SECOND REPORT ON PROBATIONARY ASYLUMS FOR THE INSANE IN LARGE CITIES.

BY A. B. STOUT, M. D., SAN FRANCISCO.

In accordance with the first report on this subject, submitted to the honorable Legislature of California, a bill, under the auspices of the State Board of Health, was presented for the adoption of this reform in State medicine, to that body, at its last session.

Owing to the heavy appropriations made by the State so recently, to construct an Insane Asylum at Napa, and also the very nervous state of mind of the Legislature in regard to public economy, reduction of ap propriations, and increase of taxation, the bill was unfavorably reported upon by the committee it was referred to, and consequently failed to pass. The action of the committee in no wise diminished the merit of the proposition.

Constant observation and experience since the incipiency of this project of hygienic reform, have greatly contributed to increase the testimony of its expediency, its utility, and its necessity in the cause of justice and humanity.

In this view we shall renew our efforts, and present this second report, as supplementary to the first, in order to reinforce the latter with additional evidence and further argument.

A Probationary Asylum for the Insane does not imply solely an institution within which to determine and detect feigned insanity, or falsely charged insanity, and thus intercept the frauds and injuries attempted in litigation, whether in civil or criminal prosecutions. Great as would be the advantage of possessing such a check, guarded by commissioned experts in lunacy, and with legal power to inforce seclusion without sacrifice of the constitutional rights of man, it is not in this alone that the proposed establishment possesses merit.

In an extended meaning the word probationary signifies tentative, or an institution in which the effort is made to afford relief by quick and prompt intervention in the incipiency of mental disorders, and thereby prevent the disasters which so often render simple physical disorders, accompanied with mental alienations, forever incurable; and then entail the long catalogue of family calamities and the revolutions in matters of estate. We say, with confidence, that the large majority of such cases, as they now stand recorded, is the result of neglect not necessarily will ful, but from the want of the required facilities in the incipiency of the invasion of the malady to arrest its progress. Give it no foothold, it will fail to hold possession. As things now are, parties interested, in the most loyal faith, rush around for relief, but can only find it after protracted and expensive delay. It is just in this delay that the irrepar able damage is done. How perfectly would this evil be averted, could they quickly transport the person without delay to the provident asylum of the State. In extreme perils, it is admitted that humanity and selfdefense take precedence of law and the individual right of liberty.

This last mentioned right we would be among the last to infringe, but this right has its limit. An insane man on the street menacing great harm to himself or others, would be arrested instanter, and be confined in prison, at least for a short time; but insanity being neither a crime nor a willful misdemeanor, he has only deserved confinement; not, however, in a prison, but in a hygienic place of restraint authorized by legal

enactment.

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No one would suppose, in the case cited, that a suit for false imprisonment would be entertained, yet suits of this character have been brought by persons confined against their protest, although insane, in private asylums, so that such institutions have become, often harmfully, guarded against whom they receive. What, now, becomes of the person thus arrested instanter?" He is punished, virtually, though only the subject of an involuntary disease, or with hereditary reference, he is imprisoned for his father's misdemeanors. This is not all, he may pass a night in a comfortless cell, perhaps the subject of felons' curiosity or diversion; and yet the exposure, want of care, of food, of sleep, that ,night, might fix uncurability upon his case, which would have been cured in a few days, had he been transported "instanter" to a humane asylum, provided immediately with a comfortable bed, seclusion, but among kini friends, without disgrace, and the required food, the needed sedative, and, in last recourse, the harmless "camisade de force." Yet, more, the helpless maniac is made a subject of notoriety; his name is reported in newspapers, with all the story done up, perhaps, in ridicule, to please morbid tastes; hence, for weeks, he is subject to annoyance; his family and business relations damaged, and, finally, a bill of useless expenditures; or if some mistake occur, or friends fail to appear, thirty days in the County Jail.

Now all this scene would be evaded by the alternative proposed, while the unfortunate invalid would be humanely and silently cared for without undue notoriety.

We offer this to show the importance of instant relief in cases of sudden outbreaks of insanity.

PART II.

Relief in the first stages of insanity.

There is nothing incompatible in a Probationary Asylum, as explained already, in the last biennial report, with the addition of a department for the cure of alcoholism in its first invasions, and while yet a curable disease. A Home for the Inebriate could, therefore, be annexed to the institution. There are about ten such homes in the United States, one of which, to our honor be it said, is in San Francisco. This latter is, however, a private charity, sustained by a few humanitarian individuals. The question of the intrinsic value of benevolent aid-resorts for the ills of intemperance has been largely discussed. Socialists and philanthropists have not failed, whether or not they are truly wise provisions against those "ills that flesh is heir to." It would be vain to recapitulate them here; but the result of the investigation is, that on grounds of sound social economy, as well as accordance with the dictates of Christian conscience and the general indulgence of popular sentiment, that they are not only wise and good, but indispensable. With or without comment as to how they come, delirium tremens and alcoholism are diseases,

the subjects to which have their natural claims, as members of the body politic, like those diseased from all the other objectionable irregularities of social life. A very large proportion of such cases, if early relieved, are perfectly redeemable, which now are lost by maltreatment at the

outset.

Now, it is well known to medical men, if not to legislators, that inanition from want of food, and exhaustion from insomnia or want of sleep, are the symptoms most destructive and the most difficult to combat. Abundant food and rest are, therefore, the indispensable requisites. As things now go, do inebriates get this treatment? As for themselves, they repugn food, and are driven by an uncontrollable brain to inordinate physical efforts and insane mental activity. They resist what they most need. In many cases food and rest can only be procured by a force applied with method. Generally, in the cases brought for hospital treatment from the streets, from jails, from their homes, many days, often weeks, have been consumed in the various tentatives of friends or others to obtain relief, while in this very time the precious moments to administer aid escape and have flown forever.

It must be manifest that to control these exigencies in the incipiency of alcoholic insanity, the opportune moment, time, skill, and place, can only be found combined in such an institution. What has been already well said need not be rewritten; we, therefore, adopt and append to this report the three following essays on the subject. (See Documents A, B, and C.) Such valuable and disinterested testimony should be decisive evidence. It would be vain to continue further the discussion at present, as the report would become unreadable by reason of its length; hence, we commend it to your approbation.

A. B. STOUT, M. D.,

Member State Board of Health.

[DOCUMENT A.]

WHAT SHALL BE DONE WITH THE HABITUAL DRUNKARD?

BY JAMES F. HIBBERD, m. d.

[A paper read to the Wayne County Medical Society, January 7th, 1875, in support of the resolutions attached.]

It is not the intent of this paper to discuss the general subject of intemperance, but to consider that phase of it which is denominated habitual drunkenness. And by this phrase is meant that condition of a man wherein he drinks alcoholic beverages to intoxication whenever oppor tunity offers. Not when opportunity incidently offers merely, but who makes opportunity when none offers otherwise. In other words, a man is an habitual drunkard when the desire for alcoholic beverages becomes his ruling passion, and the drinking of them his leading practice, and all for the sake of the intoxication they produce.

When a man has arrived at this stage of a drunkard's career, he has lost the higher characteristics of his manhood. He has lost his recognition of the dignity of his position in the scale of created beings; he has smothered his moral nature; he has drowned his sense of honor; he has. dishonored the ties of consanguinity; and he has ignored his obligation to care for himself and for those dependent on the proper exercise of his physical and mental ability.

This condition is never, it is believed, a congenital one, but always the result of education or training-a condition into which the victim voluntarily enters; yet, nevertheless, one, when fairly entered, he can no more control than he can control the advent of hunger, or the necessity for sleep.

In short, under the change wrought in his mental operations through alterations induced in his physical organization by the action of alcohol, he has become irresponsible for his acts. Disease has been engendered in his body, such that it makes the healthy action of his mind impossible. And this abnormal mental activity is a species of insanity, differing widely from ordinary insanity in its cause and manifestation, but insanity nevertheless. Perhaps it would be better to regard the term insanity as generic, as it really is, and make the aberration under consideration a species, to be designated alcoholic insanity.

It can scarcely be necessary to enter into a lengthened argument to establish the fact that an habitual drunkard is insane. A very brief argument will suffice.

An insane person is defined to be one of unsound mind. A sound mind being the standard, it becomes necessary to define it, which, for our purpose, may be done by saying that a sound mind, as regards any given department of sociology, is one that approximates the average condition of the minds of all the people in a community touching the duty of an individual in that particular department.

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Let us apply this principle. In this community it is the sense of a vast majority of the people that it is a man's duty to provide shelter, food, and raiment for himself and family; to contract no unreasonable obligations, and to fulfill all obligations that he enters into; to protect his own property and to respect that of others; to maintain certain social relations with his neighbors, and to live up to his religious convictions.

Now let us adduce the career of an habitual drunkard, and witness how widely he fails of fulfilling these reasonable responsibilities. There is a married man in this city, an accomplished mechanic, who always had a thrifty establishment until he became an excessive drinker of alcoholic beverages. Then his business ran down, soon utterly faded away, and he became a financial wreck. His family are in rags and insufficiently fed. He works by fits and starts for another man until he obtains some money, then gets drunk, generally has a fight or two, is arrested and fined, induces some one to go his bail, works again until he earns more money, then starts on a fresh spree. Does this man live up to his responsibilities? If not, he is insane.

Another married man allows his wife to do washing to support him and their children, and the little he earns he spends for drink, and occasionally begs, steals, or forces from her, a little of his wife's hard earnings to buy liquor with. Is he fulfilling his reasonable responsibilities according to the standard? If not, he is insane..

An unmarried man, formerly a good mechanic, with full work and plenty of money, is now supported by his brother. He is so devoted to gratifying his love for drink, and so lost to his once high sense of honor and honesty, that if his brother gives him money to buy a pound of butter for the family, he will buy whisky with the money, and return drunk without the butter. Is this man's conduct up to the average of the community in which he lives? If not, he is insane.

Another unmarried man, twenty-five years old, with many accomplishments of manners and mind, lives on his father's bounty, and his sprees are so frequent, and in them he is so violent, that the whole family are in a state of perpetual terror, and are, by his bad conduct, wholly unfitted for the high social duties that their wealth and education would otherwise so admirably fit them for. The father has spent thou sands of dollars to repair damages done to property, person, and character by this erring son in his drunken rage. Is this son up to our standard? If not, he is insane.

But is it needful to recite more examples? If the premises laid down be correct, does not every sound mind know of many, alas! too many unsound ones of this particular class. Where is the blood in human vessels that does not have kindred blood coursing through crazy brainsbrains that would honor their possessor and his kind, if it were not for the undue ascendency of the fiery king that beguiles and destroys? We therefore conclude that every man who drinks an excess of alcohol loses his normality, and the most notable feature of this loss is the unsound condition of his mental faculties, and this unsoundness is of the nature of a special phase of insanity. Do you

The resolutions propose to confine a man who is thus insane. ask what right has any man or any number of men to rob a fellow citizen of his liberty? That is the point. We will address ourselves to its consideration for a few moments. Only two adequate reasons can be assigned for such an act; first, to benefit the subject of the restraint, and, second, to protect the community.