Library Collections: Document: Full Text


American Charities

Creator: Amos G. Warner (author)
Date: 1908
Publisher: Thomas Y. Crowell Company, New York
Source: Straight Ahead Pictures Collection

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430  

Patients are cared for to a decreasing extent in private institutions. Some of the gravest abuses have grown up in these private homes or retreats, and, as a rule, commitment to a public institution is regarded as safer than to a private institution, unless the character of the man in charge is very well known.

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After the classification by sex, and in the South by color, the next great line of division among the insane which specialists have attempted to make has been between acute, or possibly curable, and the chronic, or probably incurable, cases. In order to make cure as likely as possible, it is desirable that institutions should be small, the number of attendants large, of good character, and the best training, and all the conditions of life as nearly like those of a normal home as possible. To provide such facilities as these with the purpose of curative treatment is expensive; while, on the other hand, to take adequate care of the chronic or probably incurable insane requires a comparatively small per capita expenditure. Experts have constantly agitated for the separation of the two classes; but the ordinary citizen' generally objects to the establishment of an asylum for the chronic insane because it emphasizes the hopelessness of their condition.

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In the States where this classification between institu-tions has been measurably maintained, it results in very considerable saving, and in considerably better treatment for the curable insane. At the same time insanity is not usually a curable disease. Even in the best-managed institutions, and those receiving the likeliest class of patients, less than 30 per cent permanently recover. The statement of Dr. Thurnam, an English expert, made many years ago, based on the experience of forty-four years at the York Retreat, still comes nearer the truth than the more sanguine predictions of later authorities. Dr. Thurnam says: --

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"In round numbers, of ten persons attacked by insanity, five recover, and five die sooner or later during the first attack. Of the five who recover, not more than two remain well during the rest of their lives; the other three sustain subsequent attacks, during which at least two of them die."

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After the separation of the curable from the incurable, in order to provide for the proper care of each, the next most important classification is, perhaps, into the criminal and the non-criminal insane. Some States have treated the criminal insane as criminals, and provided for them in branch penitentiaries. Others have treated them as insane, and put them into the same institution with other persons of that class, sometimes to the danger and often to the disgust of such other patients and their friends and relatives. The best policy, and the one adopted by the progressive States, is to have a separate asylum for the criminal insane. (150)


(150) Barrows, "The Criminal Insane," pp. 5-14.

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Another essential to the proper classification is the separation from the insane of those who are epileptics, and also the distinctly feeble-minded. The class of epileptics, especially, is a great annoyance both to the inmates and managers of institutions for the insane, as they require special treatment which they can properly have only in a special institution. Beyond these distinctions which obtain as between institutions, there must further be a classification of the insane in any given institution to bring together those that do not vex or excite one another, and to segregate the filthy and the unmanageable. It is one of the defects of very large institutions that have been erected in some States, that the wards are too large to make possible proper classification and consequent individualization of cases.

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The recent discussions upon the care of the insane have turned upon the harmonizing and unifying of the most desirable features of all the systems now in use. Dr. Frederick Peterson names as the two essential provisions of an adequate system, psychopathic hospitals for the acutely insane in the cities, and colonies for the mixed classes of insane in the adjacent country. In 1907, the Committee on the Insane, of the National Conference of Charities and Corrections, formulated a comprehensive plan in which they laid down the following principles: the claims of locality should have primary consideration in the location of institutions and dis-tribution of patients in order that they may be accessible to friends and to promote local convenience and interest. Classification is imperative, -- the acute and curable from the chronic and incurable, the harmless from the violent, -- but the Committee think these requirements are best met under the same local management, by suitable separation in space, variety of buildings and equipment, and judicious grouping. They believe that large institutions, whether desirable or not, are inevitable and must develop along the two lines of efficient economical administration and excellence of medical and scientific work under a single unifying authority, -- a medical executive, with a clear subdivision and definition of departments.

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