tirely to give up mechanical restraints in treating patients. There are some cases that demand its use. But where occupation can be had, and the insane can be steadily employed, there is little need of mechanical, or what has been called "chemical," restraint. Dr. LOUISE FISK BRYSON said that, to be successful, the employment must be suited to the characteristics and tastes of the patient.

Mr. JONES, of Chicago, said: After I had travelled over this country and much of Europe and Asia, I had to go down into the Barbary States to find anywhere an asylum for the insane that was as bad and inhuman as some in our own counties in Illinois.

He had been a Commissioner of Cook County, Illinois, having charge of the insane; and he thought that mechanical restraints were necessary at times. The public were too ready to condemn the insane asylum methods.

ADDITIONAL TESTIMONY.

Soon after the discussion at Saratoga, the National Conference of Charities, in session at San Francisco, discussed the same question of family care and domestic employment for the insane; and some of the remarks made bear so closely on our subject that they may here be quoted.

Dr. C. I. FISHER, superintendent and physician of the Tewksbury Almshouse and Asylum for the Insane, said (Sept. 16, 1889): :

At the State Almshouse in Massachusetts, we have 350 insane patients of the chronic class: 300 of them are women. Within the past two or three years there has been adopted a plan for boarding out, by which some of these have been put into families, the State paying three dollars and a quarter a week for their board. We sent out about sixty women. It was my fortune to know the condition and progress of some of them intimately; and I believe that for those patients who have become quiet, in whom the acute stages are past and they have come into a condition of dementia, their prospects are better, and they are much more likely to improve under the influences of family life than in the institutions where large numbers are gathered together on the congregate plan. The public have very erroneous ideas in regard to the insane. The popular idea is that they are maniacs, utterly dangerous in a home. But those of us who are familiar with the subject realize that many are more like children in mind, that they are not maniacs, that they can be safely taken into our homes, and that in these homes they will receive individual attention and teaching, as we teach children, and that they may gradually develop and become better able to take care of themselves and to be helpful than if they were left in the asylum or hospital. I remember some persons, living far away from any city in a farm

ing community, asked me about taking boarders; and I suggested that they take the insane. They lifted up their hands in horror at the suggestion. "Very well,” I said, come down and see me, and perhaps you can pick out some one." The experiment was tried. They took one, and then another, and they became interested in their wards, and the patients soon became helpful. They learned to wash dishes, make beds, and to do plain sewing. It is this individual attention which develops them faster than can be done in the asylum. We who have charge of institutions realize that the average insane attendant is quite desirous of getting her living "in the line of the least resistance," and that she will educate patients to do a certain amount of her' work if she can. When my assistants knew that I was about to send out patients, they objected to having those whom they had trained sent; but the patients went. Then I observed that the attendants picked out other patients and devoted their attention to them individually, that they might train them to do the work of those sent out. So I considered the reaction of this system as beneficial to the institution. The activities and energy of the attendants were roused in the process, educating patients up to a degree of helpfulness; and they did not fully relapse into the state of indifference in which they were before. So I have been willing and glad to put out my best patients to board, believing that it was better for the patient to receive the kindly care of the family, and better for the institution. Of course, great care must be exercised in selecting the family into which these patients go. There will be those who regard only the loaves and fishes, hoping to get work out of their boarders, and will overwork them. The families who take these patients must be watched over by supervising boards as carefully as those in which neglected children are placed. But I cannot but believe that there will be more and more of these unfortunate people who will be put into homes, where they will receive the help of the family life and will develop into conditions of helpfulness, and that many eventually will be kept free of expense, the State still holding supervision over them.

Prof. A. O. WRIGHT, of Madison, Wis., secretary of the Wisconsin State Board of Charities, describing the County Asylums of Wisconsin, in the same discussion, said:

Broken down, old, crippled, blind, and demented persons, all unable to work, make up about ten or fifteen per cent. of the asylum inmates. We have about 75 per cent. at some occupation; and that, we think, is a good record. If some of our superintendents had more enterprise and more faith, we could get a better average. The best asylums have from 85 to 95 per cent. at some occupation; that is to say, every inmate capable of doing any work does some work. About half of the inmates are busy all day. I do not mean to say that their work is worth much pecuniarily. There are some whose work is worth as much as

that of a sane person, however. We encourage our superintendents to bring up the laboring capacity of these insane people, not for the sake of getting work out of them, but to keep the inmates employed. We have in many cases a crude system of manual training. In some, we have been able to train back the intelligence through this manual training. An attendant will take an entirely demented person by the hand, and clasp the hand over some tool, and then move the hand round to do the work. It may be something as simple as dish-washing. She will teach her to hold the dish, without dropping it, in one hand, and the cloth in the other. By patience and steady teaching, the patient will learn the operation, and with this activity of the body comes back, little by little, the lost intelligence. We have had a great many cases of that kind.

The recoveries of the chronic insane are few; but the improvement in their condition and in their happiness is marked under this system, and many are so far improved that they can go home, and all are more content than they ever were before. We claim that taking the chronic insane out of the hospitals leaves the superintendent more time to attend to the acute and recent cases. We claim, also, that it is more economical and natural to transfer these people to farm life. We think that the money that is usually spent on large fine buildings can be better spent in caring for the patients. In many Eastern States, a portion of the insane are cared for at great expense in State hospitals, and another large portion are cared for improperly in jails and poorhouses. The same amount of money used more economically would care for all the insane; and that is what we are doing. When we say that the cost of our insane averages about $1.75 a week, gentlemen from other States say that we are not doing it properly; but leaders in this Conference who have visited our institutions have satisfied themselves that this is not a false, but a true economy. The economy comes in the fact of having more land and a larger amount of labor from the insane, and that we raise a large part of what we use. Our bills for fuel, meat, and vegetables are small, because we raise them all. We are asked if we have physicians for superintendents. No: we would rather not have them. Good physicians cost too much, and poor ones are worse than none at all. We have visiting physicians, the best in the neighborhood, who visit regularly, who are the health officers of the institution and advisers in regard to the treatment of the insane. Our superintendents are from the best class of farmers. Salaries range from eight to thirteen hundred dollars, including board for themselves and families. We try to secure the services of good farmers and their wives; and the wives are often the better of the two. We say to the county officers, In selecting a superintendent, see what kind of a wife he has. If you can find a good woman, and the man is tolerable, that will do. The woman has charge of the interests of the house. She has the home life in her hands, and that is the most important part.

Dr. WILKINS, Superintendent of a California Asylum for the Insane at Napa, said : —

I may say a word about placing the insane in families. I visited Gheel with great interest, where we find, perhaps, the perfection of the family system. About 1,100 insane are boarded in that community. About 800 families take boarders. They receive a franc a day for each patient kept by them. Most of the families take but one patient, a few two, but four is the limit that any one can take. In Scotland they have undertaken this to a limited extent; and, when I was there, I was taken by the commissioners for an entire day round to see the different families where these people were boarded. In each place, I think, the plan was working admirably. But in the report which I made on my return to California (and commended this system) I expressed the opinion that the difficulty in this country would be to find persons who were willing to take charge of the insane, even for the compensation paid by the State in caring for them in the asylum. We have encouraged relatives and friends to take patients from the asylum. I have never objected to having a patient taken out that I thought was harmless. We have encouraged them to go out on trial, on leave of absence. There is a great prejudice in this State against the insane. A few miles from here a board of supervisors passed an ordinance concerning a private asylum that was to be built in that neighborhood, that it should be surrounded by an eight-foot brick wall with guards, and that no insane person should be allowed to go out without an attendant. That is the kind of prejudice we have to meet, and it will take time to overcome that. In Massachusetts, more people are willing to take these people for a small consideration. The older the community and the denser the population, the more readily you will find homes for them. Perhaps the plan of Mr. Wright might help to overcome this prejudice. I have never been in favor of large asylums. One great difficulty here is that people are too ready to send their friends to insane asylums. We have people who bring friends who are perfectly harmless, but who are a little troublesome at home. Many of our patients could go home if they had some one there to look after them. We have adopted the cottage system in connection with our institution at Napa, and I hope to extend it. The people are raising small fruits, cultivating the land, and are employed usefully. Employment is the great thing in their care.

2.

POPULAR FALLACIES IN REGARD TO INSANITY

AND THE INSANE.

BY DR. PLINY EARLE, NORTHAMPTON, MASS.

(Read Sept. 4, 1889.)

Although it is impossible to demonstrate it as a fact, yet all the known data bearing upon the subject very clearly lead to the inference that insanity in the United States is increasing, not merely absolutely, in correspondence with the increase of population, but relatively, as compared with the number of inhabitants. Fifty years ago, the writers upon the subject placed the ratio of the insane to the whole population, in Massachusetts, at one in a thousand. In the last national census, it is shown that in 1880 there was one insane person in each three hundred and forty-three of the population of the State. Had the ratio of fifty years ago been derived from a census as carefully taken as that of 1880, it might be assumed as a demonstrated proposition that insanity had increased nearly threefold within the last half century. But that first-mentioned ratio was a mere estimate, based upon very imperfect, insufficient, and, doubtless, often indefinite or inaccurate data, and hence unworthy of reliance as a truthful standard for comparison.

But, under existing circumstances, even the present number of the insane in the Commonwealth do not constitute a class sufficiently large to enable the people to become acquainted with their characters, peculiarities, habits, and propensities, both mental and physical, as compared or contrasted with those of that portion of the inhabitants who, by common consent, are regarded as sane. Nearly three-fourths of them are in hospitals, and a large part of the remaining fourth in almshouses and other places of detention or surveillance, where they are withdrawn from general observation. Hence the present generation is probably less acquainted with their characteristics than were the people of seventy-five years ago, before the special institutions for their care had been called into existence, and they were allowed, to a much larger extent than at present, to associate or to mingle with the general population. As