classified according to Dr. Skae. Later on, that classification was thrown aside, and the last year or two everything has been classified according to Kraepelin. One particular form of insanity to which Dr. Russell referred was " dementia praecox," which was formerly known as acute or primary dementia. It is really the same disease to-day it was twenty years ago, except that it is reclassified. The finest thing, in my opinion, that has been done in this State since the establishment of the Utica State Hospital in 1843 was the establishment of the Bycheatric Institute by Dr. Adolph Meyer, and we look forward with a great deal of hope to what that institute is bound to do in time in the way of discovering the causes of insanity. I must confess that I am somewhat skeptical when it comes to what may be expected of pure pathology in discovering the causes of insanity. I think a combination of the pathologist, the chemist and the clinical pathologist would be an ideal one. Sometimes I doubt whether we can ever carry this investigation on under a State system to the point it will be carried on under some other form for carrying on such work, for it is expensive and it takes time. Certainly, the work Dr. Adolph Meyer is doing is most commendable, and it is a step along the line of progress in the care of the insane. I think, as I said before, that we should pay more attention to the etiology of insanity. I desire to congratulate Dr. Russell again on his paper.

CHAIRMAN HOWARD: If there is no further discussion, we will proceed to the next paper. I take great pleasure in introducing to you a strong man, and a man that we may all be proud of as our assistant in this work, Daniel B. Murphy of Rochester.

DUTIES AND RESPONSIBILITIES OF VISITORS AND MANAGERS OF INSTITUTIONS FOR THE CARE OF THE MENTALLY DEFECTIVE.

In the time allotted me, I can only briefly discuss the main points under the title of this paper. The dominant ideas have been gathered not only from some years of experience, but largely from associates whose years of service in State charitable institutions eminently qualify them to speak.

We are living in an age that is essentially charitable. The beneficent work of alleviating human suffering is not limited to any race, creed or country-all members of society seem to vie

with one another in tender solicitude for their afflicted brethren. In viewing this broad, humane and generous treatment to afflicted humanity, we are deeply impressed to note how universal is the fulfilment of the trite saying relative to the fatherhood of God, and the brotherhood of man. It is a matter of deep gratification that our own great commonwealth ranks foremost among the sisterhood of states in eleemosynary works, but her chief solicitude, however, seems to be for those who are mentally afflicted, and properly so, for mental derangement is among the worst of human afflictions. It is with this class of State wards that I am expected to deal in this paper.

All charity work carried on under entire State control may be broadly divided into two parts. The first includes the State hospital system for the insane, a system that underwent great expansion with the adoption of the State Care Act of 1890, and that has grown to such an extent as to include at this time, fourteen hospital plants widely scattered throughout the State, and which provide for the care of about twenty-six thousand patients. The second includes the fifteen charitable institutions that care for epileptics, idiots, imbeciles, feeble-minded, the reformatory classes, the blind, and the consumptive. The total of these seven classes, now under State care, is approximately eight thousand, so that all told, there are at present not less than thirty-four thousand persons being cared for in the various state institutions. It is in relation to the management, actual and supervisory, financial and general, of these twenty-nine great institutions, that I desire to speak at this time.

From the date of the founding of the first State hospital for the insane, at Utica, more than sixty years ago, down to 1902, these hospitals were under the direct management of local boards of managers, all of whom served without pay, all of whom were representative people in their communities, and all of whom fulfilled their duties to the State with the single purpose of safeguarding the best interests of the dependent sick committed to their care. In 1902, all this was changed. The effective and satisfactory system of non-partisan management of the State hospitals was ruthlessly overthrown, and a dual system of visitation by local members, with actual control from Albany, was installed.

This was brought about by amending the insanity law. Paragraph 31, of this law (Chapter 26, Laws of 1902) provided in part as follows: "The boards of managers of the several State hospitals shall be abolished on the first day of April, 1902, and their powers and duties conferred upon the State Commission in Lunacy, unless otherwise provided by law." The same section further provided: "There shall be a board of visitation for each State hospital, to consist of five members to be appointed by the Governor." The minor functions and duties of these boards of visitors may be omitted, in order that I may speak at once of any real powers they may, or may not have. Their first duty under the law was to visit and inspect each hospital to which they were appointed. They were to make a written report in duplicate to the Governor and to the Commission in Lunacy within ten days after each visitation, these reports to be signed by each member making such visitation. It was made incumbent upon all hospital officers to admit the members of the boards of visitation into all parts of the hospital and of its buildings, and to show them all the property, supplies, books, papers, accounts and writings belonging to the hospital, or pertaining to its business management or government, and to furnish copies, abstracts and reports whenever required by them. With these simple requirements the duties of such visitors terminated. They have no voice, whatever, in the actual management of the institutions. They are permitted to make reports and recommendations upon the needs and managements of the hospital, these reports to be handed over to the Governor or to the State Commission in Lunacy. This leaves it, in the end, absolutely in the hands of either the Governor or the State Commission in Lunacy, to carry out plans for improvements or other changes suggested by the visitors. When this law withdrew from the boards of managers the powers and duties previously held by them, it transferred such duties to the State Commission in Lunacy residing in the Capitol at Albany, and appointed by the Governor, and to the Governor himself! The last statement is the most significant! In transferring the powers and duties formerly held by the boards of managers to the other officials, the Governor of this sovereign State in reality transferred them to himself! I say this, because by scanning closely

the provisions of the act referred to above, it will be noted that the sanction or approval of the Governor is required for about everything of note the Commission in Lunacy may do. If plans for a new building are to be passed upon, they must have the approval of the Governor before the buildings can go up. If sites for new hospitals to meet the pressing demand of the increase of the insane are to be chosen, the site selected must meet with the requirements of the Governor. If medical officers are to be transferred from one hospital to another, as the law provides may be done, such transfers can not be made without the approval of the Governor. If new rules and regulations for hospital management are to be made by the Commission in Lunacy, they must first be approved by the Governor before they can become effective. In all seriousness, I ask, is the Governor of the Empire State of New York, with his vast multitude of other duties, capable of passing intelligently upon every detailed item in connection with the management of a vast and complicated system of charities that it has taken the best and most philanthropic citizens among us years to build up and to understand rightly ? Personally, I fear not. Then, naturally, comes the question : Why this approval and control by the Executive at Albany? Why relieve the local boards, made up of non-political and unselfish men and women, of duties they have always performed to the satisfaction of the people of the State? To this, it seems to me, there can be but one answer, and that is, a desire to place the entire charity system of this great commonwealth alongside of other opportunities that exist at the State capital for furthering political aim and ambition.

There is hope of change in the future, and it springs from the fact that the form of management of the State charities has reached a stage so acute, that the best interests of these institutions recently demanded the careful consideration-anteelection consideration of the candidates who a few days since appealed for the suffrages of the people of the State. "Charities," the official organ of the Charity Organization Society of New York, heads its issue of October 22, 1904, "New York Charities and the Campaign," and on opening it we find direct and positive statements by the two opposing candidates for Governor, of what

they recommend for the charitable institutions of the State in the event of their respective election. Quoting from "Charities," Mr. Higgins, the successful candidate, is made to say by that journal: "I am in favor of reestablishing local boards of managers of the State hospitals for the insane, and of transferring from the State Commission in Lunacy to such local boards, all the administrative powers and responsibilities which they had when abolished, except those which are strictly financial. I would prefer to see the financial responsibility kept where it now is, in the State Commission in Lunacy, which is, I understand, discharging this responsibility very satisfactorily. I would give the local boards power to say how patients should be fed, how they should be clothed, how they should be cared for, and who should feed, clothe and care for them." It is gratifying to note that with the passing of the present State administration, there is a likelihood of local boards of managers being restored to the State institutions, who may, once more, be permitted to serve the wards of the State, not only in a fitting manner, but also judiciously and economically. It is also interesting to note at this time, the recent vote cast in this State for the successful candidates for President and Governor, the latter of whom, only indirectly, was made to represent the existing State administration. A comparison of the votes cast for the respective candidates seems to indicate that substantially 80,000 men stepped outside of party lines to administer an unmistakable rebuke to an administration, that, without warrant or justification, sought to place State institutions under the direction and control of a political machine.

The important problem which it seems now the charities will have to confront later on, will be the financial management of the institution. Every business man knows that he who holds the purse-strings of an institution, or of a business house, or of a corporation, largely controls the effective service of that institution, or business house, or corporation. The great problem in connection with the case in point is this: Can this dual system of management, partly by local boards of managers, and partly by other officials at Albany, hundreds of miles away, serve the best interests of the institutions? Should the financial management