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ming pools, are recognized as important adjuncts to an up-to-date institution. These methods of diversion aid in producing new fields of thought and stimulate a cheerful feeling, besides it goes without contradiction that a depressed mental state naturally exists in any individual who is deprived of his freedom, which is the fundamental principle of this glorious government.
A system of open wards where patients are allowed the privilege of going out and coming in at pleasure, within certain prescribed hours, has proven to be quite a success; it restores the confidence of the patient and cultivates self-reliance. Certain rules are prescribed as to boundary limitations and conduct. It requires clear forethought and judgment in perfecting a classification for this system and can only be available by those who understand what constitutes honor and integrity.
A most important feature of this plan is the abolition of restraints, which permits a more natural condition and removes the continuous exciting influences that close confinement and seclusion engender.
It is the present policy in many institutions to discountenance any mechanical restraint, as padded rooms, chains, muffs, wristlets, lock-beds and lock-chairs. It has been ascertained that the most violent, restless and destructive patient can be controlled without these methods; however, chemical restraints assist in a measure, but they have been reduced to a minimum.
The locking of patients in rooms and dormitories at night is becoming obsolete, but is necessary in some cases. This open door policy aids materially in improving the hygienic conditions and reduces the danger of accident.
The employment of an increased number of night attendants is necessary, but the expense incurred is of secondary importance when the health and comfort of the patient is under consideration.
The construction of open pavilions on the grounds, isolated from the public drives and walks, is a feature that redounds to the credit of any hospital, especially when an abundance of shade trees are conspicuous by their absence. Its architecture should be rustic in
design and equipped with comfortable seats, patent swings and hammocks, free latitude being permitted for social enjoyment and amusement.
Admission of visitors to the grounds, various departments and special wards is a prevalent custom in many State hospitals. I regret to say that the existing ideas of restraint and raving maniacs as the phenomena to be observed, continues to cling to the public and many turn away with disappointment, because they were not allowed to see the worst cases, where dungeons, chains, padded rooms and other contrivances existed. Such ideas show lack of education on the part of our citizenship and they do not understand that these methods have about disappeared under modern provision, care and treatment.
The plan for adjudging patients requires a regular legal process but the jury trials and other procedures that are necessary for criminals are becoming obsolete, in determining the mental soundness of an individual. It is only those who come in daily contact with these patients that can appreciate the mental anxiety that such methods excite and practical experience has demonstrated that deleterious results follow such practice, both from a moral and physical standpoint. You frequently hear them plead that they were innocent of the charge and that no infraction of the criminal statutes was committed, but the usual confinement in jail makes an indelible impression, which requires patience and reason to eliminate. This particularly applies to those cases that have a degree of intelligence and possess delusions of persecution.
The most approved method for adjudging a person of unsound mind is outside of the temple of justice, except in contested cases. No publicity should be countenanced and in preparing the necessary court papers, care should be exercised that unbiased evidence of two or more members of the medical profession should be secured as well as any other evidence, under oath, to prove conclusively that such a person is of unsound mind.
Approved blank forms, as recommended by the State hospitals, should be filled out with care, so that a complete history of
the case can be ascertained. It is important to have the family and personal history, as also the facts pertaining to the immediate attack. Correct data aid in making up the statistical tables for the annual report and furnishes compact knowledge from which deductions and conclusions can be made.
It should be the policy of all our States to make ample provision for the insane, so that trained attendants can be dispatched to immediately and safely conduct the individual to the State hospital.
Public opinion will ultimately demand that such cases should not be incarcerated in prison, even for a short period of time. Mental unsoundness is a disease of the brain, either due to direct or remote functional derangement of the nervous system, which may be transient or organic in character, resulting from heredity or stress, therefore ample provision, care and best methods of treatment is a duty that the public owes to its unfortunate fellow man. It devolves upon the twentieth century to correct these inhuman customs, which can only be done by education.
The evil effect produced by an aggregation of the different types of mental diseases clearly demonstrates the wisdom of segregation. It is necessary for many of the State hospitals to provide custodial care and treatment for idiots, imbeciles, feeble minded, inebriates and epileptics, which bring together a heterogeneous condition, which is not conducive to the improvement of each class.
It is practically impossible to manage scientifically an institution of this kind. State provision for each class is the solution of the problem, and special institutions should be constructed with all the modern appointments, where the number of cases will justify the expense. Texas is now building the State Epileptic Colony at Abilene, which will eventually remove the epileptics from hospitals for the insane. The time is coming when another eleemosynary institution will be constructed for the care, education (both industrial and literary) and treatment of those mental defectives termed idiots, imbeciles and feeble-minded. The purpose will be to admit children within certain prescribed ages and remove them from the
hospitals for the insane. It has been clearly shown by similar institutions in other States and countries that a certain per cent can be educated and so mentally improved as to make useful citizens, besides the general improvement in the majority of cases.
Public provision for inebriates is another approved plan, but little progress has been made in this country, separate institutions being provided for those types of mental diseases resulting from alcoholism, both acute and chronic. It requires no forethought to see what a benefit it will be to the citizenship and posterity of any State. Numbers of these cases can be cured in a very short time, if no permanent pathological change has taken place in the cerebral tissue or vital organs.
In all eleemosynary institutions there are cases of pulmonary tuberculosis and special cottages should be erected, with complete equipment a perfect sanitary condition is all important—with good ventilation and solariums. The most approved method of treatment should be given in all its details.
There is another class known as the criminally insane, which requires observation and judgment to form an opinion in those cases of suspected simulation. The association of this class with the other patients in our State hospitals exerts a detrimental influence upon the sensitive and appreciative person, also on those that have delusions of persecution. Insane criminals, according to their nature, require entirely different disciplinary treatment from the ordinary insane. It is best to segregate such cases in isolated annexes or establish a branch department at the most centrally located institution, the object and purpose of said department being to admit persons, where the plea of insanity is a defense for a violation of the criminal statutes, and those that become mentally unsound after conviction or before term of punishment expires. The suspected cases of simulation should be closely observed at all times and the importance of a trained corps of attendants will materially aid in detecting the malingerer. The system of provision, care and treatment will necessarily be more drastic than that for the mentally diseased.
The most approved method for the criminal class is separate institutions, but this is not economical unless the number of cases justifies the expense.
It is difficult to realize the number of eleemosynary and penal institutions in all countries, and their number is gradually increasing. There is a limit to all things, and it is only a question of time when the philanthropists and taxpayers will see the necessity of restrictive laws as the only solution to the hereditary transmission of disease. The statutes should be so drastic as to stop all procreation of species, and if enforced in all its details, will in a degree improve the society and health of our citizenship, as is forcibly illustrated in the animal kingdom.
Education of the masses is a means to this end of solving this momentous problem, but so long as personal liberty is engrafted in our souls, so will the hereditary transmission of disease continue, notwithstanding the protests of our profession and students of psychiatry.
In conclusion, I can not refrain from trying to impress the necessity of education along this line in regard to our legislative bodies. It is a physical impossibility for the management of the State hospitals for the insane and mental defectives to incorporate modern principles with inadequate appropriations.
Economy and honesty are a necessity in all State governments, but the public service frequently retrogrades because cheapness is considered economy. It is not right to place the dollar before our unfortunate fellow man, and liberal means should be provided, from time to time as necessity demands, for the proper care and treatment of mental diseases. Legislators know that the people desire an economical and honest administration of the State government and their consciences dictate the necessity of guarding their interests, but in doing so they do not represent the friends and relatives of the indigent patients who demand and expect of the management of these institutions everything imaginable for their proper treatment, which brings us face to face with the saying, "If you are going to do anything, do it well."