THE ST. LAWRENCE HOSPITAL FOR THE INSANE

Scientific American Supplement, No. 799, April 25, 1891 by Various, is part of the HackerNoon Books Series. You can jump to any chapter in this book here. THE ST. LAWRENCE HOSPITAL FOR THE INSANE.

THE ST. LAWRENCE HOSPITAL FOR THE INSANE.

The St. Lawrence State Hospital at Ogdensburg, N.Y., is a center of public, professional, philanthropic, and legislative interest. Though projected in advance of the adoption of the system of State care for the insane, it was opened at a time to make it come under close observation in relation to the question of State care, and the friends of this departure from the inefficient, often almost barbarous provisions of county house confinement could have no better example to point the excellence of their theories than this new and progressively planned State hospital. The members of the State Lunacy Commission and Miss Schuyler and her colleagues of the State Charities Aid Society, who fought the State care bills through the Legislature this winter and in 1890, would be repaid for all of their trouble by contrasting the condition of the inmates of the St. Lawrence State Hospital with the state they were in under their former custodians, the county officers of the northern New York counties. At the best, even when these officials realized the responsibility of their charge and were actuated by humane impulses, the county houses offered no chance of remedial treatment. Custody and maintenance, the former mainly a reliance on force, the later often of scant provision, were the sum total of what was deemed necessary for the lunatics. In their new environment they find everything as different in accommodations and treatment as the word hospital in the title of the institution is different in sound and significance from the hope-dispelling, soul-chilling names of "asylum," "mad house," and "bedlam" formerly given to all retreats for the mentally afflicted. They find, and it is an encouraging feature of the plan that so many of them quickly see and appreciate it, that they are considered as sufferers from disease and not from demoniacal possession. The remarkable range of classification provided for, the adaptability of construction to the different classifications, the reliance on occupation, the dependence on treatment, and the subordination of the custodial feature, except where a wise conservatism demands its retention, are apparent alike to inmates and visitors.

This hospital is complete as to plans, and as to the power plant, drainage, and subway construction necessary for the 1,500 patients, that the legislature has provided for in its law establishing the institution. Buildings are already finished and occupied that accommodate 200 inmates, and the contractors have nearly finished part of the central group that will bring that number up to nearly 1,300. The appropriation asked for this year by the managers will be scaled down considerably by Mr. McClelland, the very economical chairman of the Ways and Means Committee of the Democratic Assembly. But, unless he has miscalculated, there will be money enough to carry on the work of construction to advantage for the year. An appropriation sufficient to complete the buildings at once was thought by many to be the wisest economy, but big figures in an appropriation bill have very little chance this year. The bill establishing the State Hospital district and providing for the building of the institution fixed the per capita cost of construction, including the purchase of land, at $1,150, and the plans have been made on that basis for 1,500 patients. But if the needs of the district should require it, the capacity could be increased by an almost indefinite extension of the system of outlying colony groups at a very small per capita cost, as the central group is by far the most expensive in construction.

The administration group in part, and one outlying group, with the general kitchen, bakery, workshop, laundry, employes' dwelling house, power house, and pumping station, are already erected, and have added a feature of architectural beauty to Point Airy. This point, of itself of picturesque and romantic beauty, juts into the St. Lawrence River at the head of the Galoup Rapids, three miles below Ogdensburg. It is a part of the hospital farm of 950 acres, which includes woodland, meadow, farm land, and a market garden tract of the $100 an acre grade. The location of the institution in these particulars and in reference to salubrity, sewerage facilities and abundance and excellence of water supply, is wonderfully advantageous.

In planning the hospital Dr. P.M. Wise, who has since become its medical superintendent, aimed to take the utmost advantage of the scenic and hygienic capabilities of the site, and to improve on all previous combinations of the two general divisions of a mixed asylum—a hospital department for the concentration of professional treatment, and a maintenance department for the separate care of the chronic insane. He was anxious to secure as much as possible of the compactness and ease of administration of the linear plan of construction, with wings on either side of the executive building of long corridors occupied as day rooms, with sleeping rooms opening out of them on both sides. But he wanted to avoid the depressing influence of this monotonous structure, as the better results of variety and increased opportunities of subdivision and classification are well recognized. He was not, however, prepared to accept wholly that abrupt departure from the linear plan known as the "cottage plan," which in some institutions has been carried to the extreme of erecting a detached building for every ward. The climate of St. Lawrence county forbade this. Her winters are as vigorous as those of her Canadian neighbors, even as her people are almost as ebullient in their politics as the vigorous warring liberals and conservatives across the river. And there are features of the linear plan that can only be left out of our asylum structure at the expense of efficiency. Other rules that he formulated from his experience were that a building for the insane should never exceed two stories in height; that fire proof construction and at least two stairways from the upper floors should be provided; that day rooms should be on the first and sleeping rooms on the second floor; that all buildings for the insane who suffer from sluggish and enfeebled circulation of the blood should be capable of being warmed to 70° in the coldest weather; that ample cubic space and ventilation should be provided; and that, as far as possible, without too great increase of the cost of maintenance or sacrificing essential provisions for treatment and necessary restraint, asylums should aim to reproduce the conditions of domestic life.

State Architect Isaac G. Perry planned the St. Lawrence State Hospital buildings on ideas suggested by medical experience, with a breadth of comprehension and a technical skill in combining adaptability, utility, and beauty that have accomplished wonders. The buildings are satisfactory in every particular to every one who has seen them, and even the most casual observer is impressed with the effect of beauty. This was accomplished without elaboration of material, expressive carving or finish. The ornamentation is purely structural and is obtained by a handling of the materials of construction which also yielded the largest promise of strength and durability.

The central hospital group, of which an idea is given in the cut, now consists of five buildings. The picture shows three, the center one and two of the flanking cottages on one side. They are matched on the other side. The central or administration building is a three story structure of Gouverneur marble, and, like all of the stone used, a native St. Lawrence county stone. The marble's bluish gray is relieved by sparkling crystallizations, and its unwrought blocks are handled with an ornamental effect in the piers, lintels, and arches, and well set off by a simple high-pitched slate roof, with terra-cotta hiprolls, crestings, and finials. The open porches are both ornamental and useful, taking the place of piazzas. The tower is embellished with a terra-cotta frieze. All accommodations for an executive staff for the 1,500 patients may be provided in this building.

Behind it on the south is a one story building whose ground plan is the segment of a circle. It contains sun rooms, medical offices, general library, laboratory and dispensary, and the corridor connecting the reception cottages, one for women, on one side, and one for men on the other, with the administration building. As this one story structure is 171 feet by 41, the buildings known as cottages of the central group are more than nominally separated. All the advantages of segregation and congregation are combined.

The reception cottages are of pale red Potsdam sandstone. Their simple construction is pleasing. The ground plan is in the form of a cross; the angles of the projections being flanked by heavy piers between which are recessed circular bays carried up to the attic and arched over in the gables. The cross plan affords abundant light to all the rooms, and as much of the irregular outline as possible is utilized with piazzas. With still another recourse to the combination corridor plan, the observation cottages are joined to the reception cottages on each side. The other utilization of the corridor in this case is for conservatories. The observation cottages are irregular in plan and vary from each other and from the other buildings in the group. Unwrought native bluestone is the building material. These cottages contain a preponderance of single rooms, the purpose being to keep patients separate until their classification is decided upon.

The buildings planned but not yet constructed of the central group include two cottages for convalescents and two one-story retreats for noisy and disturbed patients. In both cases the plans are the most complete and progressive ever made. In the first the degree of construction is reduced to the minimum. Convalescents are to have freedom from the irritations of hospital life that often retard recovery. Great reliance is placed upon that important element in treatment, the rousing of a hopeful feeling in the mind of the patient.

The retreat wards, with accommodations in each wing for eighteen patients, show in this particular how little the old method of strict confinement is to be employed in the new institution. That proportion of the total insane population of 1,500 is regarded as all that it is necessary to sequester to prevent the disturbance of the rest. Hollow walls, sleeping room windows opening into small areas, and corridor space between the several divisions are features which make the per capita cost of the construction comparatively large for these two cottages, but which, it is believed, will prove to be wise ones.

All of these buildings are as complete from a hospital standpoint as can possibly be devised. Outer walls wind and moisture proof, and inner walls of brick, with an absolutely protected air space between, insure strength and warmth. An interior wall finish of the hardest and most non-absorbent materials known for such uses is a valuable hygienic provision, and both safety and salubrity are further conserved by an absence of any hollow spaces between floors and ceilings, or in stud partitions. No vermin retreats, no harbors for rodents, no channels for flame exist. Heating is accomplished by indirect radiation with the steam supply from the power house, but there are many open fireplaces to add to the complete stack and flue system of ventilation.

Attached to the central group and completed are the kitchen building, the laundry building and a dwelling house for employes, which are so disposed in the rear of the group as to make a courtyard of value for the resort of patients, as the main buildings protect and shelter it. These buildings are ample for their work when the institution's full capacity is attained. The kitchen building is a particularly interesting one. All of the cooking is to be done there, and a system of subways, with tracks on which food cars are run, connects it with all of the groups. An idea of the magnitude of kitchen plans for such an institution may be got from one single fact. The pantry is a lofty room, 20x32 feet.

The calculation that 80 per cent. of the insane of the district would be in the chronic stages of the disease explains the provision in detached cottage groups for this proportion of the patients. A great proportion of these are feeble and helpless, requiring constant attendance night and day, but attendance that can be given cheaply and efficiently in associate day rooms, dining rooms and large dormitories. Detached group No. 1, which is completed, is an infirmary group for patients of both sexes of this class. It is chiefly one story in height, and the plan permits an abundance of sunlight and air for every room.

Detached group No. 2 is intended for 185 men of the chronic insane class, who require more than ordinary care and observation. Detached group No. 3 is composed of two-story buildings for 322 women. It has several large work-shops. Occupation is one of the main reliances of the planners of the institution as a part of the treatment there.

Detached group No. 4 is designed for both men and women, and will accommodate 150. A wholly different classification is here provided for, the actively industrious classes being intended for this group. Those who are able to do outdoor work, and for whom some diverting employment will be beneficial in making them contented and physically healthy, will live here. There is complete separation of day rooms, but the two sexes will dine together in an associate hall.

An amusement hall to harmonize with the central group, and to be built adjacent to it, is planned, and will be built this year if the appropriation will permit. It is a valuable and necessary adjunct to the other provisions for the care of a population of 1,500. Accommodations for entertainments, chapel exercises, dancing and a bathing establishment are included in the plans in a way that gives great results with great economy of construction.

Probably the feature in the scheme of the St. Lawrence State Hospital of the greatest popular and professional interest is Dr. Wise's plan to have there an Americanized and improved Gheel. The original Gheel in Belgium is a colony where for many years lunatics have been sent for domiciliary care. Its inhabitants, mostly of the peasant class, have grown accustomed to the presence and care of patients with disordered minds. The system is the outgrowth of a superstition founded in the presumed miraculous cure of a lunatic whose reason was restored by the shock of the sight of the killing of a beautiful girl by her pursuing father, whose fury had been roused by her choice of a husband. A monument to this unfortunate graces Gheel, and as St. Dymphna she is supposed to be in benign control of the lunatic-sheltering colony. Some of the features of the Gheel system of care are also distinctively known as the Scotch system. There the placing of patients in family care is common. Massachusetts has also adopted it to a considerable extent. But there are many objections to family care in isolated domiciles, as practiced in Massachusetts. Special medical attention and official visits are made expensive and inconvenient. Dr. Wise plans to get all the advantages of such a mode of life for patients whose condition retrogrades under institutional influence. Not the least of these advantages is that of economy in relieving the State from the per capita cost of construction for at least one-fourth of the insane of the district. He would utilize the families in the settlement which always grows up in the vicinity of a large hospital. It is composed of the households of employes, many of which are the result of marriages among the attendants and employes. On Point Airy, by the use of the buildings that were on the different plots bought by the State to make up the hospital farm, such a settlement can be easily made up. Its inhabitants would pay rent to the State. They would be particularly fit and proper persons to board and care for patients whose condition was suitable for that sort of a life, and the patients could have many privileges and benefits not possible in the hospital. Point Airy's little Gheel on such a plan would be a most interesting and valuable extension of the beneficent rule of St. Dymphna.

The St. Lawrence State Hospital was built and is operated under the supervision of a board of managers, whose fidelity to it is described as phenomenal by the people of Ogdensburg. The members of the executive committee, Chairman William L. Proctor, Secretary A.E. Smith, John Hannan and George Hall, especially Mr. Proctor and Mr. Smith, have given as much time and attention to it as most men would to a matter in which they had a business interest. The result has been a performance of contract obligations in which the State got its money's worth. The people of Ogdensburg, too, have taken a great interest in the institution. Such men as Mayor Edgar A. Newell, ex-Collector of the Port of New York Daniel Magone, Postmaster A.A. Smith, Assemblyman George R. Malby, and his predecessor, Gen. N.M. Curtis, who was the legislative father of the hospital scheme; Frank Tallman and Amasa Thornton take as much pride in the institution that the State has set down at the gates of their city as they do in their cherished and admired city hall, which combines a tidy little opera house with the quarters necessary for all public and department uses.

The executive staff of the hospital consists of Dr. P.M. Wise, medical superintendent; Dr. J. Montgomery Mosher, assistant: Dr. J.A. Barnette and Steward W.C. Hall.—N.Y. Sun.

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