WISCONSIN 
County Asylums 
FOR THK 
CHRONIC INSANE. 
A paper read at the National Conference of Charities and Corrections by 
JAMES E. HEG, 
Member of WUeonsin Slab Hoard of Control. 
MADISON, WISCONSIN: 
DEMOCRAT PRINTING COMPANY, STATE PRINTER, 
1896. WISCONSIN 
County Asylums 
FOR THE 
CHRONIC INSANE. 
A paper read at the National Conference of Charities and Corrections by 
JAMES E. HEG, 
Member of Wisconsin State Hoard of Control. 
MADISON, WISCONSIN: 
DEMOCRAT PRINTING COMPANY, STATE PRINTER, 
1896. COUNTY CARE OF THE INSANE UNDER STATE 
SUPERVISION. 
Certain facts have been established beyond a doubt in 
what is known as the " Wisconsin system, or county care 
of the insane under state supervision. They rest upon no 
hypothesis nor course of reasoning. They have gone into 
history and no attempt is made by any fair-minded or well 
informed man to contradict or question them even. It is 
upon these that we must rely, rather than suppositions, or 
theories, or wishes and the like. No clever hypotheses, no 
imposing array of venerable opinions, no plausibly con- 
structed arguments, no abstruse scientific deductions may 
serve as a substitute for actual knowledge. 
Disclaiming any professional knowledge in the care of 
the insane, and therefore unable to present plausible argu- 
ments or dogmatic theories on the subject, it will be all 
the more necessary for me to confine my statements en- 
tirely to facts that I know and about things I have seen. 
I shall speak only of the county care of the insane as un- 
derstood in Wisconsin. Whether its success in Wisconsin 
is due to special laws or other causes not found elsewhere, 
I do not feel qualified to say, but its success has been dem- 
onstrated by fifteen years and the system is now a per- 
manent institution of the state, which few would want to 
change. 
The most humane and generous care of the insane, com- 
patible with that economy rightly due to the tax payers, 
is the problem vexing the philanthropic mind nearly every- 
where to dajr and if the county care as exemplified in the 4 
Wisconsin system is not a complete solution of the ques- 
tion, it comes nearer to it than any plan yet devised and 
proved. 
This system rests upon two principles, Economy and Hu- 
manity, the true basic principles for the care of all our de- 
fective, delinquent and dependent classes. The present 
Wisconsin method of managing the insane was devised 
sixteen years ago by the State Board of Charities, now 
called Board of Control. In 1880, that board found in jails 
and poorhouses scattered throughout the state, 533 insane, 
crowded out of the hospitals, though the large northern 
hospital had been built only six years previously. The state 
hospitals were so overfilled that a new case could be re- 
ceived only by sending away an old one. Reports from 
many states show that the same condition of affairs exists 
to-day in nearly every state in the Union. Insanity in- 
creases much more rapidly than the ability of the people 
to pay for the erection of the expensive and pretentious 
palaces in which from 500 to 2,700 unfortunates can be 
herded and which cost from 81,000 to 82,500 per capita for 
the accommodations provided. Legislatures generally find 
so many needed avenues for the people’s hard earned 
money that they cannot be blamed for not realizing as 
acutely as those who have immediate care of the insane, 
the great increase of people with minds diseased. In every 
state is heard the urgent cry for more hospital capacity, 
but alas, in how few of them is the cry heeded and relief 
given! 
In the report of the Indiana conference of charities for 
1895, the statement is made by Dr. S. E. Smith, in an argu- 
ment for the state care of the insane, that there are about 
700 insane in that state, "worthy of hospital care and 
treatment, yet denied this aid because the state has not 
made its accommodations keep pace with the needs. ” In a 
recent report of the Ohio board of charities the statement 
is made that in November, 1895, there were 1,422 insane in 5 
the county infirmaries or poor-houses of Ohio, the condi- 
tion of whom was reported as truly pitiable. From a late 
report from New Jersey, made by the able secretary of the 
state board, Mrs. Williamson, we notice that 189 insane are 
kept in almshouses and a loud call for a reform in this line 
is made. The report of nearly every state we have been 
able to examine is of similar character or even worse, and 
this shows that state care of the insane does not mean the 
care of all the insane. 
The condition of the 533 insane found in jails and poor- 
houses by the old State Board of Charities in 1880, was de- 
plorable in the extreme. But the saddening record of 
humanity, neglect and brutality was in no wise different 
from that which could be told by any of you who are at 
all familiar with the care of the insane crowded out of the 
hospitals and asylums into jails and poor-houses. Raving 
maniacs were found in cells of jails where they had spent 
months, women were found literally in pens with no beds 
but loose straw, others were in cellars and basement cells, 
or chained to staples in the walls. The record is indeed sick- 
ening, but is it worse than can be seen even now in many 
states where state care of the insane is the policy? 
The original intention of the Board of Charities was to 
provide for the 533 only, or rather to provide for the sur- 
plus insane who couid not be cared for in the state hos- 
pitals. But the idea soon developed into the present sys- 
tem, which fifteen years has demonstrated to be eminently 
satisfactory. To-day Wisconsin has over 4,000 insane and 
not one of them is in a poor house or jail. And what is 
more, every insane person in the state is cared for. Can 
any other state say as much? 
The law under which the Wisconsin county asylums for 
the chronic insane were organized was passed in 1881, and 
was entitled: 
An act to provide for the humane care of the chronic 
insane, not otherwise provided for.” 6 
It, in brief, provided that such counties as provide for 
their own chronic insane, under such rules as the State Board 
of Charities should prescribe, on the properly verified certifi- 
cates of said board to the secretary of state, should receive 
the sum of $1.50 per week for each person so cared for. 
The chronic insane only are provided for in these county 
asylums, while the hospitals are kept for the acute cases 
entirely. About 2,700 chronic insane are now being cared 
for in the 23 county asylums and fully as well cared for as 
in any state institution in the country. To have cared for 
these by the state would have required buildings that would 
have cost two million dollars. To have obtained that im- 
mense sum from the legislature would have been almost 
impossible and, if possible, would have entailed heavy bur- 
dens on the people. 
For each person cared for in our state hospitals the 
county to which he belongs pays one dollar and fifty cents 
and his clothing bill to the state. For each inmate of a 
county asylum, the state pays the county $1 50. It will 
thus be seen that a county caring for its own insane really 
gets $3.25 a week in what it saves and what it receives. 
Three dollars and twenty-five cents a week is about as low 
as most state institutions in the country are able to care 
for their chronic insane. Very few, counting salaries, 
clothing, subsistence, fuel and repairs are as low even as 
this. The average weekly cost of keeping the insane in 
the county asylums, counting everything, is about $1.75, 
which makes an average gain of $1.50 per week for each 
inmate. Out of this gain, the counties that have had asy- 
lums ten or twelve years have paid for their entire perma- 
nent investment in land, buildings, improvements and re- 
pairs. In other words, the people have paid no more than 
they otherwise would have had to pay for the care of these 
insane in state institutions, yet have been able to save 
enough in twelve years to pay for their entire investment 
in handsome buildings, large farms, barns, and the like. 7 
As a matter of economy could any better showing be made 
than this? 
But some one says, “ You must starve your insane to be 
able to make the weekly average as low as 11.75.” By no 
means. I want to say right here that I have visited nearly 
all of these asylums at meal time, and I believe that the in- 
mates are fully as well fed, if indeed not much better fed, 
as in any state asylum for chronics in the country. I have 
with me statements showing the dietary established in 
each county institution, which I shall be glad to have any 
one examine. I have verified the statements made in these 
papers and know that the facts are as represented. 
Nearly all of the 23 asylums have a common dining room 
with seating capacity for all the inmates. With the kitch- 
en adjoining, the food is served warm and in right con- 
dition. The tables of the dining room are covered with 
cloth and in season are graced with flowers. The walls 
have pictures and in general the room is the cheerful and 
pleasant apartment that it is in the ordinary home. Waiter 
girls, neatly attired, attend to the wants of the patients 
and see that every one has all he wants. Few homes have 
a more ample variety, more abundant supply and better 
cooked meals than one finds alwTays in these county asy- 
lums. 
Indeed, the inmates live fully as well as the average 
well-to-do American citizen, farmer or mechanic. 
How is it that this can be done for $1.75 per week or less? 
In the state hospitals, the cost per patient for wages 
and salaries is from $75 to $100 per year, while in the 
county asylums, with no expensive corps of officers, the 
average cost is about $?*\50 per capita. 
In the state hospitals, for subsistence the expense is 
about $65, while in the county asylums, the inmates being 
nearly all employed in some productive work, raising to a 
great extent the food consumed, the expense is but a trifle 
over $27 a year for each inmate. 8 
In some of the county asylums the inmates make all of 
the clothing, shoes, etc., used and in all of them the 
women’s clothing is made. 
The county asylum farms contain from 80 to 500 acres 
of choice land. Such of the inmates as are able and will- 
ing to work — and a large percentage are both — help to 
raise the greater amount of the food consumed and this 
necessarily reduces the cost of the subsistence. And in 
these farms lies the secret of the beneficial results that are 
manifested from the county asylums. Occupation is found 
if possible for every inmate not entirely bed ridden, with 
the result that the demented are roused from their stupor, 
the violent become calm and quiet, the filthy become clean- 
ly and the physical condition of a large proportion is de- 
cidedly improved. 
In nearly all of these asylums are hospital rooms for the 
sick, but there are so few at any one time that are ill that 
I have never yet seen any of these hospitals in use as such. 
A small bedroom off some ward is all that is necessary and 
is better when one is sick because more homelike and 
cheerful than the larger hospital apartment. 
But it is not alone that the system is so economical that 
it is so well liked, but because it is the most humane plan 
yet devised and has accomplished results not dreamed of 
by the originators. In the first place, it permits the ener- 
gies of the larger state hospitals to be devoted entirely to 
the cure of the curable, a consideration that must not be 
ignored. These hospitals are not weighed down with the 
care of a large number of unimprovable cases but are purely 
and wholly hospitals for the new cases of insanity in the 
fullest sense of the word. 
Speaking of the condition in the Indiana state-care insti' 
tutions Dr. Smith said in his paper before referred to, 
“ The overcrowded wards prevent early and prompt admis- 
“ sion of new cases. That delay in the treatment of the 
“ acutely insane, under the most favorable surroundings, 9 
“ is harmful and diminishes the chances of safe recovery, 
" will be denied by no one. Our first duty is to the cur- 
"able insane and nothin# should be omitted looking to a 
" restoration to health and useful citizenship." 
On that principle we are working in Wisconsin. In the 
work that is being done in its state hospitals, Wisconsin 
takes great pride. We invite comparison with that wrought 
in any other state for the scientific and progressive in- 
terest and investigation in the problems of practical psy- 
chiatry and in the results upon the mind diseased. 
The insane are committed first to the hospitals. So 
long as there is any hope that hospital treatment can bene- 
fit either the mind or the body of the patient, he is kept 
at the hospital, but when it is felt that there is no hope 
for his recovery under existing conditions, the patient 
is transferred to the county asylum nearest to his home 
and relatives. The superintendent of the hospital and the 
physician immediately in charge certify to the Board of 
Control that the patient is eligible and suitable for trans- 
fer as being probably incurable. The Board of Control 
then issues orders for his transfer. Notice of the trans- 
fer is sent by the superintendent of the hospital to the 
relatives of the patient, who are free to visit him at the 
asylum at nearly all times. One of the real benefits of the 
system is that it educates the masses in the care of the 
insane, in that it brings this unfortuante class closer to 
the people. All of these asylums have large number of 
visitors, some having as high as 100 a day, at times. All 
of them have been obliged, in self defense, to forbid Sun- 
day visits, but at other times there are few days that do 
not bring some friends and relatives to the inmates. This 
constant influx of visitors prevents the abuse or neglect 
of inmates, even if there was a disposition to that effect. 
We hear much from the state-care advocates about the 
proverbial stinginess of the county boards in making ap- 10 
propriations for these asylums. But as a matter of fact 
there has been no cause for complaint in Wisconsin. 
The State Board of Control is the only medium through 
which a county can get any money from the state treasury, 
and, if this Board does its duty, there will be no trouble 
with the county authorities. 
The State Board of Control is compelled by law to visit 
and inspect these asylums at least once every 90 days. 
Frequent visits are made without notice and at all times of 
the day. If the county authorities fail to properly care 
for the insane in any county asylum, the State Board can, 
and undoubtedly would, immediately transfer the insane in 
that asylum to some other institution, or it would withhold 
the payment of state money to the asylum until every- 
thing was arranged to the satisfaction of the Board. The 
superintendents of these asylums are very proud each of his 
own particular institution and all seem to be deeply in love 
with their work. They consult the State Board often and 
I have never found one who was not glad to receive official 
visits of inspection. 
As a rule, the counties have been liberal with their ap- 
propriations for all purposes and have often given more 
money than is needed. The State Board and the local 
boards have worked in the greatest harmony and sugges- 
tions of the State Board are acted on with cheerfulness and 
alacrity. The local trustees are in nearly every instance 
the most prominent men in the county. They have the re- 
spect of their fellow-citizens to a marked degree and all 
of them take special interest in the work of these asylums. 
They know every inmate and the circumstances of each 
case. Their hearts are in the work and they give valu- 
able and splendid service to the cause of humanity. 
There is considerable strife among the counties as to 
which shall build the next asylum needed and applications 
are before the Board at all times. The Board first grants 11 
permission to some county to build an asylum, limiting the 
capacity of the same, generally to 100 or 125. Then all 
plans for buildings are submitted to the Board for approval 
and changes are made in accordance with the suggestions 
of the Board. Some of the newer asylums are most beauti- 
ful structures, finished in hard woods, with an abundant 
supply of water, lighted by electricity and heated by 
steam. It has often been noticed, however, that the nearer 
to his normal condition the patient gets, the better is the 
result. The majority of the inmates come from very poor 
homes and to keep them in the palaces built for the insane 
in many of the states does not benefit the patients unaccus- 
tomed to such splendor and luxury. 
The more homelike the buildings and rooms are, the less 
formality and restraint, the better the inmates get along, 
and the greater the chances appear for their recovery. 
Quite a number do recover. For the year ending March 1st 
of this year, there were 38 recoveries, while fully 100 were 
absent on leave, visiting their old homes. More than 60 
per cent, of the entire number of inmates were on parole 
and allowed to go about the farm without an attendant. 
Less than one per cent, were under restraint at any time. 
The doors are wide open all day and but few patients are 
kept on the wards. 
Considerable stress is laid by the opponents of this sys- 
tem on the necessity of medical attendance. We go on the 
broad theory that there is nothing further that medical 
treatment can do for the diseased mind. All that can be 
done in the hospitals has been done. The physician is 
needed only for the ordinary and usual complaints of a 
similar number of normal people. A physician is appointed 
for each institution. He visits the same at regular and 
stated intervals, usually once or twice a week. In an 
emergency requiring the immediate services of a physician, 
he can be called by telephone in most asylums, and respond 
to a call in from fifteen minutes for the nearest to an hour 12 
for the farthest. Out of a total of about 2,800, there were 
145 deaths for the year ending March 1st. Is the death 
rate at the state care institutions any less than this. 
So far as I can learn, and so far as my observation goes, 
the amount of medical treatment which the chronic insane 
receive at the state-care asylums is limited to an autopsy 
and such treatment of physical infirmities as is always 
found in any large body of humanity, whether in or out of 
an asylum. 
There can be, indeed, no question that with occupation 
for nearly every patient, with almost perfect liberty, open 
doors, no restraint of any sort, with general dining room, 
home comforts of all kinds and personal individual atten- 
tion absolutely essential to the insane, that there is a de- 
cided improvement in the mental as well as the physical 
condition of at least four-fifths of all those who are sent 
to these asylums. The secret lies in the plain fact that 
the insane are treated as human beings. The life of a 
patient in the county asylum is freer and less artificial than 
in the hospital. He is near to his people if they wish to 
see him. He has larger liberty and more labor. The simple 
life and healthful work of the farm induce vigor of muscle 
and tranquility of mind. The little remnant of intellect 
that each one has left is busied with the petty cares that 
each day brings. And thus in comparative serenity and 
peace, the flying years go by until one day the beautiful 
angel of death sets the clouded spirit free. 
Allow me to add the testimony of one or two well posted 
gentlemen who have visited our county asylums and studied 
the system. 
Hon. J. R. Elder, a member of the State Board of Char- 
ities of Indiana said in a paper to this Conference: “On 
“a visit to Wisconsin, I learned how they care for their 
“insane. That was anew development to me, to see one 
“hundred insane people in one building, men and women 
“taken from the poorhouses and state hospitals, in charge 13 
“of one male and one female superintendent, doing all the 
“ work of the house and a large farm, with no doors locked, 
"no resident physician, coming and going as they pleased, 
“contented and as happy as they could be in their condition, 
“Wisconsin has accomplished what other states must do. 
“ More than half of the present inmates in our state hos- 
"pitals could be cared for in this way-better for the harm- 
"less insane, much better and cheaper for the state. ” 
So great an authority as Hon. F. B. Sanborn of Massa- 
chusetts, who has made a full and thorough study of this 
question, said to this conference in 1892: 
" I make the assertion and I challenge any one to prove 
" the contrary that the state of Wisconsin comes at this 
" moment nearer to the ideal standard of providing for 
“ every person the treatment best adapted to his needs 
“than any state in the Union. I have studied this matter 
“ for years, have watched and examined the Wisconsin sys- 
" tern, and have repeatedly stated (and it has never been 
“ disproved) that the insane of Wisconsin are better pro- 
“ vided for in all the essentials of treatment than the in- 
“ sane of any other state.” 
In order to settle this question, however, I would here 
with urge this Conference to appoint a committee to visit 
as many of our 23 county asylums as may be possible, talk 
with the inmates, examine into the dietary, the work and 
daily life of these institutions, and make a report of their 
investigations to the next Conference. 
The State Board of Control of Wisconsin will do all in 
its power to make such investigation complete and thor- 
ough and will aid this committee in every possible way. 14 
.Statement showing total cost, acres in farms, and cost of same, num- 
ber of inmates and where from, and average cost per capita in 
county asylums of Wisconsin for year ending Sept. 30, 1895. 
County 
Asylum. 
Total cost, 
exclusive 
ot farm. 
Acres 
in 
farm. 
]>st of 
rarm. 
Number 
of in- 
mates 
from 
own 
county. 
Number 
of in- 
mates 
from 
other 
counties. 
Total 
number 
of 
inmates. 
Average 
cost per 
capita 
per week. 
Brown 
$30,073 08 
113 
$5,000 00 
86 
23 
109 
$1 80 
Chippewa (not 
opened until 
1896) 
54,785 15 
240 
7,000 00 
Columbia 
28,489 4:J 
200 
5;200 00 
49 
52 
ioi 
1 32 
Dane 
52,542 90 
485 
24,250 00 
130 
17 
147 
1 18 
Dodge 
43,909 64 
220 
17, OX) 00 
74 
41 
115 
1 85 
Dunn 
80,831 58 
420 
10,500 00 
46 
92 
138 
1 53 
Fond du Lac... 
59,855 96 
58 
5,800 00 
97 
32 
129 
1 96 
Grant 
41,635 49 
423 
21,150 00 
71 
39 
111) 
1 72 
Green 
42,294 50 
320 
12,000 00 
65 
48 
113 
1 73 
Iowa 
49,120 61 
420 
18,600 00 
52 
61 
113 
1 65 
.Jefferson 
71,5a) 28 
182 
12,000 at 
72 
43 
115 
1 79 
La Crosse 
84,788 13 
320 
8,225 a) 
69 
49 
113 
1 39 
Marathon 
89,754 38 
235 
5,000 00 
31 
112 
143 
1 67 
Manitowoc — 
49,948 37 
173 
15,900 00 
61 
60 
121 
1 77 
85,807 11 
40 
20,000 00 
126 
126 
2 48 
Outagamie — 
76,901 08 
335 
18,023 90 
62 
54 
116 
1 47 
Kacine 
62,965 82 
144 
10,343 75 
76 
46 
122 
1 95 
Hock 
143,559 32 
380 
38,000 00 
108 
28 
136 
1 58 
26,994 88 
165 
7, (XX) 00 
45 
43 
83 
1 35 
Sheboygan 
54,882 05 
40 
6,000 a) 
85 
24 
109 
1 90 
Vernon 
60,051 70 
230 
8,200 a) 
47 
73 
120 
1 63 
Walworth 
29,516 15 
240 
9,600 00 
64 
31 
95 
1 12 
Winnebago 
99,964 49 
291 
14,259 00 
11 r2 
56 
158 
1 93 
Totals 
$1,420,172 10 
5.674 
$299,051 65 
1,618 
1,024 
2,642