and sink slowly into incurable dementia. Other cases are marked from the outset by the stigmata of chronicity, being slow and insidious in development, and the disease is often fully established before the patient's friends awake to a realization of the event. These chronic classes of the insane require a specialized treatment, a home where they can be protected from the world and from themselves, where congenial occupation may be obtained, where a strict but humanely enforced control may be exercised over their conduct and where their lives may be lived in comfort and in peace. Until recent years all classes of insane have been cared for in large institutions where proper classification has been difficult or impossible and where the acute and curable cases have been in daily contact with the incurable and the demented.
Of late much effort has been made to overcome this objectionable state of thing by the establishment of colonies, where the chronic insane may live in small separated cottages scattered in groups over a large tract of land. Here the patients live in small groups or families under conditions more approximating home surroundings. The farm and industrial shops furnish the occupation so necessary to relieve the monotony of life and to counteract abnormal tendencies. The little colony has its chapel and amusement hall, sometimes a store, and furnishes an environment in which a man may live in comparative comfort and with a reasonable degree of contentment. Such colonies are now quite numerous in Europe and America and seem to furnish ideal conditions for the care of the chronic and presumably incurable cases. In Scotland, Germany, Belgium, and to a limited extent in Massachusetts, a system is in operation with a fair degree of success in which selected chronic cases are boarded out in private families in the country districts while under the observation and control of a governmental bureau or commission.
It is unfortunately a fact that many of the chronic insane are still detained in almshouses and poor farms not only in this country but abroad. Here they, who are the unfortunate victims of disease and not to be held responsible for their condition, are obliged to associate with paupers and criminals and are kept in a condition unworthy of the civilization of the twentieth century. The cruelty of a past age still lingers in many of these places, and not only do they suffer from the stigma of their associations, but are too often the victims of improper and insufficient attendance and are not strangers to bonds and chains.
But the grand work of emancipation is still going on, and enlightened public sentiment is everywhere at work and the realization of a fuller charity is surely not long to be delayed. At the beginning of the twentieth century we are on the threshold of a new era in the working out of this great problem, and the scientific and philanthropic spirits of the day are laboring together and energetically toward its ultimate solution.
