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Schools In Lunatic Asylums

Creator: n/a
Date: April 1845
Publication: American Journal of Insanity
Source: Available at selected libraries


Introduction

Amariah Brigham, the founder of the Journal of Insanity, promoted many innovations as superintendent of the New York State Lunatic Asylum. Here, the establishment of schools at the asylum is discussed.


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At the New York State Lunatic Asylum, at Utica, schools for the instruction of the patients of both sexes, were established soon after the opening of the Institution. These have been continued most of the time since, and to the manifest enjoyment and improvement of the patients.

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We have three schools for the men, one of which has been managed for the past six months, wholly by a patient, the others by a teacher, hired for the purpose.

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We have one school for the women, which is conducted by a hired instructress.

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The schools commence at 10 in the morning, and at 3 in the afternoon, and continue about one hour. They are opened and closed by singing a hymn by the pupils. To enable all to unite in singing, we have hymns printed on cards, which each pupil holds in his hand.

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The patients then read, spell, answer questions in Arithmetic, Geography, History, &e., assisted by black-boards, and a globe. A majority commit pieces to memory, and once in two weeks, we have a meeting of all the schools in the chapel, when they unite in singing. Then follows declamations and the reading of compositions.

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In all the schools good order prevails, and many of the patients have made great proficiency. Some have here first learned to read and to write. Several inclined to be discontented, have been made far less so by attending school, and a considerable number who were already in a demented state, or fast approaching it, have improved in mind, and become interested in learning.

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Occasionally we have an exhibition, when original plays are exhibited. The following account of two of these exhibitions, written by a patient, and published some time since in the Utica Gazette, may not be uninteresting:

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Mr. EDITOR -- Few of your citizens are probably aware of the entertainments, which are got up at the Asylum -- and none would think of finding amusement there. Yet I have been present on two recent occasions, when it abounded, and I was also gratified, to witness the success with which the more quiet portion of the patients, seek the means of rendering their condition happy. The first was a sort of theatrical exhibition, by the females, in the south wing, and consisted of music on the piano, by one who accompanied it with a voice that denoted its former power, though now its notes were a little wild. Then there was a dialogue, in which a young lady was warned by a friendly aunt, against a certain matrimonial alliance; recitations, addresses, songs, and various characters followed -- altogether a serio-comic affair, and very interesting from its novelty.

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On Saturday evening last, a number of ladies and gentlemen from the city, were invited to a similar exhibition by patients of the other sex, in the north wing. There was speaking, dialogues, some recitations, and a display of mesmerism, which was done to the life, and was a capital burlesque of that science. The audience were convulsed with laughter, at the operation of the professor upon his Roderic Dhu. It was the production of genius, and would have been applauded in any place where wit is appreciated. The contents of a manuscript newspaper, called the Asylumian, just established, were then read, made up of the usual variety of miscellany, news, advertisements, &c. The terms are stated at $3 a year, if paid in advance; and $4, if not paid at all. There are several things worth copying into your paper, Mr. Editor; but I will send you but one, being an advertisement, which you may insert pro bone publico -- if you please:

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"Messrs. C. & F. hereby advertise to their friends and customers, that having made arrangements with the proprietor of the New York State Astor House, rear Utica, under the auspices of Dr. Brigham, they will be able to accommodate ladies and gentlemen, on the most reasonable terms. Having experienced the good effects of its operations upon themselves, they can with confidence recommend it to others. The Table d'Hote will be well supplied, the attendants obliging, and the resting places easy and luxurious.

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"Baths, warm and cold, and shower baths, free of charge, can be had at all hours. Carriages are had at the shortest notice, with good drivers; and the beautiful city of Utica and villages adjacent, with mountains, hills and dales are always in prospect.

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"Good music is had, and a variety of amusements. And in conclusion we would say, that refractory youths, and wild young men and women, are tamed at the shortest notice. The timid need have no fears, as the mildest ladies and gentlemen are employed as attendants, of great sagacity and trust-worthiness."

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We wish not to over estimate the importance of schools in Lunatic Asylums, but we are confident, they have here been of great service; and like beneficial effects seem to have resulted from them in some other Asylums.

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Dr. Conolly, Physician to the Hanwell Asylum, an immense establishment for the Insane near London, quite recently visited the Hospitals, for the Insane at Paris, and in the January number of the British and Foreign Medical Review, has given the following interesting account of the schools at the Salpetriere and Bicetre Hospitals:

THE SALPETRIERE.


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The first Asylum which I visited, was the Salpetriere, a part of which immense institution is appropriated to insane women; of whom there were 1,600. M. Battelle, the Director of the civil hospitals of Paris, accompanied me; and we found M. Falret, one of the physicians of the Asylum, sitting in the school room, a somewhat small but comfortable apartment, in which were collected about 100 of the patients, all perfectly orderly, all neatly dressed, and appearing to take as much pleasure in the occupations of the school as those who witnessed them.

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To any one accustomed like myself to the daily observation of the insane, the mere appearance of these patients gave eloquent testimony concerning their general good and kind management. Some were engaged in needlework, which they chose to continue whilst attending to the singing, recitations, and other proceedings of the school. A few only were absorbed in ideas which no change of place can always relieve. None appeared to be in any way troubled or fatigued. All were neatly dressed; their handkerchiefs and caps presenting the variety and some of the singularities always seen when the dress of insane females is not regulated by severe general rules. Above all, almost every one was cheerful, and regarded the attendants, officers, and visitors, without the least indication of Suspicion or dislike. A few of the attendants were &tting among them, and by their participation in all that was done, contributed to the general good effect.

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As the institution of schools in the Hanwell Asylum has been a favorite object of my ambition, but one in which my hopes have been frustrated, in consequence of their suppression by an authority, which I have no power of resisting, it was not without the most singular gratification that I beheld Dr. Palret sitting among his patients, like a father among his children, encouraging them, assisting them, directing them, and promoting all kinds of easy and agreeable intellectual exercises, that might diversify the time for the afflicted objects of his care, and, by gentle efforts, lead perhaps, in not a few cases, to the gradual restoration of those powers with the loss of which all is lost that is worth preserving. The tranquility, the content, the cheerfulness of that little room, I shall never forget; and I trust that the hope such a spectacle inspired of being some day aided in a like attempt among the insane of my own country, will yet be realized before my mortal labors are concluded.

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The patients at the Salpetriere, have the advantage of a library, and several of them have read parts of the excellent books allowed for their perusal with so much attention as to be able, when requested, to recite them for the amusement of the other patients. Three or four of the women, in the school-room, were called upon in succession by Dr. Falret to do this. Each immediately stood up with much cheerfulness, and distinctly and pleasingly recited a short story or poem. This was done with great correctness; and it seemed as if the patients knew the whole of some long poems, which they went on reciting until stopped, when they sat down with an equal air of content. During the recitation many of the other patients appeared to be attentive hearers. Several of the patients were then invited to join in singing something; and they sung several verses, and in parts, very correctly and agreeably, and apparently without any sane leader. Afterward an Italian patient sung a beautiful air with considerable skill, to the evident satisfaction of her companions. I saw various specimens of their writing, which were excellent; it was, indeed, with regret that I left this part of the establishment, where, by means of innocent and improving recreations, the patients pass a portion of each day in tranquility, and, it may even be said, in happiness; and it will be long before I lose the wish to see those cheerful grateful groups again. The school at the Salpetriere is only a part of what has been done, and what I shall have to describe to you, for the instruction of the insane in Paris.

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This place of careful instruction was but a preface to the whole of the establishment, which I found to be remarkable for its cleanliness, order, and tranquility.

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The number and the comfort of the separate rooms for work, or reading, or recreation, at the Salpetriere are among the great advantages possessed by this Asylum. In more than one there is an excellent piano, and patients who are fond of music are permitted to play and sing there almost whenever they choose. These rooms are of various dimensions; some very large. In one large work-room there are 150 patients, some at needle work, and many employed in making, under the direction of a patient, very comfortable shoes of colored worsted, on a last. In other rooms I saw many patients collected together for employment, or sitting down to dinner, who were formerly considered so refractory as to make such social assembling impossible. One hundred and forty-three chronic cases were in one such apartment at dinner; and in another, eighty-four, of whom the greater number were advanced far into dementia, and many of whom were to be seen, only three or four years ago, lying on the floor, and presenting the most lamentable spectacle. The ameliorations in this part of the Asylum, are all of very recent date, and very striking. Rooms have been built for these poor people, and their condition raised at once from abject wretchedness to comfort. The number of those capable of being usefully employed, has been found great beyond expectation, even among the least intelligent, the most inactive, and the least orderly of the patients; and idleness has become the exception.

THE BICETRE.


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This large Asylum is appropriated to male patients, or rather, as in the case of the Salpetriere, a portion of the immense hospital is set apart for them, the rest being occupied by elderly or decayed trades-people and others. About 2,000 of these occupy the parts of the building first approached, and the buildings behind these contain 800 or 900 male lunatics. M. Voisin and M. Leuret are physicians to this part of the establishment; with both of whom, as well as with M. Mitivie, one of the physicians to the Salpetriere, I had subsequent opportunities of becoming acquainted.

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I was accompanied around this asylum by M. Hattelle, and by M. Mallon, the director, and had afterward an opportunity of hearing from himself the exposition of the views of one of its able physicians, M. Voisin, whose singular zeal in the cause of the idiotic class of patients has caused difficulties to be overcome, which appeared at first to be insurmountable. The first part of the Bicetre to which I was conducted was a school exclusively established for the improvement of these cases and of the epileptic, and nothing more extraordinary can well be imagined. No fewer than forty of these patients were assembled in a moderate sized school-room, receiving various lessons and performing various evolutions under the direction of a very able school-master, M. Seguin, himself a pupil of the celebrated Itard, and endowed with that enthusiasm respecting his occupation before which difficulties vanish. His pupils had been all taught to sing to music; and the little band of violins and other instruments, by which they were accompanied, was formed of the old almsmen of the hospital.

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But all the idiotic part of this remarkable class also sung without any musical accompaniment, and kept excellent tune and tune. They sung several compositions, and among others a very pretty song, written for them by M. Battelle, and sung by them on entering the class-room. Both the epileptic and idiotic were taught to write, and their copy-books would have done credit to any writing-school for young persons. Numerous exercises were gone through, of a kind of military character, with perfect correctness and precision. The youngest of the class was a little idiot boy of five years old, and it was interesting to see him following the rest and imitating their actions, holding out his right arm, left arm, both arms, marching to the right and left, at the word of command, and to the sound of a drum, beaten with all the lively skill of a French drummer by another idiot, who was gratified by wearing a demi-military uniform. All these exercises were gone through by a collection of beings offering the smallest degree of intellectual promise, and usually left in all asylums, in total indolence and apathy. Among them was one youth whose intellectual deficiency was marked in every look, gesture, and feature.

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I think a more particular account of this poor boy's progress deserving of record, as an inducement to the philanthropist, to enter on a new field of instruction, presenting many difficulties, but yet not unproductive of results. But I must premise that to M. Voisin, one of the physicians of the Bicetre, the honor seems chiefly if not wholly due of having attracted attention to the various characters of idiots and their various capacities, with a view to cultivating, with precise views, even the fragmentary faculties existing in them. His work, entitled 'De l'Idiotie chez les Enfants,' abounds with remarks calculated to rescue the most infirm minds from neglect, and to encourage culture in cases before given up to despair. Fourteen years experience has confirmed the soundness of his opinions; and they have had the sanction of MM. Ferrus, Falret, and Leuret, physicians of the highest distinction in the department of mental disorders. M. Ferrus, who is the President of the Academy of Medicine, and Inspector-General of the Lunatic Asylums. of France, was, indeed, the first to occupy himself, so long ago as in 1828. with the condition of idiots at the Bicetre, of which hospital he was the chief physician. He organized a school for them, caused them to be taught habits of order and industry, and to be instructed in reading. writing, arithmetic, and gymnastic exercises. M. Voisin's first publication on the subject appeared in 1830. The efforts of M. Falret at the Salpetriere, for the instruction of the insane, already spoken of, began in 1831 by the establishment of a school in that institution for idiotic females. Nine years later, MM. Vosin and Leuret, as physicians to the Bicetre, organized a system of instruction and education on a greater scale. These benevolent and successful efforts deserve to be remembered, as they no doubt prepared the way for the systematic attempt since made at the Bicetre, where M. Seguin is enabled to apply to practice, principles of tuition long recognized as regards the deaf and dumb, but only beginning to be acknowledged as respects those unfortunate beings whose mental faculties are congenitally imperfect in all the various degrees classed under the term idiocy. In this application, the master has to educate the muscular system and the sensorial apparatus, as well as the intellectual faculties, or rather the intellectual faculties through them, as a preliminary; doing in fact, for them by art, by instruction, by rousing imitation, what nature does for healthier infant organization. The healthy infant is placed in a world calculated to exercise its senses and to evoke and perfect all its muscular powers, and, to a certain extent, its intellectual faculties. The imperfect or idiotic infants is in the same world, but its senses are, to a certain extent, closed to these natural influences, and its powers of muscular motion are incomplete; its intellectual faculties are not evoked by these means, and are even incapable of being fully evoked by any means whatever. The attention is vague, the memory feeble, the imagination futile, comparison is most limited, judgment most imperfect, and all the affections, sentiments, and moral qualities are disordered or perverted. The interesting question is, to what extent can careful and skilful instruction make up for these natural deficiences; and, as already done for the deal, the dumb, and the blind, reclaim for these unfinished creatures the powers and privileges of life. The exertions of future philanthropists will answer this question. Improvement must not be looked for beyond what is strictly relative to the imperfect individual in each case; but it would seem to be true of idiots, as of the insane in general, that there is no case incapable of some amendment; that every case may be improved or cured, up to a certain point, -- a principle of great general importance in reference to treatment.


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In the school for idiots and epileptics, at the Bicetre, a careful register is kept of the psychological condition of each pupil, according to a printed form, for the examination of their instinctive, moral, intellectual, and perceptive state. I was obligingly furnished with a copy of the register relative to the subject of my immediate observations, Charles Emile, and also with a copy of the resume or summary of his case, made by M. Voisin himself.

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The age of Charles Emile is fifteen: he was admitted to the school in June, 1843. He is described as being of a nervous and sanguine temperment, and in an almost complete state of idiocy: the faculties which remain being in a state of extraordinary activity, and rendering him dangerous to himself and to others: but still idiotic in his inclinations, sentiments, perceptions, faculties of perception and understanding, and also of his senses, of which some were obtuse, and others too excitable. He was consequently unfit, to use the words of M. Voisin, "to harmonise with the world without." As regards his inclinations, he was signalized by a voracious, indiscriminate, gluttonous appetite, un erotisme hideux, and a blind and terrible instinct of destruction. He was wholly an animal. He was without attachment; overturned everything in his way, but without courage or intent; possessed no tact, intelligence, power of dissimulation, or sense of propriety ; and was awkward to excess. His moral sentiments are described as null, except the love of approbation, and a noisy instinctive gaiety, independent of the external world. As to his senses, his eyes were never fixed, and seemed to act without his will; his taste was depraved; his touch obtuse; his ear recognized sounds, but was not attracted by any sound in particular; and he scarcely seemed to be possessed of the sense of smell. Devouring everything, however disgusting; brutally sensual; passionate, breaking, tearing, and burning whatever he could lay his hand upon; and if prevented from doing so, pinching biting, scratching, and tearing himself, until he was covered with blood. He had the particularity of being so attracted by the eyes of his brothers, sisters, and playfellows, as to make the most persevering efforts to push them out with his fingers. He walked very imperfectly, and could neither run, leap, nor exert the act of throwing; sometimes he sprang like a leopard, and his delight was to strike one sonorous body against another. When any attempt was made to associate him with the other patients, he would start away with a sharp cry, and then come back to them hastily M. Voisin's description concludes with these expressions: "All the faculties of perception in this youth are in a rudimentary state; and if I may venture so to express myself, it is incredibly difficult to draw him out of his individuality, to place him before exterior objects, and to make him take any notice of them. It would not be far from the truth to say, that for him all nature is almost completely veiled."

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This description not only exemplifies M. Voisin's careful mode of observation, but shows that an example of idiocy less favorable to culture could scarcely have been presented to the instructor. This same poor idiot boy is now docile in his manners, decent in his habits, and capable, though not without some visible effort, of directing his vague senses and wandering attention, so as to have developed his memory, to have acquired a limited instruction concerning various objects. and to have become affectionately conscious of the presence of his instructors and friends, His general appearance is still that of an idiot. His countenance, his mode of walking, all that he does, declares his very limited faculties. Nature has placed limits to the exercise of his powers which no art can remove. But he is redeemed from the constant dominion of the lowest animal propensities; several of his intellectual faculties are cultivated, some have even been called into life, arid his better feelings have acquired some objects and some exercise. In such a case as this we are not so much to regard what is merely accomplished for the individual. A great principle is established by it in favour of thousands of defective organizations. After witnessing the general efforts of this school of the most imbecile human beings, and hearing the particulars of Charles Emile's history, it was really affecting to see him come forward when called, and essay to sing a little solo when requested; his attempt at first not being quite successful, but amended by his attention being more roused to it. His copy-book was then shown to me, and his writing was steady, and as good as that of most youths of his station in life. The schoolmaster, who seemed to take great pleasure in the improvement of this poor fellow, then showed us how he had taught Charles to count, by means of marbles and small pieces of wood, or marks made on a board, arranged in lines, the first containing an 0, the second 00, the third 000, and so on. Charles was sometimes out in his first calculations, but then made an effort and rectified himself He distinguished one figure from another, naming their value. Large pieces of strong card, of various shapes, were placed in succession in his hands; and he named the figure of each, as square, triangle, &c., and afterward drew their outlines with chalk on a black board, and, according to the desire of M. Seguin, drew a perpendicular, or horizontal, or oblique line; so effectually attending to what he was doing, that if any line was drawn incorrectly he rubbed it out and began anew. He also wrote several words on the board, and the name of the director of the Bicetre, without the name being spoken to him.


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This case was altogether the most interesting of those which I saw; but there was one poor idiot standing a great part of the time in a corner, to all appearance the very despair of art; even this poor creature however, upon being noticed and brought to the table, proved capable of distinguishing the letters of the alphabet. Most of the others had received as much instruction as has been described, and could count, draw lines and figures, write, perform various exercises, and point to different parts of the body, as the head, the eyes, the arms, the feet, &c., when named to them. In all these cases, and preeminently in that of Charles Emile. the crowning glory of the attempt is, that whilst the senses, the muscular powers, and the intellect have received some cultivation, the habits have been improved, the propensities regulated. and some play has been given to the affections; so that a wild, ungovernable animal, calculated to excite fear, aversion, or disgust, has been transformed into the likeness and manners of a man. It is difficult to avoid falling into the language of enthusiasm on beholding such an apparent miracle; but the means of its performance. are simple. demanding only that rare perseverance without which nothing good or great is ever effected; and suitable space, and local arrangements adapted to the conservation of the health and safety of the pupils to the establishment of cleanly habits; to presenting them with objects for the exercise of their faculties of sense, motion, and intellect; and to the promotion of good feelings and a cheerful active disposition. The idiot who is capable of playing and amusing himself is already, as M. Seguin observes, somewhat improved. I can but regret that I had not time to watch the progress of this interesting school from day to day, and to trace the growth of knowledge in the different pupils; as of the first ideas of form and color, into writing and drawing; the development of articulation and the power of verbal expression; the extension of memory to calculation; the subsidence of gross propensities, and the springing forth and flourishing of virtuous emotions in a soil where, if even under the most favorable circumstances the blossoms and fruits are few, but for philanthropic culture all would be noxious or utterly barren.

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The schools fur the insane patients of the Bicetre, who are neither idiotic nor epileptic, exceed in interest, if possible, those of the Salpetriere. Male patients are better prepared in general than female patients to derive benefit from such instruction; they are also more attentive, and perhaps, more able to receive various instruction. I have never seen more exquisite penmanship than that of some of the male patients; the drawings of some of them were most beautiful; and I will not attempt to describe the effect of their singing, although I can never lose the impression of it. Here, too, as in the school at the Salpetriere, the most cheering thing of all was to see the evident comfort and happiness created by the various and not fatiguing occupations of the schools; to witness the satisfaction with which the afflicted, the paralysed, the utterly incurable, exhibited the performances which they yet retained the power to accomplish. if no other end were answered by the formation of schools, they ought to be established as recreative, palliative, remedial even, in every Lunatic Asylum.

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There is no Asylum in which the good effect of occupation has been tried to greater extent, than at the Bicetre. The exertions of M. Ferrus long since procured for this purpose the farm on St. Anne, at some distance from the Asylum. Unfavorable weather and want of time contributed to prevent my visiting this farm, the extent of which is, I believe, about 150 acres. Its cultivation has realized the most sanguine expectations of the physicians as regards the bodily and mental improvement of the patients employed upon it; and, what is of far less consequence, has actually been profitable. A simple regard to the profit of occupation for the insane, will always limit the application of this most important remedy; and it is, therefore satisfactory that the farming at St. Anne has not been a source of loss. The patients in the schools, even some of the epileptic and idiotic, work when the weather permits it; and for some, who are employed nearly every day, there are evening classes. Thus every objection is removed, which can be raised against the instruction of the insane, even by those who regard economy as the first consideration. Out of 800 male patients, 200 receive instruction.

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