nerowary, why, the board suggests that if some county desires to buld they can have permission to do it, and another one is built. We he enry counties in our state and we have but twenty-six asylums, and the g to build new ones and to enlarge old ones will probably dispose of or t gane as long as any of us who are here now will have anything to do with 2

Now, there was one criticism made, I think by Dr. Welch, upon our sys tem that perhaps is correct, and that is that it inspires a spirit of avaries1 the countles having the asylums; they want to make money out of ther Well, they do. Bat they are under strict state supervision through the Bo of Control. The Board of Control has the absolute power to transfer the 1 mates from any one of these institutions to another. They have the absome Doser to shut off the state revenue if the institutions are not properly ma azert. This is a great power to lodge in any mere political board, or adminis trative board, it is true, but the real fact is and now I am not a member d anch board myself-the real fact is, you cannot give your general boards of control too much power; you can't do it to the injury of the efficiency of e work. They must have great power. The only danger is that you will g Incompetent men in office to handle that power. If executives and sends who make the appointments are sufficiently impressed with the importance of their duty they will select men such as have been selected, if you please In the State Board of Iowa, men of almost national reputation, men agains whose administrations you never hear a breath, never hear a charge of usurpation of power. Give the power, and then put men on the Board of Control who are competent to do the work, and you will have no trouble.

We see, only occasionally, however, a little effort to economize too mu and make some money over in some of our institutions. I went into one within a month, and I found they had no female night attendant on the wards. I inquired the reason, and the superintendent gave as a reason that they could not get one, and his wife gave as a reason that it was not necessary. Well. I said to the superintendent, "You say to your trustees-and when I get home I will write it to them-no female night attendant, no patients, no state revenue." In less than a week I got notice, or the board did, that they had a female night attendant. So, of course, they require close supervision; they require watching and looking after; but with that there is no danger that the spirit of economy will interfere with the welfare of the inmates.

Now let me say in conclusion, ladies and gentlemen, I am not here to boast of our system. It is the best within our reach. We have it. Nobody thinks of throwing it up, and we are doing our very best to improve it, and I hope and expect to get here ideas in fact, I am getting ideas here—that I think can be worked out to the improvement of our system.

DR. SMITH: We have an intelligent person with us from Iowa, and we should be very glad to hear from Governor Larrabee upon the subject now

before the conference.

GOVERNOR LARRABEE: Mr. President-I did not come here for the purpose of contributing or giving information to this organization, but rather as a listener, with a desire to profit for myself and for my own state. I wish to improve this opportunity, however, and to thank the organization for the honor conferred upon our delegation.

This subject is one which is attracting a great deal of attention` at the present time, and it occurs to me it is a good deal like the old question that the poet presented to us many years ago:

"For forms of government let fools contest;

That which is best administered is best."

Now, so far as the system of state hospitals or county or district hospitals is concerned, it seems to me it is a good deal like that, "That which is administered best is best." In Iowa our system has grown up from the infancy of the state under state care, but the state did not provide sufficient accommodations for all of the insane patients of the state, and the result has been that county hospitals have grown up, and I am sorry to say that some of our insane are still in the poorhouses of the state owing to the fact that the state has not afforded sufficient facilities for the care of all of the insane.

The first object, I suppose, in treating the insane is to cure. There is a desire to heal all that it is possible to heal, to cure them and to restore them to their families again in a healthy condition. The next object is to afford them humane treatment and to care for them at the least expense possible. Both of these objects should be kept in view. It seems to me it is natural that we can command a little higher order of talent, a little better class of persons, to cure the insane, by having them in large groups or companies or in large state hospitais. And many of the objections that are raised against the large hospitals are removed when you consider the fact that you can have better classification of the patients there than you can in the smaller ones. And so far as the objections which have been raised to the large hospitals, I would say that in our hospitals the inmates are classified in such a way that those who are naturally of the same temperament are brought together, they are treated and handled by the same attendants, and are taken onto the grounds and exercised together, and they work in the fields and in the shops and in the kitchen by themselves, and are not brought in immediate contact with those who are not congenial to them. So I think one of the large objections that is raised against the great hospital is removed if the hospital is properly administered.

One of the directions given to the superintendents of our state hospitals is to permit the greatest amount of freedom possible to the patient. Every restraint that can be removed is removed. We even carry this principle to the extent that we do not consider it a great offense if the superintendent permits a patient to run away occasionally from the institution; we permit such an amount of freedom that it results, frequently, in patients running away. Of course, those that are dangerous or violent are more closely watched and restrained; but all indications of prisons are removed from our hospitals at the present time. Many think that the great object in caring for the insane is to reduce the cost to a minimum.

JUDGE LYON: You have a parole system, have you not, governor?

GOVERNOR LARRABEE: We have no law permitting the parole of patients, but we do it. It has grown to be a custom. We have a great many patients out on parole at the present time, notwithstanding there is no provision in the statute that provides for it. We find it has a very wholesome effect, and there is not a month passes but we parole quite a large number of patients and let them go home on trial.

Now, so far as the humane part of the work is concerned, the Board of Control of the State of Iowa is not endeavoring to see how cheaply it can keep its patients. We have endeavored to get the most that we could for the money, but we have not reduced the wages of the employes to such an extent but what we can command the best talent that we have in the state. We purchase the very best of supplies, and we have made every effort to have those supplies served in such a manner as to promote the efficiency of the institution.

So far as county care is concerned, in our state, I cannot say much for it. It seems to me it should not be permitted at all without strict supervision on the part of the state board; and even then, it seems to me, the objection cannot be removed that you are likely to have a class of persons in charge of your county hospitals and district hospitals less efficient than those in charge of the great hospitals. To begin with, you can hardly afford to pay the compensation necessary to attract the highest class of managers. The next thing. You cannot afford that strict supervision that you can over a less number of hospitals. In Iowa we have ninety-nine counties. For a single board of three members, as we have now, to visit ninety-nine hospitals, would take nearly all of their time; very little time would be left to give attention to the management, which is more desirable.

But, Mr. President, I did not come here to give you information or to direct what should be done in this matter. I still believe that with state supervision and with large hospitals we are apt to secure a greater number of cures, of recoveries, than we could from the smaller institutions. This is a day of organization, we all understand. Great organizations to-day accomplish great work, and it seems to me that we should have our institutions

34

with a sufficient number of insane to afford proper classification and to command for their care the best talent in the state.

PRESIDENT ROGERS: We have with us to-day not only Governor Larrabee, but the other two members of the Iowa board, and we feel honored by this Visitation from the whole board. Judge Kinne, cannot we have a word from

you!

JUDGE KINNE: Mr. Chairman-I hardly think it is fair for a few gentle men, strangers, from Iowa, to come here and monopolize the time of this whole conference. However, we are very glad to be here and to enjoy the discussions and profit by the experiences of our neighbors. Perhaps it is just as well that we do not all agree in this world upon the management of insane institutions as well as upon other topics, because such monotony would be very disagreeable and undoubtedly result in getting into a rut. I thought as I was sitting here, listening to the remarks of Judge Lyon and the other gentlemen upon the desirability of taking care of the insane, the so-called chronic insane, because that is a misnomer; there is no such thing as that; that is, you can't set a man down and say he shall always be insane, because he may or he may not; but the desirability of taking care of few of them in one place and a few of them in another, instead of aggregating them together in one institution. Now, I think one might conceive the germs of the argument made on that subject, and yet when you look it all over you see you are not very far apart after all. Now, Judge Lyon told us that they had about a hundred in each of their county institutions, and perhaps in the largest hospital you have in Minnesota, you have a thousand or twelve hundred inmates. Certainly in all these states we have state hospitals that have not over eight hundred or nine hundred patients in them. Now, it is simply a question of degree; whether proportionately you can take care of one hun dred people and make them feel more the benefits of a home in a county institution, where they are deprived of all the higher ability and skill which comes to and is found in state hospitals, both as to medical service and all other service-whether you can better take care of them there and furnish them with a home life than you can in a large state institution. It seems to me that in the state institution they can have as much home life as one hun dred people congregated together on some farm. If you could get it down to twenty-five or thirty people, so it would be within the range or limits of a probable family, then there is a good deal in it, everything in it, but when you have got to make an aggregate of one hundred in order to administer it. tell me, if you please, wherein lies the virtue and the difference between the administration of the one hundred and the eight hundred? I profess I can. not see it.

Mr. Cownie was called for.

MR. COWNIE: Mr. President. Ladies and Gentlemen-Reference has been made to the fact that the chronic insane were practically farmed out in continental Europe-distributed among the farmers of that country and take into their homes. I do not believe the American farmer-I know the West ern farmer is not in such condition that he would desire to have a chronic in sane patient placed in his family. It may do in Europe, it may do in some of the Eastern States where the farmers are poor, but with the average Western farmer I assure you that that is one condition we will never arrive at in either Minnesota or Iowa. I have no sympathy whatever with county car of the insane. The Board of Control of Iowa is continually being asked to allow patients to go from state institutions to the county institutions, and the only reason given is on the score of economy. "We have to pay the state. they say, "$12 per capita per month; we can support our insane in our county houses at $5 or $6 per month." No claim is made that they will be better cared for. It is all economy. But these people forget that the chronic insane so-called, are the least expensive, virtually requiring no care, being able t care for themselves; while the acute cases, that require care, nurses, medica attendance and a large number of attendants, cost twice or three times per capita per month more than those who have become chronic insane. I know in some of our state institutions patients have been an expense to the state of from $50 to $75 for the first month, and I have seen those same patients Ileave the institution, to all appearances, as well as they ever were. M

the

hey hal in the

Te hu

that

it is &

are of e

in a c

and skill

1 services

here andr

thought is taken of this by those people who are clamoring for county houses;
but the fact remains, if only the acute cases are to be sent to the state hos-
pitals and the counties are to care for the chronic cases, it will be necessary
to double, perhaps to treble, the amount per capita to support the state in-
stitutions and care for acute cases alone. Instead of county houses, I believe
it would be much better to have buildings specially erected for chronic cases,
have them separated entirely from the acute, give them different care, give
them more freedom, and, whether male or female, endeavor to provide labor
for them, labor which they can perform-perhaps in the shops, perhaps in the
fields. If this were done, I can see no reason why our chronic insane could
not be better cared for in a state institution than they could in a score, or
perhaps a hundred (as we would require in Iowa), county houses. I believe
that state care will always be superior to county care, for, as it has been said,
we can command better ability, we can give them more diversions, and
there is no question in my mind but, so far as Iowa is concerned, the fewer
county houses we have the better it will be for the insane patients of the
state.

DR. FOLWELL: As Dr. Smith said, Mr. President, those papers are very
able papers, but they just make me sick, and ought to make us all sick in
the State of Minnesota. I gave several weeks and months of study and con-
sideration to this subject last year as a member of the State Board of Cor-
rections and Charities, and that board, collectively and individually, visited
a large number of the institutions of Wisconsin. I escaped from five insane
asylums there in one week. [Laughter.] A report was written by ex-Gov-
ernor Wakefield of Minnesota and presented to the legislature, and it con-
tains the best argument that he could make for a change of our system. You
will find this report in print in the eighth biennial report of the State
Board of Corrections and Charities, and I commend it to your consideration.
But what is the use. Dr. Smith said to me when the legislature got together,
"It is no use; the politicians will beat you." And the politicians did beat us,
and we have got the two new asylums, one at Anoka and one at Hastings,
and they are to be there, and, as Dr. Welch has suggested, they are to grow,
and they will become the large hospitals of this state, and the present hos-
pitals will become outlying institutions for the care of the chronic insane;
that is to say, unless you and other good people conspire together, and by and
by beat the politicians. That is the present situation. And so these good
papers and this admirable discussion make me sick when I think of the lost
opportunity in Minnesota-probably lost. If it is not lost, it will be on ac-
count of the activity and enterprise of such people as you.

ion. It se life as

ould get i ange or E in it, bet to admis

ence betw

I profess

the average

Il never arri er with cour ally being as

institutions

I visited those institutions of Wisconsin with a great deal of interest and with prejudice against them. That prejudice was largely removed, but at the same time I saw there were objections against them, as there always will be against those and other institutions. Dr. Welch has very properly said that the old institution, with hundreds and even thousands collected and herded together in the same place, ought to go. That admirable institution presided over by Dr. Welch, where everything is in perfect order, where there is a humane spirit pervading the whole place, where the discipline seems to be admirable, after all is a place to make insane people more insane if they are incarcerated there. That kind of institution, it seems to me, ought to go, and I believe that any man who will study the question thoroughly will come to the conclusion that the great hospital of hundreds and thousands ought to go; that it is no place to treat either sané or insane people in those large

e to pay the numbers.

insane in our

they will be

care, nurses.

Now, the advantage of the Wisconsin plan is that the numbers are small,
and "occupation and liberty," as they phrase it over in Wisconsin, are pos-

it the chronic sible in those institutions. They are larger, I think, than they ought to be.
care, being A very wise woman-a Mrs. Forbes of Menomonee, Wis., who was the
Tonic insane. be treated, and she is a very wise woman.
ce or three ti about fifty are as many persons as ought to be got together in one place to

expense to th those same p

they ever w

matron of one of those institutions for many years, told me that she thinks

I think she knows more about it than all the rest of us. I advise you to go and see Mrs. Forbes if you want to study the question. But the advantage of the smaller institution, if there

is proper assortment and proper discipline, is this: that there is occupation and liberty. In some of these institutions there are no more locks or bolts or bars than there are upon the doors of your own houses. I think they have gone rather too far in that respect. It seems to me there ought to be a place to confine a person who might upon occasions become violent. The oppor tunity for occupation is admirable; and I want to enlarge upon this just one moment. Dr. Welch has remarked that one objection against the county sys tem or the local hospital is that they are run for the purpose of economy. I want to say that I think they ought to be, and I want to bring out here this idea: This is a coöperative age, and one of the advantages of coöperation everywhere, whether it is technical or otherwise, is that you cannot help making money in a truly coöperative institution. You collect a little body of men and women together and set them at work at productive occupations and you make arrangements so that they shall not spend their money for whisky nor for tobacco nor for luxuries of any sort. When people thus work and live they have got to make money; they can't help it, and it ought to be so And I think this ought to be taken into consideration in the organization of these institutions. Now, these insane people, many of them, can work just as well as you or I. At Menomonee I saw an insane woman taking care of a dairy of forty cows, and she did it just as well as any woman in this world could do it; thoroughly interested in it, perfectly capable, and just as much devoted to that dairy as if it were her own business. I saw a man there tak ing care of a thousand chickens, a perfectly insane man, and he was caring for those chickens as well as they could be cared for by anybody. And to show you how insane he was, he was finishing up a most fantastic cupola to go on top of his chicken house. It took some time to discover what that man was worth. But the matron, one morning, thought she would try an experi ment, and she said to this man: "John, these chickens are not well taken care of, and they won't be unless you and I take care of them." He said: "That is so." That was a year ago, and since that time he has been as faithful and devoted to that work as anyone could be. At new Richmond they had a man caring for pigs, and so interested was he in them that they had some difficulty to prevent him from sleeping with the pigs.

Well, these insane people can work, and they are better for working they were working people, most of them, in their early lives, and they ought to be at work; and if they live modestly, without luxury, and are without vices, the institution cannot help making money. I think that removes to a large degree the objection mentioned by Dr. Welch.

Well. I won't talk further upon this matter. As I say, it makes me sick when I think of the situation in Minnesota, and I hope this matter will be kept in mind and that we shall watch the progress of things in this state and, if possible, prevent the undue development of these new institutions at Anoka and Hastings.

CAPT. FAULKNER: In closing the discussion of this subject, I want to take only a few minutes' time to read an extract from a report under date of Aug. 30, 1899, from Dr. Henry M. Wetherill, secretary of the Pennsylvania committee on lunacy of the Board of Public Charities. Referring to their work in Pennsylvania, omitting all that relates to county care, he speaks of their colony work as follows:

"As to your second question, relating to farmhouse colonization of certain classes of insane patients who are inmates of state hospitals for the insane, I would reply that, as there is 'nothing new under the sun,' some very successful farm colonies of this character have been in operation in Pennsylvania for some years past, and the present tendency on the part of boards of trustees and medical superintendents is toward the further development of the plan. Several years ago the trustees of our state hospital for the insane at Norristown had adapted a comfortable farmhouse on the property, at some little distance from the main buildings and adjacent to one of the barns, for the occupancy of a selected class of women patients, upon an industrial basis. The project succeeded admirably. These women milked the cows, did all the dairy work, fed and attended to the poultry, performed all the many domestic duties of an isolated community and washed and