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GERMANY-PRUSSIA-BADEN

APPENDIX.-Report of the Governor Hoyt Lunacy Commission of Pennsyl-

vania, with proposed Act of Assembly .

NOTE.-Brackets in the text denote: 1. A conjectural emendation. 2. An
amendment to the original section. Punctuation is in every case that of the work
cited. Spelling and use of capital letters have been made uniform. The tables
of contents have been made without reference to the marginal notes, which are
those of the various statutes. In the tables the words "asylum," "insane" and
"indigent insane" have been uniformly used. The word "ibid" has been omitted
in the citations when the paragraphs have been taken from a revised statute or
code whose sections are numbered consecutively. Where a chapter is cited without
a date it refers to a revised statute or code already cited. When a date appears
it is cited from the pamphlet laws. The laws of England are exceptions to this.

LEGISLATION ON INSANITY.

PREFACE.

INSANITY is the saddest and most terrible of all diseases,the most pitiable and helpless of all the states and forms of human helplessness. And yet it is a condition to which all men are liable, and into which any man may at any time fall with or without premonition. Not only does it provoke the compassion of the philanthropist, but it appeals to and it tasks the highest medical skill; it demands and exhausts all the resources of legislative wisdom. In its relation to crime it presents one of the darkest and most mysterious problems of medical and criminal jurisprudence. In connexion with the poor and friendless, it imperatively calls upon the State for care and protection. But so complex and intricate is the subject in its various relations and aspects, it is no wonder that in regard to it the legislation of many States is very crude and defective, and of all States, as yet, more or less tentative and imperfect.

During my term of service upon the Board of Public Charities of Pennsylvania, mainly as its President, I had ample opportunities of observing the condition of the inmates of Hospitals and Asylums for the Insane, in this and other States, as well as that of all the other defective classes of the commonwealth, in their respective Institutions; and since my withdrawal from that office, I have had favorable opportunities in Great Britain and on the Continent of Europe, to indulge the interest which I felt in the subject, and to study it further by a comparison of the several methods of administering these various charities. Some of these questions were discussed in a volume which I printed (privately) in 1877,

under the title of "Chapters on Social Science in relation to State Charities," and the views which were then set forth are still entertained by me. The intimations which were given of the peculiar and unhappy relation of the Insane to the community, have assumed the character of distinctness and certainty upon further observation and reflection.

This relation is that of a ward, who is a stranger to his guardian, of a guardian who has no acquaintance with his ward. The system of "care and treatment" which rules in all Hospitals for the Insane, places in complete isolation from social intercourse with the sane, at the will of the Hospital officials, all classes of the Insane within their walls. The medical superintendent, under the laws which prevail generally in this country, and which, until recently, have been in force in this State, preserves a despotic power over the liberty, at least, of all who have been "committed" in proper form to his Hospital,-even so far as to justify the detention there, of a sane man throughout all his days, without responsibility for the enormous wrong. I desire simply to state facts. I am not questioning the honor, the integrity, or the humanity of any one. But the public has been sedulously taught that the mentally sick, however slight the malady may be, are subjects solely for the disposal of the members of the medical profession; it matters not how youthful, how inexperienced, or how occupied in their professional work. If the diplomas

be but one hour old, if their branch of practice be dentistry or chiropody, two, at most, of such persons, if respectable in the opinion of a Justice of the Peace, have had the power to commit any member of the community to a hospital for the insane, there to be detained indefinitely and with impunity, at the will of the medical superintendent, unless liberated through the intervention of the court. This has been the law in Pennsylvania until recently.

The chief physician of one of the best institutions for the insane in this country says: "I have no knowledge of the wrongful detention of a sane person in this or any other hospital, but I can very well understand that this injustice may occur. Every superintendent of a hospital desires the wards to be full, and where the inmates are 'pay patients', there exists a temptation to detain them." These influences may

operate so far as to lessen the strictness of an examination of the patient upon admission.

If the present status of this sad but interesting question was appreciated by the public, as well as the true position it should occupy, no citizen, sane or insane, would be exposed to the risks or the actual wrongs which confront them always, and from which they cannot always escape.

When the error is dispelled, that public concern and personal interest in the well-being of the insane are not legitimate factors to their improvement or recovery, and when these take the practical shape of observation and activity in their service, there will come to pass, however gradually, a recognition of the needs of these helpless ones; they will be allowed. a more personal intercourse with the just, the judicious, and the philanthropic, which will keep open to the public, who are their real guardians and judges, a knowledge of their condition, and of the measure of justice or injustice they receive. It will then happen that the chief physician shall not be the housekeeper and the financier for 500 or 1000 boarders; that his assistants will not necessarily assume his authority and fulfill his duty in the gravest cases; that the nurses and attendants will be selected for their actual qualifications, and special fitness for their delicate work, and not for their cheapness. A system will then ensue, which will, by its own merit and adaptation to the circumstances of the case, duly protect these sufferers, and which will give time and opportunity for the consideration, by those who have them in charge, of the peculiar claim they have upon their sympathy and their sense of justice.

The Hon. F. B. Sanborn of Massachusetts, the inspector of charities of that State, distinguished alike by his general intelligence and his wisdom and good judgment on all questions relating to State charities, writes in regard to the matter of intercourse of the insane with the community, "It is a just provision, that inmates of asylums for the insane should have the opportunity of communicating with parties outside, who are or should be satisfactory to them. This tends to reconcile them to their situation; and it may happen that it is even more essential than this to them,"-for example, in cases of sanity or doubtful cases-"but such intercourse should be reasonably regulated."

I may, at this point, refer, with propriety, to a few instances of distressing injustice in this State, which could not have occurred under a more enlightened system of legislation, and a more just and generous appreciation of the question by hospital managers or superintendents.

1. On the occasion of an official visit to a hospital for the insane, I noticed a lad, helpless from the loss of both legs, suffering great mental agony, and tossing about on a bed, with the insane around and about him. This display of mental pain being unusual, I was impulsively drawn to the sufferer, laid my hand upon him in a soothing manner, and spoke to him a few kind words. He turned his averted face towards me, and almost immediately the expression of anguish departed. I had him removed to the infirmary, commended him to the special attention of doctor and nurse, and when I made a visit to him a few days afterwards, I found this case of "insanity" to be what might reasonably be regarded as no more than an instance of severe distress, induced by the neglect and brutality of an employer, in whose service his limbs were frozen to suppuration, and by whom he was then turned into the road. He was picked up by a passing wagoner, and eventually left upon a sidewalk of the city, unable to rise with his festered limbs; he was carried to a hospital, and his legs amputated. All traces of his family were gone, (they were German emigrants); and at length, overwhelmed with agony and despair, he found himself a tenant of a "madhouse." The friendly touch of a humanity, which all possess, taught him that he was not entirely without sympathy, and a revived hope soon restored him to confidence and peace. The replacing of his human limbs with artificial ones, gained for him a situation where he could earn a living for himself, and now, after ten years, for a partner in life.

2. At a meeting of the directors of a large charity, it was announced that the physicians of the institution were prepared to sign a certificate of insanity, after several weeks' attendance, for the admission of a beneficiary to a hospital for the insane. This would have been allowed, as a matter of course, but that a special committee was asked for and appointed. The case was indeed a pitiable one, and likely to mislead even a professional man of ordinary experience. Suggestions were made by one of the committee, which were accepted by the doctors;