THE gradual process of evolution in methods of caring for the insane may be roughly divided into four periods,1

viz:

1. The era of demoniacal exorcism, or of revenge.

2. The chain and dungeon period, or of indifference. 3. The era of asylums for the insane, or of humanitarianism and empirical treatment.

4. The era of hospitals planned and organized to meet the needs of the various classes of the insane, including psychopathic hospitals for the acutely insane in cities, and colonies for the chronic and mixed classes of insane in the country; or of scientific study, rational treatment and preventive medicine.2

These periods, while distinct in their outline, have not shown any sudden break of continuity in the transition from one period to the other. It is difficult, therefore, to fix the time limits of these eras by centuries, and yet we may approximate an historical sequence by assigning the era of demoniacal exorcism to the Middle Ages, the chain and dungeon era to the 17th and 18th centuries, and the era of special asylums to the 19th century, while we reserve for the

1 Peterson, Frederick, American Journal of Insanity, vol. lviii, Nov. 3, 1902, p. 405.

' Van Gieson, Ira, National Conference of Charities and Correction, 1901, "Public Policy in the Care of the Insane," p. 161.

157]

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20th century the distinction of introducing more generally into modern civilization the methods of care and treatment based upon scientific study, rational treatment and, above all, preventive medicine.

The aim of this study being limited to a consideration of the genesis and development of methods in the social care and treatment of the insane in New York State, and of the social aspects of the problem, it is obvious that a discussion of the era of revenge and of the chain and dungeon period would be largely out of place.

II. CARE AND TREATMENT

(a) Under Commonwealth of New York, 1777-1827. The first public hospital or asylum in the State of New York, in which the insane received special medical treatment, was the New York City Hospital. This institution was incorporated by royal charter bearing date June 13, 1771,1 and a building in pursuance of its objects was begun in 1773, which, unfortunately, was destroyed by fire before completion. The intervention of the Revolutionary War, bringing with it financial embarrassments, delayed the progress of the work of contruction, so that, despite pecuniary aid received from the colonial legislature, the edifice was not opened until January, 1791. It was then opened as a general hospital, receiving all cases of disease indiscriminately, and in this way cases of insanity gradually found their way into it. The exact date of the reception of the first case cannot be ascertained, although two are reported as admitted in May, 1797.3 Hitherto the insane had been

2

1 Peterson, Arthur E., and Edwards, Geo. W., New York as an Eighteenth Century Municipality, p. 301.

'Ordronaux, John, Lunacy Laws of New York, p. 199.

'Earle, Pliny, History of the Bloomingdale Asylum for the Insane, 1848, p. 8.

legally classified among disorderly persons,1 and were to be disposed of according to the pleasure of the magistrates before whom they were brought, either by being confined, or if strangers, returned to their last legal place of settlement.

3

Meanwhile, as the insane had greatly multiplied in numbers, and formed an exceptional class whose condition required for its successful treatment such space and isolation as could not be obtained in a general hospital, the governors of the New York Hospital applied to the legislature for assistance to enable them to build a separate structure for this class of patients. This was granted them in 1806,2 through the enactment of " An Act for the better and more permanent support of the hospital in the City of New York." It provided that the State of New York should appropriate the sum of $12,500 annually for a period of fifty years as a subsidy to the hospital. The new structure was opened in July, 1808. No requirements were stipulated at this time as to the admission of insane patients, but in 1809 a law was passed, granting authority to the overseers of the poor of any city or town in the state to contract with the governors of the New York Hospital for the maintenance and care of any lunatics chargeable to such city or town. This act was the initial step taken by the legislature in the recognition of the insane as a special class of diseased persons, requiring medical care and treatment in institutions. of a definite character. It also established the principle of its judicial custody over them as wards, to be protected and supervised in their persons as well as in their estates through the agency of its courts and appointed officers.

4

At this period there was no institution to which the

In

criminal insane could be sent, and two cases arose requiring the action of the legislature, the governor not being at that time empowered to grant pardons in such cases. 1799 one John Pastano was convicted of murder and sentenced to be executed. It transpired that the man was insane. An appeal was made to the legislature to save him and a law was passed pardoning him, on condition that he be kept in prison until he could be returned to his place of legal residence.1 A similar case arose again in 1816 and was disposed of in the same way, except that arrangements were to be made by the friends or relatives for care in some "lunatic hospital or asylum." In 1816 the society of the New York Hospital was again given authority by law to erect a new building. This was opened for use June, 1821, as the Bloomingdale Asylum for the accommodation of insane persons, and received a further annuity of $10,000, to be continued like the other to 1866.3

" 2

There was no further legislation dealing with the commitment and care of the insane until 1827, when a law was passed bearing upon the proper provision for the custody of insane persons in jails, and the responsibility of the next of kin to care for or make proper provision for the care of insane persons.* It might be well to note at this point that

1 Laws of 1800, chap. 3, entitled "An Act to pardon John Pastano for murder."

2 Laws of 1816, chap. 4.

4

3 Ibid., chap. 203.

* Laws of 1827, chap. 294, entitled An Act concerning Lunatics. Secs. 2, 3 and 4 recite that " no lunatic shall be confined in any prison, gaol or house of correction, or be confined in the same room with any person charged with, or convicted of, any criminal offense. But he shall be sent to the asylum in New York, or to the County poor-house or almshouse, or other place provided for the reception of lunatics by the county superintendents."

Sec. 5 recites that it shall be the duty of the parents or relatives of any lunatic, if able, to support him in such asylum.