1846 exhibits the following summary: "Of 2,028 patients, 102 were insane." The last returns show yet an increase of this afflicted class, notwithstanding the enlarged accommodations in the State Hospital at Columbus, and the new buildings for the insane at the excellent asylum for persons in necessitous circumstances in the same city. I might adduce additional records, but believe the above are sufficient to establish the correctness of my position.

Allowing at the present time 22,000,000 inhabitants in the United States, (which is below the estimated number,) and supposing only one in every thousand to be insane or idiotic, we have then 22,000 to take charge of; a majority of whom are in needy or necessitous circumstances. Present hospital provision relieves (if we do not include those institutions not considered remedial) less than 3,700 patients. Where are the remainder, and what is their condition? More than 18,000 are unsuitably placed in private dwellings, in jails, in poorhouses, and other often most wretched habitations.

Dr. Kirkbride, who has carefully reviewed this subject, writes as follows: "In regard to whole numbers, my own inquires lead me to believe that one in every six or seven hundred inhabitants would be a nearer approximation to correct estimate than one in every thousand, which has heretofore been assumed as the common rule." According to the latest parliamentary returns taken with the report of the Metropolitan Commissioners on Lunacy, which give the numbers of all classes of insane in the hospitals of England and Wales, it is ascertained that in these two countries "there is one insane pauper to every one thousand inhabitants alone."

The liability of communities to insanity should not, I suppose, be estimated by the number of existing cases at any one time; for insanity does not usually hasten the termination of life. Take for example Massachusetts, New York, and Virginia, where are found so large numbers of established long-existing cases. These are counted again and again, every year, every five, or every ten years. A fairer test of the liability of communities to insanity is to be found in the occurring cases in corresponding given periods.

There are twenty State hospitals, besides several incorporated hospitals, for the treatment of the insane, in nineteen States of the Union, Virginia alone having two government institutions of State and incorporated hospitals. The following is a correct list, omitting several small establishments conducted by private individuals, and several pretty extensive poorhouse and prison departments, which cannot properly be classed with regularly organized hospitals, being usually deficient in remedial appliances.

The first hospital for the insane in the United States was established in Philadelphia, as a department of the Penn Hospital, in the year 1752. This has been transferred to a fine district near the village of Mantua, in the vicinity of Philadelphia, since 1832: number of patients 188. The second institution receiving insane patients, and the first exclusively for their use, was at Williamsburg, Virginia, in 1773: number of patients 164.

The third was the Friends' Hospital, at Frankfort, near Philadephia, in 1817: number of patients 95.

The next was the McLean Hospital, at Charlestown, (now Somerville,) in Massachusetts, 1818. This valuable institution is second to none in America. Number of patients 180.

Bloomingdale Hospital, near the city of New York, was established in 1821; number of patients 145: South Carolina Hospital, at Columbia, in 1822; number of patients 74: Connecticut Hospital at Hartford, patients 122: and Kentucky Hospital at Lexington, patients 247, in 1824.

In 1845-46, the legislature of Kentucky passed a bill to establish a second State institution in the Green River country.

Virginia Western Hospital was opened at Staunton in 1828; number of patients 217. Massachusetts State Hospital, at Worcester, was opened in 1833, and enlarged in 1843; it has 370 patients. Maryland Hospital, at Baltimore, was founded in 1834; it has the present year 109 patients. Vermont State Hospital, at Brattleborough, was opened for patients in 1837, and enlarged in 1846-'47; it has at present 320 patients. New York City Hospital for the poor, on Blackwell's island, was occupied in 1838; it is now being considerably enlarged: above 400 patients.

The grand jury this month (June, 1848) have made the following presentment in relation to the Blackwell's island hospital for the insane poor: "We found no less than 425 afflicted children of humanity suffering under the most terrible of all privations, and, we observed with regret, less adequately cared for than their situation and the dictates of humanity require."

The same document places before the public the concurrent testimony of Drs. Macdonald, Williams, and Ogden, who in a clear and true report show that "the accommodations for the insane poor of New York city are at present inadequate and miserable; and the imperfect manner of their treatment is such as to be a disgrace to the city, which otherwise is deservedly famed for its liberal benevolent institutions. In the present state of affairs it is useless to attempt the recovery of any patients here."

The same remark holds good of the department for the insane connected with the Commercial Hospital in Cincinnati.

Well organized hospitals are the only fit places of residence for the insane of all classes; ill-conducted institutions are worse than none at all. The New York City Hospital for the insane, and the State hospitals of Georgia and Tennessee, cannot take present respectable rank as curative or comfortable hospitals.

Tennessee State Hospital, at Nashville, was opened in 1839. According to an act of the legislature the present year, this hospital is to be replaced by one of capacity to receive 250 patients. In the old hospital are sixty-four patients. Boston City Hospital for the indigent, which has 150 patients, and Ohio State Hospital, at Columbus, were severally opened in 1839. The latter has been considerably enlarged, and has now 329 patients. Maine State Hospital, at Augusta, 1840; patients 130. New Hampshire State Hospital, at Concord, was opened in 1842, and has 100 patients. New York State Hospital, at Utica, was established in 1843, and has since been largely extended, and has 600 patients, Mount Hope Hospital, near Baltimore, 1844-'45; has seventy

two insane patients. Georgia has an institution for the insane at Mill

Rhode Island State Hospital
Ray, early in 1848. New
Indiana Štate Hospital, at

edgeville, and at present 128 patients. opened, under the able direction of Dr. Jersey State Hospital, at Trenton, 1848. Indianapolis, will be opened in 1848. State Hospital of Illinois, at Jacksonville, will be occupied before 1849. The Louisiana State Hospital will be occupied perhaps within a year.

I repeat that these institutions, liberally sustained, as are most of them, cannot accommodate the insane population of the United States who require prompt remedial care.

It may be suggested that though hospital treatment is expedient, perhaps it may not be absolutely necessary, especially for vast numbers whose condition may be considered irrecoverable, and in whom the right exercise of the reasoning faculties may be looked upon as past hope. Rather than enter upon a philosophical and abstract argument to prove the contrary to be the facts, I will ask permission to spread before you a few statements gathered, without special selection, from a mass of records made from existing cases, sought out and noted during eight years of sad, patient, deliberate investigation. To assure accuracy, establish facts beyond controversy, and procure, so far as so far as possible, temporary or permanent relief, more than sixty thousand miles have been traversed, and no time or labor spared which fidelity to this imperative and grievous vocation demanded. The only States as yet unvisited. are North Carolina, Florida, and Texas. From each of these, however, I have had communications which clearly prove that the conditions of the indigent insane differ in no essential degree from those of other States.

I have myself seen more than nine thousand idiots, epileptics, and insane, in these United States, destitute of appropriate care and protection; and of this vast and most miserable company, sought out in jails, in poor-houses, and in private dwellings, there have been hundreds, nay, rather thousands, bound with galling chains, bowed beneath fetters and heavy iron balls, attached to drag-chains, lacerated with ropes, scourged with rods, and terrified beneath storms of profane execrations and cruel blows; now subject to gibes, and scorn, and torturing tricks-now abandoned to the most loathsome necessities, or subject to the vilest and most outrageous violations. These are strong terms, but language fails to convey the astounding truths. I proceed to verify this assertion, commencing with the State of Maine: I will be ready to specify the towns and districts where each example quoted did exist, or exist still.

In B., a furious maniac confined in the jail; case doubtful from long delay in removing to an hospital; a heap of filthy straw in one corner served for a bed; food was introduced through a small aperture, called a slit in the wall, through which also was the sole source of ventilationand avenue for light.

Near C., a man for several years in a narrow filthy pen, chained; condition loathsome in the extreme.

In A., insane man in a small damp room in the jail; greatly excited; had been confined many years; during his paroxysms, which were aggravated by every manner of neglect, except want of food, he had torn out his eyes, lacerated his face, chest, and arms, seriously injured his

limbs, and was in a state most shocking to behold. In P., nine very insane men and woman in the poor-house, all exposed to neglect and every species of injudicious treatment; several chained, some in pens or stalls in the barn, and treated less kindly than the brute beasts in their vicinity. At C., four furiously crazy ; ill-treated, through the ignorance of those who held them in charge. Forty-seven cases in the middle district, either scattered in poor-houses, jails, or in private families, and all inappropriately treated in every respect; many chained, some bearing the marks of injuries self-inflicted, and many of injuries received from others. In New Hampshire, on the opening of the hospital for the reception of patients, in 1842, many were removed from cages, small unventilated cells in poor-houses, private houses, and from the dungeons of county jails. Many of these were bound with cords, or confined with chains; some bore the marks of severe usage by blows and stripes. They were neglected and filthy, and some who yet remain in remote parts of the State, through exposure to cold in inclement seasons, have been badly frozen, so as to be maimed for life. Details in many cases will not bear recital.

In New Hampshire, a committee of the legislature was named in 1832, whose duty it was to collect and report statistics of the insane. Returns were received from only one hundred and forty-one towns in these were returned the names of one hundred and eighty-nine persons bereft of their reason, and incapable of taking care of themselves; ninety men and ninety-nine women. The number confined was seventy-six, twentyfive of whom were in private houses, seven in cells and cages, six in chains and irons, and four in the jails. Of the number at liberty, many had, at various times, been confined. Many of the facts represented by this committee are too horrible to repeat, and would lead many to the belief that they could not be correct, were they not so undeniably authenticated. The committee remark that from many towns no returns had been made, and conclude their report with the declaration "that they could not doubt that the numbers of the insane greatly exceeded the estimates rendered."

Where were these insane? "Some were in cells or cages; some in out-buildings. garrets, or cellars; some in county jails, shut up with felons and criminals; some in almshouses, in brick cells, never warmed by fire, nor lighted by the rays of the sun." The facts presented to this committee not only exhibit severe unnecessary suffering, but utter neglect, and in many cases actual barbarity.

Most of the cases reported, I could authenticate from direct investigation. One very insane woman was confined all winter in a jail without fire; and from the severity of the cold, and her fixed posture, her feet were so much injured that it was deemed necessary to amputate them at the ankle, which was accordingly done.

“Another female was confined in a garret, where from the lowness of the roof, and the restrained position, she grew double, and is now obliged to walk with her hands, as well as her feet, upon the floor." I recollect eight cases corresponding with this, produced from similar causes, in other States. A man was confined in a cellar for many years without clothing, and couching in a heap of wet straw, which was from time to time renewed; another in a similar condition is chained in an

out-building; another is at this time (1846) chained to the floor in an out-building, glad to pick the bones thrown into his kennel, like a beast: one with sufficient property, and formerly correct in life, active and happy. This case was reported to the committee in 1832, who, summing up their report, state, that "in the extremity of disease, the maniac is withdrawn from observation, and is forgotten. His voice, in his raving, grates not upon the ear of the happy. They who have the custody of the wretched being are too prone to forget their duty, and his claims upon them for kindness and forbearance. Their sympathy is exhausted and their kindness becomes blunted by familiarity with misery. They give up the feelings of the friend for the apathy of the jailer." They adopt a common error, that the maniac is insensible to suffering; that he is incurable; and therefore there is no use in rendering the cares his situation demands.

A committee reported (in 1836) to the legislature of New-Hampshire, that their whole number of returns was 312: the number of towns returned having insane, was 141; the whole number of inhabitants in all the towns returned, was 193,569. The number returned as confined, including all in cages, jails, close rooms, by chains and hand-cuffs, &c., was 81. From these statistics, carefully collected, it appears that one in every six hundred and twenty is insane. The committee of 1836 conclude their report as follows: "Neither the time nor the occasion requires us to allude to instances of the aggravated and almost incredible suffering of the insane poor which have come to our knowledge. We are convinced that the legislature require no high-wrought pictures of the various gradations of intense misery to which the pauper lunatic is subjected; extending from his incarceration in the cold, narrow, sunless, and fireless cell of the almshouse, to the scarcely more humane mode of 'selling him at auction,' as it is called, by which he falls into the hands, and is exposed to the tender mercies, of the most worthless of society, who alone could be excited by cupidity to such a revolting charge. Suffice it on this point, your committee are satisfied that the horrors of the present condition of the insane poor of New Hampshire are far from having been exaggerated; and of course they find great unwillingness on the part of those having charge of them to render correct accounts, or to have these repeated to the public."

The report of the nine trustees for the hospital, for 1847, states, that from authentic sources they are informed that "in eight of the twentyfour towns in Merrimack county, having an aggregate population of twelve thousand, there are eighteen insane paupers; part supported upon the town farms, and part set up and bid off at auction from year to year, to be kept and maintained by the lowest bidder." According to the data afforded above, there must be in the State several hundred insane. supported on the poor-farms, or put up at auction, annually.

In Vermont, the same neglects, ignorance, and sometimes brutal severity, led to like results. Dr. Rockwell, his assistant physicians, and the whole corps of hospital nurses, bear accordant testimony to the sufferings of patients formerly brought to that institution from all parts of the State; and many even now arrive under circumstances the most revolting and shocking, subject to the roughest treatment or the most inexcusable and extreme neglects.