ABSTRACT
Smith resisted public health colleagues who blamed increases in the country’s insane population on defective European immigrants, but the eugenics movement gained standing in insanity care. Nellie Bly’s 1887 exposé of the New York City Female Asylum made insanity care a visible issue. Smith had to face a personal crisis in 1888 when he and Lucy witnessed the slow death of their teenage son Stephen from a bleeding ulcer. It was a problem Smith could have managed surgically, but the procedure, Billroth’s 1881 gastric resection, had not yet gained credibility in the United States. Having left the Lunacy Commissioner position in 1888, Smith devoted his public efforts to passing three laws: a uniform commitment act, which failed, and New York’s State Lunacy Commission Act of 1889 and State Care Act of 1890, which brought insanity care under state supervision.
