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(h) a wife with minor children, working several years prior to death of husband, and supporting the entire family.

(i) a wife and minor children, latter cared for by relatives while mother went out working, even during the lifetime of husband.

(j) a wife and children, family with independent means and in comfortable circumstances.

(k) a wife and minor children, recipients of a pension, father having been a citizen.

(1) a wife in a state hospital and children all adults. (m) a wife and children in Europe.

A

(d) Status of Family Following Death of Wife. consideration of the cases in which the mother of the family died would quite naturally be expected to indicate fewer instances in which financial aid or assistance was needed, but other forms of social service had to be called upon to meet the emergency created through the death of the mother of minor children. The analysis of the deaths among married females shows that they might be classified as follows from the point of view of social need discovered in the families:

(a) minor children cared for by relatives other than the father.

(b) husband being cared for by adult children, patient having died at an advanced age leaving no depend

ents.

(c) husband boarding out the minor children.

(d) husband committing children to an orphan asylum. (e) husband alone remaining; childless marriage. (f) husband unable properly to care for children during illness of wife, and children placed with relatives. (g) husband in army when wife died; children placed with relatives by Home Service Section, American Red Cross.

It is of course realized that the instances above enumerated in regard to both the male and the female married patients dying in the institutions do not exhaust the list of possible circumstances in which the families might have been left, but they do represent the actual conditions in which a number of families were found. The groups under study are particularly interesting from the social point of view because they represent almost entirely persons of wageearning families and very few, if any, of large or comparatively large business or other holdings.

VI. SOCIAL PROBLEMS FOLLOWING DEATH OF MARRIED PATIENTS

Attention has already been paid to the desirability as well as to the necessity of considering the patients from the point of view of their place in a given family, if constructive work is to be done for the patients as well as for those related to them by ties of blood. This particular part of the discussion deals with patients who have passed beyond all possible aid and relief, and have left behind them heritages which are not always social assets. In his volume on the Psychic Treatment of Nervous Disorders,1 Dr. Dubois states that in the treatment of such ailments, it is essential not to confine one's therapeutic effort to the patients alone, but to extend it to those who live with them. The family must be considered as the ultimate unit of our social organization, and any plans for the social treatment of one member of the group must take into consideration the effect of such treatment upon the other members of the family, for the good results of individual treatment often crumble away before the onslaughts of difficult and complex group or

1Dubois, Paul, Psychic Treatment of Nervous Disorders, 1909, p. 44. 2 Devine, Principles of Relief, 1904, p. 77.

family problems. Just as in medicine, so in the field of social science, our patients and their families must be thought of as integral parts of a given whole.

(a) Death of Aged Married Men. Turning to the deaths of husbands and fathers, and the effect of their demise upon the family life and structure, it is quite apparent that family conditions are but slightly affected when a man of advanced years dies, leaving a widow and several adult children. In the instances in which this happened, the children assumed the burden of supporting the entire household, their only task being the support of an aged mother with few and simple wants. The presumption is that the family structure will continue as before the death of the patient, until, through the natural withdrawal of the children to establish new families of their own, it is found advisable to take the widowed mother into the household of one of the children. The death of a man of advanced years, leaving a widow of about the same age but no children, involves problems of a more complex nature than the mere adjustment of family affairs following in the wake of the previous instance. There are three alternatives to choose from; either relatives must support or take into their homes such widows, or they can be aided financially by a relief organization and allowed to board with friends, or provision must be found for them in some home for the aged. None of the wives of the patients considered under this heading found their way into institutions, as they were either taken in by relatives or subsidized by a relief organization.

(b) Care of Dependent Widows and Orphans. Most of the serious social problems following upon the deaths of married men would naturally fall in the families in which there were one or more minor children left to the care of a penniless mother. Analysis has shown that in these cases

relatives in comfortable circumstances sometimes came to the rescue of the family in distress, making all the necessary provision for their sustenance and comfort. It is the proverbial way of caring for such dependents, and self-sacrificing relatives of this calibre are fully deserving of the thanks of the community, even though such service should be looked upon as a duty and an obligation rather than as a favor. The difficulty is, however, that few of the patients admitted to the psychopathic wards of Bellevue Hospital and subsequently to the state hospitals have immediate relatives in a position to assume such serious financial obligations. The result has been that in instances where the deceased was not a citizen and the widow was left with no estate and several minor children, she has had to wend her way to a relief organization for the support of her children and herself, until such time as they became of wage-earning

age.

The effect of sexual disease in the husband upon the sterility of his wife is a well-recognized phenomenon, and it is not surprising therefore that there were a number of childless widows of men dying in the state hospitals, largely with a diagnosis of general paralysis. Wives learning the true mental and physical conditions of their husbands have in many instances left them in order to earn their own livelihoods; or, where the affection of the wife for the husband was not sufficiently destroyed to lead her to desert the sick and suffering man, she has gone out to work as soon as his inability further to support her and himself became apparent.

Fortunately for some of the widows and their halforphaned children, the husbands and fathers had operated and owned some small retail business and it was out of the income from this source that several of the families managed to support themselves, sometimes with the occasional finan

cial assistance of kind friends and relatives. Mental disease often incapacitates persons for a long period of time, with the result that they become unable properly to discharge. their family responsibilities. In a number of cases where there was a combination of a wife and minor children and a husband and father too ill mentally to work regularly, the wife has gone into industry to earn sufficient to keep the family together. She has either left the children at home under the care of a father who suffered from periodic attacks of mental instability and alienation, or has placed them in day nurseries or with friends and relatives until her return from the shop and factory. The inadvisability of permitting such a father to be the guardian of the young children throughout the day is quite obvious, but no agency is as yet prepared to take care of the large number of cases in which this and similar incidents are of almost daily occurrence. This is but another indication of the need of concerted action throughout the community if the problem of the insane and their families is to be solved along empirical and rational lines. At present such family problems are met in the best way known to the immediate relatives and friends, sometimes with the aid of a social agency unacquainted with the special and peculiar problems involved in the adjustment for any long or short period of time, of the dependents of a mentally unbalanced husband and father.

Families in which the father has died in a state hospital leaving a wife and minor children, and also means sufficient to maintain the family in comfort, present few problems needing solution. It has been found however, that often the relatives are in need of advice regarding the probable effect, if any, of insanity in the father upon the children. In instances in which the father died of general paralysis the utility of Wasserman tests performed upon all immediate members of the family is readily apparent, and invariably

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