This is a very lengthy Letter to the Editor of The New York Times written by MEDICUS, The Medicus – A Journal for the Busy Practitioner, of the nineteenth century. What MEDICUS was basically stating among other things was: After 1890 with the passage of THE STATE CARE ACT, all New York State Hospitals accepted both CHRONIC and ACUTE patients from their corresponding districts so that the patients would be able to remain in their hometown area. There were no longer asylums specifically for the CHRONIC INSANE as in WILLARD and BINGHAMTON State Hospitals. However, if an asylum became overcrowded, the state would transfer patients to another state hospital out of the patients’ district. The main point that MEDICUS made was: If New York State was transferring patients out of their district to another state hospital, why couldn’t the State pay for the transportation of patients whose family and friends wanted them to receive HOMEOPATHIC medical care as opposed to ALLOPATHIC medical care? They eventually won their case. There were two STATE HOMEOPATHIC HOSPITALS for the Insane: MIDDLETOWN located in Middletown (1874), Orange County, New York; and GOWANDA (1898), located in Collins, Erie County, New York.

DEFINITIONS:
“HOMEOPATHY: a system of medical practice that treats a disease especially by the administration of minute doses of a remedy that would in healthy persons produce symptoms similar to those of the disease.

System of therapeutics founded in 1796 by Samuel Hahnemann on the principle that ‘like cures like.’ That is, substances that in healthy persons would produce the symptoms from which the patient suffers are used to treat the patient. Hahnemann further stated that the potency of a curative agent increases as the substance is diluted. When it was introduced, homeopathy was a mild, welcome alternative to heavy-handed therapies such as bleeding, but it has since been criticized for focusing on symptoms rather than causes. With the rise of alternative medicine, it has seen resurgence.”

“ALLOPATHY: a system of medical practice that aims to combat disease by use of remedies (as drugs or surgery) producing effects different from or incompatible with those produced by the disease being treated. 2. a system of medical practice making use of all measures that have proved of value in treatment of disease.”
SOURCE: Merriam Webster.com

Middletown State Homeopathic Hospital 1896

THE MIDDLETOWN HOSPITAL. It’s History And The Laws Which Govern It.
How It Is Affected By The State Care Of The Insane Act –
How Proposed Legislation Would Affect The Insane Poor.

 To the Editor of the New-York Times:

The State Homeopathic Hospital, or, as it was formerly called, the State Homeopathic Asylum, was established by act of the Legislature of 1870 and was opened in 1874. The friends of homeopathy, in order to secure an asylum for the insane in which the treatment should be exclusively of the homeopathic order, entered into an agreement with the State substantially to contribute $100,000 for each $100,000 which the State should furnish. This agreement was carried out to only a very limited extent.

The utmost claim put forth by the friends of homeopathy as to the extent of the carrying out of the agreement on their part is this – that they contributed a few hundred acres of land and the sum of $50,000 in cash. The State was induced to waive the carrying out of the remainder of the agreement, and the institution was fully organized and equipped as a State institution in all respects whatsoever, differing in no regard from the other hospitals of the State, with the exception of the insertion of a special clause in the statute which provided that the treatment should be wholly of the homeopathic order. Subsequent legislation was obtained providing that the acceptance of the office of Trustee should amount to a pledge on the part of such officer that the principles of homeopathy should be maintained. A reference to the organic act will show that, with the above exception, it was placed precisely upon the same footing as the other, at that time, so-called “acute” asylums for the insane, said act of 1870 providing for the doing of that which had been and might be done without its passage, namely, that to the extent of its capacity courts and Judges should have the power to commit such pauper and insane poor from any part of the State as might desire to secure homeopathic treatment. The right to receive private or pay patients was also conferred upon the MiddletownStateHomeopathicHospital in the same manner and to the same extent only as was conferred upon the UticaStateHospital, which is the governing act of all the State hospitals in the State.

This act provided that such private or pay patients might be received whenever there were vacancies. From the foregoing it will readily be seen that the Legislature unquestionably intended that, while the treatment given should be purely of the homeopathic order, in all other respects the hospital should be conducted under the same laws and in the same manner as all the other State insane asylums.

By the passage of this act and the erection of this asylum the Legislature of 1870 did what had never before been done in the history of its dealings with the dependent insane, to wit, recognize a particular school of medicine-a distinction which to this day no other school has sought or had-yet, so far as a study of the statutes reveals, it was indisputably intended that the corporation of this asylum should be held to as strict a measure of legal accountability as any one of the other State asylums, an that it should enjoy no other or greater privilege than was possessed by all of them.

This institution, from the time of its erection down to the time of the passage of the State Care act, had always been regarded in the same light as the other State asylums of the State. It received appropriations from the Legislature and its capacity was enlarged from time to time, the laws under which it was governed remaining the same as when established, except as modified by the State Care act, which was prepared, it is understood, by Theodore W. Dwight, the distinguished Warden of the Columbia College Law School-than whom a more just or equitable man never lived-provided, as is well known, for the division of the State into as many districts as there were State asylums for the insane, and provided that the insane poor of any particular district should be sent to the hospital situated within said district. But the author of the statute, no doubt having in view the Middletown State Homeopathic Hospital and the special treatment given there, provided that, if a patient or his friends elected so to do, he might be received into an asylum beyond the limits of the district in which he lived upon the following conditions:

First – That there shall be a vacancy in the hospital in which the patient desired treatment.

Second – That the consent of the Superintendent of the hospital and the consent of the Chairman of the State Commission in Lunacy shall be obtained.

Third – That the patient’s friends or relatives should pay the expense of transportation beyond the limits of the district in which the patient resides.

It would not have been necessary to impose any condition upon the free choice by a patient of a hospital in which he might desire treatment, had it not been for the fact that, except for some such condition, Superintendents of the Poor, for the sake of the increased mileage and emoluments which could be derived from traveling long distances, might frequently take patients to asylums situated a long distance from the place in which the patient lived. In fact, but for this reason it perhaps might not have been necessary to have established any districts whatever, as, if the element of greed could have been eliminated, convenience, accessibility, and the desires of the patients and their friends might safely have been trusted to regulate the whole matter. It was necessary, however, that some check should be imposed, in order that patients may not be obliged to travel greater distances than are absolutely necessary; and, therefore, on of the conditions named was that of requiring the consent of the President of the State Commission in Lunacy. But inquiry at the office of the commission shows that since the State Care act went into effect on the lst of October, 1890, less than thirty applications to go beyond the limits of the district have been received, thus clearly showing that a comparatively small number of people have any choice or care anything whatever as to what particular institution their insane relatives of friends shall be cared for in.

The legal rights heretofore enjoyed by the Middletown Hospital have not been interfered with in any way by the passage of this law except in the manner herein indicated. The right to receive private or pay patients under the law is precisely the same to-day as it was at the time the hospital was first opened, namely, the right to receive that class of patients when vacancies exist. The passage of the State Care act did not in any other manner whatever change existing laws upon the subject. But upon the taking effect of the State Care act on the 1st of October, 1890, it was found that there were about two thousand more insane poor to be provided for than could be accommodated in all the State hospitals in the State, and, of course, there ceased to be any vacancies for the admission of private or pay patients in the State hospitals. The State Commission in Lunacy, to which is confided the execution of the laws of the State so far as they affect the insane, were compelled to enforce the law in regard to the admission of private patients. It did not, however, enforce the law as rigorously as it might have done. It held that, at least within the spirit and intent of the law, private patients whose means are limited to the extent of being able to pay but a small sum per week might be admitted, and such patients have been admitted without objection from that time to this: That it declined to permit the admission of wealthy or high-priced private patients on the ground that the admission of such patients was not provided for by the statute, and that they could be provided for in the private asylums of the State, of which there are a large number representing the two principal schools of medicine, or equally open to both.

The bill which has passed the State Senate, if it becomes a law, will for the first time in the history of the State establish a principle which has been justly regarded as foreign to the spirit of our institutions, namely, the principle of paternalism in government – the duty of the State to provide for a class of its citizens able to provide for themselves. Moreover, it places at the disposal of one of the schools of medicine in the State a great hospital for the insane, which has cost in round numbers a million of dollars, and practically discriminates against all the other schools of medicine. This bill, which many have believed to simply restore the law as it existed prior to the passage of the State Care act, not only does this, but goes very much beyond it, as it provides for the admission of the indigent and insane poor from any part of the State, and also for the admission of “private patients” of whatever grade and upon such terms and conditions as may be fixed by the Trustees of the institution. In fact, the words “private patients” are for the first time recognized in the statutes of the State. The words “when vacancies exist” are wholly eliminated, so that it becomes a pure matter of discretion in the Trustees of a State institution, which is owned and controlled by the State and supposedly erected for the benefit of the insane poor now in the poorhouses or the wealthy private or pay patients. This is the really objectionable and dangerous feature of the bill. No matter how pressing may be the necessities of the insane poor, the rich who are able to provide for themselves may have the preference if the Trustees choose to give it. Singularly, too, no restrictions have surrounded the question of the determination of who desire homeopathic treatment. Upon the mere say-so of the patient or his friends, which would be sufficient to a Superintendent of the Poor, a patient may be transported hundreds of miles across the State to this institution simply for the purpose of adding to the fees and emoluments of a Superintendent of the Poor.

The right of the indigent insane for whom homeopathic treatment is desired to free admission to the Homeopathic Hospital from any part of the State might, perhaps, be conceded without any intervention or concurrence on the part of the Lunacy Commission, although in practice, as already stated, the occasion for such concurrence seldom arises. And incidentally, it may be added at the Lunacy Commission office the fact is freely admitted that they would, personally, be glad to be relieved of all connection with the matter, provided that some other efficient safeguard against imposition and abuse in the matter of transportation charges were suggested.

It is claimed by the friends of the Middletown State Hospital that medical liberty has been encroached upon by the passage of the State Care act. It is difficult, however, to see wherein this effect has been produced. The free and unrestricted right of the Middletown State Homeopathic Hospital to give homeopathic treatment has not been abridged in any manner, nor, so far as it is known, is it claimed to have been abridged. But while by the passage of the bill under discussion this liberty demanded in the name of homeopathic profession will have been extended even further than as it was held before the State Care act became law, an equal measure of the same liberty is practically denied to all other schools of medicine.

The laws of the State of New-York, with the exception above indicated, have never recognized any particular school of medicine whatsoever, and do not do so now. The rules and regulations of the Civil Service Commission, so far as they relate to schools of medicine, place them upon an equality, and always have done so. The right of any particular school of medicine, so far as the method of treatment in the other State hospitals is concerned, is not abridged in any way. A homeopathic physician may secure appointment in any of the other hospitals in the State, and enforce such medical treatment as he believes in, without let or hindrance. But, if medical liberty is to be enjoyed by one school of medicine, it is difficult to see why it should be denied to the others; in other words, why a wealthy private patient who desires homeopathic treatment should be afforded by the State magnificent opportunities for its enjoyment at Middletown, while another patient who, for example, desires allopathic treatment in the Buffalo State Hospital or the Utica State Hospital, should be denied an equal privilege. It is hard to conceive how the State can thus discriminate against its citizens, can thus patronize one school of medicine at the expense of another, can place a great hospital, with all the prestige which such an institution commands, at the exclusive disposal of one school of medicine, without conferring a like privilege upon other schools; how, for instance, the eclectic school of medicine be denied the same privilege of the use of a State Hospital wherein only the eclectic method of treatment shall prevail.

The effect of the passage of such an act could not fail to be most pronounced upon State care of the insane, for it can hardly be denied that if this privilege is extended without restriction to the Middletown State Homeopathic Hospital it will ultimately, if not immediately, be claimed for and must be given to all other State hospitals of the State. This would, in practical effect, destroy the distraction system, would greatly embarrass the operation of the law, and would necessitate making large additional provisions for the insane poor, since the amount of space for the insane poor, since the amount of space occupied by the wealthy private or pay patients is out of proportion to that occupied by the insane poor. Frequently it is as high as six to one, sometimes as high as twelve to one. Over and beyond the question of the recognition of one particular school of medicine by the State to the exclusion of the others, the broad question remains of how far the State is to make provision for of its citizens as are able to make provision for themselves, how far it is willing to compete with the efforts of private individuals, who are permitted and in fact encouraged by law to operate and maintain private insane asylums.

Let it be repeated that the passage of this bill will confer privileges which the institution never before enjoyed, and which an examination of the statutes heretofore enacted will clearly show were never intended to be given. It hardly seems credible that the great body of the homeopathic medical profession desire to be relieved from their share of the responsibility of caring for the insane, or to be given privileges which cannot be exercised in an equal degree by the other medical schools of the State.  MEDICUS.
BUFFALO, Sunday, April 12, 1891.

SOURCE: Reprinted from The New York Times. Published April 19, 1891. Copyright @ The New York Times.