The Construction of Hospitals for the Insane

PART I.

* Chapters 1 - 10

Chapter I
PRELIMINARY REMARKS
Chapter II
DEFINITIONS OF INSANITY
Chapter III
FREQUENCY OF INSANITY
Chapter IV
CURABILITY OF INSANITY
Chapter V
ECONOMY OF CURING INSANITY
Chapter VI
HOSPITALS THE BEST PLACES FOR TREATMENT
Chapter VII
DIFFERENT CLASSES OF HOSPITALS FOR THE INSANE
Chapter VIII
STATE PROVISION TO BE FOR ALL CLASSES
Chapter IX
THE ASSOCIATION OF MEDICAL SUPERINTENDENTS OF AMERICAN INSTITUTIONS FOR THE INSANE
Chapter X
FIRST STEPS TO SECURE A HOSPITAL

* Chapters 11 - 20

Chapter XI
FORM OF LAW FOR ESTABLISHING A HOSPITAL
Chapter XII
BUILDING COMMISSIONS
Chapter XIII
SELECTION OF A SITE
Chapter XIV
AMOUNT OF LAND
Chapter XV
SUPPLY OF WATER
Chapter XVI
DRAINAGE
Chapter XVII
ENCLOSURES
Chapter XVIII
PATIENTS' YARDS
Chapter XIX
IMPORTANCE OF ARCHITECTURAL ARRANGEMENTS
Chapter XX
CHARACTER OF PROPOSED PLANS

* Chapters 21 - 30

Chapter XXI
SIZE OF BUILDINGS AND NUMBER OF PATIENTS
Chapter XXII
POSITION, AND GENERAL ARRANGEMENTS OF THE BUILDING
Chapter XXIII
FORM OF BUILDING
Chapter XXIV
HEIGHT OF HOSPITALS
Chapter XXV
TEMPORARY OR WOODEN STRUCTURES
Chapter XXVI
NUMBER OF PATIENTS IN A WARD
Chapter XXVII
NATURAL VENTILATION
Chapter XXVIII
CELLARS
Chapter XXIX
MATERIALS OF WALLS
Chapter XXX
PLASTERING

* Chapters 31 - 40

Chapter XXXI
SECURITY FROM FIRE IN CONSTRUCTION
Chapter XXXII
ROOFS
Chapter XXXIII
SIZE OF ROOMS AND HEIGHT OF CEILINGS
Chapter XXXIV
FLOORS
Chapter XXXV
DOORS
Chapter XXXVI
LOCKS
Chapter XXXVII
WINDOWS AND WINDOW GUARDS
Chapter XXXVIII
INSIDE WINDOW SCREENS
Chapter XXXIX
STAIRS
Chapter XL
ASSOCIATED DORMITORIES

* Chapters 41 - 50

Chapter XLI
INFIRMARY WARDS
Chapter XLII
BATH ROOMS
Chapter XLIII
WATER CLOSETS
Chapter XLIV
WARD DRYING ROOMS
Chapter XLV
WATER PIPES
Chapter XLVI
DUST FLUES AND SOILED CLOTHES HOPPERS
Chapter XLVII
KITCHENS AND SCULLERIES
Chapter XLVIII
DUMB WAITERS AND DISTRIBUTION OF FOOD
Chapter XLIX
RAILROAD
Chapter L
HEATING AND VENTILATION

* Chapters 51 - 60

Chapter LI
AXIOMS ON HEATING AND VENTILATION
Chapter LII
HOT AIR AND VENTILATING FLUES
Chapter LIII
LIGHTING
Chapter LIV
PATIENTS' WORK ROOMS
Chapter LV
GENERAL COLLECTION ROOM
Chapter LVI
WASHING, DRYING, IRONING, AND BAKING
Chapter LVII
FARM BUILDINGS
Chapter LVIII
COST OF HOSPITALS FOR THE INSANE
Chapter LIX
DESCRIPTION OF THE PLATES
Chapter LX
DESCRIPTION OF THE FRONTISPIECE AND ITS GROUND PLAN

More to come...

CHAPTER IV
CURABILITY OF INSANITY.

INSANITY, when uncomplicated, properly and promptly treated, and having this treatment duly perservered in, may be regarded as curable as most other serious diseases; but its curability mainly depends upon these conditions. Of the class of cases alluded to, it is safe to say that about as many as eighty per cent. may be expected to recover. Where cases of insanity are left without proper treatment, they rarely get well, but are more apt to sink into some form of dementia, and to be for life a source of anxiety and a charge upon their friends or the community.

In all discussions in regard to the character of insanity and its curability, it is important that it should be placed in the same category as other diseases. It is just as possible for any one to have an attack of insanity, to recover from it, and to have another attack at a subsequent period of life, as it is of any other disease, or as any one is liable to have a first attack. It would be quite as reasonable to say that a patient with fever or rheumatism, or dysentary, or any other affection that he may have had in a past year, had not recovered from either of them, because from some cause (understood or not as the case might be) he had suffered from another attack of the same disorder in the same year or in subsequent years, as to insist that any one who had had an attack of insanity, and who had been relieved of every symptom of it, had not been cured, because at some later period of life, from some cause or other, he had another attack of the same disease. Whenever an individual suffering from insanity, is relieved from all indications of mental unsoundness, returns to his home and family without any developed eccentricity, resumes his ordinary relations with society, attends to his business with his usual ability and intelligence, for a year, or even a much less period, there should be no hesitation in recording such a case as "cured," without any reference to the future, about which we can know nothing. There is no power to insure any case, or to say that there may never be another attack. No one has a right to assert that a combination of circumstances, like that which produced the first, may not cause another; that ill health, and commercial revulsions, and family sorrows, and the many other causes that may have originally developed the disorder, may not again bring on a return of the same symptoms, just as they may produce them in one who has never before been insane. Out of seven thousand eight hundred and sixty-seven consecutive cases in the author's observation, five thousand six hindred and ninety-five had never had an attack before. Whatever induced the disease in them, certainly may induce it in those who have already suffered from the same malady, for we cannot expect one attack of insanity to act as a prophylactic, and like measles or smallpox to give immunity for the future.But this new attack is no evidence that the patient was not cured of the previous one. If the patient, then, is well in the sense in which he is considered well from an attack of typhoid fever, or dysentary, or rheumatism, or a score of other maladies,—when another attack is developed, it is as much a new case, and the recovery is a cure, just as much as it would be if he suffered from any other form of illness, and it ought to be so recorded. If he does not recover, in the sense in which a recovery has already been described, he should not be recorded as cured. Insanity uncured does really tend to shorten the duration of life, because individuals thus afflicted do not resist attacks of other diseases as well as the sane, and there are often great difficulties in carrying out a proper form of treatment.

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