Every place for these unfortunates should provide for them ample room and congenial employment, whether profitable to the State or not, and the labor should be induced, not enforced, and always timed and suited to their malady. A variety of interesting occupations tends to divert from delusional introspection.
Most institutions attempt to give their patients some occupation, but State policy should be liberal in this direction.
Deductions are obvious: Every insane community of mixed recent and long standing cases, or of chronic cases exclusively, should be a home, and not a mere place of detention. It should be as unprison-like and attractive as any residence for the non-criminal. It should have for any considerable number of insane persons at least a section (640 acres) of ground. It should be in the country, of course, but accessible to the supplies of a large city. It should have a central main building, as architecturally beautiful and substantial as the State may choose to make it, provided with places of security for such as require them in times of excitement, with a chapel, amusement hall, and hospital in easy covered reach of the feeble and decrepit, and accessible, without risk to health, in bad weather.
Outhouses should be built with rooms attached, and set apart from the residence of trustworthy patients, for farmer, gardener, dairyman, herdsman, shepherd, and engineer, that those who desired to be employed with them, and might safely be intrusted, and were physically able, could have opportunity of work.
Cottages should be scattered about the ground for the use and benefit of such as might enjoy a segregate life, which could be used for isolation in case of epidemic visitation. Recreation, games, drives, and walks should be liberally provided.
A perfect, but not direct and offensive, surveillance should be exercised over all the patients, with a view to securing them the largest possible liberty compatible with the singular nature of their malady.
In short, the hospital home for the chronic insane, or when acute and chronic insane are domiciled together, should be a colonial home, with the living arrangements as nearly those which would be most congenial to a large body of sane people as the condition of the insane, changed by disease, will allow.
It is as obvious as that experience demonstrates it, that the reigning head or heads of such a community should be medical, and not that medical mediocrity either which covets and accepts political preferment without medical qualifications.
The largest personal liberty to the chronic insane may be best secured to them by provision for the sexes in widely separated establishments.
It is plain that the whole duty of man is not discharged toward his fallen insane brother when he has accomplished his sequestration from society at large, or fed and housed him well. The study of the needs of the insane and of the duty of the State in regard to them is as important and imperative a study as any subject of political economy.