THE DUTY OF THE STATE TO THE INSANE. 741 

 THE DUTY OF THE STATE TO THE INSANE. 



Br DR. ANDREW MACFARLANE. 



~T UNACY legislation in the State of New York has been 

 J-^ marked by two recent acts which are among the noblest 

 monuments of the State's generosity, as well as witnesses of a 

 scientific appreciation of the needs of the unfortunate class who 

 are affected by them. 

 These acts are : 



1. The change in the titles of these State institutions from 

 lunatic asylums to that of State hospitals. 



2. The State care of the chronic insane. 



The first is the natural outcome of modern ideas on the sub- 

 ject of insanity, which is now regarded not as a manifestation of 

 the evil one, but as a disease of the brain, affecting it in the same 

 way as pleurisy affects the pleura or peritonitis the peritoneum, 

 and that those suffering from mental disease should be treated 

 not as criminals or dangerous madmen but as very sick people. 



The second is a grand philanthropic work, proving that the 

 State cares for even the most unfortunate of her children, and 

 seeks to soften as much as possible their sad lot. 



The time is fortunately past when these measures required 

 advocates, and to-day it is necessary to keep in view only what 

 are the best means for carrying to a successful issue both of these 

 measures, and to consider if in any way the one tends to render 

 the other less successful. 



The fact that it is thought the saddest affliction which can 

 befall mankind, that it affects all grades of society, that three out 

 of every thousand are its victims, makes the consideration of the 

 care of the insane, from the purely scientific, the philanthropic, 

 or the economic standpoint, a subject worthy of the most serious 

 thought and of the deepest interest to all. To-day (May, 1893) 

 there are in the State of New York 17,814 insane patients under 

 legal certificates of commitment in thirty -two public or private 

 asylums, whose buildings and equipments have cost $17,500,000, 

 where 2,900 people are employed, and which are maintained at 

 an annual cost of $3,500,000. 



This huge creation is the work of less than fifty years, for in 

 1843 the Utica Asylum, the first State institution for the insane, 

 was opened for the reception of patients. Bloomingdale Asylum, 

 a private institution, had, however, been in successful operation 

 for many years, and was then in receipt of an annual grant from 

 the State, and the asylum on Blackwell's Island began in 1842 to 

 care for the insane in New York city. 



The erection of the Utica Asylum marked the first decided step 



