding the second Wednesday of May, A. D. 1822, at 60'clock, P. M. for the purpose of adopting such measures as will conduce to the prosperity of the institution for the insane, and for the transaction of any other business which falls within the limits of their instructions. Neither the Committee of Correspondence, nor the County Com- mittees, are to receive any remuneration for their services. Voted, To appropriate two hundred dollars from the funds of the Connecticut Medical Society for the promotion of the objects of the Asylum. Voted, To print 700 copies of the doings of this Convention for distribution. Voted, To adjourn sine die. J. KNIGHT, Secretary. REPORT. The Committtee,to whom was referred the subject of an Asylum for the Insane, respectfully report; that in obedience to their instruc- tions, they have framed a plan for its institution and government; an outline of which will be submitted to the convention. In detail- ing the course which has been pursued, in relation to this subject, we claim your indulgence and need your co operation ; and from the interest manifested in its behalf, we doubt not, but we shall receive them both. Our first object was to ascertain the number and condition of in- sane persons in this state. For this purpose circulars were distribu- ted, soliciting information, respecting their age, their employment, the duration of their malady, and its supposed cause. The answers to these inquiries, have been in many cases imperfect. Nor will they, except in those towns where the subject has been investigated with unusual care, furnish an adequate idea of the prevalence of mental derangement. In some instances it appears that mania has been the only object of inquiry, in others, neither occasional nor partial insanity has been reported, while many have omitted to re- cord cases, which fell under their observation, from an apprehen- sion, that they would not immediately derive any benefit from the contemplated institution. We are therefore unable to determine, with that precision which would have been desirable, respecting the actual number of the insane—and we submit an abstract of the re- turns which have been received, confident that no member of the convention will hesitate to take into consideration, the great propor- tion of cases which have not been noticed—And, however we may vary in our ideas, relative to the extent of insanity—there is but one voice, respect a retreat for its cure. From our brethren, we have assurances that in every part of the state, the object of this meeting has been approved.* From those with whom we have in- dividually conversed, we have received that encouragement, which * Seepage 13. 6 the humane are accustomed to give, and which an institution, so be- nevolent, and so necessary, has a right to demand. An abstract of the returns which we have received, will be presented to your view, from which, it appears, that in 70 towns, there are somewhat more than 500 cases of insanity—Fifty four towns remain to be heard from, and if the disorder should be found equally prevalent in them, the entire number will scarcely fall short of a thousand. How many escaped attention we presume not to say—but we have the strongest reason to believe, that at least one half have been overlooked.— Their situation is wretched in the extreme. The victims of " moody melancholy" constitute a class of beings, enslaved by the phantoms of their own imagination,—phantoms which hover around their dwellings and pursue them in their customary rambles—As they enter a home endeared to them by many a fond recollection, the anxious countenances of a family once lighted by the rays of cheer- fulness and hope, serve but to depress hearts already overloaded with sorrow. In their intercourse with society, their spirits are wounded by a sneer or a jest, which would have fallen upon others, equally innocent and harmless. The force of their disease is augmented from day to day, and at last, suicide or confirmed insanity is the result of accumulated though imaginary sufferings.—With them a retreat from the world is the only refuge from grief, and the medicina mentis with which that retreat should be stored, is indispensable in the treatment of their disorder. But the poor maniac, doomed to confinement in the lonely dun- geon, and often to wear the chains which should be reserved for guilt alone, claims our intercession and our sympathy. In most cases, he retains mind enough to see that he is an outcast from society, or as- sociated with its most infamous members. Thus situated, and re- taining a consciousness Of his own innocence, he feels that he is in- jured and abused. But even the poor maniac does not, in most cases, require to be thus rigorously confined. Sometimes he wanders from place ta^rhreej without food and without decent apparel—sometimes he occupies an apartment in the family mansion, at once the monu- ment, and the source of wretchedness, the victim, and in many cases the cause of insanity. With the utmost care on the part of his attend- ants, such a patient frequently suffers for the want of the ordinary comforts of life, and more especially for the want of that moral treat- ment which is almost incompatable with his situation. And hence it is, that in the milder forms of insanity, those cases become estab- lished, which might have been readily cured by timely recourse to diversion arid employment. The wretchedness of those families upon whom devolve the care and maintenance of the insane, can be estimated only by those, who, from personal observation have become acquainted with its extent. Their peace is interrupted, their cares are mul- tiplied, their time is engrossed, and their fortunes reduced or en- tirely dissipated, in attempting to restore to reason one unfortunate «en*ber. And when all their efforts have proved unavailing, when 7 all their " wordly goods" are wasted, there is added to the preceding catalogue of afflictions, the disappointment of high expectations and the anxiety which admits of no relief. The misery which they suf- fer, is communicated to an extensive circle of friends, and the whole neighbourhood is indirectly disturbed by the malady of one. Less de- plorable would it be, if these sufferings were propagated only through the medium of friendly intercourse. But when the madman loses entirely his self possession, especially if his unruly passions gain the ascendency, he seems to delight in the waste of property and of life, and it may be literally said, that " destruction and misery are in his paths.'' From the returns which will be presented to the convention, we infer that insanity is neither a rare nor a trivial disorder. Having no means of ascertaining the degree of its pievalence in former days, we cannot say whether it is a growing evil or not, but from the little attention which it has hitherto excited among medical men, we are induced to believe that here, as in other countries, as the com- munity has risen on the scale of refinement, it has been more and more exposed to the disease in question. Nor will it be difficult to assign a satisfactory reason for its prevalence in this section of the country. The people of New-England inherit the constitution of their ancestors, and parlake to a greater or less extent of their hered- itary disorders—One of these, and by no means the least consid- erable, is insanity. But other causes here operate with peculiar force. The easy transition from one rank of society to another, and the facility with which wealth is accumulated, serve to cherish even in humble life, those hopes, which in other countries, are re- pressed or entirely subdued. Expectations high raised, are the usu- al precursors of disappointment—and on the paper to which we have referred, it will be found, that numerous cases of insanity have been thus produced. The residence of the insane with their respective families, is per- haps a more productive source of their malady, than the constitution we inherit, or the hopes we have unreasonably cherished. Many diseases become prevalent, under circumstances, which leave no doubt but sympathy is their exciting cause. The numerous cases of epilepsy, which were at once cured by the ingenuity of the great Boerhaave, all arose from sympathy with one unfortu- nate patient. It is so with insanity—and when an individual be- comes insane, unless he is removed from his family and associates, it is probable that some of them will become the subjects of the same disorder. In different sections of the state, we find examples of insanity, apparently produced in this manner, and hence it be- comes endemic in particular villages and at particular seasons. In six towns adjoining each other, on the banks of the Connecticut river, there are, according to the returns which have been made, 172 cases of insanity—In six other towns, also contiguous to each other, but 2 cases have been noticed. Other facts, in illustration of the same 8 proposition, have been communicated to us—but, instead of relating them at this time, we wou'd refer each member of the convention to observations of his own, in confirmation of its truth. In England, the insane are sequestered from public view, and being subjected to the most judicious treatment, they usually regain their reason. The incurable remain in asylums, erected for their reception, secluded from society, and supported at a moderate expense by their families, or in cases of necessity, by their respective parishes. Here, they rove from house to house, alternately the objects of merriment and of dread—or if confined in the family mansion, they awaken those sympathies which frequently lead to confirmed derangement. From the preceding observations, we infer, that while the causes which have been enumerated, continue to operate, mental alienation will continue to prevail.— Vnd in private practice, no disorder is more unmanageable. The patient suffers for the want of that steady course of discipline, which is equally remote from cruelty and indul- gence—for the want of attendants, qualified for their task and faith- ful in its performance, and for the want of that medical skill which is rarely possessed by those, whose attention is chiefly directed to other diseases. And unfortunately, it often happens, that the char- acter and rank of the patient prohibit the use of those salutary measures, which in a public institution might be pursued. Is he the master of a family ? The recollection of his former ascendency, and the idea of his parental rights will cling to him, until he is removed from the dwelling over which he claims controul. Is he a child ? Accustomed to indulgence, he brooks not restraint, but reproaches, for their cruelty, all who oppose his ungoverned passions. A m:id- man, in his own house, has of all situations the worst. The same causes which produced his disorder, in most cases continue to ope- rate with their original force, and oppose every exertion which is made to mitigate its symptoms or arrest its progress. In the United States, three public asylums,designed exclusively for the insane, have been established, and the munificence with which they are endowed is highly creditable to their respective benefac- tors.* There can be no question but that these institutions are un- der good regulations, and that they will attain the high rank they de- serve among the public charities of the country. Situated however in the immediate vicinity of large towns, their expenditures, and of course their charges are very considerable ; and if we mistake not none but the poor of the states in which they are located, or of the societies by whom they were established, are admitted on the most favourable terms. Hence it happens, that the expense of support- ing patients in either of these establishments, prevents the people of * The Institutions to which we allude are in the neighbourhood of Boston, New-York, and Philadelphia. A large number of the in- sane are also accommodated in the Pennsylvania Hospital: and we are informed that the Legislature of Ohio has recently apj o- priated ten thousand dollars to a similar establishment at Cincin- nati. 9 this state from deriving much benefit from them. They are also too remote from us to admit of that easy communication with the resi- dence of the insane, which the friends are usually anxious to main- tain. By these circumstances they are induced to delay for a time their application for relief; and often the only period, which might have been employed in restoring to sanity the wandering and the shattered intellects, is lost between hesitation, and hope and fear. The disease becomes confirmed and the poor maniac is given up as final- ly and irrecoverably lost. We appeal to the physicians of the state, and ask if this has not been the fate of their patients ?—to the connex- ions, and inquire if this has not been the unhappy lot of their friends. Painful indeed would have been the duty assigned us, if after in- vestigating the extent of this evil, we had seen no prospect of its diminution. But when we turn our attention towards an asylum established on humane principles, and presenting to the unfortunate sufferers who enter its portals, all that ingenuity can suggest or be- nevolence bestow for the cure of their disorder, that cheering pros- pect is ours. Such an asylum should be the reverse of every thing which usually enters into our conceptions of a mad house. It should not be a jail, in which for individual and public security the unfortu- nate maniacs are confined. Nor should it be merely a hospital, where they may have the benefit of medical treatment—for without moral management, the most judicious course of medication is rarely successful. Nor should it be merely a school where the mind is sub- jected to discipline, while the body continues to suffer in consequence of original or symptomatic disease. At the present time, it will not be expected that we should do more than barely sketch the outline of a plan, which may hereafter be mo- dified by circumstances, and matured by reflection. If the unani- mous opinion of the committee receives the sanction of the conven- tion, the first step will be to make the public acquainted with the val- ue and the need of the contemplated asylum. And when that is once effected, we doubt not but it will find an advocate and a patron in every friend of the public welfare. In this one object we shall be all united, and it would be strange indeed, if in its behalf its fu- ture guardians should plead in vain. It seems desirable therefore, that the generous and the wealthy in every part of the state, should have an opportunity of expressing in terms never to be mistaken, the interest they feel in its prosperity. Whenever its prospects will justify the measure, lands may be purchased and a building erected, for the accommodation of the insane. The formei should be divi- ded, so as to furnish detached portions for walks, for a garden, and for agricultural pui suits. The latter should be constructed of dura- ble materials, and so situated as to combine the advantages of health with a pleasant and variegated prospect. Its exterior should not exhibit the aspect nor even the faint resemblance of a prison; and at the same time, in its formation the safety of its inmates should not bo overlookrd. The Lunatic Asylum at Wake&eld in England i< 10 »;iid to furnish an excellent model, worthy the attention of all enga- ged in th<- construction oe simihr buildings. JNiuch will depend ur on the judicious choice of medical and do- mestic attendants, and much upon the economical expenditure of the funds. It has been our. aim to guard against abuses in these several departments, and we call upon those to whom they are to be entrus- ted, to act with deliberation and prudence. The friends of the un- happy patients must be assured, that no effort will be wanting to cor- rect the delusions and arouse the dormant energies of the mind dis- eased. They must be assured also that the inmates of this asylum will in all cases be treated with humanity, subjected to no unneces- sary rigour of discipline, and controuled by no force unless their personal safety requires it. The chains and the scourge, which have too often been the implements of correction, must be abolished, and every attendant dismissed from the institution who resorts to vio- lence in the performance of his ordinary duties. In ancient Eg\pt,the insane were conducted to those temples, in which were collected whatever seemed calculated to please the eyfe and rivet the attention. There, as they wandered from one magni- ficent object to another, the world and its vexations were forgotten, and amid the deep interest of the scene, the gloomy images which hauued them wore banished from their minds. In Greece, on the ether hand, the followers of Hippocrates relied exclusively on the specific powers of Hellebore and its adjuvants, medicines which at this day are rarely employed. Among the improvements of modern science, and we wish to impress it deeply on the minds of those who have the direction of the proposed asylum, must be ranked the co-op- eration of these two modes of practice. The history and ceremony of the Retreat, established by the So- ciety of Friends in the neighbourhood of York, may be consulted with equal pleasure and advantage. Jt furnishes a lucid view of the effects of moral management, and teaches how much may be effect- ed, by the perseverance and the charity of a few. For many years that asylum excited little atientior, diid received as little patronage, bur it has now assumed that pre eminent rank, to which from its su- perior regulations it is justly entitled. Its managers appear, how- ever, to have placed too little rtliance upon the efficacy of medicine in the treatment ot insanity, and hence rheir success is not equal to that of other as>Iums in #hich medicines are more freely employed. It remains for us to notice some advantage, which the communi- ty may expect to derive from the institution which we have recom- mended. It will diminish the number of the insane. At present no diseases are more dangerous, and none more obstinate than those whose " seat and thione" is in the mind. The utmost skill is baf- fled in attempting to controul them, and with faint hopes of success do the most intelligent of our professional brethren encounter an en- emy by which they have been so often discomfitted. In some in- stances, it is true that their efforts are successful, but the long cata- logue of those who remain uncured, and are deemed incurable, will 11 carry conviction wherever it is seen, that such instances are com- paratively unfrequent. In the contemplated asylum, many whose cases are now deemed hopeless, would regain their reason. We say this with confidence, for the experience of other institutions and the opinions of those physicians whom we have consulted, all point to the same flattering conclusion. There are also many cases whose restoration to health is yet uncertain. To them, a well governed asy- lum presents every prospect of immediate and permanent relief.— Many a wandering maniac might have been restored to health, if at the commencement of his disorder, he had been placed in such an institution. He is now a burden to his family or to the state, in- creasing to a considerable extent their annual expenditures : he might have been a useful member of society. The injury which he has sustained cannot be repaired—but others, and we are all exposed to the same misfortune, may live to reap the benefit of our present ex- ertions. On this subject however we wish no one to rely on the bare assertions of the committee, and appeal to statements, the truth of which cannot be doubted, to prove the justness of these observ- ations. It was long since stated by Dr. Willis, in his evidence be- fore the Parliament of England, that nine out of ten cases recover- ed if placed under his care within three months of the attack. The records of the great French hospital, over which Pinel so ably pre- sides, present the same flattering result: and in the extensive prac- tice of Dr. Burrows, the proportion of cures has been still greater. By the latter it is announced, that of one hundred recent cases, 91 have been cured :—that 35 of an hundred old cases, such as are generally deemed hopeless, have recovered, and that the aggregate proportion of cases, has been 81 in a hundred. What has. been the experience of physicians in this state, we leave for others to decide : but excepting cases of delirium which occur hi febrile and other disorders, it is feared that a large proportion of the insane never regain their reason. The above statement, while it refutes the popular opinion that insanity is incurable, exhibits in its true light, the importance of directing the energies of a few minus to those diseases, which baffle the ordinary resources of our art, Having already referred to sympathy and grief resulting from the promiscuous residence of the insane with their respective families, as frequent causes of the malady in question, it is perhaps unneces- sary to state, that by their seclusion from society these causes will be removed, and the disease whose frequency has become alarming, will be less frequent and more easily subdued. We conclude there- fore, that by removing some of the exciting causes of insanity, and subjecting it more completely under the controul of medicine, the proposedasylum will materially diminish the number of its unhap- py subjects. It will also diminish the expense oj their maintenance. Knowing how much the peace of a neighbourhood is often distur- bed by a single maniac, that two or three constant attendants are necessary to secure him, and that medical advice can be obtained only at distant intervals, or at a considerable expense, we believe that 12 in cases of mania no one will refuse assent to the above proposition. And in the milder forms of insanity, where restraint is unnecessary, we have usually observed a gradual waste of property, making poor those families who once possessed a respectable fortune, and redu- cing to penury those whose possessions were originally small. We doubt not but others have made the same observation, and will con- clude with us that the present mode of treating the insane is as ru- inous as it is ineffectual. In an asylum they might be supported at a moderate expense, and their friends enabled to pursue their cus- tomary avocations without molestation and without fear. They and the public would be secure from the depredations of these unhappy beings, many of whom annually destroy more property than would be necessary to maintain them.—And the admittance of the insane into an asylum would add very materially to their own comfort. There they would be treated with humanity, and allowed every in- dulgence compatible with their recovery ; and there they would ex- perience the benefit of judicious medical treatment, associated with the experience of benevolent and faithful attendants. There too they would find neither solitude to depress, nor unwelcome society to estrange the diseased mind; and with these advantages, it is rea- sonable to expect, that the subject of melancholy will become cheer- ful, and the wild maniac regain his composure. As Christians, and as men, it is our duty to alleviate the sufferings of others : as physicians, it is also our imperative duty to use every exertion for the improvement of medicine. No one conversant with the records of our profession, can hesitate for a moment to be- lieve that its interests would be greatly promoted by adopting the plan which we have suggested. When, we ask, did Crowther, Has- lam and Coxe become familiar with the diseases of the mind ? Beth- lem hospital was the great school in which they were instructed. To what source do we owe the masterly sketches of Pinel and Rush ? The public charities of Paris and Philadelphia, which fur- nished the subjt cts of their observations, have been perhaps of more utility to the world at large than to their respective patients. They served to accumulate observations, and that information which is lost by diffusion, becomes of immense value when concentrated in the mind of one. Such a mind is not merely illumined, it is lumin- ous, and there is not a member of our profession so remote but he may occasionally be guided by its rays. With this view of the subject we conclude; believing that the convention will take immediate measures for the formation of a so- ciety for the relief of the insane. The principles upon which such a society should be formed are embraced in the annexed Constitu- tion. T. MINER, E. TODD, S. B. WOODWARD, W. TULLY, G. SUMNER. 13 The number of Towns in each county, from which returns have been received, and the cases of insanity which have been noticed, are exhibited in the following table. Counties. No. of Towns. Cases of Insanity. Hartford, 11 149 New-Haven, 7 56 New-London, 7 28 Litchfield, 16 96 Windham, 7 11 Fairfield, 8 51 Middlesex, 5 88 Tolland, 9 31 70 510 During the past summer, the Committee received several commu- nications from each county. The commendations which they bestow upon the course pursued by the Medical Convention, must be gratify- ing to every friend of the contemplated Asylum. Our limits permit not their entire publication ; and the following extracts, taken indiscrim- inately from a large number of letters now on our table, may serve as a specimen of the whole. " Permit me to express my decided approbation of the object of the Medical Society. A hospital for the reception and recovery of the insane, will be approbated by the public; and if judiciously Con- ducted, the means of restoring many of the insane to their friends and society." " I cordially approve of the measures adopted by the Medical So- ciety, and doubt not, should the contemplated plan be executed, it will greatly ameliorate the condition of all, and be the means of cure to many who would otherwise fail of relief." " As to the propriety of establishing a retreat for the reception and recovery of insane persons, it has the approbation of all whom I hear speak on the subject." " There is no question in my mind, but what many of the subjects of mental derangement might have their condition greatly ameliora- ted, and, in many instances, be restored to the regular exercise of their faculties, under proper restraint and mild treatment, which ob- jects cannot usually be accomplished except in a well endowed pub- lic institution." " Religion, reason, humanity and the public safety, call aloud for an establishment, upon mild and humane principles, for the reception and recovery of the insane. 1 am surprised that this important ob- ject should have been so long neglected." constitution of tFje J>octetp FOR THE RELIEF OF THE INSANE. This Society shall be composed of those subscribers, whose ben- efactions amount to either of the subsequent sums. Those who pay twenty dollars shall be members for life, and those who pay twelve dollars shall be members for ten years. Those who pay two dollars shall also be members of the society, and shall be required to pay the same annually, until their names are withdrawn from the sub- scribers' list, on application to the Secretary. Two hundred dollars paid by the Connecticut Medical Society shall constitute the President and Fellows of the same ex efficio members of the Society. The members of the Society shall meet annually for the choice of Pirectors, and for the transaction of any other business not delegated to. its officers.. None but members shall be eligible to any office except those of attending physicians and domestics. Directors. There shall be two classes of directors, one annually appointed, the other hold their office for life. Those subscribers who pay one hundred dollars, or an equivalent annuity, or twenty-five dollars annually, for five years, shall be di- rectors for life. At least ten directors shall be annually chosen by the society, and in all cases as many as shall equal the number by subscription- There shall be an annual meeting of the directors, at which twelve shall constitute a quorum to choose a President, Vice-President, T^asurer, Auditor, Secretary, Prudential Committee, and Visitors. The President shall preside at the meetings of the society and of the directors, shall have a vote at all times, and a casting vote when there js a fc, and shall, when requested by the Superintendant or Prudential Committee, summon an extra meeting of the directors. Vice President. The elected Vice-President shall have the priv- ileges of a director, and perform the duties of the President during the absence of the latter. Those persons who pay two hundred dollars shall bje Vice Presi- dents for life. 15 The Treasurer having given adequate security Tor the faithful dis charge of his duties, shall receive the funds of the society, and pay the same to the order of the Prudential Committee. He shall trans- mit a copy of his accounts every quarter to the Auditor, and pre- sent a financial report every year to the society. The Auditor having examined the Treasurer's accounts, shall re- port accordingly at the annualmeeting of the directors. The Seaetary, upon oath, shall keep an accurate register of the members of the society for each year, and record the transactions of both society and directors. He shall also report at each meeting of the society, the names of those who for the preceding year have become menbers of the society, and also those who have withdrawn their patronage. The Prudential Committee shall consist of twelve individuals, an- nually elerte !, and of the superintendant.—At least one fourth of the twelve shall be physicians. They are to regulate the economical and financial concerns of the institution, and determine upon what terms the patients are to be admitted. They shall also appoint the steward, house-keeper, and domestics ; and may dismiss the same if deemed unworthy of theit tr ist. They shall meet monthly and del- egate their powers to three of their number, of which one shall be a physician ; and these three shall constitute the attending committee. The Attending Committee shall meet at least once a week for the transaction of the ordinary business of the institution, for the ad- mission and discharge of patients, prescribing the terms, and accep- ting such security as they deem satisfactory. The Visitors shall be six in number, and all physicians. Two at least shall visit the institution every month—and.it shall be their du- ty to invite an equal number of females to accompany them. They shall inquire into the medical and moral concerns of the institution, suirgest improvements, and designate abuses, in a monthly report to the Prudential Committee. The Superintendant shall be nominated by a committee of five members, appointed by the Medical Convention, and their nomina- tion shall be transmitted 10 the directors for their approbation. If the person thus nominated, is not approved by the directors, the committee shall nominate another person without delay. If the nomination is approved, the election shall be declared valid, and the person thus elected, may hold his office till removed by a majority of the whole number of directors. The medical and moral treatment of the patients shall be confi- ded to him, and he is to determine the propriety of their admission and discharge. He shall visit the hospital daily to give instruction to the assistant, and advice, when requested, to the attending «m> mittee. He shall also inspect the medical records of the house, and observe that they are correctly made. The Superintendant may nominate an assistant physician, who is to reside in the house, or in its immediate vicinity, and may be 16 eligible to the office of apothecary. His appointment becomes valid if approved by the directors. He shall devote his whole time to the patients of the institution, visiting them daily, recording the his- tory of each case, and reporting to the superintendant the result of observations, made during the absence of the latter. He is also to note the prescriptions, and see that the nurses and attendants are faithful in the discharge of their respective duties. ADMISSION OF PATIENTS. Any subscriber paying two hundred dollars, may at all times name one indigent patient, who is to be received into the Asylum on the most favourable terms. Any town, corporate society, or association of individuals, paying two hundred and fifty dollars, may have the same privilege. Other patients are to be admitted, by their friends applying first to the superintendant, who states whether in his opinion they are fit subjects for admission or not, and then to the attending committee, who shall prescribe the terms and the accommodations to which they shall be entitled. No patient of any description can be admitted, until his friends or guardians have deposited with the treasurer of the society, ade- quate security for the payment of the quarterly expenses, and the removal of the patients when discharged. Any person dissatisfied with the decision of the attending committee, may appeal to the Prudential Committee, at their monthly meetings, for relief. In Convention, ~) Oct. 3d, 1821. 5 Voted—To accept and approve the foregoing Constitution ar reported by the Committee and amended by the Convention. J. KNIGHT, Secretary