The conditions that existed in the county poor houses of New York State during the nineteenth century were deplorable. Thousands of desperate working class people who were down on their luck and had nowhere else to turn found themselves knocking at the doors of the county poor house in order to survive. Men, women, and children were congregated together in the main house. The “insane” were kept chained and shackled to floors and walls in windowless basements, outhouses, and sheds. In 1864, an investigation was made concerning the treatment of the “insane” confined in the county poor houses of New York State. Dr. Sylvester D. Willard’s Report was the instrument that persuaded the New York State Legislature to pass, on April 8, 1865, The Willard Act, “An Act to authorize the establishment of a State asylum for the chronic insane, and for the better care of the insane poor, to be known as The Willard Asylum for the Insane.” When the county physicians returned the completed questionnaires, Dr. John B. Chapin not only compiled all the data that was presented to the legislature but wrote Sections 10 and 11 of the law. Dr. Chapin became the first Medical Superintendent of the Willard Asylum for the Insane when it opened its doors on October 13, 1869. What follows is the original report to the New York State Legislature by Dr. Sylvester D. Willard, Secretary of the Medical Society.
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Article XVII. Report on the Condition of the Insane Poor in the County Poor Houses of New York. By Sylvester D. Willard, M.D., of Albany.
To the Honorable the Legislature of the State of New York:
As Secretary of the Medical Society of the State of New York, I was authorized by an act passed on the 30th day of April, 1864, to investigate the condition of the insane poor in the various poor houses, alms houses, insane asylums, and other institutions, where the insane poor are kept, not including, however, such institutions as are now required by law to report to the Legislature of the State.
The law directed that I should arrange a series of questions, such as in my judgment would be likely to elicit the greatest amount of information on this subject, procure them printed, and transmit them to each county judge in the State. It directed the county judge on the reception thereof, to appoint a competent physician, a resident of the county, to visit the county poor house, or institution where the insane poor are kept, and to examine into the condition and treatment of the insane inmates, and to transmit the result of the investigation to the undersigned. It directed me, thereupon, to condense the information so received and report the same to your honorable body.
Previous to entering upon this duty, I visited Dr. John P. Gray, the Superintendent of the New York State Asylum at Utica, and Drs. George Cook and John B. Chapin, Superintendents of Brigham Hall Asylum for the insane at Canandaigua, for the purpose of conferring with them, relative to the more important facts that should be developed by this investigation, with a view to the practical results to be attained by it. It is proper, though almost needless to remark, that the plan of this investigation met the cordial approbation of those gentlemen, together with the kind offer to bestow any assistance they could render to facilitate so important a labor. It is unnecessary to speak in this report of the cruelties that were practiced upon the insane in a less civilized age, but the object will be so-far as possible to direct our attention to the misery and wretchedness that still exist, in the hope of inducting measures for its aversion in the future. (It is due to acknowledge that this investigation was instigated by Dr. Wm. H. Riehardson, of Essex; Dr. C. M. Crandall, of Allegany; Dr. W. H. Barnes, of Columbia, and Dr. Julien T. Williams, of Chautauqua, Members of Assembly, on the committee of public health in 1864. They were all earnest in support of the measure.)
The attention of the Legislature was drawn to the condition of the insane poor in 1857, by an elaborate report of the select committee of the Senate, appointed in 1856, to visit the charitable institutions supported by the State, and city and county poor and work houses and jails. The committee consisted of Senators Mark Spencer, George W. Bradford and M. Lindley Lee. They entered with enthusiasm upon their mission. Their visits were made during the summer, when the population of the poor houses was one quarter less than in winter. It is apparent, therefore, that they did not witness the suffering incident to winter, when the sleeping rooms would be over-crowded, when the want of fuel, and bedding and clothing would be most felt. But the miseries in which they found the insane poor confined in the various county poor houses are appalling, and shocking to record. Doubtless that report stimulated some of the county authorities to remove to some extent the stigma and disgrace it fastened upon them, but it led in most instances to no permanent improvement, nor did the State act in view of it to a more ample provision for these unfortunates. The Medical Society of the State has likewise in years past, directed the attention of the Legislature to the importance of more ample provision for the insane, but its suggestions have been likewise unheeded.
The New York State Asylum at Utica, is an institution in every respect worthy of the great State by whose liberality it was erected, and is now supported. Grand as is the scale on which it is conducted, it is not sufficient to meet the claims that are made upon it.
In order to make room for recent cases, and such as afford promise of relief or cure by treatment, and those are constantly urging for admission, and humanity demands that they shall not be turned away, it becomes necessary for that institution to return to the counties by which they have been supported at the asylum, many chronic and incurable cases. Such insane persons are therefore sent to the county poor houses where others are confined who have never been able to gain admittance at the State Asylum, or who have been untimely removed for new patients. In many of the county houses there are a large number of the insane inmates who have never been sent by the authorities to the asylum. Indeed the law gives county officers no authority to send cases of more than one year’s duration to the State Asylum. In many instances the counties have had little or no disposition to send recent cases there, prompted by the idea that they can be supported at a less expense in a county poor house. The State has grown immensely in population, and in due ratio the number of its insane have increased, until its State Asylum is filled to its utmost capacity, and the tide of its overflow has set back upon county poor houses; and they too, have become filled to an excess of human misery, degradation and wretchedness that wrings a cry of distress from the heart of every philanthropist. These evils have become so great and so glaring, that they are a stigma upon the class of our charitable institutions where insane poor are confined, upon our communities, and upon the fair name of our State. It is in vain that we any longer attempt to conceal the true condition of lunatics in county poor houses, or to pacify the pleadings of humanity in their behalf, with the excuse that a great war is involving our public attention, and that we cannot remedy their condition now. Humanity will listen to no such false representation. Truth will not bear testimony to such an excuse. The facts elicited by this investigation are too appalling to be forgotten, and too important to be thrown aside. Repulsive to our sensibilities, as many of the facts set forth are, the investigation was made in the summer when the suffering from want of care and clothing is less than in winter, and consequently it does not show the state of things as bad as they really exist at some seasons of the year.
The following is the series of questions sent to each county.
1. What is the population of your county house?
2. How many insane are there at present provided for?
3. How many males are capable of labor?
4. How many females are capable of labor?
5. How many males perform out of door labor?
6. How many females perform out of door labor?
7. What amusement have those who are unable to work?
8. What amusement have females who are unable to work?
9. What number are destructive and tear off their clothing?
10. How many are restrained by chains or hand-cuffs occasionally?
11. How many constantly?
12. What other forms of mechanical restraints are used?
13. What other means are resorted to for controlling and managing the violent insane?
14. Has the poor house a full supply of water?
15. How many bath tubs are there in it?
16. How often are the insane required to bathe?
17. Is each insane washed, hands and face, daily?
18. Is any arrangement made for cleanliness, ventilation and uniformity of heat in winter?
19. Are any insane confined in basement cells?
20. Are any so confined without the privilege of coming daily into the open air?
21. Is the building in which the insane arc confined of wood or brick?
22. How many stories?
23. What is the height of each story?
24. What is the length and width of each room?
25. What is the size of each window?
26. Are there any rooms without a window opening out of doors?
27. What are the floors made of?
28. Are any of the basement rooms without a floor?
29. Have you bedsteads in all the rooms?
30. Are the bedsteads of wood or iron?
31. Are they fastened to the floor?
32. Have you double or single beds?
33. How many sleep in one bed?
34. What is the greatest number, in any case, who sleep in one bed?
35. What material do you use for bedding?
36. How many sleep on straw alone, without bedsteads or beds?
37. How often is the straw changed?
38. What is the diet provided each day?
39. How is it distributed to each?
40. How is the building heated in winter?
41. Are all the rooms heated?
42. Is attention paid to the uniformity of heat by a thermometer?
43. What is the temperature maintained?
44. Are any insane confined in rooms without heat, in the winter?
45. Are there any accommodations for the various grades of insane?
46. If so, what?
47. Are they all confined in one ward?
48. How many in single rooms or cells?
49. Are the sexes kept entirely separated?
50. Are male attendants employed to care for female insane?
51. Are any attendants beside paupers uniformly and constantly employed in the immediate care of the insane?
52. What is the actual condition of the rooms and cells occupied by insane, as to cleanliness?
53. What do you think of the atmosphere of the rooms?
54. Did you look for vermin on their persons?
55. Did you observe any?
56. Are any of the pauper insane cared for in private families?
57. Does your county take care of recent cases?
58. What changes of under garments have each of the insane?
59. How many have shoes?
60. How many had neither shoes nor stockings during the winter?
61. What number of insane is your county house designed to accommodate?
62. What is the greatest number ever there confined?
63. Are the accommodations separate from those of the sane paupers?
64. How many escaped within a year who were not returned?
65. How many were removed by their friends?
66. What provisions are made for medical treatment of the insane?
67. How often are they actually visited?
68. Does each case receive care with reference to its ultimate recovery?
Number; name; age; sex; native: foreign; year of admission; occupation; mild; excitable or paroxysmal; violent; filthy; destructive; confined to house; confined in strong rooms; requires mechanical restraint; been treated in an asylum; died during the year; discharged.
The direction to the physician appointed by the county judge is as follows:
Medical Society Of The State Of New York, Albany, N. Y., May, 23, 1864.
Sir – In obedience to the appointment made by the judge of your county, in accordance with chapter 418, Session Laws 1864, a copy of which you will find herewith, you are requested at an early day to visit your county poor house, alms house, or asylum, and make the investigations as indicated in the blanks enclosed. You are requested to give the overseer or superintendent no notice of your appointment or the time of your visit, and upon your arrival to enter at once upon the duties assigned to you. The object is to see every insane inmate, and all the surroundings precisely as they exist in the every day condition of the institution, to discover the evils which exist in the management of the insane poor, and by this well directed effort so bring them to light as to incite a wise and generous legislation in respect to them, with such actual provision for this unfortunate class of our fellow beings as is in accordance with the teachings of science, and the dictates of an enlightened humanity.
Your services will be a claim upon your county, to be audited by your board of supervisors on the voucher of the county judge. You can retain one set of the blanks for your own personal use, one for the use of the county judge, one for your board of supervisors, and return the remaining two to me, on or before the time specified in section 2d.
Very respectfully yours, S.D. WILLARD, M.D., Secretary.
Returns have been received from all the counties but Onondaga, Clinton, Wyoming and Hamilton. The city and county of New York, among her great public charities, maintains a large and well conducted asylum for the insane on Blackwell’s island. Kings county has also provided properly for her insane poor, and these two counties were not embraced in this investigation.
Oneida county feels the influence of the State asylum, and hence has an institution more satisfactorily conducted than in any of the other counties.
The earnest attention of the Legislature is requested to the subjoined report for each particular county. The facts have been furnished in accordance with the law by a competent physician, resident in the county, who would have no motive for representing them unfavorably.
It is not my intention to set forth fully all the evils that are brought to light by this investigation, in the condition of the insane poor, but to notice briefly a few of the more prominent ones, and then suggest a remedy for these terrible abuses.
The investigation shows gross want of provision for the common necessities of physical health and comfort, in a large majority of the poor houses where pauper lunatics are kept. Cleanliness and ablution are not enforced, indeed, very few of the institutions have even the conveniences for bathing, and many of the buildings are supplied inadequately with water. In a few instances the insane are not washed at all, and their persons besmeared with their own excrements, are unapproachably filthy, disgusting and repulsive. In some violent cases the clothing is torn and strewed about the apartments, and the lunatics continue to exist in wretched nakedness, having no clothing, and sleeping upon straw, wet and filthy with excrements, and unchanged for several days. The number of these cases may not be large, but there should be none such. There exists gross inattention to ventilation, and in frequent instances these unfortunates are denied even the fresh air of heaven. The buildings in many instances are but miserable tenements and were erected without any regard to ventilation. It is impossible from their very construction and arrangement to procure uniformity of pure air, and thus another great principle of health is denied. It will be observed that the returns not unfrequently mention the air of the rooms as “foul,” “bad,” “unhealthy.”
In some of these buildings the insane are kept in cages, and cells, dark and prison like, as if they were convicts, instead of the lifeweary, deprived of reason. They are in numerous instances left to sleep on straw like animals, without other bedding, and there are scores who endure the piercing cold and frost of winter without either shoes or stockings being provided for them – they are pauper lunatics, and shut out from the charity of the world where they could at least beg shoes. Insane, in a narrow cell, perhaps without clothing, sleeping on straw or in a bunk, receiving air and light and warmth only through a diamond hole through a rough prison like door, bereft of sympathy and of social life, except it be with a fellow lunatic, without a cheering influence, or a bright hope of the future! Can any picture be more dismal, and yet it is not overdrawn.
There are but few of the poor house asylums that have any provision for exercise in the open air, or sufficient yards or grounds for it. The mild cases wander about often where they please, but not so the more violent, and in stormy or winter weather all are kept housed together. No system of exercise is established, no amusement is furnished for the weak, the feeble, the melancholic. Each one is allowed to dwell upon and magnify the evils of a disordered mind, and thus become more distressed, confirmed, incurable, demented. No amusements are furnished, no pleasant occupation devised. The violent have only to rave and become more violent, and pace in madness their miserable apartments. These institutions afford no possible means for the various grades of the insane; the old and the young, the timid and the brazen, the sick, the feeble, and the violent, are herded together without distinction to the character or degree of their madness, and the natural tendency is for all to become irretrievably worse.
There is no uniform system of mild government and restraint of lunatics in poor houses. The attendants for the most part employed to care for them are the pauper inmates of the establishment! Paupers, who in many instances are depraved by vice, cold, sordid, selfish from poverty, utterly incapable of taking care of themselves; these are employed to oversee and apply moral and physical means of restraint for the insane! To paupers is committed the task of carrying them food and supplying their daily wants. The consequences are the most wicked and cruel neglect, and not unfrequently brutal treatment of these unfortunates, and the punishments inflicted on them are arbitrary, cruel and undeserved. There is an utter destitution of well trained, kind, efficient attendants. The mingling of sane and insane paupers, the male attendants in some instances in the care of female insane, and the commingling of the sexes, in no way promote either restoration or virtue.
Where recent cases are received into a poor house no special attention is generally given to them with reference to their ultimate recovery. The medical attendance is so embarrassed by want of means for general care, that it is impossible to arrive at any satisfactory management of the insane, and it proves as unsatisfactory to the physician as it is without benefit to the patient.
Few of the interior counties have more than thirty lunatics, and several less than twenty. It is impossible to maintain an asylum efficient in all its apartments with such a small number. It would incur an expense quite too large and unnecessary, without commensurate advantage to the inmates.
His Excellency Governor FENTON, in his message to your honorable body, alludes to this subject as follows:
“The Legislature of 1864 directed an investigation into the condition of the insane poor confined in the various county poor houses. A report, by Dr. S. D. Willard, will be duly presented, showing the deplorable condition of this most unfortunate class. There are in fifty-five counties, not including New York and Kings, thirteen hundred and forty-five lunatics, confined in poor houses or poor house asylums, nearly all of whom are incurable; many have become, and others are fast becoming incurable, from inefficient care and treatment. The time has arrived when Legislative provision for them should be made. The propriety of establishing an institution for incurables – an institution that shall relieve county authorities from the care of the insane, should be deliberately considered.
“More than one fourth of this number of insane are capable of some labor. To what extent that labor, organized and systemized, might be made productive in the maintenance of an institution, under well directed medical superintendence, is likewise worthy of consideration.”
The suggestion of His Excellency seems entirely practical and economical. Let an institution for incurables be established. Let the incurables be there colonized. Take the insane from the counties where they are ill provided for first, and change the law relative to the insane poor, so that counties shall not have the management of them, nor any authority over them. The statistics gathered show that out of 1,345 insane, 345 are capable of labor; properly managed, this number would be increased, and there would be gathered into such an institution scores of mild cases now at large, whose friends, unable to support them at the State Asylum, are unwilling to consign them to the miseries of the poor house. By such a regulation, the cost of supporting each insane person would be diminished, so that the expense to each county would not be greater, and probably much less than it now is, while the lunatics would enjoy the benefits and comforts of a well regulated institution. The early attention to their care would doubtless insure recovery to a much larger number than now become restored, and cases that progress to violence, filth or dementia, might remain mild and passive.
It is a fearful thought that, among the poor, parents who from the ills of life suffer mental alienation, fathers depressed from losses and anxiety, mothers exhausted with child bearing and the rearing of a large family, the youthful, from vice or disappointed hopes, and the foreigner among strangers, looking wistfully back to his native home, that these, all suffering from disease which might be stayed, should be thrust into miserable poor houses and almost compelled to suffer the miseries of incurable lunacy. It is not pretended that all such inevitably become confirmed lunatics. Some indeed, recover, but the ratio would be greatly increased with more adequate measures for their care.
It not unfrequently happens that the most important plans for the advancement of either science or philanthropy must be approached and developed through the channels of political economy. To what extent, therefore, is it economy to give the insane of every class the advantages of treatment in a well managed asylum – in an institution conducted on principles of science? And to what extent is it a want of economy to place those who are mentally deranged in circumstances that tend to make them confirmed lunatics? It is not asked to what extent are these propositions humane, but, in dollars and cents, what is economical. The following calculation is based on authentic statistics :-
For example: Of one hundred cases of recent insanity, placed under immediate care and treatment in a proper asylum, about eighty will recover, and the average period will be six months, at a cost of $5 per week, $130; add for transportation, $20, making $150 each, or $15,000 expense to the State. But, argues the narrow-sighted official, “they can be supported at the county house for $1.75 per week.” It is true, and of the one hundred cases, about seventy will thus become confirmed lunatics, and the average duration of life will be eighteen years, and the cost will be $l,638 for each person, or $114,660 for the seventy. At $2 per week, the cost would be $131,040. All this misery, and seventy incurables, with a tax of $131,040, against eighty cured, with a tax of only $15,000. Is the economy then in favor of the poor house system of care?
Again: The difference in the value of an acre of ground in the heart of the city of New York and on a western prairie, is owing to the greater density of able bodied and clear minded population on the former. The life of each individual has a financial value in the development of the wealth of a State. Horace Mann, and Dr. Alexander H. Stevens have fixed this value upon individual life at $150 per year. At the present time this would be a very low estimate, but by this estimate, eighty lives of usefulness saved, each for a period of seventeen years, would add $204,000 to the wealth of the State. This includes nothing for the natural increase of population, which would swell the sum to millions in a single generation. Is it not conclusive that the present system of poor house care for the insane is a financial madness, of which no man in his right senses should be chargeable.
The question might be presented with reference to humanity, or advancing another step in the light of Christianity, but in that light the false economist would wither as if scorched by the lightning’s fire.
I have thus accomplished the services imposed upon me by the Legislature of 1864. In presenting the result of my labors to your honorable body, I have to beg that you will accept it as a plea from those who, deprived of reason, locked in filthy cells, breathing impure air, neglected and destitute, cannot approach you; I present it in behalf of my profession, who are constant in urging the claims of humanity; I present it as a duty I owe the State of New York; nay, more; I present it as a duty I owe the Divine Master, who, when upon earth, healed the sick, visited the poor, and made the lunatic to appear clothed in his right mind.
Very respectfully your obedient servant,
SYLVESTER D. WILLARD. Secretary of the Medical Society.”