CONFERENCE SERMON.

Sunday, July 11.

The Conference sermon was preached in St. Andrew's Church by Rev. C. R. Henderson, of Chicago University, on Sunday morning (page 352).

SEVENTH SESSION.

Monday morning, July 12.

The Conference was called to order at 9.50 A.M. by the President. The subject for the morning was the Report from States. It was made by Mr. H. H. Hart, the General Secretary (page 362).

General Brinkerhoff announced that the Southern Conference of Charities and Correction would meet in Nashville October 12 to 14, and that the National Prison Congress would meet in Austin, Tex., October 16 to 20,* thus allowing persons to attend both.

The next subject was the report of the Committee on the Care of the Insane and Epileptics, chairman, Dr. H. C. Rutter, manager of Hospital for Epileptics, Gallipolis, Ohio (page 63).

A paper on "The Relation of the Public to the Insane" was read by Dr. Daniel Clark, superintendent Hospital for Insane, Toronto, Ont. (page 83).

A paper on "After-care of Recovered and Convalescent Insane Patients" was read by Dr. Richard Dewey, Wauwatosa, Wis. (page 76).

DISCUSSION.

Miss Jane Addams, Hull House, Chicago, was invited to open the discussion.

Miss ADDAMS.-Living, as I do, in an industrial community, I see a great deal of the insane before they go and after they come back from the hospitals provided by the State. I am constantly impressed with the fact that it is very hard for patients, coming home to get used to not being in an institution. They have to be de-institutionized, which is sure to be a difficult undertaking. As patients they have been accustomed for weeks and months, and perhaps years, to The Prison Congress was afterward deferred till December on account of yellow fever in the

South.

wash, dress, and eat their meals by rule; and it is difficult for them to perform even the ordinary offices of life without direction. The family on their return either go to one extreme or the other. They let the convalescents alone, for fear of hurting their feelings, or they watch and direct them so constantly that the jarred and ill-adjusted mind is bewildered. It would be better if they could go to some house during their convalescence where they could gradually grow accustomed to self-direction, and that would give them gradual detachment from the institution, where self-discipline might be re-established. During 1893 in Chicago, when we were pressed by the hard times, we had not only the poor of Chicago, but a great many people left over from the World's Fair; and we had an alarming number of cases of insanity. We all know that business worry and family cares are not good for mental health and poise; but we remember the words of old George Herbert, "that all griefs are lighter with bread." If, in addition to the struggles as to the present and the fear of the future, one is constantly hungry, and the body breaks down through malnutrition, the chances of insanity are greater. During that winter the number of people sent to asylums was alarming; and, when they came back in six months or a year, the cases were almost as pitiful. For the times continued very hard. I think now of a woman who came out of the asylum, and was returned in three weeks. I do not like to think of her, because, if we had exerted ourselves properly, her return might perhaps have been prevented. It was one of those cases of the family first neglecting her and then overdoing the care. Between the two methods they nagged her back again. Something might be accomplished by careful visiting. If you can make a family feel that the patient is very important, and that you are interested in his recovery, the family insensibly takes the same attitude. But, when no one visits them who takes that point of view, the family grow careless; and the lonely patient is subjected to a heavy strain.

This week I have seen a man who has been dismissed from Kankakee. He has been a merchant, and has always had property; but his business went to pieces, and he is trying all sorts of things. He cannot get hold anywhere. He is completely institutionized. He has lost confidence in himself and in what he does. He is a gentleman, well educated; and he needs something more than a ticket for a lodging-house and the privilege of meals, which he has now. He needs expert care. He needs a place where he belongs, where he may feel that he is surrounded by medical attention and tenderness, which a layman cannot give. I do not believe there is anything in Chicago quite so overlooked as this care of the convalescent insane. I might give you fifty cases, and we are not in the way of coming across them more than other people are. I presume all charity visitors could give the same sort of testimony. It does seem stupid for the State to expend large sums of money upon the cure of insanity, to provide nursing and expert care, and then, for lack of three weeks or a month of

further cherishing during convalescence, to allow the patients to drop back again. The human suffering involved in these cases is very great. The sensitiveness which one always feels after an illness, the sense of alienation from well and strong people, the fear that because you have failed once you are going to fail again, and the curious prejudices which abound, can scarcely be overestimated. There are many good reasons why we should set about making plans for better care of the convalescent insane.

The following resolution was offered by Dr. W. F. Spratling:

Resolved, That the National Conference of Charities and Correction, having had under consideration the subject of the after-care of persons discharged from institutions for the insane, recommends the President of the Conference to appoint a committee of three, whose duty it shall be to report upon a plan for the organization of After-care Associations" at the next annual meeting of the Conference, and to disseminate information regarding after-care work for the insane among the members of this Conference.

Referred to the Business Committee without discussion.

Dr. KEENE. There is a constant stream of degeneracy. Although the process of evolution is upward, the stream of degeneracy seems to be going forward with great volume, and increasing in its momentum. We must spend money and effort to keep it within bounds. We must rouse public sentiment, in order to successfully combat it. Public sentiment is at the basis of public charity, but we are apt to forget that. The stream of degenerates must be kept from coming to our shores. Although we have immigration laws, they cannot be too stringent or too closely enforced. And, again, the degenerate should not be allowed to perpetuate their kind. We should have a revolution in our marriage laws. We are too apt to be afraid of public sentiment. There is no stronger safeguard to an institution than public sentiment. The public must be in touch with our institutions and our charities. It is not sufficient that we look with pride on architectural piles; but we must see that they are constructed without undue expense, and that what is going on inside, within the walls, is grounded on the best thought of the century and in behalf of humanity.

Gen. BRINKERHOFF. I hope that some means will be devised for the after-care of the insane, but I also hope that some means will be found by which patients can be cared for at the threshold of insanity without putting the brand of insanity on them by an official investigation. I think an acute case of mania could be put under the charge of some one without an official condemnation. When the brand of insanity is put on a man, the world scorns him. I have known of some cases that were terrible. I know one instance where one of our superintendents was wise enough, when consulted about

a case of acute mania, to advise the family to send the patient to an institution for the treatment of nervous diseases for three months. He was sent, and was cured before the three months expired; and to-day he is occupying a position worth ten thousand a year. If he had been sent to an insane asylum and discharged, he would never have been trusted in such a position.

Dr. E. A. Down. I heartily indorse all that has been said with regard to the treatment of patients before they reach asylums, but you have got to think of one thing: what are asylums for? They are to keep patients away from private homes. Miss Dix and others have found that, where people take the insane for hire, they are sometimes not well treated. If people know that these patients are subject to recurrent mania, the patients may be subject to abuse in some cases. There is that objection to having them in private care after they are convalescent. The true history of the case must be always given. You can say of a case of acute mania, Perhaps the person will not again become excited; but you cannot predict it with certainty. Heredity has a great deal to do with it. Suppose we send them to these houses: then people will say, What is the use of asylums at all? It will bring the asylums into disrepute. I think we shall have a great deal of trouble in placing insane convalescents in homes, if we are honest. There are sanatoriums where they could be placed, and they are becoming patronized. To these persons of means can go for mania or melancholia. I should heartily indorse anything that would remove the stigma of insanity; but, as to placing persons from institutions in private dwellings, I should there exercise great caution.

Dr. G. W. Cutter, Newport, R.I., offered the following amendment, which without debate was referred to the Business Committee:

Whose duty it shall be to consider the best after-care of discharged patients, also consider by what means persons afflicted with incipient dementia may be cared for without being formally committed to an asylum.

Dr. DEWEY.- In some of the States provision is made for voluntary commitment to institutions for the insane. There will always be that question as between the strict provision of the law as to personal rights and the desire to save a person from being pronounced formally insane. With reference to the feature referred to by the last speaker, I have had in mind a class altogether exceptional, although there are a great many of them. They are exceptional in having no home or friends, no one to take an interest in them, and also exceptional in not being able to step out into the world. The most of the insane who recover do go back, and get started in one way or another; but there are certain ones who never will unless express care is taken of them.

Judge FOLLETT related an incident of a woman who was treated in her home for insanity, and recovered. He favored having home care and treatment by a specialist in nervous diseases, when possible, rather than sending a patient against her will to an asylum. If she could not be cured at home, then was the time to go to the asylum.

A paper on "The Care of Epileptics" was read by Dr. W. P. Spratling (page 69).

DISCUSSION ON EPILEPSY.

Dr. Down. I would like to inquire whether Dr. Spratling employed medical treatment in the case to which he refers.

Dr. SPRATLING.

Medical treatment had been employed fifteen years, but it had had no effect whatever.

Dr. Down. These statistics, to be conclusive, must leave out medical treatment. I think physical exercise is of value to all classes. A test case without medicine would be interesting.

Dr. GEORGE H. KNIGHT, Lakeville, Conn.- I think we could all give records of cases where the convulsive actions have ceased as a result of giving the child occupation, changing the whole bent of the mind. I consider that a large number of cases of epilepsy in early years are nothing more nor less than what we may call habit diseases; and those particular cases are always benefited, and a certain per cent. cured, by giving occupation and proper education.

Dr. F. M. POWELL, Superintendent Iowa Institution for Feebleminded Children.- We have carried a large number of epileptics for many years, during which time I have learned to value labor as a therapeutic agent in the management of epileptics, and therefore can heartily indorse much that has been said on this subject. When I went into this work, it was with the expectation that medication would be the means of curing many cases. I earnestly sought information from all available sources, and made many experiments, but became discouraged with my efforts in that direction; but I recall many cases of boys who were greatly benefited by field labor and other kinds of work that required physical application. Some of them recovered. I remember one great, strong boy who came to us with epilepsy. We could do but little with him in school, he was so rebellious in his disposition; and, to punish him, I put him on the farm, where he went to work with interest, and has almost recovered. The public has but little idea or conception of the number of epileptics there are in the land. Statistics are not accurate on this subject, and do not conclusively show the number that exist. To satisfy myself in regard to the number in Iowa, I corresponded last summer with eight hundred physicians in the State, asking questions as to the number of epileptics they knew or had under their observaI chose two or three physicians from each county only. The