Library Collections: Document: Full Text

"It now remains to speak of the means to be adopted for the care and treatment of the insane who are deemed curable. This treatment is moral and medical, the two methods being properly combined in every case. Again, it should be specially directed to the character and circumstances of the individual case; it is necessary to penetrate the individual character, in order to influence it beneficially by moral means, and to investigate carefully the concurrence of conditions that have issued in insanity, in order, so far as possible, to remove them. Not the least of the evils of our present monstrous asylums is the entire impossibility of any thing like individual treatment in them. It would not be putting the matter fairly to point out the absurdity of two medical men affecting to treat really seven or eight hundred lunatics in an asylum, because the majority of them assuredly do not require any medical treatment; but it is perfectly fair to call attention to the uncertain chances of satisfactory treatment which the small, curable minority have under such circumstances. To the medical officer these are not so many individuals, having particular characters and particular bodily disposition's, with which he is thoroughly acquainted, but they are apt to become so many lunatics, whom he has to inspect as he goes his round of the establishment, as he inspects the baths and the beds; and the only person, perhaps, really aware that each of them has an individual character, is the attendant. Herein lies a reason why the best possible treatment in some instances undoubtedly is to remove a patient from an asylum to the care of his own friends. . . . Indeed, I cannot help feeling, from my experience, that one effect of asylums is to make some permanent lunatics; continually living in the atmosphere of the worst lunacy, certain patients seem to become impregnated with its baneful inspiration, and after a time sink to the situation. And I can certainly call to mind more than one instance in which I thoroughly believe that the removal of a patient from an asylum was the salvation of his reason."

Could not the term "absurdity," applied above, be used with still more force, in a case where, practically under the direction of but two medical men, six hundred patients are supposed to be treated; and all these, under the law, regarded as curable cases, and, at all events, 70 per cent. of whom have been insane less than a year.

Says Griesinger: "Nowhere is the desideratum strictly to keep in view the individual of greater importance than in the treatment of insanity; nowhere is the constant consciousness more necessary that it is not a disease, but an individual patient-that it is not mania, but an individual who has become maniacal-that is the object of our treatment. Each individual case should be specially investigated in all its bearings, which constantly vary, and all the means of anatomical diagnosis and pathological research ought to be brought to bear upon its elucidation; in fact, a penetration into the psychical individuality of the patient is here demanded, which is scarcely ever necessary in ordinary medical practice."

In the annual reports of the asylum at Utica, it is said with complacency, that "its records will show that full pace has been kept with the general progress of medical science -- that moral or medical remedies have been discarded or adopted, as soon as investigation or experience has shown them to be evil or good. The proportion of attendants to patients has been nearly doubled, and in all respects the institution has sought to adopt at once whatever has seemed essential to the more certain and speedy recovery of patients, or which might contribute to their more humane treatment. It has always maintained a foremost rank in all the great improvements in sanitary measures."

In short, every means and appliance, that money could supply, has been at the command of its management. The annual cost of board and maintenance of the patients is certainly up to the average of the other State institutions of the country. It is claimed that the method of treatment, based upon the modern theory of the causation and nature of insanity, is a very great improvement upon that in vogue twenty years ago; and in reading the paper, and seeing with what zeal and earnestness the peculiar views and methods of the author are commended to the profession, one almost wonders that the insane in former days were cured at all. Certainly, during the period named, important remedies have been added, empirically or otherwise, to the resources of the specialist in insanity.

That homely old proverb, "The proof of the pudding is in the eating," has an application even in relation to medical practice. I therefore, in closing, present some of the statistics of the Utica Asylum, from its establishment. It will be borne in mind that the records cited have been kept under the supervision of the author of the paper, for the last eighteen years, or nearly two-thirds of the whole period.