Cmu^ Kikk 
 
 
 THE CARE OF THE INSANE IN CANADA.* 
 
 BY C. K. CLARKE, M. D., 
 
 Medical Superintendent of the Kingston Asylum, Ontario. 
 
 The Province of Ontario has ahvays been looked upon as the 
 most progressive part of Canada, and in the care of the insane 
 this Province has endeavoured to keep up with the advance of science 
 and in a few respects has possibly led. The development of the 
 State care under the intelligent eye of that accomplished alienist, 
 Dr. Workman, is a chapter in history known to too few, but the 
 influence of this remarkable man has been felt for many years and 
 a great deal that is best in the present avSylum system can be 
 traced to his thoughtful foresight. Non-restraint has been 
 accepted as a principle in nearly all of the Ontario institutions and, 
 in two, at least, has been an accomplished fact for ten years. 
 
 I believe in one institution the long sleeved jacket is still used 
 at times, but beyond this there is nothing that can be called re- 
 straint. At the same time all of the superintendents are agreed thjit 
 w hile non-restraint is admirable, the case might occur in which 
 restraint would prove of value and should be adopted. 
 
 Dr. Bucke, of London Asylum, who has always been a progressive 
 man, was the first to adopt non-restraint some ten years ago, and 
 w'as closely followed by Dr. Metcalf, of Kingston. 
 
 These facts are of interest and should be recorded, as at tliat 
 time nearly every institution in America ridiculed non-restraint as 
 an impossible fad, and those who adopted the system were looked 
 upon as “cranks” and imbeciles. 
 
 The Asylums of Ontario are State institutions in the most complete 
 sense of the w^ord ; and, in all but a few^ w^ards in Toronto, patients 
 are cared for at the expense of the (Tovernnient. 
 
 When they are able to contribute to their support, a rate that 
 covers the bare cost of maintenance is charged. 
 
 The Province furnishes asylum accommodation for about three 
 thousand insane persons, and another institution is being erected 
 at Brockville on the St. Lawrence River. 
 
 Ontario has never been lavish in her expenditure on buildings, 
 and, it is possible, has gone to an extreme in economy in this matter. 
 
 * Read at the International Congress of Charities, Correction and Philanthropy, (Sect. 
 IV; on the Commitment, Detention, Care and Treatment of the Insane), Chicago, 111., 
 June 15M8, 1893. 
 
 
2 
 
 THE CARE OF THE INSAXE IX CAX^ADA. 
 
 There has been a good deal of doubt in regard to the most 
 desirable style of hospital to erect, but now it seems to be accepted 
 that a central building with detached cottages is the most 
 convenient institution for the purposes of the Province. 
 
 Mimico is composed of several cottages and affords a lefuge foi 
 chronics chietiy,— the other asylums are on the plan before men- 
 tioned. 
 
 If Ontario has had any particular merit, it has been in the way 
 of substituting emplo3"ment for restraint, and that this has been 
 successfully done, a visit to almost any of the hospitals will show. 
 In the institution over which I preside the occupation of patients 
 has been regarded as a most important matter and, as the Supei- 
 intendents of London and Hamilton asylums are firm belie\eis in 
 employment, possibly a description of the methods followed in 
 Kingston may apply to a great extent to the other hospitals refei led 
 to. In Toronto the patients are from a different class; the 
 grounds are limited and different conditions generally obtain so 
 that varied occupations cannot be followed as in the other asylums. 
 
 In Kingston the idea has been not only to furnish plenty of oc- 
 cupation but variety as well, and it is the aim of those in charge to 
 find the particular employment that is likel}^ to prove suitable to 
 each case. With this end in view there have been established the 
 following industries: 
 
 Cabinet making, upholstering, broom making, weaving, shoe- 
 making, laundry work, painting and decorating, farming, stone 
 cutting, carpentering, brush making, bookbinding, tinsmithing, 
 tailoring, blacksmithing, gardening, quarrying, sewing and 
 knitting. 
 
 In addition, those who care for music are instructed in the band 
 i-oom, — a scliool is carried on and the patients who cannot be trusted 
 outside are regularly instructed in gymnastics. 
 
 ddie physical culture classes reach the highest development in 
 wards that were formerly designated, refractory. These wards 
 are now as orderly as any in the asylum and the word 
 refractory has lost its meaning. DiflFerent forms of drill 
 such as dumb bell, extension movements, marching, &c., with 
 parallel bar exercise are adopted by the men, while the women are 
 drilled to music in one large class and go through Barbell exercise, 
 hoop drill, &c. 
 
 The brass band of twenty-two is made up chiefly of patients, the 
 
BY C. K. CLARKE, M. D. 
 
 3 
 
 majority of whom have been taught music since admission to the 
 asylum. A qualified instructor has charge of the band and gives 
 his whole time to the care and development of his patients. This 
 brass band plays well and, outside of its use as furnishing employ- 
 ment, is a valuable addition to our resources in the way of provid- 
 ing music for indoor and outdoor concerts. 
 
 The school is modelled after that in the Utica asylum and is 
 appreciated by the women who attend it. 
 
 It has been found possible to do a great deal by patients’ labor, 
 and last year a fine stone cottage for thirty farm patients was put 
 up ahnost entirely by their work, and the success of this experiment 
 has induced us to launch out on a bigger undertaking. 
 
 At the tinje of writing the stone for our infirmary 64x72 is 
 being quarried and dressed by our patients. It has not been 
 decided yet whether they will undertake the erection of such a 
 large building ; but if it is decided that we shall do the work, I am 
 satisfied that the result will be sat isf actory . The chief idea governing 
 the extensive system of employment is to furnish each patient with 
 work that is attractive to himself. In addition, hours are short, 
 and we have a system of rewards in the way of lunches that answers 
 admirably. 
 
 On the whole, the insane of the Province of Ontario are well and 
 liberally cared for by the Government and the asylums enjoy the 
 confidence of the general public to such an extent that actions for 
 illegal detention of sane persons do not occur, and newspaper 
 discussions over so-called atrocities are unheard of. 
 
 The people realize the value of the service to the general public, 
 and udien it is so clearly understood that it cannot be in the inter- 
 rest of any one to detain a sane person, scandals do not occur. 
 
 All sick patients, both male and female, are nursed by trained 
 hospital nurses in properly equipped infirmaries, and in Kingston 
 all nurses are trained, not oidy in the nursing and care of the in- 
 sane, but in medical and surgical nursing as well. The hospital 
 idea is carefully taught and all nurses are made to understand that 
 patients under their care are sick people and must be treated 
 as such. In order to carry out this idea to its legitimate conclu- 
 sion, separate hospital buildings are to be erected in connection 
 with each asylum, and the day is not distant when acute cases 
 will be treated in small buildings on the hospital plan. 
 
 Foreigners, as a rule, regard Canada as a small country with a 
 
4 
 
 THE CARE OF THE INSANE IN CANADA. 
 
 population centralized within a limited territory. Although the 
 population is small, say five millions, it is scattered over an im- 
 mense territory from the Atlantic to the Pacific, and each Prov- 
 ince cares for its own insane. As a matter of fact the asylum 
 system of Quebec is the one that is generally attributed to the 
 whole of Canada, because its defects have brought it into glaring 
 prominence. Since the advent of the new asjdum in Montreal 
 and the disastrous fire in Longue Pointe, a better state of things 
 has come about, but until the Quebec Government assumes 
 absolute control of the care of the insane, the system will be open 
 to grave criticism. The Protestant Asylum at Montreal is a non- 
 restraint institution and conducted on modern principles. 
 
 New Brunswick, Nova Scotia and Manitoba, have ahva^’^s kept 
 up with the times and their institutions arc, I believe, admii-able. 
 
 About Prince Edward Island and British Columbia I am not in 
 a position to speak from actual knowledge, but I have every reason 
 to believe that they are well conducted. ^ 
 
 Since Dr. Hack Tuke wrote his interesting but bitterly crit- 
 icized brochure on the Insane of the United States and Canada, 
 steady advances have been made, and it is only a question of 
 time as to when Quebec must fall in line with the other Provinces 
 and give up the farming out system. 
 
 Canada is behind the times in the matter of the care of the criminal 
 insane, and I regret to have to chronicle the fact that the general 
 public has not yet learned to regard insanity as a disease that mav 
 be the cause of crime. As long as the legal definition of insanity 
 is so crude and imperfect, and the newspapers hold up the bogy 
 called the “ insanity dodge,” we may look for little or no improve- 
 ment in this line. In this respect of course we are not much worse 
 than our neighbors, who believe that as a general policy the hang- 
 ing of so-called cranks’^ is very convenient in the way of ridding 
 the world of certain dangerous elements. Of course they are 
 not prepared to carry the argument to its legitimate conclusion 
 and appl}" it generally. 
 
 In Canada it is, I regret to sa}% a difficult matter for an insane 
 criminal guilty of murder to escape the death penalty, and within 
 a comparatively recent period several men with well marked brain 
 disease have been hanged. W e have no provision for the special 
 care of the criminal insane and will not require it until popular 
 ignorance disappears. Many of our legal lights assert that in 
 
BY C. K. CLARKE, M. D. 
 
 5 
 
 Canada we make no mistakes res^arding the “insanity dodge” as 
 we hang all murderers sane and insane. It will not be 
 many years before a complete change of sentiment will take 
 ])lace regarding this matter, just as it is developing in 
 England where public opinion is not as bitter as it is with us. 
 
 Leaving this unpleasant feature of the discussion, the care of the 
 insane in most of the Canadian Provinces may be said to be all that 
 could be desired, that is, leaving Quebec out of the question, and 
 even there the advance toward a better condition of affairs has 
 commenced. Ontario, being the wealthiest Province, has of course 
 been able to outstrip the others and has found it comparatively 
 easy to carry the burden of the care of her insane, and has never 
 shirked the duty. She too had the advantage of an illustrious 
 pioneer in the shape of Dr. Workman, who introduced and developed 
 a system characterized by kindness and gentleness. Just as the 
 York Retreat in England exercised a beneficial influence, the 
 teachings of Dr. Workman have silently proved a means of 
 untold good in Ontario. 
 
V.