in the humanitarian care of the insane by the State and the recognition of the obligation of the State to these unfortunates. It was designed that the Utica Asylum should receive all the recent cases of insanity. Those who, after a period of treatment, were deemed incurable were to be returned to the county houses, thus making room for all the recent cases. This condition lasted until 1865, when public opinion, shocked and horrified by the treatment in almshouses of the chronic insane, who then numbered 1,300, demanded that these, the most wretched of all God's creatures, should receive at least kindly care. The Willard Asylum was therefore established in 1865 for the care of the chronic insane, who were to be there maintained at the lowest rate conformable with a plain, simple diet and humane care. All the counties were required to send their chronic insane to the Willard Asylum except those which furnished suitable maintenance for them. Twenty counties, largely because of inadequacy of accommodations in State institutions, were accordingly temporarily exempted from the operation of this act. The State, however, continued to build State asylums: at Poughkeepsie in 1870; at Middletown in 1874; at Buffalo in 1880; at Binghamton, the State Inebriate Asylum, first used as a State asylum, in 1879; and the St. Lawrence Asylum in 1890.
The State asylum for insane criminals, formerly at Auburn, now at Matteawan, has not been considered in the following statistics, as the conditions there, on account of the character of the patients, are peculiar to itself and different from the other State hospitals.
The same general principle was carried into effect in their design—that is, the Utica, Poughkeepsie, Buffalo, and Middletown asylums were for the recent cases, while the chronic incurable cases were sent to the Willard and Binghamton asylums. The reason for this was the recognition of the difference in the requirements of these two classes of patients—the acute and the chronic insane. The acute insane are often dangerously sick, and should receive all the strictly medical care and attention which the character of their mental disease demands, the custodial supervision being here entirely secondary and kept as much as possible in the background. The chronic insane are incapable of living at home, and almost no hope of their recovery is entertained. These require custodial care, with incidental medical supervision. Their care is purely a question of sociology, of interest to the philanthropist rather than the physician. The supervising spirit, however, must always be medical, as only a scientifically trained mind can properly appreciate the influence of surroundings on their welfare, and can wisely and humanely classify them as their mental condition gradually changes.
