the largest number of insane persons. For a moment let us consider these: First, What they should not be. They should not be receptacles for idiots, imbeciles, epileptics and convicts, whose insanity has supervened on crime and its detection and punishment (I do not mean persons who commit criminal acts while insane). For them separate institutions should be provided. I have had occasion to call attention to some of the evils of the presence of the first class, either in asylums or in almshouses. They need physiological education, which can be obtained in neither place. They, on the contrary, learn to imitate the vicious practices, the emotional phraseology of the insane. In the almshouses they simply vegetate. As they grow in years, with reason undeveloped, without the conventional restraint of civilized life, their instincts increase and dominate over them. The erotic tendencies of both sexes of this class excite the fear and horror of those around them, or too easily assist the gratification of the passions of the utterly depraved. Some of the saddest examples of this crime have been brought to my knowledge, creating in my mind a fearful realization of the depths of degradation into which the human spark divine can descend. The need of schools for training the juvenile idiot, and custodial homes for such adults as cannot be cared for in Christian homes, is known to you all. Let me urge upon you to aid in the call for their establishment in States where they do not exist, as one of the noblest works in which man can engage. For those that have no helper in the depths of human misery I would send forth an appeal of no uncertain sound.

The separation of the insane convicts is urged on various grounds, to which I need not allude, as they are well known; and, when practicable, distinct institutions should be built for their care. Insane epileptics should not be deprived of hospital care, as no class of the insane appeal so strongly to our sympathies, or really need the restraint of a well-ordered institution. But the effect of these terrible paroxysms upon the other insane, the long intervals of apparent sound reason, developed, that occur, during which they chafe at the companionship of the other insane, and their extreme violence and strength, all exercise an unfavorable influence upon the construction and government of every institution, where they are numerous. Special institutions for these are, therefore, urgently needed, both for their own sake and the best welfare of those among whom they are now placed.

Hospitals or asylums for the insane will always have two classes within them: the recent and chronic. At any given moment the latter will largely preponderate. The one class will naturally shut out the other, unless checked by artificial means-by sending away cases to make room for others. In Ohio and some other States this is the rule; recent cases must be admitted; if no room exists, a vacancy is made by the discharge of a chronic case. The accumulation of these in poorhouses, after discharge from asylums, leads to the building of other asylums of a general character, or for chronic cases only. I have never been able to see the justice of discriminating against this class by providing inferior houses for them. Their susceptibility of enjoyment is often great, and their gratification in all reasonable amusements and pleasures is surely a proper set-off to their otherwise sad condition. We must not forget the old maxim of Anaxagoras, that "things in this world cannot all be cut off as with a hatchet," in thinking of these two classes, the recent and chronic insane. No man admires more than I the general features of the Willard asylum for the chronic insane, or appreciates the ability, fidelity and success of its distinguished Medical Director, Dr. Chapin; but I may be pardoned the expression of my opinion that it would be greatly improved if a small cluster of buildings, properly adapted for curative purposes, could be added for those attacked in the region round about the institution. The hatchet has been applied to divide things inseparable. Theoretically, small asylums, situated in the centre of compact territorial divisions, are the best. A late Governor of Ohio is reported to have said that it would have been better to have built an asylum in every Congressional district of Ohio, of a size proportionate to its population, than the large one at Columbus. The expression may have been extravagant, but the sentiment was correct. But the large institutions are here, and yet the cry is for more accommodation for the chronic insane. Rather would I add to each some special departments for the recent cases, and such others as are assimilated to them by their symptoms, who require more medical treatment, more close nursing, more nearly allied to ordinary sickness. In this direction our energies should be turned, and for them no expense should be spared necessary to effect the purpose.

Into the controversy of detached or consolidated wards I do not enter. This must be settled in every locality as circumstances may

arise. I will only say, the advantages in an economical point of view of either is not demonstrated, and will not be for some time to come.

As to the treatment of recent cases there is no difference of opinion. Medical skill, supplemented by moral agencies, above all, by love working in intelligent channels, is required here. For the chronic insane, moral discipline, to supplant erratic diseased action by acquired good habits, must be our aim in many cases, and for these I may formulate the proper course in two words, faith and works-trust in the individual with more liberty of person as far as practicable-work of the individual, regular systematic work as far as it can be developed. These should go hand in hand. Circumstances of each institution must determine their limits.

Upon one question respecting treatment, that of mechanical restraint, my opinions are well known, and I need not reiterate them here. It is only justifiable, in my opinion, where all else has failed, and is always a confession of failure on our part. I do not say it is absolutely unnecessary. Amputation of a limb may become so, but is a confession of failure to save the limb. Absence of restraint will sweeten the tempers of the whole household; its presence is irritating and degrading to the innate self-respect of the lowest in intellect. It saps his manhood.

Insane persons, restrained of their own control by the law for their good, are entitled to all the safeguards that society can afford them. The character of the medical and other officers who virtually control them is of the highest importance. No supervision or other advantage can compensate for deficiencies here. Hardly less important is the character of those composing the boards of management of the institutions. Without high moral character, adequate cultivation and a warm heart, responsive to every creature's plaint of woe, the member of such a board is out of place. The warm greetings of the patients, the radiant smile at his approach, the patient listening to their complaints and requests, the interest manifested in their work or amusements,-these are, perhaps, little things, like as the cup of cold water to the thirsting wanderer, but they are the visible signs of a good trustee. These have their reward. The business management necessarily requires special business qualifications in gentlemen composing such boards. One feature I venture to call attention to, as of first importance: the regular systematic habit of going through the wards and becoming

acquainted with the patients. One trustee or more should, weekly, if practicable, or as often as possible, make such a visit. It is a safeguard to every patient, and a blessing beyond price to every medical superintendent. It may be urged that boards of management become interested in these institutions, become more or less biased in favor of, or against, certain methods, and to that extent are not wholly disinterested judges between the world and the institutions. The public, which supplies the means, insists on knowing that the means are properly applied to the end it seeks to attain, and the public has this right. Hence, among other reasons, boards of State charities have come into existence, which, among other duties, assume the supervision of hospitals for insane. Those members of the Board of State Charities in Ohio, who have been in office during my residence in that State, will, I think, bear witness to the cordiality and sincerity with which I have always welcomed these visits and aided their purposes. If I shall differ from some of my colleagues in this Conference in my views, it comes, therefore, from no distrust of their purposes or antagonism in practice. Boards of supervision should, in my opinion, have the right of visitation when and how they please; if necessary, they should investigate all complaints which managers may be supposed to be unwilling or disinclined to act on, but they should not have lot or part in the management of the institution, in the appointment or displacement of any connected therewith, in the assignment or removal of any patients therein. Their province is to see, inspect, and report. When they go beyond they become interested in their own methods, and every other suffers in the comparison in their minds. The English Commissioners of Lunacy, in their dealings with county asylums, have, I believe, never been questioned as to the good they have accomplished. They there simply inspect and report; but as to the institutions in the metropolitan districts, which they, to a certain extent control, they have not been exempt from criticism. It is charged that the worst instances of asylums are among those under their control, and the reason is not far to seek. The supervision of these boards should extend to all places where insane are to be found controlled by others, whether in almshouses, in public or private asylums, and the duty of reporting is an important one. It is a weapon of fearful power, and should be used firmly but judiciously. The people of Ohio know how much improvement has taken place in the infirmaries of the State from the visitation of the

members and Secretary of the Board of State Charities. No board of State Charities exists in Maryland, but the work has, to a certain extent, been discharged by the Secretary of the State Board of Health with admirable results, and, by a late law, the duty is in future assigned to that functionary. The visits of Dr. Chancellor to the various institutions in Maryland, two years ago, and his fearless report on what he saw, aroused public attention to the matter adverted upon. In the past year a similar visitation was made by him, and his report shows the immense results gained to humanity by his brave and trenchant criticisms. Light let into dark places dispels the foul atmosphere engendered, and scatters the brood of vermin secreted under its cover; so inspection and reporting drive away neglect or criminal proceedings in public institutions.