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has been augmented, in years when the public poor of all classes have so rapidly decreased. To show this I will take only the figures for Massachusetts, since no others are so accessible. We have precise returns, up to the first of the present month, showing the whole number of the poor fully supported at certain dates, and the number among these who were insane; and we have had these returns, more or less complete, for 27 years, or since the 1st of October, 1854, at which time the population of Massachusetts may be taken to have been 1,100,000. The returns for July 1, 1881, when the population of the State could not have been less than 1,800 000, are not yet quite complete, but sufficiently so to be here given. Now, while there were in October, 1854, 5,450 in-door poor, of whom but little more than a thousand were insane, in October, 1864 (the whole number of the poor remaining the same), more than 1,600 of them were insane; in 1874, when the number had increased only to 5,734, about 2,200 of them were insane; and now (in July, 1881), the whole number of in-door poor being about 7,800, the number of those who are insane is upward of 3,000. That is to say, while the whole number of the in-door poor supported in Massachusetts at a given date has increased in 27 years about 40 per cent. (the population in the meantime having increased more than 60 per cent.), the number of the in-door poor who are insane has increased more than 200 per cent. The insane poor now constitute considerably more than a third part of all paupers fully supported, while in 1854 they made but about a fifth part.
Observe now, if you please, the relative proportion of in-door and out-door relief here in Massachusetts (and no doubt the same holds true elsewhere), as affected by the return of prosperity to our people. In 1878, at this mid-summer period, when pauperism is at its lowest point, we had, according to the returns, 7,541 persons fully supported, and 18,056 persons partially supported at a given date; in other words, the cases of out-door relief were considerably more than twice as many as the cases of in-door relief, including the insane. But in July of the present year, the number of in-door cases having risen to 7,800, the cases of out-door relief have fallen to a little more than 11,000, certainly not exceeding 11,500. That is to say, while the in-door cases have increased in number, solely by reason of the accumulation of insanity, the out-door cases have fallen away in three years more than one-third; our population in the interval having been rapidly increasing. Assuming the whole number of our public poor at this time to be 19,000, and our population 1,800,000, the present proportion of paupers to population in Massachusetts is a little less than one in 100; and it is not likely that this proportion is much exceeded anywhere in the United States at this time.
While the number of our Massachusetts poor, especially at this mild season, has been so much diminished, the cost of supporting and relieving them remains about the same, nor can it fall in due
proportion so long as the most costly class among our poor-the insane-are continually accumulating as I have shown that they are. I speak now only of the cost to the tax-payers, for I doubt not that the systematic organization of charity in our Massachusetts cities, in Philadelphia, Buffalo, Cincinnati, and elsewhere has relieved the community from much almsgiving, while it has in some places, rightly enough, increased the public burden. Upon this subject, however, I will leave the field clear for Dr. Cadwalader and his committee in their reports and discussions to-morrow.
BOARDS OF CHARITY AND THEIR WORK.
Without trenching on the reports of the able committee which is to occupy our session this afternoon and evening with the consideration of State charities, I may here observe that no important change has taken place since we met at Cleveland, in the number or the administrative powers of the ten Boards of State Charities which have for some years existed in Massachusetts, New York, Connecticut, Ohio, Rhode Island, Pennsylvania, Illinois, Wisconsin, Michigan and Kansas. The Massachusetts Board, which two years ago was consolidated with the State Board of Health, has found its powers and duties increased thereby; while the New York Board, which has lately had the State Charities Aid Association introduced into its field of labor as a semi-official auxiliary, by special act of the legislature of 1881, will not, as we suppose, find its own powers abridged. A controversy which has been carried on for some time in the State of Pennsylvania, concerning its Board of Public Charities, seems to have had no important result affecting that Board. In Wisconsin, where a new feature has been introduced in the charitable administration of the State, by the creation of a "Board of Control" with paid members to perform all the duties of hospital trustees, reform-school managers, prison commissioners, etc.,-the long-existing Board of Public Charities remains in office, with its powers modified and its opportunities for good apparently increased by the change. It was to this Wisconsin Board, acting in concert with the Illinois Board, that we owed the first suggestion of such a Conference as ours; and I may further say without invidious comparison, that none of these State Boards, present or past, has done its work more thoroughly and judiciously than our colleagues in Wisconsin.
PUBLIC AND PRIVATE CHARITY IN MASSACHUSETTS.
In a long-established community of dense population like the southern States of New England and the seaboard portions of the middle States, the problems of public and private charity cannot fail to be more numerous and more complicated than in a newer State like Wisconsin. Referring once more to Massachusetts alone, our ancient commonwealth, with a population of nearly two millions, averaging nearly 230 to the square mile,-which approaches the density of European populations,—with a greater variety of employments and a more equal mixture of city, village and rustic inhabitants than could be found elsewhere in America, is also so curiously circumstanced, in respect to laws and customs, that it presents nearly every problem found in the social experience of modern Europe, with this great exception, that democratic ideas prevail and have long prevailed very fully here. Moreover, the natural tendency of the Massachusetts people to philanthropy has led to the creation of nearly every class of benevolent institutions,namely, schools for the blind and the deaf, for poor children and for juvenile offenders, asylums for orphans, for the insane, the idiotic, the inebriate; almshouses, public and private charitable societies of every kind; and a more minute classification of the objects of charity than perhaps exists elsewhere. We have two distinct systems of public relief for the poor: one administered by the State in half a dozen establishments, averaging hundreds of inmates; the other administered by 345 cities and towns in 220 poorhouses, averaging each some 20 inmates, but ranging in capacity all the way from the almshouses of Boston and other cities, with their hundreds, to the cottage of some hill-town with only an old couple for tenants, and an occasional vagrant who straggles along and asks for a night's shelter. Besides which, these cities and towns support or aid their poor in some thousands of private families at the public expense; while charitable societies, various in purpose, indefinitely and constantly increasing in number, are giving aid in a hundred ways at the expense of old endowments or of annual contributions.
It was the thought of this great diversity in charitable work, together with the well-earned reputation of Massachusetts for thoroughness and liberality, which, as I suppose, induced the members of the Conference to meet this year in Boston. You desire to see, and we desire to show you, what has been done and is now doing in this community for the relief of suffering humanity and the prevention of some of its worst evils. For this object a week is far too short a time; but what can be done within that limit our good citizens and our benevolent ladies
are ready to do. In their name I bid you welcome, and desire for you that quiet in your deliberations, that activity in your inquiries, and that coöperation in essential principles which will render our meeting fruitful of results. I am requested to invite you to visit freely, at your own convenience, the charitable institutions, prisons, reformatories and other establishments here accessible, and to communicate freely your criticisms, whether of commendation or censure. The business of the Conference has been arranged by the Committee of Arrangements in the general manner which this printed programme sets forth, and it is the purpose of the committee, in accordance with instructions of the last year's Conference, to give full opportunity for discussion, by limiting the number and the length of the papers presented. This matter must be left, however, to the pleasure of the Conference itself, which will not fail to arrange its time wisely, and dispose of the topics before it with due attention to the importance of each.
THE DEBATE ON INSANITY.
Monday Morning, July 25.
The PRESIDENT : In accordance with the notice already given, the Committee of Arrangements have provided for the usual reporting by States, but each State is not bound to report, as a whole, at once. Reports will be called for on special subjects, and the first subject assigned for this morning is Insanity. I see before me Dr. Earle, one of the Massachusetts delegates, than whom no gentleman present has studied this subject longer or has a larger experience. I hope he will favor the Conference with a report. Dr. EARLE, who was not prepared with a written report, spoke, from statistical notes, in substance as follows:
Mr. President: As you are well aware, I have been engaged for the last four or five years in an attempt, in the reports of the Northampton Hospital, to show, as far as possible, the actual curability of the insane who are received into the hospitals. It had become a fact that a very large proportion of the persons who knew or cared anything in regard to the subject, had come to believe that from 75 to 90 per cent. of the insane can be permanently restored to mental health. It is not proposed to discuss the question as a general proposition at this time, but merely to throw a little light upon it by presenting the results of treatment at the State hospitals of Massachusetts during the last completed official year.
At those four institutions, at Worcester, Taunton, Northampton
and Danvers, in the course of the year ending with Sept. 30, 1880, the number of persons admitted was 1092,-persons, or individuals, be it understood, because it not unfrequently happens that one and the same person is admitted more than once in the course of a year. Out of this number of persons and those who were in the said hospitals at the beginning of the year, the number of persons discharged recovered, was 283. This makes the recoveries, calculated on the admissions, the method which approximates most nearly the truth,-equal to 25.91 per cent., or a small fraction more than one-fourth of the whole. Such, then, are the results for one year, at the curative State institutions of Massachusetts. I have here stated them in the way that similar results have always (prior to the year 1880) been reported at the institutions for the insane throughout the United States.
A little more than a year ago the members of the Massachusetts State Board of Health, Lunacy and Charity, having become convinced that by this method of reporting recoveries the true nature of the results is not shown,-inasmuch as a considerable number of the persons recovered have not only, at some previous time or times, been discharged recovered, once or more each, but will probably return again to the hospital, some of them to "recover" again and others to remain there for life,-prepared a set of tables, which were adopted by all the Massachusetts hospitals in their reports for the last official year. Aided by those tables we can, to a certain extent, analyze and compare the statistics, and thereby arrive at conclusions very much nearer the truth than is otherwise possible.
The hospital at Danvers, the newest of the four institutions mentioned, and situated nearest the populous centres of the State, received nearly all the recent cases from Boston during the past year. It also received nearly all from Lynn, Salem, Lowell and Lawrence. But as that hospital has been only a short time in operation, I disregard it in the showing that I am now about to make, and take the three other hospitals, which have been in operation different periods varying from twenty-three to forty-eight years.
Those three older hospitals, Worcester, Taunton and Northampton, admitted, during the official year 1879-80, 521 persons. They discharged, recovered, 118 persons, making a percentage of recoveries of 22.64, a noteworthy fraction less than one-fourth of the number admitted. Hence, even were there no conditions modifying this result, the number of persons returned to the community in mental health was not encouragingly large.
But let us look a little farther. The three hospitals discharged 118 persons recovered; but they admitted 55 persons whom they had previously discharged recovered. Consequently, the actual gain, in the course of the year, of recovered persons in the community was only 118 minus 55, which is 63. This is only 12.09 per cent. of the number of persons admitted, and an average of