repairs. It is to be regretted that such squalid institutions should ever be allowed the custody of the insane even for one moment. In the common diseases to which "flesh is heir" there are knowns in our present state of knowledge, three classes, according to the results of therapeusis: First, those forms of disease whose tendency is to recover without treatment, or in spite of bad treatment; second, those which are incapable of cure by any known methods of treatment; and third, a small number of cases which depend solely on the treatment. If this be true of diseases as seen in every day practice, how much truer must it be of diseases of the mind, where the body's most highly delicate and sensitive organ is implicated; and what hope of benefiting, much less curing these mental diseases, is there to be held out to these suffering ones, especially under such circumstances and in such surroundings as are offered in county poor houses? What are the facts, then, as regards the care and treatment of the insane in these institutions? 1. There is no system of classification as to the kind or degree of mental derangement. The patients are thrust away by themselves into wretched outbuildings, and are herded together as so many beasts of the field-the curable and the incurable, the harmless and the violent; the one by association with the other delaying each other's recuperation and recovery. The filthy are, too, often thrown with the decent, the aged and enfeebled with the young and strong; and if, as a result, a patient is found with a broken limb or blackened eye, no cause for it is assigned and no record is kept! 2. No alienists are connected with these institutions. The patients, while needing constant medical care and attention, are only visited once a week, or month, perhaps, by under-paid physicians, whose salaries, according to the State Board of Health, average less than $300 per annum, and besides these duties they are expected to attend, free of charge, all indigent suppliants who may desire their services. 3. The attendance is insufficient and inexperienced. The number of attendants will average one to every twenty patients in the poor houses; but this does not represent the actual state of affairs, even, for generally the only attendants are the more active and able-bodied paupers who often perform their enforced duties in an unintelligent manner and always grudgingly, because they feel and recognize that the duties are an imposition. The quality of this service should be of a superior order, for most cases require constant care and attention, and this does not apply to the dangerous and destructive cases only, but to the broken down and enfeebled as well. As a consequence of this arrangement but little attention is given to the patients during the day and no supervision at all is exercised at night; for, retiring to their own apartments, which are far removed from this "madding crowd," the attendants wrap the drapery of their couch about them and lie down to pleasant dreams, oblivious of the shrieks and frenzies of these unfortunates, to whose fevered brains "nature's sweet restorer" never comes to soothe and quiet by her gentle wooings. This lack of humanity requires no comment; it is disgraceful beyond palliation! 4. There are no hospital arrangements. Every well-appointed institution for the care of the insane should have proper accommodations for the acutely sick as well as facilities for bathing, together with means of occupation and amusement. In the county poor houses no especial care is given to the sick. It is sufficient excuse for the heartless attendants to know that their patients are under the ban of mental disease, and that their minds are too feeble to take cognizance of the sorrowings or note the lack of attention. They console themselves with the comforting thought that, being insane, the patient can never recover, and they thus preserve a "masterly inactivity," stopping their ears and closing their eyes to the agonies of sorrow and suffering all about them. In the matter of bathing, it is a recognized necessity that there should be an abundant supply of pure water in every asylum where the insane are confined; yet, as a matter of fact, this is a point in the treatment of lunatics in county asylums which is essentially defective. As insane people frequently suffer from ulcerations of the body and other skin affections, cleanliness is imperatively necessary, but, instead, the repulsiveness of the filth too often seen is horrible to look upon. What Superintendent of Health in this audience can say truthfully to-day that he has one single raving lunatic in his county asylum under his charge that is as neat and cleanly as he should be, if comfort and health are to be promoted thereby? 5. There are no proper sleeping accommodations. Insane people require more sleep than persons of healthy minds; but in our county institutions this desideratum is incapable of being realized, first, on account, oftentimes, of the noisy surroundings, and secondly, because of the uncomfortable arrangements for sleeping. The hard bare floor too often suffices, alas! for pillowing the aching head and resting the cramped and tortured limbs; and if there be any beds, these are generally the homes of countless hordes of vermin, and too vile for description. 6. There are no adequate heating facilities. But few counties have devised adequate means for distributing heat in the wards of the insane patients that are confined, and, as a result, some, if not all of them, being ill-nourished, poorly clothed and helpless by reason of physical infirmities and mental weakness to aid themselves, must suffer in the miserable apartments, provided the pangs of an unutterable existence, exposed as they are to the cold blasts of winter's storms and tempests. 7. There is no regular dietary prescribed. The food which these poor wretches are expected to eat is oftentimes abominable, and it is a known fact that a wholesome and nutritious diet is of the greatest importance in the treatment of the insane. Besides, the food furnished is often regulated for those who are well and sick alike by some attendant of the poor house, or perhaps even by the cook of the institution! It is thrust through an opening into the cell, it may be, and left there to be consumed or not, at the will of the babbling maniac or helpless imbecile! Salt pork is allowed once or twice a day, salt mackarel once or twice a month, perhaps, throughout the year, with a little rice or beef occasionally as a toothsome entrée! Despite the fact that farms are attached to most of the poor houses, vegetables are not grown in sufficient quantity or variety to offset this hard diet. The sole object of the Superintendent seems to be to screw down expenses, and thus curry favor with the county commissioners, even if his poor and feeble charges do suffer and starve ! 8. There is no suitable provision for refractory patients. The dominant idea seems to prevail in these institutions that all being alike bereft of reason, all should receive the same routine treatment. However, it sometimes occurs that the more violent have to be more forcibly restrained, and these are either confined in a jail or darkened cell. Restraint is applied at the will of an untrained attend ant when in his judgment it is deemed necessary. This sounds like a tale of feudal times, but it is true, nevertheless. "Does the patient disturb others?" then the mandate goes forth, "narcotize him, or muzzle, or manacle him." If that be impossible, he is very probably removed to the jail building, where others like himself are confined in the various stages of insanity, and where the genius of Pandemonium reigns supreme. There, his sick and fevered brain, haunted before only by his own phantasmagoria, "beholds now materialized the most hideous spectres of his imagination." And it is doubtful, indeed, if any one in wildest delirium has ever seen aught to compare with the waking nightmares experienced in some of these poor house jails. Such, gentlemen, are some of the evils in county asylums as illus trated in some of our poor houses. This picture is not overdrawn, but its every feature and outline is perfect, and is fashioned without an artist's skill from the scenes of real life as portrayed in our county institutions. Here all laws of hygiene are disregarded, and no attempt at proper treatment even undertaken-all are treated alike, and the wild maniac, the unkempt epileptic as well as the chronic incurable, are all subjected to the same condition and surroundings, each constantly a hindrance to the other in improvement and restoration to health. Above all, the greatest sin and crime that can be attached to these institutions, as they now exist, is that acute curable cases, those which under proper and skilled treatment would recover in from three weeks to three months, are here detained until, by association, they are placed beyond the pale of curability. Who among you has ever known a case of insanity, of any kind or degree, to recover after being entrusted to one of these institutions? I ask you, who? To the shame of the State, also, be it known that many insane have been detained in the walls of these asylums for long years, either from ignorance or neglect on the part of the attendants or superintendents, one case in my knowledge languishing in the county institutions for thirteen years before being sent to the asylum for treatment. From the above it is evident, then, that in the asylums already existing, and in the county institutions as at present administered, there are grievous evils. What are these evils? (1) Overcrowding in the State asylums, and (2) as a result, the detention of insane patients in jails and poor houses. How can the first evil, and, as a natural consequence, the second, be explained? Simply and solely because of the State's brutal parsimony in the past in not providing needful buildings for the reception and treatment of its increasing insane population. Is there now only necessity for this step? Let the records speak for themselves. The three existing asylums in this State are capable of treating comfortably and skilfully about 900 patients. To the Western Asylum are assigned 40 counties, and to the North Carolina Asylum, at Raleigh, 56 counties-in this latter division, known as the Eastern Division of the State, there are said to be, according to the last report of the President of the Board of Directors of the Raleigh Asylum, about 1,000 white insane, while the Asylum is only capable of treating, at most, 250 patients. There are, consequently, in this Division alone, four times as many white insane, not to mention the colored, unprovided for as are now cared for by the State in this Asylum; or in this division alone equally as many as are now in all the asylums. It is a fact, too, that in all of the asylums nearly three-fourths of the patients are chronic cases who thus occupy the wards to the exclusion of others who might fill their places and again become producers and taxpayers. From some of these institutions, as a consequence, comes to us the reply with every new application, be it urgent or not, that they are overcrowded, and that our patient must wait, yes, wait and die perhaps; or, what is worse, sink into incurable insanity with its attendant train of living miseries! These are startling facts and must fill every right-thinking citizen's mind with shame as well as anxious thought and enquiry. It shows, beyond all dispute, that the State is not doing her duty towards her helpless insane, and that the largest number of this unfortunate class are now unprovided for, except in the most frugal and parsimonious manner, as proved by the system of county asylums, of which we have spoken. The recent action of the Executive Committee of the North Carolina Insane Asylum in ordering the county officers, according to law, to remove their harmless and incurable insane from that Asylum, will be a telling object lesson to the citizens of this State. It is true that we recognize the justice of such an action by the officials, but it is nevertheless a crying disgrace to our State and its advancing civilization that there was need for such action, and that |