years is released by her friends, sent on a charity ticket into Minnesota, where she was committed to one of our insane hospitals in less than a week. Such is, or was, our generosity.

What in humanity ought to have been done in these cases? The first and second should have been sent on their way without detention. If an attendant was required, the State should have furnished one. The only justifiable reason for detaining these cases in the State hospital is that their condition is such that they cannot safely travel even with an attendant. The third case, a young girl, a stranger in a strange land, insane probably from homesickness, should be returned to her home. The fourth and fifth are cases of pure imposition, and there is no humanitarian reason why they should not be returned.

We still have in our hospitals persons whose names we do not know. They are probably mourned by their friends as dead. We have restored some cases of this kind to their homes, to the great gratification of their families as well as themselves. There are strong humanitarian as well as financial reasons why this work should be done.

This law, whether in the deportation of paupers, insane or other dependants, must be administered in a spirit of justice. It can be abused. There should be no deportation made except to a place which is clearly the person's legal settlement.

In deporting insane or other cases, the proper delivery of the person is an important matter. If the person has relatives or friends who accept him and concede that to be his home, the work is done. But a certain town may be a person's place of legal settlement, and yet there be no relative or friend who can or will receive him. Under no circumstance is this person to be turned loose or dumped into the community. He must be delivered to the authorities, an information of insanity filed in the proper court, and the evidence as to residence there produced to the satisfaction of the judge or jury. We know of one instance where a man was taken from the hospital of a neighboring State, brought to the city of Minneapolis, and abandoned on the front steps of the court-house with one dollar in his pocket. He has disappeared; and, so far as I know, no one knows what has become of him. These facts I learned from a letter from the man who sent him, and complained because neither the judge of probate nor the sheriff would take the man upon the word

of the attendant, the latter declining to file an information in insanity.

In one case I took a man to a town in Michigan that he claimed to be his home. I was unable to find his friends or any evidence as to his residence; and I brought him back to Minnesota.

In all cases of doubt we keep the man, if he becomes insane in our State; but, if he is sent into our State from another for the purpose of dumping him, we shall see that he is returned and kept there, if it takes the State militia to do it. I hope no one, however, will take advantage of us while our national guard is in the Spanish

war.

The question may be asked, If all States do this work, what will be gained? Will you not get back as many as you send away?

The tide of immigration is toward the West, and therefore Western States will get more from the East than the East does from the West. Again, we all get a still larger number from Europe. It is quite popular in some parts of Europe to send dependent relatives over to America. We have one instance where a father sent his twenty-twoyear-old son to Minnesota in a few weeks after he came out of an insane hospital in Norway; and he went into ours in four weeks after he landed at New York.

It may be well in this connection to call attention to the United States statute on this subject. All immigrants becoming dependent within a year after landing, application being made therefor within. the year, shall be deported by the government. Cases that come under the United States laws-and there are many must be delivered to the immigration office at the port of entry; and the deportation is then at government expense.

There are many of these government cases in all parts of the country, if they were hunted out as they should be. Notwithstanding the United States government inspection, many of these classes get into the country. If they are permitted to remain, they will breed generations of dependants. This winter at Jamestown, North Dakota State hospital, I was shown a mother and four of her grown children, all confined for insanity. The family could have been sent back if there had been some one in that State to hunt up their cases. Now they and their descendants will probably be a burden to North Dakota for all time.

Immigration is not what it once was. In earlier days it took

heroes to undertake the trials and privations hecessary to journey from the old home across the sea and found a new home in a wilderness. It also required some means. We then got good immigrants. We get some now. But, with the ease of the lightning express, the speed and comfort of an ocean greyhound, the seductive smile of the steamship agent, the low cost of transportation, and, above all, the willingness of friends to send us their dependent relatives, we are getting not heroes altogether, but a large class of undesirable dependants.

A union of all the States in this matter will supplement the government law. The sending them back will be a salutary lesson, and have a deterrent effect upon others contemplating sending over their dependants. The time has arrived when the people of this country. should protect themselves against the influx of degenerates from the Old World. We need more efficient national legislation, and we need more vigorous action on the part of both national and State authorities. More than that, we need a union of all our forces for the common end.

VIII.

The Care of the Insane.

REPORT OF THE COMMITTEE ON INSANITY.

BY WILLIAM G. STEARNS, CHAIRMAN,

SUPERINTENDENT ILLINOIS EASTERN HOSPITAL.

The field of insanity is so broad that your committee have thought best not to attempt to deal with it in its entirety, but have decided to call the attention of the Conference to a few of the more salient points that have been considered by this department in its sectional meetings of this week, supplementing the same by a few remarks upon subjects that seem to the committee to be especially worthy of

comment.

In reference to the subject of the commitment of the insane, it is gratifying to note that greater adaptation to needs is being secured. Voluntary commitment, in which lies the possibility of restoration to health of many persons threatened with insanity, is being increasingly used in those States permitting it, and should be adopted in all the States. In New York State the wise action of the Lunacy Commissioners in permitting voluntary commitment to the private institutions for the insane is to be noted as a distinct advance.

From the great number of individuals who need hospital treatment, and who would voluntarily seek admission to our hospitals for the insane, but are in many States debarred by legal enactment, your attention is called to a still greater number of persons positively insane who are debarred admission to our hospitals by family prejudice.

One of the influences that militates most disastrously against the proper treatment of the insane in the earlier stages of the disease, when treatment is most effective, is that popular prejudice born of ignorance, which associates with "lunatic asylum " "lunatic asylum" or "insane

asylum" ideas of loathsome cells, clanking chains, and horrors manifold. This revulsion of feeling has been instilled and inherited through many generations until it has become innate,— a part of our very being.

The patient is wrongfully kept at home until it is no longer possible to care for him, every resource of care and energy on the part of the fond family being exhausted; and in dire distress, as a last resort, recourse is had to the hospital for the insane. At last the patient is transferred from the most unfavorable surroundings to those most favorable for recovery. Our people are ignorant of the modern methods of nursing and treatment of the insane.

We should lose no opportunity to present to the public through social converse, the platform, and the press, in every possible way, such information as will dispel these popular delusions, that will inculcate the fact that the insane man the crazy man - is suffering from a disease that demands as prompt and efficient treatment as does typhoid fever, blotting out the idea that the hospital for the insane is a chamber of horrors and making known the fact that the treatment of the insane can nowhere else be so efficiently administered.

The removal from our hospitals for the insane of those classes whose moral and mental instability and unsoundness make their presence inimical to the best care and treatment of the insane, and the caring for them in separate institutions built and managed with especial reference to their needs, cannot be too highly commended.

With reference to the medical treatment of the insane, one of the most encouraging features is the gradual breaking down of the dividing line between general diseases and mental diseases.

We note with great satisfaction that those immediately in charge of hospitals for the care and treatment of the insane are making use of the great mass of facts supplied by the various departments of special investigation, and are insisting upon the completest possible knowledge of the patients placed in their charge,— such knowledge as can be gained from: (1) careful collection of the patient's history before admission; (2) thorough physical and mental examination; (3) collateral data from the various laboratories; (4) post-mortem examination.

It is a cause of congratulation that psychiatry is more and more laying tribute to all the sciences that can render any possible assistance in the study of mind.