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TO THE LEGISLATURE. 
 
 A PLEA 
 
 FOR THE 
 
 INSANE 
 
 IN THE 
 
 PRISONS AND POOR-HOUSES 
 
 / " 
 
 PENNSYLVANIA. 
 
 PHILADELPHIA : 
 
 A. C. Bryson & Co., Steam-Power Printers, 607 Chestnut Street. 
 
 1873. 
 
CONTENTS: 
 
 Pag*. 
 
 Insane Poor 1-27 
 
 riminal Insane, &c, ! 27-103 
 
 INDEX 
 
 Art of 1861, evil eflfects of, 46, 47, 50, 56; 
 remands Insane from Hospitals to Prisons, 
 40; Judge Brewster's Opinion of, 61-64; 
 rt_-pc.il demanded, 39. 
 
 Aims-Houses, Sufferings of Tnsane in, 7, 15. 
 
 Appeals, from Inspectors of Penitentiaries, in 
 1844, i s 57. 1871,34. 37. 
 
 ition of "Criminal Insane" with felons, 
 88, 91. 
 
 Claims of Insane upon the State, 13. 
 
 Chronic Neglect of Insane in Poorhouses, 16 ; 
 causes of, 19. 
 
 Cruel detention of Insane in Jails, 33-37. 
 
 Cure of Insane, 29; percentage, 12. 
 
 Convict Insane, 27 ; condition, needs, 33-37 ; 
 separate department for, in State Hospitals 
 suggested, ^, 59, 101. 
 
 Criminal Insane, 5 ; before trial, 27 ; untried, 
 28 ; should not be in jails, 29 ; condition 
 in State Penitentiaries, 32-37, 56; remedies 
 proposed, 96. 
 
 Duty of State to all Insane Poor, 100 ; to In- 
 sane Criminals, 31. 
 
 Dangerous Lunatics, proper provision for, 101. 
 
 Danville, Insane Hospital, special department 
 for Criminal Insane suggested, 73, 75,96. 
 
 Eastern Penitentiary, Insane Convicts in, 32, 
 74 ; recommendation of Inspectors, 55 ; 
 Warden's Reports, 32-34. 
 
 Frightful Condition of Insane in Poorhouses, 
 10, 14, 16, 17 ; in Prisons, 8, 10. 
 
 Facts, about present cruel neglect of Insane 
 Poor, 15-19; about Criminal in Peniten- 
 tiary, 33-37. 
 
 Harmless Insane, 5 ; care of, 25, 38 ; cruel 
 indefinite imprisonment of, 46. 
 
 Harmful Insane, 5, 25; not always criminals,38. 
 
 Humane Legislation in other States, 64. 
 
 Humane treatment of Insane Criminals, 93 ; 
 nullified by Act of 1861. 
 
 Hardships of Poor Insane Criminals, 31 ; 
 remedies proposed, 48. 
 
 Hopeless Condition of Insane-inPoorhouses,53 
 
 Insanity, a cause of pauperism, 13. 
 
 Insane, simply put out of sight, 20; duty of. 
 state to, 4. 
 
 Inhuman View of Insanity of Criminals, 93. 
 
 Insane Poor, What the State ought to do, 5, 
 
 7, 27, 54, 101 ; unjust treatment of, 23 ; 
 
 number now suffering, 100; not removed to 
 
 ral hospitals, 21 ; memorial of judges 
 
 - ipreine Court, 51 ; memorials in behalf 
 
 of, 94 96. 
 
 Insane Convicts, before and after conviction, 
 5. 27, transfer to Asylums, 29; separate 
 department for, needed, 60, 73, 75, 76; 
 should be in hospitals, 85, 86, IOO ; Discus- 
 sion mod of Medical Superinten- 
 dents at Baltimore, 74-85, Memorials, 94-96. 
 
 Insane Criminals, injudicious treatment of, 8; 
 in Penitentiaries, 32, 57, 59; suggestions, 
 79, 80 83, 90, 97 ; concurrent testimony 
 respecting, 80 — S^- 
 
 Incurable Insanity, caused by present neglect 
 in Poorhouses, 53 ; by punishment as con- 
 victs, 30; discharges from State Hospital, 
 23 ; remarks, 102. 
 
 Insane Hospitals, State, not largely used for 
 Poor Insane, 21. 
 
 Jails not proper places for the Insane, 55, 85, 
 89, 100. 
 
 Legislation, course of, in Penn'a, 39—46; 61 
 64, proposed 98, 102. 
 
 Moral Insanity, viciousness of, 4. 
 
 Medical Superintendents of Insane Hospitals, 
 Discussion by Associations of, 74-85. 
 
 Numbers of Insane Poor now raving and ne- 
 glected in Poorhouses, 53. 
 
 No Insane Person should be in Prison, 101. 
 
 Oi.ginal intention of Penna. Legislature frus- 
 trated, 22, 46. 
 
 Practising Physicians, Memorial in behalf of 
 Insane, - . 
 
 Pauperism caused by Insanity, 13. 
 
 Perversion of State Hospitals to use of "rich" 
 patients, 22-23. 
 
 Parsimony of Directors of the Poor, 19 ; In- 
 sane not sent to Asylums, 53. 
 
 Partisanship in appointments, Evils of, II. 
 
 Reforms, progress of, 14, 21. 
 
 Remedies proposed for present evils, 20, 91, 
 99, 100-102. 
 
 State, duty of the, to Insane, 13. 
 
 Stewards and Superintendents, Incompetency 
 of, 11, 19. 
 
 Special Hospital Department for Insane Con- 
 victs, 79, 86, 88. 
 
 Supervision of Insane Hospitals, the proper, 26. 
 
 State Lunatic Asylum, original object of 56 ; 
 provisions of, 100; "pay" patients ad- 
 mitted, 21 ; "poor" shut out, 21-25, 5°> IO °- 
 
 Superintendents of Hospitals for the Insane, 
 Letter of President of Board, 75-79. 
 
 Temporary Insanity, crimes during, 27, 30, 38. 
 
 Testimony, High character of, in this "Plea," 
 102. 
 
 Use of Prisons for Detention of Insane, evils 
 of, 20. 
 
 Warden Townsend, report, 74 ; Warden 
 Wright, Insane in Western Penitentiary, 
 
 34-37, 74- 
 What the State ought to do for the Insane, 
 11, 27, 29, 32; provide for all Insane Poor, 
 22, 54; Repeal the Act of 1861, 39; gen- 
 eral suggestions, 99-103. 
 
TO THE LEGISLATURE. 
 
 A PLEA 
 
 INSANE 
 
 IN THE 
 
 PRISONS AND POOR-HOUSES 
 
 OF 
 
 PENNSYLVANIA. 
 
 4y 
 
 PHILADELPHIA ■ 
 
 A. C. Bryson & Co., Steam-Power Printers, 607 Chestnut Street. 
 
 1.873. 
 
^ 
 
 BOARD OF PUBLIC CHARITIES 
 
 OF 
 
 - PENNSYLVANIA, 
 
 OFFICERS. 
 
 President : 
 
 GEORGE L. HARRISON, 
 Philadelphia. 
 
 General Agent and Secretary : 
 
 DILLER LUTHER, M.D., 
 Reading. 
 
 Members of the Board : 
 
 GEO. L. HARRISON. WM. BAKEWELL. 
 
 G. DAWSON COLEMAN. A. C. NOYES. 
 
 HIESTER CLYMER. GEORGE BULLOCK. 
 
 FRANCIS WELLS. 
 
 Statistician : 
 A. J. OURT. 
 
THE INSANE. 
 
 Insanity, in its relation to legislation and jurisprudence, 
 as well as to mental, moral and medical science, to its char- 
 acteristics and the mode of determining its presence, as well 
 as the method of treatment for its cure, to the best means of 
 protecting society against its violent or mischievous assaults, 
 as well as to its claims upon our human regard and sympa- 
 thy ; — is a subject of great difficulty, but, at the same time, 
 of commensurate interest and importance. 
 
 It is not easy to give a clear 
 
 DEFINITION OF INSANITY, 
 
 and when we attempt it, the danger is that we run into one 
 extreme or another, and either allow none to be insane but 
 the raving maniac, or make all insane who commit anything 
 foolish or wrong. But we need not attempt a definition 
 here. 
 
 Whenever the condition of the raving maniac is so far 
 approximated, and the reason sofar disordered or dethroned, 
 that the apprehension of the distinction between right and 
 wrong is lost, either wholly and in all relations, or partially 
 and in relation to some particular subjects, then insanity so 
 far exists as to demand to be specifically recognized in the 
 administration of justice, in the means to be provided for 
 the protection of society, and in determining the treatment 
 due to those who are its subjects. 
 
 The diagnosis of such cases we may leave to experts, and 
 the determination of the facts to the proper officials, j udges 
 or juries. We have nothing here to do with the question of 
 insanity as it is presented to the psychologist or to a petit 
 
jury or to a commission de hinatico inquirendo, or to a board 
 of medical examiners. In the cases to which we propose to 
 call attention, we assume the fact of insanity to be estab- 
 lished, and then, looking at the insane man afterwards, 
 
 WE INQUIRE WHAT IS TO BE DONE ? 
 
 But we must protest, at the outset, against a certain form 
 of mistaken feeling, which, we suspect, may very generally 
 exist : — we refer to the disposition to regard all persons, 
 who, being charged with crime, are acquitted on the ground 
 of insanity, as at least highly suspicious characters, to be 
 classed with criminals without reserve, because it happens 
 that the greatest criminals so often seek to evade the punish- 
 ment due to their crimes by setting up 
 
 THE PLEA OF INSANITY. 
 
 But this sweeping generalization is no more reasonable — 
 especially in the case of the poor, who have no powerful 
 friends to work for them, and cannot pay liberal fees for an 
 elaborate defence, than it would be to regard all men as 
 criminals and suspicious characters, who are charged with 
 any crime, however clearly their innocence may be demon- 
 strated ; for this plea of insanity is, by no means, the only 
 plea which is abused for the protection of knavery and 
 violence. 
 
 As to the specious modern plea of 
 
 either it must be absolutely rejected, or all administration of 
 penal jurisprudence must, consistently, be abandoned. Any 
 insanity, that can be recognized in law, must include a de- 
 rangement or loss of the rational faculties, and by such de- 
 rangement or loss it must be measured. A " moral insanity' 7 
 which consists merely in an abnormal violence of vicious 
 propensities, or of some particular vicious propensity, while 
 yet the light of reason remains unabridged, and the conscious 
 moral judgment is clear and distinct, is only another ex- 
 
pression either for diabolical wickedness, or for the ordinary 
 condition of human temptation. 
 
 But, waiving all such discussions, the subject which we 
 desire to present to the practical consideration of the Legis- 
 lature is this : 
 
 WHAT PUBLIC PROVISION" SHOULD BE MADE FOR THE CARE 
 
 including thpse who have been convicted of crime or 
 charged with its commission. 
 
 In order to a clear exposition and apprehension of the 
 subject which we thus desire to present, it will be advisable 
 and even necessary to analyze it, and to distribute the insane 
 into their several classes, with reference to the end we have 
 in view ; — to the public provision to be made for their safe- 
 keeping, care and treatment. With this view, the insane 
 may be distributed into 
 
 THREE DIFFERENT CLASSES. 
 
 1. Those who have done no violence or public harm — the 
 ordinary insane. These, again, fall into two sub-classes : 
 
 1. The harmless, or those from whom no harm is feared. 
 
 2. The harmful — those with manifestly dangerous and de- 
 structive propensities. 
 
 2. Those who have done harm — have committed crime — 
 while sane, but (1) have become insane before trial or con- 
 viction ; or (2) have become insane after conviction ; — " in- 
 sane convicts" in the strict legal sense. 
 
 3. Those who having done harm, having committed acts 
 of violence or mischief, have been acquitted of crime on the 
 ground of insanity. 
 
 And first, of the 
 
 INSANE WHO HAVE; DONE NO HARM. 
 
 Among these, the insanity may vary in character and degree 
 from some simple special hallucination down to complete de- 
 mentia. It may include both sexes and all ages ; may pro • 
 
6 
 
 ceed from a variety of causes, moral and physical, may be 
 recent or may have become chronic, may be more or less 
 violent or dangerous, may be curable in various degrees, or 
 may be absolutely incurable. These varieties may call for 
 various medical classifications and modifications of treat- 
 ment ; all which we leave to medical men to arrange and 
 determine. The classification which more directly concerns 
 us, viewing the subject in its relation to the demand for leg- 
 islative interposition or State aid, is 
 
 1. Those who have the means of support, and - * 
 
 2. Those who are dependent and destitute. 
 
 The first class can be cared for, either at home by their 
 friends, or at private asylums established for the purpose. 
 The only occasion for legislative interposition in their behalf 
 is, to see that they have proper guardianship to secure them 
 in the possession and right use of their property. And the 
 only occasion for such interposition for the protection of the 
 community in this regard, is, on the one hand, to see that 
 friends, who undertake their guardianship, do not neglect it 
 to the peril of the community, or abuse it to the detriment of 
 the sufferer ; and, on the other hand, to provide lest by the 
 criminal collusion or interested misjudgment of relations and 
 physicians, any sane person should, under certain circum- 
 stances of helplessness or exposure, be condemned to the 
 living death of incarceration, in some private hospital for 
 the insane : — a fate next in horror to that of being buried 
 alive. As to what legislation is required in relation to this 
 class, we have only to refer to the suggestions presented in 
 our last report. 
 
 But however important the claims of this class may be 
 upon the public consideration, they are as nothing in com- 
 parison with those of the other class of the harmless insane r 
 viz : 
 
 THE DESTITUTE*' AND DEPENDENT. 
 
 To these and their sad fate, we beg once more respectfully 
 but most earnestly, to urge the serious and special atten- 
 
tion of the Legislature. In our former reports, we have not 
 overlooked the claims of these helpless victims of the 
 sorest of human maladies ; but, in the discharge of our offi- 
 cial duty, we have, repeatedly, though hitherto, perhaps, 
 without sufficient fullness and emphasis, presented those 
 claims to the consideration of the Legislature, and we now 
 beg to refer to our 
 
 FORMER STATEMENTS AND SUGGESTIONS ON THIS SUBJECT. 
 
 In our report for 1870 : " More especially do we wish to de- 
 nounce the cruel wrongs which the insane suffer who are in- 
 mates of almshouses. These institutions are generally 
 wholly unsuitable for their care or even detention! or, if 
 suitable, are presided over by persons who are entirely igno- 
 rant of the needs of this class of the sick and infirm, and 
 whose administration is based on the crudest ideas of 
 mental disease; it is limited to the discovery of the most 
 available methods of preventing them from harming any- 
 thing or any person but themselves. We could instance the 
 most glaring abuses, not, as we believe, intentionally inflict- 
 ed, but the result of incapacity and ignorance. The time 
 has gone by when a disturbed imagination or a disordered 
 intellect should be held to have converted its human victim 
 into a distempered brute, whose home should be akin to the 
 sty or the stable, and whose lightest restraint should be perpet- 
 ual incarceration within the limits of a cell. These wrongs de- 
 mand prompt redress. No hospital for the insane should remain 
 without the constant supervision of a medical superintend- 
 ent. The stewards of almshouses are never selected from 
 any consideration of the needs of the insane." 
 
 The report was also accompanied with the following for- 
 mal resolutions of the Board. 
 
 Resolved, " That the Board of Public Charities, having 
 witnessed the evils which result from the connection of in- 
 sane asylums with almshouses, and believing that a wrong is 
 done to the insane by classing them with paupers, hindering 
 the public from estimating aright their claims to sympathy 
 
8 
 
 and remedial treatment, disapprove of such an alliance, and 
 believe that the best interests of this afflicted class of the 
 people, and the duty of the State, concur in the establish- 
 ment by the State, within a reasonable time, of sufficient ac- 
 commodations for the maintenance and treatment of all the 
 insane who may not be cared for in private hospitals." 
 
 Resolved, "That, in the judgment of the Board, all superin- 
 tendents of hospitals for the insane should be members of the 
 medical profession." 
 
 In 1871, the following, from our General Agent, was laid 
 before the Legislature : — 
 
 "In «ome of our prisons, cases of insanity are found 
 which ought to be transferred to hospitals established for the 
 maintenance and treatment of this class of persons. In the 
 course of my inspection of these institutions, as will be seen 
 by a reference to my report, instances of this character have 
 been noticed. It occasionally happens that insane persons 
 have to be, at least temporarily, committed to a prison ; but 
 few cases can arise where this necessity exists for any great 
 length of time. If they have been arrested for a crime, the 
 law has made ample provision for a proper disposition of 
 them, without a protracted confinement in a county jail, and 
 the sooner they are removed therefrom the better, whether 
 their incarceration is the result of crime or merely for the 
 purpose of safe-keeping. All the better feelings of humanity, 
 as well as a sound philanthrophy, concur in this sentiment. 
 <^" Among the various defects in our poorhouses, none are 
 more to be deplored than that which relates to the provision 
 made for the insane. Scarcely one can be mentioned which 
 is not deficient in this particular. The sexes, like the ar- 
 rangements in the other departments, are frequently allowed 
 to mingle together; few have suitable accommodations for 
 their comfort, and even in the best of them, there is a lack 
 of sufficient attendance. New buildings have been erected 
 in several counties, with a view to increased facilities for the 
 support of this class, but even here, in some cases, persons 
 have been selected who have no experience and but little 
 
qualification for the duties to which they have been as- 
 signed. 
 
 " The attention which I have given to this grave subject 
 induces me to believe that all case3 of an acute character 
 should be placed in one of the public institutions which have 
 been established in the State, City, or County, with a view to 
 their treatment. To place a recent case where no suitable 
 medical treatment or other proper attendance can be had, is 
 either simply to leave it to nature or facilitate its passage 
 into a chronic condition. To render an institution suitable 
 for the successful management of such cases, nearly all the 
 means essential for such a purpose are wanting. A proper 
 construction of the building, where a favorable classification 
 of the inmates can be maintained, where all the modern im- 
 provements for in-door comforts and amusements and out- 
 door exercise and recreation, and where competent medical 
 and other attendance can always be procured, are necessary 
 to attain the great object in view — a restoration to health 
 and a sound mind. 
 
 5 " For the most part all that can be expected in our county 
 almshouses is to secure such provision for the chronic and 
 incurable insane, as will meet the demands of a Christian 
 humanity. To confine them in close and badly ventilated 
 apartments, with scarcely any of the comforts which an en- 
 lightened philanthropy would suggest — a condition in which 
 they are too often found, — manifests such a failure of duty 
 as to bring odium and shame upon the civilization of the 
 age. 
 
 ^ In New York, a State institution was established in 
 1865 under the name of the Willard Asylum for the Insane, 
 for the reception, care and treatment of the chronic in- 
 sane poor, who were then provided for in the several county 
 poorhouses in the State. This institution is reported to be 
 in successful operation. Whether the plan of separating 
 this class of insane from the more acute and hopeful cases, 
 and keeping them in different institutions is best adapted to 
 the successful treatment of the insane population, is a ques- 
 
10 
 
 don much discussed among experts of the present day. The 
 medical superintendents of our insane hospitals, after a full 
 and able discussion of the subject, came to the conclusion, 
 that such a classification would be detrimental to the inter- 
 ests of both classes. With such able authority against such 
 a measure, I am not prepared to endorse the action of the 
 New York Legislature, but prefer to leave the subject for 
 further experience, and the candid consideration of philan- 
 thropists." 
 
 In 1872, the Board says in its report: "What the condition 
 of the insane is, as a general rule, in the poorhouses of the 
 State, we set forth clearly in our earliest report, and although 
 there has been since then a manifest improvement in their 
 condition and treatment, in several of the county establish- 
 ments, it is impossible, from the circumstances which charac 
 terize the whole arrangement, discipline, and government of 
 such institutions, that these invalids can be otherwise than 
 grossly neglected and foully wronged ; for, at the best, they 
 are merely confined in places of detention, under the guar- 
 dianship of a respectable overseer, who is wholly ignorant 
 of their disease, and of the means necessary for its alleviation 
 or its cure. We say, at the best. We hesitate to describe the 
 reverse of the picture. It would exibit a scene of as cheer- 
 less and uncomforted misery as the most bitter misanthrope 
 could desire to look upon. It is hardly fair to claim that we 
 have passed beyond the ignorance and barbarity of the mid- 
 dle ages, in our consideration and care of this class of unfor- 
 tunates, so long as we suffer the glaring abuses which are 
 prevalent in our midst to continue unredressed. 
 
 11 It is inconceivable to every reflecting mind, that abuses 
 can be heaped upon the defenceless victims of this saddest 
 of disorders, who should rather be the objects of the most 
 spontaneous sympathy and the most willing kindness and 
 consideration. The reasons that the chances of exposure are 
 too remote to be estimated, and, as in the case of the child 
 and the brute, that resistance is impossible, no doubt give 
 impunity to the foul wrong-doing which the insane frequently 
 
11 
 
 suffer. But the most fruitful cause of this evil is the incom- 
 petency of those who are set over them. It is an evil almost 
 irremediable, under the present system of appointments in 
 the county almshouses and county jails. It generally hap- 
 pens that these are based solely upon political considerations. 
 Some useful partizan must be rewarded or in some way 
 helped, and he is given an office, the duties of which he 
 feels in no wise called upon to discharge ; having earned 
 its perquisites by political services before he received it ; 
 and, feeling his position secure, is quite naturally led to 
 neglect his trust, by ignoring its most essential requirements. 
 Unfitness of the highest measure is the character of such 
 appointments generally ; and the victims in this case are a 
 class of defenceless invalids, whose circumstances appeal 
 with especial deserving to the highest claims of humanity and 
 justice. 
 
 " This mode of appointment should be abolished, rather 
 than extended, and we earnestly invoke the action of your 
 honorable bodies to revoke all legislation which favors it. 
 The institutions established by the State and the counties, 
 at so great a cost, and supported from year to year by large 
 expenditure of the public funds, extracted often by onerous 
 taxation, should be managed after a principle which will 
 secure those objects to accomplish which they were respect- 
 ively founded." 
 
 As to the statistics in regard to this class of unfortu- 
 nates, this Board hereby renews the offer made last year : 
 " We are prepared, upon a call of either branch of the 
 Legislature, to report upon the whole subject, stating the 
 numbers and condition of this class, how they are now 
 circumstanced, what proportion are probably chronic, and 
 what curable cases, what additional accommodations are 
 needed, and, if required, a scheme for realizing the demand 
 which is made upon the State for the complete fulfilment of 
 this imperative duty." 
 
 But as to the number of these helpless sufferers, these de- 
 pendent wards of the State, we may say beforehand, and 
 
12 
 
 without reference to statistics, that, if the number is some 
 thousands, their moral claim upon the State, as a matter of 
 simple duty on her part, is multiplied so many thousand 
 fold ; and if the number is small, there is the less excuse for 
 shrinking from the performance of that duty — for making 
 proper and complete provision for the care and treatment of 
 them all. 
 
 If these persons are to be allowed to live among us ; if 
 they are not to be left, some to starve and perish, and others 
 to spread their mischief far and wide, it is for 
 
 THE INTEREST OF THE STATE 
 
 that public provision should be made for their detention and 
 maintenance ; and if they are to be detained and supported 
 at the public expense, it is for the interest — the palpable, 
 pecuniary interest of the State, that they should have appro- 
 priate and comfortable accommodations, kind supervision, 
 and the most patient and skillful curative treatment. This 
 may be demonstrated in a few words. We may take two 
 facts as well ascertained, and we believe they are admitted 
 without a dissenting voice, (1) that under proper care and 
 skillful treatment — as in our best hospitals — about 75 per 
 cent, of recent cases of insanity will be cured in the first 
 six or twelve months; (2) in poorhouses, not more than 
 7 per cent, will be cured in the first year. Assuming these 
 premises, and making the expense of each patient in the 
 hospital twice what it would be in the almshouse, the gain 
 in the first instance, under hospital treatment, is simply 
 enormous. But this is not all. There are likely to be more 
 cures afterwards under the skillful treatment than under the 
 other. But suppose' there were not, and that all the remain- 
 ing cases were incurable, there would remain, on one side, 
 93 incurables to be maintained for life, and, on the other, 25 ; 
 and if the ratio of expense were still double, the result 
 would be in favor of hospital treatment as $50 to $93. That 
 is to say, the latter method would be a continual saving to 
 the State for many subsequent years of more than 46 per 
 
13 
 
 cent, per annum. Nor is this all. It must be remembered 
 that the greater part of 
 
 THE INSANE POOR OWE THEIR POVERTY TO THEIR INSANITY, 
 
 and not their insanity to their poverty ; and that, in losing 
 their power to support themselves, they have lost also, in a 
 very -large proportion of cases, the power to support families 
 more or less numerous, who thus become dependent upon 
 the public for their maintenance. The restored maniac re- 
 sumes not only the enjoyment of a man's consciousness, but 
 of a man's activity — the power of self-support ; and not only 
 this, but of supporting by his industry those dependent upon 
 him ; and every man who, by his enterprise, skill, and labor, 
 supports himself and his family, contributes also to the sup- 
 port of other men and their families. Such are the economi- 
 cal advantages accruing to the State from a proper treat- 
 ment of the insane poor, and their consequent restoration to 
 mental health. 
 
 But these unfortunate persons have claims upon the State 
 higher far than mere considerations of economy. They are 
 her wards, and she is bound by the dictates of 
 
 SIMPLE JUSTICE AND IMPERATIVE DUTY 
 
 to secure to them that humane, watchful, and patient care, 
 and that skillful treatment, which will give the best pro- 
 mise of their speedy restoration. If she chose to put them 
 out of the way, like noxious beasts, or to let them alone 
 to starve and die, she might say that charity and philan- 
 thropy were no part of her mission, and ask who made her 
 their keeper ? But when she has laid her hand upon them, 
 put them in places of restraint and detention, and taken 
 control and charge of them, she has made herself their keeper, 
 and has bound herself so to treat them, as shall most conduce 
 to their future well-being, as well as to her own. 
 As to their actual 
 
 CONDITION IN OUR COUNTY POORHOUSES OR PRISONS, 
 
 we do not propose to weary the patience or offend the sensi- 
 bilities of the honorable members of the Legislature by the 
 
u 
 
 renewed recital of the more than three times thrice told tale 
 of the woes and sufferings of this sorely stricken class of 
 our fellow-citizens. That the story, with all its touching 
 and terrible details, ranging from the intensely sad to the 
 unspeakably horrible, should have been so often repeated, 
 and yet the evil remain to so large a degree unremedied, 
 instead of exciting our impatience, should raise our shame, 
 and provoke us to immediate and energetic action. The 
 story can never grow old or worn, as long as the subject- 
 matter itself remains a fresh and living reality. There is 
 
 BUT ONE VOICE IN THIS CASE. 
 
 No intelligent person has ever made a general visitation of 
 the prisons and almhouses of this State without being 
 startled and almost overwhelmed by the forlorn and hopeless 
 and sometimes horrible condition of their insane inmates. 
 Those who some years since made a similar visitation in 
 the State of New York pronounced their condition " de- 
 plorable," and that State forthwith determined to apply an 
 effectual remedy. The impressions made upon this Board by 
 similar visitations in our own State have been laid before the 
 Legislature in our reports from year to year. The shocking 
 and sickening revelations, so graphically set forth in the me- 
 morial of Miss Dix, presented to the Legislature of 1845, are 
 not yet obsolete. There have been some improvements since 
 made in some of these places. In the Philadelphia Alms- 
 house, since then, there has been a great reform ; and in 
 several other counties, well constructed hospitals for the sick 
 and insane have been built ; but, with one or two exceptions, 
 there is no special medical supervision or paid attendance at 
 all. But in most parts of the State that condition remains 
 now substantially the same as then. Indeed, without 
 
 A TOTAL EEVOLUTION OF THE SYSTEM 
 
 it is impossible greatly to improve it. There may be grave 
 faults in the management of these poorhouses, some of which 
 might be remedied, and others are probably incapable of 
 
15 
 
 remedy; but the great fault — the fundamental cause of the 
 evil, is in the system itself. If the administration were made 
 as perfect as human infirmity allows, if the best superintend- 
 ents or wardens, and the most faithful attendants were secured, 
 while the evil might be mitigated, it would remain substanti- 
 ally the same, until the system itself is changed. The 
 remedy is not reform but revolution. 
 
 We take leave to insert here the report made in the course 
 of the present year by a member of this Board, of his per- 
 sonal inspection of one of our county poorhouses. 
 
 " With respect to the strictly pauper department of this 
 almshouse, it bore a resemblance to other establishments. 
 There was a scene of listless idleness and uselessness, without 
 any superintending care. My attention was particularly di- 
 rected by the general agent to the hospital for the insane, which 
 was a separate building, upon the same ground with the other 
 departments of the almshouse. I found these inmates suffer- 
 ing for the want of almost every attention and consideration 
 which are necessary to make life, even to the strong and 
 hardy, tolerable. They have sufficient food, such as it is, at 
 stated intervals, and the cells they occupy are furnished gen- 
 erally with a rough bed and bed-clothes. These cells, too, 
 are tolerably clean, for the cleansing of an establishment such 
 as this, can be done without much difficulty, because there is 
 always a sufficient number of paupers to do the work. W here 
 the insane patients are considered violent or even disagree- 
 able, it often happens that their cells are either neglected, or 
 forcible measures are resorted to for the purpose of over- 
 coming their interference, while their cells are being cleaned 
 by the paupers. Though the board had previously called 
 the attention of the directors of this institution to the im- 
 perfect ventilation of the insane hospital, I found that even 
 the means available for correcting the cause of this com- 
 plaint, had been very imperfectly attended to. The conse- 
 quence was that the atmosphere of most of the cells had 
 become so vitiated and offensive that any person accustomed 
 to the open air, would necessarily have fainted upon remain- 
 
16 
 
 ing within the apartment for a moment of time. The in- 
 mates seemed to have become used to this noxious atmos- 
 phere, and they did not complain of it. On the contrary, 
 the only complaint on their part was that made by an old 
 woman, when her window was lowered a little to admit the 
 fresh air. 
 
 THE RESPONSIBILITY FOR THIS CHRONIC NEGLECT OP 
 THESE CLASSES 
 
 begins with the public and ends with the humblest attendant 
 of the institution. So lost to all sense of decency have the 
 insane in this hospital become, by reason of the failure on 
 the part of those in authority to encourage a proper appre- 
 ciation of self-respect among the inmates, that their habits are 
 precisely like those of a brute. Consequently many of them 
 are kept naked in their cells, from which they are drawn 
 out each morning to be cleaned and their rooms put in order. 
 The filthiest part of the litter — for their bedding consists 
 wholly of straw — is then removed and its place supplied with a 
 similar quantity of the fresh material ; when they are returned 
 to their disgusting dens, there to pass another period of 
 solitary wretchedness in an atmosphere whose odor exceeds 
 in offensiveness, anything which the imagination can con- 
 ceive. Through the gradual enfeebling of the higher attri- 
 butes of their natures, some of these people come to be 
 regarded by the other inmates as mere animals, and the 
 young girls of the establishment look upon these naked men 
 simply as they would look upon a horse or a hog. I am 
 told that frequently two of the young female inmates of this 
 insane hospital are called upon to clean these men each morn- 
 ing as they are drawn out from their cells." 
 
 The following statement of the condition of the insane in 
 another poorhouse, is given on the well-sustained authority 
 of another member of the Board. 
 
 " In February last a visit was paid this almshouse, and an 
 insane inmate was seen, — a young women over twenty years 
 of age, whose whole dress consisted of a thin chemise with 
 
17 
 
 short sleeves, a single skirt, and a pair of shoes. When 
 brought before the visitors a borrowed cloak was thrown 
 over her shoulders. She was blue with cold and utterly 
 filthy in person. Her cell had the appearance of having 
 undergone a recent hasty washing, but was pervaded with 
 an odor loathsome in the extreme. On the day of this visit 
 the thermometer fell to 14 degrees." 
 
 "In March another visit was paid to the institution by 
 several gentlemen in a body. Only one portion of the build- 
 ing was visited, which is supposed to be devoted exclusively 
 to women. In one cell was a young woman, the one already 
 referred to. Her cell was without any furniture whatever, 
 her bed consisted of one blanket, her clothing a ragged 
 chemise open to her waist, and one scanty skirt and a pair of 
 shoes. She was indescribably unclean, and alive with ver- 
 min. Her cell reeked with a sickening odor, the result of a 
 total absence of all conveniences for cleanliness. She shivered 
 with cold, while in the presence of her visitors ; the ther- 
 mometer standing, at the time several degrees below the 
 freezing point. 
 
 "Opposite to the cell, which we have very faintly described, 
 was another. The short day had already faded into dusk, 
 and as the light was thrown through the little aperture in 
 the door, it fell upon two wretched women, both of whom 
 were absolutely without a single garment to cover them. 
 One of the poor creatures sat crouching in the corner with a 
 small blanket drawn across her shoulders, while the other 
 was crawling on all fours on the floor, without even this 
 poor apology for any remnant of human decency ! There was 
 not a particle of furniture in the cell; and there, on this 
 wintry March night, in an atmosphere which the witnesses 
 declare to have been utterly horrible, were these two human 
 beings, brought down far below the level of our domestic 
 brutes. 
 
 "In an adjoining cell the visitors found a man lying on am 
 old mattress, the only sign of furniture which they saw in 
 either of the rooms inspected. They were informed that the 
 
 [2] 
 
18 
 
 inmate was a woman ; but upon one of the gentlemen calling 
 to him, he sat up, and it was seen that it was a man. The 
 attendant with some confusion explained that he must have 
 been brought in while he was away. 
 
 " We found the female insane department in a shocking 
 condition ; so bad that it would be impossible to give a de- 
 scription of the place on paper. In some cells there were 
 two or more women confined ; some without any clothing, 
 lying on the floor, without mattress, carpet or any thing else, 
 except an old government blanket. The place had a horrible 
 putrid odor. 
 
 "We examined one woman who was quite young. I was 
 afraid to go near her, as she seemed covered with vermin. 
 We were all much shocked by the visit, and I think I shall 
 remember it as long as I live." 
 
 And the General Agent reports the following amongst 
 many similar instances of abuses and neglects in the same 
 establishments : 
 
 "Insane totally neglected, morally, physically and medi- 
 cally ; less attention is given to them, than would be given 
 to the lowest animals; four are incapable of self care, con- 
 fined in filthy cells ; one, a female, has great neighborhood 
 notoriety, from sad incidents connected with her history; 
 known as an intelligent, esteemed and attractive young lady, 
 the daughter of a well-known inhabitant of the neighbor- 
 hood, she fell a victim to the arts of the seducer. Insanity 
 is alleged to have been caused by her disappointment. This 
 occurred twenty-one years ago. The sad case is rendered 
 still more painful by her present forlorn condition. A bed 
 of straw, upon a damp dirty floor, into which the external 
 light can find no entrance, is the only furniture. A seat, a 
 chair or a bench, has apparently never been furnished ; the 
 consequence of which is that the muscles of the lower ex- 
 tremities, from the cramped position in which she was always 
 found, have become permanently contracted ; so that the 
 only movement of which she is capable, is one similar to 
 that of a frog." 
 
19 
 
 "An unusually large number of insane; many of chronic 
 form, but quite a number of strongly marked cases, who 
 were confined, and had been chained to the floor until re- 
 leased by rny direction. A young girl of seventeen years of 
 age confined in a gloomy cell; since removed by my request 
 to the State Hospital, where she is gradually being restored." 
 
 " Twenty-two insane, twelve are kept in close confinement, 
 some in chains ; one always chained to the ceiling to prevent 
 him from tearing his clothes ; some entirely nude ; at least 
 six with straw litters ; not one of the twelve was ever removed 
 into the open air. All confined in apartments opposite each 
 other, a narrow corridor extending between them. The effect 
 of this close proximity was, to make the day and night 
 hideous, with the distressing shrieks and yells of the wretched 
 and mal-treated madmen." 
 
 11 Eight insane, one of whom handcuffed, one hobbled; one 
 female confined to her room." 
 
 11 One hundred and thirty-five inmates, four blind, one palsied, 
 seven idiots; seven cells in the basement, with insane in each, 
 in a revolting condition." 
 
 " Twenty insane ; of these about eight were confined, not to 
 their uncomfortable cells only, but restrained by iron fetters, 
 long after the necessity had passed away. These were re- 
 moved at my instigation and the doors of their cells were 
 opened, to give them the benefit of the open air and exercise, 
 with decided improvement in their condition." 
 
 There are two difficulties in the way of checking 
 
 THESE AND SIMILAR ABOMINATIONS: 
 
 One is the unwillingness of the Directors of the poor to 
 make expenditures for the comfort and well-being of the 
 classes committed to their charge. They employ a steward 
 whose principal requisite is that he shall be a good farmer, 
 and whose attention must be given mainly to the farm of the 
 institution, which may be, in extent, from 100 to 400 acres. 
 As a consequence, the care and supervision of the human 
 
20 
 
 beings, over whom this " steward" is placed, are lost sight of r 
 to a great degree, in the apparently more important business 
 of the farm, and are generally committed to the oversight of 
 the paupers themselves. This is one evil. The other is ap- 
 parent in the very unsuitable arrangement and construction 
 in which the most helpless inmates — we mean the insane — 
 are placed. In these structures it is a rare thing to find the 
 sexes at all adequately separated, and, generally, they have 
 no airing grounds, or even yards, to which the patients can 
 repair and refresh themselves during the day. Therefore, 
 they must remain in seclusion within their cells, from the 
 beginning to the end of the year, existing in an atmosphere 
 of great impurity, and constantly deteriorating in their men- 
 tal and physical condition. 
 
 In order to make the work of the Board effective, a cer- 
 tain amount of 
 
 EXECUTIVE POWER 
 
 should be granted to it ; as has recently been conferred upon 
 the New York Board of Public Charities, by the Legislature 
 of that State. The public seem to be satisfied with 
 
 HOUSES OF DETENTION: 
 
 To get the various classes of unfortunates out of sight, 
 seems to be the main object. The consequence is, that, as a 
 general rule, the 
 
 PRISON IS BETTER THAN THE POORHOUSE, 
 
 as a receptacle for the insane. 
 
 We may lay it down as a principle, at length become too 
 plain to be controverted ; indeed as a point admitted on all 
 hands, that poorhouses are not, and cannot be made fit places 
 for the care and treatment of the insane, That they may 
 receive proper treatment with any hope of recovery, they 
 must be placed in hospitals or asylums, especially constructed 
 and fitted up for their accommodation, with cheerful scenes 
 within and cheerful scenery around, with skilled medical 
 supervision and carefully selected and well trained attend- 
 
21 
 
 ants; none of which conditions can be commanded in, or in 
 connection with an ordinary county poorhonse. In con- 
 nection with so large an establishment as the Philadel- 
 phia Almshouse, where are gathered nearly one-half of all 
 the pauper population of the State, a separate hospital of the 
 required character may be provided and supported ; and we 
 commend the humane and earnest spirit which is engaged in 
 two or three of the larger communities, as, for instance, 
 Berks and Lancaster Counties — in making adequate provi- 
 sion for their insane. But in connection with the smaller 
 almshouses of the several counties, and still more in connec- 
 tion with the township arrangements for the care of the 
 poor, such separate hospital accommodations are out of the 
 question. They will never be established, and, if they were, 
 they could not be maintained^ 
 
 It will naturally be asked here, whether the State has not 
 already established one or more 
 
 GENERAL HOSPITALS FOR THE CARE OF THE INSANE, 
 
 with a view of meeting this precise difficulty ? She has; and 
 established them, professedly, for this very class of the 
 insane, whose case we are now considering — for the insane 
 poor, the insane who had been or are liable to be, gathered 
 into the almshouses, or sent for safe-keeping to the prisons, 
 in the several counties. The State has established these 
 hospitals at no little expense ; 
 
 BUT A VERY SMALL PERCENTAGE OF THE " POOR" INSANE 
 ARE NOW IN THEM ; 
 
 the great mass still remain in their former wretched, forlorn 
 and hopeless quarters, a spectacle of misery or a butt of de- 
 rision ; and an element of disturbance and irritation to the 
 rest of the inmates. To the hospital at Harrisburg there 
 were committed by the public authorities and courts during 
 the year 1872, sixty-one poor patients and one hundred and 
 thirty-eight " paying" patients were sent there by " friends." 
 And of the four hundred and eight remaining on Dec. 31, 
 1872, there were one hundred and seventy-nine supported by 
 
22 
 
 " public authorities" and two-hundred and twenty-nine by 
 "friends of patients." Again, of the one hundred and six- 
 teen patients committed to this hospital during the nine 
 months ending Sept. 30, 1873, eighty-four were " paying" and 
 only thirty-two public or indigent insane" patients. 
 
 Now it is manifest from the memorial of Miss Dix, in 
 response to which the State Hospital was established, and by 
 the express words of the law of 1845, coeval with its estab- 
 lishment, that the original design of the hospital was what 
 that of any such hospital ought, in all reason, — to be, to pro- 
 vide for 
 
 THE INSANE POOE. 
 
 The law, section 25, declares that, in order of admission the 
 "poor" shall have precedence of the "rich," (defined through- 
 out the act "paying patients") and while the finances of the 
 State do not permit ample provision for all cases of insanity, 
 recent cases shall have precedence over cases of long stand- 
 ing. If, under this law, the whole capacity of the hospital 
 were devoted to the "poor," no objection, perhaps, could be 
 made to sending away the incurable, after a reasonable period 
 of trial, to make room for recent cases ; although it does not 
 appear that such was the intention of the law, which seems 
 to have merely laid down a " rule" to govern the order of 
 admission to vacancies as they should be found to exist. 
 But how should it happen that a majority of the inmates 
 of this State institution should be " paying" patients ? 
 
 How happens it that during the year 1872, sixty-nine per 
 cent, of the patients admitted were paying patients, and only 
 thirty-one per cent, public patients, and of those admitted 
 during the nine months ending Sept. 30, 1873, the paying 
 patients should increase to seventy-two per cent, with a 
 corresponding reduction of public patients to twenty-eight 
 per cent. Again, that at the close of the year 1872 this 
 hospital should be occupied with fifty-five per cent, of pay- 
 ing patients, and at the end of Sept. 30, 1873, with fifty six 
 per cent, of the same class ? 
 
23 
 
 Is it said that the incurables are sent away to make room 
 for recent cases. But upon what authority? And, besides, 
 if those sent to the hospital by their friends are recent and 
 curable cases, in a larger proportion than the others, how 
 comes it that a smaller percentage of these are discharged 
 during the year ? Or, if they are incurable in a larger pro- 
 portion than those committed by the public authorities, why 
 are they not sent away in still greater proportion than the 
 others, instead of being discharged in still less proportion ? 
 Or, rather, why are they not all sent away; or rather kept 
 away, as long as any of the others remain unprovided for ? 
 We understand that, as a general rule, those committed to 
 this hospital by the county authorities, if not " speedily" 
 curable, are sent back to the helpless and hopeless life-doom 
 of the poorhouses. On the other hand it is evident that 
 "paying" patients may stay as long apparently as their 
 comfort and the convenience of their friends require, and 
 their means suffice for their support. Now we cannot but 
 regard all this as a gross public wrong. The State has 
 erected hospitals, 
 
 NOT FOR THE "RICH," BUT FOR THE "POOR;" 
 
 or, for the rich only when the poor should all be provided 
 for. There is no need, even if it were right, that the State 
 should erect hospitals at the public expense and out of the pub- 
 lic taxes, for the accommodation of the rich ; they can or they 
 will provide hospitals for themselves, including persons of 
 moderate means as well as of considerable wealth. We 
 maintain that the entire capacity of the State hospitals 
 should be appropriated to the poor patients, before any such 
 are refused admission or sent away under any pretext what- 
 ever. The hospital at Dixmont, though a private charitable 
 corporation, and only aided by the State, comes much nearer 
 to our idea of the duty and the intention of the State in this 
 regard, than that at Harrisburg. At the former, there re- 
 mained at the close of the year 1872, only 117 private 
 patients out of a total of 446 ; and on Sept. 30, 1873, only 
 
24 
 
 23.89 per cent, of "paying" patients, or 108 out of a total 
 of 452. 
 
 And, again, of the 116 patients received into the State 
 Hospital at Ilarrisburg, daring the nine months, ending Sep- 
 tember 30, 1873, 84 of them or nearly three-fourths were 
 "paying" patients; while, for the same period, out of 173 
 patients admitted to the hospital at Dixmont, only 72 or 
 about two fifths were "paying" patients. In other words 
 30.79 per cent, more private patients were received into the 
 State Hospital for the " insane poor," at Harrisburg, than 
 into the private hospital for the insane (aided by the State) 
 at Dixmont. 
 
 It may be said, and perhaps with truth, that in many 
 cases, the friends of insane patients, who can furnish the 
 smaller sum required at the State Hospital for their support, 
 would not be able to meet the heavier charges of a private 
 asylum; and that, therefore, such insane patients must be 
 thus admitted at the hospital or sent to the poorhouse. This 
 idea seems highly plausible, and might at first receive favor 
 from inconsiderate persons. But upon reflection it clearly 
 appears unsound in theory ; and "upon experience it proves 
 highly objectionable. If these patients are poor, why should 
 precisely this class of poor patients have precedence of those 
 who are still poorer ? And if they are rich — as by the terms 
 of the statute all " paying " patients are, then the law ex- 
 pressly gives the poor the precedence over them. Besides 
 all these 
 
 MIDDLE MEASURES OF GIVING PUBLIC AID TO THE POOR, 
 
 are found in practice to be dangerous, and liable to great abuses 
 on the part both of the recipients and t.he almoners of the 
 public bounty. This case has proved itself, in our judgment, 
 no exception to the general rule, 
 
 It may be suggested that it has been thought well to have 
 some paying patients in order to give 
 
 RESPECTABILITY TO THE INSTITUTION. 
 
 We can scarcely listen to the suggestion with patience, or 
 
25 
 
 answer it with calmness. If all the poor were already pro- 
 vided for and accommodated, the suggestion might pass ; al- 
 though we should not make it. We should never propose 
 that the State should tax herself to furnish hospital accom- 
 modations to the rich in any case, whether by way of gratu- 
 ity or of profitable speculation. But that is not the case. 
 The poor are not all enjoying the care and treatment of tfie 
 hospitals ; and shall they by the hundred and the thousand 
 continue to languish into idiocy, or rave out their miserable 
 lives in the cells of prisons with malefactors and felons, or in 
 the more foul and wretched and hopeless receptacles of county 
 poorhouses, in order that the hospital, which receives a few 
 score of them, may be respectable, and its superintendent and 
 officers may not find themselves in charge of an institution 
 of mere paupers ? 
 
 But, finally, it may be said, as a partial explanation of the 
 great comparative rapidity with which the poor who are 
 committed to the hospital are sent away, that a large part of 
 them — those committed by the courts — are 
 
 PERSONS CHARGED WITH CRIME 
 
 who have been acquitted on the ground of insanity. Under 
 the present law this explanation must, to a certain extent, be 
 accepted ; but as these persons do not fall under the general 
 class of the insane now under consideration, viz : those who 
 have done no harm, and are free from any charge of crime, 
 their case is reserved for consideration in the sequel. 
 
 In the class of harmless insane, we include, it will be re- 
 membered, all those who are legally charged with no acts of 
 mischief, violence or crime ; as well, therefore, those, from 
 whom such acts may be apprehended, as those, who, from 
 their apparently gentle and inoffensive habits, are the objects 
 of no such fear. Whether there be any of the insane so en- 
 tirely harmless, that they can be trusted with absolute con- 
 fidence, needing no special watch or restraint, some have 
 doubted, and we need not decide or discuss the question ; for, 
 in our clear judgment, there is no good reason why those who 
 

 26 
 
 may need greater degrees of watchful care and restraint* 
 should not be treated in the same establishments with those 
 who may need less, especially as the distinction is merely one 
 of varying degrees. Even those who exhibit the greatest de- 
 velopments of insane cunning for mischief, or are subject to 
 the fiercest paroxysms of violence, or even of homicidal im- 
 pulse, may be kept with proper classifications and internal 
 arrangements, in the same institution with patients of the 
 greatest gentleness and quietness of temper and demeanor. 
 At all events, the proper hospital, with its more skillful su- 
 perintendence and its more varied and thorough appli- 
 ances, is, of all others, precisely the place for the former 
 class ; for in poorhouses they can scarcely be kept at all, ex- 
 cept as wild beasts ; and prisons are not places to which jus- 
 tice or humanity can doom the innocent and helpless mad- 
 man, however violent or dangerous. Yet are not such poor 
 defenceless unfortunates, if adjudged too dangerous to go at 
 large, and pronounced not curable, habitually sent to rave 
 and rot in the foul dens of a poorhouse, or in the dungeons 
 of a prison, there to be classed with robbers and murderers ? 
 The importance of having the State Hospitals for the In- 
 sane, subjected in this and in other respects, to the 
 
 SUPERVISION OF SOME PARTY NOT CONNECTED WITH 
 THEIR IMMEDIATE MANAGEMENT, 
 
 so that the rights of the poor may be more surely, steadily, 
 and systematically protected, we reserve for fuller considera- 
 tion further on. But we cannot omit to observe here, that 
 the State hospitals for the insane poor were not devised 
 originally at the suggestion of experts ; but upon the pains- 
 taking investigations and earnest petitions of Miss Dix and 
 other benevolent persons ; and it is highly reasonable that 
 their management, particularly as regards the receiving and 
 discharge of patients, should be placed under the visitatorial 
 power of disinterested parties, concerned only in securing the 
 good to be derived from them for the defenceless insane poor. 
 It is not to be supposed, however, that, under any manage- 
 
27 
 
 ment, sufficient provision has yet been made in our State 
 hospitals for 
 
 ALL THE INSANE POOR IN THE COMMONWEALTH. 
 
 Such provision ought to be made with all possible de- 
 spatch. To propose to make it is no wild or visionary or 
 extravagant scheme. It can be made in Pennsylvania as 
 well as in New York. And we have already shown, that if 
 we are to take care of the insane poor at all at the public ex- 
 pense, the most economical method, irrespective of the 
 demands of humanity, is to gather them into well-managed 
 hospitals, instead of leaving them to linger out a miserable 
 existence, hopeless of restoration, in prisons and poorhouses. 
 
 We proceed now to consider the case of the two other 
 classes of the insane. 
 
 II. Those who, while sane, have committed acts of vio- 
 lence or crime, but have either 
 
 1. Become insane before arraignment, and so have never 
 been tried ; or, 
 
 2. Have become insane after conviction — insane convicts. 
 
 3. Those who were insane at the time of committing such 
 acts, and who, therefore, have been acquitted of crime on the 
 ground of their insanity. These fall into various subdivi- 
 sions to be mentioned hereafter. 
 
 These two classes (1) those who stand charged or convict- 
 ed of committing acts of violence or mischief while sane; 
 and (2) those, who, although charged with crime for the com- 
 mission of such acts, have been acquitted on the ground of in- 
 sanity at the time of their commission, we place together, not to 
 identify or confound them under any such denomination as 
 "criminal insane," but rather in order the more emphatically 
 to contradistinguish them. 
 
 We begin with the case of the first of these classes ; and 
 the question is, what disposition is to be made of the insane, 
 who stand charged with, or have been convicted of, crime. 
 
28 
 
 And first of those who may, with some propriety, be called 
 " criminal insane," i. e, those who are charged with the com- 
 mission of crime while sane, but who have become insane 
 before arraignment ; and who, consequently, have never been 
 convicted or tried. Their case is a somewhat delicate one 
 in a legal as well as a moral point of view. According to 
 legal principles, it would seem that their detention cannot be 
 regarded as a punishment, for they are 
 
 because they are charged with crime, .nor until they are 
 found guilty upon trial and proof; but in their present con- 
 dition they are not capable of pleading, and, of course, cannot 
 be put upon their trial. Both as accused and as dangerous 
 persons, they may properly be kept under detention and 
 restraint ; but neither in fact nor in feeling, are they to be 
 classed with felons or looked upon as tainted with crime, 
 or as suffering a penalty. The fact of their present lunacy 
 may be ascertained and established without the intervention 
 of a jury, by the court itself, or by a commission appointed 
 for the purpose ; but their having committed the criminal 
 acts laid to their charge, and having committed them in a 
 sound state of mind, can be ascertained and determined only 
 by the intervention and verdict of a jury ; and any investi- 
 gation or inquiry in that direction, instituted without such 
 intervention, and without a hearing of the defendant, must 
 necessarily be merely ex parte. And it is but the natural 
 course of things, when a poor, friendless man, in his 
 squalor and raggedness, is arraigned before a court, under 
 the charge of some atrocious crime, accompanied with the 
 confident allegation that, whatever may be his present mental 
 condition, he was sane up to and at the time of the com- 
 mission of the acts charged against him — it is but the natural 
 course of things, that such a man is easily believed and 
 presumed to be guilty ; and as society must at all events, be 
 protected from his violence, whether sane or insane, he is 
 consigned, side by side, with the convicts and felons, to the 
 safe keeping of a prison cell. 
 
29 
 
 But surely this ought not to be so — in all reason it ought 
 not to be so. The State owes it to her own self-respect, to 
 her own sense of justice, if not to her sentiments of human- 
 ity, not to consign to the odium and punishment of crime, 
 one of her citizens whose guilt has never been duly ascertained. 
 What then shall be done with such persons? That is a se- 
 rious question, and we shall endeavor to answer it. But, for 
 the present, we only say, what is clear in the face of the 
 matter, that they Ought 
 
 NOT TO BE PLACED IN PKISON, 
 
 or in any department of a prison ; and they ought to be 
 placed where they not only will be effectually restrained 
 from doing harm, but where they will have the best curative 
 treatment, and the best prospect of being restored from their 
 fearful malady. 
 
 THE CASE OF INSANE CONVICTS, 
 
 that is, of those who become insane after conviction, and 
 while undergoing the punishment of crime, is different from 
 the foregoing in several important particulars. For these 
 the question of guilt is presumed to have been duly ascer- 
 tained, and that they are suffering a just punishment. But 
 in the midst of it, the mind loses its balance, and they be- 
 come lunatics. Supposing this point to be ascertained and 
 admitted — and the feigning of madness is pretty easily de- 
 tected — then they are no longer responsible beings ; they are 
 no longer proper subjects of prison discipline. It is utterly 
 unreasonable and unjust, as well as inhuman, to continue 
 
 TO INFLICT PUNISHMENT ON A MANIAC, 
 
 who neither knows the reason, nor the end, nor the idea of 
 rightful punishment. It is as absurd as to inflict indignities 
 or violence upon the dead body of a criminal ; it is even 
 more malignant, for the dead body has no sense of pain, but 
 the maniac has. 
 
 Besides, the State owes it to these helpless beings, who, 
 while under her enforced control and guardianship, have 
 
30 
 
 been smitten down with the most terrible of maladies — owes 
 it to them as a mere matter of right, to give them the most 
 skillful and promising curative treatment in her power, to 
 save them, if possible, from confirmed and permanent 
 mania or imbecility. To suffer a convict to become, from 
 neglect, an incurable lunatic is worse, unspeakably worse 
 than to dismiss him, at the expiration of his sentence, bereft 
 of sight or hearing, or crippled by loss of limbs, or under 
 some chronic bodily disease, in consequence of a reckless 
 neglect of the proper medical care and treatment at the 
 proper time. These irremediable losses and disabilities 
 formed 
 
 NO PART OF HIS SENTENCE. 
 
 The State is bound, so far as she reasonably can, to dis- 
 charge the convict, at the close of his term of punishment, 
 in at least as good a condition — mental, moral, and physical 
 — as that in which she received him. And, for failing in 
 this, it will not do to seek an excuse in the small number, or 
 the unworthy character of those who may suffer the wrong. 
 The State, the very fountain of justice, she who takes it 
 upon herself to punish wrongs, is bound to do no wrong to 
 even one, and that one the meanest and most undeserving of 
 her citizens. If there are but few convicts who need surgi- 
 cal or medical treatment, whether for bodily or mental 
 diseases, so much the less excuse is there, at least on the 
 ground of economy, for neglecting them. 
 
 Nor is this all. Even of those who are strictly insane 
 convicts in the legal sense, and it is of those only we are 
 now treating — i.e. of those who have been convicted of 
 crime, as having been sane both at the time of the com- 
 mission and the conviction, but being found insane after- 
 wards — even of these it would be easy to show that by far 
 the larger number were probably 
 
 INSANE BEFORE CONVICTION, AND EVEN AT THE TIME OF 
 THE COMMISSION 
 
 of the alleged offence. It is the rich and respectable offender, 
 who has friends and money, who can fee lawyers, who can 
 
31 
 
 procure and array a crowd of witnesses in his behalf, who 
 can protract his trial, clog the wheels of justice, and make 
 interest by his audacity — it is he who too often escapes 
 from merited punishment under a mistaken verdict of in- 
 sanity. But 
 
 who has been seized in some terrible act of atrocity, though 
 committed under the impulse of actual insanity, is swiftly 
 arraigned; and having nobody of any consideration or in- 
 fluence, who personally cares for him, to stand by him or 
 advise him ; without testimony, and, from his very unsound- 
 ness of mind, perhaps, neither caring or knowing how to 
 procure it, the evidence against him ample and clear, his de- 
 fence provided by the court being merely professional and 
 perfunctory, and, of course, under such circumstances, both 
 hasty and imperfect, 
 
 HE IS FORTHWITH CONVICTED AND SENTENCED TO THE 
 PENITENTIARY OR THE GALLOWS. 
 
 That this is no fancy picture, but a familiar matter of fact, is 
 established by an abundance of proof. The uniform testi- 
 mony of those who have charge of jails and penitentiaries, is, 
 that almost all the so-called insane convicts under their 
 charge were 
 
 and so were almost certainly insane when tried, and probably 
 so when they committed the offences for which they were 
 convicted. 
 
 Dr. Compton, in charge of the State Lunatic Asylum of 
 Mississippi, says : M My own experience with insane criminals 
 leads me to feel rather charitable towards them. I have 
 had only three, and there have been circumstances connected 
 with each of these cases, which lead me to think they were 
 insane before committing the crime." 
 
 Of the eighteen prisoners reported insane in the Eastern 
 
32 
 
 Penitentiary in 1852, the Inspectors declare that "three had 
 been placed in the penitentiary for safe keeping only, and 
 
 and had already been confined in its cells, one nearly three, 
 one over three, and one over seven years ! Eleven of the 
 remaining fifteen were more or less insane when they were 
 received into the penitentiary, two of the others became so 
 a few months after, one a year, and one about four years 
 after his reception. It will thus be seen that a large pro- 
 portion were insane in a greater or less degree when first 
 sentenced to the penitentiary ; and all but one or two of the 
 rest developed it shortly after. The observation and ex- 
 perience of the Inspectors have convinced them that the 
 commission of crime is more frequently connected with 
 mental disease than courts and juries (far less the public,) 
 suspect : — hence the necessity of a prompt removal of all, 
 who are found to be thus afflicted, to a place where proper 
 treatment may restore them to mental health, and, as a con- 
 sequence, to moral rectitude." Nor did this state of affairs 
 cease at a later period. In their report for 1862, the Inspec- 
 tors repeat that " There are yearly received into this Peni- 
 sentiary insane convicts, insane or of diseased mental 
 condition, on their admission." And again, in 1863 : " The 
 Inspectors again ask the Legislature to require the State 
 Lunatic Asylum to take insane convicts, or to make an ap- 
 propriation for their medical treatment in the Penitentiary. 
 When so many convicts are known to be insane on reception 
 into this prison, this course is wise, humane and necessary." 
 There are now about twenty of these " insane criminals " 
 in the two penitentiaries, all of whom, according to the 
 reports of the wardens, were insane or imbecile when re- 
 ceived there. We insert here the report of Mr. Townsend, 
 warden of the Eastern Penitentiary, made on this subject 
 in October last : and, also, that of Capt. Wright, warden of 
 the Western Penitentiary, made on November 24th. 
 
33 
 
 REPORT OF WARDEN TOWNSEND. 
 
 "E. S. Penitentiary, October 24, 1873. 
 " To Geo. L. Harrison, Esq., 
 
 11 President of the Board of State Charities. 
 
 " Dear Sir, — I sent you a list some time ago of eleven 
 persons confined in this penitentiary who were more or less 
 insane. Since that time one has died, and one was pardoned 
 by the Governor of the State, leaving now in confinement, 
 nine. The one who was pardoned is now an inmate of an 
 insane asylum. The nine who remain were all noted on our 
 physician's book as 'insane, 1 or 'mentally uyisound" 1 at the 
 time of admission. One was sent here twenty-three years and 
 ten months ago, charged with assault and battery to kill, and 
 sentenced not for a term of years, but for safe keeping ; he 
 is a harmless imbecile. One was sent here from Luzerne 
 couoty for ten years, on a charge of burglary and larceny. 
 The object seemed to be, to rid the neighborhood of a 
 troublesome fellow. One sent from Northampton county 
 for ten years on charge of rape. One from Bradford county, 
 charged with child murder, holding his own child under 
 water, to see the effect of it, thus proving the insanity of the 
 act ; his sentence is twelve years. A woman from Luzerne 
 county, for shooting her husband, sentenced to eleven years, 
 and eleven months. She is very crazy, and not a fit subject 
 for penitentiary discipline. 
 
 " One woman on several charges of larceny, sentenced to 
 nine years. This woman has been an inmate of an insane 
 asylum. One from Luzerne Co., for ' injury to rail road.' 
 He piled lumber on the road to see how it would be scat- 
 tered by the engine (a crazy man's trick.) One from Phila- 
 delphia, for aggraved assault and battery, sentenced to seven 
 years ; very weak minded on admission, and easily provoked 
 to violence. One from Philadelphia, for wife murder, sen- 
 tence ten years ; insane on admission. These individuals 
 have received such care and attention as we were enabled to 
 
 [3] . 
 
34 
 
 give them, but we have no accommodations for insane 
 patients — no rooms larger than the ordinary cells. They 
 have had such medical care as our resident physician was 
 able to give them, but we have no suitable nurses, nor place 
 for any. I consider it very improper, very unkind, very 
 cruel, to send insane persons to a jail or penitentiary. It is 
 almost certain to fasten the malady upon them, until it be- 
 comes irremediable. A hospital, with hospital appliances, 
 is the only place for these poor stricken ones. 
 
 " I think that a hospital for the insane should not be con- 
 nected in any way with a prison, but be entirely separate, 
 and under separate administration. 
 
 " Could not a part of the Danville Asylum be thus used ? 
 
 " Hoping these interrogatories are sufficiently answered, I 
 remain, very truly and respectfully, thy friend, 
 
 "EDWARD TOWNSEND, 
 " Warden." 
 
 REPORT OF WARDEN WRIGHT. 
 
 " Allegheny, Pa., November 24, 1873. 
 " Geo. L. Harrison, Esq., 
 
 " President Board of Public Charities, 
 
 " Dear Sir. — In your letter of 17th of October, you re- 
 quest that I give you my views on the subject of the treat- 
 ment of the criminal insane confined in penitentiaries and 
 jails. 
 
 " The subject has often been referred to in the Annual 
 Reports of this penitentiary, and the Inspectors in their 
 report for 1844, say, ' If, in the present pecuniary embarrass- 
 ment of the Commonwealth, you cannot erect and endow a 
 State Asylum for the insane, we must urge upon you the 
 propriety and necessity of authorizing us to establish, 
 within the prison walls, a hospital, for the reception of the 
 
35 
 
 limited number of demented convicts which may unhappily 
 come under our supervision. The occurrence is rare that 
 they become so after they enter the penitentiary, but, in 
 many instances, they are sent here after the commission of 
 crime, because there is no other barrier to protect society 
 from their demoniac depredations. There is a convict of 
 this character now immured in one of our cells, for such is 
 the sentence of the law. He came here in this lamentable 
 condition.' In the report for 1857 it is said, ' convicts are 
 often sent here whose proper destination should be the State 
 Lunatic Hospital. Why they are sent here, whether for the 
 purpose of supposed relief to the treasury of the county 
 from which they come; from culpable ignorance of the law 
 regulating the State Lunatic Asylum, or from the suggestion 
 flattering to us, that we will take good care of them, and that 
 society at large will be exempt from the dangers incident 
 to a too close proximity to madmen ; it is a practice alike 
 contrary to the policy of the law,- and the dictates of 
 humanity.' 
 
 " I have thus far made up, as briefly as practicable, from 
 our own reports evidence that insanity has proven no bar to 
 conviction and confinement in the penitentiary, and do not 
 doubt further evidence could be given showing that harmless 
 imbecile prisoners, have been received and discharged with- 
 out further record, than such as was given to other prisoners. 
 
 11 As having a direct bearing upon the views expressed in 
 a, former report, that prisons are often used as asylums, the 
 following extract from the report of the Warden of the 
 Eastern Penitentiary for the year 1871, bears pertinent testi- 
 mony, ' men are frequently sent to this penitentiary who 
 .are not fit subjects for its discipline. During the year four 
 men were received who were quite insane when admitted ; 
 one in unsound mind ; and four of weak intellect. One of 
 these insane prisoners died of tetanus, resulting from injuries 
 inflicted upon himself shortly after his reception, and another 
 committed suicide in one month after he came here. Of the 
 nine hundred and eleven confined in 1871, twelve were in- 
 
36 
 
 sane when admitted ; four of unsound mind ; two feeble 
 minded and thirty-six of weak intellect, bordering on idiocy/ 
 
 " In the annual report of the Eastern Penitentiary for 1872 
 it is stated that two hundred and twenty- six convicts were 
 received during the year, of whom one was of unsound 
 mind, four were weak minded, fifteen were dull and two 
 doubtful, making nearly ten per cent, of impaired intellect. 
 Of the two hundred and seventeen convicts discharged, one 
 insane, died, two were weak-minded and thirteen were dull r 
 being nearly seven and a half per cent, of the discharged, 
 impaired in intellect. 
 
 " Under the provisions of the Act of 1852, four prisoners 
 were removed in December, 1859, of whom the physician of 
 the prison states, ' It would be absurd to assert that no case 
 of insanity ever occurred in this prison, but, to show the 
 probable effect of the discipline in these cases, I will refer to 
 their condition on admission : — No. 1419 general good health, 
 but appears to be of unsound mind ; circumstances had led 
 to the belief of insanity, before he was brought to the prison. 
 No. 1485 general good health. No. 1987 good health, but 
 owing to his inability to speak English, his mental condi- 
 tion was not recognized, but I now have no doubt he was 
 insane when admitted. No. 2094 insane.' One of the above 
 noted prisoners, No. 1485, was returned to the prison exactly 
 three months after his transfer to the hospital, of whom it 
 is afterwards entered that he died in the prison, insane, in 
 January, 1862, after an imprisonment of ten years and nine 
 months. The physician notes in his official report, ' upon 
 his return here, he was still decidedly insane.' [Dixmont 
 Hospital was not then open.] 
 
 " The physician's record of insane prisoners as given to 
 your Board and printed on page 14 of report for 1870, in 
 brief, shows that one prisoner died in 1862, (previously 
 noted as received in good health in 1851,) and seven others 
 were received from 1863 to 1868, five were sent to Dixmont 
 by order of the Governor, and two were discharged insane. 
 All were insane or of feeble intellect when admitted. 
 
37 
 
 " The physician notices eight cases of the various forms 
 of insanity under treatment in 1871, who are stated to have 
 been received insane ; four were transferred from the Eastern 
 Penitentiary ; one had been in several insane asylums ; one 
 when received was a mental and physical wreck (since dead ;) 
 one had been held in jail a long time, owing to uncertainty 
 is still confined, a complete imbecile ; one had been mentally 
 as to his mental health. He was sent to Dixmont where' he 
 impaired for several years. None of the cases originated in 
 this prison. The report for 1872 contains further mention 
 of the four cases remaining over from the preceding year. 
 
 "The records of jails and other institutions within the 
 Commonwealth, if culled from the official reports to your 
 Board, would furnish abundant evidence of the need for a 
 change in the present method of treatment of the criminal 
 insane. 
 
 " I doubt not you will recommend some important changes, 
 and whether you favor the erection of a State Asylum for 
 the ' Crimimal Insane,' or, endeavor to meet the present ex- 
 igency, by procuring the setting apart of a wing in one or 
 more of the existing State Lunatic Hospitals, I trust you 
 will arrive at a satisfactory solution of this important ques- 
 tion, and submit a plan wise in its details and ennobling in 
 Its humanity. Very respectfully, 
 
 "EDWABD S.WRIGHT, 
 " Warden? 
 
 We pass now to the consideration of the third class of 
 insane persons, viz., of those who having committed acts of 
 violence or mischief, are acquitted of crime on the ground 
 of insanity. 
 
 Here we presume that those persons who commit such 
 acts under a partial aberration of mind, or a monomania, 
 or a sudden impulse, which did not destroy or disable the 
 power of rational, moral judgment; or under a temporary 
 
38 
 
 delirous excitement, resulting from their own deliberate ac- 
 tion, and the cause of which was under their own control, as- 
 in a fit of intoxication, are 
 
 and should not be acquitted of crime on that ground. But 
 acts committed in a state of proper insanity, that is to say,, 
 
 WHEN THE WHOLE RATIONAL FACULTY IS SO DERANGED, 
 
 that the moral judgment, the power of discrimination be- 
 tween right and wrong, is, by the visitation of Providence, 
 utterly blotted out or partially paralyzed ; such acts, how- 
 ever destructive or atrocious, cannot, without great impro- 
 priety and even absurdity, be denominated crimes; and 
 those who so commit them, cannot be classed among crimi- 
 nals. An "insane criminal," as an expression intended to de- 
 scribe a person as having committed a crime while in a state 
 of insanity, is a contradiction in terms. 
 
 How the facts are to be ascertained in these cases or what 
 are the proper evidences, is not a point which concerns us at 
 present ; such questions belong to courts, juries and experts;, 
 but if the facts have been ascertained and adjudicated ; if 
 there is admitted to have existed in the person arraigned,, 
 such a general mental derangement as obliterated the moral 
 judgment, or any other mania which involved the loss or 
 subversion of the moral judgment and control, in relation to 
 those acts to which the impulse or propensity points, 
 whether such be judged and found curable or incurable, and 
 whether the lunatic be adjudged dangerous or harmless; — 
 then 
 
 SUCH ACTS CANNOT BE RECKONED CRIMES, 
 
 and the person who has committed them cannot, without 
 gross injustice and inhumanity, be regarded or treated as a 
 criminal. And such is presumed to be the case of all those? 
 who are acquitted of crime on the ground of insanity. Yet 
 under our laws and the administration of justice (!) in this 
 
39 
 
 Commonwealth, numbers of these innocent and pitiable suf- 
 ferers are so regarded and treated, — especially those who are 
 tainted with the sin of poverty, as well as the crime of in- 
 sanity. This is, at the present moment, one of the 
 
 FOULEST BLOTS UPON" THE ESCUTCHEON OF OUR STATE, 
 
 a blot, which, instead of being in process of gradual efface- 
 ment, has been made darker and deeper by our more recent 
 legislation. All the improvement and tendency to improve- 
 ment in this respect, which resulted and promised to result 
 from the just and merciful laws of 1845 and 1852, have been 
 retracted and reversed by the law of 1861. 
 
 The cases of insanity to which we now refer may be vari- 
 ously classified, but the law fixes its attention chiefly on 
 that form of mania, which is more or less dangerous, arjd 
 requires more or less restraint for the protection of the com- 
 munity, as well as for the safety of the patient. 
 
 And that the case may be brought clearly and in one view 
 under the eye of the members of the Legislature, we may be 
 excused for here reciting somewhat at large the present pro- 
 visions of our laws on this subject, as they stand in the stat- 
 ute book. 
 
 PROCEEDINGS AGAINST CRIMINAL LUNATICS. 
 ACT OF 1836. 
 
 [At the time this Act was passed there was no State Hospital for the insane, and for 
 want of snch institutions they were sent to the penitentiaries and jails.] 
 
 Section. 58. In every case in which it shall be given in 
 evidence upon the trial of any person charged with any crime 
 or misdemeanor, that such person was insane at the time of 
 the commission of such offence, and such person shall be ac- 
 quitted, the jury shall be required to find specially whether 
 such person was insane at the time of the commission of 
 such offence, and to declare whether such person was acquit- 
 ted by them on the ground of such insanity, and if they 
 shall so find and declare, the court before whom the trial was 
 
40 
 
 iad, shall have power to order such person to be kept in 
 strict custody, in such place and in such manner as to the 
 said court shall seem fit, at the expense of the county 
 in which the trial was had, so long as such person shall con- 
 tinue to be of unsound mind. 
 
 Sec. 59. The same proceedings may be had, if any per- 
 son indicted for an offence shall, upon arraignment, be found 
 to be a lunatic by a jury, lawfully impanelled for the pur- 
 pose; or if upon the trial of any person so indicted, such 
 person shall appear to the jury, charged with such indict- 
 ment, to be a lunatic ; in which case, the court shall direct 
 such finding to be recorded, and may proceed as aforesaid. 
 
 Sec. 60. In every case in which any person, charged 
 with any offence, shall be brought before the court, to be 
 discharged for want of prosecution ; and shall, by the oath 
 or affirmation of one or more credible persons, appear to be 
 insane, the court shall order the prosecuting attorney to 
 send before the grand j ury, a written allegation of such insanity, 
 in the nature of a bill of indictment, and, thereupon the 
 said grand jury shall make inquiry into the case, as in cases 
 of crime, and make presentment of their finding to said 
 court ; and if said grand jury shall affirm said written allega- 
 tion, they shall endorse the same thereon, and, thereupon, 
 the court shall order a jury to be impanelled to try the in- 
 sanity of such person. Bat before a trial thereof be ordered, 
 the court shall direct notice thereof to be given to the next 
 of kin of such person, by publication or otherwise, as the case 
 may require. And if the jury shall find such person to be 
 iasane, the like proceedings may be had as aforesaid. 
 
 Sec. 61. Provided, That if the kindred or friends of any 
 person, who may have been acquitted, as aforesaid, on the 
 ground of insanity, or in default of such, the guardians, 
 overseers, or supervisors of any county, township, or place, 
 shall give security in such amount as shall be satisfactory to 
 the court, with condition that such lunatic shall be restrain- 
 ed from the commission'of any offence by seclusion or other- 
 wise, in such case it shall be lawful for the court to make an 
 
41 
 
 order for the enlargement of such lunatic, and his deliv- 
 ery to his kindred or friends ; or, as the case may be, to such 
 guardian, overseers, or supervisors. 
 
 ACT APEIL 14th, 1845. 
 
 Sec. 8. The admission of insane patients, from the sev- 
 eral counties of the Commonwealth, shall be in the ratio of 
 their insane population : Provided that each county shall 
 be entitled to send at least one insane patient. 
 
 Sec. 9. Indigent persons and paupers shall be charged 
 actual cost, &c, payable by counties. 
 
 Sec. 10. The courts of this Commonwealth shall have 
 power to commit to said asylum, any person, who, having 
 been charged with an offence punishable by imprisonment 
 or death, who shall have been found to have been insane in 
 the manner now provided by law, at the time the offence was 
 committed, and who still continues insane, and the expenses 
 of said person, if in indigent circumstances shall be paid by 
 the county, &c. 
 
 Sec. 12. The several constituted authorities having care 
 and charge of the poor of the respective counties, districts, 
 and townships, shall have authority to send to the asylum, 
 such insane paupers under their charge, as they may deem 
 proper subjects, and they shall be severally chargeable with 
 the expenses of the care, and maintenance, and removal to 
 and from the asylum, of such paupers. 
 
 Sec. 14. That if any person shall apply to any court of 
 record within this Commonwealth, having jurisdiction of 
 offences, which are punishable by imprisonment, for the 
 term of ninety days or longer, for the commitment to said 
 asylum of any insane person within the county in which such 
 court has jurisdiction, it shall be the duty of said court to 
 inquire into the fact of insanity in the manner provided by 
 law ; and if such court shall be satisfied, that such person 
 is, by reason of insanity, unsafe to be at large, or is suffer- 
 ing any unnecessary duress or hardship, such court, shall, 
 
42 
 
 on the application aforesaid, commit such insane person to 
 said asylum. 
 
 Sec. 15. In the order of admission, the indigent insane 
 of this Commonwealth, shall have always precedence of the 
 
 rich (in another place " paying patients ") and : — recent 
 
 cases shall have precedence of those of long standing. 
 
 ACT OF MAY 4th, 1852. 
 
 Whenever in the opinion of the Inspectors of the Eastern 
 Penitentiary, any of the prisoners therein confined, shall de- 
 velop such marked insanity, as to render their continued 
 confinement in said penitentiary improper, and their removal 
 to the State Lunatic Hospital necessary to their restoration, 
 it shall be the duty of the said Inspectors to submit such 
 cases to a Board composed of the District Attorney of the 
 county of Philadelphia, the principal physician of the Penn- 
 sylvania Hospital for the Insane, at Philadelphia, and the 
 principal physician of the Friends' Insane Asylum, at Frank- 
 ford, in Philadelphia County, and in case a majority of them 
 cannot at any time, when required, attend, a competent phy- 
 sician, or physicians to be appointed by the Court of Quar- 
 ter Sessions of the County of Philadelphia, in the place of 
 such as cannot attend, upon whose certificate of insanity or 
 the certificate of any two transmitted to the governor, and 
 if by him approved, he shall direct that said insane prison- 
 ers, shall be, by said Inspectors, removed to the State Luna- 
 tic Hospital, there to be kept and properly provided for at 
 the cost and charge of the county from which they were 
 sent to the penitentiary, and if, at any time during the pe- 
 riod for which any such insane prisoners shall have been 
 sentenced to confinement in the Eastern Penitentiary, they 
 shall in the opinion of the trustees of the said Lunatic Hos- 
 pital be so far restored as to render their return to said pen- 
 itentiary safe and proper, then the said trustees shall cause 
 the said prisoner to be returned to said Eastern Penitentia- 
 ry, due notice to be given to the clerk of the Court of Quar- 
 
43 
 
 ter Sessions of the county from which such prisoners were 
 sent to the penitentiary, of all such removals or transfers. 
 
 ACT OF APEIL 8th, 1861. 
 
 Sec. 1. When application shall be made under the 14th 
 section of the Act of April 14, 1845, to which this is sup- 
 plementary, to any court of this Commonwealth for the com- 
 mitment of any person to the Pennsylvania State Lunatic 
 Hospital, it shall be lawful for such court either to inquire 
 into the fact of insanity in a summary way, &c. ; and in 
 all cases, it shall be lawful for the several courts to use their 
 discretion in sending insane persons to said hospital, or 
 cause them to be confined elsewhere, as the said court may 
 deem the case to be curable or otherwise. 
 
 Sec. 2. No person shall hereafter be sent to the said 
 Lunatic Hospital, under the 10th section of Act 14, April, 
 1845, or any other law of this Commonwealth, who shall 
 have been charged with homicide, or having endeavored or 
 attempted to commit the same, or to commit any arson, rape, 
 robbery or burglary, and have been acquitted of any such of- 
 fences on the ground of insanity, or been proceeded against 
 under the 59th or 60th sections of the Act of 1836, [see above] 
 where the court trying the same shall be satisfied that it 
 will be dangerous for such lunatic to be at large, on account 
 of having committed or attempted to commit either of the 
 crimes aforesaid, but such persons shall be confined in a pen- 
 itentiary or the prison of the proper county. 
 
 Sec. 3. In every case where a lunatic has been or shall 
 be committed to said hospital, after an acquittal of any 
 crime on the ground of insanity, or after an investigation in 
 court under the 59th & 60th sections of the Act 13, June 1836, 
 or on account of its being adjudged dangerous for such luna- 
 tic to be at large; and in all cases where any lunatic has 
 been, or shall be removed from either of the penitentiaries, 
 or any prison of this Commonwealth, under the order of a 
 judge or of any court it shall be lawful for the trustees of 
 
44 
 
 said hospital with the aid of the superintending physician, 
 to inquire carefully into the situation of the lunatic, and if 
 a majority of the Board, including the physician, shall be 
 satisfied that that there is no reasonable prospect of a cure 
 of the insanity, being affected by a retention of the lunatic 
 in the hospital they shall at the expense of the proper city 
 or county, cause him or her, to be removed to the prison of 
 the proper county or the penitentiary from which he or she 
 was sent. 
 
 Thus it appears that before 1845, — before the erection of 
 a State Lunatic Hospital, (1) persons tried and acquitted of 
 crime on the ground of insanity, (2) persons indicted for an 
 offence and found to be insane when brought up for trial, 
 and (3) persons charged with some offence and brought be- 
 fore the court, to be discharged for want of prosecution, but 
 being found in a state of lunacy, — provided they had no 
 friends — were to be sent to the penitentiary, the county jail, 
 or, if the county authorities should give the required 
 guarantees, to the county poorhouse — as the court should 
 judge most proper. 
 
 By the Act of 1845 and the establishment of the State 
 Lunatic Hospital, this state of things was at once and in 
 prospect greatly improved. This alleviation was obtained 
 upon the Memorials of Miss Dix and other philanthropic 
 citizens, backed by the following representation from the 
 judges of the criminal courts : 
 
 The Memorial of Miss Dix to the Legislature, dated 
 February 3d, 1845, contains the following certificate from 
 members of the Judiciary in relation to the imprisonment 
 of " insane criminals," Miss Dix prefacing its introduction 
 with this paragraph : 
 
 " Next after private families and poorhouses, the insane 
 will be found in the jails and penitentiaries. On this subject 
 the opinion of some of your jurists has been so explicitly 
 declared, that I feel it but justice to the cause, to give this 
 expression of theii sentiments place here." 
 
45 
 
 " Philadelphia, March 5, 1839. 
 
 " The want of an asylum for the insane poor often 
 occasions painful embarrassments to the courts, when the 
 defence in the criminal charge is insanity fully sustained by 
 proof. Although the jury may certify that their acquittal 
 is on that ground, and thus empower the court to order the 
 prisoner into close custody, yet that custody can be in no other 
 place than the common prisons, places illy qualified for such a 
 subject of incarceration. We cannot doubt that the ends 
 of justice would be greatly promoted, if such an asylum as 
 the petitioners contemplated were established with proper 
 regulations, and the courts were authorized to commit to it, 
 all persons acquitted of crimes on the ground of insanity." 
 
 (Signed) EDWARD KING, 
 
 ARCHIBALD RANDALL, 
 J. RICHTER JONES, 
 
 Judges of the Court of Quarter Sessions * 
 
 JAMES TODD, 
 J. BOUVIER, 
 R. T. CONRAD, 
 
 Judges of the Criminal Sessio?is : 
 
 CALYIN BLYTHE, 
 
 Judge of the Twelfth Judicial District. 
 
 Miss Dix adds, " It is believed that all the judges of the 
 courts of the Commonwealth of Pennsylvania, having 
 criminal jurisdiction, would coincide in the above opinion." 
 
 But by the Act of 1861, now in force, the benefits which 
 had been secured — which it was hoped would be secured, 
 and which the judiciary thus earnestly desired might be 
 secured, have been substantially annulled and frustrated : — 
 for, as to the subsequent Act of April 20, 1869, — an Act 
 intended to guard the commitment to, and secure a proper 
 discharge from private hospitals, — it will be seen immediately, 
 that they simply provide for the mode of procedure in one 
 particular case, viz : in discharging a person who has been 
 
46 
 
 acquitted of crime on the ground of insanity, at the time of 
 its commission, but who is alleged now to be sane. It pro- 
 vides for his "confinement," and then prescribes how the 
 question of his sanity shall, before his discharge, be adjudi- 
 cated. It is, in fact, legislation for the sane and not for the 
 insane. [See Judge Brewster's "opinion" further on.] 
 
 Under the first section of this Act (of 1861) a person, a 
 man or woman, though free from the taint or charge of any 
 crime whatever, having committed no act of violence or 
 mischief — a poor, pitiable, harmless lunatic, 
 
 MAY BE SENT TO A JAIL FOR INDEFINITE INCARCERATION ; 
 
 and if, upon summary examination, such person is thought 
 to be more probably incurable, it is more than suggested to 
 be the duty of the court to send him to prison. And, if 
 once sent there, his case is remediless, unless he can get 
 through the provision of Sect. 3, and we shall see what pro- 
 bability there is of that. 
 
 Under the second section, no person charged with com- 
 mitting or attempting to commit certain heinous crimes, and 
 acquitted of the charge on the ground of insanity, shall, if 
 the court judge it dangerous to be at large, be sent to the 
 hospital at all, but he 
 
 SHALL BE CONFINED IN THE PENITENTIARY OR THE PRISON 
 OF THE PROPER COUNTY; 
 
 that is to say, the only option left to the court is, either at 
 once to discharge such a person and let him go at large, or 
 to commit him to a hopeless imprisonment — hopeless, we 
 say, unless he can run the gauntlet of Sect. 3. 
 
 Under this third section — and this is the key to the right 
 understanding of the present state of our whole legislation 
 on this subject, — any lunatic who (1) upon trial, has been 
 acquitted 
 
 OF ANY CRIME WHATEVER, 
 
 and however slight, or, (2) who has been indicted for any 
 offence, and upon being brought up for trial, has been found 
 
47 
 
 insane, or, (3) who, when brought up to be discharged for 
 want of prosecution, is found insane, or, (4) who, though 
 never charged with any crime or any act of violence or harm, 
 has been adjudged dangerous, if allowed to go at large, — any 
 lunatic of either of these four classes, who has, thereupon 
 been sent by the order of any court, to a State hospital 
 for the insane, — as well as any lunatic (5) who by the order 
 of the Governor or by any provision of law, has been re- 
 moved from any penitentiary or jail to the said hospital, 
 may, upon the judgment of the trustees and superintending 
 physician, of said hospital, that there is no reasonable 
 prospect of a cure of his insanity, be, by tbem, and by 
 their sole and uncontrolled authority, consigned to a help- 
 less and hopeless 
 
 IMPRISONMENT IN THE PENITENTIARY OR THE COUNTY JAIL. 
 
 (Perhaps we ought to remark by the way that the last words 
 of the section, " from which he or she was sent," may seem 
 to confine the exercise of the power of the hospital authori- 
 ties to the fifth class of persons before described ; but as, in 
 that case the four other classes would have been enumerated 
 in the section without any enactment in regard to them, it 
 is presumed the Act should be interpreted as extending the 
 same power of removing the parties from the hospital to 
 prison, to all those four classes of cases also ; and so we be- 
 lieve it has always been interpreted. But, perhaps it is to 
 the credit of those who drew the Act, that that there should 
 be marks of haste in its composition.) It is clear, however, 
 that this act contains no authority for sending any patients, 
 however incurable, to the county poorhouses ; they can be 
 sent back only to the prison or the penitentiary. 
 
 "We must ask your indulgence, gentlemen of the Legisla- 
 ture, if we find ourselves compelled to speak harshly, or 
 even disrespectfully, of the law of the land. We are ad- 
 dressing legislators and not a jury. But what a law is this ! 
 Is it possible that the members of our subsequent legisla- 
 
48 
 
 t ur es — is it possible that you, gentlemen, have been fully 
 aware of its extraordinary, of its atrocious provisions ! 
 a law, which we are constrained to say, in the terrible cool- 
 ness of its barbarous enactments — in its disregard not only 
 of all the claims of humanity and justice, but of the simplest 
 civil rights of every citizen, is, so far as we can find, with- 
 out a parallel in the legislation of any other State of this 
 Union, or of any Christian or civilized community in the 
 world. By this law, not only are persons — men and women, 
 who are admitted and solemnly adjudged to be innocent of 
 all crime, — men and women, who have never even been 
 charged with any act of violence or harm, — liable to be 
 hopelessly incarcerated — incarcerated professedly for life; 
 (for they are pronounced probably incurable, — and this is 
 their only crime,) incarcerated in the common jail or the 
 penitentiary, — incarcerated in the society of felons, — incar- 
 cerated where they can have no proper care or treatment ; — 
 not only this — but such persons liable to be so incarcerated, 
 not upon the verdict of a jury of their fellow citizens, or the 
 examination and sentence of any court of justice, but upon 
 the dictum — the sole, peremptory, uncontrolled and irrever- 
 sible dictum — of whom ? 
 
 THE DICTUM OF THE TRUSTEES AND SUPERINTENDING PHYSI- 
 CIAN OF A STATE HOSPITAL ! 
 
 a tribunal unknown, elsewhere, to the constitution and 
 laws of the State ; whose rescript overrides and reverses the 
 solemn sentences of all the criminal courts of the Common- 
 wealth ; and holds, in respect to them, the character of a 
 judgment of a Supreme Court of Errors and Appeals; and 
 the appeal to this court is made by the court itself: — and 
 even this is not all ; but the court is the party interested 
 to be rid of the care and burden of the poor speechless and 
 defenceless victims, whose cases are to be passed upon ! 
 
 Can anything be added to the extraordinary character of 
 such a law ? Shall it be allowed any longer to disgrace our 
 
49 
 
 statute book, and tarnish the fair fame of our beloved and 
 honored State ? 
 
 JSTo man, no one of us, gentlemen, can be sure that he will 
 not become a helpless lunatic to-morrow. But does every 
 citizen of Pennsylvania know that he is liable, without any 
 fault of his own, to be sent at any time to the common jail 
 for life long detention, by the sole and irrevokable authority 
 and sentence of the superintendent and trustees of a State 
 Lunatic Hospital ? And that in spite of, and reversal of, the 
 contrary judgment and sentence of any and every court of 
 justice, which may have passed, or which by law can pass 
 upon his case. 
 
 We beg here to disclaim, once for all, intending any per- 
 sonal reference to or reflection upon the estimable gentlemen 
 who have the charge of the State Hospitals for the insane. 
 We doubt not they are honorable and conscientious men ; 
 but they are men. The constitution of such a court of 
 review must, we think, be admitted to be 
 
 AN ANOMALY IN OUR LEGISLATION, 
 
 and no less an anomaly that interested parties, however hon- 
 orable and trustworthy, should be empowered to decide in 
 their own case. And perhaps it is worth observing that, while 
 a lunatic may be thus summarily removed from the hospital 
 to the prison, by the simple flat of the hospital authorities 
 alone, a lunatic could not so readily be removed from the 
 penitentiary to the hospital. For this purpose the law of 
 1852 presented a complex process. In order that a lunatic 
 might be removed from the penitentiary to the hospital, the 
 law provided that not only the inspectors of the penitentiary 
 — honorable and conscientious men — should judge the con- 
 tinued confinement of such lunatic in the penitentiary to be 
 improper, and his removal to the State Lunatic Asylum 
 necessary to his restoration, but the case must also be sub- 
 mitted to a board composed of the District Attorney and 
 either two superintendents of insane asylums or a compe- 
 tent physician or physicians to be appointed by the Court of 
 
 M 
 
50 
 
 Quarter Sessions. Nor was their certificate of approval 
 sufficient to secure the object: but that certificate must be 
 transmitted to the Governor, and, if he approved, he might 
 order the removal. So careful was the law in that case to 
 guard the process against abuse. 
 
 But we may be asked why we shonld cavil at what may 
 be considered a theoretic anomaly, while it accomplishes the 
 best results, and is the shortest and best way of accomplish 
 ing them ? We answer by asking in return, 
 
 WHAT HAVE BEEN THE EESULTS ? 
 
 Have the courts, by them, been encouraged to send lunatics 
 to the hospital, or, on the contrary, have they found that 
 this is too often a roundabout way of sending them to prison ? 
 But why is it that for more than twenty years the law has 
 existed for sending certian lunatics from the penitentiaries 
 to the hospital, and yet the experiment of doing so has been 
 tried in the Eastern District of the State but once — indeed 
 has not been tried at all in that district, for full twenty 
 years past ? Is it said that the lunatics so transmitted very 
 soon made their escape ? But if the hospital is by law to 
 receive such lunatics, some part of it ought manifestly to be 
 so constructed and arranged as to be suitable for their safe- 
 keeping ; as has been done without difficulty or opposition 
 in the hospitals of several other States. Have the hospital 
 authorities sought to provide such construction and arrange- 
 ments, in order that the ends of the law might not be de- 
 feated ? Or, have they not rather sought and obtained. the 
 counter provisions of the law of 1861, authorizing them to 
 send all such lunatics back to prison ? Since which time it 
 has been hardly thought worth while to commit any such to 
 their care. Indeed it has been triumphantly said, on appar- 
 ently good authority, (see Journal of Insanity, Oct. 1873, 
 page 214) that, after the first experiment, i. e. before the law 
 of 1861, as well as since, the Board of Trustees of the State 
 Lunatic Hospital at Harrisburg declined receiving any more 
 cases." That is to say, the Board of Trustees decided the 
 question by their sole and ultimate authority — commission 
 
51 
 
 or no commission — law or no law. We do not vouch for 
 the fact, but it has been publicly so stated, without dissent, 
 in the presence of the Superintendent of the Lunatic Asylum. 
 We presume the refusal, if made, was a mere declaration and 
 not an act ; but the statement, however interpreted, is highly 
 suggestive. The Act of 1852 is still the law of the land — a 
 law whose ends are eminently politic, just and humane, but 
 can the authorities of the State Hospital be counted upon as 
 ready cordially to concur in carrying out the provisions of 
 that law, for the accomplishment of those ends ? 
 
 The views of the judges of our criminal courts and of the 
 Supreme Court of the State, upon present legislation in re- 
 gard to the insane poor and the insane criminal will appear in 
 their petitions to the Legislature, which we here introduce : 
 
 To the Legislature of the State of Pennsylvania. 
 
 " The judges of the criminal courts being greatly embar- 
 rassed under the law of 1836, in the disposal of persons 
 charged with crime, who were acquitted on the ground of 
 insanity, being obliged to commit them to 'close custody;' 
 the jails and penitentiaries being alone open to them, me- 
 morialized the Legislature in 1839, in behalf of the establish- 
 ment of a hospital for the ' insane poor,' and denounced the 
 commitment of the irresponsible insane to the prisons of the 
 State. By such influence and other humane and rightful 
 effort, the Legislature, in 1845, established the State Lunatic 
 Hospital at Harrisburg, under a law which gave proper pro- 
 tection to the rights of the ' poor ' and the ' criminal insane.' 
 This legislation satisfied the judges who bore the responsi- 
 bility of disposing of such persons, and was also a clear ex- 
 ponent of the public mind on the subject. 
 
 " By more recent legislation, namely by the Act of April 
 8th, 1861, the courts, having jurisdiction of such cases, are for- 
 bidden to send them to the State hospitals, however irrespon- 
 sible for crime, unless ' speedily curable,' if they are deemed 
 dangerous persons to he at large ; and in every case where a 
 lunatic may have been sent to the State Hospital, after an 
 acquittal of any crime on the ground of insanity, the authorities 
 
52 
 
 of such hospital may send such persons lo a penitentiary or 
 jail, at the expense of the county where he belongs, unless 
 they deem the case ' speedily curable.' Substantially the same 
 provisions are contained in the Act of April, 1863, relating 
 to the western part of the State. The undersigned, regarding 
 the provisions of the Acts of 1861 and 1863, above cited, as 
 an obstruction to the ends of justice ; and, being greatly em- 
 barrassed in our administration of such causes, respectfully 
 beg that the legislation be repealed, or such amendments 
 made, as will relieve from unjust and injurious imprisonment 
 with felons, the irresponsible class referred to, and which will 
 also protect the ' insane poor ' in their rights, and enable the 
 courts to comply with the laws, without violating a sense of 
 right or a sentiment of humanity. 
 
 " The Act of April, 1863, in relation to the commitment 
 of the insane to the Western Pennsylvania Hospital provides 
 for the return of insane criminals and persons acquitted on 
 the ground of insanity, to the jail or penitentiary if deemed 
 incurable." 
 
 JOS. ALLISON, 
 JAS. R. LUDLOW, 
 WM. S. PEIKCE, 
 THOS. A. FINLETTER, 
 EDWARD M. PAXSON, 
 Judges of Court of Quarter Sessions, Philadelphia Co. 
 
 F. H. COLLIER, 
 JAMES P. STERRETT, 
 EDWIN H. STOWE, 
 
 Judges of Court of Quarter Sessions of Allegheny Co. 
 
 " We concur in the above recommendation," 
 
 GEO. SHARSWOOD, 
 HENRY W. WILLIAMS, 
 JOHN M. READ, 
 
 Nov. 28th, 1873. 
 
 Judges of Supreme Court. 
 
53 
 
 We turn to another description of the insane — to those, 
 who without any charge or suggestion of crime, have, either 
 as dangerous or simply as helpless lunatics, been placed in 
 the county poorhouses. These may by law be committed 
 by the county authorities to the State hospitals for the in- 
 sane — How many of them have been so committed ? Does 
 the management of these hospitals encourage and stimulate 
 the authorities to send them there ? 
 
 THEY NEED ENCOURAGEMENT AND STIMULUS ; 
 
 for, as experience too constantly shows, those authorities are 
 extremely liable to be led by the considerations of a false and 
 short-sighted economy, to endeavor to make a cheaper provi- 
 sion for the care and maintenance of their insane, 
 than that furnished by the hospital. Are those whom they 
 actually commit, sent back to them again, with a charge for 
 the expense of both transfers ? If so, 
 
 BY THE AUTHORITY OF WHAT LAW ARE THEY SENT BACK ? 
 
 What law provides that the authorities of the hospitals may 
 send any of their patients, or allow any of their patients, 
 however violent or incurable, to be taken to a county poor- 
 house ? Yet the simple fact is that while there are some 
 five hundred of the insane poor, in our hospitals, sent from 
 the county almhouses, there are more than twice that 
 number 
 
 RAVING OR LANGUISHING IN OUR COUNTY POORHOUSES, 
 
 an incarceration much better fitted to make a sane man mad, 
 than a madman sane. And of the two, if there is less dis- 
 grace, there is also, in a majority of cases, less chance for 
 comfort, and no better chance for recovery, in the poor- 
 house than in the prison. So that it may be said upon a 
 deliberate calculation, to be better, as regards comfort and a 
 prospect of restoration, 
 
 FOR AN INSANE PERSON TO BE CONVICTED OF CRIME, 
 
 and sentenced to the penitentiary for a definite time, than, 
 as an innocent lunatic, to be imprisoned in the poorhouse. 
 
54 
 
 But, we may add that the great and irremediable defect in 
 both the prison and the poorhouse, but especially in the 
 latter, is the want of proper attendance, and of skillful medi- 
 cal care. These poor creatures are not expected to recover. 
 They are given over to utter hopelessness. 
 And now, 
 
 WHAT IS TO BE DONE ? 
 
 To this question we would address ourselves with the full 
 appreciation of the many and formidable difficulties 'with 
 which the subject is encompassed. But we believe that 
 there is no thoughtful person, who has made himself prac- 
 tically acquainted with the facts, that does not fully concur 
 in the judgment that no poorhouse can be a proper receptacle 
 for the insane. We shall enter into no argument, therefore, 
 to show that 
 
 ALL THE INSANE POOR 
 
 now gathered in the county poorhouses should, as soon as 
 possible, be provided for in State lunatic hospitals, and 
 transferred to them, to be there supported as the law may 
 direct, unless any particular county has population enough, 
 and insane poor enough, to render it advisable and feasible to 
 establish and maintain a separate hospital for itself, with the 
 full appointments and provisions for the best and most skill- 
 ful care and medical treatment of the inmates, with a view 
 both to their comfort and their care, as well as to the safety 
 of the community. 
 
 As to the other less numerous class, who have been com- 
 mitted by the courts (or by the hospital authorities) to the 
 jails or the penitentiaries ; including (1) those who, having 
 been charged with the most heinous felonies, have been ac- 
 quitted on the ground of insanity, (2) those who, on the same 
 ground, have been acquitted of any offence whatever and 
 however slight, (3) those who have been indicted for any 
 offence, and upon being brought up for trial, have been 
 found insane; (4) those, who, when brought up to be dis- 
 charged for want of prosecution, have been found insane; 
 
55 
 
 (5) those, who, though never charged with any act of crime 
 or harm whatever, have been judged dangerous if allowed to 
 go at large ; as well as (6) those who, having been convicted 
 of crime, committed while they were presumed to be sane, 
 have since become lunatics, — in regard to all these, it seems 
 now to be universally conceded that, 
 
 THE JAIL OR THE PENITENTIARY IS NOT THE PROPER PLACE 
 FOR THE KEEPING OR CARE OF SUCH LUNATICS. 
 
 The practical question then is what other provision is to 
 be made for them ? 
 
 The Act of May 4, 1852, had, as we have seen, provided 
 that any of the prisoners confined in the Eastern Peniten- 
 tiary, being found insane (thus, insane convicts as well, but 
 not insane convicts only) might, by a certain process, be 
 removed to the State Lunatic Asylum. In their report of 
 the year following, the Inspectors of the Penitentiary inform 
 us, that of eighteen persons proposed by them as candidates 
 for removal, eight had been so transferred by order of the 
 Governor, and they add : 
 
 " The Inspectors cannot omit this opportunity of again 
 calling upon the General Assembly, should the means pro- 
 vided for this object be found in any way inadequate, either 
 in the terms of the law authorizing the removal, or in the 
 provision for the safe-keeping in the lunatic hospital, not to 
 halt in the good work until it is carried into full effect. 
 Let it no longer rest upon the fair fame of Pennsylvania, 
 who claims to be foremost in the work of penitentiary re- 
 forms, that insane men are imprisoned in the cells of her 
 penitentiary for long years or for life. . . . Surely in this 
 enlightened Christian age and country, the cells of the peni- 
 tentiary should cease to be the abode of human beings with- 
 out moral perceptions or responsibilities to fit them for the 
 salutary effects of either penitentiary punishments or moral 
 reform. The inspectors have gone more fully into this sub- 
 ject than they otherwise would have done, from the fact that 
 a state hospital has been been put into operation by the Legis- 
 
56 
 
 lature for this enlightened and benevolent purpose. Its estab- 
 ment lias been long needed." 
 
 In their report for the next year (1854) the Inspectors re- 
 mark that " the eight persons before alluded to, were the first 
 so removed since the opening of the prison twenty-five years 
 ago, as until last year no institution existed in Pennsylvania, 
 as in other States, for the reception and treatment of persons, 
 who, though insane, required punitive restraint. No other 
 cases have since occurred requiring removal from the peni- 
 tentiary. The State Lunatic Hospital is an establishment of 
 the highest utility, — its purpose approved by the most en- 
 lightened benevolence and sound policy. Every humane 
 mind cannot but hope that it it will be fostered and encour- 
 aged for the accomplishment of benefits to an increasing class 
 of unfortunate people." They then proceed to a class who 
 are sometimes included among the " criminal insane," in the 
 following terms : — " As yet no complete provisions have been 
 made for the reception and treatment of those insane who are 
 sentenced to restraint of their liberty, because the fact of their 
 unsound mind renders them irresponsible for the crimes 
 charged against them. There are now four prisoners in the 
 penitentiary thus confined ; their dangerous character, arising 
 from homicidal mania, rendering them unsafe, unless under 
 a cautious restraint. As they are in the penitentiary not as 
 convicts, but here retained because of no other place of equal 
 security, it is difficult properly to treat them for the confirmed 
 malady under which they labor. The time will come when 
 in the State Hospital, provision can be made for this class of" 
 insane." # 
 
 Nearly twenty years have elapsed, and these poor, wretched 
 beings are still in jails and almshouses. 
 
 The inspectors making the report in 1853, were John Bacon, 
 Kichard Yaux, Hugh Campbell, Singleton A. Mercer and 
 Charles Brown ; in 1854, Messrs. Bacon, Yaux, Mercer, An- 
 drew Miller and Charles McKibben. 
 
 Then came the law of 186 L ; which empowers the trustees 
 and physician of the State Lunatic Hospital to send insane 
 
57 
 
 persons committed to the hospital by the courts or removed 
 to it from the penitentiary, back to the penitentiary from 
 which they were sent, or to a prison to whioh- they were not 
 committed by the courts, when there appeared no reasonable 
 prospect of a cure. The result is that it is found a useless 
 expenditure of pains and money, in many cases, for the courts 
 to send to the hospitals insane men acquitted of crime, and 
 always for the penitentiary to remove thither its prisoners or 
 insane convicts, while authority resides in the hospital to 
 forthwith send them back again. In anticipation of this re- 
 sult, the inspectors of the Eastern Penitentiary, in their re- 
 port of the following year (1862,) " respectfully suggest to the 
 Legislature that provision by law be made requiring the State 
 Lunatic Asylum to take insane persons convicted of crime into that 
 institution. 1 '' And, in 1863, " the inspectors again ask the Leg- 
 islature to require the State Lunatic Asylum to take ' insane 
 convicts.' " The inspectors in 1862 and 1863 were Richard 
 Vaux, Samuel Jones, M. D., Alexander Henry, Thomas H. 
 Powers and Furman Sheppard. 
 
 It is plain that these gentlemen, as well as the Inspectors 
 of 1853 and 1854, judged it to be the wisest and most desir- 
 able plan, in this as in other States, that provision should be 
 made for the criminal insane and even for insane convicts 
 
 IN CONNECTION WITH THE STATE HOSPITAL RATHER THAN 
 WITH THE STATE PENITENTIARY. 
 
 We append here, without comment as the documents tell 
 their own story very clearly, the communications to this 
 Board from the Inspectors of the Eastern and Western Peni- 
 tentiaries requesting its intervention with the Legislature, 
 for the modification or repeal of the obnoxious laws against 
 the rights of the insane, which now disgrace our statute 
 books. 
 
 November 26th, 1873. 
 " To the Board of Public Charities : 
 
 " The Inspectors of the State Penitentiary for the Eastern 
 District of Pennsylvania have heretofore in their reports 
 
58 
 
 called the attention of the Legislature to the deplorable con- 
 dition of the insane committed to the custody of that Insti- 
 tution, and have suggested legislation which would relieve 
 us from the pressure of a duty which we could not fulfil in 
 providing for them proper care and medical treatment — and, 
 which also would provide for these defenceless, and, for the 
 most part, irresponsible, persons, a more rightful and suitable 
 abode than a prison. We now most respectfully appeal to 
 the Legislature, through your Board, to so amend the legis- 
 lation of the Act of April 8, 1861, as will give effect to the 
 former representations of the Inspectors, and place the class 
 of the ' poor insane ' and the ' criminal insane ' in the 
 more just and favorable position which they occupied under 
 the law of April 14, 1845, which established the State Lun- 
 atic Asylum at Harrisburg." 
 
 EICHAED YAUX, 
 THOMAS H. POWERS, 
 ALEX. HENEY, 
 CHAELES THOMSON JONES, 
 JOHN M. MAEIS. 
 
 "To The Board of Public Charities : 
 
 " The Inspectors of the Western Penitentiary, desire to call 
 the attention of the Legislature, through your Board, to 
 the necessity of further and fuller provision by law, for the 
 care and protection of the indigent and criminal insane. 
 
 " In many of the annual reports of this Penitentiary, atten- 
 tion has been directed to the fact, that insane persons have 
 been convicted of crime and sent to prison. The following, 
 from our report for 1867, briefly states the facts in the case, and 
 in its conclusions, we trust, will receive your earnest co- 
 operation. 
 
 " We would ask the attention of the Legislature to the 
 great necessity there is for such legislation as will secure to 
 the insane convict a place in some State institution where he 
 may be properly cared for. By special amended enactments 
 of the law on this subject, no insane convict, who has been 
 
59 
 
 committed to prison on the higher grades of crime, can be 
 transferred to the hospital at Dixmont, ' unless by the 
 verdict of the jury in the case there is reason to believe that 
 a cure of such insanity may be speedily effected.' 
 
 " If this institution is intended only for the benefit of the 
 curahly insane, what is to become of the ill fated wretch who 
 has no helper, and whose reason is declared to be '* clean 
 gone forever.' 
 
 " We hold that it is the duty of the State to make some 
 speedy provision for his relief, either by the modification of 
 existing laws, or the enactment of such statutes as will 
 guarantee to him a humane and Christian protection." 
 
 T. H. KEVIN, 
 EGBERT H. DAVIS, 
 JOHN DEAN, 
 GEORGE A.KELLY, 
 ORMSBY PHILLIPS, 
 
 Inspectors. 
 
 In like manner- the Secretary of the Massachusetts Board 
 of State Charities, in his report for 1871, recommends, and 
 in that for 1872 renews the recommendation, that a special 
 " receptacle or institution be provided for insane convicts, and 
 for insane persons, who, in a state of insanity, have committed 
 or are disposed to commit violent acts ;" for which he gives 
 his reasons at large, and then adds, "it is submitted that the 
 construction of such a receptacle may perhaps be wisely 
 made a part of the plan for a new hospital at Worcester. It 
 can be made a separate building, surrounded by a wall, suf- 
 ficiently removed from other buildings to avoid any un- 
 pleasant associations, and yet near enough to have the bene- 
 fit of the general superintendence of that institution." 
 
 That is to say, as the Secretary immediately adds, the 
 project of a new and (totally) separate institution for the 
 class referred to, is sure to start some vexed question, with 
 which it would not be well to embarrass the desired im- 
 provement. The " convict insane " would give to it its dis. 
 
60 
 
 tinctive character ; and then any proposition to admit to it 
 others, not " convict insane," who could be better provided 
 for in it, than elsewhere, would be resisted, as affixing to 
 them the repute of a criminal class. Nor is it likely that it 
 would, with its peculiar character, as well as its smaller 
 numbers, be provided, in the long run, with a corps of 
 officers equal in skill to those whose services are commanded 
 by the other hospitals. For these and other reasons, it is 
 better that provision should be made for the insane, who 
 have committed or are pre-disposed to homicidal or violent 
 acts, in buildings or apartments, properly arranged and pro- 
 vided with means of security, 
 
 IN CONNECTION WITH SOME ONE OF THE LUNATIC HOSPITALS." 
 
 So much from the secretary. The Board itself, in its 
 first report, had said, "There is still another class, the 'crimi- 
 nal insane,' for whom special provision should be made. 
 Formerly they were kept at the prisons, confined in cells ; 
 but more recently they have been placed in the State hospi- 
 tals. It is generally thought that this class of the insane 
 should not be allowed to mingle with those who are 
 free from crime, but should have apartments built ex- 
 pressly for their accommodation. The most appropriate 
 plan for an asylum, designed for this class of insane persons, 
 would probably be 
 
 AT ONE OF THE STATE HOSPITALS." 
 
 The same subject was again referred to in their 5th & 6th 
 reports ; and again it is added, if a proper building for "in- 
 sane convicts" and others predisposed to violent acts should 
 be provided in connection with one of the State Lunatic Hospitals, 
 power should be given to this Board, to transfer from the 
 other hospitals to the one where such provision is made, 
 persons of the class referred to. " From the other hospi- 
 tals," observe — not, '' from the prisons ;,, in Massachusetts 
 there are no "insane criminals," nor " insane convicts" in the 
 prisons. 
 
61 
 
 We have referred to the injurious and wrongful effects of 
 the Act of 1861, and we have seen the earnest counter- 
 recommendations of the Inspectors of the Eastern Peniten- 
 tiary and other just and honorable authorities. We have, 
 ourselves, already pointed out 
 
 THE DISASTROUS CONSEQUENCES OF THAT ACT; 
 
 and now, to confirm our position, we beg leave to insert here 
 the results of the experience and research, and the carefully 
 drawn statements, of Judge Brewster, on this point, con- 
 veyed to us in a letter dated October 10, 1873. 
 
 "No. 214 West Washington Square. 
 "Philadelphia, October, 10, 1873. 
 
 "To Hon. Geo. L. Harrison. 
 
 " President of the Board of Public Charities, 
 
 "Dear Sir: 
 
 "Your communication of August 14, in refer- 
 ence to ' insane criminals ' was duly received and acknowl- 
 edged. 
 
 " With your permission the examination of the authorities 
 which you desired was postponed until a recent date. 
 
 "I have considered with some care the question you pro- 
 pound, and the several Acts of Assembly to which you re- 
 ferred me. I was induced to do this not only because of the 
 respect due to your letter — but also because of the peculiar 
 interest which ever attaches to the subject of the treatment of 
 persons afflicted with the peculiar and distressing calamity 
 of insanity. 
 
 "Your favor refers me to a passage which is to be found in 
 a communication addressed by your Board to the public. 
 
 "As you invite a statement of my opinion as to its accuracy, 
 it is proper that I should quote it at length — it is in these 
 words : — 
 
 " ' The sad and anomalous condition of 'insane criminals' 
 ' under the provisions of the Act of 1836 relating to this 
 1 class, did not satisfy the public mind little as the public 
 
62 
 
 ' mind takes cognizance of such matters, and it found in 
 ' Miss Dix such an exponent of its wishes, as led to the leg- 
 ' islation of 1845, which established the State Lunatic Hos- 
 ' pital at Harrisburg, at which provision was made for the 
 'reception of this class of the insane, in community with 
 ' the other patients. So largely did this feature interest the 
 ' public that it was the common thought that this Institu. 
 1 tion was created for the special care of this class. The 
 ' Act of 1861 practically nullified this legislation and since 
 ' then, a great wrong has been imposed upon them, which 
 ' this Board is endeavoring to remove. Very many of 
 ' them are consigned to the public jails. While wholly ir- 
 ' responsible in the eyes of the law, they are dealt with by 
 'the law, as convicted criminals. We maintain that under 
 ' the law of 1861, the wisdom and humanity of our able and 
 ' excellent judges are not competent to make any other dis- 
 1 position of them." ' 
 
 " You ask me to give my 'professional opinion upon the 
 ' accuracy of the statement' just quoted. 
 
 " Save for your request, which implies that some one has 
 ventured to doubt the correctnesss of your narrative, I should 
 not have supposed it possible that it needed confirmation. 
 
 " My first impression was decidedly in favor of its entire 
 truth and my subsequent examination of the law has con- 
 firmed my original conviction. 
 
 " By the Act of June 13, 1836, it was provided that upon 
 the acquittal of a defendant in a criminal case 'upon the 
 ground of insanity,' the court should have the 'power to 
 ' order such person to be kept in strict custody in such place 
 ' and in such manner as ***** should seem fit * * so long 
 'as such person should continue to be of unsound mind.' 
 (Act of June 13, 1836, § 58, P. L. 1836, page 603. 
 
 " The like proceedings were authorized if the defendant 
 were upon arraignment found to be a lunatic and even where 
 he was about to be discharged for want of prosecution. 
 
 " Prior to 1841 there was no place in which such unfortu- 
 nate persons could be 'kept in strict custody, except prisons 
 
63 
 
 and penitentairies. The private asylums were evidently not 
 contemplated by the law, and were probably under no obliga- 
 tion to receive any person sent to them by the courts. 
 
 " March 4, 1841, Governor Porter approved an Act ' to 
 1 establish an asylum for the insane of this Commonwealth.' 
 This statute reflects great credit upon the gentleman who 
 drafted it, and upon the Legislature and the Governor who pas- 
 sed and approved of it. It established " a public asylum for 
 'the reception and relief of the insane of this Commonwealth.' 
 The Governor was to appoint three commissioners to pur- 
 chase a site and to erect a building for the accommodation 
 of 300 patients and necessary offices, at an expense not ex- 
 ceeding $120,000. 
 
 " The 8th section of said Act was designed to remedy the 
 evil you refer to as existing under the statute of 1836. It 
 provided : — 
 
 " 'That the proper courts of this Commonwealth shall 
 'have power to commit to said asylum, any person who 
 'having been charged with an offence punishable by im- 
 ' prisonment or death, shall have been declared by the ver- 
 ' diet of a jury or otherwise, to the satisfaction of the court, 
 ' to have been insane at the time the offence was committed, 
 , and who still continues insane.' 
 
 "The prior Act of 1751 had contained no such provision. 
 The Act of 1841 removed the blot upon our system of con- 
 fining insane persons as criminals. 
 
 "So far as I have been able to discover, there was no 
 change in this system for many years. It evidently met with 
 the support of the people. By Act approved by Governor 
 Shunk, April 14, 1845, a hospital was established at Harris- 
 burg (P. L. 1845 p. 442.) 
 
 " The 10th section of this statute repeats the humane pro- 
 vision of the Act of 1841. 
 
 " March 18, 1848, Governor Shunk appoved the Act incor- 
 porating the Pittsburg Hospital. (P. L. 1848, p. 218.) By a 
 supplement to this charter approved by Governor Pollock, 
 May 8, 1855 (P. L.1855 p. 512) the provisions of the Act of 
 1841 were extended to that institution. 
 
64 
 
 "Provisions for the removal of insane persons from prisons 
 and penitentaries to insane asylums were repeated by the 
 Acts of May 4th, 1852 (P. L. 1852, p. 552,) and March 24th, 
 1858 (P. L. 1858, page 151.) 
 
 "So the law stood from 1841 to 1861. During those 
 twenty years, the courts and all classes of citizens were 
 satisfied with the propriety, justice and necessity of these 
 laws. 
 
 "April 8, 1861, a statute was approved which prohibited 
 the commitment to the Pennsylvania State Lunatic Asylum 
 of any person charged with certain crimes therein enumer- 
 ated. It, however, contained a humane proviso which left 
 the power of commitment with the courts where they were 
 satisfied that there was c reason to believe that a cure of the 
 insanity might be speedily effected' (P. L. 1861, page 249.) 
 But a subsequent section authorizes the trustees and the super- 
 intending physician to reverse the order of the court, for if 
 they are satisfied ' that there is no reasonable prospect of a 
 ' cure' * * . * they may in all cases cause the patient to be re- 
 1 moved to the prison of the proper county or the penitentiary- 
 ' from which he or she was sent.' 
 
 "It is, therefore, unfortunately true as stated by you, that 
 the Act of 1861 practically nullifies the humane legislation of 
 former years, and that since 1861 a great wrong has been im- 
 posed upon a class of unfortunate persons who although not 
 responsible to the law, are yet subject to confinement in prisons 
 and penitentiaries as felons. These views are not affected in 
 any wise by the Act of April 20, 1869, (P. L. 78) for the offi- 
 cers of the State asylums are not embraced within its provi- 
 sions. The Act of 1861 stands unrepealed. 
 I am, very respectfully yours, 
 
 " F. CARROLL BREWSTER." 
 
 In a large number of our sister States, constitutional provi- 
 sion has been made to secure appropriate legislation in behalf of 
 the insane ; but in order to bring the whole subject more fully be- 
 fore the Legislature, in all its bearings, or, at least, in a great 
 
65 
 
 variety of points of view, we take leave to introduce here the 
 legislative provisions of a number of States as to insane per- 
 sons, charged or convicted of crime ; premising that we have 
 examined the constitutions and laws, together, of thirty-three 
 States (all that we have been able to reach,) in relation to the 
 insane, and in all cases their rights have been tenderly pro- 
 tected — and the legislation in behalf of the class to which we 
 are now directing your attention, with the single exception of 
 Pennsylvania, is invariably of the most humane character. 
 
 LEGISLATION OF OTHER STATES IN RELATION 
 TO INSANE CRIMINALS. 
 
 ARKANSAS. 
 
 A person that becomes insane or lunatic after the commis- 
 sion of a crime or misdemeanor, shall not be tried for the 
 offence during the insanity or lunacy. 
 
 If, after verdict of guilty and before judgment pronounced, 
 such person becomes insane or lunatic, then no judgment shall 
 be given while the insanity or lunacy shall continue. 
 
 If, after judgment and before execution of the sentence such 
 convict becomes insane or lunatic, if the punishment be capital 
 or corporal, the execution thereof shall be stayed until the 
 recovery of such convict from such insanity or lunacy. 
 
 CONNECTICUT. 
 
 That section two hundred and forty- three of the Act 
 concerning; crimes and misdemeanors be amended bv erasing: 
 from the fourth line thereof the words the " common jail " 
 and inserting in lieu thereof the words " the General Hospital 
 for the insane of the State of Connecticut." 
 
 GEORGIA. 
 
 It shall be the duty of the physician to the penitentiary of 
 this State, when he discovers that any one of the convicts in 
 said penitentiary has become lunatic or insane, to certify the 
 same to the principal keeper of said penitentiarv, and it shall 
 
 [5] 
 
6Q 
 
 be the duty of said principal keeper, upon the receipt of such 
 certificate, to transfer said convict to the lunatic asylum of 
 this State, and shall send together with such convict a copy 
 of said certificate, together with the day on which the term 
 of service of such convict will expire in said penitentiary, and 
 the county from which he was sentenced. 
 
 LOUISIANA. 
 
 Whenever any person arrested to answer for any crime or 
 misdemeanor before any court of this State, shall be acquitted 
 thereof by the jury, or shall not be indicted by the grand 
 jury, by reason of the insanity or mental derangement of such 
 person, and the discharge or going at large of such person, 
 shall be deemed by the court to be dangerous to the safety of 
 the citizens or to the peace of the State, the court is authorized 
 and empowered to commit such person to the State Insane 
 Hospital or any similar institution in any parish within the 
 jurisdiction of the court : There to be detained until he is 
 restored to his right mind or otherwise delivered by due 
 course of law. 
 
 MAINE. 
 
 When any person is indicted for a criminal offence, or is 
 committed to jail on a charge thereof by a justice of the peace 
 or judge of a police or municipal court, any judge of the court 
 before which he is to be tried when a plea of insanity is made 
 in court, or he is notified that it will be made, may in vacation 
 or term time order such person into the care of the superin- 
 tendent of the insane hospital, to be detained and observed by 
 him till the further order of the court, that the truth or falsity 
 of the plea may be ascertained. 
 
 When the grand jury omits to find an indictment against 
 any person arrested by legal process to answer for any offence 
 by reason of his insanity, they shall certify that fact to the 
 court ; and when a traverse jury for the same reason acquits 
 any person indicted, they shall state that fact to the court 
 
 
67 
 
 when they return their verdict ; and the court by a precept 
 stating the fact of insanity, may commit him to prison or to 
 the insane hospital till restored to his right mind or delivered 
 according to law; but he shall only remain in prison till provi- 
 sion can be made for him at the hospital and then removed 
 thereto . 
 
 When an inmate of the State prison becomes insane, the 
 warden shall notify the Governor of the fact and he, with the 
 advice of counsel, shall appoint a commission of two or more 
 skillful physicians to investigate the case, and if such inmate 
 is found insane by their investigation, he shall be sent to the 
 insane hospital until he becomes of sound mind ; and if this 
 takes place before the expiration of his sentence, he shall be 
 returned to prison; but if after, he shall be discharged free. 
 The expenses of the commission, removal, and support shall 
 be paid by the State. 
 
 MINNESOTA AND WISCONSIN. 
 
 When any person, indicted or informed against for an of- 
 fence, shall on trial be acquitted by the jury, by reason of in- 
 sanity, the jury in giving their verdict of not guilty, shall 
 state that «is was given for such cause, and thereupon if the 
 discharge or going at large of such insane person shall be 
 considered by the court manifestly dangerous to the peace and 
 safety of the community, the court may order him to be com- 
 mitted to prison, or may give him into the care of his friends, 
 if they shall give bonds with surety, to the satisfaction of the 
 court, conditioned that he shall be well and securely kept ; 
 otherwise he shall be discharged. 
 
 OEEGON. 
 
 If the defence be the insanity of the defendant, the jury 
 must be instructed if they find him not guilty on that ground, 
 to state that fact in their verdict, and the court must there- 
 upon, if it deems his being at large dangerous to the public 
 peace or safety, order him to be committed to any lunatic 
 
'68 
 
 asylum authorized by the State to receive and keep such per- 
 sons, until he become sane -or be otherwise discharged there- 
 from, by authority of law. General laws Oregon, page 
 469 § 170. 
 
 NEW JERSEY AND NEW YORK. 
 
 When a person shall have escaped indictment or have been 
 acquitted of a criminal charge upon trial, on the ground of 
 insanity, upon the plea pleaded of insanity or otherwise, the 
 court being certified by the jury or otherwise of the fact, 
 shall carefully inquire and ascertain whether his insanity in 
 any degree continues, and if it does, shall order him into safe 
 custody, and to be sent to the asylum. 
 
 If any person in confinement, under indictment or under 
 sentence of imprisonment, or for want of bail for good beha- 
 vior * * shall appear to be insane, the judge of the circuit 
 court of the county where he is confined shall institute a 
 careful investigation, call two respectable witnesses, physicians 
 and other credible witnesses, invite the prosecutor of the pleas 
 to aid in the examination, and if he shall deem it necessary, 
 call a jury, and for that purpose is fully empowered to compel 
 the attendance of witnesses and jurors, and if it be satisfacto- 
 rily proved that he is insane, said judge may discharge him 
 from imprisonment, and order his safe custody, and removal 
 to the asylum, where he shall remain until restored to his 
 right mind, and then if the said judge shall have so directed, 
 the superintendent shall inform the said judge and the county 
 clerk and prosecutor of the pleas thereof, whereupon he shall 
 be remanded to prison, and criminal proceedings be resumed, 
 or otherwise be discharged. 
 
 Persons charged with misdemeanors, and acquitted on the 
 ground of insanity, may be kept in custody and sent to the 
 asylum in the same way as persons charged with crimes. 
 
 NEW YORK. 
 
 An Act to organize the State Lunatic Asylum for insane 
 convicts, passed April 8th, 1858. 
 
69 
 
 Sec. 1. The building now being erected on the prison 
 grounds at Auburn, for an asylum for insane convicts, shall be 
 known and designated as the "State Lunatic Asylum for insane 
 convicts." 
 
 [After defining the method of administration, the statute' 
 proceeds ; ] 
 
 Sec. 8. "Whenever the physicians of either of the State pris- 
 oners of this State shall certify to the inspectors, that any convict 
 is insane, they shall make immediately a full examination into the 
 condition of such convict, and shall cause such convict to be ex- 
 amined by one of the physicians of the State Lunatic Asylum at 
 Utica, and if satisfied that the said convict is insane, or that 
 there is probable cause to believe such convict to be insane, 
 they shall order the agent and warden of the prison where 
 such convict confined, forthwith to convey such convict 
 to the State Lunatic Asylum for insane convicts, and to de- 
 liver the said convict to the superintendent thereof, who is 
 hereby required to receive said convict into the said asylum, 
 and retain him there so long as he shall continue to be insane, 
 and no convict who has been committed to said asylum as 
 insane, shall be discharged from said asylum by reason of the 
 expiration of the term for which he was sentenced, unless the 
 relatives of such convict shall produce to said superintend- 
 ent satisfactory evidence of their ability to maintain such con- 
 vict, and shall execute and deliver to said superintendent an 
 agreement in writing that such convict shall not be a charge 
 upon any public charity, if such convict shall continue to be 
 insane at the expiration of the time for which such convict 
 was sentenced. 
 
 ACT OF MAY 21, 1873. 
 
 No person, association or corporation shall establish or 
 keep any asylum, institution, house of retreat for the care, 
 custody or treatment of the insane, or persons of unsound 
 mind, without first obtaining a license therefor from the Board 
 of State Charities ; provided, that this section shall not apply 
 to any State asylum or institution, or to any asylum or insti- 
 
70 
 
 tution established or conducted by any county or by any city 
 or municipal corporation. 
 
 The said Board mab revoke the license of any asylum or 
 institution, issued under the provisions of this Act, for 
 reasons deemed satisfactory to said board ; but such revoca- 
 tion shall be in writing and filed, and notice given in writing 
 to the person, association or corporation to whom such license 
 was given. 
 
 ACT OF JUNE 7, 1873. 
 
 If any inmate of any such almshouse, when admitted, is 
 insane, or thereafter becomes insane, or of unsound mind, and 
 the accommodations in said almshouse are not adequate and 
 proper, in the opinion of the said Secretary of the State Board 
 of Charities, for his treatment and care, the said Secretary 
 may cause his removal to the appropriate State Asylum for 
 the Insane and he shall be received by the officer in charge 
 of such asylum and maintained therein until duly discharged. 
 
 OHIO. 
 
 If any person in prison shall, after the commission of an 
 offence, and before conviction, become insane * * * an ex- 
 amining court may be called in the manner provided in the 
 Act entitled * * * and if such court shall find that such 
 person became insane after the commission of the crime or 
 misdemeanor of which he stands or charged indicted, and is 
 still insane, the said court shall proceed and the prisoner 
 shall for the time being, and until restored to reason be dealt 
 with in like manner as other lunatics are required to be after 
 inquest had, provided, however, that if said lunatic be dis- 
 charged, the bond given for his support and safe-keeping 
 shall also be conditioned that said lunatic shall when restored 
 to reason answer to said crime or misdemeanor and abide the 
 order of the court in the premises ; and any such lunatic 
 may, when restored to reason, be prosecuted for any offence 
 committed by him previous to such insanity. 
 
 If any person, after being convicted of any crime or mis- 
 demeanor, and before the execution in whole or in part of the 
 
71 
 
 sentence of the court, become insane, it shall be the duty of 
 the Governor of the State to inquire into the facts, and he 
 may pardon such lunatic, and commute or suspend for the 
 time being the execution in such manner, and for such a 
 period as he may think proper, and may by his warrant to the 
 Sheriff of the proper county, or Warden of the Ohio Peniten- 
 tiary, order such lunatic to be conveyed to the asylum and 
 there kept until restored to his reason. If the sentence of 
 any such lunatic is suspended by the Governor, the sen- 
 tence of the court shall be executed upon him after such 
 period of suspension hath expired, unless otherwise directed 
 by the Governor. 
 
 RHODE ISLAND. 
 
 If upon examination a judge is satisfied that the person 
 thus imprisoned is insane or idiotic, he shall have the power 
 to order the removal of such prisoner from the State prison 
 or jail aforesaid, to be detained in the State Asylum for the 
 Insane, if he can be there received, or if not in the Butler 
 Hospital. 
 
 Such order of removal shall be for and during the term 
 of said prisoner's sentence, and be directed to the Sheriff of 
 the county in which such prisoner stands committed. 
 
 Any person removed as aforesaid, upon restoration to reason 
 may, by an order of either of the judges of the Supreme Court 
 in his discretion be remanded to the place of his original con- 
 finement, to serve out the remainder of his term of service. 
 
 MASSACHUSETTS. 
 
 The physician of the State Prison, as chairman with the 
 Superintendents of the State Lunatic Hospital, shall consti- 
 tute a commission for the examination of convicts in said 
 prison alleged to be insane. Each commissioner shall receive 
 for his services in such capacity his travelling expenses and 
 three dollars a day for each day he is so employed. 
 
 The Commission shall investigate the case, and if in the 
 opinion of the majority of them, the convict has become in- 
 
72 
 
 sane and his removal would be expedient, they shall so re- 
 port, with their reasons, to a judge of the Superior Court, 
 who shall forthwith issue his warrant under the seal of that 
 court, directed to the Warden, authorizing him to remove 
 the convict to one of the State lunatic hospitals, there to be 
 kept till in the opinion of the Superintendent and Trustees 
 thereof, he may be recommitted consistently with his health. 
 When a convict in the prison appears to be insane, the 
 Warden or Inspector shall give notice to the chairman of said 
 commission, who shall forthwith notify the members thereof 
 to meet at the prison. 
 
 NEW HAMPSHIRE, 
 
 The Governor, with the advice of the Council, may remove 
 to the Asylum, to be there kept at the expense of the State, 
 any person confined in the State prison who is insane. 
 
 SOUTH CAROLINA. 
 
 Any judge of the circuit court is authorized to send to the 
 lunatic asylum every person charged with the commission of 
 any criminal offence who shall upon the trial before him 
 prove to be non compos mentis, and the said judge is authorized 
 to make all necessary orders to carry into effect this power. 
 
 TENNESSEE. 
 
 That section 5488 of the code of Tennessee be so amended 
 as to read, whenever the physician reports to the keeper of the 
 penitentiary that any convict is insane, and ought on that 
 account to be removed to the lunatic asylum, the keeper shall 
 cause such insane convict to be removed accordingly, there to. 
 remain until discharged by the physician of said lunatic 
 asylum. 
 
 TEXAS AND IOWA. 
 
 If any person charged with, or convicted of any criminal 
 offence be found to be insane in the court before which he is 
 
73 
 
 so charged or convicted, said court shall order him to be con- 
 veyed to and retained in the State Lunatic Asylum, and he 
 shall be received and retained, until removed by the order of 
 the court by which he was commit ed to the asylum. 
 
 If any person after being convicted of any crime or mis- 
 demeanor, and before the execution in whole or part of the 
 sentence of the court, becomes insane, it shall be the duty of 
 the Governor of the State to inquire into the facts, and he may 
 pardon such lunatic or commute or suspend for the time being 
 the execution, in such manner and for such a period, as he 
 may think proper, and may by his warrant to the Sheriff of 
 the proper county, or Warden of the Iowa penitentiary, order 
 such lunatic to be conveyed to the hospital and there kept 
 until restored to reason. 
 
 As before said, the State of New York has made provision 
 for the care in hospitals of all her insane poor. For this she 
 is to be commended ; in this to be imitated. But the hospital 
 or asylum referred to in the foregoing statutes, as that to 
 which " insane convicts " and others are to be sent, is a luna- 
 tic asylum established by a statute of 1858, 
 
 ON THE PEISON GBOUNDS 
 
 at Auburn, expressly for this object. In this, her purpose is most 
 laudable ; but the propriety of her course is most questionable, 
 as will more fully appear in the sequel. 
 
 This Board had the honor, last year, of causing to be pre- 
 pared and laid before the Senate, the draught of a bill " to 
 provide for the care and keeping of the criminal insane of this 
 commonwealth, — including those who may be acquitted of 
 crime on the ground of insanity." And the proposition was, 
 in general terms, that a department, a wing or a distinct 
 building surrounded by a wall, of the hospital now under 
 construction at Danville, should be so planned, arranged, 
 completed and organized as to make it fit, suitable and con- 
 venient for the care, keeping and treatm ent of the classes of 
 
74 
 
 insane persons referred to. It may be proper to say that 
 the Board had 
 
 CHIEFLY IN VIEW, THE MORE NUMEROUS CLASS ; 
 
 those who were in prisons with criminals, without ever hav- 
 ing been convicted of crime ; and that they made their 
 recommendation, so far as regards the less numerous class, 
 the strictly "convict insane," on the assumption, which 
 we have shown may fairly be made, that the vast ma- 
 jority of such convicts were really insane, or, at least, in the 
 incipient or latent stages of insanity, at the time the acts 
 charged against them as crimes, were committed.* They 
 were cases of this sort, or this was the aspect of the cases we 
 had in mind, and for which we sought relief ; the others, the 
 ten per cent, or so, we regarded as simply exceptions, which, 
 at all events, should not vitiate the rule. We proposed but 
 did not urge the bill ; and, through misunderstanding, and in 
 consequence of opposition from interested parties, it was lost. 
 
 At the late meeting in Baltimore of the Association of 
 Medical Superintendents of Hospitals for the Insane, it was 
 openly stated by a member from Pennsylvania that "that 
 measure was defeated (I suppose) by the efforts of certain 
 members of this association," and the statement was not con- 
 tradicted. (See Journal of Insanity, Oct. 1873, page 236.) 
 
 This meeting of medical superintendents was a notable one. 
 
 * Report in relation to the insane convicts in the Eastern Penitentiary on February 24, 
 1873, by Edward Townsend, Warden — number this date, 12. 
 W. W. Confirmed lunatic on admission. 
 M. L. Imbecile in mind on admission. 
 T. R. Unsound mind on admission. 
 A. N. Unsound mind on admisson. 
 I. B. H. Imbecile on admission. 
 G. V. Decidedly imbecile wben admitted. 
 M. V. B. S. Very weak-minded on admiseion, since insane. 
 Dora S. Insane on admission and remains so. 
 
 Mary S. Insane on admission and had been an inmate of an insane asylum. 
 M. McG. Very feeble-minded on admission. 
 E L. Weak-minded, bordering on lunacy, when admitted. 
 P. L. Insane on admission. 
 
 Report of Edward S. Wright, Warden of Western Penitentiary, on the same subject, 
 made at the same time. Number of insane convicts in Penitentiary, 8. 
 Prisoner No. 3324, mental health, impaired on admission. 
 ii 37 2 0) 
 
 " 37.00, " " " 
 
 " 3958, " " u 
 
 ii ,« 400gj .< ii i< 
 
 ,< 400g) 
 
 " " 4019, " insane on admission. 
 
 " " 4030, " insane on admission. 
 
75 
 
 Believing that the case of the proposed law just referred to, 
 had not been fully understood, and wishing to have the subject 
 freely and thoroughly ventilated, we addressed to the Presi- 
 dent of this association, the following communication : 
 
 Philadelphia, May 28th, 1873. 
 11 Dr. J. S. Butler, 
 "President of Convention of Medical Superintendents for the Insane. 
 
 " Dear sir, — The morning papers inform me that the impor- 
 tant humanitarian body over which you preside, has as- 
 sembled for the consideration of the interests of the insane 
 in convention at Baltimore. On other like occasions, the 
 commissioners of this board have been honored with an invi- 
 tation, — to be represented, of course, in presence merely ; but 
 still we are glad to be apprised of your meeting by public 
 announcement, and venture to address you on a subject of 
 great interest to this Board, and one which, we think, has 
 escaped any authoritative action of your body. 
 
 " We refer to the subject of the care of the ' criminal in- 
 sane.' TVe are led to refer this matter to you for action, be- 
 cause of an unsuccessful effort made by this Board to have a 
 precedent established by the Legislature of the State of Penn- 
 sylvania, to construct a department for this class upon the 
 grounds of the Hospital for the Insane at Danville, Pen?ia.. 
 for the reception and treatment of (for the most part) the 
 irresponsible insane, wh o are now incarcerated in the peniten- 
 tiaries and jails of this Commonwealth. 
 
 "It is true that we did not press this matter upon the Legis- 
 lature, believing that the simple proposition should be suffi- 
 cient for favorable action ; but as the higher advice of repre- 
 sentatives from this State in your Convention prevailed to 
 defeat the measure which we proposed, we feel justified in 
 asking you to take such definite action as will have like influ- 
 ence in protecting the class, who are committed, in this State. 
 at least, (I am glad to say not in all other States) to the mis- 
 eries of a felon's doom. 
 
 " In noticing this subject I beg your permission to venture 
 
ll> 
 
 on a few observations on the subject, and in doing so I ex- 
 press the mind of every member of this Board. 
 
 •• It is a fact patent to all of us, that multitudes of irrespon- 
 sible criminal insane are now in the prisons of many of the 
 States, and it is equally true that the influence of the body 
 known as the Association of Medical Superintendents of 
 American Institutions for the Insane, has exercised a most 
 potent and salutary influence, in shaping the legislation of 
 the several States, in behalf of this afflicted class of their 
 citizens. 
 
 " Believing that your influence will avail to check the enor- 
 mous wrong which the class we refer to suffer, we ask your 
 intervention in their behalf, and urge you to set forth a dis- 
 tinct and definite policy which shall satisfy its demands. 
 
 "We know that in Great Britain there are two asylums for 
 the specially criminal insane ; one at Broadmoor, not far from 
 London, a distinct institution with accommodations for from 
 live to six hundred inmates ; and one at Perth, Scotland, 
 under penal jurisdisdiction, but in charge of a special super- 
 intendent. 
 
 " We know that on the continent of Europe there is no special 
 provision for the criminal insane ; it being held by the most 
 distinguished alienist physicians and so proclaimed in many 
 works on psychological subjects, that insanity should level all 
 distinctions ; and, as Dr. Manning reports, that 'the great gulf 
 which separates the convict from the honest man is bridged 
 over by insanity ; that when sick in body, the prisoner should 
 be kept within his prison and treated for his malady, but 
 when sick in mind, the prison should be opened and the badge 
 of the convict be forgotten." 
 
 " In this view, the well known humanitarian, Miss Dix, 
 concurred. 
 
 •• We also know that in these United States there is an asy- 
 lum for insane convicts at Auburn, Xew York, intended 
 originally for the reception of such as became insane when 
 convicts but more recently for those,, also, who have been 
 acquitted on the ground of insanity. We know of no other 
 
77 
 
 special provision made for this class, unless it be in jails. 
 In the State of Pennsylvania there are no t, we think, over 
 ten per cent, of the number who are now confined in the 
 penitentiaries and jails, who, on the report of the wardens and 
 prison-keepers, were not insane when sentenced, and of this 
 small percentage, some, of course, were mentally imbecile or, 
 in the incipient stage of insanity, when the crime was com- 
 mitted. The law holds them to be ' irresponsible,' and, still, 
 they are held as felons by the act of the law. As has been 
 well said ' the courts fail to detect the disability for want of 
 a proper defence or because the mental disease is still latent.' 
 The jails thus receive these forlorn ' wards of the State' 
 forsaken by man, not, we believe, by God. We could 
 enumerate instances of marked cruelty in individual cases, 
 but we point only to the injustice which must inevitably 
 oppress them, when subjected to the treatment of prisoners 
 in the State and county jails : Their lightest affliction being 
 perpetual incarceration within the limits of a cell, without the 
 slightest consideration of their sufferings or their needs. 
 This is the case, certainly, in Pennsylvania. 
 
 "There will be no dispute as to the impolicy as well 
 as the wrong-doing of such ' proceedings.' These 'irre- 
 sponsible' citizens are, as is often said, 'wards of the State.' 
 Surely no official of the State, no private citizen, who is the 
 head of a family, would overlook the claims of his own chil- 
 dren. They would extend the solace and the help all the more 
 for their infirmities. 
 
 "In the year 1871 the Massachusetts Board of Public 
 Charities addressed communications to the Superintendents 
 of the lunatic hospitals of that State, requesting their views 
 on certain points. That which concerns this Board is the in- 
 quiry as to the provision which should be made for the class 
 to whom we refer. It is highly honorable, in our judgment, 
 to the intelligence as well as to the humanity of each of these 
 distinguished gentlemen, that neither recommended that a 
 hospital for the ' criminal insane ' should be an appendage or 
 an appurtenance of a prison, or built at all on prison grounds. 
 
78 
 
 On the contrary, although one of them, to relieve the urgency 
 of the case, admits that he has recommended the fitting up 
 of a lunatic ward in the State Prison, to be placed under the 
 special care of the prison physician, still he declares, ' there 
 would be but little objection, aside from sentiment, to the 
 treatment of lunatic convicts in a properly constructed hos- 
 pital for the insane, where they would not mingle indis- 
 criminately with the other classes of patients.' Another 
 says, ' I would not advocate making it an adjunct of the State 
 Prison, or any penal institution.' The last, after recommending- 
 that a distinct institution "be established for the reception of 
 this class, says, with the knowledge that they are provided for r . 
 [in Mass.] in the State lunatic hospitals, 'if the Superinten- 
 dent and Trustees of any State lunatic hospital, and the* 
 general agent of the Board of State Charities, concur in the 
 opinion that a patient of said hospital ought to be removed 
 to said building, he should be so removed. This is the alter- 
 native to care and treatment in a general hospital for the 
 insane: in Pennsylvania, [it would be] from a prison to a 
 hospital. 
 
 " As the result of the investigations of this intelligent 
 Commission, and the views forcibly presented by the eminent 
 alienist physicians of their own State, viz., Drs. Godding, 
 Earle, and Bemis, this cautious Board has recommended in 
 their present report, just issued, the establishment of a hospital 
 for the ''criminal insane? to be placed near enough one of the 
 other State hospitals for the insane to be under the same ad- 
 ministration. 
 
 " This Board concurs in the principle which underlies this 
 recommendation, as well as in its practical wisdom; for, as to 
 the latter, it cannot be expected that any one State will incur the 
 expense of an independent establishment for this class and 
 the cost of its proper oversight and maintenance. As has 
 been already stated, there is but one in England whose 
 population approximates to our own, [that of the United 
 States.] As to the former, there is no moral ground upon 
 
79 
 
 which the separation of the two classes can be based. It is 
 simply the ground of disagreeableness, to those who conduct 
 the institution, to a small proportion of the patients, and to 
 some of their friends. It is ' sentiment ;' and this we admit 
 should be religiously regard ed in the consideration of every 
 provision for the insane. Let it not be overlooked in behalf 
 of the class we are now considering! We say sentiment only, 
 for the scheme proposed to our Legislature provided for a 
 separate and secure building, separately enclosed with suit- 
 able walls, but to be under the supervision of the Superintendent 
 of the General Hospital, on the same premises." 
 
 "Believing that our views have been clearly conveyed in 
 this communication, and excusing its crudeness, by the 
 obvious necessity of haste, I beg most respectfully to com- 
 mit the subject to your thoughtful determination and action; 
 and I trust that they may be so enlightened, as to reflect 
 honor upon your body and yourselves individualy — not 
 merely for the present, but for all time. 
 
 " I am most respectfully yours, 
 
 " GEO. L. HAKRISON, 
 
 " President." 
 
 When the association entered upon the consideration of 
 this letter, the following resolutions were offered : 
 
 " Whereas, The proper disposal of that class of the in- 
 sane, whose criminal acts require their seclusion and confine- 
 ment, is a matter on which this association is requested to 
 express an opinion, 
 
 "1. Resolved, Therefore, as the opinion of this association, 
 that neither jails and penitentiaries, nor ordinary hospitals 
 for the insane are proper receptacles for this class of persons ; 
 but that they should be cared for in establishments designed 
 expressly and solely for them. 
 
 "2. Resolved, That under no circunstances should 'insane 
 convicts' be associated with other insane persons, believing 
 
80 
 
 that such an association is not calculated to improve the con- 
 dition of the latter, and that the best interests of the former 
 require a special manage ment, and architectural arrangements 
 of a peculiar kind, both very different from such as are 
 adapted to the needs of other classes of the insane. 
 
 " 3. Resolved, also, that the example of the State of New 
 York, which has thus provided for its 'criminal insane,' as 
 they are usually called, be commended to imitation by other 
 States, either singly or collectively." 
 
 We take the liberty of reproducing here some of the most 
 note- worthy utterances which this discussion called forth in 
 the association, as they are published in the jonrnal of in- 
 sanity, before cited. 
 
 Dr. Shew, Superintendent of the General Hospital for the 
 Insane, Middletown, Conn., " If the resolutions refer to per- 
 sons who commit acts which would be considered criminal 
 were they not insane, I cannot concur in all the resolutions. 
 Many of the patients received in our hospital commit those 
 acts, and are sent to the hospital because they are dangerous 
 to society; — dangerous as insane persons. It seems to me that 
 there can be but one opinion, and that is that insane criminals 
 should be separated entirely from patients in hospitals. First, 
 because of the dangerous influence upon other patients ; 
 secondly, because of the odium which it brings on the insti- 
 tution, and the unpleasant feeling which the friends of the 
 patients have in supposing or believing, that their loved - 
 ones are associating daily and hourly with criminal persons." 
 
 "In practical experience I have not found that 'insane 
 convicts' are particularly objectionable in themselves — not so 
 much as Dr. Shurtleff and Dr. Curwen have." [Dr. Curwen 
 has not given his remarks in the official publication.] "Three 
 years ago the Legislature of Conne cticut passed a law requir- 
 ing the Trustees of the Hospital at Middletown to receive all 
 insane convicts after a proper examination, which was 
 specified, and a commission appointed. We had no separate 
 
81 
 
 provision, and were obliged to receive them in the hospital 
 proper, 
 
 AND PLACE THEM IN ASSOCIATION 
 
 with the other patients. Since that time twelve insane con- 
 victs have been transferred from TVethersfleld to Middletown ; 
 two of that number have escaped; one of them feigned in- 
 sanity ; arrangements had been made to transfer him to \Yeth- 
 ersfield, but he escaped the very night before the transfer was 
 to be made. Of the ten others, seven have been among the 
 most valuable farm laborers, harmless, industrious and 
 peaceable, and yet positively insane; much less dangerous 
 than many of the chronic patients. One of the number has 
 been very valuable the past few years, in sharpening the 
 tools used by the stone-cutters in the erection of the two 
 wings, saving the cost of one skilled mechanic. It was his 
 trade and occupation, before being sent to prison. 
 
 NONE OF THE SEVEN WHO HAVE BEEN EMPLOYED EVER 
 ATTEMPTED TO ESCAPE." 
 
 [ Why then was it, that in the case of the eight insane convicts 
 sent to the Harrisburg Institution, five managed to escape?] 
 
 " They are generally liked by the patients, and are not more 
 troublesome than others. The friends of the patients [' pay- 
 ing' patients, doubtless] object to the association, and in my 
 report last year, I called the attention of the Legislature to 
 that fact, and asked that an appropriation be made for a sep- 
 arate building, distinct from the main hospital, a cottage sim- 
 ply, to provide for the insane convicts. * * * * During the 
 present year, we hope to have a building for the accommoda- 
 tion of twenty persons, in which we will provide for all the in- 
 sane convicts. There have been only three transferred from 
 \Yethersneld each year." 
 
 Dr. Shew, then, assuming that the population and re- 
 sources of some of the States, and the number of their in- 
 sane convicts, may be such as to warrant the construction in 
 each, of an entirely separate hospital for their accommoda- 
 tion, with all the best appointments for their proper care 
 
 [6] 
 
82 
 
 and treatment, — proceeds to express, in that case, his prefer- 
 ence for having such a hospital, intended exclusively for the 
 insane convicts proper, erected on the grounds of the State 
 Prison, rather than on those of a general hospital; but 
 otherwise, and for other States, he clearly prefers such an 
 arrangement as he has described at Middletown. 
 Dr. Compton of Mississippi : — 
 
 II The third resolution I think I would amend, because that 
 condemns the action of my own State in this matter. It de- 
 clares that under no circumstances should insane convicts be 
 permitted to associate with other insane persons, believing 
 that such association is not calculated to 'benefit the insane, 
 &c. I would be very decidedly against the first part of the 
 resolution, that, ' under no circumstances should they be 
 associated.' I would take them into my asylum, rather than let 
 them remain in the penitentiary or jail. In the absence of the 
 proper provisions, I would take them out of the penitentiary and 
 jails, and put them into my asylum." 
 
 Dr. Earle, of Northampton, Mass. : 
 
 II I would put the convict insane in a separate institution, 
 independent of all other institutions. 
 
 I WOULD PUT IN THE SAME PLACE, 
 
 those who have been tried for crime and acquitted on the 
 ground of insanity ; then those incendiary and homicidal 
 patients, who never had been tried for crime. I would make 
 the provision that they should be removed to that institu- 
 tion, but not unless it was decided by the Superintendent of 
 the hospital, and the Board of State Charities and its agents ;■ 
 all these authorities must concur before a man who had com- 
 mitted a criminal act, and had not been convicted of crime, 
 should be removed [not from the common hospital to t"he 
 penitentiary or prison, but] from the common hospital to 
 this institution. This applied only to the incendiary and 
 homicidal class, because 
 
 OUR MOST DANGEROUS PATIENTS ARE NOT CONVICTS, 
 
 and have never been tried for crime and acquitted on the 
 ground of insanity." 
 
83 
 
 Dr. Gundry, of Athens, Ohio : 
 
 " In endorsing the action of the State of New York, we go 
 further than my amendment would contemplate, because we 
 endorse this course. They have done very well in providing 
 a hospital for insane convicts, but with those insane convicts 
 they send persons who are compelled to mingle with them, 
 whose acts of violence were committed in their diseased con- 
 dition. It is urged that this is a matter of expediency, be- 
 cause the hospitals are not able to contain them for various 
 reasons. 
 
 IF THE HOSPITALS ARE NOT PKOPERLY CONSTRUCTED MAKE 
 
 THEM SO. 
 
 " If special arrangement are required for violent patients, 
 have those special arrangements made." The doctor then 
 goes on to speak with more kindness than respect, of Boards 
 of State Charities, but with this we have nothing to do. 
 
 Dr. Smith, of Fulton, Missouri: — 
 
 " I must also object to that part of one of the resolutions, 
 which endorses the New York law. Those conversant with 
 this law inform us that one of its provisions requires that 
 all acquitted on the ground of insanity, shall, in the discre- 
 tion of the judge, be sent to the same institution designed 
 for convicts." [And, he might have added, standing as a de- 
 partment of the State Prison.] " Such a provision as this I 
 cannot endorse. * * * Endorsing this law would be equiva- 
 lent to endorsing the punishment of the insane, because of the 
 acquittal of crime ; the penalty of assigning them to a position 
 most repulsive to their feelings and those of their friends, 
 and one that would not only retard but often prevent re- 
 covery". [What would the Doctor have said of sending 
 them, as we do, not to a common hospital, but to a common 
 prison ?] " We have patients in our institution, who, prior to ad- 
 mission, committed terrible deeds, and, no doubt, there are such in 
 most hospitals for the insane. We have fathers who killed 
 their wives and children ; and a mother who killed her hus- 
 band, all under the influence of delusions in regard to differ- 
 
84 
 
 ent members of their families. These patients have been as 
 orderly, quiet and pleasant as any in our building ; have 
 shown no tendency to violence, and exerted no injurious 
 influence over others." 
 
 The resolutions were amended and finally passed as fol- 
 lows ; and were transmitted to us as the response of the 
 Association. 
 
 "Whereas, The President of the Board of Charities of 
 Pennsylvania has requested that this Association should ex- 
 press its opinion in regard to the proper disposition of insane 
 convicts, therefore, 
 
 "Resolved, 1. That neither the cells of penitentiaries and 
 jails, nor the wards of ordinary hospitals for the insane are 
 proper places for the custody and treatment of this class of 
 the insane. 
 
 " 2. That when the number of this class in any State (or 
 in any two or more adjoining States which will unite in the 
 project) is sufficient to justify such a course, these cases 
 should be placed in a hospital specially provided for the pur- 
 pose : and that until this can be done, they should be treated 
 in a hospital connected with some prison, and not in the 
 wards nor in separate buildings, upon any part of the grounds 
 of an ordinary hospital for the insane." 
 
 The published report of the debate, from which we have 
 made the foregoing citations, as containing important medi- 
 cal opinions bearing on the subject in hand, would have been 
 more complete and fair, as well as less liable to misunder- 
 standing, if the letter from this Board, which called it forth, 
 had not been suppressed. It would then have appeared that 
 both the debate and the final action of the Association failed 
 to grasp the precise points presented in the'letter. They 
 treated the subject with reference to an ideal standard, rather 
 than with reference to the actual laws and practice of Penn- 
 sylvania in the case. 
 
 The whole debate and the final action were eventually 
 narrowed down to the case of " insane convicts " exclusively, 
 
85 
 
 instead of taking into view all the classes of the " criminal 
 insane," so called, which were presented for their considera- 
 tion. 
 
 It is instructive, however, to compare the resolutions 
 finally adopted with those originally proposed. 
 
 1. Both sets of resolutions agree, — and so did, apparently 
 every member of the Association, in the most emphatic 
 manner — in the fundamental principle, that neither the cells 
 of jails and penitentiaries, nor the wards of ordinary hospitals 
 for the insane, are proper receptacles for the custody and treat- 
 ment of that class of the insane, whose case was under con- 
 sideration. 
 
 2. The resolutions adopted confine themselves to the care 
 of 
 
 INSANE CONVICTS AS SUCH, 
 
 a portion only of the cases submitted for consideration, while 
 the original preamble included the "proper disposal of that 
 class of the insane, whose criminal acts require their seclu- 
 sion and confinement." Precisely what class was intended 
 to be thus described, might be doubted, but if simply 
 "insane convicts" were intended, it was a very circuitous 
 way of saying so. 
 
 3. It is not expressly and positively declared, in these, as 
 in the former resolutions, that, under no circumstances, should 
 " insane convicts " be associated with other insane persons ; 
 but merely that they should be treated 
 
 It is left an open question whether or not other special 
 classes of insane persons may be treated in the same specially 
 provided hospital, i. e. supposing such hospital not to be on 
 prison grounds, and at the same time not a department of 
 any ordinary hospital for the insane. 
 
 ■i. The commendation of the Xew York plan, of sending 
 other insane persons besides convicts to a hospital connected 
 with a State prison, is carefully avoided. 
 
5. A separate hospital for this class, — separate from pri- 
 sons as well as ordinary hospitals, — is proposed as the pro- 
 per and desirable plan — provided it can be had. 
 
 6. Until such a hospital can be had, it is proposed, as an 
 imperfect, temporary and unsatisfactory substitute, — but 
 as much better than giving "insane convicts" no special or 
 remedial treatment at all, that they, i. e. 
 
 should be treated in a hospital connected with some prison, 
 rather than on the grounds of any " ordinary " hospital for 
 the insane. 
 
 The conclusions thus reached, as far as they go, would be 
 quite in harmony with the views of this Board, except, per- 
 haps, in the last-mentioned particular ; and, on that point, 
 there might be no substantial disagreement, when the case is 
 narrowed down to the precise circumstances contemplated, 
 and the precise expressions employed. It is, in terms, an un- 
 desirable alternative, which is thus presented. We think, and 
 we shall hope to show that it is 
 
 NEITHER REASONABLE NOR NECESSARY TO RESORT TO 
 SUCH AN ALTERNATIVE AT ALL. 
 
 The plan of two or more States joining in the erection or 
 support of a hospital for insane convicts is not new. Such 
 a plan was proposed and drawn out at large by Dr. Edward 
 Jarvis of Massachusetts, in 1857, in a very able and sugges- 
 tive paper on the "criminal insane." We cannot but regard 
 all such propositions as simply futile. 
 
 NO TWO OR MORE STATES WILL EVER COMBINE 
 
 in building a common hospital for their "insane convicts;" 
 nor will any one State ever provide such a hospital for the 
 use of other States. In reference to such joint action, the 
 case of insane convicts is very different from that of the 
 
87 
 
 blind or deaf mutes or the ordinary insane. We may there- 
 fore dismiss such suggestions as visionary and illusory : And 
 the fact that United States convicts are received into the con- 
 vict prisons of several of the States, in the absence of a na- 
 tional prison, furnishes no parallel at all to the expedient 
 suggested, of one State taking charge of another State's con- 
 victs. It may be quite possible, and fair, also, for a child to 
 accommodate a parent in an emergency; and impracticable 
 and unreasonable to extend like assistance to a fellow child. 
 But let it be observed in any case, that we make no objection 
 to the joint action of several States in the premises; we only 
 express a decided opinion that it will never be brought 
 about. 
 
 It remains, then, for each State, to make provision for her- 
 self. We must consider the subject in this point of view, if 
 we are to give it any practical consideration at all. Now no 
 one State, — not even New York or Pennsylvania, has such a 
 number of insane convicts, in the strict sense of the terms, as 
 would warrant- the erection and equipment of a completely 
 separate hospital for their exclusive care and treatment: 
 Such a hospital as should furnish them the best supervision 
 and attendance — and nothing less ought to be furnished 
 them. The number of such convicts in this State is proba- 
 bly not many more at any one time, than could be accommo- 
 dated in Dr. Shew's "little cottage" attached to his hospital. 
 For it is to be observed that the magnitude of the existing 
 evil in this particular case, consists not so much in its nu- 
 merical extent, as 
 
 IN THE PRINCIPLE INVOLVED, AND IN ITS RAMIFYING 
 CONNECTIONS. 
 
 The State has no right to offset economy against an in- 
 justice or against inhumanity; but she has a right, in doing 
 justice, to study economy; and she is likely more fully to 
 meet the demands of justice and humanity on the whole 
 and in the long run, when she makes her plans with a far- 
 
88 
 
 seeing and systematic economy, than when she indulges in 
 spasmodic extravagance. 
 It may be assumed as another settled thing, that 
 
 THE STATE WILL NEVER ESTABLISH AN ENTIRELY 
 SEPARATE HOSPITAL, 
 
 separate from all connection either with prisons or with ordi- 
 nary hospitals, 
 
 FOR THE EXCLUSIVE ACCOMMODATION OF TWENTY OR 
 THIRTY "INSANE CONVICTS;" 
 
 and provide it with all the appointments of a complete hos- 
 pital for the care and treatment of the insane. This plan 
 may be dismissed as equally visionary and illusory with the 
 other. 
 
 But it is not to be forgotten that, besides the strictly insane 
 convicts, there are other analogous and closely bordering 
 classes of insane persons yet to be provided for in this 
 State: (1) Those who have been convicted of crime, but 
 have served out their sentences and continue insane ; and of 
 these, there may be nearly as many as of the others. (2) 
 Those who have been charged with crime, but are found in- 
 sane before trial or sentence; — these are a class nearly as nu- 
 merous, probably, as the insane convicts, and yet they are 
 not insane convicts. (3) Those who have committed terrible 
 acts of violence or destruction, as homicide, arson, burglary 
 &c, and have been acquitted of crime on the ground of in- 
 sanity; but, who, for the safety of the community, must be 
 kept under the most watchful and perhaps rigorous restraint, 
 as well as provided with the most skillful curative treatment. 
 
 ALL THESE CLASSES ARE NOW IN OUR JAILS AND 
 PENITENTIARIES OR POORHOUSES, 
 
 or are by law liable to be there, and other classes beside 
 them ;* and their case is to be provided for as well as that 
 
 *The following facts are reported by the General Agent of this Board, under date : Nov. 1 
 Insane frequently sent into prison, sometimes as many as eight or ten at a time, who aie 
 kept until the court decides what disposition to mako of them. 
 One lunatic sentenced Nov. 13th, 1868, for ten days, to enter bail for good behavior. In 
 
 
 
89 
 
 of the strictly insane convicts. And even if a special hos- 
 pital should be provided for insane convicts, in connection 
 with some prison or penitentiary and on the prison ground, 
 rather than in connection with one of the State Lunatic 
 Asylums, and with the imperfect appointments and supervi- 
 sion which must needs characterize such an establishment, 
 considered as a mere department of the prison ; we will not 
 ask noAV whether this is all that is due to the "insane con- 
 victs" themselves, but we do ask whether those other classes 
 of insane persons ought to be 
 
 SEXT TO SUCH A HOSPITAL, TO ASSOCIATE WITH THE INSANE 
 COXVICTS IX A DEPARTMENT OF A PRISOX ? 
 
 Either that, or left in the cells of the jails and penitentiaries, 
 or poorhouses, where they are. But it is asked, why not send 
 them, in such a case, to the ordinary lunatic hospitals ? We- 
 answer by asking why they are not uniformly sent there 
 now ? or, why, when sent there, they are exposed to be re- 
 manded to the prison cells ? 
 
 It may be said that this very class of "criminal insane" 
 are in the hospitals, and that the "returns"' to this Board 
 from these institutions present this fact continually. We 
 have not denied or disputed the fact. We have not found 
 fault with the little good that is done ; but only with the 
 great wrong-doing which so completely obscures and over- 
 shadows it. The law should declare the rights of every citi- 
 zen, and vindicate them uniformly and without exception, 
 especially the rights of the poor and defenceless. 
 
 In fact the whole question is narrowed down to these 
 points : 
 
 default of bail he has been confined ever since. The cause of his detention is the want of 
 suitable accommodations in the County Almshouse. 
 
 Eight insane were sent to this prison in 1S72, all of whom were transferred to the County 
 Almsh .mse. 
 
 One lunatic confined since last winter, was sent here from the poorhouse for safety, not 
 being able to keep her at the latter. 
 
 One "criminal insane" confined nearly six years under a " charge" of arson. 
 
 One man charged with having stolen a horse, was acquitted on the ground of insanity, 
 but is still confined. 
 
 One committed for threat to kill. 
 
 One man not charged with crime, committed for safe-keeping. 
 
 Insane frequently committed. 
 
 One charged with attempt to shoot, suffers under mental disorder. 
 
 Insane frequently committed. 
 
90 
 
 1. It is agreed on all hands that neither prisons nor ordin- 
 ary hospitals, with the ordinary arrangements, are fit places 
 for the custody and treatment of " insane convicts." 
 
 2. The co-operation of several States in establishing or 
 maintaining a special hospital for that purpose, is out of the 
 question. 
 
 3. It is equally out of the question for one State, for this 
 State, to provide for the exclusive use of this class of insane, 
 an entirely separate institution, with the proper hospital 
 equipment and superintendence. 
 
 4. Their special hospital, therefore, if they are to have 
 any, must either be upon the grounds of a prison and an 
 appendage to it, with the imperiect and insufficient supervi- 
 sion of the prison physician, the attendance of* prison over- 
 seers or keepers, and the atmosphere of prison associations, 
 or 
 
 UPON THE GROUNDS OF SOME STATE HOSPITAL, 
 
 so as to be under the same supervision of high and appro- 
 priate medical character, the same attendance and the same 
 curative influences; though, while a department of the hos- 
 pita], it may be made as completely secure and kept as sepa- 
 rate from it as may be thought best, — to be denominated not 
 " the convict department" or " the criminal department," but 
 simply " the special department of such a hospital." This 
 remains 
 
 THE ONLY PRACTICAL ALTERNATIVE. 
 
 If the former course is chosen, the patients will not be 
 secured that degree of skillful treatment and of humane and care- 
 ful attendance, which is their due, and without which there is 
 small prospect of their recovery ; and, what is perhaps more, 
 it would be 
 
 UTTERLY UNJUST AND OUTRAGEOUS TO RETAIN THOSE OTHER 
 CLASSES OF THE INSANE, — 
 
 if placed in the same hospital with the convicts,— not only 
 in connection with those convicts, but in association with 
 
91 
 
 the scenes and the character and the odium of the peniten- 
 tiary. Even that might, indeed, be an improvement upon 
 their present condition ; but in principle and in fact the 
 wrong inflicted upon them would be the same ; they would 
 still be 
 
 CONSIGNED TO THE PENITENTIARY. 
 
 Either this, we say again, or they must be sent to ordinary 
 hospitals. 
 
 If, on the other hand, the latter alternative is chosen, then 
 this special or separate department of the hospital, instead of being 
 regarded as properly intended for insane convicts, may and should 
 be regarded as intended chiefly and in the first instance, for the 
 accommodation and safe-keeping of the three, and perhaps 
 other, classes of insane persons above described; and the far 
 less numerous class of insane convicts may be regarded as 
 being admitted, in the character of insane, to a higher position 
 than, as convicts, they could claim; and, meantime, the 
 infamy of incarcerating innocent and helpless men and 
 women in the criminal's dungeon would be done away, 
 while the ordinary hospitals would be relieved from the 
 charge of some of the insane, who require the most 
 special and expensive arrangements for their safe-keeping. 
 It would not be that the insane of these other classes would be 
 thrust into a convict hospital ; but convicts would be admitted to 
 a hospital intended for other classes. And even this need not con- 
 tinue, and should continue no longer than till the State should 
 feel justified in establishing a totally separate hospital for the 
 insane convicts themselves. If, till then, it be thought a wrong 
 to these other classes of lunatics, that convicts, though in- 
 sane, like themselves and equally irresponsible, should be 
 thrust upon their society at all, we answer that among 
 these classes as little of actual association or intercourse 
 might be allowed, even within this separate department or 
 wing of the hospital, which they would occupy in common, 
 as might be thought advisable. At all events, to be obliged 
 
92 
 
 to be associated with insane convicts in a common hospital is 
 small ground for complaint, in comparison to being thrust into 
 association with felons, sane as well as insane, in a common 
 prison. As to the inmates of the other departments of the 
 general hospital, on whose grounds this special and separate 
 department would stand, for us or for their friends to think 
 of any hardship or degradation to them in consequence of 
 their separate connection with this department, is, surely, nothing 
 less than the most superlative extravagance of sentimental 
 fastidiousness ; especially when it is remembered that the 
 whole hospital is furnished by the liberality of the State for the 
 
 ACCOMMODATION OF POOR AND DESTITUTE INSANE PEOPLE; 
 
 people, too, who would, otherwise, be miserably and hope- 
 lessly languishing in poorhouses and prisons. 
 
 And, besides, the objection to making the provision we have 
 suggested for the criminal insane, so called, in a separate de- 
 partment on hospital grounds, leaves only the alternative of 
 keeping them in direct association with unoffending insane in 
 the poorhouses, where they are constantly sent ; so that, as 
 these are not "paying" patients, it would seem that they are 
 to be left out in a discussion of the subject, and their rights 
 are not to be considered. Let us not continue, as a State, to 
 inflict, by the wholesale, upon our helpless fellow creatures 
 the most outrageous wrongs, until we can be sure of doing 
 right with the most mathematical precision, or 
 
 AFTER THE NICEST AND MOST PERFECT IDEAL AND SENTI- 
 MENTAL MODEL. 
 
 Let us not strain out the gnat, while we unhesitatingly 
 swallow the camel ! 
 
 The suggestion, that in dealing with insane convicts, one 
 of two things must occur, namely, that, "you must make a 
 prison of the hospital or a hospital of the prison " — and that 
 the latter alternative is wiser and more humane, is, we con- 
 sider, more specious than sound. We think, we have shown 
 that the tendency of the prevailing system in this State is to 
 
93 
 
 " imprison " numbers of irresponsible insane, whose clear 
 right it is to enjoy " hospital " care. Surely this should be 
 reversed even, if need be, at the inconvenience, (if it be such) 
 to the hospital of caring for a few individuals who have 
 been guilty of crime, and have since become insane. 
 
 One of the strangest and most inhuman suggestions in 
 Tegard to the insanity of convicts, is, that it should be con- 
 sidered as " a part of their punishment." So far as their 
 whole punishment is to be regarded as a divine infliction, 
 the suggestion is entirely true, and God's ways can un- 
 doubtedly be vindicated ; but, from this point of view, the 
 same is true of all cases of insanity : they are all visitations 
 of Divine Providence, and, as such, are just and not to be 
 murmured against. However great the suffering, it is, in 
 every case, a righteous infliction. But to say that insanity 
 is any part of the punishment inflicted on convicts by the 
 sentence of human law, is simply false. If it were true ; if, 
 by the sentence of the law, men were to be driven insane, as 
 a punishment for their crimes, — some, and not others ; without 
 any " rhyme or reason " in making the distinction, — it would 
 be nothing short of the grossest and most detestable inhu- 
 manity as well as injustice. In the case of convicts, in- 
 sanity is no more a part of their punishment, than any other 
 disease. If a convict is seized with fever or small-pox, shall 
 we say "it is a part of his punishment," and so leave him to 
 its consequences ? No, we are to give him such diet and 
 care and medical treatment as will be likely to ensure Ms re- 
 covery in the shortest time. This can be done in the prison 
 hospital. All we ask, is, that the same be done in case the 
 disease is insanity. If this can be done, — if the best medical 
 superintendence and care can be provided in connection with 
 the prison, let it be done; we have no objection to make. 
 But if not, if better provision can be supplied for these pur- 
 poses, in connection with some established hospital, and at 
 vastly less cost, then let this latter course be preferred and 
 adopted. 
 
 The whole matter is narrowed to a question of expediency 
 
94 
 
 and expense. If the State is prepared to meet the expense 
 of providing the appointments of a first-class hospital, ex- 
 pressly and exclusively for twenty or thirty "insane con- 
 victs;" very well, let them be forthwith provided. But, if 
 not, let some other adequate provision be made. At all 
 events, let not helpless lunatics be left incarcerated in the cells of 
 prisons and poorhouses. 
 
 We have said before, and we now say again, that neither 
 insanity nor the privation of proper treatment in case of 
 insanity, is any part of the sentence imposed upon convicts 
 by law ; and if there are still any who maintain that insan- 
 ity is to be regarded as " a part of the convict's punishment," 
 we beg only to add that such views as these are not shared in 
 by the distinguished medical gentlemen, nor by the eminent 
 philanthropic citizens, who have intelligently, and with full 
 knowledge of the import of what they have done, set their 
 hands to the accompanying 
 
 MBMOEIALS 
 
 to the Legislature, praying your honorable bodies to redress 
 the wrongs not merely or chiefly of insane convicts, but of 
 the several classes of insane poor, upon whose defence we 
 have entered, against not only the injurious insinuations of 
 interested parties, but the actual personal injuries and suffer- 
 ings, which are continuously heaped upon them, in defiance 
 of every impulse .of humanity, as well as every sober and 
 righteous conviction of reason and judgment. 
 
 To the Board of Public Charities of the State of 
 Pennsylvania. 
 
 The undersigned, practising physicians of the cities of 
 Pittsburg and Allegheny, request your Board to take action 
 looking to the repeal or modification of some of the provisions 
 of law in relation to the treatment of the insane, more es- 
 pecially of those who have been acquitted on the ground of 
 insanity, or who have ^become insane while incarcerated in 
 prison or penitentiary. 
 
95 
 
 We understand that the laws of this State in reference to 
 these unfortunates are such, that in some cases, the courts 
 are expressly forbidden to commit them to the hospitals un- 
 less they are deemed speedily curable ; and that in cases where 
 insane criminals or persons acquitted on the ground of in- 
 sanity, have been sent by the court to the hospital, the 
 Board of Managers and Superintendent or physician, if they 
 deem them incurable, may send them back to the jail or 
 penitentiary from which they came. 
 
 "We are assured that such treatment of the insane, whether 
 criminals or not, is inhuman ; and knowing as we do that a 
 prison or penitentiary is not, and cannot be a fitting place for 
 the treatment of human beings so sadly afflicted, whether in- 
 curable or not, we earnestly appeal to you, and through you, 
 to the Legislature of our State to have such a change made 
 in the laws as will effectually prevent the exposure of the 
 insane of any class, to incarceration in our prisons, jails, or 
 penitentiaries. 
 
 Yours, &c, 
 
 Andrew Fleming, M. D. A. M. Pollock, M. D. 
 
 Geo. D. Bruce, M. D. W. C. Eeiter, M. D. 
 
 H. T. Coffey, M. D. Julian Bogers, M. D. 
 
 F. Le Moyne, M. D. R. B. Mowby, M. D. 
 
 W. J. Estep, M. D, C. B. King, M. D. 
 
 J. N. Dickson, M. D. J. B. Murdoch, M. D. 
 
 Thos. W. Shaw, M. D. W. R. Hamilton, M. D. 
 
 John Dickson, M. D. Jas. King, M. D. 
 
 A. W. McCoy, M. D. Jas. McCann, M. D. 
 
 John S. Dickson, M. D. T. C. Rhoads, M. D. 
 
 W. Snively, M. D. James Macfarlane, M. D. 
 
 • Pittsburgh, December, 1873. 
 
 To the Legislature of Pennsylvania, 
 
 Philadelphia, December, 1873. 
 The undersigned, members of the Medical Profession, 
 being aware of the sad condition of the " poor " and the 
 
96 
 
 c< criminal " insane, who are suffering cruel personal wrongs 
 and constant deterioration of their mental and bodily condi- 
 tion, in the jails and poorhouses of the State, respectfully 
 appeal to your honorable bodies to provide such legislation, 
 as will effectually secure the admission and detention of 
 these classes in the State hospitals for the insane, so long as 
 their malady requires it. 
 
 We believe that both humanity and public policy demand 
 such legislation for the relief of wrongful suffering, and for 
 the restoration to health and usefulness, of these afflicted 
 and injured classes. 
 
 S. D. Gross, M.D. J. Forsyth Meigs, M.D. 
 
 Joseph Pancoast, M.D. Edw. Hartshorne, M.D. 
 
 Alfred Stille, M.D. Caspar Morris, M.D. 
 
 Francis GL Smith, M.D. J. M. Dacosta, M.D. 
 
 S. "Weir Mitchell, M.D. Hiram Corson, M.D. 
 
 William Pepper, M.D. Horatio C. Wood, M.D. 
 
 D. Hayes Agnew, M. D. John H. Packard, M. D. 
 F. F.Maury, M.D. 
 
 To the Senate and House of Eepresentatives of 
 Pennsylvania: 
 
 We gladly unite our names with those of the eminent 
 jurists, the. distinguished physicians, the inspectors and war- 
 dens of the penitentiaries, and other noted personages, familiar 
 with the subject, in the appeal of the Board of Public Chari- 
 ties to your honorable bodies, to redress, by proper legisla- 
 tion, the wrongs of the " poor " and the " criminal " insane, 
 who are now consigned to the jails and almshouses of the State; 
 and who should, properly, be placed in the State Hospitals 
 
97 
 
 for the insane, which were established by the public for their 
 reception, their care and remedial treatment. 
 
 James J. Barclay, 
 
 TTm. Bacox Steyexs, 
 
 Jos. E. Chandler, 
 
 Jxo. TVelsh, 
 
 Mahlox H. Dickinson, 
 
 Caleb Cope, 
 
 Henry C. Carey, 
 
 Johx M. "Whitall, 
 
 Isaac Lea, 
 
 TVm. Bigler, 
 
 Jxo. 0. James, 
 
 Asa TVhitxey, 
 
 James Thompson, 
 
 M. SlMPSOX, 
 
 late Chief Justice. 
 
 Bishop. 
 
 December 1, 1873. 
 
 • 
 
 After the fullest investigation of facts and the maturest 
 reflection upon the case, we are constrained to declare that, 
 in our clear conviction and judgment, every consideration of 
 humanity, justice, propriety and expediency, is combined in 
 favor of placing the special hospital for the "criminal in- 
 sane," so called, including incidentally and temporarily " insane 
 convicts" 
 
 OX THE GROUXDS OF SOME STATE HOSPITAL, 
 
 so as to be under a common superintendence therewith, 
 rather than within the purlieus of any prison. 
 
 TVe, therefore, most earnestly renew our recommendation 
 that such a separate hospital department be speedily pro. 
 vided, with the proper construction and arrangements for 
 the purposes indicated, on the grounds of the Danville 
 Hospital. 
 
 We, further, feel constrained to suggest, — and we do it 
 with much hesitation, and with sincere respect for all parties, 
 — that, in forming a judgment on this scheme, a prepon- 
 derating weight ought not to be attached to the opinions of 
 parties, who may have any personal interest or convenience 
 involved in the question, however respectable thev may be. 
 
 [7] 
 
98 
 
 and even though, they present themselves in the charac- 
 ter of experts. 
 
 THE AUTHORITY OF EXPERTS IS LIMITED 
 
 to their particular professional sphere. Their proper office 
 is to serve as witnesses and not as judges ; and any intelligent 
 and disinterested layman, who by personal observation, and 
 thorough study, has made himself acquainted with the 
 condition of the insane in our penitentiaries, jails, poor- 
 honses and hospitals, is as well (perhaps better) qualified to 
 judge, as they are, of the broad features of any plan proposed 
 for ameliorating their condition — to judge what is consistent 
 with or demanded by the dictates of justice, humanity and 
 the public good. 
 
 We beg also to suggest, that for examining and determin- 
 ing what persons should be transferred from the prisons or 
 poorhouses or other hospitals, to the separate hospital de- 
 partment above recommended, or therefrom to prison or the 
 other hospitals, the law should provide that, either the 
 Board of Public Charities by their general agent, or some 
 other commissioner or commissioners specially appointed, — 
 who should make themselves thoroughly acquainted with 
 the condition and wants of the insane throughout the Com- 
 monwealth (i. e. of such as are kept under detention and re- 
 straint), who could be supposed to have no interests to sub- 
 serve but those of justice, humanity and the public good, and 
 who would act systematically and on general and impartial 
 principles, — should 
 
 HAVE THE ULTIMATE CONTROL, 
 
 with such advice from the superintendents of the State hospi- 
 tals and other experts as they may require ; or as in the case 
 of the New York law in this behalf, with the aid and advice 
 of a commissioner of lunacy, specially appointed to aid the 
 Board of Public Charities in their action. 
 
 If your honorable bodies should prefer the appointment 
 of an independent commission, this Board will, of course, 
 be entirely satisfied. 
 
In all this, we presume, of course, that the courts would, 
 in the first instance, make such disposition of the insane, 
 who come under their judicial cognizance, as they should by 
 law he authorized or required to do. Provision might 
 also be made for carrying out any decision of the aforesaid 
 commission or of the General Agent of this Board, which 
 may be alleged to be erroneous or unjust, to some court to 
 be reviewed and either confirmed or reversed. It is remark- 
 able that in the late convention of Superintendents of the 
 insane, to which reference has before been made, one of its 
 members, having alluded to the provision of the New York 
 law, empowering a judge to dispose, according to his discre- 
 tion, of persons acquitted of murder and other crimes on the 
 ground of insanity — sending them either to a convict hospi- 
 tal or some other, exclaimed, " Too great a sweep of power 
 for one man !" And almost immediately after another mem- 
 ber naively declared that "persons acquitted of a criminal 
 act on the ground of insanity should be placed in the hospi- 
 tal for the insane, and the moment the superintendent con- 
 siders him a fit subject for the asylum for convicts, he should 
 be sent there ! " 
 
 The truth is the very fact of the malady being obscure, 
 and thus causing the general public to neglect its victims, 
 excepting through mere curiosity, makes it important that 
 the State, representing the community, should have a special 
 agency whose duty it shall be to scrutinize the condition 
 and needs of this class. Such a commission can understand 
 these, as well as the physicians or attendants, and have no 
 considerations of personal convenience to warp the judg- 
 ment. The simple point of diagnosis of the particular 
 phase of the malady is all in which, he would necessarily be 
 deficient. 
 
 It is the universal practice of governments which appoint 
 such commissions, to constitute them of laymen. 
 
 We have said that the wrongs of the insane in prisons and 
 poorhouses continue as they were, when Miss Dix's " Memo- 
 rial " caused the State to provide a hospital for their alleviation. 
 
100 
 
 We now say that, although every hospital built and pro- 
 jected, has been recommended to the Legislature with the 
 same view, and, seemingly, with the same design, the system 
 pursued has never extinguished and never will extinguish 
 or even abate the evil. There are twelve hundred of these (out- 
 side of Philadelphia, where alone there are one thousand and 
 fifty in the almshouse asylum,) suffering incarceration and 
 neglect. The unnecessary costliness of these hospital estab- 
 lishments, for the indigent insane, and the liberal admission 
 into them of " paying patients," forbid the realization of the 
 intentions and the desires of the Legislature and the public. 
 
 In conclusion, 
 
 we think we may assume the following as established princi- 
 ples or settled points 
 
 1. The State is bound to provide, not only for the safe- 
 keeping, but for the proper care and treatment of all her 
 insane poor. 
 
 2. Neither jails, penitentiaries nor poorhouses are proper 
 places for their detention or treatment, whatever may be the 
 character of their insanity, or whether it be recent or of long 
 standing — curable or incurable. 
 
 3. A person, while insane can be guilty of no crime, and it 
 is both unjust and inhuman to consign innocent men and 
 women to the ignominious cells of jails and penitentiaries, or 
 to the foul kennels of poorhouses, simply because, though 
 insane and irresponsible, they are "dangerous to be at large." 
 
 4. Even insane convicts ought not to be retained in the 
 cells of prisons, but transferred to some hospital where they 
 may be both safely kept and receive appropriate medical treat- 
 ment. 
 
 In view of the foregoing admitted facts and principles, this 
 Board begs to renew and repeat, 
 
 BY WAY OF SUMMARY, THE FOLLOWING RECOMMENDATIONS, 
 
 and most earnestly to urge them upon the attention of the 
 Legislature. 
 
101 
 
 1. That the State should make prompt and adequate pro- 
 vision in General State Hospitals for all the insane poor in 
 the Commonwealth, determine by law how their expenses 
 should be paid, require the several counties either to make 
 equally suitable provision in proper hospitals for their 
 insane poor, or to send them to the State Hospitals, and 
 require the authorities of these hospitals to receive and 
 retain them, as long as they need hospital care. 
 
 2. That a separate wing or department of one of the State 
 Hospitals, — to be under the charge of its superintendent, — 
 should be suitably constructed, arranged and equipped for 
 the reception, custody and proper medical -treatment (1) of 
 those persons who continue insane after completing the 
 period of their sentence for crime; (2) of those who, being 
 charged Avith the commission of crime while sane, are ad- 
 judged insane before trial or sentence, (3) of those who are 
 acquitted of certain crimes, as murder, arson, rape, burglary, 
 &c, on the ground of insanity, and are adjudged too danger- 
 ous to be discharged, and, (4) perhaps, of other dangerous 
 lunatics; — all these to be sent either to this department, or 
 to the ordinary hospitals, according to the discretion of the 
 court or of the proper commission. 
 
 3. That all other insane persons, who are brought up for 
 the sentence of the courts, should be sent to the ordinary 
 hospitals, 
 
 SO THAT NO INSANE PERSONS IN ANY CASE SHOULD BE 
 COMMITTED TO PRISON. 
 
 4. That, until an entirely separate hospital may he provided 
 for their accommodation, " insane convicts " should be admitted 
 to appropriate quarters in the above mentioned special department, 
 — their insanity to be ascertained and their transfer regu- 
 lated according to provisions of law, and they themselves 
 allowed as much or as little association with the other in 
 mates of this department as the Superintendent of the hos- 
 pital shall judge proper and expedient. 
 
 5. That a special Commission, appointed for the purpose, 
 
102 
 
 or the Board of Public Charities of the Commonwealth, be 
 authorized to transfer from the other State hospitals to the 
 special department above proposed, and from that to the 
 ordinary hospitals, such persons as upon due examination 
 and inquiry, shall be judged proper. Whether this same 
 Commission should have authority to remove insane persons 
 from prison to the special hospital department, we leave with- 
 out any expression of opinion. Definite provisions as to this 
 might be prescribed by statute. 
 
 6. Inasmuch as there are strong and well founded objec- 
 tions to condemning any person as incurably insane before- 
 hand, and as the presence of incurables is no more disadvan- 
 tageous to the curable, and often less so, than some others 
 who are curable, the Board are not prepared to recommend 
 their systematic separation, but, under the presumption that 
 
 GENERAL HOSPITALS 
 
 will be provided for all the insane poor, — leave them to be 
 retained in the several hospitals and distributed in each as 
 the Superintendents may deem most advisable. 
 
 Such are our recommendations, and we present and urge 
 them, not as theories, but as practical suggestions, looking 
 to positive and immediate action. 
 
 We beg to call the particular attention of the members of 
 the General Assembly to the fact that most of these recom- 
 mendations are supported and guaranteed, not by the mere 
 
 OPINION, BUT BY THE DIRECT TESTIMONY OF THIS BOARD 
 
 AND ITS general agent ; and not only so, but by both the 
 opinions and the testimony of the present and former judges 
 
 OF OUR CRIMINAL COURTS, the JUDGES OF THE SUPREME 
 
 court, and by the inspectors and wardens of our 
 penitentiaries, as well as by those of many Superinten- 
 dents of the insane whose declarations, on this behalf, are 
 embodied in this report: as also by those of learned 
 physicians and intelligent philanthropists, who have 
 
103 
 
 made the facts of this case a subject of special examination 
 and study ; — to which many other names might have been 
 added from all parts of the State, if pains had been taken to 
 secure them : — and, finally, by the example axd experience 
 
 OF OTHER STATES. 
 
 Eespectfully submitted, 
 
 GEO. L. HARBISON, 
 
 President. 
 G. DAWSON COLEMAN, 
 HIESTER CLYMER, 
 WILLIAM BAKE WELL, 
 GEORGE BULLOCK, 
 A. C. NOYES, 
 FRANCIS WELLS, 
 DILLER LUTHER, M.D. 
 
 General Agent. 
 Harrisburg, December 31s*, 1873. 
 

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