INSANE, Institutional Care of the, in the United States.— Previous to the 19th cen tury there was practically speaking no such thing as care of the insane and no hospitals in which to care for them. The mentally ill were either permitted to roam at large, to subsist on begging and other charities, or indifferently confined with paupers in poorhouses or with criminals in prisons, or perhaps more frequently were cared for as best they could be by their people at home. This latter type of care was? often not much better than the care that they received in prisons and in poorhouses because their folks were equally ignorant of how to minister to them.
Previous to the beginning of the 19th century there are recorded here and there laws ad dressed to the problem of the care of the insane, In 1676 a law of Massachusetts delegated the care of the person and the estate of the de. pendent insane to the selectmen. In 1798 a law was passed in the same State which provided for the commitment to the house of correction of lunatics who were "furiously mad.' In 1811 the Massachusetts General Hospital was incor porated and the McLean Hospital established and subsequently opened in 1818. As early as 1650 in Rhode Island we find the Puritan, Roger Williams, making an urgent appeal on behalf of Mrs. Wilson. urging provision for her, whom he describes as a distracted woman. In 1725 a law was passed permitting inland towns to build houses of correction for vag rants and also for "mad persons.' In 1742 the care of all the insane and imbeciles was given to the town council with power to appoint guardians for their estates. In 1828 the Dex ter Hospital was opened and in 1847 the °Butler Asylum for the Insane.' Similar records of legislation are found in a number of the other States, more particularly States along the At lantic Coast. The earliest action in this country providing for the special care of the insane in specially constructed hospitals was taken by the "Religious Society of Friends' in 1709 and this action resulted in the foundation of the Penn sylvania Hospital in 1751. A portion of this
hospital was set apart for the insane and the first patients were admitted in 1752. The first State hospital, however, for the exclusive care of the. insane was established in Virginia and is now known as the Eastern State Hospital, at Williamsburg, Va. It was incorporated in 1768 under the name of the "Public Hospital for Persons of Insane and Disordered Minds' and its first patients were admitted in 1773. In 1806 an authorization to a hospital in the city of New York was granted to erect additions and provide suitable apartments for maniacs adapted to the various forms and degrees of insanity. Other important dates in the early part of the 19th century were the opening of an institution for the care of the insane at Frankfort, Pa., by the Society of Friends in 1817, the founding of the Hartford Retreat, in Hartford, Conn., in 1824, the opening of the South Carolina State Hospital for the Insane in 1824, of the Eastern State Hospital at Lexington, Ky., in 1824, of the Western State Hospital at Staunton, Va., in 18213, of one of the buildings of the Blockley Almshouse for the dependent insane in Philadelphia from 1830 to 1834, the Maryland State Hospital for the In sane in 1832, and the New Hampshire State Hospital for the Insane at Concord in 1842.
From this period on the erection of State hospitals went rapidly forward in the different States of the Union. The first law for the creation of a State hospital in New York was passed in 1842. The Utica State Hospital was opened approximately in 1850. The creation of this hospital, as of many others, was largely the work of Dorothea Lynde Dix (1802-87) whose broad philanthrophy extended over many States of the Union and in Europe as far as Constan tinople. It was through her efforts that insti tutions were erected in Massachusetts, Pennsyl vania, New Jersey, Rhode Island, North Carolina and the District of Columbia. Some 32 institutions in this country owe their existence, in whole or in part, according to her biographers, to her efforts.