AMSAII, courtesy National Library of Medicine
In 1844, thirteen superintendents of insane asylums met to exchange ideas about how to best run institutions for the insane. From this meeting, they formed the Association of Medical Superintendents of American Institutions for the Insane (AMSAII). As recognized experts in a very young field, they felt themselves the top authority on all matters concerning mental disease. Some of the superintendents were somewhat arrogant, but were undoubtedly sincere and enthusiastic.
In 1844, the Association proposed some ground rules for asylums. Among other propositions, they agreed that asylums should be in the country, but easily accessible from a large town. Each site should have about 50 acres of landscaped grounds besides other acreage for its needs. Superintendents felt strongly that no building should hold more than 200 patients, and only 250 at the very most. In 1866, they increased that acceptable number to 600. The original members would have been shocked to find how quickly overcrowding became one of the worst features of asylums, with sometimes thousands of patients crammed together in filth and disorder.
Crowded New York Lunatic Asylum
Unruly Patients at Blackwell's Island, from Harper's Magazine, 1860, courtesy New York Public Library
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