spected. The officials would be chosen for ability, and not on account of political affinity or cheapness. The district cottage system may be planned to furnish care for all classes of chronic cases, which is not possible under the Wisconsin system, the dangerous and criminal insane being kept in buildings especially adapted for them. Patients would be under the immediate observation of responsible officials, and so could not become a source of mental or moral degeneration to a community, as is possible under the boarding-out system. Lastly, patients could be cared for under this system as economically as under any other reputable method in vogue, and from these cottage asylums could be selected those patients who were proper subjects for boarding out.

I wish to say, in closing, that in my sketch of European institutions, I have copied largely from a book on “The Insane in Foreign Countries," by William F. Letchworth of New York.

PUBLIC POLICY IN THE CARE OF THE CHRONIC INSANE. BY HON. C. E. FAULKNER, SUPT. WASHBURN MEMORIAL ORPHAN

HOME.

Public policy in the humane care of the insane must take into account the impressive truth, that the majority of those who are afflicted with the disease of insanity are incurable. This fact has been established by a painstaking observation which is conclusive, and is supported by the experience of every state or country of considerable age. Science is struggling with the problem of discovering a line of defense which will stay the tide, and encourage the hope that, with the education of the masses, the day will dawn when the disorder of lunacy and the causes of its development will be well enough understood to nourish the hope of its reduction to a natural and unavoidable minimum.

The leaders in the fields of psychological study should not rest until they have mapped out a system of technical schools organized and equipped for the study of this disturbing problem, and their finding should be supported by pulpit, press and platform, until a public sentiment is aroused which will give them due effect in law and custom.

Germany is leading in the quality and order of a comprehensive study of this great question, and we of the United States are spurred by a sense of duty, as well as patriotic pride, to enter the lists of competitive inquiry. Leaving to the specialists the work for which their minds and hands are trained, and loyally awaiting their requests for coöperation in the public forums, may we not in the meantime discover some important principles upon which a concensus of opinion has been reached, and move with united effort to secure their recognition in the practice of the immediate future? The proposition that insanity is a disease, and that its victims may be discovered and subjected to timely detention and treatment under a code of medical jurisprudence, free from misapplied safeguards of personal liberty, is rooted in the logic of common sense, and must soon come to be the approved course of procedure in all the states. The intervention of a court, with its accessories of sheriff, witnesses, jury, and county jail, to conserve

EIGHTH TATE CONFERENCE OF CHARITIES.

the rights of jensenal Dampyr f the asane stizen .ffords a ri lesson of stishineed. „Judness and the ; rietve Just surely pass to 2 1 shen of absolute matuna If there Minnesota mar verurse jis decision which declares that the disease (fu e in het de supreme "r te hay not be (solated and treated inder mies similar to those v pernitted in other senses remmiring detention in quarantine and committal to lesmiral or pesthouse, there may strators of law vill disegrer their int n the practicable of the methods velien tend to fix the tension in the mid 21 infortunate nate that the court is actually engaged in the awi despcilment of the Therty which it is appointed to safeguard.

actful voidance. 8 I § e 1 one that the e

May we not also find a round of common agreement on the ans tion, that nespital organizations, which represent the frst auis of selence 1 the diagnosis and treatment of the maladies of nerve and ́›ram. «Gould * equipped with all the complete appliances of materials and methods VELL the specialists may pronounce necessary to the est attainable results. 2 would not the hospitals for first detention and diagnosis. Located in the arrest centers of population, separated from the retreats for the supposedly new able groups, do much to encourage the promut surrender of the disturbed members of family groups whose condition exeites alarm?

The Increased cost of a thoroughly approved hospital service. vith 3 associate school and Laboratory, would be compensated by a wise disposition of a comfortable class of the incurable insane to the congenial industry f farm nomes suitable to the familiar habit of the larger number of patients. and increasing the comfort of those who could be taught to share its Jege, and jessening the cost of their support in Institution life. This brings ue fo the consideration of the main question of public policy in the care of ench patients as are not necessarily dependent upon hospital care and Teat

ment.

The Wisconsin plan is unique. It llustrates the practicability of simple constriction in the care of the insane, the value of farm industry as 1 remedies, comfortable and remunerative occupation, stimulates proper efforts. to roty n egges of senile debility and harmless dementia in their proper home lodgment, and facilitates the useful practice of frequent parole to the care of relatives and guardians of those whose condition indicates the value of sch frogtient, It encourages the development of all that science may afford 'n an improved gospital service, and brings under immediate shelter and care every afflicted ditizen. without the injurious delay so often the accompaniment of the oroperowded system of composite hospital and asylum Construction.

Neonein jas druck the blow of a giant to aid the disintegration of wrong ejetome and to light the way to improved policies. for the umane eve of THATIG

Penny,vania * probing by the experience of Wisconsin to lessen the evils of her inadequate egnica of massing the insane in large institutions. where misery nay food won the object lessons of its own misfortune, and I am indebted by byl Verwagizania committee on lunacy for a copy of its finding, ade 6 né jegsdature of that state in November, 1896, and which Wors aporojbl in vé pro zixtions of "An act to provide for the maintenance.

care and treatment of the indigent insane in county and local institutions." Commenting upon this policy the board, in a communication under date of November, 1897, says: "Practically, county care, in this state as elsewhere, has and will mainly apply to the chronic insane, and to such as do not require active medical treatment, who far outnumber all the other classes combined." It is also interesting to note that New York, after abolishing a bad system of county poorhouse care for the insane and gathering them to the shelter of her state institutions, is experimenting with the care of the teachable class in farm dwellings, grouped within convenient distance of the Utica state hospital. I am indebted to Dr. G. Alder Blumer, superintendent of the Utica state hospital, for a copy of a paper read before the American Psychological Association, which affords an interesting description of successful efforts to domicile a selected number of their insane in a comfortable farm home.

This report affords the added testimony of an experienced specialist, operating under the permission of the New York board of commissioners in lunacy, to the oft-repeated claims of the Wisconsin managers, that a considerable per cent of the insane can be comfortably and profitably employed in farin homes, under a large measure of freedom, and under a system which affords the contentment incident to a congenial classification.

The keynote of Doctor Blumer's paper is found in the sentence, "So long as the family is recognized with us, as in all civilized countries, as the unit of social life, so long must approximation to that ideal be the goal to which we should strive in our care of the chronic insane who are capable of appreciating its natural and greater advantages." This sentence adds to the accumulation of purely expert testimony which supports a demand for an improved classification of the insane, to promote congenial association and to lessen the friction incident to the indiscriminate massing, which is more in harmony with a "mad-house" environment than with the atmosphere of an intelligent and painstaking ministry. The interesting report of the farm-colony experiment at Utica proves the economic value of such a disposition of teachable patients, and a few words give us the effect upon the patients dealt with: "They were nearly all chronic cases, but the improvement which occurred in their condition, physical and mental, exceeded the most sanguine expectation. The well-known institution look and manner began to disappear as the men responded promptly to the freer life and became bronzed by the sun. It was the life they had lived at home, the only life to them that was a natural one."

It will be interesting to follow up this experiment at Utica, and to learn of the results of its development. When humanity and economy join hands to better the condition of the teachable insane, society should applaud every victory won, and encourage renewed endeavor. The fundamental truth which should illumine every phase of study for the improved care of the incurable insane is, that God's plan is the family group, and that the practice of massing humanity in enforced association in large numbers and exposed to the friction of uncongenial fellowship is a makeshift of a false economy which has no defense in enlightened statesmanship.

From a paper prepared by Hon. Frank B. Sanborn of Massachusetts the following statements are summarized:

1. That cases of insanity are everywhere increasing, and that less than a third of the persons attacked permanently recover.

EIGHTH STATE CONFERENCE OF CHARITIES.

2. That few causes of pauperism (meaning by that dependence relief) are in America so fruitful as persistent insanity.

3. That 'herefore this disease must be treated, not so much for rester (since a majority of all cases never recover) as for care, and for the minimum of pecuniary burden imposed on every community in fast

amonnt.

Mr. Sanborn saya, on "Family Care in Belgium." that. of the ar Insane now estimated in Belgium (a ratio of about 1 to 500 of the out tlom, about 2,000 are under the direction of Dr. Peeters, in the own ? Cheel and the country regions about it, a territory in all of forty-three qu miles. Less than 100 of the 2.000 are in a central hospital; the rest in town honses, villas, cottages and farm houses, in this area about as a a« an old-fashioned New England township. Dr. Peeters declares s position to the close asylum for the chronic insane who are not dangerous the following language: "For patients, harmless and incurable. impr.setment cannot be justfied. They are not dangerous, medical treatment s useless for them, and they can have outside of an asylum prison the general care they need. I go farther: Asylums by no means give a favorable I mosphere for the restoration, or the mere keeping up, of the cerebral tions. They lack the natural, customary stimulants of mental activi Family life, the miniature of society, and society itself (which excite in the sane man an activity of mind), do not exist for the imprisoned insane. The groans and complaints of some; the shouts, the singing, and the wild laugh ter of other companions; the mad notions of all sorts which these afficted souls are eager to communicate all this can but confuse and weaken menta faculty." Such testimony as this challenges the attention of all thoughtful

students and deserves the most searching examination.

The burning question for the statesmen and philanthropists of the United States to consider is, Shall the humane and economic policies of public care for the chronic insane find a fairer exemplification in the opening years of

the new century?

It is a charge upon the conscience and intelligence of the present day that some of the lessons learned in the centuries of experience of the old world in the care of the insane shall be noticed in the improving policies of the new; that the massing of misery under a false plea of economy shall be stopped; that the hospital flags which float over the shelters for the defense less victims of misfortune shall warn away the camp followers of political armies; and that the men and women of a Christian generation shall recongeerate themselves to the need which pleads the cause of the worried and

helpless insane.

DISCUSSION.

PRESIDENT ROGERS: We have had several references to what is known as the Wisconsin plan. I am very glad to say that we have with us this morning Judge Lyon, of the Board of Control of Wisconsin. I am very sure the conference would be glad to hear him.

JUDGE LYON: Mr. President and Ladies and Gentlemen-When I came here this morning nothing was further from my mind than the idea I should be called upon to say anything. Down home it is very well known that I do

not pose as a public speaker at all, and yet when I am challenged to talk a little about our own system it perhaps would be cowardly were I to decline.. Mr. Faulkner has made my speech about the Wisconsin system, very nearly. He said very kind things of it, and I thank him for his commendation of it.

Our system is a process of evolution, I think. I do not believe anybody invented it. It grew up, started from the county insane asylum built by county authority alone, for the convenience of their own insane. The idea occurred to somebody, to some legislature, that by a little state aid the benefits of those institutions might be extended, and in that way has grown up our system of county insane asylums for the chronic insane. It is the best thing for us, we think, within our reach, but we do not claim perfection for it by any means. I never go into one of our institutions, but I see what I fear are evils in the system. We have twenty-six of them. Since the 4th of July I have visited nineteen of them, and expect to visit the rest during the current month. And I never go into one but I see what I wish could be remedied, and one of those features was very graphically alluded to by Mr. Faulkner; that is, the incongruous grouping together of classes of insane that ought not to be together. The quiet, the peaceable, the retiring (and there are a great many of them) are disturbed by the ravings of the more maniacal or by the disturbance made by epileptics. A great many of the latter are in those institutions. All we can claim for our system is that we minimize this. These county institutions contain usually from 100 to 150 inmates. They are adapted to that number; a few of them, in the larger counties, have more. As a general rule, they are quiet and peaceable. There is but little of the element of a prison, of confinement, of restraint. There is, so to speak, in all those institutions a sort of esprit de corps (if that is the right expression), by which each seeks to give the largest amount of liberty to the inmates, and it is surprising how far some of the institutions are able to carry it, how little restraint there is. Our system probably comes nearest to the home life that any public system, any system of collecting the insane in aggregate bodies, can come. I think it does. There is a great deal of the home life in those institutions. People go there and remain there for life, or remain there for a great many years. There are scores and hundreds of them who have no other homes, who have been insane and in public institutions so long that they are either entirely alienated from their families or their families are scattered or dead, and there is no place for them but the institution, and that is the home; and the object is to give them as many home enjoyments, as many home surroundings, as little restraint, with proper employment, as possible. Hence all these institutions have connected with them quite large farms, and the men and women work there with all the zeal and interest and energy that they would in their own homes. Those people are better off there, doubtless, than they would be anywhere else. But that does not include the whole of the number.

The great benefit that we claim for our institution is this: There is not to-day in Wisconsin an insane person necessarily in a poorhouse, a jail or a private family-not in all Wisconsin-and there need not be for an indefinite time to come under our system. Now, the system can be carried on and extended without legislation. Now, it is a terrible affliction for the authorities managing these institutions (and I presume some of you gentlemen here understand it) to be compelled to go to every session of the legislature for every necessary of the institution. You get full; you don't know what to do with your insane; they are in your poorhouses and perhaps in your jails and in your private families. You go to the legislature for money to build' new institutions and the legislature may have a fit of economy on, and will not give you the appropriation, and there you are. With us, any county, with the permission of the State Board of Control, may build a county asylum. Without the permission of the State Board of Control it cannot do so. The State Board of Control supervises the location and the plan and the construction of the asylum. Now, Mr. Chairman, I know I am using up too much time; just rap me down when the time is up.

PRESIDENT ROGERS: You have about three minutes more, judge.

JUDGE LYON: There are always plenty of counties ready to build asylums, and when it seems that, in a year or two, another asylum will be