Reprint from The Lancet-Clinic,‘ December 27, 1913. 
 
 BEGINNING AT JERUSALEM. 
 
 Does the Board of Administration or Do the 
 Attendant Nurses Administer the 
 Custody of the Insane. 
 
 BY BAYARD HOLMES, 
 
 H 
 
 CHICAGO. • 
 
 T HE interest taken in the case of Mendel Beilis, 
 in Kiev, Russia, was and is one of the remark¬ 
 able incidents of the century. Thousands of 
 Russians left their jobs for days in a demonstration 
 strike. University students struck for weeks in the 
 great cities and in the capital of Russia. 
 
 In America, hundreds of mass meetings were held 
 and petitions were sent to our government to use any 
 influence possible to secure justice to Beilis. 
 
 As a people, we are very sensitive to injustice, to 
 cruelty and to barbarism in remote and distant places 
 like Russia, China and India. Not many years ago, 
 George Kennan wrote up for us the terrible condi¬ 
 tion of the Russian prisons, and we read his accounts 
 in our thirty-five cent magazines before “muck-rake” 
 had become a verb in the English language. It is 
 passing strange that we are so far-sighted and yet 
 can not see what is in our very midst. Our own 
 prisons-are scandalously managed, and yet, with all 
 the encouragement of an avaricious and sensation 
 mongering press, the atrocities of Jackson, Michigan, 
 and Sing Sing, N. Y., aroused only the slightest blush 
 of apology in American Christian democrats. 
 
 There is hardly a hamlet in the United States that 
 does not have one or two missionary societies collect¬ 
 ing money to send civilizers and Christianizers to re¬ 
 mote and oppressed peoples, and no college in our 
 country is so small that it has not one or more country- 
 bred or prayerfully-educated missionaries in heathen 
 lands. 
 
 We are eager and alert to remove the mote from 
 
our brother’s eye, but the beam in our own eye gives 
 us no concern. We are ready to preach salvation and 
 righteousness to all the world, but if anyone would 
 have salvation and righteousness beginning in Jeru¬ 
 salem he is but a common scold. 
 
 There is at the junction of three rivers in the 
 garden spot of our country, a beautiful and highly 
 civilized city that has made itself known in many 
 ways. In every mart of China and India, as well as 
 in every retail business house and shoe-shine booth 
 in America and Europe, this city, through its princes 
 of manufacture and commerce, has set up a monu¬ 
 ment to the three gods of modern civilization— 
 Righteousness, Accuracy and Efficiency. It is a little 
 self-recording and adding machine. A nickel-plated 
 mathematical court of justice that can’t be bribed; a 
 brass and iron jury that can’t be suborned. 
 
 The three rivers that come together where this 
 beautiful city spreads herself out, not long ago united 
 in one tremendous assault to drown her out, as our 
 fathers would have said, because, though contributing 
 to the righteousness of all the earth, she had allowed 
 much injustice to flourish in her very midst. 
 
 On a beautiful hilltop overlooking the happy homes 
 of this city, overlooking busy factories surrounded 
 by charming gardens, overlooking clubs, hotels, music 
 halls and busy streets, stands, in architectural pre¬ 
 sumption, one of the bedlams maintained by the 
 richest of our too rich States. In this house of bolts, 
 bars and restraint are confined fifteen hundred insane 
 citizens, sick of an unknown and unsought-for dis¬ 
 ease. They are the sons, the brothers, the fathers, 
 or they are the daughters, the sisters and the mothers 
 of the most active, the most useful, the most suc¬ 
 cessful and often the richest citizens of this charming 
 modern missionary city. Here they are confined, 
 confined with no attempt to cure; confined by law 
 without protection by the provision of that law from 
 ignorance, cruelty and neglect. 
 
 In this madhouse there was confined for eight 
 years in a dungeon (the “strong” room in the ver¬ 
 nacular of the nurses and doctors), a man whose 
 
*3 G £. SL 
 V\ ^ ^A- V 
 
 only crime was a sickness for which he was not per¬ 
 sonally responsible, with no light, ho bath, no de¬ 
 cencies. His name was Okey Lee. 
 
 In this house of gloom was held in custody, in 
 squalor and filth the father of a beautiful society 
 woman, a woman sought in every salon on two con¬ 
 tinents. This poor man was left in drooling filth and 
 neglected attire except when visited by one of his tip¬ 
 giving family. 
 
 The inmates in this neglected asylum are under the 
 care ostensibly of the superintendent (who does noth¬ 
 ing with the bedlamites except to see to feeding and 
 housing) and two, sometimes three, physicians, one 
 physician for each 500 lunatics. The salary of the 
 assistant superintendent and acting physicians is 
 $75.00 per month. The salary of the farmer is $125.00 
 per month. 
 
 The superintendent has many duties and must 
 decide matters every few minutes for a family of 
 nearly two thousand. He has no time or interest in ' 
 the diseases that bring fifteen hundred lunatics into 
 his charge, and he is unmindful or careless of any 
 possibilities of cure. But he is thrifty. He, at one 
 time, to save the State, ordered a cow with a large 
 abscess on her rump, killed and turned over to the 
 butcher to be fed to the patients and attendants, and 
 because the institution blacksmith protested, the black¬ 
 smith was discharged from the State service for in¬ 
 subordination ! 
 
 This superintendent is much interested in astron¬ 
 omy,‘also in hen culture. He has devoted much time, 
 
 1 energy and cunning to his hennery, which is the show 
 
 place of this State Hospital. When psychiatrists from 
 New Zealand visit this proud monument of State 
 i charity and State civilization, does the superintendent 
 
 show the visitors to his laboratories equipped for 
 bacteriologic, hematologic and serologic researches ? 
 Does he show them his baths for disturbed patients 
 and his outdoor facilities for the manic-depressive 
 and the tuberculous? Does he conduct them to the 
 occupational training rooms or to the outdoor re¬ 
 education classes? Does he show his clinical charts 
 
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and case histories, his weight charts, his sleep charts, 
 his blood corpuscle charts? No, none of these. He 
 unrolls his telescope and points it to a red spot on 
 the gibbosity of Jupiter, or he brings out the pedigree 
 of his registered hens and roosters, and shows painted 
 photographs of his chickens in every stage of plumage. 
 His charts show only the number of eggs, the weight 
 of birds and the expense to the State of each pound 
 of poultry, and each dozen of eggs. What is done 
 with this poultry and these eggs? Are the eggs used 
 to feed the starving, excited, manic-depressive cases 
 as they lie in the tubs of running water? Are these 
 eggs forced into their stomach through nasal tubes? 
 Are the broilers served on Sundays to the conva¬ 
 lescents ? Or, mayhap are they sold to the dis¬ 
 criminating citizens of our beautiful city to be dis¬ 
 placed by cold-storage stuff? 
 
 This beautiful hennery is the pride of the hospital 
 superintendent, and is in charge of a college professor 
 at salary unknown to the writer, but doubtless satis¬ 
 factory to the Board of Administration and pub¬ 
 lished in their annual or bi-annual report to the legis- 
 ture elected by the friends of the insane. 
 
 The charming community in which this State hos¬ 
 pital is located is full of churches, and the young 
 people in the churches are full of charitable activities. 
 They read of the burning of widows in India with 
 horror and give their mites to send missionaries there. 
 Some of them actually educate themselves, or are 
 educating themselves for missionaries, and yet they 
 have never heard of the atrocities committed in the 
 Greek temple-like Bedlam on the hill above them. For 
 eight years poor Okey Lee heard the church bells ring 
 “Peace on Earth” and “Brotherhood of man,” and 
 yet all that time he was never visited by one of the 
 “little brothers of the poor.” Better was it for the 
 lepers of Assisi than for the wards of the too rich 
 State and the guests of the too cultured and charm¬ 
 ing city at the junction of the three rich river valleys. 
 
 Once an humble son of that most envied city, a 
 city so rich that it can call the builder of the Panama 
 Canal at a doubled salary to come and mayor it, 
 
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a son of that city, by chance, became, at a salary of 
 $75.00 a month, assistant physician in this asylum 
 for the insane. He found the most desperate con¬ 
 ditions. He brought to the notice of the superin¬ 
 tendent and the Board of Administration the most 
 revolting atrocities committed by the nurse attendants, 
 both of active cruelty and passive neglect. He ordered 
 baths, surgical dressings to bed-sores, enemas to suf¬ 
 fering maniacs who had been doped for days, removal 
 from restraint, exercise in the open, and general 
 cleaning up and getting busy. 
 
 The attendant nurses saw that they were up against 
 a stiff proposition. It was a case either of work and 
 earn their wages, or fight and remove the doctor. 
 Many of them were old stagers and had lived in the 
 State hospitals longer than anyone else. They held 
 meetings and put the screws on the superintendent 
 and some members of the Board, of Administration. 
 They openly rebelled. The assistant physician dis¬ 
 charged them at once. They were tried before the 
 alienist of the board and reinstated and the physician 
 let go. 
 
 As citizens, we are interested in the efficiency of 
 our State institutions. As physicians, we are jealous 
 of our profession’s traditions. If a physician is at 
 the head of such a disgraceful and atrocious institu¬ 
 tion, he should be deprived of his professional stand¬ 
 ing by being expelled from all medical fellowship. 
 So should any young, starving doctor who remains 
 in the institution where such atrocities are frequent 
 and such neglect constant. If the uneducated, in¬ 
 human and vicious band of tramp nurse attendants 
 can secure the discharge of a physician because he 
 is determined to bring order and cleanliness out of 
 rowdyism and filth, then it is time for the medical 
 profession to boycott the Board of Administration 
 and prevent any medical man in good standing from 
 entering the State service while these conditions pre¬ 
 vail. 
 
 The abortionist has often at least humanity and 
 pity on his side. The unfortunate girl claims his 
 sympathy in her desperation and threatened degrada- 
 
 5 
 
tion, but the hospital physician who permits the every¬ 
 day abuses and the frequent atrocities which are per¬ 
 petrated in the prison-like asylums of our rich States 
 is either a coward or a criminal of the basest instincts. 
 
 There is hope only in the interest and activity of 
 the friends of the insane. They should organize in 
 every town in the State. One out of every 500 are 
 now in the asylums and madhouses. Fifteen thou¬ 
 sand young -folks of about high school age go each 
 year into these bedlams never to come out. Most of 
 them die of tuberculosis or bed-sores in revolting 
 filth. Some of them become the drudges to fetch and 
 carry about the place. 
 
 The friends of the insane should organize and 
 demand of the Board of Administration, above all 
 things, a visitor with keys to all wards and unre¬ 
 strained admission, day and night. They should de¬ 
 mand liberal provisions for research and adequate pay 
 for medical service. They should demand that all 
 meetings of the Board of Administration be open to 
 their representatives. 
 
 In the old days the local political boss had control 
 of the asylum in his district. He was approachable 
 and human. He certainly could be reached, but this 
 safety-brake to abuses is gone. The Board of Con¬ 
 trol is a remote, impersonal and often cruel entity. 
 It has power without sympathy, without mercy, 
 like the corporation without the rump to kick, or the 
 soul to damn. 
 
 PITY, HAVE PITY! 
 
 Oh, for a gleam of the sun, a taste of the sweet air's breath, g 
 
 Keeper of man in this hole of darkness, and foulness, and 
 death: 
 
 Even the hounds of hell would pray to escape his fate, 
 
 You who can rescue, and save, pity, ere it is too late. 
 
 Lift up your voices and plead; shout it from mountain to sea, 
 
 Ever the world-old story, for the prisoned slave to be free, 
 
 Ever the human martyr, in a suffering Okey Lee. 
 
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