OUR HOSPITALS FOR THE INSANE. BY HIRAM COESO InT. REPRINTED FROM THE PHILADELPHIA MEDICAL TIMES, November 1, 1888. OUIl HOSPITALS FOR THE INSANE. Mil. Editor: OINCE my paper of a few weeks ago ''“'in reply to yours, 3-011 have published with apparent satisfaction an article headed “ A Demoralized Hospital,” in which you report that certain patients had had bones fractured, and that twenty-eight acres of potatoes had been destroyed by hogs at the Norristown Hospital for the Insane. This was done to show your readers that an institution of that kind which is managed by trus- tees cannot be as well managed as if it were managed by a physician who has the charge (in addition to the onerous and multiform duties of the farm and providing for the numerous household) of hundreds of insane men and women. To those persons who have ordinary judgment and have been accustomed to business it sounds strangely to hear that he can attend better to several hundred insane people, if he have enough other duties—duties for which he is poorly qualified—to take up his whole time. Rut as I am writing merely to correct the errors in your ’paper, let me say that I obtained from the hospital report, on which your communication was said to be based, the following record : “ The committee have learned that about twenty-eight acres of potatoes 011 1 2 the farm have been destroyed by potato bugs.” To those of ns who know what devas- tation can be produced by potato-bugs in two or three and with what in- accuracy persons sometimes speak, this word, destroyed, must be taken with much allowance. I often hear persons say, “ Oh, my whole crop of potatoes is destroyed by the bugs,” when, in reality, the crop was only much less than he would have had if the bugs could have been held in cheek. This very season I have in several instances seen a very promising patch of potatoes stripped of almost every leaf by the bugs—not the hogs—in two or three days, when the farmer was too busy to attend to them. But what of the fractures ? I fancy that I hear you say, “ we never hear of such things in the other hos- pitals managed by superintendents.” I confess that this is true. But wdiy do we not ? And now I hope your readers will give ear.-to what I say. I shall not speak lightly ; but soberly, truthfully, sorrowfully, that we do not hear of ac- cidents and wrong-doing in those other hospitals. No ! no ! We do not hear of them, because what ;s done is as safe from the public eye and ear— even from the trustees—as are the do- ings in a convent. This is one of the things which should impel every man of our pro- fession to demand that these super- 3 intendents should be deprived of their despotic power and should be only physicians, under the watchful eyes of the trustees. Is it likely that among the 1900 persons in the three hospitals at Danville, Harrisburg and Warren, no bones were ever broken ? That the attendants were such fine fellows, that they never did wrong? Were there never any deaths in these hospitals under circumstances which in private life would have called for the coroner ? Certainly! certainly! Was there ever a coroner’s inquest held in the Harris- burgh hospital during its nearly forty years of existence ? Eight years ago I was informed by the superintendent (in answer to my inquiry) that there had never been a single one. Have there been sudden deaths? Yes. Were the trustees notified and investigations made? No. Do the newspapers of Har- risburgh every week, or after every meeting of the trustees, give to their readers a report of the meeting and all that was brought before it, of accidents or injuries to the patients, of sudden deaths, and the action taken upon them? No. Never a word do they hear of the work of the physicians, nurses and at- tendants. It is safe with the “ one head of the institution.” Safe as if the trans- actions were the work of an inquisition. How is it at Norristown where the trustees have exclusive power, where there is no concealment, where 4 the trustees are informed of every abuse, and every sudden death or any death connected with the least suspic- ion of negligence or wrong doing which in private life would be considered a case proper for a coroner’s inquest ? I will inform you if allowed space in your columns. The trustees of the'Norristown Hos- pital have rules of the strictest kind in relation to every person in the institu- tion. The slightest injury to a patient —a mere scratch on the face, or bruise anywhere — must be reported by the attendant to the supervisor, by the lat- ter to the physician, who must investi- gate it, and if found to be the work of an attendant, the fact must be reported by the physician to the board of trus- tees, and should it prove to have been done improperly by the attendant, he will immediately be discharged. Why do I say if done by the atten- dant? Would it be likely to be done by any one else ? Yes, more injuries occur to patients from other patients or them- selves than from attendants. Some years ago, while walking along the corridor in the hospital at Harrisburg, and just as all but one of the trustees had passed out into another passage, and one of the patients was importun- ing the last trustee for release—leave to go home—a girl who was seated close by jumped up, and with both hands spread out before her dashed upon the 5 otie who was with the trustee, and pushed her with great force flat oh the floor, face downward. Then she resumed her seat, and laughed loudly at the success of her feat. It was done so violently that death might have occurred with a weaker or a diseased person, and hut few persons would have regarded the at- tendant as being innocent; and fewer still who would not have charged negligence and bad management in the hospital. Again, it is not unusual in these days when patients are not kept in cells, but allowed the whole range of corri- dors and bay windows, to have them violently resist attendants, or attack each other. Quite recently a most ex- cellent female attendant was severely bitten by a patient. A few years since, while walking with Dr. Kirkbride and the late Joseph Patterson of Phila- delphia, through the hospital in West Philadelphia, as we passed a room, we saw a patient naked and literally cov- ered with blood, laughing and seeming very happy, while two attendants were preparing to dress him. Dr. Kirkbride inquired about the case, and was told that he had been trying to knock his brains out by jumping head-foremost against the wall. Now, these cases occurred in the presence of a person who was the first and only time in this latter hospital, and rarely in the one at Harrisburg, and I mention them here 6 lo show, that with the greatest care and vigilance on the part of the attendants and physicians, or superintendents, in- juries may be caused to patients by patients who are with them, and who usually may be on pleasant terms; or by a patient on himself, as was the case in Dr. Kirkbride’s hospital. We all know how suddenly comes to the insane the impulse to do violence—a mother to destroy her children, a son to kill his father, etc. To return from this digression to the doings of the trustees in the Eastern Hospital, they not only have these rules strictly enforced, and thus become cog- nizant of even the slightest injury to a patient, but they do not conceal any- thing; their meetings are open; their reports made public, and reported by the Norristown newspapers that very day or the next. There is no secrecy like that existing in the three hospitals where superintendents have it all their own way ; and where even the trustees are neither consulted as to what should be done, nor informed of what has happened. In addition to these rules of the trus- tees to secure the safety of patients, there are six persons, three physicians and three women, a committee appointed by the Lunacy Committee, who have certain privileges and duties. They can inspect the condition of the patients at any time—hear their complaints, listen 7 to their appeals, or to their charges of ill treatment, or neglect by attendants or physicians or any employe, and re- port to the board of trustees. It is a great comfort to many patients to write to friends or relatives at home. Some, too, are not satisfied with their treatment, and write long letters to per- sons to come and redress their wrongs, believing that they are improperly kept in confinement. To all these appeals, superintendents, who are responsible to nobody,too often pay no attention—stuff the letters into their pockets and let the writers wait in vain for answers or relief. In the Norristown Hospital, if the letters go to the physician, and if he thinks they should not be sent to the person named, he has to send them to this committee of six, and if when they have considered them, they think it proper to send them, they can do so —thus relieving the physician of re- sponsibility—or they can visit the writer and examine the case. What greater safeguards could be thrown around these insane people ? In the other hospitals, the super- intendent is the sovereign of the concern—there is no appeal else- where—his word is law ; he can turn a deaf ear to the most piteous appeals ; refuse attention to all wants ; there is no committee of physicians and women to examine the case. But you ask, where are the trus- tees; can’t the patients appeal to 8 them ? Not with effect. I have al- ready said they have no power; they might advise, if they could have proof of wrong doing; but how get proof? Every attendant, every employe, knows he or she holds the situation there by favor of the superintendent, regardless of the trustees, and when asked for information by the trustees (in the presence of the superintendent, for he always attends them in their walks through the building) the attend- ant is mum. I have said they might advise—that alone—power to enforce they have none. This is one of our complaints against the law, which makes the trustees responsible while it gives all the governing power to the super- intendent, who can disregard all their advice. I would not have you believe that the superintendent defies the board of trustees. Oh, no ! he is gentle, ap- parently frank with them, and reports what is comfortable to himself—no more —One said to a friend a few years ago: ‘ I always have something to consult them about to make them believe that they are of importance.” How amazing that we have allowed these hospitals to go on, one of them for 3T years, and the others for a good many years, and sudden deaths occur- ring frequently, and never a single cor- oner’s inquest. But, as there is much more to be said on the workings of these hospitals, I close for the present. Hiram Corson.