advantages for the treatment of patients of this class, as any
institution in the world, and we are happy to know, that the prominent
principles which have been recognized in its structure and economy,
have been adopted in asylums of the latest date. The hospital has been
quite full during the whole year, and yet the health of the patients
has been remarkably good. The present arrangements are fitted to
accommodate 200 patients, and provision will soon be made for receiving
20 more. It is certainly desirable to extend the benefits of such an
institution to as large a number as can divide without diminishing
the aggregate of good, but we quite concur with Dr. Kirkbride in the
opinion, that a larger number than 220 could not be well received in
one building, nor receive due attention from one medical officer--“a
daily visit to all the wards, and a daily supervision of all the
departments by its official head, being exceedingly desirable in every
institution for the insane.” Seven of the seventeen deaths during the
year, “occurred within a fortnight after the patients’ admission,” and
only one had been more than a year in the asylum.
Of 1391 patients admitted to this hospital, 725 were under middle age,
(35 years,) and 666 over. Of 773 male patients, the leading occupations
were as follows:--farmers, 115; merchants, 66; laborers, 62; clerks,
50; carpenters, 30; shoemakers, 22; physicians, 19; seamen and
watermen, 19; teachers, 17; tailors, 15; students, 15; NO OCCUPATION,
108.
Of 618 females, 66 were seamstresses or mantua-makers, and 64
domestics; store-keepers and attendants in stores, 12, and teachers, 9.
Of single females, not pursuing a regular employment, 29 were daughters
of farmers, and 29 daughters of merchants. Of the married, 57 were
wives of farmers; 39 of laborers; 35 of merchants; 23 of clerks. Of the
618, 244 were single, 286 married and 88 widows. And of the 1391, 773
were natives of Pennsylvania; 91 of New Jersey; 197 from other of the
United States; 340 from foreign parts, of whom 189 were from Ireland!
The most productive cause of insanity, as shown by the returns, is
intemperance, 84; the next is mental anxiety, 69; grief for loss
of friends, &c., 69; then comes the loss of property, 67; religious
excitement, 56; domestic difficulties, 45, and _unascertained_, 563! In
907 of the cases, insanity appeared before middle age, leaving 384 only
developed after that period.
The plan of detached cottages for a particular class of patients,
continues to be an approved feature of the arrangements; and among the
valuable improvements of the last year is the erection of a museum
and reading-room on an eligible site. The building is 46 feet by 24,
with a piazza, and the interior is furnished with interesting and
valuable cabinets in natural science, as well as with newspapers, maps,
periodicals, pamphlets, &c. On the interesting topics of society,
instruction, and moral treatment, and the arrangements for heating
and ventilation, much valuable information is furnished. The annual
receipts and expenses are balanced with the sum of _twenty-six cents_,
and the cost of each patient per week, including every thing, is $3 88.
The amount expended on _free patients_ during the year is $7,666 88.
This is unalloyed charity.
2. The State Hospital at Worcester, (Massachusetts,) under the care of
Dr. Chandler, was overflowing with patients, though fifteen new rooms
were added during the year. The average number for the year was 404,
and the number of dormitories 360 only. The number of foreigners in the
hospital at the close of 1842 was 34, at the close of 1847 it was 121,
and at the close of 1848 it was 150!
Dr. Chandler is of opinion, that it would not be judicious to enlarge
the present hospital, but he would rather erect a new one, and separate
the sexes. He thinks three small hospitals, in different sections of
the State, would have some advantage over a large one.
The whole number of patients admitted from January 1833, to November
30, 1848, is 3084, of whom 1433 were discharged cured, 416 improved,
and 272 died. Of the patients admitted last year, 154 were under
middle age, and 255 above, showing a very different result from that
which we have stated above at the Pennsylvania hospital. Of the whole
number received at Worcester, the cause of insanity in 322 cases is
supposed to have been intemperance; in 266 domestic affliction; in
233 religious views, and in 161 self-abuse. Hereditary tendencies to
insanity were traced in 691 cases. Fifteen hundred and sixty-one were
single, one thousand two hundred and thirty-two married, one hundred
and ninety-nine widows, and eighty-six widowers. Dr. C. thinks it very
clear that the sympathies and motives to action, which the domestic
relations supply, are all but indispensable to keep the whole system of
mind and body in a healthful state. If we understand the report of the
trustees, the cost to the State of each patient is $2 33⅓.
3. The report of the New York State Lunatic Asylum established at
Utica, was made to the Legislature, February 1, 1849. During the
six years since it was opened, it has had an annual average of 335
patients. The whole number under care during 1848, was 877, of whom
495 were removed at the end of the year. Judges of county courts have
authority to send to the asylum any person who becomes insane and whose
estate is insufficient for the support of himself and family; and the
county is chargeable with the expenses of his restoration, if it is
effected within the space of two years. Six hundred and twenty-nine of
this class have been received into the institution since it was opened,
and have thus been partakers of the most seasonable and appropriate
charity which the public can bestow. These have been among the most
hopeful subjects of hospital treatment, and would have suffered most
for want of it.
The hospital is lighted by 280 burners from gas manufactured on the
premises. The expense of work, fixtures, &c., was $5,346 48,--and this
mode of lighting, is regarded not only as safer and more secure and
pleasant, but as cheaper than the former mode. The price of board and
hospital care, to patients who are chargeable to towns or counties,
is $2 per week. Pay patients are charged from $2 50 to $4 per week,
according to the accommodations they receive. The receipts of the year
fully meet the current expenses.
Of 382 discharges during the year, 189 were men and 193 were women;
174 were cured, (viz., 87 men and 87 women,) and 84 were improved.
There were 86 deaths. Some salutary cautions are given respecting the
removal of distant patients to the hospital, especially in sudden and
acute cases of insanity, and where they are in a weak or diseased
state, and exposed to much suffering and fatigue on the journey. The
opinion of a judicious physician should be taken before the attempt to
remove them is made. Other and equally important cautions are given
against delaying to send such as are clearly deranged, merely because
they are monomaniacs, or not violent, nor very excitable. “Those cases
of insanity that are most improperly and most frequently neglected
and kept at home until they are incurable, are unattended by much
excitement; those that come on very gradually, unperceived for a long
time, excepting by the most intimate acquaintances,” (p. 20.)
Of the whole number, (2,014,) 1017 were men, and 997 women; 1213 became
insane before middle life, and 801 after that period. Of the 1017 men,
437 were farmers and 133 laborers, 57 merchants and 51 scholars; and
of the 997 women, 853 were employed at house-work, or were without any
special trade or employment; 45 were school girls; 30 tailoresses; 24
instructresses; 21 milliners; 16 mantua-makers; 7 factory-girls; and
1 music-teacher. As to their civil condition, 957 were single; 937
married; 83 widows; and 39 widowers. 1417 were natives of New York, and
300 were from foreign lands.
Among the causes of insanity, are religious anxiety 178, loss of
property 86, sickness and death of kindred 74, excessive study 51,
intemperance 67, Millerism 36, disappointed in love 53, abuse by
husband 28, blows on the head 24, fright 24, excessive labor 33,
anxiety about absent friends, 18. Among the amusements of the patients,
debates, tableaux, singing and dancing, and theatrical performances.
Of the whole number, (2014,) 251, (108 men and 143 women,) were
disposed to suicide. This variety of insanity is by no means the most
incurable. On the contrary, some of the most permanent and complete
recoveries, are from this form of disease. From a register kept by Dr.
Bingham for four years at this hospital, of all the suicides occurring
in the State of New York, and noticed in the public prints, it appears
that 74 cases occurred in 1845, 64 in 1846, 106 in 1847, and 88 in 1848.
In relation to hereditary insanity, the report shows that of the 2014
patients received at the institution, 637 are known to have insane
relatives, and 273 are known to have had insane parents, or nearly 1 in
7. Dr. Brigham expresses the opinion that _all other causes combined
have not so much influence in producing insanity, as the transmission
of the disease from parents to their offspring_, p. 36. In other words,
that the exciting causes would be inadequate to produce insanity, but
for the inherent constitutional tendency to it. Dr. B also declares
his belief, that there is more insanity in this country than in any
other, especially in the northern and eastern States, and _that it is
fearfully on the increase_, p. 38.
Some valuable suggestions respecting the prevalent causes of insanity
and the means of obviating them, are thrown out, and are entitled to
the earnest and studious regard of parents and teachers, as well as of
professional circles.
4. In the _M’Lean Asylum_ there were received during the year 1848,
153 patients, (71 males and 72 females.) Dismissed, 155, (87 males, 68
females,) of whom 82 were restored, (55 males, and 37 females.) There
were 23 deaths during the year. The total number of patients received
from 1837, is 1696. The average of the first six years of this term was
115, and the average of the second six years, was 166. Of the whole
number, 884 were discharged as cured, and 184 died. The report enters
at much length into a history of the construction of the buildings, and
of the recent alterations, amounting almost to a reconstruction of the
largest and most modern building on the male side.
In conjunction with these alterations, a new heating and ventilating
apparatus has been introduced, and as we know the very great solicitude
that is felt in respect to this point by those who are commissioned
to devise the plan and oversee the construction of such edifices, we
extract so much of the report as relates to it.
“Every room has a hot air and a foul air flue opening in it, the
entrance being protected by an ornamental grate, and the galleries
have five or six flues of each kind opening in them, in order that
the diffusion may be general. The flues are twelve by twelve, and
twelve by nine inches in size.
“The pure supplies of air are received into a large reservoir
or space in the basement between the walls forming the sides of
the galleries above, and in which both kinds of flues are built.
This main air channel has an area of at least fifteen feet, and
terminates externally in a low tower, fully exposed to the passing
air.
“The heater is a vertical boiler on the tubular plan, about
eight feet in height and thirty inches in diameter. The fuel
(anthracite) is placed within the boiler, and that is so placed
within the reservoir before named, that only a small part of it,
required to receive the fuel, is left outside.
“On each side of the reservoir of air, is a construction consisting
of six longitudinal chambers one above the other, the whole length
of it. The lower three, separated from the upper three by a brick
arch and from each other by partitions of wood, are the ventilating
channels receiving at intervals the flues from above and finally
terminating beneath the exhausting shaft, to be described.
“The upper range consists of the three channels for hot air.
Both of these ranges are so arranged that a channel answers to a
story above, and thus each story of the house has its heating and
ventilation entirely independent of any other.
“Each hot air channel has a pair of four inch cast iron water pipes
connected with spigot joints and iron cement; one end of each comes
off the boiler near the top, and the other or return end, enters
the boiler on the other side, near its bottom. The hot and cold
ends of each pair of pipes are on opposite sides, in order that the
average heat at any place where the air is delivered above may be
the same. The three pair of pipes receive and return their water,
through tubes reduced to two inches diameter, as recommended by
Mr. Hood, the highest authority on this class of subjects, and at
the same level. The degree of curvature essential in this form
of connection, was expected to make a difference in the velocity
of the circulating fluid, and consequent temperature at which
the water would be found in the different ranges. Practically no
material difference is remarked. The radiating pipes cross at the
bottom of the cold air reservoir. The air flows in to impinge upon
them through arched spaces left in the front of the channels,
looking towards the reservoir. Every flue for hot or foul air is
commanded by a slide readily approached below.
“The heated air is always admitted near the ceiling to obviate any
contamination at its point of delivery. The foul air is drawn off
near the wash-board, any impurities there deposited being drawn
down, but not into the room. The diffusion of the air, where an
adequate exhaustive power is provided, is also much favored by
being thus turned in its course, and the lower stratum is not
uncomfortably cool to the feet,--a common objection to the usual
method of receiving and withdrawing the supplies.
“The foul air channels into which the flues from each story open,
do not come together, until just as they pass under the foot of
the ventilating shaft or chimney, which through the agency of a
cast iron pipe, a foot in diameter in the middle of the shaft,
running up fifty feet and receiving the smoke from the furnaces,
constitutes the moving power. This shaft is built of brick in a
useless angle where the two buildings approached each other, and
has an internal diameter, it being a circle, of about six feet at
its basis a few feet below the cellar floor, and terminates in one
of the original chimney stacks at the corner of the foundation
of the dome, height of about seventy-five feet, and with about
one half its size at bottom. A deviation of a few feet from the
perpendicular was inevitable at about two-thirds its length.
It is carefully plastered or _pargetted_ within. As its upper
opening was commanded by the spherical dome, endangering the
regurgitation of wind at certain times, it was surmounted with a
form of chimney-cap, figured in Mr. Tredgold’s works some forty
years since, and being essentially that recently introduced into
considerable use in this vicinity.
“As a cure for smoky chimneys, this cap has considerable
efficiency, but is regarded as of very trifling moment as for as
suction or exhaustion from below is required. For its power is too
feeble at all times, for such an amount of ventilation as an insane
hospital requires, and depends wholly on the fluctuation currents
of external air. If the upper range of bricks had been laid with a
bevel upwards, and a plain plate of metal placed on four short
legs a few inches above, it would have answered equally well and at
a tenth of the cost. The rarefaction produced by the heat radiated
from the central iron smoke pipe occasions a partial vacuum,
instantly filled from the rooms behind.
“The whole length of cast iron hot water pipe is about 600 feet,
and with the portion of the heater within the main air cell or
reservoir, and the smaller wrought iron tubes connecting the
extremes of each of the six pipes with the upper and lower ends
of the boiler, constitutes a radiating surface of over 700 square
feet. The effective fire surface of the boiler is probably about 30
superficial feet, and about 60,000 cubic feet of space above in the
three corridors, and the rooms opening upon them, are to be heated.
“The amount of anthracite consumed in the twenty-four hours of
our coldest weather, is not far from 400 lbs.; the water in the
extremities of the pipes receiving it from the heater, rarely
exceeds 180° F. and falls off about 20° at its point of re-entering.
“All these expressions, however, are quite indefinite without
taking into consideration the extent of change required in the
air. It is obvious that by closing the damper which commands the
ventilating shaft, the relations of temperature of the air, and
of the pipes would at once sympathize. With the active power of
the shaft, it is certain that any possible amount of ventilation
may be attained. Indeed, it is probable that the present shaft is
equal to the demands of the remainder of the male wing in addition.
The escape of the steam pump is injected into the centre of the
ventilating space, giving us, for some hours daily, the aid of this
recently adopted and exceedingly efficient means of ventilation.
“While a sufficient time has not yet elapsed to stamp our apparatus
with the seal of experience, the only test of such appliances in
the mechanical arts, yet we are authorized to declare that, as
far it has been tried, it promises all that could be desired in
supplying a full, certain, and manageable amount of air, in its
highest hygienic conditions.
“The cost of getting up a complete system of hot-water warming
and exhaustive ventilation in a country where few examples or
approximate specimens are to be found--in a climate which nullifies
all European experience--where all parties, suggesters and
mechanics, are obliged to acquire a certain experience as they go
along, must be much greater than when this subject shall be well
understood and generally adopted, as it eventually cannot fail to
be. Independent of making the flues and ventilating chimney, items
which in new undertakings would naturally come under the head of
construction account, the expense of our undertaking will fall
considerably below a thousand dollars, and we are satisfied that
with the experience acquired in this single trial, it could be gone
over again at a very considerable reduction of cost.”
We have left ourselves but a finger’s breadth of room for a notice
of the report of the _N. Jersey State Lunatic Asylum_ at Trenton,
rendered December 1848. It is accompanied by a view and ground plan of
the buildings, which were opened for patients on the 15th of May last,
under the superintendence of Dr. H. A. Buttolph. They are designed for
the accommodation of 200 patients, and in their general structure and
arrangement accord with those of the Pennsylvania Hospital already
noticed. The asylum occupies a most eligible site, about two miles
north-west of the public buildings, surrounded by a choice farm of 111
acres, with an unfailing supply of fine soft water, and a beautiful
grove in the rear, thus affording abundant room for hospital purposes,
and embracing every variety of scenery and spacious pleasure grounds
for the use of the patients. The various fixtures for warming,
ventilating and lighting, as well as the arrangements for cooking,
washing, bathing, &c., are after the most improved models, and are
described with interesting and intelligible minuteness in the report,
an examination of which we would recommend to all who are seeking
information on the subject. The number received during the year was
86, of whom 83 remained in the asylum at the date of the report. A
large proportion of the number received were chronic cases, which are
generally very numerous at the opening of such institutions. Of the
86, 27 were under middle age; 52 were single and 30 married. Of their
occupations, 22 of the men were farmers, and 16 of the women were
house-keepers. An hereditary tendency to insanity was traced in 18 of
the 86 cases, or about as 1 to 5.
SUMMARY OF PRINCIPAL FACTS.
======================================================================
| Admitted | Discharged | Remaining | |
| during | or died | at date | |
| the | during | of | Cured. | Deaths.
| year. | the year. | report. | |
---------------+----------+------------+-----------+--------+---------
Pennsylvania, | 215 | 203 | 200 | 120 | 17
New Jersey,[5] | 86 | 3 | 83 | 3 | 0
New York, | 405 | 382 | 495 | 174 | 86[6]
Massachusetts, | 261 | 246 | 409 | 136 | 30
======================================================================
VIRGINIA.--The Eastern Insane Asylum of Virginia is established at
Williamsburg, and the Western at Staunton. At the former were received
in 1848, 34 patients, 15 males and 19 females. The number under care,
October 1, 1848, was 165. Aggregate of inmates during the year 198;
discharged 6 males and 10 females; deaths 17, (8 males and 9 females.)
Spacious additions to the buildings are now in progress, a portion of
which will be appropriated to colored patients. The receipts of the
year were $41,350 64, and the expenditures $29,716 89.
At the latter institution were received during the year ending October
1, 1848, 70, (39 males and 31 females,) making an aggregate of 277
under care during the year. There were discharged in the same time 50
patients, of whom 40 were recovered, (21 males and 19 females,) and 7
more or less improved; 2 were unimproved, 1 eloped, and 22 died.
Among the causes assigned for insanity, we notice hard study is given
in the case of 11 males and 1 female, intemperance 16 males, and
domestic affliction 6 males and 18 females. Seven thousand dollars have
been expended lately in new buildings.
No. 2.--_The precise present character of transportation explained,
with suggestions by Ignotus._
We observe in our English papers a brief notice of a pamphlet of
fifty pages, published in London a short time since, advocating some
important modifications of the transportation system. As we regard
the system itself too near extinction to render any modifications of
it particularly valuable or interesting, we notice the publication
only for the sake of what the author says about _convict-separation_.
We take, by piece-meal, the whole extract of the English reviewer,
venturing a brief comment on some passages.
“This sort of confinement (separation) has, of late years, been
extravagantly commended by some, and as loudly reprobated by
others. The truth seems to lie between the two extreme opinions.
(A position which truth has long been supposed to occupy.) We are
led, by our own observations, to value it but little as an _active
agency_ for reforming criminals, but to allow it a high place as
auxiliary, in general, to that which is reformatory in the highest
degree, _Christian instruction in the hands of Christian men_.”
We are not aware of any system of prison discipline that possesses
or pretends to possess an “active agency for reforming criminals,”
independent of Christian instruction. We imprison men to punish them,
and we think the “_active agency_” of punishment is quickened by
separation. And hence we hold, that apart from reformatory influences,
separation during imprisonment is preferable to association, considered
merely as a punishment. When, however, we introduce the agency which is
“reformatory in the highest degree,” (to wit, “_Christian instruction
in the hands of Christian men_,”) the comparative fitness of the two
modes of imprisonment to receive and employ it, is at once revealed,
and, as “Ignotus” says, the separation of the convicts is then seen to
occupy a high place as an auxiliary to its influence.