io6 WILLIAM M. EDWARDS 



hospitals for the insane throughout the country. This is well 

 illustrated in the constant effort made by boards of control and 

 superintendents to improve the conditions under which the 

 insane live and to afford every possible means for treatment 

 with a view to their restoration to normal conditions or to such 

 improvement as shall render them to a degree at least useful 

 members of society or to place them in condition to obtain the 

 greatest comfort in life while residents of the asylums. 



We long since determined that the reception and care of 

 acute cases in the general ward of the asylum, given oyer to its 

 more or less chronic inhabitants, was wrong in principle and 

 detrimental to the interests of the curable case. The ideal 

 surrounding for an acute case would probably be exclusive 

 association with normal minds, but this condition is unattain- 

 able for the insane person supported at public expense. One 

 of the efforts to meet the requirements of acute cases was to 

 establish separate asylums for the acute and chronic insane. 

 The state of New York made such provision for the separation 

 of cases by special asylums, but long since this theory was 

 abandoned. Pennsylvania maintains one institution for 

 chronic cases, but so far as I am able to learn, this is merely an 

 asylum for the able-bodied working class, the frail, feeble, 

 chronic patients having no part in it. Wisconsin has perhaps 

 accomplished more effectively separation by the establish- 

 ment of its hospitals at Mendota and Winnebago for the recent 

 patients and the care of its more permanent cases in the several 

 county institutions. Even here acute cases find their way 

 into the county asylums, and as the theory upon which they are 

 founded is custodial care these cases are deprived of the care, 

 attention, nursing and medical treatment that their condition 

 demands they should receive. In one state an effort was once 

 made to estai3lish the medical condition of the patient by legal 

 enactment, and it was declared that at the end of two years of 

 asylum treatment patients were to be considered chronic and 

 incurable and were to be transferred to special places provided 

 for their cheaper care. In Indiana, congestion in state hospi- 

 tals is relieved from time to time by returning to the county 

 poorhouses from the oldest state asylum patients who are 

 supposed to be incurable and to require only custodial care. 



