"A Modern Lettre De Cachet" Reviewed
[It is not our custom to print any criticism on articles which have appeared in these pages ; but the following paper comes to us with such high claims for consideration, that we give space to it. — EDITORS.]
AN article in the May number of this Magazine, entitled “A Modern Lettre de Cachet,” is so incorrect in most of its statements, that it does great injustice to certain individuals, and is calculated to leave a false impression respecting the merits of the question at issue. As few of its readers will be likely to detect these misstatements, and fewer still suspect that they are advanced without some color of fact, we feel constrained to give it a notice to which, otherwise, it would hardly be entitled. The scene of the occurrences is hundreds of miles away from most readers, the persons referred to are entirely unknown to them, and the sub-
ject discussed quite foreign to their thoughts. The common tendency is, in the absence of particular information, to regard that as presumptively true which is confidently and plausibly told ; and, thus received, to hold rather than relinquish it, even in the face of the strongest evidence to the contrary. When a man is put on trial for a criminal offence, he is presumed in law to be innocent until proved to be guilty. On the contrary, when an individual or an institution is charged with delinquency at the bar of public opinion, the charge is generally held to be true, until —and sometimes after — it is proved to be false. A judicious scepticism in such a case is one of those degrees of mental training which multitudes never attain.
The ostensible purpose of the article in question is to urge a change of the method by which persons are admitted into our asylums and hospitals for the insane. This, it is alleged, can be and actually is perverted into a means of the grossest wrong-doing. In the discussion of the subject, — if the wild and reckless statements which make up the staple of the article are worthy of that name, — many things are related, implicating more or less directly the honor and honesty of men who have ever stood unspotted before the world; and imputing venality or something worse to institutions generally believed to be engaged in a work of humanity, under the direction of men supposed worthy of their trust. The connection between the thing to be reformed and most of these allegations is not very obvious, for the formalities with which a patient may be admitted into a hospital can have nothing to do with his subsequent treatment. It seems to be only the old artifice of assailing a cause by bringing up some obnoxious incident, remotely, and not necessarily, connected with it; and the way in which this is managed leads us to suspect that the writer was governed more by private pique than any regard for the public good. We propose to follow him through from one statement to another, and show by indisputable evidence precisely what each is worth ; and we solicit the patient attention of all who have been inclined to suppose that they were made in truth and sincerity.
It appears that patients are now admitted into hospitals for the insane chiefly on the strength of a certificate of insanity signed by one or two physicians. This is alleged to be all wrong, because physicians — considering what wretches many of them are — may be bribed to certify what they do not believe, or may honestly be mistaken in their opinion; and thus persons never supposed to be insane may be hurried away to a place of perpetual confinement, solely in order that ill-natured relatives may be the better able to work out some nefarious purpose. Relatives are so anxious to do this, and physicians are so ready to help them, according to the intimations of this writer, that we can only wonder that half the community, at least, are not shut up, with no hope of release but by death. And inasmuch as physicians have it in their power also to poison every patient whom wicked relations may think it worth their money to get rid of in that way, we wonder that they have not been swept from the face of the earth, instead of being still trusted with the lives of those we hold most dear.
Seriously, the usages of society and the common feelings of men indicate no difference between insanity and other diseases, as to the manner in which the patient should be treated by his family and friends. When a person is struck down by mental or other disease, the usual means and appliances of cure are provided ; the physician is called in, nurses are engaged, and visitors are excluded from the room. If the physician advises that he can be better cared for somewhere else, that the chances of recovery would be increased by removal to the country, or the seaside, or a watering-place, or by a trip to Europe, the advice may or may not be followed; but it is not customary to think that the physician is actuated by corrupt motives, or assumes a duty that does not belong to him, in giving it. The presumption is nowise different, if, it being a case of mental disease, he advises removal to a hospital as the most approved instrumentality which the science and philanthropy of the age have created for the treatment of mental disorders. We are willing to admit that the medical profession has its share of unworthy members, some of whom, for a consideration, might be induced to commit the alleged offencc; but it does not follow that this or any other possible form of delinquency should be met by indiscriminating legislation. No accumulation of safeguards can change completely the course of human nature. To some extent, certainly, we are obliged to trust to the honesty of men. The business of life could not be carried on without this trust, and it would be no mark of wisdom to act as if everybody were only waiting for an opportunity to abuse it. A physician gives a certificate of insanity precisely as he performs any other professional duty,—in both cases under the same sanctions of morality and religion, and with the same deference to the laws of the land and the good opinion of his fellow-men. What better safeguards can we have ?
But doctors disagree, and litigated cases are given in which there was a diversity of opinion among the medical witnesses. Hence it follows that a medical certificate is totally unreliable, because it is only the opinion of one or two physicians, from which one or two others might be found who would be likely to dissent. Is that in accordance with the principles on which men ordinarily act? Is the opinion of a lawyer, or a judge, or a merchant, or an engineer, or a mechanic, or a farmer, on subjects belonging to their respective callings, worthless, because other lawyers, or judges, or merchants might not concur in it ? The writer labors under the mistaken notion that rare, exceptional abuse of a thing can be remedied only by the total abolition of the thing itself. The truth is, that, in ninety-nine cases out of a hundred, the medical certificate is all that can be justly required. The disease is obvious, the necessity for hospital treatment is imperative, and all parties are satisfied. For the exceptional cases, in regard to which any reasonable doubt or dissatisfaction may exist, it is easy to provide by a suitable legal process without abolishing altogether the present practice.
“ There it stands,” says the writer of the Lettre de Cachet, meaning the medical certificate, “in all its monstrous proportions, the foulest blot upon a nation’s statute-books.” And again he speaks of legislators “ wincing at the existence of a law which permits such oppression,” and only regretting “that it is not expunged from our statutebooks,” referring to the certificate, if we may judge from the context, though the connection of his thoughts one with another is not always very easily traced. He evidently supposes that this certificate is required by the laws of the State, but such is not the fact. It is required by the rules of every hospital in the land,as a salutary measure of protection against abuse ; but only in two or three States is it made obligatory by law. The fact is, the merit of whatever has been done for this purpose belongs to these very institutions which are charged with favoring the designs of wrong-doers. Without their spontaneous and unsolicited action, not even the medical certificate would have been required. They have been regarded as purely benevolent in their object, and philanthropists have thought they were doing good service in the cause of humanity by providing for the admission within their walls of as many as possible of those afflicted ones who have lost Heaven’s noblest gift to man. Our stupid forefathers never became aware of the appalling fact, so obvious to the keener discernment of some of their descendants, that they are only “nurseries for and manufactories of madness.” Thus, completely unaware of their true character, they took no measures of prevention, and weakly reposed upon the honor and honesty of a class of men who, we are now told, are ever ready to convert the opportunities of benevolence into a means for perpetrating the foulest of wrongs. Even after the light of modern humanity had fairly dawned upon them, people continued so insensible that when one of those victims of oppression was brought from an insane asylum into court on a writ of habeas corpus, and his discharge was urged for the reason that his detention was authorized by no law whatever, common or statute, the court was swift to say by the mouth of that eminent judge, Chief Justice Shaw of Massachusetts, that his detention in the asylum was amply authorized by “the great law of humanity.”
It may be well to say, in this connection, that for several years the Association of Superintendents of North American hospitals for the insane, at its annual meetings, has been, discussing and maturing the project of a general law for regulating the position of the insane, which it proposes to recommend for adoption in every State of the Union. This proposed law, while recognizing the sacred right of the family, under the great law of humanity, to place one of its members in a hospital for the insane, restricted by no other condition than that of the medical certificate, provides a judicial procedure for authorizing this measure in the case of those who have no family or near friend to care for them, and also for that class of patients whose relatives may differ respecting the proper course to be pursued. It also provides a judicial inquisition for ascertaining the mental condition of such as may be alleged to be detained in a hospital after recovery from their derangement; and it makes such disposition of those who are acquitted on trial for criminal acts as will best secure the safety of society and satisfy the claims of humanity.
It would seem as if a would-be reformer of the laws should know with some degree of accuracy what the laws are ; but to our writer that kind of information is a matter of perfect indifference. His remarks on the pecuniary bond given by the friends of patients exhibit the same confusion of ideas that we have witnessed in his remarks about the medical certificate. Having quoted the bond required at the Frankford asylum, he adds immediately : “ Thus is written the law upon this matter, borrowed scores and scores of years ago from England.....Yet here upon our statute-books it stands as it was recorded on the day of its adoption.” It seems almost an insult to the understanding of our readers to tell them that neither this nor any bond for the Frankford or other hospital in Pennsylvania ever existed in the shape of a statute. It was required by the managers of the asylum, in order to secure the payment of their expenses. A similar bond is used in every hospital where the patients are not entirely supported at the public expense. It has no connection whatever with the mode of admission, and would be retained even if the former were made to depend on a trial by jury. It is a common usage of the world to require security for the payment of pecuniary obligations. Hospitals for the insane are charitable institutions, depending for their support more or less on the income derived from their patients. If the rich sometimes pay more than the actual cost, they obtain what they get at a much lower price than they could in any other way, while the excess inures to the benefit of the poorer classes, who thereby pay considerably less than the cost. The effect of bad debts, therefore, is to enhance the price to the latter class, and to that extent deprive them of the benefit of hospital treatment. To find in such a bond an occasion of reproach indicates either an extraordinary ignorance of the ways of business, or a determination to excite prejudice and ill-feeling at all hazards.
“ The natural consequences,” he says, “of granting physicians such immense powers” (meaning thereby, we suppose, the power of giving a certificate of insanity, and perhaps that of requiring a bond for the payment of expenses) “ are flung into the faces of our legislators, judges, and jurors, with ‘damnable iteration. ” What is meant by consequences that are flung about in this extraordinary manner he does not vouchsafe to inform us, but we are inclined to believe it is only one of those spontaneous flights of rhetoric in which he is fond of indulging. The sentence is immediately followed by the statement that “the lawbooks are full of such cases,” but we are left as much in the dark as to these “ cases ” as we are about the “ consequences ” aforesaid. He can hardly mean the cases of persons who have been delivered from durance by the writ of habeas corpus, because he presently harrows up our feelings with a sensational paragraph on the extreme difficulty of obtaining the writ at all, and the cold comfort afforded by it when it is obtained. At the victim’s hearing, “everything is against him”; “he comes into court feverish and excited. His wrongs, his sufferings, his associations in the asylum, have wrought their worst upon him.” His witnesses fail to appear, “for his star is in the descendant, and the taint of the prison is on him.” Then, too, on the other side are feed counsel and the “ influential citizens ” that compose the Board of Directors ; and “ the medical staff of eminent men already biassed against any one ” pronounced insane by a professional brother ; and “ the crowd of spectators, who glare at the prisoner as if he were a wild beast ”; and the “keeper ever by his side”; and “the judge, whose face betokens no interest in him, but is lighted up with cordial recognition of each of the eminent medical jailers as they enter. They have sworn away so many men’s liberties, before his Honor, that they and the court are quite old friends.” If the prisoner can stand all this, and rise superior to the depressing influences that have surrounded him, and “undergo an examination with perfect calmness,” even then he has but “a desperate chance.” The Anglo-Saxon world has been in the habit of thinking, that, of all the instrumentalities of the law none is more potent in effecting its objects than the writ of habeas corpus. No strength of surroundings, no influence of wealth or station, no cunning device of lawyers, has been supposed capable of resisting its power or thwarting its purposes. All this, it appears, is one of those popular fallacies which pass among unenlightened people for veritable facts. To the poor unfortunate who has suffered the wrong and indignity of being pronounced insane, and shut up among “gibbering idiots and raving maniacs,” it furnishes no relief. Plain people, insensible to the arts of rhetoric, and governed solely by the dictates of common sense, would rather conclude that the failure of the writ to procure redress in the class of cases referred to only showed that the persons were really insane and properly held in confinement.
Again we are puzzled. In spite of the inefficiency of the writ here complained of, the writer says that “a distinguished member of the Philadelphia bar lately referred to six cases in which he had been engaged during the last year, where there had been imprisonment for alleged insanity, and release effected only after long confinement and tedious efforts ” ; and this, he intimates, is not an unusually large proportion, “ for, if we could examine the dockets of every practising lawyer in the United States, we should find multitudes of entries telling the same story.” This curious fact in the statistics of insanity we commend to the attention of our friend, Dr. Jarvis, by whom it seems to have been overlooked in his researches in this department of knowledge. In the mean time, we will give him the benefit of such inquiries as the above statement induced us to make. In the last Philadelphia Directory the list of lawyers embraces about seven hundred names. On the supposition that only half of these are in actual practice, and that these have been engaged in only half as many cases of imprisonment for alleged insanity as the “ distinguished member of the Philadelphia bar,” with whom it may have been a specialty, then the whole number of cases must have amounted, for the year 1867, to one thousand and fifty ! We find, however, that during that year two persons only were discharged from the Pennsylvania Hospital for the Insane by means of the writ of habeas corpus, and neither of them on the ground of their not being insane, and not one from either of the other hospitals, public or private, out of an aggregate of about thirteen hundred patients. During the twenty-seven years that the firstnamed institution has existed, out of more than five thousand patients received, only three cases have been discharged by writ of habeas corpus, where the officers made any objection, and in these cases the discharge was not made because the patients were believed to be sane. One other patient was released during the proceedings of a Commission in Lunacy, and one was removed by his friends before the final hearing, and soon afterwards found drowned in the Delaware River. From all the other establishments together, since they began, one only — from that at Harrisburg — has been discharged by the writ. The conclusion seems to be inevitable, that "the distinguished member of the Philadelphia bar” who succeeded in delivering six persons from durance vile in the year 1867 is no better than a myth ; or, if he were really a thing of flesh and blood, that he was playing upon the credulity of the writer.
The writer is not content with general assertions respecting the abuses that grow out of the present arrangement. Several cases are described that would seem to furnish some ground for his conclusions, provided they are fairly related. If, however, these accounts abound in misrepresentations, then they only prove that the writer is unreliable in anything. Let us see how this is.
The first case adduced for the purpose of showing that sane men may be caught up while quietly pursuing their customary avocations, and kept in close confinement under the false pretence of their insanity, is that of Morgan Hinchman, which occurred in Philadelphia, Pennsylvania, over twenty years ago. It would be impossible within our allotted space to enter into the merits or demerits of this case, and we must, therefore, be content with noticing only the misrepresentations of the writer, vitiating, as they do, almost every statement he has made concerning it. This will show, however, the animus with which the article was written, and the degree of credit which it deserves.
The facts of the case were disclosed at the trial of an action of conspiracy, brought by Hinchman against fifteen persons, among whom were his sister, his wife’s sister, the men who took him to the asylum, the physician who gave the certificate, the officers of the asylum, and a person who was charged with being placed corruptly on the jury that pronounced him insane (after making inquisition in compliance with a writ de lunatico inquirendo). The alleged object of the conspiracy was to place him in the asylum at Frankford, in order to obtain the possession or control of his property. He obtained a verdict; but few, we believe, can read the evidence now, free from the prejudices of the time, without being satisfied that he was very insane, and that no corrupt or other improper motive could be fairly imputed to any one of the defendants. In fact, there was nothing whatever to distinguish the course of events in this case from that which ordinarily occurs. For several years this person had labored under mental derangement, which at times deprived him of all self-control, and made him behave as most insane people do in the highest grade of the disease, though at other times he retained his self-possession, and to the casual observer presented no trace of disorder. Gradually he grew worse. His paroxysms became more frequent, and created constant apprehension in the family circle. Naturally reluctant to take the last step, and hoping that every attack would be the last, his friends attempted no interference until his own welfare and the safety of others rendered it imperatively necessary. Then his mother and his sister, his wife and her sister, assuming a responsibility that belonged to them alone, concluded to send him to a hospital. Accordingly, they invoked the aid of some male friends to carry this measure into effect. A physician who had long and intimately known him gave the medical certificate, his family physician advised him to go quietly, and all concerned were his friends and wellwishers. He was placed in an asylum admirably fitted for its destined purpose, allowed every comfort and privilege conducive to his welfare, and in less than six months discharged, free from all trace of active disease. On the face of this transaction there was nothing suspicious ; everything was done openly and aboveboard, in the usual way and by the usual means. The very day after his admission to the asylum application was made by his mother for a jury of inquest, which was granted ; and, the fact of insanity being established, a committee was appointed to take charge of his property and manage his affairs. Yet, out of this simple transaction, conceived in kindness and completed in good faith, this writer conjures up an array of horrors suggestive of the Holy Inquisition, the Star Chamber, the Bastile, and iron cages. How much foundation the horrors have is a question we propose to answer, and we will take them in the order in which they stand.
Horror 1st. — “An estrangement arising out of it [his wife’s assignment of her property to him] grew up between him and his wife, instigated, it was alleged, by her family.”
There was not a tittle of proof of any estrangement on her part, nor any change of manner or feeling beyond what would necessarily result from the manifestation of Hinchman’s mental disease.
Horror 2d. — “ For six long and dreadful months was this gentleman kept a close prisoner, denied the usual privileges of the establishment, encompassed by gibbering idiots and raving maniacs,” “ deprived of all intercourse with the outer world, save those of his enemies who had placed him there.”
Dr. Evans, the visiting physician, testified, on the trial, that, “during the early period of his being in the asylum, he was limited to the men’s wing of the building, and to the airing-yard attached thereto. As his health improved, he was allowed the use of the garden, the library, and grounds adjoining it; and, when his convalescence was thought to be secured, he was allowed the range of the whole farm, to go where and as he would ” ; and it appeared from other witnesses, that once he visited a brotherin-law living a few miles from the asylum, and spent the night with him. He received a visit from his mother and his wife, though they probably are ranked by our writer among his “enemies”; from his brother-in-law, who had nothing to do with placing him in the asylum ; from his uncle, who tried hard to have him discharged, and several other persons. Several letters, too, passed between him and the “outer world.” By a rule of the asylum, no idiots, gibbering or otherwise, are ever received ; and it raving maniacs were in the house at that time, they were in a different ward from that occupied by Hinchman, and could not have seriously annoyed him.
Horror 3d.— “ In his far-away home, and unknown to him, his eldest child lay dying.”
We are unable to see what bearing this event has on the question of Mr. Hinchman’s insanity, or the manner in which he was placed in the asylum. He was not informed of this fact, probably for the reason that it seemed likely to disturb and agitate him, and thus retard his recovery. Such is the course often pursued in asylums ; and that it is merciful and judicious no one can doubt who has been much conversant with the insane.
Horror 4th.— “His property was sold away from him under the auctioneer’s hammer; his books, his furniture, his very garments, divided among ‘ his friends', who had given the orders by which he was buried alive.”
It seems that one of Hinchman’s creditors obtained a judgment previously to his being sent to the asylum, but the execution was issued afterwards. To prevent the sacrifice of the stock and other things on the farm, the sale of which had been ordered by the sheriff, one of the persons included in the roll of conspirators, in the kindness of his heart, advanced the money to satisfy the execution, and by judicious management obtained a good price for the property. The surplus was used to discharge other demands against the estate. So that on the discharge of the commission, as was abundantly proved by the evidence, Hinchman’s real estate was restored to him just as he left it, and his personal property accounted for to him within two hundred dollars of his own estimate,—a number of debts having been paid, his family supported, and an execution advantageously satisfied.
What ground the writer has for saying Hinchman’s clothes were divided among his friends we cannot ascertain. We doubt if he has any. There is not a syllable to that effect in the testimony, and no one within reach of inquiry ever heard of it before. Hinchman’s wife may possibly have given away a pair of old trousers, or some other worn-out garment supposed to be not worth keeping.
Horror 5th. — “They had consigned him to a living death ; nobody came to his rescue, nobody knew of the place of his incarceration,—nobody, relative or true friend, alien or neighbor.”
The testimony showed that many persons, friends, neighbors, and relatives, knew of his being in the asylum, and his uncle visited him two or three times, and used every effort to get him discharged.
Horror 6th.— At the trial, “signatures were denied, orders repudiated, minutes kept back, records vitiated and altered, letters burned.”
It is true that some papers of little importance, called for from the defence, were not forthcoming at once, having been obviously mislaid ; and that is the only grain of truth in the whole charge. Nothing was kept back, denied, vitiated, or burned.
Horror 7th. — When the uncle “ went in his wrath to those who had placed him there, who had sold his property and divided his raiment among them, he was told ‘ that he had better not attempt reclaiming his nephew’s property, but leave it with them, because they would either prove him insane or so blacken his character that he could not walk the streets.’ ”
The conversation referred to was with the person who had been appointed the committee to take charge of his affairs, and is here grossly misrepresented. This person, who had taken no part, by word or deed, in placing Hinchman in the asylum, said to the uncle, what he had already said to the nephew, as a reason why they should refrain from revoking the guardianship, — that it would be the means of blackening his character ; that is, Hinchman had done things that could be excused only on the ground of insanity, such as taking money from a bank in which he was employed, and in which he consequently lost his place. The Friends’ Meeting, to which he belonged, directed inquiry to be made into the matter, according to their custom ; and the conclusion was that he was insane, and therefore not deserving of censure or discipline.
Horror 8th. — “Said the chief conspirator to his victim, 'Make a deed of trust. If you do that, you may come out a sane man.’ Another witness testified that the superintendent of the asylum said: ‘It is a mere family quarrel; if he would arrange his property, there would be an end of it.’ ”
The truth of these statements, which were said by the uncle to have been made to him, not to the ‘ victim,’ was positively denied by affidavit of the persons referred to, one ot whom was. Hinchman’s wife.
Horror 9th. — “The physician who signed the certificate had never been Morgan Hinchman’s physician, had not seen him a single moment for four months previous to issuing it.
This may have been so, but it must be borne in mind that the physician was made a defendant in the case, and of course his mouth was shut. The writer was careful not to add, what he knew very well, that this gentleman was a fellow-member of the same Friends’ Meeting ; that, when the Meeting was obliged to take cognizance of Hinchman’s conduct, he was one of the committee chosen to visit and examine him, and report on the proper course to be pursued ; that, in consequence of these relations, he became well acquainted with Hinchman’s mental condition, came to the conclusion that he was insane, and advised the Meeting to treat him accordingly. He was, therefore, as well fitted to give a certificate as any other physician would have been on the strength of one or two interviews. But instead of “ being outside of the reach of the law, and acquitted,” as the writer states, with his usual inaccuracy, he was convicted with the rest of the conspirators.
Horror roth.— “A manager of the asylum testified that ‘the superintendent could not look beyond the papers of admission supplied by the patient’s friends ; that the superintendent had no power to discharge an inmate, no matter how long his cure had been established, without the consent of the friends who had placed him there? ”
We can find nothing like this in the printed testimony. On the contrary, one of the rules of the asylum, produced at the trial, is, that, “in case of a patient being fully restored, or other causes rendering his or her removal proper, reasonable notice shall be given thereof to the friends of the patient; but, should they decline applying for a discharge, the visiting managers shall report the case to the board, and proceed under its direction to discharge and remove the patient.”
It must be a desperate cause that can derive any support from a distorted account of a case which no true friend ot the principal party concerned would have been anxious to drag from its long sleep into the gaze of a new generation. The fact of Hinchman’s insanity was abundantly established by the testimony of his own family, his neighbors, and his physicians. He was placed in an asylum where he was properly and kindly cared for,and allowed every suitable privilege, and from which he was discharged, if not as perfectly recovered, yet in a far better mental condition than when he entered. His property was very properly placed in charge of a committee, by whom it was prudently and judiciously managed. The case did present an extraordinary feature, unparalleled in the records of jury-trials. It was the spirit in which this man and his coadjutor pushed through an action at law against those from whom he had received nothing but kindness, and obtained vindictive damages, which, with a noble sense of honor, was paid chiefly by his own flesh and blood, though it stripped his aged mother of the greater portion of her humble means.
In pursuing his design of exposing the wrongs effected by the medical certificate, the writer mentions the case of a lady who was recently placed in the Pennsylvania Hospital for the insane by her husband, who had ceased to love her, and took this means of getting her out of the way, and, perhaps, of obtaining a libel of divorce, for which, with his wonderfully accurate knowledge of law, he thinks “incarceration in a mad-house for a certain period would give him grounds.” This wicked scheme was frustrated, it seems, by Dr. Kirkbride,the physician of the hospital, who “ became especially interested in her, watched her assiduously, examined into the facts of her case, taking a great deal of trouble in the matter, satisfied himself of her sanity, brought the attention of the court to the subject, and procured her discharge.” Various circumstances render it impossible to mistake the case here alluded to, and a more unfortunate one for the purpose can scarcely be imagined. The certificate of insanity was signed by two physicians, one of whom had attended her and her children for several months, and taken great pains to ascertain her mental condition, which his relation to the family gave him ample opportunity of doing; and the other was a gentleman who had had charge of a large establishment for the insane for several years, and had observed and conversed with the patient several times. In their depositions, given before a commissioner, to be used in an application she made for the custody of the children, the reasons for their opinion are so clearly, so fully, and so intelligently presented as to remove any shadow of doubt respecting its correctness. It was strengthened, if that were possible, by the testimony of a host of witnesses, — servants, nurses, the people with whom she boarded, and casual acquaintances. It was no friendly office to try to deprive her of the only possible excuse for conduct that would have been disgraceful to any sane woman. What is said of Dr. Ivirkbride’s attention to the case is all very true, we doubt not ; but he authorizes us to say that he never expressed the opinion that she was not insane, that he never called the attention of the court to her case, and that neither she nor any one else was ever discharged from his care under the circumstances stated. She was removed by her brother, her husband not objecting, and without any process of law, at the end of seven or eight weeks. As an indication of the temper and designs of her husband, let it be remembered that some six or seven months previously he had placed her in the hospital, and, at the end of a fortnight, yielded to her importunities, and took her home, where her previous conduct was renewed in a more objectionable form.
Another case is given of a man recently sent to the same institution by his relatives, merely because in the indulgence of his æsthetic tastes he bought a few books and pictures, thereby diminishing the hoards that would naturally come to them after his death. The reader is to believe that for this reason alone, as no other is given, a man in Philadelphia was put into a hospital for the insane, and kept there some two or three months ! Considering the multitude of indifferent pictures disposed of in that market, at almost incredible prices, the purchase of paintings would seem about the last thing to be regarded by Philadelphians as proof of insanity. There was, unquestionably, an old man in Philadelphia, who bought a great many pictures, was pronounced insane by his physician, sent to the Pennsylvania Hospital for the insane, and discharged therefrom by order of court. Thus much is true, and a great deal more not mentioned at all, which omission we propose to supply as fully as possible. We are unable to obtain any notes of the testimony, but the following private communication from Judge Allison, who issued the Writ of habeas corpus, will sufficiently answer our purpose. “ I had no doubt of his insanity at the time when he was placed in the hospital. The testimony of his friends and associates, and also that of a very respectable physician who had attended him professionally for a long time, satisfied me on that point. His conduct towards his relations suddenly, and without cause, changed from gentleness and kindness to violence and abuse. The evidence showed that his daily behavior was strange and unnatural, and wholly inconsistent with reason and sound judgment. The proof of his acts, of his speech, and of his appearance left no doubt on my mind that at the time when he was sent to the asylum he was insane, and needed both restraint and judicious treatment, with a view to his restoration to reason. When brought before me, he was, according to the evidence, very much improved; and although manifesting in court considerable excitement of manner, I did not think it would be unsafe to discharge him from custody, or that he would do violence to himself or to others. And on this ground mainly I rested my decision. To this may be added my belief, — presumptuous, perhaps,—from what I saw of the man, as well as from the testimony, that his entire recovery would be aided by freedom rather than by further restraint of liberty. That he was a monomaniac in relation to the purchase of pictures and furniture no one, I think, could doubt for a moment. His purchases at auction were frequent, as well as large in amount, reaching some thousands of dollars, and, as the auctioneer testified, without judgment, and very much at random. This was carried to so great an extent, that auctioneers, after a time, avoided or refused his bids. Mresided with his mother, and her house was filled with his purchases ; not only the rooms, but the passage-ways as well. I informed his friends at the hearing, that he could be restrained by process of law from wasting his property, because of his unsoundness of mind; and I delayed my decision, to afford them an opportunity to apply for a commission of lunacy, as well as to test his case for my own satisfaction by a further delay; but no inquisition was instituted, and, for the reasons already stated, I discharged him.”So it seems that these rapacious relatives, who did not shrink from the Outrage of falsely imprisoning this old gentleman, would not trouble themselves to attempt to deprive him by legal measures of the control of his property, even with a fair prospect of success.
We are sorry to say that one statement in this case is unquestionably true. He was taken to a station-house, and kept there overnight. The stupid policeman who had charge of him either thought that patients were not received into the hospital after dark, or that it would be more agreeable to go by daylight, and so he took him to the police station for safe-keeping until morning. It was no fault of the friends or the physician, and might have happened had he been committed by order of court.
Whether this person subsequently served on a jury, as the writer states, we have not taken the trouble to ascertain. If he did, we dare say he performed the duty acceptably, but we have not been so profoundly impressed with the wisdom of juries as to regard the fact as conclusive proof that he was not then, and never had been, insane. We doubt not that many of the inmates of our hospitals would perform the functions of a juryman as creditably as the average of men now put into the jurybox. They do a great many other things requiring more forethought and steadiness than it does to say yes or no to a verdict as likely to be wrong as right.
The writer’s grievances are not confined to the medical certificate nor the mercenary motives of the friends who procure it. He more than insinuates that hospitals for the insane, all the country over, are guilty of many reprehensible practices, and even gross abuses, while admitting, Judaslike, that “their laws are perfection, and their treatment of patients tender and thoughtful as it should be ; that their principles are the highest results of refined and cultivated minds, and generous, sympathetic hearts.”
He complains that the patients’ letters are not sent without being first read by the superintendent, and not always then. This is not exactly true. In many hospitals, — for of course we cannot know respecting every one in the country,—many a patient’s letters are sent without being read by the officers ; and nothing is more common than a regular correspondence between a patient and friends, that meets no other eye than theirs. Patients in an active stage of disease often write letters full of folly and nonsense, which are wisely and kindly withheld; and no one is more grateful for the discretion thus exercised than the patient when he comes to himself. No sooner is convalescence fairly established than he begins to be mortified by the recollection of such letters, and experiences a sense of relief most salutary in his condition when assured that they were withheld. Why should an insane person be allowed to expose his infirmities in the shape of a letter that may be read by scores or hundreds, more than in the shape of crazy acts and crazy discourse ? Not unfrequently, a refined and cultivated woman writes letters, while in the height of disease, the thought of which, when restored, overwhelms her with shame and confusion. To forward such letters would be an outrage upon decency, and would raise the blood of every true husband, brother, and parent, who would make the case their own. It would be a breach of trust on the part of any hospital officer permitting it, that should be followed by his instant dismissal. Besides, the letters of the insane often convey information respecting their mental condition of the utmost importance to those intrusted with their care. Many a patient who conceals his delusions and mad designs from ordinary observation betrays them in his writings, and many a patient has been preserved from harm to himself or to others by means of the statements contained in his letters. It is the business and the duty of the physician of the insane to make himself acquainted with what is passing in the mind of his patient; and to inspect his writings in furtherance of this purpose is as proper as it would be to ascertain the condition of his heart and lungs by means of the stethoscope, or the state of his eyes by means of the ophthalmoscope.
The writer also complains that to the superintendent is intrusted “ the sole direction of the medical, moral, and dietetic treatment of the patients, and the selection of all persons employed in their care.” All this is bad enough in the public and incorporated asylums, but it must be far worse, he thinks, in “ those private mad-houses whose name is legion.” It will not be very obvious, we imagine, why an organization of service that has been universally adopted in mills, ships, railways, and many other industrial establishments where well-defined responsibility, harmonious working, and prompt execution are necessary to the highest degree of success, should not be equally suitable to a hospital where many persons are employed, and many operations going on requiring industry, vigilance, thoughtfulness, and fidelity, and all with reference to a common end. Hospitals are now put into the charge of a superintendent responsible for the management, because, after a thorough trial of every other method, this his been found to be the most efficient. The time was when the physician, whose duties were exclusively medical, came in three or four times a week, walked through the wards, exchanged a few words with the attendants, prescribed the necessary medicines, and then went his way. The steward, warden, or whatever might be his title, lived in the house, obtained the supplies, looked after the house and grounds, paid the employees, and reported their misconduct to the directors. The attendants were called to account by these functionaries, to whom they may have owed their appointment, and by whom their delinquencies would naturally be regarded with indulgence. The directors themselves might take a turn at executive duty occasionally, which proved not very conducive to the general harmony. In this way, nobody was strictly responsible for anything, nobody’s duties were defined, and an endless jar was the usual result. It was under such management that those terrible abuses occurred in the English establishments, which were exposed by parliamentary inquiry in 1815. If we are anxious to have them renewed among ourselves, we have only to take from the physician the sole direction of affairs, fritter away everybody’s responsibility, and rely upon every employee to do his duty only according to his own good will and pleasure.
How the writer arrives at the fact that we have among us a “legion of private mad-houses,” as he elegantly designates them, we are quite unable to conceive. With opportunities, fully equal, probably, to his, of knowing, we doubt if there are a dozen; indeed, we cannot reckon up more than seven. We begin to think that he has some remarkable endowment of mental vision analogous to the structure of the eye in some insects, which, being composed of a multitude of lesser eyes, sees the object it looks at multiplied ten-thousand-fold. In some such extraordinary manner this writer, who may have seen our friend Given’s excellent establishment at Media, beholds the images of it depicted on his mental retina, multiplied more times than any known denomination of numbers can express. Of course the mountain of abuse suggested by this large expression will sink into a very insignificant pile.
Another charge against hospitals for the insane is, that, while they may be all very well for insane people, “ they become torture - houses, breeders of insanity, for those who may, by cruel chance, be brought improperly under their peculiar influences,” a circumlocution which refers, no doubt, to people who are not insane. To discuss the effect of hospitals on the sane, before we have better proof of the existence of this abuse, would be but a waste of time and space. With that class of worthies who think it their mission to excite popular prejudices against hospitals for the insane, it is a favorite means to represent them as calculated to remove any vestige of sanity that may be left, and destroy all chances of cure. Many persons have been kept away from them, under the influence of this notion, until the disease has become completely incurable, or, worse still, until some deplorable deed of violence has rendered delay no longer possible. The steadily increasing list of suicides and homicides attributed by coroners’ juries to insanity bears witness to the power and extent of this miserable prejudice. Surely, nothing less than some constitutional mental obliquity can account for the satisfaction these people take in witnessing the mischief they occasion, and finding in it a fresh reason for persevering in their unholy work.
Not the least of this writer’s complaints against hospitals is, that the patients are subjected to all manner of ill - treatment. He says that in England “it was recently found necessary to direct, under the authority of Parliament, an investigation into the character and treatment of the patients confined in the mad-houses of the United Kingdom. The official reports of these investigations are tales of wrong, cruelty, and oppression, at which the heart sickens,” &c. Now, we feel safe in denying that any such investigation has been made recently, and the annual reports of the Commissioners in Lunacy must convince any reasonable mind that such charges against the asylums of the present day are groundless. The statement here quoted will apply to the famous parliamentary inquiry of 1815, which, with the writer’s usual proclivity for confusing all the relations of time, space, and number, he represents as an occurrence within our own time.
According to the writer’s account, our own hospitals, especially those of Pennsylvania, are no less shamefully managed ; and in proof he quotes from two public documents, one, the report of what he calls the “ Pennsylvania Medical Association,” and the other, the “ Report of a Special Commission Appointed by the Governor.” The passages quoted reveal the most barbarous treatment of the insane, attributed by implication to the hospitals and asylums for the insane. Some were in cold basement rooms, without fresh air and the means of exercise; males and females without clothing were found in adjoining rooms; some were fastened by a chain to a staple in the floor ; one said to be deranged was chained to a sixty-pound weight, which he was obliged to carry about; and one, over eighty years old, had been chained for twenty years. These passages are so introduced as to give the impression — which, no doubt, the writer deliberately intended to give — that such things were witnessed in the incorporated and the State hospitals for the insane. Here are the actual facts, known as well to the writer as to anybody else.
The State hospitals being filled to their utmost capacity, it was thought necessary that more should be provided ; and, to make the necessity as obvious as possible, the “Medical Society of the State of Pennsylvania ” appointed a committee to prepare a memorial to the Legislature on the subject, in which, among other things, they exposed the wretched condition of the insane in the poor-houses of the towns and counties. With the same object in view, the special commissioner was directed to examine into the condition of the insane inmates of the poor-houses and jails. The results of these inquiries were presented to the Legislature, as an inducement for establishing another hospital, and the Legislature voted the necessary appropriation. Not one word, be it observed, is said by the writer about jails or poor-houses in connection with these passages. In view of this attempt to cast a lasting reproach upon honest men, what credit can be given to any of his statements, and what terms of reprobation can be too strong to bestow upon such a deliberate deception ?
The writer’s remedy for all defects in the present practices and laws is “ some statutory regulation as to the degree of aberration of mind justifying detention, and provision made for a hearing before a board of magistrates, and a sworn jury of twelve, composed of men of strong and sterling sense.”He does not tell us what degree of aberration ought, in his opinion, to warrant a person’s detention in a hospital ; and we are puzzled to conceive how our law-makers, who are not supposed to be remarkably inclined to psychological studies, will be able to take the first step towards framing the “statutory regulation” required. Their attemps at definition would be likely to result, we apprehend, much like that of Polonius in the play : —
What is’t, but to be nothing else but mad ? ”
But, supposing this difficulty surmounted, we are no less puzzled to conceive by what sort of evidence the prescribed degree of insanity is to be proved. Our writer has no faith in doctors, because doctors sometimes disagree, and besides they may be bribed, so they would have to be excluded as incompetent witnesses. But, probably, he considers it the crowning excellence of this arrangement, that the degree of insanity is to be determined solely by that strong and sterling sense which, it is well known, is so characteristic of juries. Seriously, since a jury-trial is not universally considered the perfection of wisdom, even when the facts are intelligible to the meanest understanding, we are unable to see how a jury can be the best tribunal for deciding questions of a professional nature. The Solans of Illinois think otherwise, for they have provided, by a stringent law, that no person shall be placed in any hospital for the insane whose discase has not been proved by a jurytrial. Are we prepared to follow such legislation ? When an afflictive disease is filling our homes with sorrow and apprehension, is it a matter of pleasing reflection that we can lay our griefs before the judge or the sheriff, who will authorize twelve men to gather around the bedside of the beloved wife or daughter, and there, after learning those painful circumstances of the domestic history which every sentiment of propriety would forbid us to mention beyond the family circle, but which may immediately become food for gossip in the streets and the shops, — even without the aid of a newspaper-reporter, though the “ representatives of the press ” probably would not be excluded from the room, — this august tribunal may or may not decide that the patient is insane, and give or withhold its authority for removal to a hospital? Would we rejoice at the prospect of thus bringing the law and its ministers within our very doors, at the moment when of all others we would wish to be shielded from the public gaze ? Few families, we are sure, would submit to the operation of such a law as long as it could be possibly avoided ; and every expedient and makeshift would be resorted to, until the exhaustion of their means and strength left them no alternative.
One or two words respecting the great grievance which forms the burden of the article in question.
Of all the bugbears conjured up in these latter times to frighten grown people from the course pointed out by true science and true humanity, it would be hard to find one more destitute of real substance than the alleged practice of confining sane persons in hospitals for the insane. We have yet to learn of the first well-authenticated case in this country; and we have heard the same thing asserted by others, whose professional duties have enabled them to be well informed on this subject. Although this does not prove the impossibility of such an abuse, it certainly does prove that it must be an exceedingly rare occurrence. If it be answered, that these persons were biassed by their occupations, and thus labored under an insuperable difficulty in discovering the sanity of people wrongly charged with being insane, let us listen to the deciaration of one who, with the amplest opportunities for learning the truth, cannot be charged with having been under a bias that would lead him to overlook or ignore an abuse of the kind in question. Some thirty years ago, the British Parliament established a “ Board of Commissioners in Lunacy,” whose business it was to visit every hospital for the insane, public and private, once, at least, every year ; to make themselves acquainted with their accommodations and management, their merits and defects ; to point out faults and suggest improvements ; to mark the circumstances of particular patients, and, if thought expedient, recommend their removal to some other establishment. Though clothed with no executive powers, yet so potent was their advice, that when they recommended, as they sometimes did, the withdrawal of the license of some private house, their advice was always followed. The present Earl Shaftesbury was a member and chairman of this Board from the beginning up to a very recent period, and was particularly distinguished by the activity and intelligence with which he discharged his duties, and by his interest in whatever pertained to the welfare of the insane. He was never slow to perceive deficiencies, nor to administer a sharp rebuke when it seemed to be deserved. He was never supposed to entertain any partiality for medical men likely to influence his opinion in questions where they were concerned. In the parliamentary session of 1858 and 1859 a committee was appointed to inquire and report respecting some lunacy question, and the Earl was requested to testify. On that occasion he said, “ The notion of improper admissions or detentions is essentially wrong”; and he left it to be implied that such occurrences could only take place at rare intervals, and under unusual circumstances.
We occasionally hear it alleged, no doubt, as it is in the article before us, that a certain inmate of an asylum is not insane, but only a victim of the greed or hatred of his or her relations. A persistent clamor may be heard through the whole length and breadth of the land over some case of this kind ; the newspapers may teem with angry paragraphs ; and the courts be beset for writs of habeas corpus, writs of injunction, and every possible legal instrumentality for the relief of injured innocence. All this is perfectly compatible with what we have said above, and is satisfactorily explained by what we know of the nature or insanity. This disease is not always obvious to the casual observer. Its manifestations require time and opportunity, in the absence of which its workings are confined to the inmost thoughts, or exhibited only in those domestic relations that are not exposed to the public view; and, even when the patient proclaims his delusions, they may not be of a kind necessarily impossible. If he believes that his head is turned round, or that he is the son of perdition, nobody doubts his insanity. But when a child or parent is charged with unkindness, a husband or wife with infidelity to marriage-vows, and that too with an air of sincerity seemingly incompatible with deception and a minuteness of circumstance incompatible with fiction, it is not surprising that the stranger, or sometimes even the intimate friend, should believe the story, and use every endeavor to abate the wrong. If disposed to doubt or hesitate in view of the unsullied reputation of the parties accused, there comes the artful suggestion, that if a man is tired of his wife or a woman of her husband, and bent upon forbidden pleasures ; if children are looking with greedy eyes upon houses and lands and stocks which the prolonged existence of a parent keeps from their grasp,— what more convenient course could they adopt than to declare the person who bars the way to the coveted object to be insane, and consign him to imprisonment in a hospital ? The most common traits of the insane, —their ability to conceal more or less the manifestations of disease, the plausibility with which they set forth the wrongs alleged to be inflicted on them, the fact that the mental disorder is often witnessed rather in the conduct than the conversation, their disposition to hate and malign those who have been most assiduous in offices of kindness and affection,— these are all ignored, even by persons whose culture would seem to have secured them from such grievous ignorance.
We cannot conclude without animadverting upon the spirit of hostility towards hospitals for the insane which pervades the whole article reviewed. That they are not perfect, that they are liable to defects like every other enterprise conducted by men and women, it needs no prophet to tell us. Considering the unavoidable difficulties of their work, — difficulties which the world knows little about, — and the rare moral and intellectual endowments required for its successful performance, we only wonder that they have reached a measure of excellence worthy of the admiration of all who can see in a good work something besides its little imperfections. To remedy their defects, to give them the highest degree of efficiency, to keep them fully up with the advancing steps of modern civilization, — these are things that require, not the ill-natured flings of amateur reformers who never spent a couple of hours in them in all their lives, and have no conception of any other form of insanity than that of raving mania, but the counsel and aid of those who have personal knowledge of their management and affairs, of the nature of insanity, and of the ways of the insane. It is too late in the day to decry these institutions. Consecrated by the labors of a Tuke, a Mann, a Dix, and others like them in spirit, if not in fame, and the better fitted for their work by the bounties of those who have been glad to devote a portion of their wealth to the service of humanity, they are among the best fruits of that noble philanthropy, of that peculiarly Christian spirit and principle, which distinguish the social condition of our times. To gain an adequate conception of the good they accomplish, let one traverse their halls and grounds, witness the order, peace, and freedom that prevail,—the admirable arrangements for promoting the physical and mental comfort of their inmates by means of good food, pure air, abundant recreation, and employment out of doors books, papers, pictures, amusements within, — and learn something of the unceasing, unwearied effort to prevent abuses and render the law of kindness paramount to every other influence ; and then go to the jails and almshouses where these stricken ones, “bound in affliction and iron,” endure too often the last extremity of human wretchedness. We envy not the heart of that man who could witness this contrast without invoking blessings on the modern hospital for the insane and bidding it God speed in its holy work.
The writer professes to entertain only the kindest feeling towards these institutions ; but let him take no credit to himself on that score. Almost every sentence bears witness to a very different kind of feeling. The vocabulary of oppression and tyranny is ransacked for titles and epithets wherewith to render them odious and unworthy of confidence. They are called “ prisons,” “ Bastiles,” “torture-houses,” “ breeders of insanity”; their physicians are styled “jailers,” and their attendants “morose keepers ”; their inmates are called “ prisoners,” and their seclusion “ imprisonment,” “ being buried alive,” and “incarceration in a mad-house,”where they “ vainly beat against the iron bars of their cage.” We do not suppose that such spiteful effusions do much harm to these institutions or the persons connected with them. They may excite a temporary sensation in the minds of over-credulous people, and of all those who are ever ready to believe that the fairest outside is only a cloak for concealing some hideous evil beneath it. There need be no fear that these institutions will fail to meet the demand of the times for higher and still higher grades of excellence, since the men who control them are of the sort that recognize the great law of improvement, and have given their hearts and their hands to the duty of meeting its requirements. As an earnest of what they will be hereafter, it is fair to present the contrast between their present condition and that which marked the earliest days of their existence, — a contrast fully equal to that exhibited by the progress of any other benevolent enterprise of modern times.