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- Board of
Transmitted to the Legislature with the I6th Annual Report of the state O2. l
( Charities, January 17, 1883.)
(2 / (, , 35
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y
IVERSITY OF CHICAC.
UN!\! liº RAR tº
266892
MARCH (93."
R E E2 O R.T.
To the State Board of Charities :
It is two years since any report has been made in regard to the in-
sane asylums of New York city, but unfortunately the several needs
then enumerated still exist, and until they are supplied, the condition of
the asylums and their inmates can not be much improved.
The superintendents must be made actually responsible for the in-
stitutions under their charge, by having full authority given them to
appoint and dismiss all their subordinates.
Experienced and adequately paid physicians and trained attendants
are an absolute necessity, and more land and more buildings are of al-
most equal importance.
The New York city commissioners of the State Board of Charities,
have exerted themselves to obtain from the city authorities sufficient
salaries for the physicians, as appears by the following letters:
STATE OF NEW YORK,
OFFICE OF THE STATE BOARD OF CHARITIES,
April 8, 1882.
To the Board of Estimate and Apportionment :
GENTLEMEN — We would respectfully, but most earnestly and em-
phatically, ask that you make a special appropriation of five thousand
eight hundred and fifty dollars ($5,850) as an addition to the salaries of
the medical superintendents, assistant superintendents, and assistant phy-
sicians of the New York city insane and lunatic asylums. There are in
these two asylums more than two thousand five hundred (2,500) pa-
tients, and the amount appropriated to pay the salaries of physicians to
care for these patients is six thousand six hundred and fifty dollars
($6,650). As a consequence of this, it is impossible to attract to the
asylums a sufficient number of physicians to properly care for the pa-
tients; with twelve hundred and thirty-five (1,235) patients, the insane
asylum had last month five physicians, including medical superintend-
ent and assistant superintendent, the regular number being eleven, while
the lunatic asylum, with almost thirteen hundred (1,300) patients, was,
during the past year left for six weeks with only four physicians.
The assistant physicians are constantly leaving the asylums, after
gaining such experience as makes them valuable, to take paid positions
in other asylums, and these could be retained were even moderate sala-
ries offered them in our own asylums. º
4
The additional appropriation we ask for would provide, with that al-
ready made, for a salary of $2,500 to each superintendent, of $1.5oo for
each assistant superintendent, and for salaries of $1,000, $750 and $500,
respectively, for three assistant physicians in each asylum.
With such salaries in prospect, young men could be found to serve
for a year or two in the asylums without pay, and the advantage to the
patients of being under the charge of experienced physicians, acquainted
with them and their peculiarities, would be incalculable.
Respectfully yours,
STEPHEN SMITH, M. D.
JOSEPHINE SHAW LOWELL.
JAMES R. WOOD.
JOHN J. MILHAU.
New York, December 14, 1882.
To the Board of Estimate and Apportionment, Wew York City :
GENTLEMEN – On April 8, 1882, a letter was presented to you, signed
by the New York City commissioners of the State Board of Charities, and
by the late Dr. James R. Wood, then chairman of the Advisory Board of
the Insane and Lunatic asylums of this city, asking that you would make
an especial appropriation for the salaries of physicians in these two asy-
lums, and stating that it was impossible to secure and retain the services
of competent physicians, without adequate payment. *
We would now renew this request with increased emphasis.
The asylums have suffered very much owing to the loss of physicians,
who, having become valuable by experience gained in the asylums, are
forced to leave to take paid positions elsewhere. -
During the year 1882 the lunatic asylum lost five physicians from this
cause, and Dr. McDonald, superintendent of the insane asylum writes:
“During the current year six (6) assistant physicians have resigned
in order to accept salaried positions in other asylums, * * *
“The senior in point of time of service at present in the asylum, Dr.
Harrison, has been here only since April of this year, and he has an
offer from a State asylum at $1,000 a year.” - . .
To-day the insane asylum contains 1,232 patients, and the appropria-
tion asked for salaries and wages is $46,595, or $37.82 per Capita ; the
lunatic asylum has 1,345 patients, and the estimate is only $34,496.50,
or $25,64 per capita, while the per capita expense for salaries and wages
in the Utica asylum for the year 1881 was $86.55, and in the Willard
asylum it was $46.83. * - . . . . - -
The whole amount asked for by the Commissioners for the insane of
the city, who number 3,251, is not more than $126 for each one per
annum ; at the Willard asylum the yearly cost for each patient is $159,
and the superintendent in his annual report for 1881, says:
“Any material reduction of the yearly charge must be attended with
a diminished dietary, more mechanical restraint, lower temperature in
the wards, a dirty house and worse Odors, dilapidated furniture, and in
time a shabby, worn-out interior.”
5
With some exceptions, these results are to be found in our New York
city asylums at present, owing to the very Small amount of money an-
nually appropriated for their care.
Respectfully yours,
W. R. STEWART,
JOSEPHINE SHAW LOWELL,
Commissioners of the State Board of Charities.
The very great need of more land for the insane of the city, was also
brought to the attention of the Board of Estimate and Apportionment by
the New York Commissioners of the State Board, and the Board of
Commissioners of Public Charities and Correction supported the re-
quest for an appropriation for the purchase of a farm. After due con-
sideration, the Board of Estimate and Apportionment appropriated
$25,000 for this purpose.
The reasonableness of the demand for more land is shown by the
following figures, which give the present accommodation and the pres-
ent census of the asylums.
The patients number 3,251, 1,91 I women and 1,340 men, who are
distributed as follows:
MALE PATIENTS.
On Ward's Island, with 70 acres of land, in main building (capac-
ity 5oo), and west wing (capacity 240). . . . . . . . . . . . . . . . . . 905
In Emigration Annex (belonging to Commissioners of Emi-
gration, who insist on its being vacated at once). . . . . . . . . 3 I5
(East wing not finished to accommodate 260.)
On Randall's Island in old building not suited for them . . . . . . I 2 O
Present number of male patients. . . . . . . . . . . . . . . . . . . . . • - - - I - 34o
Proper accommodation, including unfinished wing for . . . . . . . 1, Ooo
Surplus unprovided for . . . . . . . . . e tº o e g c e e º e º e º 'º e º e tº 9 ºf e • * * * 34C
FEMALE PATIENTS.
On Blackwell's Island, with thirty acres of land:
Main building (capacity 408). . . . . N G k e o e s tº e e • & © e o e º e a • . . 449
Lodge (capacity 66). . . . . . . . . . . . . . . . . . . . . . . * * * * * * e e - © e e s a 90
Old Retreat (capacity 130). . . . . . . . . . . • - - - - - - - - - - - - - - - - - - - I 5 1
New Retreat (not finished, 130) . . . . . . . . tº 9 e º 'o e e e e a • O e º e º e
Pavilions (capacity 540). . . . . . . . . . . . © e º e 6 & e º 9 s e e º e e e e e s e e 642
On Ward's Island, -
In Homoeopathic Hospital (capacity 150). . . . . . . . . is . . . . . . . . I5O
6
On Hart's Island, with twenty-eight acres of land,
In five pavilions (capacity 360)... . . . . . . . • - - - - - - - - - - - - - - - - 429
Present number of female patients. . . . . . . . . . . . . . . . . . . . . . . I , 9 II
Proper accommodation (including unfinished Retreat) for.... I ,784
Surplus women. . . . . . . . . . . . . . . . . . . . & s e e º 'º e o 0 e º e º 'º tº e º e º 'º - I 27
Surplus men. . . . . . . . . . . . . . . . . . . . . . . . tº e º a e s - e. e. e. e e s e º e o ſº e 34O
467
--
Almost 5oo patients, not only with no present provision for their
comfortable and proper shelter, but with none in process of preparation,
while the new Retreat and the east wing of the insane asylum, although
counted in as providing accommodation for 390 patients, are neither of
them finished and may not be for some weeks or months, thus making
the actual surplus insane in our asylums, 857, who are suffering them-
selves and a cause of suffering to others.
There is no land moreover at present, under the control of the de-
partment, on which buildings can be erected to relieve the present over-
crowding or make provision for the future increase, and the amount of
land provided for exercise and employment for these 3,251 patients is
only a hundred and thirty acres, an entirely insufficient amount, accord-
ing to all experts.
In urging the purchase of land and the establishment of a new branch
asylum for the insane, it is not proposed that a large and expensive
asylum building shall be erected, but that detached “ cottages” shall
be built upon the plans now approved by almost all experts.
Indeed, at first, it would be practicable and desirable to put up the
cheapest possible wooden buildings to receive a few mechanic and labor
patients, with their attendants and a physician in charge, and they should
at once go to work to prepare homes for another detachment of their
companions, these in turn to be employed in the same way, immedi-
ately upon their arrival. Thus, means to relieve the overcrowding of
the Ward's Island Asylum, would be found at once, all the labor being
done by the patients, their attendants and employees of the depart-
ment.
That these patients are capable under proper supervision of doing a
great deal of work, will appear from the report of the trades already
carried on in the insane asylum on Ward’s Island.
INSANE ASYLUM, WARD's ISLAND.
Census, December 31, 1882.
I881 I882
Consulting physicians. . . . . . . . . . . . . . . . . . . . . . . . . . . o 9 9
Resident physicians.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . o II II
Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I, 225 I, 238
Employees. . . . . . . . . . . . . . . . . . . . . . . . . . . e e º e s e s e e e e tº e o e II.8 .
Number of employees dismissed. . . . . . . . . © e e º e º e s tº e 3O 28
Number of employees who resigned. . . . . . . . . . . . . . . . . 72 67
Work-house help :
Men . . . . . . . . . . . c + c e º a e e º ſº e º e = * * * as e g º º e > e e º ºs e º 'º e 3O 28
Women. . . . . . . . . . . . . . . . e e º e º º & © tº e º 'º e º 'º º • * * g e º 'º e tº 35 37
Daily average number of patients employed . . . . . . . . . 378 4O3
Daily average number of patients taken out to walk. . . 851 962
Daily average number of patients in restraint. . . . . . . . I# 4
Daily average number of patients in seclusion . . . . . . . 2 2#.
Daily average number of patients in seclusion and re-
straint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . # I}
Suicides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . tº e º e º º I I
Fatal accidents. . . . . . . . . . . . . . . . . . tº º ºs e e º e e e s e e s > * > 3*
List of trades carried on in the asylum :
Tailors, - Printers,
Matmakers, Painters,
Shoemakers, Masons,
Broommakers, Tinsmiths,
Blacksmiths, Plumbers,
Barbers, Book-keepers.
So far as I am able to judge, this asylum continues to improve, not-
withstanding the many drawbacks under which it is carried on.
The overcrowding continues, and cannot be remedied until the sur-
plus population of the asylum is removed to the new farm, which is in
time to be provided by the city authorities. The second new wing,
against the erection of which I protested two years since, has been
built, but is not yet occupied — the “Emigration Annex” has been de-
manded by the Commissioners of Emigration every month, for some
time, but is still occupied by the insane, because there is no other place
to put them. The Board of Estimate and Apportionment has granted
$60,000 to build a new hospital pavilion, but it would be wiser to put
up a wooden building, which could easily be torn down when it becomes
infected, than to spend this large sum on a brick or stone structure.
The many changes among the assistant physicians and among the
attendants, is a great evil here as in the other asylums.
Among one hundred and eighteen attendants there were one hundred
and two changes in 1881 and ninety-five changes in 1882. The confu-
sion which a state of things must cause is scarcely to be imagined.
In regard to the physicians, the superintendent writes:
NEW YORK, ZXecember 12, 1882.
Mrs. J. S. LOWELL, State Commissioner, etc. :
DEAR MADAM – In reply to your inquiries, I have the honor to state
that the assistant medical staff of this asylum consists-to-day of eight
(8) physicians, and that there are two (2) vacancies which I am allow-
ing to remain unfilled until I can tell whether we are to pay salaries to
all the physicians next year or no.
* The three fatal accidents in 1882 were drowning of patients trying to escape. That is the
penalty of being on an island, and of the increased outdoor liberty we are giving to patients.
Very respectfully {*i.
A. E. MACDONALD,
Med. Supt.
8
During the current year six (6) assistant physicians have resigned in
order to accept salaried positions in other asylums, they were : W. E.
Dold, Bloomingdale Asylum; Allan Fitch, State Asylum, Elgin, Ill.; J.
S. Christison, State Asylum, Madison, Wis.; J. I. Shanks, State Asylum,
Oshkosh, Wis.; H. W. Wildman, Pavilion, Bellevue Hospital; Andrew
Egan, Branch asylum, Hart's Island.
The senior in point of time of service at present in the asylum, Dr.
Harrison, has been here only since April of this year, and he has an
offer from a State asylum at $1, ooo a year.
In the preceding four years, six other assistants left under similar cir-
cumstances, they were: Sanger Brown, State Asylum, Worcester, Mass.;
W. E. Sylvester, State Asylum, Willard, N. Y.; R. Van Nest, Hospital,
Philadelphia; W. Harriman, Bloomingdale Asylum ; A. Vrautman,
State Asylum, Oshkosh, Wis.; C. E. Cross, Seamens’ Retreat, N. Y.
Very respectfully yours,
A. E. MACDONALD,
Medical Superintendent.
The want of adequate salaries is the cause, of course, of these frequent
changes, and the character of the attendants and the difficulties of their
positions may be judged of, by the numbers who were discharged and
who resigned.
The number of patients employed increases slowly but constantly,
and is one of the most excellent features of the asylum management,
During the past year the printing for the whole Department of Public
Charities and Correction, has been done by the patients of this asylum.
So far as I can judge by a cursory examination, the wards of the asy-
lum are very well kept; all of the beds and bedding are found in good
condition, and the closets, pantries, etc., in good order. The convale-
scent wards, and the wards where the trades are carried on, are pleasant
and cheerful, and almost the whole asylum has been painted and orna-
mented with bright colors and tasteful devices, by the patients. The
ornamenting of the wards makes them very attractive, besides furnish-
ing steady work to many patients
The whole institution is wonderfully well managed, considering the
difficulties to be overcome.
THE BELLEVUE PAVILION FOR THE INSANE.
One great step in advance in this pavilion, is the appointment of a
resident-physician who has had some experience in the treatment of the
insane, and who has charge of the inmates, both men and women.
This change has only been made lately, and so far there seems no
other improvement to notice. The pavilion on both sides is often over-
crowded, making it necessary to put two patients in one room.
The whole building is cheerless and not fitted for the use of the insane
for which it was built. The blank rough walls never colored in any way
as yet, are, I am told, to be painted, which will be a good thing; but
nothing can Conceal the ugly shape of the building, or make it in the
least homelike or cheerful.
9
The bath rooms are very inconvenient, so small and approached by
so narrow a passage that a violent patient cannot possibly be bathed,
while the stone floor is cold and unhealthy. The heavy stone partitions
separating the bath rooms from the passage ways should be taken down
to enlarge the bath rooms. There are no pantries or proper places in
which to keep dishes, food or clothing, and the day nurse and orderlies
sleep in the pavilion, thus taking up necessary room, and subject them-
selves to disturbance at night after days of hard work.
There are two orderlies for the men, but only one nurse for the women.
A work-house helper is employed on each side and ought to be dispensed
with.
The medical care of the patients is much better than formerly, and
less restraint is used, and it is to be hoped that other improvements will
follow.
LUNATIC ASYLUM CENSUs, DECEMBER 31, 1882.
Consulting physicians. . . . . . . . tº t e º e º e s e e tº e º º tº º 0 ° e º º is a e º 'º e e c 9
Resident physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Patients. . . . . . . . . . . . . . & © tº a s e e s e e º ºs e e º 'º e º e s is e º e s e º e ºs e e º a I , 3O2
Employees. . . . . . tº º & © tº e º gº tº e º sº º ºs e e º e º e º e º 'º º e º e º 'º e º gº is tº ſº tº e º e e Ioé
Number of employees dismissed in 1881. . . . . e is s e e a tº e © tº t e º e º e ºs IO
{{ { { 6 & & 4 “ 1882. . . . . . . . . . . . . © tº º e º e < e is 6
( & & C “ who resigned in 1881. . . . . . . . . . . . . . . . . . . 63
( & & & {{ ( & & 4 “ 1882. . . . . . . . . . . . . . . . . . 36
Work-house help, men. . . . . . . . tº e º 'º e º gº º tº e º ſº 3 e º 'º e º º tº e º 'º e g & e. 22
& 4 “ women. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Unpaid help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Daily average engaged in amusements in 1882. . . . . . . . . . . . . . . . 385
Daily average number of patients employed in 1881. . . . . . . . . . . . 53O
( & & 4 & 4 ( & { { { { “ 1882. . . . . . . . . . . . 576
& 4 ( & { % ( & “ taken out to walk in 1881. ... 658
& 4 { % ( & ( & {{ ( & & 4 & 4 I882. tº gº º 7 oz
& C & 4 & 4 ( & & 4 in restraint or seclusion in 1881
12 5o-Ioo (average of patients, 13 Io).
Daily average number of patients in restraint or seclusion in 1882
7 90-Ioo (average of patients, 1,333).
Suicides in 1881 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I
& C 6 * 1882 . . tº gº a a º º tº º & © e º e º 'º e º e º º Q & Q & Q & © e º e º 'º e s p → e is e O
Fatal accidents in 1881 . . . . . . . . . . . tº e º ºs º 'º e tº © a • e º is ºn e º e º e º 'º e º e O
{ { { { ( & I882 . . . . • * tº e º e º 'º t e º 'º e º e º e º e º 'º e º e s e e s e e s e I
Medical Superintendent.
January 5, 1882.
The improvements to be found in this asylum are due entirely to the
devotion of the officers and employees.
The only change for the better in buildings has been the finishing of
the new laundry, which is indeed a great gain, but there has been no
improvement in food or clothing, no increase in the number of physi-
cians, or in the number of attendants, and no special training given to
either the former or the latter.
IO
The medical superintendent, has a herculean task and is furnished
with but poor tools to work with ; he has no paid clerk in the institu-
tion, and he and his over-worked assistants and the steward, have often
to supply the deficiencies of the work-house prisoners who are sent to
the asylum for days or weeks to do the clerical labor. The records
have to be correct, even though the patients suffer for want of the over-
sight of the physicians who are busy over the books.
The One matron having devoted more than thirty years to the loving
care of the patients, does more than any other woman could do, but
much in her department must simply be left undone. There should be
at least four educated and efficient assistant matrons to train and super-
vise the attendants, to be present at the meals and spend their time in
the wards. There is not one, and has not been for months.
The number of changes among the attendants shows the necessity of
instruction for the new ones, but there is no one to give it, and the con-
stant wonder is, not that the condition of the asylum is not better, but
that as a whole, the great institution runs on as easily as it does.
The deficiency in the numbers and the constant change of assistant
physicians has already been mentioned, but this great and fundamental
evil cannot be too much insisted upon. The number of the staff
allowed by the Department of Public Charities and Correction is nine
beside the superintendent ; usually there are only five or six, often only
four members, and sometimes but three. Of the six assistant physicians
on duty in December, 1882, three had been appointed since April of the
same year.
During 1882 five physicians left to take salaried positions. The utter
impossibility of proper care being given to the patients by young men,
who accept the appointments for the purpose of gaining experience, is
apparent, for when they first enter the asylum they are necessarily igno-
rant, and they generally leave as soon as they have learned what makes
their services of value,
The difference between an asylum and a common hospital is radical.
In the latter the younger men are continually under the direction of
experienced visiting physicians, while in the asylum the superintendent
has so much to do that he can give little time to the care of patients,
and the counseling board cannot visit often enough to supply the defi-
ciency. -
The board of consulting physicians in the present case are men too
distinguished, and too busy to be able to give sufficient time to the asy-
lum. A board of less well known physicians would undoubtedly be of
more value to the asylums,
The improvements to be observed in the asylum are important and
encouraging. Little or no restraint, more exercise, more employment,
quieter patients, and generally an improved “tone" throughout the
asylum are to be noted.
MAIN BUILDING.
The halls of this building are generally found in good order, and the
beds almost always clean and free from bugs. Some of the halls
have a very cheerful and really pleasant appearance, being prettily col-
I I
ored and having pictures on the walls; the patients are employed the
greater part of the time, there is no restraint used, and no restraining
apparatus in the hands of the attendants; fancy work engages such
patients as have no other occupation, and in fact a visit to these halls
is a pleasant and not a painful, experience.
Other halls, however, are so crowded that the patients necessa-
rily irritate each other and become noisy and excited. Many patients
sleep on the floors, and the dining-rooms are so crowded as to prevent
any order or decency at meals. On September 25, 1882, in one hall
there were seventy-three (73) patients, and but fifty-five (55) bed-
steads. In another hall sixty-six (66) patients and forty-nine (49) bed-
steads. On February 4, 1882, one hall had seventy (70) patients and
forty-nine (49) bedsteads. On December 13, 1882, one had fifty-nine
(59) patients and forty-nine (49) bedsteads, and another seventy-one
(71) patients and fifty-five (55) bedsteads.
On one of my visits, in the dining-rooms of two of the halls, there
were from ten to sixteen women standing with their dinner in their
hands, because the tables were already full to crowding, and the general
confusion and untidiness of the meals shows the need of official super-
vision.
The employment of seventy patients in the new laundry (half of the
number working in the morning and half in the afternoon) and the
dancing lessons and calisthenic exercises Mondays and Wednesdays and
Saturdays in the amusement hall, are decidedly good features in the
asylum life, and the introduction of fancy work and the making of arti-
ficial flowers under the matron's own supervision, have served to
brighten the lives of many of the patients.
The patients need better clothing and the means for moderate per-
Sonal adornment, collars, aprons, etc., which would encourage a little
pride in their appearance. They generally have at present a most for-
lorn, untidy and unwomanly aspect.
During the summer one hundred patients were taken each week on an
excursion to Hart's Island, which gave great pleasure, and no doubt
was very beneficial to them.
RETREAT.
The work on the “new wing ” has caused considerable confusion
during the past two years, and even now the building is not ready to be
occupied. It is an improvement on the old building, of course, but
never should have been placed where it is. There was not enough land
to warrant the addition of a single new building, and, moreover, the
$60,000, more or less, spent on this great prison-like “new wing,” might
have been used to much better advantage in putting up cheaper build-
ings for the insane elsewhere.
The old Retreat is always an unhappy place to visit ; the cells have
no communication with the Outer air, two patients sleep in each, there
is but little Supervision of the attendants (who, however, seem to do the
best they can) the patients are of rather an excited type, and the whole
appearance of the building and of the inmates is that of a prison and of
prisoners. For months no matron has had any charge of this building,
I 2
and young and inexperienced physicians are often appointed to care for
the patients. An educated female physician should be placed over this
building and the Lodge, with a competent matron under her. The
building and beds are usually found in good order; the patients them-
selves are untidy as to hair and dress, but apparently clean; there is
little restraint used and the patients are supposed to go out daily.
In my last report I mentioned that one patient in this building had
killed a companion with whom she slept. She was, of course, removed
to another building where she could have a room to herself, but in Janu-
ary, 1882, one of the attendants mentioned to me that she was back
again and sleeping in the cell with another patient, and had been
“rather excited the night before.”
I notified the superinteudent, who wrote: “The patient (Elizabeth
Christ) had been sent to the Retreat by a doctor who was not at the
asylum when Mrs. Ottmer was killed, and, to my astonishment, the history
of E. Christ makes no mention of the occurrence.” This is one example
of the dangers of constantly changing physicians, and of the deficiency
in records which must occur when there are no properly paid clerks.
Apart from the inherent disadvantages of the building itself, compe-
tent supervision is the great want of the Retreat. The attendants have
a hard time, hard fare, hard work, and there is little wrong for which
they can be held responsible.
LODGE.
There has been a decided improvement in this building, caused by
the introduction of more employment for the patients, and the use of
less restraint, both resulting in greater quiet among the patients. The
building is about as unfit as it can be for the housing of any human
beings, but the small number on each hall (only twelve or fourteen
patients) with the large number of attendants makes it preferable for
excitable patients to larger and more pleasant halls, where there is more
friction from other patients. It is a very painful thing in the halls of
the main building, to find one noisy patient disturbing from sixty to
seventy others.
The attendants in the lodge are most poorly provided for.
PAVILIONS.
The pavilions are usually found in good condition so far as the attend-
ants can keep them so, but there are not infrequently pipes out of order,
tubs rusty, poor straw in beds, etc., things to be remedied, but where
the deficiencies are due to want of supervision and want of money.
In winter the pavilions are imperfectly warmed, and most of the bath
rooms and water-closets are so cold that the water sometimes freezes on
the floors. The clothing of the patients is not sufficient for such build
ings in winter. Two Cotton chemises, canton flannel drawers, a denim
skirt and dress constitute the costume of most of them.
Many of the patients go out from the pavilions to work. All go out
to walk twice a day and no restraint is used.
The attendants have lately taken a great interest in having their
I3
patients better dressed; the material for dresses has been made up in a
tasteful manner, and generally there is much improvement in this direc-
t1On.
The patients usually make their own clothing of all kinds.
The attendants in the lunatic asylum are but little considered ; they
have uncomfortable rooms, unappetizing food poorly served, low pay,
dangerous and trying work, long hours and little recreation.
It is a wonder they do as well on the whole as they do.
Doctor C. F. Folsom, one of the managers of a Massachusetts asylum,
writing of the work of attendants, says:
“The attendants are not less important than the physicians, to the
successful administration of an insane asylum. They require firmness,
patience, kindness, tact, experience, and very exceptional self-control.
They have every variety of duty to perform, from being companions to
ladies to acting as scrub-women for menials. They must be nurses,
housekeepers, companions, and servants. They are expected to practice
all the Christian virtues, under circumstances that have sorely tried the
tempers or ruined the happiness of a hundred families. That there is
occasional harshness toward patients under exceptional provocation we
all know, but as a rule much less, I feel sure, in our hospitals than in
their own homes at the hands of their own relatives, who often insist
that they are simply ugly.”
* * * * * * * * * >k *
“We and the doctors are comparatively a short time in direct contact
with the insane; the attendants are their constant companions, pounded
and abused by day, kept awake at night, and lied about all the time. I
am amazed that we can secure as excellent service as we do.”
One of the first steps in improving any asylum for the insane, should
certainly be to provide proper care and accommodation for the attend-
ants — at the lunatic asylum they very much require such consideration
BRANCH INSANE ASYLUM, RANDALL's ISLAND.
Census, December 31, 1882 :
Physicians . . . . . . . . . . . . . . . . . . gº º e s tº e º ºs e º e e • - - - - - - - - - - - - - - - - 3
Patients. . . . . . . . . . . . . . . º e º e º e º e º & a º e º e º e e tº e º ſº º 'º & & º e º e º e º gº e I 25
Employees. . . . . . . . . . . . . . . ſº tº dº e º ſº dº e g º 'º e tº a tº 6 & 8 tº e º e º & © e o 'º e º e º e 7
I88I. I882.
Daily average of patients employed. . . . . . . . . . . . . . . • , 52 52
Daily average of patients taken out to walk. . . . . . . . . . 85 85
Daily average of patients in restraint. . . . . . . . . . . . . . . I] OIlê In OIle
Suicides . . . . . . . . . . . • e e s a e o e º e s s e e e s a e e a e e s a e ea o In OIn e In OIAC
Fatal accidents. . . . . tº º ºs e º dº e º 'º º £ o º is s a e e º e º e º e º is e s tº In On 6 In OIlê
These men have formerly been much neglected, and their appearance
is always forlorn and untidy and hopeless.
Within a few weeks, however, a new medical superintendent has been
appointed, and many external improvements have been made—the beds
are neater and cleaner, the building has been painted and kalsomined
inside ; white bowls have been substituted, in part, for the old tin mugs,
I4.
formerly used at meals, and it is to be hoped that soon more important
and radical changes will be made, and some plan inaugurated for keep-
ing the men more constantly employed, for arousing their interest, etc.
One step in this direction has already been taken by requiring the
men to do all the work of the building, except the weekly scrubbing.
Formerly two work-house women were employed to make the beds, and
these were not seldom found to be very dirty. At my last visit, there
was a decided change for the better in this regard. The beds were all
clean and much neater than usual.
Forty of the men sleep in another building, and this also is now cared
for by the patients themselves.
HOMCEOPATHIC HOSPITAL.
One hundred and fifty insane patients, eight day attendants, two night
attendants.
There is but little change to report among these one hundred and fifty
women. They need more regular employment and would be better off
in a building where they could have more opportunities for out door
exercise. They go out twice a day, but there is not much room for
walking.
They are generally quiet, but look untidy in dress and their hair is
often in disorder.
The wards and beds I have always found in good order, but I have
visited the hospital but seldom. Sometimes more straw is needed in the
beds.
The patients mend and make clothes, and do the work of the
wards.
Taking down a partition in one of the upper wards has greatly
improved it. *
BRANCH LUNATIC ASYLUM, HART's ISLAND.
Census, December 31, 1882.
Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • 3
Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . * e º 'º e o e ge tº e º ſº º & © tº dº e g º º ſº 43 I
Employees . . . . . . . © 2 & e º a © e º e º e º e º 'º e º 'º e º 'º e º 'o a tº tº ſº e º ºs º is dº e tº g to 4 I
Number of employees dismissed in 1881. . . . . . . . . . . . . . . . . . . . . . . 4.
é & ( & ( & 1882 . . . . . . . . . . . . . . . . . . . . . . O
{{ 4 - who resigned in 1881. . . . . . . . & e º is e e i e º a u I6
& 4 ( { & 4 “ 1882. . . . . . . . . . . . . . . . . . . 1 I
Work-house help, men . . . . . . . . . . . . . tº e º te e o ºs e º 'º e ſº tº e e tº º ºs e º e º e is I6
{ { “ women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I4
Daily average number of patients employed in 1881, about . . . . . . I 3o
{{ & & ( { “ 1882, “ . . . . . . 130
{{ ( & “ taken out to walk in 1881 . . . . . . 33O
& & {{ ( & 6 * { { I882 . . . . . . 42O
& 6 { % “ in restraint or seclusion in 1881. O
46 & 4 ( & & 4 & 4 & 4 I882 e O
Suicides in 1881. . . . . . . . . . . . to e º e º 'º e º e º p & 8 e e º e º e º a e º ºs e º e s a s 6 O
& 4 1882 . . . . . . . . . . . . . . © tº e e º 'º & g g º gº e º e º 'º e º & © tº e º 'º º e g º º O
Total accidents in 1881 . . . . . . . . . . e e º ºs e º e º 'º e º e e º e a tº a 5 e º º e s a s O
& 4 I882 . . . . . . . . e is a e e º e º e º e º e º 'º e º e º o ſº a tº dº e º e º 'º O