health and able to contribute their share to the general wealth, and thus bear their portion of the general expenses, than to have a number laboring under disease and requiring the care and treatment necessary to remove that disease, or to support them, if the disease cannot be cured, so long as they may be suffering from that disease. And this applies with greater force to cases of mental disorder for the reason that that takes away the ability to direct and control the mind in any particular calling, and may often so change the character of the individual as to render it dangerous for him to be at large, from a disposition to do injury to life or property. That true economy, in every application of that term, is practised when cases of insanity are placed under proper treatment in the earliest stages, can be proved as clearly as any proposition in mathematics. Every person becoming insane deducts so much from the producing power of the community, and is to that extent an incumbrance or mortgage on the property and income of the Commonwealth, or some of its parts, collectively or individually, to the extent of the cost of his or her support so long as the insanity shall continue. The individual's estate pays, if it can, but if not, the public must, for the body politic is the bondsman for every one in sickness and poverty to pay what he cannot. But it is not alone those who become insane who are a burden on the resources, but the majority of them have families who are dependent on their labor for their daily support; and if this support be withdrawn and not again renewed, these families will necessarily become an additional burden on the community in which they reside, and thus abstract so much more from the ability of that portion to add to the general wealth. The cost of keeping an insane person at home, in a poor-house, or a jail, is not less than three dollars a week on the average, and this must be multiplied by as many weeks as the insanity shall continue. The average duration of life of an insane person, not cured, attacked between twenty and thirty, is 21.31 years; between thirty and forty is 20.64 years; attacked between forty and fifty is 17.65 years; that is, an insane person, when taken near twenty or thirty years old, will, if not restored, live on an average eleven hundred and eighteen weeks, and will cost $3354 for his support. Those from thirty to forty when taken will live one thousand and seventythree weeks, and cost $3219; and those who are from forty to fifty when taken will live seven hundred and seventeen weeks, and cosť $2751. These are sums which the people must pay; they are debts in curred the moment the man becomes insane, and are a mortgage on the public property until these patients are restored. This, however, is not all the cost of insanity neglected and uncured; the Commonwealth loses all the services of these men, all that they would have earned during a sane life if they are restored. The probable longevity or average time sane men will live after twenty to thirty years is 39.12 years; after thirty to forty 32.76 years and after forty to fifty, 26.06 years. Then the public must not only pay the cost of supporting an uncured insane person when between 20 to 30 years for 1118 weeks, but lose his earnings for 2034 weeks. The earnings, of course, will vary with capacity, position, and circumstances. person, In England the prospective earnings over and above the cost of the support of an unskilled laborer, at 25 years of age, are worth $1157; that is an annuity equal to this profit on his labor through his probable life could be bought at that age for this sum. The earnings are more in America, the cost of living for laborers and others is about the same; hence the profits of life are greater and the annuity worth more. We may safely add fifty per cent. and more, and estimate the annuity as worth at least one thousand eight hundred for the unskilled laborer; for the mechanic, trader, and professional man it is worth more. Then, if an unskilled laborer becomes insane at twenty-five, this annuity is lost to him, to his family, and the body politic, unless he be restored and the annuity regained. Let us consider the cost of restoration. For those whose disease was less than one year before admission, the period of restoration has been found, on calculation of returns, to have been somewhat over five months. But if taken earlier and treated as promptly as fever, pneumonia, etc., the time required for cure is much less. The cost of this restoration, even including interest on the hospital and all other expenses in our State Institutions, will not exceed five dollars a week, that is about $130 for each insane person restored. If taken early, eighty per cent. at least can be restored, and twenty per cent. will either die or remain insane for life. The recent cases of insanity are always more expensive to take care of, from the greater attention required, their disposition to destroy clothing, furniture, and fixtures. The cost of the curative experiment must include both that paid for those who are curable, and for the attempt to restore the incurable during an average period required to determine the question of their curability-say two years-or for such as are restored to power $260. It must, however, be remembered that this estimate of the cost allows the whole expense of the hospital to be five dollars a week for each patient. In calculating the cost of a cure, we should only include the increased expense of support for this purpose over and above what must necessarily otherwise have been incurred. Whether they cure or attempt to cure or not, the public must pay three dollars a week for the patient's support, and the curative process costs only two dollars a week in addition, and only so much then should be charged to place and means of restoration. The cost, then, should be stated as $104 for each one restored. Taking the English calculations of the present worth of a laboring man at twenty-five, and adding the difference of earnings in this country, an annuity equal to the excess of his support through his probable average life, thirty-nine years, can be bought for $1800. The present worth of the cost of his earnings over the cost of his support, if insane, $156 a year, through his probable insane life, twenty-one years, will be $1834. Both these are lost, equal to $3634, if the man is attacked with insanity, and not restored. From the statements above made, it is clear that insanity is a disease to be treated like other diseases, by the prompt and proper application, in the early stages, of the most approved hygienic and medical means; but owing to the peculiar character of the disease, the degree of excitement which frequently occurs, the dislike and often hatred of those most loved in health, the difficulty of administering food and medicine in many cases, the amount of care and watching required for those who seem bent on destroying their own lives, the wearing and wearying nature of the attendance required from the other members of the family, the refusal to submit to be controlled and directed in their own houses, where they have always been accustomed to direct and manage, that treatment, except in a few special cases, cannot be effectively carried out in the families of which they may be members; and it is, therefore, necessary that they should be removed to some institution specially arranged for the treatment of this particular disease. These institutions require to be constructed in a different manner from ordinary hospitals, so that the different forms of mental disorder may be properly classified and arranged, and better opportunities be thus afforded for the more thorough and careful management and treatment of the particular classes into which the patients must be arranged, according to the form which their disease may From the necessity of these special arrangements-that certain rooms must be stronger and more secure, and the windows more carefully constructed and guarded, and in many protected on the inside; that every ward must be provided with all that is need assume. ful for the proper and careful management and treatment of the patients; that all parts of the building be so arranged as to give as much liberty as possible, with the requisite degree of security to the individual and to the community, with the least appearance of restraint the construction of such institutions necessarily involves a greater degree of expense than can ordinarily be met by associations of individuals, and, therefore, for the great majority of the insane, it is necessary that the hospitals be constructed by the State. The bulk of the population in any community may be considered to be in that condition which will enable them to live comfortably and maintain their families, and provide for them in cases of ordinary sickness and disease; but when a member of the family becomes insane, particularly either head of the family, all the time is generally required to look after and give the requisite attention to the sick member, and thus the means of the support for the family are taken away or very much impaired; and if this condition continues, the whole family suffers, and notably the younger members, from the bad influence exerted on them by the conduct and conversation of the insane member. The Commonwealth is the legally appointed guardian of all within its borders who, by reason of disease or disability, are unable to provide for or take care of themselves. The insane are more especially the wards of the State, because in them the governing and guiding power is either destroyed or misdirected, and they require more particular provision for their custody and treatment, inasmuch as their disease renders them often dangerous to themselves and the family or community of which they more immediately form a part; and as the majority of those who become insane in any community belong to the class who cannot pay the rates charged in institutions under the care of associations of individuals, from the necessity of making these rates high in order to meet all their expenses, the duty becomes more imperative that the authorities of the State should make such ample provision that all who may become insane may receive treatment at the earliest period. No discrimination should be made in favor of one class against another, as the hospitals in this State are now compelled to do on account of their overcrowded condition, but all, no matter what the character of their disease, should receive treatment adapted to their disordered condition. A large number of the insane who are now a burden on the community in consequence of long-continued insanity, would, in all reasonable probability, have been restored and become useful members of the community, if the means had been provided by which they could have had prompt treatment in the early stages of their disease. The only certain mode of preventing the increase of mental disorders in those who now constitute the community is to make such provision that all can receive careful and skilful treatment as soon as the symptoms of the disease appear. It is a fact established by the most extended observation that the majority of the insane in any given hospital are derived from the section of country more immediately adjacent to that hospital, so that it may be regarded almost as an axiom that a hospital should be placed as near as may be, convenience of access and supplies considered, to the centre of population of the district it is designed to accommodate. The facts, then, being as stated,-the advantage and economy in every point of view of treatment in the early stages of the disease, the necessity of special provision for that treatment, the crowded condition of all the hospitals for the insane in this State, and the consequent inability of the citizens of the counties named to procure that treatment for those of their fellow citizens who are now suffering from the most afflictive of all diseases, or who may require treatment in the years to come, being fully admitted,—it seems to the committee that no further argument can be needed to convince your honorable bodies of the absolute necessity of the passage of a bill, at an early day, to provide for the appointment of a commission to select a site and build a hospital for the insane of these counties, which will be an ornament to the State, and will confer untold benefits on the inhabitants of this section of our beloved Commonwealth. JOHN CURWEN, P. B. BREINIG, E. G. MARTIN, W. MURRAY WEIDMAN, |