NOTICES.
No. 1.—Institutions for the Insane.
We have upon our table, the reports for the year 1848-9 of the Pennsylvania Hospital for the Insane, (the eighth,) of the Massachusetts State Lunatic Asylum, (the sixteenth,) of the New York State Lunatic Asylum, (the sixth,) of the Physician and Superintendent of the M’Lean Asylum for the Insane at Somerville, Massachusetts, (the thirty-first,) and of the New Jersey State Lunatic Asylum, (the second.) The first and fourth are on private, and the other three on a public foundation.
1. We suppose the first in our list combines as many of the substantial advantages for the treatment of patients of this class, as any institution in the world, and we are happy to know, that the prominent principles which have been recognized in its structure and economy, have been adopted in asylums of the latest date. The hospital has been quite full during the whole year, and yet the health of the patients has been remarkably good. The present arrangements are fitted to accommodate 200 patients, and provision will soon be made for receiving 20 more. It is certainly desirable to extend the benefits of such an institution to as large a number as can divide without diminishing the aggregate of good, but we quite concur with Dr. Kirkbride in the opinion, that a larger number than 220 could not be well received in one building, nor receive due attention from one medical officer—“a daily visit to all the wards, and a daily supervision of all the departments by its official head, being exceedingly desirable in every institution for the insane.” Seven of the seventeen deaths during the year, “occurred within a fortnight after the patients’ admission,” and only one had been more than a year in the asylum.
Of 1391 patients admitted to this hospital, 725 were under middle age, (35 years,) and 666 over. Of 773 male patients, the leading occupations were as follows:—farmers, 115; merchants, 66; laborers, 62; clerks, 50; carpenters, 30; shoemakers, 22; physicians, 19; seamen and watermen, 19; teachers, 17; tailors, 15; students, 15; NO OCCUPATION, 108.
Of 618 females, 66 were seamstresses or mantua-makers, and 64 domestics; store-keepers and attendants in stores, 12, and teachers, 9. Of single females, not pursuing a regular employment, 29 were daughters of farmers, and 29 daughters of merchants. Of the married, 57 were wives of farmers; 39 of laborers; 35 of merchants; 23 of clerks. Of the 618, 244 were single, 286 married and 88 widows. And of the 1391, 773 were natives of Pennsylvania; 91 of New Jersey; 197 from other of the United States; 340 from foreign parts, of whom 189 were from Ireland!
The most productive cause of insanity, as shown by the returns, is intemperance, 84; the next is mental anxiety, 69; grief for loss of friends, &c., 69; then comes the loss of property, 67; religious excitement, 56; domestic difficulties, 45, and unascertained, 563! In 907 of the cases, insanity appeared before middle age, leaving 384 only developed after that period.
The plan of detached cottages for a particular class of patients, continues to be an approved feature of the arrangements; and among the valuable improvements of the last year is the erection of a museum and reading-room on an eligible site. The building is 46 feet by 24, with a piazza, and the interior is furnished with interesting and valuable cabinets in natural science, as well as with newspapers, maps, periodicals, pamphlets, &c. On the interesting topics of society, instruction, and moral treatment, and the arrangements for heating and ventilation, much valuable information is furnished. The annual receipts and expenses are balanced with the sum of twenty-six cents, and the cost of each patient per week, including every thing, is $3 88. The amount expended on free patients during the year is $7,666 88. This is unalloyed charity.
2. The State Hospital at Worcester, (Massachusetts,) under the care of Dr. Chandler, was overflowing with patients, though fifteen new rooms were added during the year. The average number for the year was 404, and the number of dormitories 360 only. The number of foreigners in the hospital at the close of 1842 was 34, at the close of 1847 it was 121, and at the close of 1848 it was 150!
Dr. Chandler is of opinion, that it would not be judicious to enlarge the present hospital, but he would rather erect a new one, and separate the sexes. He thinks three small hospitals, in different sections of the State, would have some advantage over a large one.
The whole number of patients admitted from January 1833, to November 30, 1848, is 3084, of whom 1433 were discharged cured, 416 improved, and 272 died. Of the patients admitted last year, 154 were under middle age, and 255 above, showing a very different result from that which we have stated above at the Pennsylvania hospital. Of the whole number received at Worcester, the cause of insanity in 322 cases is supposed to have been intemperance; in 266 domestic affliction; in 233 religious views, and in 161 self-abuse. Hereditary tendencies to insanity were traced in 691 cases. Fifteen hundred and sixty-one were single, one thousand two hundred and thirty-two married, one hundred and ninety-nine widows, and eighty-six widowers. Dr. C. thinks it very clear that the sympathies and motives to action, which the domestic relations supply, are all but indispensable to keep the whole system of mind and body in a healthful state. If we understand the report of the trustees, the cost to the State of each patient is $2 33⅓.
3. The report of the New York State Lunatic Asylum established at Utica, was made to the Legislature, February 1, 1849. During the six years since it was opened, it has had an annual average of 335 patients. The whole number under care during 1848, was 877, of whom 495 were removed at the end of the year. Judges of county courts have authority to send to the asylum any person who becomes insane and whose estate is insufficient for the support of himself and family; and the county is chargeable with the expenses of his restoration, if it is effected within the space of two years. Six hundred and twenty-nine of this class have been received into the institution since it was opened, and have thus been partakers of the most seasonable and appropriate charity which the public can bestow. These have been among the most hopeful subjects of hospital treatment, and would have suffered most for want of it.
The hospital is lighted by 280 burners from gas manufactured on the premises. The expense of work, fixtures, &c., was $5,346 48,—and this mode of lighting, is regarded not only as safer and more secure and pleasant, but as cheaper than the former mode. The price of board and hospital care, to patients who are chargeable to towns or counties, is $2 per week. Pay patients are charged from $2 50 to $4 per week, according to the accommodations they receive. The receipts of the year fully meet the current expenses.
Of 382 discharges during the year, 189 were men and 193 were women; 174 were cured, (viz., 87 men and 87 women,) and 84 were improved. There were 86 deaths. Some salutary cautions are given respecting the removal of distant patients to the hospital, especially in sudden and acute cases of insanity, and where they are in a weak or diseased state, and exposed to much suffering and fatigue on the journey. The opinion of a judicious physician should be taken before the attempt to remove them is made. Other and equally important cautions are given against delaying to send such as are clearly deranged, merely because they are monomaniacs, or not violent, nor very excitable. “Those cases of insanity that are most improperly and most frequently neglected and kept at home until they are incurable, are unattended by much excitement; those that come on very gradually, unperceived for a long time, excepting by the most intimate acquaintances,” (p. 20.)
Of the whole number, (2,014,) 1017 were men, and 997 women; 1213 became insane before middle life, and 801 after that period. Of the 1017 men, 437 were farmers and 133 laborers, 57 merchants and 51 scholars; and of the 997 women, 853 were employed at house-work, or were without any special trade or employment; 45 were school girls; 30 tailoresses; 24 instructresses; 21 milliners; 16 mantua-makers; 7 factory-girls; and 1 music-teacher. As to their civil condition, 957 were single; 937 married; 83 widows; and 39 widowers. 1417 were natives of New York, and 300 were from foreign lands.
Among the causes of insanity, are religious anxiety 178, loss of property 86, sickness and death of kindred 74, excessive study 51, intemperance 67, Millerism 36, disappointed in love 53, abuse by husband 28, blows on the head 24, fright 24, excessive labor 33, anxiety about absent friends, 18. Among the amusements of the patients, debates, tableaux, singing and dancing, and theatrical performances. Of the whole number, (2014,) 251, (108 men and 143 women,) were disposed to suicide. This variety of insanity is by no means the most incurable. On the contrary, some of the most permanent and complete recoveries, are from this form of disease. From a register kept by Dr. Bingham for four years at this hospital, of all the suicides occurring in the State of New York, and noticed in the public prints, it appears that 74 cases occurred in 1845, 64 in 1846, 106 in 1847, and 88 in 1848.
In relation to hereditary insanity, the report shows that of the 2014 patients received at the institution, 637 are known to have insane relatives, and 273 are known to have had insane parents, or nearly 1 in 7. Dr. Brigham expresses the opinion that all other causes combined have not so much influence in producing insanity, as the transmission of the disease from parents to their offspring, p. 36. In other words, that the exciting causes would be inadequate to produce insanity, but for the inherent constitutional tendency to it. Dr. B also declares his belief, that there is more insanity in this country than in any other, especially in the northern and eastern States, and that it is fearfully on the increase, p. 38.
Some valuable suggestions respecting the prevalent causes of insanity and the means of obviating them, are thrown out, and are entitled to the earnest and studious regard of parents and teachers, as well as of professional circles.
4. In the M’Lean Asylum there were received during the year 1848, 153 patients, (71 males and 72 females.) Dismissed, 155, (87 males, 68 females,) of whom 82 were restored, (55 males, and 37 females.) There were 23 deaths during the year. The total number of patients received from 1837, is 1696. The average of the first six years of this term was 115, and the average of the second six years, was 166. Of the whole number, 884 were discharged as cured, and 184 died. The report enters at much length into a history of the construction of the buildings, and of the recent alterations, amounting almost to a reconstruction of the largest and most modern building on the male side.
In conjunction with these alterations, a new heating and ventilating apparatus has been introduced, and as we know the very great solicitude that is felt in respect to this point by those who are commissioned to devise the plan and oversee the construction of such edifices, we extract so much of the report as relates to it.
“Every room has a hot air and a foul air flue opening in it, the entrance being protected by an ornamental grate, and the galleries have five or six flues of each kind opening in them, in order that the diffusion may be general. The flues are twelve by twelve, and twelve by nine inches in size.
“The pure supplies of air are received into a large reservoir or space in the basement between the walls forming the sides of the galleries above, and in which both kinds of flues are built. This main air channel has an area of at least fifteen feet, and terminates externally in a low tower, fully exposed to the passing air.
“The heater is a vertical boiler on the tubular plan, about eight feet in height and thirty inches in diameter. The fuel (anthracite) is placed within the boiler, and that is so placed within the reservoir before named, that only a small part of it, required to receive the fuel, is left outside.
“On each side of the reservoir of air, is a construction consisting of six longitudinal chambers one above the other, the whole length of it. The lower three, separated from the upper three by a brick arch and from each other by partitions of wood, are the ventilating channels receiving at intervals the flues from above and finally terminating beneath the exhausting shaft, to be described.
“The upper range consists of the three channels for hot air. Both of these ranges are so arranged that a channel answers to a story above, and thus each story of the house has its heating and ventilation entirely independent of any other.
“Each hot air channel has a pair of four inch cast iron water pipes connected with spigot joints and iron cement; one end of each comes off the boiler near the top, and the other or return end, enters the boiler on the other side, near its bottom. The hot and cold ends of each pair of pipes are on opposite sides, in order that the average heat at any place where the air is delivered above may be the same. The three pair of pipes receive and return their water, through tubes reduced to two inches diameter, as recommended by Mr. Hood, the highest authority on this class of subjects, and at the same level. The degree of curvature essential in this form of connection, was expected to make a difference in the velocity of the circulating fluid, and consequent temperature at which the water would be found in the different ranges. Practically no material difference is remarked. The radiating pipes cross at the bottom of the cold air reservoir. The air flows in to impinge upon them through arched spaces left in the front of the channels, looking towards the reservoir. Every flue for hot or foul air is commanded by a slide readily approached below.
“The heated air is always admitted near the ceiling to obviate any contamination at its point of delivery. The foul air is drawn off near the wash-board, any impurities there deposited being drawn down, but not into the room. The diffusion of the air, where an adequate exhaustive power is provided, is also much favored by being thus turned in its course, and the lower stratum is not uncomfortably cool to the feet,—a common objection to the usual method of receiving and withdrawing the supplies.
“The foul air channels into which the flues from each story open, do not come together, until just as they pass under the foot of the ventilating shaft or chimney, which through the agency of a cast iron pipe, a foot in diameter in the middle of the shaft, running up fifty feet and receiving the smoke from the furnaces, constitutes the moving power. This shaft is built of brick in a useless angle where the two buildings approached each other, and has an internal diameter, it being a circle, of about six feet at its basis a few feet below the cellar floor, and terminates in one of the original chimney stacks at the corner of the foundation of the dome, height of about seventy-five feet, and with about one half its size at bottom. A deviation of a few feet from the perpendicular was inevitable at about two-thirds its length. It is carefully plastered or pargetted within. As its upper opening was commanded by the spherical dome, endangering the regurgitation of wind at certain times, it was surmounted with a form of chimney-cap, figured in Mr. Tredgold’s works some forty years since, and being essentially that recently introduced into considerable use in this vicinity.
“As a cure for smoky chimneys, this cap has considerable efficiency, but is regarded as of very trifling moment as for as suction or exhaustion from below is required. For its power is too feeble at all times, for such an amount of ventilation as an insane hospital requires, and depends wholly on the fluctuation currents of external air. If the upper range of bricks had been laid with a bevel upwards, and a plain plate of metal placed on four short legs a few inches above, it would have answered equally well and at a tenth of the cost. The rarefaction produced by the heat radiated from the central iron smoke pipe occasions a partial vacuum, instantly filled from the rooms behind.
“The whole length of cast iron hot water pipe is about 600 feet, and with the portion of the heater within the main air cell or reservoir, and the smaller wrought iron tubes connecting the extremes of each of the six pipes with the upper and lower ends of the boiler, constitutes a radiating surface of over 700 square feet. The effective fire surface of the boiler is probably about 30 superficial feet, and about 60,000 cubic feet of space above in the three corridors, and the rooms opening upon them, are to be heated.
“The amount of anthracite consumed in the twenty-four hours of our coldest weather, is not far from 400 lbs.; the water in the extremities of the pipes receiving it from the heater, rarely exceeds 180° F. and falls off about 20° at its point of re-entering.
“All these expressions, however, are quite indefinite without taking into consideration the extent of change required in the air. It is obvious that by closing the damper which commands the ventilating shaft, the relations of temperature of the air, and of the pipes would at once sympathize. With the active power of the shaft, it is certain that any possible amount of ventilation may be attained. Indeed, it is probable that the present shaft is equal to the demands of the remainder of the male wing in addition. The escape of the steam pump is injected into the centre of the ventilating space, giving us, for some hours daily, the aid of this recently adopted and exceedingly efficient means of ventilation.
“While a sufficient time has not yet elapsed to stamp our apparatus with the seal of experience, the only test of such appliances in the mechanical arts, yet we are authorized to declare that, as far it has been tried, it promises all that could be desired in supplying a full, certain, and manageable amount of air, in its highest hygienic conditions.
“The cost of getting up a complete system of hot-water warming and exhaustive ventilation in a country where few examples or approximate specimens are to be found—in a climate which nullifies all European experience—where all parties, suggesters and mechanics, are obliged to acquire a certain experience as they go along, must be much greater than when this subject shall be well understood and generally adopted, as it eventually cannot fail to be. Independent of making the flues and ventilating chimney, items which in new undertakings would naturally come under the head of construction account, the expense of our undertaking will fall considerably below a thousand dollars, and we are satisfied that with the experience acquired in this single trial, it could be gone over again at a very considerable reduction of cost.”
We have left ourselves but a finger’s breadth of room for a notice of the report of the N. Jersey State Lunatic Asylum at Trenton, rendered December 1848. It is accompanied by a view and ground plan of the buildings, which were opened for patients on the 15th of May last, under the superintendence of Dr. H. A. Buttolph. They are designed for the accommodation of 200 patients, and in their general structure and arrangement accord with those of the Pennsylvania Hospital already noticed. The asylum occupies a most eligible site, about two miles north-west of the public buildings, surrounded by a choice farm of 111 acres, with an unfailing supply of fine soft water, and a beautiful grove in the rear, thus affording abundant room for hospital purposes, and embracing every variety of scenery and spacious pleasure grounds for the use of the patients. The various fixtures for warming, ventilating and lighting, as well as the arrangements for cooking, washing, bathing, &c., are after the most improved models, and are described with interesting and intelligible minuteness in the report, an examination of which we would recommend to all who are seeking information on the subject. The number received during the year was 86, of whom 83 remained in the asylum at the date of the report. A large proportion of the number received were chronic cases, which are generally very numerous at the opening of such institutions. Of the 86, 27 were under middle age; 52 were single and 30 married. Of their occupations, 22 of the men were farmers, and 16 of the women were house-keepers. An hereditary tendency to insanity was traced in 18 of the 86 cases, or about as 1 to 5.