publish no separate reports of their insane. I do not question the disposition of the officials to make these asylums cleanly, and give them as much character as is practicable under the plan, but it is the plan that is at fault. This is adopted only in the supposed interest of economy, and the great temptation is to be satisfied with a grade of care and attention below the actual demands of reason and humanity. Besides this, too much is left to the local officials in a case where so important interests are at stake, as the comfort and welfare of these specially suffering and helpless persons. The State should at least provide means to inform the public whether the just demands of humanity are answered, as it does in the case of its own institution. To this end the least that the State should do is to bring these asylums within its official view, and to require its own standard of treatment. I hope, before another meeting of this Conference, it may be possible to report such action in progress. With this I close what I have to report from the State of New Hampshire regarding its insane.

While I am up I wish to say a word on the subject just presented by my friend, Dr. Earle; and it will refer to the question of what cases are entitled to be recorded as recoveries among those who have been treated for more than one attack of insanity. Manifestly the insane person who experiences frequent remissions in course of the disease, without the radical removal of the disease itself, should not figure in reports as a recovery at each remission. On the other hand, I think it equally true that the same person may suffer several attacks of insanity during life and may properly be reported as recovered from each attack. What principle then ought to guide to the proper record to be made in any case? The causes which predispose to insanity may exist, and yet the subject of them may never have an attack; under other circumstances he may have an attack and recover from it; under still other circumstances the symptoms may remit temporarily, but periodically recur, the morbid force producing the recurrence still remaining in the system. The occurrence of several attacks in the same individual diminishes the recuperative power, and, at length, remission only, instead of recovery, takes place. Now the point at which I believe these cases should drop out of the list of recoveries, is where they pass into this last condition. Previously to this I think they may properly be reported as recoveries, being relieved essentially of all but the original predisposing causes, and possessing the power with intelligent care to avoid future attacks. Subsequently, to this stage, those discharged during remissions, I think, are properly recorded as improved. Unless this principle is admitted, we have no settled basis on which to complete the records of recoveries, since each first recovery must have the balance of a life-time to settle the question whether another attack will occur.

It matters little, on the side of institutions and systems of treat

ment, what results are recorded, since one in a series of attacks in the same person demands all the remedial resources required for the only recovery of a life time. But for the uses of Social Science it is important that records of results of treatment should be so kept that no confusion can arise as to the number of persons restored.

The PRESIDENT: We are indebted to Dr. Bancroft for setting before us the condition of things in his own State. I may say that the change in the law, when it shall have taken place, will be due to his efforts more than to those of all other persons combined.

We have before us this morning a special subject on which the Conference will wish to hear something, namely: the treatment of insane women by women. Before introducing that topic, let me beg the Conference not to consider anything in my address as beyond criticism or attack. I do not desire it to be spared. I will now call upon Dr. Cleaves, of the Harrisburg Asylum, to tell us of the treatment of insane women by physicians of their own

sex.

I

Dr. MARGARET A. CLEAVES, of Harrisburg, Pa.: I believe that there is a good deal of work which can be done by women better than by men, because of the mental condition of insane women. may say that my experience has fully justified me in what I have previously written on this topic. I have treated fifty special cases in the hospital during the past ten months, and have never yet missed finding the special trouble, which I indicated in my paper at Chicago, of any patient which I have made a subject of investigation. The results of treatment have been quite satisfactory. In some cases we have had recoveries where it was believed by the male physicians, who knew the patients before I had charge of them, that they would not have recovered under other circumstances. In other persons there has been a marked improvement, due to the special treatment, and which, it is evident, would not have taken place otherwise. But whether the patients improve or not, whether they recover or not, I hold it is the duty of the physician to do all in his power to remove every physical disability. Whatever the results of our work may be this is a duty we owe to all the patients under our care.

My relations with my patients and with the friends of patients, have been exceedingly pleasant and satisfactory. When I was called to Pennsylvania I was surprised to find the public so ready to receive me. I did not expect it. I have little trouble in treating insane women. I believe it is a complaint that women cannot have the control over patients of their own sex that they ought to have. I have never yet experienced this difficulty. Whether this comes from the novelty of the thing or not, I do not know; time only will prove that. Nor have I had trouble with my subordinates.

Our government is different from that of any other hospital in the country. The male physician is physician-in-chief of the male department, and also General Superintendent of the whole hospital, attending as well to the legal admission and discharge of female patients. I have the entire medical control of the female patients, with all that this necessarily involves in such an institution. Our organization is an experiment. It remains to be proved whether it will be a success or not. My experience thus far would not lead me to advise its introduction into hospitals generally; for I believe that all institutions will be better managed if there is but one head. Our effort at Harrisburg has been to preserve, despite our dual organization, the unity of the institution. Dr. Gerhard, the present superintendent, has, by his generous and untiring efforts, contributed largely to this result, and also by his cordial coöperation with me in my work rendered me valuable assistance. His best endeavor has been given to the advance and success of woman's work in the hospital at Harrisburg.

There is, in my opinion, an abundance of work which can be better done, in hospitals, by women than by men; and, in order that this may be done successfully, women should either have entire charge of institutions for women, separate from men, or they should be assistants in hospitals where the superintendent is a male physician. Unfortunately at this time, in most hospitals, women would not be allowed by the superintendent to do the work for their patients that they should do under their superintendents; but with a superintendent who had faith in the propriety and necessity of it, I believe that women would be offered almost every opportunity to do what is necessary for insane women.

There are as yet very few women who are able to do this work. They have not had the education or the experience, and, on the other hand there are now very few (and there always will be comparatively few) good women physicians. Most women will marry and their duties will be at home, in domestic life. If a woman wants to devote herself to the care of insane women, then she must give up all else. Unless women are ready to do this they cannot succeed. I have thought about the matter of separate hospitals for women a good deal lately, and I believe that in this way we shall reach our best success. If we are to have women employed in hospitals for the insane, they will have their best chance to do their work in separate institutions. After a longer lapse of time I shall feel better prepared to say whether my work at Harrisburg or the work of women in hospitals is to be a success. We hope for great things; whether we shall ever obtain our ideal, I know not.

The PRESIDENT: I understand the fact to be, at present, that there are eight hospitals in the country in which women are employed as physicians; in two of them they are either fully in charge of the female patients, or in charge in the manner which Dr. Cleaves has explained with reference to her own State Hospital

at Harrisburg. There is a gentleman present from Wisconsin, who may have nothing to say about the insane there, but who has recently visited a hospital in Canada, which is managed entirely by women, by Sisters of Charity.

COL. BURCHARD, of Wisconsin: Coming to attend this Conference I passed through the city of Montreal. Enquiring for the objects which would interest a stranger, I learned that, among others, there was a hospital for the insane near the city. Being interested in that subject, I resolved to devote a portion of my time to seeing it. I did not learn until I reached the building that it was a private institution. On coming to the door I attempted to turn the handle, (as is our custom in Wisconsin,) to walk in, and was surprised to find it locked; and I was still more surprised to be met by a woman in the garb of a Sister of Charity, and, more than all to be addressed in French! However, I contrived in one way and another, to give her to understand that I desired to learn something about the hospital.

Thereupon I was very politely motioned to the reception room. Very soon the Lady Superior made her appearance, and I entered into conversation with her. She spoke English, and seemed willing to communicate a very considerable portion of the information she had, but I felt in the progress of the conversation that she was reticent on some points. I learned this how ever: the institution is essentially a private hospital, with this exception, that they have a contract with the authorities of the Province of Quebec, to take care of any insane patients that may be sent there, for the astonishing sum of one hundred dollars a year, and that the institution should be subject to governmental inspection. The ground was purchased and the hospital built by the Sisters. Just how large a corporation that includes, I could not understand. I endeavored to find out the actual cost of managing the institution, but in reply I was quietly told that the sum of one hundred dollars given by the government, was quite too little compensation for the Province to pay. The Lady Superior politely invited me to inspect some of the wards, and put me in charge of a Sister, who took me through several. I desired to visit the kitchen, and the apartments where the violent and bad patients were kept, as well as the better wards. My guide did not talk English very well, and I could not seem to make her understand where I wanted to go. We went, however, through several wards, and found them in most excellent order, as you may well believe. This was their day for bathing, and for general renovation throughout the hospital, and all the patients were inside. There were large piazzas opening from the wards, lightly grated, and many patients were there. I did not see any great difference from what I have seen in other hospitals. Some of the wards had common dormitories for sleeping, others had individual rooms. Some of the wards were, as we

should say in Wisconsin, pretty well crowded; others were abundantly roomy. The whole number of patients was seven hundred and sixty. The building was not so extensive as our hospitals in Wisconsin, where the capacity does not exceed five hundred and fifty.

I was shown the kitchen, but in a way that may serve as a hint to people who do not wish visitors in the kitchen. Instead of going to the kitchen proper, amongst the ranges, tables, ovens, cooks, &c., I went in from the upper floor on a platform, where I could look down and see what was going on, but could not talk with the workers. I saw in the wards some pretty hard cases, but nothing to be compared with what we may see in some hospitals. I had another interview with the Lady Superior and said I should like to see some of the bad cases. I learned that it was the custom to keep the noisy and troublesome patients in seclusion. I wanted to see them, but was told that it was against the orders of the physician. By the way, I would say that there is no physician residing on the premises at all. There is one regular physician connected with the hospital, who makes a daily visit. It is seven miles from the city, and the physician resides perhaps a quarter of a mile from the hospital, so that he is within call. I made some enquiry about the matter, and imagine that there is no more restraint than in nearly all other hospitals.

One wonderful thing I did notice, was this: that they have two Sisters in every ward, besides the regular attendants, in the male as well as in the female wards.

The Lady Superior told me, that for some reason or other, all the patients seem to have such supreme respect for the Sisters, that without any force, whatever, they can quiet the most refractory. In the male ward, if two patients get into a scuffle a Sister will step between them and quiet them at once. In five years, no patient has assaulted, or attempted to assault one of the Sisters, This respect shown by the male patients, is something greater than that shown by the female patients; so that, instead of having the female patients under charge of a woman, it becomes a question whether the rule should not be reversed!

Let me make a suggestion about a system which we have very recently adopted in Wisconsin, and from which we hope to have good results. It is, to bring the best medical skill of our entire medical staff, to bear upon each individual patient, men and women alike, and that the superintendent shall thoroughly familiarize himself with every case in the hospital; that the assistant physicians from the male side shall be familiar with the female side, and vice versa, and the physicians shall come together daily, weekly, or semi-weekly as necessity shall require, for general consultation upon all the cases, and especially upon all the hopeful cases in the hospital.