The functions of an asylum: an analysis of male and female admissions to Essex County Asylum in 1904

BACKGROUND

Contrasting historical views represent the asylum as a manifestation of humanitarian and therapeutic progress or as an institution of social control designed to bolster the capitalist economic order. More extreme critics suggest it was used to incarcerate people exhibiting only political or social deviance.

METHODS

Case notes of 200 consecutive male and female admissions to the Essex County Asylum in 1904 were inspected. The nature of presentations was classified in contemporary terms into broad categories of disorder. Outcomes were identified and differences between men and women were explored.

RESULTS

We found no evidence that patients were admitted without signs of significant mental and behavioural disturbance. In total, 44% of admissions had signs of an organic condition, and these were more frequent among men. Women were admitted at a faster rate and were 1.6 times more likely to have mania or a psychotic disorder. Overall, 45.5% of patients were discharged, with 62% of patients with non-organic disorders discharged recovered or improved.

CONCLUSIONS

Evidence partially supports both views of the asylum. In line with other studies, there is no evidence that the asylum was used to incarcerate people who did not show significant signs of disorder, but it did provide care and containment for those who could not be accommodated elsewhere, including many with organic conditions. The asylum also had a therapeutic orientation, however, and encouraged discharge where possible. In contrast to some other studies, women were more likely to be institutionalised than men, possibly reflecting their greater economic dependency.

The history of mental health policy in Turkey: tradition, transition and transformation

This article offers a brief history and the evolution of mental health policy in Turkey. It aims to analyse how mental health policies were transformed and why certain policies were introduced at specific times. The modern history of mental health policy is divided into three periods: the institutionalization of psychiatry and hospital-based mental health services; the introduction of community-based mental healthcare services; and lastly, the policy of deinstitutionalization after the 1980s. These periods have been categorized in a way that basically coincides with Turkey's modern political history.

The Psychopharmacological Revolution in the USSR: Schizophrenia Treatment and the Thaw in Soviet Psychiatry, 1954-64

Twentieth-century psychiatry was transformed in the 1950s and 1960s by the introduction of powerful psychopharmaceuticals, particularly Chlorpromazine (Thorazine). This paper examines the reception of Chlorpromazine in the Soviet Union and its effect on the Soviet practice of psychiatry. The drug, known in the USSR by the name Aminazine, was first used in Moscow in 1954 and was officially approved in 1955. I argue that Soviet psychiatrists initially embraced it because Aminazine enabled them to successfully challenge the Stalin-era dogma in their field (Ivan Pavlov's 'theory of higher nervous activity'). Unlike in the West, however, the new psychopharmaceuticals did not lead to deinstitutionalisation. I argue that the new drugs did not disrupt the existing Soviet system because, unlike the system in the West, the Soviets were already dedicated, at least in theory, to a model which paired psychiatric hospitals with community-based 'neuropsychiatric dispensaries.' Chlorpromazine gave this system a new lease on life, encouraging Soviet psychiatrists to more rapidly move patients from in-patient treatment to 'supporting' treatment in the community.

[In the middle of the road there was a stone: the history of violence and social suffering among young adults with trajectories of psychiatric hospitalization]

This article presents the life stories of three young adults with a long history of psychiatric hospitalization who became residents of a psychiatric hospital in Sorocaba (SP), in a region known as a center for the mentally ill. This study analyzes mental health policies and their effects on the lives of these individuals based on discussions about social suffering. Using the participant objectivation technique, these individuals were followed for two years after dehospitalization. The results show that health policy in Sorocaba has been advanced through totalizing and coercive schemes with institutionalization and medicalization comprising the "solution" to some social problems.

The role of therapeutic jurisprudence to support persons with intellectual and developmental disabilities in the courtroom: Reflections from Ontario, Canada

It is generally recognized that persons with intellectual and developmental disabilities (IDD) are at greater risk than the general population when they encounter the criminal justice system due to vulnerabilities such as cognition, memory and language (Jones, 2007). To date, little evidence has been generated regarding best practice to support persons with IDD in the criminal justice system, specifically the courtroom. Various models of problem-solving courts have developed across Canada to divert cases composed of complex human social problems to more appropriate community-based treatment and supports. Past Canadian authors have raised critical questions that require reflection about the broader theory of Therapeutic Jurisprudence (TJ) and its current implementation in problem-solving courts. Given the risk and vulnerabilities of persons with IDD in the criminal justice system, problem-solving courts (specifically mental health courts) hold great promise to address some of the unique needs of these individuals. We reflect on the critical questions raised by previous Canadian authors regarding problem-solving courts and suggest some considerations that need to be addressed to maximize the benefits of these courts for persons with IDD.

The Final Years of Central State Hospital

There is a rich literature on the deinstitutionalization movement in the US but few, if any, parallel histories of state mental hospitals. Under attack from the 1950s on, state hospitals dwindled in size and importance. Yet, their budgets remained large. This paper offers a case study of one such facility, Indiana's Central State Hospital, between 1968 and 1994. During these years, local newspapers published multiple stories of patient abuse and neglect. Internal hospital materials also acknowledged problems but offered few solutions. In 1984, the US Department of Justice intervened, charging Central State with having violated patients' civil rights, the first such action filed under the 1980 Civil Rights of Institutionalized Persons Act. Although Indiana signed a consent decree promising major reform, long-lasting change proved elusive. Civil and criminal lawsuits proliferated. In 1992, as Central State continued to attract negative attention, Indiana Governor Evan Bayh ordered the troubled hospital closed. His decision promised to save the state millions of dollars and won plaudits from many, but not all, mental health advocates. Even as the last patients left in 1994, some families continued to challenge the wisdom of eliminating Indiana's only large urban mental hospital, but to no effect.

Deviancy, Dependency, and Disability: the Forgotten History of Eugenics and Mass Incarceration

Three widely discussed explanations of the punitive carceral state are racism, harsh drug laws, and prosecutorial overreach. These three narratives, however, only partially explain how our correctional system expanded to its current overcrowded state. Neglected in our discussion of mass incarceration is our largely forgotten history of the long-term, wholesale institutionalization of the disabled. This form of mass detention, motivated by a continuing application of eugenics and persistent class-based discrimination, is an important part of our history of imprisonment, one that has shaped key contours of our current supersized correctional system. Only by fully exploring this forgotten narrative of long-term detention and isolation will policy makers be able to understand, diagnose, and solve the crisis of mass incarceration.

Institutionalising senile dementia in 19th-century Britain

This article explains how old, poor people living with dementia came to be institutionalised in 19th-century Britain (with a focus on London), and how they were responded to by the people who ran those institutions. The institutions in question are lunatic asylums, workhouses and charitable homes. Old people with dementia were admitted to lunatic asylums, workhouses and charitable homes, but were not welcome there. Using the records of Hanwell lunatic asylum, published texts of psychiatric theory, and the administrative records that all of these institutions generated at local and national levels, this article argues that 'the senile' were a perpetual classificatory residuum in the bureaucracy of 19th-century health and welfare. They were too weak and unresponsive to adhere to the norms of the asylum regime, yet too challenging in their behaviour to conform to that of the workhouse, or the charitable home. Across all of these institutions, old people with dementia were represented as an intractable burden, many decades before the 'ageing society' became a demographic reality.

Bastard Breadfruit and other Cheap Provisions: Early Food Science for the Welfare of the Lower Orders

Breadfruit is best known in connection with an infamously failed project: the 1789 mutiny against the Bounty, commanded by William Bligh. However, four years later, Bligh returned to the Pacific and fulfilled his commission, delivering breadfruit and other Pacific foods to Caribbean plantations. Placing these plant transfers in the emerg- ing sciences of food and nutrition in the eighteenth century, this essay examines the broader political project of what would much later be called 'the welfare state; which motivated British officials' interest in experimenting with novel ingredients and recipes to cheaply nourish a range of dependent populations in institutional settings. Perhaps most strikingly, their nutritional recommendations borrowed directly from agricultural practices, particularly from new methods for feeding livestock in confinement.

'Without decontextualisation': the Stanley Royd Museum and the progressive history of mental health care

This paper builds on recent scholarship exploring museum exhibitions and the heritage of mental health care. Using the development of the Stanley Royd Museum in the mid-1970s as a case study, the paper will examine the rationale for the opening of the museum and its link to changing perceptions of mental hospitals in both historical study and what was then 'current' practice. It will then provide an overview of the proposed audience for the new museum and briefly analyse its success in communicating its history to its visitors. Ultimately, it will question how successful mental health professionals were in presenting the progressive nature of institutional care at a time when the system was being radically overhauled and reoriented.

The Utica crib: Biography of an unknown barbarous object

During the latter half of the 19th century, a device known popularly as the "Utica crib" became widely used in asylums and state hospitals across North America. The design varied to an extent between institutions but generally consisted of an enclosed, rectangular box made from combinations of wood slats or metal screening, with a hinged lid that could be latched closed on one side. The box was large enough to allow a person to lie straight inside with the lid closed. It has generally been described as no more than a restraint device used to confine patients in a recumbent position. In this article, I resituate the Utica crib in its broader historical context, focusing on the key role it played in the boundary debates faced by North American alienists. Particular attention is paid to the challenge from British alienists with regard to the nonrestraint movement and the attack from neurologists concerning the purported expertise of alienists.

'A disease that makes criminals': encephalitis lethargica (EL) in children, mental deficiency, and the 1927 Mental Deficiency Act

Encephalitis lethargica (EL) was an epidemic that spread throughout Europe and North America during the 1920s. Although it could affect both children and adults alike, there were a strange series of chronic symptoms that exclusively affected its younger victims: behavioural disorders which could include criminal propensities. In Britain, which had passed the Mental Deficiency Act in 1913, the concept of mental deficiency was well understood when EL appeared. However, EL defied some of the basic precepts of mental deficiency to such an extent that amendments were made to the Mental Deficiency Act in 1927. I examine how clinicians approached the sequelae of EL in children during the 1920s, and how their work and the social problem that these children posed eventually led to changes in the legal definition of mental deficiency. EL serves as an example of how diseases are not only framed by the society they emerge in, but can also help to frame and change existing concepts within that same society.

"A visitation of providence:" Public health and eugenic reform in the wake of the Halifax disaster

The Halifax Explosion provided the opportunity for an "experiment in public health" that was meant not only to restore but also to improve the city and its population in the process. The restructuring that occurred during the restoration was influenced by pre-existing ideals and prejudices which were reflected in the goals of the newly formed committees in charge of the reconstruction. The primary emphasis on improvement as well as control was the result of existing regional concerns regarding the emigration of the province's most "desirable" stock, in the form of healthy, educated young men and women, to central Canada and the eastern United States. Public health reforms reflected the eugenic goal of improving the overall quality of the population through education, surveillance, and inspection, resorting finally to institutionalizing people who public health officials determined were genuinely deficient.

Translating leprosy: the expert and the public in Stanley Stein's anti-stigmatization campaigns, 1931-60

This article examines three campaigns through which patient activist Stanley Stein sought to combat the stigmatized connotations of the word "leprosy." In 1931, soon after starting the first patient newspaper at the U.S. national leprosy hospital at Carville, Stein became convinced of the necessity of finding an alternative to "leprosy." His ensuing campaign to promote the use of the words "Hansen's Disease" to describe the condition from which he and fellow Carville patients suffered became his most passionate and life-long project. In the 1950s, Stein became involved in efforts to change the translation of "leprosy" in the Bible. Finally, in 1960, he waged a campaign to de-stigmatize encyclopedia entries on leprosy. These campaigns illustrate how even elevation of the medical expert and a seeming disdain for the public can function as a protest of medical authority and reveal a presumption that a significant degree of authority actually resides with the public.

Perspectives on Erving Goffman's "Asylums" fifty years on

Erving Goffman's "Asylums" is a key text in the development of contemporary, community-orientated mental health practice. It has survived as a trenchant critique of the asylum as total institution, and its publication in 1961 in book form marked a further stage in the discrediting of the asylum model of mental health care. In this paper, some responses from a range of disciplines to this text, 50 years on, are presented. A consultant psychiatrist with a special interest in cultural psychiatry and mental health legislation, two collaborating psychotherapists in adult and forensic mental health, a philosopher, and a recent medical graduate, present their varying responses to the text. The editors present these with the hope of encouraging further dialogue and debate from service users, carers, clinicians, and academics and researchers across a range of disciplines.

Insanity, gender and empire: women living a 'loose kind of life' on the colonial institutional margins, 1870-1910

This article examines how female immigrants were characterised inside the Yarra Bend Asylum in Melbourne, Victoria (Hospital for the Insane after 1905), once they slipped into the world of the institutionally 'hidden.' Forms of social difference inside colonial institutions for the insane were embedded in patient case records. This article argues that through a closer examination of cases of female immigrants, we might find out more about gender relations in colonial situations. In particular this article returns to ideas about women patients and constructions of these women through case records to uncover new interpretations of this material in the Australasian context. To do this, it sets out specific ways of reading patient cases and teases out the importance of these frameworks for making some kind of synthesis of the ways in which institutionalised people--already at the margins of society--were further marginalised inside institutional populations through specific practices. It examines immigrant women in the hospitals for the insane; the cases of women designated as living so-called 'loose' lives who also ended up inside the institution for the insane; and finally concludes with a commentary about the descriptive power of cases and the production of concepts of gender, class, and race difference within their pages.

Institutionalization of mentally-impaired children in Scotland, c. 1855-1914

This article examines two institutions which were established in Scotland specifically for the accommodation of mentally-impaired children: Baldovan Asylum near Dundee and the 'Scottish National Institution for the Education of Imbecile Children' in Larbert, Stirlingshire. It surveys the aims and agendas of the institutions in the spheres of residential childcare, mental health, and education and training. It compares the admission regimes of these institutions and considers whether they complemented one another in serving an unsatisfied demand for places, or whether they were in competition for admissions, staff and charitable support. The survey covers the period from the opening of both institutions to the implementation of the Mental Deficiency Act of 1913 which required the (re)certification of all children.

'These pushful days': time and disability in the age of eugenics

At the turn of the twentieth century, social attitudes toward disability turned sharply negative. An international eugenics movement brought about restrictive immigration laws in the United States and other immigrant nations. One cause was the changing understanding of time, both historical and quotidian, that accompanied the advent of evolutionary theory and a competitive industrial economy. As analogies of competition became culturally ubiquitous, new words to talk about disability such as 'handicapped', 'retarded', 'abnormal', 'degenerate', and 'defective', came into everyday use, all of them explicitly or implicitly rooted in new ways of thinking about time. The intense fear of disability that characterised the eugenics movement grew, in good part, from this new and unsettling vision of time.

Crackpots and basket-cases: a history of therapeutic work and occupation

Despite the long history of beliefs about the therapeutic properties of work for people with mental ill health, rarely has therapeutic work itself been a focus for historical analysis. In this article, the development of a therapeutic work ethic (1813-1979) is presented, drawing particular attention to the changing character and quality of beliefs about therapeutic work throughout time. From hospital factories to radical "anti-psychiatric" communities, the article reveals the myriad forms of activities that have variously been considered fit work for people with mental health problems. While popular stereotypes of basket-weaving paint a hapless portrait of institutional work, a more nuanced reading of therapeutic work and its political and philosophical commitments is advanced. The article concludes by arguing that the non-linear and inherently contested development of therapeutic work is less the effect of paradigmatic shifts within the therapeutic professions, but rather evidence of a broader human struggle with work.

'A group of parents came together': parent advocacy groups for children with intellectual disabilities in post-World War II Australia

In the late 1940s, small groups of 'interested parents' and 'concerned citizens' began to gather in community halls, hoping to assuage the 'plight' of their intellectually disabled offspring. These meetings led to the formation of an association dedicated to the foundation of schools, day centres, or hostels for their children. By the 1960s, at least one of these groups existed in every Australian state. Together, they established several hundred schools, farm colonies, hostels, and workshops, and successfully lobbied state and federal governments to fund their ventures. Just as importantly, their extensive publicity campaigns changed the public discourse surrounding intellectual disability. Despite their wide-ranging influence, these groups have been largely overlooked by historians. In this paper I survey the rise of the parent groups, their philosophy, and the facilities they operated.

A life-course approach to studying transitions among Canadian seniors in couple-only households

This study tracked the occurrence of death, widowhood, institutionalization, and coresidence with others between 1994 and 2002 for a nationally representative sample of 1,580 Canadian respondents who, at initial interview, were aged 55 and older and living in a couple-only household. Although the majority of seniors remained in a couple-only household throughout the duration of the survey, nearly one in four who experienced a first transition underwent one or more subsequent transitions. Age, economic resources, and health were significant predictors of a specific first transition and multiple transitions. More work is needed to understand the dynamics of the aging process.

Counterpoints of care: two moments of struggle

This paper examines the history of care in modern society and seeks to expose how deep transformations in care arise from wider social relations. From historical survey we may discern a series of transitional points, where the practice and the experience of care was greatly, sometimes suddenly, redefined. Each betrayed deeper political and ethical struggles that went to the core of social relations, and which weren't merely therapeutic in nature. This paper explores two such 'moments'. I first examine the emergence of a new institutional landscape during the middle industrial era, in the wake of a series of legal and political reforms that sought to settle a social order uprooted and distressed by raw modernisation. I provide a composite, yet incomplete view, of how this transformation proceeded in one urban setting, colonial Melbourne. In the second instance, I review the ambitions and process of deinstitutionalisation in the late 20(th) century. Ostensibly, this reform sought, inter alia, to collapse the great division between 'fit' and 'unfit' established in 1834. Again, empirical reference is made to the reconstitution of care in Melbourne, Australia, this time during its late 20th experience of institutional reform. The focus in this case is the process of downscaling and closure for a major congregate facility, Kew Cottages. The major conclusion is that periods of intense transition in the ideology and mode of care are reflective of wider social transformations not merely of therapeutic or institutional shifts.

[The compulsory isolation of Hansen's disease patients: memories of the elderly]

From 1924 to 1962, Brazil used compulsory internment of Hansen's disease patients as one of the ways of controlling the disease in the community. After this policy ended, many patients continued to live in these units. The former Asilo Pirapitingui, now the Hospital Dr. Francisco Ribeiro Arantes, is the only old-style asylum for the socially determined internment of those suffering from Hansen's disease. Through recorded and transcribed interviews of eight of those remaining, we sought to learn their history and the meaning of this isolation in their lives. The thematic analysis of the discourse enabled identification of the following analysis categories: Hansen's disease; internment day-to-day life; the institution; current health conditions; and staying in the institution after the end of compulsory internment.

[Institutionalisation of Croatian medicine by the first World War]

Unfavourable socioeconomic and political conditions delayed stronger development of medicine in Croatia until the last decades of the 19th century and the turn of the 20th century. This relatively short period saw the establishment of a number of key healthcare institutions such as the institute for smallpox vaccine production, department of bacteriology and hygiene, tuberculosis sanatorium, paediatric outpatient clinic, emergency medical facility, and dissection facility. Hospitals became centres of medical research and started to develop specific clinical professions. New medical associations saw the light of day [Sbor liecnika kr. Hrvatske i Slavonije (Association of Physicians of the Kingdom of Croatia and Slavonia) in Zagreb and DruZtvo slavonskih liecnika (Society of Physicians of Slavonia) in Osijek] and started their own bulletins Liecnicki viestnik and Glasnik DruZtva slavonskoh liecnika, respectively. Medical training was then provided by a midwifery school and a university school of pharmacy, while the Austrian government discouraged medical studies at the local level for decades, as it feared it would create a new class of free-thinking intellectuals. Those times also saw the first welfare institutions. Croatia was not producing pharmaceuticals at the time, but there was a new factory producing medical instruments, orthopaedic devices, and bandages.

Imprisoned in state care? Life inside Kew Cottages 1925-2008

Established in 1887, Kew Cottages was Australia's oldest and largest specialised institution for people with intellectual disability. Kew Cottages was originally designed as a place of benevolent care and education for children. However its secluded location, adjacent to a 'Lunatic Asylum,' and its use of physical security measures resulted in its reputation as a place of incarceration. This viewpoint emerged through oral history testimony collected as part of the Kew Cottages History Project during 2005-08. Oral histories, which were recorded from people closely associated with Kew Cottages, reveal that despite the introduction of reforms in the mid-twentieth century to accord residents greater freedoms, poor living conditions, strict regimentation, violence, and abuse, all contributed to a prison-like environment within the institution.

Gags, funnels and tubes: forced feeding of the insane and of suffragettes

Just before the outbreak of World War I, British suffragettes were imprisoned in large numbers. Many engaged in hunger strikes and suffered brutal treatment, most notoriously forced feeding. Government authorities, backed by prominent physicians, justified forced feeding by citing its successful use with insane patients in asylums. In the nineteenth century forced feeding was, in fact, common in the asylum and much discussed in leading medical publications. Physicians generally ignored the feelings of patients, concentrating on technical problems such as the design of feeding instruments. Nor did critics amid the suffrage crisis sympathize with asylum patients. They defended women protesters but portrayed the force-fed insane as insensate. Forced feeding of the insane was nonetheless tainted by its association with the brutalization of suffragettes and in later years rarely discussed outside specialized psychiatric venues.

A family point of view: negotiating asylum care in Alberta, 1905-1930

This paper analyzes the meaning of mental illness and institutional care from a family point of view, using family correspondence and police reports about asylum admission of family members in Alberta at the beginning of the 20th century. Portraying the asylum as a place of negotiation, the analysis reveals that despite families' lack of authority over asylum admission, they nevertheless were active participants in structuring this new form of public care once it became available in Alberta. Families negotiated and contested existing medical and legal norms that structured asylum care in order to meet their own needs and demands. Categories of age, class, gender, race, and region intersected in shaping the family experience of mental illness. The paper concludes that families expected a newly built institution to provide relief of their social problems, which was at odds with the legal and medical norms regarding asylum admission.

Forty-five years of schizophrenia: personal reflections

Views about schizophrenia can change dramatically, even within one lifetime. In order to illustrate such changes over last forty-five years, this article uses the example of 'Mandy', a composite woman patient with a diagnosis of schizophrenia. It shows that, although there have been many advances over this period, understanding of schizophrenia continues to be elusive, and treatments remain imperfect. Therefore, as perspectives shift and the ground moves beneath us, the psychiatric profession needs to anchor itself firmly in the stories our patients tell us.

Nursing, obedience, and complicity with eugenics: a contextual interpretation of nursing morality at the turn of the twentieth century

This paper uses Margaret Urban Walker's "expressive collaborative" method of moral inquiry to examine and illustrate the morality of nurses in Great Britain from around 1860 to 1915, as well as nursing complicity in one of the first eugenic policies. The authors aim to focus on how context shapes and limits morality and agency in nurses and contributes to a better understanding of debates in nursing ethics both in the past and present.

The making of contemporary American psychiatry, Part 2: therapeutics and gender before and after World War II

In this article, the 2nd in a 2-part series, the authors use patient records from California's Stockton State Hospital to explore the changing role of gender norms and other cultural values in the care of psychiatric patients. The authors show that cultural values are always imbedded in psychiatric practice and that their role in that practice depends on the patients, treatments, and therapeutic rationales present in a given therapeutic encounter. Because the decade following World War II witnessed dramatic changes in psychiatry's patients, therapeutics, and rationales, Stockton State Hospital's patient records from this time period allow the authors to show not only the extent to which gender norms shape psychiatric practice but also how psychiatry's expansion into the problems of everyday life has led to psychiatry taking a more subtle and yet more active role in enforcing societal norms.

Visual indictment: a contextual analysis of the Kallikak Family photographs

The Kallikak Family is a pre-eminent text in the history of mental retardation and psychology in which Goddard (1912) claimed he proved the heritability of feeble-mindedness and the necessity of institutionalization. The book contains 14 photographs, some of which have been retouched. These photographs were interpreted in this paper within the context of clinical photography of the feeble-minded during the eugenics era, and the conclusion was made that the photographs are masterpieces of visual indictment propaganda that worked on the levels of assumed scientific objectivity, hovel imagery, mutually amplifying juxtapositions, stereotypic images of imbecility, and religious symbolism to achieve persuasiveness. A resolution of alleged "skullduggery" surrounding the retouching is presented.

Service utilization in 1896 and 1996: morbidity and mortality data from North Wales

The 1896 and 1996 populations of North-West Wales are similar in number, ethnic and social mix and rurality, enabling a study of the comparative prevalence of service utilization, as well as the morbidity and mortality associated with mental illness in 1894-96 and 1996. The 1996 data reveal a 15 times greater prevalence of admissions for all diagnoses, and three times greater prevalence of admissions by detention, compared with 1896. Patients now spend more time in a service bed than they did 100 years ago. Death as a direct consequence of mental illness is commoner now than 100 years ago. There is therefore a major disjunction between the rhetoric and the reality of mental health service utilization. General factors related to changing health care and expectations and specific factors linked to the mental health appear to have led to an increased rate of service utilization in the modern period.

[History of Hansen's disease control policy in the United States]

Federal government set up the institutions for the study and treatment of Hansen's disease patients in Hawaii in 1905. Then in 1917, a legislation was made to build a national leprosarium (leper home), authorize the Surgeon General (SG) to receive into that institution any person afflicted with leprosy who presents himself or herself for care, detention, and treatment, or any person afflicted with leprosy duly consigned to said home by the proper health authorities. The National Leprosarium (later renamed as National Hansen's Disease Center) opened in Carville in 1922. Although promin treatment had started in the early 1940s, the Public Health Service Act of 1944 retained the SG's authority for detention and apprehension. Discharge codes were gradually loosened since then, but the efforts to revise the Act were never successful for a long time. It was in 1985 when the Act was abolished. Provision of long-term care for new patients at the Center was terminated finally in 1997.

Voices from the past: early institutional experience of children with disabilities--the case of Scotland

In the countries of the western world, the institutional option for confining and endeavouring to 'correct' traits and attributes of people who did not conform to a rising consciousness of 'normalcy' developed rapidly during the 19th century. Scotland, a small, but rapidly urbanizing and industrializing country on the edge of Europe, was not an exception, but in its adoption of the institutional option for children with disabilities, its responses and objectives to different forms of impairment followed an uneven path. This article considers the reason for this erratic response, and the varied objectives of those responses, in the context of different forms of impairment and the differing interests of those with a professional or philanthropic involvement. The responses of some of the children directly affected are also considered.

The public face of Southern institutions for the "feeble-minded"

The article examines the history of Southern institutions and how these facilities are presently facing up to that past. Established both to care for and to control a population of individuals labeled as feeble-minded and deviant, these facilities provided little support and help for patients and quickly devolved into over-crowded, under-funded operations. With the de-institutionalization revolution of the late twentieth century, they ceased to be the center of their state's program to handle this population. Currently through websites, museums, archives, and historic building designations, they are beginning to examine their past treatment in a more public fashion.

An exile in my own country: the confinement of leprosy patients at the United States National Leprosarium

Leprosy is a disease which has long been stigmatized and persons afflicted with it have frequently been segregated from the rest of society. This paper focuses on the evolution of policies concerning the confinement of patients at the national leprosarium operated by the United States Public Health Service (PHS) at Carville, Louisiana. After a brief review of the origins of the Lousiana Leper Home, which eventually became the national leprosarium, the paper traces changing attitudes and policies at Carville from 1921, when the PHS took control of the facility, to the 1950s.