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tees, therefore, unhesitatingly recommend an appropriation adequate to the early completion and furnishing of the entire institution.
The law organizing the Asylum recognizes three classes of patients. First, those admitted upon the orders of superin. tendents of the poor; second, those in indigent circumstances, who are received upon orders granted by judges of probate; and, third, private patients, supported by friends or by their own estate. The expenses of the first and second classes are borne by the counties whence they come, at a weekly charge of $2 50. To the third class, patients supported at pri. vate expense, charges vary from $300 per week upward, according to the circumstances of the case, and the amount of extra attention desired or required. In our last report, it is remarked: “Under this system, the State provides for its citizens an institution properly officered, and the current expenses are borne by those directly receiving its benefits. In regard to this organization, we can only say that it has worked very advantageously in similar institutions of other States in which it has been adopted, and that we discover no inconvenience in its operations here. Its justice is apparent. Those who are able to bear their own expense, do so; and the benefits of the Institution are enjoyed without charge by the poor and indigent, through the counties of which they are respectively residents, and its officers, are very properly made the judges of their claims for gratuitous consideration."
It was suggested that this system of support was not adaptable to an Asylum in this State: that the Institution, as in a few other States, should be free, open to rich and poor alike, with. out charge; and that the bills for the support of patients would not be promptly paid either by countie's or individuals. The difficulties referred to have not been experienced. It is true that in a very few instances there has been a little delay in payment, but never to a degree to cause the least embarrassment, and the business relations of the county officers and
patrons of the Institution with our treasurer, have been aniformly pleasant. Thus far, nothing has occurred to lead to a wish on our part for a change in the organization, and it has uniformly met with the entire approval of all county officers from whom an expression of opinion has been received.
In the very interesting report of ļhe trustees of the Pennsylvania State Lunatic Hospital, at Harrisburgh, we find the subjoined paragraph, which presents the experience upon this point of a most successfully conducted institution. This hospital, which has been in operation about twelve years, is, we believe, finished in all its parts, and provides for two hundred and eighty patients. “The price of board for all those who are supported at the public charge, is two dollars and fifty cents a week. For private patients, or those supported by themselves or friends, the price varies from three to ten dollars, according to the trouble and expense incurred, and according to their ability to pay. When patients are sent by the county or township authorities, payment is required at the time of admission for twenty-six weeks in advance, and quarterly afterwards. When the patient is supported by friends, payments are re quired quarterly in advance.” In this Asylum, the rates of charges are the same; payments, however, are required to be made quarterly, but in advance only from private patients. The trustees remark:
.“ In the first establishment of this bospital, it became a subject of interesting discussion with the friends of the insane and the Goveroment, to decide in what manner it should be supported. After a thorough examination of the systems adopted by other States, and the wants of our own citizens, with the desire to give the widest degree of usefulness to the institution, it was determined, with unanimity, to place the rate of board so low as to prevent any reasonable objection being made by those in bumble circumstances, who could pay for their friead«. 'I by counties and townships which were responsible for their poor, to sending them to the institution. Eleven years experience gives no reason to doubt the wisdom of this decision. It was known that this system must render necessary a considerable annual appropriation by the State, to meet the deficiency which was sure to result from the rate of board being placed so much below the actual cost of support; and the liberality and promptness with which these appropriations have been made by succeo
sive Legislatures, is the most conclusive proof of their regarding the system as subserving the best interests of the whole community, without being oppressive to any one. It bas unquestionably enabled many families in very moderate circumstances to partake of the benefits of the hospital, who could not otherwise have done so, and bas induced distant counties and townships, with thinly settled populations—to whom a bigb rate would bave been onerous—to place their poor in creditable accommodations, instead of keeping them in a condition of wretchedness, suffering and exposure, unworthy of the age or the good name of our commonwealth. The amount required, in successive years, to make up the deficiency of income arising from the low rate of board, and to provide means for keeping the buildings and fixtures in proper repair, is so small in comparison with the benefits attained, that it is believed no tax-payer could well object to contributing the small pittance that would be his share of the moderate sum anoually appropriated.”
As far as this system of support is concerned, the only difficulties experienced in its operation in this Institution are those which have arisen through the insufficiency of our accommodations. The number of private patients seeking admission is large, and, while able to provide for them, the revenue of the Institution was adequate to its support, although less than one half of the building was in use. During the fall of 1861, applications for the admission of patients of the poor and indigent classes multiplied to such an extent as to require the refusal of private patients; this demand increasing, the subsequent removal of selected individuals supported by friends became necessary, whereby the income of the Institution was materially lessened, without any corresponding decrease in its expenditures.
The matter was presented to the Trustees at one of their meetings, and duly considered. It was evident that patients of the poor and indigent classes, for whom application was made by county officers, should continue invariably to have the preference, and that the claims of individuals in such straitened circumstances as to render removal and treatment in the institutions of other States impossible, should be next considered. An increase in the rates of charge would have obviated the difficulty as far as the deficiency in revenue was concerned, but it would have placed the benefits of the Institu
tion beyond the reach of those able and willing to meet the usual charge to persons of limited means, and thus force them to retain their friends at home, or to throw them upon the counties, to the serious prejudice both of public and private interests. Although empowered by the act of organization to make such modifications in charge as might from time to time be demanded, the Trustees were of the opinion that the increased expenses of the Institution, incident in part to the effects of the war upon the prices of labor and provisions, but more particolarly to the enhanced cost of maintenance growing out of the unfinished condition of the building, and the inadequacy of its accommodations, should be distributed as equally as possible. To this end they decided to make no change in the rates charged either to private individuals or counties, and to carry the deficit to the close of the biennial period, and ask of the Legislature an appropriation sufficient to meet it. The deficiency referred to is $2,200. Should the views of the Trustees in reference to this subject be concurred in by the Legislature, a further appro priation of at least $2,000 would be required to meet the anticipated deficiency for the next biennial period. Without such provision the burden must principally fall upon those not well able to bear it.
In this connection, a remark or two in reference to the expenses of maintenance in such establishments, will not be deemed inappropriate. The diet required for the insane is that classed in the hospital dietary as "generous" or "full," in order to arrest the tendency to deterioration, physical as well as mental, which is so marked, especially in the recent and more violent forms of disease. The number requiring special dket must vary with the varying condition of the general health of the inmates and the proportion of acute cases. The average in this Institution, during the past year, is 32 per cent. The cost of fuel is another important item of expenditure. Large numbers of individuals are congregated together in apartments kept in constant use both night and day. They cannot be removed from one part of the building to another, to give opportunity for frequent purification; and in wards occupied by certain classes of patients, the sources of impurity are of such a nature that, at first thought, the idea of absolute cleanliness and purity of atmosphere would seem preposterous. The supply of fresh air must consequently be very liberal, and in computing it, the space actually warmed is but one item in the calculation. It is necessary first to know how frequently the health of the inmates requires that the atmosphere of the ward be changed, and the extent of radiating surface for warming must be proportioned, not to the cubic capacity of the wards, but to the quantity of air necessary to effect these changes. Hence the uniform failure, in such institutions, of all systems of ventilation depending upon the spontaneous movements of warm air currents, and possessing no adequate means for the withdrawal of foul air, to the same extent and simultaneously with the admission of fresh. Frequent bathing must be em. ployed as a hygienic measure, and it is often prescribed to allay maniacal excitement. For this purpose, an ample supply of warm water must be ready for use at all hours. For laundry purposes there is also required a large outlay for labor, water and fuel. In many cases it becomes necessary to change the entire clothing of the patient several times each day, and the bedding every morning. The number of pieces washed at the Asylum each week is now about two bundred and fifty dozens. The average weekly cost to each patient for fuel, light and provisions is $1 48, which sum, as a little reflection will show, would be materially reduced were the Institution completed. This result, as well as the evidences of care and thoughtfulness in the details of management found at our repeated visits to the Asylum, attest to the capacity and fidelity of the attendants and assistants.