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NATIONAL ASSOCIATION 
 
 FOR THE 
 
 PROTECTION OF THE INSANE 
 
 AND THE 
 
 PREVENTION OF INSANITY. 
 
 BOSTON : 
 
 TOLMAN & WHITE, PRINTERS, 383 WASHINGTON STREET. 
 1880. 
 
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 sponsible for its return to the library from 
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 Latest Date stamped below. 
 
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 are reasons for disciplinary action and may 
 result in dismissal from the University. 
 
 UNIVERSITY OF ILLINOIS LIBRARY AT URBANA-CHAMPAIGN 
 
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 NATIONAL ASSOCIATION 
 
 FOR THE 
 
 PROTECTION OF THE INSANE AND THE PREVENTION OF 
 
 INSANITY. 
 
 The evils of insanity have now attained such magnitude, that the organized 
 
 institutions and devices are unable to cope with and control them. The 
 
 number of those more or less insane, who either do not need to go to public 
 institutions, or who cannot find room in, or be supported by them, is increas- 
 ingly large, and for this great class there is no systematic supervision or 
 guardianship. 
 
 (ere are multitudes of insane men and women in the United States for 
 
 t horn no special provision is made in the way of care and treatment. Occa- 
 qnal legislative and other investigations have brought to light the misery 
 and suffering that this absence of special care and treatment has produced. 
 Furthermore, even when it has been supposed that this has been secured by 
 the establishment of State, county, and city insane asylums, these have 
 sometimes failed of their purpose through mismanagement, or a misconception 
 of the proper methods to be used. Thus there is room for organized effort 
 to improve the condition of the insane. Again, inasmuch as each State has 
 the exclusive control of the policy and the mode of management of the 
 insane within its borders, it would seem as if such organization were desir- 
 able to unify the principle and the practices in the care and treatment in the 
 United States generally. Two other organizations may perhaps be supposed 
 to cover the same field with the new society. 
 
 The Association of Superintendents of Insane Asylums was established 
 with somewhat similar ends in view. But this is strictly a professional and 
 technical organization. It includes only the medical superintendents of 
 insane asylums, and it is safe to say that their interest in the insane bears no 
 greater proportion to the public interest in the same class, than their mem- 
 bership bears to the vast number of the insane under treatment, together with 
 their families and friends. 
 
 The Conference of Charities, which has been working in the same direction, 
 falls short of covering the whole field, in the fact that it is commensurate 
 only with the States where Boards of State Charities exist, and also because 
 its energies are scattered over the whole ground of the dependent and 
 criminal classes. This National Association, then, by confining its labors to 
 a single class, but the whole of that class in the United States, wherever 
 situated, may reasonably hope to accomplish more in the line of its purpose 
 than the others named, especially if cooperating with them in the general aims. 
 It solicits, therefore, the general cooperation of all friends of the insane, and 
 all interested in the subject, whether connected with the other organizations 
 named, or among the public generally. 
 
 254013 
 
4 
 
 CONSTITUTION AND BY-LAWS 
 
 The fee for membership has been made very small, that all who receive this 
 circular may be induced to connect themselves with the Society, and to 
 receive and circulate the documents which may be issued by its publishing 
 committee. 
 
 Organizations in the interests of the criminal classes in prisons have been 
 long in existence, and have been successful ; for this greater class of insane, 
 who have all the criminal’s punishments, deprivation of liberty without the 
 criminality, there is at present in this country no organized supervision. 
 
 The object and scope of the National Association for tbe Protection 
 of the Insane and the Prevention of Insanity are perhaps sufficiently 
 set forth in the Constitution which was adopted at the meeting for the organi- 
 zation of the Association, held in Cleveland, Ohio, July 1, 1880. 
 
 THE CONSTITUTION. 
 
 This Society shall be known as the National Association for the 
 Protection of the Insane and the Prevention of Insanity. 
 
 The methods by which the Society proposes to attain its end are : 
 
 First. By the encouragement of special and thorough clinical and 
 pathological observations by the medical profession generally, as well as by 
 those connected with asylums. 
 
 Second. By enlightening public sentiment as to the nature of the malady, 
 the importance of early treatment, improved methods of management and 
 treatment at home and abroad. 
 
 Third. By recommending an enlightened State policy, which, while 
 neglecting no one of its insane population, shall so administer relief and 
 protection as not to lay unnecessary or undue burdens upon the tax-payers. 
 
 Fourth. By holding public meetings, wherever needed, to stimulate 
 legislation that will secure efficient State supervision of all public institutions 
 for the care of the insane, as a mutual safeguard for the protection of society 
 — the patients, as well as those who have them in charge. 
 
 Fifth. To further the perfection of laws relating to the treatment of the 
 insane, and their rights while patients in the asylum. 
 
 Sixth. By efforts to allay the public distrust in relation to the manage- 
 ment of insane asylums, by placing them on the same footing as that of other 
 hospitals, both in the matter of freer communication with the outside world, 
 and the privilege of a consulting medical staff of general practitioners. 
 
 The Constitution was amended so that it might be amended at any regular 
 meeting by a vote of two-thirds of the members present. 
 
 We, the undersigned, form ourselves into a Society to be known as the 
 National Association for the Protection of the Insane and the 
 Prevention of Insanity, under the following form of organization, subject 
 to the ordinary rules of amendment : 
 
 BY-LAWS. 
 
 First. The officers of this Society shall be a President, Vice-President, 
 Secretary, Treasurer, and a Council of not less than fourteen persons, 
 including the above-mentioned persons, the members of the Council being 
 chosen to represent as many of the States as possible. 
 
BY-LAWS 
 
 5 
 
 Branch associations may be formed in the various States, and their 
 presidents shall be e%-ojfficio members of the Council, and their secretaries 
 and treasurers shall be members of the parent organization. 
 
 The Council shall appoint such committees from their own members, and 
 such agents and officers of the Association as the work to be done may require. 
 Six members of the Council and thirty members of the Association shall form 
 a quorum. 
 
 Second. Public meetings to awaken and increase a more general interest 
 in the purposes of the Association shall be held at such times and places as 
 the Council may appoint ; and the Council, by the committee appointed among 
 their members, shall elect persons, who shall be willing to accept the trust, 
 to prepare and read essays on medical and social problems connected with 
 insanity, and such essays shall form subjects of discussion at the meetings 
 of the Association. 
 
 ^T^iird. Any person may be a member of this Association by paying two 
 i dollars annually to its Treasurer. Honorary members may be elected by the 
 VCouncil, who shall be exempt from assessments. 
 
 The Annual Meeting of the Association, for the choice of officers and the 
 transaction of other business, shall be held at such time and place as the 
 Council may appoint, and the same officers may prepare a code of by-laws 
 for carrying out and governing the more specific details in the operation of 
 the Society. 
 
 At this meeting the following officers of the Association were elected: 
 
 H. B. Wilbur, M.D ., Syracuse, N. Y., President Natha n Allen, M. D ., 
 LL.D., Lowell, Mass., Vice-President ; Miss A. A. Chevaillier, Boston, 
 Mass., Secretary ; Ge org e JVL Beard, M.D., New York, N. Y., Treasurer. 
 
 There was also elected a Councif of prominent individuals of the medical, 
 legal, and other professions, representing many different sections of the 
 country. 
 
 This Society already has a large number of sympathizers, including many 
 distinguished citizens of the different States. It is desired to secure in each 
 State some effective form of governmental supervision of the insane, both in 
 and out of the hospitals and asylums, and to promote a scientific study of the 
 subject in its various aspects — the causes, the treatment and prevention of 
 insanity. 
 
 One of the most important of the many questions to which the Society 
 must give attention, is that which relates to the prevention of insanity ; and 
 in the study of this subject, and in the diffusion of sound information in 
 regard to it, the cooperation of physicians, both general practitioners and 
 specialists in the diseases of the nervous system, is earnestly invited. 
 
 
 H. B. Wilbur, M.D., Syracuse, N. Y., President. 
 
 Nathan Allen, M.D., LL.D. Lowell, Mass., Vice-President. 
 
 Miss A. A. Chevaillier, 10 Marble St., Boston, Mass., Secretary. 
 George M. Beard, M.D., 13 W. 29th St., New York, N. Y., Treas. 
 
6 
 
 MEMBERS OF THE COUNCIL, 
 
 Members of the Council. 
 
 Prof. T. N. Haskell, Denver, Colorado. 
 
 Hon. Vincent Colyer, Rowayton, Connecticut. 
 
 M. Abbie Cleaves, M.D., Davenport, Iowa. 
 
 A. Reynolds, M.D., Medical Sup’t Insane Hospital , Independence, Iowa. 
 J. S. Jewell, M.D., Chicago, Illinois. 
 
 J. C. Corbus, M.D., Mendota, Illinois. 
 
 C. C. Yemans, M.D., Detroit, Michigan. 
 
 Joseph Parrish, M.D., Burlington, New Jersey. 
 
 E. C. Seguin, M.D., New York, N. Y. 
 
 Mrs. Benoni Lockwood, New York, N. Y. 
 
 Mary Putnam Jacobi, M.D., New York, N. Y. 
 
 J. C. Shaw, M.D., Medical Sup’t Flatlush Asylum, Brooklyn, New York. 
 Hon. M. D. Eollett, Marietta, Ohio. 
 
 Hiram Corson, M.D., Conshohocken, Pennsylvania. 
 
 Hon. R. L. Lamberton, Pres’t Lehigh TJniv., Bethlehem, Pennsylvania. 
 J. C. Hall, M.D., Monroe, Wisconsin. 
 
 Hon, John W. Andrews, Columbus, Ohio. 
 
STATEMENT OF THE NEW YORK COMMITTEE. 
 
 In presenting his Paper, Dr. Beard made the following intro- 
 ductory remarks : 
 
 “In the absence of Mr. Dorman B. Eaton, of NewYor 
 member of our Committee, Yhave a double duty to perform, — at 
 once to state very briefly what has been done by this Committee, 
 and then to give our plan for the future. I shall speak of our 
 object — the formation of a National Association for the Protection 
 of the Insane and the Prevention of Insanity ; but, first of all, a 
 word in regard to Dr. Shaw’s asylum, which I visited a short time 
 since. I wish to speak in the highest possible terms of that insti- 
 tution. It is a noteworthy fact that the King’s County Asylum 
 had a terrible reputation ; but this young man took hold of it and 
 turned it from evil to good in a short time. Rev. Dr. Storrs, of 
 Brooklyn, said it was the meanest asylum under Heaven. That 
 /was not strictly true, then, but it is true now that it is one of the 
 /best asylums in the world. 
 
 The Committee, of which I am a member, was appointed last 
 winter by George William Curtis, Esq., who was the chairman of 
 the Cooper Institute meeting which voted such a committee, for 
 the purpose of introducing into this country, so far as possible, 
 the English system of central governmental supervision, that has 
 been referred to this morning and afternoon. Correspondents in 
 England with whom I was acquainted, taking them all as they 
 came, wrote to me recommending the principle of supervision as 
 it has been carried on in England for years. The opinion of all 
 these men, most of whom have charge of asylums, and who were 
 under the central Board of Lunacy Commissioners, to whom they 
 must report, — is unanimous that their supervision was a good 
 thing, and that they would not go back to the old system before 
 such a commission was formed. I speak of this because there has 
 been, in some quarters, an opposition. A bill was introduced in 
 the New York Legislature by our Committee, the object of which 
 was to form a Lunacy Commission there by extending the powers 
 of the State Board of Charities. The bill was defeated by a small 
 majority, largely through the influence of a superintendent of one 
 of the State asylums in New York.” 
 
WHY WE NEED A NATIONAL ASSOCIATION FOR THE PROTEC- 
 TION OF THE INSANE. 
 
 PAPER READ JULY FIRST, AT THE CONFERENCE OF CHARITIES AND CORREC- 
 TIONS, HELD AT CLEVELAND, BY DR. GEORGE M. BEARD, AS A DELEGATE 
 TO THE CONFERENCE, AND REPRESENTATIVE OF THE NEW YORK COOPER 
 UNION COMMITTEE ON ORGANIZATION OF A NATIONAL ASSOCIATION FOR 
 THE PROTECTION OF THE INSANE. 
 
 While passing, the other evening, through a collection of flowers 
 at an exhibition in New York, I observed a crowd looking at some 
 geraniums. One who professed to be skilled in these matters, told 
 me that the object of attention was a double white geranium which 
 had only been developed within the last ten or fifteen years ; if it 
 existed before that time it had not been known in this country, at 
 least to horticulture. 
 
 liseases, like flowers, are developing, with each decade, new 
 phases, presenting unheard of manifestations, the friction of our 
 civilization. These new diseases, or new phases of old diseases, 
 require new methods of attacking them. The increase of diseases 
 of the nervous system (to which insanity in its different forms 
 belongs) is a phenomenal and unprecedented fact in history ; 
 neither in the ancient nor the modern civilization have we any 
 analogue or comparison to the rise and multiplication of mental 
 diseases, during the past half century, in Europe and in America. 
 The five distinguished characteristics of civilization during the 
 past half century — steam power, the periodical press, the tele- 
 graph, the sciences, and the mental activity of woman (and to 
 these one of my critics, in the London Journal of Science, adds a 
 sixth, that is, the competitive examinations) — are not only all 
 modern, but peculiar to this century, or, if they existed before, it 
 was in embryo only. The competitive examinations of the 
 Greeks were for skill and excellence in muscular feats, and in 
 their great processions, it is said, the places of glory were 
 awarded to those who were victorious in the games that required 
 physical strength and training. The general worship of the intel- 
 lect is all modern. For all these supreme advantages we must pay 
 the full price, part of which is insanity and the nervous diseases 
 of the family to which insanity belongs, and societies like this that 
 is now to be organized. 
 
 Not only have new forms of insanity arisen, but the actual num- 
 ber of the insane and the relative numbers to the population, are 
 
PAPER BY DR. GEORGE M. BEARD. 
 
 9 
 
 much greater than fifty years ago ; both in quantity and in quality 
 there has been an evolution. New York is a great city, but the 
 prospective insane population of this country must, in time, be far 
 greater than that of New York at present. The armies that on 
 both sides fought the war of the rebellion were enormous, but the 
 army of the insane of the future is more likely to be greater than 
 aller. This continent is to be the home of five hundred millions, 
 if not double that number, and unless forces, that we cannot now 
 suspect, much less control, appear to our rescue, one out of every 
 three hundred of this republic will be insane. At the time of the 
 Declaration of Independence there was in these colonies a popula- 
 tion of three millions ; it is not wild to surmise that in the coming 
 centuries there should be half of three millions insane in this 
 republic. 
 
 This augmentation of the numbers of the insane, and this 
 development of novel symptoms and forms of insanity, are most 
 notably seen among the English speaking people. Insanity is a 
 part of the cost of liberty ; it is a tax on our freedom, that so 
 many must be deprived of their freedom. In the great despot- 
 isms there is little need of societies for the protection of the 
 insane ; where the sane are all oppresed, the number of the insane 
 has never been very great. The Czardom of Russia oppresses its 
 subjects, but does not make them crazy, and the Turks, with all 
 their weaknesses, are mostly sane. England, the spawning ground 
 of empires, sends out her children through all the earth, carrying 
 with them the seeds both of liberty and nervous disease, ^iberty 
 implies responsibility ; responsibility leads to worry, and worry 
 is attended always with disappointment. Out of the throes and 
 agonies and manipulations and calculations of the last month, two 
 men have been nominated for the supreme office of this nation, to the 
 disappointment of thousands upon thousands of candidates, their 
 followers and friends. A solid despotism and established religion 
 are partly redeemed byTEfs — that they "keep the asyhiffiFnTiTpty ; if 
 "we think for ourselves and govern ourselves, thousands must go 
 down in the struggle. Nature knows nothing of disinterested 
 benevolence ; she never gives anything ; she may often trust for a 
 time, but sooner or later we have got to pay, principle and interest. 
 
 As a philosopher has said, all progress is in waves — >a motion i? 
 
 without any advance. 
 
 The peculiar helplessness of the insane is a third and self- 
 asserting reason for the formation of organizations for their pro- 
 
10 NATIONAL ASSOCIATION FOR PROTECTION OF THE INSANE. 
 
 tection. We have societies for the prevention of cruelty to 
 children, b ut the insane are childre n without their naivete , their 
 innocence or their sweetness ; we have societies for the prevention 
 of cruelty to animals, but insanity oftentimes reduces man below 
 the grade and habits of the lowest animal ; we have societies for 
 relieving the condition of the poor^lmTlnganity" m ake s us poor, 
 while pove rty makes us insane ; we have associations for the care 
 of criminals and the amelioration of prisons, but the insane have 
 oftentimes a worse than criminal's punishment, without his crime. 
 We have health boards, local and national, for the warding off of 
 fatal epidemics, but death, even at the hands of the foulest 
 disease, is poetry compared with hopeless disease of the mind. 
 Most of the evils of this world can be relieved, even when not 
 cured, by money ; as Richter puts it, “ To a shower of gold most 
 things are easily penetrable ; ” but the possession of money is 
 sometimes the very temptation for the charge of insanity by 
 interested heirs. 
 
 A fourth reason why this society should exist is, that it may 
 help to bring about the principle of central governmental super- 
 vision of the insane, in or out of the asylums, through all the 
 States of this Republic. More and more, each year, matters of 
 minor import are becoming the objects of systematic official super- 
 vision ; our banks, our insurance organizations, our churches and 
 schools, our institutions of charity, are subordinate to some cen- 
 tral authority, or authorities ; only the insane, and they who care 
 for them, are left wholly to themselves, in some States. Central 
 governmental supervision, when carried out in this country, as for 
 more than thirty years it has been carried out in Great Britain, 
 will give assurance to the friends of sufferers, and to the people, 
 that the insane in asylums, public and private, and at their homes, 
 are treated wisely and kindly. 
 
 Central supervision will prevent outrageous cruelty, and the 
 incarceration and imprisonment of the sane ; central supervision 
 will aid those who seek homes for unfortunates in finding 
 precisety the institutions that they need ; central supervision will 
 help, among other forces, to elevate the standard of scientific 
 study on all the great questions relating to insanity — theoretical 
 and practical ; finally, central supervision will protect the officers 
 and managers of asylums themselves, who now stand right in 
 range of artillery which is directed upon them from every quarter, 
 
PAPER BY DR. GEORGE M. BEARD. 
 
 11 
 
 and against the assaults of which they themselves are powerless. 
 
 If asylums were perfect, they could not prove themselves such to 
 the satisfaction either of the people or of the medical profession ; 
 if your friend is confined in any institution, and is treated 
 judiciously and treated scientifically, you have no way of knowing 
 that fact. In this most delicate of all questions we must walk by 
 faith. 
 
 Another reason for the existence of such a society as this, is the 
 necessity of raising the standard of thought and of treatment of 
 the insane, both in and out of asylums. In no branch o f science 
 has there been, on the whole, progr ess more satisfactory, or more 
 jrapid , or more widely diff used, during the past t wenty^ears , _th ah 
 in the study and management of diseases of theTnervous system ; 
 and of this progress the insane everywIrere--^ttghirto~imftalre'^aT — 
 more freely than* they do now. You say that this advance should 
 be led wholly, and controlled exclusively, by students - of the ner- 
 vous system, but this is a matter in which every boot-black has an 
 interest. The questions of insanity are not exclusively confined 
 to experts in the nervous system ; politics come in, since the 
 insane become wards of the State, and, in this country, politics 
 means the people who make the laws, and men of science must 
 partly work with and through the people, if they would advance this 
 subject. Laws, among English-speaking people, are results more 
 than causes ; legislators are servants, waiting on the table of the 
 nation, and give us what they are ordered ; they do not have, and are 
 not expected to have, any thoughts or suggestions beyond the will 
 of their constituents. If any of the asylums are not as they 
 should be, if too much money is given for the buildings and too 
 little for the medical officers, if assistance is meagre and bad, if 
 there is lack of accommodation, the people are the ones to be 
 blamed ; the people are the persons to be addressed, and, so far 
 as public institutions are concerned, only the people can bring the 
 remedy. These are questions of knowledge, of confidence, and of 
 money ; and the money will not come until it has been preceded 
 both by knowledge and by confidence. You say “ the asylums, the 
 chiefs of asylums, and the national Association of Asylum 
 Superintendents, should do this work,” but this is not their busi- 
 ness, and, were it so, they would be unequal to it. The force that 
 makes the body grow comes from outside the body ; the elements 
 that make a civilization must come, in part, from outside the race 
 
12 NATIONAL ASSOCIATION FOR PROTECTION OF THE INSANE. 
 
 that is civilized. If we had waited for jailers to reform the jails, 
 or for prisoners themselves to organize a prisoners’ association, 
 or for our infants to have led the way in the formation of the 
 society for the prevention of cruelty to children, or for domestic 
 animals to have inaugurated institutions to keep them from being 
 treated cruelly, we should not have been more unwise than to 
 wait for asylums, their officers, their managers or their inmates, 
 to lead and control the advance which is now being made in the 
 study “and treatment of insanity. In this rising flood of nervous 
 diseases, asylums are themselves submerged and helpless, like 
 unfortunate villages surprised by mountain torrents, and all who 
 have strength should come to the rescue. 
 
 The subject of insanity is greater than asylums ; it is greater 
 than all institutions, public or private, that have been organized to 
 meet and overcome this great evil. Asylums are, to the general 
 subject of insanity, what hospitals in war are to the great battles 
 going on in the front ; they but receive those who have fallen in the 
 ranks, and are to keep in the rear, while the lines of battle are far 
 in advance and outside of them. The subject of insanity is greater 
 than insanity itself, since all the diseases of the brain and the nerve 
 system, by whatsoever names known, are related to each other, 
 run into each other, and take each other’s place. The man who 
 only knows insanity, does not know even that ; all the diseases of 
 the nervous system are members, one of another, and are to be 
 studied as parts of a great whole and in relation to each other. 
 More and more I am persuaded, in the study of my cases of 
 neurasthenia, or nervous exhaustion and allied states, that insanity, 
 in the parent or grandparent, may appear in the offspring, near or 
 remote, not as insanity, but in some milder form of neurosis, of 
 which neurasthenia is a type and centre. I have thought that, in 
 this way, one of the problems of insanity is solving itself; that 
 there is a tendency to self-cure running through the generations, 
 perhaps with increasing mildness of nerve trouble in the place of 
 increasing severity, and that possibly, in some families, there would 
 be in the next generation less nervousness than now. 
 
 A sixth mission of this society will be to obtain from every 
 source, and diffuse through all ranks of intelligent society, a 
 knowledge of all the branches of the subject. That insanity, for 
 example, is a disease of the nervous system, and a physical disease, 
 as much as small-pox or a broken leg, is a truism among neuralo- 
 
PAPER BY DR. GEORGE M. BEARD. 
 
 13 
 
 gists, but it is not a truism among the people. Like witchcraft, 
 
 like astrology, like alchemy, the delusion that disease of the mind 
 is something separate from the body, lingers all along our hillsides 
 and in the valleys, and even on the mountain tops of our civiliza- 
 tion ; men run from an insane person as from one possessed of an 
 evil spirit. This society will have justified its existence if it shall 
 succeed in doing nothing hut this — in obtaining universal recognition 
 of the fact that it is no disgrace to he crazy. Through all the 
 avenues of information we are to seek for light on this problem, — 
 how to prevent insanity, how to reduce to a minimum the friction 
 of modern life. The London critic, to whom I have referred, 
 reminds us that, when the steam engine was introduced, it was 
 supposed it would do all the work of the world and allow us to be 
 idle ; whereas, it has increased the world’s work, and helped to 
 increase nervous disease. This society will have justified its 
 existence if it shall succeed in making it no longer discreditable to 
 be manfully idle. A century ago, the problem was how to make 
 everybody work ; today, the problem is how to keep people from 
 overworking ; the children of the last generation were goaded and 
 spurred into study ; the children of this generation must be checked 
 and restrained — kept back — held in from study. The details of 
 the reform which is now beginning in the methods of education, 
 belong in part to this society. We must give up either our sanity 
 or our schools, as man}*- of them are now managed. The whole 
 English speaking race is facing the problems that are offered to 
 this society ; in England, even more than this country, at this very 
 hour all these questions are raised and asked, and pressed with 
 more force and persistence than here. 
 
 I close with three or four suggestions of a general character, 
 that will apply not only to this organization, but to all organiza- 
 tions that have for their object the well-being of mankind. 
 
 First of all, we should beware of unintelligent philanthropy, 
 
 is, doing good at short range, relieving present evils by increasing 
 
 those that are to come. No form of human energy so often fails in 
 its purpose as philanthropy. Among the wisest words ever uttered 
 are these: “Charity creates much of the misery that it relieves, 
 but it does not relieve all the misery that it creates.” Philanthropy 
 in excess becomes cruelty, and, with a force and success that no 
 tyrant can rival, heightens and deepens the miseries of mankind ; 
 doing good is easily turned to doing evil, and present distresses, 
 
14 NATIONAL ASSOCIATION FOR PROTECTION OF THE INSANE. 
 
 when relieved, but enrich the soil out of which other and more ter- 
 rible distresses are to arise. Talking on this subject the other day 
 with one of our best known philanthropists, who for years has 
 given largely and freely, — Mrs. Elizabeth Thompson, of New 
 York, — I asked her if her experience confirmed my scientific 
 deductions that philanthropy was too often a mistake. She 
 said, u Yes, it has taken me all my life to learn this. I can but feel 
 that I have, on the whole, done more evil than good in what I have 
 given away. I have denied myself to give to others ; to find, in 
 return, not only ingratitude, but failure. I see no way of helping the 
 poor but to make the poor help themselves.” Philanthropy is not 
 wise in attempting to walk alone ; she needs the support, on the 
 one hand, of science, on the other, of philosophy. 
 
 A second suggestion is, that we do not depend too much on law. 
 Even in a monarchy, laws cannot be very far ahead of the people, 
 and in a republic they are but the expressions of the wishes or 
 fancies of the majority. The enacting of laws, therefore, even 
 those most necessary and imminent, as those that relate to the 
 central governmental supervision of the insane, may be among the 
 last stages in this advance on the subject of insanit} 7- . We are in 
 the habit of running to the law and burying our heads in it, and 
 cr} 7 ing like children, whenever we are in trouble, forgetting that 
 legislators are themselves but children, whom we, the people, are 
 to educate and command. The principle of central supervision of 
 the insane by government is to prevail on this continent from the 
 Atlantic to the Gulf, but not until thousands of messages have gone 
 forth among the people, as so many school-masters, to train them 
 to desire and ask for, and appreciate, such legislation. 
 
 Finally, we are not to look for the completion of our labors as 
 soon as they are begun. All nature is but a process of preparation ; 
 results are but means to higher results ; nothing is final and com- 
 plete ; what we call preparation may be far more useful than the 
 end for which we prepare. 
 
 In all organisms, each layer of growth is the pathway for a higher 
 growth ; our very reformations need themselves to be reformed, and 
 the consummate issue ma} T flash out suddenly after long and hopeless 
 delay. We bury the seed, the. plant breaks through the surface, a 
 huge trunk is developed that sends its branches farther and higher, 
 and clothes itself with richer and richer foliage, year by } T ear, and the 
 buds appear ; but, as yet, no fruit or flower ; we go away for a night, 
 and on our return our barren tree is alive and eloquent with blossoms. 
 
PAPER BY DR. GEORGE M. BEARD. 
 
 15 
 
 In these United States of America, it requires on the average 
 from five to fifteen years for a new and unpopular truth, if it have 
 practical relations, and be wisely engineered, to become old and 
 popular. Those whose faith will allow them to wait for a decade, 
 will see this movement, begun in doubt and gloom, pass into and 
 through the early twilight into the clearness and glorj 7 of the 
 morning. 
 
SPECIAL SESSION ON LUNACY. 
 Thursday Afternoon, July 1. 
 
 The President, at the opening of this Session, said that it was 
 held for the purpose of hearing what a committee from New'York, 
 represented by Dr. G. M. Beard, Dr. E. C. Seguin and Miss A. 
 A. Chevail'lier, have to present in respect to the important subject 
 of lunacy. He then introduced Dr. Seguin, who read the follow- 
 ing paper : 
 
 THE PRACTICABILITY AND VALUE OF NON-RESTRAINT IN 
 TREATING THE INSANE. 
 
 PAPER READ JULY FIRST, AT THE CONFERENCE OF CHARITIES AND CORREC- 
 TIONS, HELD AT CLEVELAND, BY DR. J. C. SHAW, AS A DELEGATE TO THE 
 CONFERENCE, AND REPRESENTATIVE OF THE NEW YORK COOPER UNION 
 COMMITTEE ON ORGANIZATION OF A NATIONAL ASSOCIATION FOR THE 
 PROTECTION OF THE INSANE. 
 
 Mr. Chairman , Gentlemen and Ladies: — I am not here to pre- 
 sent to you an historical sketch of the subject of non-restraint in 
 the management and care of the insane, but to direct your atten- 
 tion briefly to the practical part of the subject ; and to demonstrate 
 that it is practicable and beneficial, observations have been made 
 in the King’s Count}* Insane Asylum, which is under my direction. 
 f Several papers have been presented to this Conference at its meet- 
 ly ings during the past six years, some treating the subject pretty 
 N exhaustively. Among them are the papers by Dr. H. B. Wilbur, 
 Dr. J. L. Bodine and Mr. F. H. Wines. There are also papers 
 by Drs. Folsom and Bucknill on asylums in America, to all of 
 which I refer you. 
 
 On taking charge of the asylum, not two years ago, I found a 
 large number of patients in restraint-jackets, straps and seclusion. 
 On inquiring why certain male patients were in restraint, I was 
 told by the attendants and the assistant physician, who was then 
 in charge of the wards, that they were bad, vicious patients, who 
 would injure the nurses and other patients. Some of these 
 patients had been in restraint for months, and even for years. 
 On considering the situation of things, and the best way of 
 reducing this very high ratio of restraint, I observed that the 
 patients, whenever they were in the presence of the attendants, 
 showed by the expression of their faces evident dislike to them ; 
 and, as the nurses stoutly insisted that these patients could not get 
 
PAPER BY DR. J. C. SHAW. 
 
 17 
 
 along without restraint, I saw that if I took the apparatus off in these 
 halls, and with these nurses, I should certainly be unsuccessful, as 
 there soon would be a collision between the patients and their 
 nurses. I therefore removed the patients into other halls, with 
 nurses comparatively strangers to them, and then took the 
 apparatus off. This proved to be a complete success, and 
 patients who had been in continued restraint, night and day, for 
 ^ /fhonths, and even for years, now got along so quietty that I some- 
 ( times wondered why they had ever been put in restraint at all. 
 \£he restraint on the female side was less than on the male side, 
 and this was due to the greater intelligence of the assistant in 
 charge. Here also we adopted the same plan, with like success. 
 Simultaneously all the restraint apparatus was taken from the 
 halls where previously it had been kept (for the nurses to apply at 
 their discretion), to the office, so that it could only be applied by 
 direction of the medical staff ; the restraint to be for such a length 
 of time as they directed, and then returned to the office and a 
 record kept of it. In this way we reduced the restraint to about 
 five^iatients in 700. This proved to be so successful and satisfac- 
 tory to all the staff, as well as to myself, that I determined to have 
 no restraint apparatus at all, for then none could be used. So I 
 had it all burnt, and I do not exaggerate when I say that there 
 must have been three hundred pairs of restraint apparatus, straps, 
 camisades, etc. 
 
 The only thing that now could be used was seclusion, and this 
 was strictly watched, and its use, without permission, made an 
 offence punishable by dismissal ; hence, we had little use made of 
 it. I must speak of one woman on whom we bestowed much 
 thought. She is very. large, tall and stout, weighing at least two 
 jitmdred and fifty pounds ; she had been in seclusion for years, and 
 ! her food was handed in to her ; she was at times a very quiet 
 j patient, and at others violent ; she was in the charge of a good 
 ^ nurse, who used to take her out in the evening, when she was 
 fjuiet, and allow her to walk up and down the hall ; she would 
 strike other patients if she became angry, and, from her size, was 
 quite a terror. My assistant, Dr. Arnold, was determined to find 
 a way of keeping her out in the hall with the rest of the patients. 
 She had been in seclusion so long that it really became a matter 
 of judicious management how to have her out associating with the 
 other patients, and have no continued quarrels and fights ; but at 
 2 
 
18 NON-RESTRAINT IN TREATING THE INSANE. 
 
 last he succeeded, and now she moves about the hall with the other 
 patients, and dines in the associated dining-room. 
 
 I must now beg you to consider what has been accomplished 
 under great disadvantages : as is well known, county asylums have 
 far less facilities than State asylums. We have over 700 patients, 
 on an average one attendant to 15 patients, no grounds to speak 
 of, except an airing court ; and a comparatively low diet. This 
 system of non-restraint is of the best possible effect on the 
 patients ; they are less violent and more contented. We do not 
 /find, as has been alleged, I believe, that it is more irritating to 
 the patients to be under the control of the attendants than it is to 
 have the apparatus on them, but just the reverse. Patients dislike 
 very much to be tied up in any kind of apparatus ; if the attend- 
 ants treat them courteously and with consideration, but with 
 firmness, there need be no ill feeling or resentment on the part of 
 patients. A great deal can be accomplished without force. As 
 soon as we find that a patient takes a dislike to a nurse, and cannot 
 get along with him or her, we remove the patient. We find that 
 since the abolition of the restraint we hear and see less of violent 
 patients than we did with the restraint ; and we certainly have 
 fewer scuffles between patients and attendants, and no more 
 instances of patients hitting each other than we had when it was 
 in vogue. 
 
 Now, as to how this system is to be carried out in any asylum ; 
 and, if you please, let us take an asylum under the worst possible 
 circumstances, and containing a great many patients. It has been 
 said by an expert German psychologist and neurologist, that when 
 the non-restraint system was introduced into the Charite-Kran- 
 kenliaus at Berlin, every attendant had to be dismissed ; I hardly 
 think this would be necessary in America, but if it were, why, let 
 us do it. I here quote a passage from the paper of Dr. Bodine : 
 -“ The attendant, is. the weak point in the non-restraint system; 
 The natural impulse of fhe 'aTerage attendants to treat the 
 patients entrusted to his care ‘ like dumb, driven cattle,’ but well 
 chosen attendants, being treated by their superior officers with 
 kindness, consideration and humanity, will thus be prepared to 
 extend the same law of human kindness to their afflicted and often 
 perverse charges. The superintendent always gives tone to his 
 whole institution, and the insane unconsciously assimilate the 
 character of their surroundings and associations very much as 
 
PAPER BY DR. J. C. SHAW. 
 
 19 
 
 children do. The attendant will never be more careful and con- 
 siderate of the interests and welfare of the patients than his 
 superior officers are.” This is a correct statement of the relation 
 of the officers to the attendants and patients. 
 
 I did not find it necessary to dismiss any of my attendants to 
 carry out the non-restraint plan, but they were given to understand 
 that it had to be carried out, and no harshness would be tolerated ; 
 and they were closely supervised. Attendants, as a rule, will very 
 soon do what they find the superintendent intends to carry out, with- 
 out vacillation. One thing is absolutely necessary, however, and it 
 is that the assistant medical officers should be in entire accord with 
 the superintendent; in this I have been most fortunate. Dr. 
 John Arnold and Dr. John S. Woodside, my two senior assistants, 
 have been just as anxious and zealous in carrying it out as I have 
 been myself, and to them a great deal of credit is due. 
 
 / Closely connected with this matter of non-restraint is the 
 employment of patients ; these two go together. The employment 
 of patients means the abolition of restraint apparatus ; the plan 
 \pf keeping patients day after day and month after month in a 
 hall, is, in my judgment and observation, highly detrimental to 
 their mental health ; even the demented become more stupid under 
 these circumstances. With the limited ground and facilities at my 
 command, I have been able to do comparatively little in my asylum, 
 but I hope and believe it will compare well in this with other 
 asylums having ampler facilities and grounds. I succeeded in 
 having placed at my disposal about sixteen acres of garden. On 
 this we have occupied many of our male patients, whilst others 
 made roads, etc. The non-restraint and occupation of patients 
 are, in our experience, most efficient means of treatment. Patients 
 who appeared almost hopelessly insane, recovered while out of 
 doors working ; others recovered much faster than they otherwise 
 would have done. 
 
 At first a number of patients ran away, but after a while, as 
 they became more accustomed to being out and had more freedom, 
 the runaways became less and less. The patients like to go out, 
 and they ask to be allowed to do so ; of course, a few refuse to 
 do anything. The employment of women is more difficult, as we 
 cannot so easily give them the outside work, in the way of garden- 
 ing, that we do men ; sewing, housework and employment in the 
 laundry are mostly the occupations that they can engage in. 
 
20 
 
 NON-RESTRAINT IN TREATING THE INSANE. 
 
 From what I have seen of this increased freedom among our 
 patients, I am convinced that a great deal of freedom can be 
 allowed them, and I do not think that it is at all exaggerated by 
 the English and Scotch superintendents. I have become more and 
 more convinced that the occupation of these patients is a most 
 important element in treatment, and in the happiness of those who 
 are incurable. Had I the ground that surrounds some of the State 
 asylums I could get almost every one of my patients out to work. 
 I am sure that a great deal can be done with a short allowance of 
 attendants ; this need be no excuse ; there are many patients in 
 every asylum who are almost as good as nurses, and will help to 
 keep the others in order. 
 
 I regret very much that there is such a lack of public confidence 
 in asylum management. This, I am convinced, plays a. certain 
 part in obstructing the progress of changes. I mean the ill feeling 
 which is entertained by ignorant persons. I do not mean intelli- 
 gent criticism, but the ignorant friends and relatives of patients 
 in asylums — these, I say, are obstructions to improvements. I 
 believe I do not speak unadvisedly ; for instance, I have had 
 persons make complaints and tirades against me because I 
 employed patients in gardening and other out-of-door work. In 
 one instance the aunt of a young man was highly indignant 
 because her nephew worked in a garden, and she demanded that 
 he should be removed from the work. The young man was sent 
 to his work at his own request. When he was sent for and asked 
 if he wished to remain in the hall where he was and continue to 
 work in the garden, or be sent back to the hall he was in before, 
 he said that he did not wish to be moved. His aunt then pro- 
 tested that he was nothing but an insane boy and did not know 
 what was good for him, lamented that he was all sunburnt, and 
 said that he had no business to work, and she would see about it. 
 I, of course, gratified the young man, and positively refused to 
 change him ; he was in a hall where the door was always open, 
 and he could go in and out as he pleased. At another time, the 
 'grand jury of the county inquired of a judge if they could indict 
 a superintendent for making insane persons work. Now, it 
 requires some courage on the part of superintendents to change 
 the old routine under this kind of tyranny and interference ; a 
 man who is timid, yields rather than subject himself to this and 
 similar annoyance ; but he who does so must be a man who has 
 
PAPER BY DR. J. C. SHAW. 
 
 21 
 
 little feeling for his patients, and is satisfied to go through his 
 halls and see them as prisoners, rather than unfortunate creatures 
 needing care and kindness. It becomes the duty then, in my 
 opinion, of such bodies as this, and other philanthropic bodies and 
 individuals, to instil into the public mind the importance of a 
 change in the present system of keeping the patients shut, up, 
 which is almost universally done in American asylums. Patients 
 in asylums are not half as insane as some persons suppose them 
 to be ; a great deal can be trusted to most of them, and a greater 
 amount of liberty allowed them. 
 
 This very brief communication is brought before this Conference 
 to prove that the non-restraint system is quite practicable in 
 America, notwithstanding the opposite has been stated. 
 
THE RIGHT OF THE INSANE TO LIBERTY. 
 
 PAPER READ JULY FIRST, AT THE CONFERENCE OF CHARITIES AND CORREC- 
 TIONS, HELD AT CLEVELAND, BY DR. E. C. SEGUIN, AS A DELEGATE TO THE 
 CONFERENCE, AND REPRESENTATIVE OF THE NEW YORK COOPER UNION 
 COMMITTEE ON ORGANIZATION OF A NATIONAL ASSOCIATION FOR THE 
 PROTECTION OF THE INSANE. 
 
 “The true principle to guide our practice should be this, — that no one, 
 sane or insane, should ever be entirely deprived of his liberty, unless for his 
 own protection or for the protection of society.” Henry Maudsley. 
 
 It is fair to say that in the present state of psychiatry in 
 America, to be pronounced insane by physicians, by a judge, or by 
 a jury, means imprisonment for months, for years, or for life. To 
 put it in another way, there is a disease which reduces its victims 
 to a level with persons accused of crime, and exposes them to loss 
 of liberty, property and happiness. 
 
 Is this just? Is this worthy of a country like ours, which aims 
 to be foremost in works of philanthropy, and preeminent as regards 
 individual liberty ? 
 
 Let us review the facts of medico-legal practice in the State of 
 New York, on which these statements rest. 
 
 1. A man has acute mania, he becomes unmanageable at home, 
 is dangerous to himself and to others. This man is summarily 
 placed in a carriage, taken to an asylum and locked in, without any 
 process of law. Before a certain time has elapsed after his recep- 
 tion (five days), certificates duly executed before a judge of a 
 court of record must be furnished to the superintendent of the 
 asylum as a justification for further detention. 
 
 Viewed without prejudice, this course seems the only one which 
 can be pursued, and consequently we deem it right. For to wait 
 man}" hours or several days for all the legal forms of commitment 
 to be executed, might endanger the life of the patient or of those 
 about him. Still it must be remembered that such cases of very 
 severe acute mania are rare. In most cases a delay of twenty-four 
 hours can do no harm. 
 
 2. The same patient recovers in greater part; he becomes 
 quiet, and, with the exception of an occasional false notion and a 
 degree of mental enfeeblement, is like most well men. Yet by 
 virtue of the power of the original commitment this man is kept 
 confined to the asylum, he is yet a prisoner. If he wishes to walk, 
 or to breathe fresh air, or to attempt some little outdoor work, 
 
PAPER BY DR. E. C. SEGUIN. 
 
 23 
 
 £ 
 
 doors must be unlocked to let him pass, and when he returns to his 
 room or ward he is locked in for the night. And this stage of 
 partial recovery may last almost indefinitely. The sole power of 
 discharge rests in the judgment and hands of a single man, the 
 superintendent ; the patient is practically under a most singular 
 Torm of tyranny for any enlightened state to permit to flourish. 
 
 No matter how scientific or how good a man the superintendent 
 may be, I hold that this degree of authority, of uncontrolled 
 authority over the liberty of citizens, ought not to be allowed. 
 
 3. The same sort of a case, i. e., one of acute mania, terminates 
 unfavorably. The delirium is transformed into a group of more 
 or less fixed delusions, kept up by hallucinations ; the memory and 
 judgment are fatally impaired, — in other words, secondary dementia 
 is established. If, as in innumerable cases now in asylums, the 
 delusions of the patient are not delusions of persecution, or of any 
 other form likely to lead to an outbreak of violence or destructive- 
 ness, is it right to keep this patient in the more or less costly and 
 elegant prisons we call asylums ? 
 
 Why should not these remains of a man enjoy freedom under a 
 certain supervision? Why should he not be allowed to go and 
 come as he pleases and to have what little pleasure there remains 
 for him in life ? 
 
 Let us make a further supposition, which is perfectly in accord 
 with cases daily observed. If this harmless dement has property 
 of his own, why should not this property be used to provide him 
 with a suitable mode of life, and expended in reasonable amount 
 for his benefit ? There is good reason to believe that many such 
 patients are kept in asylums, private or public, indefinitely, unpro- 
 vided with the luxuries or quasi-luxuries to which they are entitled. 
 After a few years of patience on the part of the relatives, and of 
 more or less conscious misery on the part of the patient, the disease 
 ends in death, and the carefully preserved property of the deceased 
 is duly apportioned among heirs. 
 
 4. A woman drifts through domestic trouble, semi-starvation, 
 intp a state of cerebral mal-nutrition and anaemia ; delusions of a 
 melancholic type appear, together with a depression and sadness 
 which cannot be reacted against. 
 
 Is it right to imprison such a woman, to place her actually under 
 lock and key for months ? 
 
 In some cases I am willing to admit that it is justifiable, but in 
 the majority of cases I believe that such a procedure is unjust, 
 
 tt 4 f 
 
24 
 
 THE RIGHT OF THE INSANE TO LIBERTY. 
 
 morally and legally, and decidedly opposed to the patient’s 
 recovery. 
 
 To decide which cases belong to the former category and which 
 to the latter, and to judge when a given case passes from one 
 category into the other, requires, I admit, careful observation and 
 ripe judgment, but no more, I am prepared to maintain, than do 
 many other problems in medicine and surgery which are decided 
 every day in our midst with average good success. 
 
 5. Cases of primary dementia occur frequently in both middle- 
 aged and old people. Many such patients are simply foolish, but 
 quite harmless. Why are they sent to asylums, except for safe 
 keeping, because of the lack of relatives, or because of pecuniary 
 inability of friends to take care of the deteriorating member of 
 the family ; or lastly, pretty often, I fear, because of unwillingness 
 to keep the patient at home ? 
 
 In all these three categories I believe that confinement under the 
 present asylum system is unjustifiable, legalfy and morally. 
 ^-'''What right have we to bar a man’s window and keep him all 
 day, or part of the day, for months and years, under lock and ke}’, 
 Nbecause he is simple or foolish, or, to put it technically, demented? 
 
 ' The pauper insane of the harmless demented class must, I 
 suppose, be aggregated in institutions, preferably under medical 
 supervision, if not medical control, but have we not the right to 
 ^"demand that these unfortunates shaH have the maximum of personal 
 
 G iberty consistent with safety to themselves and others ; that they 
 ball be both employed and amused in an inexpensive manner? 
 A^ust we not remember that so long as any reason survives, perhaps 
 longer, the animal capacity for simple enjoyment persists ? How 
 many hundred chronic insane in this nation are quite capable of 
 \j enjoying a game of cards or dominoes, bowling, a pipe of tobacco, 
 
 \ etc., in comparative freedom, under a surveillance that need not at 
 all resemble the present prison-like manner of watching patients in 
 asylums ? 
 
 6. Epileptic and hysteric patients are rarely detained in asylums 
 without justification. I have had personal knowledge of such 
 cases. 
 
 The alleged cause of certification originally, and of unlimited 
 detention afterward at the request of relatives, is some psychical 
 disorder which, in a majorit} r of cases, is temporary, and quite as 
 much under the control of a physician as of a superintendent. 
 
PAPER BY DR. E. C. SEGUIN. 
 
 25 
 
 I do not, let it be clearly understood, mean to say that such 
 cases should not be sent to institutions, but I protest most energeti- 
 cally against their commitment to prison-like asylums, to their 
 forced association with the insane, and their subjection to the 
 imperfect medical treatment which obtains in most asylums. 
 
 Removal from home often does much good in these diseases, and 
 is a sine qua non to recovery in certain cases of hysteria ; but from 
 this statement to the present evil practice of judicial commitment 
 and locking up there is a vast gulf — a gulf as deep and wide as is 
 the great human right to personal liberty. 
 
 I do not mean to refer in detail to a last class of cases, viz., 
 those in which a sane person is fraudulently imprisoned as insane 
 under our present imperfect laws. 
 
 I firmly believe that such cases are extremely rare, and from my 
 personal knowledge of many of the superintendents of insane 
 asylums, I do not believe that any of those gentlemen would for 
 one moment countenance such a procedure. 
 
 I trust that I have made myself understood. 
 
 With many others, some of them to be cited further on, I believe : 
 / (a) That a large number of the inmates of asylums could be 
 f taken care of with open doors and unbarred windows, and, of 
 f course, without restraining apparatus. 
 
 (6) That many insane now confined in our asylums could be 
 trusted almost implicitly to go and come at will ; could be given 
 nominally remunerative occupation, and, above all, could be pro- 
 vided with simple amusements suited to their stations in life (and 
 I do not refer to costly stereopticons, or the solitary billiard .table, 
 or the lectures, to which superintendents now refer with so much 
 complaisance) . 
 
 (c) That the phases of insanity should be watched more closely, 
 with especial reference to early discharge of a patient ; to his 
 transfer to another institution ; to the amount of liberty allowed 
 him, etc. And I do not think it safe_t.o J.eave this power wholly 
 in the hands of the superintendent. 
 
 Jd) That the time has come to look around and attempt in this 
 country the English and Scotch plan of placing harmless insane 
 persons singly in the families of farmers, and of others willing to 
 undertake the task under frequent and efficient visitation. 
 
 There is not, I dare say, a single county in the State of New 
 York where a number of harmless chronic, or even sub-acute, 
 
26 
 
 THE RIGHT OF THE INSANE TO LIBERTY. 
 
 
 cases of insanity might not be safely and happily treated or kept in 
 families, and where a good, yet just and firm country doctor, could 
 not be found to visit a dozen or more of these patients occasionally 
 and unexpectedly, and keep a strict watch over their health and 
 happiness, reporting fully to the State Commissioner or Com- 
 missioners of Lunacy, or to a special general inspecting official. 
 
 There are, I have reason to believe, many families who would 
 much prefer to keep their insane in this manner, at a reasonable 
 cost, who are made to shudder at the mere mention of an asylum, 
 whose long and desolate corridors they see in imagination, whose 
 locks and keys they almost think they can hear, and whose 
 deteriorating influences upon patients they more than half suspect. 
 
 While expressing the above views I also desire to state just as 
 clearly my belief that certain cases of insanity, more especially acute 
 mania or melancholia, all psychosis accompanied by homicidal, 
 suicidal or marked destructive tendencies, should be placed, as 
 quickly as the law will allow, in confinement. But even here we 
 may implore that the confinement may be made as easy as possible 
 for the unfortunate patient, who is, contrary to public prejudice, 
 just as much a sick man as if he had phthisis or a chronic ulcer ; 
 and that all the barbarous means of corporeal restraint, such as 
 cribs, jackets, straps, etc., shall be radically done away with as 
 asylum implements, as a part of the nosocomial armamentarium , 
 and only applied by express directions of the medical officer in 
 exceptional cases, very much in the same way as we resort to 
 heroic medication or surgical procedures in general practice. 
 
 If you will pardon a simile, I would say that I look upon restrain- 
 ing apparatus in the treatment of insanity very much as upon the 
 lancet in the treatment of general diseases. The sight of restrain- 
 ing apparatus in an asylum seems to me as demoralizing and 
 uncalled for, as would be the carrying of a lancet and the celebrated 
 palette by a physician of today in his hospital visit. Bleeding is 
 generally condemned, and so is physical restraint of the insane, 
 ^e^cepting in this country, and yet I will not deny but that once in 
 a while, under peculiar circumstances, both phlebotomy and 
 estraint are justifiable. Let us join in the hope that before many 
 r "ears both procedures will be equalty rare. 
 
 ^ I desire to close this essay by reference to the opinions of much 
 abler men, and much more expert specialists than myself upon 
 this subject. And I believe that the gentlemen whose views I am 
 
PAPER BY DR. E. C. SEGUIN. 
 
 27 
 
 to quote are so eminent in their specialty that the most bigoted 
 defender of our present prison system of asylums cannot question 
 their right to be considered as foremost authorities. 
 
 /^T)r. Henry Maudsley, who has held almost every possible officialN 
 ^pos ition in relation to insane administration in England, and 
 who is justly regarded as one of the most distinguished European 
 alienists, expressed himself as follows, years ago : I quote from 
 the second edition of 4 4 The Physiology and Pathology of the 
 Mind ” (London, 1868) : 
 
 44 To be a lunatic, as public sentiment goes, is to be cut off 
 socially from humanity. With such feeling prevalent with regard 
 to the insane, can it be thought possible that the treatment, at 
 present sanctioned by general approbation, should be the most 
 just and humane possible ? The feeling is one which cannot be 
 justified, and the system which it inspires cannot be just. That 
 system is the system of indiscriminate sequestration — of locking 
 up a person in an asylum simply because he is mad. 
 
 44 Now, I believe this practice to spring out of an unjust feeling, 
 as already said, and to be founded on false principle, as I shall now 
 endeavor to show. The principle which guides the present practice 
 is that an insane person, by the simple warrant of his insanity, 
 should be shut up in an asylum, the exceptions being made of 
 particular cases. This I hold to be an erroneous principle. The 
 true principle to guide our practice should be this : that no one, 
 sane or insane, should ever be entirely deprived of his liberty, 
 unless for his own protection or for the protection of society.” 
 (pp. 494, 495.) 
 
 44 1 venture, indeed, to affirm in opposition to it, that there are 
 many chronic and incurable insane persons, neither dangerous to 
 themselves nor to others, who are at present confined in asylums, 
 and who might as well be at large.” (p. 495.) 
 
 “Another objection to the liberation advocated will be, that 
 the insane in private houses will not be as well cared for as they 
 are, nor have any more comfort than they now have, in well- 
 conducted asylums. The quarter from which this objection is 
 urged taints it with suspicion ; I never heard it put forward but 
 by those who are interested in the continuance of the present 
 state of things. Those who make it, appear to fail entirely to 
 appreciate the strength of the passion for liberty which there is in 
 the human breast ; and as assuredly there are but very few persons 
 
28 
 
 THE RIGHT OF THE INSANE TO LIBERTY. 
 
 who would not infinitely prefer a garret or a cellar for lodgings, 
 with bread and water only for food, to being clothed in purple and 
 fine linen, and faring sumptuously every day as prisoners ; I can 
 well believe that all the comforts which the insane person has in 
 
 f his captivity are but a miserable compensation for his entire loss 
 
 of liberty, that they are petty things, which weigh not at all 
 
 against the mighty suffering of a life-long imprisonment.” (pp. 
 496, 497.) 
 
 “ For the reasons adduced, I cannot but think that future 
 1 J progress in the improvement of the treatment of the insane, lies 
 
 WT in the direction of lessening the sequestration and increasing the 
 
 liberty of them.” (p. 501.) 
 
 “Not the least of the evils of our present monstrous asylums, 
 is the entire impossibility of anything like individual treatment in 
 them.” (p. 502.) 
 
 “Indeed, I cannot help feeling, from my experience, that one 
 ~~T effect of asylums is to make some permanent lunatics. * * * 
 
 And I can certainly call to mind more than one instance in which 
 t I thoroughly believe that the removal of a patient from an asylum 
 was the salvation of his reason.” (p. 503.) 
 
 Our distinguished countryman, Dr. Samuel G. Howe, everywhere 
 known for his philanthropic efforts, enters a noble protest against 
 the unnecessary restraint of lunatics by confinement to asylums, 
 in the Sixth Annual Report of the State Board of Charities of 
 Massachusetts, for 1869. I quote : 
 
 “Yes, disguise it as we may, we do keep under unnecessary 
 restraint and in a sort of slavery, a multitude of unfortunates who 
 sigh for liberty, and to whom it would be very sweet. Their 
 appearance of quiet and their seeming acquiescence are oftentimes 
 utterly deceptive. Bewildered, doubtful of their own power of 
 self-guidance, half conscious of insanity, still they know enough 
 to know that the whole power of society holds them in its grip, 
 (_ and they resign themselves in despair.” (p. lxxxvii.) 
 
 “It would be folly to deny that restraint by walls, by iron 
 sashes, by oaken doors and by constant guard is necessary for a 
 certain class of patients under our mode of treatment. But it is 
 
 r equal folly to maintain that it is necessary for all, or for nine- 
 tenths ; and if not necessar}^, upon what ground can we defend our 
 \ violation of a right which the lunatic never forfeited ? 
 
 “ It is sinful and criminal to abridge unnecessarily the freedom of 
 
PAPER BY DR. E. C. SEGUIN. 
 
 29 
 
 an innocent man ; and it is, moreover, cowardly and cruel to 
 abridge that of an unfortunate lunatic.” (p. lxxxix.) 
 
 In the next place I quote from G. Fielding Blandford’s work on 
 “Insanity and its Treatment” (London edition, 1870, American 
 edition, 1871). He says : 
 
 “ Doubtless, you have all heard of the moral tresitment'- oL 
 insanity, fait- shutting a_rnn n up in an^^hrnT"ean" bnr(l ly be called 
 moral treatment.” (p. 379.) 
 
 u In asyluifis they dwelt from 3^ear to year, a few walking beyond 
 the premises, but none sleeping beyond, or going to any places of 
 amusement like ordinary men. Now, from all asjdums patients 
 are sent to the sea-side, to the theatre, the picture galleries, and 
 each proprietor vies with his fellows in providing recreation and 
 entertainment for his patients — in proving, in fact, how little they 
 need the restraint of an asylum.” (p. 383.) 
 
 [The above passage applies only to a special class of private 
 asylums in Great Britain, but its bearing on the general question is 
 obvious.] 
 
 “ As the last generation did away with the fetters and mechanical 
 restraint used in asylums, so let the present release from the 
 restraint of an asylum all those capable of enjoying a larger amount 
 of liberty and a freer atmosphere than that in which they now fret 
 and chafe.” (p. 385.) 
 
 Dr. John Charles Bucknill is known to the profession in this 
 country as an eminent authority upon the topic in hand. 
 
 He has this spring given us in book-form the series of papers on 
 Lunacy Law Reform which appeared in the British Medical Journal 
 in 1879. The purpose '6f“fhese'papersds-mainly warfare upon the 
 private or proprietary asylums as they flourish in England, but 
 scattered throughout the volume are numerous passages proving 
 how thoroughly Dr. Bucknill, after a most varied experience with 
 the insane and with asylums, coincides with Dr. Maudsley in the 
 opinion that for many cases of insanity or mental unsoundness 
 confinement to an asylum, subjection to asylum routine, and 
 deprivation of liberty and social enjoyments are cruel, and legally 
 unjustifiable. 
 
 I quote a few sentences only : 
 
 “ Custom-blindness (which is more than color-blindness, because 
 it blurs the outline of things as they are) often leads official people 
 to associate unsoundness of mind with detention under care and 
 
30 
 
 THE RIGHT OF THE INSANE TO LIBERTY. 
 
 treatment as correlative if not identical conditions ; but with the 
 general public it is not so, and still less with the medical profession, 
 and still less again with that of the law.” (pp. 25-26.) 
 
 “ * * * And, therefore, it would appear to be imperative to 
 
 ' a proper certification of a lunatic for detention in an asylum that 
 the reasons for which such detention is needful should be fully 
 stated upon the face of the documents, and distinguished from the 
 facts which simply indicate lunacy.” (p. 26.) 
 
 “But it is not merely the happy change which takes place in 
 confirmed lunatics when they are judiciously removed from the 
 dreary detention of the asylum into domestic life, it is the efficiency 
 of the domestic treatment of lunacy during the whole course of the 
 disease which constitutes its greatest value, and of this the 
 /author’ s fullest and latest experience has convinced him that the 
 figurative influences of asylums have been vastly overrated, and 
 / that those of isolated treatment in domestic care have been greatly 
 ( undervalued.” (p. 114.) 
 
 “ Many a suicidal patient can live as safely with two faithful and 
 skilful attendants in a villa or cottage as in any asylum, and in the 
 free air he will walk or drive, employ or amuse himself in various 
 ways, and recover without the asylum brand or the asylum danger 
 of falling more and more into subjective ways of thought and 
 \ shunting into the sad list of incurables.” (p. 116.) 
 
 The President (Dr. Wilbur) : In connection with this paper 
 I will make a single observation. When in London the last time, 
 I visited the Bedlam Hospital of centuries ago, an endowed institu- 
 tion of a semi-private character, where they are able to take patients 
 from what are called the middle classes, and among other patients 
 in it are many infirm actors and actresses, and as an act of grate- 
 ful recognition on the part of the profession for the kindness 
 vouchsafed by that institution, complimentary tickets are often 
 sent to it ; and on the morning of my visit, while present with the 
 officers, a list was made out of those in the institution who should 
 be selected to attend the theatrical performance of the evening. 
 
LETTER FROM MR. SEWALL 
 
 31 
 
 The President (Mr. Sanborn) : I will now read a letter from 
 one of the oldest lawyers and philanthropists of Massachusetts — 
 Mr. Samuel E. Sewall, of Boston — whose ancestor — Chief Justice 
 Sewall — was one of those judges who sentenced the Salem witches 
 "to death, and, some years after, stood up in church on Sunday and 
 .repented publicly his great sin in that matter. The letter makes 
 a valuable suggestion for the Conference to consider : 
 
 Boston, June 25, 1880. 
 
 Dear Miss Chevaillier : 
 
 The circular in regard to a “National Association for the Protection of the 
 Insane,” with the invitation to attend a meeting of the Conference of Charities, 
 was duly received. I certainly desire to be enrolled as a member of such an 
 association, if one be formed. I had intended to write some remarks respecting 
 the laws regulating lunatic hospitals, but I have been so pressed by urgent 
 affairs that I gave up the design. One point, however, I hope you will bring 
 before the meeting. It is the importance of having a full abstract made of 
 the laws of all the States regarding lunacy. It is a laborious task, but when 
 done it cannot fail to be highly useful. Among the immense mass of crude 
 and unwise legislation there cannot fail to be found some valuable sugges- 
 tions for future reform, — a few ounces of gold in a ton of stone. Could not 
 a committee be appointed to undertake this work, and also the same, or 
 another committee to prepare annually a summary of all important facts to be 
 gathered from the reports of the lunatic hospitals throughout the United States, 
 in a tabular form, or otherwise; and to collect from them useful ideas for 
 reform? I cannot act on any committee, but throw out these thoughts for 
 your consideration. 
 
 I am very glad you are to be at the meeting in Cleveland. It makes me 
 feel sure that something will be done. 
 
 Yours, very truly, 
 
 S. E. SEWALL. 
 

 
 
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