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 VI
HOSPITALS THE BEST PLACES FOR TREATMENT.

AS already intimated, the general experience seems to show, that a very large proportion of all the insane are treated more effectively and far more economically among strangers, and in well-managed institutions specially provided for their treatment, than at their homes, and surrounded by their families, and by familiar scenes and associations.

Much as has been said in commendation of "home treatment" and "family treatment," it is not to be forgotten that these are commonly tried, and fail, before the idea of removing a patient to an institution is seriously discussed. The great danger in unduly protracting these efforts at home, is that the best period for successful hospital treatment is lost, and that what was recent in its character, becomes chronic, with all the diminished chances of recovery connected with this latter condition.

The history of "home" treatment before the establishment of hospitals is one of the saddest records of inhumanity and cruelty to be found anywhere. It was the discovery of this state of things, and the plain unvarnished recital of what was found by benevolent women and men, that led to the establishment of most State and government hospitals for the insane, which now do so much honor to the country and give such blessings to the aflicted and their families.

Very often this simple change from home to an institution, seems to be of itself sufficient to secure the beginning of convalescence, and not unfrequently the improvement in behavior and conversation is, from the first, most remarkable.

As the insane generally cannot be treated successfully nor be properly cared for in private houses, very clearly they cannot be in ordinary hospitals, almshouses, nor in penal institutions. The only mode, then, of taking proper care of this class in a community, it is obvious, as all enlightened experience shows, is to provide in every State just as many special hospitals as may be necessary, to give prompt and proper accomodations for all its insane, to cure those that are curable, to give every reasonable comfort to those that are not curable, and to prevent their becoming worse—and, what is of very great importance, hardly ever to be over-estimated—to protect their families and the community from the acts and influences of irresponsible and often dangerous persons.

The dangers incident to insane persons being at large, are much greater than is commonly supposed. Not a week, scarcely a day, indeed, passes without the public press containing the details of some occurence resulting in loss of life, or serious injuries to individuals, or destruction of property, from a neglect of proper care and supervision on the part of their friends or the public authorities, of those who had become insane and irresponsible for their actions. Very many of the cases of suicide that are reported very clearly belong to this class, and of those a large proportion, there is good reason to believe, were curable if their cases had been understood and properly treated. It is worthy of note, too, that many of these acts, even those of peculiar atrocity, are often committed by individuals who, with all their obvious mental infirmity, had previously been regarded as perfectly harmless. This fact shows the importance of proper provision being made for the prompt care and treatment of all classes of the insane, as well as the danger of allowing persons bereft of their reason and not accountable for their doings, a freedom, which only subjects them and others to risks, that benefit nobody.

It is only a few years since the writer of these pages, by a careful comparison of a list of lives lost and of persons injured by this class of irresponsible people being at large, as reported in the newspapers during a twelvemonth, found that these cases actually exceeded in number all the deaths and injuries from railroad accidents occuring in the United States during the same period.

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