PROVISION FOR THE INSANE 107 



That these cases depjenerate in the county institutions without 

 medical oversi<!;ht and their condition becomes deplorable in a 

 short time, has not yd impressed itself so forcibly upon the 

 minds of the citizens of that state as to make a change in 

 method. 



In no instance do I think we have attained perfection in 

 our care of the insane. I hope that we never shall so feel, for 

 as soon as we come to that conclusion, decay of the worst kind 

 will supervene. In the administration of this great charity, as 

 in any other undertaking, we can not stand still. We must 

 either progress or we will retrograde ; and if the latter condition 

 obtains, retrogression will be rapid. In the care of insane in 

 state hospitals at public expense there always must be a com- 

 promise between the patient and the taxpayer. The aggre- 

 gate cost in any given state of maintaining patients is very 

 great, so that constantly we are constrained to exercise great 

 economy. Like the politician we can not always obtain what 

 w^e desire and must be content with what we can get. That 

 the burden of caring for the insane weighs heavily finds ex- 

 pression in the many attempts to lighten it. 



The public, however, is becoming more and more alive to 

 the conditions surrounding the insane and the quality of care 

 afforded them. A man eminent in their care once estimated 

 that only two per cent of our population is interested in asy- 

 lums. This two per cent includes primarily the relatives and 

 friends of the patients ; secondarily, the members of the boards 

 of control, officers and employes of the institutions, philan- 

 thropists and perhaps a few others. The relatives of an insane 

 person are acutely aUve only to the interests of their own 

 friend. This we see manifested in the very often expressed 

 wish that a patient when brought to the hospital be placed in 

 special surroundings, that he must not be put with insane peo- 

 ple, because he is only a Httle depressed or disturbed, that he 

 must be kept away from those whose behavior is of a distress- 

 ing or revolting character. In other words, whatever the pro- 

 vision made by the state, the individual when the question is 

 brought home to him demands a special arrangement for his 

 friend. We all recognize the undesirability of placing the 

 acute, depressed, hypersensitive or apprehensive patient in a 



