The Board has held six public stated meetings since its last annual report, and also three meetings of the executive committee. The attendance at these meetings, often extending over three days, has been quite full, and in no case has there been a lack of a quorum. A list of the members present at each of its public meetings during the year, furnished the Legislature in accordance with the statute, appears in schedule number one.

The statistical and financial returns of the various institutions subject to visitation, fully analyzed and tabulated, are appended.

STATE INSTITUTIONS.

The charitable institutions having a State foundation are as follows: Hospitals for the acute insane; asylums for the chronic insane; institutions for the blind; institutions for the deaf and dumb; institutions for idiots; and reformatory institutions. The statistical and financial tables relating to these institutions are Nos. 1 to 7 inclusive. These tables give the name and location of each of the State institutions; the names of the resident officers, and the officers of the boards of trustees or managers; the total and classified valuation of the property held by them; the receipts and expenditures for the past year; the average number of persons under care, and the weekly cost of support; and the assets at the close of the year.

Hospitals for the Acute Insane.

The hospitals for the acute insane, in the order of their organziation, are: The New York State Lunatic Asylum, at Utica; the Hudson River State Hospital, at Poughkeepsie; the State Homœopathic Asylum, at Middletown; the Buffalo State Asylum for the Insane, at Buffalo.

The New York State Lunatic Asylum is fully completed, and has capacity for 600 patients. The buildings of the other institutions are so far advanced as to furnish room for about 200 patients each. The State Homoeopathic Asylum is being extended, and the buildings are nearly completed. The Buffalo State Asylum has been open only a few months. Each of these new hospitals, when finished in accordance with its original design, will furnish room for 400 patients. It will thus be seen that the State at present has accomnodations for 1,200 acute insane, and upon completion of these projected hospitals, its accommodations will be adequate to 1,800 patients. The number of insane under treatment and care in these hospitals, October 1, 1880, was 1,044, as against 1,033, October 1, 1879. These State hospitals are designed primarily for the acute insane poor, but they are authorized to receive paying patients, whenever

they have room not required by the public exigencies. As the prospect of recovery in insanity greatly lessens as the disease progresses, no opportunity should be lost by officials in placing the acute insane poor under prompt curative treatment. It not infrequently occurs, however, that the insane of this class, instead of being promptly sent to the State hospitals, are placed in county poor-houses, or ill-conditioned county asylums, where they receive little or no attention. The plea for this procedure is generally a desire on the part of the official to gratify relatives or friends, by retaining the insane in their immediate vicinity, or for the avowed purpose of saving in the expenditure. The practice, however, is unwise and poor economy, and cannot be too strongly condemned, as the disease in most such cases becomes chronic, and the person thereafter burdens the county through life. This evil needs fully to be corrected, either by statutory or other regulations, as it is likely to increase with the increase in the number of county asylums.

There is another and numerous class from which a large proportion of the insane burdening the public is derived, in which great neglect of early treatment exists, viz.: persons in moderate circumstances in life. The wealthy are in condition to avail themselves of every needed facility for prompt relief, while the pauper class, as has been seen, is fully provided for by the public. Not so, however, with the middle class whose energies are always heavily taxed in meeting the ordinary conditions of life. When insanity attacks members of families in moderate circumstances, owing to the inability to meet the expense of their treatment and care, at the rate charged for private patients, and from a repugnance to making them burdens upon the public, either as indigent or pauper, resort is had to confinement at home, often in small, ill-ventilated and imperfectly-warmed rooms, and that without medical oversight or care. In this manner they pass the period offering hopes of recovery, and in the end come upon the public as chronic insane, wholly dependent the remainder of their lives. On the contrary, if the attempt be made by such families to maintain their insane members in some State or private hospital, their resources are soon exhausted, and the burden eventually falls upon the public. The effect, however, does not always end here, as not infrequently entire families, in their efforts. thus to provide for such insane members, sink into hopeless pauperism. In view therefore, of the extended accommodations of our State hospitals for the acute insane, and of the importance of affording every facility for the prompt treatment of all classes for which they were designed, we believe that sound public policy requires a revision of the system of charges in these institutions.

Asylums for the Chronic Insane.

The creation of the Willard Asylum in 1865 was the first organized effort by this State, in the interest of the chronic insane. Its design was to afford shelter for the chronic pauper insane, then in the county poor-houses, and for those who might thereafter be discharged from the State hospitals as incurable, and to secure to them proper treatment and care. This institution, opened in 1869, comprises a central building with accommodations for 500 excited and disturbed patients, and five detached groups, each having accommodations for about 200 mild and quiet cases. It had 1,619 patients in its care October 1, 1880, as against 1,493 October 1, 1879.

The institution is now full, and some of its departments are overcrowded; nor has it been enabled, as yet, to provide for all of the chronic insane for whom it was intended. The policy of the State since its establishment, however, has been to bring all of this class of insane under its protecting care. To this end, the Legislature, by chapter 713 of the Laws of 1871, empowered this Board, to exempt any county from the operation of the Willard Asylum Act, upon its providing proper buildings and means for the care of its chronic insane, and to authorize it to retain such insane under county control, subject to such rules and regulations as the Board may establish and prescribe. Under this authority, the Board has, from time to time, granted such exemption to fourteen counties. In these counties, new asylums have been erected, or the old buildings enlarged and improved, and they had 1,234 patients under their care October 1, 1880. The Board maintains supervision over these exempted county asylums, and although in some of them the standard of care is not all that could be desired, great improvements in these institutions have upon the whole been secured. In a few and the least populous of these counties, the authorities declare their intention to abandon their county asylums whenever the State shall provide room for their chronic insane. It may be proper to add, that several of these exemptions have been granted because of the insufficiency of the State accommodations for this class. The counties of New York, Kings, Monroe and Clinton retain their chronic insane in asylums, under special legislative acts, and each of these, except the last, provides also for its acute insane. The Board has the power of visitation of these asylums, but no authority to limit the number of patients, or to prescribe rules and regulations for their government.

In the continuance of the policy of the State in the care of the chronic insane, as declared by the act creating the Willard Asylum, the Legislature, by chapter 280 of the Laws of 1879, provided for the conversion of the State Inebriate Asylum at Binghamton, into an

asylum for the chronic insane. Appropriations have been made to adapt the building to the purposes intended. These appropriations have been exhausted, and the building is still unfinished. When completed according to the plans designed, it will furnish accommodations for about 300 chronic insane, with central and administrative arrangements for 600 patients.

Impressed with the importance of early providing for the opening of this institution, in accordance with its purposes, the Board, the past year, referred the matter to a committee to examine into the condition and progress of the work upon the building, and to procure reliable estimates as to the cost of its completion. This committee visited the institution, made a careful examination of the building and materials on hand, and employed a competent architect to aid them in arriving at conclusions upon the subject. By the report of this committee, which, with the report of the architect, is hereto appended, it will be seen that the estimated cost of completing the building is $49,233. A moderate sum will also be required for out-buildings, farm implements and improvements, for furnishing, and for current expenses in the maintenance of patients until reimbursed by the counties. Attention is invited to the report of the committee referred to, for full details regarding the matter.

In addition to the chronic insane in the county asylums exempt by this Board, there were 758 of this class of insane in other counties, not thus exempt, October 1, 1880, and who are not, as yet, properly provided for. The authorities of most of these counties have refrained from erecting buildings adapted to their needs, expecting that the State would enlarge its accommodations so as to meet their requirements. Some of the more violent and distressed insane have, from time to time, been transferred from these counties to the Willard Asylum, yet many of them. are still burdened with considerable numbers of disturbed and troublesome cases, for whose care no adequate provision exists. If the State, therefore, does not extend its accommodations so as to receive and provide for the chronic insane of these counties, the county authorities will, of necessity, soon be compelled to make provision for them. While it is probably true that a small portion of the chronic insane may be cared for in connection with the county poor-houses, the mass require a supervision and oversight which cannot be extended to them in association with other paupers. Hence the erection of buildings. adapted to the condition and needs of this class becomes a public necessity. When these buildings are erected in connection with the county poor-houses, and are, as is usual in such cases, under the same supervision, the standard of care for the insane varies according to the individual views of the officers in charge, instead of being based

upon, and adapted to, the real needs of this class. If the keeper be a person of kind and humane sympathies, he spares no effort to provide a suitable diet, proper attendants, and every needed facility for the comfort and welfare of the insane. The kindly interest shown by him toward this class extends also to the paupers in the poor-house, and as a result, the standard of care for them is raised beyond their actual requirements. The whole establishment in consequence becomes expensive and burdensome, and soon excites criticism and distrust in the community, on the part of those taxed for its support; On the contrary, if the keeper, as is not infrequently the case, be governed by motives of economy only, the standard of diet and care for the insane is lowered to that fixed for the poor-house inmates, and is therefore wholly inadequate to its purposes. The insane, as a consequence, soon become impoverished, violent, filthy and disturbed, and the efforts at economy, in the end, lead to increased and expensive burdens. Moreover, in the frequent change of keepers occurring in counties thus providing for their chronic insane, great abuses imperceptibly creep into the management, which result in irreparable injury to the insane, and become a matter of deep regret and mortification to its citizens. For these reasons the Board, in authorizing counties to retain their chronic insane, has invariably advised the erection of separate buildings, and the placing of the insane, whenever practicable, under management apart from the poor-house. In counties where the number of insane under care reaches 100, the employment of a resident physician is required by the rules of this Board.

From an extended and careful examination of the subject in all its varied aspects, the Board early reached the conclusion that the proper care of the chronic pauper insane could be better and more economically secured in institutions controlled and managed by the State, than in institutions under the management and control of counties. The grounds upon which this conclusion is based have from time to time been set forth in its reports to the Legislature, and may briefly be summed up as follows:

1. In the erection of buildings for the chronic insane, by the State, a much larger number may be provided for in one institution than in the case of a single county; fewer administrative apartments proportionately are required, and a lower per capita expenditure for shelter may therefore be attained.

2. The supervision of a large number of chronic insane under one management, by the State, is less expensive than when such insane. are diffused in numerous county institutions.

3. The supplies, clothing, etc., for the chronic insane in State institutions may be purchased in large quantities, and wholesale prices be