Family care for the chronic insane : Miss Alice Cooke and her patients / by F. B. Sanborn.

  • Sanborn, F. B. (Franklin Benjamin), 1831-1917.
Date:
[1902]
Catalogue details

Licence: Public Domain Mark

Credit: Family care for the chronic insane : Miss Alice Cooke and her patients / by F. B. Sanborn. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    deaths a year upon an average of 100 in families) is not quite .05. Considering now the number who have become self-supporting, or have been eared for by- friends in the 17 years (86), and remembering that these patients, in nine cases out of ten, were the public poor, and that most of them were chronic cases, ranging in their period of asylum life, before they were placed out, from one year to twelve and fifteen, and their average asylum life having been, at least, three years,—the re- sult is surprising and satisfactory. An average of five persons a year,—rather more than the number of deaths—upon a total average of 100 persons, have been taken off the public list, and have ceased to be a public burden. Indeed, of the total number of different persons thus placed under family care (534), of whom 125 are still in families, leaving a total of 409 to be ac- counted for, 86 persons, or one in every four and and three fourths (more than one fifth) have ceased to be a public burden. This is far more than the usual proportion among the insane poor in asylums, and it shows one of the most bene- ficial results of this method of care in Massachu- setts. Attention to a few of such cases which have come within my own knowledge, before and since I had official charge of the system, will show this in a more striking manner. Three patients, women, were placed by me in a family in the town of Sandwich in Massachusetts, in October, 1886. Their average asylum life at that time must have exceeded five years, and no one of them was contributing by her labor, in the least, to the cost of her support in the asylum from which they were taken. They were oid, hopeless cases, in the judgment of the asylum physician, and he was not sorry to have them removed. In the family where they were placed they came under the affectionate oversight of a mother and two daughters,—the whole family then,—and in a few months they became active in domestic industry, to which all had been bred. Two of them still remain where I placed them, and for fourteen years, now, they have recom- pensed by their willing labor the cost of their support, and have had a home they would not have exchanged for any hospital care. The third patient, who was not in firm health when placed there, yet supported herself in the family by her labor for eight or ten years; then was cared for in age and infirmity by the family, but finally, her disease growing unsuitable for family care, she was returned to an asylum hos- pital, where she died a few years ago. Her ab- sence from the asylum had saved to the public treasury thrice the cost which her last illness made necessary. The care of these two who remain would have cost the public, had they not been placed out, and had they lived till now, at least $3,000; and their life has been made cheer- ful and wholesome, instead of the dismal years in the incurable ward which would otherwise have been theirs. These women were of the servant class, and of Irish parentage or birth. An older patient, a woman of education and refinement, after an asylum life of nearly ten years, in which her for- une had been consumed, and her support thrown upon the public (perhaps repaid by rela- tives at a small board-rate), was one of the first to be placed in a family by me in 1885-'86. Her relatives were so anxious to have her properly restrained (having seen her, years before, in her disturbed state) that they desired me to promise I would return her to the hospital if she was not suitably restricted in the family. In a few weeks they found her so quiet and happy in her new home, away from the noise and distraction of the hospital ward, that they took her to their own comfortable city home, where she spent the rest of her long life, dying at the age of 79, after living happily and agreeably to her friends for four- teen years after leaving the hospital. Such cases are, in some degree, exceptional, but there are far more of them than the ignorant or indifferent opponents of the Family Care sys- tem in America know or imagine. But the cases not exceptional, and which do not become self- supporting, do yet relieve the public of much cost, in the matter of asylum-building, particu- larly. At the rate of building-cost prevalent in Massachusetts since 1885, the 100 patients who have been constantly kept in families would have cost, in buildings and repairs, at least $50,000, the interest on which, at 5 per cent., would have maintained 15 persons in families all the inter- vening time. Scotland, which maintains about one fifth of all her insane in families (something more than 2,500 at present) is relieved of what would cost for buildings alone, in Massachusetts, at least $1,000,000. When to this it is added that the insane thus provided for without costly asy- lum buildings, are, as a rule, much happier and more useful than they can be in the best close asylums, it will be seen that family care is bound to prevail, up to the limit of safety, wherever people have the right use of their own reason, in disposing of those whose reason has left them. In other states than Massachusetts little has been done in the way of family care for the in- sane, but the question Is now much discussed, and the tendency, in the more enlightened states, is towards adopting it in some form or degree. Perhaps Wisconsin, which has a pecu- liar lunacy law, allowing many unrecovered in- sane to remain outside of all asylums, may be the first to follow the example of Massachusetts. Some persons, writing in much ignorance of the actual facts of the family care experiment in Massachusetts, have spoken of its results as unsatisfactory. On the contrary, it has been quite satisfactory, so far as it went, but has not been carried so far as it should have been, in the lo'ng period since I began it. The authorities that discontinued it in 1888, and then took it up again because popular feeling would not allow it to be abandoned, had no love for that or any other measure which improved the condi- tion of the insane. They had little knowledge of what insanity is, and less regard for its poor vic- tims; but they did not venture to do more than stay the progress of improvement in the treat- ment of the insane. The superintendents of the insane hospitals, most of whom favored the boarding-out experiment, would have under-