The patients are distributed as follows:

Bristol County, 12, viz.: Easton, 3; North Attleborough, 1; Norton; 2; Mansfield, 1; Taunton, 5.

Essex County, 2, viz. : Danvers, 1; Lawrence, 1.

Franklin County, 2, viz : Ashfield, 1; Hawley, 1.

Hampden County, 3, viz.: Monson, 1; Southwick, 1; Springfield, 1. Hampshire County, 19, viz.: Cummington, 2; Easthampton, 2; Goshen, 6; Williamsburg, 9.

Middlesex County, 29, viz: Marlborough, 3; Newton, 2; Tewksbury, 21; Tyngsborough, 2; Somerville, 1.

Norfolk County, 14, viz.: Dover, 2; Foxborough, 1; Norwood, 2; Walpole, 9.

Plymouth County, 7, viz.: East Bridgewater, 3; West Bridgewater, 4. Suffolk County, 4, viz.: Boston, 3; Chelsea, 1.

Worcester County, 26, viz.: Athol, 4; Northborough, 5; North Brookfield, 10; Oakham, 1; Shrewsbury, 1; Southborough, 1; Sutton, 1; Westborough, 2; Winchendon, 1.

There are also three patients outside the State, viz.:

Kensington, N. H., 1; North Barnstead, N. H., 1; Providence, R. I., 1.

The 121 patients remaining September 30, 1897, were in 75 families. Five families had 4 patients each; ten families, 3; eleven families, 2; and forty-nine families, one patient each. In the last class, 4 patients were self-supporting, and 11 were with friends.

THE GENERAL CARE OF THE INSANE.

It is safe to say that with every succeeding year the care of the hopelessly insane inmates of the State Institutions becomes more considerate, more humane, more mindful of individual needs; while, at the same time, the study of the great problem of cure, and the still greater problem of prevention, grows more serious, more thorough, and more. promising of results. Pathological research in the hands of men trained for that special purpose; the better classification of patients; the employment of trained attendants and the establishment of schools for training them; the construction of homes for nurses outside of the buildings for the care of the patients, where the nurses when off duty may have

entire rest and freedom from care; these and other important improvements are being rapidly adopted. In some of the buildings faulty construction still stands in the way of success, but for the most part the Hospitals are making the best use of existing conditions, and in general, as fast as possible, are replacing old and worn-out appliances with

new.

The

Following the example of the McLean Hospital, the several State Hospitals are adopting the policy of taking internes to aid the overworked assistants. These internes not only relieve the assistants from routine work, but enable them to secure time for scientific research, and a more thorough treatment of the difficult cases they have to encounter. science of the treatment of the insane is obscure enough at best, and every opportunity should be given those engaged in this specialty to enable them to work to the best advantage. A sufficient pecuniary inducement should be offered for such service. It is hoped that all the Hospitals, without exception, will adopt this method.

Regarding the pathological study of insanity, for which the different institutions offer such good opportunities, the Board recommended, several years ago, the appointment of a State pathologist, who should have general charge of the pathological work at the different Hospitals. This did not meet with the approval of the Hospital authorities, but since that time provision has been made in at least four of the State Institutions for the appointment of resident pathologists.

The accidents which still occasionally occur emphasize the need of a closer night supervision of the insane. It does not seem sufficient for a watchman to pass through the halls and corridors once an hour during the night, or for a person known to be suicidal to be placed in restraint and receive only occasional supervision. The objection to constant supervision, on the ground of its interfering with the sleep of the patient, is very easily overcome, and in one of our Hospitals special structural provision has been made for this purpose; and there would be no difficulty in so arranging the suicidal wards of all the Institutions that all cases of suspected suicide should be under constant super

vision; nor should any ward be without regular night supervision by nurses and attendants.

Two of the Institutions have already nearly completed separate houses for the use of female nurses, and the good results thus obtained are so clearly manifest that there is no question that the other Hospitals should without hesitation, and as rapidly as possible, adopt this system. With a home to go to, a nurse on leaving her ward and work gets immediate and entire release from duty. She is thus enabled to rest thoroughly, and to return with renewed vigor to the care of her patients. No nurse should have a room in a building where the insane are cared for, or remain in the building excepting when on actual duty. Night emergencies, such as attempted suicide, or homicide, or escape from the wards, can be readily provided for by an adequate system of night supervision.

The problem of securing and retaining suitable help in institutions has not been found altogether easy of solution, but the example set at the School for the Feeble-Minded, and to some extent at the State Almshouse, in this respect, is one that may well be followed elsewhere, — namely, making provision for a gathering place within, or immediately outside of, the Institution, where all the employees can meet for instruction and amusement. Such an arrangement would naturally result in longer continuance of service of the employees, and consequent greater efficiency on their part; and from it would finally accrue much benefit to the patients.

The Board is of the opinion that great benefit would result from regular meetings between the Superintendents and assistants of the several Institutions. The tendency in all Institutions is for the officers to remain at home, and so become unconsciously and inevitably more or less self-centered. Their duties are incessant and exacting, and there is always danger of their becoming slaves to a routine life. It is suggested that such meetings be held at the different Hospitals of the State at least as often as five or six times a year, the expense to be met by the Hospitals where they are held, for the purpose of discussing any topics that may arise regarding the care and treatment of the insane as individual cases and as to their surroundings,

or any subject pertaining to hospitals and their management. Almost every Superintendent is by nature or education an expert in one or more points, and able to instruct his brethren in some respects. There is no doubt that such a series of meetings would result in good to the patients and the Institutions as well as immediately to the Superintendents and other officers.

The attention of alienists is more and more drawn towards the study of moral insanity, or that disorder which affects the moral powers rather than the understanding or intellect. This class of patients is found in nearly every Institution in the State; not only in the Hospitals, but in the School for the Feeble-Minded, and even in the Houses of Correction. In the School for the Feeble-Minded a large number of the morally insane are kept, for want of a better place. They are unfit to mingle with the world, and yet, under proper supervision, are fully capable of being selfsupporting. They are a class requiring special care and supervision, and it is a question whether special laws should not be enacted in order to make suitable provision for them. It is a matter for serious consideration whether it would not be well to provide an institution for their keeping, in which various industries should be carried on. Such an institution might be in time not only self-supporting, but a source of revenue to the State.

There is urgent need of a codification of the laws governing the commitment of the insane. The laws originally contained in Chapter 87 of the Public Statutes, published in 1882, have been so variously altered and amended that they have become confusing and somewhat difficult to understand and apply. The simplification and rearrangement of them which an expert codification would secure is very much to be desired; and the Board here recommends that the Legislature make provision for such codification.

The present form of certificate used in the commitment of insane persons is very unsatisfactory, and the Attorney General has recently given an opinion that the committing magistrate's "determination of the sufficiency of the evidence on the certificates submitted is final and binding

upon committing officers and keepers of state institutions. to whom his precepts are directed. They are not called. upon, neither have they a right, to question his adjudication in the matter. The provisions requiring a copy of the certificate to be filed are obviously for the benefit of the person committed and are not intended to require the determination of the superintendents as to its sufficiency before obeying the order of commitment." So that, as the law stands at present, the Superintendents of institutions are obliged to receive patients committed by any magistrate authorized to do so, even in cases where the physician's certificate is manifestly incorrect or imperfect, or even where there is no evidence of any certificate having been filed. In spite of all the attempts that have been made to secure uniformity of commitment papers, we are gradually falling back into the old condition in which the different Courts, especially those remote from the Capital, print a form of their own to suit their own ideas. In the case of the commitment of dipsomaniacs there is no form authorized by law, and the method commonly followed is to use the form printed for the commitment of the insane, with the necessary erasures and additions. There will soon be needed a special form for the commitment of epileptics to the Hospital at Monson shortly to be opened. There seems to be no doubt that committing magistrates throughout the State will welcome any movement on the part of the Board towards securing a uniformity of method, and the Board here recommends that in providing for the desired codification of the laws regarding the insane, this matter of uniformity of certificates be taken into consideration by the Legislature.

THE CITY AND TOWN ALMSHOUSES.

It is a satisfaction to state that the condition of the almshouses, in most of the cities and towns of the Commonwealth, has improved within the last few years. In a great majority of the cases Overseers of the Poor have met in a most cordial way the suggestions and criticisms offered by the Board, and have acted upon them, to the great improvement of the condition of the poor under their charge. It still remains true, however, that in some instances an unwise