now occupied, accommodates, by crowding, from 180 to 200 patients. The entire structure will be finished and ready for use by the middle of next summer, or by the early autumn, and will then contain as many as 450 patients.

The hospital at Anna will, when completed, accommodate 500 patients. The north wing, now occupied, if furnished, would contain, say 200; but so many ought not to be crowded into it with its present lack of facilities for proper classification in wards.

Besides these State institutions, there are two private retreats for the insane-one at Batavia, in Kane county, under the charge of Dr. Patterson, and one at Jacksonville, under the charge of Dr. McFarland.

There is also an institution known as the Cook County Insane Asylum, which is really a department of the Cook County Almshouse. Its organization is imperfect, its facilities for treatment very inferior, and its management parsimonious. Before the addition of the fourth story it was designed for 200 patients, but, by the use of an abominable basement, more were crowded into it. It now contains 260.

To recapitulate, there is at present hospital accommodation in Illinois for not exceeding 1,100 or 1,200 insane, as follows:

The completion of the Northern and Southern Hospitals will add about 570 beds to this total, making hospital provision in all for about 1,700 patients, leaving 1,300 still unprovided for, except in county almshouses and jails and in private families.

The number at present in the county jails and almshouses of Illinois is shown in the following table:

The figures in this table have been furnished us since the date of the Senate resolution of inquiry, by the county clerks, and it is this correspondence which has occasioned the delay in our reply.

Out of one hundred and two counties in the State, ten have failed to

respond to our circular, among which are the populous and wealthy counties of Kane, Peoria, Pike, Randolph, Schuyler and Will. Of the ninety-two remaining, fifty-eight, or a little more than one-half, report that they have six hundred and forty-one insane in their alms-houses, and nine in their jails. Outside of Cook county there are three hundred and eighty insane persons on the county farms. Full returns from all the counties would increase this figure. Some of the counties which report "none" have no alms-houses; and some of the alms-houses being full to overflowing, as in Jo Daviess county, there are as many outside, possibly, as on the county farm, who are nevertheless a county charge, and supported at county expense. A number of the clerks from whom statements have been received, mention other chronic cases supported at home or by friends, or sent to hospitals in other states. In Hancock county, e. g., the clerk informs us that there are about a dozen cared for by their friends outside the county farm. The clerk of Tazewell county reports six or seven, the clerk of Cass county five, etc., etc. The clerk of Kankakee county writes: "Our insane are kept by contract either at the Kankakee town poor-house, or by individuals in other parts of the county," and, to give a vivid impression of their condition, he adds: "I have reported all our insane in jail, which is not literally true, but very much the same."

The condition of the insane in the county alms houses is for the most part extremely unfortunate, though not more so in Illinois than in other states. While some of the counties, like Knox and St. Clair, have made special provision for their care, in the great majority none such has been made, or at least none worthy of the name. It is true, as we believe, that there are some of the chronic insane who are harmless and inoffensive, to whom a degree of freedom can be granted on the county farm more promotive of their happiness than all the appliances of the best regulated hospital, and we have never thought that the rigid confinement of the hospital is the best possible condition and treatment for any and every insane patient. But it is also true that in the ordinary and typical alms-house the diet, nursing, medical attendance, discipline and associations of the insane are horribly inferior and often cruel. It is a common thing for an insane patient, of whom the keeper entertains more or less dread, to be shut up for months or years in a close apartment, unlighted, unventilated, unwarmed, unfurnished, and in this situ ation his slowly-wasting life is passed, often without clothing other than a blanket, or bedding other than a litter of straw, soiled with the pa-tient's own urine and faeces. Often the insane are chained. They wander around the farm by day with a ball and chain firmly fastened to their ankles, and they sleep at night chained to a ring or staple in the floor. Sometimes they are whipped, sometimes guns and pistols are fired over their heads, to intimidate them. They are often insufficiently clothed. Occasionally the insane of both sexes occupy the same apartments, and some cases of terrible exposure have come to our knowledge. But the subject is so painful that we do not care to dwell upon it, or to give individual cases in detail.

The confinement of an insane person in any county jail is, we believe, under our present code, entirely illegal. Yet we have known such confinement to last, in one instance, for seven years.

What further provision for the insane is needed?

No argument, other than the bare presentation of the facts, is necessary, to prove that additional hospital facilities, in this State, are imperatively demanded at the earliest practicable moment. The legislature of Illinois has provided the means of completing the Elgin hos

pital, and for the erection of a center building at Auna. The appropriation for the erection of the south wing of the Anna hospital is now pending. But it cannot be long before the people will demand of their Senators and Representatives still further appropriations for the erection of additional hospitals. This has been the history of legislation for the insane in every State in the Union.

With regard to the question whether it is better to enlarge existing hospitals or to build new ones, we are unanimously of the opinion that it is not wise to multiply the number of insane under the care of a single superintendent, however able. Such enlargement substitutes system for individual attention and relief, and, for many reasons, does not, in our judgment, promote the real interests of the insane.

With regard to the question whether it is desirable and expedient to erect institutions designed exclusively for chronic cases of insanity, and to separate the curable from the incurable insane, we submit the following resolutions, adopted at the meeting of the Association of Medical Superintendents of American Institutions for the Insane, at Toronto, in June, 1871:

Resolved, That this Association reaffirm, in the most emphatic manner, its former declarations in regard to the construction and organization of hospitals for the insane; and it would take the present occasion to add that, at no time since these declarations were originally made, has anything been said or done to change in any respect its frequently expressed and unequivocal convictions on the following points-derived as they have been from the patient, varied and long continued observations of most of its members:

First. That a very large majority of those suffering from mental disease, can now bere else be as well or as successfully cared for, for the cure of their maladies, or be made as comfortable, if not curable, with equal protection to the patients and the community, as in well arranged hospitals specially provided for the treatment of the insane.

Second. That neither humanity, economy or expediency can make it desirable that the care of recent and chronic insane should be in separate institutions.

Third. That these institutions, especially if provided at the public cost, should always be of a plain but substantial character; and while characterized by good taste, and furnished with everything es sential to the health, comfort and successful treatment of the patients, should avoid all extravagant embellishment and every unnecessary expenditure.

Fourth. That no expense that is required to provide just as many of these hospitals as may be necessary to give the most enlightened care to all their insane, can properly be regarded as either unwise, inexpedient, or beyond the means of any one of the United States.

We call the attention of the Senate to the second of these resolutions, in which the separation of the chronic insane from the curable is condemned. The reasons for this opinion, in which we fully concur, are, briefly :

1. It is impossible to discriminate, in individual cases, and with absolute certainty, between curable and incurable insanity. While the majority of chronic cases are also incurable, yet some surprising recoveries take place, even where the disease is of long standing.

2. If it were even possible to determine in every instance whether a given patient is or is not curable, yet the branding of any patient as incurable, by assigning him to an institution designed exclusively for incurables, would be a cruelty to the patient and to his friends, for it is always cruel to rob a man of hope, his last consolation in the presence of any ill.

3. Of whom nothing is expected, nothing will be obtained. If it is understood by the superintendent and by the public that his patients are beyond the reach of hope, the greatest stimulus to exertion on his part will be removed, and the result will be laxity of discipline, inefficient nursing and medical care, general deterioration in the management, and, in the end, disgraceful failure.

4. In an institution designed for the incurably insane alone, the fre quent communication with the outside world secured by the constant discharge of recovered patients would be lacking, and thus an important safeguard against the growth of abuse would be removed,

5. It would not be possible to prevent the admission to any hospital or asylum of patients from the inmediate vicinity, who were curable, and, if possible, it would not be desirable.

6. All experience shows that the presence of chronic cases of insanity in any institution has a happy influence over the newly insane, and is an aid not only to discipline but to recovery on their part.

7. If the separation of the incurable from the curable insane is the question to be determined, then the form of the inquiry should be, not whether to make separate provision for the chronic insane, but whether we shall make separate provision for recent cases; for the recent cases are the less numerous of the two.

For these and other reasons, we advise, not the erection of mammoth poor houses, under State supervision, for the reception of the outcast insane of Illinois; but the erection of additional hospitals, whenever the condition of the finances of the State will admit of it.

Finally, with regard to the question whether the incurable insane cannot be "accommodated and cared for without cost or charge to relations or friends," we can only repeat what we have said on this subject already, in our second biennial report:

"The true view of these charitable institutions is, that they are of the nature of all insurance against disaster. Every man is liable to misfortune in his own person or in the person of his family. The tax imposed for the support of public charity is a premium for insurance against such a calamity-the only difference between this premium and one for protection against loss by fire being that that is voluntary, while this is compulsory. In both cases, he who derives no direct personal benefit from the payment of his premium is more fortunate than the man who does. But in both cases, also, the insured are interested to see that the provision made is sufficient, and of the best character, at the least relative cost. Insurance, however, is the principal consideration, and the question of cost, however important in itself, is after all of secondary consequence." [p. 120.]

"The view which we take of this subject is, that if the rich pay their share of the taxes for the support of the hospital, they are entitled to their share of the benefits accruing from it, one of which is admission to the hospital, in case of need, without extra charge. The duty imposed upon the superintendent, under the present law, of inquiring into the pecuniary ability of each applicant to pay for board and treatment, is one of great delicacy, and very disagreeable to both parties, and it is impossible for him to ascertain the truth, as some persons, unwilling to rest under the stigma of pauperism, represent themselves as more able to pay than they really are, while others are avaricious and falsely plead poverty as an excuse for paying less than they are actually able. It is impossible in the hospital to graduate the amount of attention given in proportion to the amount paid; the brand of pauperism upon the majority of the inmates is unkind and often unjust; the presence of pay-patients creates an artificial class distinction; and a comparison of the amounts paid by different individuals creates outside dissatisfaction. All the other State institutions are free. The amount received by the hospital from private persons is too small, in our judgment, to compensate for the evils which we have indicated. We therefore recommend the total abolition of the pay list." [p. 104.]

All of which is respectfully submitted.

S. M. CHURCH, Pres't of the Board.

FRED. H. WINES, Secretary.