THE DUTY OF THE STATE TO THE INSANE. 751 



twenty chronic incurable patients could be humanely and kindly 

 cared for at three dollars per week for each person, or $2,760, 

 thus making the total cost of treatment, under probably the best 

 conditions, $3,560. 



This mode of treatment of the insane, far from being Utopian, 

 is at present in successful operation in Strasburg and Heidelberg, 

 and is about to be carried into effect in some of the Scotch asy- 

 lums. The most eminent alienists in Great Britain and America 

 have strongly advocated it. 



Lord Shaftesbury, before a select committee of the House of 

 Commons in 1887, thus explained the intention of the promoters of 

 the early lunacy laws : " The asylum was to be divided into two ; 

 there was to be the principal asylum, which was for the acute 

 cases; and there was to be a chronic asylum alongside of it, 

 which was for old, chronic, incurable cases. All the recent cases 

 were to be sent to the principal asylum, which was to have a full 

 medical staff, and everything which could be necessary for treat- 

 ment and cure." 



Dr. J. Wigglesworth, superintendent of an English asylum, in 

 the discussion on The Future Provision for the Chronic Insane 

 before the British Medico-Psychological Society, said : " A more 

 important question than the care of the chronic insane was 

 whether they could not make a more determined effort to do more 

 for the cure of the recent cases. To do this they must hospital- 

 ize asylums more. They must have small buildings properly 

 officered and equipped, to which all recent cases should first be 

 sent. The increased knowledge thus obtained would without 

 doubt in time bring about an increase of the recovery rate." 



Dr. H. Hayes Newington, in his presidential address delivered 

 at the annual meeting of the Medico-Psychological Society of 

 Great Britain in 1890, advocated the hospital annex for curable 

 cases within easy distance of the main building. He stated that, 

 in a hospital of one thousand patients, not more than sixty on an 

 average would need such treatment. 



Dr. D. Hack Tuke, in discussing the above address, said: 

 " There should be means of treating acute cases in a separate hos- 

 pital block, one in the construction of which no reasonable expense 

 should be spared ; or there should be a hospital at some distance 

 from the asylum, on the lines laid down by Dr. Newington." 



Dr. E. B. Whitcomb, in his presidential address before the 

 British Medico-Psychological Society in 1891, stated : " The hos- 

 pital treatment of the acute insane would insure the separation 

 of acute from chronic insanity, sustain and encourage the more 

 rational treatment of insanity as a symptom of physical de- 

 rangement; but above these a well-constituted hospital would 

 be the means of promoting to a greater extent and in a more elab- 



