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institutions, it has generally been of short duration, and not been attended with abstinence from liquor while it lasted.
In the capacity in which we now write it would be out of place for us to discuss the most proper modes, either of preventing inebriety or of reforming inebriates before the habit becomes confirmed. In relation to confirmed inebriates. however, we believe the desideratum of this particular time is a public judgment distinctly expressed in the State constitutions and laws, and expounded and enforced by the courts, that they are dangerous to themselves and others, and may and should be legally subjected to prolonged restraint, both for the protection of society and for their own protection and reformation. The discipline of an inebriate hospital should be coercive, and so understood; but as its inmates are not convicts, however culpable they may be in the eye of the moral law, tbe coercion may and should be disguised in every way that does not impair its essential efficiency. It was the practical error of the former treatment of the insane that it was too coercive, and time will probably show that it is the practical error of the system of treatment adopted in this latest enterprise which has appeared in the great field of social philanthropy that it is too voluntary. The fault referred to may not be wholly due to the inexperience of the conductors of a new enterprise. A more efficient system of reformatory restraint requires the authority of laws that have hitherto been enacted by one State only, and a court of that State has since decided that they are unconstitutional
The reports of the institutions for the insane, both of this country and Europe, show that intemperance is a common cause of insanity in its ordinary forms. The authorities alsu almost unanimously agree that inebriety sometimes becomes an insanity—a settled mental alienation, arising from a morbid condition of the brain and nervous system, which is chiefly characterized by a total abandonment to extreme indulgence, regardless of the most sacred claims and pledges, and by more or less impairment of the moral and intellectual powers of the individual. Where inebriety has clearly become a concomitant as well as a cause of insanity, the case should be treated in an institution for the insane. · Such is the increasing practice in American institutions, and it accords with the proposition adopted by the “Association of Medical Superintendents of American Institutions for the Insane,” at its meeting in Washington in 1866, and reaffirmed at its meeting held this year in Philadelphia, that “all State, county, and city hospitals for the insane should receive all persons belonging to the vicinage designed to be accommodated by each hospital, who are affected with insanity proper, whatever may be the form or nature of the bodily disease accompanying the mental disease. Another proposition adopted at the same time, viz : “That the facilities of classification or ward separation possessed by each institution should equal the requirements of the different conditions of the several classes received by such institution, whether those differences are mental or physical in their character,” meets the objections that have been made to associating dipsomaniacs with persons affected with other forms of mental disease. What we have said in relation to the continuance of the detention, and to the certain and entire abstinence of the inmates of an inebriate institution, applies equally to the treatment of dipsomaniacs in our institutions for the insane; and it is upon these two points, so essential to the success of any effort to reclaim inebriates or cure dipsomaniacs, that the public needs to be better instructed, and the most prevalent doctrines of the courts reformed. In a few weeks-sometimes in a few days-after the dipsomaniac is placed under restraint and proper treatment, the immediate effects of drinking pass off, and to a casual observer he appears to be entirely sane; and if he can then manage to appeal to a court of competent jurisdiction by the writ of habeas corpus it will probably set him at liberty. He is not sane, however. His moral and intellectual powers are weak and deeply perverted; his nervous system is irritable and depressed; every fibre • of his being seems to demand stimulants and his thirst for them is intense, and
the moment he is discharged he resorts to their use with the unreasoning directness with which the brutes obey their instincts. In permitting him to renew his self-destruction—a self-destruction that carries so much misery along with it-society rejects the guidance of science, fails to discharge its obligations to the individual and to itself
, and reaps a harvest of ills which, in their severity and extent, are second to none that afflicts humanity. We know of no more distressing embarrassment than that which the families of inebriates often experience, who find themselves the anxious but passive victims of a terribly destructive evil which they have no power either to avert or remedy.
The question may be asked whether restraint, prolonged for a year or two, will cure dipsomania. The answer of science is, we believe, that this form of insanity appears in this respect to follow the law of other forms of mental disease. It should be recollected that the cure is not undertaken in dipsomania till the disease has become chronic and deeply seated;. but if there be no constitutional tendency to this or any other form of insanity, and the treatment is continued till the susceptibilities and strength both of the body and the mind become entirely normal, the cure is likely to prove permanent.
Mental medicine is one of the specialties of a learned profession, and, as in other learned professions, the soundness of the philosophy and judgments of its members is determined at the bar of their peers. In these reports, therefore, we only propose to discuss those practical points in the treatment of the insane in relation to which the public needs to be better informed or the public judgment invoked. The great necessity of a more distinct legal provision for the prolonged restraint of dipsomaniacs is such a point, and believing that the views we have expressed upon this subject are sound and in all respects just, we earnestly hope they will sooner or later prevail. The great importance of the early, uninterrupted, and undisturbed hospital treatment of the insane, which we presented at some length last year, is also such a point, and we think we have already witnessed the good fruits of the views then put forth, in the fidelity and perseverance with which the friends of patients have supported our plans of treatment in individual cases of great interest.
Classified abstract of the receipts and expenditures of the hospital during the
year ending June 30, 1867.
3,755 25 11,678 87
458 13 406 88 6,777 02
659 32 1,537 05
Expended for flour......
vines, and shrubs...
1,191 35 2,696 97
203 27 4,220 71
143 05 1,204 41 2,091 80 539 74
517 53 3,637 22
Expended for books, stationery, and printing ...
$316 55 7,660 48 114 57
55 96 576 44
112 69 33,761 40 3,080 06 1,346 84 2,300 00
401 95 2,436 69
Balance from last year due the United States from the superin
$4,081 74 90,500 00 5,478 32 1,417 93 387 96
The board of visitors respectfully recommend that ninety thousand five-hundred dollars ($90,500) be asked for the support of the hospital during the year ending June 30, 1869. This is the sum that has been annually appropriated by Cougress for the same purpose for four years past, and will, we believe, be sufficient for the year in question. The expectation expressed in our last report, that the extension by act of Congress of the privileges of the institution to certain elasses of men discharged from service in the late war might materially increase the number of inmates and the cost of supporting the establishment has been realized, but the regular annual increase of the products both of the farm and garden and of pay patients, from whom a revenue is derived slightly in excess of the actual outlay for their support and treatment, will, it is thought, render it unnecessary to ask for any increase of the appropriation for the support of the house.
In no one year since the opening of the institution has more been done out of its ordinary funds, and by the patients and hands employed to conduct its ordinary operations, towards improving and perfecting the establishment as a complete hospital for the care and curative treatment of the insane, than in the course of the year under consideration. An orchard, containing upwards of seven acres, has been enclosed by two thousand one hundred and fifty-six run. ning feet of substantial paling fence seven feet high, and underdrained with upwards of three thousand feet of tiles laid three feet deep. Eleven hundred grape vines have been set in the orchard, with trellises of locust posts and galvanized wire, and a considerable number of fruit trees and shrubs of the choicest varieties have been planted. Roads, meadows, and lawns have been underdrained, and large amounts of stable manure and other fertilizers have been incorporated into the soil of the farm, garden, and orchard. The scheme of raising fruit for the general use of the inmates of the hospital was undertaken several years ago, and the yield, both of large and small fruits, has already
been considerable. The fruit is much prized by the patients, and the free consumption of fresh, ripe fruit and vegetables has evidently been conducive to their health. Several springs in the pleasure grounds of the patients have been opened, walled, covered, and the water conducted in indestructible earthen pipes to fountains and drinking reservoirs. The newly acquired out-farm of sixty acres has been enclosed by a substantial fence of pales on the public road, and of sawed rails on the other sides. Twenty-one neat animals of the most approved breeds have been added to the stock of the farm by purchase and natural increase, in order to supply a greater abundance of milk of a better quality, and to facilitate the agricultural operations of the establishment.
In-doors the largest improvement has been the addition of two of Chickering's best pianos to the means of entertainment in the wards, and an organ of twenty-three stops to the chapel. The organ was made to order by Geo. Jardine & Son, of New York. Prof. J. G. Barnett, of Hartford, Conn., and Mr. and Mrs. Ewer, of Washington, D. C., distinguished experts in music, have favored the inmates of the institution with two organ concerts since the instrument was set up, and pronounced the organ a superior one in volume of sound, in tone, and in the variety of musical combinations of which it is capable. The case of the organ is made of the southern pine, and adapted in its style to the architecture of the hospital edifice. The effect of it is both tasteful and imposing. Among the minor improvements within doors may be mentioned the thorough renovation and refitting of several wards which were either used as a general naval hospital during the late war, or were over-crowded and somewhat abused by our own patients in consequence of such use; also, the purchase of a number of carpets, not one yard having been bought during the war, nor since, till within the last year.
On the first Sabbath of July, 1866, the plan previously matured went into effect, of having the religious services in the chapel of the hospital conducted in turn by six associate chaplains, representing the six leading denominations of the District. Each chaplain preached in the afternoon of every Sunday for two months in the year, and, as occasion required, attended the sick of his faith throughout the year, and the funerals of such as died and were buried in the hospital cemetery. Under this system, the patients of all denominations are generally willing to attend all the services; much more willing than under any other system which we have tried. Under it each patient receives the same concession to his sectarian prejudices from others which he makes to them, and it has worked so well that it has been continued into the current year. It is the rule of the house that all patients who are able shall attend all chapel services.
The list of executive officers prefixed to this report shows that no change in the medical staff of the hospital took place during the last year, and we are glad to be able to report that, as their zeal and fidelity, so has their skill and efficiency in the discharge of their highly responsible duties, increased with their experience. We have also been much indebted to several under-officers and attendants for the faithfulness and intelligence with which they have discharged their respective duties.
The tri-weekly evening entertainments were continued through the winter half of the year, as heretofore, and a general in-door lecture, exhibition, or festival was occasionally given in the course of the summer months. Besides the musical soirées already referred to, we wish to acknowledge the delivery in the chapel of the institution of a very classical description of his own observations among the ruins of Pompeii, by James O. Welling, esq. The interest of Mr. Welling's very graphic and pleasing descriptions was greatly enhanced by an exhibition at the same time, conducted by Dr. W. W. Godding, the first assistant physician of the hospital, of numerous photographic views of the ruins, projected on a large screen by the oxyhydrogen light. The institution is also indebted to Brevet Major General J. K. Barnes, Surgeon General of the army, and to Dr. P. J. Horwitz, chief of the Bureau of Medicine and Surgery of the navy, for valuable pictures for the wards; also to General J. C. Cox, of the Interior Department, and R. S. Chew, esq., of the State Department, for the pains they have taken to have large numbers of newspapers sent to the hospital from the departments with which they are respectively connected, which have afforded the patients much entertaining reading. We have the honor to be, very respectfully, your obedient servants,
P. D. GURLEY,
President of the Board. C. H. NICHOLS,
Secretary of the Board. Hon. O. H. BROWNING, Secretary of the Interior.
REPORT OF THE SUPERINTENDENT OF CONSTRUCTION.
GOVERNMENT HOSPITAL FOR THE INSANE,
Office of Construction, November 1, 1867. SIR : The estimates submitted in my last annual report for the continuation of the finishing of the hospital edifice and the wall enclosing the grounds, and for a coal-house, amounting to only nineteen thousand dollars ($19,000) altogether, having received your approval, were voted by Congress.
A large ward for women, the locust, was mentioned a year ago as having just been finished. Since then the furniture has been manufactured of locust wood and the bedding made up, both at the hospital, and the ward is now occupied greatly to the relief of the other women's wards, which had become considerably crowded. Satisfactory progress has been made in the several branches of work under the small appropriations that have been asked and received from year to year for the continuation of the finishing, furnishing, heating, and lighting of the hospital edifice.
The rebuilding of the hospital wharf on an extended plan, authorized by an appropriation for that and other purposes, and referred to in my last report, has just been completed in a very substantial and durable manner. All the woodwork above water has been well covered with gas tar, and I propose that a coat of the same tar be given it at least once a year hereafter, and thoroughly test its efficacy in preserving from decay wood exposed to the weather in considerable horizontal surfaces that hold more or less water.
The quarrying of stone for the wall enclosing the grounds of the hospital, by a party of out-door attendants and patients, and the hauling it to the line of the wall, have been uninterruptedly continued through the year. The laying of the wall in a workmanlike manner and on reasonable terms suffered no interruption in the course of the year, except that occasioned by the cold of winter. The progress of this work has been rapid and entirely satisfactory to me. Two thousand three hundred and six (2,306) running feet of the wall have been built in the course of the year. It is now being carried across a ravine sixty (60) feet deep, one hundred and sixty-one (161) feet wide at the bottom, and three hundred and fifty-one (351) feet across at the top. The average slope of the banks is an angle of thirty-three degrees (339) with the horizon. This part of the work looked difficult before it was undertaken, but it has now been nearly accomplished without accident or extraordinary outlay.
The sixty (60) acres of pasture land, for the purchase of which an appropriation was made at the first session of the 39th Congress, has been conveyed to the United States. It became fully available for the use of the hospital early