4. American Retrospect
The asylums of the State are divided into the public, the quasi-public, and the private. Exclusive of idiots and feeble-minded women, the number of insane under custody on the 1st of October, 1889, was 15,507. The Commission consists of three members, a physician, a barrister, and “a citizen of reputable character.” The medical and legal commissioners are required to make 132 visits each year; the medical commissioner is expected to make 22; and the whole Commission, or a majority thereof, have to make 106, being a total of 260 visits to the various State institutions during the year. Literal compliance with the requirements of the Act of 1889 is physically impossible, and the Commissioners detail certain arrangements which will facilitate the performance of their duties. The systems of accounts and statistics in vogue at the several State asylums show a lack of uniformity, and the Commission believes that these systems can be unified; to this end they have suggested a conference of asylum managers and superintendents with itself. The first effort towards intervention by the State in the case of the insane was made by Governor Throop, in January, 1830, but it was not until January 16th, 1843, that the New York State Lunatic Asylum was opened. In the course of a few years the asylum was filled, and it became necessary to send back to the poorhouses those patients who had received what was supposed to be the limit of beneficial treatment. Their treatment in these poorhouses was so bad that the Legislature passed what is known as the “Willard Asylum Act,” which provided for a State Asylum for the chronic insane. The Willard. Asylum was opened on October 13th, 1869, but soon became overcrowded. At this time the debt incurred by the State in aiding the prosecution of the civil war was most grievously felt, and in 1871 the Legislature passed an Act, by which counties might, upon showing that they had made proper provisions, care for their chronic patients. On October 1st, 1889, there were 5,371 patients in the county poorhouses and State asylums for the chronic insane. The Commission inquired into the two systems of care and treatment—the one conducted by the States and the other by the counties—and found that the latter did not provide the facilities which one would expect to find in every well-managed custodial institution or in any ordinary hospital. Some illustrations of evils inherent in the system of county care of insane patients in county alms-houses arc related, and the Commission concludes that the system “in practical operation has been found to have failed and fallen short of the hope entertained for it when the Act of 1871, sanctioning its trial, was passed.” The Commission makes many recommendations, of which the most important are: (1) that all of the insane in the county poorhouses in all the counties of the State, except New York and Kings, be transferred at the earliest possible date to State asylums; (2) that all laws having for their object the division of the insane into the so-called classes “acute” and “chronic” be repealed, and that all the insane be treated solely with reference to their curability; and (3) that an asylum be provided for the helpless and unteachable idiots.