TREATMENT OF THE INSANE. 
There are several institutions in Scotland and 
England where employment has been made—par- 
ticularly within a few years—a primary object, and 
this has been attended with the most beneficial 
results. It is believed we have some such institu- 
tions in this country, among the foremost of which 
may be mentioned the Northampton lunatic hos- 
pital, in Massachusetts, and the Willard asylum, 
New York. If wholesome exercise of body and mind 
—as a law of nature, as a remedial agency—i- an in- 
dispensable condition upon which depend general 
health and soundness of mind, it should certainly 
be resorted to, under the mo t favorable circum- 
stances and to the fullest extent. By the use of 
such means success, and not failure,'must inevi- 
tably follow. Not only experience and observa- 
tion confirm this position, but such a course of 
treatment harmonizes with the established laws 
of physiology both in a normal and a morbid con- 
dition. Many illustrations could be given where 
health of body and sanity of mind have thus 1 een 
restored after much medication and long hospital 
treatment. 
Mod intimately connected with this subject of 
employment is another that vitally affects the 
interests of the insane, that of 
PERSONAL FREEDOM. 
Ever since Dr. Conolly broke open the prison 
doors and knocked off the chains from the bodies 
of the, insane, the question of freedom, restraint, 
seclusion, etc., has been the occasion of contro- 
versy. Since that period the whole history of the 
treatment of the insane shows that it has been one 
of steady improvement,—more liberty and free- 
dom,—less confinement and restraint. All nui-t 
admit that cases of insanity occasionally occur of 
such violence and danger to human life, that 
restraint of some kind is indispensab’e; 
but, just how far, or to what extent, this 
shall he carried there are differences of opinion. 
But because force or seclusion may occasionally 
he necessary, it does not follow that all in; ane 
persons must he confined by locks, bolts and bar*. 
Great improvement has recently been made in 
this respect in several asylums in Great Britain. 
The buildings have been changed or constructed 
with reference particularly to making these ex- 
periments of greater freedom. The leading fea- 
tures of this reform are thus characterized: First, 
unlocked doors; second, great amount of per- 
sonal freedom; third, the large numbers on pa- 
role; and fourth, the special attention given to 
the occupation of patients. No locks or keys are 
used except to small wards or parts of the hospi- 
tal, where but few patients are confined. The in- 
sane are so taught, trained and treated that they 
are not disposed to make trouble nor escape. 
Their apartments are constructed and arranged as 
though designed for private hoarders or families. 
The asylum or hospital is regarded by the in- 
sane as a home, not a prison or penitentiary. Act- 
ing on the motto, “'The more you trust, the more 
you may,” appeals to the self-respect and the self- 
government, even, of the insane, which is found to 
exert a wonderful influence over them. Under 
such treatment it is surprising how rapidly they 
improve, and how few attempt or want to leave 
the institution. The effects of such man- 
agement are found to he—first, greater 
contentment and general happiness of the 
patients; second, better conduct in everyone— 
less excitement; third, the preservation of the in- 
dividuality of each patient ; fourth, less degenera- 
tion, and fifth, greater vigilance and care on the 
part of attendants. Special pains are taken that 
every insane person shall have something to do,— 
some worn to occupy his time and attention. 
Under such treatment it is seldom found neces- 
sary to resort to restraint or seclusion of any kind, 
though increased care, watchfulness and fidelity 
may become requisite. 
The description here given is no fancy sketch, 
hut a simple statement of facts, the results of ex- 
periments begun, carried on and approved by the 
highest authorities in such matters. And why 
should not such treatment of the insane he suc- 
cessful and be approved? Does it not harmonize 
with the laws which govern both the body and the 
mind ? 
On no one point are we so sensitive as on that of 
personal.freedom or liberty. This idea of having 
our liberty, our freedom forcibly taken from us, 
of being confined by holts and bars, shock* our 
sensibilities. This is j eifectly natural. It accords 
with our best instincts of self-respect and self- 
government. In case of the insane surrendering 
up their personal rights, their liberties, may not 
the change, in many instances, aggravate 
or increase their derangement, and 
serve as a powerful hinderance to 
the restoration of health and sanily? If cer- 
tain muscles, limbs or organs of the body have 
become weak and reduced m vitality, it is exercise 
—free and voluntary—continued and persevered 
in for a long time, that gives strength and vigor. 
The individual must do this for himself, and, if 
need he, he must he encouraged and urged to do 
it. Those means and appliances must be used to 
give strength and cure disease which nature and 
the laws of pathology ha,-e adapted to the pur- 
pose. 
So of the laws of the mind. The love of liberty, 
of freedom, of voluntary exercise, is here the first 
law. Our best Instincts,—the governing faculties 
of the mind,—self-will, self-respect, self-govern- 
ment, all tend in this direction, and their free, 
voluntary exercise should he encouraged. All 
moral, social and civil provisions and agencies 
must have a powerful influence to improve, both 
physically and menially, the chronic insane. And 
jus't as long as they are treated as criminals, as 
prisoners, as dangerous pet sous who must be con- 
fined, placed under guardianship and constantly 
watched, just so long will their physical energies 
suffer and be crippled, and their spirits languish 
and he depressed. 
There are, of course, many individuals among 
the insane who have become so demented, so lost 
to all self-respect and sense of their rights, as to 
be incapable of appreciating such treatment, or 
being influenced by it. At the same time there 
are large numbers among the chronic insane, if 
they could have the same kind treatment and use- 
ful employment,the same confidence and freedom, 
as are accorded to sane neople, what a surprising 
change it would soon make in their conduct and 
character! It would not, only improve their heal i h 
and spirits, make them more contented and haunv. 
hut would doubtless restore some of them to 
sanity, usefulness and self-support. Such a 
boon, we believe, will yet come to many of 
the insane. The discoveries and application* of 
modern science everywhere favor health and hu- 
man improvement, and the best instincts of hu- 
manity, guided by the higher mental faculties, are 
pretty sure to move in an onward and upward di- 
rection. Wherever the rights, the liberties and 
the interests of any class of per.- ons are invaded Gl- 
are suffering, whether inside or outside of an in- 
stitution, such a state ot things cannot always 
continue. Reform some time must and will come. 
Another point, in olving the rights and the per- 
sonal freedom of the insane (if not at times the 
sane) should receive far greater attention than it 
has received. We refer to the 
COMMITTAL OtF Till! INSANE. 
The laws in the various States differ materially 
as to the process of committing insane persons lo 
a lunatic hospital. As the medical testimony 
affords the principal evidence, it is highly im- 
portant that this should be correct and piopcily 
presented. Sometimes the court* take an active 
and leading part, but more generally their course 
is formal and approbative, and not unfrequen ly 
judges decide without seeing the person or know- 
ing anything of the merits of the case except from 
the medical testimony and the representations of 
interested parlies. In some States the certificate 
of one physician only is necessary, but more gen- 
erally 1 he law requires the sworn testimony of two 
“reputable physicians.” Neither ihe courts nor 
the laws make much discrimination in the qi aliti- 
cations or character of the physicians, further 
than that they shall ho “repulable,” or of “re- 
spectable standing in the community.” It is, of 
course, an easy thing to find such physicians every- 
where. The trouble arises, not so much from 
bribery or any self-interest as from ihe fact that 
the certificates are too hastily signed and a mere 
formal opinion sworn to without such careful ex- 
amination and such reasons given as the merits 
of the case demand. No judge decides an im- 
portant case or pronounces a sentence upon an 
Individual without giving his reasons. 
For a physician to declare publicly that a per- 
son is insane, and to make oath to a statement 
which consigns the individual to a lunatic hospi- 
tal, is to assume a vast responsibility. It deprives 
the person at once of his rights and privileges; it 
cuts him off from all business relations and from 
tne legal disposition of his property; it di chaiges 
him virtually from the duties he owes to society 
and to his family; it renders him no longer re- 
sponsible for his acts and subjects his | erson to 
the control of others. But this is not all; there is 
the moral etlect, the stigma, the sense of degrada- 
tion and humiliation of being forcibly removed 
from a position of freedom and independence, to 
one of confinement and unpleasant a sociaiion*— 
this sudden change has not unfrequently such a 
crushing effect upon the individual that he some- 
times never recovers fully from the shock. 
In the preparation and completion of a docu- 
ment that makes such changes in the rights, situ- 
ation and prospects of a person, the greatest pains 
possible should he taken, and no examination can 
he too careful or thorough lest some wrong or in- 
jury he done. The law stipulates that the vagrant 
and the criminal cannot he punished without a 
trial by a judge or jury ; he is commonly provided 
with counsel; the evidence and the facts must he 
clearly set forth, and spread out before the public. 
Should the law provide greater safeguards and 
stronger defences for the vicious and the criminr 1 
than for the innocent and unprotected insane? It 
is true in most, if not in all the States, the law 
does provide for trial and appeal to the courts in 
behalf of the insane, but how seldom is this pro- 
tection resorted to by them or their friends! In 
most cases this part of the law is a mere form,— 
in fact a dead letter to the insane. 
In the medical certificate declaring a person in- 
sane, the law should require that the reasons be 
stated. In some States the statutes direct the 
wording of the certificate,—that the person is 
“dangerous to the community,” or is “furiously 
mad”; but in many of the States it allows the cer- 
tificate to say that the person is a “fit subject” tor 
a lunatic hospital, and this opinion must be formed 
from personal examination and inquiry. It will 
be seen at once bow easy it is to sign such a certifi- 
cate upon very slight examination. 
Suppose, now, the law required that the reasons, 
the facts, the evidence, should be clearly and dis- 
tinctly stated upon which this opinion is ba-ed, 
and ic were understood that the document was to 
be subjected to rigid criticism,—and, if found in- 
correct or imperfect, to be returned for revision,— 
would not such a procedure compel a more 
thorough examination? Would it not lead to a 
better i nowledge of the symptoms of insanity as 
well as a higher appreciation of the nature and the 
results of this legal process? Once in the practice 
of medicine mere opinions, without explanations 
or reasons, might have answered, but something 
more is demanded at the present day, especially 
where the rights, the interests and the character 
of the patient are so deeply involved. The grounds 
or reasons for the “opinion” should afio be stated, 
not only for the infos mation and protection of the 
patient, but for the satisfaction of the friends and 
the public. Besides, such a statement may be 
turned to most valuable account by the physician 
in the hospital who is afterwards to treat this same 
patient. 
Two other important advantages would al*o he 
secured by such a course. It would tend to a bet- 
ter understanding of ihe symptoms and causes of 
insanity on the part of all physicians called upon 
to fill out such certificates. “Another advantage 
which is of no small account: Some persons now 
consigned to a lunatic hospital would never be 
sent there under such a law. In Great Britain, 
where far more attention has been given to the 
treatment of the insane than in this country, es- 
pecially in all legal proceedings, the medical cer- 
tificate, signed by two physicians, requires that 
the reasons be definitely stated, not what the wit- 
ness thinks, believes or hears, but the tpicifie facts 
which he, as a medical man, has obseived before 
or at the time of signing the certificate. The law 
goes further,—it has a second provision,—Hie phy- 
sician must state in the certificate what facts or 
evidence indicating insanity in the parient he has 
derived from others, givingnames and describing 
definitely the nature and character ot those fart v 
Every blank certificate lias a wide, open space 
for each of the heads or provisions to be filled 
out. Andif by design or negligence these fact* are 
not properly stated, the phy ician becomes Fable 
for damages to the insane person thus committed. 
After long experience and much leg! lation in 
Great Britain, there careful and wise piovis'ous 
in the medical certificate for the committal of the 
insane have been found not only expedient, but to 
woik well for all parties concerned. Mow why 
should not some similar course be pursued in tne 
United States? >ew York is the only Slate where 
any such legislation has taken place. Theie, the 
law requires that not mere opinion be stated in 
the certificate, but the reasons—the grounds upon 
which an opinion is based—must be cleaily and 
definitely set forth. This law has been in opera- 
tion only two years, encountered at first some op- 
position, but the longer it is tried and the better 
it is understood the more favorably it is received 
by all parties. The State of New York is indebted 
for this law to a “commission of lunacy.” which 
leads ns, in concluding this paper, to offer a few 
remarks on that subject under the be d of 
MANAGEMENT OF LUNATIC HO'PIT ' L*. 
Most of the asylums and hospital* for 1m in ane 
are managed by a superintendent and l< ard of 
trustees, who have the sole charge. In some 
States there, may he a committee of inspection or 
board of State charities, who e duties a e chiefly, 
if rot wholly, that of visitation and counsel. 
WhTethe executive in each State, or some private 
corporation, has the appointment of their rruc<eer, 
and the legislature the enactment of Jaws for their 
government, seldom, it ever, does either the exec- 
utive or the legislature interfere directly wilh the 
management of these institutions. Thnsthe whole 
responsibility and power of government are placed 
in the hands of the superintendent and trustees, 
who are virtually one body. Now, no thoughtful 
person can often visit these hospitals and make 
much observation without seeing the importance 
of having more careful and discriminating sttrer- 
vision over them, and a, more thorough investiga- 
tion into the whole subject of insanity than exists 
at present. There are three great interests or 
parties that require such supervision : 
First,—The institutions themselves. Evils and 
abuses will spring up in these establishments: and 
the most effectual way to correct or pi evert them 
is by suitable authorities outside, charged in part 
with such duties. Correction and reform will sel- 
dom come from local officers. Besides, until some 
such provision is made, prejudices and distrust 
will exist, more or less, in reference to rirese insti- 
tutions, causing injury not only to the office s 
and their management, but indirectly far greater 
injury to the public. 
Again,—There is always room for improvement 
in every such institution, and this is less likely to 
come from persons constantly occupying the same 
points of view, and following the same routine of 
duties, day after day, than from others looking 
from different and distant points of view, who can 
compare the merits of one institution with another, 
and make careful observations over a large field. 
Hence the necessity in such management of moi e 
diversified experience, more general knowledge 
and larger observation than local officers munilv 
have whose labors and interests are almost wholly 
identified with one establishment. 
The second party interested is the insane, iheir 
friends and Ibe public at large. These justly de- 
mand that they should in some way be represent- 
ed in such Inspection and manageirr nt. 
The law takes away the rights of the in ane in 
respect to their liberty and property; it unsettles 
them in all business relations and in the duties 
they owe to their families: it cuts them off in a 
great measure from communication with their 
friends, and exposes them to personal aim e from 
attendants. Where such personal and funda- 
mental rights are either taken away or abridged, 
should not legislation make some better provision 
for protection, defence and appeal in In half of the 
insane than now exists? Not only the insane and 
their friends are concerned in this question, but 
every member of society, every man and woman 
should feel an interest in it. For who is not liable 
to be insane «r have a friend thus afflicted? No 
intelligent or though If ul community will alwavs 
rest easy under such a state of things, 01 he satis- 
fied with presei t legislation on this subject. There 
must be some change or improvement iieie in leg- 
islation. Reform is only the woik of time. 
Hie third party interested is humanity it1 elf, 
aspiring to a higher state of civilization.' Every 
generation owes something to its successor. We 
have here a great evil—insanity constantly in- 
creasing—occasioning immense expense and an 
u itqld amount of suffering. This evil is the i esnlt 
of violated ljuv, physical and mental,—it is abno - 
mal, no part of a healthy civilization. To check 
the evil its causes must lie better understood,— 
the public niust be instructed and enlightened on 
the subject. It is the duty of the State to do 
something in this direction. It is not wi-e to 
build great institutions and make large appropiii- 
tions for carrying them on, without trying to do 
something to remove the causes which necessitate 
such measures when, it is evident, the evils in- 
volved are to some extent under human control. 
There should he in every State a permanent com- 
mission, consisting of one or more perso s, who- e 
duty it should no to investigate this whole subject 
of insanity in all its bearings, relations and can e~, 
and make from time to time reports to the pub- 
lic. But no such im estigations and reports will 
ever he made without some express legislation in 
relation to it. If a hundredth or a thousandth 
part of the means now expended upon this unfor- 
tunate class should he expended for the objects 
here set forth, it would he difficult to estimate 
either on the score of humanity or tnat of econo- 
my the amount of good that would in time be 
thus accomplished. 
For several years there has been held connected 
with the annual meetings of the American Social 
Science Association a conference of the hoards of 
State charities. Many of the subjects that come 
under the scope of both fctebodies occupy common 
ground, and may with great propriety be presented 
and discussed at the same time. The Mas acini- 
setts hoard of charities was the first organization 
of this kind, since which time (1862) eight or ten 
similar State boards nave been organized. In dis- 
charging the duties of public charily required 1 y 
the law, the members of these hoards find many 
topics for consideration in each of the States very 
similar, and which are surrounded with the same 
difficulties in the way of improvement and reform. 
One of the most important of these subjects is 
that of insanity. At the conference of the repre- 
sentatives of these hoards last year at Detroit, Dr. 
Nathan Allen, delegate from the Massachusetts 
hoard, was appointed chairman of a committee on 
insanity. At the meeting this year of the confer- 
ence of these boards at Saratoga, September 6, 
Dr. Allen made a report on the “Treatment of the 
Insane,” presenting particularly those topics con- 
nected with insanity and lunatic hospitals which 
are found practically to concern these boards 
most in the discharge of official duties. The 
lirst topic discussed in this report was that of the 
BY DE. NATHAN ALLEN. 
Though the increase is largely made up from Jhe 
chronic insane, still there is an increase of in- 
sanity over that of population in a greater ratio, 
but to just what extent it is difficult to decide. 
The questions wheie and how lo support the in- 
sane, whether in aim houses, asylums or hospitals, 
were discussed at much length." It is found that 
large numbers, about one-half of the insane, are 
not, or cannot tie, cured, and this residuum, the 
harmless and incurable, must be permanently pro- 
vided for somewhere. What shall be done with 
them is a question not ea yto determine. This re- 
port discussed at much length the question of 
classification of the insane,—ihe criminal and the 
epileptic, the inebriate and the chronic,—that in- 
stitutions adapted to these several classes should 
be provided, etc.: that tbe interests of each class 
in this way would be best promoted. The com- 
parative merits, in cures and results, between 
small and large institutions were particularly no- 
ticed, and preference given to the former. The 
following topics, of a more general and practical 
nature, we here present as follows 
INCREASE OF INSANITY. 
As the law's of physiology have become of late 
years better understood, together with the causes 
of disease, physical exercise has assumed as a 
r&mediahayeney more and more linporiancc. Es- 
pecially is this the case in all kinds of chionic dis- 
ease. Insanity is a disease of the brain and ner- 
vous system, and in its acute stages requires, 
like other diseases, medication and the appliances 
of a hospital; but when it has passed into a chionic 
state there should be added to, or combined with 
this treatment, a strict observance of the princi- 
ples of hygiene and sanitary laws. The symptoms 
of insanity in its acute stages are generally dis- 
tinctly marked, so that medical treatment can be 
brought to bear directly upon it; but when it lias 
settled into a chronic state the indications of dis- 
ease become more obscure and comp deaf ed, so 
that the exact pathological condition of the sys- 
tem cannot he so easily understood. Here comes 
in the law of exercies. 
Amusements and recreations of various kinds 
are provided for diverting the mind. These are 
good in their place; w'e w'ould have more of them 
rather than less. Airing courts are good in their 
way; so is the exercise of walking and riding. All 
these have a most beneficial influence upon both the 
body and tbe mind. But v ork,— active employment 
of some kind,—is more important than all other 
things to the chronic insane. It develops muscle 
and gives strength; improves the appetite and di- 
gestion; increases all the vital foices of the sys- 
tem ; occupies and diverts the mind ; has a strong 
tendency to give selt-control and bring into exer- 
cise all the mental faculties in haunony with the 
laws of the body. It has also a decided tendency 
to prevent not only slight attacks of mental der- 
rangement, but also involuntary outbreaks of in- 
sanity. It would often obviate the necessny of 
resoring to physical restraint and seclusiop. 
This employment should be suited to the need 
and tastes of the Insane. Farm work and garden- 
ing afford the greatest variety and most whole- 
some kinds of occupation. They call into exerci e 
all parts of the bedy—surround one with pure air 
and plenty of sunlight, and, at the tame time, oc- 
cupy pleasantly the higher and better faculties of 
the mind. Among a large body of men, many may 
prefer trades or some kinds of mechanical busi- 
ness,—perhaps have had experience in these or 
can readily learn some one cf them. While a 
plenty of good land connected with a large insti- 
tution may furnish a great variety of work, other 
kinds of occupation and business can easily be 
introduced if desired. 
In the treatment of the insane formerly very 
little account was made of work or exercise, anil 
even at the present day it is consideted by manv 
persons of small consequence. Once it was 
thought that diseases could he cured by medicine 
alone, hut the better we understand the laws of 
the human system and the causes of disease the 
less dependence is placed upon medication, but 
the greater the necessity is found for a strict ob- 
servance, of the laws of nature. Most emphati- 
cally is this true in diseases of leng standing in- 
volving the nervous system and mental soundness. 
Accordingly, we find in all asylums for the Insane 
that where wholesome exercise of body and mind 
has been most systematically and extensively in- 
troduced, in those institutions there has been 
found the most successful treatment _of the in- 
sane—the best health, the least mortality and the 
most recoveries. Of course the measure of suc- 
cess varies, and is exhibited in a variety of w ays. 
employment of the insane.