Chapter Five
The Discovery of the Asylum Revisited: Lunacy Reform in the New American Republic

With the hubris so characteristic of graduate students, I originally intended that my dissertation would be a comparative study of changing responses to mental disorder in nineteenth-century England and the United States. Reason subsequently prevailed (or rather, my supervising committee, swamped with 700 pages on England alone, declared themselves ready to surrender). By this time, I had a rather extensive acquaintance with the existing secondary literature on the United States and had begun to burrow about in a variety of archives, most notably those at the Northampton State Hospital in Massachusetts and at the Institute of Living (formerly the Hartford Retreat), located charmingly enough (though in blatant contradiction of its managers' feeble attempt at euphemism) on Asylum Avenue, at some small remove from the Connecticut State Capitol. In substantial measure, I set this work aside once I arrived at the University of Pennsylvania, first concentrating my energies on a new topic more readily seen as legitimate among my sociological colleagues, a study of the disenchantment with and abandonment of the mental hospital in the third quarter of the twentieth century;^[1] and then, when the passage of time rendered the task slightly less unpalatable, pruning my examination of the social organization of insanity in nineteenth-century England to a more manageable (and publishable) size.^[2]

[1] See Andrew Scull, Decarceration: Community Treatment and the Deviant—A Radical View (Englewood Cliffs, N.J.: Prentice-Hall, 1977; 2d ed., Oxford: Polity Press; New Brunswick, N.J.: Rutgers University Press, 1984).

[2] Andrew Scull, Museums of Madness: The Social Organization of Insanity in Nineteenth-Century England (London: Allen Lane; New York: St. Martin's Press, 1979).

But I did not entirely lose touch with my earlier ambition to examine the parallel developments in the United States, and despite the competing distractions, I could not completely resist the temptation to nose around in the archives of the two very important pioneering American asylums that happened to be located in my new home town, the Frankford Retreat, and the psychiatric division of the Pennsylvania Hospital. A few years later, I was asked to present some general reflections on the historiography of Anglo-American psychiatry,^[3] and in rereading David Rothman's influential The Discovery of the Asylum, was struck with how poorly his emphasis on the uniquely American character of the Jacksonian asylum accorded with the archival records I had examined. This finding seemed worth documenting with some care: hence the following chapter.

The Discovery of the Asylum Revisited: Lunacy Reform in the New American Republic

During the past fifteen years, with the possible exception of Michel Foucault's work, David Rothman's Discovery of the Asylum has attracted more attention than any other book on the history of our responses to insanity.^[1] Like Foucault, Rothman has succeeded in reaching an audience far beyond the limited circle of historians who ordinarily concern themselves with social reform and administrative history. Indeed, he has even been widely read among sociologists, despite the well-known aversion of many of them to studying anything but contemporary America.

It is not difficult to suggest reasons for his success. At the very least, they include the following: the belated and welcome rupture with lingering Whiggish tendencies (still evident in many histories of psychiatry, though long since formally renounced in other areas of historical inquiry); the boldness and sweep of his argument, as well as his willingness (deriving in part from his acquaintance with the work of Goffman and others on "total institutions")^[2] to seek similarities and connections be-

[3] See Chapter 2.

[1] Michel Foucault, Madness and Civilization (New York: Pantheon, 1965); David Rothman, The Discovery of the Asylum: Social Order and Disorder in the New Republic (Boston: Little, Brown, 1971).

[2] Erving Goffman, Asylums (Garden City, N.Y.: Doubleday, 1961).

tween the rise of the lunatic asylum and the adoption of segregative responses to other forms of deviance; the intrinsic appeal of his subject matter, given the newly fashionable interest in the poor and the powerless, in "history from below," bolstered in this instance by Rothman's claim that attention to these apparently peripheral concerns could shed new light upon so central an issue as the bases of social order and cohesion; and the resonance of his implicitly anti-institutional, antibureaucratic, antiexpert analysis, not just with the general intellectual climate of the 1970s, but (ironically enough) with the more particular ideology of a contemporary "reform" movement seeking the deinstitutionalization of the deviant.^[3]

One further source of the book's popularity, I think, lies in its subliminal appeal to a certain sophisticated variant of cultural chauvinism. English historians have long treasured and nurtured the myth of "the peculiarities of the English,"^[4] their American counterparts have been equally enamored of the image of "the city on the hill," the unique and special destiny of the American Republic. And, of course, the central element in Rothman's fundamentally idealist account of the rise of the asylum is his emphasis on the uniquely American properties of the new institutions and on their origins in a peculiarly Jacksonian mixture of angst about the stability of the social order and utopianism about the solutions available to meet the difficulty. As I have pointed out elsewhere, such an account is vulnerable to the overwhelming evidence that, so far from being a uniquely American phenomenon, the "discovery of the asylum" was well under way in Europe long before the Jacksonian era began. Furthermore, while Rothman's account persuasively describes the anxiety and the vision of perfectibility, it neither explains the emergence of these ideas nor analyzes the social location of those who espoused them.^[5]

In this essay, however, I want to take this criticism a step further. For it is not just a comparative perspective on parallel developments in England, France, and elsewhere that undermines Rothman's argument. Rather, in his insistence on the domestic character of the changes he describes, he gives scant attention to evidence that the lines of influence were precisely the reverse of those he implies, to intimations that the first critical stages of the American lunacy reform movement involved a

[3] On this last point, see Andrew Scull, Decarceration: Community Treatment and the Deviant—A Radical View (Englewood Cliffs, N.J.: Prentice-Hall, 1977; 2d ed., Oxford: Polity Press; New Brunswick, N.J.: Rutgers University Press, 1984).

[4] The latest, and perhaps oddest, example of this school is the anthropologist turned historian, and former specialist on Nepal, Alan Macfarlane. See his Origins of English Individualism (Oxford: Basil Blackwell, 1978).

[5] See Andrew Scull, "Madness and Segregative Control: The Rise of the Insane Asylum," Social Problems 24 (1977):338–51.

heavy dependence on ideas and examples that were borrowed from abroad.^[6]

In what follows, I shall examine the developments that led, between 1810 and 1824, to the construction of a number of lunatic asylums on the eastern seaboard of the United States. I shall suggest that while each of these so-called corporate asylums^[7] had its idiosyncrasies, they all also exhibited striking similarities. I shall also suggest that these "family resemblances" mark them as a distinct departure in the history of American responses to insanity. I shall show that, taken together, these institutions had a profound impact on the movement to "reform" the treatment of lunatics in the United States, notwithstanding their eventual fate as asylums for the rich, precursors of the dual, class-based system that is still characteristic of our approach to mental disorder. And I shall demonstrate that the early history of these corporate asylums is marked at every turn by evidence of European inspiration and influence.

The new corporate asylums were not, of course, the first institutional provision made for lunatics in the United States. From its foundation in 1751, the Pennsylvania Hospital had made some provision for the distracted, first in the basement of the original building and later in a separate structure adjacent to the rest of the hospital.^[8] Prompted largely by the urgings of two successive provincial governors, the Virginia burgesses had set up a "madhouse," modeled to some extent on London's Bethlem, in 1773.^[9] And when a hospital for New York was first canvassed in 1769, its projectors urged that provision be made for maniacs as well as for medical and surgical cases. After its long-delayed opening in 179l, the maniacs were assigned to the basement; by 1803 a third story had to be added to accommodate them; and in 1808 they were moved to a separate building on the hospital grounds.^[10] But each of these early institutions was little more than a "place of safekeeping" where the inmates could be "disabled from injuring themselves and others."^[11] At best, those in charge hoped that "the wretched maniac, sequestered from society,

[6] Though I shall not do so here, a similar case could be made about the origins of the penitentiary. Cf. in this regard Michael Ignatieff, A Just Measure of Pain: The Penitentiary in the Industrial Revolution (New York: Pantheon, 1978); and R. Evans, "A Rational Plan for Softening the Mind" (Ph.D. dissertation, Essex University, 1974).

[7] "So-called" because they were built primarily with funds raised by private appeals to the public.

[8] See Nancy J. Tomes, "The Persuasive Institution: Thomas Story Kirkbride and the Art of Asylum Keeping, 1841–1883" (Ph.D. dissertation, University of Pennsylvania, 1978).

[9] Norman Dain, Disordered Minds (Williamsburg, Va.: Colonial Williamsburg Foundation, 1971), esp. 7–9.

[10] S. I. Pomerantz, New Yorh—An American City, 1783–1803 (New York: Columbia University Press, 1938).

[11] Bloomingdale Asylum Annual Report (1818), 11.

might be made subject to such regimen and regulations, which if not always the means of recovery, would at least ensure safety, decency and order."^[12] As this implies, these institutions were intended "to secure" rather than "cure,"^[13] and the treatment that was given was dispensed haphazardly, consisting of the application of such standard medical therapies of the period as bleedings, purges, and emetics.

If these eighteenth-century institutions had looked to contemporary English developments for their models—to the growing number of voluntary hospitals of the period and to idealized accounts of the success of the regime at Bethlem—their nineteenth-century counterparts, too, looked across the Atlantic for inspiration, though with rather different results. Both England and France were by now in the throes of their own movements to reform the treatment of the insane, and it was to the work of Pinel and (to a much greater extent) of Tuke that the founders of the new corporate asylums looked for guidance. The means by which they obtained that guidance were sometimes more, sometimes less, direct, but the impact in each case was marked, and the outcome was an influential group of asylums that exemplified a radically different approach to the insane,^[14] even while giving that approach some peculiarly American overtones.

The most direct lines of influence are found in the cases of the Friends' Asylum at Frankford and in the Bloomingdale Asylum in New York. The Friends' Asylum, as its name suggests, was, like its inspiration, a Quaker foundation. The prime mover in the enterprise was Thomas Scatter-good, who had visited the York Retreat during an extended religious sojourn in England between 1794 and 1800. Beginning at their meeting in the spring of 181l, the Philadelphia Friends began to debate the question of making "provision for such of our members as may be deprived of the use of their reason."^[15] Even from three thousand miles away, Tuke's grandson Samuel played a direct role in the process, contributing an anonymous article, "Hints on the Treatment of Insane Persons," to the October 1811 issue of the Philadelphia Eclectic Repertory and Analytic Review . The Philadelphia Friends subsequently sponsored an American edition of Tuke's Description of the Retreat, which appeared only a matter of months after the original English printing. The latter "was circulated among Friends in Philadelphia and the adjoining districts of the Yearly

[12] Pennsylvania Hospital Archives, Board of Managers' Minutes, 6: 390–92, quoted in Tomes, "Persuasive Institution,"42.

[13] William Malin, clerk at the Pennsylvania Hospital, 1828, cited in Tomes, "Persuasive Institution,"67.

[14] See chapters 2 and 4.

[15] An Account of the Rise and Progress of the [Frankford] Asylum, Proposed to Be Established near Philadelphia for the Relief of Persons Deprived of the Use of Their Reason (Philadelphia: Kimber and Conrad, 1814), 2.

Meeting and served to stimulate the interest of Friends in collecting funds and in pushing forward the work to completion."^[16] By 4 June 1813, the management committee had raised $24,092.50, having received "extensive approbation of the proposed institution" and contributions from a large number of individual subscribers as well as from more than twenty district Quaker Meetings.^[17] The site selection and construction now proceeded alongside further fund-raising efforts, and in 1817 the asylum finally opened its doors to an exclusively Quaker clientele.^[18]

The direct lines of communication between English and American Quakers played a similarly important role in the founding of the Bloomingdale Asylum in New York. Unlike Frankford, this was not a completely new foundation, but it resulted from a sharp change in the arrangements for dealing with the insane at an existing institution. As we have seen, the New York Hospital had begun by placing its lunatics in basement cells, but subsequently, it had moved them to a separate building on the hospital grounds, in an effort to diminish the deleterious impact on the remaining patients of the noise and confusion they created. This expedient proved to be little more than a palliative measure, as the accumulation of chronic cases, the lack of any systematic plan of treatment or management, the limited interest of the hospital's physicians in dealing with lunacy, and the absence of any unified authority over the insane department combined to create recurring difficulties for the hospital's governors.^[19]

It was, therefore, with conditions ripe for change that, in April 1815,

[16] "A History of Friends' Asylum," Friends' Hospital Archives, Pbiladelphia (typescript, n.d.), 16.

[17] Friends' Asylum Contributors' Book, vol. 1, 4 June 1813. Both the fund-raising procedures and the organization of the Contributors' Association were borrowed directly from those used by the founders of the York Retreat.

[18] These included the publication of reports, in editions of a thousand and more, designed to stimulate further interest in the project. To the 1814 version, "An abridged account of the proceedings of Friends relative to the Retreat near York, in England, is added, in order to convey correct information of the nature of the proposed establishment, the views of both institutions being nearly the same" (Rise and Progress of the Asylum, 18). Quaker clientele: Again, it followed here the example of the York Retreat. But unlike the English establishment, the Frankford Asylum was unable to generate sufficient inmates to fill the available space, a situation that persisted until the rule restricting admissions to Quakers was abandoned in 1834.

[19] For an insightful discussion of the emergence of similar problems at another "mixed" institution, the Pennsylvania Hospital, see Tomes, "Persuasive Institution," chap. 1. Tomes astutely suggests that these administrative difficulties may have contributed to the managers' receptivity to moral treatment. But I feel she pushes her case too far when she argues that "moral treatment must be looked at as a product of institutional experience at least as much as emulation of foreign precedents" (ibid., 69). In this connection, one may note that the Pennsylvania Hospital did not adopt the new approach until 1841, long after the administrative difficulties to which she refers had become apparent.

Thomas Eddy set about converting his fellow members of the hospital board to the advantages of "a course of moral treatment for the lunatic patients, more extensive than had hitherto been practiced in this country, and similar to that pursued at 'The Retreat' near York, in England."^[20] Highly active in many of the Quaker-inspired reforms of the period (he has been called "the American Howard" for his role in prison reform), Eddy had almost certainly learned of the new approach through the publications and appeals of his fellow Quakers who were on the asylum committee in Philadelphia. However, he also corresponded regularly with Lindley Murray, a member of the York Quaker Meeting and a close friend of the Tuke family.

Mention of his project to Murray brought forth a swift and detailed response from Samuel Tuke himself concerning the principles that should guide "the erection of an asylum for lunatics." Tuke's suggestions were published as a pamphlet in New York in 1815.^[21] Eddy proposed both a new asylum on a separate site, a farm in the northern part of Manhattan Island, and an immediate attempt to apply the principles of moral treatment in the existing building^[22] —proposals whose realization was made easier when the New York legislature voted an annual subvention of $10,000 to support the erection of more extensive accommodations for the insane.

The new Bloomingdale Asylum opened in 1821.^[23] Like the Friends' Asylum at Frankford, it bore a pronounced physical resemblance to the York Retreat, which is perhaps not surprising in view of Tuke's emphasis on the contribution architecture could make to the patients' recovery.^[24] All three institutions concurred on the primary qualification of a successful asylum superintendent: he should, in the words of the Bloomingdale

[20] Quoted in Henry Hurd, The Institutional Care of the Insane in the United States and Canada (Baltimore: Johns Hopkins University Press, 1916), 3: 137.

[21] Samuel Tuke, A Letter to Thomas Eddy of New York on Pauper Lunatic Asylums (New York: Samuel Wood, 1815).

[22] See Thomas Eddy, Hints for Introducing an Improved Mode of Treating the Insane in Asylums (New York: Samuel Wood, 1815).

[23] Significantly, it is referred to in some early hospital sources as "the Rural Retreat." Cf. William L. Russell, The New York Hospital: A History of the Psychiatric Service, 1771–1936 (New York: Columbia University Press, 1945), 178.

[24] See Andrew Scull, "The Architecture of the Victorian Lunatic Asylum," in Buildings and Society: Essays on the Social Development of the Built Environment, ed. A.D. King (London and Boston: Routledge and Kegan Paul, 1980). The Friends' Asylum was particularly reminiscent of the York Retreat, incorporating only some minor modifications that had been suggested by Tuke himself, based on his experiences at the Retreat. The most important of these was building patients' rooms on only one side of the corridors in the wings, to make the structure more light and airy. In other respects, the Frankford institution's indebtedness is evident even to the untrained eye, and extended to even so fine a detail as the use of Tuke's design for iron-window sashes. The use of sashes would obviate the need for bars and thus make the building more nearly resemble an ordinary residence.

committee, be "reasonable, humane, moral and religious, possessing stability and dignity of character, mild and gentle, . . . resolute, . . . compassionate, [and] of just and sagacious observation."^[25]

The omission of medical qualifications was neither accidental nor insignificant. Moral treatment, as I have pointed out elsewhere, had been developed at the York Retreat by laymen.^[26] Following this precedent, both the Friends' and Bloomingdale Asylums placed this position of superintendent in lay hands.^[27] At the New York Hospital, William Handy announced that medicine was "rarely given" and that "we do not believe in the specific power of any drug in curing madness." Reiterating Tuke's own conclusions in an American context, he denounced bloodletting, emetics, violent cathartics, setons, and blisters as generally useless and asserted that with the addition of warm baths, recovery "will be the most certainly accomplished by strict attention to a moral regimen."^[28] The superintendent at Friends' Asylum made similar efforts to insist on the primacy of moral treatment but faced some opposition, for the resident physician continued to demand the frequent use of medicine.^[29]

Boston had neglected to build a general hospital in the eighteenth century, possibly, as Leonard Eaton suggests, because the homogeneity of the elite there and the consequent lack of religious and social rivalry hampered the kind of competitive philanthropy that aided the establishment of the Pennsylvania and New York hospitals.^[30] By 1810, however, some of the more ambitious young Boston physicians, perhaps resenting the provincial status quo to which the lack of such a hospital consigned them, were urging the establishment of a hospital and lunatic asylum.^[31] The campaign quickly attracted the support of some of "the wealthiest and most respectable men of Boston." However, delayed somewhat by unsettled political conditions, the construction of the two institutions was

[25] Bloomingdale Asylum, Annual Report (1818), 13.

[26] See Andrew Scull, Museums of Madness: The Social Organization of lnsanity in Nineteenth-Century England (London: Allen Lane; New York: St. Martin's Press, 1979).

[27] Isaac Bonsall and his wife at Frankford; and Laban Gardner and his wife at Bloomingdale. Both institutions difiered from the Retreal, however, in having from the outset a resident as well as a visiting physician. I shall discuss the significance of this fact further on in this essay.

[28] Bloomingdale Asylum, Annual Report (1818), 7–10. See also Russell, New York Hospital, 178–79.

[29] Cf. Norman Dain and Eric T. Carlson, "Milieu Therapy in the Nineteenth Century: Patient Care at the Friends' Asylum, Frankford, Pennsylvania, 1817–1861," Journal of Nervous and Mental Disease 131 (1960): 284–85.

[30] Leonard K. Eaton, New England Hospitals, 1790–1833 (Ann Arbor: University of Michigan Press, 1957), 11–13.

[31] See the 20 August 1810 appeal from Dr. Warren and Dr. Jackson, reprinted in Nathaniel I. Bowditch, A History of the Massachusetts General Hospital (Boston: Privately printed, 1851), 3–6.

not completed until 1818.^[32] Having learned from the experiences of New York and Philadelphia, the trustees of the new Massachusetts General Hospital had planned from the beginning to keep the hospital and lunatic asylum physically and administratively separate. Now they also sought to imitate the novel and supposedly more curative system of moral treatment. Accordingly, before taking up his appointment as the first superintendent of the asylum, Dr. Morrill Wyman was dispatched by the trustees to view and report back to them on conditions at the Philadelphia, New York, and Frankford asylums.^[33]

At New York, he was conducted round by Thomas Eddy, who then presented him with a copy of Tuke's Description of the Retreat .^[34] His subsequent practice indicates that he became a convinced disciple. In his only separately published writing, a lecture delivered in 1830, Wyman suggested a very restricted role for conventional medical therapeutics because they were "seldom useful in relieving mental disease [and were] usually injurious and frequently fatal." The contrast with the value of Tuke's approach was stark: obviously, "without symptoms of organic disease, a judicious moral management is more successful." However, he went on, "moral treatment is indispensable even in cases arising from organic disease."^[35]

The evidence we have about Wyman's practice at the McLean Hospital reinforces this portrait. Chains and straitjackets were absent; high qualifications were demanded of the attendants; patients ate at the superintendent's table, rowed on the Charles River, took country rides, and in some instances were allowed to visit the newly founded Boston Athenaeum. In the words of an English visitor, "To gain his confidence and imperceptibly lead him to the exercise of his disused energies and faculties . . . is all that the physician studies in the management of his patient."^[36]

In their early years of operation, then, these three asylums tended to play down the importance of the medical armamentarium and to urge that moral treatment be employed widely in its place. In this respect, they differed sharply from the fourth corporate lunatic asylum that was built in this era, the Hartford Retreat. For here, from the outset,

[32] Eaton, New England Hospitals, 43–46.

[33] Nina F. Little, Early Years of the McLean Hospital (Boston: Countway Library of Medicine, 1972), 63. He made a verbal report to the trustees on 2 June 1818.

[34] This copy is still in the McLean Archives.

[35] Rufus Wyman, A Discourse on Mental Philosophy as Connected with Mental Disease, Delivered Before the Massachusetts Medical Society (Boston: Office of the Daily Advertiser, 1830), 24.

[36] Edward Sturit Abdy, cited in Helen E. Marshall, Dorothea Dix: Forgotten Samaritan (Chapel Hill: University of North Carolina Press, 1937), 78–79. See also Eaton, New England Hospitals, 136–37.

medicine was accorded primacy, an approach that came to characterize American treatment of insanity during the remainder of the nineteenth century.^[37]

This inversion of emphasis is scarcely surprising in view of the central place that was occupied by medical men in creating and running the Hartford Retreat. An asylum for the state had first been proposed before the Connecticut State Medical Society in 1812. At that time, little action was taken. But the project was revived again in 1820 by a group of Hartford physicians led by Eli Todd. In a speech before the local Hartford County Medical Society in December 1820, Todd articulated his conviction that "mental disorder is as definitely a manifestation of disease as is a fever or fracture. It is our duty as civilized men to attack this disease. Let us make diligent inquiry, find out how prevalent this disease is, and then establish an institution for its treatment and cure."^[38] Within a year, the state medical society supported the asylum proposal and thereafter played a major role in bringing the plan to fruition. Society funds were made available to publicize the project and to print appeals for contributions; with the aid of local clergy, committees were formed throughout the state to collect donations; the public was repeatedly informed of the benefits and advantages of asylum treatment; and a state subvention was successfully sought.

Because Connecticut lacked the concentrations of wealth that were present in New York, Pennsylvania, and Massachusetts, fund-raising proved to be far more difficult there than it had been elsewhere,^[39] and one may reasonably doubt that the Hartford Retreat would have been built at this time without the sustained initiative of the medical society—the more so since the state's wealthy inhabitants could clearly avail themselves of the new asylums in New York and Boston. The society's leaders were convinced that "no-one conversant with the records of our profession, can hesitate for a moment to believe that its interest would be greatly promoted by adopting the plan which we have suggested."^[40] And in setting up the new institution, the society went to great lengths to ensure the dominance of the profession's interests.^[41] The state charter that

[37] On this last point, see Gerald Grob, "Samuel B. Woodward and the Practice of Psychiatry in Early Nineteenth-Century America," Bulletin of the History of Medicine 36 (1962): 490–43.

[38] Eli Todd, quoted in John Winkler and Adele Norton, "History of the Institute" (i.e., the Hartford Retreat), Institute of Living Library, Hartford (typescript, chapters paginated separately), chap. 1:19.

[39] Cf. Eaton, New England Hospitals, 72.

[40] Connecticut State Medical Society, Report of a Committee . . . Respecting an Asylum for the lnsane, with the Constitution of a Society for Their Relief (Hartford: Bowles and Frances, 1821), 12.

[41] Particularly prominent in the asylum movement were Dr. Eli Todd, Dr. Mason Fitch Cogswell, Dr. George Sumner, and Dr. Samuel Woodward (who later, on Todd's recommendation, became superintendent of the new Worcester [Massachusetts] State Hospital).

was passed in 1822 provided that at least a quarter of the committee of trustees were to be physicians, as were all six of the official asylum visitors. Perhaps even more significantly, the power of appointing the superintendent rested with the state medical society, thereby cementing the profession's dominance.^[42]

As the Very name of the institution indicates, those setting up the Hartford Retreat were heavily influenced by the recent developments in England and France. In his declining years, looking back on his role on the planning committee for the asylum, George Sumner commented, "We had no other guides than 'Pinel on Insanity' and 'Tuke's History of the Retreat,' near York, in England."^[43] The English institution was the most frequently mentioned in the fund-raising literature, the public being assured that, in accordance with Tuke's approach, "the inmates of this asylum will in all cases be treated with humanity, subjected to no unnecessary rigour of discipline, and controlled by no force unless their safety requires it. The chains and the scourge, which have too often been the implements of correction, must be abolished, and every attendant dismissed from the institution who resorts to violence in the performance of his ordinary duties."^[44]

Shortly after the Hartford Retreat opened its doors in 1824, its new superintendent, Eli Todd, informed the public of the principles that guided his practice:

These are to treat [the insane], in all cases, as far as possible, as rational beings. To allow them all the liberty and indulgence compatible with their own safety and that of others. To cherish in them sentiments of self-respect, To excite an ambition for the good will and esteem of others. To draw out the latent sparks of natural and social affection. To occupy their attention, to exercise their judgement and ingenuity, and to administer to their self-complacency by engaging them in useful employments, alternated with amusements. To withdraw, in most instances, their minds as much as possible from every former scene and every former companion, setting before them a new world and giving an entire change to the current of their recollections and ideas.^[45]

[42] Connecticut State Medical Society, Report (1821), 15. This situation contrasted markedly with that at the McLean, where in the early years the state directly appointed four of the trustees; and with that at Frankford, where lay managers were clearly the final authority in the institution's affairs.

[43] George Sumner, "Sketches of Physicians in Hartford in 1820 and Reminiscences," Paper read before the Hartford Medical Society, 1 January 1848 (Hartford: Case, Lockwood, and Brainard, 1890), 8–9.

[44] Connecticut State Medical Society, Report (l821), 10.

[45] Cited in Winkler and Norton, "History of the Institute," chap. 3:6.

The techniques, even the very wording, come directly from the Description of the Retreat .

But the Hartford Retreat was no mere copy of its namesake. Breaking sharply with his model, and criticizing the other American corporate asylums for failing to do so, Todd placed great stress on the value of medical treatment. The York Retreat had marked a distinct advance in the treatment of insanity: "Its managers appear, however, to have placed too little reliance upon the efficacy of medicine in the treatment of insanity, and hence their success is not equal to that of other asylums in which medicines are more freely employed."^[46] And the managers of the McLean, Bloomingdale, and Friends' asylums had perpetuated the error, with the result that "their treatment is feeble [as] compared to the lofty conceptions of truly combined medical and moral management."^[47] "The aid of medicine" was essential, since

the mind and body are so connected that there can scarcely be a disease of either in which the other is not involved, and in which medical and moral treatment may not be advantageously combined. When mental derangement originates entirely in a diseased state of the body—medication constitutes the paramount, and moral treatment the subsidiary, means of cure. On the other hand, when bodily disease is merely the effect of mental derangement, then there is a complete inversion of the relative importance of these curative means. In most states of insanity, therefore, a judicious combination of both promises the most successful results.^[48]

Gradually, practice at the other corporate asylums began to resemble that at Hartford. Stress was placed on the traditional medical therapeutics and was soon accompanied by the growing reliance on opium and morphine that became characteristic of American asylum practice. The McLean from the outset had a medical superintendent, albeit one skeptical of the value of medical as opposed to moral treatment of insanity.^[49] But at Bloomingdale and the Friends' Asylum, the administrative structure was more fragmented and confused, and here the realignment in treatment philosophies was signaled and in large part produced by changes in the asylums' internal organization.

As we have seen, the latter asylums had initially opted for lay superintendents; but they also had a resident physician, a young man who prac-

[46] Connecticut State Medical Society, Report (182l), 10.

[47] Eli Todd, speech before the Hartford County Medical Society, December 1820, cited in Winkler and Norton, "History of the Institute," chap. 1:19.

[48] Todd, cited in ibid., chap. 3:6.

[49] Bulfinch, the asylum architect, had tried to persuade the trustees that appointing a medical man, rather than a lay administrator, to the post of superintendent was "very objectionable." (His report is reprinted in Isis 41 [1950]:8–10). But the board ignored the suggestion, deciding that "it is expedient to unite in one person the offices of Physician and Superintendent of the Asylum" (quoted in Bowditch, Massachusetts General Hospital, 37).

ticed under the supervision of two or more visiting physicians.^[50] The superintendent was "entrusted with the general control of the concerns of the Institution" and the supervision of the moral regimen; the medical men dealt with the strictly medical treatment.^[51] At Bloomingdale, this system was abruptly abandoned in 1831, "the position of attending physician being dispensed with and the resident physician given immediate control of the moral and medical treatment of the patients." The lay superintendent, meanwhile, was reduced to the status of a steward.^[52] At the Friends' Asylum, the changes were more gradual and subtle: perhaps the Quaker managers here were less willing to abandon Tuke's original vision.

Symptomatic of growing medical ambition, the attending physicians' contribution to the Annual Report for 1830 for the first time moved beyond the compilation of routine statistics to a more elaborate discussion of the medical role in patient care. Two years later, the superintendent and his wife resigned, and the appointment of their replacements was accompanied by upheavals in the medical department, with "Dr. Robert Morton and Dr. Charles Evans, appointed attending physicians to the House."^[53]

Like Eli Todd, Evans and Morton were convinced that moral and medical treatment were inextricably linked:

Where a judicious system of medical treatment is steadily pursued [they commented] it exerts a strong influence on the other departments, which would not at first sight he obvious. . . . A course of moral treatment is almost a necessary consequence of a proper sense of the value of medical remedies. They, in fact, are parts of the same system. After what have been called medical means have been successfully resorted to, to remove obvious physical disease, moral treatment will then be found very efficient in restoring and strengthening the functions of the diseased organ.—And we believe that it is only by thus uniting them that full benefit can be derived front either.^[54]

Subsequently, they sought a steadily larger role than the superintendent in the dispensing of the "moral" side of the treatment, a campaign bolstered by an insistence on insanity's somatic basis. In a complaint

[50] The relative status of the two resident officers is clearly indicated by their respective salaries: at Frankford, at its opening, these were $500 per annum for the superintendent (and $250 for his wife, who acted as matron), and only $100 for Dr. Charles Lukens, the resident physician (Friends' Asylum Contributors' Book, vol. 1, 19 March 1817).

[51] Ibid.

[52] Hurd, Institutional Care, 3:140–41. The steward retained some residual power via his control over materials; but clearly this was of minor importance and ultimately, in 1877, even this source of independence was lost.

[53] Friends' Asylum, Annual Report (1832), 3; (1833), 3.

[54] In ibid. (1833), 3. See also Dain and Carlson, "Milieu Therapy."

seemingly intended as much for internal as for external consumption, they commented that "instead of regarding it, as it really is, strictly a morbid state of some of the physical organs, and the deranged manifestations of the mind merely the symptoms of that state, it has been too common to look upon it as an unintelligible malady of the immaterial existence itself; and the unhappy lunatic has been left . . . a victim to the idle and ignorant belief that his disease was immedicable."^[55]

The success of their efforts can be measured in a series of changes in the asylum's rules. A new codification in 1840 for the first time included the provision that "it shall be their [the attending physicians'] duty to act in concert with the Superintendent in the moral treatment of the patients and promote their restoration with all the means in their power."^[56] A decade later, this uneasy joint authority came to an end. In a further revision of the rules, it was laid down that "the Superintendent shall be a well-qualified Physician, and shall be the official head of the Institution. . . . He shall . . . direct such medical, moral and dietetic treatment, as may be best adapted to [the patients'] relief or comfort."^[57]

Important as they were, administrative turbulence and realignments were not confined to these changes or, indeed, to these asylums. At none of the four corporate asylums were the founders familiar with the administrative problems associated with the organization and running of large institutions. It is thus not surprising that their first efforts in this sphere usually created unwieldy administrative structures. Thus the McLean was originally seriously understaffed^[58] and placed trivial administrative tasks on the superintendent's shoulders—a situation mitigated somewhat only by the appointment in 1823 of a steward who was to assume some of these burdens.^[59] Even the Hartford Retreat did not entirely escape these problems. Here, the superintendent from the outset had the aid of a steward, but even during Eli Todd's tenure (1824–33),

[55] In Friends' Asylum, Annual Report (1836), 9.

[56] Friends' Asylum, Rules for the Management of the Asylum, Adopted by the Board of Managers, First Month 20th, 1840 (Philadelphia: Rakestraw, 1840), 11–12.

[57] Friends' Asylum, Rules. . . . 1850 (Philadelphia: Rakestraw, 1850), 13–14. Again, the degree to which American developments recapitulated similar events elsewhere is quite striking. In my work on lunacy reform in England, I have demonstrated the extent to which the advent of moral treatment rendered medical control over the treatment of the insane highly problematic for a time, and I have documented the maneuvering by which medical dominance was reestablished. See Chapter 6 and Andrew Scull, "Mad-doctors and Magistrates: English Psychiatry's Struggle for Professional Autonomy in the Nineteenth Century," European Journal of Sociology 17 (1976): 279–305; and see also William Bynum, "Rationales for Therapy in British Psychiatry, 1780–1835," in Madhouses, Mad-Doctors, and Madmen: The Social History of Psychiatry in the Victorian Era, ed. Andrew Scull (Philadelphia: University of Pennsylvania Press; London: Athlone, 1981), 35–57.

[58] Eaton, New England Hospitals, 127.

[59] Little, McLean Hospital, 39.

there were squabbles occasioned by the absence of clear lines of authority.^[60] After his death, the problem became more acute, for his successor as superintendent, Silas Fuller, gave much of his attention to outside activities that were designed to augment his income. The lay steward and matron, who had previously served for four years under Todd and who claimed (correctly) to know more than Fuller about asylum treatment, sought to exploit this situation to expand their own roles. Ultimately, the managers only succeeded in restoring the status quo ante by obtaining the resignations of all three in 1840. Thereafter, Brigham (Fuller's replacement) quickly destroyed all remnants of divided authority and regained undisputed medical control of the institution.^[61]

Thus after a period of experiment, all four institutions converged upon a standard system of authority relationships, one that gave allembracing hegemony to the medical superintendent. Moreover, in every institution, moral treatment came to be defined as the physicians' responsibility, and its administration was inextricably bound up with the employment of conventional medical therapeutics. Consequently, in these matters, as in so many others, these new institutions established the basic framework and ground rules within which subsequent asylums were to operate.

To an important extent, the rapid spread of the asylum idea in midcentury America rested on the well-publicized success of these early institutions. In their first fund-raising efforts, the asylums' founders had perforce to conduct an extensive campaign to convince the public of the superior merits of their chosen solution. Subsequently, in their printed annual reports and in more occasional addresses (often distributed in editions of 2,000 or more)^[62] the asylum's officers initiated increasingly complex and extensive discussions of the nature of insanity and its proper treatment, all explicitly aimed at modifying public opinion on these matters.

The public was warned of the inconvenience and danger associated with leaving the mad at large. The threats to life and property, and the distress and hardship visited on families forced to cope with an insane member, meant that "the whole community is indirectly disturbed by the malady of the one."^[63] There were more subtle and perhaps more serious dangers, including those of contagion: "When an individual becomes insane, unless he is removed from his family and associates, it is probable

[60] Eaton, New England Hospitals, 66–67.

[61] See Winkler and Norton, "Institute," chaps. 5 and 6.

[62] E.g., Robert Waln, Jr., An Account of the Asylum for the Insane . . . near Frankford (Philadelphia: Kite, 1825); Wyman, Discourse on Mental Philosophy; Charles Evans, An Account of the Asylum for the Relief of Persons Deprived of Their Reason near Frankford, Pennsylvania (Philadelphia: Rakestraw, 1846).

[63] Connecticut State Medical Society, Report (1821), 7.

that some of them will become the subjects of the same disorder."^[64] Families and physicians alike should recognize that

in private practice no disorder is more unmanageable. The patient suffers for the want of that steady course of discipline, which is equally remote from cruelty and indulgence—for the want of attendants, qualified for their task and faithful in its performance, and for want of that medical skill which is rarely possessed, by those whose attention is chiefly directed to other diseases. . . . A madman in his own house, has of all situations the worst. The same causes which produced his disorder continue to operate with their original force, and oppose every exertion which is made to mitigate its symptoms or arrest its progress.^[65]

The obverse was true, of course, of the controlled environment of the asylum. The evil reputation the madhouse had long possessed in England was not unfamiliar to Americans, even if they possessed scarcely any domestic examples of the phenomenon.^[66] The asylum authorities sought energetically to supplant it with the image of a humane institution that was carefully designed as a curative apparatus.^[67] And they insisted repeatedly that "it is only in Lunatic Hospitals that the course of treatment indicated by an intelligent consideration of the different phases of insanity can be applied."^[68]

Even before their asylums opened, committees announced confidently that, based on European experience, the new structures would markedly "diminish the number of the insane ."^[69] Subsequent experience seemed to suggest that such claims had been overly modest. As little as three years after opening its doors, the superintendent of the Hartford Retreat informed the public that "during the last year there [have] been admitted twenty-three recent cases, of which twenty-one have recovered, a number equivalent to 91 3/10 per cent. The whole number of recent cases in the Institution during the year was twenty-eight, of which twenty-five have recovered—equal to 89 2/10 per cent"^[70] —a result he attributed to the judicious combination of medical and moral treatment. Following the announcements of similar successes in 1830

[64] Ibid.

[65] Ibid., 8.

[66] William L. Parry-Jones, The Trade in Lunacy (London: Routledge and Kegan Paul, 1972).

[67] E.g., Bloomingdale Asylum Annual Report (1818), p. 13; Connecticut State Medical Society, Report (1821); Friends' Asylum, Account of the Present State of the Asylum for the Relief of Persons Deprived of the Use of Their Reason (Philadelphia: Brown, 1816).

[68] Hartford Retreat, Twentieth Annual Report (1844), 17.

[69] Connecticut State Medical Society, Report (1821), 10 (italics in the original). For the actual experience in England, cf. Scull, Museums of Madness, esp. chap. 3; and John Walton, "The Treatment of Pauper Lunatics in Victorian England: The Case of Lancaster Asylum, 1816–1870," in Madhouses, Mad-Doctors, and Madmen, ed. Scull, 166–97.

[70] Hartford Retreat, Third Annual Report (1827), 5.

and 1831,^[71] he underlined the moral: "It is not an extravagant calculation that three fourths of these would have continued under the influence of mental derangement if no institution like the Retreat had been prepared for their reception."^[72] As the "attending physician" at the Friends' Asylum, Charles Evans, had pointed out, the joint experience of the new asylums had demonstrated that, given early treatment, "this deplorable malady is equally with other diseases of the human system under the control of proper medical treatment, the proportion of cures being as great."^[73]

There can be little doubt that the superintendents successfully communicated their message to "informed" opinion; or that the optimism they did so much to foster had much to do with the rapidity with which the asylum solution was to spread. Captain Basil Hall was only the first of a number of English travelers touring the United States to comment favorably on conditions in the new asylums and to extol their superintendents' extraordinary therapeutic success. That the praise was an isolated moment in the midst of a parade of sour and scornful comments on American manners and mores only increased the attention it received.^[74] The result, as Pliny Earle pointed out, was that "the newspapers took it up and sent it throughout the land, and in this way, whatever a few physicians might have learned from the report itself, the people at large received the impression that insanity is largely curable."^[75] By the mid1830s, the North American Review could inform its readers, with no little satisfaction, that "no fact relating to insanity appears better established than the general certainty of curing it in its early stage." The Review was able to cite in support of this claim not just such foreign authorities as Tuke and Dr. Francis Willis, Dr. George Man Burrows, and Dr. William Ellis, but also the "uniform testimony" provided by the experience of Bloomingdale and McLean asylums and the Hartford Retreat. Follow-

[71] Hartford Retreat, Sixth Annual Report (1830), 5; Seventh Annual Report (1831), 5.

[72] Friends' Asylum, Seventh Annual Report (1831), 7.

[73] Friends' Asylum, Eleventh Annual Report (1835), 8. During Wyman's years at the McLean, he refrained from making "the exaggerated claims put forward by most of his fellow superintendents; the highest percentage of recoveries he ever announced was fortythree percent" (Eaton, New England Hospitals, 144–45). Perhaps this accounts tot the clear preference most visitors showed for the Hartford Retreat. Under Bell, however, the McLean contributed its voice to the chorus.

[74] See Basil Hall, Travels in North America in the Years 1827 and 1828, 2d ed. (Edinburgh: Cadell, 1830), 2: 191–97. See also E. S. Abdy, Journal of a Residence and Tour in the United States of North America, 3 vols. (London: Murray, 1835); and Charles Dickens' similarly favorable response to the Hartford Retreat in his otherwise equally jaundiced American Notes (London: Penguin, 1972), 122–24.

[75] . Pliny Earle, The Curability of Insanity: A Series of Studies (Philadelphia: Lippincott, 1887), 21. The press had earlier given much favorable attention to the founding of the corporate asylums, to the "humane" principles on which they were based, and to the high cure rate they promised to achieve. Cf. Eaton, New England Hospitals .

ing a review of that experience, the journal sounded a theme that was to be the leitmotiv of the American reform movement in the following decade: "We doubt not but that every State in the Union will, within a very few years, be supplied with at least one [asylum]. Interest will prompt the States to this, if feelings of benevolence do not; for it requires but slight observation to see, that the expense of supporting the insane poor will be much lessened by providing them with a good Asylum."^[76] In the succinct words of the Pennsylvania Prison Discipline Society, "The expense incurred in making a proper provision for this class of paupers is a very profitable investment."^[77]

Again and again in her crusade across the American continent in behalf of state asylums, Dorothea Dix was to draw upon such claims, coupling them with her own vivid (and sometimes imaginary) recital of the abuses to which the insane were exposed in the community. Repeatedly she informed state legislatures that "all experience shows that insanity reasonably treated is as certainly curable as a cold or a fever." She drew upon the elaborate statistics provided by her allies among the asylum superintendents (most notably Luther Bell of the McLean) to provide estimates to the penny of the money to be saved by "a combination of medical and moral treatment" in an asylum.^[78] And always she succeeded in loosening the states' purse strings.

In the early years at least, the new state asylums continued to be beholden in a variety of ways to the preceding generation of corporate asylums. This indebtedness was true even of new corporate asylums built in the 1840s. For example, prior to his appointment in 1841 as the superintendent of the Pennsylvania Hospital's newly separate branch for the insane, Thomas Kirkbride had served a year in 1833 as resident physician at the Friends' Asylum at Frankford; and before assuming his new duties, he supplemented that experience with a tour of the Bloomingdale and McLean asylums and the Hartford Retreat, as well as the recently opened Worcester State Hospital.^[79] And during the construction and or-

[76] "Insanity and Insane Hospitals," North American Review 44 (1837): 99, 101, 114.

[77] Pennsylvania Journal of Prison Discipline and Philanthropy 1 (1845): 60 (italics in the original). For similar comments and for a calculation that the potential savings of asylum treatment on only 150 patients was $179,420 (without taking into account that those cured would then return to work), see Connecticut Assembly, Report of the Committee for Locating a Site for a Hospital for the Insane Poor (New Haven: Babcock and Wildman, 1840), 12–13. Note the spurious precision.

[78] See, among many examples, Dorothea Dix, Memorial Soliciting a State Hospital for . . . Pennsylvania (Harrisburg, Pa.: Lescure, 1845), 57; idem, Memorial Soliciting an Appropriation for the State [of Kentucky] (Lexington: Hodges, 1846), 10; idem, Memorial to the Senate and House of Representatives of the State of Illinois (Springfield: State Printer, 1847), 19, 24–25; idem, Memorial Soliciting a State Hospital for . . . Alabama (Montgomery: Office of the Advertizer, 1849), 13–15.

[79] Earle D. Bond, Dr. Kirkbride and HIS Mental Hospital (Philadelphia: Lippincott, 1947), 39.

ganization of the Butler Hospital for the Insane in Rhode Island, the committee utilized Luther Bell of the McLean as its consultant.^[80]

The two most influential state hospitals of this period, which set the pattern for similar institutions elsewhere, were the Worcester State Hospital in Massachusetts^[81] and the Utica Asylum in New York. Again, both had close links to the corporate asylums. When Horace Mann sought, in the late 1820s, to secure a state asylum for Massachusetts, he frequently sought advice and support for his project from Eli Todd of the Hartford Retreat, and often visited that asylum himself to observe the new regime at first hand. Later, when the Worcester asylum was about to open, he tried unsuccessfully to induce Todd to become its first superintendent. When Todd refused, Mann accepted his suggestion that he appoint Samuel Woodward instead. (Woodward, an old friend of Todd's, had played one of the most active parts in securing the establishment of the Hartford Retreat, and he was intimately familiar with that asylum's operation.)^[82]

Even the external appearance of the Worcester asylum—widely copied by other states—was modeled on an existing corporate asylum, this time the McLean.^[83] There were important differences, however, emblematic of which was the use of brick in place of stone. As a consequence, Worcester's "cheap and flimsy style of construction presented a striking contrast to the finished massive features of the other. Being intended for the poorer classes, it was the first considerable example of very cheap construction, and one, unfortunately, which building committees have been too ready to imitate."^[84]

Todd was at least as influential in New York. "When the New York Assembly first began to debate the advisability of a state hospital for the insane, several of its members visited the Connecticut Asylum."^[85] Subsequently, both Todd and Amariah Brigham (who became superintendent at the Hartford Retreat in 1840) were consulted on the construction of the Utica Asylum. And in 1843, Brigham resigned his post at Hartford to take over the new state institution.^[86]

The spread of state hospitals was to have important consequences for the corporate asylums as a whole, strengthening and intensifying some

[80] Isaac Ray, Description of the Butler Hospital for the Insane (reprinted from the American Journal of Insanity 5 [1848]: 2–3).

[81] See Gerald Grob, The State and the Mentally Ill: A History of Worcester State Hospital (Chapel Hill: University of North Carolina Press, 1966).

[82] See Winkler and Norton, "History of the Institute," chap. 3.

[83] Cf. Grob, State and the Mentally Ill, 33–34.

[84] Isaac Ray, "American Hospitals for the Insane," North American Review 79 (1854): 75.

[85] Eaton, New England Hospitals, 157.

[86] Winkler and Norton, "Institute," 6:19–20. Similarly, from its opening in 1836 until 1872, the Vermont Asylum employed William Rockwell, a former assistant at the Retreat, as its superintendent.

preexisting tendencies and increasing the homogeneity of their patient populations. In their early years, as virtually the only specialized institutional provision for the insane, the private asylums (with the exception of the Friends' Asylum at Frankford)^[87] had been under considerable pressure to make some space available for the poor. They responded with varying degrees of reluctance. At the McLean, in return for a contribution from the state to the initial fund-raising, the trustees had not only given the state the power to nominate four of their number, but had agreed to set aside thirty beds for the indigent insane. Two years before the asylum even opened, however, discreet lobbying had secured the repeal of this provision. In the short run, this created problems, especially since the poorer classes were, if anything, more anxious than the wealthy to obtain an asylum.^[88] Accordingly, the trustees felt impelled to publish signed notices in the Columbian Sentinel, the Commercial Gazette, and the Independent Chronicle refuting the widespread belief that the asylum would accept only monied patients. These announcements were followed up, in 1817, with "an address to the public [devised] to obviate an impression that the Insane Hospital was designed exclusively for the wealthy."^[89] Notwithstanding the repeated denials, the suspicions proved well founded. Two sizable bequests within the first few years of operation rendered the asylum independent of state support; and in response, the McLean became the first of the corporate institutions systematically to exclude the poor and thus to avoid "the odor of pauperism."^[90]

At Bloomingdale and Hartford, the situation was somewhat different, and the exclusion of the poor came more slowly. With a much less generous endowment than the McLean, the Hartford Retreat perforce had to continue to rely on state subsidies. And in 1817, the governors of the New York Hospital had accepted an annual subsidy of $10,000 from the New York legislature, to remain in effect for thirty years.^[91] Hence both, with some misgivings, took substantial numbers of poor patients. Bloomingdale's proportion of publicly supported patients grew from 17 percent in 1828 to 40 percent a decade later; while Hartford's share of the total jumped still more abruptly in 1842 and 1843, when the state legis-

[87] As a sectarian institution, which had sought no subsidy from the state and which retained an exclusively, or almost exclusively, Quaker clientele, the Friends' Asylum was largely spared these pressures.

[88] Eaton (New England Hospitals, 48) shows that, while the poorer wards contributed twice as much for the insane asylum as for the general hospital, the wealthier wards gave the asylum much less preference.

[89] Bowditch, Massachusetts General Hospital, 26.

[90] Massachusetts State Board of Charities, Annual Report No. 8 (1871), xli.

[91] This was by no means the first such subsidy they had accepted, and, as Grob points out, for a time it gave both branches of the hospital a "quasi-public character" (Gerald Grob, Mental Institutions in America: Social Policy to 1875 [New York: Free Press, 1973]), 63–64.

lature granted both capital funds and an annual maintenance sum, provided that the asylum would make provision for pauper lunatics.

Eli Todd's fears that any such moves "would lower the character of the Institution" were amply borne outY.^[92] Complaints were quickly voiced of "filthy, noisy or dangerous pauper lunatics" filling the asylum;^[93] reported cure rates declined; and the quality of the physical plant began to deteriorate. Bloomingdale experienced a similar decline. By 1847, the superintendent reported that "the House is filled with a mass of chronic and incurable cases," and the trustees conceded that most "were listless and indifferent and wholly unoccupied."^[94]

There was obviously an acute danger that both asylums would lose their well-to-do clientele. Of the two, Bloomingdale was able to respond to the situation more quickly. Taking advantage of the opening of the Utica State Hospital in 1843 and the Kings County Lunatic Asylum in Flatbush in 1856, it no longer offered space for the pauper insane and ceased to accept state support in 1847.^[95] Henceforth, it concentrated upon "the wealthy" and "indigent persons of superior respectability and personal refinement"—"families of clergymen, and other professional persons, . . . teachers and businessmen who have experienced reverses, . . . [and] dependent unmarried females."^[96]

At Hartford, however, the managers remained hamstrung for a decade more by the failure of the Connecticut legislature to build a state facility. Their situation grew more desperate as the decline of state hospitals into warehouses for the unwanted intensified upper-class objections to any association with paupers. It was therefore with scarcely disguised relief that they greeted the legislature's decision in 1866 to build a state hospital at Middletown:

It is evident [said John Butler, the superintendent] that different classes will require different styles of accommodation. The State should provide for its indigent insane, liberally and abundantly, all the needful means of treatment, but in a plain and rigidly economical way. Other classes of more abundant means will require, with an increased expenditure, a corresponding increase of conveniences and comforts, it may be of luxuries, that use has made essential. This common sense rule is adopted in other arrangements of our social life—our hotels, watering places, private dwellings and various personal expenditures.^[97]

[92] Hartford Retreat, Sixth Annual Report (1830), 5.

[93] Hartford Retreat, Nineteenth Annual Report (1843), 5.

[94] Cited in Rothman, Discovery of the Asylum, 279.

[95] Hurd, Institutional Care, 3: 141.

[96] Bloomingdale Asylum, Annual Report (1851), 15–16; (1856), 19–20; (1862) (1866), 17–25.

[97] Hartford Retreat, Forty-third Annual Report (1867), 33.

To compete successfully for a monied clientele required a substantial immediate expenditure to upgrade the physical facilities. Renovations began within weeks of the removal of the state patients, and at a cost of about $133,500, the managers secured a "beautiful homelike structure, resembling a country residence of a private gentleman more than a public building or a hospital."^[98]

Ultimately, therefore, all the corporate asylums came to adhere to Luther Bell's dictum that "to the polished and cultivated it is due as much to separate them from the coarse and degraded, as to administer to them in other respects."^[99] The asylums resembled one another in still a further respect: their decline from curative to custodial institutions. For all the extravagant expenditure of money—the opulent surroundings, the provision of French lessons, drawing classes, singing classes, theaters, and the like—they faced the same decline in curability as the "plain and rigidly economical" state asylums. No matter that "its scale of expenditure is faudrom six to eight times as costly" as the pauper institution; that "its sane population (physicians, attendants, nurses, etc.) is about half as numerous as the insane patients, while at [the state asylum] the sane are but one in thirty as compared with the insane." Inescapably, "like the State hospitals, and almost to the same extent, it has become the resort of incurable lunacy, and its noble endowments are bestowed, not so much for the cure or prevention as for the alleviation of this disease."^[100]

In this study, I have shown that the influence of the corporate asylums upon American lunacy reform was pervasive. They played an important role in the conversion of the public to the merits of institutionalization as a response to the problems posed by the mentally disordered. It was through these institutions that Tuke's and Pinel's new "moral treatment of the insane" was most dramatically made known to an American audience. It was here that moral treatment was absorbed and became part of the therapeutic armamentarium of the medical profession. It was the apparent and widely publicized "success" of their programs that encouraged large-scale emulation and expansion of the asylum system. And even if they ultimately became resorts for the upper classes, distinctively different and self-consciously as remote as possible from the harsh realities of the state hospital system, this differentiation should not lead us to

[98] Hartford Retreat, Forty-fourth and Forty-fifth Annual Reports (1870), 21. Modern observers have thought that a more appropriate comparison would be "a luxurious spa hotel" (Winkler and Norton, "Institute," 7:21).

[99] McLean Asylum, Twenty-second Annual Report (1839), in Massachusetts General Hospital, Annual Report (1839), 16.

[100] Massachusetts State Board of Health, Lunacy, and Charity, First Annual Report (1879), xxxii. The comparison may be extended, of course. The same therapeutic failures characterized the English asylums for the rich. See Scull, Museums of Madness, 204–8.

slight their part in creating, and to some degree shaping, that system. For the earliest state hospitals, the corporate asylums provided not only a model to be copied, but a source of professional staff and advice once they opened. Lastly, given the extent to which the corporate asylums in turn drew upon European antecedents, parochial theories about the American discovery of the asylum must surely collapse.