But the 468 independent patients under care indicate either that the self-sustaining families enjoy a remarkable immunity from mental disease, or, more probably, that but a small proportion of their lunatics are sent to the hospitals and a large proportion retained at their homes. As the self-sustaining families are as anxious that their insane relatives should be restored as the poor, it is worth while to inquire why so many of the latter class and so few of the former are found in the hospitals. The established charge in the state hospitals for private patients is five dollars ($5) a week, and more when circumstances permit. A large proportion of the independent families, in this and all civilized States, earn a comfortable living only, and have no surplus. By diligence and good discipline of economy they have sufficient for all their common wants, and no more. To them the payment of two hundred and sixty dollars a year, for the support of a member in a hospital, is nearly or quite impossible, and certainly a burden painful to be borne, and especially if that diseased member be one of the heads, who creates or administers the income. This class embraces professional men,-especially clergymen and teachers,-small farmers, mechanics, journeymen, small traders, etc., who constitute no small proportion of the people, to whom, or, at least, to many of whom, the state hospitals are practically closed by their inability to pay the appointed charge for board and care.* From the e and other causes, we have, in Massachusetts, about 3,300 lunatics, who are and must be supported at an average expense of three dollars a week, at least, for each, or $514,800 a year for all. Add to this the loss of their earnings, and the whole cost of the burden of insanity approaches a million dollars annually in Massachusetts. Three unmarried sisters sustain themselves and, in great part, their aged parents, by their personal labor; one taught school, one is a book-keeper, and one a saleswoman in a store. Three years ago one of them became insane. They applied to one of the state hospitals for admission, stating their pecuniary condition. They received answer, that the patient could be received for five or ten dollars a week. They could not spare five hundred and sixty dollars a year, nor even two hundred and fifty. They could not call themselves paupers and apply to the overseers of the poor. The patient was not sent. She is now insane for life. Constant Recurrence of Insanity. The causes of insanity are many and various. They inhere in the constitutions of some. They are connected with many physical disorders and forms of vital depression. They grow out of perversions, excesses, abuses of the mental, moral and bodily powers, especially the appetites and lower passions. These vary in different periods, and with different people, yet in any population their united destructive force is about the same from year to year. The number of patients admitted to the hospitals, within any year, may be assumed to represent as many new cases of the disease. For although in the last year, and in the preceding year, many of the lunatics received had been diseased one, two, five, ten and more years, they left behind as many, who will be presented to the hospitals when their maladies shall have been standing as long. Taking thus the annual admissions into the hospitals of Massachusetts as representatives of the number attacked, there was an annual average of 953 new cases in the last six years, or one in 1,508 of our people were stricken down with insanity in each year. The proportions to the population were singularly regular in these six years, 1867 to 1872,-being severally one in 1,546, 1,486, 1,533, 1,350, 1,389 and 1,357. There was a similar regularity through many preceding years. During the war the proportion was less. The opening of each new hospital increased it. What has been will be, in the same conditions, unless our personal habits and exposures and our social customs change. A similar proportion of our people will annually become insane. And unless more effective influences be used to induce their friends to use the proper means of healing, or to draw them into the hospitals in the early and curable stage of their malady, a like proportion will be kept at home until their disease is fixed beyond hope of removal, or deprived entirely of the opportunity of being restored, and be life-long burdens on the body politic. With this experience of the past, with this great and increasing burden on the income and capital of the people, considering how small the cost of restoration and how large the cost of neglect, it is good economy for the State to open its hospitals freely to every lunatic, and even compel every one to use these or other appropriate means for healing, and allow none to remain permanently insane except the small residuum whose mental disorders are, in their nature, incurable. Humanity as well as economy still further demands that the government lend its intelligence and its influence to discover the causes of mental disorder, and to lead the people from those paths of error and those pitfalls that have hitherto destroyed so many among them. |