Among the papers read at this Conference eight are by experts in the Psychological Department of Medicine, and occupy more than 60 pages. Dr. Chapin, the Superintendent of the Penn. Hospital, Philadelphia, presents a report of the Committee on the Provision for the insane, in which it is stated that of the 92,000 insane persons in the United States 43,000 are not in asylums. Of Boards of State Charities it is held that their powers in respect to asylums should be limited to the examination and report of their condition and the investigation of abuses. The policy of committing the responsibility of administration to such Boards is not wise. It is observed that whatever may be the objections to Local Boards entrusted with State Institutions, there are other largely compensating advantages in their favour. It is added that “Boards of State Charities” may exercise a wholesome oversight and supervision, observe the best methods, and urge their general adoption. Great satisfaction is expressed at the wide departures that have been made from former plans of asylum construction, as at Willard; Middletown; the open wards of the Government Asylum, Washington; the asylum at Kankakee; the Bancroft wards at the Concord Asylum; the “Cottage by the Sea,” under the direction of the Friends' Asylum, Philadelphia; and the Mountain House connected with the Vermont Asylum. Such asylums as Kankakee have succeeded in showing that the cost of construction and the maintenance of patients may be considerably reduced, thus removing a great obstacle to the extension of State provision for the insane; while there has been an increase of personal liberty and a greater opportunity for the various occupations in which a community engages. Dr. Chapin makes this honourable acknowledgment:—“Candour compels us to acknowledge some of the results have been aided by fair and wholesome criticism, which has furnished moral support to bring about changes as well as incentment to devise ways for improvement. It is an unfortunate error to cultivate an opinion that any human work is perfect or cannot be improved.” He advocates for the accommodation of bed-ridden patients, feeble dements, and epileptics, large associated dormitories (like our Caterham and Leavesden), with an efficient staff of night attendants, or a total separate building one storey in height, comprising a day-room or ward, and a dormitory with a few adjoining single rooms. Of the patients at Willard, 10 per cent. were of the class suited for this arrangement.
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