"great and rapid advances were made throughout the United States in methods of caring for the insane. The reforms then accomplished attracted the attention of Europe, and it may be said, without any egotism, that they were in advance of contemporary progress in other countries." Much of this reform was due to the exertions of Dorothea L. Dix, who about 1837 began a career of remarkable success in arousing public attention and securing legislative action for the betterment of the condition of the insane. She is said to have been influential in the establishment of thirty-two asylums for the insane. But unfortunately this high standard of achievement was not maintained. During the civil war and the early period of reconstruction this reform suffered a reaction, and the country failed to keep pace with the progressive movement in other lands. Within the last thirty years of the century, however, rapid advance was made, and to-day the standard of work done for the insane in America is not lower than that attained in other countries.
The period of large and imposing buildings, palatial in exterior appearance, has passed. The buildings erected twenty or thirty years ago were uniformly massive, three-or four-story structures, the interiors often monotonous and cheerless. To-day the tendency is to place the patient in surroundings as cheerful and homelike as possible. To have smaller buildings, comfortably furnished, with pictures on the walls, with books, games and the means for light amusements and employment. No longer is the patient forced to pace ceaselessly long cheerless corridors, the walls lined with benches and heavy chairs and bare of all adornment.
Now, instead of large blocks of buildings, the modern hospital consists of a group of cottages, best of two stories, separated or connected by a low corridor. Here the patients are separated into small groups carefully classified as to their mental condition. These buildings are surrounded by nicely kept grounds, with green lawns dotted with shrubbery and flowers. There are groves to afford a shady retreat, and here the patients spend much time every pleasant day. Many of them have the parole of the grounds and come and go without oversight. Freedom is allowed as far as is consistent with safety. In many places the usual iron gratings have been removed from the windows and doors left unlocked.
But the institutions for the insane of to-day are not places merely of detention. The insane asylum, except for the chronic cases, in most states both here and abroad, has passed away and in its place has arisen a hospital to which the patient comes as a sick man to have the kind care and systematic treatment that the word hospital implies. He is received and cared for by nurses trained to the work and is at once impressed with the idea that he is a sick man, so regarded by his fellow