THE DUTY OF THE STATE TO THE INSANE. 749 



valescing period when the acute insane are not so susceptible to 

 morbid influences. But most important, because of the difficulty 

 of determining at once in some cases the curability of the disease, 

 is the possibility of keeping under observation doubtful cases 

 until the character of their disease can be determined and they 

 can be correctly classified. Transferences from the chronic to the 

 acute buildings could also easily be made if any supposed chronic 

 case should manifest signs of mental improvement. 



The State has always recognized the principle that curable 

 patients required more and better care and attention than the 

 chronic cases. This was formerly shown by the greater sums per 

 patient given to the hospitals for the acute insane. The same 

 fact underlies the present allowance of $4.25 per week for the first 

 three years of hospital residence, the presumably curable period, 

 and $2.50 per week for the remaining time, when the patient 

 would be regarded as chronic. This is an exceedingly poor, 

 though probably under the circumstances the best, way to meet 

 this problem, the difference in the character of the care required 

 by the curable and the chronic patients. Only sixty per cent of 

 the admissions are curable cases ; the others can be diagnosed as 

 incurable at the first meeting, and require only the simple care 

 which chronic patients should receive. As the hospitals are now 

 constituted, the acute cases are placed among the chronic, and of 

 necessity can receive little more than the average care of tlje hos- 

 pital. We have here a double injustice : first, greater sums are 

 given for some patients (those whose recovery is hopeless from 

 admission) than the character of care for their disease demands ; 

 second, many (those who are curable at admission) do not receive 

 the extra care which their illness demands, and to which the in- 

 creased sum ($4.25) entitles them. It practically means, therefore, 

 that the increased sums received from the recent cases go to ele- 

 vate the general standard of care of all the patients rather than 

 to be expended exclusively on the acute cases for whom this in- 

 creased amount is given. Thus the chronic cases get more care 

 than it was designed that they should have, or than they really 

 need, and the acute patients are deprived of the better care and 

 attention which it was intended they should receive. 



" The duty of the State is such provision as to accomplish the 

 largest result in the restoration to health of curable cases, the 

 element of expense being here a subordinate one, and for the re- 

 mainder such comfortable provision as shall insure safety to the 

 community and humane care to the sufferer." * 



* Address of Dr. W. W. Godding, Superintendent of the Government Hospital for the 

 Insane, Washington, D. C., read before the National Conference of Charities and Corrections, 

 September 16, 1889. 



