1907 The Deportation of Insane Aliens

By 1880, New York State was overwhelmed with the immigrant pauper insane population which by its own laws, was required to care for them. The state legislature enacted new laws allowing for the deportation of this “dependant, defective and delinquent class” of immigrants in order to relieve the state of its financial burden. One of the problems that resulted from the actions of the state legislature was that the sick, blind, deaf and dumb, crippled, feeble-minded, and insane class of immigrants, were sent back to their original port of departure in Europe by themselves with little or no money, and many were sick and improperly clothed. No one bothered to make sure that these helpless people actually made it back to their homes, which in many cases was quite a distance from the port. Many of their relatives and friends never saw or heard from them again. Without the efforts of Miss Louisa Lee Schuyler and The State Charities Aid Association in 1904, this problem may never have been brought to light. On February 20, 1907, the problem was resolved with a new immigration law.

Immigrants Aboard Ship 1902

Immigrants Aboard Ship 1902

State Charities Aid Association of New York 1904
“The United States immigration regulations exclude from admission into the United States insane persons, persons who have been insane within five years previous to landing, and persons who have had two or more attacks of insanity at any time previously. Any alien of these classes who succeeds in entering the United States, or any person who becomes a public charge from causes existing prior to landing, may be deported at any time within two years after arrival, at the expense of the person bringing such alien into the United States. Under certain conditions, the secretary of the treasury is authorized to deport such aliens within three years of landing. Under the provisions of this law 147 insane persons were deported to foreign countries from the State of New York during the fiscal year 1903.

From different sources it came to the attention of the Association that insane aliens deported by the government did not always reach their homes so promptly as they should, and sometimes not at all.  In this connection the following quotation from the annual report of the superintendent of the Manhattan State Hospital, West, for the year just closed is significant:

‘While perhaps, it is a matter that does not officially concern the hospital, I desire to state, that I have received several communications from the relatives of patients deported, who claim, up to four or six weeks after such deportation, they have been unable to find that they have arrived at their homes, and could obtain no trace of them. Any conditions which do not afford protection to the insane alien until she reaches her home, are indeed unfortunate, and it appears to me, that some steps should be taken by the proper authorities, toward remedying these matters. The steamship companies do not appear to hold themselves responsible beyond the port where the patient was originally received aboard their steamship.’

The Association, therefore, has made some inquiry into the methods pursued in the deportation of insane aliens, and although it has been possible as yet to make only a cursory examination of a few cases, the conviction is inevitable that the methods of deportation are not such as to afford the patients proper care and protection in all cases, nor to do justice to their friends and relatives. Only five cases have been studied. A brief account of three of the five cases which are at all complete will give some idea of present methods.

1. ‘Case of M.S., a young woman, aged 29 years, a native of Finland, arrived in this country November 1, 1902. About a year and a half later she became insane and was committed to the Manhattan State Hospital, West, April 14, 1904, where she was visited the following week by her friends, the matron and missionary of the Immigrant Girl’s Home. Hearing that the girl was to be deported, these friends offered to arrange for her deportation, hoping to find some woman returning to Finland who would take charge of her. Ten days after this, before the girl’s friends had had time to move in the matter, they received a notice from the hospital that she was to be deported in three days. The names and addresses of the girl’s relatives in Europe were not in the possession of the hospital nor of the steamship company which was to take charge of her, and how she was expected to reach her home, the Association has been unable to discover. The friends of the girl, at the suggestion of the Association, procured these names and addresses, and gave them to the purser of the steamer on which she was to sail, and the Association took the precaution of sending the information to the home office of the steamship company in Glasgow, and of asking the officials there for some particulars regarding the method of transporting the patient from Glasgow to Finland. The following extract from the steamship company’s reply shows the methods employed:

‘Immediately on landing at the dock she was taken to a boarding house where she was properly taken charge of, being attended to by the women of that house. We are forwarding her to-night in charge of our shore interpreter to Hull, and he has instructions to see her safely on board the steamer for Helsingfors, which leaves Hull to-morrow. We have also addressed letters to the owners of the steamer, both in Hull and in Helsingfors, with a request to take some interest in the case, and to give the necessary instructions regarding treatment on board.’

A letter received by the girl’s friends in New York from the girl’s sister in Finland says that no communication was ever received by the friends in Finland from the steamship company, or from any one except the New York friends. The sister writes that she spent three days going from place to place trying to get information regarding the whereabouts of the patient, and finally located her in the Helsingfors hospital for the insane, where she had presumably been sent by the steamship company. This was in July, – two months after the girl sailed from America. The latest letter received from the patient’s sister came in October, and mentioned that she had been unable to find the trunk which was sent with the patient by the New York friends, and which contained all her possessions. The steamship company seems to have done nothing to see that the patient’s property followed her to the hospital.

The features of this case to which we would call attention are these: The failure of the hospital to cooperate with the friends of the patient in providing for her deportation, though no great haste was necessary, as the time in which she could be deported would not expire for six months; the failure of the authorities of this State to take any responsibility for the patient after she had been handed over to the steamship company, including a failure both on their part and on the part of the steamship company to notify the relatives in Europe, or even to ask her friends in this country to notify her relatives; the failure of the steamship company to make any effort to secure the names and addresses of the girl’s family or to make any use of them when furnished by others; the lack of proper care and protection shown in sending an insane person to a boarding house instead of to a hospital, and in forwarding her by night, in the company of a male attendant, on a long railroad journey. It would be interesting to know how this girl fared from the time she left Glasgow in May until her friends found her in July and how she would have fared if her friends in this country and this Association had not actively interested themselves in her case.

2. Case of M.R., an Austrian girl, aged 20 years. The following account of this case was given by the girl’s cousin: ‘When she became insane her brother, who lives in New York city, thought he would send her home, and told the Manhattan State Hospital authorities that he would try to arrange to do this, planning to send her with some acquaintance who was going over. The hospital, however, said that this could not be done; that she was to be returned by the government. The brother was not informed regarding the time of her return until May 3rd, when he received a letter saying that she was to be deported on May 4th. By the time he received the letter she was already on board, and it was impossible for him to go to the steamer that night. He went, however, the next morning about 8 o’clock, and had great difficulty in getting permission to see her. Finally he was allowed to see her for a few minutes. He found her dressed in a cotton wrapper, such as is worn at the State hospital, and provided with no other clothing. He would have brought her clothing if he had known that she needed it, but as nothing had been said by the State hospital it had not occurred to him to do this. He wished to give her money so that she could buy clothing when she got to Hamburg and spoke to the captain about the matter. The captain thought it useless for the girl to have money, but finally consented to take a few dollars for her use.’

The girl was taken to a hospital in Hamburg on landing there, and the parents of the patient were notified by the hospital of her arrival. In this case the significant feature seems to be again the failure of the authorities in this State to co-operate with the friends of the patient for her deportation.

3. Case of F.H. This patient is the son of one of the two sisters whose pathetic story appeared in the newspapers in November, 1904, at the time they committed suicide because of inability to support themselves. The following extract from the newspaper account of the case, though not altogether accurate, gives an idea of the story of the boy: ‘Everything went well with the sisters until a little more than a year ago. Then the boy was taken sick. His illness left him with a deranged brain. He was kept for a time in Bellevue Hospital and then was sent to Ward’s Island. The sisters visited him regularly once a week there. One week, about a year ago, they learned on their regular visit, that he had been sent back to Austria. This, friends of the sisters say, had been done without notification being sent to the mother. Her grief and her fear that some harm would come to him on the voyage were intense. She immediately raised all the money she could get, and, taking also the little which her sister had, she boarded a fast ocean liner for Hamburg. She landed there on the same day that her son landed, and, taking him under her charge, continued the journey to Vienna, where she had him put in an asylum. Then she hurried back to her sister in this country. The strain on the income of the two, however, was too great, and when they got out of work a few weeks ago they became despondent.’

It appears from the records of the Manhattan State Hospital, East, that the boy was admitted there September 25, 1902, and was visited by his mother Sunday, October 5. As he was an alien, having been but nine months in the United States, arrangements were made immediately for his deportation. On October 16, the hospital was informed that the boy would be deported on a vessel sailing October 18, and that he was to be placed on board the 17th. A letter dated October 17 was sent by the hospital to the boy’s mother informing her of his deportation.

Again we note the failure of the State authorities to make any effort to co-operate with the friends of the patient. In this case the hospital did not know of the plans of the Immigration Department for the deportation of the patient until the day before his deportation, and cannot be blamed for not writing earlier to his mother, but under such circumstances it would seem that the friends of the patient should be notified by telegram or special messenger, instead of by a letter, which could hardly be expected to reach its destination before the patient sailed.

To subject insane persons, many of them young and in an acute stage of the disease, to the vicissitudes of a long ocean voyage, with a further journey on the other side of the ocean, is certainly a sufficient risk under the best conditions, and every possible protection should be provided against physical or moral injury. The inhumanity of subjecting relatives of patients to unnecessary anxiety and alarm by leaving them in ignorance of what is happening to those they hold dear, should also be prevented by the establishment of some system which will provide for more personal attention to each case. At present insane aliens are dispatched with little more ceremony than if they were able-minded and able-bodied immigrants, capable of attending to their own interests.”

SOURCE: Reprinted from Twelfth Annual Report of the State Charities Aid Association to the State Commission In Lunacy, No. 89, November 1, 1904, New York City, Untied Charities Building, 105 East 22d Street, Pages 29-34.

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1872 Miss Louisa Lee Schuyler – The State Charities Aid Association

To say that Louisa Lee Schuyler was a humanitarian and a pioneer in social work would be an understatement. Miss Schuyler was the driving force in the movement to reform the poor house system in New York State. She was born into a life of wealth and privilege on October 26, 1837, the daughter of George Lee and Eliza (Hamilton) Schuyler; and great-granddaughter of General Phillip Schuyler and Alexander Hamilton. She founded The State Charities Aid Association on May 11, 1872, which was based in New York City and consisted of volunteer members; men and women, from all walks of life. Her involvement with the Sanitary Commission during the Civil War had taught her the great value and importance of organization. She had read the official reports about the deplorable conditions of the poor houses and alms houses in the state and knew that something had to be done about the inhumane treatment of the poor. She also knew that the “say-so” of one woman wouldn’t change anything; she needed a league of educated citizens united in a common goal.

Louisa Lee Schuyler

Louisa Lee Schuyler

(Photograph Source: http://educationtechnologyreview.com/folio/dodge/images05/index.html)

The association’s purpose was to raise the awareness of the general public to the abuses and sufferings of paupers in the poor house system; to visit every institution of charity supported by public funds in the state of New York; to report findings of mismanagement and corruption, and to make recommendations to the State Commissioners of Public Charities (later renamed The State Board of Charities). Miss Schuyler formed the association first; wrote the by-laws; encouraged her friends to join the association; visited the Westchester County Poor House and Bellevue Hospital with a few of her volunteers; and then, wrote a letter that included a complete report of the association’s findings of both institutions to the State Board of Commissioners. The association immediately received the approval of the State Commissioners and was given the right to visit and inspect the charitable public institutions under the powers and authority already held by the State Commissioners of Public Charities. There were three committees whose purpose it was to focus on the interests of the dependent classes. The categories were divided into: Children (all aspects of their welfare), Adult Able-Bodied Paupers (in poor houses and alms houses), and Hospitals (that included a sub-committee representing the Insane).

Led by Miss Schuyler, Chairman of the Committee on the Insane, the State Charities Aid Association pushed for and eventually forced the passage of The State Care Act, Chapter 126, Laws of 1890. Miss Schuyler started the first Training School for Nurses in connection with Bellevue Hospital in 1873, and was instrumental in After Care of the Insane which was implemented in 1906. In 1907, she was appointed as one of the original Trustees of the Russell Sage Foundation, and in 1908, she organized the first committee of physicians and laymen for the prevention of blindness. Honored by her forty years of charitable work, she was the first woman to receive an honorary degree of laws (LL.D.) from Columbia University in 1915. Miss Schuyler died at the age of eighty-eight on October 10, 1926, in Highland Falls, Westchester County, New York.

The following First Annual Report of the State Charities Aid Association was addressed to The Board of State Commissioners of Public Charities of the State of New York, on March 1, 1873.

 First Annual Report of the State Charities Aid Association

“The objects of our work are of a twofold nature. 1. To promote an active public interest in the New York State Institutions of Public Charities, with a view to the physical, mental and moral improvement of their pauper inmates. 2. To make the present pauper system more efficient, and to bring about such reforms in it as may be in accordance with the most enlightened views of Christianity, Science and Philanthropy.” (54)

“Again another question: Has not the time come for the officers in charge of our County Charities to be appointed and not elected? How can a man with no especial fitness for the position be expected, during his short term of office, to understand the best way of treating several hundred human beings suddenly placed under his care? He is at once obliged to grapple with this great question of pauperism, not as a theory, but practically – a subject to which, in its separate branches, philanthropists have given lives of study and of work. But he is called upon to deal, not merely with single branches, but with the whole question – with the best method of caring for pauper-children, how to keep them from following in the footsteps of their intemperate parents; with the most enlightened treatment of insanity; with the vexed questions of diet-lists for sick and well, of ventilation, and sanitary science, and hospital management; with occupation for the blind, and instruction for the idiot; with the labor question as affected by work-houses. How can one man, who has previously given no study to the subject, fit himself in one, two or three years to fill such a position? And then, when perhaps he may have gained some little knowledge of the subject, the next turn of the political wheel whirls him off and puts in another beginner as his successor. Can we not have carefully selected persons, thoroughly qualified, appointed to fill these positions for long terms of office? Are not the great improvements in our City Charities due to the adoption of this plan? The advanced methods of treatment used in our State Asylums are undoubtedly due to the fact that those in charge are pre-eminently fitted to hold the permanent positions they do. In a large city like ours, where the care of the poor is an enormous business in itself, taking the whole time of those having the supervision of it, good salaries should be paid, for the work is no light task; it demands and should have first-class ability. But in the country, where the supervision required is comparatively slight, taking perhaps a few hours a week, or two or three days a month, we are confident that benevolent and capable citizens can be found to fill these offices without pay, from motives of humanity alone. And even these should be held strictly accountable for the good management of their trust to a supervisory board like your own, as well as to their own county supervisors, for too many safeguards cannot be placed round those who have human beings in their keeping. The streets are out of order, and our carriages break down; the gas is poor, and our eyes pain us every evening; the sewerage is defective, and we tremble for the health of our children; criminals go unpunished, and our lives are in danger; taxes are exorbitant, and we feel it in our pockets; and when these abuses become so great as to be unbearable, we rise in our might, unite with other indignant citizens, drive out the thieves, and insist upon reform. But who knows what goes on in those far-away great buildings called hospitals and poorhouses? There is a class of persons who, if abused, cannot defend themselves – whose sufferings we do not see, whose cries we cannot hear, who have no influence or power to help them break their bonds. At least, let us see to it that those who have the lives of these unfortunate fellow-beings under their control shall be fitted for the position, and shall also be responsible to some authority above them. With this reform, and with the intelligent co-operation of our citizens as Visitors, we may feel that our duty toward these helpless people has been in some degree fulfilled.” (54)


“Voluntary, Unofficial Supervision Of Public Charitable Institutions In Co-Operation With Official Boards, As Illustrated By The Work Of The State Charities Aid Association Of New York. By Miss Louisa Lee Schuyler, Member of the Association.

The following are named as direct results of the work of the State Charities Aid Association. And, in stating them, we wish it borne in mind that what has been accomplished is equally due to the co-operation of the local authorities. In addition to this, and where this has not been attainable, the co-operation of the State Board of Charities and the State Commission in Lunacy have been invaluable.  At times the association as been obliged to carry its reforms single-handed, but these instances are fortunately rare.

1. A higher standard of care has been introduced into every poor house and alms house in the state. – This means better nursing, special diet for the sick, improved hospital accommodation, separation of the sexes, suitable food, proper clothing, and many little comforts for the aged and infirm. It is impossible to enumerate the small and the great benefits conferred upon the inmates of these institutions through the presence of a few humane and intelligent visitors, commanding the confidence and respect of their own communities and sure of a powerful backing from headquarters.

2. Training-School for Nurses, 1873. – This school, attached to Bellevue Hospital, one of the largest pauper general hospitals of the city of New York, was established by our New York County Visiting Committee, who raised the necessary $20,000 with which to begin it, opened the training school on the first day of May, 1873, and to whom is due its efficient management and great success. At first governed by a special committee, the school increased so rapidly in importance that it was soon incorporated as a separate society, merely reporting annually to the parent association in recognition of its origin. The whole number of patients nursed by this school, from 1879 to 1893, is 50,059. Its graduates number 424; of these, 45 are now holding positions in hospitals, 19 as superintendents of training schools, 10 as matrons, and 16 as head nurses.

3. Hospital Book and Newspaper Society, 1874. – Boxes for the reception of fresh daily newspapers are placed, by this society, at the railway stations, the ferry slips, the exchanges, etc., in New York city, whence the papers are collected every day and taken to the hospitals, to be immediately distributed through the wards. In 1892 these daily papers numbered 158,417. Books and pamphlets are received at the office of the society, and are sent every week to hospitals, asylums, poor-houses, prisons, life saving stations, light houses, etc., often forming the nucleus of a small library. During the year 1892 the society distributed 7,716 books, 15,944 magazines, and 54,020 illustrated and weekly papers. The Hospital Book and Newspaper Society, at first a committee of the association, is now a branch with independent membership and treasury.

4. Farming Out the Poor Abolished, 1875. – In one of the counties of the State of New York there yet remained, when the visiting committee of that county was organized, a remnant of the barbarous system of farming out the care of the poor to the lowest bidder. The abuses connected with this practice can well be imagined. Through the exertions of our visiting committee, this system was speedily and completely abolished.

5. Temporary Homes for Children, 1877-85. – In 1875 the New York State Board of Charities secured the enactment of a law, known as ‘the Children’s Law,’ which made obligatory the removal of all children over two years of age from the poorhouses and almshouses of the state. In this great reform the board had the full sympathy of the members of the association throughout the state, who have also been active in promoting the enforcement of the law. To provide a suitable place (the poorhouse being very properly forbidden) where temporary lodging for children could be had, pending their removal to homes in families, the visiting committees of Ulster, Westchester and Queens counties established three Temporary Homes for Children, in 1877, 1880 and 1885.

6. Tramp Act, 1880. – In several counties it was found to be the direct pecuniary interest of the Overseers of the Poor to encourage vagrancy, as they received from the county treasury fifty cents per capita, often more, for each night’s lodging given a tramp. It required three years to obtain the necessary remedial legislation; but since the enactment of this deterrent measure, the State of New York has been less attractive to tramps. (Laws of New York, 1880, Chap. 176.)

7. First Aid to the Injured, 1882. – The serious condition in which accident cases were received at the hospitals in New York city, owing to ignorance of what should be done before a physician could be summoned, induced the organization, by the Hospital Committee of the association, of a Society for Instruction in First Aid to the Injured, modeled upon the English societies of like nature. This society, since its formation, (at first as a committee of the association,) has given 264 courses of lectures, of which 62 were to pay-classes and 202 to free classes, to the police, railroad employees, working girl’s clubs, and to members of the Young Men’s Christian Association and Young Men’s Institute, making a total of 6,595 persons thus instructed, of which number 3,545 received diplomas qualifying them to render first aid to the injured. During the eleven years of the existence of the society, it has received over one thousand testimonials from members of the police force and others, attesting the value of the instructions received.

8. Trained Nurses for the Insane, 1885. – Acting in co-operation with the Bellevue Training-School for Nurses and the City Commissioners of Charities of Kings County, the Association secured for six graduates of that school a special course of training at the Kings County Insane Asylum. Later, one of these nurses was the first principal of a training-school for nurses for the insane, established at the Hudson River State Hospital.

9. Municipal Lodging Houses, 1886. – The association obtained the passage of an act for the establishment, by the New York city authorities, of one or more municipal lodging houses, with the object of diminishing the number of tramps and vagrants at present sheltered without charge by the city in the police-station houses, and of providing decent lodging for respectable persons in temporary distress; labor to be exacted in return for shelter. The act, being permissive and not mandatory, has never been put in operation. An amendment will doubtless be applied for by the Committee on Adult Able-bodied Paupers, to remedy this defect.

10. State Care for the Insane Act of 1890.  State Care Appropriation Act of 1891. – For over fifty years it has been the policy of the State of New York to provide hospital treatment and care for its dependent insane. State asylums were first established for acute cases of insanity, to be succeeded later by state asylums for the reception of chronic cases from the poorhouses. Seven large state hospitals have thus been erected and equipped, for the purpose of giving the insane skilled medical treatment and suitable care. It was owing to an infringement, in recent years, of this humane policy, a backward step of the legislature, through which county after county was authorized to retain its milder cases of insanity, until one-third of all the counties of the state had been exempted from the general law, that brought about the necessity, in 1888, of applying for legislation which should restore to the state its old-time policy, and at one stroke completely abolish the poorhouse system of caring for the insane.” (55)

54. Reprinted from First Annual Report of The State Charities Aid Association To The State Commissioners Of Public Charities Of The State Of New York, March 1, 1873, New York: Cushing, Bardua & Co., Steam Book and Job Printers, Nos. 644 and 646 Broadway, Pages 6, 21-23.

55. Reprinted from The Organization of Charities, Being a Report of The Sixth Section Of The International Congress Of Charities, Corrections, And Philanthropy, Chicago, June 1893, Baltimore: The John Hopkins Press; London: The Scientific Press, 428 Strand W.C., 1894, Pages 62-65.

Louisa Lee Schuyler  

1906 After Care for the Insane

After Care for the Insane was another much needed service that was introduced, organized and came to fruition in 1906 by Miss Louisa Lee Schuyler. When inmates were discharged from the state hospitals, many had no where to go. They had no home, no job, no friends or relatives willing to help them and many had children that had been separated from them during their incarceration. Miss Schuyler and her league of volunteers of The State Charities Aid Association helped these people to re-enter society with a helping hand by working in co-operation with the superintendents of the state hospitals.


“In our last year’s report we expressed the hope that during the coming year it might ‘be found possible to carry into practical operation some plan of assistance for those among the recovered insane (recently discharged from State Hospitals), who are in need of material relief or advice and counsel.’ This hope has been realized, and it is gratifying to be able to state that this Association, during the past year, has initiated and put into operation the first organized practical work in this country for After Care of the Insane. The first steps in this movement were taken on November 19, 1906, when at a conference of the State Commission in Lunacy with the Managers and Superintendents of State Hospitals, held in New York City, Miss Louisa Lee Schuyler, of our Committee on the Insane, upon invitation of the Chairman, Dr. Mabon, addressed the conference on the subject of ‘After Care of the Insane.’ Miss Schuyler gave a brief account of the work of the English After Care Association, based upon information obtained by her during the previous summer while in England, and closed with the following statement, outlining a plan for the organization of such work in the State of New York:

‘Conditions in England differ from those we have here, but the need of a helping hand to be extended to poor and friendless convalescents, and those discharged cured, upon leaving our State Hospitals, is just as much needed here as there, and this is what we ought to do. We need no new society because we have the machinery ready at hand; nor do we need to establish a new institution, or to own buildings, or incur large expense. All that we need is earnest interest in the subject, co-operation, organization, readiness to work.

I have thought that, with the concurrence of the medical superintendents, of two or three members of the re-established boards of managers of our State Hospitals, and of some of the local visitors of the State Charities Aid Association – those living in the respective State Hospital districts – that, with this combination, a working joint committee to provide After Care might be formed for each State Hospital. The experiment might be tried at first on a small scale, with one State Hospital, to see how it would work. I should like to see it tried, and will gladly help toward it in any way I can.’

The Chairman suggested that the subject be again presented in the form of a paper at a later conference. This suggestion was promptly adopted by the Chairman of the Committee on Topics and, at the next conference of the State Commission in Lunacy with the Managers and Superintendents of State Hospitals, held at the State Capitol at Albany, January 30, 1906, a paper upon After Care of the Insane, by Dr. Adolf Meyer, was read and discussed. The conference was largely attended, by representatives of the State Commission in Lunacy, by the medical superintendents and some of the managers of the State Hospitals, and by several officers and members of the State Charities Aid Association. It was presided over by Dr. William Mabon, President of the State Commission in Lunacy. The following resolutions were adopted by unanimous vote of the conference:

‘Resolved, That in the opinion of this Conference, it is desirable that there shall be established in this State, through private philanthropy, a system for providing temporary assistance and friendly aid and counsel for needy persons discharged, recovered, from State Hospitals for the Insane, otherwise known as ‘After Care for the Insane.’

Resolved, That the State Charities Aid Association be requested, by this Conference, to organize a system of After Care for the Insane in this State, and to put it into practical operation.

Resolved, That the representatives of the State Commission in Lunacy and the managers and superintendents of the State Hospitals for the Insane, here present, hereby pledge to the State Charities Aid Association their earnest and hearty co-operation in the establishment and maintenance of a system of After Care for the Insane in this State.”

“Immediately after this Conference the Committee on the Insane of the Association appointed a Sub-committee on the After Care of the Insane (Miss Schuyler, Chairman, Miss Mary Vida Clark, Secretary), to carry into effect the resolutions adopted by the Conference as quoted above.  At a meeting of the Board of Managers of the State Charities Aid Association, held February 9, 1906, the first report of the Sub-committee was presented and approved.  The report outlines the plan of organization as follows:

‘We propose that After Care Committees for each State Hospital shall be appointed by the Association, which shall work under the immediate control and direction of the ‘Sub-committee on After Care of the Insane’ of our Standing Committee on the Insane. These Hospital District Committees shall consist of the present visitors of the Association to the State Hospitals, or such of them as may be willing to serve, with others added as the need may arise, all residents of their respective Hospital Districts; and with them, as ex-officio members of the Committee, two or more Managers to be appointed by each Hospital Board, and the Superintendent of the Hospital. The chairmen and secretaries of the Committees are to be members of the Association. The Committees are to receive the names of their respective Hospitals, viz.: ‘Manhattan After Care Committee of the State Charities Aid Association,’ ‘Willard After Care Committee,’ etc.

In regard to expenses. Fortunately there is a humane provision on the statute books of our State, which makes it mandatory for Superintendents of Hospitals to supply to each patient leaving hospital, who may require it, clothing suitable to the season, and money, not to exceed $25, for traveling and other necessary expenses until he can reach his home or find employment. That section of the Insanity Law reads as follows:

Section 75. Clothing and money to be furnished discharged patients. No patient shall be discharged from a State Hospital without suitable clothing adapted to the season in which he is discharged; and, if it cannot be otherwise obtained, the steward shall, upon the order of the Superintendent, furnish the same, and money not exceeding twenty-five dollars, to defray his necessary expenses until he can reach his relatives or friends, or find employment to earn a subsistence.

It is expected that money advanced by the Committee for the temporary assistance of needy discharged patients, as defined and limited by the above section, will be repaid by the hospitals upon the presentation of proper vouchers.

For our part, we have offered to pay the entire administrative expenses; more especially for the employment of an agent whose duties, under our direction, will be to help local Committees requiring assistance in different parts of the State. This means a salary, traveling and other After Care expenses, which we estimate to amount to about $2,500 annually. For these purposes and for the assistance, if needed, of patients beyond the $25 allowed by the State, we shall have to ask for contributions from those who may wish to help.’

At the first meeting of the Sub-committee on the After Care of the Insane, held February 15, 1906, the first Hospital District Committee was appointed, that of the ‘Manhattan After Care Committee’ (Miss Florence M. Rhett, Chairman). Shortly afterwards an agent trained and experienced in work among the poor in their homes, Miss E.H. Horton, was engaged as After Care agent by the Sub-committee, and was immediately assigned to the duty of assisting the Manhattan After Care Committee.

After Care Committees were subsequently appointed as follows: For the Willard State Hospital, April 10, 1906; for the Hudson River State Hospital, May 22, 1906; for the Binghamton State Hospital, November 8, 1906.  These Committees have done very valuable work for the patients discharged, recovered, from their respective State Hospitals and have presented interesting reports to the Sub-committee. The work of the Committees outside of New York City has been done almost exclusively by the regular and ex-officio members, but the Agent of the Sub-committee has continued to assist the Manhattan After Care Committee in the great amount of work required in connection with the large numbers of patients discharged from the hospital on Ward’s Island to their homes in the City of New York, or frequently discharged to the Committee in the absence of a home or friends to whom they can go.

The plan of co-operation between the Hospital District After Care Committees and the State Hospitals has been outlined in detail and, to give a definite idea of the actual procedure which is followed, is here presented:

1. The Hospital is to notify the Committee of cases likely to be discharged, as soon as such discharge seems reasonably certain, preferably from a week to a month before the patient is likely to leave the Hospital. The Hospital is to furnish the Committee at that time with a summary of such facts in connection with the history of such patient recommended for supervision as will be of assistance to the Committee in the investigation of the case, including the name, age, nativity, creed, occupation, civil condition, date of commitment, previous commitments, form of insanity, character, habits and tendencies and previous history and circumstances of the patient, and the names and addresses of the patient’s relatives and friends, the character and condition of the home and the number in the family so far as known.

2. The Hospital is to notify the Committee of the final discharge, or discharge on parole, of every patient within 48 hours of such discharge, and to furnish at this time particulars regarding the case, if such particulars have not been previously furnished.

3. The Hospital is to notify the Committee if it learns of a likelihood on the part of any former patient to relapse, or of the desirability of assistance or advice in preventing a relapse on the part of former patients, whether such patients are on parole or have been finally discharged.

The Hospital After Care Committees undertake to visit through their members, or the agent of the Sub-committee, the homes and friends of patients about to be discharged, and to report immediately to the hospital such facts and recommendations as may seem likely to be helpful to the hospital in making a decision as to when and to whom patients should be discharged. The Committees also undertake to visit in their homes all patients discharged on parole, who in the opinion of the hospital may need supervision, and to report to the hospital before the expiration of the period of parole such facts as may be of service to the hospital. The Committees are ready, at the request of the hospital, to investigate the circumstances of any former patients who have been discharged, recovered, who may be considered by the hospital to be in danger of a relapse, and to require assistance or advice to maintain their physical or mental health.

In carrying out this plan of co-operation the hospital physicians have shown a generous appreciation of the value of the work done for their patients, and an earnest effort to fulfill the requirements made of them, by bringing to the attention of the Committees cases requiring assistance or supervision. By making suggestions from their extensive experience of such cases, as to the kind of assistance required, the hospital physicians can be, and have already proved themselves, invaluable allies of the Committees, co-operating with them for the permanent welfare of their patients. The practical operation of this plan may be better understood by a study of individual cases. We therefore select, from among those reported by the different After Care Committees a few individual cases assisted by these Committees, to illustrate the aims and methods and results of this work.

A.B. – A middle-aged woman, discharged from hospital May 14, 1906. She was too weak to work and the After Care agent arranged to send her to board in the country on a farm. While there she has gained steadily.  Upon her return a situation will be found for her.

C.D. – While in hospital for a number of months, her husband died, and her only child, a little girl of 12, had to be cared for by strangers. Mother worried about child, and doctor asked agent to see child and report. She found the child well and happy, and the man and wife with whom it was, much attached to the little girl. Agent secured a place with this family, at low wages, for the mother upon her discharge from the hospital. Has visited C.D. several times, and finds her much improved and very happily settled with her child.

E.F. – Discharged September 8, 1906. Agent visited her relatives several times, but found them not able to assist her in any way; also made various attempts to secure work for her. Finally found a place for her as ward helper in BellevueHospital, purchasing for her the necessary clothing. When calling to see her two weeks later, learned from the nurses that her work was satisfactory and that she was doing well.

G.H. – A married man, about 40 years old, who had broken down from over-work as bookkeeper in a large firm. After a few months at the hospital, he completely recovered, and a position was found for him in a bank, where he had formerly worked and where he was given employment of a less responsible and exacting nature, but at a very good salary.

J.K. – A young woman who had been a domestic. She was without friends to assist her and was provided for by the Committee with a temporary lodging place in the city, through the courtesy of the Children’s Aid Society Emergency Shelter, and later with a good situation, as a domestic, through the Charity Organization Society’s Agency for the Handicapped.

L.M. – A young girl of 17, whose mind became unbalanced largely because of poverty, sickness and unsanitary conditions at home. The Committee, with the co-operation of the Association for Improving the Condition of the Poor, the church and a settlement in the neighborhood, established the home-life on a somewhat better basis, provided better rooms and sent the girl and her little sister to the seashore and after their return, got the girl to join a social club at the Settlement where she will have pleasant associates and more opportunities for recreation.

N.O. – A preventive case, heard of through a State Hospital physician who served at a dispensary in the city, and there met a young girl who was so run down and nervous as to be threatened with a mental breakdown. She was sent to the country for several weeks and was completely restored to health.

P.R. – Young woman from the West who had no friends or relatives in the city; an excellent worker but, when recovered and able to leave the hospital, had no place to go to. She was discharged to the Agent who placed her with a lady, with whom she is happy, and who finds her a most satisfactory servant.

S.T. – Young woman, a Hungarian, entirely recovered, whose husband was anxious to take her home. Agent called to see her home, and found that the man was boarding in very crowded quarters and not working, although a plasterer who could earn good wages. Learned from neighbors and the woman’s family that he never had worked, that his wife had supported him. Her brother was willing to pay her passage home to Germany, where her father and mother have their own home, and she was glad to go. The husband was finally persuaded to consent, and the woman sailed for Germany within a week of her discharge from the hospital.

The Committee is glad to report that the expense of the work has not been so large as was expected at the outset. It has averaged about $100 a month. The comparatively small cost of the work is due to the fact that the Committee has been able to avail itself of the many existing charities in New York City which have shown a gratifying willingness to co-operate with our After Care Agency in furnishing temporary boarding places in the country or at the seashore, in providing material assistance in the home, in helping us to secure employment for our recovered patients, and in other ways.

The Committee has not been obliged, except in a very few instances, to call upon the State hospital funds for reimbursement for expenditures, provided for under section 75 of the Insanity Law, which authorizes the expenditure of $25 for the temporary assistance of a patient discharged from a State hospital. Whenever it has been found necessary to call upon a State hospital for such assistance the bills have been immediately approved and forwarded to the office of the State Commission in Lunacy where they have been honored. While the central office is responsible for the administrative expenses, including the salary and traveling expenses of the After Care Agent, and the hospital district After Care Committees are at liberty to call upon the Sub-committee to assist them, it is hoped that each Committee will endeavor to raise a small fund of its own over and above the amount received from the public funds, to meet the expense of assisting individual patients accepted for supervision by the Committee.

The Committee is gratified to note the many evidences of a widespread interest in After Care work. An account of the work of the Association for the After Care of the Insane was presented by Dr. Adolf Meyer, Director of the New York State Pathological Institute, at the annual meeting of the American Neurological Association, and by Dr. William Mabon, Superintendent and Medical Director of the Manhattan State Hospital, at a meeting of the American Medico-Psychological Association, both held in Boston in June, 1906.

The following resolution was unanimously adopted at the annual meeting of the American Medico-Psychological Association:

‘Whereas, The State Charities Aid Association of New York has recently established a Committee on the After Care of the Insane to work in co-operation with the State Hospitals for the Insane in that State, and to provide temporary assistance, employment and friendly aid and counsel for needy persons discharged from such hospitals as recovered, and Whereas, In the opinion of the American Medico-Psychological Association, it is very desirable that there should be carried on in connection with all hospitals for the insane such a system of After Care, therefore Resolved, That the American Medico-Psychological Association expresses its gratification at the inauguration of this movement in the State of New York, and its earnest hope that similar work may be undertaken for hospitals for the insane generally.’

Editorial articles on the subject appeared in the July, 1906, numbers of the ‘American Journal of Insanity’ and the ‘Albany Medical Annals.’ The Sunday editions of the New York Tribune and the New York Sun had, during the summer months, extensive articles on the work of the Association for the After Care of the Insane. A number of letters have been received from physicians and public officials in different parts of the country, referring to articles which had appeared in papers or medical journals and asking for printed reports and further information. Several of these correspondents have written with a view to the establishment of similar work in their localities. We greatly hope that work for the After Care of the Insane, now in practical operation in the State of New York, may soon be undertaken in other States of this country.”

SOURCE: Reprinted from Fourteenth Annual Report of the State Charities Aid Association to the State Commission in Lunacy, November 1, 1906, No.93, New York City, United CharitiesBuilding, 105 East 22d Street, Pages 20-28.  http://books.google.com/