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  Colony Treatment

  OF THE

  Insane and Other Defectives

  --BY--

  DR. P. L. MURPHY
  MORGANTON, N. C.

  Read Before the Meeting of the N. C. Medical Association
  June, 1906, Charlotte, N. C.

  (REPRINT FROM CAROLINA MEDICAL JOURNAL.)




Colony Treatment of the Insane and Other Defectives


The subject of this paper might be called "Employment as a means of
treating and caring for the insane and other defectives" the colony
being the means of finding agreeable and profitable work for the
inmates.

To many of you a description of what is meant by the "colony treatment"
is needed to fully understand the subject.

As the expression is used in this paper, and as it is generally
understood, it means the erection of buildings some distance from the
central hospital plant and placing farm working patients there, to be
under the control and management of the hospital officers.

[Illustration: FIRST BUILDING AT THE COLONY]

Without discussing the origin of the idea, and with no reference to
Gheel, it is sufficient to say it was begun in Germany in the sixties,
and that it has slowly found its way into other countries.

[Illustration: THE COLONY BUILDINGS]

Such a colony was established in connection with the Morganton Hospital
three years ago, or rather it was ready for occupancy about that time.
It took several years of talk to get the idea adopted, and as many more
to get the colony built. The plan of conducting it by the hospital
authorities was largely experimental, and was made to suit the people
of Western North Carolina, but it is, after all, a modification of the
original German conception.

The first building was for 30 men with rooms for a man and his family,
the man to have general supervision of the place and the wife to cook
and do the household work. Afterwards a small cottage was built for
the manager and his family, and his rooms were used for patients and
later still another building was erected so that now 75 patients can be
accommodated. It would have been much better to have limited the rooms
to 30 as first intended. No single colony plant for the insane should
much exceed that number. As many colonies as are needed may be had if
land is sufficient, the number depending on the size of the hospital,
as only a certain proportion of patients, about 25 per cent., can thus
be cared for, or at the outside 40 per cent.

[Illustration: PATIENTS WORKING RASPBERRIES]

The colony buildings, outhouses and surroundings at the Morganton
colony were made as near as possible like the farm houses in this
section of the State. This was done to give it a home-like appearance,
and the management has been such as to make each patient feel at home;
they are free to sit on the porches and the lawn in the summer, in
the sitting room before open fires in the winter. They smoke, have
games, read or do what pleases them during these hours of recreation.
They have their own garden, orchard, vineyard, berry patches, poultry,
pigs and cows, which they attend to. Every effort is to make each one
feel that these things are his own, he can gather berries, pull the
fruit when he wants it or as he pleases. Every one is expected to do
something if no more than pick up chips for the cook.

[Illustration: GENERAL VIEW OF COLONY]


EARLY EXPERIMENTS.

The first party of patients sent to the colony, about 15, were
quiet, industrious men who were expected to be the nucleus of the
organization. After these became accustomed to their new surroundings,
others who were quiet and who had some remnant of mind left, but who
did little or no work were tried. These readily dropped into the ways
of those who preceded them and who set the pace. Further experiment
was made by sending those who seemed incurably demented, incapable by
reason of their weakened minds of doing any kind of work. Most of the
last mentioned had been residents of the hospital for years and years
in whom the last vestige of hope for any improvement had long vanished.
Strange as it may seem to you, as it did to us, acquainted with these
men and their disease, they immediately went to work and are to-day
profitably employed. They have gained in health and self-confidence,
they are happier because they feel there is yet something in life for
them.

[Illustration: SNAP SHOT--COLONY PATIENTS CULTIVATING STRAWBERRIES]

It may occur to some to ask why these men had not been sent out to work
before and given an opportunity. It has been the invariable custom
since the hospital opened to try to induce every one to engage in some
kind of employment and it had been tried repeatedly with these very men
with complete failure. To conjecture why they were willing to work in
one place and not in another might be profitless, it is sufficient to
know it is true.

[Illustration: RESTING AFTER THE DAY'S WORK]

After the work was well under way, it was strange to see the
development of the different fancies of the different men. Each one
was allowed, so far as possible, to follow his own inclination and to
select his own work. One fancied painting and whitewashing and building
fires under the heating apparatus. He studied economy in the use of
fuel as much as the average head of a family, and is as intelligent
in his work as could be expected of any ordinary man. Another patient
has become greatly interested in poultry and shows more than ordinary
intelligence in following his bent. He reads journals on poultry, and
not only builds coops, box nests, etc., but has actually invented
several useful contrivances. Another hauls wood to the kitchen in a
little wagon he made himself, and so on almost indefinitely.

[Illustration: PATIENT TENDING BRONZE TURKEYS]

A brief report of two cases will partly illustrate what has been done.
The following is quoted from a report to the Board last December: "A
boy, J. B., 13 years old, came to the hospital in June, 1895. He had
a form of insanity (Dementia praecox) which rarely improves; indeed,
its tendency is generally to deterioration. This boy was no exception
to the rule and he grew worse and worse until hope for any improvement
had been given up. Three months ago he was sent to the colony, but it
was considered a desperate chance. To the astonishment of everyone
he immediately began to improve, and this has steadily gone on until
to-day he is a strong, vigorous young fellow of 23, full of hope
and energy, whereas when he went there he was dull, indifferent and
listless; he never inquired of his home or home people and seemed to
care for nothing. Recently he has written home telling of his marvelous
improvement and of his joy in life. 'He testified as one risen from
the dead,' after ten years of mental darkness. It is not certain that
the improvement will continue; in fact, it is not expected, but even if
he improves no more, great good has been accomplished in relieving this
young fellow of such suffering as we shudder to think of." Six months
after this report was written this young man has gained but little and
it is probable he is as well as he will ever be. He enjoys life as much
as the average man, taking part and interest in baseball and other
amusements we are able to furnish our people. The second case is of a
man who was committed to the hospital in November, 1898, this being
his second admission. He complained of great discomfort in his head
which he described as being unbearable, so much so, that he begged to
be killed. His appetite was poor, he was anaemic and greatly run down
in health and evidently was a great sufferer. Every effort to relieve
him failed. We were sure if he could be induced to exercise he would
improve, but nothing we could do would cause him to take the slightest
interest in anything. He was finally forced to go out with the working
party, but he would lie on the ground complaining of his head. He was a
few months ago sent to the colony along with nine other men almost as
bad as he. To the amazement of us all, the man went to work, his health
improved, the pain and discomfort disappeared and his face is ruddy
and he gives every evidence of health and vigor. He works cheerfully,
seems perfectly satisfied, never complaining of any bad feeling and is
as comfortable as he can be. These two cases are only two of many as
unpromising, who have been greatly relieved and some few cured by the
colony treatment.

[Illustration: PATIENTS INTERESTED IN GRAPE GROWING]

[Illustration: BARNYARD AND POULTRY HOUSES AT COLONY]

[Illustration: CHICKEN RUNS]

All this seems so simple and is so obviously the right course that we
wonder why it had not long ago been tried.

Two ideas are prominent in this system, the first to find agreeable,
healthful employment for the patients and to give them a home.


SHOW APPRECIATION.

This working class, while too defective to take up the burden of life,
are yet appreciative of their surroundings and of most things that
make life happy to the people in the outside world. They require the
minimum amount of care and discipline and with this given they conduct
themselves as well, indeed, better, than the same number of sane men.
Some under this treatment recover that otherwise would not, but the
majority must remain under hospital care, this being their refuge and
their home. How much need therefore that every effort should be put
forth to make it pleasant to these afflicted men.

In general hospitals, in institutions for children, and in
reformatories we have a different class to deal with. A large number
under one roof is not so objectionable, but these cases of chronic
insanity are not children in whom the desire for a home is small, nor
are they malefactors in prison for punishment.

You will pardon a little digression, which, after all, leads to this
subject from another and a practical standpoint.

[Illustration: TWO COLONY BUILDINGS]

In North Carolina there are not less than 4,000 white insane; of
this number 1,500 are in two hospitals, leaving 2,500 uncared for by
the State. To properly house all these people means the expenditure
of a million dollars, and the annual cost of maintaining them will
be $500,000. It is well then to consider carefully how this burden
on the taxpayers may be lightened. Without discussing the question
of the increase of insanity, there can be no doubt that there is an
increased demand to have these persons cared for and properly so.
All insane persons are dangerous in some degree to their neighbors,
more so to themselves. Insanity is the cause of many suicides, while
sexual crimes, arson, assault, impostures, are often committed by those
mentally deranged.

[Illustration: PEACH ORCHARD AND GARDEN, SEEN FROM A COLONY PORCH]

Too often families are ruined by some insane member, the bread winner
having to devote his whole time to the control of wife or child, or a
crime is committed and every energy and the savings of a lifetime must
be devoted to the cost of courts. Whole communities are frequently
terrorized by an insane person and the lives of the women and children
made miserable.

Only a few recover at once or die, they live on for years not only
imbecile and helpless themselves, but a burden on the family and
community, a severe drain which must tend to weaken the general welfare
of the State.

There are sufficient reasons for you as physicians, men of standing in
your respective communities, not only to make yourselves familiar with
the disease in order that you may prescribe intelligently for those
suffering from it, but to use your influence, which is great, to see
that proper provision is made for them by the public.

[Illustration: PATIENTS PLAYING BASEBALL]

Much insanity is caused by alcohol and drugs. This touches you more
closely, for you are largely responsible for these habits. You may do
something by preventing unwise marriages of those whose heredity is not
good.

It should be your special province to recognize dangerous symptoms in
time and by prompt action prevent suicides and accidents and to send to
the hospitals at once these patients who have infinitely more chances
to recover when placed under the care of competent alienists.

[Illustration: MAKING FIRST BASE]


2,500 WHITE INSANE UNCARED FOR.

The conclusions we reach are that 2,500 white insane people in North
Carolina are uncared for, that a great outlay of money will be required
to build for this number and after that the never ending expense of
maintaining them begins. If it can be demonstrated that the colony
system is the best and the cheapest, it should by all means be adopted.

There is an end to the willingness and even ability of the taxpayers
to provide for the defectives in expensive hospitals and asylums, and
it is clearly the duty of those who have these matters in hand to use
proper economy. What is done by the Legislature will depend on the
demand of the people and the wisdom of the Legislators. It will require
great deliberation and the wisest action to solve this question.

In North Carolina no more hospitals ought to be built at present, those
now in existence should be enlarged if possible.

Unfortunately at Morganton no more land can be purchased and that
institution cannot with advantage be greatly increased in size. The
last opportunity to buy land there has been allowed to pass. This is
to be deplored for the plan there has been so successful that much was
hoped for in the judicious extension of these colonies.

Much more might be said on the general subject of caring for the
insane, but time forbids. Perhaps on some future occasion this will be
taken up and discussed.

Hospitals for the insane cannot properly care for epileptics or idiots.
I use the term idiot in the sense in which it is defined by the North
Carolina statutes "a person born deficient or who became deficient
before the completion of the twelfth year of age."

Many of these defectives are capable of doing common labor and can be
made very nearly self-sustaining if properly managed in such a colony
for the insane as has been described. In many of the States where this
is tried, it has been successful. In North Carolina, where we have
such good climate and where land can be purchased cheaply, more can
be done than in other less fortunate communities. I believe in the
cotton and truck section of the State such a colony could be nearly
self-sustaining, but leaving that out of the question, there can be no
doubt it is the best for these people to live outdoor lives with proper
employment. I would like also to enlarge on this feature of my paper,
but time will not permit.

I trust, gentlemen, that you will become enough interested in these
subjects to give them your hearty support. If you do, then the labors
of those of us who are immediately responsible, will be greatly
lightened and these afflicted fellow citizens will be happier and your
State will be a better State.

Since this paper was written my attention was drawn to a statement in
a medical journal of the number of insane sent to the hospitals in
Massachusetts during the year 1904. It bears so closely on what has
been said I repeat it and compare it with our State and hospitals.
During that year 2,426 insane persons were admitted into the hospitals
of Massachusetts, none of whom had ever before been inmates of any
hospital for insane. Adding to these the number of re-admissions,
which could not have been less than 600, we see 3,000 persons sent
yearly to the hospitals of that State. Between 7,000 and 8,000 patients
are cared for by the public hospitals.

As compared with North Carolina the population of Massachusetts is
twice that of the white people of our State. We should have 1,500
white patients sent to our hospitals every year and we ought to have
accommodation for 4,000. As it is, less than 400 are admitted and only
1,500 can be cared for in our hospitals. There is some differences,
I believe, in the proportion of insane to the population in the two
States, but not that much. Massachusetts gives her insane citizens
proper care. North Carolina does not.

[Illustration]




  TRANSCRIBER'S NOTES:

  Inconsistencies in spelling and punctuation have been standardized.

  Some illustrations have been moved to paragraph breaks and may or may
    not be on their original page.