the case even to a limited extent among normal individuals, how much more liable to mental deterioration are persons already adjudged insane and confined in overcrowded hospitals and wards month after month and year upon year.

(b) Attitude of Patients' Relatives toward State Hospitals. Many visits to the homes of relatives of patients committed to state hospitals, even where such relatives have not been directly dependent upon the patients for either total or even partial support, have shown the forcefulness with which the relatives are impressed with the fact that, at least to their way of thinking, well-nigh nothing is being done to hasten the recovery of the persons detained in the hospitals by the state. The result is that the next of kin and friends are constantly insisting upon the discharge to their custody of patients who may be a menace to themselves and to others, and would certainly be a definite burden to keep at home. They feel that they can do more for the afflicted members of their families than the hospitals accomplish.

It is quite useless and of no avail to discuss with these relatives the fact, for instance, that the hospital superintendents and physicians would do more to hasten the improvement of patients if they only had the necessary funds which which to provide better accommodations, or to hire a higher grade of attendants and a larger proportion of trained nurses. It is likewise inadvisable, as a rule, to tell them, even if one always had the heart to do so, that their dear ones are suffering from a form of insanity which has to this day baffled the best minds in the field of psychiatry; and that, as far as one can truthfully say, the patients will probably never be well mentally. The only thing that can be done is to point out to relatives and friends that the doctors and nurses are doing all in their power to hasten the recovery of all patients, and to advise against the attempted withdrawal from the institutions of patients of

known suicidal or homicidal or probable perverted tendencies.

IV. MARRIED, WIDOWED AND DIVORCED PERSONS, WITHOUT DEPENDENTS, REMAINING IN STATE HOSPITALS

As might naturally be expected, there were smaller numbers of married, widowed and divorced persons without dependents detained in the hospitals at the end of one year of institutional residence than there were single persons placed in this category. The statements already made regarding unmarried people apply with equal force to the three groups now being considered. In many instances, the desire to obtain the early discharge of a husband or wife, father or mother, is even more determined. The departure from the home of such a person has in numerous cases resulted in the breaking up of the household and the scattering of the remaining members. As a rule, it is only after prolonged deliberation on the part of immediate relatives that such patients are committed, this usually occurring when it is found that the entire life of the family is disturbed by the peculiar habits and behavior of those who have become mentally ill. Families of very meagre income have put themselves greatly in debt so as to send such persons to high-priced private sanatoria, only to find to their dismay that at the end of a few weeks all the resources are exhausted and the patients very little improved, if improvement there has been. The result has been that these patients are finally committed to a state hospital.

1

V. SOCIAL STATUS OF PATIENTS WHO DIED IN STATE HOS

PITALS

The ratio of the deaths to the total admissions has already

1 Henderson, Charles R., Dependents, Defectives and Delinquents, 1909, p. 184.

been indicated, and the division into sexes has likewise been dwelt upon (Table 24). For purposes of convenience these figures are repeated; of the total of 784 admissions to state hospitals there were 107 deaths during the year, equivalent to a death rate of 13.6 per cent. There were 436 males admitted, of whom 67 or 15.3 per cent died, whereas of the 348 females admitted, 40 or 11.5 per cent died.

(a) Single. A further classification of these patients has shown that of the single persons who died, 17 were males and 9 females. From the point of view of their relation to their next of kin and the bearing such deaths had upon the immediate and future social status of the families of which they were a part, it has been found that these patients fall into five groups. The first group comprises young people who either contributed very little or nothing to the family income, often having been a serious burden and drain upon the financial resources of the family. The untimely deaths of these persons did not in any case seriously affect the status of the family; in some instances the removal of the hopelessly insane was a cause of positive relief in more ways than one. The second group is made up of workers whose loss of income will be felt by the family but not sufficiently to render appeal for financial assistance to a social agency necessary. Such families readily adjusted themselves to the lessened income. In fact, so many of these patients had been ill for varying and prolonged periods of time that while they were periodically engaged in some gainful occupation, nevertheless they represented an economic loss both from the point of view of society as a whole and of their own families in particular. In the third group are classed persons who had no immediate relatives in this country, representing almost altogether recent immigrants whose deaths could not materially affect the social status of their families in other lands. It is, of

Stress

course, realized that families in European as well as other lands often pool their savings in order to help one of the more able members of the group to migrate to “the land of promise," hoping thereby to profit from the increased earnings of such as come to these shores. The question is whether in these cases loss of income and any resultant lowering of the standard of living can be properly gauged, as we presumably can only surmise the effects of the death of adult wage-earners. Furthermore, from the point of view of the problem here in this state and country, these cases are negligible factors, at least insofar as our standards are affected and the welfare of future citizens involved. has already been laid upon the social drain incurred through the loss of efficiency and health as well as of life itself by those who become infected with syphilis and such of their number who eventually develop general paralysis. These constitute the fourth group. Of the single persons dying of this disease, none bore any definite family responsibilities. They were largely individuals who had either become alienated or otherwise separated from their families years before their deaths took place and whose loss was not seriously felt by relatives, except perhaps for the sympathetic reaction exerted upon kith and kin. The last group represents deaths of single persons of advanced years from senile psychosis. Such deaths would naturally be expected to affect the social status of few, if any, persons.

(b) Married. It is interesting to note that married persons dying in the state hospitals contributed 62 out of 107 deaths; of these 41 were males and 21 females. The possible social needs to be uncovered by a careful study of families of wage-earners in which either the father or mother have died would necessitate a discussion in great detail of almost every social agency operating in a community, coupled with an appraisal of the efficiency with which ser

vice has been rendered in the comparatively large number of cases being considered. The purpose of this work being rather to point out the social implications of the problem of insanity as a whole, and not to limit its scope to a study of particular cases only, it is obvious that the aim in view could not be realized within the confines of a single volume unless some necessary limitations were set. And so, instead of considering at length all details of the problems found to be involved in the cases being studied under this heading, it is taken for granted that certain factors are only touched upon and it is left to the reader to follow out in greater detail by reference to standard works on the subject, such particular interests as may be awakened by a perusal of these pages.

(c) Status of Family Following Death of Husband. Analysis of the social histories of the married persons who died in the state hospitals shows that they fall into several classes. Of the males dying there were those who left behind them:

(a) a wife and wage-earning adult children.

(b) a wife of advanced years taken in by relatives or aided by a relief organization.

(c) a wife and minor children, all aided by relatives. (d) a wife and minor children aided by a relief organization as husband and father was not a citizen, thereby disqualifying children from receiving a pension. (e) a wife, childless, living apart from husband the latter part of his lifetime, because of his physical and mental condition.

(f) a wife, with minor children, self-supporting, because of a small business operated by the mother. (g) a wife, childless, working and self-supporting for a number of years prior to death of husband.