readily ascertained from the reports of the institutions themselves. Take the six hospitals of Pennsylvania,-four State hospitals, one private hospital and the insane department of the Philadelphia Almshouse, in which there are 1,100 cases; their reports for two years show the following results: For the year ending September 30, 1875, the admissions into the six hospitals and asylums for the insane in Pennsylvania, were 1,180, with total discharges, 1,103; admissions over discharges, 77; total admissions in the same institutions in 1876, 1,214; discharges, 1,123; admissions over discharges, 91. In 1876, 17 3-10ths per cent. of the admissions were relapses or re-admissions; that is, they are not all new cases by any means; patients are re-admitted again and again. In the two years, 1875-6, 28 per cent. of the entire hospital population were discharged, and the statistics of 1877-8-9, are of a similar character. The increase of admissions is distributed among the six institutions, and more than half of it was received in the hospital department of the Philadelphia Almshouse alone, leaving only from 20 to 30 per annum for the other five hospitals in 1875, and from 40 to 50 for 1876; with a similar result, no doubt, for 1877 and 1878, which I did not compute.

It is not correct, therefore, in Pennsylvania to say that the insane population in institutions shows an aggregate of rapid increase in new cases, and even the admissions without corresponding discharges are not very numerous. Our experience in Pennsylvania is, that while two hospitals are overcrowded, that at Danville, with a capacity for 750, has been occupied for several years, and has a population of only 350, leaving about one-half of its wards unoccupied. The same will also be true of the hospital at Warren, which is approaching completion; it will commence with about 125 patients, and it will be years before it is fully occupied. The new hospital at Norristown, for the southeastern part of the State (the six eastern counties), will not be fully occupied at first, because the intention is to transfer thither not more than two or three hundred out of the 1,200 cases in the hospital department of the Blockley Almshouse at Philadelphia. The rest are all of the chronic class, a good many of them capable of self care, and able to perform outdoor work; and this will be true of some that will be transferred to Norristown.

Mr. WINES: Another thought occurs to me. There is no doubt a great deal of alarm in the public mind about what appears to be

an increase of insanity, and all the explanation that can be made of it should be given to the public freely. An explanation that has not been dwelt upon is that the insane are much more sought out and much better reported on than they used to be. If you look at the present census I presume it will show an alarming increase of insanity, because means have been taken which will report all of them. There will appear to be an increase, which is not actual but only apparent increase. Just so in regard to crime. We think crime is increasing wonderfully because every one of us reads the paper at the breakfast table, and learns about all the crime that has taken place.

Dr. WILBUR: There is another reason. Under the care of physicians a great many persons are now considered insane who were not so formerly. The diagnosis is much more complete now than twenty or thirty years ago; and consequently more persons are considered insane and are taken to the hospital than at that time, or even ten years ago. I have in mind several instances of this kind, and also of persons taken to asylums for their excessive use of opium. Ten years ago these persons would have been left to go their downward course, and would have died as inebriates, or through some other development of disease.

Dr. YEAMANS: I meant to say we were accumulating these cases, and that they live longer; it is the accumulation I was speaking of. Dr. NOLAN: Some years ago many patients were kept hid away in private rooms; they are now brought to the surface, since the care of the insane has so much improved. It has really become quite popular now, since we have got such nice hospitals, to have insanity in the family. [Laughter.] It is really no disgrace; it is a disease of the mind, and there are more persons permanently cured of insanity than of broken limbs. If the accidents of broken limbs were to be numbered, and only those finally cured were to be recorded as recovered, it would make a very poor showing. If the limb is amputated it will not grow on, while without that they get well. People have been taken out of their hiding places of late years and sent to the asylums; I know of a dozen cases of this kind in our section of the country.

Dr. Hort: In New York the ratio of insane to the population has about doubled within the past twelve years. This is doubtless due in part, to an actual increase in the number of new cases, incident to the financial embarrassment of the country during that

period, and the attendant privations and hardships among the poor. The increase, however, is mainly of the chronic class of insane, of which at present we have an undue proportion.

Twelve years ago the chronic insane of New York were generally held in poorhouses and poorhouse asylums without intelligent supervision, medical oversight, or proper care. The mortality among this class then, was exceedingly great, the average duration of life being only about eight or ten years; whereas, now, under the improved methods of treatment and care in State and county asylums, the average duration of life has been greatly prolonged, probably reaching fully eighteen years. Hence we have a large accumulation of this class of insane, which serves for the time being, greatly to swell the ratio of insane to the population.

What is true in New York in this respect, probably holds largely true in other, the older States especially. In all of these States, there is a pressing demand for provision for the chronic insane. As it is probable that the average duration of the life of this class cannot be prolonged much beyond eighteen years, unless we have an increase in the number of recent cases, which does not seem probable under the present favorable condition of the country, this accumulation must soon cease, and consequently the proportion of insane to the population be thereby diminished. It is highly important that we do not overlook this fact in our efforts to secure further accommodations for the insane, otherwise we may create a sentiment that will lead to the erection of buildings for them in excess of the public requirements.

The PRESIDENT (Mr. Lord): I have no doubt the apparent increase of insanity is greater than that which is real. The increase of the insane seems to be very great; and it is disturbing the popular mind, and Legislatures are becoming concerned for fear they will not have money enough to take care of them. If we have doubled in length the lives of the insane by our care, it is creditable to our humanity, even though the statistics show that the community is sustaining greater burdens on that account. The statistical reports of the number of insane cases for any given time, within the last ten years, will not cover one-half of them; and if you look into your census tables to discover the number of idiots you will not discover a third part of them; the reason is, families are reluctant to report these cases, as well as cases of idiocy. So that by extending the lives of insane persons from ten years to eighteen

years, as a matter of fact we just about double the number, without there being any actual increase. Yet there may be an increase. There is now a greater strain of the mental fibre than ever before, and a greater breakage of the fabric. If we could do away with our newspapers, and have no revival meetings, and go back to those remote times of primitive habits, from which we have departed, and on which we think we have improved,-as we should approach them in the dim past, no doubt the ratio of insanity would rapidly decrease. This mental strain will increase insanity rapidly, but not with the same ratio that appears; as has been abundantly explained by Dr. Hoyt, Dr. Wilbur, Mr. Wines and Mr. Sanborn.

PUBLIC BUILDINGS FOR THE DEPENDENT CLASSES.

I. REPORT OF THE COMMITTEE.

READ BY R. BRINKERHOFF, CHAIRMAN.

(Friday, July 2, 1880.)

Your Committee on "Public Buildings for the Dependent Classes" have not deemed it advisable to present an extended report on the general subject submitted to them, believing that the time. allotted could be better occupied with the papers prepared upon special subjects, by members of the Committee, and by discussion of the general topics thus introduced.

We present, therefore, for consideration and discussion:

1. The subject of economy in the construction of public buildings for charitable or correctional uses, to be introduced by a paper on "The Construction of Hospitals for Insane Paupers," by Dr. Walter Channing, of Massachusetts.

The conviction has become very general, and we may say almost universal, that entirely too much money has been expended upon these structures, and it is very evident that there must be a large curtailment in the future, if we are to provide the necessary accommodations for our dependent and defective classes. This extravagance in construction is, perhaps, most conspicuous in our insane asylums, and therefore Dr. Channing's paper is especially pertinent.

As a practical demonstration of what can be done in this direc

tion without loss of comfort or convenience, there is at present, probably, no better example than the Willard Asylum in New York, where substantial fire-proof brick buildings have been erected, with accommodations in each for 250 patients, at the moderate cost of $85,000, or $340 per capita.

2. "Taste and Utility in Architecture," to be introduced by a paper entitled "Taste and Recreation regarded in the Construction and Arrangement of Buildings for Charity," by Rt. Rev. George D. Gillespie, of Michigan.

The extravagance in construction and decoration, without regard to use or utility, so often perpetrated in our public buildings, is not only an inexcusable waste of public money, but it is a flagrant violation of every principle of good taste. The average architect does not seem to have the slightest conception of the grotesque incongruity of erecting a poorhouse on the plan of a city hotel, or a jail in imitation of a Greek temple. The tendency to these ornate monstrosities is a growing evil which ought to be rebuked, and, if possible, corrected. We consider, therefore, that the topic of taste and utility in architecture is timely and pertinent, and merits discussion.

3. The subject of Ventilation in our public buildings is second to none in importance, and yet it is usually the very last thing considered in their construction, and very often is not considered at all. We are gratified, therefore, to be able to introduce the subject with a Paper carefully prepared by the Hon. John P. Early, of Indiana.

For the Committee,

R. BRINKERHOFF, Chairman.

II. THE CONSTRUCTION OF HOSPITALS FOR INSANE PAUPERS.

BY WALTER CHANNING, M. D., BROOKLINE, MASS.

Owing to a combination of circumstances, the standard of insane hospital construction has rapidly risen during the last few years. Perhaps with a worthy desire to do enough for the insane too much has at last been done; we are now, at any rate, called on to deplore the needless expenditure of large sums of money on insane hospitals. As a consequence of this extravagance a climax has been reached, and the reaction which is now beginning