Evening public ledger. [volume] (Philadelphia [Pa.]) 1914-1942, 1916-06-20
STATE CARE OF INSANE
the Editor Of Euentng Ledger:


Slrr,It Is certain that one of the issues
which will cause most discussion at the
next session of the Legislature will be the
proposed abandonment of county insane
asylums and the establishment of State
care for all the INDECENT insane.
Not only because OF the immense sum
of money nVolved--about $3,000,000 Il year
but because of the many interests affect
ed by any change in the distribution of the
States charity fund, this question will be
of wide public interest. 1t will directly
affect 90 important counties that now have
insane asylums.
Because the experience of Pennsylvania
has shown that individual counties or
municipalities cannot be relied upon to
care properly for their own insane, Dr,
John A. Llchty, of Pittsburgh, a member of
the State Board of Public Charities and
of its Committee on Lunacy has come out
strongly for the abandonment of the present
county hospitals and the adoption of the
policy of State care for all the dependent
insane, in institutions owned and controlled
by the State.
DR.. Lichty has aroused the keenest inter-
est in official circles throughout the State
bv his UNQUALIFIED Endorsement of this plan,
in view of the fact that the State Board will
shortly make a detailed report upon the
same subject to Governor Brumbaugh, His
paper was first presented at n regular
meeting of the board in March, when the
board voted to distribute thousand copies
of 1t. Later II was incorporated in n report
of the semlannual meeting of the Asso-
citation of Trustees and Superintendents of
State and Incorporated Hospitals for the
Insane and Feeble-Minded of Pennsylvania
held in Philadelphia last October, which has
just been published, reprint of DR.
Lichty's paper and of one read at the
Philadelphia meeting by Robert d. Dripps
executive secretary Of the Public Charities
Association of Pennsylvania, on the same
subject Is also being distributed widely by
the latter association.
DR.. Llchty calls attention to the undisput-
ed fact that the custodial care and scien-
tific treatment accorded TO the insane in
State institutions Is incomparably better
than that given to the inmates of most of
the county and municipal asylums. This,
he SAYS Is partly because few of the indi-
viduaI counties have a large enough number
of insane patients TO warrant them in pro-
yIdIng the elaborate and relatively expensive
equipment, the large number of physicians,
nurses and attendants, the special medical
and other facilities for the proper treatment
Of the insane, the opportunities and facilities
for recreation, re-education and occupation,
all now regarded as essential for improving
the mental and physical condition of such
unfortunates
Every institution caring for the insane,
says DR.. Llchty, should have at least these
three essentials;
First A high-grade, thoroughly trained
Dhysician as superintendent surrounded
by a staff of competent experts and as
sistants. who are making psychiatry their
life work This Is usually impossible, he
saws, in a county institution under the con-
troll Of a poor board that changes with the
change OF party supremacy and which Is
too often willing, for the sake of record
politically satisfactory, to economlze at the
expense of efficiency
Second well equipped laboratory,
where clinical examinations of all sorts can
he made This Is the more necessary, he
insists, because 80 per cent. of all cases
of insanity coming under observation be-
fore middle life cannot be traced 10 a
definite change of the brain structure. but
seem 10 be due rather to perverted func-
lions of other organs of the body which can
and should be Investigated in laboratories.
only Two of the county hospitals have such
laboratories -,,,.,--- =.
the insan ne such as adequate equipment and
nersonnel for hydrOtherapeutie treatment,
serum treatment oeeupational instruction
ana Employment. This sort Of thing is apt
10 he lacking in county Institutions, or to
he used 50 unintelligently as to be Of little
value 10 the patient.
Furthermore. he says that since the per
eapita cost, under proper administration,
for the maintenance Of patients Is lower IN
Institutions having q population Of from
1900 10 1900. It follows that only State insti-
hitions can provide the best possible basis
for wise economy
Doctor I1chty advises the following plan