Insanity in the Middle States: 1876

Editor’s Note: With the founding of the National Conference of Charities and Corrections in 1974, the subject of insanity received much attention. This entry is from the Proceedings of the third Conference of Charities held at Saratoga, New York, September 6, 1876. 

 Mr. Sanborn presented the following paper by Dr. Edward C. Mann, Medical Superintendent, State Emigrant Insane Asylum, Ward’s Island, New York, which was ordered published in the proceedings:

 INSANITY IN THE MIDDLE STATES.

Insanity is, in the middle states, as in the other states, increasing disproportionately to the increase of population; and it also seems to be appearing at an earlier age than formerly, which latter fact is probably due to hereditary influences, which have gradually become intensified by violation of physical laws in early life, want of proper training, or too high pressure in education. Next to hereditary predisposition, which is the first and great predisposing cause of insanity in the middle states, as elsewhere, comes the great mental activity and strain upon the nervous system that appertains to the present age and state of civilization. This feverish haste and unrest which characterize us as a people, the undue predominance of the nervous temperament and the want of proper recreation and sleep tend to a rapid decay of the nervous system and to insanity, as a necessary sequence. It is much to be deplored that intemperance is operating more and more, each succeeding year, as a formidable cause in the production of insanity. It is not too much to say that twenty-five per cent of all cases of insanity admitted into the asylums of our middle states is due either proximately or remotely to intemperance which has produced a permanently diseased state of the brain, due to the interference in the nutrition, growth and renovation of the brain tissue. The evil does not stop here; for the offspring of intemperate parents are growing up in our midst with weakened, if not actually diseased, nervous systems and will inevitably, in time, become insane, diseased or idiots. The relative increase in the proportion of the insane to the sane population is more favorable in the middle states than in some others. The census returns for 1870 of the United States show an increase of insanity of fifty-five per cent while the increase of the general population has been only twenty-two per cent. The proportion of insane to sane population has increased from 1860, when it was shown that the entire population of the United States was 31,443,321, with an insane population of 23,999, or one insane person in every 1,310 of the whole population; up to 1875, inclusive, when, by bringing up the calculation at the same rate of increase for both sane and insane population as obtained between 1860 and 1870, we find the former to be 42,115,896, and the latter or insane population 44,148, or one insane person in every 953 of the whole population of the United States. It may not be uninteresting to glance for a moment at the proportion of insane to sane population in other countries as compared with our own. In England there is one insane person to every 403 of the whole population, or more than double the proportionate number of the United States. In France there is an average of about one insane person to every six hundred of the whole population. In Scotland there is one insane person to every 336 of the sane population, while in Ireland there is one insane person in every 302 of the population. In the United States, California exhibits the greatest proportion of insane to sane population, there being one in every 484. This is due to local causes. Massachusetts shows the next greatest proportionate number of insane, while the New England states, as a whole, have a greater relative increase in the proportion of the insane to the sane population than is observable in either the middle, southern or western states. In the care, the treatment, in finely appointed institutions, and in scientific investigations into the causes of insanity, the niiddle states hold a place of which they may be very justly proud.

 NEW YORK.

 In the year 1844, the state of New York erected the first Insane Asylum at Utica, which has accommodations for 600 patients. In 1867 the Willard Asylum for the chronic insane was erected at Ovid and provides accommodations for 1100 patients. The state has three more institutions for the care and treatment of the insane. One at Poughkeepsie, one at Middletown and one at Buffalo. These asylums will furnish for the next few years ample and adequate provisions for the acute insane, while for the 1,300 or 1,500 of the chronic insane, now in county institutions, are needed asylums similar to the one in successful operation at Ovid. Kings county and New York county provide for their insane under special statutes. The former county provides for 800 or 1000 insane and the latter for over 1,700. On Ward’s island is situated the State Emigrant Insane Asylum which provides for the insane emigrants for the term of five years from the time of their landing in this country. This asylum furnishes accommodations for about 200 patients. The annual expense per patient in this institution is $150. The per capita cost of building $1,138 and the total annual cost, $22,500. There are upward of 500 patients in private asylums so that the insane population of New York state is probably not far from 7,000 or 8,000 at the present time. The census of June 30th, 1870, enumerated 6,353 insane. The annual expense per patient at the State Asylum at Utica is $271. The per capita cost of building is estimated at $1,061 while the total annual cost of the asylum is $157,939. The state appropriates annually $15,000, and each county pays $5.42 per’week’for its own paupers. The annual expense per patient in the Willard Asylum is $174. The per capita cost of building $942, while the total annual cost of the asylum is $181,542. Each county pays for its own paupers.

The annual expense per patient in the two New York county institutions is in the New York City Asylum for the insane $92.89, and for the New York Lunatic Asylum on Blackwell’s island $73.84. The annual expense per patient in the Kings County Lunatic Asylum, situated at Flatbush, L. I., is $120. The total annual cost for these three county institutions for the insane is as follows: New York City Asylum for the insane, Ward’s island, $53,504; New York Lunatic Asylum, Blackwell’s island, $89,420; Kings County Lunatic Asylum, Flatbush, $92,400. The annual expense for the Hudson River State 67 Hospital for the insane at Poughkeepsie is $50,000 (appropriated by the state) and has a capacity of 600 patients. It is built of brick and has attached to it 333 acres of land. There are at present 207 patients occupying it. The Buffalo State Asylum for the insane is not yet completed. It is built of red sandstone and brick and has attached to it 200 acres of land. The State Asylum for insane criminals at Auburn, N. Y., was erected in 1859 at a cost of $125,000, and has 842 acres of land attached to it. The cost of subsequent additions has been $52,000, making the total cost of the present building $177,000. The per capita cost of building is $1,222. The number of patients is 118, and the annual expense per patient is $208. The state appropriates annually $16,000, for this institution. The total annual cost of the institution is $24,544. The laws of New York, relating to the commitment of the insane, provide that no person shall be committed to, or confined as a patient in any asylum, public or private, except upon the certificate of two reputable physicians, under oath, after a personal examination of the party alleged to be insane, setting forth the insanity of such person, said certificate to be approved by a judge or justice of a court of record of the county or district in which the alleged lunatic resides. It would seem very desirable that an addition to the laws of New York, and also to the laws relating to insanity in the other middle states, should be made so as to guard, as far as possible, against the unfortunate results which are liable at any time to occur in the trials of the insane for homicide. It would seem very desirable, in order to secure society, to protect the legally and morally innocent, and to ensure the punishment of the legally and morally guilty, to have some improvement on the method now in use in criminal trials of the insane. There should be in each state a board of commissioners of lunacy, specially selected to investigate and testify in regard to these cases. Such a commission, appointed by the governor with the consent of the senate and consisting of able and experienced alienists, could hardly fail to be of great benefit. They should visit the prisoner before his trial, or still better, the prisoner’s counsel, if intending to advance the plea of insanity, should be required to announce that fact to the district attorney and the prisoner should then be committed to the state asylum for the investigation of his case. Being thus placed under the observation of such a board of experts, they would be afforded a better opportunity for forming a correct judgment. They could then, if such was the case, announce that the prisoner was insane and unfit for trial, or in the event of a trial they could be called into court and give their evidence and professional opinion without being obliged to testify for either the prisoner or the district attorney. In this way perfect impartiality and fairness could be secured and the jury would naturally attach great weight to such testimony and would be led to an unprejudiced and thoughtful view of the prisoner’s condition, which is of paramount importance in these cases. The jury would then, with the aid of the commission of experts, decide, whether the act in question was the offspring or product of mental disease, whether he has sufficient mental power to control the sudden impulses of his disordered mind; whether or no there exists an inability to control mental action; whether the moral sense may not have been overborne by the superior force derived from disease and other similar questions, the proper answers to which would do much to make the results of these trials more certain and satisfactory both to the legal and medical professions and to the general public.

Source: Proceedings of the Conference Of Charities, Held In Connection With The General Meeting of the American Social Science Association At Saratoga, September, 1876. By Joel Munsell, Albany, N. Y. December, 1876. Pp. 54-58. National Conference on Social Welfare Proceedings (1874-1982) http://www.hti.umich.edu/n/ncosw/