REPOET OF COMMITTEE ON THE INSANE DEPARTMENT OF THE |[lt« IjuiiM. FEBRUARY 27, 1871. ORDERED BY THE BOARD TO BE PRINTED. PHILADELPHIA: .IAS. B. RODGERS CO., BOOK AND JOB PRINTERS, Nos. 52 & 54 North Sixth Street. 1871. JREPOBT OF COMMITTEE ON THE INSANE DEPARTMENT OF THE r r e ;pf|iladelgfcia j[liM jjfltta*. FEBRUARY 27, 1871. OHDMRED BY THE BOARD TO BE PRINTED. PHILADELPHIA: JAS. B, RODGERS CO., BOOK AND JOB ••KBJXfrgRS* Nos, 52 & 54 North Sixth Street, REPORT OF COMMITTEE ON THE INSANE DEPARTMENT. The Committee of the Insane Department, having carefully examined its present condition, are satisfied that many of its deficiencies may and should be remedied, that the institution may thus he brought much nearer the standard presented by the best State hospitals for the insane. For it cannot be denied that now it is far below that standard, and so far below it, that we cannot point to it, as we do to the other charities sur- rounding it, with feelings of satisfaction and pride. The Committee, therefore, would invite the most serious attention of the Board to the changes they would recommend for the purpose of raising it to a point nearer to that demanded by the claims of humanity and science and more 4 worthy an intelligent, benevolent and wealthy community. Much of the existing trouble arises, no doubt, from the crowded state of the house,—eight hun- dred patients being obliged to live and move and have their being in apartments that would be crowded even with half that number. Lodging- rooms, scarcely large enough for one, are made to receive three, and in the large associated dormi- tories, which are provided with proper beds as closely as they can be set against the Avails, every foot of room on the floor is also occupied by beds at night. The noise, confusion, idleness, mutual irritation, and personal collisions, as'well as imme- diate danger to life and limb, incident to this state of things, may be easily conceived, and no stretch of imagination, we are sure, can exaggerate the actual facts. If patients ever recover, it must be in spite of, and not in consequence of, their surroundings, for we can imagine no conjunction of circumstances more calculated to exasperate the disease—to excite the excitable and depress the depressed. That casualties do not oftener happen, that epidemics do not prevail, in season and out of season, is a fact that can be explained by no law of mental or physical action. We can see nothing in it but the watchful care of Providence, and can only express our admiration and thank- fulness. The new wings that are now building will furnish some relief, but even then the present hospital will be crowded farther beyond its proper capacity than is any other similar establishment in the country; and at the usual rate of increase this institution, within two or three years, will be- come as crowded as ever. We take this opportunity to say that, if the pauper insane of this city are ever to be provided for in a manner which they may rightfully claim, as fellow-members with us of a Christian com- munity, it is time to begin the work. In other words, if they are to be removed from their present surroundings and placed in the country, where they can have ample house-room and plenty of air and land, nothing can be gained by delay. Let it be borne in mind that the new buildings have always been regarded as but temporary ex- pedients designed to bridge over the period of preparation for the proper, permanent arrange- ments. But the present deplorable condition of the Insane Department does not entirely result 6 from the want of room. Much of it is attributa- ble to arrangements that have no other excuse than a misplaced economy. Here great improve- ment is practicable, if we will but furnish the necessary means. First and foremost, then, of the evils under which the Department is now laboring, is the kind of attendants or nurses who have the immediate care of the patients. These, you well know, are mostly paupers, inmates of the out-wards, who are required to serve the Almshouse for a few weeks, as a quasi compensation for the care and support they have themselves received. It is well under- stood that much of the success of hospital treat- ment, and much of the comfort of the patients, depends on the attendants. If any service on earth requires some graces of character, moral and intellectual, it is certainly this, for it implies the hourly exercise of patience, forbearance, kind- ness, gentleness, and discretion. It belongs to the attendant to rebuke and re- strain, to cheer and encourage his patients; to watch over and protect them from harm; to wait upon them in their uprising and downlying, and to render them necessary attentions, often under 7 circumstances most calculated to try his temper. He must be cool and calm, while they are excited; considerate and thoughtful, while they are reckless and angry; silent under abuse, and by a soft answTer turning away wrath. He must be intelli- gent enough to perceive such manifestations of disease as he only can, and thus be able to give valuable information to the medical officers. No member of this Board will contend that the at- tendants now furnished by the out-wards wrill answer this description. We all know that they are, for the most part, people of coarse, dull na- tures, whose moral and intellectual training has not tended to make them any better. Hoes any one of us suppose that, when struck, they will not strike back? that, when abused, they will not return railing for railing ? that, when re- quired to lay hands on a patient, they will not do it in the most provoking manner ? that, when re- proved, they will receive reproof respectfully and promise amendment? If any one entertains a doubt on these points, the officers of the Depart- ment will easily remove it. Indeed, wThat possible management can keep such persons up to the pro- per performance of their duty ? They cannot be 8 punished, and no practicable use of rewards is suf- ficient to counteract the impulses of their depraved and undisciplined natures. It must be remem bered, too, that their term of service is so short that they no sooner become tolerably familiar with it than they are discharged. Insanity is one of those dread calamities which may happen to the best of us, or those most near and dear to us ; and in some whirl of fortune, it may be accompanied by extreme poverty. Can wTe contemplate without a shudder the idea of a wife, a mother, a sister or daughter, consigned to the care of people like these ? True, there ai'e a few attendants who are em- ployed expressly for this purpose and are paid at the ordinary rates, and we have no reason to sup- pose that they are otherwise than faithful and re- liable. But their duty is confined to a general oversight of the service, and they can have but lit- tle control over the unruly elements placed at their disposal. In our State hospitals for the in- sane, the proportion of attendants to patients ranges from one in ten to one in twenty. At the latter rate, our number should be forty, but in ad- dition to the twelve we already have, we ask for only twenty-three. This number we propose, if 9 duly authorized, to employ, and thenceforth dis- pense entirely with pauper nurses and helpers. The next crying evil in the condition of the Department, is the almost complete lack of em- ployment for the male patients. From morning to night, week in and week out, these four hun- dred people, many of them active and robust, with nerves and muscles craving exercise, may be seen hovering around the registers, or stretched out on the floor or benches, or moving about uneasily within the narrow limits of their ward. It is an old adage that idleness is the parent of every other vice, and it loses none of its truth when applied to the insane. If there is any one principle of moral treatment now well established, it is that, of the paramount, the indispensable necessity of employ- ment. Any institution that does not recognize this principle, and provide suitable means for ap- plying it, is justly regarded as behind the age. In many of the European hospitals, almost every inmate not disabled by bodily infirmity is engaged in some industrial employment. With an ample amount of land and numerous work- shops, every one finds the occupation most con- genial to his taste and former pursuits. In this 10 country the kind of employment principally re- sorted to is that of labor on the farm and garden, for the reason that the means are easily provided; that it requires comparatively little skill; that it is generally liked by the patients ; that its effect is eminently restorative both to body and mind, and that it is more remunerative than any me- chanical labor. During the last forty years no hospital for the insane has been established in this country with- out an abundance of land. The hospital now building at Danville, designed for three hundred and fifty patients, has two hundred and fifty acres. The General Government hospital, at Washington, with between four hundred and five hundred patients, has four hundred acres. This land is cultivated by the patients under the di- rection of a few attendants, and thus they raise all their vegetables, hay and other feed for their stock, as well as many other things used in the house. They are interested in the work, and are led to think about something besides their own diseased fancies. They are more contented, eat better, sleep better, and thus, in curable cases, the process of restoration is begun. The Committee 11 are aware that it has been the custom for the gardener to take out a few of the patients to work, but the number, as we are informed by Dr. Rich- ardson, has hardly averaged ten a day, and com- prised those only who were perfectly docile and required but little oversight. Besides, far more patients could be employed in the labors of the farm than in the nicer work required in the garden. Many could do good service in hoeing potatoes or trenching the land, who could not be trusted with potting plants or pruning vines. Let the means be provided, and at the very least, fifty men could be sent out every day to work. Of course they must be put in charge of attendants to oversee and direct them. We propose, therefore, that in future, some portion of the land, as much as can possibly be spared, be set apart for this purpose—to be cultivated exclusively by the insane, the ploughing and all other operations requiring carts and horses to be done as usual. Some of the internal arrangements are not calculated to increase the comfort or self-respect of the patients, and, therefore, the Committee would suggest the necessary change. It should be under- stood that the insane are laboring under a disease 12 which makes large drafts on the vital energies, and which, consequently, makes them crave and need a generous diet. Every one who has had charge of the insane will confirm the truth of this statement. They will also tell us that, under a meagre diet, these patients are very liable to diarrhoea, and to the development of any bodily disease to which they may be predisposed ; and that when attacked by such disease, their recovery is more slow and tedious. We have no hesitation in saying that their dietary should be equal to that required by the average sane working-man. That is to say, it should embrace animal food at least once a day, some fresh vegetables, beside bread, and tea or coffee twice. At present, they get animal food but four times a week, and that is always boiled. The Committee would say, in this connection, that the present allowance of meat would be made more palatable and nutritious if it were roasted occasionally, as it may be done with no other ex- pense than that of a rotary baker. Another serious deficiency now experienced in the Insane Department is the very imperfect arrangement for washing and drying the clothes. 13 A single glance at the dilapidated building used for washing must satisfy anyone that it is quite inadequate for the purpose. No doubt, the wash- ing may be done there, after a fashion, but it must be attended with much discomfort to the women, and done far less thoroughly than it should be. No single arrangement is what it should be in order to have the work go on easily and satisfac- torily. It seems to be understood that every diffi- culty can be overcome by force of numbers, but such is not the event. By persons who, like those employed there, are naturally disposed to slight their work, every hindrance is regarded as an ex- cuse for so doing. They have no special induce- ment to remedy these defects, in some measure, by greater care and effort. Besides, we are told that the numbers are not always there, and, conse- quently, the work must be either imperfectly done, or done by extra exertions on the part of those who are there. In justice to those who are re- quired to wash, there should be provided a room of proper size, well warmed and ventilated, and well drained, with fixed tubs supplied with cold and warm water or steam, and some simple machinery 14 for wringing and squeezing. At present there is no means for drying the clothes in wet weather hut that of hanging them up in the day or dining-rooms, to the great annoyance and discom- fort of the patients. Besides, this is a tedious pro- cess, and thus, not unfrequently, it is rendered necessary for some patients to go without a change of underclothing two or three weeks together. Some provision is obviously required for drying by arti- ficial heat, and it can be furnished at no great expense. The Committee take this opportunity to remind the Board that, in the original engagement with Dr. Richardson, he was to receive as part of his compensation the rent of a house. The house thus provided having been destroyed by fire, a year or two since, a few apartments in the Insane Department were allotted to his use. How unsuit- able they are for the requirements of a private family is a matter too obvious to admit of any question. The only question for us is whether we are not bound to comply with the original terms of the engagement at the earliest possible moment. In strict justice, can it be avoided ? 15 The cost of the changes here recommended is estimated as follows: Twelve male attendants at $25 a month will cost $3,600; eleven female attendants at $4 per week will cost $2,288, or $5,888 altogether for increase of wages. From this should be deducted the wages now paid to pauper attendants, amount- ing to some $300 or $400 a year. The extra expense to be incurred by employing the men on the farm might be about $200 for tools. No expense needs to be incurred for out of door attendance, for the regular corps would be able to furnish the requisite. number without ne- glecting any duty in the house. To furnish animal food three more days in the week, reckoning the expense at ten cents per pa- tient per day, would cost $12,480 a year. A revolving roaster for the purpose of roasting the meat occasionally would cost $175. The cost of additional table furniture would not exceed $100. Recapitulating these several items we have the following as the addition to our annual expenses, viz.: 16 Additional attendants, deducting $400 as the wages now paid to pauper attend- ants $ 5,488 00 Improved dietary 12,480 00 The annual outlay $17,968 00 The special outlays would be— For Roaster $175 Table Furniture 100 Tools 200 475 00 Total .$18,443 00 JAMES ARMSTRONG, HENRY HAINES. ISAAC RAY.