CURRENT 
Medical Opinion 
ON THE ATTITUDE OF THE 
New York State Commission in Lunacy. 
DANGERS TO STATE HOSPITALS FOR THE INSANE. 
The care of the insane in public institutions always vitally inter- 
ests the people. They are willing to see the criminal punished and 
the tramp committed to the workhouse, but they resent the ill-treat- 
ment of the insane. For the latter class there is universal sympathy. 
No building is too costly for his residence, if it conduces to his well- 
being; no luxury is denied him, if it is essential to his happiness ; 
no expense is spared for physicians or attendants, if thev can con- 
tribute to his recovery. The people of the State of New York have 
especially been distinguished for their generous treatment of the in- 
sane. They have provided the most costly hospitals for their resi- 
dence in this or any other country; they have equipped these hos- 
pitals with every condition necessary for the physical comfort of the 
inmates; they have supplied them with every appliance which 
science could suggest for the proper treatment of insanity. 
The last and most significant act of the people, was the removal of 
the pauper insane from the poor-houses to the State Hospitals, in 
order that this wretched class of' dependents might have the benefit 
of the better food, clothing, housing, and nursing of these institu- 
tions. The provisions of the Act show that the purpose of the Leg- 
islature was to provide an inexpensive but thoroughly commodious 
class of buildings for these poor house inmates, in such relations to 
the State Hospitals as to come under their general management, and 
yet not to interfere with their special methods of administration. 
The fundamental idea of the projectors of the State Care Act was as 
follows, viz: 1. Maintain the present State Hospitals for the acute 
insane, and perfect their ai rangements, equipments, and manage- 
ment by every means necessary to the cure of those committed to 
them, in order that they might be made, in tire highest and best 
sense, curative institutions. 2. On suitable farm lands, removed 
from the hospital, but not to remote too prevent direct and easy 
general supervision by the management of the hospital, erect a va- 
riety of comparatively cheap buildings, and thus create a colony, to 
which would be transferred the incurable inmates who now over- 
crowd the hospital wards, and the pauper insane of the poor houses. 
It was believed, and we think justly, that if this policy was carried 2 
out, the existing State Hospitals, relieved of the incurable insane 
who fill their wards and greatly interfere with classification and 
discipline, would so improve their methods of treament, that a far 
larger percentage of recoveries would be secured than was hitherto 
reported or even deemed possible. At the same time there would 
gradually be organized a- colony of chronic or incurable insane, 
under the management of each hospital, which would become 
largely self-supporting, and would, by means of industries, schools, 
discipline, and amusements, utilize, in a healthy manner, every re- 
maining faculty of each individual inmate. A system of lunacy 
administration based on these views, and intelligently carried out by 
the hospital authorities, aided by intelligent State supervision and 
advice, would have been worthy of the Empire State. 
The question is beginning to be widely agitated among these inter- 
ested in our public charities: What has been the effect of the execu- 
tion of the State Care Act upon the State Hospitals, and upon the 
pauper insane who have been removed from the County Asylums? 
It is evident that there is a growing public sentiment adverse to the 
methods of administration of the State Care Act by the Lunacy Com- 
mission. It is alleged that not only have the pauper insane not been 
greatly benefited by the change from the County Asylums, but the 
whole procedure is tending to convert the State Hospitals into im- 
mense pauper establishments. The public prints report interviews 
with the Commissioners, detailing the economy with which they 
are now running the institutions: one has succeeded in diminishing 
the wages of employees, another has found a method of purchasing 
the food supplies at cheaper rates, and a third has stricken from the 
supply-list that solace of a disturbed mind-tobacco! 
These reports from the Commission are very familiar reading, for 
the same statements w'ere formerly annually rehearsed at the meet- 
ing of the Superintendents of the Poor, who detailed, with great mi- 
nuteness, their methods of keeping the insane poor at low rates. 
No reports come from the Commission announcing new and success- 
ful methods of curing the insane, which they have introduced into 
the hospitals, nor that they have rendered these hospitals far more 
efficient in the cure of the acute insane by reforms in the manage- 
ment, better equipment, diminishing crowding, or a higher grade of 
attendants. 
We believe the State Care Act wras a wise and beneficient meas- 
ure, and, if administered by a judicious and experienced fyody, it 
would have accomplished a most important reform, both in the care 
of the poor-house insane, and in the higher development of the re- 
sources of the State Hospitals for restoring the acute insane to health 
But we are forced to the conclusion that the pauper insane trans 
ferred from the County Asylums will not be greatly benefited by 
the change, and that the State Hospitals, once the pride of the State, 
are rapidly deteriorating as curative institutions. We give this note 
of warning while it is yet possible to arrest the progress of an ad- 
ministration of the State Care Act, which will involve our hitherto 
greatest and most useful public charities in irretrievable ruin.-New 
York Medical liecord, Dec. 9 th, 1893. 3 
THE ADMINISTRATION OF HOSPITALS FOR THE INSANE IN 
NEW YORK. 
The laws of New York and Massachusetts have placed those States 
in the foremost rank of intelligent and liberal care for the insane. 
The enactments regulating the commitment to asylums, and the care 
while there, of the insane, and especially the State Care Act of 
New York, have been, in the main, wise and beneficent. They are 
chiefly due to the persistent efforts of the State Board of Charities, 
and especially of Mr. Letchworth, chairman of the Board, and Mrs. 
Lowell, and to the excellent administration and advice of Dr. Stephen 
Smith, the former Lunacy Commissioner. 
The essential points of superiority in the New York system are 
(i) the control of the hospitals by an unpaid board of managers 
free from personal and political motives ; (2) the appointment of 
medical officers by merit and not through political favor; (3) the 
maintenance of State Hospitals of a high grade of excellence for the 
curable insane and for those needing hospital care; (4) the removal 
of the chronic and pauper insane from poor-houses, jails and county 
asylums, to inexpensive buildings under the supervision of the offi- 
cers of the hospitals, with the establishment of farms or colonies for 
such of the insane as do not need much medical care, where they 
can be treated as nearly like sane and industrious people as possible. 
The weak point in the New York Law is that a plan for central- 
izing in a State Commission power as to details of management of 
the hospitals, which was overwhelmingly defeated in the Massachu- 
setts Legislature, has become part of the New York statute, and 
that the Lunacy Commission, which ought to be a purely supervising 
and advisory board, has executive functions which are not only 
needlessly vexatious to the hospital managers and medical officers 
and prejudicial to the interests of their patients, but also may be 
destructive of good morals. Moreover, the law is in danger of 
making a corrupt political machine out of what ought to be a phil- 
anthropic and unselfish body. 
There are indications that what was feared has happened, and 
that the Lunacy Commission, which it is possible to construct into 
partof agreat party machine, has made the enforcement of a bad 
law even worse than the law itself. The managers and medical offi- 
cers of the hospitals for the insane have taken courage from the 
political upheaval in favor of good government in their State, and 
are attempting a reform, in which we wish them every success.- 
Boston .Medical and Surgical Journal, Dec. 14, 1893. 
THE OPPRESSIVELY AUTOCRATIC DOINGS OF THE 
LUNACY COMMISSION. 
To The Editor of lhe Medical Record : 
Sir : About two weeks ago there appeared in the New York 
Tribune an article on the Care of the Insane. That article was laud- 4 
atory of the State Commission in Lunacy, but was interspersed with 
what seemed to be authoritative statements made by certain members 
of that board; and while the main: burden of the article related to 
questions of an economic nature, it was manifest that the plans and 
methods of the Commission contemplated an interference with the 
medical and even minor details of the management of the State 
Hospitals; hence, it assumes a professional interest. 
While the writer is not in a situation to know the details of the 
plan adopted by the State Commissioners in their control of the 
Asylums, he has observed the current of events in our State Institu- 
tions long enough not to accept at once a plea for a reduction of ex- 
penditures as paramount to other interests, or even as the real 
motive in all instances in which it is made. From the days of 
JEsop to the present time, to call attention to a probable error in an- 
other has occasionally been the means of withdrawing public 
attention from our own objects. The commissioners, as public 
officers, must not feel aggrieved if their own acts be watched and 
criticised as they profess to be watching and criticising those charged 
with the local management of the State Asylums. 
It would seem that the object of the article referred to, and of 
certain paragraphs in the public press since seen by me, was to con- 
vey the idea that the commissioners were instituting certain reforms, 
and correcting certain abuses in these State institutions, not only in 
relation to fiscal affairs, but in what may be regarded as the moral 
and medical management of the unfortunate inmates. It 
may then be properly asked : " What reform or movement in ad- 
vance has the Commission actually instituted?" That supplies 
should be economically purchased and carefully used is only a busi- 
ness proposition, but that the estimates for the expenditures for the 
asylums, for a certain month, have been "cut down " even to the 
extent of $55,000, is not necessarily a meritorious act, for injury 
may have resulted from the " economy," or even increased further 
expenditure. In these matters the officers of the several institutions 
are entitled to be heard as to the necessity for the articles named in 
their estimates, and no praise is due the commissioners until that 
evidence is submitted, as well as a detailed statement as to the items 
on which the saving was effected. 
As a matter of fact, has this Commission instituted a single genu- 
ine reform in the care of the insane ? 
Those of us who have watched and studied the development of 
the asylums for the insane from prisons to hospitals, know how 
earnestly the matter had been considered and treated from apparently 
every possible standpoint, and we also know that the actual im- 
provement in the care of the insane has come through asylum officers. 
Asylum reform began in the asylums, was conducted by the 
medical officers, and has not resulted from outside influences. 
Criticism of an individual superintendent, or asylum, by outside 
parties has constituted only eddies in the current of improvement 
which has been moving steadily on during the last fifty years. 
These criticisms served only to mark the progress, not to cause it. 
Conollyism was an ideal, the details of which required time and 5 
patient work before a general and useful application of its principles 
and this work was given by the medical officers of asylums. It is 
eminently true that asylum methods have been reformed from with- 
in rather than from without. 
The medical supervision of each State Hospital, containing on an 
average over one thousand patients, requires qualifications of a 
special and high order. If any of the State hospitals has a superin- 
tendent unfitted for his duties, the specific statement should be made 
and measures should be instituted to secure a change. This would 
certainly seem preferable to placing all the asylums practically under 
the control of non-resident officials, who deem it important to interfere 
in such matters as the use of tobacco, as has been done by the State 
Commissioners. The State hospitals are not penal institutions, and it 
is apparent that such questions as the use or disuse of tobacco is a 
matter properly belonging to the local medical officers, and should 
not be settled by a disallowance of an estimate for that article. It 
is to be hoped that the public does not approve of such measures of 
economy, nor do we believe that the commissioners can justify their 
act on the plea that it is injurious to health; for the allowed list of 
articles includes such stimulants as tea and coffee. The use and 
abuse of an article are distinct ideas. The present position of the 
resident medical officers of our State hospitals seeems little better 
than that of clerks appointed to enforce the ideas of an autocratic 
board. Favorable opportunity for the exercise of individual talent 
by the eight superintendents in the State in the solution of problems 
in psychiatry is removed. 
So far as can be judged by public acts, no true reform has been 
instituted by the State Commission in Lunacy. The effort to utilize 
the labor of the patients, as an economic factor in asylum manage- 
ment, is only new in the apparent purpose to render it compulsory, 
as in the prisons. " Sew and make your garments, or you shall not 
be clothed," would seem to be the edict. For a long time sys- 
tematic work by a portion of the patients has been regarded as a 
curative and otherwise useful means of treatment, and doubtless it 
has been used as fully as was practicable for proper purposes. The 
time has hardly come-rather, is past-for using forcible measures 
to secure work from the inmates of our asylums which may yet be 
justified in our penal institutions. 
Having no interest in this question aside from that which belongs 
to every citizen of the State, except a pride in the noble professional 
and humanitarian work done in our State asylums by the medical 
officers, I can speak without bias from a partisan standpoint, and it 
is my sincere conviction that the present plan of State supervision 
is unwise. Though the present Commission may give a safe and 
even useful application of the law, enough has already been done by 
them to show that the plan is dangerous, in that it is susceptible of 
development into an autocratic control of persons who should be 
free to act, until it is shown that they are unfitted for their posts; 
when they should be removed instead of being restrained and con- 
trolled by the rules of the Board. 
If the plea for honor through a useful lessening of expenditures is 6 
to be made, then by all means let us have the items by which the 
saving is secured, and let these items be criticised by the aid of the 
statements of those who made the estimates, after giving the reasons 
for asking the allowance. 
Further, it does not seem that the moral influence of the Commis- 
sion will be enhanced by such general statements as that a number 
of persons have been maintained at State expense by being improp- 
erly included in the "families" of asylum officers. If there has 
been fraud on the State it should be dealt with in a proper w'ay, and 
not condoned by decreeing that it shall not continue. The interests 
are too important and delicate for such coarse methods. 
Each citizen of the State must feel that this subject may have a 
personal importance, for there is always the liability to the occur- 
ence of insanity in some friend or relative. Shall the care of that 
person be under hospital or prison methods? 
My letter is written solely in what I deem to be the interests of 
truth and right, for I have neither a personal cause to defend nor an 
enemy to punish. 
E. D. Ferguson, M. D. 
Troy, N. Y., December 9, 1893. 
-New Yoik Medical Record, December 16, 1893. 
STATE ASYLUMS AND LUNACY BOARDS. 
We note in the American press a warm dispute between the 
Lunacy Board of the State of New York and the asylums under its 
supervision. There are occasionally times in England when the 
managing committees and the superintendents of asylums feel dis- 
posed to resent the interference of the Board of Lunacy in White- 
hall. It is impossible, however, for us to conceive the Commission 
even taking the position which they recently assumed in America. 
There would instantly be a revolt, with a result not difficult to pre- 
dict. The management of State Hospitals for the insane in the 
United States is essentially different from the county asylums of 
England. Practically the Lunacy Board in the former country has 
come to bear the same authoritative relation to the institution that 
the County Council, representing the ratepayers, does with us. The 
committee of management goes to the wall. It is easy to understand 
that the orders of the latter would be much more likely to be received 
with respect than those of a board not meeting on the spot, and not 
in a position to judge of the administrative needs of an asylum. We 
have not, of course, any right to assume that there has been no need 
for reform in the expenditure of the New York hospitals for the 
insane. What seems to us inexplicable is that the power over the 
commissariat should be transferred from the managers to a central 
board. The former have issued a protest in which they say, " the 
Commission is a centralization of power, and is putting into three 
men's hands more authority than was hitherto entrusted to the 
several boards of managersand they add, "if any manager, any 7 
superintendent, or any board of managers has been recreant to their 
trust, it is proper to publish that fact, but it is neither dignified nor 
decent by generalization to indulge in wholesale defamation." 
What is called tlie" State care system " came into force in October, 
1893. In an article in the Utica Morning Herald, December 4th, 
a statement is made which, if true, indicates an extraordinary, and 
indeed intolerable, state of things. "Under it the State Commis> 
sion in Lunacy exercises centralized power. No purchases can be 
made, employes engaged, or repairs effected without its authority. 
So tightly are the reins of power held, that the other day the supply 
of oil having given out at the Utica Hospital, and authority to pur- 
chase not having been granted, an employe was obliged to carry his 
State lamp to his home, and fill it from his private can ! " 
The same paper maintains that the State of New York in de- 
creeing, as it has done, State care of the insane, did not contemplate 
" saving " by the hampering and harassing asylum administration 
which has now occurred, and proceeds : " The people will not tolerate 
any such interpretation of their action or purpose. They are 
humane, and able to provide for such of their fellows as are the 
most unfortunate of human beings the comforts which the judgment 
of the trained specialists and intelligent local managers decide to be 
needful and wise." 
After reading the articles which this controversy has called forth, 
it appears to us that under the new system in New York the asylum 
superintendents in the State are degraded : that the managers can- 
not purchase the smallest item of supply without permission from the 
Commissioners, who revise quantity and prices, and may even sug- 
gest where purchases shall be made. It is very evident that estimates 
may be arbitrarily reduced without regard to the special needs of 
the asylum, in order to make the taxpayer believe that a great 
" saving " has been effected. We confess that in view of the abuse 
of centralization which appears to have been committed by the Lunacy 
Board, our sympathies go with the managers who have revolted, in 
the absence of any proof that they have failed in their duties to the 
State. If they have failed, let their places be filled by better men. 
We have no faith in the detailed administration of several asylums 
by a central board, composed, we believe, of only three men.-British 
Medical Journal, December 23, 1893. 
" CENTRAL SUPERVISION" OF THE STATE HOSPITALS- 
The policy which the Lunacy Commission is pursuing will, if fol- 
lowed to its logical conclusion, result in the subordination of the 
State Hospitals to political control, and thus accomplish their inev- 
itable ruin. From the first the Commission has proceeded along 
lines laid down many years ago by a coterie of politicians whose pur- 
pose and aim have been to bring all the departments of the public 
service of the State under their centralized management. This 
policy was boldly announced by the Commission, soon after it had 
begun active work, in the following terms: " The Commission does 8 
not hesitate to affirm, that in its deliberate judgment no great and en- 
during improvement in the management can reasonably be looked 
for until they (the State Hospitals) are put under more effective and 
thorough central supervision by the State than now obtains." The 
argument by which this proposition is sustained is based on the 
change in the management of the prisons and canals by which a 
single officer was invested with powers that the Commission declares 
are " so absolute that not even the Legislature can interfere . . 
with their (his) appointment of subordinates." In anticipation of the 
enormous power which it would wield, and the immense patronage 
at its disposal should its policy of centralization succeed, the Com- 
mission declares that the interests concentrated in these hospitals 
" in the number of persons employed . . . rivals the canals and 
the schools, . . . surpasses by far the State prisons." 
This is a prize which the politicians had long eagerly sought to 
grasp before the creation of the Commission, but the local boards of 
trustees, the superintendents, and the State Board of Charities, have 
stood as impregnable barriers to the accomplishment of their pur- 
poses. Even the original law organizing the Lunacy Commission 
was carefully drawn to protect the hospitals from the exercise of any 
executive control in their management by that body. In this re- 
spect the law closely followed the English Lunacy Commission Act, 
which, for nearly half a century, has given to England the best ad- 
ministration of her institutions for the insane of any civilized country. 
Repeated efforts have been made to induce the English Commission 
to obtain from Parliament a centralization of executive powers in tjie 
management of the asylums, but it has steadily refused. The Ear] 
of Shaftesbury, who originated the act, and who was chairman of the 
commission for upward of a score and a half of years, always main- 
tained that the usefulness of the commission depended entirely upon 
its lack of power, and to the fact that its duties consisted in constant 
visitation of asylums and exhaustive inquiries into the management, 
with friendly advice and aid. 
Though the projectors cf the law creating the Lunacy Commission 
of this State were governed by the conservative opinions which have 
made lunacy administration so successful in England, the commission 
created by the law was from the first inspired with the idea that re- 
forms in the management of the hospitals could not be effected through 
the local boards by friendly advice and assistance, but must be ac- 
complished by its own assumption of executive powers. Instead of 
immediately making an exhaustive examination of all the institutions 
in order to discover defects of management, and attempt to remedy 
them by advice and friendly cooperation, the first notable act of the 
Commission was to secure an amendment of the entire law. There 
are three noticeable features in the amended law, viz.: 1. The salaries 
of the Commissioners, already liberal, were considerably raised. 2. 
The regular and systematic visitation of hospitals, made statutory as 
in the English Act, were made discretionary, the reason of this 
change, as given by the Commission, being that the individual Com- 
missioners had not the physical ability to make the required visits. 
3. A much more simple and direct method of enforcing the orders of 
the Commission upon the hospital management. By these amend- 9 
ments the objects sought to be attained by the original law were 
largely nullified or perverted, and the first step in the direction of 
" central supervision " was taken. The physical inability of the 
Commission to make inspections became evident when left to their 
discretion, while the peremptory orders issued from the central of- 
fice proved that their energies were diverted to another sphere of 
activity. 
The passage of the State Care Act added to the power of the 
Commission, and the policy of "central supervision " was finally con- 
summated by the Act of the last Legislature providing the necessary 
appropriations for the care of the transferred pauper insane. That 
law gave the Lunacy Commission full power to revise the monthly 
estimates of the asylums, and thereby not only to enter directly into 
the details of their management, but absolutely to control their op- 
erations. Practically, the local boards are ignored, and the superin- 
tendents are brought into the most abject subordination to the central 
authority at the capital. The last stage in the policy of " central 
supervision" of the State Hospitals, in accordance with the precedent 
of the prisons and canals, so highly commended by the Commission, 
will be the reduction of its numbers from three to one, and that one 
must be a partisan politician. This is the logical conclusion of the 
policy which the Commission has declared to the people of the State 
that it approves, has inaugurated, and is now zealously following. 
Admitting that the present Commission is composed of men who 
will wisely exercise their power and jealously preserve the State 
Hospitals from the contamination of political influences, the history 
of centralized power at Albany shows conclusively that sooner or 
later it brings disaster to the interest which comes under its control. 
It remains for the Legislature to determine how far the policy of 
" central supervision " of the State Hospitals, under the plausible 
guise of economy, shall proceed to intrench itself in our State system 
of supervision of public charities. While we heartily approve of 
State supervision of the institutions for the insane, as provided by the 
law of 1889, which also brought into existence the Lunacy Commis- 
sion, we earnestly recommend that such duties be conferred upon a 
conservative body which can be relied on to to build up and 
strengthen the institutions of the State, rather than to make them the 
medium through which it seeks to gain power and patronage.- 
New York Medical December 23, 1893. 
NEW YORK STATE LUNACY COMMISSION. 
For some time there has been apprehension lest the Lunacy Com- 
missioners of this State should tall from the grace and honor of 
their office by undue exercise of the despotic power with which they 
have been invested by the legislature, and by the insatiable desire 
and greed for more power begotten of the privileges already given 
them. No particular fault is found with the commissioners them- 
selves, except that they do not stand upon the same plane as some of 
their predecessors, like Ordronaux, who administered the functions of 
the office in such a way as to bring distinction to himself and glory 
to the commonwealth. 10 
The object of the creation of such an office as that of commis- 
sioner in lunacy was to provide for the regular inspection of public 
and private asylums for the insane. In England the need for such 
an officer originally arose in connection with the abuses of private 
asylums, to which occasionally sane persons were sent, and in which 
at times patients were unduly detained and restrained. Such a gov- 
ernment inspector should see the patients, talk with those that have 
complaints to make, investigate charges of abuse, diminish mechan- 
ical restraint, and note whether inmates are properly fed, clothed 
and exercised. He should aid and abet in every way the asylum 
superintendent's natural desire to improve the institution under his 
care, and to ameliorate the condition of the unfortunates committed 
to his charge. Beyond such duties and the minor details pertaining 
to the same, the Commission in Lunacy should have no other pre- 
rogatives, and indeed we doubt if a properly constituted commission 
would desire more. 
The evils which are now arousing a storm of protest in the- daily 
papers all over the State, and in some of the medical journals, are 
wholly due to the extraordinary powers granted to the present com- 
mission, and to the meddlesome and oppressive manner in which 
such powers are wielded. As is well known, the hospitals for the 
insane of this State are foremost among institutions of the kind in 
this country. Their superintendents are medical men preeminent in 
their special calling, understanding more clearly the needs of the 
asylums and better able to provide for the welfare and happiness of 
their charges than the commissioners. In addition to a medical 
superintendent and his corps of medical assistants, each asylum has a 
board of managers sekcted from among the best citizens in every 
part of the State, whose duty it is to cooperate with the superintend- 
ent in managing all of the affairs of the institution. These citizens 
are gentlemen of high standing in their respective communities, and 
fortunately, owing to the time-honored custom of their being ap- 
pointed by governor without party distinction, few if any of them 
are politicians. It is needless to say that the State hospitals for the 
insane, as thus constituted, have been in all respects creditably man- 
aged, and no meddlesome interference in the management should 
ever have been permitted. As already intimated, such interference 
has been instituted by the commissioners in lunacy, apparently to 
gratify an insatiable ambition, and the tendency seems to be toward 
the creation of a huge political machine at Albany having control of 
all the purchases of supplies, of appropriations for new buildings, and 
after a time of the appointment of superintendents, stewards, medical 
assistants, nurses and attendants. The commission has already ab- 
solute authoiity as regards each minute expenditure in every asylum 
of the State, so that not even a lead pencil can be purchased without 
the consent of this centralized body. The cutting down of neces- 
sary appropriations for blankets, clothing, fuel, food, tobacco and the 
like has been the immediate cause of the indignation everywhere 
aroused. Now, instead of a commission to look to the welfare of the 
insane, we have a body whose only purpose apparently is to make 
political capital out of the cry of economy. The tendency is down 
hill. It is toward demoralization of the whole scheme of State 11 
charity. It is against the interests of the insane. It will place the 
State care of the insane on the so-called "economical" level of the 
county house. 
While we have nothing personal against any member of the pres- 
ent commission, we believe that the inherent human instinct to grasp 
for more power, manifested so decidedly in this instance, should be 
curbed. We believe the law should be so changed as not to stimu- 
late and develop this instinct. The Massachusetts people are con- 
gratulating themselves at the present moment that the same plan for 
centralizing power as to details of management of State hospitals was 
overwhelmingly defeated in their legislature, and are commiserating 
us on account of the mode of enforcement of bad law, which en- 
forcement is worse than the law itself. Every reform and improve- 
ment in the care of the insane in this State has had its inception in 
the State Board of Charities, the State Charities Aid Association and 
former commissioners in lunacy. Much that the present commission 
has undertaken has been for the purpose of self-aggrandizement, and 
to serve political interests. It is rather obstructive of legislation, 
looking toward the real interests of the afflicted people whom they 
were originally intended to protect. It has been said that the true 
reason of the veto of the epileptic colony bill last winter was the in- 
fluence of the Commissioner in Lunacy upon the Governor, for the 
law establishing said colony placed it in the charge of the State Board 
of Charities, and not in the hands of a body itching for further ex- 
tension of its executive powers in the State. We sincerely trust 
that a legislative remedy will soon be sought for this state of things, 
and that the Commission in Lunacy will hereafter be charged only 
with its legitimate supervising and advisory functions.-New York 
Medical Journal, Dec. 23, 1893. 
LUNACY ADMINISTRATION IN AMERICA. 
We had occasion some months ago to indicate with a force 
of language which subsequent events have justified, the iniquitous 
and cruel policy of the Lunacy Commission of the State of New 
York. It is a question of men and motives, and the average citizen 
needs no expert evidence to guide him in getting to the bottom of 
the matter. The facts are plain business facts, that may be called 
jury facts, and if the average intelligence of the State of New York 
is not competent to come to a sound jury decision on the matter we 
are much mistaken. It seems incredible that in this fin de siecle age, 
the State of New York, of all places on earth, should be com- 
pletely at the mercy of three men in respect of its lunacy adminis- 
tration. One can scarcely conceive it possible that these three Com- 
missioners have legally vested authority to control the commissariat 
of the eight State Hospitals for the insane directly from headquarters, 
that the Managing Boards of these hospitals may submit schedules 
of requirements to the Central Board, but cannot contract for or 
order supplies for their own asylums. These institutions have been 
hampered and harrassed in their work by the pettifogging practices 
of the Lunacy Commission. In one asylum the patients were deprived 
of oatmeal for a month because of failure to specify the particular 12 
brand desired, though quality and price were mentioned. Striking 
out requests for nails, timber, lime and bricks had stopped necessary 
repairs. In another case the complaint is, " We have gone weeks 
without tea, and then got permission to buy 2 lbs.," &c. A confer- 
ence of Asylum Managers and Superintendents at New York revealed 
these and other delinquencies of the Lunacy Commission. Numer- 
ous instances were given of the positive hardships suffered by the 
insane in the New York State Asylums, and to cut off the supply 
of tobacco is but one of many illustrations of the scandalous ex- 
cisions perpetrated by the red-tape machinery of the headquarters 
at Albany. It might be supposed that a committee of three would 
be practically unanimous in working out its self-concerted scheme 
of economic reform, but it is not so, and though there might be some 
hope of playing one Commissioner against another, in actual practice 
it does not work to the advantage of the asylums. For example, pipes, 
valves, fittings, &c., estimated for by direction of Dr. MacDonald, the 
Medical Commissioner,were disallowed by the Commisson of which he 
is chairman. An item for hoppers,disallowed,was an estimate for a spe- 
cial kind recommended by Commissioner Brown. Dealing next with 
the machinery of asylum administration, this absolute and arbitrary 
board tries to reduce the strength of the staff, on the principle that in- 
sane labour is as good and reliable as sane labour. If an insane person 
can do without supervision, and can labour to maintain himself, why 
should he be kept in a State Hospital? Why does this cheeseparing 
Commission not take a broad statesmanlike view of the matter, and 
shut out from asylum care the men who can apparently work for a liv- 
ing outside in the world at large ? They ought to see the end from the 
beginning, and face the logical result of the fiscal policy and princi- 
ples which they now enunciate. This Commission would have the 
patients make the soap, wash the clothes, mend them, herd pigs, do 
all the farm work, and in short, to use an American phrase, "run 
the machine" themselves. Did ever a more preposterous idea origi- 
nate outside an asylum before, either in America or elsewhere? 
Now, it may be asked, what is the composition of this remarkable 
Commission, what is its authority, and what are its duties? It is, as 
already stated, a committee of three, one medical man, with very 
little medical spirit or sympathy for the true wants of the insane, 
and two laymen. The authority of this Commission is absolute, 
and the history of its present position may be quoted from the New 
York Medical Record:-"Though the projectors of the law creat- 
ing the Lunacy Commission of this State were governed by the 
conservative opinions which have made lunacy administration so 
successful in England, the Commission created by the law was from 
the first inspired with the idea that reforms in the management of 
the hospitals could not be effected through the local boards, by 
friendly advice and assistance, but must be accomplished by its own 
assumption of executive powers. Instead of making an exhaustive 
examination of all the institutions in order to discover defects of 
management, and attempt to remedy them by advice and friendly 
cooperation, the first notable act of the Commission was to secure 
an amendment of the entire law. There are three noticeable features 
in the amended law : " (1) The salaries of the Commissioners, already 
liberal, were considerably raised ; (2) The regular and systematic vis- 13 
itation of hospitals-made statutory in the English Act-were made 
discretionary, the reason of this change as given by the Commission, 
being that the individual Commissioners had not the physical ability to 
make the required visits; (3) A much more simple and direct method 
of enforcing the orders of the Commission upon the hospital man- 
agement." We need not quote further. This arm chair Commission 
is a political machine, and a disgrace to the premier State of a great 
Republic. It utterly and ungraciously ignores all local authorities 
and all local considerations. It has degraded one of the noblest and 
most humane functions of the State-the care and hospital treatment 
of the insane-to the level of Profit and Loss accounting. Such a 
Commission has no raison d'etre, it belongs rather to the Middle Ages, 
and we are sure of this, that outside the political machine of which it 
is a part, and which, if a healthy organism, would have ejected it 'ong 
ago, there can be no true sympathy with this treatment of asylums 
for the insane among the people of the State of New York. It is 
one of the inconsistencies of a country which is the home of local 
government that such absolute and arbitrary centralization of power 
should exist. What would be thought of the English Commission- 
ers projecting and carrying a complete Lunacy Act in Parliament 
and superintending feeding, clothing, and physicing all the English 
asylums direct from their office at Whitehall. Compare the re- 
lation of the Scotch Commissioners with asylum superintendents as 
it is so favorably and justly described by Dr. Clouston in the Octo- 
ber number of the American Journal of Insanity with the state of 
matters in New York. All interested in the well-being of the insane 
must sympathize wdth the Boards of Management and the Medical 
Officers of the New York hospitals for the insane. They have 
thrown down the gauntlet. They are backed up by the medical 
press of New York and Boston, and a long and severe struggle must 
ensue to have the present lunacy law cancelled, and a new and more 
enlightened one to take its place. For the sake of the unfortunate 
insane, and for the credit of New York heads and hearts, we hope 
this end will be soon accomplished.-Medical Press and Circular, 
January 17, 1894. 
THE ATTITUDE OF THE STATE COMMISSION IN LUNACY. 
It would seem as if the New York State Commission in Lunacy 
had deliberately set out to bring contempt upon itself and disgrace 
upon the noble charities of this State. We recently pointed out the 
unfortunate political proclivities of the Commission in Lunacy, and 
the apparent object of this body to evolve itself into an enormous 
political machine. On all sides in the State these tendencies have 
been subjected to severe criticism from honorable men of every pro- 
fession, and the voice of reproof grows louder every day as the low- 
ering ambitions of the commissioners become clearer and clearer. In 
spite of these ominous warnings, the commissioners grip more firmly 
the rein of power already in their hands. Indeed, they seem dis- 
posed to use their authority to crush those who oppose theevolution 
of the political machine. Among the men who have openly arid 
fearlessly discussed the positions taken by the Commission is Dr. G. 14 
Alder Blumer, of the Utica State Hospital, one of the ablest super- 
intendents of this State. In retaliation for this the Commission stulti- 
fies itself thoroughly by an organized and vindictive persecution of 
Dr. Blumer. It is protended to show that Dr. Blumer was not regu- 
larly appointed through the Civil Service Bureau of the State, and 
an attempt is made to wrest from him the conduct of the American 
Journal of Insanity, which has been published at the Utica Asvlum 
for fifty years. In an interview published in the Utica Daily Press, 
Dr. Blumer makes the following statement: 
"I have set my face resolutely against the attempted injection of 
politics into the management of State Hospitals, and I have not hesi- 
tated to raise my voice and use my pen in behalf of local autonomy, 
under the wise management of trustees of high character, nominated 
by the Governor and confirmed by the Senate, subject, of course, 
to proper State supervision and inspection, as against a centralized 
despotism composed of two laymen and one medical politician. I 
have insisted upon my rights as the chief executive officer of a great 
public charity, and dared to decline to be regarded as a cog in what 
bids fair to become a monster political machine. My independence 
has cost me a good deal, but not more than it is worth. The story is 
too long for an interview, but, as aptly illustrating the animus of the 
Lunacy Commission, I should like to say a word about the American 
Journal of Insanity, a publication established in 1844, of which I 
have the honor to be editor-in-chief. Ever since the present Com- 
mission in Lunacy came into existence that journal has been a thorn 
in its flesh, because, forsooth, it has striven to live upto the claim of 
its title to nationality and has stoutly refused to lower itself, on de- 
mand and threat, to the grade of a servile organ of the Lunacy Com- 
mission. Several futile attempts have been made to wrest the editor- 
ship from me, but the latest of them so well exemplifies the high- 
handed methods of the Commission that it is worth mentioning. It 
came in the shape of an opinion of the attorney general's office last 
October, to the extraordinary effect that, whereas, under chapter 214 
of the laws of 1893, it was for the State Commission in Lunacy to 
pass upon supplies for the State Hospitals, and revise estimates, as to 
quantity and price, it followed of necessity that it was also within 
the province of the Commission to determine the propriety of a 
superintendent's devoting a portion of his time to editing medical 
publications. Under this rule the Lunacy Commission has already 
begun a policy of starving a scientific medical journal that has 
flourished, to the honor and credit of the Utica Hospital, for fully 
fifty years. The superintendent's right to utilize his leisure time in 
editing, without pecuniary reward, a publication in the line of his 
professional work, is questioned, but the president of the Lunacy 
Commission may be hired to testify in a Field case, without let or 
hindrance, imposed by either officer of State or conscience, and 
quietly pocket his fat fees, while the legal member of the Commission 
permits himself the privilege of lecturing at Cornell University and 
the faculty that of paying him for his services, to say nothing of 
numerous ex parte articles prepared for the lay press on the lunacy 
situation as viewed from the southwest corner of the Capitol." 
We can only say that it is unfortunate that this State, after years 15 
of prosperity and happy fame in the management of its great chari- 
ties, should have its good reputation thus dragged in the dust. But 
the board's action is pretty sure to work its own destruction.- The, 
New Y')tk Medical Journal, February 3, 1894. 
The discussion of the State Care Act for the Insane, and its auto- 
cratic interpretation by the Lunacy Commission, have cumulated in 
the presentation of a new bill for the abolition of the Commission, 
and the creation in its stead of a Committee on Lunacy, to be ap- 
pointed and controlled by the State Board of Charities. This bill 
contains the following sensible and practical provisions: 
Within ten days after the passage of this Act, the State Board of 
Charities shall, at a meeting called for that purpose, elect by ballot 
three members of its own body, who shall serve without compensa- 
tion, and who shall constitute the " State Committee " of said board 
thereafter. At each annual meeting said board shall elect three 
members of said committee for the ensuing year. Said State Board 
of Charities shall appoint a Secretary of said Committee who shall be 
known and designated as the "State Commissioner in Lunacy," and 
who shall be a reputable physician, a citizen of this State, and a 
graduate of a legally chartered medical college, having been in he 
actual practice of his profession at least ten years, and who has com- 
petent knowledge of the treatment of the insane and the manage- 
ment of institutions for their care and custody ; he shall receive a 
salary of five thousand dollars per annum, and one thousand dollars 
in lieu of traveling and other incidental expenses. The said com- 
mittee shall elect its own chairman. 
" The said Committee in Lunacy is empowered and required to 
execute, through itself or its secretary, all the provisions of this Act 
which pertain to its office, and shall direct its secietary accordingly ; 
and shall also, with the consent of the Board, make such other rules 
and regulations for its own government, and that of its secretary, as 
are not inconsistent with the provisions of this Act; but said com- 
mittee shall, at all times, be subject to the authority and control of 
the State Board of Charities. 
" All the powers and duties conferred upon, and exercised by, the 
State Commission in Lunacy, in conformity with Chap. 273, Laws of 
1890, and Chap. 214, Laws of 1893, or acts amendatory thereof, or 
by any other act not specially mentioned or enumerated herein, are 
hereby transferred to, and conferred upon, the State Committee in 
Lunacy and its secretary, created by the first section of this Act, and 
the State Commission in Lunacy is hereby abolished. 
" It shall be the duty of the State Commission in Lunacy to trans- 
fer to the State Committee in Lunacy, on the written request of the 
chairman of said Committee, all records, papers, books, office furni- 
ture, and other property of whatever name or nature, belonging to 
the State and in its possession. 
" The said Committee shall be provided by the proper authorities 
with suitable accommodations in the State Capitol for its office, 
where it shall hold its meetings as often as once in three months, the 
time for such meetings being fixed by the Committee; additional 
meetings may be held at other times and places as the exigencies of 
THE NEW STATE LUNACY BILL. 16 
the service may require. The Committee is authorized to employ 
such number of clerks as it may deem necessary, but the total cost 
of such service shall not exceed four thousand dollars in any one 
year." 
This bill is the outcome of a free interchange of opinion by all 
those who are interested in the success of the State Care Act, and 
whose practical experience in the treatment of the insane in our State 
hospitals entitles their conclusions to respect and their recommenda- 
tions to confidence. 
Notwithstanding efforts on the part of such as still believe in 
County care to prove that the present law is a failure, and that a re- 
turn must be made to the old system, the convictions of those who 
have given the subject careful study arc firmer than ever, as to the 
great advantages of State care for both acute and chronic insane. 
The only fault has been in the objectionable and perverse methods 
of its administration by the Lunacy Commission as now' constituted. 
In fact the time has come for a change, not only in the personnel of 
the commission, but in such curtailment of its powers as shall make 
appeal from its judgment in all times and under all circumstances a 
possible measure. 
While willing to give the Commission due credit for its efforts to 
carry out the law, we must admit that it has signally failed in so do- 
ing. At best the present construction of the law can only prove the 
danger, even to conscientiously inclined public officers, of having ex- 
traordinary power given them, and the temptation to enforce it 
oftentimes against the dictates of common sense or ordinary reason. 
It will be seen that the proposed law has several features which 
are improvements on the one now in force. It is a transfer of the 
duties of the Commission to a Committee of the State Board of 
Charities, which latter has always had a supervisory control of all 
State charities. It consolidates functions which are now uselessly 
separated, thus simplifying machinery, conserving common interests, 
and restricting expenditure. The present Lunacy Commission costs 
the State nearly thirty thousand a year, while the new committee 
can do its work more efficiently, more harmoniously, and more con- 
sistently, for one-third of that sum. Moreover, the effectiveness of 
the proposed law has already been amply demonstrated in Pennsyl- 
vania, which, after a varied experience in lunacy legislation, has 
settled upon it as incomparably the best. While there is no inten- 
tion in the new bill to alter the essential features of State control of 
expenditures, the advocates of the new measure are content to try 
the experiment of continuing the principle of such supervision under 
a more distributive method of its administration, and one in which 
there is more division of responsibility and consequently less oppor- 
tunity for error by individual judgment. But above all, it very 
properly removes the supervision of our great State hospitals from 
the domain of politics, by vesting all responsibility in the State 
Board of Charities, composed of independent and representative citi- 
zens who make and control appointments, and whose only account- 
ability is to the public through their reports to the Legislature. The 
profession throughout this State should be particularly interested in 
this new bill, and should use its influence in every direction to se- 
cure its passage.-New York Medical Record, February 10, 1894.