and clothed, but there was a lack of medical attention, a lamentable deficiency in the number of attendants, marked evidence of a lack of system and order, an undesirable amount of restraint and seclusion, insufficient facilities for occupation, and a total absence of means of amusement or even exercise. In fact the arguments so frequently heard in favor of local or county care seemed without weight, while the faults appeared to be very great. Even the argument of cheapness did not appear to be very well substantiated, for in any State institution for the chronic insane only it would appear that a much higher grade of care could be given at the same cost.

These criticisms do not apply to the county asylum at Wauwatosa, where the chronic insane from Milwaukee are excellently and inexpensively cared for.

The presence of the mentally defective in prisons, reformatories and penal institutions is becoming more and more a matter of general recognition. No question connected with the study of the criminal is arousing more public interest to-day than that relating to degeneracy and crime. One glance at the inmates of any correctional institution shows many examples of the degenerative type and among them are mingled large numbers of those who are actually insane. The custody of imbeciles, epileptics, paranoiacs, the insane and other defectives, should not be permitted in prisons. Such institutions primarily should be reformatory in their nature for the improvement of the physical condition, the development of the mental faculties and the training of the hand in manual labor. The detention of those who are mentally impaired is as sure to detract from such aims and pur'poses as it would detract from the work accomplished by our public schools were similar persons permitted to enter them as pupils.

The State of New York in 1855 early became the pioneer in providing proper accommodations for the care of the mentally defective under sentence for crime. The first institution was

erected at Auburn, which subsequently became so crowded that a new site was chosen at Matteawan, where a new and greatly enlarged hospital was opened in 1892. Its growth has been rapid, and last November another hospital was opened at Dannemora to provide for the overcrowded conditions at Matteawan. It is proposed at Dannemora to care for male persons who become insane while undergoing sentence for felony, reserving Matteawan for insane female criminals and for cases declared insane by the courts or whose insanity developed in penitentiaries while serving sentence for petty offenses. In view of the character of the acts committed by the criminal insane which are often of the nature of an assault upon the person with intent to do bodily harm, the necessity for such institutions, apart from the general hospital for the insane, becomes apparent. Public sentiment should also require that the inmates of all the penal institutions of the State should undergo a rigid scrutiny to the end that the convicts therein who are possessed of dangerous delusions or who are insane and in need of medical treatment shall be removed therefrom and committed to these hospitals which are provided for their care. The provision of the law requiring the hospitals for the criminal insane to detain in custody all convicts with expired terms who still remain insane and are not reasonably safe to be at large, results in a considerable aggregation of persons who, were it not for the barrier thus provided, would be set free to become an element of danger in the community. The operation of this feature of the law has resulted in there being now detained at Matteawan 232 such persons, and there probably are to-day in the other hospitals of the State over a hundred similar cases transferred to the State hospitals by order of the State Commission in Lunacy, as a measure of relief, in the period during which Matteawan was most overcrowded, thus making a total of over 300 cases.

The results which have been achieved in the State of New York are similar to those which have been accomplished in England.

The conditions there in the care of the insane, led to an experience similar to those found in the State of New York and resulted in the establishment of the Broadmoor Criminal Lunatic Asylum, an institution whose aims and purposes are parallel to those of the Matteawan State Hospital. The States of Michigan, Massachusetts, Illinois and Connecticut have made provisions for the same class of the insane; and the question is actively agitated at present in the State of Pennsylvania and more especially in Ohio where a strong effort is now being made to establish a separate institution for the care of the insane criminal. Whatever reasons exist for the custody of the insane, may all be applied with greater force as arguments for the care and custody of the criminal who is mentally defective. So far as attention is directed to the study of each individual's condition, by so much the existence of mental derangement among criminals will become apparent. The necessity for their continued custody, so long as they are unfit to be at large by reason of their mental derangement, will soon come to be generally acknowledged.

As we have stated, during the height of the overcrowding at Matteawan, the State Commission in Lunacy, to relieve the congestion, transferred to other State hospitals many insane criminals, whose terms of imprisonment had expired but who were still insane and unsafe to be at large. It is possible that some legislation may become necessary in order to return these cases to Matteawan. Moreover, it is desirable that the State hospitals be freed from patients possessed of dangerous tendencies or homicidal impulses, and legislative authority may be asked to enable the transfers of such patients; also some admissions to the State hospitals are found to be members of the criminal class. Others are inclined to be dangerous and to detain them in safe custody requires special measures and gives to the general hospitals for the insane somewhat the atmosphere of a prison. On the other hand the whole tendency of medical treatment and

general management of such institutions are very decidedly toward the greatest extension of personal liberty and the opendoor system. Patients, therefore, who possess a criminal history or who are to be held securely upon a warrant of a criminal court, obstruct progress in the direction of the greater freedom of the person which is considered essential for the best interests of the general class of the insane. As such they require the care and custody of a special institution so long as they are dangerous or detrimental to the interest of the far larger class of the well-disposed insane.

Dr. Frederick Peterson, President of the State Commission in Lunacy, New York, presented a paper on "The Twentieth Century Method of Provision for the Insane."

THE TWENTIETH CENTURY METHOD OF PROVISION FOR THE INSANE.

The gradual process of evolution in methods of caring for the insane may be roughly divided into four periods, viz.:

I. The era of demoniacal exorcism.

II. The chain and dungeon era.

III. The era of asylums for the insane.

IV. The era just begun of psychopathic hospitals for the acutely insane in cities, and colonies for the chronic insane in

the country.

These periods, while distinct in their general outlines, are naturally not demarcated by any sudden break of continuity in the progress from one period to the other. As in all other types of natural evolution, the transition has been slow, gradual and unbroken. It is difficult, therefore, to fix the time limits of these eras by centuries, and yet we may approximate a historical sequence by assigning the era of demoniacal exorcism to the middle ages, the chain and dungeon era to the seventeenth and eighteenth centuries, and the era of special asylums and hos

pitals to the nineteenth century, while we reserve for the twentieth century the distinction of introducing more generally into modern civilization the methods of care we are presently to describe, and which have been sporadically in vogue for the past two or three decades.

It is true that we find here and there some historical evidence of even ancient precedents for our modern methods of care for the insane. There is mention, for instance, of an asylum founded by monks at Jerusalem in the latter part of the fifth century, and even carlier among the Egyptians and Greeks we find indications of the employment of humane methods of treatment of the insane. But in the middle ages no vestiges of these antique customs remained, and the theory of demoniacal possession everywhere prevailed. To the European people of that age the insane were not suffering from disease, but were possessed of devils, requiring exorcism by one or another spiritual or moral agency. These agencies were, in pronounced cases of insanity, torture, scourging, burning and other inhuman and cruel practices. The milder cases of mental disorder were conveyed to the shrines of certain saints reputed to have special skill in the exorcism of evil spirits. One of these shrines, that of St. Dymphna, dating from the seventh century, gave rise to the modern unique colony for the insane at Gheel in Belgium. There were numerous other shrines and holy wells in various parts of Europe which were considered specific for the relief of insanity, such as Lochmanur, Glen-na-Galt, the well of St. Winifred, St. Fillan's wells, and St. Nun's Pool. At St. Nun's the patient was plunged backward into the water and dragged to and fro till the mental excitement abated.

As time went on and these methods of cure proved to be more or less ineffectual, the prisons began to be utilized for the care of disturbed patients who were a menace to society, and they soon harbored, in addition to their criminal population, large numbers of idiots and insane persons. In the prisons they were