342 READINGS IN BIOLOGICAL SCIENCE 



when it is realized that only the "furiously mad" were confined in institu- 

 tions, that little or nothing was done for them even in the line of elementary 

 hygiene, and that these places were scenes of the worst types of filth and 

 confusion. 



The first public mental hospital in this country, at Williamsburg, Vir- 

 ginia, was founded in 1773, but it was not until the middle of the nineteenth 

 century that the practice of building public mental hospitals became gen- 

 eral, thanks to the activities of Dorothea L. Dix. The purpose of these in- 

 stitutions, which were then known as asylums, was primarily to care for 

 the "furiously mad," as they were denominated. The more quiet patients 

 were often cared for in jails or in almshouses, a situation which is not un- 

 known in some parts of this country even to-day. It may be pointed out 

 and emphasized that mental disorder was early looked upon as being of 

 public interest only in connection with the disturbance of the peace or 

 with "pauperism"; it was a subject to be dealt with by the police or by the 

 poor authorities, not as a medical problem. Historically, these facts are 

 probably connected to some extent with an attitude not entirely unknown, 

 that mental disease impresses some sort of "stigma" upon the person who 

 suffers from it and upon his family. Indeed, even to-day in many parts of 

 the country the mental hospitals are under the control of departments of 

 public welfare; that is, under organizations which are designed primarily 

 to deal with the dependent, rather than raised to the dignity of recognition 

 as medical institutions. The development of the medical attitude toward 

 mental disorder, the attitude that we are dealing with disease and which 

 is amenable to treatment, is relatively recent. It is this evolution which has 

 brought about the change of name from "asylum" to "hospital," with all 

 that that name implies. 



In the early days in this country admission to mental hospitals was not 

 especially difficult, although those who were able to pay for care avoided, 

 so far as possible, being sent to the public institution. The "asylum" was 

 designed, as we have said before, primarily for "paupers" and for those 

 who had been considered dangerous to the public peace. In the beginning 

 hospital admission was a simple matter, but in the '50's the "railroading 

 myth" seems to have become established. As a result of the fear that per- 

 sons would be improperly sent to mental hospitals and there detained for 

 the purpose of permitting others to obtain control of their property, the 

 admission to mental hospitals was in a good many states made decidedly 

 difiicult, and some went so far as to require a trial by jury on a charge of 

 lunacy before the patient could be admitted to the hospital. Such a barbaric 

 and antiquated procedure was abolished by statute in the District of Co- 

 lumbia only as recently indeed as 1938, and is still retained in at least one 

 state. There are many people to-day who believe seriously, in spite of the 

 overcrowding and the constant pressure by hospital administrators to dis- 

 miss patients from hospitals, that patients are actually sent to such institu- 



