The two federal institutions for the insane (St. Elizabeths and the Canton Asylum for Insane Indians) were investigated several times. In 1926, the comptroller general of the United States listed his findings concerning the investigation into St. Elizabeths. They included the following:
— The laws under which persons …are committed to the hospital are not adequate or sufficiently definite.
— There are too many patients in some of the wards, resulting in a crowded and unhealthy condition.
— Dining rooms, sitting rooms, toilets, baths, and other facilities of some of the wards are quite inadequate and most unsatisfactory.
— The fire hazard in certain wards is too great, and there does not appear to be sufficient fire fighting equipment.
— Several findings concerned the proper accounting of patients’ monies and valuables, including the need for a place to safeguard them.
Some of these 1926 findings were similar to those at Canton Asylum (overcrowding, inadequate facilities, and fire hazards). However, St. Elizabeths had 4,340 patients in June 1926, well over 50 times the number of patients at the Canton Asylum. The facility was not perfect, but by no means did it have 50 times the problems of its sister asylum. Undoubtedly St. Elizabeths’ leadership had something to do with its better performance.
Asylums were frequently inspected and investigated, and most had similar problems. Appropriations were generally set for a certain time period and included set numbers of personnel positions. Because funding wasn’t based on actual patient populations or patient to staff ratios, overcrowding could set off a cascade of problems. Facilities became inadequate and attendants became overburdened. In turn, stressed attendants probably lost patience or reacted less professionally with difficult patients. A new (and possibly sufficient) cycle of funding may have given an institution a chance to catch its figurative breath, but a new cycle of overcrowding was almost certain to begin shortly thereafter. As the public became more comfortable using insane asylums, their demands on these institutions created perpetual overcrowding. Insane asylums were often victims of their own success.