THE DUTY OF THE STATE TO THE INSANE. 743 



This difference, too, is most strikingly shown by the fact that 

 the average weekly cost per patient in the acute asylums was 

 $5.29, while in the Willard and Binghamton asylums for the 

 chronic insane it was less than half that amount, or about $2.60. 

 The ratio of physicians to patients in the acute asylums was 1 to 

 110, while in the chronic asylums it was 1 to 272. The recovery 

 rate on average daily population was twenty per cent in the acute 

 asylums, while in the chronic it was two per cent. The average 

 recovery rate on admissions was about thirty-three per cent in 

 acute asylums and about five per cent in chronic asylums.* 



In spite of the fact that the State had built many new asylums, 

 the number of insane patients in the State increased more rapidly 

 than the accommodations provided for them. The counties also 

 found it more economical to abuse, under the guise of care, many 

 of their own chronic insane. The result, therefore, was that the 

 number of these unfortunates in county houses had in 1889 in- 

 creased to 2,200. Their condition was most pitiable, and the 

 recital of what they were subjected to carries one back to the 

 barbarities practiced in the middle ages and by savage tribes. 

 The Charities Aid Association, President Craig of the State 

 Board of Charities, and Dr. Stephen Smith, then State Commis- 

 sioner in Lunacy, kept for three years nobly at the work of mak- 

 ing public this disgrace and blot on our civilization. Finally, in 

 1890, the present State care act, the consummation of their en- 

 deavors and those of the present commission in lunacy created 

 in 1889, became a law. This State care act calls for the removal 

 of all the insane patients from county houses to State hospitals 

 and their care therein. New York and Kings (Brooklyn) Coun- 

 ties are exempted from this act, as they are considered to furnish 

 suitable accommodations distinct from their poorhouses for their 

 insane. The State has been divided into districts, and each hos- 

 pital has its own district, from which it draws all the patients, 

 both acute and chronic, thus making all the State hospitals of 

 the same character — that is, mixed hospitals for the care of both 

 the acute and chronic insane, instead of hospitals for the acute 

 cases and asylums for the chronic incurable cases. 



In order to furnish accommodations for this large increase to 

 the State hospital population, it has been designed and is now be- 

 ing carried out to erect cheap buildings as annexes to the pres- 

 ent State hospitals on the hospital grounds at a cost of $550 per 

 patient. These buildings are intended for the more easily man- 

 aged chronic cases, and will enable the State to care for the 2,200 

 insane patients who were inmates of county houses before this 



* Many of the recoveries in chronic asylums were of acute cases of insanity in persons 

 living in the immediate vicinity of the asylum. 



