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of such a view and adopt the policy of boastfulness, without facts to support their claims, will receive their reward.

But our knowledge of the various Boards of Health, of the public spirit of citizens, and our determination, as a Board, not to censure without discrimination, not to conceal, and only to boast where there is ground of security, leads us to feel confident that no health resorts will surpass these in prevision, and provision for the interests of patrons as well as for the welfare and success of residents.



The duties devolving on the State Board of Health in examining the sanitary condition of asylums, prisons and almshouses, made it necessary for us also to inquire into the personal and hygienic management of inmates, the methods of confinement, etc., since it is quite impossible to separate the sanitary management of individuals from that of their surroundings.

The two State asylums show a careful attention to all the details of sanitary arrangement, as well as in general the application of those principles of mental and moral hygiene which are indispensable in the treatment and care of alienism. We believe the most of those connected with these asylums are not content to accept what was long years ago regarded as the essential and established methods, but are realizing that advances made demand a corresponding change in methods of dealing with this class of patients. Indeed, the progress of sanitary science has especially developed attention to this as a department of State medicine and public hygiene. There has come to be a fuller recognition that in no class of cases is the direction of cure or of relief more to be sought in a fuller comprehension of the possibilities of good food, good air, regulated exercise, employment and amusement, and of the relation of perfected hygienic conditions to relief. Such knowledge and a closer diagnosis between the various forms of insanity will yet lead to such modifications of treatment and of management as will quite change State methods of dealing with this dependent class.

It is felt to be a great misfortune that in most cases these essentials of return to physical and mental health are so neglected that often the first regret of the State alienist is that the subject has not earlier come within the sphere of his jurisdiction and control. Morbid conditions, in part dependent on physical states, or such as could be relieved by a regulated hygiene, too often by delay become so fastened on the victim as either to embarrass or prevent recovery. Besides the personal infliction, the ward becomes a perpetual charge to the State instead of the grateful recipient of its restorative agency.

This will never be overcome by mere advice as to early admission. Such advice rarely, if ever, reaches those concerned, and if it did would need the personal endorsement of the skilled visitant. It would be a great gain to this charity, and an ultimate saving to the State, if each one of these institutions was at liberty to send the physician in charge, or his assistant, to examine into cases earlier and either indicate as to the treatment or advise as to their early removal to the institution. Many a one would thus never need to come, and others would come at a time when the prospect for recovery would be far more hopeful.

In reference to the county asylums, it must be said of them, as a whole, that the principles upon which they are governed are radically defective. The whole system tends to put the management into unskilled hands and not to provide for inmates that kind of special expert oversight which such a disease or which such dependency demands. There is nothing inviting in frequent examinations of the insane. The freeholders, however well intentioned, cannot be expected to acquaint themselves with the exact kind of oversight which is due. We have known such men to express their deepest mortification and regret at what has been found to be occurring under their own administration.

The physicians chosen are, in some cases, selected only for political reasons, and are persons who have not made a special study of alienism. Many of them frankly say so, and say that with their uncertain tenure of office they cannot afford special preparation and expenditure. As a rule, there is no resident physician in such institutions, and more than once have we been told that the visiting physician has never seen the deranged persons unless some rare and acute attack of sickness occurs. As a consequence there are serious neglects so common as not to be regarded as neglects. The solitary confinement of the insane is the rule in a part of the county asylums of the State, and the individual study of the cases is an exception to the rule.

In some cases incompetency results from defective knowledge and the absence of experience, in others from a total want of comprehension of the problem on hand and the possibilities of amelioration which intelligent authorities recognize. We are glad to be able to say, notwithstanding this, that the larger county asylums of the State

have been fortunate in their choice of chief officers and matrons, and have faithful medical oversight.

This Board has no reason to complain, for many of its suggestions have been accepted, but it has reason to know that there are defects in the system which either need to be given up or to be under classified administration. While the idea of economy is valuable and has been reached in some of these county institutions, it has too often been at an expense of uncharity, which is a poor compensation for the saving made. So long as the State contributes to the support of these county asylums it should see to it that the care, both medical, hygienic and personal, is of the proper kind. Indeed, this would be due to such afflicted persons who had become a public charge, because of their relation to the population of the State, but is also to be urged on grounds of economy. While we are not in sympathy with any captious or sensational review of State, county, city or township institutions, we cannot but feel that the sanitary, and social, and general management of these institutions and of their inmates is an important concern of legislators. These have been accepted as wards, and while under public care we are not to lose sight of the fact that their welfare has important relations, not only to their personal condition, but to the limitation of disease, pauperism or crime. As to the insane, it is enough to say that some defects in management in local asylums were so flagrant as, upon the complaints of this Board, to lead to partial or complete change of method. In other cases the mistakes are too adherent to the system to admit of correction until the State, by its directing superintendence, secures methods that are satisfactory. Less uncertain tenure of office for those who are capable, more uncertain for those who are not, and a system by which more than one person shall determine the disposition to be made of each case in hand in accord with the highest known intelligence as to the management of various degrees of unsoundness, are greatly to be desired.


The same statement will, in a modified degree, apply to the penal institutions of the State. It is to be remembered that the two thousand or more that are each year to be found in the various State or county institutions are mostly under short sentences, and are, therefore, to be returned to the population of the State. Some of them are hopelessly beyond the reach of reformation and should be kept, not so

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