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THE POPULAR FEELING TOWARDS HOSPITALS FOR THE INSANE. "On the best methods of saving our Hospitals for the Insane from the odium and scandal to which such Institutions are liable, and maintaining their place in the popular estimation; including the consideration of the question, how far is the community to be allowed acces to such Hospitals." By I. RAY, M. D., Superintendent of Butler Hospital, R.I. -- Read before a Meeting of the Association of Medical Superintendents of American Institutions for the Insane, held at New-York, May 18, 1852.

Within a few years past, no class of charities has obtained so strong a hold on the public sympathies as hospitals for the insane. Most of the States have endowed and fostered them with unusual liberality; private beneficence, living and posthumous, has showered upon them its favors, and the time has come when no community among us is supposed to have discharged its obligations to this unfortunate class of our fellow-men, that has not provided an establishment expressly for their care and protection. In the older States they are crowded to their utmost capacity of accommodation, and for a considerable period, every year has witnessed the erection of a new, or the enlargement of an old one. It is a curious fact, however, that, in connection with this general current of public opinion, there is a strong under-current of a very different character. None but those who have our opportunity of knowing, can have any adequate idea of the amount of bad feeling, gross misconception, scandalous gossip, and even fierce hostility, that quietly pervades the community, with the effect of circumscribing more or less their sphere of usefulness. The most of us, fortunately, are so much concerned with the increasing pressure upon our means of accommodation, and intent, perhaps, on schemes of enlargement, as to make too little account of this state of feeling and of its legitimate consequences. I believe, however, it will be worth our while to give this subject a thorough consideration -- more thorough than I find it within my power to give it at this time. My observations must be very brief and general rather calculated to suggest discussion than exhaust it, and while freely commenting on existing defects and errors, disclaiming all intention of a particular application.

No hospital for the insane in this country, or any other I presume, has been so fortunate as to be universally regarded, wherever known, as an honestly and kindly administered charity, fulfilling its mission of benevolence with. as little drawback as possible on the score of human infirmity. The separate counts of the indictment against them, so to speak, may be reduced to a few general heads. It is supposed that the patients are not treated with invariable kindness; that the management is harsh and cruel; that obedience is enforced by blows or rough handling; that refractory conduct, is met by the discipline of shower-baths, or confinement in dark dungeons; that they are neglected when sick; that they have improper and insufficient food ; that their friends are not allowed to visit them and finally, that to favor the schemes of interested relatives, persons are deprived of their liberty under a mere pretence of insanity. Besides all this, there exists a general and indefinite prejudice that does not pretend to any foundation in fact or reason, but, none the less, bitter on that account.

Generally, no doubt, these allegations are entirely unfounded, and it will not be difficult to explain their origin. Some of it springs, in fact, from the ordinary principles and feelings of our nature, and some from causes of a special and peculiar character. The seclusion to which patients are subjected, by withdrawing them from constant observation, involves the institution in an air of mystery which stimulates the imagination and excites the apprehensions of the ignorant and credulous. Any appearance of concealment very naturally, gives rise to the suspicion of something wrong, and thus the very measures designed to promote the restoration of the patient, are apt to be regarded as indications of a management that will not bear the light. Cooperating with this cause of ill-feeling, is the natural disposition to attribute to others unworthy motives and a readiness to abuse whatever power or confidence may be placed in them. The most prolific source of this distrust of hospitals for the insane, is, undoubtedly, the communications of patients themselves, the more effective for falling, as they generally do, on willing ears. We instinctively believe whatever is seriously related, and this disposition is increased by every appearance of sincerity and plausibility. That the stories of the insane, as well as of some who are discharged from hospitals partially restored, exhibit these qualities in a remarkable degree, is well known to us, while it is equally well known that no moral traits are so common among the insane as a total disregard of veracity, and a feeling of hostility toward those who have had any part in controlling their movements and thwarting their wishes. It is not strange, therefore, that they should abuse the institution whose benefits they enjoyed, nor is it more strange that such abuse, should be received as the honest and truthful expression of a matter of fact. It is not in human nature to listen to a coherent and circumstantial account of ill-treatment, without allowing it to make the slightest impression, even though a very large, personal experience with the author of the narrative, may have shown him utterly unworthy of credit. Such plain, deliberate, and touching statements are supposed, in spite of one's better judgment, to have some shadow of foundation in fact, and thus many a friend or relative gives a hesitating assent to a patient's abuse of others, who would consider himself hardly dealt with, if a tithe of the same person's abuse of him were supposed to be true. The friends of patients, too, are apt to be exacting and fault-finding, never satisfied that enough is done for the patient, though infinitely more, perhaps, than they ever did themselves, and are restrained by no feeling of delicacy or gratitude from free and frequent expressions of their dissatisfaction. In point of fact, however, I presume there can be no difference of opinion among us on this subject, and that all are ready to admit, that the charges above recited cannot be entirely attributed to these sources.

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No one will be bold enough to say that in no hospital in our country has there ever been an abuse of trust, or any arrangements of construction, direction, or discipline, calculated to defeat the object in view, -- the comfort and restoration of the patients. Instead of blinking the matter, it is better to admit the facts so far as they are true, ascertain their causes, and fix the responsibility where it fairly belongs. If our attendants abuse their trust, let us acknowledge the fact and present it as a reason for employing a better and more expensive class of persons, consequently establishing a higher rate of payment from the patients. If an incompetent or time-serving building committee has adopted a plan of construction which leads to casualties, and, in one way or another, prevents us from attaining the highest practicable results, I see no reason why the fault should not be laid at the proper door. When the trustees or directors, in order to advance some political intrigue, are ready to strike a blow at the usefulness of an institution, I am for letting the public know how their confidence is abused. Admitting then the general fact, that the ill-feeling towards hospitals for the insane, so prevalent in the community, is not altogether without foundation, I proceed to consider those usages, arrangements and events which are calculated to produce it.

It cannot be denied by any candid person, that in some of our establishments there are arrangements of one kind or another, that furnish legitimate grounds of complaint and do much to weaken the confidence of the public. They indicate a misconception of the true character of the insane and of the exact objects to be obtained in secluding them from their families and the world. The buildings must necessarily present some prison-like features, and the safety of the inmates forbids many of those provisions which long habit has associated with their notions of domestic comfort. This must be regarded as a necessary evil, but any degree of it not implicitly required by the circumstances of the case, is a justifiable ground of complaint. Let me ask if our establishments are faultless in this respect; if everything has been done to make the patient feel as little as possible, the want of domestic comfort, the deprivation of liberty, the control of another's will, and the separation from those who did whatever he would permit to gratify his wishes, to allay his irritation, and minister to his infirmities. To this question, I apprehend that a hearty, unqualified affirmative cannot always be returned, and hence a fruitful occasion of distrust and aversion towards hospitals for the insane.

Let us observe for a moment, the change to which the patient is at first subjected. Against his own will probably, and not without the use of some force, he is taken from his own home, -- a home to which, notwithstanding his seeming disregard of all its claims and proprieties, he still retains some strong attachments, -- and placed in an apartment of unusual size and form. It is scantily provided with furniture, and the walls are as bare and cheerless as unpapered and unpainted surface can make them. A range of bed-rooms on each side shut out the light and obstruct the view without. No open fire invites him to forget his troubles, for a moment, in the range of its genial rays, and a crowd of persons, by their strange looks and stranger conduct, appear to make a mock of his calamity. At night, cries and other unaccountable noises disturb his rest, and fill him with suspicion and fear. Friends, while visiting him, bear a tale of wrongs and indignities, in the investigation of which, unnecessary annoyance may be brought to light, and the unfavorable impression strengthened by the screams of some excited patient, or the sight of one peculiarly repulsive and disagreeable. That such impressions would frequently be made, under any system of arrangements, I do not doubt, for the insane, as a class, are wonderfully fault-finding and difficult to please, in which qualities they are frequently excelled by their friends, but I believe they would occur less often, if, in some points, our establishments were differently ordered.

In the first place, in the plan and details of construction, the single consideration of cheapness has been too much allowed to prevail over that of perfect adaptedness to the purpose. The question that over-rides every other is, not how the proposed object can be best accomplished, but how much it will cost. When the friends of humanity have presented to a State-Legislature a project for establishing a hospital for the insane, the voice which rests the claims of this unfortunate class of our fellow-men, upon moral obligation, is feeble, compared with that which shows how cheap it can be done. The estimate of cost is made far lower than it should be, an appropriation is voted, and the gentlemen go home exceedingly well pleased that so much good may be done for so little money. Whether the end would not be better accomplished by a more liberal expenditure, is a question never asked. In no single instance, I venture to say, has any one been bold enough to say to a State- Legislature, -- "The insane within your borders require your aid; you are bound by the great law of humanity and by every sense of obligation to give it, as cheaply as you can consistently with the perfect accomplishment of the object, but cheap or dear, it must be given to the utmost extent which the progress of improvement has shown to be possible." The result has been that most of our establishments have wanted architectural arrangements that would have promoted the comfort of their inmates and left less unfavorable impressions upon their minds. On this point it is high time that our views should be definite and well-settled, because sooner or later the country will look to us for instruction on all subjects connected with our vocation.

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The earliest lunatic hospitals among us were constructed very much after the fashion of the old establishments of England, with this important difference, that some of their few redeeming qualities were sacrificed to economy, while the loss was counterbalanced by no compensating qualities. The architectural construction of our hospitals, thus bad in the beginning, has rather deteriorated than improved, and it is a mortifying fact that while we have been satisfied with going from bad to worse, in Great Britain hospitals, better than some which have been erected among us since this Association commenced its meetings, have been taken down to make room for others comprising more perfect arrangements.

The first step towards increasing the confidence of the public in our hospitals, will be to deprive them, as far as possible, of their prison-like or peculiar features, and assimilate them to domestic dwellings. Narrow, dark halls, low ceilings, and bare walls, should give way to more spacious and cheerful apartments. The monotonous ranges of windows, row above row, the long, blank wall, extending its dreary monotony for many a rod, a style of building in short, which is no style at all, but that of providing the greatest number of rooms at the smallest expense, should be replaced by more pleasing forms of architecture, reminding us less of a jail or a factory, and more of a comfortable and graceful private residence.

There are many particular arrangements quite common among us, that tend more or less directly, to create ill-feeling, and consequently must be abandoned, if we would diminish this evil. First and foremost among these objectionable points are the apartments for the most violent and refractory patients. The only object which seems to have been sought for, in their construction, is strength, without the least attempt to conceal or soften down those obnoxious features which are always associated with mere strength. The patients who are obliged to occupy them, call them cells or dungeons; they regard them as places of punishment or degradation; think of them with an emotion of horror, and not all the benefits they have derived from the hospital can efface the unfavorable impressions which these rooms have stamped upon their minds. The friends are apt to imbibe the same impressions, and fortunate it may be for all parties, if they are not led thereby to a precipitate removal of the patient. Now, I do not believe there is any necessity for this. Rooms may be made strong without being made like a cell or a cage. A little ingenuity and a little expense are only required, to render them, apparently, like the other rooms in the house. The walls may be covered with an indestructible paint or cement; the light may be admitted through windows out of reach or protected by iron netting; hot air may be discharged by registers at the upper part of the room; the door may be secured by the ordinary lock; and a close-stool may be placed in a corner, discharging into a soil-pipe connected with the main drain. These rooms may open upon a hall arranged in all essential respects like the others, and provided, like them, with dining-room, water-closet, bathing-room, clothes-closet, &c. Not only is the comfort of the patient thereby greatly enhanced, but the friends who sometimes insist on seeing his room, are shocked by none of those disagreeable features which now frequently meet their view.

For the same as well as other reasons, these apartments should form a portion of the main building, or at least, not entirely separated from it. I doubt if any arrangement in our hospitals is so strongly calculated to excite dissatisfaction and hard feeling, as separate buildings for this class of patients, and, judging from my own experience, with such ample reason. In passing back and forth, females are necessarily exposed in a very unseemly manner, sometimes it may be, to visitors on whom the sight will make a disagreeable impression. Although of all classes of patients, that which needs the closest supervision of the officers, it is made the least accessible, and consequently the least attended to. If the plea of necessity could be urged in favor of this arrangement, or if it were chosen as the least of existing evils, it might be tolerated, but I have been led to the conclusion, that in no single respect, does it possess any advantage over the other. The principal, if not the only object supposed to be gained by it, that of having the noise beyond the hearing of the quiet patients, can as well, if not better be obtained in a different way. By a little contrivance, these apartments, though constituting a part of the main building, may be so insulated from it by means of thick partition-walls, entries and closets, that sound cannot be easily propagated from one to the other. In the Butler Hospital, with an insulation of this kind, but much less perfect than it might have been made, I can truly say, after an experience of over four years, that the annoyance resulting from such proximity, is practically so little as to be scarcely noticed by officers, attendants or patients. When we consider the greater facility thus afforded for removing patients, especially in the night, the less danger of making those disagreeable impressions which such a transference is liable to occasion, and the greater ease by which they may be inspected by the officers, the question between the two arrangements is settled, I think, beyond the reach of dispute.

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For a similar reason it is desirable that the house should be amply provided with parlors well-warmed, lighted and furnished, in which patients might forget, for a moment, that they were not in a domestic dwelling, and lose some of their acerbity of feeling which is cherished, if not provoked by the peculiar aspect of the rooms and galleries. Rooms should also be provided, where patients may meet their friends, so arranged that the former may not be exposed to the observation of visitors, and the latter may not be admitted into the galleries, to mingle with other patients and receive from them such impressions as their wayward fancies may happen to excite.

To secure these objects, it is not only necessary that hospitals for the insane should be planned by those who know by personal experience what architectural arrangements are required, but such persons should superintend their erection, from the digging of the cellar to the last finishing touch of the painter. No plans nor specifications can be so definite and minute, as to render such a supervision unnecessary. In a great many points, the fancy of the builder, or mere accident becomes the guide, and, with the popular notions respecting the strength and appropriateness of materials, the result may be one, very likely, that jeopardizes the reputation of the institution. A door or window-guard, so weak that a vigorous blow leaves nothing between the patient and the open air, locks that may be opened by the simplest contrivance, dust-flues large enough for the escape of patients, drains imperfectly trapped, pipes placed where they never can be subsequently reached, -- things like these may lead to accidents calculated to impair the confidence of the community in the very beginning, and I see no other way of preventing them, but an intelligent supervision of every step and stage of the construction. The common practice of entrusting the erection of hospitals for the insane, whether with or without a suitable plan, exclusively to a board of commissioners, having no practical acquaintance with the subject, cannot be too strongly condemned. To suppose that a person, because an eminent lawyer, or a successful merchant, or even a professed builder, is best fitted to superintend the building of an establishment so special as that of a hospital for the insane, is to ignore the universal experience of mankind.

To these architectural defects, there is frequently added another evil well calculated to produce a disagreeable result. That niggardly economy which, in our State-Legislatures, is swift to cripple any project or enterprise that has nothing to recommend it but its benevolent character, and grudges the necessary means for executing even the poorest plan in a generous and liberal way, has frequently led to the opening of hospitals before their completion, and while wanting some important provisions. A whole wing perhaps, is left unfinished, and patients and attendants of both sexes are placed in fearful proximity to one another, the lamentable fruits of which constitute a page it the history of our insane hospitals, which would deter any body less reckless and irresponsible than a State-Legislature, from marring an important project solely for the sake of saving the people's money. Doors and windows are left improperly secured, water is inadequately supplied, and the danger of fire has been scarce considered. Solitaries for noisy patients have been left to be provided at a more convenient season, and thus the noisy and the quiet, the violent and the convalescent, are mixed up together so as to disturb the peace of the day and the slumbers of the night. For want of proper fences, intruders make their way to the windows, and the grounds are left in the rough, year after year; at one season covered with pools of water and heaps of rubbish, and at another, the scene of blasting operations that involve the risk of life and limb. Any remonstrance upon the insufficiency of such provisions for accomplishing the highest objects of a hospital for the insane, is met by the usual reply: -- "We have already spent considerable money, and the people are anxious to see some result. We do not expect you will accomplish as much as if the establishment had that degree of completion we would wish to give it. But we are prepared to make due allowances; all we ask of you is to do the best you can, and at a future time as our means increase, these deficiences shall be supplied." All this sounds very fair and very reasonable, but if any one is sufficiently verdant to be deceived by it, I can assure him, on the strength of much personal experience, in times long since gone by, that he will have abundant opportunity of learning how far this promised allowance for his anticipated short-comings will be endorsed by the public, when the first murmur of complaint, shall reach its ears. Were this matter rightly understood, I am sure that no man with a proper regard for his own reputation and peace of mind, would embark in the care of one of these unfinished establishments.

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The location of an insane hospital is highly important in regard to the points we are now considering, for on this it very much depends, how far its reputation will be assailed by that kind of scandal and gossip which, in various degrees, is peculiarly incident to this class of institutions. If placed in a rural district and surrounded by the usual neighborhood, it is exposed to a prying observation and meddlesome interference that are only increased by any effort to restrain them. The neighbors assume the right of coming on the grounds at their pleasure, where they mingle with the attendants and patients, exerting an influence that may be positively bad, while it is altogether beyond the control of the officers. The measures of self-protection, to which they resort finally arouse a spirit of inveterate hostility that manifests itself in scandal and abuse. No person can come within their reach, especially if it be for the purpose of making inquiries respecting the institution, whose mind is not poisoned by this people's unscrupulous lies. If he have a friend in it already, favorable prepossessions however well-founded, are replaced by the most painful distrust that sooner or later, perhaps, ends in the removal of the patient. From this focus of ill-feeling, malign influences are disseminated over the whole community which never troubles itself to inquire about their origin, and fortunate is the institution that is able to live down unfavorable impressions thus created and maintained.

The proximity of a small town produces the same consequences. In those little communities where business is never so pressing as to debar any man from making himself acquainted with every other man's concerns, those of so considerable an establishment as an insane hospital, furnish inexhaustible materials for gossip. Every incident as it drops fresh from the lips of the village-butcher, or some prying neighbor, or some leaky attendant who finds a ready market for every thing of the kind he can carry, becomes the nine days' wonder, to be revolved in every circle until made to present some damnatory aspect.

It has been a common practice to place our insane hospitals in the neighborhood of the Capitol, and of all the evils of a bad location, I do not hesitate to say, this is the greatest. The political vortex which is eternally boiling and seething there, does not spare the hospital. Its proximity to the scenes of political intrigue and aggrandizement is enough to suggest the idea of making it an element in every scheme of party-operations, and if the purpose require it, detraction varied by every artifice of a malignant ingenuity, is unscrupulously used. The hospital may thereby lose the confidence of the public, but some needy camp-follower has got his reward, or some other equally commendable political end is obtained.

This is not the only nor the smallest evil incident to the connection in question. The legislature is the foundation of power, and its proximity renders it easy of access to all however remotely connected with the hospital, who have any fancied grievances to be redressed, or are bent on revenging some fancied wrong or slight. The tale of defamation finds eager listeners in men who, like the ancient father, believe because it is impossible, and who have no higher idea of public duty than that of raking among the sewers of village-scandal, for materials where-with to depreciate the value of an institution and blacken the character of its officers. Of course, such wiseacres have no difficulty in finding a mare's nest. Without the least idea how such an institution should be administered, neither knowing nor caring what maybe even the mildest consequences of their interference, they undertake to tear away the veil that shields it from the public gaze, to lay open to the inspection of the curious a class of incidents which the dullest sense of propriety would have withheld any one from revealing, and sit in judgment on conduct and measures which they are as little able to appreciate, as they are to calculate the movements of the heavenly bodies. It is not impossible that some who hear me may be unable to conceive of a sufficient warrant for language like this, but a single fact may convince them that I am not dealing with shadows. Within the last ten years the legislature of an eastern State, has investigated its insane hospital nearly every winter, on a vague charge of abuse, by means of special committees before whom have been summoned domestics, attendants and even patients, to testify whatever they might know, or were prompted to know, against the management. In several instances neither the officers nor directors received notice of the inquiry. In two instances the investigation was instigated by the representations of a discharged patient whose statements betrayed the grossest delusions, and after numerous meetings of the committee who were engaged in listening to such testimony, a vote of censure was defeated by a bare majority of the members. The stream of scandal was not confined to the committee-room, but found its way to the chambers, and in their printed debates, was carried to the remotest sections of the State, filling the minds of all who had friends in the hospital, with mortification and dismay. And yet this establishment was under the control of a Board of Directors, honest, able and vigilant, who would have quietly investigated any alleged abuse, and applied an effectual remedy with-out proclaiming the facts to the public ear. Such are the evils which result from the proximity of the Capitol and I cannot see that they are accompanied by a single counterbalancing advantage. Those institutions have flourished best where the legislature has least interfered, and therefore it is better for both that they should be placed as far asunder as possible.

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After making every reasonable allowance, however, I presume I only utter the common sentiment among us, when I say, that all our hospitals are liable to an indefinite amount of real abuse on the part of those who, in one capacity or another, are employed in the care of the patients. It is this with which we as Superintendents, are chiefly concerned in this inquiry, and if the importance of the subject implicitly requires plain speaking, I trust I shall have the credit of doing it in a spirit of candor and friendliness of feeling. Seeking nothing but the good of the cause, and disclaiming any intention to offend, I do not see how difference of opinion on this point more than on any other, should necessarily give offence. I presume no member of this Association will say that, to the best of his knowledge and belief, at no time, in no way, has an instance of abuse on the part of attendants, occurred in the institution under his charge -- that nothing has ever been said or done by them calculated, if made known, to impair the confidence of the public. The question, be it observed, is not whether such abuses are inconsiderable in comparison with the positive and unquestionable benefits by which they are accompanied, but whether they do not actually create disaffection towards these institutions, and diminish the amount of good they would otherwise accomplish. Unable as we are to ignore the fact implied in the question, it becomes our duty to provide, as far as we can, the necessary remedy.

When we consider the moral and intellectual calibre of the class of persons whom we employ as attendants, in connexion with the traits of character which we require in them, it is not surprising that improper practices should sometimes occur. They must manifest patience under the most trying emergencies, control of temper under the strongest provocations, and a steady perseverance in the performance of duty, disagreeable and repulsive as it oftentimes is. They must be kind and considerate, ever ready to sacrifice their own comfort to the welfare of their charge, cleanly in al their ways, and unsaving of any pains necessary to render their charge so also. In all respects, their deportment and demeanor must be precisely such as refined and cultivated persons have indicated as most appropriate to the management of the insane. In short, they are expected to possess a combination of virtues which, in the ordinary walks of life, would render their possessor one of the shining ornaments of the race. Now, although there can be no objection to a high standard of excellence, that man can be little better than a fool, who supposes it will be often reached by the persons whom we employ as attendants. They have been prepared for this delicate and responsible duty, by no special course of self-discipline, and, we know well enough, are seldom distinguished by the beauty or abundance of their moral endowments. They are in fact, plain every-day men and women, with the common infirmities of the race, losing their temper under extraordinary irritations, and sometimes guilty of downright abuse of their trust. This is the truth, and there would be as little wisdom in denying it, as in expecting that persons, on becoming attendants upon the insane, are transformed by some mysterious process, from ordinary men and women into angels. In this view of the case we might rest with tolerable satisfaction, but there is much reason to fear that the future will bring an additional difficulty which cannot be contemplated with quite so much philosophical composure. Although in New-England, we are still able to secure the services of a class of native Americans, possessing, for the most part, some sterling qualities, it seems as if we should be driven ere long, like our brethren south of us, to the employment of foreigners.

Relinquishing all idea of obtaining perfection out of imperfection, it is incumbent on us to circumscribe the abuses of attendants within the narrowest limits, and this can only be done by a suitable organization of the service. Without thorough organization, and the strictest discipline under it, I am well assured that no amount of vigilance will quite secure the object in view. Different men will have different ways, of course, of arriving at the same result, but there are some ways so grossly defective, that I see not how they can be followed under any circumstances whatever. Let us consider for a moment, what used to be the practice, and which, for any thing I know, may still be found to some extent among us. An attendant is placed in charge of from ten to twenty patients, and, with almost unlimited authority for certain purposes, he is truly "monarch of all he surveys, and his right there, is none to dispute." He controls every movement, and by a stricter rule than that by which the school-master governs his pupils. He directs their uprising and their down-lying, their incoming and their outgoing, their meals, their labors and amusements. The refractory are made to obey, and the turbulent are stilled in some way or another, or turned over to somebody else. His will is law, and no appeal lies from his decisions. His orders are general, and he is responsible to none but the chief. If desirous of farther orders, he leaves his charge to take care of themselves, and goes in quest of the fountain of power; and thus whether it be to call the doctor, to procure a dose of medicine, to hunt up an article of clothing, to make a poultice, or to inquire for his letters, he must leave his gallery and go to the centre-house, and if there he happens to meet a female-attendant on a similar errand, or encounters any one as little in a hurry as himself, where is the harm in saying "how d'ye do," and exchanging a little gossip? No one can charge him with neglect of duty. He has reasons for being just where he is, and if he says he came to the kitchen for hot water, it will not be easy to prove, that it was to make an appointment with one of the girls. The radical fault in this way of conducting the service, is the idea of the attendants being directly controlled by the officers. When we consider how small a portion of the twenty-four hours, any officer, much less the Superintendent, can be in any particular gallery, nothing can be more preposterous than this idea. The truth is, and it could not possibly be otherwise, that, to a very great extent, the attendant does what seemeth good to himself, and if any of it happens to be wrong, his chief may find it out if he can, in spite of the dust he can easily throw in his eyes.

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This inevitable tendency to abuse can be checked, and the wishes of the Superintendent thoroughly and systematically enforced, only by means of a party who shall spend his time among the patients and attendants, both day and night, clothed with authority to which all other authority is subordinate. In some institutions he is called a supervisor, and the following may be considered as his principal duties. He is responsible for the manner in which the service is performed, and the attendants are directly responsible to him. He arranges and directs their duties, meets every exigency as it occurs, knows whatever is going on in his department, and infuses order and harmony in every branch of the service. He is the organ of communication between the wing and the centre-house. The attendants should never enter the centre-house without express permission, and the locks should be so arranged that they could not if they would. The supervisor administers the medicine, attends particularly to the sick, watches the varying humors and phases of the patients, and regulates the special attentions they may require. He is responsible for the care and custody of the clothing and other property of patients, and the furniture of the wing, and, the last thing, at night, makes a thorough visitation of the galleries locks the outside-doors, and puts the keys in his pocket. Thus, by his frequent presence, the delinquencies of attendants are speedily discovered, the wants of patients more readily known and supplied, and the general effectiveness of the service most certainly secured. It follows of course, that the degree of excellence which this system will manifest in practice, must depend very much on the personal character of the supervisor. If kind and gentlemanly or lady-like in their demeanor, of a careful, vigilant turn, jealous of their authority and capable of maintaining it without giving offence, possessing a habit of order and a desire to excel, the institution in which they serve, has one of the surest elements of success, and their services are cheap at almost any price they choose to fix.

My views of police also require that the persons engaged in the various branches of domestic service, should never enter the wings, except by special permission. Whatever reason may exist against the introduction of visitors to the galleries, may be urged with tenfold force against the admission of the domestics. In short, I do not see how the peace and order of an establishment can be maintained a single day, if the employees of every description are to be constantly mixed up together, to idle away their time, to circulate gossip, and participate in one another's bickerings and dissensions.

In every institution, I presume, there may be found practices which are connected with some peculiar views or system of the superintendent, that cannot fairly be tested by any conventional notions of propriety. There may be, therefore, some reason for the somewhat prevalent practice of allowing patients both male and female to leave the wing at their pleasure, and have free access to the centre-house and grounds, where they roam about at will, but to me it seems to be subversive of all discipline, as well as of that privacy and seclusion which are supposed to be necessary to the restoration of the disordered mind, as I am sure they are to the maintenance of that kind of propriety which regards every unnecessary exposure of the insane as an unnecessary evil. The only benefit I have ever heard claimed for the practice, that of making patients more contented, because less restricted by locks and bolts, I have thought more fanciful than real, and at best I doubt if enough is gained by it to compensate for the real mischief that must arise from it. I see not how we can pretend to rely on moral treatment in the work of restoration, while we expose our patients every hour to such communications as they may receive from domestics and visitors.

There is another point in the administration of our establishments, of which I venture to speak, because it is intimately connected with the subject in hand. The same spirit of economy which has so mischievously presided over their construction, has demanded a reduction of the price at which their benefits are to be dispensed, to a very low figure. The general desire seemed to be, not to raise the hospital to the highest possible degree of excellence, but to reduce the rate of board too the minimum point, thereby making the merit of its administration to consist, less in the success with which, its peculiar ends are promoted, than in the small amount of means by which, it may be carried on. How the very peculiar and expensive attentions required by the insane, can be rendered at a price below that of the humblest boarding-houses in the country, has never been very satisfactorily explained. However that may be, the very low price of board in the most of our hospitals, has become a fixed fact, and the common impression now is that people may be maintained in a hospital for the insane for little or nothing. Persons who have occasion to place a friend or dependant in one of them, are surprised and dissatisfied if required to pay anything like an equivalent, while their own domestic economy may be indicative of abundance, if not splendor. By all means let the poor be received at the lowest possible point consistent with the true objects of a hospital, but I see no reason why the affluent, those who are able to pay an equivalent for this as well as any other privilege, should be admitted on the same terms. It never could have been intended that the bounty of the State or of individuals should be devoted to this class of persons. Charity does not consist in giving to the rich. But apart from this consideration, there is reason to fear that the charges are sometimes too low to make the institution what it should be to any class of persons. Such charges may procure the means of subsistence, but can they afford all the provisions for maintaining the health and comfort of the patients, which science or a progressive philanthropy have brought forward? Can they give the institution the means of constant improvement, and enable it to take an honorable stand by the side of others? We all know that these questions must be answered in the negative. When an institution is warmed and ventilated in the most perfect manner; when an ample corps of attendants is employed, in one way or another, in ministering to the comfort and gratification of the inmates; when, naked walls are covered with paint and pictures; when parlors and day-rooms, well-lighted, warmed and furnished, present to the patient some of the graces and refinements of a domestic residence; when the grounds are tastefully planted, and offer every charm that springs from lawns, flower-beds and gravel-walks, mounds and fountains, in their most pleasing combinations; then and not till then, should the weekly rate be reduced to a sum just sufficient for the means of animal subsistence.

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The only plea offered for these low rates, is that the pecuniary condition of the community, does not admit of higher, and that the establishment must be maintained at these rates, or not at all. The plea would be a strong one, certainly, were it not founded on a fallacy too much resorted to whenever the claims of humanity become importunate. There is in fact, no such public poverty as the plea would imply. On the contrary, such is our prosperity, that in every community within our borders, the taxes might be doubled and even quadrupled, and then be light when compared with the burdens of other nations. Let the object be one which the people have strongly at heart, any amount of taxation necessary to attain it, would be cheerfully submitted to. This perhaps would prove nothing, were the object manifestly and confessedly of a worthier character than that whose claims we are advocating. But how seldom has this been the case! It is a true and mournful fact, that any scheme of military achievement or territorial aggrandizement in which the popular feeling has embarked, has ever been pursued among us with supreme indifference respecting the cost. The Mexican war cost us more than enough to support all the insane of the country in hospitals of the highest character, through all coming time. And yet who ever troubled himself about the cost of the Mexican war? Let the country once feel that its true glory consists less in its powers of aggression, than in its institutions for promoting the cause of learning and humanity, and then we shall hear very little about the expense of the latter.

Perhaps, as regards individuals, this plea of inability may have more foundation, but let us beware how we suffer this consideration to affect our prices. Such is the general prosperity of our people, that most of those whose means may be called humble, are in the habitual use of certain indulgencies regarded as essential to their comfort, which cannot be afforded at our low rates of board. The peculiar attentions and privileges that constitute the merit of insane hospitals, can scarcely be appreciated by many who would be loud in their complaints on missing some animal gratification which, perhaps, they would better be without than with. We do not find that parties who make the most urgent claims on our charity, for that is essentially charity which is dispensed for less than cost, are disposed to make any sacrifice themselves. We do not find them limiting their indulgence in rum and tobacco, silk and fine broadcloth, on account of the domestic misfortune. If we are to have a very low rate in our hospitals for the insane, let it be for the unquestionably destitute and friendless, but I firmly believe that the highest degree of success, and especially of public confidence, requires for all others, a scale of charges that will warrant the establishment in a generous indulgence in whatever is calculated to promote the comfort and pleasure of its inmates.

The question now remains to be considered, whether the free admission of the public into our: hospitals for the insane, would raise them in the popular estimation. During the last and the early part of the present century, they were secluded from the public gaze, and people ,were unable, without some difficulty, to gain admission, within their walls. Within a comparatively short period, a very different practice has prevailed both in this country, and in France and Great Britain. Here the doors have been thrown open and the public invited, if not solicited to enter, to converse with patients, observe their accommodations, and learn as much as possible, of their history and treatment. The object of this practice, if I understand it rightly, is to increase the public confidence in these institutions, by making people personally acquainted with their advantages for contributing to the comfort and restoration of the insane; to substitute for the darkness and mystery which envelope them, an intelligent appreciation of their merits, and awaken a sympathy for that large class of our fellow-men whose disorder is supposed to incapacitate them for any farther participation in the decencies, not to say the humanities of life. That this object has been obtained in some degree, I am not disposed to deny, and it is quite probable that this publicity has contributed to raise that interest in the pauper-insane, which, under God, has resulted in a great work of humanity characteristic of our times. This, I apprehend, is the only good it has effected. Least of all am I inclined to think it has increased that kind of confidence which we have supposed to be deficient. We must guard against misapprehension of the real sentiment in question. In that general estimation which is made up of the views of all humane, intelligent, reflecting men, hospitals for the insane stand in the first rank of benevolent institutions. On the other hand, among those classes whose intercourse with the world has been too narrow to impart any enlargement of mind, and whose education has been just enough to give them a certain pride of opinion without increasing their capacity to think for themselves, or otherwise than wrong except by accident, there is an under-current of distrust and aversion, having no other source perhaps, than some idle story that has floated into their ears. Now, in regard to the first mentioned class, the proposed remedy is not required, because the evi I does not exist; and in regard to the latter, it is inadequate to accomplish the object in view. They may pass through the halls of the quiet patients, for to them I sup- pose the visits of strangers would be confined, observe them engage in various employments, and for the most part, appearing like ordinary persons ; they may notice the cleanliness of the house, and the many indications of neatness, good order and even kindness, but the real difficulty is not reached. The feeling is, that these traits which make such favorable impressions on the casual observer, may co-exist with a kind of management unseen by the world, which is marked by unkindness, neglect and even positive cruelty. Shocking abuses are not practised before spectators, but at times and occasions when no eye can see, nor tongue proclaim the fact. From any thing seen, there is no guaranty that a patient would not be neglected when sick, shaken or beaten when refractory, supplied with improper or insufficient food, or in some way or other, treated without due regard to the proprieties of life, or the requirements of humanity.

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But even if this kind of publicity had the effect of turning the popular undercurrent against hospitals for the insane, I am not sure we should be justified in incurring the numberless evils by which it is always accompanied. The promiscuous admission of visitors to the galleries, is inconsistent with that seclusion which they are supposed to afford, and for the sake of which many patients are expressly placed there. To expose them therefore, in this manner, to public observation, is equivalent to a breach of trust. No degree of precaution will entirely prevent some unpleasant exhibition which is reported abroad, until under the magnifying process of repeated transmission, it is fitted for a nine days' wonder. It is painful to many, and annoying to all, to have the behavior of those whom they love, made the theme of village gossip, and, at some future day perhaps, brought to the notice of the patients themselves, to cover them with shame and mortification. We all know that even the simplest remark from the lips of a spectator, respecting the appearance or conduct of a certain patient, is apt to be so distorted, in the course of its circulation, as to reach the ears of friends, in a shape well-calculated to excite their apprehensions and disturb their peace. For these reasons I cannot think that the free admission of the public into our hospitals would prove a remedy for the evil in question, even if it were not forbidden by a proper regard for the rights of the insane and of their friends.

The only kind of supervision which ought to secure the public confidence, is, that which is exercised by a board of Directors or Trustees possessing the qualities necessary for the successful performance of their trust. The success of an insane hospital is so dependent upon the character of this board, that it is to be regretted that it should so often be constituted with little or no reference to the special duties that are required. A Director should be free, in that capacity, from all political or other unworthy biasses, strongly anxious to promote the cause of humanity, and without any object whatever but the highest welfare of the institution. He should possess habits of business in order that he may perform his duty ,with that promptitude, precision and correctness which are expected in other business, and sufficient discretion to meet the perplexities of his position. He should cheerfully bestow the time and pains which the office requires, and his social and moral position should place him beyond the reach of the arts, the passions and the prejudices of others. Especially should he be of a liberal turn of mind, to meet the questions frequently coming up, of improvement and chance, and of that generous and elevated spirit which places a man beyond the temptation of doing a mean thing, and allies him to truth and justice. I know of no better guaranty for the proper management of a hospital, than the frequent and thorough visitations of such men as this, and I believe that no better could be reasonably wished. True, special instances of abuse would seldom meet their notice, because such things are not done before company, however common they may be under other circumstances: but with such opportunities, careful and intelligent observers could not fail to discern the general spirit which pervades the establishment and characterizes its moral management. If an institution can bear creditably such inspections, once a week, we mnay be quite sure that it cannot be very remiss any intermediate day. The most labored attempt to give it a character on these occasions, not properly belonging to it, could not prevent its prevalent spirit and habitual usages from sometimes making their appearance.

An institution of this kind should always find in its board of Directors a tower of strength on which it can rely for support in the day of adversity and trial, and that kind of moral credit necessary to ensure the confidence of the public. But what benefit can it derive from the kind of men that are often placed in this position, retired or broken-down politicians to whom the office is tendered as a cheap recognition of past services, or an inducement to continued fidelity; country doctors or lawyers to whom the pay and mileage becomes a very acceptable addition to their professional income; small shopkeepers and traders who covet the place for the sake of driving profitable bargains with the hospital; together with a numerous class who have no other thought in regard to the office but the little consequence which it is supposed to confer. Such men have been the occasion of much mischief to our hospitals for the insane. I believe if they had uniformly been under the direction of honorable, intelligent and high-minded men selected solely on account of these qualities, they would have secured a far higher degree of public favor than that which they actually possess.

To ensure the success of a hospital for the insane, there is another requisite more important perhaps than all others, of which it may be expected that I should speak. I refer to the personal character of the superintendent. My own limits, if not the occasion, will forbid my dwelling upon this point. I must therefore confine myself to the simple statement, that unless he possess the talents necessary to command the respect of intelligent men, that devotion to his profession which will lead him to spare no pains to qualify himself in the most perfect manner for the performance of its duties, that temper and disposition that will establish something stronger and dearer than a merely professional relation between himself and the objects of his charge, and that moral and intellectual elevation which is only satisfied with high aims and substantial results, -- unless he possess these traits, he has much reason to believe that he has mistaken his calling and that he will fail to obtain that public confidence which ought to be as the very breath of his nostrils.