ABSTRACT
Smith dug into the details of insanity care in 1883, attempting to visit every patient in New York’s asylums and poorhouses. He found state asylums in decent shape, but the large city asylums were deplorable, and the poorhouses were little more than filthy jails. He tried to support the failing National Board of Health with a prescient letter to Congress about the shortsightedness of ignoring public health in 1884. His quiet but persistent mental illness advocacy led to state asylum reforms that became standard, such as elimination of restraints, improved building hygiene, and training programs for attendants. He worked to transfer mentally ill inmates from county poorhouses to state facilities, but these legislative efforts failed. He encouraged New York City to develop its Central Islip farm colony for the insane in 1885, which became a national model. He began working with Louisa Lee Schuyler for an overhaul of New York’s insanity care system in 1886.
