morally and legally, and decidedly opposed to the patient's recovery.

To decide which cases belong to the former category and which to the latter, and to judge when a given case passes from one category into the other, requires, I admit, careful observation and ripe judgment, but no more, I am prepared to maintain, than do many other problems in medicine and surgery which are decided every day in our midst with average good success.

5. Cases of primary dementia occur frequently in both middleaged and old people. Many such patients are simply foolish, but quite harmless. Why are they sent to asylums, except for safe keeping, because of the lack of relatives, or because of pecuniary inability of friends to take care of the deteriorating member of the family; or lastly, pretty often, I fear, because of unwillingness to keep the patient at home?

In all these three categories I believe that confinement under the present asylum system is unjustifiable, legally and morally.

What right have we to bar a man's window and keep him all day, or part of the day, for months and years, under lock and key, because he is simple or foolish, or, to put it technically, demented?

The pauper insane of the harmless demented class must, I suppose, be aggregated in institutions, preferably under medical supervision, if not medical control, but have we not the right to demand that these unfortunates shall have the maximum of personal liberty consistent with safety to themselves and others; that they shall be both employed and amused in an inexpensive manner? Must we not remember that so long as any reason survives, perhaps longer, the animal capacity for simple enjoyment persists? How many hundred chronic insane in this nation are quite capable of enjoying a game of cards or dominoes, bowling, a pipe of tobacco, etc., in comparative freedom, under a surveillance that need not at all resemble the present prison-like manner of watching patients in asylums?

6. Epileptic and hysteric patients are rarely detained in asylums without justification. I have had personal knowledge of such

cases.

The alleged cause of certification originally, and of unlimited detention afterward at the request of relatives, is some psychical disorder which, in a majority of cases, is temporary, and quite as much under the control of a physician as of a superintendent.

I do not, let it be clearly understood, mean to say that such cases should not be sent to institutions, but I protest most energetically against their commitment to prison-like asylums, to their forced association with the insane, and their subjection to the imperfect medical treatment which obtains in most asylums.

Removal from home often does much good in these diseases, and is a sine qua non to recovery in certain cases of hysteria; but from this statement to the present evil practice of judicial commitment and locking up there is a vast gulf-a gulf as deep and wide as is the great human right to personal liberty.

I do not mean to refer in detail to a last class of cases, viz., those in which a sane person is fraudulently imprisoned as insane under our present imperfect laws.

I firmly believe that such cases are extremely rare, and from my personal knowledge of many of the superintendents of insane asylums, I do not believe that any of those gentlemen would for one moment countenance such a procedure.

I trust that I have made myself understood.

With many others, some of them to be cited further on, I believe : (a) That a large number of the inmates of asylums could be taken care of with open doors and unbarred windows, and, of course, without restraining apparatus.

(b) That many insane now confined in our asylums could be trusted almost implicitly to go and come at will; could be given nominally remunerative occupation, and, above all, could be provided with simple amusements suited to their stations in life (and I do not refer to costly stereopticons, or the solitary billiard table, or the lectures, to which superintendents now refer with so much complaisance).

(c) That the phases of insanity should be watched more closely, with especial reference to early discharge of a patient; to his transfer to another institution; to the amount of liberty allowed him, etc. And I do not think it safe to leave this power wholly in the hands of the superintendent.

(d) That the time has come to look around and attempt in this country the English and Scotch plan of placing harmless insane persons singly in the families of farmers, and of others willing to undertake the task under frequent and efficient visitation.

There is not, I dare say, a single county in the State of New York where a number of harmless chronic, or even sub-acute,

cases of insanity might not be safely and happily treated or kept in families, and where a good, yet just and firm country doctor, could not be found to visit a dozen or more of these patients occasionally and unexpectedly, and keep a strict watch over their health and happiness, reporting fully to the State Commissioner or Commissioners of Lunacy, or to a special general inspecting official.

There are, I have reason to believe, many families who would much prefer to keep their insane in this manner, at a reasonable cost, who are made to shudder at the mere mention of an asylum, whose long and desolate corridors they see in imaginátion, whose locks and keys they almost think they can hear, and whose deteriorating influences upon patients they more than half suspect.

While expressing the above views I also desire to state just as clearly my belief that certain cases of insanity, more especially acute mania or melancholia, all psychosis accompanied by homicidal, suicidal or marked destructive tendencies, should be placed, as quickly as the law will allow, in confinement. But even here we may implore that the confinement may be made as easy as possible for the unfortunate patient, who is, contrary to public prejudice, just as much a sick man as if he had phthisis or a chronic ulcer; and that all the barbarous means of corporeal restraint, such as cribs, jackets, straps, etc., shall be radically done away with as asylum implements, as a part of the nosocomial armamentarium, and only applied by express directions of the medical officer in exceptional cases, very much in the same way as we resort to heroic medication or surgical procedures in general practice.

If you will pardon a simile, I would say that I look upon restraining apparatus in the treatment of insanity very much as upon the lancet in the treatment of general diseases. The sight of restraining apparatus in an asylum seems to me as demoralizing and uncalled for, as would be the carrying of a lancet and the celebrated palette by a physician of today in his hospital visit. Bleeding is generally condemned, and so is physical restraint of the insane, excepting in this country, and yet I will not deny but that once in a while, under peculiar circumstances, both phlebotomy and restraint are justifiable. Let us join in the hope that before many years both procedures will be equally rare.

I desire to close this essay by reference to the opinions of much abler men, and much more expert specialists than myself upon this subject. And I believe that the gentlemen whose views I am

to quote are so eminent in their specialty that the most bigoted defender of our present prison system of asylums cannot question their right to be considered as foremost authorities.

Dr. Henry Maudsley, who has held almost every possible official position in relation to insane administration in England, and who is justly regarded as one of the most distinguished European alienists, expressed himself as follows, years ago: I quote from the second edition of "The Physiology and Pathology of the Mind" (London, 1868):

"To be a lunatic, as public sentiment goes, is to be cut off socially from humanity. With such feeling prevalent with regard to the insane, can it be thought possible that the treatment, at present sanctioned by general approbation, should be the most just and humane possible? The feeling is one which cannot be justified, and the system which it inspires cannot be just. That system is the system of indiscriminate sequestration — of locking up a person in an asylum simply because he is mad.

"Now, I believe this practice to spring out of an unjust feeling, as already said, and to be founded on false principle, as I shall now endeavor to show. The principle which guides the present practice is that an insane person, by the simple warrant of his insanity, should be shut up in an asylum, the exceptions being made of particular cases. This I hold to be an erroneous principle. The true principle to guide our practice should be this: that no one, sane or insane, should ever be entirely deprived of his liberty, unless for his own protection or for the protection of society." (pp. 494, 495.)

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"I venture, indeed, to affirm in opposition to it, that there are many chronic and incurable insane persons, neither dangerous to themselves nor to others, who are at present confined in asylums, and who might as well be at large." (p. 495.)

"Another objection to the liberation advocated will be, that the insane in private houses will not be as well cared for as they are, nor have any more comfort than they now have, in wellconducted asylums. The quarter from which this objection is urged taints it with suspicion; I never heard it put forward but by those who are interested in the continuance of the present state of things. Those who make it, appear to fail entirely to appreciate the strength of the passion for liberty which there is in the human breast; and as assuredly there are but

very

few persons

who would not infinitely prefer a garret or a cellar for lodgings, with bread and water only for food, to being clothed in purple and fine linen, and faring sumptuously every day as prisoners; I can well believe that all the comforts which the insane person has in his captivity are but a miserable compensation for his entire loss of liberty, that they are petty things, which weigh not at all against the mighty suffering of a life-long imprisonment." (pp. 496, 497.)

"For the reasons adduced, I cannot but think that future progress in the improvement of the treatment of the insane, lies in the direction of lessening the sequestration and increasing the liberty of them." (p. 501.)

"Not the least of the evils of our present monstrous asylums, is the entire impossibility of anything like individual treatment in them." (p. 502.)

"Indeed, I cannot help feeling, from my experience, that one effect of asylums is to make some permanent lunatics.

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." (p. 503.)

Our distinguished countryman, Dr. Samuel G. Howe, everywhere known for his philanthropic efforts, enters a noble protest against the unnecessary restraint of lunatics by confinement to asylums, in the Sixth Annual Report of the State Board of Charities of Massachusetts, for 1869. I quote:

"Yes, disguise it as we may, we do keep under unnecessary restraint and in a sort of slavery, a multitude of unfortunates who sigh for liberty, and to whom it would be very sweet. Their appearance of quiet and their seeming acquiescence are oftentimes utterly deceptive. Bewildered, doubtful of their own power of self-guidance, half conscious of insanity, still they know enough to know that the whole power of society holds them in its grip, and they resign themselves in despair." (p. lxxxvii.)

"It would be folly to deny that restraint by walls, by iron sashes, by oaken doors and by constant guard is necessary for a certain class of patients under our mode of treatment. But it is equal folly to maintain that it is necessary for all, or for ninetenths; and if not necessary, upon what ground can we defend our violation of a right which the lunatic never forfeited?

"It is sinful and criminal to abridge unnecessarily the freedom of