UNIVERSITY OF ILLINOIS LIBRARY Class Book 3(bO IIgZ Volume My 08-1 5M »!Wfwrwsw9ai Return this book on or before the Latest Date stamped below. Theft, mutilation, and underlining of books are reasons for disciplinary action and may result in dismissal from the University University of Illinois Library M 18 Y m 3 i 13W isw L16I— O-1096 NINETEENTH BIENNIAL REPORT OF THE BOARD OF STATE COMMISSIONERS OF PUBLIC CHARITIES OF THE STATE OF ILLINOIS Being a Statistical Record of the Public Charity Service for the Period July 1, 1904 to June 30, 1906. and embrac- mg Reconunendations for the Period July 1, 1906 to June 30, 1908. SPRINGFIELD: Phillips Bros., State Pbintkbs. 1907 c60 119^98 < z UJ X H o X H ^ <-i K s h- •>: UJ «> < Id ^ r < S r aT -^ a .1— H QQ o (5 ^; 1/3 < < > w r. K <■ o p) u_ B P VD a; L 05 s O [i_ fc ORGANIZATION STATE BOARD OF PUBLIC CHARITIES COMMISSIONERS. Appoited by His Excellency Governor Denecn. MISS JULIA C. LATHROP, of Rockford. Term Expires ipo8. DR. JOHN T. McANALLY, of Carbondale. Term Expires ipog. DR. FRANK BILLINGS, of Chicago. Term Expires igio. MRS. CLARA P. BOURLAND. of Peoria. Term Expires ipii. f DR. EMIL G. HIRSCH, of Chicago. Term Expires igi2 OFFICERS. President. . DR. FRAXK BILLINGS, of Chicago. Executive OMcer and Secretary. WILLIAM C. GRAVES, of Springfield. Assistant Secretary. HARRY S. MOORE, of Carrollton. TABLE OF CONTENTS. PAGE. Preface 7-8 PART I. Biennial Report State Board of Public Charities 9 Hospitals for the Insane and Feeble-Minded 10-21 New Institutions 21-25 Complete State care 25-26 Quick treatment for the insane 26-27 Other State charitable institutions 28-29 Semi-Public and Private Institutions 30-31 Superintendent's conferences 31 Civil service 32 Prison industries 32 State Board of Charities 33-34 Appropriations 35-36 Addenda 36-52 Annual Report Almshouse Inspection by Illinois Board of Charities 53-62 History of the Care of the Insane 62-77 Children, Epileptics and Consumptives in Illinois County Almshouses 78-88 Details of Special Inspection of Almshouses 89-130 Physical Inspection of Joliet Penitentiary 131-138 Addenda 138-142 October, 1906 Conference of Superintendents 143-247 December, 1906, Conference of Superintendents 248-312 PART II. Department for the visitation of children. . . .' 313-321 Report of inspection of institutions and societies caring for children 322-336 Report made by institutions and societies caring for children 337-379 Certified orphanages and child saving institutions 380-382 Placement of children in family homes 338 PART III. Official list and statistical tables 384-386 Board of Auxiliary visitors of County Almshouses. 387-390 Superintendents of County Almshouses and their postoffice addresses 391-392 Appropriation accounts for 1905-1906 393-535 Showing statement of expenditures 536-540 Proceedings of eleventh annual meeting of The Illinois Conference of Charities. 541 The program «. , 542-543 First session of the Conference 545 Service in Illinois Charitable Institution 647-554 Charity service in European institutions 554-560 Address by President Butler 560-563 Second sesison of the conference, epileptics and feeble-minded 563-578 Business session 578-579 Third session of the conference ; problems presented at Dunning 579-587 Fourth session of the conference ; civil service ; nursing 558-640 PREFACE. Eighteen months of the two years covered in this biennial report passed during the service of a Board of Charities headed by Dr. Will- iam Jayne of Springfield, as president. The other members were Mr. Ensley Moore of Jacksonville, Mr. A. S. Wright of Woodstock, the Reverend Father Edward A. Kelly of Chicago, and Dr. H. C. Fair- brother of East St. Louis. Colonel J. Mack Tanner was the secretary. The biennial period was ended before all the present Board of Charities appointments were made, and before sustained constructive work could be undertaken. The great part of the statistical matter in this volume developed during the active service of the retiring commissioners. Nearly all the tables were prepared on data collected by the machinery of the former board. The task of preparing recommendations to his excellency, the Gov- ernor, and, through him, to the forty-fifth General Assembly, for the two years ending June 30, 1909, fell to the new board. The material on which such recommendations were based was gathered and put into written form under direction of the present commissioners. The great bulk of this work was done during a period of a little more than six months. In an endeavor to comply with the expressed wish of Governor Deneen, that it indicate any changes needed to make the state charitable service of Illinois the equal of any like public service an)rwhere, the Board of Charities caused surveys and inspections, and reports thereof, to be made by medical, nursing, architectural, sanitary and engineer- ing experts. The reports of these experts indicated that the time was at hand for Illinois to begin a new epoch of advancement in charity administration. The reports were submitted to conferences attended by his Excellency, the Governor, trustees and superintendents of State charitable institutions, the State Architect, members of the Board of Charities and of the Civil Service Commission, and private individuals who freely gave of their time and experience for the public good. The final recommendations of the State Board of Charities were made with the helpful cooperation of those attending these conferences. While . the board makes recommendations looking to greater effi- ciency and greater economy in operating the mechanical equipment of institutions, it leaves the question of business administration for care- ful consideration during the next two years. It asks the General As- sembly for an appropriation to m^ke a detailed study of systems of charity administration in America and abroad, that a comprehensive report and recommendations may be made to the Forty-sixth General Assembly looking to the adoption of such business system as is best adapted to the needs local to Illinois. For the benefit of persons who desire only a condensed statement of the vital policies developed in this lx)ok, attention is called to the first twenty-eight (28) pages. In succeeding pages will be found the details. The recommendation that a new institution replace the old unsani- tary, ill-located prison at Joliet is out of the line of this board's usual service and is treated separately on ])ai;es 131 -142. Ilie in^pectiun and report were made by request of his Excellency, the Governor. This biennial report presents in permanent form various matters gathered from time to time by the State Board of Charities for the in- formation of his Excellency, the Governor ; the members of the Gen- eral Assembly, state department officials, the officials of the several State charitable institutions, State employes of all kinds, and that grow- ing element of the general public which is aggressively interested in public philanthropy. William C. Graves, Executive OMcer and Secretary. PART I. Biennial Report State Board of Public Charities. Humanity and State of Illinois, Office of the Board of State Commissioners OF Public Charities. Springfield, III,, Dec. 14, 1906. To His Excellency, the Honorable Charles S. Deneen, Governor of Illinois, Springfield: Sir — The Board of State Commissioners of Public Chari-i Report sub- ties herewith submits to your Excellency its nineteenth bi- ennial report, for the period July i, 1904, to July i, 1906. The members of this board, appointed on January nth and July 5th, 1906, have canvassed, personally and through agents, the situation in the seventeen institutions in the chari- table group, in private sanitariums, in county jails and alms- houses, and in orphanages; and, by request of your Excel- lency, have inspected the two State penitentiaries and the State reformatory. In addition many children placed in family homes have been visited. In making investigations, in suggesting changes, and in recommending legislative action for improvements requiring such authority, the board has placed above all other consid- erations the safety and the welfare of the sick, dependent, delinquent, and criminal charges of the State. This humane procedure, in many instances, will prove an economic pro- cedure for the State. While the board finds need of certain improvements it desires to commend the excellent system of uniform account- ing in the State charitable institutions, the kindness toward patients and inmates on the part of the responsible heads, the scrupulous neatness of most of the buildings, and the eco- nomical business administration so far as equipment will permit. Natural Grouping of Institutions. The institutions for the care of the classes named may be.^'proypg divided into five groups : 1. State hospitals for the insane and 'feeble-minded 2. All other State charitable institutions. 3. State penitentiaries and reformatories. 4. County almshouses and jails. 5. Semi-public and private institutions. Safety and welfare. Words of commenda- tion. BsMDtial needs covered. Iniform service. Order of discussion. System In vogue. Qualiflca I Because of the great volume of work placed upon it and ithe very brief time at its disposal, since the appointment of its members, less than a year ago, the board has focused its |energies for the most part on institutions caring for the in- isane and feeble-minded. However, imperatively essential Ineeds of all State charitable institutions have been con- sidered. Hospitals for thi-: Insank and Fi;i:ble-Minded. The board has taken the initiative in making suggestions for improvements in the eight institutions in this group. These suggestions have been laid before conferences attended by your Excellency, by the superintendents, and. in some instances, by the trustees of the several hospitals, and by men not in the public service, who have achieved success in their several vocations. The recommendations of the board, .is indorsed at these conferences, have brought about a uniform and improved service, which, if adhered to. must increase in- calculably the efficiency of the public service and thereby give greater benefit to each patient. In discussing the hospitals for the insane and feeble- minded, the following order will be observed, with a few additions which are classified naturally under some of the sub-heads : 1. Medical and business administration. 2. Re-habilitation of buildings and mechanical equip- ment. 3. New institutions. 4. Legislation not included under the three foregoing heads. MEDICAL AND BUSINESS ADMINISTRATION. The following system of medical and business adminis- tration, partly in vogue when this board came into office, has been adopted by the superintendents : 1. Medical superintendent in charge of the entire institution. 2. Assistant physicians, including a clinical assistant. 3. Paid Internes. 4. Superintendent of nurses and a trained nursing and attendant service. 5. Steward or business m.nnager. 6. Hydrotherapeutic treatment for acute hopeful cases of insanity. 7. Industrial re-education for chronic types of in- sanity. MEDICAL SUPERINTENDENT. To carry out this scheme successfully the medical si.pf^r- intendent must be fitted by education and natural endow- ments to manage a large institution. He must be an expert I in his specialty. He must possess initiative and creative, rnnstructivc and administrative abilitv. He must take a II Specialists provided. heart interest in his patients and employes. He mu^t have sound business judgment. He should be well paid for his service. The character of the medical superintendent is the vital element upon which the efficient administration of a State hospital must depend. He should be given a free rein to run his institution so long as he is successful and pro- gressive. ASSISTANT PHYSICIANS. One of the assistant physicians is a gynecologist (an ex- pert in the diseases of women and skilled in the surgery of that class of cases), while among them is always a woman, who may or not be the gynecologist. All physicians must be interested in psychopathology (the nature of mental disorders and the structural havoc they make in the body), and the clinical assistant must be skilled in psychopathologi- cal work. Periodically visits are made by doctors who are specialists in diseases of the eye and ear. The assistant physicians hold frequent staff meetings to compare notes, to report and consult about interesting cases, and to dis- cuss current scientific literature. INTERNE SERVICE. The interne service is provided to relieve assistant physi-j^o"* routine cians of the routine care of cases, to secure histories of cases, ^ and to keep clinical and other records of each patient after admittance. This interne work is essential because the as- sistant physician who does his duty by his patients and keeps abreast of the times, can not undertake the details properly assigned to the internes. Internes are chosen from among the best of newly graduated medical students, who are eager to acquire the benefit of hospital experience before going into private practice. They should be paid small salaries. One should be a dental interne. "By making the public service at- tractive to internes, Illinois can build up a staff of competent men from whom to fill vacancies among assistant physicians and the suncrin Pendents. TRAINING SCHOOL FOR NURSES AND ATTEN1>ANT5. Compulsory training schools to educate nurses and attend- Need of in- ants have been established in six of the eight institutions in the insane group. The pupils are taught by institution phy-j sicians and by experts brought in from the outside. Thej superintendent of nurses and attendants is a woman who hasi graduated from a training school of recognized standing. It is proper that a woman should head this service and direct it. Women have natural aptitude for nursing. Men bave not. Many hospitals for the insane (some in Illinois) have women nurses in charge of all male wards with excellent re- sults. The nurses and attendants come into closer toncli with patients than do physicians. They are the medical' 12 Staff's right arm in this service. The lack of proper training in the nurses and attendants undoubtedly results in imper- fect, often totally erroneous, conceptions of symptoms of mental disease. This misconception leads to the employ- ment of erroneous methods of treatment. The t.aming school crowds unfit employes out of the service. Those who are fit, it trains and prepares for a highly honorable career which pays better in private than in public life. There is i. growing demand for humane, experienced nurses. In the institutions of Illinois the hours of work have been decreased in number and wages have been made more uniform and Ihigher. business details. I STEWARD OR BUSINESS MANAGER. I Relieves :. The hospitals, in adopting a scheme of uniform nomen- tendent of clature of positions of employment, have provided for a :steward, who is the business manager. This official is under ithe authority of the medical superintendent. He is not the independent head of the business administration. His duties are to relieve the medical superintendent of the details of business administration so that the superintendent can de- vote most of his time to the patients and to the study of the mass of scientific material under his very eyes, in the hope that better and more efficient care can be given to the unfortunates the State intrusts to him. One of the new functions of the steward is to select food of the proper kind and quality, to see that it is properly and economically prepared and served to groups of patients ar- ranged so far as possible according to their similarity of ap- petite and food consumption. Usually an eflFort is made to ensure economy in buying food. More care should be ex- ercised to prevent waste in its preparation and consumption. The kitchen usually is the place of greatest needless waste in a public institution. Id charge of diet HYDROTHERAPEUTIC TREATMENT. Healing with water. Hydrotherapy is healing the sick with water. It is in jservice now at Elgin, (part of the equipment having been mstalled) and soon will be at Kankakee. If the General As- sembly looks with favor on certain appropriation requests, jthis treatment will be introduced in every Illinois State in- iStitution caring for the insane. The Board of Charities urges its full employment as a humane and economic meas- ure of proved value. It is of service in many physical ail- ments, but in this report only its use to cure, or palliate, ner- vous and mental diseases will be discussed. Long used flydrothcrapy has been used with marked success for in Etiropp. more than twenty years in Germany, Holland, France, Bel- igium, Italy and Austria. So early as fifteen years ago it 13 ancient remedy. was employed in a then new hospital for the insane in' Athens, Ureece, generally supposed to be a place out of the track of modern scientific progress. It is used to some ex-j tent in England. Mexico recognizes it. | Water as an orthodox remedy has been used from the water an days of Hippocrates "the father of medicine," who was born 468 years before Christ. According to Baruch, "the application of diet and the use of water are really the onlyl remedies that have withstood the test of time." I The private hospitals and sanitariums in America quickly where em- noted the success of this treatment abroad and installed the imerfca." necessary apparatus^nd the public hospitals in time began to adopt it. It is in successful operation now in the United States government hospital for the insane at Washington and in institutions in New York, Massachusetts, Ohio, Mi- chigan and South Dakota. It is to be established on a large scale by the state of New York in a special building to be erected in New York City, at a cost of $250,000.00, although the Manhattan State Hospital for the Insane on Ward's Is-i land, East River, has a hydrotherpeutic plant in operation and intends to amplify it, because of its excellent results. Hydrotherapeutic apparatus is about to be installed in the! Philadelphia City Hospital (Blockley) for the treatment of the insane. Already Cook county, Illinois, has such a plant at the Dunning institution near Chicago. The Board of Charities has letters from alienists express- Letters of ing their views on the value of hydrotherapy. All strongly ^gn°|r®^ favor this form of treatment. As a sample of these letters, the following extract from one written by Dr. William A. White, superintendent of the United 'States governmenti hospital for the insane at Washington, D. C, may be quoted :• "From our experience here I am inclined to the be- Letter from lief that no other therapeutic agent is so valuable in such ^nmei^°^' an institution. We expect by the aid of hydrotherapeutic official, measures to practically do away with all forms of re- straint whatever, either mechanical or chemical. The| most recent statistics on the matter of restraint in oun hospital show only one patient in 900 in mechanical re-i straint, and this low proportioin is especially noteworthy] because of the large proportion of criminals of a dan-' gerous type in our population, and it is due in the main to the wide use of hydrotherapeutic measures." This treatment applies water to patients in various ways Gentle sub- and of various temperatures. Applied to the excited maniac, it soothes him. It takes the place of restraint chains, straps, padlocked cribs and screen rooms. It is a natural and; beneficial substitute for powerful drugs, which leave patients on awakening stupified and weakened. For the wakeful, hydrotherapy induces sleep. For the depressed, it acts as a stimulant, and, if need be, as an irritant. This treatment is of genuine value in every variety of insanity. For mani- acal and delirious patients, who are the most trying in any institution, hydrotherapy is of greater value than any other stitute for restraint M Water- treatment Increases percentagt' of en res. BcoDoniic value to the State. Time for the Stat, to act. Cost of hydro- therapeutii apparatus. treatment known to modern science. The results obtained at the hands of a skilled operator with no detrimental sec- ondary effect, make hydrotherapy in this respect preferable to any other remedy. Where treatment is not given thoroughly in the early stages, only from 5 to 7 per cent of the patients committed to hospitals for the insane, are discharged as cured. Experts state that from 60 to 75 per cent of the acute supposedly cur- able cases could have been cured and returned to a produc- tive life, if they had been treated in the earl\- stages of the disease. From 20 to 30 per cent of the chronic incurable in- sane stood a good chance of cure at the onset of their de- rangement, if they had been given water treatment. When it is considered that the average age of persons com- mitted to hospitals for the insane in the United States is be- tween 30 and 35 years, the age of maximum productive ca- pacity, the necessity for curing as many early cases of mental disorder, as possible, becomes apparent as a purely economic measure. Persons not cured are fixed charges on the public at a cost of about $200.00 a year to the state and county. Some of them are in public institutions more than 40 years. If the insane person is the head of a family often those de- pendent upon his work become charges of the public. As all Illinois State hospitals for the insane are over- crowded, and as the number of cases under public care in this State is increasing at the rate of 317 a year, there is every humane and economic reason for establishing modern treat- ment and for providing means to educate physicians in pri- vate practice to recognize more clearly the danger symp- toms of approaching insanity in their patients as well as for modern treatment in those early stages when the largest per- centage of cures is possible. The plans of this board con- template all of these humane and economical procedures. A satisfactory hydrotherapeutic equipment for the seven hospitals for the insane would cost about $20,000.00. This should be installed in new hospital buildings erected at five institutions for other nurposes as well, which will cost, in- cluding all apparatus, $270,000.00. Chletly for chronic Insane. INDUSTRIAL RF.-EDUCATION AMUSEMENT — RF.CRF..\TION. Employment, recreation and annisement are necessary fac- tors in the medical administration of a hospital for the in- sane. The same elements of life that are necessary for mentally normal persons are necessary for the mentally un- balanced. Employment, recreation and amuse?ncnt should be prescribed by a physician, when patients need them, just as water treatment or medicine is prescribed. From 40 to 70 per cent of ail patients in Illinois hospitals for the insane are physically able to work. These chiefl\- are the chronic insane. Emplovment i«: of great value to them. The incar- 15 Economic value. ceration of these unfortunates in long, dark, inside corridors of the older institutions is inhumane and unnecessary. Many of these persons are the victims of horrible hallucinations and delusions. Employment tends to veil these false mental impressions. It is of medicinal value to give these patients work on the farm, in the garden, in the kitchen and in shops where they can do plain sewing, crocheting, lace making, car- pet weaving, rug weaving, and engage in the manufacture of various supplies consumed at the institution. Domestic service for some time has been performed by patients in the Illinois hospitals for the insane. An encouraging start has been made in teaching other domestic arts, • The chronic insane because of degenerating brain power are able to do very little or no intellectual work, but they are capable of learning the manual arts. In fact this in- dustrial re-education can be carried to such a point of per- fection as to make it possible for many of the patients now charges upon the State to return to the home and find light employment and make enough money to support themselves, or at least aid in their support. Some money is saved the State by not having to purchase supplies made by patients, but the chief value of industrial re-education is medicinal. The monotony of hospital life is unbearable without diver- Amusement sion in addition to work. Therefore patients should be enter tained through games, reading matter, outdoor sports, mov ing pictures, musical instruments, dances, masquerades, etc., etc. Many of these amusements and diversions are now provided in Illinois hospitals for the insane. An aggregate appropriation of $35,000.00 is recommended for special em ployment of the insane and feeble-minded. PHYSICALLY SICK INSANE. Too little attention has been paid in the Illinois hospitals for the insane to patients who were physically sick. Many of the hospital wards and buildings are antiquated, unsanitary and inadequately equipped. The insane, like mentally normal persons, are subject to physical diseases. Some of the pa- tients require segregation and special treatment. Some can be benefited by surgical operations. Every hospital for the in- sane should have a well equipped general hospital for its physically sick, in charge of a trained nursing force. The capacity should be for about 200 patients in each 1,000. In this hospital should be a modern, well equipped operating room. Tuberculosis should be detected at the earliest possible moment and suflFerers therefrom at once be segregated. The Board of Charities has made a census of tuberculosis in the 20 State charitable, penal, and reformatory institutions of Illinois. It shows the presence of 1,123 suspected, curable, and advanced stage consumptives in a total population of 17,- 382, or 6 47-100 per cent. In seven of the institutions there is to break monotony. Need genuine hospital care. Segregation of con- sumptives. i6 segregation of these patients in buildings or tents. The con- sumptives are given outdoor Hfe and are furnished with special food. Thus a double benefit results in that those who are not suffering from consumption are not exposed to the infection of those who have it, and those who are tubercu- lous receive the best treatment known to modern medicine. The board recommends that every institution have separate quarters for its consumptive patients. At the charitable in- istitutions not already treating consumptives separately this can be done in cheaply constructed tents. For the con- sumptives in the penal institutions the board recommends that at one of the penitentiaries a specially constructed building be provided to which all convicts so affected be sent . for treatment. Consumptives ! These recommendations apply to consumptives under de- tention in existing State institutions and do not refer to jthose who would go to the proposed State Sanatorium for : Consumptives. This enterprise will be discussed under the [general head of new institutions. under detention. Reduced to minimum. Dniformlty adopted. I MECHANICAL AND MEDICINAL TREATMENT. I Mechanical restraint has been abolished absolutely in two of the seven Illinois hospitals for the insane. In the others it has been reduced to a minimum. Medicinal restraint has been abolished in one institution. Hydrotherapy will reduce its application still further as unnecessary in many cases. More- over restraint, except in the most harmless form, such as the wet sheet pack, which is a hydrotherapeutic procedure, can be abolished by maintaining a high grade nursing and attend- ant service. This means not merely humane and educated employes, but a sufficient number of them. Mechanical re- straint is as a rule the lazy attendant's friend and is used un- necessarily, but if enough high grade attendants are pro- vided by the State, no insane man or woman need endure the humiliation of being bound nor be provoked to rage by it. MEDICAL RECORDS. The board found the medical records in nearly all tlie hospitals for the insane and other charitable institutions ex- tremely primitive and valueless. Each institution had its own system. The board recommended to the superintendents that a system of uniform, up-to-date medical records be drafted for use in all hospitals for the insane and a system adapted for general hospitals be drafted for institutions having such hospitals, with special provisions for such ser- 'Vice as is peculiarly local. Thorough records are the basis ifor scientific study of the causes of insanity. Our forms for records have been adopted by the superintendents of the hospitals for the insane. 17 PROBLEM OF THE FEEBLE-MINDED. | Several investigations have been made at the Asylum for Feeble-Minded Children, at Lincoln. New methods of medical administration have been introduced, including sur- gery, and a start toward the segregation of consumptives. This place is a hot-bed of tuberculosis. Sixty per cent of the patients either are suspected of having this disease or ac- tually have it in some form. In twenty per cent of the popu- lation the type is pulmonary. The institution is paying too much attention to the book education of feeble-minded children whose aptitude, such as it is, is for manual work. The board recommends the con- struction and equipment of a gymnasium, with play room facilities, at a total cost of $20,000.00, and a larger equip- ment for teaching and practicing the manual arts. With this in view $10,000.00- is recommended for the industrial building. The problem of the feeble-minded calls for consideration by the State of means to prevent the increase of persons in this class. As there is no law in Illinois to prevent a parent or guardian from removing his child from custodial care whenever he may see fit to do so, it follows that many, es- pecially of the higher grade, are thus removed. The greatest menace to the State in the problem of the feeble-minded lies in the freedom allowed to these defectives. In the cases of 126 feeble-minded persons parentage can be traced directly, through either the father or the mother, to former inmates of the institution at Lincoln. While it is the duty of the State to provide protection and scientific treament for the least of its unfortunate wards, legislation to prevent the in- crease of this growing family of dependents would be both wise and merciful. The state of Connecticut, since July 4, 1905, has prohibited by law the marriage of epileptics, im- beciles or feeble-minded persons, when the woman is under 45 years of age. The penalty for violation of this law is imprisonment for not less than three years. In 1901 a bill for the prevention of idiocy by asexualization passed both houses of the Pennsylvania legislature, but, on being re- turned by the Governor for the correction of a technicality, was lost and failed to become a law. A plea urging the pass- age of this bill was signed by celebrated physicians who took the ground that, as the state always must care for feeble- minded defectives, and as heredity plays such an important part in their increase, the state had a right to take measure to prevent their propagation. A committee of physicians has been appointed by the State Board of Charities to take under consideration the ques- tion of State legislation in Illinois for the prevention of idiocy. The Board of Charities recommends to your Ex- cellency careful consideration of this committee's report, -2 P C Hotbed for tubercu- losis. Need more manual training. Legislation to prevent idiocy. Committee to investi- gate and report. i8 Serious proposition Impractical location. Unsatisfac- tory plan. Sick men In prison cells. Fire pro- tection poor. Primitive toilet arrange- ments. Expensive undertal< Ing. Recommend.'' new Inst I tutlon. Cost. Must take women. which will be presented to you as soon as it is received by this board, ASYLUM FOR INSANE CRIMINALS. The Board of Charities believes it will be to the best in- jterest of all concerned to abandon the present structure and jsite of this institution. This board realizes the seriousness of so radical a proposition, but it is equally aware of the use- lessness and hopelessness of an attempt to improve to any extent the existing conditions without expending an amount nearly equal to the cost of a new building. The institution is beautifully located but the site is only eighteen acres in size. The building site proper is on the j slope of a steep hill and is a source of constant expense on 'account of yearly landslides and settlements due to the un- stable character of the subsoil. ; The buildings, with the exception of one wing are of a low grade "ordinary" construction, and are planned and arranged in an unsatisfactory manner. I A great majority of the inmates, who are insane persons iand therefore sick, are confined to cell houses of the com- mon prison type. The cells are without proper ventilation and of insufficient size and air space. The dormitories are abnormally overcrowded, the beds abutting with hardly aisle space to reach them. Twenty inmates are crowded into a room 21x30 feet, only nine feet high, and with only one way of escape in case of emergency, and that through a highly combustible building. There is no proper provision for interior fire fighting ar- rangements and the supply and pressure of water for this purpose is entirely inadequate. No emergency exits and fire escapes are provided. The danger of a calamity in this di- rection is great. The toilet arrangements are of a primitive character, the toilet rooms ill situated, the fixtures antiquated and in bad condition. To correct all these features, to rebuild the structure and remodel the equipment would be an expensive undertaking and at its best would bring about an unsatisfactory condiiton. The Board of Charities., therefore, respectfully recom- mends that a new site be sought, one of sufficient size to al- low for full farm employment of the patients, and that new ibuildings be erected, fitted and arranged in accordance with modern requirements for the treatment of this class of un- fortunates. Well situated and well conditioned land for building and farm purposes can be bought in the immediate neighbor- hood. A site of 118 acres can be purchased for about $14.- 000.00. Modern fireproof buildings, planned to house 300 inmates, would cost $336,000.00. including $80,000.00 main- tenance for two years, total expenditure of $350,000.00. I Recently the Attorney General rendered an opinion in the 'case of a female insane criminal detained at a hospital for 19 the insane, that all insane criminals must be kept at the asy- lum for insane criminals. This means that provision must be made for women. The present institution has no such quarters. Only men are there now. CUT OUT THE NAME "INCURABLE." For obvious reasons the board recommends that the name The Asylum for the Incurable Insane be changed to The Illinois General Hospital for the Insane. RE-HABILITATION OF BUILDINGS AND MECHANICAL EQUIP- MENT. To ascertain the physical condition of the State's property, your Excellency, upon the recommendation of the Board of Charities, directed the State Architect to make a survey. He has reported certain alterations, additions and repairs as necessary for the safety and well being of the patients, and for the operation of the institutions. These changes also assure economies especially in fuel consumption. The report of the State Architect and his consulting engineer showed the imperative need of extensive work. The State, in its old institutions, has not kept abreast of the progress made in architectural and engineering science, just as it has failed to parallel the advancement in medical science. The report of the architect and engineer, embodied in a committee report to this board, is a moderate statement of facts which any one can prc^^^ by investigation. A portion of this report follows : "It was found that the structural parts of the build- ings, old and new, are in as good a condition and repair as can reasonably be expected. It would appear, however, that in the older buildings the fixtures, the equipment and the finish, viz.: the non-structural part of the build- ings have, in some of the institutions, been allowed to run down, are antiquated, obsolete and worn out, so that these features are dangerous and unsanitary in many instances. This is especially true of the plumbing, floors and in the majority of cases of the machinery and electric work. Your committee was unpleasantly impressed by the the fact that with very few exceptions all of the institu- tional buildings, old and new, are of ordinary non-fire- proof construction. This regretable fact would, in view of the number and character of the occupants, necessarily demand the most complete system of fire escapes, exits and fire extinguishing arrangements possible to arrange for. It was found, however, that a most lamentable condi- tion existed in most Institutions regarding this matter. In very few institutions are there sufficient exits and fire escape arrangements or is there, a fire extinguishing sys- tem with a sufficient water supply that would, in case of emergency, answer the purpose and prevent a catastrophe too fearful to think of. Change in Barton- vlUe. Necessary altera- tions, ad- ditions and r^airs. Extracts from report. Antequated, obsolete and worn out. Non-fire proof con- struction 20 Ventilation, unsatisfac- tory. I.ack of efficiency and ecunomy in power plants. Correct vital mat- ters first. Draw on State surplus. Full com- petition possible. Ventilation Basis of computa- tion. While the heating is in the main quite satisfactory the proper ventilation or rooms occupied by many has been either entirely ignored or but ill provided for in all but one institution. In ^'iew of the relative great number and character of the occupants and the purpose of the institutions, it is most essential and imperative that there be furnished at all times an unlimited supply of fresh, clean, warm air, obtainable only by the installation of a power ventilating system. It was found that only in a few of the institutions is there a power plant with an equipment insuring the highest eflBciency and the lowest cost of operation so de- sirable in all larger plants. While it is evident that an immediate remedy of these and other conditions is highly desirable, and in soma instances imperative, the cost of the alterations, recon- struction and re-equipment on the other hand is such that it might impose unjustifiable hardships and burdens on the State. It would seem proper, therefore, that the improvements to be made be undertaken in the order of their importance, that vital matters be corrected at the earliest moment possible, and that features of lesser importance be taken care of at a later period." After careful consultations with your Excellency, the architect and his engineer and the superintendents and their trustees, during which many items were eliminated and others were absorbed into the ordinary funds and the usual special appropriations, the Board of Charities reluctantly cut the figures to a total expenditure of $637,380.00, which is considered imperatively necessary. As the State has a sur- plus, the board recommends that the General Assembly be urged to appropriate this amount as extra specials and that the work involved be contracted for, where it can not be performed by patients, and be rushed to completion at the earliest possible date. The appropriations recommended by the board show in detail those items assigned to the surplus and items for rehabilitation that are cared for in usual special appropriations. The Board of Charities is informed that full cnninetitiMi can be secured on all mechanical devices and equipment re- quired. This board recommends no specific device, special make or patent. It only calls attention to manifest defects and urges that they be corrected by the use of any satisfac- tory apparatus. When the State Architect made his survey he was re- quested to ascertain to what extent the institutions were overcrowded by computing a reasonable standard of air space for each patient under varying conditions. This work has been done, except at the hospital for criminal insane, which is condemned elsewhere in this report. The proper cubic feet air space allowance for one patient in the different rooms, taken on th(> basis of an arbitrary minimum standard ceiling height of ten (10) feet six (6) 21 inches, and allowing for a complete change of air three times an hour, would be, according to the State Architect : Sq. Ft. In day rooms 50 In sleeping rooms 60 In infirmaries 100 Height. Cu. Ft. 10 ft. 6 in. 525 10 ft. 6 in. 630 10 ft. 6 in. 1,050 Extent of over crowding. Surveyed on the basis of the State Architect's table six of the seven Illinois institutions in the same group show over- crowding when each is taken as a whole, to the extent of 1,577 patients or 15 20-100 per cent of the total population, as indicated in the following table : Overcrowding in Institutions Shown by Air Space Measurements. Name of Institution. 3 d p CO 1! : 1 ■ 03 Infirmary shortage A verage air space short- age in cubic f p.ftt c o' a Excess popula- tion over nor- mal breathing capacity Northern Elgin 74 46 101 55 118 101 129 73 436 588 398 475 346 230 136 261 104 260 257 162 1,250 2,242 1,375 1.230 1,826 1.252 1,198 237 Eastern Kankakee 94 382 Cent'l Insane Jacksonville. 140 67 Western Watertown Bartonville. 188 325 127 194 458 Feeble-Minded 111 Southern- Anna 81 128 Totals ... 10,373 1.577 Percentage of excess population ISi^o per cent. The Southern Hospital for the Insane at Anna shows the average excess of 8 cubic feet, but no computations were made on the infirmary basis of 1,050 cubic feet to each pa- tient. The State Architect in a note says : "The sick pa- tients at Anna are gathered together as much as possible; no separate wings or buildings are used as infirmaries." NEW "institutions. STATE PSYCHOPATHIC INSTITUTE. This board found the hospitals for the insane and feeble- minded top heavy on the custodial side, i. e., the idea of de- tention of patients prevailed over the idea of providing scien- tific treatment for them as sick or defective persons. This condition was due in part to a lack of adequate education of the hospital physicians through no fault of theirs, and to the absence of the inspiration of a central institution of research and instruction. To supply this manifest need an institution for the systematic study of diseases of the mental and ner- vous systems has been established at Kankakee. There are branches in each hospital for the insane and in the institution for feeble-minded children. This institution is known as the State Psychopathic Institute. Explanation of Anna figures. Education and In- spiration needed. 22 Twenty-two in German}-. Lack of op- portunity. Directed by an expert. Oo tor In- struction. Clinics for general practition- ers. I'nstablc persons in Illinois. Ignorance affects the State. In Germany since 1874, twenty-two such institutes, with clinics, have been established. Many are in connection with the universities, so that graduates in medicine go out into practice with experience in this sort of work. There is no opportunity, in most of the states of the Am erican Union, for any young medical man to acquire practi- cal knowledge of diseases of the mind. The little he can learn is by going, with a teacher from the medical school, to a hospital for the insane for two or three trips, looking at patients, and perhaps talking about them to some degree. The remainder of his information is gained from contact with mental and nervous diseases in his practice. In addition to this individual ignorance is the inevitable general ignorance which affects the State, because the State must draw upon men imperfectly educated, through no fault of theirs, for the medical staffs of its institutions. The su- perintendents must take this deficient material and attempt to mould it for efficient medical work. Many of these indi- viduals are capable of learning, under the direction of a good superintendent, and become good workers, in time, but they do not have half the advantage they should. When in full operation the State Psychopathic Institute will be presided over at Kankakee by an expert in mental and nervous diseases, both as manifested and presented in the living patient and as found in the structural changes demonstrable in the dead. This man will be a master of modern methods of examinations, analysis, criticism, termi- nology, diagnosis and prognosis. He will be an expert in clinical and pathological laboratory work. The doctors in the State hospitals will go in rotation to Kankakee to study under the direction of this expert. They will return to their own institution inspired to carry on their studies there. The patients will receive the benefit. By means of local clinics, conducted at the several hos- pitals, to which physicians in general practice in the vari- ous insane districts of the State are invited .these physicians are instructed too. Recently one of these clinics was at- tended by thirty-five physicians practicing in seven cities and towns near the hospital. Thus, this great institution, giving a service like the German clinics in psychiatry, brings the benefits of expert knowledge to the very homes of those afflicted with approaching insanity. A careful attempt has been made herein to approximate the number of people in Illinois who are rated as mentally and nervously normal, but are predisposed to dependency. Such per.sons arc unstable. They need medical watching. Basing the estimate on those who are unstable because of hereditary weakness, on those with habits such as the un- wise use of alcohol, morphine, cocaine, etc. ; and on those who suffer from certain infections, one person in every 90, in Cook county, is an unstable person. In Illinois, outside 2Z education. of Cook county, one person in every loo is an unstable per- son. Thus in Illinois today about 58,000 persons are un- stable, and likely, under the stress of life, to become de- pendents and be added to the wards of the State. This figure is a minimum. Probably there are more than 58.000 such persons in Illinois who today are productive members of society in some way. • It is little short of calamitous that American medical edu- Need of cation has not equipped the general practitioners to recognize the early symptoms of insanity in these unstable persons and give proper treatment in the early hopeful stages pre- ceding and immediately following the onset of nervous and mental break-down. The State Psychopathic Institute aims to give just the education required without cost to the doc- tor and at small expense to the State. More than this. By means of complete modern medical Records and records, which are the basis of productive search for the causes of insanity, physicians in the State service will have a vast amount of scientific data at hand, and this, with modern laboratory studies, will be used in an effort to learn new things about mental and nervous disorders, and perhaps to discover new remedies which will benefit the whole human family. As great as is the work of this institute, it is not an ex- pensive afifair for the State. An expert psychopathologist, a sufficient office force, and diagnostic laboratory equipment, are needed at Kankakee. These will cost $15,000 a year for two years. A modest laboratory equipment is needed at each hospital not now so supplied, and an assistant physician will be the local psychopathologist. The service already es tablished, needs only small appropriations to swing into full operation. laboratory studies. Cost Is small. Needs only an appro- priation. epileptics. STATE VILLAGE FOR EPILEPTICS. The Forty-first General Assembly passed an Act for the establishment in Illinois of a State colony for epileptics. This law still is on the statute books, valid, and needs only a sufficient appropriation to make it effective. The Board of Charities recently made a census of epilep- Census of tics in the various State charitable institutions. The number is 1,015. The number of epileptics in county almshouses is 160, making a total of 1175 epileptics receiving care in pub- lic institutions today. In the entire State it is estimated by experts that there are 10,000 epileptics. Limiting this report to these unfortunates who are charges upon the public it can be stated that there is no adequate provision for their care in any institution. No systematic plan of life is fol- lowed for either adults or children. There is no provision for regular daily work for the adults and no provision for the proper training and education of the children. Those 24 Separate treatment essential. Coat Deaths from consump- tion. I in the hospitals for the insane are housed intimately with I insane persons to the positive detriment of both the insane land the epileptic. Many of the epileptics are not insane. Some of them are insane only at the time of their seizures. Others chance to be insane just as a person afflicted with typhoid fever may be insane. It is manifestly injurious to these epileptics to house them with mentally unbalanced persons. On the other hand while the seizures of epileptics are not affecting to persons of their own unfortunate class they are most distressing to insane persons and retard the latter's recovery. The separation of these classes is neces- ary for the well being of both. The epileptics in county almshouses are even worse off than those in the hospitals for the insane. They have no proper care, no regular work and their general surroundings are most unfortunate. All improvable epileptics who are not insane should be taken out of their present surroundings, thus relieving over- crowded institutions, and placed in a village by themselves where proper provisions can be made for their care. The colony treatment of epileptics is the most humane, and the one attended by the best results. It is a more economic means of providing for them than by housing them with the insap_. This has been proved by the experts of the New York colony at Sonyea, where the average cost per capita is $30.00 less per annum than is the cost for caring for the insane in that State. This saving is due to the large numbers of pro- ductive laborers available among epileptics. Ohio, New York, New Jersey, Massachusetts. Kansas and Texas have epileptic colonies in operation and Indiana is starting one, having purchased the land and begun the erection of build- ings. Virginia has taken steps to care for epileptics. The Board of Charities recommends the purchase of 1,000 acres of land for an epileptic colony with power house, cottages, pavilions, etc., to accommodate at first 200 selected epileptics who are able bodied and can work. For this an appropriation of $265,000 is asked. This amount is sufficient, according to carefully made estimates, to pur- chase the land, make the necessary surveys, build five cot- tages with a capacity of 20 colonists each and two buildings with a capacity of 50 colonists each, and to maintain 200 colonists for the last year of the next biennial period. SANATORIUM FOR CONSUMPTIVES. When it is realized that 8.000 (estimated) deaths occur annually in Illinois from tuberculosis, and that one death in every seven is caused b> it, the need of action by this State to provide means of cure becomes apparent, for both humane .md economic reasons. Massachusetts, New York. New ferscy. Pennsylvania. Ohio. Indiana. Iowa. Kentucky. Maryland. Michigan and Wisconsin have either created 25 such sanatoria or have taken the preliminary steps towardl their estabUshment. The experience of others shows that from 10 to 20 per cent of patients in the incipient stages of consumption are cured, and that patients are restored to economic independence for from one to many years in 60 per cent of cases. It is the plan, if this institui:ion is estab- lished, to receive only hopeful cases. But the sanatorium would be more than a place of cure, ^-ducationai It would be a place for education. Every consumptive who left it cured would disseminate knowledge regarding the prevention, treatment and cure of tuberculosis. Public bulletins would be printed for wide distribution, showing the most advanced treatment advocated by medical science, so that the service of this institution would be given wide publicity, with beneficial results to the people of this and other states. For the creation of a State Sanatorium for Consumptives, cost. the Board of Charities recommends an appropriation of $150,000 of which $32,000 is for land, $100,000 for build- ings and equipment and $18,000 for maintenance for a part of the coming biennial period. The capacity of the proposed sanatorium at the start is figured at 400 and the cost of the buildings and equipment was figured at $250 per capita, as expensive buildings are not required and not desired for the treatment of consumptives. COMPLETE STATE CARE. In the care and treatment of groups of unfortunates like the insane, the epileptic, the feeble-minded ,the consumptive, and the dependent, the greater the governmental unit in charge the more perfect the classification, treatment and care. The State of Illinois is better able to classify and treat and care for mefficient population than is any one of its counties. An insane patient, or other unfortunate, in one county, is entitled, as a resident of the State, to as good care as another dependent receives in another county. But county care in Illinois today ranges from the primitive to approved modern methods of treatment. This is not fair to those re- ceiving primitive care. State care is one of the humane evo- lutions, based on experience, as best for all concerned, in- cluding the taxpayer. Illinois already has made strides in advance in State care, Illinois For this great credit is due, but the Board of Charities be- cvedir^ lieves the time has arrived for legislation providing, within, a reasonable time, for complete State care of all insane, epileptics, feeble-minded women of the child-bearing age, and feeble-minded and dependent children now in county almshouses ; and of dependent curable consumptives. Under the heading of new institutions provisions are Provision in made which, if adopted by the General Assembly, will lead ?u«ons.^"" State treat- ment and care best 26 Imperfect county care. Ventilation a factor. Two hundred epileptics subtracted. Special re- port later. Insanity not a disgrace. to State care of epileptics and dependent curable consump- tives. In the State Hospitals for the Insane there are 9326 patients. In the almshouses, including Cook county, there are 2,234 or 11,560 insane patients receiving public care in Illinois. This total does not include 450 patients on parole. Excluding 1,608 in the Cook county almshouses at Dunning, who are receiving high grade care, there are 626 insane in county almshouses, some of them providing only mediaeval custody for these unfortunates. Insanity is increasing in Illinois in the number cared for in public institutions at the rate of 317 a year. Every State hospital for the insane is so overcrowded today that within six months it will be neces- sary to return patients to inadequate county almshouses. Therefore, if Illinois is to prepare State care for those re- quiring it during the next two years it must make provision for 1,260 additional patients, excluding those cared for at the Cook county almshouse. This figure will not be large enough, unless the recommen- dations in the appropriation bills for adequate ventilation are made effective by the General Assembly. The State archi- tect estimates that there are 1,466 more patients in the hos- pitals for the insane than the present means for ventilation justify. The Board of Charities has eliminated from the architect's estimates hospitals of cottage construction and has recommended artificial ventilation in several of the hos- pitals of the old type construction, so that, for the present, at lleast, if the ventilation appropriations recommended by the the board are allowed, the excess of 1,466 need not be con- sidered in computing the extra space required to bring about State care. In the additional buildings recommended by the State Board of Public Charities for the several hospitals for the insane, will be found room to care for 1,260 patients, if 2(X) epileptics are removed from State hospitals for the insane into the proposed village for epileptics. Thus the almshouses, except that of Cook county, can be cleared of insane within two years. The Board of Charities has not concluded its investiga- tion into the needs of complete State care, but will make a special report to your Excellency at a later date, going into the details of this important problem. QUICK TREATMENT FOR THE INSANE. The greatest value of hydrotherapeutic treatment for the insane depends, as stated in the foregoing, upon its quick use in the early stages of the disease. Here is presented one of the most perplexing problems that has come before your State Board of Charities. Insanity is looked upon by the public at large as a disgrace. It should not be so considered. Insane persons are sick just as persons suflFering from anv 27 physical ailment are sick. But the deep-seated belief that commitment as insane is a stigma upon a person so commit- ted and upon his relatives, prevents early appeals to science for the prevention of approaching insanity or for its cure, if the onset already has taken place. The law provides for voluntary patients who may avail themselves of aid before it is too late, but the great majority of persons needing treatment vigorously combat the idea of going to a hospital. It is necessary in these cases to go through a court process which usually requires the interven- tion of a jury. Cases of borderline insanity are difficult even for an expert to diagnose. The average jury, pass ing upon a genuine case of this character, one in urgent need of immediate medical treatment, would be unable to detect such necessity and would decline to commit. Your board has sought legal advice as to whether a valid law could be passed providing for temporary commitments by a judge, without a jury, for short periods for scientific observation and treatment upon the affidavit of a commission of physicians, the procedure being safeguarded against pos sible abuses. This, in many cases, would obviate permanent commitment as insane. But it is a matter of doubt whether such law would be constitutional, because it would deprive a person of his liberty without giving him notice of the pro ceeding or affording him an opportunity to be heard in his own behalf. Furthermore it is doubtful whether a person legally can be committed to a hospital for the insane because he is suspected of approaching insanity any more than he could be sent to prison because he is suspected of being about to commit a crime. The present law offers an alternative which is of service and which this board urges relatives and county judges to employ — regular commitment on the affidavit of a commis- sion of physicians. If temporary commitments are pro- nounced illegal, regular commitment on medical affidavit is the next best step in perplexing cases. The public and persons suffering from approaching insanity should be taught the necessity of quick treatment, even if it requires a regular commitment as insane, which is only a commitment as nerv- ously or mentally sick. For the use of those interested in borderline cases the fol- lowing statement seems to open a way for quick commit- ments under the present law. The first section of the Illinois Lunacy Act provides, among other things, if one's physical or mental condition is such as to render him a fit subject for care and treatment in a hospital or asylum for the insane, he shall be deemed insane. A proper presentation, to a jury or judge, of the true facts in borderline cases might convince a judge or jury that commitment is warranted. Voluntary patients. Temporary commit- ments probably Illegal. Permanent commit- ment on affidavit of physicians. Provision In the law. 28 Provision for soldiers and tbelr wives. In otber sutes. Cost fJIft of tTrm- nasliitn. OTHER STATE CHARITABLE INSTITUTIONS. In discussing this group attention will be given to certain institutions, leaving the items in the appropriation bills to speak for the others. soldiers' and sailors' home. At the last annual encampment of the G. A. R. Depart- ment of Illinois, it was resolved the time had come when the State should make some provision whereby when age and want compelled the veteran to seek refuge in the Soldiers' and Sailors' Home he might be permitted to take with him his wife who had shared his joys and sorrows and not be obliged at the very time when he needed her love and sym- pathy most to be separated from her. In recognition of this condition, because in several such cases the husband has gone to Quincy and the wife to an almshouse, the General Assembly passed a law authorizing counties to erect on the State property at Quincy cottages to be occupied by soldiers and their wives. Only one county has started to do this, and that county desires ^tate help. The county scheme is manifestly impractical, just as is the county almshouse scheme for the care of the insane. The Board of Charities believes the plea of the old soldier is reasonable and that it is the duty of the State to grant it. In the states of Indiana, Iowa, Kansas, Michigan, Minne- sota, Missouri, Montana, Nebraska, New Jersey, New York, North Dakota, South Dakota, and Wisconsin provis- ions of some sort are made for the wives of soldiers. Illinois has opened its Soldiers' Widows' Home at Wilmington to wives as well as to widows of soldiers, but it seems inhumane to separate these old people in their declining years. Therefore the Board of Charities recommends that $184.- 686.00 be appropriated for the erection of two cottages at Quincy to be occupied by soldiers and their wives and for the erection of a hospital building for the treatment of the soldiers' wives. This figure includes necessary additional equipment, furnishings and service and maintenance for a part of the next biennial period. ST. CIIAKI.KS SCHOOL FOR HOY.^. The Commercial Club of Chicago has given $50.(X)0.oo to this school for a g}ninasium. The appropriation contains an item of $5,000.00 to equip this gymnasium. There also are items of $55,000.00 for an administration building. $25.- 000.00 for one new cottage and $15,000.00 for a hospital. .Ml are needed. 2Q STATE LIBRARY FOR THE BLIND. This board recommends the appropriation of $2,000.00 Smaii ap propriatloD asked. Institution should be encouraged. More hospital care. in addition to the appropriations asked by the School for the BHnd at Jacksonville to provide a State library for the free* use of the 5,000 blind persons in Illinois, not in State in- stitutions. The institution at Jacksonville is ready to do- nate 400 volumes as the nucleus of this library. The United States has recognized the need of assisting blind persons by franking books to and from the residences of such per- sons. This is a manifest humanity and has been provided in several states, notably New York. STATE INDUSTRIAL HOME FOR THE BLIND. This institution has been a source of frequent attack by persons who have advocated its abandonment. Its finances for the last five quarters show a continuous decrease in per capita cost. The Board of Charities feels that this institution should be given a new chance to prove its right to live, and recommends that its appropriation of $133,500.00 be granted. One new grade of manufacture there, of women's hat frames, seems to promise better financial returns. soldiers' widows' home AT WILMINGTON. This institution needs provision for better hospital care A large percentage of the women are old, infirm and sick They have not received proper hospital care. The Board of Charities has placed in the appropriation asked an item of $7,000.00 to provide for a resident woman physician and six nurses. This, contemplates hospital care for the inmates in their several rooms. The board has cut out of the appropri- ation asked an item of $25,000.00 for a new hospital, be- cause the present building contains so large a percentage of hospital cases that it is a hospital itself and is large enough. By law the salary of the matron of this institution is placed at $50.00 a month. This is inadequate for the nerve-trying and difficult position. The Board of Charities recommends that this law be so amended that the Board of Trustees can pay what is a fair compensation. The Board of Charities has added to the ordinary fund asked $600.00 a year for this purpose, making the salary $1,200 a year. JOLIET PENITENTIARY. By request of your Excellency the board will prepare a special report on Joliet penitentiary. ALMSHOUSES AND JAILS. ! Within a few weeks the board will present a special re- Special re- port covering almshouses and jails. I ^^^^ "*"* Special re- port later. 30 Money can be saved. Crimes aealnst children. More employes. Regarding guardians. Transfer of guardian- ship. "Baby farms.' Lylng-ln hospitals. COUNTY POOR RELIEF. If the experience of New York, Massachusetts and Indi- ana is an index of conditions in Illinois much money can be saved to counties by modern methods of poor relief. As a step in this direction the board recommends the passage of a law compelling counties to report to this board each year on blanks furnished by the Board of Charities certain facts and figures regarding poor relief, including the cost thereof. SEMI-PUBLIC AND PRIVATE INSTITUTIONS. VISITATION OF CHILDREN. The law for the visitation of children passed by the last General Assembly has been administered through the office of the State Board of Charities by the State agent and two assistants provided for in the law. The work done by this department has disclosed conditions which showed the ne- cessity for such a statute. While most of the children placed in families by the various child helping agencies of the State were found to have been judiciously placed and well cared for, the discovery of crimes against children who had been "placed out" in some homes and the conduct of certain or- phanages showed the necessity for a most faithful inspection and in certain cases relentless prosecution. This force is now organized for active work but it is inadequate in size and the compensation is inadequate. The Board of Chari- ties recommends that two additional visitors be provided for, that a larger office force be supplied and that the law be so amended as to eliminate specific salaries, giving the Board of Charities autliority to pay employes in this department on the basis of the value of the work performed. The study of child visitation brings to light the need of other additions and amendments to the law. These sugges- tions have been carefully thought out by experts in the prob- lem of child saving and child care and the Board of Chari- ties submits them with the recommendation that the Legis- lature give them favorable consideration : 1. Provision whereby every child shall have a re- sponsible legal guardian, and that children not having a legal guardian shall be reported to the clerk of the county or probate court, in order that a legal guardian may be appointed. 2. Provision whereby no transfer of the guardianship of a child shall be legal until it has been passed upon and approved by a court of competent jurisdiction. 3. Provision whereby "baby farms," i. e., places where more than two infants are kept on board, shall be subject to Inspection and certification by the State Board of Public Charities. 4. Provision whereby all lying-in hospitals shall be subject to Inspection and certification by the State Board of Public Charities and State Board of Health. 31 law. Charity Board sug- gestions. 5. That the State visitation law be so amended as toiMore provide an adequate salary for the State agent, and to} emp'oyfia. provide additional visitors and additional appropriation to cover necessary expense. 6. That the present law for the adoption of children Adoption be recodified so as to make it consistent with other statutes relating to the care and disposal of dependent children. PRIVATE HOSPITALS. The board, owing to press of other work, . has inspected only two private hospitals for the insane. It will extend its work as soon as practical. SUPERINTENDENTS' CONFERENCES. Two conferences have been held by your Excellency, the superintendents and some of the trustees of institutions in the insane group, members of the Board of Charities and public spirited citizens to discuss institution needs. To the first conference held in Springfield in October the Board of Charities submitted a number of suggestions as a basis for discussion. These suggestions are printed in the October Bulletin of the board. At this conference committees were appointed to investigate and report on the board's sugges- tions at an adjourned conference. The adjourned conference was held in Chicago in December, when committee repoi^ts were made and adopted and work on the appropriation recommendations was begun. , In a nut shell the agreements and understanding as a re- Brief of suit of these conferences were : 1. To establish the State Psychopathic Institute. To favor installation of hydrotherapeutic appa- 2. ratus. 3. 4. To encourage industrial re-education. To establish uniformity of nomenclature and po- sitions of service in the hospitals for the insane and to recommend that trustees establish a uniform maximum and minimum wage scale in all hospitals for the insane. Such wage scale was submitted. 5. To adopt uniform complete medical records. 6. To draft a uniform curriculum for training schools. 7. To erect only fire proof buildings in the future. 8. To use tile floors in all toilet rooms. results. Psychopathic Institute. Hydro- theraphy. Re-educa- tion. Uniform no- menclature and wages. Uniform records. Uniform curriculum. Only fire proof buildings. Tile floors. 9. To replace wooden beds with iron beds. iron beds. 10. To support the State Board of Health in its en- Fr«e deavor to secure an appropriation of $15,000.00 a year for antitoxin* free diphtheria antitoxin, as a purely economic item in hospital service, not to mention its manifest humanity. 11. To favor and work for an appropriation for a' Epileptic State village for epileptics. I village. 12. To favor and work for a State sanatorium for Sanatorium curable consumptives. for con- 13. To use the cottage plan in new institutions. sumptives. 14. For the Board of Charities to introduce the in- stitution appropriation bills into the legislature. i2 Work done by new commis- sion Tenure pro- lonsed. fphold s'lperin- tendents. Discourages pay to patients. Merit law justified. Bndorse- ment. Charitable institutions as con- sumers. c i\ IL s1':k\ ici:. ' The State Civil Service Commission in its first thirteen months made 1,468 appointments and held 539 examinations in 35 different cities of the State. For these examinations 2,240 applications were received and 1.625 persons were ex- amined. Of this number 77.09 per cent passed. There were 954 resignations and 295 discharges; 12 persons were trans- ferred from one institution to another, and 98 transferred I from one position to another in the same institution. ' The tenure of the average State employe has been pro- longed, there having been few changes in the institutions except in the position of attendant. Tramping from one in- stitution to another by employes has been stopped entirely. The commission has upheld the superintendents in enforc- ing discipline and employes realize that they must obey the ; rules of the institution or leave the service. This support of the superintendents has done much toward increasing the efficiency of the service, as employes realize now that they are dependent entirely upon their merits to retain their positions. Further, they appreciate that if they do Uieir duty they have prospect of advancement. I The commission has discouraged the placing of patients on the pay rolls in institutions where the system does not lexist, and opposes increasing the patient pay roll where it Ihas been the policy of the superintendent to pay patients for working. In the appointment of new employes the commission be- lieves it has justified the claims that have been made for the merit law. Young and energetic physicians have been ap- pointed in a number of institutions and chief nurses and trained nurses have been selected for the training schools. Wherever vacancies in the position of engineer or firemen have occurred, skilled men have been selected and the com- mission in this way hopes to protect the machinery in the engine rooms of the institutions and benefit the service. This board endorses the work of the Civil Service Com- mission. PRISON INDUSTRIES. With the enactment of the anti-convict labor law. which requires that the labor of the convicts in the penal and re- formatory institutions should be devoted, in part, at least, to manufacturing supplies for State institutions, a new ob- ligation rests upon the charitable institutions, to purchase certain supplies through the Board of Prison Industries. For this purpose, a sales department has been established, upon which requisitions for these supplies are to be made. In the event that a requisition can not be filled with goods 33 Overcoming difficulties. Progress. manufactured in the penal institutions, a release is granted by the Board of Prison Industries. The radical change from the old system presented grave difficulties, both to the penal institutions which had to do with the manufacture, and the charitable institutions, as con- sumers of these supplies. These difficulties are being over- come gradually. Few supplies which are manufactured by the penal institutions are now purchased on the open market by the charitable institutions, and these only in case of emer- gency, where requisitions are made and releases granted. While it can not be said that all the supplies manufactured in the penal institutions are such as to meet every require- ment, progress has been made, and an improvement in the prison products is noticeable. The question of prices of cer- tain staple supplies presents some difficulties, which it is hoped will adjust themselves in due time. The suggestions of su- perintendents of charitable institutions, looking to the im- provement of institution supplies, this board is informed' have at all times been given consideration by the Board of Prison Industries, and an effort to meet the mutual obliga- tions imposed by the anti-convict labor law has been made. The Board of Charities feels that in amplifying employ- ^oi'^y ^^^^ ment at the hospitals for the insane, to provide the treat- industrial ment known as industrial re-education, there should be the «on^"^^ least possible manufacture of goods such as are made at the; prisons, particularly clothing and shoes. STATE BOARD OF CHARITIES. The State Board of Charities finds it necessary to increase its office force. The board asks for a total of nine em- ployes and an annual appropriation of $26,000.00. The ad- ditional employes are needed to perform inspecting and clerical work, which has increased four fold. The office has a library of 1,938 books and 4,292 pam- phlets. This valuable material is not catalogued nor indexed. Only one set of reports is complete. Thus the library is valueless for quick reference. Among the new employes the board asks for a librarian and statistician to catalogue and index this library, to list and secure volumes to complete incomplete sets, to assemble and publish chpritable, reforma- tory, penological and sociological information, so that mem- bers of the Legislature, State officials and the public may have at their command data to aid in the humane and eco- nomical administration of the State charitable and correc- tional institutions. The board recommends the abolition of county auxiliary boards, as representatives of the State, because the work can be done more effectively and quickly by a paid inspector of almshouses and jails. Voluntary boards, whose members receive only $5.00 a year each as expenses, can not be ex- — 3 P C Larger office force needed. Library needs in- dexing, etc. Inspector in in place of auxiliary boards. 34 State con- ference. Filing cases. Larger quarters. OpDosite systems. Asks appro- priation. pected to do satisfactory work. The $1,500.00 a year ap- propriated for them will bring better results if paid to one inspector. This amount is provided for in the appropriations asked by this board. The board recommends that the usual special appropria- tions for the State conference of charities be increased from $500.00 per annum to $750.00 per annum. A special appropriation of $1,250.00 is asked for metal filing cases to protect duplicates of the documents of the several institutions. These documents now are stored on open wooden shelves in a basement room. The office quarters of the board are too small. It is re- quested that more room be provided when certain depart- ments move from the capitol into the new Supreme Court building. CHARITY ADMINISTRATION. The Board of Charities has been urged to recommend a new system of charity administration for Illinois. Many persons are dissatisfied with the present system of a State Board of Charities with the right of inspection and recom- mendation, but with no absolute power to supervise local ad- ministration. This board has made a superficial investigation into charity administration in fourteen states. It has ad- vised with presidents of large corporations and persons ex- perienced in the successful administration of public charity. It finds two diverse systems in operation. One is by a board of charities with largely moral powers, like the board in this State. The other is by a board of control with prac- tically absolute powers. In some instances the two systems are blended in part. Strong arguments are made in favor of each system. Because of lack of time and of money to make a thorough investigation this board is not prepared to report recom- mendations. As there is a strong probability that an ex- haustive study of this question will disclose methods of ef- fecting large economies in the administration of charity in Illinois, this board asks a special appropriation of $4,000.00 to be used in making a deliberate investigation of the charity systems in America and abroad and in preparing, print- ing and circulating a report to the General Assembly recom mending what this boards believes, from the experience of others, to be the system' of charity administration best adapted to the needs of Illinois. 35 APPROPRIATIONS. I Reductions in appropriation estimates were made at two *^s°^gijeg conferences of those interested to amounts held to be neces- made, sary for the safety and comfort of the patients and the operation of the institutions. At the close of the last con- ference the total for the seventeen State charitable insitu- tions stood $8,867,510.00. Carefully considering each item in this total the Board of Charities has reluctantly made a net cut of $1,062,594.00, leaving the total recommended $7,804,916.00. The items reduced or cut out are those in- dicated by superintendents as of least importance. The amount asked by these institutions two years ago was $6,- 521,050.00, showing the excess asked this year to be $1,283,- 866.00. As the State has a surplus of $3,254,000.00, the board recommends that $637,380.00 for physical improve- ments, $265,000.00 for a village of epileptics, and $150,- 000.00 for a State sanatorium for consumptives, or a total of $1,052,380.00 be appropriated and used from the surplus. The total appropriation recommended by the State Board of Charities for the seventeen State charitable institutions for the two years beginning July i, 1907, and ending June 30, 1909, is apportioned as follows : Northern Insane Hospital, Elgin $ 695,800 00 Eastern Insane Hospital, Kankakee 1,127,900 00 Central Insane Hospital, Jacksonville 637,475 00 Southern Insane Hospital, Anna 566.700 00 Western Insane Hospital, Watertown 570,000 00 Asylum for Incurable Insane, Bartonville 690,000 00 Asylum for Insane Criminals, Menard 350,000 00 School for the Deaf, Jacksonville 313,000 00 School for the Blind, Jacksonville 149,600 00 Industrial Home for the Blind, Chicago 133,500 00 Asylum for Feeble-Minded Children, Lincoln 478,108 00 Soldiers' and Sailors' Home, Quincy 710,563 00 Soldiers' Orphans' Home, Normal 187,221 00 Soldiers' Widows' Home, Wilmington 48,500 00 Charitable Eye and Ear Infirmary, Chicago 121,868 00 State Training School for Girls, Geneva 279,531 00 St. Charles School for Boys, St. Charles 330,150 00 Apportion- ment of the funds. Total ?7,389,916 00 Proposed Epileptic Colony 265,000 00 Proposed Sanatorium for Consumptives 150,000 00 Total amount of recommendations $7,804,916 00 The items in the several appropriations appear in the recommended appropriation bills, which are attached hereto and made a part of this report. In closing the State Board of Charities desires to thank your Excellency for continued support and counsel, without which its labors could not have been performed. It also de- Items In ap- propriation bills. 36 sires to express gratitude to superintendents for great help and uniform courtesy. Respectfully submitted, [Signed] Frank Billings, [Signed] [Signed] [Signed] [Signed] [Signed] William C. Graves, Secretary. Emil G. Hirsch, Julia C. Lathrop, John T. McAnally, Clara P. Bourland, ADDENDA. Appropriations as Finally Asked by Charitable In- stitutions, Showing Changes Made by the State Board of Charities. The following are the appropriations asked by the seven- teen charitable institutions at the final conference, indi- cating also items pointed out by superintendents or trustees as those that could best be reduced or cut out, if necessary, and the changes made by the board. The Board of Charities cut in most institutions, but added items in some. The net cut made was $1,062,594.00.* The reductions were made for reasons of economy. Additions were made where the good of the service seemed to require additions. Certain items which it would seem could have been spared were left because of the peculiar fitness of superintendents to get excellent results from the sums recommended. Elgin — A'ppropri(di<)nf<. Asked— Ri 'rised. Item. Ordinary appropriations asked. Special appropriations asl^ed. 1 1 •Surplus ippropriations asltt'ii. Ordinary $403,000 00 1 Repairs and Improvement $ 20.00000 6.000 00 4.000 00 7.000 00 2,000 00 2,500 00 1.000 00 20.000 00 10.000 00 10, 000 ool 25. 000 00 100,000 OOi 25,000 00'. Painting Improvement of grounds Iron oedsteads Live stock Farm implements and buildings Fencing Cold storage and Ice plant Shops for patients Cottage for official Farm ward (fifty patients) Four cottages Hospital Fire escapes S 1.800 00 Plumbing 7 000 00 Power house, boilers, etc S2. 000 00 Wiring ' 12 000 00 Extension water system 10,000 00 Heat and ventilation ' 25 000 00 J403, 000 00 $232, 500 00; $137, 800 00 37 SUMMARY. Ordinary $403,000 00 Special 232,500 00 Surplus 137,800 00 Total $773,300 00 Possible cuts suggested by superintendent — Take out the following amounts if necessary: Fencing, $1,000.00; shops for patients, $10,000.00, but keep if can; cottage for officials, $10,000.00; two cot- tages, $50,000.00; possible to cut out two cottages. Note. Prom the appropriations asked, amounting to $773,300 00 The board made the following reduction — Ordinary expense fund $16,500 00 li'encing 1,000 00 Cottage for officials 10,000 00 Two cottages 50,000 00 Total reduction 77,500 00 Total amount of appropriation recommended $695,800 00 Kankakee — Appropriations Asked — Revised. Item. Ordinary appropriations asked. Special appropriations asked. Surplus appropriations asked. Ordinary $759, 500 00 Repairs and improvement ■$ 60,660 66 4,000 00 4,000 00 . 140, 000 00 3,000 00 30,000 00 4,000 00 4, 000 00 19, 500 00 10,000 00 8,000 00 Improvement of grounds Live stoclr and farm implements Two new buildings and furnishings for 125 patients each Twelve hundred double windows Psychopathic Institute and maintenance for two years Live stock (milch cows) Hydrotherapeutlc equipment Fourteen hundred Iron beds and mattresses. Warehouse addition Painting Fire escape $ 1,400 00 Plumbing 10 000 00 Floors 5 500 00 Power house and water 50 000 00 Wiring 10 000 00 Ventilation S 000 00 $759, 500 00 $286, 500 00 $81.900 00 SUMMARY. Ordinary $759,500 00 Special 286,500 00 Surplus 81,900 00 Total $1,127,900 00 All appropriations asked were recommended by the board. 38 Jacksonville Insane — Appropriations Asked — Revised. Item. Ordinary appropriations asked. Special appropriations asked. Surplus appropriations a.sked. Oidinary $410,000 00 Bepairs and Improvement . . _ $ 30. 000 00 200.000 00 60.000 00 25.000 00 51.000 00 5.000 00 3.000 00 6.000 00 3.000 00 4.000 00 6.000 00 1.000 00 6.000 00 2.500 00 New building to increase capacity Psychopathic hospital Home for nurses . Purchase of land i Plumbing Fencing, and extension concrete wall Painting Concrete walk i Improvement of grounds New furniture and iron beds Library New building for consumptives, etc Live stock and farm implements Ventilation .f 6. 000 00 Enlarging power house, smoke stack, etc. . 24.000 00 Plumbing and bathing facUltltes 37. 975 00 Enlarging and rebuilding laundry 8.000 00 2.000 00 $410.000 00 $402.500 00 $77,975 00 ' SUMMARY. Ordinary $410,000 00 Special 402,500 00 Surplus 77,975 00 Total $890,475 00 Possible cut suggested by superintendent — If necessary cut out new building, $200,000. From the appropriations asked, amounting to $890,475 00 The board made the following reduction — New building to increase capacity $200,000 00 Purchase of land 51,000 00 Improvement of grounds .*. . . 2,000 00 Total reduction 253,000 00 Total amount appropriations recommended $637,475 00 39 Anna — Appropriations Asked — Revised. Item. Ordinary appropriations asked. Special Surplus appropriations appropriation asked. asked. Ordinary Repairs and improvement Library Live stock and farm implements. Cement walks Widening road Hospital buiiuing and furnishing. Home for nurses and furnishing. Telephone system Painting Improvement of grounds Rebuilding greenhouse Track scales Industrial building Iron beds and furniture Farm land, about 350 acres Fire escapes Plumbing Floors Power house, boilers, etc Wiring Fire protection $378,000 00 $378, 000 00 $ 20,000 00 1, 000 00 4,000 00 6, 000 00 5, 000 00 100, 000 00 25,000 00 2,000 00 4.000 00 4,000 00 2,500 00 1.200 00 15,000 00 8,000 00 30, 000 00 $227, 700 00 $ 1, 000 GO 4,000 00 5,000 00 50,000 00 10,000 00 10,000 00 $80,000 00 SUMMARY. Ordinary $378,000 00 Special 227,700 00 Surplus 80,000 00 Total $685,700 00 Possible cuts suggested by superintendent — Take out if necessary, $100,000 (hospital building and furnishing) ; nurses' home, $25,000.00; land, $30,000.00. From appropriations asked, amounting to $685,700 00 The board made the following reduction — Ordinary expense fund $28,000 00 Cement walks 6,000 00 Widening road 5,000 00 Hospital building and furnishing 50,000 00 Farm land 30,000 00 Total reduction 119,000 00 Total amount of appropriations recommended $566,700 00 Watertown — Appropriations Asked — Revised. Item. Ordinary appiTopriations asked . Special appropriations asked. Surplus appropriations asked. Ordinary Repairs and improvement Improvement of grounds and fnrra New buildings, psychopathic and hydratic. Land, 120 by 300 Superintendent's residence Ventilation, power plant, etc $350,000 00 $ 20. 000 00 21 000 00 100, 000 00 40,000 00 15.000 00 $350, 000 00 $195.000 00 $40,000 00 $40,000 00 40 SUMMARY. Ordinary $350,000 00 Special 195,000 00 Surplus 40,000 00 Total $585,000 00 Possible cuts suggested by superintendent — Take out if necessary superintendent's residence, $15,000.00." From appropriations asked, amounting to $585,000 00 The board made the following reduction — Superintendent's residence 15,000 00 Total amount of appropriations recommended $570,000 00 Bartonville — Appropriations Asked — Rcz'ised. Ordinary Special Surplus Item. I appropriations appropriations appropriations asked. asked. asked. Ordinary $675, 000 00 Repairs and improvement Additional cottages for ],000 patients Two large fire proof hospitals (250 pa- tients) Additional land Artesian well $ 30, 000 00 250.000 00 60.000 00 40.000 00 \r>. 000 00 To complete State railroad j 10. 000 00 $675,000 001 $40), 000 00 SUMMARY. Ordinary $675,000 00 Special 405,000 00 Total $] ,080.000 00 From appropriations asked, amounting to $1,080,000 00 The board made the following reduction — Ordinary expense fund $1 00,000 00 Additional cottages for 1,000 patients 250,000 00 Additional land 40,000 00 Total reduction 390,000 00 Total amount appropriations recommended $690,000 00 Menard. SUMMARY. NEW BUILDING. Building, land and equipment $270,000 00 Ordinary 80,000 00 Total $350,000 00 The board recommends $350,000.00, the amount asked, for construction of new building, land and maintenance. 41 Jackson vt'lle — Deaf. — Appropriations Asked — Revised. Item. Ordinary appropriation asked. Special appropriation asked. Ordinary Repairs and improvement Library Dairy barn Fire proof stairway, school building. Purchase of land Greenhouse $250, 000 00 $250, 000 00 $50. 000 00 1.000 GO 20,000 00 20.000 GO 1,000 GO 3,000 GO $95, 000 00 Surplus appropriation asked. SUMMARY. Ordinary $250,000 00 Special 95,000 00 Total $345,000 00 Possible cuts suggested by superintendent — Take out if necessary, fire proof stairway, $20,000.00; land, $1,000.00. From the appropriation asked, amounting to $345,000 00 The board made the following reduction — Dairy barn $10,000 00 Fire proof stairways in school building 20,000 00 Purchase of land 1,000 00 Greenhouse 1,000 00 Total reduction 32,000 00 Total amount of appropriations recommended $313,000 00 Jacksonville Blind — Appropriations Asked — Revised. Item. Ordinary appropriation asked. Special appropriation asked. Surplus appropriation asked. Ordinary $94, 000 00 Repairs and Improvement $8. 000 00 1. 000 00 800 GO 2.000 00 6. GOG 00 4. 500 GO 2.000 00 Printing material Library and apparatus ■ Special training for deaf blind Isolation hospital New storehouse and ice plant State library for blind Ventilation $ 4 100 GO Radiation 4 700 00 Automatic temperature regulation 8 300 GO Fire hydrants and water supply 2. 000 00 Wiring 1 3 500 00 Steam distribution system 2. 400 00 Tile floors, wainscoting 3 100 00 Power plant and tunnel 22 500 GO Wood floors 400 00 $94,000 GO $24. 300 00 $51. 200 00 42 SUMMARY. Ordinary $94,000 00 Special 24,300 00 Surplus 51,200 00 Total $169,500 00 From appropriations asked, amounting to $169,500 00 The board made the following reduction — New storehouse and ice plant $4,500 00 Radiation 4,700 00 Automatic temperature regulation 8,300 00 Steam distributing system 2,400 00 Total reduction 19,900 00 Total amount of appropriation recommended $149,600 00 Lincoln Feeble Minded — Appropriations Asked — Revised. Item. Ordinary Special appropriation appropriation asked. asked. Ordinary , Repairs and improvement Improvement of grounds , Library and school books Gymnasium and play room , Shops , Fire escapes Fire protection , Alteration In domestic water supply.... Underground steam distributing system . $420,000 00 $420,000 00' $20,000 00 4.000 00 1,500 00 20,000 00 10,000 00 Surplus appropriation asked. $55.500 001 * 3, 700 00 7. 974 00 934 00 10.000 00 $22,608 00 SUMMARY. Ordinary $420,000 00 Special 55,500 00 Surplus 22,608 00 Total $498,108 00 From the appropriations asked, amounting to $498,108 00 The board made the following reduction — Ordinary expense fund 20,000 00 Total amount of appropriations recommended $478,108 00 The Item regarding shops was placed in the appropriation at the sugges- tion of the board. 43 Qiiincy Soldiers Horhe — Appropriations Asked— Revised. Item. Ordinary appropriation asked. Special appropriation asked. Surplus appropriation asked. Ordinary Repairs and Improvement Improvement of grounds, roads, bridges, etc. Library Improvement of cemetery and roads Track scales and switch Fire proof cook house and bakery Smoke stack and breeching. Reconstruction of laundry Lodge house at Twelfth st entrance Ice plant and refrigerator room Main tunnel extension Two new cottages Hospital Furnishing cottages and hospital Sewerage extension Fire protection Electric wiring Electric power plant and new boilers Wood flooring Plastering hollow walls Glazing porches Improving hospital laundry Tin roof, main building Painting $390,000 00 $390, 000 00 $ 40, 000 00 4,000 00 1, 200 00 2,000 00 2,500 00 5,000 00 4,000 00 4,000 00 2,500 00 8,000 00 8,000 00 115, 000 00 17. 500 00 15.686 00 2,500 00 $231,886 00 $11, 077 00 20, 785 00 42,000 00 10, 000 00 15, 279 00 6, 780 00 3,200 00 2,400 00 5,000 00 $116, 521 00 SUMMARY. Ordinary $390,000 00 Special 231,886 00 Surplus 116,521 00 Total $738,407 00 In case new cottages are erected, add to ordinary ex- pense fund, first year $10,000.00, second year $15,000.00 $25,000 00 Also, two new boilers 11,500 00 Total $36,500 00 I'rom the appropriations asked, amounting to $738,407 00 The board made the following changes — Add to ordinary expense fund 25,000 00 Add two new boilders 11,500 00 Deduct from repairs and improvement $20,000 00 Deduct improvement of grounds, etc 4,000 00 Deduct fire proof cook house and bakery 5,000 00 Deduct lodge house at Twelfth street 2,500 00 Deduct from electric wiring 10,785 00 Deduct plastering hollow wall 15,279 00 Deduct glazing porches 6,780 00 $64,344 00 $774,907 00 Total reductions 64,344 00 Total amount of appropriations recommended $710,563 00 44 jN'ormw/ — Appropriations Asked — Revised. Item. Ordinary | Siiecial Surplus appropriation appropriation appropriation asked. asked. asked. Ordinary Uepairs and improvement. Library lioofing riastering ralntiug Flooring (hard wood).... Flooring (tile) Radiation Fire protection. Wlr' $135, 000 00 $5.000 00 600 00 ring Plumbing I ron stairs Concrete walk Installing electric light plant. Installing throe new boilers. . Cold storage plant Opening Lincoln street Masonry Mangle Iron bedsteads (single) Miscellaneous $135.000 00 $5,600 00 $3,242 00 1.027 00 3.667 00 1.462 00 1.125 00 5.065 00 5.004 00 2.000 00 1.869 00 700 00 1.260 00 3.000 00 8.000 00 6.800 00 1.500 00 1.000 00 1.000 00 1,000 00 2.000 00 $50. 721 00 SUMMARY. Ordinary $135,000 00 Special 5,600 00 Surplus 50,721 00 Total $191,321 00 From the appropriation asked, amounting to $191,321 00 The board made the following changes — Add industrial shop equipment 5,000 00 Deduct cold storage plant $6,800 00 Deduct from opening Lincoln street 300 00 Deduct miscellaneous 2,000 00 $9,100 00 $196,321 00 Total reduction 9,100 00 Total amount appropriation recommended $187,221 00 WilmiHfifnn — SoJdio'fi^ Widoivs — Apjyropriaf inns^ Asked — l\erised Item. Ordinary appropriation asked. SiH'ciiil Surplu.s appropriation appropriation '.isUod iiskfd. Ordinary Ufljalrs and Improvement N'l'w hospital building and equipment. I'^irn firotectlon $;i6.000 OU $36.000 00 $3,000 00; 25,000 00' $28,000 00 $.500 00 $500 00 45 SUMMARY. Ordinary $36,000 00 Special 28,000 00 Surplus 500 00 Total $64,500 00 From the appropriations asked, amounting to $64,500 00 The board made the following changes — Add to ordinary expense fund (for a resident woman physician and five nurses, for increasing the matron's salary, and for better food) 9,000 GO $73,500 00 Deduct new hospital building and equipment 25,000 00 Total amount of appropriations recommended $48,500 00 Chicago Eye and Ear — Ap'pro'priations Asked — Revised. Item. Ordinary appropriation asked. Special appropriation aslied. Surplus appropriation aslted. Ordinary $88, 000 00 $'7,'666'66 500 00 10, 000 00 2, 500 00 5,000 00 2, 500 00 4,000 00 Repairs and Improvement Library and amusement To complete new addition and roof garden. Paving on Peoria street Elevator Bath room and sterilizer Tile floors in old building Wiring $2, 205 00 Mecbnical equipments 163 00 $88, 000 00 $31, 500 00 $2,368 00 SUMMARY. Ordinary $88,000 00 Special 31,500 00 Surplus 2,368 00 Total $121,868 00 The board recommends the appropriation asked. Geneva — Appropriaiions Asked — Revised. Item. Ordinary appropriation asked. Special appropriation asked. Surplus appropriation asked. Ordinary $155, 000 00 Repairs and improvement $16,000 00 4,000 00 3, 000 00 6, 000 00 15, 000 00 500 00 70, 000 00 22, 500 00 3, 000 00 6,400 00 25,000 00 1,500 00 Improving grounds, walks, grounds tiling and cemetery fence Live stoclj and implements Furniture Paroling and discliarging girls Library Three new cottages Land Two deep well pumps Boiler dynamo pumps Gymnasium Greenhouse Fire protection $9,931 00 Wiring 8,000 00 Water mains 3,700 00 Enjrine for dynamo boilers 3,000 00 Automatic door openers 2,500 00 $155, 000 00 $159. 400 00 $26,631 00 46 SUMMARY. Ordinary $155,000 00 Special 159.400 00 Surplus 27,131 00 Total $341,531 00 Possible cuts suggested by superintendent — Take out if necessary, gymnasium, $25,000.00; greenhouse, 1,500.00. From the appropriations asked, amotinting to $341,531 00 The board made the following reduction — Ordinary expense fund $15,000 00 Furniture 2,000 00 Three new cottages (two) 20,000 00 Gymnasium 25,000 00 Total reduction 62,000 00 Total amount of appropriations recommended $279,531 00 Sf. CIko'Ics School — Appropriations Asked — Bcriscil. Item. Ordinary appropriation asked. Special Surplus appropriation 1 appropriation asked. ' asked. Ordinary Repairs and improvement Two cottages Furnishings Administration building Infirmary Sewer and drainage Pump and well Gymnasium equipment Library Walks Parole offices Improving laundry Live stock and Implements. . . . Dynamos, conduits, etc Reducing pressure on plumbing. Fire escape on school building. $202,000 001 $ 5,000 00 50,000 00 2.500 00, 55,000 00 15,000 00 15.000 00 5.000 00 5.000 00 500 00 1,000 00 2. 400 00 1.000 00 2,000 00 6,000 00 $202.000 90 $165, 400 00 pm 00 400 00 $1,000 00 SUMMARY. Ordinary $202,000 00 Special 145,400 00 Surplus 1,000 00 Total $348,400 00 Possible cuts suggested by superintendent — Take out if necessary, ordinary (second year), $12,000.00. From the appropriations asked, amounting to $368,400 00 The board made the following reductions — Ordinary expense fund $12,000 on Two new cottages (one cottage) 25,000 00 Furnishing 1,250 00 Total reduction 38.250 00 Total amount of appropriations recommended $310,150 00 47 Chicago Blind — Appropriations Asked — Revised. Items. Ordinary appropriation asked. Special appropriation asked. Surplus appropriation asked. Ordinary Working capital Finisliing fourth story. . . . Fi'rnishing fourth story. . . Repairs and improvement. $61, 000 00 $61, 000 00 $50,000 00 12.000 00 3,500 00 7.000 00 $72, 500 00 SUMMARY. Ordinary $61,000 00 Special 72,500 00 Total $133,500 00 The board recommends the appropriations asked. Total amount of appropriations recommended for the seventeen State charitable institutions $7,389,916 00 FINANCIAL SUMMARY. Statement showing Increase of Recommended Appropriations, over Amount Received by the Seventeen State Charitable Institutions, 1905, also Amounts asked by Superintendents and Recommendations and Cuts made by Board for 1907. Institutions. Increase. Decrease. Appropria- tions asked by Superinten- dents. Appropria- tions recom- mended by board. Cuts made by board. $ 274, 930 389,900 200,975 193,800 220,000 153,000 247, 100 53,000 21,100 63,500 12,108 250,363 52, 921 15,500 $ 773.300 1,127,900 890,475 685,700 585,000 1,080,000 $ 695,800 1.127,900 637, 475 566.700 570.000 690.000 350.000 313.000 149. 600 133. 500 478. 108 710. 563 187. 221 48,500 121, 868 379, 531 330, 150 $ 77,500 Central Insane. 253,666 119.000 15.000 390,000 350,000 345.000 167, 500 133. 500 488.108 738. 407 191. 321 64.500 121. 868 341.531 32,000 School for Blind 17,900 Industrial Home for Blind 10.000 ■27.844 4.100 Soldiers-Orphans' Home 16.000 $40, 432 Eye and Ear Infirmary 60, 631 71,900 62.000 368, 400 38,260 St. Charles School for Boys Totals $2,280,728 40, 432 $40. 432 $8, 452, 510 $7, 389, 916 $1,062,594 Net increase $2, 240. 296 ■ 48 Appropriation Bills Recommended by the Board. The following are appropriation bills, arranged in due form for con- sideration by the General Assembly and as recommended by the State Board of Public Charities : ORDINARY EXPENSE APPROPRIATIONS RECOMMENDED BY THE BOARD. A Bill For An Act making an appropriation for the ordinary and other expenses of the State Charitable institutions herein named. Section 1. Be it enacted by the People of the State of Illinois, represented in the General Assembly: That there be and is hereby appropriated for the purpose of defraying the ordinary expenses of the State institutions named in this Act, for the year beginning July 1, 1907, the sum of $2,341,250.00, pay- able quarterly in advance, and the said appropriations shall be apportioned smong the institutions as follows: To the— Northern Hospital for the Insane, Elgin $ 185,000 00 Eastern Hospital for the Insane, Kankakee 379,750 00 Central Hospital for the Insane, Jacksonville 205,000 00 Southern Hospital for the Insane, Anna 175,000 00 Western Hospital for the Insane, Watertown 175,000 00 Asylum for the Incurable Insane, South BartonvIIle 287,500 00 Asylum for Insane Criminals, Menard 40,00u 00 Illinois School for the Deaf. Jacksonville 125,000 00 Illinois School for the Blind, Jacksonville 47,000 00 Asylum for Feeble Minded Children. Lincoln 200.00(1 00 Soldiers' and Sailors' Home, Quincy 205,000 00 Soldiers' Orphans' Home, Normal 67.500 00 Soldiers' Widows' Home, Wilmington 22,500 00 Illinois Charitable Eye and Ear Infirmary, Chicago 44,000 00 Training School for Girls, Geneva 65.000 00 St. Charles School for Boys, St. Charles 90.000 00 Illinois Industrial Home for the Blind, Chicago 28.000 00 Total $2,341,250 00 2. For the purpose of defraying the ordinary expenses of the State institu- tions named in this Act for the year beginning July 1st, 1908, the sum of $2,387,750.00 is appropriated, payable quarterly in advance, and the said ap- propriation shall be apportioned among the institutions as follows, until the expiration of the first fiscal quarter after the adjournment of the next Gen- eral Assembly: To the — Northern Hospital for the Insane. Elgin $ 201.500 00 Eastern Hospital for the Insane, Kankakee 370.7.'5O 00 Central Hospital for the Insane, Jacksonville 205.000 00 Southern Hospital for the Insane, Anna 175,000 00 Western Hospital for the insane. Watertown 175.000 00 Asylum for the Incurable Insane. South BartonvIIle 287.500 00 Asylum for Insane Criminals. Menard 40.000 00 Illinois School for the Deaf. Jacksonville 125.000 00 Illinois School for the BUnd. Jncksonvillo 47.000 00 Asylum for Eepble Minded Children. Lincoln 200.000 00 Soldiers' and Sailors' Home. Quincy 210.000 00 Soldiers' Orphans' Home. Normal (57.500 00 Soldiers' Widows' Home, Wilmington 22.500 00 Illinois Charitable Eye and Ear Infirmary. Chicago 44.000 00 State Training School for Girls, Geneva 7.">.000 00 St. Charles School for Bovs, St. Charlns 100.000 00 Illinois Industrial Home for the Blind. Chicago :<:^ooo oo Total $2,387,750 00 All moneys herein appropriated shall be due nnd payable to the trustees of the several Institutions named, or to their order, only on the terms and In the manner provided In the 19th section of an Act entitled, "An Act to regu- late the State charitable Institutions and the State Reform School, nnd to Improve their organization and Increase their efficiency." 49 SPECIAL APPROPRIATIONS RECOMMENDED BY THE BOARD. A Bill For An Act making appropriations for the State charitable institutions herein named. Section 1. Be it enacted by the People of the State of Illinois, represented in the General Assembly: That the following sums be and are hereby appro- priated to the State institutions named in this Act, for the purposes herein stated, for the two years beginning July 1, 1907, the sum of $2,660,916.00, and that the appropriations shall be apportioned between the institutions and shall be payable as herein stated, as follows: To THE NOKTHEUN UOSriTAL FOR TUB INSANE, ELGIN Repairs and Improvements, $10.00 per annum Painting, $3,000.00 per annum Improvement of grounds, $2,000.00 per annum , Iron bedsteads Live stock Farm implements and buildings Cold storage and ice plant Shops for patients Farm ward, to accommodate fifty patients Two new cottages Hospital building Fire escapes Plumbing Power house, boilers, etc Wiring Extension water system Improving system of heating and ventilation , Total To THE Eastern Hospital for the Insane, Kankakee. Kepairs and improvements, $30,000.00 per annum Improvement of grounds, $2,000.00 per annum , Live stocls and farm implements, $2,000.00 per annum Two new buildings and furnishing same Twelve hundred double windows Psychopathic Institute and maintenance for two years Milch cows Hydrotherapeutlc equipment Fourteen hundred iron beds and mattresses Warehouse addition Painting Fire escapes Plumbing Flooring Power house and water supply New electric wiring Ventilation Total To THE Central Hospital foe the Insane. Jacksonville Repairs and Improvements, $15,000.00 per annum Improvement of grounds, $1,000.00 per annum Llbrarv, $500.00 per annum Plumbing, $2,500 per annum Concrete walks. $1,500.00 per annum Psychopathic hospital Home for nurses Fencing and extension concrete wall Painting New furniture and Iron beds New building for consumptives and contagious diseases Live stock and farm Implements Ventilation Enlarging power house, smoke stack, etc Plumbing and bathing facilities Enlarging and rebuilding laundry Repairing greenhouse Total $ 20,000 00 6,000 00 4,000 00 7,000 00 2,000 00 2,500 00 20,000 00 10,000 00 25,000 00 50,000 00 25,000 00 1,800 00 7,000 00 82,000 00 12,000 00 10,000 00 25,000 00 $309,300 00 533B. $ 60,000 00 4,000 00 4,000 00 140,000 00 3,000 00 30,000 00 4,000 00 4,000 00 19,500 00 10,000 00 8,000 00 1,400 00 10,000 00 5,500 00 50,000 00 10,000 00 5,000 00 $368,400 00 $ 30,000 00 2,000 00 1,000 00 5,000 00 3,000 00 60,000 00 25,000 00 3,000 00 6,000 00 6,000 00 6,000 00 2,500 01) 6,000 00 24,000 00 37,975 00 8.000 00 2,000 00 $227,475 00 -4 P C 50 To THE Southern Hospital for the Insane, Anna. Repairs and Improvement, $10,000.00 per annum $ 20.000 00 Improvement of grounds, $2,000.00 per annum 4.000 00 Library, $500.00 per annum 1,000 00 Live stock and farm Implements, $2,000.00 per annum 4.000 00 Hospital building and furnishing 50.000 00 Home for nurses and furnishing 25.000 00 Telephone system 2.000 00 Painting 4,000 00 Rebuilding greenhouse 2,500 00 Track scales 1.200 00 Industrial building 15.000 oo Iron beds and furniture 8.000 00 F'lre escapes 1.000 00 Plumbing 4.000 00 Flooring 5.000 00 Power house, boilers, etc 50.000 00 Wiring 1 0.000 00 Fire protection 10,000 00 Total $216,700 00 To the Western Hospital for the Insane, Watertown. Repairs and improvements, $10,000.00 per annum $ 20.000 00 Improvements of grounds and farm, $10,000.00 per annum 20.000 00 New buildings, psychopathic and hydratlc 100.000 00 Land 40.000 00 Ventilation, power plant, etc 40.000 00 Total $220,000 00 To THE ASYLDM FOR INCURABLE INSANE, SOUTH BaRTONVILLE. Repairs and Improvements, $15,000.00 per annum $ 30.000 00 Fireproof hospital building or buildings 60,000 00 Artesian well 1 5.000 00 To complete State railroad 10.000 00 Total $115,000 00 To the Asylum for Insane Criminals, Menard. Buildings and land $270,000 00 To THE School for the Deaf, Jacksonville. Repairs and improvements, $25,000.00 per annum $50,000 00 Library, $500.00 par annum 1 ,000 00 Dairy barn 10,000 00 Greenhouse 2,000 00 Total $63,000 00 To the School for the Blind, Jacksonville. Repairs and improvements, $4,000.00 per annum $ .S.OOO 00 Printing material, $500.00 per annum 1,000 00 Library and apparatus. $400.00 per annum SOO 00 Special training for the deaf blind, $1,000.00 per annum 2.000 00 Isolation hospital 6.000 00 State I,lbrary for blind 2.000 00 Ventilation 4.100 00 Fire hydrants and water supply 2.200 OO Wiring 3.500 00 Tile floors and wainscoting 3.100 00 Power plant and tunnel 22,500 00 Wood floors 400 00 Total $55,600 00 To the Asylum for Feerle Minded PiiiLDnEN. Lincoln. Repairs and improvements, $10,000.00 per annum $20,000 00 Improvement of grounds. $2,000.00 per annum 4.000 00 Library and school books. $750.00 per annum 1.500 00 Oymnnslum and playroom 20.000 00 Shops lO.noo 00 Fire escapes 3.700 00 Fire protection 7.074 00 Alteration In domestic water supply 034 00 I'nderground steam distributing system 10.000 00 Total $78,108 00 51 To THB SOU)IBES' AND SAILOES' HOMB, QDINCI. Repairs and improvements, $10,000.00 per annum $ 20,000 00 Library, $600.00 per annum 1,200 00 Improvement of cemetery and roads 2,000 00 Track scales and switches 2,500 00 Smolie stack and breeclilng 4,000 00 Reconstruction laundry 4,000 00 Ice plant and refrigerator room 8,000 00 Main tunnel extension 8,000 00 Two new cottages 115,000 00 Hospital for women 17,500 00 Furnisliing cottages and liospital 15.686 00 Sewerage extension 2,500 00 Fire protection 11,077 00 Electric wiring 10,000 00 Electric power plant and new boilers 42,000 00 Wood flooring 10,000 00 Improving liospital laundry 3,200 00 Tin roof on main building 2,400 00 Painting 5,000 00 Two new boilers 11,500 00 Total $295,563 00 To THK Soldiers' Orphans' Home, Normal. Repairs and improvements, $2,500.00 per annum $ 5,000 00 Library, $300.00 per annum 600 00 Roofing 3,242 00 Plastering 1,027 00 Painting 3,667 00 Hardwood flooring 1,462 00 Tile flooring 1,125 00 Radiation 5,065 00 Fire protection 5,004 00 Wiring 2,000 00 Plumbing 1,869 00 Iron stairs 700 00 Concrete walks 1,260 00 Installing electric light plant 3,000 00 Installing three new boilers 8,000 00 Opening Lincoln street 1,200 00 Masonry 1,000 00 Mangle 1,000 00 Iron bedsteads, single 1,000 00 Industrial shop equipment 5,000 00 Total $52,221 00 To THH Soldiers' Widows' Home, Wilmington. Repairs and Improvements, $1,500.00 per annum $3,000 00 Fire protection 500 00 Total $3,500 00 To THE Charitable Eye and Ear Infirmary, Chicago. Repairs and improvements, $3,500.00 per annum $ 7,000 00 Library and amusement, $250.00 per annum 500 00 To complete new additions and roof garden 10,000 00 Paving on Peoria street 2,500 00 Elevator 5,000 00 Bath room and sterilizer 2,500 00 Tile floors In old building 4,000 00 Wiring 2,205 00 Mechanical equipments 163 00 Total $33,868 00 To THE State Training School for Girls, Geneva. Repairs and Improvements, $8,000.00 per annum $ 16,000 00 Improvement grounds, walks, tiling and cemetery fence 4,000 00 Live stock and Implements 3,000 00 Furniture 4,000 00 Paroling and discharging girls 1,500 00 Library 500 00 Two new cottages 50.000 00 Land 22.500 00 Two deep well pumps, etc 3,000 00 Boiler, dynamo and pump 6,400 00 Greenhouse 1.500 00 Fire protection 9,931 00 52 Wiring 8,000 00 Water mains 3,700 00 Engine for dynamo boilers 3,000 00 Automatic door openers 2,500 00 Total $139,531 00 To THE St. Cuahles School fou Boys, St. Chables. Repairs and Improvement, $2,500.00 per annum $ 5,000 00 Live stock and farm Implements, $1,000.00 per annum 2,000 00 Library, $250.00 per annum 500 00 Parole officer, $1,200 per annum 2,400 00 One cottage 25,000 00 Furnishings for cottage 1,250 00 Administration building 55,000 00 Infirmary 15,000 00 Sewers and drainage 15,000 00 Pump and well 5,000 00 Gymnasium equipment 5,000 00 Walks 1,000 00 Imrovlng laundry 1,000 00 Dynamos, conduits, etc 6,000 00 Reducing pressure on plumbing 600 00 Fire escape on school building 400 00 Total $140,150 00 To the Industrial Home for Blind, Chicago. Working capital $50,000 00 Finishing fourth story 12,000 00 Furnishing fourth story 3,500 00 Repairs and improvements 7,000 00 Total $72,500 00 APPROPRIATION TO ESTABLISH A STATE EPILEPTIC COLONY, AS RECOMMENDED BY THE BOARD. A Bill For An Act making appropriations for the Illinois State Colony for Epileptics. Section 1. Be it enacted by the People of the State of Illinois, represented in the General Assembly : . That the sum of two hundred and sixty-five thous- and (265,000) dollars be appropriated to the Board of State Commissioners of Public Charities for the purpose of locating and constructing necessary buildings and maintenance of the colony for epileptics under the provisions of an Act of the Forty-first General Assembly, approved April 19, 1899, Land and buildings $235,000 00 Maintenance till 1909 30,000 00 Total $205,000 00 § 2. The Auditor of Public Accounts Is hereby authorized and required to draw his warrant upon the State Treasurer for the amount herein appro- priated upon presentation of proper vouchers certified to by the Board of State Commissioners of Public Charities and approved by the Governor. 53 Annual Report Almshouse Inspection by Illinois Board of Charities. state of illinois Office of the Board of State Commissioners of Public Charities. "How do they 'xpect a feller is goiri' to git well, when they put Hm where a well feller'd git sick." — Jim Fenton in J. O. Holland's "Sevenoaks." Springfield, III., April 22, 1907- To His Excellency, the Honorable Charles S. Deneen, Gov- ernor of Illinois, Springfield: Sir — Sixty years to a month after Dorothy L. Dix pre- sented her memorial to the Illinois General Assembly, in favor of State care for the insane, the Illinois Board of Charities made a midwinter inspection of the almshouses maintained by Illinois county governments. It found condi- tions which resemble some of those described by the famous philanthropist more than half a century ago. To remedy the conditions reported by Miss Dix she declared certain facts about insanity and made recommendations for the cura- tive care of mental defectives in State institutions as follows : 1. Practical recognition that insanity is not a "hopeless and incurable disease," but arises "from physical causes" and is "subject to successful physical treatment, as surely as a fever, or other common bodily disease."' 2. Hospital care for acute curable cases in well equipped State institutions looking, for humane and economic reasons, to larger percentages of those discharged as cured.' 3. Industrial re-education, at State institutions, of chronic types for humane, medical and economic reasons.' 4. Clearing almshouses of the insane, because alms- houses do not and cannot afford proper hospital care for them.' The essential recommendations of Dorothy L. Dix, sixty years ago, are the same as those made by the State Board of Charities today, except for the water treatment,^ which was not practiced for the insane in America during Miss Dix's splended activity, and except for more thorough Instruction of physicians,^ which is a product of medical methods of education developed during the last quarter of a century. Dorothy Dix plan. 1. Miss Dix's memorial to Illinois General Assembly, January. 1847. 2. Nineteenth Biennial Report, State Board of Charities. Insane per- sons are sick. Hospital care looking to cures. Industrial re- education. Clear alms- houses of Insane. Water " treatment Education. 54 Millions ex- pended. Time for final step. Attacks a system, not Indl- yiduals. Insiiffiolent modlcal and nurs- ing service. Girl chained STATE'S MAGNIFICENT BENEVOLENCE. Since Miss Dix gave the impetus in her memorial, which resulted in establishing the State's first hospital for the in- sane at Jacksonville^ in 1847, Illinois has been working v'aliantly to provide State care for its insane and feeble- minded. In this endeavor it has expended the enormous sum of $36,548,000. The money has been used to locate, erect, equip and maintain eight State institutions. This is a notable proof that the care of defectives by the State is held by Illinois a sacred duty to be met with benevolence and generosity. Account is no: taken, in the foregoing figures, of the State's outlay for other charitable institutions than those for the insane and feeble minded. The State Board of Charities now recommends steps for the full realization of the plan of Miss Dix for the curative treatment of the insane in State institutions, and for the ccmplete relief of county governments of this burden. The relief of the counties is only an incident in the recommenda- tions of this board. If the State Legislature will make its recommended appropriations of $772,000 for buJdings for modern curative treatment and appropriations fc r ventila- tion in old large buildings, room will be made at existing institutions to accommodate all insane now in county alms- houses, except that of Cook county. Thus Illinois will join New York State and Massachusetts in providing complete State care. FIFTEEN REASONS FOR COMPLETE STATE CARE. In setting forth existing almshouse conditions, as a reason for complete State care, the hoard desires to attack a system, not indiinduals. Therefore, without attaching blame to any superintendent or to any set of officials, and excluding Cook county because of modern service there, the Board of Chari- ties desires to state the reasons for completelv substituting the State care system for the almshouse system of care of de- fectives as maintained by county governments. On the basis of inspections and study this board believes the Fortv- fifth General Assembly should give authority for complete State care at the earliest practical date : 1. Because almshouses do not and cannot provide contin- uous, expert medical and nursing service. They do not and cannot properly classify the insane. Almshouses are main- tained to provide the bare necessities of life, to discourage pauperism. 2. Because, xohUe this Oeneral Assembly has been sitting, a girl in an Illinois almshouse has been hobbled with chains padlocked to her bare ankles, because her stamping disturbed other inmates in the insane department. 3. Fourth Biennial Report. State Board of Charities. 55 3. Because, while this General Assembly has heen sitting, a rude box, with wooden slats across the top, supplied with iron hinges, hasps and bolt, is ready, in a certain Illinois almshouse, to receive any insane man who becomes unruly, a service it has performed for others. 4. Because today there are almshouses in Illinois where steel handcuffs, barred cells, cages and padlocks are in ser- vice, when required to restrain the insane. Imagine an in- sane girl 20 years old locked in a steel cage. This happened recently in Stark county. 5. Because in thirty-five counties the almshouses have no bathtubs and in a number of others the water supply is defi- cient. 6. Because in eighteen almshouses there is no effective separation of the sexes, resulting in such scandals as the birth of illigitimate children by mentally irresponsible women. 7. Because in certain almshouses insane persons are pun- ished physically to make them behave. 8. Because in fifty-four almshouses there is no provi- sion to separate the insane from the plain paupers. 9. Because sixty-four almshouses have no fire protection. 10. Because in twenty-seven counties the care of the alms- house population is let by contract, substantially on the basis of the lowest bid, a system which tends to reduce all out- lays to the lowest notch and to leave human misery at the mercy of human greed. 4 11. Because some oj.' the insane are detained without hav- ing been tried and committed. 12. Because only primitive toilet facilities are provided in some of the almshouses and proper ventilation and heat- ing are not provided. 13. Because some of the almshouses are filthy and over run with vermin. 14. Because any insane resident of Illinois should have just as good care as any other insane resident, which is im- possible under varying county r. M. D.. William P. T.otchwortl). Pr. Wilhelm Wintcrnitz, ami Illinois Hoard of Charities Committee Hcport on ' "Hydrotherapy and Industrial Ke-education. Recreation' January, 1907, Bulletin. 65 tlon. Twent}-seven years ago European hospitals began the ^^''gcfeStiflc scientific use of water in the treatment of the insane and appiica- have achieved such marked success that thirty-nine private and public hospitals in America have adopted it. Mexican and Cuban hospitals use this treatment. For a specific state- ment of how water cures insanity the board refers to its January (1907) Bulletin, which contains a complete state- ment, inclding testimonials from conspicuous physicians who speak from experience of the value of water in curing insanity and in rendering useless chains, handcuffs, cribs and other forms of restraint ; also poisonous drugs.* MODERN CARE EXCEEDS COUNTY RESOURCES Such is the record of the care of the insane, from bar- barism to humane hospital treatment. Is it possible for the counties of Illinois to handle the care of the insane along modern lines ? They are not doing it. It is unfair to expect them to do it. They differ in size and wealth. They have not tlie resources to do it even under rigid State supervision. It is a matter of history in states which have assumed com- plete state care of the insane that during the hard work toward that end counties have lapsed into mediaeval meth- ods when state supervision has lagged. It requires a larger unit than the county to meet this great public responsibility as it should be met, not only for humane but for economic reasons. Certainly almshouses are not proper places to treat sick persons, for, as stated in the foregoing, the idea of their service is to provide the bare necessities of life so as to dis- courage the growth of pauperism. County can- not solve the problem. HOW SHALL THE STATE PROCEED? j How shall the State provide curative treatment for the Knotty que»- ... . ,,... , tlons. insane, m large mstitutions or m small mstitutions, by treat- ing all classes of the insane at the several curative hospitals or by segregating the so-called incurables in a separate asylum? These questions have been fought over bitterly in America for more than a half century. Necessity has dic- t.'ited the answers in this State. Illinois adopted the idea of a separate institution for chronic insane and established the asvlum for the incurable insane at South Bartonville. This 8. A simple illustration of the manner in which water, scientifically applied, causes an excited insane person to sleep, thus obviating the use of stupefying drugs and throwing mechanical restraint to the scrap heap, is given by Dr. J. H. Kellogg in Dr, Wilhel m Winterni tz's ' 'System of Phvsiologic Therapeutics, " as ' 'The overfilling of the cutaneous (skin; vesseis aiverts from the interior of the body a considerable amount of blood, since, when filled, the vessels of the skin may contain one half to (wo thirds the total quantity of blood in the body. The natural result is a draining of all the viscera; a condition allied to collateral anaemia is established in the brain, liver, kidneys, stomach, spleen and other viscera. Cerebral [braiM anaemia manifests itself in drowsiness, which often causes the patient to fall into a profound slumber.'' — 5 P C 66 Three meth- ods open. Best for all concerned. Aaotber part ?«rt or he State. decision was opposed as ill-advised by a previous State Board of Charities, but the plan was earned out, considering all factors, "as the only possible compromise between the practicable and the ideal."" Three ways are open to the State now to ameliorate the condition of the insane in almshouses : 1. By increasing the hospital facilities of all existing in- stitutions, thus benefitting all insane in public institution* and absorbing the almshouse population, except that of Cook county. 2. By increasing the capacity and facilities at Bartonville, thus emptying the almshouse population into that institu- tion. 3. By authorizing an absolute supervision of the insane in almshouses by the State Board of Charities with powei to make and enforce specific plans. The board favors the first solution as the only practicJil one, considering- the problem of proper care of the insane as u problem of all the State hospitals and not the problem of one institution. Each institution needs modern hospital equipment to care for its acute insane and its patients suffer^ ing from purely physical diseases. Each hospital needs chronic insane to reduce the cost of maintenance by perform- ing work. By providing new buildings, equipment and ventilation systems, present institutions can be .so enlarged as to give proper curative care to present populations, to the 626 in county almshouses and to the normal increase by new cases of 317 a year for the next two .ears, or a total of 1,26c new patients in the State hospitals. By following this policy all institutions will be benefitted permanently. By increas- ing the size of the Asylum for the Incurable Insane io solve the problem of housing the almshouse population, all the uiher hospitals for the insane will suflFer, unless the $772,000 iccommended by this board is increased to about $1,000,000 Furthermore, Bartonville itself would become unwieldlv be Lp.use of its size. The Board of Cha/ities op])Os<'s the idea ct large hospitals. It regrets the necessity of increasing the capacity of Kankakee, already too lar^e, but the humane and economic demand for curative treatment for patients makes Click course imperative not only at Kankakee, but at tJie other i ospitals for the i)isauc. including th erection of pure hos pital buildings at Bartonville, for whV.h the State Board of I. haritics has provided in its recommendations If the time comes when it ii. necessarv to increase the ca- pacity for chronic insane, this board believes some other part of the State should have a new institution instead of in- creasing the capacity at Bartonville. The site there is smal! n-ad made up of ravines and hillsides To support a larger chronic population would require :i much more ample acreage than is available at the Bartonvilic institution. There should be one acre to each patient of the type of those at Bartonville. This is not practical at that site. 9. Biennial report niinois Slate Board of Public Charities. 1898. 67 CURATIVE TREATMENT; ECONOMIC NECESSITY! While the most effective curative treatment is imperative for humane reasons, it is a necessity from an economic '^^vaiue of standpoint. The records of the oldest State hospital for the ^"L^^iL* / T 1 -UNI 1 1 • • treatment, msane (Jacksonville) shows that ten chronic patents cost $39,194, an average of $3,919.40 each, whereas ten cases that were received in the early curable stage cost ^450.60, or ^^pecord^s"* an average of $45.06 each. The time the State has cared for chronic cases now in the hospital ranges from 25 vears to 31 years. With the acute cases the time in the hospital ranged from six v/ecks to eight months. At Elgin, the next to the oldest hospital for the insane in Illinois, thirty chronic inmates cost $99,840, or an average cost of $3,328 each, whereas twenty acute cases cost $1,905, or an average of $95 each. The period of insanity of chronic cases ranged from 16 years to 35 years. With the acute the period of insanity ranged from eight weeks to fifty-six weeks. These figures do not attempt to compute the earning ca- ^'^^ful''^" pacity of the insane persons who were cured and returned to a productive life outside the institutions. Every 100 added cures, preventing that number of chronic sane, saves the State more than $200,000. Elgin records. CONTRAST OF STATE AND COUNTY CARE. In the State institutions where the numbers are great enough to permit of classifying the patients according to their condition and needs, it is possible to provide for their comfort and special care with the economics of a good sys- tem. Some of the counties of Illinois which have a number of insane to care for have made liberal provision for them bespeaking a humane, intelligent and well-to-do constitu- ency. Even in these, however, the number is not large enough to permit of proper classification, or enable the insti- tutions to have a resident physician, a trained nurse, or to have the mechanical and medicinal facilities enjoyed by a large institution for care and treatment. The great majority of the counties are making the best use they can of the bad conditions to which they have fallen heir. Gradually better buildings are replacing the dilapidated structurco of the early day, now past their usefulness. Nevertheless it is manifest that the whole system of attempting to care for the insane a lew in a place, where facilities and competent provision and the application of the fruits of wide experience are out of the question, is wrong. The sooner these facts are looked squarely in the face and their teachings adopted the bettei for the State and especially for the wretched and afflicted people who have been the sufferers under the old way Almshouses not de- signed for the insane. 68 EXPERIENCE OF NEW YORK STATE. significant protest Fruits of the county system. Moral effects of the exposure. The teachings of experience in Illinois are fullv borne out by that of other States. County care was practicallv all the public care there was in New York till nearly the middle of the last century. It was the predominant provision for some years after. In i8s5 ^^^ state convention of the superin- tendents of the poor made a public protest against further care of the insane in the almshouses, declaring that "the state should make ample and suitable provision foi' all of its insane ;" and that "no insane person should be treated, or in any way taken care of, in any county ,:)oor-house, almshouse, cr other receptacle provided for and in which paupers are maintained or supported." These resolutions contributed I owerfully to the development of a public demand for better things, but it was not till 1864 that an investigation was ordered by the legislature, under the direction of Dr. Sylves- ter D. Willard, secretary of the state medical society. The Willard report^'' graphically portrayed the facts, which called out a public protest of the county authorities against allowing the insane to be cared for in the county-houses ; a portrayal of human misery, wretchedness and degradation, public knowledge of which wrought an immediate change in the declared policy of the state. The fruits of the county care of that day in' New York are instructive and pertinent to the present discussion in Illinois, because they bore the same testimony then as now. At that time the greater parr of the insane population of the state was cared for in the county almshouses. By the Willard re- port it became known that no care or treatment whatever was provided with reference to recovery in the almshouses ; that the demoralized conditions aggravated the degrading tendencies of the disease ; that in a large number of counties patients were allowed to go all winter without shoes 01 stockings ; that violent patients were confined in cells having no provision for light or air ; that the filth of ihe cells was permitted to accumulate, filling the atmosphere with poison ti be breathed into the system of the patient ; in not a few cases there were no beds ; vermin was unchecked ; and that the insane were left to the care of incompetent paupers as a quite prevalent practice. When the facts of the Willard report came to public knowledge the demand for the abolition of this state of things swept aw^ay all opposition. It was determined that the state should assume exclusive care of the insane. This policy was given efl^ect by a large maiority in both houses, and an extensive state institution was provided foi , to carry the purpose into eflFect. The rapid growth of the s^ate, how ever, neutralized the provision to carry out the policv. The entire capacity of the new Willard asyhnn was absorbed by 10. Assembly Document No. 19, New York stale, 1865. 69 the demand as toon as it was opened, leaving r.c surplus j provision for the succeeding interval. The accumulation of financial burdens growirig out of the civil war fell upon the same period. The consequences of these unforeseen de- mands was that the overcrowding of the state insane p.sylums forced the return of increasmg numbers of the in- sane to the county -houses, and from 1S71 the counties were again left to deal with the insane. After eighteen years of further attempt to care for the in- sane in the almshouses it >v3s found that many of the old abuses were again prevalent in considerable degree and were growing worse. The state again took up the duty of making a complete separation of the insane from the other wards under its care, and this time with adequate measures. Dur- ing this interval the county system had been conducted imder as favorable conditions as could be hoped for in any state. No county-house had to deal with less than 25 pa- tients ; the numbers being sufficient to warrant better provi- sion than when there are few. In 1889 the legislature established the State Commission in Lunacy, and required of it an investigation of the condi- tions prevailing in the almshouses where insane were cared for. Its report" followed the same year, revealing shocking conditions in many of the almshouses where the insane were housed. The commission recommended that the state assume the complete and exclusive care of all ins-me rot provided for by the private hospitals. A law was Dssed to carr • out this policy, to take complete effect by I096. This policy is '"n force today. For ten years all the insane in the state of New York who come under public care hiv^e received the benefit of all that the best-equipped institutions could supply. EXPERIENCE OF THE STATE OF MASSACHU- SETTS. Massachusetts profited by the experience of New York In 1900 it provided that the insane should be cared for by the .state alone, relieving the almerlence8. the new policy, was 373; for 1902, 468; for 1903, 332; foi 1904, 300- and for 1905, 174. EXPERIENCE OF THE STATE OF ILLINOIS In Illinois, and in other states, up to the beginning of state icare, the insane frequently were allowed to run at large. Neighborhoods were terrorized by them. They burned 'buildings. Sometimes they committed horrible homicides and suicides. The private care of insane by relatives was attended, in instances, with great hardship, often with un- witting cruelty, because of ignorance and lack of proper facilities. The almshouse care was the first step in public care. It was taken to relieve families of burdens they were not able to bear. After the State had attempted to handle the insane the population of mental defectives grew so rapidly it out- stripped the applied resources of the State. To provide each newly committed person with the benefit of State care, the law was enacted authorizing the return to almshouses of as many chronic, quiet patients as were m excess of the allow- ance to any one county. To take care of this return popula- tion counties built infirmaries, or annexes. Paupers in the almshouses, who became insane, were also placed in these cnnexes. Some of the counties, considering their resources made good provision for the insane, but none, except Cook county, could approach the facilities provided in State insti- tutions. Many almshouse superintendents became advocates of State care, the only objections being advanced bv those who desired to retain insane persons as workers and by cer- tain contractors. In 1895 the Asylum for Incurable Insane was founded to relieve the almshouse situation, which, without any reason- able blame, was characterized in many instances by mediae- val methods. The completion of the new asylum was de- layed for seven years. It at once demonstrated afresh the inadequacy of county care. In one party of insane taken tc South Bartonville for State care, five were in restraint. The other three were two blind persons and one minus a leg. The windows of the passenger coach used in the transfer had wooden strips screwed to the sasn to avert the expected indiscriminate breaking of glass and possible escapes. Two days after Christmas of the current season 100 patients taken thereby transfer came in passenger coaches without visible restraint and with no pretense of protecting the large land- scape windows. Tt is by no means an uncommon experience for the patients to be accompanied by as many officers as there are patients. In one such instance five officers accom- panied five patients ; one of the latter being not only hand cuflFed, but having a handkerchief tied tightly across his mouth to prevent his spitting on his custodians. One man 71 v/ho had been at Bartonville previously for a year, under treatment, was returned there handcuffed, his wrists bleed- ing from his efforts to free himself. On his reception at the institution he was liberated and sent to his former cottage alone, where his attendants were women. He has since been restored to his family. A famous patient, who died recently, was Rhoda Derry. Ihis woman had been discovered by an inspector of a pre- vious board of charities, locked in a room of the Adams county almshouse. For forty years she had been kept in a rough box bed, with about such toilet facilities as are pro- vided for an animal in captivity. She had scrateched out her eyes. She was taken to Bartonville and carried in a basket up the hill to the asylum. She was placed in a white enamel bed in a room flooded with sunshine. She had expert medi- cal and nursing service. She became a pet of the great insti- tution. When she died the nurses cried. Such is ? contrast of State with county care of the insane. It has been a frequent experience at Bartonville to receive patients in handcuffs, leather restraint, and even in ball and chain. These implements are at once removed and placed in a museum because restraint is not employed at this institu- tion. Bartonville at one time had relieved thirty-five counties and partly relieved many others of their insane, but the in- crease in insane population has so overcrowded the institu t on and all other State institutions that almshouses are again beginning to fill. At the time of the inspection oniv twenty nine were without insane. LIGHT ON THE CONTRACT SYSTEM. The contract system of carrying on the poor-houses is in vogue in one form or another in 27 of the counties of this State. There are qualifying circumstances in most of the cases which need to be taken into account to form a correct conclusion of the actual workings. In some of the cases die plan has been attended with fair results, as such things go; but the system, as such, is open to grave abuses. That this consequence is appreciated among most of the county au- thorities is evident in the fact that the number of counties adhering to the practice is gradually being diminished iii favor of the system of paying a fixed salary to the superin- tendent of the almshouse ; the county paying all the ex- penses of carrying on the institution by direct appropriation. The fatal defect of the contract system is that in Its essence it consists of letting the care of the unfortunates who tail to public charge to an indiscriminate competition, and leaves the winning bidder to make his profit by scrimping the outlay on which the quality of the care and treatment de- pends. Where the county is small and the number of in- A famous case. Ball and chain. Overcrowd- ing. Workings of the contract system in Illinois. A vital defect 72 Farmi. Variations of the systeiD. mates of the almshouse also small, the chances of adequate care are what might be expected. Most of the almshouses are located on farms. In a por- tion of the cases the superintendent has the use of the farm in addition to the allowance which constituted the basis of l)js bid. In others he pays rent for the farm, so that, theoret- i.-ally, the farm does not modify the face of the per capita cMowance of the contract, provided the rental :s about what the farm ought to bring independent of the rest of the com.- }.ensation. The farms themselves, however, are of varying size and productiveness, and in some cases are so barren by nature or run down by bad management that the acreage is altogether misleading. Some of the variations of the system as at present in force .)! Illinois will be better understood from the following par- uculars : BooxE — This county has no farm or almshouse, but pays F. M. Leach $1,000 a year for taking care of those who would otherwise be cared for in such an institution; Mr. Leach furnishing the buildings and grounds, taking care of all in- mates, and of the tramps, and at the time of the inspection paying for half of the care of one person outside. The coun- ty makes considerable appropriations for outdoor relief. The system is said to work to the financial advantage of the county. At the time of the inspector's visit there were ten persons sheltered by Mr. Leach at his farm. Calhoun — The superintendent pays rent for the farm at the rate of $5.00 per acre, 160 acres, of which 100 acres is under cultivation. He receives from the county $1.50 a week for each inmate. The number of inmates was seven. The place is let to the highest bidder for the farm and the lowest bid per capita for care, in combination bid. Cass — The superintendent bid for the place originally, but has been continued six years. The farm is 190 acres, 100 in cultivation. Clakk — The superintendent received $1.50 per week per capita, and the rent of the farm in addition; the farm hav- ing 60 acres, 50 under cultivation. The per capita was to be increased to $2.00 per week March 1. He furnished food, fuel, clothing, bedding, care, medical attendance and funeral expenses. Clay — The superintendent has the use of the farm, 80 acres, 60 being under cultivation; and $1.30 per capita per week; there being 11 inmates at the time of the inspection. 1 For this compensation he furnishes care, food, clothing, med- ical attendance and bedding, works up the fuel and meets j the expenses for burying the dead. I Clinton — With 19 inmates of the almshouse Clinton coun- ty pays $1.10 per capita a week, for the care, clothing, food I and fuel of these people, in addition to the use of the farm I of 160 acres, 90 acres being under cultivation. Cumberland — The superintendent pays rent on the farm, 60 acres. 50 acres of which is farmed; amount of rent not [ stated. He receives from the county $1.50 a week per capita: the number of Inmates at time of Inspection being five. He furnishes care, food and clothing for that compensation. Eftingham — The superintendent provides food, clothing, fuel and bedding for the Inmates for $1.50 per capita a week, ' and pays rent on the farm, 160 acres, of which 115 acres Is 71 farmed. There were ten inmates at the time of the inspec- tion. Fba>-klin — For $1.55 per capita a week the superintendent and his wife furnish food, fuel, care and bedding and make the clothes of the women; there being 15 female inmates and three male. The farm has ten acres, the land being practically worthless. Gaixatin — The superintendent furnishes food, fuel, clothes and bedding and pays rent on the 80 acre farm, 60 acres of this being farmed. He receives from the county $2.50 per capita a week, the number of inmates at time of inspection being four. Grundy — There are 14 inmates here, for whose care the county pays $1.80 per week each. The relation of the 80 acre farm to the contract is not stated. Thomas Sykes has been superintendent here 24 years. Hamilton — ^With eight inmates to provide for, according to the number at the time of inspection, the county pays $55 per annum for each inmate, and the use of the farm, 70 acres of the 160 being farmed. The farm is stated to be poor, producing little. Jasper — The almshouse caring for 30 inmates at the time of the inspection, paying $1.50 a week an inmate for food, clothes, medical services and burial expenses. The superin tendent pays $3.00 an acre rent for the farm, 160 acres, 110 acres being farmed; most of which is said to be but fair land Jefferson — Fourteen inmates were being provided for at a public outlay of $1.00 a week per capita for care and food, in addition to the use of the farm, 160 acres, 135 acres being farmed. The county furnishes everything excepting as stated. Johnson — With four inmates to care for the county was paying $1.25 per capita a week, besides the use of the farm, 120 acres, 100 acres being farmed. For this remuneration the superintendent provides care, food, fuel, clothes and bedding, but the county pays for all medical services and funeral expenses. Lawrence — Seven inmates were provided with care and food for 23 cents a day each, in addition to the use of the farm. The latter contains 80 acres, 70 being farmed. It ia generally poor and unproductive. Massac — The county supports nine inmates at the alms- house for which it pays $1.00 per capita a week and the use of the farm, 120 acres, 75 of which is farmed. The super intendent furnishes food and care. Menaed — The number of Inmates averages 20, for whose care the county pays $1.50 each. The superintendent paya $4.50 an acre rent for the farm, 190 acres of which about all is farmed. Monroe — The almshouse had 20 inmates, the county pay- ing 25 cents per capita each day for care, food and fuel. Fop the insane inmates the county pays 35 cents a day. Pctlaski — Six inmates were cared for at an expense to the county of $1.35 per capita each week for food, fuel, clothing and care; this being in addition to the use of the 80 acre farm, 60 acres being farmed. Putnam — There are only four to provide for in this alms- house, for whom the county pays $2.50 a week for care, food and fuel. The farm contains 30 acres of inferior soil, RicHXAND — Nineteen inmates were cared for at $1.00 per capita each week and the use of the 160 acre farm, 135 acres being farmed. 74 Saline — There were 15 Inmates, the county paying $97.50 per capita per annum for care, food, fuel, clothing, bedding, furniture, medical attendance and burial expenses. The su- pprintendent pays $250 rent for the 125 acre farm; 80 acres of which is farmed. Scott — The superintendent pays $400 a year for the 80 acre farm, nearly all of which is farmed; and takes care of the Inmates, of which there were 13 at the time of the In spection, for 25 cents a day. The selection of superintendent by accepting the lowest bid is said to have always prevailed in Scott. Wabash — There were five Inmates to be cared for in this almshouse, for which the county pays $1.25 a week and th« use of the farm. The latter has 110 acres, 15 acres being farmed. The farm Is poor and unproductive. White — There were 22 housed here, the county paying 16 cents a day; an average ot ZV2 cents over the preceeding contract. The superintendent also has the use of the farm, 40 acres, but only four acres is farmed, the farm being prac- tically without soil. The superintendent furnishes care, food, clothing, bedding and toilet articles for the remuneration stated. Williamson — The county had ten under care at the alms- house at a cost of $1.75 per capita a week for care and food. How the farm Is counted is not stated, but it has but 80 acres, being old, worn out and of small value. WHAT IS THE MONEY COST? ThequesUon The naked question of the money cost between the two °' ^*'°°™^' ! systems of care is not as pertinent as the necessity' for pre- venting human misery. Still the greater expense of State care is slight. But who is willing to rest in the contempla- tion that he may one day suffer the wretchedness described in some of the experiences of the poor-houses in Illinois, or liave any member of his family thus treated, on a dispute of the saving of dollars? Is it a question of dollars against dementia? There are places in Illinois where the inmates of the poor-houses are kept for about a dollar a week. But that is not care. It is barely existence. County care is wasteful of the very opportunities for which care is instituted, namely, the chance of recovery and human comfort. In most of the counties in which the best almshouses are found there is little saving in the care of th** insane over the system provided by the State. The average in a number of these ranges in per capita cost from $2.20 a V, eek to $3.20. The average cost in the State institutions ii about $2.80 per capita a week. Yet the county-houses fulfill none of the main purposes which are the steady aim of the well-equipped State institutions. This fact ove' towers all L se. Under the present laws of Illinois, insane patients in State institutions are divided into private and county cases. The cost of clothing, transportation and oth'.r inci-len.al ex- l)enses, not including any part of the maintenance or treat- ment of county pitients, is defrayed at the expense of the countv from which the oat'ents are ad nitted. For the vear County care truly wasteful. Private and county cases. 75 responsibil- ity. ending June 30, 1905, $09,770 was pa'd into the State treas- ury out of the tieasiiries of the diff,tent counties To the individual tax-payer it probably is inmaterial whether the taxes which go into this item of public expenditure shall be paid by him in the shape of a State or county tax ; whether it be State 01 county, he pays it but once. Viewed from a purely economical st?ndooint, it will be better to piv this item of expenditure out of the State taxes. The increi^se of State taxes occasioned thereby would be met by a nearly corresponding decrease of cciinty taxes. Two reasons for this conclusion arc: 1st. The county boards are held strictly accountable, and rightly so, for the expenditure of moneys which they cause Division of to be raised by taxation, and those boards ought to have considerable discretion as to how and for what purposes these taxes should be expended. Under the present system an annual expenditure of approximately $100,000 of county taxes is made by the officers of the State who are not con- cerned in the levying of the tax. If it is proper at all that the State should care for the insane, this should be done as economically as is consistent with the welfare of the patients, and the officials who spend the money should also assume the responsibility of levying the tax to meet the expenditure. A system which divides this responsibility in the nature of things cannot be the most economical, nor can it be for the best interests of the public. 2d. The present system works to the detriment of the unfair to smaller tax-paying communities. For example: Of the total paid into the State treasury for the year 1905, as set forth in the foregoing, 36.83 per cent was paid out of the treasury of Cook county for that year. The total assessed value of Cook county was about 40.35 per cent of the total value of State. It may be that from the larger counties more pri- vate patients are sent to the State institutions than from the smaller counties, and that this percentage may vary from year to year. In the year 1904 there were in the various county almshouses of the State an average of about three thousand insane persons. This board has endeavored to ob- tain accurate information as to the actual cost per capita in each county. Inaccuracies and great variations make it impossible to reach a satisfactory conclusion. The average number of insane in the several countiea usually bears the same percentage to the total number of in- habitants in one county that they do in another, except that those cities and villages which lie in close proximity to the centers of transportation usually have dumped upon them, as a natural consequence of their location, during certain periods of the year, a floating population, which strictly be- lt ngs neither to them nor to any other community. In this 1 opulation usually are found a proportion of insane w'r o He- come charges upon the public. From a purely economical standpoint, assum.ing that all insane shouM have propter car^* and attention, it would seem that it must be an expensive thing to require that these insane should be scattered through the 100 almshouses maintained by the counties. It would seem that better results, with less money, could be obtained small counties. Unfair dis- tribution. 76 Equal burden on all. Free coun- ties of all direct cost. What the State can provide. Hospital care. to gather all these insane into State institutions arranged and maintained solely for the purpose of caring for the insane. All taxable property of the State ought to bear its pro- l-ortionate share of this item ot public expense. Und^r one management the expense ought to be less than under one hundred separate and di.stinct managements. Here, as in the matter of the incidental expenses of county cases in State institutions, it is immaterial to the individual tax payer whether he pays his tax as a State tax or a county tax He IS concerned only that, whether State or county, the tax should be levied and expended by that body which can do it the cheaper. As to the additional cost to the State, if it should assume the absolute cost of maintaining and caring for the insane, an additional expenditure of $100,000 a )'ear, now paid out of the county treasuries, and the cost neces- sary to care for 3,000 insane, would mean such a small in- crease of the State tax rate that none of the smaller tax- payers would notice it. Over 40% of these taxes would be paid by Cook county, and over 6% of the total tax would be paid by the steam railways outside of Cook county. It seems that from every possible financial view the re- sponsibility of caring for the insane ought to be placed with one central body, the State, which central body should not only spend the money, but should by taxation raise the money that it spends and thus assume full responsibility to the people. There should be no direct charge upon the county for the care of the insane. ADVANTAGES OF A PROPERLY EQUIPPED HOSPITAL. In contrast to the poor-house, the properly equipped State hospital for the insane has buildings adapted to their pur- i)Ose and representing generations of experience in the pro- visions with which they are equipped. There is uniform warmth and superior ventilation, with a constant supply of iresh air. There is an abundant supply of good water for all uses. There are systematic regulations for bathing. There are approved sanitary arrangements and all possible con- veniences for personal cleanliness. Clean and wholesome conditions are provided for the filthy, and a training calcu- lated to bring about good habits. The patient is under the constant care of experienced at- tendants and trained nurses, and is twice daily under the observation of a physician selected for his fitness for this class of duties. He receives approved treatment suited to h.is mental or nervous malady and in this treatment mechan- ical and drug restraint are reduced to a minimum, or dis- pensed with. He is cared for in a well-provided hospital arid with skilled nursing when physically ill. He is given a diet wholesome and chosen with reference to his well being. He n is, so far as possible, provided with occupation out-of-doors to furnish healthful activity and exercise. He is reeducated so as to become at least partly self-supporting outside an institution. Amusement, recreation and diversion are sup- plied to stimulate interest. His spirits are appealed to by the chances and prospects for recovery or sufficient restoration to be returned to his family and again become a productive, self-supporting and useful member of society. All of these conditions are found in the best appointed and best managed iiospitals for the insane today. Moreover, all of them have in prospect better results and standards for their general average than have ever yet been attained. It is clear from the liberal provision already made by Illinois that the underlying purpose and spirit has been to give to all of the insane the benefits of State care, and with- draw them altogether from the conditions prevailing in the almshouses. By the latest returns, including the Cook County Hospital at Dunning, which cares for i,6o8 patients with the facilities of the best State institutions, ii,c;6o insane were receiving public care, of whom only 626, or a little over five per cent (5.4) were in the county-houses. CONCLUSIONS AND RECOMMENDATIONS. Every State hospital for the insane in Illinois is so over- crowded today that, unless more room is provided, it will be necessary to return insane patients now receiving State care to the almshouse care described in this report. This most unfortunate step can be avoided, and curative treat- ment of the highest approved value can be provided for al! the insane wards of the State if the Forty-fifth General As- sembly and Your Excellency approve the recommendations of this board as set forth in its 19th biennial report. In the name of humanity and progress, we, as members of the State Board of Charities and as individuals, recommend complete State care for the mental defectives of Illinois at the earliest practical date. Respectfullv "submitted, (Signed) Frank Billings, Emil G. Hirsch, Julia C. Lathrop, John T. McAnally, Clara P. Bourland, Insane in public In- stitution!. Small per- centage In alms- houses. Either for- ward or backward. (Signed) William C. Graves, Secretary. 78 CHILDREN, EPILEPTICS AND CONSUMPTIVES IN NOIS COUNTY ALMSHOUSES. ILLI- Provision for Insane. Majority have no children. Children In 40 alms- houses. Tabular statement. When the Board of Charities inspected conditions sur- rounding the insane in almshouses, outside of Cook county, maintained by IlHnois county governments it also noted the children, the epileptics and the consumptives kept in these institutions. CHILDREN IN ALMSHOUSES. The aim of the State that no children shall be cared for in the almshouse, in the sense of making that their home and growing up under the influence of such associations, is being faithfully supported in the great majority of the counties. Of the 98 counties for which these facts are re- ported, 58 have no children in their almshouses, namely : Adams, Alexander, Bond, Brown, Calhoun, Carroll, Cass, Cham- paign, Christian, Clark, Coles, Cumberland, DuPage, Edgar, Edwards, Effingham, Ford, Fulton, Gallatin, Grundy, Hancock, Henderson, Iroquois, Jackson, Jersey, Jo Daviess, Johnson, Kane, Kankakee, Lake, Lee, Macon, Macoupin, Marshall, Mason, Mas- sac, McHenry, Menard. Monroe, Montgomery, Morgan, Moultrie, Ogle, Perry, Piatt, PulaakI, Putnam, Randolph, Sangamon, Stephenson, Union, Vermilion, Wabash, Washington, Wayne, Whiteside, Winnebago, Woodford. Of the other 40 counties the children are in the alms- houses because of waiting for homes or other disposition that is decided on for their special cases ; but there are some instances where it is purely through neglect of the proper authorities that the children have not been placed before this. Distribution of the Children. The counties in which children were being cared for in the almshouses at the time of the inspection (totaling 107) and the number in each, are as follows: 79 County. Male. Female. Total. Boone 1 2 2 2 Bureau 3 Clay Clinton .. 3 2 Crawford 1 DeKalb 1 DeWltt 1 1 3 2 1 Douglas 1 Fayette Franklin 7 3 Greene 2 Hamilton 1 1 5 1 Henry ■ 1 Jasper Jefferson 12 1 3 LaSalle 1 2 1 Livingston i "" 2 1 1 4 2 4 3 2 McDonough 1 8 4 1 2 1 Pike 5 1 Rock Island 2 1 Schuyler 1 1 2 1 1 1 4 2 1 3 2 Shelby 2 1 St. Clair 1 2 Warren 8 White 5 Will 1 1 61 46 107 Survey of Conditions. Some understanding of the circumstances attending the various cases are necessary in order to see how far they are consistent with the spirit of the Illinois law and what coun- ties are delinquent in this respect. Additional facts are given in the following memoranda : Boone — The two children are a boy of 3 and girl of 5, brother and sister; the father being an Inebriate and the mother in the hospital, where she was not expected to live. It was the purpose to place the chil- dren in some home in the event of the mother's death. BuEEAU — Two children, brother and sister, aged 3 and 7, respectively, were to be placed in homes as soon as suitable ones could be found. The third child, 10 months of age, was detained there to prevent the mother from running away, the child, it was declared, being Ille- gitimate. Clay — A lad of 7, deaf from birth, was waiting the age of 8 in order that the authorities might place him in the school for that class. The others are two reported as illegitimate children, a boy of 4 and girl of 7, both feeble minded. No effort had been made to place them in the asylum for feeble minded. Various circum- stances. bo Clinton — Two children here are both reported as ille- gitimate children. The oldest, aged 10, had been placed once and returned because of difficulty in controlling him. No effort sems to have been made to place the other. Crawford — A lad of 3 is awaiting the determination whether his mother, confined a second time at Anna, is incurable insane; the mother's second husband, the stepfather, and the divorced father of the boy being in dispute as to which should have the child. DeKLaxb — A lad of 12, idiotic; should be provided for elsewhere. DeWitt — A girl of 13, with defective vision; has been treated at the eye and ear infirmary, where it was determined that she would eventually become blind. Douglas — One inmate here is a girl of 13, epileptic and feeble minded, whom the State ought to be able to provide for better in some special institution. Fayette — Six, four boys and one girl, belong to one family and are here with their father and mother, who resist every effort to place them elsewhere. Another, a girl of 15, has tuberculosis. F'ranklin — Three children, all said to be illegitimate, are here with their mothers, through neglect to place them. Greene — Two boys of 12 and 16 have remained here since 1900 because of a dispute among the supervisors at that time as to who should accompany them to the school for feeble minded. HAiMLLTON — A girl of 3; should be sent to the school for feeble minded, where her condition classifies her. Henry — A reputed illegitimate child of 18 months, with her mother; is to be placed in a home, when a suit- able one is found. Jasper — No one seems to feel any responsibility for placing such of the twelve children as could be provided for in homes. Two should be in the home for feeble minded. According to the report, five belong to a woman of violent temper, who is unwilling to give them up, she having been deserted by her husband. The mothers of six other children include a shiftless woman, the father being nearly dead; a feeble minded woman; a prostitute; an idiotic woman, tramping the country, and a vagrant woman, who was out working, but might return any day, the last named woman having two children in the almshouse. Jefferson — A boy of 2 years, the mother being unwill- ing to part with him, although realizing that he would be much better off in a good home. His father was killed soon after the child was born. Knox — Boy of 11, mother living in Galcsburg; no reason being given for his detention in the almshouse. Two boys of 2 and 1 year, deserted by their father, their mother ill; apparently awaiting the development of events. LaSalle — A boy of 16 and girl of 14, both feeble minded, brought to the almshouse with their parents; boy was to be sent to Lincoln soon. Lawrence — A boy of 7, his mother crippled, "not bright," an inveterate smoker. The boy will probably be cared for permanently by the family of the alms- house superintendent. 8i Livingston — Two boys of 12 and 14, who are to be provided for by their father as soon as he can make suitable arrangements, being at the time hampered by some litigation. Logan — A girl of 8 and two boys of 9 and 5, children of a father and a mother who are described as "bad ones," are to be placed as soon as suitable homes are found. A boy of 7 was born in the almshouse. It is stated that they have never been able to find a home for him. Madison — It had been arranged to place a girl of 5 in a home. Two reputed illegitimate children, a boy of 2 and girl of 6 months, here with their mother, were to be sent with her to Sangamon county. Mabion — A girl of 3 years and boy of 2 months were with their mother, both reported as illegitimate. She refused to give them up. She was pronounced unfor- tunate, rather than vicious. McDoNOUGH — A girl of 7 came with her grandmother about Dec. 1. Was soon after sent to the hospital, hav- ing typhoid fever; should not be allowed to return, as conditions were very unfavorable, in the judgment of the inspector. McLean — Five of the eight belong to a family at the almshouse temporarily, being stranded in Bloomington. A boy of 7 is the reputed illegitimate child of an in- mate who resists with tigerish ferocity any attempt to place him in a home. A girl of 14 is fairly bright, but is unable to walk without support, and could not be placed in a home. A girl of 4, rather bright, is with her mother; serious defects of the eyes prevent her adop- tion in a family. Meecee — Two mothers made such hysterical protest against placing their children that the step was de ferred for the present. They comprise three . sons of one woman, 3, 6 and 10 years of age, and a boy of 6, son of the other woman. Peoeia — A baby boy a week old; was to be placed in a home. Pike — Two girls were carried on the rolls here, although for the time one was in the blind institute at Jacksonville, being blind; the other with a family in Pittsfield, attending school. Two boys of 14 and 9 be- long to a father out on parole from the penitentiary, who refuses to release them. A boy of 8 was with his mother, who would probably refuse to release him, although she is not considered a proper person to have the care of him. Richland — A lad of 12, here seven years; should be sent to the asylum for feeble minded; can learn nothing at school. Rock Island — A colored baby boy, 2 weeks old, and a lad of 12, aflaicted with tuberculosis of the bones; almost helpless; mother insane and father a vagrant. Saline — A lad of 13, feeble minded; has not been sent to the school for such because of neglect. ScHUYLEB — A boy of 2 was about to be sent to Chicago to the Illinois Children's Home and Aid Society. A lad of 10, who came to the almshouse two weeks before, was in a most uncleanly state; he was to be sent to school soon. A girl of 14 had been placed in homes several times, but returned as unsatisfactory. —6 P C 82 Counties placing clilldren Counties whence Informa- tion Is at band. Scott — A girl of 14, simple minded, but capable of being taught, had been in the institution at Whitehall, but was returned, as her parents were living. A boy of 14 came to the almshouse, being in a weak state since November, his mother being dead and no one to care for him. His mouth was filled with tobacco. He could neither read nor write. He was formerly employed in the Alton glass works. Shelby — Two girls of 13 and 14, feeble minded, had been at the almshouse seven and five years, respectively. Neglect to send them to the proper school was not ex- plained. Stabk — A girl of 7 had been at the almshouse three months; was about to be placed through the Illinois Children's Home and Aid Society. St. Claik — A girl of 6 who came with her mother a few days before, her mother being a shiftless kind of woman, utterly unfit to have the care of the child, in the judgment of the inspector. Tazewell — A boy of 3 and girl of 7, members of a family of seven children placed through the Evangelical Lutheran Kinderfreund Society, was returned as syphi- litic, under order of the court and under the court's Jurisdiction. The superintendent considered the boy healthy and worthy of a good home. White — Two were with a mother who became stranded, and expected to leave in the spring. The other three were with their mother, a widow, who refused to give them up. Will — A girl of 11 months, with her mother, feeble minded, who has an estate and expected to go to her people. Her mother's people were expected to care for the child. Williamson — The commissioners refrained from plac- ing the boy of 13 because of the pleading of his mother, a woman in feeble health, who had come but a few months before. Disposition of Children. ! The data is not complete in regard to action by the no county courts in placing children during the year 1906. The reports show that no children were placed by action of the court in the following counties, namely : Boone, Brown, Bureau, Calhoun. Carroll, Cass, Clark, Clay, Clin- ton, Coles, DeWitt, Douglas. Dupage, Edgar, Edwa."ds, Fayette, Ford, Fulton, Grundy, Hancock, Henderson. Jer- sey, Jo Daviess, Kane, Kankakee, Lake. Lawrence, Liv- ingston, Mason. Montgomery, Piatt, Pike, Scott, Stephen- son, Will, Woodford. Owing to a change in the court or other reasons the in- formation as to action of the court in the placing of children t in homes or elsewhere was not furnished in the following counties, so that it cannot be stated whether such action was had or not, namely, the counties of Cumberland, jEffingham, Greene, Gallatin, Hamilton, Henry, Iroquois, 83 Jasper, Jackson, Jefferson, Johnson, Lee, Logan, Macon, Macoupin, Marion, Marshall, Ogle, Perry, Pulaski, Put- nam, Randolph, Rock Island, Saline, Sangamon, Union, Vermilion, Wabash, Washington, Wayne, Whiteside, Winnebago, Williamson. In some of the counties the old usages still prevail, the courts having failed to note the result of habeas corpus pro- ceedings in Illinois courts with regard to the lawful title to children. Under the decision of the courts in these cases a family adopting a child can be protected in its rights to the child by a certain procedure. The best organized of the children's home-finding societies are accordingly requiring that title to the child be secured through that procedure, which necessitates the action of the county court. The usages which have obained in former years have not all dis- appeared, but a radical change must be made in this respect, where it has not already gone into force, in order that those who provide homes for the little ones may be protected in their right and title to the child. The reports of the inspectors show that — Adams County — The court had acted in fifty-eight cases, of which one-third were placed in new homes and the rest left in their own homes, under court super- vision. Alexander — Children were placed by the Illinois Chil- dren's Home and Aid Society and the Cairo Home Find- ing Society. Bond — Money was paid during the year to the Illinois Children's Home and Aid Society and the Whitehall Orphans' Home. Champaign — Two were sent under court order to St. Charles School for Boys and three to the Geneva Train- ing School for Girls. Money was also paid by the county to the Cunningham Deaconesses Orphanage and the Illinois Children's Home and Aid Society. Christian — The court placed two at St. Charles and three with the Illinois Children's Home and Aid Society. Cumberland — Children are sent to the Illinois Chil- dren's Home and Aid Society or the Chaddock Deacon- esses' Home, Quincy; three were placed in an orphans* home in the preceding few months. Coles — No children have been in the almshouse in six years, all being turned over to the Illinois Children's Home and Aid Society. DeKalb — One child was placed with the Illinois Chil- dren's Home and Aid Society. Effingham — Money had been paid to the Illinois Chil- dren's Home and Aid Society. Fayette — Two children were placed by the superin- tendent of the almshouse. Franklin — The county avails itself of the Illinois Children's Home and Aid Society. Fulton — Five children were placed in the Whitehall orphanage, the county paying $35.00 each. Hamilton — Money had been paid the Illinois Chil- dren's Home and Aid Society. Old usages prevail. Action by counties. 84 Ha>-cock — Ten children were placed by the court, in the Evangelical Lutheran Kinderfreund, Peoria, the Whitehall orphanage and in the State training schools. Henry — Two children were placed in homes. Gallatin — The Illinois Children's Home and Aid Society is employed in placing children. Iroquois — The court placed two in homes by adoption decrees and two were placed with the Illinois Children's Home and Aid Society. Jasper — \o responsibility seems to be felt by anybody about placing children in homes. Johnson — The county places children with the Illinois Children's Home and Aid Society. Kankakee — One baby was placed with the Illinois Children's Home and Aid Society. Knox — The court placed several children. The county pays $400.00 yearly to the Illinois Children's Home and Aid Society. LaSalle — The court places children. The county paid money to the Illinois Children's Home and Aid Society, St. Mary's Training School and the Home of the Good Shepherd. Livingston — The county paid the Illinois Children's Home and Aid Society $200.00 for placing four children; the American Home Finding Association $100.00 for placing two, and $100.00 was then due the Salem or- phanage. Marshall — Home finding societies are depended on by the county. Mason — The county pays $200.00 yearly to the Coun- cil Bluffs Orphans' Home. Madison — The court placed nine; six being sent to the iriinois Children's Home and Aid Society, two to St. Charles and one to Geneva. Massac — The Illinois Children's Home and Aid Soci- ety places the children from this county. Marion — The Illinois Children's Home and Aid Soci- ety is employed by the county. McDoNOUGH — The court placed four, two being sent to Geneva and two to St. Charles. McHenry — The court sent one to Chicago. McLean — The court placed a number. The county paid money to the Girls' Industrial School, Blooming- ton; the Metamora Catholic Orphanage; the Home of the Good Shepherd, Peoria, and the Illinois Children's Home and Aid Society. Menakd — Five or six children were sent to Whitehall; it is not stated by whose authority. Mercer — Four children were placed with a home- finding society the past year. Monroe — One child was placed with a family in Waterloo during the year, by order of the court. Morgan — Eight children were placed by the county court; two being sent to Geneva, two to St. Charles, and four to Whitehall. Moultrie — One was sent to St. Charles, but had been returned to the parents. Ogle — The county places children through the Illinois Children's Home and Aid Society. Peoria — Ten were placed during the year by order of the court; two at Metamora. four at St. Vincent's, two at Geneva, one at the Home of the Good Shepherd and one placed for adoption with a family. 85 Peeey — The services of the Illinois Children's Home and Aid Society are employed for placing children. Pike — None were placed by the court, but six were sent to Whitehall. The county pays the Illinois Child- ren's Home and Aid Society $25.00 for placing children. Pulaski — The county employs some home-finding so- ciety. Randolph — The county usually avails itself of the Illinois Children's Home and Aid Society, but last year three children were placed with the Evangelical Luth- eran Kinderfreund Home at Peoria. Richland — One child was sent to the American Home Finding Association last summer. Saline — The Illinois Children's Home and Aid Society is employed. Schuyler — The court sent two to Geneva. Scott — The county board places children with the Whitehall Orphanage, but none the past year. Shelby — The court sent one to Geneva. Stabk — The court placed three with the Illinois Chil- dren's Home and Aid Society, the county paying $50.00 each. St. Claie — The past year eleven were placed in or- phans' homes or through home-finding societies. Tazewell — Nine were placed by tl^e court, all in the .Kinderfreund Society at Peoria. Vermilion — All children are placed in the Vermilion County Orphans' Home or at Glenwood Industrial School for Boys. Warren — The court placed one at the poor farm and one at Glenwood. Wayne — The superintendent placed one girl and one bo3' in family homes the last year and sent two boys and one girl to the Christian Orphans' Home, St. Louis. Whiteside — Home finding societies are the medium for placing children. Winnebago — No record has been kept, and, owing to a change in the court, the information could not be ob- tained, but the clerk decided to keep a docket of such cases in future. Williamson — The Illinois Children's Home and Aid Society is the means for placing children. The foregoing record includes court action on children who had not been in the almshouse as well as those who had been inmates there. Improper Places for Children. The superintendents of the alsmhouses are almost a unit in the declaration that children should not be kept in the almshouses. The associations of the latter are in the great majority of cases ill suited to give any child a start with self-respect and self-reliance, while in a considerable pro- portion of the alsmhouses the associations are such as to make them schools of vice to the young. One of the most gratifying facts of the State's inspection of these institutions is the large number in which there are no children at all. This is especially noteworthy in most of the counties of large population, where the number of children, in the ab- Includes In and out of alms- houses. Damaging associa- tions. 86 Indifferent In Jasper county. In fifty-five counties. Some feeble minded, too. A distress- ing case. sence of the humane feeling indicated in the view of ihe superintendents of the county farms and given force and by the policy of the State, would be greatest. The reports show, also, that scarcely any normal children of school age in the county houses fail to attend school. The principal exception to the rule as to the feeling of the almshouse superintendents is in the case of Jasper county, where the number of children in the almshouse is 12, and no one seems to feel any responsibility for seeing that they are placed in homes. The circumstances indicate the suggestion that the self-interest of the superintendent may have some influence in permitting this condition of affairs to continue. EPILEPTICS IN ILLINOIS COUNTY ALMS- HOUSES. Fifty-five of the 97 counties returned for the inquiry re- garding epileptics had cases of inmates subject to attacks of epilepsy. Of these 55, twenty had one case each, namely: Alexander, Bureau, Carroll, Cass, Christian, Greene, Ham- ilton, Kane, Lake, Macoupin, Madison, Montgomery, Mor- gan, Moultrie, Perry, Putnam, Saline, Shelby, Stephenson and Washington. Seventeen others had two each, namely: Adams, Champaign, Fayette, Franklin, Fulton, Jasper, Kankakee, Lee, Livingston, McLean, Menard, Mercer, Richland, Rock Island, White, Will and Williamson. Nine had three each, being Douglas, Hancock, Iroquois, Marion, Marshall, McHenry, Peoria, Tazewell and Union. LaSalle, Logan, Ogle, Pike and Vermilion had four each ; Knox and Sangamon five, and St. Clair nine. Seventeen of the epileptics are also classed as feeble- minded ; two idiotic, one blind and one insane. A consider- able number of these unfortunate epileptic and of the feeble- minded beings owe their existence to criminal conditions in the lack of separation of the sexes where feeble-minded and insane women of child-bearing age are the subjects of public care in Illinois. The most distressing case of epilepsy is reported from McLean county; a young man of intelligent appearance, courteous and industrious up to the time he was seized with this affliction. He is reported to have had 5,000 convulsions during the year, and nearly 450 in one day. His writhings in these attacks, during which he is kept strapped to the bed to prevent harm to himself as much as possible, are sufficient to make the bed jump from the floor and propel it about the room, unless held by attendants. He has pleaded with the superintendent to leave some means of self-destruction where he can lay his hands on it. His father developed epilepsy after reaching maturity and died in the Kankakee asylum. 87 No suitable care. Counties with cases. One woman epileptic in the Stephenson almshouse has lost|^^™^^°}°|C3 her mind entirely from the effects of the malady. At the time of the inspection her face was black ard blue, her nose terribly swollen and her dress matted with blood from the effects of falling in her attacks. In none of the almshouses is there suitable means for the care of such cases. CONSUMPTIVES IN ALMSHOUSES. Cases of tuberculosis are reported from the almshouses of the following counties : Clay, DeKalb, Dupage, Edgar, Fayette, Ford, Jackson, Jefferson, Jo Daviess. Massac, Rock Island, Union, Vermilion and Williamson. Grundy had two incipient cases. Kane reported several cases ; also Kanka- kee. McLean had one well developed case of tuberculosis of the lungs and one distressing case of tuberculosis of the bones of the leg. St. Clair had five cases and Winnebago three. Winnebago had a room specially fitted up for con- sumptive cases, but it was not used. Champaign reported the death of two women from this cause last fall, but had no further cases at present. In Clay an inmate in the last stages of consumption occu- pied a bed located in the general sitting room with the rest. In the DeKalb almshouse, in addition to the case then in charge, one inmate died from this cause the day preceding the inspection. The survivor of the two apparently had not long to live. The case at the Dupage almshouse was suffering from cancer as well as tuberculosis, and was also insane. The case in Edgar county was in the last stages of the disease. The victim of the malady in Fayette was a girl of 15. In Gallatin one inmate died from this disease the last year. One inmate died from tuberculosis the day before the inspection of the Kankakee almshouse. At the almshouse in Lake one woman who was insane was in a delicate state of health, the inspector suggesting that an examination ought to be made to determine whether she was suffering from the incipient stages of the disease. No attempt was made to isolate the victim of the disease in Massac almshouse. In the Rock Island almshouse a lad of 12 was wastmg away from tuberculosis of the bones. The woman suffering from the disease in the Vermilion almshouse was in the last stages. The case in the Williamson almshouse is returned as scrof- ulous. Two deaths In Cham- paign. Clay county. DeKalb county. DuPage county. Edgar county. Fayette county. Gallatin county. Kankakee county. Lake county. Massac county. Rock Island county. Vermilion county. Williamson county. 88 Caas county. Madison county. Schuyler county. No suitable care. In Cass county an inmate in the advanced stage of tuber- culosis mingled freely with the others, and shared his room and bed with one of them. In Madison county a consumptive patient occupies a de- tached cottage under wretched conditions as to comfort and cleanliness ; no attendant being provided for the care of the sick. In Schuyler county a patient suffering from tuberculosis was provided for in a tent till the severe weather came on, after which he was removed to the men's building. They were able to give him special diet, but the means of provid- ing for his comfort were poor, and the rest of the inmates were exposed to .the infection. County almshouses do not afford the nursing and special diet and other care required for consumptives. In only a few of the almshouses is there any attempt to protect from infection those not suffering from the disease. 89 DETAILS OF THE SPECIAL INSPECTION OF ALMSHOUSES. The special inspectors sent out by the State Board of Public Chari- ties to ascertain mid-winter conditions in the county almshouses, main- tained by county governments, visited such institutions in ninety-seven of the one hundred and two counties of Illinois. Two counties. Pope and Kendall, have no almshouses. The Hardin county almshouse was inaccessible on account of high water. The Warren county almshouse was in quarantine on account of diphtheria. However, the inspectors made reports on material gathered in these two counties. Hence the canvass covers every county almshouse in Illinois, except the Cook county institutions at Dunning, which in recent years have been elevated to a high plane of efficiency. The reports of the inspectors, covering all counties in the State, except Cook county, follow : ADAMS. The Adams county poor farm, situated two and one-half miles southwest of Paloma, contains 160 acres, most of which is under cultivation. At the time of inspection there were eightj^-eight inmates, there being sixty-eight men and twenty women. Of this number seven are reported insane, seventeen feeble minded and two epileptic ; one of the latter also being insane. There are no children in the institution. Conditions in general are favorable. The building is in need of some repairs. Many of the rooms should be replastered and painted. In an old building where five or six male inmates are lodged, the walls are black with grime and dirt, venti- lation is poor and conditions generally unfavorable. This building is heated by stoves. In the other parts of the almshouse conditions are very favorable. The rooms are clean and comfortable and the inmates are well cared for. There is separate pro- visions for the insane and adequate provision is made for the separation of male and female inmates, except that the dining room is used in common ; separate tables being provided. Ventilation is good, and the plumbing in satisfactory condition. The water supply excellent. Adequate fire protection is provided : three hose on each floor, with an iron fire escape, afEord protection to inmates. Toilet and bath facili- ties are provided. The beds are clean, free from vermin and provided with good, warm covering. The inmates bathe and change underclothing weelily. There are in this almshouse several inmates absolutely helpless, but they are evidently well cared for. Their rooms and beds were comparatively clean. Religious services are held about once a month. A physician visits the almshouse twice a week and on call. A pest house for the isolation patients ill with contagious diseases is pro- vided ; also a morgue. This institution seems to be very energetically and capably managed. The temperature of sleeping rooms and sitting rooms was 70° ; outside temperature 32°. There are radiators in each room and in the large halls which serve as sitting rooms ; and stoves in old parts of building. Date of Inspection, Jan. 18, 1907. ALEXANDER Seven of the eighteen inmates are colored, three are paralyzed, wholly or in part, one woman is blind, and five are feeble-minded. The almshouse is a large frame building which, If fitted up with a furnace, lavatories and bath rooms, would be well adapted to Its purpose. It is a satisfaction to know these much-needed Im- 90 provements are bclns; seriously considered. There are separate parts of the building and sitting rooms In each, for the different sexes. One strong-room is maintained for any who are violent. The bedding was found clean, sufficient, and free from vermin. No ventilation is provided, but the rooms are aired daily. The food is all prepared under the personal direction of the management. A local colored preacher conducts religious services every two weeks, and is paid two dollars for the burial service of each Inmate who dies. Ueading matter in considerable quantities Is fur- nished by interested persons. The farm contains about 500 acres but much of It is timbered and subject to overflow. About 135 acres is cultivated. Over $1,300 Vas received last year for the saie of surplus farm products. The county owns six mules, one horse, twelve head of cattle, a number of hogs, and numerous stands of bees. The superintendent Is paid a salary ; and a farm hand and one kitchen helper are provided. Some small fruits, common chairs and a few rocking chairs for the feeble, are much needed. The present management seems to l)e firm, humane, conscientious, as well as unusuallv thrifty. The farm is located about two miles north of Beech Ridge. Date of Inspection, Jan. 28, 1907. BOND. The building Is brick, \ > 2 ^ 5 1 o I > r m o O H 2 3j m f-i 01 > c z z i> O 2 li 2 CO O f" i> •». ^ 3) !!! o o O Z s -< O CD 33 m 23 ii 52 ■D yi > o m w i. ^ oi O 01 ^<^ Ir" C rnCC z u 91 pense of one poor person at Belvidere and feeds and shelters all tramps who come to him. He states that there Is no money in it but he keeps them for humanitarian reasons. The supervisors say they have him keep them because it ii "much cheaper" than having an almshouse. Date of inspection, Jan. 3, 1907. BROWN. The Brown county almshouse is situated five miles west of Mt. Sterling. It is a frame building, the part occupied by the inmates being one story in height. This building is separated into two parts by a partition extending lengthwise ; one side being occupied by the male, the other by the female inmates. Each side contains a long narrow hall, upon which six bedrooms open. The hall is dark, light being admitted only through the open doors of the bedrooms. This forms the only sitting room provided for either male or female inmates. A stove placed at one end is the only means of heating this hall and the adjoining bedrooms. The temperature of the hall at the time of the inspection was 66° ; of the bedrooms 60° ; outside tem- perature 33°. While male and female inmates occupy opposite sides of building, they can pass freely from side to side, there being apparently no restrictions in this respect. The kitchen, which is also the dining room, is used in common by the inmates. This room is devoid of conveniences necessary either to a kitchen or a dining-room. A large range occupies the center of the room, the dining table being placed near. This room, like most of the others, was uncleanly. There is no cellar, therefore no means of preserving vegetables other than by burying them in pits. All water used in the buildings has to be carried in buckets from a well some distapce from the house. In summer the water from the well is unfit for use, and water then has to be carried from a neighbor's. The halls, bedrooms, beds, bedding and inmates were uncleanly. Cobwebs of long standing hung from some of the ceilings. The beds showed lack of care, and traces of vermin were clearly seen. Mattresses are used, and cotton comforts, most of which are badly soiled. Apparently no attention is paid to ventilation. Vessels, foul with dirt, stood about In the rooms. There are no toilet or bath facilities, and no bathing regulations, though inmates change underclothing weekly. The heating is neither sufficient nor safe. A physician visits the almshouse on call. No religious services are held. There are no insane inmates in the almshouse, and no provision is made for their care, excepting a frame shed provided with iron-barred window and door. This has not been used for several years, other than for the temporary confinement of dis- obedient inmates. There seems to be much laxity in the supervision of this almshouse. At present there are thirteen inmates. Eiglit men and five women. Date of inspection, Jan. 17, 1907. BUREAU. The almshouse Is located four miles southwest of Princeton. The grounds are spacious and well-kept, with an abundance of shade and ornamental trees. The buildings occupied by the inmates are brick, heated by steam, and provided with in- dividual rooms. Each building has a spacious sitting boom, supplied with chairs, settees and a reading table, and is made attractive by an abundance of potted plants. Three papers are furnished by the county, and much reading matter by the people of Princeton. A man and his wife have charge of each building ; one of the men dQJng the cooking for all the inmates, and the other serving as a farm hand. The building, bedding, lavatories, and dining rooms were all in excellent order,' ciean and sanitary. There is no artifical ventilation, but the fire protection is unusually good. Eight inmates are supported wholly or in part by relatives or estates. The farm contains 365 acres, of which ten are in orchard, fifteen in garden and small fruits, and 115 acres cultivated. The county owns fourteen horses, eighty-six head of cattle, 190 head of hogs, seventy sheep, 175 chickens and twelve ducks. Forty hogs and seventeen beeves were killed for the yearly meat supplv. The income from the farm for the year ending September 14, 1906, was about $5,000. The per capita cost of maintenance for the same period, exclusive of the food produced on the farm, was 80 cents. The present superintendent has a great deal of executive ability, and numerous improvements about the place testify to his energy and good judgment. Date of inspection, Feb. 8, 1907. CALHOUN. The Calhoun county almshouse is a two-story frame building, part of which is oc- cupied by the superintendent. In addition to this, there is a two-roomed frame cot- tage which is occupied by four of the inmates. There are but seven inmates, these being males. No provision is made for separation of male and female inmates, but there have been no women inmates of the almshouse for several years past. No provision is made for the care of the insane, and there are none of this class of de- pendents in the almshouse. 92 The buildings are old and In need of repairs. There Is a general air of neglect about the place. There are none of the conveniences necessar\' to a properly con- ducted almshouse. The water used for toilet and household" purposes has to be carried from a spring situated at the foot of a hill, three hundred feet from the house. There are no adequate facilities for personal cleanliness; no bath tubs being sup- plied. Inmates change underclothing every two weeks, but there are no bathing regulations. The cottage in which the men are lodf^ed is infested with vermin. Mattresses are used with wire springs. These should be replaced and vigorous measures taken to free the place from vermin. The rooms were not clean, but the beds and bedding were clean, and fairly comfortable. Stoves are used throughout. An average temperature of 65* prevailed In the bed- rooms, which also form the sitting-rooms of the Inmates. The outside temperature was 20°. There Is no fire protection. The buildings are roofed with tin. All the outside buildings arc In a tumble-down state. No religious services are held at the almshouse. In this county the contract system of letting the care of poor to lowest bidder pre- vails. Date of inspection, Jan. 25, 1907. CARROLL. This almshouse is located two and one-half miles southeast of Mt. Carroll. Nine years ago the old building was entirely destroyed, together with the stock and out- buildings. The new building, red brick and modem throughout, was constructed one year later. It has two stories, basement and attic, and has seventy-eight rooms. The heating and air pressure, water plant and store rooms are in the basement. The rooms are well heated and are supplied with good water throughout. There are good sanitary closets and bath-rooms on each floor and In each ward. The building is lighted by coal oil lamps. The first floor consists of superintendent's living rooms, kitchen, dining rooms and sitting rooms for inmates ; the second floor of bed rooms, closets and bath-rooms. The building was in a perfectly sanitary condition ; the floors were clean ; the beds free from vermin and well supplied with bedding. The temperature ranged from 60° to 75°. One room Is used as a hospital and is supplied with an operating table, bandages, etc. The men occupy the south and the women the north side of the building. The bed- rooms and the living rooms of the superintendent are between these two wards. The men and women eat at the same time, but In separate dining rooms. Following Is the bill of fare : Breakfast ; oat meal, potatoes, bread and butter or molasses and coffee. Dinner ; meat, potatoes, vegetables, bread, tea and coffee. Supper ; fried potatoes, tea, bread, vegetables and fruit. This menu is varied from time to time. Forty-six loaves of bread are baked twice a week. They milk from nine to thirteen cows. Part of the milk is made into butter and the remainder is used for drinking purposes. They put up 1,200 quarts of fruit last season. They raised 540 bushels of potatoes, eighteen bushels of sweet potatoes and 550 heads of cabbage. Thev raise their own pork and at the time of this Inspection had 80 gallons of lard from last year. From March 1 to Nov. 1, 1906 the chickens produced 11,406 eggs. All that were needed were used by the Inmates. They have 100 feet of two Inch hose and Babcock flre-extlngulshers on every floor. The house Is located In a beautifully kept yard. The land Is exceptionally good, with good substantial buildings and is well supplied with good stock. There are no separate wards for the Insane. There Is one cell in the female and four in the male wards, intended for the insane. There is one man who has lost both feet and who, the superintendent savs, Is Insane but has not been adjudged so. He Is harmless and not locked in the cell except at night. One female epileptic, though not in bad condition at present, has had spasms, varied In frequency from four a dav to one In four months. There Is no consumption In the Carroll county almshouse. There are no children in the almshouse, and none have been born here for the last seven years. The county clerk reported none placed In family homes during the The juvenile department of the Jail Is In the women's quarters. No children have been in Jail hero for some time. Bonds were issued for $25,000 in 1897, all of which has been retired except $10,000. Elijah Pauley, the superintendent, who has been In charge for several years now has a salary of $1,000. Mrs. Pauley acts as matron, and an 18-.vear-old daughter assists with the work of the house. They appear to be splendid people, and the almshouse Is in exceptionally good condition. Date of Inspection. .Tan. 11, 1907. 93 CASS. This almshouse is a two story frame structure pleasantly situated and in good repair. The walls are freshly painted giving the interior a cheerful appearance. Good food and clothing are provided. The insane patient is reported harmless and mingles freely with the other inmates. The epileptic is subject to frequent attaclss. One of the inmates has tuberculosis in an advanced stage. He sleeps with another inmate who is thus exposed to grave danger. No provision is made to protect the other inmates from infection as he mingles freely with them. There is but one bath tub used in common by men and women. Only outdoor closets are provided. A slanting walk leads to these which in cold weather is danger- ous for old and feeble feet to tread. The need of indoor closets is urgent. There is no flre protection and no fire escapes. A narrow stairway leads from second floor, the only means of egress. A force pump, fifty feet of hose and a ninety barrel cistern are the only means of protection in case of fire. No provision is made for the separation of the men and women inmates. The lower floor has but three sleeping rooms accomodating but five persons. All others regard- less of sex must go to the second floor. Men and women occupy the same wing of the building ; access from room to room, or upper to lower floor being unimpeded. Estimated cost of maintaining insane and epileptic patients is ten dollars per month. Date of inspection Dec. 28, 1906. CHAMPAIGN. The Champaign county almshouse is located just east of the city limits of Urbana, on a well cultivated farm of 120 acres. The main building is old, illarranged, incon- venient, inadequate for the demands made upon it, and altogether out of keeping with the wealth and dignity of the county. Most of the inmates sleep two in a bed. No infirmary or isolation house is provided. A number occupy the third floor,- with practically no means of escape in case of fire. All classes without regard to mental condition, are compelled to occupy the same living room during the day, though the sexes are kept separate. The kitchen is much too small, dark and ill-ventilated. The laundry is of a primitive type and renders the washing doubly burdensome. The store rooms for the clothing have no communication with the outside. The superinten- dnt's rooms are small and inconvenient. All lavatories are outside the buildings. All parts of the building seem to be very clean and the bedding much above the average. No blankets are used, but cotton sheets and an abundance of well-made comforts sug- gest cleanliness and warmth for cold weather. The insane were all well clothed, most of them presenting an unusually good appear- ance. Three are in such condition that it would be much better to remove them to Bartonville, as in the crowded condition that now exists, it is impossible to provide adequately for them here. Two women died in this home last fall from tuberculosis. Two serious cases of epilepsy exist and three aggravated cases of infectious disorders. Six men, to all outward appearances, abundantly able to earn their living, are spend- ing the winter here, and presumably will follow their usual custom of leaving when the season for work on the county farm opens The food is abundant in quantity and embraces a good variety. By order of the county board, meat is furnished three times a day most of the year. Nearly all vegetables used, except potatoes, are pro- vided on the farm. About 3,000 quarts of fruit and vegetables were worked up into sauces, preserves or pickles, or canned last season. Three barrels of kraut furnish a winter diet much enjoyed by most of the Inmates. The number of Inmates is 68, of whom 49 are men ; 16 are classed as insane and 11 feeble minded and idiots ; two men are blind and one woman is deaf ; two are epileptics. Those desiring to attend church are permitted to do so. Services conducted by local societies are held about four times a year. Mr. Perry White and his assistants are to be commended for the care they take of the inmates and the cleanliness everywhere apparent. Date of inspection Jan. 3, 1907. CHRISTIAN. The Christian county almshouse is situated three miles south of Owaneco and con- tains seventeen inmates ; fifteen men and two women. Only two are reported insane. No adequate provision is made for the care of the insane. The buildings are four In number ; one large frame building occupied by the superin- tendent's family and by the women inmates ; and three brick buildings occupied by the male inmates. The women's appartments, consisting of two bed rooms and a sitting room, were clean and comfortable. At the rear of these rooms and above are other rooms at present unoccupied, but in which there Is no provision for supplying heat. The beds and bedding of the women's rooms were in good condition. Old fashioned wooden beds are used for which Iron beds should be substituted. A brick' cottage containing six sleeping rooms for the men and a hall extending through the length of the building, was absolutely unheated. The temperature of this building was 23°, outside temper- ature 80°. There Is a furnace, but It is reported useless. These rooms were like refrigerators. The beds had an abundance of covers,' all cotton, but it is doubtful 94 whether they were sufficient In the ley atmosphere of this building. Old coats and In somi cases strips of rag carpet were added for further warmth. These beds and rooufs were only fairly clean. In another building, also brick, are sleeping rooms for six men and also their sitting rooms. There Is but one stove In this building and that Is In the sitting room. The upper rooms are unheated. The temperature of the sitting room was 05° and of the upper rooms 48°. This building needs repairing on the Interior, as the doors and all of the wood-work are very dirty. The walls very dirty and cob-webs numerous. The doors, bods and bedding In this building were In bad condition. The place Is not free from vermin. Another small building about twenty feet square, very old and In bad condition, forms the sleeping rooms of three of the inmates. These rooms are entirely unfit for occupancy in their present condition. There Is a small stove In this building; and In one of the sleeping rooms, which Is not more than 10x8 feet, there Is a cot and beside It a bath tub, the only one the place affords. Situated as it is, it cannot be used by the women inmates and it Is comparatively useless, as there is no water connection. It was covered with dust and dirt. Indicating that it had not been In recent use. The underwear furnished the inmates is abundant and of good quality. The in- mates change underwear every week, but there are no bathing regulations, owing to the lack of proper facilities. There is no fire protection. No religious services are held at the almshouse. The farm contains IGO acres, all under cultivation. An abundance of fruit and vegetables Is raised. Date of inspection Feb. 7, 1907. CLARK. The .Clark county almshouse is located half a mile south of Marshall. The build- ings are all frame, fairly well built. The fences are somewhat dilapidated In ap- pearance, and practically" no attempts have been made to improve or beautify the lawn. No bath tubs are provided, and the laundry facilities are of a primitive type. No separate provision is made for the care of the sick or insane. The male and female inmates are kept In different parts of the building and have separate yards, surrounded by high board fences. The dietary list as given by the superintendent suggests ample variety. The meat list includes fresh and salted pork, fresh and pickled beef, and fish. The bedding of the more cleanly was In good condition, of good quality, and sufficient In quantity. If three of the filthy insane were removed the buildings could be kept in much better condition. Few of the Inmates are physi- cally or mentally capable of helping with the work. The water supply Is abundant, and apparently of good quality. The use of stoves and kerosene lamps is a constant source of danger to the Inmates. No reading matter is furnished by the county, but one local editor sends one copy gratis for the use of the inmates. Religious services are held usually twice a month during the favorable weather. The superintendent receives .$1.50 per week for each Inmate, In addition to the Income from the sixty-acre farm. He is required to furnish food, clothing, bedding and medical attendance, and pay the funeral expenses. This is to be raised to $2.00 ger capita, beginning with March 1st. The superintendent and his wife seem to be umane in their treatment of the Inmates, and considerate for their comfort and welfare. They are not responsible for some of the conditions that exist, all of which could, with no great outlay, be greatly improved and reflect credit to Clark county. Date of inspection, Jan. 7, 1907. CLAY. Everv inmate of the county almshouse has some special affliction. One man Is blind, two children of four arid seven are feeble-minded ; a boy of seven Is deaf and dumb, and all the others are idiotic or feeble-minded. One child was born during the year and taken by the mother when she left. The building is frame. In fairly good repair. The bedding was clean and free from vermin, and the clothing suffi- cient. Inmates chnnue underclothes weekly and bathe as frequently as the inad- equate facilities make possible. That the separation of the sexes has boon merely nominal Is suggested by the fact that two illegitimate children have been born of regular inmates and two conceived during the last ten years though nothing of the kind has occurred under the present management, dating back almost four years. But one heating stove Is used In the part occupied by the Inmates. A woman In the last stages of consumption occupies a bed In the sitting room used In common bv the Inmates. The farm is located one and one-half miles west of Louisville, and contains eighty acres of land of very ordinary productiveness. The superintendent receives the in- come of the farm and SL.^O per capita per week for clothing, food, care and medi- cal attendance, and pays burial expenses. The care of one Inmate Is paid for by a conservator. The general appearance of the surroundings Is good, tlie wmIoi supply abundant, and the management considerably above the aver.nire. Inspected Jan. 31, 1907. 95 CLINTON. The almshouse Is located on a 160 acre farm, ahout two miles north of Carlyle. The building is frame recently improved with new hard-wood floors, with fairly good facilities for separating the sexes, but none for the care of the insane. The bedding and clothing seemed to be sufHcient, but there seems to be a lack of close supervision in the care of the rooms, beds and other matters pertaining to the welfare of the inmates. A boy of 10 and his half brother aged 2 are in the house, seemingly through lack of effort to place them in homes. The water supply is abundant, but nothing is provided for fire protection. The superintendent considers bathing unnecessary, and was unable to recall any indulgence of this kind during the sixteen years he has had charge of the almshouse. All inmates change underclothes weekly. Meat is provided once a day, except on Friday, and butter occasionally. The vegetable supply seems to be abundant. Stoves are used for heating, .but none is provided in the bedroom occupied by the same women. No light or entertaining work is provided, but some reading matter is furnished by the superintendent and others. Inmates are permitted to attend church, and a reliable physician, employed by the county, comes on call. The superintendent receives the income of the farm and $1.10 per capita for care, clothes, food and fuel. The four acres in orchard and some small fruits, together with four acres in garden, supply practically everything in the fruit and vegetable line required by the inmates. Ninety acres is cultivated. Most of the land is of inferior quality. Inspected Jan. 30. 1907. COLES. This almshouse is located two miles west of Ashmore. The Coles county almshouse is an old brick building, two stories high. The building was not half built to begin with and is now in process of decay. The floors, which are mostly of oak, are warped and full of holes where the brick have fallen out. There is not one door or window that fits in its place. There are but two door knobs in the whole building and those are on one" of the outside doors. Some of the inmates have fastened strings to the door and filled old tin buckets with rocks, making weights to hold the door closed. The first story consists of kitchen, dining room, sleeping and living rooms for men and women indiscriminately. The ceiling is full of cracks and a constant fight is neces- sary to keep down the vermin. There are no adequate facilities for laundry, the only place being a little shed, 8x10 feet in size. There is not a closet in the house, and the building is destitute of furniture. The floors were dirty and the sanitary condition decidedly bad. There is no fire protection of any kind. There is no attempt towards the separation of male and female ; all live together, on both floors, including the insane. Six are reported insane. Only two have been adjudged insane, both natives. Most of the six are unable to do any great amount of work. One old lady has a growth on her face that disfigures her very much. It continues to grow and now covers her right eye, shutting out her sight and almost closing her mouth. There are no epileptics in the almshouse and no consumption. There have been no children in this almshouse for six years. The supervisors turn all children over to the Illinois Children's Home and Aid Society. The farm consists of 237 acres. The superintendent has but little help, and says he cannot work the farm successfully. The supervisors are talking of selling this farm and purchasing a small farm near Charleston, the county seat, and erecting a new almshouse. The barns are in a fair condition. They have 100 hogs, four horses and eleven cows. They make all the butter for the almshouse. They have 400 chickens and fresh eggs, all of which are used by the inmates. Martin Carnes has been the superintendent nine years. He appears to be an intelligent man, but very much discouraged. He has a contract with the county for $600.00 per year. The supervisors have paid him nothing for two years, and he said he would have severed his relations with the almshouse this year, but remained, hoping they would pay him. The superintendent is anxious to have something done to separate the sexes. He said that several of the men had attempted assaults, but without success. He fears that something will happen, and has told the supervisors. The county is practically bankrupt. They have a bonded debt of $240,000.00, which, with interest, now amounts to $250,000.00. The superintendent said the taxes were garnisheed as soon as collected and that the credit of the county was not good. Only one store in Ashmore will give them any credit. The court has issued an order for the payment of 10 per cent per year until the debt is lifted. I consider the conditions decidedly bad and the indiscriminate mingling of the sexes criminal. Breakfast — Eggs, coffee, potatoes and apple sauce. Dinner — Bread, meat, potatoes and vegetables. Supper — Same as dinner. There were fifty bushels of potatoes in the cellar. The inmates seemed well fed. Inspected Feb. 16, 1907. 96 CRAWFORD. The almshouse is located a mile northwest of Trimble. At the time of this inspection there were thirteen inmates, of whom only one was insane. One boy of 3 was placed there for safe keeping until the question of his mother's insanity could be determined. One boy I'J years old, having a leg incapable of sustaining weight, but otherwise strong, should be sent where he could learn some trade adapted to his crippled condition. He goes to school regularly. By comparison with the last report, I tlnd conditions have changed very much for the better. The walls have all been worked over, painting and cleaning done and vermin exterminated. Separate parts of the building are used for the different sexes. The bedding seems to be clean and abundant and the dietary list satisfactory as to amount and variety. A new barn is to be built next summer, and the renewal of fences, begun last summer, continued. A laundry and butcher house are contemplated, together with the erection of a dining room and kitchen, at no distant day. With these and improved bathing facilities, conditions here would begin to be quite satisfactory. The contract plan has been abolished, the superintendent now receiving a regular salary. The farm contains 300 acres, most of which is well cultivated, and would easily maintain the almshouse, aside from Improvements. The present management seems to be capable and energetic and the present board of supervisors Interested in bringing everything to a higher standard of elBciency and comfort. Inspected Jan. 7, 1907. CUMBERLAND. The sixty acre farm owned by Cumberland county is located three miles northeast of Toledo. The building site is devoid of trees, shrubbery or other attractive features. The buildings are all of cheap frame construction, poorly arranged for the purpose intended. There were but five inmates at the time of the inspection. Three children were sent to the orphans' home during the last few months. The facilities for personal cleanliness are poor and for the separation of the sexes Inadequate. The rooms are heated by stoves and the floors are unprotected by zinc. The bedding is of doubtful f.utliciency and vermin is in evidence frequently. The superintendent pays rent on the farm and receives $1.50 per capita per week for care, food and clothing. The county doctor comes on call. No orchard has ever been set out and small fruit is wanting. One of the inmates takes care of the garden, which furnishes all the vegetables needed. Inspected Jan. 14, 1907. DeKALB. This almshouse is located two and one-half miles northeast of DeKalb, on the electric line betwen DeKalb and Sycamore. The almshouse Is an old brick building of two stories and a cellar. There are very few modern improvements. The first floor con- sists of the superintendent's living rooms, kitchen, dining room, men's day room and women's day room, two bath rooms and closets. The second floor consists of sleeping rooms for men and womtn inmates. The door is locked between the male and female departments at night. The laundry, furnace and store room are in the cellar. The sanitary conditions are exceedingly bad. There is, however, no sign of vermin. Beds are provided with straw ticks and were quite clean, with the exception of two occupied by two very dirty inmates. They have plenty of good water, though the pumping facilities are poor. The building is heated by hot air and water and lighted by lamps. No attempt is made during the day to keep the inmates separate. Sane and Insane men and women mingle together. The superintendent informed me that a little over, a year ago an insane girl gave birth to a child in the almshouse, but they could not find who was the father of the child. The mother, Sarah Johnson, was sent to Bar- tonville and the baby to the Illinois Children's Homo and Aid Society, and the matter was hushed up. When told that with the existing conditions it might occur again, the superintendent replied that he would not be surprised if it did, but they would try to prevent It. Such public provision is criminal. The Inmates all eat in the same dining room, but at separate tables. There Is no fire protection at all. The house Is an old flre trap. There are three Perfection flre extinguishers, but they are stored away in the store room. The superin- tendent said he was afraid to put them out in the hall, for fear the crazy people would "monkey" with them and get hurt. There is no separate provision made for the Insane. All mingle together and eat and sleep together. U'here Is a pest house, so termed by the superintendent, a very small building at the roar of the main building, about 100 feet distant. It contained two cells of ho;|t;y oak bars and doors with little holes at the bottom through which the food could be passed. In one cell Is a box seven feet long and about two and one-half feet wide and three feet deep. This Is mounted on top of the frame of a bed. It has strong iron hinges, two hasps and a bolt, similar to those used on a dooor. The box Is solid, except the top, which has small openings between the slats. The superintendent said that the hox was used for an Intnnto who was glviMi io tearing his bed clothing, so that they had to lock hini up in the box at night. This Inmate was transferred to Bartonvllle In January, 190G. C30 o X c en a H o CD H > G Z PO c r z > z PI 97 The superintendent said they had one case of smallpox quite a while ago and that they would not use this room or building again, unless some of the crazy people became unruly or came down with a contagious disease. The picture shows only in part the condition of the place. There are no epileptics in this almshouse. One man died with consumption the day previous to the inspection and another was about to die. I did not see the inmates at meal time, but was told that the menu was as follows : Breakfast — Oal meal, potatoes, bread and butter and coffee. Dinner — I'otatoes, meat, bread and butter, coffee, beans and vegetables; varied. Supper — Bread and milk ; mush and milk. They had about 300 bushels of potatoes on hand, but no fruit was to be seen. There are two children in the almshouse, one a 5-year-old boy. The superintendent said he was not considered an inmate ; his wife wished to adopt him. He was not an illegitimate, but came from an unfortunate family ; their troubles coming from drink. The other of the two children is a boy 12 .vears old. He is an idiot ; has a weak spine ; cannot stand or walk a step. He cannot talk, except when made angry by some of the inmates, then swears like a pirate. This boy was born to a young girl, and it is reported that her father is the father of this child. The superintendent said he was born on the place, but before his time,; and that the authorities did not do anything about it. No children were placed in family homes during the past year. The juvenile depart- ment in the .iail is over the sheriffs rooms. The jail proper is not a tit place in which to keep any human being. The idiotic boy should be removed. The county owns a farm of 180 acres, splendid land, which produces good crops. The superintendent furnishes his own horses and machinery. The barns and out buildings are in good repair. They have twelve cows and about 250 chickens. The milk is separated and made into butter and the eggs are given to the inmates. Frank Bastian has been snuperintendent for nine years. He receives a salary of $1,000.00, house rent and living. He is allowed .'?200.00 a year for extra help in the house, and recently the supervisors have provided a matron. There is a debt on the county for a new court house, but no bonds are outstanding. Inspected Feb. 1, 1907. DeWITT. This almshouse is near Clinton. There are five different buildings. Three are occu- pied by men, one by women and one building is occupied by two old married couples. There are absolutely no facilities for bathing. The water for bathing is heated in the wash house and has to be carried to different buildings in buckets. Galvanized iron wash tubs are used to bathe in. There is certainly a great need for improvement in this direction. One feeble minded man, who is very filthy, is kept in a room by himself most of the time, as he is very noisy and boisterous when any one else is around. The superin- tendent has tried to have him committed to a State institution for the insane, but as he has always been feeble minded, the county judge does not consider it a case of insanity and will not so adjudge him, although he now has less mind than four or five years ago. Date of inspection, Jan. 2, 1907. DOUGLAS. The Douglas county almshouse is located two and one-half miles northeast of Tuscola. The superintendent and family are provided with a very convenient modern house, separate and apart from the infirmary. This almshouse is run on the cottage plan. The cottages were in poor sanitary condition. Several of the old ladies belong to the "dirty class." Their rooms and beds were in bad condition. Vermin was to be found on most of the beds. The buildings were heated by steam, furnished from the heating plant in the superintendent's house. Light is furnished by kerosene lamps. The water supply is abundant and good. Tubs are used for bathing. The men's cottage is in better condition. It consists of sitting and sleeping roms, laundry and insane department. One of the rooms contains a movable iron cage in which Insane inmates have been confined in times past. It is not used at present. There was also one room with bars on the doors, in which one man was confined because of his propensities for running away. Male and female are kept in separate cottages. The fire protection is good. It consists of 150 feet of hose and force pumps. The well furnishes an abundance of water. There are a number who are considered insane and one who has been adjudged in- sane by the court. There are several feeble-minded, bordering on insanity. One of these was confined in a cell because of his desire to run away. There is one epileptic, a girl 13 years old, a half orphan. She has had from three to four seizures a day. —7 PC 98 'I'lirri' is no <red fiO to 70 degrees. The house is well lighted and has good facilities for air. The building Is heated with steam. Tlie men and women are located in different parts of the house, but there are no locked doors between them. They eat at the same time but at sei)araie tables and in separate rooms. There are but three wonieii in the almshouse. Two of the three women and several of the men are in a feeble condition. Many inmates of the infirmary are (piite aged ; all were warmly dressed. The food at dinni'r was almndant and of good quality. The menu as given by the sui)erintendent is as follows : Breakfast, potatoes, pan-cakes, meat, liread and Initter and coffee. Dinner, meat (pork and corned beef), vegetables, bread and Imtter and cofTe<-. Supper, sauce, bread and butter, potatoes, tea and milk. All appeared well fed. Then- are seven in.sane, l)ut none was confined In the cells. Thi' insane liave all been rcturiii'd from Klgin as incurable. None is ke|>t in the insane wards iu (he north wing of (he building, but in the <'omnion wards. There are no epileptics. One man. it is reported, had ctmsumption, also cancer, and was insane. TIk- farm of IS.'J acres Is under good cultivation: being very productive and well kept. The barn and outbuildings are modern and well supplied with stock. A good herd of cows furnish milk and butter for tin- inmates. All the pork and jiarl of (he beef Is raised on (be farm. Tin- healing plant has jiisl been repaired and is in good condition. The cold slorage plaiil is an exc(>llt>nt adjunct to (ho place and sulhcient in size to ki-ep all their perishable supplies. There have been no children in this almshouse for (en years, and none were placed by the court during (he vear. The iuventle department of the jail is In the women's quarters and over (he sheriff's olfice. away from the other prisoners. The jail is modern, with good light and ventilation. It Is well kept and clean. 99 Edward B. Howe has been in charge of the almshouse for nine years. His help consists of an engineer, living in a house on the premises, a woman for general work, and a nurse who has charge of the second and third floors. The superintendent re- ceives $1,200.00 per year and everything furnished. There is no debt on the county. There is ample protection from fire ; two and one-half inch hose on all floors, stand- pipes and Are plugs on the outside. Date of inspection Jan. 14, 1907. EDGAR. The Edgar county almshouse, located about three miles northeast of Paris, Is a frame building about fifty years old and very much in need of repairs. The main building is used for the superintendent and his family. The rear building consists of living and sleeping rooms, kitchen, dining room, clothes room and bath room. The second story is used for sleeping rooms for the men and sitting room. The basement consists of a store room, milk room and root cellar. The insane department is separate from the infirmary. The sanitary condition is fair, except in the insane department, which is bad. The building is heated by steam and lighted by lamps. The water supply is good and free from pollution. The bathing facilities are poor. There is only one bath tub and this is in poor condition. It must be used by both sexes, and hot water must be carried to the tub. This tub is used by both sane and insane alike. The condition of the inmates would indicate that little use has been made of the tub. The tub, from appearances, had not been used for a long time. There is no fire protection. There are nine insane, who are kept in buildings apart from the infirmary. One building, two story, is furnished throughout with iron doors with heavy bars. The entrance to the women's department is from the outside. The men formerly used the lower floor, where there are heavy doors. They are said to have been locked in their cells during that time. Only one woman was in this ward at the time of this inspection. Others were helping in the kitchen. This old lady is paralyzed and reported to be insane. She is kept on a bed in the hall way and was surrounded by dilapidated furniture. She was in an untidy condition. Her husband stays with her and takes care of her. The superintendent has now moved the insane men to a cottage on another part of the premises. The superintendent feels that all of the insane should be transferred to Bartonville. The men and women are separated, being on separate floors, and the insane are in a separate building. There are no epileptics in the almshouse. There is one consumptive, who is also insane. He is in about the last stage of the disease. There are no children in the almshouse. While there is a juvenile department at the jail, the children of this class are kept in the house of a deputy sheriff when they are to be detained. The inmates are furnished with two meals in winter and three in the summer. I did not get the menu, but should presume that it was meager. The farm consists of 120 acres, under good cultivation. The barns are small, but sufficiently large for the stock. They have four cows and make the butter for the inmates ; also four horses and about 200 chickens. All the eggs are used for the inmates. J. M. Sims, the present superintendent, has been in charge for several years, receiv- ing a salary of $1,100.00 per year, the county furnishing one man to help with the work. Mrs. Sims superintends the work of the women. There is a floating debt on the county of $29,020.00. Date of inspection. Feb. 10, 1907. EDWARDS. The Edwards county almshoouse is located on a gently rising hill, one and a half miles northeast of Albion. The surroundings are attractive. The building is frame, very clean, and is supplied with beds and bedding of a superior quality. The four inmates are all feeble minded women, three of whom are physically and mentally capable of doing certain kinds of simple work. The bedrooms" are not heated. All inmates use a common sitting room. The clothing is sufficient and the food plentiful and of good variety. The management seem to be thrifty, conscientious people. The proceeds of the produce of the farm are turned into the county treasury. The super- intendent receives a regular salary. Date of inspection, Jan. 11, 1907. EFFINGHAM. The Effingham county almshouose is located three miles south of Effingham. Of the ten inmates, seven are insane, one girl is a hopeless idiot and one is blind. One insane woman is very destructive, tearing off plastering and laths, kicking the panels out of lOO the doors and destroying bedding and clothes in her fits of passion. In consequence the building is badly wrccijed and the Inmates terrorized at times. No one has made any si)(.'tial t-fTort to have her committed to Bartonville since she was returned from Anna live years ago. There is no adequate provision for separation of the sexes or care of the insane. All use one sitting room, in which is kept the only heating stove in the building, except a small one in the room occupied by the idiot girl and an old man who takes care of her. The bedding is insufficient for any but mild winter temperatures. The contract system prevails here, by which the superintendent agrees to furnish care, food, fuel and bedding for ."fl.50 per capita per week and pay rent on the IGO-acre farm owned bj' the county. The orchard is small and small fruits are not in evidence. There is nothing about the almshouse that is in keeping with the culture and wealth of Kffingham county. Date of inspection, Jan. 15, 1907. FAYETTE. The Fayette county almshouse building is a large brick, with adequate provision for separation of the sexes, but none for the care of the insane. It is heated by steam and is in good repair. The sanitary conditions seemed unusually good ; inmates cleanly in appearance, the bedding abundant and clean, and the food su|iply all that could I* desired. If bath tubs and lavatories were provided and some minor changes made in the furnishing, Fayette county would have a very convenient building for the care of the county charges. Two inmates should be removed to the Asylum for the Incur- able Insane. One 15-year-old girl is suffering from tuberculosis. Six children, between the ages of 1 and 10 years, are kept here, their parents refus- ing to give them up. None of them has gone to school this year, on account of the unusual distance to the school house. The farm lies four miles northwest of Vandalia. It contains 200 acres, of which twelve is in orchard, four In garden and about 100 acres cultivated. Last season 250 gallons of fruit were put up and 112 gallons of peach and apple butter. Forty- one hogs were killed for the meat supply. More than half the cost of maintenance Is paid by the income from the farm. The county owns four head of horses, fourteen head of cattle, fifty-three head of hogs, 275 chickens and twenty-four ducks. The superintendent and "his wife each receive a salary, and a kitchen helper and a farm hand are provided at county expense. It afford.s much satisfaction to find a county house in which the management is as capable and practical as the conditions found here indicate. Date of inspection, Feb. 1, 1907. FORD. The Ford county almshouse is located on a 120acre farm, one mile north of Paxton. The building is "brick, slate roofed, well built, well furnished, very conveniently arranged, and if an elevator had been Installed, might he considered a model build- ing for the smaller counties. Bath tubs and lavatories free from odor are placed on each floor and in each ward. Electric lights have been installed, and a new boiler makes the heating of the building easy and successful. Everything appears to be scrupulously clean. The grounds are spacious, well kept, and In the summer decorated with an abundance of flowei-s and shrubliery. The four buildings are substantial in appearance and well kept. The small fruit "plot is tastefully arranged and the space devoted to garden seems to be a model of arrangement and productive capacity. Over 500 quarts of fruit were cauiu'd last season, over 100 bushels of onions raised and luore than enough vegetables to supply the table for the entire year. Practically all the meat used on the farm is produced there. The treatment of the inmates is firm, but humane In every way. Hocking chairs are placed in all the women's wards, each furnished with a soft cushion, attractive in appearance. Ample facilities for cleanliness, together with a quality of clothing some- what above the average for tliese institutions, give the inmates a better appearance than one fretiuently finds in almshouses. The Insane were particularly well taken of, apparently. All employ^'-s are salaried. In addition to what the farm produces, about $1,500.00 Is required annually to maintain (he Institution. There were nineteen inmates, of whom ten were insane and two feeble minded. Mr. C W. MoTtill has been superintendent for five years. Mrs. McRllI seems to be an exceptionally capable woman, and much of the good manageemnt of the almshouse is due to her thrift, good Judgment and energy. Inspected .Tan. 2, 1907. FRANKLIN. This almshouse is located one mile southeast of Benton, on n ten acre tract that is practically devoid of soil. Part of !t Is planted In orchard and a few strips are used for garden. The buildings are all frame, some of them quite old. The floors, walla lOI and bedding seemed unusually clean. The chairs are all old and battered, few having bottoms and fewer still were of a character conducive to comfort Three children, reported illegitimate, are kept here because the mothers show an unwillingness to part with them and the supervisors have never urged the matter. Of the other fifteen Inmates, two are harmless insane, four are feeble minded, two are epileptics and two are blind, one of the latter being feeble mfnded and tuberculous also. The remaining inmates are in the regular pauper class. The attention of the resident supervisor was called to the delicate condition of one of the female inmates and some matters that seemed^ like neglect on the part of the management. No reading matter was found here. Inmates are not allowed to attend church, though at present none care to go. The contract price, $1.55. calls for the furnishing of food, fuel, care, bedding and the making of the women's clothes. The inmates bathe only at rare intervals, but change underclothes weekly. The men and women are kept in buildings on opposite sides of the yard. Date of inspection, Jan. 18, 1907. FULTON. The county farm is located three miles east of Canton and consists of eighty, acres, all under cultivation. There are thirty-seven inmates. Thirteen of these are reported by the superintendent as insane, but only three have been so adjudged. The buildings are in goud condition, clean, sanitary, well heated and ventilated. Bathing facilities are excellent, four well equipped lavatories being supplied for use of inmates. The sleeping rooms are airy and pleasant and the beds clean and well supplied wifh covers. Provision is made for the separation of the sexes, the men Inmates being confined to the lower floor and the women to the upper. A comfortable sitting room and a dining room are provided for each sex. There is hot and cold water tTiroughout the building, which is heated by steam. The inmates, with the exception of several of the insane patients, were clean, well clad and apparently contented. The building has a fire escape, but inadequate fire protection, there being only five or six fire extinguishers for use in case of fire and a tank which supplies the water for toilet use. Oil lamps are used for lighting. Date of inspection, Jan. 1, 1907. GALLATIN. The Gallatin county almshouse is located one mile west of Omaha. The building was erected in 1904 and is quite conveniently arranged, having a women's ward, men's ward, a sitting room for each and a large dining room. The sitting rooms are heated by coal stoves, and provision is made for placing stoves in the sleeping rooms, but none has been used. The floors are hard wood and clean. The bedding seems to be suffi- cient and clean and vermin under control. Meals are served three times a day and all cooking is done by the management. Pork Is the meat used most of the year. The water supply is all that could be desired. One child was born during the year, and one man died of consumption. No religious services are held, but inmates in physical and mental condition are permitted to attend at Omaha. The farm contains eighty acres of good land, on which the superintendent pays rent. JEle receives $2.50 per capita per week for care, fuel, bedding, food and clothing. At present there, are but four inmates. The small number Is accounted for by the fact that part of the town- ships .in this county keep their dependents In private homes. Inspected Jan. 22, 1907. GREENE. The Greene county poor farm is situated three and one-half miles northeast of Carrol'ton and consists of 160 acres. The building is of brick, with two small frame cottages, one of which is occupied by men, the other by women. All the buildings were fairly clean. The beds and bedding were good, but not free from vermin. The average temperature of sleeping rooms was 65 degrees ; the outside temperature being ?.8 degrees. The main building Is heated partly by stoves and partly by furnaces : the cottages entirelv by stoves. In the main building upon the third story, two elderly woman are lodged. One of these women Is very deaf. A narrow wooden stairway leads from this floor, the only means of escape in case of fire. There is no fire pro- tection. Water would have to be carried from a well in the yard. There are no fire escapes. The male and female Inmates of the main building are lodged on different floors, the communicating doors being locked at night. They have a common dining room, but separate tables. Facilities for personal cleanliness are poor. There Is a bath house, but as It is unplumbed. and heated only by stoves, it is not used regularlv in winter. It Is a small detached, two-compartment building, with a bath tub for men and one for women inmates. All water used by inmates has to be carried from the well in the yard. The Inmates change their underclothing every two weeks. In summer they bathe weekly. In winter there are no bathing regulations. A two-room cottage has recently been built for the elderly women. There is a hospital for the Isolation of patients afflicted with contagious diseases. The outside closets are in a very unsanitary condition. I02 There are 32 iumaies in the Greene county almshouse; L'l! men and 10 women. There are no insant-, and no provision for care of such. Ther are four blind, one epileptic and five fecl)le-mlndcd Inmates. Of the latter, two are boys aged 12 and 16 years. They have been in the almshouse *ieven years and are In a pitiable state of "ipnorance with the exception of the evil they have learned from their associates. Arrangements wore made four years ago to have them sent to Lincoln, but through a misunderstandinsr among the supervisors this was not done. Neither of these boys can replv intelligcntlv to the simplest questions. It is to be regretted that the.so boys should have remained so long in the almshouse. Under different conditions they might have been improved mentally. They have never attended school. Date of inspection, Jan. 24, 1907. GRUNDY. This almshouse is located at Gardner, Illinois. The building was erected four years ago at a cost of .'!;2,000 ; brick, in good condition, with near, well icept lawn. The temperature of the living roms was 70 degrees, bed rooms about the same. The building has a capacity of 50. The estimated value of farm and building is ?.35,OOO.ttO. No Uooks are furni'sbod to the inmates : one daily and one weekly paper is taken for those caring to read. IClevcn are catholics, three iirotestants. Neither priest nor ministers visit the institution unless called. All but one have been more or less addicted to the use of strong drink. Two men have consumption in the incipient stage. The dietary list given by the housekeeper contains ample variety and is sufficient in quantity. The county pays $1.80 i)er week for each person. There is neither tioating nor l>onded indebtedness. The county clerk and county agent state that no children have been placed in family homes since July, 1905, and no money has been paid out in that time for home place- ment. Thomas Sykes has been superintendent for 24 years. His treatment of the inmates seems humane and his management of the institution above the average. Date of inspection, Dec. 26, 1906. HAMILTON. The Hamilton county almshouse is located two and a half miles northeast of Mc- I.eansboro. The farm" contains IGO acres of land of inferior en accepted. Date of inspection, Jan. 10, 1907. HANCOCK. The Hancock county almshouse is situated one and one-half miles southwest of Carthage, and .•ontains 24 inmates, 18 men and si.x women. 'I'here are no insane inmates and no children in the almshouse. Tlirec epileptics and three feeble-minded patients are <'ared for. 'I'he building is brick, heated by steam, and is in good repair. Plumbing, wati>r suiiply, bath and toilet facilities are satisfactory. The building is healed by steam ; radiators being placed in each bedroom, and In the largo halls which form the sitting rooms of the inmates. These rooms were overheated, the temperature ranging from 70 to 75 degrees; outside temperature, ."C degrees. The ventilation was poor. In each room there is a cbliiiney with an opening about two feet from the lloor for the pur- pose of ventilation. These openings, which are not provided with gratings, were found to be stuffed with papers and old rags by the inmates. The reason given was that swallows nest in the cliiiiineys and the dirt falls down the chimneys into the rooms. The Inmates for this i-eason stuff the openings in the manner given. Littie attention seems to be paid to ventilation by doors and windows. On the ihirtl tloor of the Imilding provision is made for the insane patients. The rooms are heated and ventilated in the same way as the other parts of the building. Iron gratings are supplied for the doors and windows. These rooms were unoccupied. The male and female inmates occupy different floors, the doors communicating being locked at night. 103 Bath tubs, basins and some of the toilets were less cleanly than is desirable. The bed rooms are not free from vermin, and some of the beds showed lack of care. Aside from this everything seems in good condition. The floors, walls and the coverings of most of the beds were clean. Inmates are required to bathe and change underwear weekly. Fire escapes are provided, but no hose except in the basement. Water is provided on each floor. One young woman of 19, who is said to be somewhat weak mentally, is in the almshouse. She was sent there to keep her off the streets. This seems scarcely the place for her, but she is said to be too old to be admitted to the Training School at Geneva. The matron reported her as contented in the almshouse. A physician visits the almshouse on call. Religious services are held occasionally. The inmates seem well cared for. The county farm contains 260 acres, most of which is under cultivation. Date of inspection, Jan. 19, 1907. HARDIN. The prevailing high water made it impossible to visit the almshouse, which Is located eight miles southweast of Elizabethtown. Conditions seem to have changed but little for the better since the inspection two years ago. The last quarterly report to the county commissioners, made Dec. 17, 1906, stated there were five adult females and one infant abandoned by its parents in the almshouse. The superintendent pays $200.00 per year for the use of the farm and receives $8.00 per capita per month for care and furnishing all necessaries. Hardin county has a floating debt of about $2,000.00. Date of visit, Jan. 25, 1907. HENDERSON. The Henderson county poor farm, consisting of 160 acres, is situated one and one- half miles southeast of Oquawka. The buildings consist of one main building, in fair state of repair, and out of two small, rambling, old and dilapidated buildings, entirely unfit for occupancy. The main building serves as county jail and as residence for the superintendent of the poor farm. Three rooms in the building, with iron barred doors and windows, but with no provision for heating, are reserved for temporary use of insane patients, who are sent to the almshouse until arrangements are completed for taking them to State hospitals. The two old buildings are for the use of the inmates. While the beds were clean and an baundance of warm bed clothing is provided, the buildings are entirely unfit for the purpose which they serve. In one room there are four beds. This serves also as a sitting room and smoking room for the six men who sleep in this building. At one end of this same old building is the dining room and the sleeping rooms of the women inmates, of whom there is but one at present, a woman who has been returned from Jacksonville. No provision is made for the separation of the sexes. This build- ing, which is occupied by both men and women inmates, two of whom are considered insane, the woman having been ad.iudged so, is apart and separate from the superin- tendent's living rooms. In the other cottage conditions, while very primitive, are more favorable. The buildings are in a poor state of repair, and the walks loose and dangerous to walk on. There are no toilet facilities and no fire protection. The buildings are of brick, heated by stoves, and lighted by lamps. Considering the old and dilapidated state of these buildings and the lack of facilities for personal cleanliness, the condition of the inmates and of their surround- ings was such as to reflect much credit upon the superintendent. Date of inspection, Jan. 4, 1907. HENRY. The Henry county almshouse location is six miles north of Cambridge. The main building is a commodious brick, heated by steam from a large new heating plant, recently installed, and lighted by gasoline. The rooms occupied by the management are placed between the wings occupied by the different sexes, and separate yards are also provided. The grounds are beautified by large shade and evergreen trees, a smooth sloping lawn and an abundance of plants, kept through the winter in the large green house. All parts of the building, grounds, farm buildings and accessory structures were found in neat and orderly condition. The part occupied h.y the women was unusually home-like in appearance. A well 1,354 feet deep and three cisterns furnish an abundance of good water. The fire protection is above the average. Inmates bathe and change underclothes weekly. Religious services are held occasionally, and all burial services are conducted by some minister who is paid by the county. One insane soldier has been here almost 40 years. The farm contains .320 acres of good land, of which five is orchard, 12 in garden, and 170 acres cultivated. The income from the farm pays about half the cost of maintenance. The county owns 14 horses, 75 head of cattle, 114 hogs, and a great I04 deal of poultry. Thirty-nino hoes, av< raRlnp 400 pounds each were killed for part of the meat supply. Sovoral barrels of soap were made from the refuse meat. The present superintendent, W. L. Wilkinson, and his father have had charge of this almshouse for 34 vears. Date of inspection. Keb. 12, 1907. IROQUOIS. The Iroquois county almshouse Is located on a well-cultivated 390-acre farm, two and a half miles southeast of Watseka. The grounds are ornamented with well arranged drives, shade trees, ornamental shrubs and flower beds. The buildings are new, substantial in appearance, convenient in arrangement and with the addition of elevators and fire escapes, would serve as model buildings. A concrete laundry and kitchen house is to be built next spring. A finely appointed operating room and sick ward afford much satisfaction to the management and county physician. The bedding is clean, abundant and well cared for. Most of it is made by the Inmates. The clothing is somewhat superior to the average, and in a general way the physical condition and taste of the wearer are taken into account when it is supplied. The food supply Is good, carefully prepared and served with considerable regard for appearances. No tuberculosis cases are reported, no aggravated cases of epilepsy and no contag- ious diseases have developed for a long time. The facilities for personal cleanliness are all that could be desired ; the lavatories are convenient and free from odor. The county papers are furnished gratis by the publishers, and many bundles of magazines by the people of Watseka. During the summer religious services are held bi-monthly. Practically all the shoe repairing is done by the inmates, and the making of brooms has been started in a small way, several dozens more than were needed at the home having been sold recently. The stock, grain on hand, and general appearance of the farm show good management and concentrated effort. Of canned fruit. 1.060 quarts, six barrels of kraut, beans, cabbages and other vegetables furnished everything in that line needed for the entire year. The accounts of expenses, products and inventories are all in excellent business form. The people of Iroquois may well be pardoned for an unusual degree of pride in their almshouse and Its management. Date of inspection, .Tan. 5, 1907. JACKSON. Three buildings are provided, one for the management, one for negroes and one for the white Inmates, the latter containing the kitchen and dining rooms and a sitting room for the men on the first floor and another for women on the second floor. But two stoves are used for heating in this building. The lack of heat in the bedrooms, together with bed clothing insufficient In quantity and of inferior quality, must entail suffering In CQld weather. The building set apart for the negroes Is unfit for human habitation and a disgrace to any comninnify. Kattiing is so rare that most of the Inmates date events by reference to it. 'I'he fund seems lo l)e sufficient, and the meal that was on the table a1 the time of the inspection well prepared. About 400 quarts of fruit were put up last summer. The site Is particularly fine, the water supply abundant and the farm of ir>0 acres well managed by a vigorous young superintendent. The buildings have all been painted during the last year and a new barn built to relace the old one destroyed by fire last year, together with all the tools, horses and cattle belonging to the county. The sup- erintendent is paid a regular salary. More orchard, small fruits and laundry facilities are much needed. The farm Is located three miles southwest of Carbondale. Date of inspection. ,Tan. 19, 1907. JASPER. Of ihe thirty inmates present on the day of inspection, twelve were under If!. Two of these should be in the home for feeble minded. One boy of fi is partly deserted by his mother, who pays but little attention to him. The parents of tlie others are unable to care for them properly. No one seems to feel an.v particular responsibility about placing these children In family homes. The provisiiins foi- sepai'ation of the sexes are above the average. .\ strong room Is provided for the violent, but rarely used. The bedrooms are nut orinided wKb stoves. The roof Is badly In need of repair and the plastering is much damasred in conse- quence. Rathing facilities are entirely Inadequate. New cement walks were put In last summer and a new barn built. The superintendent pays ifTWfl.OO per year rent for the IfiO-acre farm and receives $1.50 per capita per week, for which he agrees to furnish bedding, clothes, food and I05 medical service and pay the funeral expenses. For this small rate the service Is unu- sually good. The farm is located seven miles north of Newton and two and one-half northeast of Falmouth. Date of inspection; Jan. 14, 1907. » JEFFERSON. A substantial brick furnishes accommodations for housing the dependents of this county. If a heating plant and bath and toilet rooms were installed, it would answer its purpose quite satisfactorily. Up to the time the present management went into effect, on New Year's day. there was much complaint about the quantity and quality of the food, the scarcity of clothing and unkind treatment. From the testimony of five of the more intelligent inmates, there seems to be little doubt that much of the cause of complaint was based on fact. It was necessary to purchase almost an entirely new supply of clothing and increase the amount of bedding. Every one seems happy now. Of the fourteen inmates, none is insane and but four are feeble minded. One woman has a well developed case of tuberculosis. A bright little boy of 2 years is with his widowed mother, who is unwilling to part with him, though she realizes she will never be able to provide for him as she wishes. The farm contains 160 acres, of which ten acres are in orchard, full bearing ; two acres in garden and ten acres in pasture. Some small fruit should be set out. Shade trees abound, and under the present vigorous, humane management there is every reason to believe the almshouse and its surroundings will be sources of continued pleasure to all directly interested. For the food, clothing and care of the inmates the superintendent receives .$1.00 a week and the income of the farm. Date of inspection, Jan. 10, 1907. JERSEY. The Jersey county poor farm is situated eight miles northwest of Jerseyville and contains 160 acres. In addition, land is rented and farmed, making a total of 340 acres. The institution is so conducted as to make it almost self supporting. There are at present seventeen inmates, thirteen men and four women. O^this number, seven are reported as insane, all but one having l)een adjudged insane and returned from Jacksonville. One insane inmate has never been adjudged insane, though he has been in the almshouse six years. This is attributed to neglect by the proper authorities. There is no adequate provision for the insane. A portion of the regular sleeping rooms in the men's and women's apartments is partitioned off by wooden gratings, extending almost to the ceiling. Some of the rooms so partitioned are unheated. This is the only provision made for the care of the insane. No insane patients are at present under restraint, and there is only one who has no exercise. He refuses to leave his bed and has become partially paralyzed from lying in bed constantly. Conditions in this almshouse as to cleanliness and order are admirable. Fresh paint, clean floors and beds and bedding In excellent condition showed careful super- vision on the part of those in charge. Other conditions were less satisfactory. There are three buijdings ; one for women. a frame Building ; and two for the men. one a frame, the other a brick building. The heating is inadequate. There is but one stove in each of these buildings. The average temperature of the bed rooms was 45 degrees. The sitting rooms, which are also used as sleeping rooms, had an average temperature of .5.5 degrees, the outside temperature being 25 degrees. During the past few months seven inmates have died of pneumonia, bad colds being the beginning of their illness. This, in connection with the very inadequate heating of the buildings, is significant. There is no system of ventilation and the Inmates are reluctant to have windows opened. There is no plumbing and adequate facilities for personal cleanliness. One bath tub, movable, is provided. This is placed in the women's building in an unheated room. The difficulties in the way of regular bathing are such that no regular rules for bath- ing are enforced. The inmates change underclothing once a week. The women's building is unplastered. the walls and ceiling being ceiled. Being a frame building, old, with windows and doors loose, it will be easily understood that one stove of medium size would prove very inadequate in heating the building. There Is no laundry. One room in the women's building is used as the inmates' laundry and the dining room of the inmates, which Is in the building otherwise occupied by the superintendent, forms the family laundry. Some other arrangement than this should be made. There is no fire protection. No religious services are held at the almshouse, but inmates who wish are at liberty to attend religious services held elsewhere. All Inmates who are able to work are required to do so. The county employs a physician, who visits the almshouse monthly and on call. The buildings are all in good repair and the farm seems well managed. Date of inspection, Jan. 28, 1907. io6 JO DAVIESS. Thf Jo Daviess couuty aln'.shouse is located two and one-half miles northwest of Galeua. - The luaia hiiildiug is of frame aud brick, with three stories and basement; is old and in dilapidated condition, and very much in need of renovation and repairs. The women's dining room and liitchen are in the basement. The tirst story consists of a living room for the superintendent aud family and two sleeping rooms for men ; fhe second and third Hours, sleeping rooms aud clothes closets. The floors were clean, but the building throughout was overrun with bed bugs and roaches. Scarcely a room iu the house was free from bed bugs, even in the hospital and insane department. In both the latter they were very bad. There were indications of rats and mice in every part of the building. The sanitary condition is very bad, owing principally to the women's closet. There is an open hallway and closed bridge from the second story to an open closet con- structed over a Hume baclc of the wash house. There is a draft that carries the odor from this closet through the upper part of the house. There is a sewer pipe open- ing into the wash house and the wash water is dumped through this into the pit, the closet thus serving the double purpose of catch basin and cesspoool. The stench in the wash hi)use was terrible. The matron, Mrs. Smith, remarked that if the inspector thought it "bad, then he ought to come in summer and inspect them." It is difficult to understand hoft' any one can live under such conditions. There is uo attempt at lire protection. The house is heated by steam from a good, modern heating plant and lighted by lamps. The women and men are in separate parts of the building. All eat at the same time, but at different tables. Each washes his own dishes. There are many aged and infirm. All appeared warmly and comfortably dressed. There were several sick and one man almost dead from cancer. The bill of fare includes : Breakfast — Bread, meat and coffee. Dinner — Bread, meat, potatoes and coffee. Supper — Tea, bread and butter and anything left on their plates from dinner. They cover such remnants with a paper and have them at supper. They bake 112 loaves of bread during the week. The hospital is a one-story stone building of about seven rooms. An elderly lady has charge. There was a lack of cleanliness in the whole establishment. Mrs. Smith reported four deaths in the hospital since Oct. 23, 1906. The insane department is separate from the almshouse proper, a two-story brick building, with a c(*rridor running the length of the building, and rooms with grated windows and solid doors with a small grating at the top and a hole through which the food is passed to the inmates. There were three locked iu these cells. One was an old lady not insane, whom they said had threatened to burn them out. They locked her in for this reason. Next to this cell was a man, in the same ward ; then a woman. Though these were "exceed- ingly dangerous,"' the inspector opened fhe door and went in and talked with them. This woman tears her bed to pieces and because she is so filthy in her habits they feed her only on bread and tea. The matron explained that "if they fed her meat, she would stink them out." The inspector saw these insane fed. It was pitiful to see them hold their cups for the tea and food. The other two had a good meal of meat, potatoes, tea and bread. The old woman from the hospital helps wait on these insane also. Wlien asked why this man was kept In the women's quarters, the matron replied that it was too much work to carry their food up stairs. There is a stockade or "bull pen" of about one-half acre inclosed by boards on end, about ten feet high, with two barb wires on top, and in places another on the inside. This is wlicre the insane are supposed to take their exercise. They should be removed at once. There is one consumptive, slowly but surely dying. There are no epileptics. There are forty acres of land, very poor, almost valueless as far as fertility Is oun- cerned. There is about one acre in garden, the balance in pasture, except a small patch. They have four cows, four horses and about forty chickens. The buildings are old, but in fair condition. I'he heating plant is good arid warms the rooms sufllclentiy. Joseph Smith lias been in charge since Oct. 28, 1900. Mrs. Smith is matron, and neither have any help, except what they get out of the Inmates, and that is little. Mrs. Smith is much overworked, and doubtle.ss matters- would be improved If she had the needed help. The superintendent and his wife receive $600.00 per year for their services. There are no children in the almshouse. The boys' and women's quarters are In the same part of the county jail. This was light and airy and in good sanitary con- dition. No children of juvenile age are ever committed. There was a hoy 16 years old there for theft. There were no children placed in homes by the court nor dependent on the county. Date of inspection, Jan. 10, 1907. I07 JOHNSON. The county farm of 120 acres lies four miles northwest of Vienna. Through neglect and careless' handling it is now much run down ; fences, barn and outl)uildings all much in need of repair. An effort is now being made to build up the soil. More orchard and some small fruits are much needed. The building for the care of the insane is decrepit with age and use. The almshouse proper is frame, ceiled, unpainted, gloomy in appearance, never has had shades at the windows and heated with wood stoves. At present there are but four inmates all of whom are feeble-minded ; one of the men is also blind and the other epileptic. The two men and two women all live in the same room, a condition that seems like an outrage on couimon decency. The cook- ing, baking, washing and ironing are done by the two feeble-minded women. Welis and cisterns afford a good water supply. Bathing is infrequent and the changing of clothes occasional. The bedding seemed to be in good condition and evidences of vermin were not seen. The superintendent receives the income from the farm and $1.25 per capita per week for each inmate for food, fuel, clothing, bedding and care. The county employs a doctor and pays funeral expenses. Date of inspection, Jan. 21, 1907. KANE. While part of the buildings are old, this almshouse, located near Batavia, is a model of neatness. The Urst floor, a high basement, is used for a bakery, kitchen and dining room, and the second floor for office and superintendent's living room and several wards. The remaining two stories are used for sleeping rooms, sitting rooms, closets and bath rooms. The sanitary condition of the house is fine. The floors throughout were as clean as they could be made and all halls were covered with strips of carpet. There are closets and baths on each floor and ward. The inmates, even those that were known as "dirty patients," were clean and well kept. There is good light and air throughout the building. The ibuilding is heated with steam and lighted with electricity. A fine electric plant furnishes light for the whole premises and for the court house at Geneva. A contract is let for a new switch board, and when completed several other buildings will be furnished with light, $1,500.00 being appropriated by the county for this purpose. Fire protection is complete. Each of the six wards is supplied inside with 100 feet of two-inch hose, attached to a standpipe. There are good Are escapes on all the build- ings. The water is supplied from a deep well and is of good quality. Males and females are separated from each other by wards in different parts of the building and strong iron doors between the departments. Most of the men and women occupy the same dining room, but separate tables. The nurse or caretaker from each ward is present and looks after them. The inmates have three meals a day as foUows : Breakfast, hash, bread and butterine, beef or pork, milk and coffee. Dinner, corned beef or boiled beef and dumplings, bread, butterine, potatoes, coffee and tea. Supper, fried potatoes, oat meal, prunes or fruit, tea and milk. There were 1,000 quarts of fruit, 800 bushels of potatoes and 1,500 heads of cabbage in the cellar. There were 57 insane and 16 idiotic and feeble-minded. Two of the latter should not be here and yet they are well cared for and remarkably clean. A nurse spends her time with a few of these, attending to their needs. The men's ward is in a separate building and is two stories with wide corridors and sitting halls clear through, well lighted and ventilated. The sitting rom is well supplied with rocking chairs and seats. This ward is ventilated with a large fan and tube system. There is one epileptic, a man who has been there for ten years ; he is also insane. There are several cases of consumption in this almshouse. The lighting and heating plant is In first class order. The root cellar, made of concrete, is one of the best of the kind. They have a large cold storage plant con- structed on the latest pattern. The laundry is well equipped with machinery, but must be remodeled for better ventilation. This will be done next summer. The farm consists of 265 acres of good land. The farm is well stocked ; they have 12 horses, 200 hogs and 48 cows. The barn is large and well built. All are well clothed. There were several sick. One man had cancer. Both legs were amputated some time ago for this reason, and now half of his face is gone. Two children have been born in the almshouse during the past year, both reported legitimate, and both were taken away by their mothers soon after birth. No children have been placed out by the court. .Juvenile criminals are held in the women's quarters in the county jail. Kane countv has a bonded debt of $30,000 and $1.3,000 not bonded. John Michalson. the superintendent, is adapted to the position and is well spoken of by the authorities. Date of inspection, Jan. 5, 1907. io8 KANKAKEE. The Kankakee county almshouse is located In the edge of the city of Kankakee. The building is a two and a half stories, with basement, built of stone. The basement contains a laundry, well equipped with modern machinery, a heating plant and store room. The first floor contains the men's day rooms and bed rooms, bath room and wash room. The second floor is the same as the first, only used for women. Both of these floors are used for the insane. The old building is of frame, two stories. The first story is used for sleeping rooms for the superintendent and family, kitchen and dining room for inmates, and the hospital. The house wa.s clean and in good sanitary Con- dition. The beds were also clean and well provided with clothing. There is no fire protection except that furnished by the city. There are two fire plugs two blocks dis- tant. The buildings are supplied "with city water, heated with hot water and lighted by electricity. The temperature of the bed rooms was from 65 to 70 degrees. " There are ample and sufHclent preparations for the separate care of the two sexes. The male and female are kept in separate parts of the building. With the exception of two or three dirty inmates all were clean, well clothed and appeared well cared for. There were three old ladies who are invalids, one man [laralyzed and another with an "eating" sore on one of his legs. These were all clean and in good condition. There is an old couple who have a room together; this room is off of the superinten- dent's department and not attached to other rooms. There are 12 insane ; seven male and five female in the Kankakee almshouse ; none of these are violent, all quiet and many good workers. Among them one old lady has been in bed for two years. The women's ward is in the second story, the men's in the first story of the stone building. The doors are locked between them. There is one who has not been adjudged insane ; he is quite old but works well. All are incurable. There are two epileptics, one male and one female, both feeble-minded. One man died with consumption the day previous to this inspection. There are no others in the almshouse. The inmates are well fed. there being plenty of good, wholesome food and well cooked. Following is the bill of fare : Breakfast, pancakes, syrup, butter and coffee. • Dinner, meat, potatoes, vegetables, bread and butter and coffee, often pudding and pie on Sunday. Supper, fried potatoes, sauce, bread and butter, onions or other vegetables. There are no children in the almshouse. One child reported illegitimate was born there during the year. The mother came to the almshouse to be confined. The girl went away and the child, a girl, was given to the Illinois Children's Home and Aid Society for adoption. No children have been placed in family homes by the courts in this county. Separate provision is made in the .lail for .iuveniles. None are ever placed there. Miss Hutten. the superintendent of associated charities, is also deputy sheriff. She takes them home with her. The farm of 48 acres is under good cultivation ; 10 acres l)eing in garden and potato patch. The farm supplies plenty of vegetables and fruit for its inmates. The outbuildings are in good repair and there are indications of thrift. Tlicy have five cows and a few hogs and they sell horses and turn the net proceeds to the credit of the farm. The superintendent has been very successful during the past year. C. M. Cooper has been superintendent for several years, and receives a salary of $100.00 per month. Both Mr. and Mrs. Cooper appear to be exceptionally fine people and are certainly adapted to the work. The county furnishes two women to help with the work of the house and pays them $20.00 each per month. There is no debt, bonded or otherwise, on the county, the last indebtedness being paid off in 1006. Date of inspection, Jan. .31, 1907. KENDALL. Kendall county has no almshouse, the paupers receive township relief. KNOX. The Knox county poor farm consists of 141 acres, forty of which is under culti- vation. The buildings are attractive in appearance and surrounded by well kept grounds. Two wings have recently been added to the building. These are modern in conslructlon and piactlcally lire proof. The insane i)atleiits are c-dntinccl in these two wings, which are separated by the superintendent's living rooms. The male patients and inmates occupy one wing, the female the other, thus separating the sexes. The sane and insane pateinis are separated, each class having a dining rdoin. The rooms are clean and well ventilated and the beds cumfortalilc The bulJding is heated throughout by steam and lighted by oil lamps. Bathing and toilet facilities are adequate. The new wings are provided with iron stair cases and flre escapes. Three hose on each floor, 250 feet In all, with flre hydrants In the yard, are provided for Are protection. 109 A small frame building in the rear of main building accommodates twelve inmates. Conditions in this building are less favorable. The sleepng rooms and sitting room provided for the feeble minded and idiot male inmates are in semi-darkness, being situ- .ited in the basement. The ceilings are low and the rooms not so well kept as in other parts of the building. The Knox county almshouse is exceedingly well equipped for the care of its inmates and is very capably managed. Date of inspection, Jan. 2, 1907. LAKE. The Lake county almshouse is located at Libertyville. The main part of the building was erected sixty years and the new part ten years ago. The building is in good sanitary condition, except the second floor. This is quite unsanitary^_ because of the open closets on that floor. The superintendent said this would be ch'anged as soon as the new water system was completed. The basement of the main building is used for kitchen, dining room, laundry and furnace room. The buildings are all lighted with electricity and heated with hot water. The temperature of the rooms ranged from 63 to 68 degrees. The men occupy the lower and the women the second story. They all eat at the •same time and on the same floor, but in separate rooms. The men and women do not mingle, except as their duties may call them to do so. The food of good quality and plentiful. At the time of this inspection the inmates were at dinner and the inspectoF had an opportunity to see what was placed before them. The superintendent gave the following as the menu for each day : Breakfast — Coffee, bread, butter, potatoes and meat. Dinner — Tea, meat, potatoes, bread, butter and vegetables of some kind. Supper — Tea, potatoes, bread, butter and sauce. The baking is done twice a week and seventy-five loaves of bread arq baked each time. The best of materials are used. The same bread is used on the table of the superintendent and his family. There are four insane ; all are incurables ; all have spent from one to ten years in the hospital for the insane and were returned as incurable. One feeble minded man is locked in his cell most of the time because he runs away when allowed his freedom. The insane were all well clad and appeared well kept. There are no night attendants on duty, the insane being locked in their cells at night. One woman who is insane has been in the almshouse for five years and is in a very delicate condition. It was suggested that the physician examine her and write to the State Board of Charities, giving the present stage of the disease. The farm is in splendid cultivation. The outbuildings are in exceptionally good condition, indicating thrift. They have eighteen high bred cows, giving an abundance of milk. The milk is separated and the cream made into butter for use on the table. The skimmed milk is used on the table by any who wish it. They were packing butter for summer use at the time of this inspection. There were 500 bushels of potatoes and an abundance of vegetables in the cellar. Two hundred chickens furnish eggs for cooking purposes and for use on the table. The new system of water works will be completed in the early spring and will he a great improvement. Bath rooms and closets are in process of construction. A new cesspool has been recently built and will be enlarged to meet the necessities of the place in "the spring. There are no children in the almshouse and none has been born there for the last three years. No children have been placed by the courts of Lake county during the past year. There is no detention home in Lake county for the care of children outside the jail. When it is found necessary to detain a child, they place him in the care of a probation officer for safe keeping. One boy 15 years old was serving a sentence of nine months in the jail for theft. He was in an upper row of cells, apart from the other prisoners. There is no debt of any kind against the county. The superintendent, C. A. Appley, has been at the almshouse for the last thirty-six years and for ten years superintendent, seems kind to the inmates and appears to have the confidence of the county authorities. Date of inspection, Dec. 26, 1906. LaSALLE. The La Salle county farm of 210 acres is located three and a half miles west of Ottawa. The buildings occupied by the inmates are all brick, heated by steam and supplied with good fire protection. The separation of the sexes is complete, and the part for the care of the insane well adapted to Its purpose. A large, well equipped laundry, an isolation building and a new barn each contributes its share for convenient man- agement of an Institution providing care for over 200 dependents. A large greenhouse furnishes attractive decorations for the wards and sitting room^ during the winter season. Settees and rocking chairs are provided for all the women and Infirm Inmates. no Much good leading matter is furnished by the people of Ottawa. Religious services are held almost every Sunday. Two children were born during the past year, both of wliom were tal occupied by men. the other by women. Tliere are .".0 men, six women and two Ijabies in these buildings, which present the appearance of a badly kept prison. The visitor was inforiiK-d tliat it is the intention of the board of supervisors to remodel these buildings and lit them for hospital use within a short time. The build- ing now used as a hospital Is heated by stoves. There were three patients without attendants, no nurses being provided. The rooms were in the same uncleanly condition that prevailed througiiont. The air was heavy, the windows all tightly closed. The patients were alone, aliiiou;:!) one was iu an advanced stage of tuberculosis. In the superintendents building there Is one room up stairs that is occupied by. Inmates. This is heated by stoves. The walls, beds and lieddlng are dirty. The kitchen is on the first floor of the building occupied by the superintendent. It Is a small room with poor equipment for preparing food for 157 Inmates. Here, too, uncleanliness prevailed. The mens dining room is In the new building. The women have no dining room. There is a small room with two tables each large enough for perhaps four persons to sit at. The food, which is prepared In the kitchen is handed through a window to the male inmates ^nd carried by them on their plates to the dining room about 30 feet distant. The women inmates eat their meals as best they can. Aside from the inconvenience of such an arrangement food served in such a manner can not but be unpalatable. No milk is given inmates except those who are sick. There are but two cows and thr- milk is apportioned among the feeble inmates. The dinner, served as it was, was most uninviting. There are no rooms for the proper preservation of food, fruit or vegetables. The bakery is poorly equipped and was not clean. There are two feeble-minded and three insane Inmates of the almshouse One of the feeble-minded inmates is kept locked in a cell. It has been found necessary to punish some of the Inmates by locking them in cells, and In the case of one muscular patient who became unruly the hose was turned on him. There is no Are protection other than two water plugs In main building with 00 feet of unattached hose. No fire escapes are provided. The main building, with cement floors and Iron stairways is practically fire proof. The facilities for personal cleanliness are good in the main buildings, in the others, very poor. 'I'here are no l>ath regulations nor rules regarding changing the underwear and" bedding of the inmates. Blankets only are used upon the beds and with scarcely an e.xception these blankets were badly soiled. The inmates do their own washing of bedding and clothing, and are expected to be a law unto themselves regarding cleanliness. No work is provided for the inmates. Religious services are held every two or three weeks. A physician visits the almshouse dally. The buildings are lighted by electrlcltv. Date of Inspection, Jan. 29, 1907. MARION. The Marlon county farm contains 200 acres, lying five miles southeast of Salem The site is good for any kind of drainage or sewers ; shade and ornamental trees are numerous and attractive in appearance. The buildings are frame, inconveniently arranged for ilie puri)ose intended and affording only nominal separation of the sexes and care of the insane. The rooms are rather large and most of the Inmates live in groups of three or lour, having separate beds, but otherwise using the room in common Heat is furnished by coal stoves. The bedding and clothing seem to be suftlclent and the food abundant. Water Is supplied by wells and cisterns. IJetter facilities for bathing, a laundry and butcher house arc much needed. Hellglous services are rarely held, and no great amount of reading matter finds its way into this institution. The superintendent receives a regular salary and the county pays all cost of mainten- ance and for extra help. The present management seems to be unusually capable and to have considerable executive ability. Date of inspection, .Tan. 16, 1907. MARSHALL. Four of the live Marshall county almshouse buildings are frame, two of them quite old and noorly adantod to the purpose. The frame buildings are healed l)y stovrs and one l)rlck building, occupied by the men. by steam. 'I'he buildings, bedding and clothing were all very clean, and showed signs of careful attention. One bath tuli Is provided, and all inmates bathe and change underclothing weekly. Male and female Inmates ari' kept In separate buildings and ample provision is made for the Insane. The welitilled bins and canned fruit in the cellars, together with the meat supply recently laiil by suggested sufficient food, while some found on tlie kitchen tables and pantry Indicated good and careful i)reparatlon. A small laundry and tank house were built recently and numerous repairs made. The county employs a superintendent, one kitchen helper and om- farm hand. The superintendent has authority to call a lihysician when one is n led. The farm contains 120 acres, with three acres In orchard, three In garden and .SO acres cultivated. The county owns seven horses, 15 cattle, 21 head of hogs and 2*iO "3 chickens. The cash value of what was produced and consumed, exclusive of the garden and orchard, last year was $1,635.80. The estimated value of the county property is $16,023.75. The farm is located two and a half miles west of Sparland. Date of inspection, Feb. 9, 1907. MASON. The Mason county poor farm consists of 100 acres, all under cultivation. The receipts are such as to make it almost self-supporting. The buildings consist of several small detached structures and one main building, occupied by the men inmates. At present there are 15 men and five women at the almshouse. The rooms are bare and comfort- less and devoid of heat in the men's building, except in one long narrow room which serves as sitting room. In this two stoves are placed. The beds have wire springs, on which a straw tick is placed, covered with cotton blankets and comforts. Neither the rooms nor beds were clean. There seems to be little attention paid to ventilation, as the air In some of the rooms was vile. There are no bathing facilities. If the in- mates bathe they must go to the washhouse and use an ordinary tub. There is no Are protection. The women patients are in two small detached cottages. These are heated by stoves, but otherwise devoid of the simplest comforts of life. No sitting room is provided for the women inmates. The food served is satisfactory. Two meals and a lunch are provided daily. There is no flre protection.. Date of inspection, Dec. 29, 1907. , MASSAC. The Massac county almshouse site is all that could be desired for the modern build- ings that are needed to replace the present old frame structures, racked by age and use. Those now in use are as clean as it is possible to keep buildings in their condi- tion. The hot air furnace heat is convenient, but not satisfactory when the wind blows from the north. Fair provisions for the separation of the sexes and for the care of the insane are provided ; likewise facilities for personal cleanliness. The bedding seemed to be ample, well made and clean. The food is all cooked and served by the management. Inmates in proper physical and mental condition are permitted to attend church, but no religious services are held at the almshouse. Some reading matter is furnished by the people of Metropolis. One inmate is suffering from tuberculosis, but is not isolated in any way. Two of the inmates are both blind and insane. Both an orchard and small fruits are much needed and shade trees, either for beauty or comfort, seem not to have been considered. The 120 acre farm lies about three miles south of Metropolis. Seventy-five acres are cultivated and four acres of garden furnishes all the vegetables necessary. The superintendent receives the income from the farm and $1.00 per capita per week for food and care. The contract is made for three years at a time. Inspected Jan. 3, 1907. Mcdonough. The McDonough county poor farm is situated two and one-half miles southeast of Macomb. It consists of 160 acres, seventy-three of which are farmed. The building is of brick. The interior of the building is inconveniently arranged and In urgent need of repairs. The plastering is broken in many places and the walls badly soiled. The plumbing needs repairing. The water supply for bathing and toilet purposes is insuflB- cient, being dependent on a windmill. 'lUhe toilet rooms, bath tubs and basins were for the most part filthy. The rooms and beds were lacking In cleanliness, as were other parts of the building. No assistants are given the superintendent, either on the farm or in the house. The work devolves upon himself, his wife and the inmates. The building is unsanitary. Open traps are In the basement floors and closets throughout the building, emitting rank odors. One room in which an insane patient Is locked has an open closet beside the bed. There Is no ventilation and when the door was opened an unbearable stench came forth into the hall. Several of the rooms unoccupied at the time of the Inspection have these open closets, one of them being in a most filthy condition. Old and feeble patients are expected to take care of their own rooms. In case of flre, the building is so arranged that escape would be diflflcult, yet no fire escapes nor flre protection are provided. Two hundred feet of hose, purchased five years ago and unattached, is in the r)asement. A tank, dependent upon a .windmill and often empty, is the only means of supply of water for use in case of fire. There is no system of ventilation other than by windows. The building is heated by steam, but the heater is placed at one end of the building, and during cold or windy weather the part of building occupied by women is insufficiently heated. In this case stoves are used. Adequate provision Is made for separating the sexes. The food and clothing are apparently satisfactory. The building is lighted by lamps. Date of inspection, Jan. 5, 1907. — 8 P C 114 McHENRY. The McHenry county almshouse Is located at Ilartland. The building consists of two stories, basement and attic. The baking room, store room, kitchen and dining room combined are in the basement : also the laundry. The first and second stories are used for sleeping rooms, sitting rooms, clothes closets and bath rooms. The attic contains two tanks for house use and lire protection. The building is of red brick. The old part is twenty-three years and the new six years old. The beds and house througliout were clean and in ;;ood condition, except the closets on the first floor In the men's department. These were poor and unsanitary. They will be repaired at once. There are four bath rooms in the house. 1'he building is heated by steam and lighted by lamps. The temperature was from »;5 to 75 degrees. They have plenty of hose and good water pressure from tanks in the attic. It is required that these tanks be pumped full of water every night. The building is supplied with fire escapes. The men's quarters are on the lower and the women's on the upper tloors, with dining room on each floor. The inmates generally appeared well cared for and well dressed. There are a few old and infirm. The work is done mostly by the insane. Twenty-one out of the thirty- nine are defective. I saw the inmates at the table at noon and found them well fed. All were allowed all they wanted to eat. The bill of fare is varied and includes for Breakfast — Oat meal, potatoes, bread, cold meat from day previous and syrup. Dinner — Potatoes, meat, vegetables, butter and bread, coffee and pie on Sunday. Supper — Potatoes, bread and butter and tea, sauce or baked apples. They have 100 gallons of lard from last year, 900 quarts of fruit, 400 bushels of potatoes. They raised forty bushels of pears and canned over 400 quarts of straw- berries. The farm ia in good cultivation. The outbuildings are good, substantial and well stocked. None of the Insane is very much disturbed. They are kept In separate wards and are well cared for. There are two epileptics, both bad at times, one of whom Is reported Insane. There are no consumptives. One child was in the almshouse during the year. It was reported illegitimate and was taken to some society In Chicago by order of the court. The county clerk reports no children placed In homes. There are separate cells for juveniles in the jail, but none were there during the year. There Is no debt on the county of any kind. George K. Mills has had charge of the almshouse and farm for several years. Mrs. lillls Is matron and both oversee the work. Mr. Mills has one helper besides the inmates. Date of inspection .Tan. 3, 1907. McLBAN. Among the inmates of the McLean county almshouse is a girl who Is fourteen years old, but appears to be about ten. She can balance herself, but cannot walk unless she holds to something or someone leads her. She is fairly bright, but was returned from the asylum for the feeble-minded on account of her inability to move about freely. There is an institution in Chicago called Tlie Home for Destitute Crippled Children, that would certainly furnish much better environment for her. I do not know what the conditions for admission are, but from what the superintendent, county Judge, and chairman of the board of auxiliary visitors told me. the supervisors would gladly allow a reasonable amount for her care in an institution that could better pro- vide for her unfortunate condition. She is kept in llie ward with the feeble-minded women. She Is very affectionate, and eager to bvirn. She has been at the county farm four years. The only near relative is a sister a little older, living with a family In Bloomington and attending school. There Is a most distressing case of epilepsy at this county farm ; a young man rather Intelligent in appearance, courteous in speech and manner, and industrious up to the time epilepsy suddenly developed, four years ago. He has a record of more than .'),000 convulsions in the last year, and nearly 4'iO in one day last summer. Some days he Is free from attack; then they start in at intervals of a few hours, sometimes every few minutes. Some days they strap him to the bed. and keep one or two men with him to prevent any serious injury to himself. While the Inspector was present one came on. In his wild wrlthlngs, strapped as he was, he would lift the iron bed several inches from the floor, and run it about the room, unless held down by the at- tendant. He has pleaded with the superintendent to leave some means of self des- truction where he could get his hands on It. Ills father developed epilepsy after reach- ing maturity, and died at the Kankakee asylum. A sister died of epilepsy at .Tackson- vllle. Another sister, unmarried, was brought- to the farm and lay In a stupor for weeks, u'nable to retain or assimilate food ; she ultimately recovered. Another sister was brought to the farm recently. In childhood, the upper bone in this girl's left arm was crushed by a blow from a poker, rendering the arm Incapable of sustaining any weight. The suggestion occurs whether some neurologist or neuropathic Institute might not be Interested in the opportunity to apply some special mellmd in the care of this young man. He would probably be glad to allow them to do anything that would give any hope of alleviating his condition, to say nothing of permanent relief. The woman and her five children, to which a sixth was soon to be added, were in the ward for feeble-minded women when I was there. The superintendent promised to put them into another building where there would be practically no contact with the Inmates except two women, not feeble-minded, and to send the two who are old enough to attend school, as soon as school opens again. The husband is working on a railroad as a section hand ; so it is not likely thev can leave the farm before spring. Date of inspection, Dec. 28, 1906. MENARD. The Menard count.v almshouse is situated two and one-half miles southeast of Peters- burg, and contains 190 acres. There are 10 inmates, fourteen men and five women. Six inmates are reported insane, one feeble-minded and two epileptic. Conditions as to cleanliness and comfort were fairly good, but heating and bathing facilities are unsatisfactory. Stoves are used, one being placed in ■ the men's sitting- room, one in the women's sitting-room, and one in the dining-room. The sleeping rooms were unheated and the halls cold. The temperature of the sitting rooms was 68 degrees, of sleeping rooms about 50 degrees, outside temperature 32 degrees. The insane and sane inmates mingle freely, no distinction being made in their care. There was little in their appearance to distinguish them from the other Inmates. There is a building formerly used by the insane but now unoccupied. This was found unsatisfactory. Insane inmates are sometimes punished. Inmates are required to bathe and change underwear regularly ; weekly in summer and bi-weekly in winter. Two porcelain bath tubs are supplied with hot and cold water attachments. Unfortunately these are placed in rooms that cannot be heated. These bathrooms were filled with lumber of various kinds, and are evidently unused In winter. There are very inadequate arrangements for separating male and female inmates, and the matron reported that only the utmost vigilance on her part could prevent im- proper communication. There is a tank filled by windmill in the almshouse, and this serves as some pro- tection in case of fire. There is but one short piece of detached hose. The ventila- tion seemed fairly good. The county employs a physician, who comes on call. The contract system prevails in Menard county. The farm is rented for $4.50 per acre, the renter taking care of the county poor for $1.50 each per week. The one who contracts thus to care for the poor, must furnish the almshouse all needed furniture. as well as clothes, food, and care for the inmates. No assistance is supplied. There is no bonded or floating debt. The present superintendent leaves the farm on March 1, 1907. Date of inspection, Feb. 9, 1907. MERCER. The Mercer county almshouse is a large, well-planned brick structure, erected four years ago at a cost of $31,500. The separation of the sexes is unusually adequate. Individual rooms are provided, and large pleasant looking sitting rooms on each floor, together with lavatories, bath- rooms, and stationary wash basins. The entire building Is heated by hot water. Cleanliness and careful supervision are everywhere evi- dent. Four boys under ten years of age are here with their mothers, and four others were taken b.v the home-finding society last year. The few insane are harmless and show evidences of good care. The care of three inmates is paid for by relatives or the in- come from property. None of the inmates at present has tuberculosis. Religious services are held at rare intervals. All the county papers, and two dailies are furnished, and man.v magazines donated. Nearly all the inmates read more or less. The fire protection seems to be adequate. An ice house afCords much satisfaction to the management. The farm is located four miles north of Aledo. and contains 360 acres. Four acres of orchard and small fruit, and five acres of garden furnish the table bountifully for the year. One hundred and forty acres are cultivated. The county owns eighteen horses, ninety-two head of cattle, eighty-two hogs, sixty chickens, six turkeys and six ducks. The income from the farm pays about two-thirds of the cost of maintaining the almshouse. The present management seems to be conscientious, thrifty and efllclent. The number of inmates is thirty-four. One farm hand, and a helper in the house, and a sewing woman part of the vear are provided at county expense. Date of inspection, Feb. 13, 1907. MONROE. The eighteen men in the Monroe count.v almshouse were all of foreign birth, repre- senting in their nativity, Germany, Canada, Switzerland and Russia. The only native- born inmate is a young woman, partly paralyzed. One child was born during the year, and taken away by his mother. Xo insane were present, and but one classed as feeble-minded. ii6 The main building Is a substantial old brick In good repair. There are adequate provisions for care of the Insane and separation of the sexes. The rooms are heated by stoves, and kept at satisfactory tfniperatnros. The rooms were found to be cl<»an and aired daily, and tlie lifddlnK in pood condition. The men have a comfortable sit- ting room in the ri-ar of the luilldinK. and are not allowed to smoke in the bed rooms. Inmates are permitted to go to the village unless they show a disposition to abuse the privilege, and all who desire attend church services. Several of the men do light work for people In the neighborhood. Some reading matter is furnished by the keeper and people Interested In the alms- house. There Is only about one acre of ground owned In connection with the building. There are neither orchard nor small fruits, and not enough vegetables are raised to supply the Inmates. The county doctor acts as superintendent, and a keeper receives 25 cents per capita per day, with ten cents additional for each insane person com- mitted, for food, fuel and care. The almshouse is located in the northwest part of Waterloo. A proposition to sell the property and buy more land further from the town is being considered. Date of inspection, Jan. 30, 1907. MONTGOMERY. The Montgomery county almshouse is situated on a slightly elevated piece of land two and one-half miles southeast of Hlllsboro. The buildings are frame, in a fair state of repair. The main building should be painted on the interior, the walls and woodwork being soiled. The main building Is heated by steam. The bod rooms up- stairs are heated by radiators placed in the halls. The temperature of the upper rooms was from 50 degrees to 55 degrees. That of the lower rooms, including men's and women's sitting rooms, averaged 65 degrees, outside temperature '28 degrees. A small cottage, formerly used by insane Inmates, is heated Ijy a stove ; temperature 65 degrees. The dining room Is used in common by male and female Inmates. Only two meals a day are served during winter, at S :;J0 a. m. and 2 ■.?,0 p. m. The inmates occasionally have butter and milk but not regularly. Occasionally apples are provided for dinner. No other fruit was mentioned as being served in winter, though the.v have an abun- dance of fresh fruit during the fruit season. The rooms, beds and bedding were clean, especially the bedding, which was good in quality and abundant. Ventilation by windows and transoms was fairly good. Thi re is no "plumbing and only fair facilities for personal cleanliness. No bath tubs are j lo- vlded, but Inmates bathe weekly and change underwear. There is no tire protection. The water supply is good. A physician comes on call. No religious services are held at the almshouse. There are at present twenty-seven Inmates ; fifteen men and twelve women. Of tlii'se fourteen are reported feeble-minded. Adequate provision is made for the separation of the sexes. The men and women occupy opposite sides of building, the comnmiii- cating doors l>eing locked. Date of inspection, .Ian. .30, 1907. MORGAN. The Morgan county poor farm is situated four mil(>s northwest of Jacksonville and i-on- talns 200 acres. At the time of inspection there were fifty-six inmates of county almshouse ; thirty-four men and twenty-two women. Of this number thirteen are re- ported in.snne, two feeble-minded, one is deaf, dumb and blind and one epileptic. Conditions in this almshouse are unfavorable. The buildings are in need of repair. The walls an- bliick with the grime and dlit of years. Tlic^ i)Ince Is infested with ver- min. Beds, bedding and Inmates were dirty. The greater part of the Inmates are in the part of the building originally fitted for the care of the insane. These rooms have heavily narred windows and doors. But little llgnt is admitted through the bars and the dirt encrusted glass of the windows. The Insane women are lodged In one end of this building, occupying both first and second floors. The other end of the building Is occupied by male inmates, both sane and Insane, who are lodged together, hut in different cells. The other women Inmates are lodged In what Is called the hospital, but it is hospital In the name only. There Is no ade(iuate provision for separation of male and female Inmates, and there seems to be great laxity In this respct. There are separate dining rooms for male and female Inmates In the basement of building, but the Insane women have a dining room on the first floor of the Insane department. To reach this dining room they pass through the hall of the men's department. Food is carried from the kitchen to the din- ing room. Some of these Insane women run back and forth through this hall to the kitchen or cellar on various errands. A numlier of men were in the hall, which serves as a kind of sitting room. This Is not only an inconvenient arrangement but dangerous In the absence of careful supervision. The facilities for [lei'sonal cleanliness are very poor. Two b.nlh tubs are provided, one for each sex. However, as all water used must be heated and carried from outside and up a filuht of steps it will be seen thai the difilcultles in the way of cleanliness are great. The inmates bathe weekly and change their underwear. The buildings are heated by steam. A temperature of 65 to 70 degrees prevailed throughout the building, outside temperature 30 degrees. 117 There are only outside closets, placed some distance from the building. The men's closet was in a most foul and unsanitary condition. The women's closet is about one hundred and fifty feet from the building, too far for some of the old and feeble inmates to walk in cold or rainy weather, but there are no indoor closets for inmates. Only the part of the building occupied by the superintendent has proper bath and toilet facilities. The rooms are dark and gloomy, furnished with bed only in most cases. These beds, almost without exception, were dirty. Traces of vermin could clearly be seen. The walls were discolored. Cobwebs and in one room wasp nests were In the ceilings. The windows in some cases were barred and inside of the bars were heavy iron screws. These not only made the rooms dark and gloomy but In case of fire would lessen the Inmates' chance of escape. These rooms are occupied by both sane and insane inmates. There is no fire protection, a small hand grenade hung in men's hail being the only pretense of fire protection. The women inmates have no sitting room. Some of the feeble women inmates are in the so-called hospital, which is simply a wing of the main building. Conditions in this wing are in no wise an improvement over other parts except that there are no bars to windows or doors. The food for these inmates is carried into this building on trays and each inmate's share is served on tin plates. In this building there is a pitiable case of a woman blind, deaf and dumb. She has been there a number of years. As no one is able to communicate with her, she is absolutely shut in from intercourse with those about her. Her attendant is a feeble, old woman of over eighty. She waits upon this poor unfortunate and cares for her, feeding her as she would a child. The two formed a most pathetic picture. There is no provision for lighting the almshouse. The inmates are in darkness after night fall. No religious services are held except occasionally in summer. Three meals of good substantial food are served. The bonded debt of county is $100,000. There is no floating debt. The commissioners appoint the superintendent of the poor farm yearly at a salary of $700 per year. His wife is matron, salary $300 per year. His oldest daughter is assistant matron and another is seamstress for the almshouse. A brother of the superintendent is the at- tendent of the male inmates and his wife is cook. In all six assistants are employed, with salaries from $25.00 to $30.00 per month. The superintendent and the county clerk were unable to give the per capita cost of maintaining an Inmate. The superintendent stated that the appointment of the person who should have the care of poor farm depended altogether on the predominance of democrats or republican members of the board of commissioners. Mr. Evans has been superintendent since March, 1906. Date of inspection Feb. 8, 1907. MOULTRIE. The Moultrie county almshouse is situated two miles west of Sullivan and contains twelve inmates : nine men and three women. There are no insane inmates, but there is one feeble-minded male. There are two deaf mutes, one blind and one epileptic inmate. Conditions in this almshouse are favorable. The buildings are heated by steam. An average temperature of 60 degrees prevailed in the bed rooms and 65 degrees in the sitting room ; outside temperature 15 degrees. The male and female inmates occupy opposite sides of the building, the communicating doors being locked. The buildings are In good condition, and the beds and bedding clean, though not wholly free from vermin. The facilities for personal cleanliness are fairly good, pans, soap and towels being furnished. There is one bath tub, supplied with hot and cold water. Inmates bathe and change underclothing weekly. There is no fire protection. There are hydrants but no hose. Three meals daily are furnished. Inmates are at liberty to attend religious services and occasionally services are held at the almshouse. A physician comes on call. The farm contains 224 acres. An abundance of fruit and vegetables Is raised. Date of Inspection Feb. 4, 1907. OGLE. ■With the Rock river flowing in front and the limestone bluffs on the opposite shore!,; crowned with a growth of trees, the site of the Osle county almshouse may easily be classed as one of the most picturesque in the State. The lawn sloping down .toward the river, is large and well kept. A large frame building, erected in ISTS, and a sub- stantial brick built in 1883, are provided for the inmates. Both the heating and ven- tilation are satisfactory, except in extremely cold weather. The water supply is all that could be desired, and some means for fighting fire are provided. The building, rooms, clothing and bedding are kept very clean. Nearly all the rooms present fti home-like appearance. All the county papers are furnished and some dailies. ,!'.i ii8 None of the Inmates are consumptives, and children as a rule are not allowed to remain here. Forty-nine inmates were present, four of whom were insane and thiee feeble-minded. Eightv acres was recently added to the farm, making 207 now owned by the county. The Income from the farm "last year was al)0ut ?S00, exclusive of wliat was used. The per capita cost for the last year was .$1U8.S0. The county appropriates $8o0 an- nually for help, with which the superintendent may hire as many as he considers nec- essary. The present management is humane and energetic. Date of Inspection, Feb. 15, 1907. PEORIA. The Peoria county almshouse, at Maxwell, cares for 165 inmates, forty of whom were in the hospital at the time of inspection. This is a separate building, fairly well equipped for caring for patients, though more assistance should be provided in order to maintain the high degree of cleanliness so necessary in a hospital, as well as to care for the patients properly. This building is wired for electric light, but connection has not yet been made. Oil lamps are still used in the hospital, as they are throughout the main building. Two insane patients are in the almshouse, all others having been removed to the State institutions. Separate but inadequate provision is made for the insane. Only one child is in the almshouse, this a babe. There is complete separation of the sexes, the men and women occupying opposite wings of the building, the superintendents apartments being between. The heating is sullicient and the ventilation good, the latter being by means of doors and windows. The temperature throughout the buildings ranged from Cs to 70 degrees. Radiators are placed in each room. The outside temperature was 29 degrees. Bathing and toilet facilities are satisfactory, though some of the toilets are in need of repair. The inmates bathe and change their underclothing weelily. The rooms and beds were clean and apparently free from vermin. Three meals of good, nutritrous food are served daily. Adequate tire protection, through abundant water supply and hose ready for immediate use, is provided. Religious services are held regularly. Two physicians are employed, who visit the almshouse twice a weelj and on call. The cement floors of the basement, where the kitchen, dining room, bakery, etc., are situated, are in need of repair, being broken and rough in many places, and for this reason dilUcult to keep clean. Some arrangement should be made to relieve the kitchen of the steam of cooking, it being tilled with a thick cloud at the time of inspection, with apparently no means of escape. Electric light is needed, as much of the building is necessarily in darkness at night, owing to the danger arising from the use of oil lamps. The general conditions in the almshouse are good. Date of inspection, Jan. 10, 1907. PERRY. The Perry county almshouse is located on a knoll one mile south of Pinckneyville. A number of fine shade trees are attractive features of the site. The building is a substantial brick, in a fairly good state of repair. If a heating plant were Installed to replace the few stoves now in use, bath tubs and lavatories placed conveniently, and a few minor changes made, the equipment would be quite modern in character. Both the site and arrangement of the building lend themselves quite readily to these im- firovements that are much needed. At present there are but five inmates, one of whom s reported insane and epileptic. The farm seems to be well managed, and the stock owned by the county in good condition. The farm contains ninety acres, of which five is in orchard and flvo in gardens. More small fruits and better laundry facilities are needed. The income from the farm i)ays most of the cost of maintenance. The superintendent is paid a salary. The present one has served five years. Date of inspoction, Jan. 18. 1907. PIATT. ' The Piatt county almshouse is situated three miles west of Monticello. The build- ing has been recently enlarged and is in good repair. It is wired for electric lights. and is heated by steam. ,\ number of rooms are lilted for insane patients, of whom there are four, who have been regualrly adjudged. In addition to this number, nine- teen Inmates arc reported, of whom some are undoubtedly insane. One of these is a man about .'{0 years of age, who has been an inmate of the almshouse for ten years, lie should be removed from the almshouse, as his condition is such as to require the care of an attendant. He destroys his clothes and his bedding, and was half naked at the time the visitor inspoctcd the almshouse; and this, although the tbonnoni(>ter registered 5 degrees above zero. He Is violent at times and is growing rapldl.v worse. He has never been ad.iudgod. \ lirother placed at the same time, then hut i4 years old, is also in the nlmshouse, and bis condition is but little better. They have been in the almshouse ten years and no investigation of their mental condition has ever been made. No attendants are provided. Insane patients are sometimes punished b.v locking them up and by boxing their ears. 119 There are in all twenty-seven inmates, twenty-one men and six women. Male and female inmates occupy opposite sides of the building, the doors being locked between. Tlie rooms were well heated, the upper rooms averaging 70 degrees and the basement rooms, in which the insane inmates and those unable to c!iml> the stairs are lodged, averaging about 60 degrees; outside temperature 5 degrees. This lower temperature was due to broken glass in the door of the basement. The ventilation was good. The beds and bedding were in good condition. The place is not wholly free from vermin. A few of the beds in the insane department were not quite up to the general standard of comfort and cleanliness, this being due to the destructive character of the occu- pants, as explained to the visitor. There are good facilities for personal cleanliness ; four bath tubs with hot and cold water, and a lavatory for men and one for women being supplied. The inmates bathe and change underwear weekly. There is no fire protection, no hose being provided, though there are two water plugs in the building. Four exits from building with wide staircases, lessen the danger to the inmates in case of Are. No religious services are held at the almshouse, but Inmates are free to attend ser- vices when they wish to do so. The farm contains 280 acres, all under cultivation. The general character of the male inmates is such that there should be some pro- vision for separating the grounds used by the superintendent's family and the women inmates from those of the male inmates. A fence should be built to divide the men's and women's grounds, in order to protect the children of the superlndendent as well the women inmates from any danger that might arise from the proximity of so large a number of mentally irresponsible men. At present there is nothing whatever to form such a division. Date of inspection, Feb. 2, 1907. PIKE. The Pike county poor farm affords shelter to sixty inmates, thirty-one of whom are men and twenty-nine women. Of this number seven men are reported insane, and eight women. Six men are feeble-minded and nine women. Three are four epileptic patients, one of whom is insane. Separate apartments are reserved for the insane : the women insane patients being lodged upon upper floors and the men on the lower. These rooms are provided with heavily barred windows and the latter being secured at 'night with heavy iron bars, padlocked. As there is no fire protection, there would be considerable danger to these patients in the event of fire. The rooms and beds in the insane department were clean and sanitary, and the inmates apparently well cared for. The men and women inmates in a normal condition are lodged in different wings of the building, but all eat in a common dining room, though the male and female Inmates have separate tables. Comfortable sitting rooms are provided for each sex and the regulations all seem intelligent and humane. The buildings are of brick with the exception of the superintendent's residence, which is frame. All are in a good state of repair. The walls are freshly painted, and cleanly throughout. The heating is by steam and by stoves placed in various parts of the building. In the Insane wards there is uniform heat throughout ; also, the women's rooms are heated. There is no provision for heating the sleeping rooms of the normal men, stoves being used in the sitting room, while the upper floor Is un- heated. The temperature here was about 50 degrees, the outside temperature being 30 degrees. In other parts of the building a temperature of from 68 to 70 degrees prevailed. The ventilation was satisfactory and cleanliness and order prevailed throughout the building. Toilet facilities are limited, only two bath tubs being provided and all water having to be carried into the buildings in buckets. The management of this alms- house is so capable that cleanliness prevails among the inmates as throughout the various buildings. Ditficulty has been found in securing a water supply commensurate with the needs of the building, there being no stream near. No fire protection is provided, owing to difficulty of securing an adequate water sup- ply. There are no fire escapes. There are three male children In the almshouse, aged 14, 9 and 8 years respectively. All are attending the district school, the county board paying their tuition. These children, when not in school, are with the other male inmates. As many of these are feeble-minded the effect of such association cannot be other than harmful to young children. The county farm is situated two and one-half miles southwest of Plttsfleld and con- tains 80 acres, much of which is unfit for cultivation. Date of inspection, Jan. 16, 1907. POPE. No almshouse has ever been maintained in Pope county. Provision is made in private homes for the care of the county charges. It was admitted by some interested persons that this care was sometimes not all that could be desired. During the last year three have been sent to the asylum for the feeble-minded. One man is kept in a home at the rate of $8.00 per month and three women at the rate of $5.00 per month, the latter all living with relatives who are willing to keep them if some aid is furnished. On account of the high water prevailing at the tme of the Inspection, it was impossible to visit any of the county charges. Dependent children are placed by two home-finding societies. I20 [I'ope county has no debt of any kind. Children are placed in the Baptist home at Haywood, or placed In family homes by the Illinois Children's Home and Aid Soclety.l Date of visit Jan. 24, 1907. PULASKI. The Pulaski county almshouse Is located two miles northwest of Olmstead. It Is a detached frame. building, built in a way to afford poor prot<'ction against cold w.-ather. The only stove Is used In the sitting room occupied in common by both the male and female Inmates. The temperature of the bed rooms is practically the same as the outer atmosphere. The bed clothing Is clean, but hardly sufficient for cold weather. No provision la made for the care of the Insane. The separation of the sexes Is fairly adequate. Of the six Inmates, four are colored, one of the latter being blind. One colored inmate is very filthy In his habits and should be placed in an asylum where there are adequate facilities for caring for this class of patients. Inmates are requested to bathe weekly In. the summer; in winter, rarely on account of lack of proper facilities. The food is well prepared and sufficient In variey and quantity. The superintendent receives the Income from the farm and $1.35 per capita per week for food, clothing, care and fuel. The farm contains eighty acres, of which about sixty Is cultivated. Contracts are made for three years. The barn was rebuilt during the last year. The fences are much in need of repair. Shade trees, small fruits and an orchard are much needed. The present management seems to he energetic, thrifty and humane in the care of the inmates. Date of inspection Jan. 26, 1907. PUTNAM. Putnam enjoys the distinction of being the smallest county in the State, and has a correspondingly small population in its almshouse, which is located three miles east of Hennepin. The three inmates were males, one of whom Is insane and one both blind and epileptic. The insane inmate imts in most of his lime mend- ing real or imaginary cuts in his clothing and presents a rather unusual appearance In consequence. The building Is frame In good repair and exceedingly clean and or- derly. The l)edding is clean, of good quality .•ind well adapted to the character of the Inmates. There Is fairly good provision for the separation of the sexes, but no women have been kept here for eight years. The food Is sufficient In variety and quantity and there is every reason to believe It Is well prepared. No Improvements have been made about the place for some time except the building of a good cistern. The farm contains but thirty acres and the soil Is of Inferior quality. An orchard and small fruits are much needed. The superintendent Is paid $2.50 per capita per week for food, fuel and care. Date of Inspection Feb. 8, 1907. RANDOLPH. One large brick, one large frame building containing wards for the different sexes, a large dining room and kitclion, all rnmfortahly heated by steam, constitule the main buildings of the Raiuloliih cfninty almshouse. The laundry, meat hniise. bnki' house and home for the superintendent, are all in detached buildings. Everything was found in a fairly good state of repair. A cellar for storing the coal, brick or concrete walks to the various buildings, better bathing and latindry facilities, would all add greatly to the comfort of the inmates and management. The care of two filthy insane is a great burden. Seven of the thirty inmates are reported Insane and sixteen are feeble- minded. The provisions for care of the Insane and separation of the sexes is much above the average. The superintendent Is paid a salary ; a farm hand, a cook and one female helper being employed bv the county also. The farm was much run down, btit now begins to show the result of good management. Seventy-five acres of the 100 is cultivated, six Is In orchard and ten acres used for gardening. The surplus of the farm last year sold for nlioni JfLfitMi. Thi' county owns two horses, two mules. pIimcu li(>a(l of rattle and a large flock of chickens. Thirty-nine hogs averaging 3.^0 potinds each were killed for the yearly meat supply; ."jOO qimrts of fruit were canned, 100 gallons of peach and apple butter put up and four barrels of kraut made during the last season. The county employs a physician who comes on call. All Inmates bathe and change under- clothes every two weeks In the cold weather. All male Inmates are shaved ivery Saturday and have their hair ctit when necessary. No religious services are held, hut Inmates In proper condition are permitted to attend church. No children were horn In the almshouse during the past year and no children were present at the time of the Inspection. The present superintendent seems to be much above the average In energy, practical management and executive ability. The farm is located one and one-half miles east of Chester. Date of Inspection Jan. 29, 1907. 121 RICHLAND. Nine males and ten females were present the day of inspection of the Richland county almshouse. One is blind, two are epileptic and two are subjects for the asylum for the feeble-minded. The latter have been here seven years. Their mother and an uncle are also inmates. Most of the cooking and care of the rooms is done by the inmates. Five of the women smoke and are allowed a ten cent package each week. The building is frame badly out of repair, entirely inadequate and practically without conveniences. But two heating stoves are used, both of which are on the first floor. The number of sheets, blankets and pillow slips was Inadequate. A bath tub that would have been preferable to none has been allowed to remain unused for over a year, through neglect to have some simple repairs made. The farm is located four miles east of Olney and contains 160 acres which could be made much more productive by better management. Enough vegetables are raised to supply the inmates. A ten-acre orchard has been set out, but small fruits are wanting. No shade trees are to be found. There is a general air of neglect in many places. The superintendent receives $1.00 per week per capita and the income from the farm. Date of inspection Jan. 12, 1907. ROCK ISLAND. The Rock Island county almshouse is located on a farm of 174 acres, two miles from Coal Valley. The grounds are unusually large and well kept. The principal building is a new brick of modern type. It contains a large dormitory for men, a men's infirmary, a dormitory for women, two large sitting rooms, kitchen, dining room, store rooms, vegetable cellars and drug store. The old county building is frame, but is in excellent repair. It contains rooms lor the insane and some needinc; occasional restraint. It was in good condition and well furnished, the rooms occupied by thiiiwomen being unusually neat and attractive. Hose in the halls, three hydrants in the yard, and an overhead" tank seemed to furnish exceptional fire protection. The water supply is good, and vermin held in check by constant battling. One negro baby was born recently. A twelve year old boy almost deaf and wasting away with bone consumption is a pitiful sight. He has never gone to school. There were 141 inmates, five of whom had consumption. The county furnishes three daily papers and some reading matter is donated. A woman from Rock Island conducts services every two weeks in the summer time.- The county employs a superintendent, a matron, assistant superintendent, engineer, cook and physician. The per capita cost of maintenance for year ending Dec. 31, 1906 was $1.80 per week. The present superintendent has served nine years. Date of inspection Feb. 14, 1907. SALINE. The Saline county almshouse buildings consist of a two-story brick with a basement, and a dilapidated frame containing five rooms. The brick building is about forty years old. with walls cracked and bulging, pieces dropping out almost daily, much of the plastering gone, poor provisions for heating and stairways steep and unsafe, and should be condemned. The frame building is utterly unfit for habitation, yet nine people are kept in it. Some of the bedding is indescribably filthy and the clothing of some of the inmates, at least, of questionable sufficiency. No religious services are ever held, and no light and entertaining work is provided for the Inmates. The chairs are old. battered and uncomfortable. Bathing is almost unknown and the changing of under- clothes indulged in upon necessity. The food Is proba'bly sufficient In quantity and there is reason to believe it is well prepared. There is neither orchard nor small fruits. The barn and outbuildings are all in per- fect harmony with the other building. Of the fifteen inmates, eight are feeble-minded or insane. One boy of thirteen has bepn there a number of years through neglect to send him to the asylum for the feeble- minded. Two children were horn during the year, both of which were taken away by the mothers. The superintendent pays $250.00 per year rent on the farm, containing 125 acres. He is paid $07.50 per capita per year for food, fuel, clothing, care, bedding, medical attendance and burial expenses. The proposition to sell the county farm and buy one further from town and erect an up-to-date bnikling is bnins; cnnsidPi-pd. There is urgent need for the change. Date of inspection Jan. 23, 1907. SANGAMON. This almshouse is located near Buffalo. The boilers of the heating plant are under the main building and on numerous occasions small fires have been started due to the floors being close to top of boilers. The gas plant Is also in basement and at times the odor from it goes through the whole building. The heating plant and gas plant should both be moved to a building apart from the main building. A modern up-to-date laundry would be an improvement over the present system of doing all the washlnjr 122 by band. On tbe men's side of tbe building tbere are but two bath tubs. One of these Is In a room where two very filthy patiouts are kept and is for their exclusive use. This gives only one tub for the use of the other 120 male patients. This cer- tainly should be changed and more tubs should be provided. There is one boy 18 years of age who is a helpless cripple besides being deaf and dumb and blind, brought on by an attaclc of spinal meningitis when 2 years old. lie should be removed to some Institution. He is a constant care. A coat of paint would improve the appearance of the interior of a number of the rooms. The superintendent has repeatedly urgt>d the need of Ilium inipioNciiii'iiis Imi has not been able to get them for the county. Date of Inspection Dec 27, 1906. SCHUYLER. The Schuyler county poor farm, situated one and one-half miles west of Itushville, con- tains .'310 acres of valuable land, most of which are under cutlivation. The farm is said to be more than self-supporting. The buildings consist of a main building, which is bricli. and of two smaller build- ings, one brick and one frame, 'i'hc women are lodged in the main building, iiart of which is occupied by the superintendent. The men occupj- the two smaller buildings. No provision is rnade for the care of the insane. There are at present seven mildly insane persons in the almshouse, four of these having been returned from Jaclison- vllle. Three insane who have not l)een adjudged are also in the almshouse. Twenty-two males and seven females are cared for. Three children, two boys, aged two and ten y(>ars respectively, and one girl of 14. are in the almshouse. The two- year old child is to be sent to one of the home-finding associations within a few days. The 10 year old boy is with his father associating with the other male inmates. He is to enter school soon. He has been in the almshouse but a short time. The girl has been placed in several good homes but has proved unruly, and is now under the care of the superintendent's wife and living with them. She attends the district school. The general condition at this almshouse is unfavorable. The buildings are old, in- conveniently arranged, and in need of repair. The plastering is brolien and the waits in many rooms black, with dirt and smoke. The heating is neither sulTicient nor safe. Stoves are placed in the halls, but in cold weather these must prove very inadequte. The average temperature of bed rooms was less than .50 degrees : of sitting rooms 65 degrees ; the outside temperature being 25 degrees. In the main building, the rooms are roughly ceiled, the openings between the boards making it very difflcut to keep the place free from vermin. The beds, how- ever, were in good condition, clean and well supplied with good warm covering. Most of the beds had springs. The rooms in the women's department were clean, but the men's departments were far from being so. There are no facilities for personal cleanliness, there being but one bath tub and this in a room that cannot be heated, and with no plumbing. Inmates change their clothing every two weeks, but bathing is optional. Two patients suffering with tuberculosis are in the men's building. A tent has been erected and. until cold weather came, these patients were isolated, but they are now with the other inmates. Special care is given these patients. There is no fire protection. Yet the place is little more than a Are trap. The water supply is poor, the wells being shallow, and the purity of the water somewhat doubtful. Perhaps the worst feature of this institution Is the condition of the outdoor closets. There is neither sewer nor vault. They are simply tumble down sheds, a disgrace to the county. In warm weather these cannot but be a menace to the health of the In- mates. The superintendent and his wife are Intelligent and progressive in their ideas of conducting the almshouse, but they are sadly hampered by the premltlve condition of things. One modern convenience has been added within the past few months. The build- ings are wired throughout, each room being supplied with electric light. Date of inspection, .Tan. 22. 1007. SCOTT. The Scott county poor farm Is situated one and three-quarters miles west of Winchester and consists of 80 acres, much of which is broken and unlit for cultivation. The building Is brick, two stories and a basement, in a poor state of repair. The contract system of letting the care of the poor to the lowest lildder prevails In Scott county, this custom having been In vogue for a number of years. 'I'lie county pays 25 cents per day for the s'tipjiort of each Inmate and In addition pays for tiie fuel, oil and brooms used in the almshouse. Out of tlie sum thus received by the superintendent of the poor farm, he pays ^-ido.OO a year, or .$5.00 per acre for rent of the farm. Conditions at this almshouse are very unfavorable. There are at present thirteen Inmates, seven men and six women. One man has been adjudged Insane and a woman is to be brought before the commission next week to ascertain her mental condition. Two men and four women are reported as feeble-minded, one of the latter being a girl of II. Tiie woman whose sanity is in question Is locked in iter room, the temperature of which was about (!() degrees. Between iier room and the adjoining one is an open grating consisting of iron bars, placed about four Inches apart. There is no door, a 123 blanket being hung part way over this grating. The adjoining room is occupied by a young man said to be simple minded. Free intercourse and conversation may be held between these rooms either day or night. The woman is kept locked in because she runs away when left at liberty. A short time ago she was absent two days and nights before she was found. She sits all day with her hands folded and refuses to tell any- thing in regard to her past. The man reported as insane was cleaner than were most of the other inmates. The rooms, beds, and inmates showed lack of care and cleanliness. There are no pretensions to comfort. The walls are soiled and the plastering broken in many places. The place is infested with vermin, the broken plastering and general uncleanliness mak- ing it difficult to rid the place of these pests. The floors were rough and dirty. One inmate, paralytic, and helpless for nine years past, lies in an unplastered, un- ceiled basement room, rough brick floor, on an unspeakably filthy bed. The air in the room was heavy and sickeningly foul. The room is little more than a cell, with one window, seldom or never opened. He is 80 years old. In summer time he is removed to a small frame building which in winter time is used for a meat house. In the women's sitting room, which is also the sleeping room of three of the in- mates, there was a small coal stove, the steam heater proving insufficient in cold weather. At the time of inspection the stove was red, the stove pipe for half its length being red hot. Near the stove sat a woman 92 years of age. While the in- spector was in another part of the building this aged woman fell, striking her head against the coal bucket and cutting an ugly gash. Had she fallen against the stove the danger would have been great to herself as well as others. She is a soldier's widow and her support is paid for out of her pension at the rate of 25 cent's a day. Two children are in the almshouse, both 14 years of age. The boy came in Novem- ber, just recovering from a fever. He is pale and sick still. His mouth was filled with tobacco, which he also smoked. For three years preceding his mother's death, which occurred last summer, he was employed in the Alton glass works. He can neither read nor write, being unable to spell his own name when asked to do so. He is with the male inmates, eating and sleeping with them. Of the seven male inmates, three are mentally weak, one blind, one a paralytic. The effect of such associations upon a young boy cannot but be disastrous. The girl, 14 years of age, is reported as simple minded and has been in the alms- house only a week. She is untaught but capable of mental development. Her cloth- ing was stiff with grease and dirt. Her whole appearance indicated the grossest ne- glect. She is said to be profane, disobedient and immoral. She is with older women, all of whom are reported mentally weak. She can neither read nor write, having only reached the second grade in school. Male and female patients are on different floors, but their rooms open upon a com- mon hall. The dining room is on the same floor with the men's sitting room, the former being shared in common. Thev have every opportunity to mingle during the day, but the superintendent reports that the women's sleeping rooms are locked at night. The dining room, like the other rooms in this institution, was comfortless and dirty. It is in the basement. A rough brick floor, unplastered walls and dingy windows make it a most desolate looking place. Everywhere there is need of repairs and only the barest comforts of life are provided. The building was comfortably heated by means of steam radiators, most of the sleep- ing rooms being furnished with a radiator. Stoves are also used in the men's and women's sitting rooms. The temperature ranged from 65 to 72 degrees with the ex- ception of one room where the woman was locked ; this was 60 degrees. The outside temperature was 23 degrees. The building is unplumbed. An outside two-compartment closet is provided. There was no door on the women's compartment, it had fallen from its hinges, and leaned against the side of the closet. There are no toilet facilities, no bath tub, and no bath regulations. The superintendent reported that inmates do not bathe much in winter. and their appearance verified the statement. He reported that they change their un- derclothing weekly. With few exceptions the inmates were unkempt and dirty. As all the water used in the building has to be carried in in buckets and the refuse carried out in the same way, the difficulties in the way of cleanliness are very great There is no fire protection. The paralytic patient, who is in the basement would have to be carried up a narrow wooden stairway in case of fire. Other old and feeble patients are in the almshouse, yet there is absolutely no fire protection. No religious services are held in the almshouse. Date of inspection, Jan. 15, 1907. SHELBY. The Shelby county poor farm, containing 240 acres, is situated five miles northwest of Shelbyville. There were at the time of inspection, thirty-three inmates of the alms- house ; ten men and twenty-three women. Of this number two are insane, nine feeble- minded, one deaf-mute, one epileptic, and two children under 16, both weak mentally. These children have been in the almshouse seven and five years respectively. Everything about the farm indicated thrift and care. The almshouse is" not modern but it is exceedingly well-kept. From cellar to garret the utmost cleanliness pre- vailed. Rooms, beds, bedding and inmates gave evidence of excellent care. The two insane inmates were reported as having improved lately but are considered incurable, having been returned as such from the Central Hospital for the Insane. These two inmates mingle freely with the other Inmates, no distinction being made in the care given them and the sane inmates. 124 A wing In the almshouse originally fitted up for the care of the insane Is now oc- cupied as sleeping room for women Inmates. Male Inmates occupy rooms In the main building and a small cottage, which also contains the sitting room for the men. This cottage Is heated by a stove ; the other buildings by steam. The temperature averaged G5 degrees, except In the women's sleeping rooms, where the thermometer reglsterd 55 degrees, the outside temperature being 10 degrees. This part of the building Is difficult to heat, owing to remoteness from the heating plant. There is no fire protection. An iron outer stairway leading from the second story serves as fire escape. While the facilities for personal cleanliness are poor, there being but one bath tub, and some hand basins, the Inmates are required to bathe regularly and change their underwear. The women bathe weekly and the men bi-weekly. Three meals a day are served. There is an abundance of preserved fruits, also of vegetables. The county employs a physician who comes on call. The county has no bonded nor floating debt. The superintendent, who is appointed by the board of supervisor.s. has served fifteen years. The per capita cost of maintaining an inmate is $1.50 per week. Date of Inspection, Feb. 4, 1907. STARK. The Stark county poor farm Is situated three and one-half miles south of Toulon and consists of IfiO acres, all under cultivation. The buildings are frame and in good repair. A small four room cottage has recently been built to serve as hospital. The inmates occupy the rear of the main building, which is heated by steam and lighted by lamps. There are no radiators in the sleeping rooms, only in the halls and In two sitting rooms. Ventilation is by doors and windows. The plumbing and sewer are unsatisfactory, and toilet facilities very inadequate. Rut one bath tub Is provided for the use of both sexes. Bathing is optional. The inmates change under- clothing ^very two weeks. Two meals a day are served, at S a. m. and 3 p. m. No provision is made for the separation of the sexes. The sitting rooms and sleep- ing rooms of both men and women open upon a common hall. The.v have, too, a com- mon dining room. The rooms are fairly comfortable and clean. As there are no assistants, other than the Inmates, most of whom are old and feeble, the provision for caring for the rooms and Inmates is inadequate. A week ago an aged woman, mentally unbalanced, fell down stairs in going to the dining room and is now ill, in consequeiioe. A woman. KO years of age. and partially blind, is the bed maker of the institution and cleans the rooms. No fire escapes are provided. Two fire extinguishers, one on each floor, form the only fire protection. In a room for confining Insane or unruly Inmates, there Is a double compartment steel cage, with iron bunk suspended by chains. The windows and doors of this room are heavily barred and heavy steel hand cuffs for additional restraint or punishment are provided. There are no vlolcat insane inmates in the almshouse. The cage has been in use within the last month to restrain a girl of about 20 years of age. who Is unruly at times and given to violent fits of anger. She is considered mentally un balanced by the superintendent. Religious services have been held three or four times within the past six years. The temperature of the men's sitting room was 70 degrees ; women's 6.") degrees : sleeping rooms 00 degrees ; outside temperature 30 degrees above zero. Date of inspection, .Tan. 8, 1007. ST. CLAIR. This institution enjoys the distinction of being the largest almshouse In the south part of the State. The numlier of Inmates on the day of inspection was 149, of whom 109 were males. Eighteen were classed as insane, eleven as feeble-minded, one deaf, dumb and feeble-ftiinded, nine as epileptics, one girl 6 years old, and 111 in the pauper class. I''ive cases of tuliercnlosis exist. Eleven children were placed In orphan homes, or turned over to home-flndlng socle- ties during the past year. The seven buildings are all brick, heated by steam and lighted by electricity. A hos- pital with an oi)crnting room, drug store, and wards for the classification of various common ailments, with tniinod nurses In attendance Is iiiaintained. The separation of the sexes is comnlele. ;ind the provisions for the care of the insniic unusually good. The bedding was found clean, plentiful and free from vermin; and the space allotted to each inmate sullicienl for comfort and licnHb. 'I'be rooms are aired daily, and an air of cleanliness was evident everywhere. Uocklng chairs and lounges for the more feeble Inmates would add much to their comfort. Durinir tlie last year a m-w barn and laundry were built at a cost of $3,500 each, and $1,200 was expended for new floors, painting, guttering and general repairs. A new chicken house is responsible for an unusual degree of activity on the part of the fowls 125 owned by the county. The character, amount, and preparation of the food is all that could be desired. Eighteen hogs averaging 400 pounds each were killed recently. , The inmates are permitted to attend church in Belleville. A priest conducts mass about six times a year, and visits the inmates frequently. Protestant ministers and organizations hold religious services occasionally. Inmates bathe and change underclothes regularly. The fire protection might be considered adequate. A baker, two cooks, seven nurses and attendants, a night watch, engineer, and am- bulance driver are employed. The superintendent and his wife each receive a salarj. For the year ending April 30, 1906, the cost of maintenance was $13,654.13 or $93.02 per capita. The county owns four horses and eight head of cattle. The farm contains but 40 acres. There is no orchard, and few small fruits are raised. Except potatoes, the ten acres of garden furnish all the vegetables necessary. A physician em- ployed by the county visits the almshouse daily. The management is to be commended for their push, practical economy and system evident throughout the entire plant. Date of inspection, Feb. 2, 1907. STEPHENSON. The main building of the Stephenson county almshouse is of stone, three stories, attic and basement. The building is divided through the center by a partition, with a hall on either side. The north side is used for the women and the south for the men. The first floor consists of kitchen, dining room, two sitting rooms, oflice and two bed rooms. The second and third stories consist of sleeping and sitting rooms and closets. The basement or cellar consists of store rooms and lighting plant. There are good sanitary closets and bath rooms on each floor. The floors and beds were clean and beds well provided with cover. There was no sign of vermin. The water supply is from a 160 foot well, the water being pumped to a tank elevated 90 feet, holding 600 barrels. The building is supplied with 200 feet of two-inch hose, band grenades and Bab- cock fire extinguishers. There are five fire-plugs on the premises, and fire escapes for each building. The buildings are heated by steam, furnished by two large boilers and lighted by a Freeport gasoline gas-lighting system. The windows are large, admitting light and air. The superintendent and his family live in a residence apart from the almshouse proper. A building southwest of the main building is fitted out as a laundry, with the latest and most modern machinery, a bakery with oven and machinery and a feed- grinding room. The men and women are in different sides of the main building. There is a parti- tion and two hall ways between them. Two aged couples are permitted to live together on the women's side of the house. All eat at the same time but in separate rooms and tables. There are many old and infirm. The work in the house and on the farm is done by the insane inmates exclusively. All were well clothed. At my first call I saw the in- mates at supper and next time at dinner. The following menu was reported to me. Breakfast ; potatoes, bread and butter, tea and coffee. Dinner ; meat, potatoes, bread and butter, molasses and vegetables. Supper ; bread and butter, molasses, coffee and tea and milk. This menu is varied from time to time. There is no consumption at this almshouse. There is one epileptic, a woman about 35 years old : she is also insane and in the Insane ward ; she was in a most pitiable condition ; her face was all black and blue and her nose terribly swollen from falling ; her dress was matted with blood from a recent fall : she has a large tumor on her breast. The superintendent, Mr. Eells, stated that she did not know anything. She has been there for many years. There are twenty-five insane in the Stephenson county almshouse. The insane de- partment is at the rear of the main building and apart from it. The inspector's first call was in the afternoon and it was late when he reached the insane department. He found a man in the woman's ward, placed across the corridor from a woman who has a mania for stripping herself nude. She was in this condition when the inspector called. He inquired into the matter and was informed that they were making an ad- dition to the house and would remove the man at once. The inspector returned two days later and found conditions materially changed. The man had been transferred to the new quarters. The superintendent stated that he had ob.iected to the super- visors against the presence of this man on the women's ward, saying that he might be there till an inspector came from the State Board of Public "Charities and they would have trouble. He gave assurance that it would never occur again. There are three men and two women in almost constant confinement. One man had both feet frozen off before going to the almshouse, and is giving to tearing his bed clothes to pieces. The others try to kill the attendant when out of the cell. The attendant is an inmate of the poor house. From appearances he seemed hardly suited to care for them. The inspector was told by the superintendent that this man did not look after the women, but that Mrs. Eells had them in charge. When asked if be did not care for this man while he was in the women's quarters he said that he did, but he had no key to the women's cells. He was cautioned about this, and promised to keep him entirely away from their department. 126 One woman, very frail and decidodly Idotlc In appearance, the Inspector was told by the superintendent, had to have her feet and ankles restrained at night to lieep her from stamping her feet. He stated that chains were fastened around her ankles by straps or anklets and padlocks. The chains wore left lii(is<> so as to strike hor aukl<'s when she stamps her feet, causing her to desist. She was barefooted at the time of the inspection. The superintendent said that ten of the inmates should be removed to Bartonville. The new addition to the Insane department has additional ceils and corridors and a silting roMin in belli wards, which the superintendent said would be fitted out with rocking chairs and a Jeatlior couch in a few days. Quite a number of insane were kept in the common wards and were said to be harmless. • A new sewer and cess pool has been constructed, being a great improvement to the place. The new addition to the insane department will add much to the comfort of the Inmates. The cemetery has been improved by shrubbery and a number of small stone markers. The superintendent, James A. Eells. has held the position for several years and has the confidence and respect of the authorities. He was solicitous for suggestions for the betterment of the inmates. There are no children in the almshouse. The county clerk stated that none had been placed In homes recently and that reports had been sent Into the office of previous placements. There are no children In the jail and none are ever sent there but they are placed In the care of probation officers when necessary. There Is no debt on the county of any kind. The farm Is quite productive. The out buildings are in good repair. Indicating thrift. The farm Is well stocked. The feeble minded and Insane do most of the work on the place. Date of inspection, Jan. 9, 1907. TAZEWELL. The Tazewell county farm, situatod two miles northwest of Tremont, consists of 224 acres ; 200 of which are under cultivation. The buildings consist of one modern brick building, occupied by the Inmates ; an old frame building in which six or eight inmates lodge ; the superintendent's residence, a frame building and a number of well kept out buildings. The main building, which Is heated by steam, Is clean and sanitary, and the rooms especially those In the women's department, are cozy and homelike. Braided rugs, cushions, pictures, blooming plants and comfortable rocking chairs give an Individuality and homelikeness to these rooms which Is very pleasing. Adequate provision Is made for the separation of the sexes, the men and women being on opposite sides of the building, the connecting doors having private locks to which the superintendent carries the keys. The bathing and toilet facilities are excellent, six bntb tubs and thi' same numlier of toilet rooms being provided, all in excellent condition. The inmates bathe weekly and change underwear. The ventilation, plumbing and boating are satisfactory and the fire protection is adequate, there lieing hose on each floor and four hydrants with suCBclent water supply. A physician visits the almshouse weekly and on call. Religious services are held every two weeks. The regulations In the almshouse seem kind, humane and Intelligent. The old building which Is occupied by six or eight men, inmates of the almshouse. Is unsanitary and unwholesome. It mars what Is otherwise an almost Ideal Institution. Date of Inspection Jan. 7, 1907. UNION. The Union county almshouse Is located on a hill two and one-half miles southwest of Anna. The farm contains eighty acres, of which five Is in orchard, three In garden and sixty cultivated. The county owns one team, five good cows, a number of hogs and chickens and geese. Eighteen large hogs were slaughtered for use during the current year. The food Is abundant and well prepared by the management The bed- ding was clean and sufliclent for the average temperatures at the time of the inspection. The rooms are heated by coal stoves, but owing to the lack of underpinning and the poor construction of the "buildings, the heating is insufliclent in cold weather. Two bath tubs are provided, but are of little use In the winter season. The Inmates bathe weekly In summer, but much less frequently In the cold season. No artificial ventilation Is provided, and the rooms are freely aired only in summer. Two of the female Inmates are binl-ridden. two inmates are Insane, three are feeble- minded and epileptic also, one Is consumptive, one is blind and nine are in the regular pauper class. One Inmate was a confederate soldier, who states that at one time be had made preparations to enter a state confederate home, but later recovered bis health and worked until about a year ago. The superintendent is p&ld $400.00 per year. Improved laundry facilities, rocking chairs for the feeble and common chairs are mnch needed. Date of inspection .Tan. 20, 1907. 127 VERMILION. The Vermilion county almshouse is located near Vandercook, three miles southwest of Danville. The three buildings occupied by the inmates are all frame with soft pine floors, without ventilation, except doors and windows and are veritable fire traps. There is absolutely no fire protection. The use of stoves to supplement the furnace heat, together with kerosene lamps, is an added source of danger. Fifty-four men are housed in a building that would afford ordinary accommodations for half that number. Each room has at least two beds and each corner room four, while five sleep in the upper hallway. The sick and feeble men are all in this buildiilg, as well as the insane, blind, idiotic and more active. The beds are as clean as it is possible to keep them with the crowded condition of the building- and almost constant use of many of them. The conditions in the women's buildings are a little better. One woman, apparently in the last stages of consumption is in one of the women's buildings. The dining room and kitchen are well built, light and attractive in appearance. The laundry and bathing facilities are entirely inadequate. All water used for bathing Is heated In iron kettles and carried to the two ancient bath tubs. The butcher house is large, conveniently arranged and represents a very practical investment by the supervisors. The food seems to be abundant in quantity and suffi- cient in variety and well prepared. No reading matter of any kind is supplied. Religious exercises are held once a month most of the year ; those who desire are permitted to attend church. The fine appearance of the stock, the well-filled barns and granaries, and the general appearance of the farm, all indicate energy and good management, on the part ol the superintendent, who has served the county for ten years. He is no way responsible for the unfavorable conditioffs that exist, many of which are a constant source of dis- tress to him. The board of supervisors is contemplating some changes and additions, that will add much to the convenience of the mangement, and the comfort of the inmates. An eflBcient matron is much needed to look after the sick and feeble, as well as care of the rooms, clothing and a number of other things now neglected. Date of inspection Feb. 4, 1907. WABASH. The Wabash county almshouse is located on a bleak treeless site, two and one-half miles west of Mt. Carmel. The buildings are old and little adapted to the use intended A proposition to issue bonds for the erection of a new building was voted down last fall. The only source of water supply Is two cisterns. In the summer the taste Is bad, and an adequate supply rare. The bathing and laundry facilities are of a primitive type. The family now in charge have cleaned up the rooms, whitewashed the walls, repaired and added to the bedding, and improved conditions very materially. They received $1.2.5, per week for each inmate for food and care. To this is added the income of the farm, l)Ut most of the 110 acres is either poor or unproductive. Neither orchard nor small fruits have ever existed, no shade trees are to be seen and some of the fences are 1,'reatly in need of repair. No records seem to have been kept, the admission, death and discharge of Inmates being items of memory solely. No religious services are held. Date of inspection Jan. 8, 1907. WARREN. The inspector was unable to visit the almshouse here, located six miles from Warren, the institution being under quarantine, owing to an invasion of diphtheria. There were six cases of the disease, none of them being considered serious. At the time of the visit there were flfty-soveu inmates in all, including ten childreu under 15 years of age and eight insane persons. This almshouse is new, being only two years old. It is a handsome structure, modern in its appointments and one of the best equipped in the state, according to general reputation. Two children were placed by the court during the past year ; one being sent to Glenwood and the other to the county farm, being too young to go to Glenwood. The superintendent is appointed yearly by the board of supervisors. Date of inspection Jan. 3, 1907. WASHINGTON. The Washington county almshouse is a large, substantial brick, which, with the in- stallation of a heating apparatus, bath and lavatory facilities, would make a very satis- factory building for the care of county charges. The separation of the sexes is satis- factoiy, but there is practically no provision for care of the insane. Heat is furnished by stoves In most of the rooms. The rooms are clean and the bedding and clothing Bufflcient. The rooms are aired daily. Inmates bathe weekly in summer, but infre- quently in the winter season. 128 A well-stored cellar furnishes an abundance of vegetables for the winter. Mor* orchard and small fruits are needed. The number of cows Is Insufficient to supply the milk and butter needed. A physician employed by the county calls once a week, oftener If necessary. The water supply Is abundant The grounds are large and well s(,(l(li il :ii)(i "oiiiaiii a iimimImt ,,( mih- sliadi' In I's. 'liii.' laiiu contain!- uighty acres and Is located three and one-half miles southeast of Nashville. The superintendent receives a salary, and all stock and tools are county property. Dat5 of inspection Jan. 17, 1907. WAYNE. The Wayne county almshouse Is situated three and one-half miles northwest of Fairfield. Separate frame Ixiildinus are provided for the separation of the sexes, and cells for the insane. The uiaiu building is? old and much racked, though improved consideral>ly during the last year by some new floors, doors and painting. The place Is fairly ireo I'roin vermin at present. No bath tubs are provided, and few conveniences for laundry work. Several of the women smoke, continually poisoning the air of the sitting ro<»ni and liouse. The present management has been quite active in having children sent from the aims- house, three having been sent to an asylum in St. Louis, and two placed in family homt's during the past year. Two stoves for heating and one for cooking are provided for the inmates. The temperature in the sitting room was 62 degrees: bed rooms 40 degrees. Most of the work is done by inmates, several of whom are fairly capable. The clothing Is good, and food plentiful. Religious services are held during the summer, and some reading matter supplied hy the people of Fairfleld. The farm contains 240 acres of which twelve acres are in orchard, five In garden, forty-five in pasture and 175 cultivated. The superintendent is paid a regular salary, and required to furnish all his help. Date of insi)t'ction .Ian. 11, 1907. WHITE. The White county almshouse site is a bleak hillside, three miles west of Carmi. The building is frame, poorly constructed and badly in need of repairs. But three doors in the entire l)uilding have either locks or latches, and twenty-seven window panes are broken out. There are six bed rooms in which stoves are placed. One large stove, in part cut off In the lower hall way, furnishes all the heat available in the lower part of the house. The temperature In the so-called sitting room was 54 degrees; bed rooms supplied with stoves, t>0 degrees. The walls are full of bed bugs which no amount of energy on the part of the present management has been able to overcome. The smoke house has practically no roof, the wash house needs repair and most of the fences have given up the struggle and dropped down exhausted. One and a half peach trees, and two small plum trees con- stitute the orchard ; small fruits and shade trees are badly needed. The 40-acre farm has but four or live acres that will produce anything. In addition to the Income from the above farm the superintendent receives 16 cents per day for each inmate and agrees to furnish bedding, clothing, toilet articles and care for this sum. That this allowance is three and one-half cents above that of the previous years is encouraging. Considering what there is to work with, the present manager deserves much credit for his efforts. Of the 22 inmates seven are under 18 years, three of them are here temporarily, and the others are with mothers who are unwilling to give them up. A brother and sister about 20 years old should be sent to the Asylum for Keeble-Minded. One in- mate is partly paralyzed, and another almost wholl.v so. Another who never has l)cen able to walk" has been a public charge for over CO years. Two children reported Illegitimates were born dead during the past year. The county employs a physician who visits when called. Heading matter rarely finds Its way Into this place. Date of inspection, .Tan. !), 1907. WHITESIDE. The Whiteside county almshouse Is located four miles east of Morrison. The build- ing Is a large, very substantial brick, with unusually adequate provision for separation of the sexes and care of the violent Insane, of whom none Is now inesent. The number of Inmates was forty-five, of whom one was blind, three Insane and one idiotic. One Insane woman tears her clothes and presents a ragged ai)pearanci' in consequence. One man Is filthy In his habits and cannot be kept very clean. The clothing and bedding were clean and showed every sign of good care. Hose and hand grenades are provided for Are protection. One well, four cisterns and an overhead lank furnish abiiiidaiit water supply. The inmates change under- clothes every two weeks In winter time and bathe frequently. The ffiod Is plentiful and well prepared. Twelve hundred quarts of fruit were put up Inst summer, and seventeen hogs, averaging ;175 pounds each, slaughtered during the winter, and a large amount of soap made. The farm contains 192 acres. The garden occupies five acres, the orchard six and 129 170 are cultivated. The stock owned by the county all seemed to be in good condition and well cared for. The average income"from the farm is about $1,800.00 per annum. Date of inspection. Feb. 14, 1907. WILL. The Will county almshouse, located at Jollet, has several stone buildings, all In a good state of preservation. The main building is old, but has been kept in good repair. The sanitary condition is good. There are closets on each floor and all were in good condition. The sewer system is good, all refuse being carried through pipes to a cesspool at a long distance from the house. The water system is perfect. There is an abundance of good water, free from pollution. The water is pumped into a reser- voir above the laundry and distributed over the buildings and farm. The house Is heated with steam and lighted by coal oil lamps. The first floor of the west part Is used for kitchen and dining room, the second for dormitories and living rooms for the inmates. The temperature was from 62 to 69 degrees. The men and women are separated by a room which runs the length of the building. The men occupy one side and the women the other. The top floor is used for men alone. They all eat in the same room, but ar separate tables. Your inspector was at the almshouse at noon and saw the food prepared for the inmates. There was plenty and of good quality and well cooked. The menu for each day was said to be as follows : Breakfast — Bread, syrup, coffee and baked apple. Dinner — Potatoes, meat (except on Friday), bread, coffee, beans, corn beef and cab- bage, vegetables. Supper — Mush of some kind, rice and syrup ; butter three times a week. The bread is baked once a week and is of good quality. The inmates, especially the old people, are allowed to drink milk fresh from the cow. All the milk is used in this way. There are two insane in the almshouse ; both are incurable. There is one man who Is locked in all the time. The inspector was told by the superintendent that he was "marked" with a lion and had all the actions of a lion. He is harmless, but cannot talk and appears to know nothing that goes on about him. The insane department Is in a separate building, provided with iron bars. It is heated by steam and is in a comfortable condition. A part of this building is used as a store room for farm produce. There are no consumptives in the almshouse. The outbuildings are in fair condition, but not up to the average. The farm is In a fine state of cultivation and produces a good crop each year. The cows furnish con- siderable of milk, all of which is used by the inmates. No butter is made on the farm. They raise all their pork. There is an abundance of potatoes and vegetables In the cellar. A fine laundry has been fitted out in a building for that purpose. They have the latest of machinery. The washing is done on Tuesday by the inmates. There is one child in the Will county almshouse. The mother is with it and pays board. She is Swedish and has some property. She will probably leave the almshouse in the spring. The child is healthy and bright and could be adopted out if the mother so desired. The county clerk stated that no children had been adopted out in family homes this year. The county has no detention home except the jail. No children are confined in the jail under juvenile age. The juvenile department, so called, is dark and dirty, without air and lirtle ventilation. There is no debt of any kind against Will county. The almshouse is in charge of Charles Rost, who has been manager for a number of vears and has given good satisfaction to the authorities. Date of inspection, Dec. 28, 1906. WILLIAMSON. In the Williamson county almshouse, by comparison with the report of the inspection made more than two years ago, a great change for the better is noted. The building occupied by the inmates is frame and contains but two rooms. One room is set apart for the use of the men, the other for the women ; though at present, with a fine disregard for common decency, a man and his wife occupy one of the three beds in this room. The dining table is placed in the men's room. The rooms are poorly heated by grates. The chairs are much the worse for wear and all are uncomfortable. The bedding is insuflScient, but most of it is clean. New iron beds are now in use and sheets are provided. The abundance of "vermin," mentioned by the last inspector, seems to have been completely overcome, much to the satisfaction of the inmates. Numerous loads of trash were hauled away, the shade trees trimmed and new fencing put up by the present manager, who seems to be unusually energetic, cleanly and capable. The old plan of making yearly contracts has been abandoned and the three-year term substituted. The present contract price, $1.75 per week per capita, requires the —9 PC I30 superintendent to furnish food and care. The eighty-acre farm, located one mile north of Marlon, has little productive power. Orchard and small fruits are much needed. Sufficient vegi'tablos are raised to supply the table. Date of inspection, Jan. 10, 1907. WINNEBAGO. The Wlnnebatro county almshouse, located four miles north of Rockford, is built of red brick and consists of three stories and basement. The basement is used for kitchen, dining room, furnace room, bakery and laundry. Washing machines are used in the laundry and the men help with the work. The remainder of the house is divided into living fjuarters for the superintendent and wards and sleeping rooms for the inmates. The iiouse throughout was neat and clean and inmates well kept and contented. There is a bath and closet for each of the floors and wards, and Inmates are required to bathe regularly. 'J"he "E" wiDg used as insane department has stools in each room. The third story is fitted out for a hospital. The almshouse is heated by steam and lighled with coal oil lamps. The sanitary con- dition is fine. The fire protection is good. There is a reel of hose on each floor and large tanks of water in the attic. The thermometer registered GO to 80 degrees. The pest house Is located one-half mile south of the almshouse. It is located on the river l)ank. in a beautiful place and has tive rooms and a kitchen, all well fur- nished, heated by stoves in the hall ways and lighted with lamps. The superintendent reported two cases of small pox during the past year. The men and women are in separate wards, with a hall way between them, and the doors opening on the halls are kept locked night and day. They all eat in the basement, but in separate rooms. There are Ave insane women ; all are harmless and are kept In the common wards. Thirteen insane men are kept in the second story of the east wing. Most of these are harmless. None are locked up in constant restraint. No night watch is needed. The inmates are locked in their cells at night. The wooden slats on the doors shut out much light and air and should be replaced with iron. The insane men do most of the work on the farm. All get exercise on a porch shut in by wire screens. There are three cases of consumption in the almshouse and a few sick besides. The supervisors have no nurse, so none of these are in the hospital. The hospital, planned by the county physician, Dr. Crawford, of Rockford, has a consumption room, which should be used for that purpose. Dr. Crawford promises to send the State Board of I'ubllc Charities a description of the cases at an early date. There are no epileptics in this almshouse. One child was brought to the almshouse by the poor master some time ago. It was six months old and was abandoned 1)y its mother. It was given to a Chicago society for adoption. The county clerk could not state whether any children had been placed by the courts during the year or not, but stated that he would keep a separate docket violation of the law. The usual" bill of fare includes : Breakfast potatoes, cold meat, bread and butter, tea and coliee. IMnner vegetables meat, bread and butter, tea and coffee and in summer, milk. Supper', bread, butter and sauce, sometimes mush or rice. This nienn is varied from time to time. , v, -^ „,„»,*. one Three meals are served each day except Sunday, then a lunch at nlgnt. une hiinrirerl and thirty loaves of bread are baked twice a week. The farm of 100 acres is under good cultivation. There is one acre of orchard and 11 acres of garden. The cows furnish plenty of milk and butter for the Inmates. Thev raise their own pork and part of their lieef. v..,oi,on^'o Mrs Eva Miller took the place of her husband as manager after her husband s death She is competent and has the confidence of the county authorities. She rece ves $800 00 per year Her son helps with the work and she hires one helper out of this salary. Date of Inspection, Jan. 5, 1907. WOODFORD. The Woodford county poor farm, situated one and one-half miles southeast of Metamorai consists of 240 acres, all under cultivation. The condlt ons in the alms- house are all favorable and the surroundings pleasant. The main building has been fecentlv enlarged and is well equipped with heating, plumbing and ^ja^/); s^P'y ^^„«- tems. 'Radiators in each room maintained a unifprm temperature of from (.1 to 68 degrees throughout. Temperature outside about 20 degrees above. Ventilation is dependent upi)n by means of doors and windows. ji„i„„ ,.„„,v.o i,niTi.T Adequate provision is made for separation of the sexes, separate dining looms being provided and sleeping rooms on dilTerent floors, the connecting door l^eing locked at night. No Insane are kept at the almshouse. „ ^ , . *, * , ^ i„oi.,= The facilities for personal cleanliness are excellent, four bath tubs and basins with hot and cold water attachments being furnished for botli sexes. The inmates bathe and change underclothing weekly. The Arc protection Is adequate. An Iron lire escape Is provided for the men's dormitory. ^, ,. The bods are clean and comfortable and well supplied with covers. The sanitary conditions are excellent. Sulllclent help Is provided to care for the inmntes properly. Date of inspection, Jan. 9, 1907. 131 PHYSICAL INSPECTION OF JOLIET PENITENTIARY. Springfield, Feb. 6, 1907. To His Excellency, the Honorable Charles S. Deneen, Governor of Illinois, Springfield: Sir — Complying with your Excellency's request, the State Board of Public Charities has made a physical in- spection of the State penitentiary at Joliet and herewith submits its report : With the exception of the cell house all buildings at Joliet are in as good repair as reasonably can be expected. They are well adapted to their several purposes. The work shops, store houses and other utility buildings are spacious and well lighted and heated. They have good natural ven- tilation and compare favorably with structures of a similar character in private establishments. The refrigerating and heating plants and the plumbing and heating throughout the entire institution apparently are in satisfactory condition. The annex, or women's prison, built twelve years ago, is well constructed and well arranged. Its ventilation, both natural and artificial, is to be commended. Its entire equip- ment appears satisfactory. Tuberculosis among female prisoners is almost unknown. The men's cell house, in the wings of the main building, erected fifty years ago, shows a decidedly unsatisfactory condition. The cells are less than half the size of those in the women's department. Two prisoners occupy a space of 4x7x7 feet from 10 to 14 hours every day, according to the season of the year, except Sundays, when they are con- fined 20 of the 24 hours. The ventilation, both natural and artificial, of these limited quarters is entirely inadequate. As these cells are grouped in the central space of the room, away from the windows, they are quite dark. No direct sun rays ever enter and purify them. Owing to the original construction there is no provision for modern toliet facilities in these cells. The contents of more or less open buckets, which take the place of sanitary toilets, contaminate the air of the cell house at night. The eflfect of this primitive arrangement on the health and well By Board of Charities. Only cell house un- satisfac- tory. Woman's prison sat- isfactory. Small un- sanitary cells. No modern toilets. 132 Showing In official record. being of the inmates has been shown in a report made by Dr. George W. Webster, president of the State Board of Health, in a paper read at the Springfield conference of superintendents on October i8th last and printed in the October, 1906. Bulletin of the State Board of Public Charities. Hot Bed for Tuberculosis. Joliet prison naturally is a hot bed for the propagation of consumptives. Sentence to imprisonment there often is equivalent to a sentence to death. This condition is shown in the official record of prison deaths for the period 1888- 1902 (Warden's report, 1902, page 24) and in a personal letter from the prison physician under date of Oct. 16, 1906. The completed table of all deaths and deaths from consump- tion as printed in Dr. Webster's paper, follows : Period. All deaths. Deaths from Tuberculosis. Percent from Tuberculosis. Four years ending Sept. 30, 1892 Four years endintr Sept. 30, 1896 Four years endintr Sept. 30, 1900 Two years ending: Sept. 30, 1902 Total deaths in 1903 Total deaths in 1904 Total deatns in 1905 Total deaths for seventeen years. 130 160 95 31 6 16 10 77 112 56 17 3 6 5 59 70 58 54 50 371^ 50 448 276 Percentage. Consumption deaths for twenty-two years. Comparison with Chi- cago Comparative mortality rates. Rock break- InK bene- ficial. The percentage of deaths due to consumption during this seventeen year period is 6i 61-100 per cent.' To cover a wide field the State Board of Charities worked out a table covering the period 1885-1906, inclusive. Dur- ing that period, according to the prison records, there were 593 deaths out of a total population of 29,980, and of these deaths 369. or 62.22 per cent were from consumption. In Chicago for the period 1851 -1902, inclusive, the highest percentage of deaths from consumption during any one year was 15.01 per cent in 1858 and the lowest was 4.53 per cent in 1 85 1. The lowest percentage of deaths at Joliet prison was 30.77 per cent in 1904 and the highest was 82.2 per cent in 1887. The federal census of 1900 gives the death rate from all causes in Chicago to be 14.8 deaths in each 1,000 of the population. The death rate from all causes at Joliet is 19.80 for each 1,000 and from consumption alone is 12 31 for each 1,000. Since rock breaking was installed at Joliet the health of the convicts has improved, but a heavy percentage of deaths from consumption continues. EXTERNAL CONDITIONS WHICH HELPED TO CONDEMN JOLIET PRISON. [ The report printed in this Bulletin discusses internal conditions which are rvorse. Frame work on Ihe left of middle and bottom pictures shows nearness of Illinois Steel Company's building.] 133 In its biennial report to your Excellency this board; segregation recommends the segregation of tuberculous convicts in a mended, separate specially adapted building. Extracts from Dr. Webster's Paper. Pertinent extracts from Dr. Webster's paper referred to in the foregoing follow : "With a view to determining what the conditions are, par- ticularly at Joliet, where 1,200 to 1,400 prisoners are confined, the State Board of Health conducted some examinations of the prison in April, 1905. "Before detailing the results of the experiments, it should be stated that the cubic measure of each cell is 196 feet; that two prisoners are confined in each cell, and that after deducting space occupied by two cots, buckets, etc., the cubic space per man is about 75 feet. There are no toilet facilities. The minimum number of cubic feet insisted upon by law in the poorest lodg- ing house of our large cities, is 400 cubic feet. The minimum normal is 1,000 cubic feet with facilities for renewal three times per hour. "The normal amount of carbonic acid gas, which is the meas- ure of contamination of air, is three volumes in 10,000. While the prisoners were absent from the cells, the average contamina- ation was about nine volumes. Two hours after the return the average volume of carbonic acid varied from 14.1 to 15.4 in differ- ent cells. Three and one-half hours after their return from dinner and with roof ventilators partially closed to approach cool weather conditions, the volume of gas arose to 21.3 volumes, seven times the normal. "A description of the conditions existing in the cell house may well be quoted from Joliet penitentiary report of 1902, quoting from the report of 1900. It is as follows: "The two wings of the penitentiary contain 900 cells in which to take care of 1,200 or more prisoners. It is necessary, there- fore, to put two prisoners in many of the cells, which are only seven feet long, seven feet high and four feet wide; and we feel that we can present the matter no more forcibly than to quote from our last biennial report and say that: ^'When one thinks of two men spending never less than four- teen hours each day during six days of the week, and on the seventh day nearly twenty-one hours, in a space so reduced and with a slop bucket in the cell for their use in responding to calls of nature which no care can prevent from being effensive and pestilential in every sense of the word, he is compelled to ask what excuse the great State of Illinois can offer for compelling the management of this penitentiary to so deal with men who are required by law to serve sentences here, that they must eat, rest and sleep in quarters so contracted, so repellant, and so utterly unfit for the purpose, that their very existence is a dis- grace to the State that permits It. "We are not believers in any system that would tend to pamper prisoners or to make the prison so attractive that confinement therein would have no terror for evil doers, but we are believers in a system that will preserve at least health and strength to the Inmates, so that they can perform the daily tasks alloted to them here, and be enabled to leave the institution In such physical and mental condition that they will have no excuse for not going to work as soon as occupation can be found for them. Pertinent paragraphs. Health board examina- tions. Conditions in cells. Computa- tions. Conditions. Small cells. Offensive and pestilen- tial. Preserve health and strength. 134 Bnter pro- test Matter of pride. Tuberculosis almost un- known. Remarkable contrast in same yard. What is to be done. Encroach- ment by Illinois Bteel Com- pany. "One visit to the cell houses during the night time, a few breaths of the atmosphere coming from there, is all that is necessary to convince the most skeptical that the half has not been told by us, and we here and now enter our solemn protest against the continuance of such a system of herding men together to the detriment of their physical and moral natures. "It will certainly be a matter of pardonable pride to any ad- ministration that an improvement so just in its conception, and so humane in its spirit, was carried to a successful conclusion under its guidance." At the close of his paper Dr. Webster prints the following paragraphs : Woman's Prison a Redeeming Featube. "The one redeeming feature of Joliet is the woman's prison, which is equipped with cells arranged for one person. The cells are amply large, ventilation facilitates permit of change of air every ten minutes, there is a permanent wash bowl and toilet facilities in every cell. There are no foul odors here and tu- berculosis among the female inmates is almost unknown. "We thus see that in the old cell houses we have the conditions most favorable for the development of tuberculosis, and in the same prison yard a remarkable contrast in the absence of the disease among the female prisoners where hygienic and sanitary conditions are reasonable. The only wonder is that the death rate among the males is as low as it is. This is due to the fact that the officials of the penitentiary have been absolutely un- remitting in their efforts and have accomplished wonders with the miserable facilities with which they have been provided. Too much credit can not be given them. Problem of Society at Large. "These are the conditions. What are we going to do about it? Some may argue that these men and women are criminals, dan- gerous to society, and that society is well rid of them, even though killed off by disease. Leaving aside for the moment the ethics of the question, it may be well to recall that statistics show that practically the entire prison population is released every five years. This means turning loose upon the community of thousands of infected individuals. To say nothing of danger of infection by infected goods from the penitentiary. It Is not then a prison problem at all. It is a problem of society at large. It is a public health measure. It becomes a matter of self preservation." EXTERNAL CONDITIONS. Stich are the internal conditions of the part of the peni- tentiary devoted to men. What are the external conditions? When the penitentiary was located half a century ago. the State cotdd not foresee the enormous growth of manufactur- ing industries that has taken place in Joliet. A mistake was made, owing to this fact, in locating the buildings on the edge — in a corner — of the State property. The Illinois Steel Company, which has expended millions of dollars on its plant at Joliet. has been building nearer and nearer to the penitentiary each year for years back. Today this com- 135 Enveloped In smoke and gases. paiiy IS erecting a building less than lOO feet south from the front doors of the prison. This board is informed, on what seems to be good authority, that this coming spring coke ovens will be erected by the company immediately west of the State's property line. These, with other existing manu- facturing industries, will almost surround the prison build- ings. The dense smoke and gases pouring out day and night from the chimneys and cupolas of the Illinois Steel Com- pany's mills vitiate the air to an extent which makes a normal healthy condition of the confined inmates almost im- possible, not to mention the great discomfort of the prison officials and employes. An example of the seriousness of this outside condition is shown in the fact that of a recent summer the hot smoke and gases pouring over and upon the prison buildings and grounds burned the grass of the lawn to a crisp and killed the leaves on the trees. DIFFERENT METHODS FOR IMPROVEMENT. Two methods of improving the condition of the convicts I'wo ways to , 1- 1 proceed. may be discussed : ] 1. To remodel existing cell bouses and build additional ^^™tend ex^ cell houses, witb modern equipment, including air wasbing istlng and cleaning devices. plant. 2. To abandon tbe present site and erect a new prison elsewhere. Improvement of Existing Plant. Build new prison. In discussing the Joliet situation the question naturally "^pJI-^^^J^^q arises as to whether it would not be possible, by making use science, of modern sanitary science, to rebuild and add to the present institution so that its interior conditions would be satisfac- tory. Could not a modern system of ventilation and air washing be installed that would so mitigate the smoke and gas conditions as to render the present site satisfactory ? The air could be washed and cleaned at intakers and then forced by a system of blowers into the cells and workshops. But even with this system new buildings would be required and the old cell houses would need to be remodeled to give satis- factory space and sanitary equipment for the present and future increasing population. New cell house wings can be added in the rear of the main buildings only, the building site, owing to an error of judgment (noted in the foregoing) being too limited to make such additions satisfactory in the front or on the sides. Extensions in the rear would mean eventually the destruc- tion and reconstruction of the present chapel and other buildings and can not be planned in a satisfactory manner, as such extensions would make a proper supervision of the prison difficult. New cell house wings. 136 Rebuild cell Two new cell wings. Estimated cost of re- modeling. Future In- crease in population and cost of new build- ings. Estimated cost. To give the inmates normal light, a sufficient cubic feet of air space, proper ventilation and toliet room facilities, it will be necessary completely to rebuild the cell winjjs. As this remodeling will demand the enlargement of the cells to over twice their size the capacity of the cell house will be cut down to less than one-half of its capacity and two additional cell wings will be required at once, if the present number of prisoners (i,6oo) is to be housed. The State Architect's approximate estimate of the cost of enlarging present cells to twice their present size and fitting them with modern plumbing fixtures, etc., of build- ing new wings to take care of present excess population over remodeled capacity, and of installing a forced air sys- tem and cleaners is $600,000. This board has endeavored to compute the probable in- crease in the prison population for the next ten years to figure the cost of needed additional buildings. It sees no accurate way to do this. The total population in 1885 was 1,521. The total population in 1906 was 1,523, only two additional. During the twenty-two years the largest annual population was 1.585 in 1895 and the smallest 1,227 i" 1902. The present population is 1,600. During the last four years the average increase was 76.19 convicts per annum. If this rate of increase were to continue for ten years the State would be called upon to house 761.90 additional pris- oners, which would cost $647,615. This added to the $600,- 000 estimated as the cost of properly housing the present population, would make the total cost of housing the popu- lation for ten years, $1,247,615. Deducting 50 per cent for labor performed by convicts, internal improvements on the present site would cost $623,808. In view of the uncer- tainty of the estimated increase this board can state only that it will cost $850 a man to erect new buildings. New Site and New Prison. The authorities of the penitentiary have carefully ap- proximated the cost of a satisfactory new prison on a new site to be $3,000,000. They oflF-set against this item the value of the present site at $250,000 and the salvage, chiefly mechanical and equipment which could be removed to the new prison, at $100,000, or $350,000 in all. leaving a net cost of $2,650,000. According to the warden all labor can be performed by the convicts and he estimates the item of labor at 50 per cent of the cost, which would make the net cost of the new establishment $1,325,000. This amount could be divided into appropriations of $200,000 a year or less for a period of years. The woman's prison could be taken down and re-erected. 137 If the Legislature were to allow $200,000 extra appro- priation for two years the total appropriation asked for Joliet would not exceed that asked for the preceding two biennial periods, because the prison industries appropria- tions, which were $200,000 for each period, will not be asked. The prison industries are now self-sustaining. The sanitary and economic place to re-locate such in- stitution, if it is deemed advisable to keep it in the Joliet region, would be on lands near the drainage canal, and near railroad facilities, where the prisoners could work in the quarries in the winter and on farm land in the summer. It would be necessary to purchase only the raw buildixig material. All the labor of erecting the prison, as stated in the foregoing, could be performed by convicts, as was done by the national government in building the new United States penitentiary at Leavenworth, Kansas. The neighborhood of Joliet would also supply in a most economic manner practically all of the building material necessary. The new site should be partly farm and partly quarry land of 500 to 1,000 acres, which could be purchased at about $250 an acre. The institution now owns 160 acres of land and the penitentiary site unfortunately is in one corner of it. The needed increase could be purchased in adjoining land, or, if prices were not satisfactory, the 160 acres could be sold and an entirely new site purchased else- where. Without doubt the commissioners of the penitentiary will consider whether the Illinois Steel Company can be com- pelled to pay damages on account of the detrimental effect upon the State's property and wards of the smoke and gases from the company's chimneys. CONCLUSION AND RECOMMENDATION. The conditions at Joliet are inhumane and intolerable. While the State has the right to deprive convicts of their liberty and to profit by their labor, it has no moral right to confine them under conditions which unfit them to work and live when restored to society. Of the plans suggested that for improvements on the present site would cost $701,192.50 less than to erect a prison on a new site, if the rate of increase in prison popula- tion for the last four years keeps up for ten years more. Imperative as is the need of remodeling the cell house, essential as it is to the physical well being of the inmates, demanded as it is by all ordinary humanitarian considera- tions, it would appear that this work should not be under- taken without giving full consideration to the hopelessly bad environment of the institution. This environment will grow worse year by year. It would seem wiser and for the Prison In- dustries self-sup- porting. Farm and quarry lands. Land. Possible damages. Inhumane and Intol- erable. Difiference in cost. New prison the wise course. 138 Agrees with commis- sioners. Figures ap- proximated. Appended data. Jollet com- missioners" report. Jollet warden's report. Statistics. Description Maryland Prison. For Gover- nor's Infor- mation. best interests of the State to take the energetic step New York has taken regarding the unsanitary Sing Sing prison and decide to erect a new penitentiary on ample, well lo- cated grouds, assured for all time of clear sunlight and pure, clean air, and better adapted to meet the advanced ideas and methods for the best care and treatment of the criminal charges of the State. The Board of Charities concurs in the recommendation of the penitentiary commissioners and warden. It recom- mends that a new prison be erected on a suitable site. The cost figures given in this report are approximat- tions. Many factors, such as the nature of the site, water supply, fluctuating cost of building materials, etc., can not be definitely stated in the present preliminary stages of this enterprise. Appended hereto and made a part of this report are : 1. Report of the commissioners of Joliet penitentiary to your Excellency for the two years ending Sept. 30, 1906. 2. Report of the warden of the Joliet penitentiary to the commissioners for the same biennial period. 3. Certain statistics of mortality at Joliet prison, 1885- 1906, inclusive. 4 Description (from a private letter) of the Maryland prison at Baltimore, which is considered, in many respects, to be a model penitentiary. Respectfully submitted. (Signed) Fr.\nk Billings, President, Emil G. Hirsch, Julia C. Lathrop, John T. McAnally, Clara P. Bourland. (Signed) William C. Graves, Secretary. ADDENDA. Biennial Report Commissioners Joliet Penitentiary. Commissioners' Office, Illinois State Penitentiary. Joliet, Illinois. October 1, 1906. To His Excellency, Charles 8. Deneen. Oovernor of Illinois: Sir — We have the honor to submit for your Excellency's In- formation our report for the two years ending September 30, 1906, to which we annex the reports of the warden and the heads of the various departments of the Institution under our charge. 139 So far as the condition of the inmates is concerned, in respect to their bodily health, it is as good as could be expected, when you take into consideration the difficulties under which we labor from sanitary conditions of so antiquated a nature as those now in operation at this prison. Indeed, so far as the cell houses are concerned, in which the Inmates spend their sleeping hours as well as Sundays and holi- days, there are no sanitary facilities of any description, and when you consider that thus fully two-thirds of their time is spent in cells 7 feet long by 4 feet wide, with a slop bucket for the use of nature's calls, it is easy to see under what difficuties the medical department labors to maintain anything like a proper degree of health among the prisoners. We, therefore, respectfully call your special attention to the recommendations of the warden in his report attached hereto, in which he has shows so clearly the absolute necessity for the erection in a proper location of a new penitentiary worthy so great a State as ours. It is simply impossible for any man, or any set of men, to visit this prison, and see with their own eyes the actual con- dition of affairs in respect to proper surroundings and internal sanitary conditions, and not be fully convinced that the State of Illinois can no longer ignore the stern necessity for the aban- donment of this prison as soon as a new one can be erected. While apparently the cost of such a new institution would be a serious question, yet in reality it could be so arranged that the tax upon the people would be comparatively light, for taking example from the method adopted by the national government in building the new United States penitentiary at Leavenworth, Kansas, nearly all the labor necessary could be furnished by the inmates of this prison, while the material would be found in the land on which the prison should be built. As it would doubtless require from six to eight years to con- struct such a prison, it can be seen that the appropriations necessary would be comparatively slight for each Legislature to authorize. We have looked into this matter carefully, and consulted freely with architects and contractors, whose experience eminently qualified them to give an opinion on the probable expense of such an undertaking, and when it is considered that the prisoners are fully capable of quarrying and dressing the stone which our own lands could furnish, could properly set the stone and do all the mason work, all the carpentry, could prepare and set all the iron work, and In fact do all the mechanical work required, we believe we are justified in saying that the amount of money necessary to be appropriated by the Legislature would be scarcely more than one and a half million dollars, which amount divided among the six to eight years necessary for the undertaking would make little, if any, more than two hundred thousand to two hundred and fifty thousand dollars per annum. This would not be so great a tax upon the people as it would appear, for if the prisoners were employed in building a new prison, we should not have to ask for anything like the very large appropriations we now require to carry on the prison in- dustries necessary to keep the prisoners employed, as required by law, and the great reduction in appropriations thus effected would go very far towards meeting the yearly expenditures on a new prison of the most approved plan. We call to your Excellency's recollection the interviews we had with you on the subject of Installing a battery of six stokers, in the expectation of thereby reducing our heavy annual ex- pense for fuel, and you will observe by reference to the warden's Antiquated sanitation. Cell bouse conditions. New prison necessary. A stern ne- cessity. Convicts to perform thie labor. Six to eigbt years. Total of $1,500,000. Reduction In Industries appropria- tion. New stokers successful. 140 General re- pairs. Thanks to the Gover- nor. Department reports. Necessity for new cell bouses. report attached that two of them are already in place and In successful operation, and the remaining four will be installed by January 31, 1907. The expense of this battery will be approx- imately fifteen thousand dollars. Your Excellency will also remember that we were not allowed any appropriation for our u.se during the past two years for gen- eral repairs, and we have been obliged to expend for such pur- poses, in order to protect and keep in proper working condition our buildings and equijjments, about twenty-three thousand dol- lars — all of which, in addition to the cost of the stokers mentioned above, we have been able to meet from our general appropriation fund, by the exercise of the most rigid economy. We cherish a feeling of deep gratitude to your Excellency for the aid and encouragement you have so freely given us in our endeavors to iirojieiiy conduct the affnirs of thi.s institution, and beg to assure you of our heartfelt appreciation of the many courtesies we have received at your hands. Very respectfully, your obedient servants, (Signed) Benjamin Bbown, (Signed) John Harrison, (Signed) Van L. Hamiton, CommissioJiers. Coke ovens next. Prison In a doiilorable plight BiENNi.\L Report Warden Joliet Prison. Wabuen's Office, Illinois State Penitentiaby, Joliet Illinois, Sept. 30, 1906. To the Honorable Board of Commissioners of the Illinois State Penitentiary : Gentlemen — I have the honor to submit herewith statements which have been carefully prepared by the heads of the different departments of this institution, and which will, I trust, give you in full detail the information necessary to show its workings for the past two years. In previous reports made by the authorities of this Institution great stress has been laid on the necessity for a new system of cell houses, with such modern improvements as are necessary to protect and promote the health of the inmates, but within the past two years the developments of the steel mills have been such as to show that they will more and more encroach upon the limits of the penitentiary, and thereby increase the discomfort and danger to health arising from the smoke and gaseous fumes of that plant. From careful investigation I am convinced that It is only a question of a reasonable time when they will add to their ex- tensive properties coke ovens, in which case the penitentiary will be i)raftically enveloiied in an atmosphere which will vitally affect the health of all connected with our Institution — employee and Inmates alike — and such a condition of affairs ought not to be longer tolerated by the great State of Illinois. I, therefore, strongly urge the suggestion that you in your re- port to his Excellency, the Governor, bring to his special notice the deplorable situation In which the penitentiary finds Itself In this respect, and recommend that the Legislature authorize the purch't.'^e in a vicinity as near the jiresent site of this prison as Is consistent with due regard to surroundings and convenience of access to canal and railroad facilities, of a tract of from Ave 141 hundred to one thousand acres of land, together with the neces- sary authority to erect thereon a new penitentiary worthy of our State. This could be done almost entirely by the labor of our own prisoners, the same as has so successfully been accomplished at the new United States penitentiary at Leavenworth, Kansas, where the inmates not only built the structure, but also made the bricks from which it was constructed. It is, therefore, rea- sonable to assume that if the class of prisoners at Leavenworth are able to make brick suitable for building the prison, the class of prisoners in our hands can surely be relied upon to quarry and prepare the necessary stone from the quarries lying at our very doors with which to build a new prison in place of the one we now occupy. In accordance with your authority for doing so, the six stokers for the boilers were ordered, and two have already been installed, and are now in successful operation, and the remaining four will probably be completed by the last of January. Thus far, the ex- pense of these stokers seems to be justified by the results pro- duced, and it would appear that when all are in operation a very material saving will be effected in our fuel. At the end of the hscal year ending Sept. 30, 1904, the number of inmates on hand was 1, 415 And at the end of the fiscal year ending Sept. 30, 1906, the num- ber of inmates on hand was 1, 523 An increase of . 108 Pclson labor. Stokers suc- cessful. Increase in population. The statistics which accompany my report have been prepared with such careful detail, and give so fully the workings of the various departments, that further comment from me is unneces- sary. [The statistical matter is omitted from this report — Editor the Bulletin of the State Board of Charities.] The working of the farm and garden during the past two years has been of a very satisfactory nature, as they have supplied the prison with all the vegetables necessary for its use, with the ex- ception of potatoes and turnips — to the cultivation of which the soil proves not to be adapted. It gives me pleasure to state that the plan of abandoning the lock step and allowing the prisoners to march two abreast in military style has been entirely successful, and the good effects are plainly seen in the improved conduct of the men. I have to thank you very sincerely for the wise counsel and Thanks to cordial cooperation I have received at your hands, and beg to the Gover- assure you that I highly appreciate the assistance you have rendered me in this discharge of my duties. Very respectfully, your obedient servant, (Signed) E. J. Murphy, Warden. Statistics. Farm and garden satisfac- tory. Lock step abandoned. Description of Marylaxd Prisox at Baltimore. [Extract from a Private Letter.'\ It may interest you to hear about the cell conditions at the ^^c^V^°* Maryland penitentiary at Baltimore, which I had occasion to visit last week. The building, erected only some six years ago, is one^ of the most modern state institutions in the country and is one well worth visiting and examining from many points of view. The; building is of a high character of fire proof construction, good in general design and plan, and fitted with the latest appliances.' Each of the cells is arranged for one person only and is five feet| 142 Natural and artificial ventilation. Bathing. <:arn and save money. Eastern prisons criticised. six inches wide, nine feet long and 8 feet one inch high, a gross content of 400 cubic feet; compare this with the Joliet cells, only four feet wide, seven feet long and seven feet high, occupied by two persons with a gross content of only 98 cubic feet per occu- IKiiit. Each cell has a modern stationary toilet and lavatory. The bed is arranged to swing against the wall when not in use, thereby enlarging the cell to its fullest capacity. Natural ventilation of the cell is very materially increased by a transom over the door so that artificial ventilation, which is properly provided for, does not have to be in constant operation, but is employed only for the thorough airing of the cells in the morning and under special weather and atmospheric conditions. The arrangement for bathing for the prisoners is a very com- plete one in this institution, one large basement room directly connected with the cell house being given over to this purpose. I was very much pleased with one feature of the management of the institution, namely: the opportunity given to the prisoners so inclined to earn and save money. The contract system is in operation and the prisoner who exceeds his daily task in piece work gets the material benefit of his special effort. The good result of this system is evident in every direction. The cells of almost all of the prisoners are neatly furnished with self earned money. Rugs, pictures, books, tables and chairs and toilet articles of all kinds make quite presentable living rooms of the cells. What effect this opportunity of having his own money has upon the self respect and character of the prisoner when he starts life anew is self evident. I was fortunate enough to meet a. Washington one of the commissioners appointed by the mayor of New York for the purpose of examining and reporting on the prisons of the east. The one fault this commission finds with eastern penitentiaries is the one so evident in our own, insufficient light, air and ventilation. Mortality Statistics Joliet Prison for Twenty-two Years. Year. Average Daily Populat'n. Total Popu- lation. Total deaths. Total deaths from Tuberculosis. Percentage of deaths by Tuberculosis. 1885 1548 1583 1459 1321 1322 1380 1419 1445 1405 1448 1615 1419 1333 1381 1349 1303 1281 1273 1295 1361 1451 1522 1521 1494 1299 1270 1254 1365 1346 1420 1355 1468 1585 1319 1272 1366 1283 1267 1263 1227 1245 1415 1423 1523 38 24 28 45 24 39 27 40 38 39 46 37 18 32 26 19 14 17 6 13 11 12 25 13 19 37 14 22 15 23 25 24 34 28 14 21 14 7 6 9 3 4 6 6 6534* 1886 54A 1887 67>fl 1888 82»i2 1889 58 lo 1890 563 1891 5513 189?.. 57>3 1893 65% 1894 6lhi 1895 74 1896 75| 77H} 1897. . 1898 65^ 1899 54 1900 36J 1901 42? 1902 63 1903 50 1904 30% 1905 64h 1906 50 Totals 29.980 593 369 Average percentage of deaths from tuberculosis, 62.22. 143 OCTOBER, 1906, CONFERENCE OF SUPERINTENDENTS. INTRODUCTION. Steps were taken at a conference held in Springfield onj To elevate Oct. i8 and 19, 1906, to elevate the service in Illinois State Hospitals for the Insane and Feeble-minded to a higher level of efficiency. This conference was suggested by his Ex- cellency, the Governor. It was called by and sat under the tion of the State Board of Public Charities. But, owing tc of every suggestion for improvement advanced is a desire to provide better care for each patient. The original purpose was to hold a conference of all ^^1^°^, ^^^ superintendents of institutions coming under the jurisdic- minded tion of the State Board of Pubic Charities. But, owing to ^^^^ the magnitude of the work and the diverse character of the three groups of institutions, it was found expedient to limit the scope of the conference to State hospitals caring for the insane and feeble-minded. After listening to remarks by his Excellency, the Gov-IComittees^^ ernor, to a basis for discussion prepared by the State Board of Public Charities, and to papers on appropriate topics, the conference authorized the appointment of committees to take up the various suggestions made and report their findings to an adjourned session of the conference to be held in Springfield early in December. In cases where legislative authority is required the re- Basis for ports of the committees will be the basis on which bills a*c?ion. will be prepared for consideration by the 45th General As- sembly. Statement of Improvements Contemplated. Briefly stated the improvements taken under consider- 1 Brief, ation are: 1. A State Psychopathic Institute to be located in State Psy- one of the hospitals for the insane which is near ai j^gfitute*^ large city. Branches of this institute in each hospital for the insane and in the hospital for feeble-minded. The purpose of this institute is to give clinical and pathological instruction to doctors in the State service and to physicians in general practice. 144 Complete State care. Uniformity of service. Treatment of patients, Records. Uniformity of grades, places and nomencla- ture. Feeble- minded. Physical ctianges. Jollet prison. Those present. 2. Complete State care of all insane, epileptic and feebleminded persons, and dependent consumptives, meaning the removal of such persons now in county almshouses to State institutions. This item includes the establishment of a State colony for epileptics and a State sanatorium for consumptives, also free diphtheria antitoxin provided by the State. 3. General uniformity of service, including a med- ical superintendent in charge of each hospital, a staff of senior physicians, a staff of internes, a dietist, a superintendent of nurses and a sufficient nursing and attendant service taught in a compulsory training school, on the medical side; and a steward, or business mana- ger, under the medical superintendent, on the business side. 4. Hydrotherapeutic treatment in a psychopathic pavilion for acute hopeful cases of insanity sent in on temporary commitments; more ample hospital facili- ties for physically sick insane; and employment and industrial re-education for chronic insane; more recre- ation for patients; the abolition of mechanical and medicinal restraint as far as possible and more thorough classification of patients. 5. Uniform and complete medical records. 6. The establishment of uniform grades of service, uniform general rules, and uniform nomenclature of places of employment. 7. Problem of the feeble-minded, especially feeble- minded women of the child bearing age. 8. Changes in the physical property, including ma- chinery and other equipment, to provide adequate ven- tilation, safe and sanitary quarters for patients, and more economical administration. 9. Consideration of changes necessitated by condi- tions at the Joliet Prison. Those Who Attended the Conference. Following is a list of those attending- the conference : His Excellency, the Honorable Charles S. Deneen. Dr. W. L. Athon, Superintendent Southern Hospital for the In- sane. Dr. Frank Billings, President of the Board of State Commis- sioners of Public Charities. Mrs. Clara P. Bourland, member of the Board of State Com- missioners of Public Charities. Mr. Ernest P. Bicknell, Superintendent Chicago Bureau of Charities. Dr. Daniel R. Brower of Chicago. Dr. H. B. Carriel, Superintendent Central Hospital for the In- sane. Mr. Thomas J. Clark, President Board of Trustees Asylum for Insane Criminals. Dr. PYank S. Churchill of Chicago. Dr. Richard Dewey. Physician, formerly superintendent at the Eastern Hospital for the Insane. Dr. Haim I. Davis, County Physician, in charge of the Cook County Detention Hospital. Dr. William A. Evans of Chicago. Dr. James L. Greene, Superintendent Eastern Hospital for the Insane. 145 Mr. Frank W. Gould, President Board of Trustees of the Westei-n Hospital for the Insane. Mr. William C. Graves, Secretary Board of State Commission- ers of Public Charities. Dr. Emil G. Hirsch, member of the Board of State Commis- sioners of Public Charities. Dr. John T. McAnally, member of the Board of State Com- missioners of Public Charities. Mr. W. B. Moulton, President State Civil Service Commis- sion. Mr. Joseph C. Mason, Secretary State Civil Service Commis- sion. Dr. V. H. Podstata, Superintendent Northern Hospital for the Insane. Mr. Robert Rew, President Board of Tiiustees Northern Hos- pital for the Insane. Dr. Walter E. Songer, Superintendent Asylum for Insane Criminals. Dr. W. E. Taylor, Superintendent Western Hospital for the Insane. Dr. C. B. Taylor, Superintendent Asylum for Feeble-minded Children. Mr. Charles M. Tinney, Manager Sales Department of the Board of Prison Industries. Dr. George W. Webster, President State Board of Health. Mr. James A. Willoughby, member State Civil Service Com- mission. Dr. P. M. Woodworth, member Board of Trustees of the Northern Hospital for the Insane. Dr. O. C. Willhite, General Superintendent Cook County Insti- tutions at Dunning. Mr. D. E. Wood, Treasurer Northern Hospital for the Insane. Dr. George A. Zeller, Superintendent Asylum for Incurable Insane. Mr. W. Carbys Zimmerman, State Architect. Letters of regret were received from Dr. Charles R. Hen- derson, Professor of Sociology in the University of Chicago ; Honorable Edward J. Brundae^e. President of the Board of Commissioners of Cook County, Dr. Hugh T. Patrick, of Chicago, and Dr. Tames A. Egan, Secretary State Board of Health. Details of the Program. The following was the program : Thursday, October 18th, 2:00 p. m. "Purpose of the Conference," His Excellency, the Governor. "State Board of Charities' Suggestions," Dr. Frank Billings, President State Board of Charities. "Civil Service Uniformity," Hon. W. B. Moulton, Chairman Civil Service Commission. DISCUSSION. "Buildings and Physical Equipment," Mr. W. Carbys Zimmer- man, State Architect. DISCUSSION. Letters of regret. The program. — lo P C 146 "Consumptives in Prisons, Asylums, Jails, and in the Com- munity at Large," Dr. Wm. A. Evans, Professor of Pathology, University of Illinois. DISCUSSION. "Illinois Should Furnish Free Diphtheria Antitoxin to Its Citizens," Dr. George W. Webster, President State Board of Health, and President Chicago Medical Society. DISCUSSION. Thursday, October 18, 8:00 p. m. "The Medical Administration of Public Hospitals for the In- sane," Daniel R. Brower, A.M., M.D., LL.D. discussion. "Nursing and Attendant Service and Compulsory Training Schools," Dr. V. H. Podstata, Superintendent Northern Hospital for the Insane. DISCUSSION. "Proved Value of Hydrotherapeutic Treatment for Cases of Acute Insanity" (illustrated), Dr. Richard Dewey. discussion. "Employment and Recreation for Chronic Insane," Dr. W. E. Taylor,' Superintendent Western Hospital for the Insane. discussion. "Mechanical and Medicinal Restraint," Dr. George A. Zeller, Superintendent Asylum for Incurable Insane. discussion. Friday, October 19, 9:00 a. m. "Pay Patients in Public Hospitals for the Insane," Mrs. Clara P. Bourland, Member State Board of Charities. DISCUSSION. "The Proposed State Psychopathic Institute," Dr. Frank Bill- ings. discussion. "Need of Uniform and Complete Medical Records," Dr. .1. T. McAnally, Member State Board of Charities. Dr. O. C. Willhite, Superintendent Cook County Institutions at Dunning. discussion-. "The Care and Treatment of Epileptics," Dr. Frank S. Churchill. discussion. "Surgery Among the Insane." Dr. JameS L. Greene, Superin- tendent Eastern Hospital for the Insane. DISCUSSION. 147 "Psychopathic Wards and Temporary Commitments Thereto," Dr. H. B. Carriel, Superintendent Central Hospital for the Insane. DISCUSSION. Friday, Octobeb 19, 1:00 p. m. Business session and discussion of the general topic: "What System of Charity Administration is Best Suited to the Needs of Illinois?" Grouped Into Chapters. . In the following pages a chapter is given to each subject presented and the discussion thereof, and action taken there- on, so far as such arrangement is practical. Subjects separately. INTRODUCTION TO GOVERNOR DENEEN'S ADDRESS. Dr. Frank Billings, President of the Board of State Com- missioners of Public Charities, calling the conference to order in the Governor's reception room on Oct. i8, at 2 :oo p. m., said: The present State Board of Charities was organized last Feb- ruary, but held its first regular quarterly meeting in April. About that time, in conversation with Governor Deneen, con- cerning the State institutions, and the work of the Board of Charities, his Excellency, after listening to some of the sugges- tions made by members of the board, said he thought it would be a good plan to hold in the fall a meeting, or a conference, to which should be invited the various State organizations, bodies like the State Board of Health, or its officers, the State Civil Service Commission, the superintendents of the State Charitable Institutions, at least that we hold a meeting to which the super intendents should be invited, if not of all of the institutions, the superintendents of hospitals for insane and feeble-minded^ together with other individuals, who could discuss certain sub jects in relation to the improvement of the State institutions. That meeting was fixed for this date. Those present are here by invitation. The Governor will make the first remarks. I want to say to you, as a member of the Board of Charities, that his Excellency has shown at all times an interest in the work of the board and of the State institutions, and is most anxious that we work on the right lines — practical lines, ideal perhaps in a measure, and yet practical. The purpose of this conference is that we come to certain conclusions upon which to base future action, not only in the institutions themselves but perhaps for future legislation. I take pleasure in presenting his Excellency, the Governor. [Applause.] Call to order. Suggested by the Governor. Interest In the board's work. Presents the Governor. 148 PURPOSE OF THE CONFERENCE. Address by Governor Deneen. Prison indus- tries, civil service. New charity board. Favors training BCbooIs. Medical records. Hydrothe- raphy. Industrial re-pfiuca- tlon. Seprepntlon of con- sumptives. Governor Deneen, in outlining the "Purpose of the Con- ference/' said : In response to clearly expressed public demands for improve- ment of the service in our State institutions, the General As- sembly has provided laws creating the Board of Prison Indus- tries and the Civil Service Commission. You are all familiar with the good work of these bodies. To infuse new spirit Into the administration of the State charitable institutions the Gov- ernor, a few months ago, appointed a new State Board of Public Charities. In doing this he desired in no way to re- flect upon the work of previous boards, but, as stated, to Infuse a new spirit into the management of the Institutions. The pur- pose of our conference today is to take up for discussion the specific policies outlined by this new State Board of Public Charities. Medical Phases of the RECOMMENnATioNs. Regarding the strictly medical phases of the recommenda- tions of Dr. Billings and his associates, I shall leave others to speak in detail, but there are certain factors which prove so interesting, even to the layman, that I shall talk briefly about them. The training school for nurses appeals at once for favor- able consideration. It surely is an excellent thing to give instruction in the care and treatment of the insane and other State wards to those who are to be their caretakers. I believe these training schools should be established in all of our hos pitals and that attendance upon them should be compulsory, so that all nurses and attendants will have to take an actual test in the service to establish their fitness to continue in it. The plan for a systematic and complete collection of medical facts in the form of records is also very desirable. Such data kept in convenient form will be of use and guidance to all em- ployed in the institutions and to the public at large. The hydrotherapeutic treatment for acute insane and indus- trial re-education for chronic insnne are of humane interest and of economic value. Surely it is desirable to cure as many as possible and return them to their homes as productive mem- bers of society, instead of allowing them to slip into a chronic condition and become burdens upon themselves, their relatives, their friends and the State. One of the sights that has depressed me in going about our hospitals for the insane is the sight of so many idle persons, brooding over their hallucinations and delusions. Work cer- tainly must be medicine for those who are physically able to work. It is so with tho.se in the world outside. The fact that people are menially ill does not repeal this natural law. On the economic side such articles as patients manufacture are a saving to the Stale, and the farm, garden, and kitchen work they perform make a smaller payroll for the sane einployi^s. I fully realize that many of our insane patients are now employed, but I think more patients should be given work. \ I note with i)leasure a genuine effort in several of the insti- tutions to detect, segregate, and scientifically treat consumptive patients. The tent colony at liartonville and the glass house and cottages at Watertown are evidences of this awakened |scientific s])irit. 149 I am glad to note, furthermore, the tendency to abolish Restraint, mechanical restraint. For safety and health. Physical Conditions. The State Architect has been making a survey of the build- ings and mechanical equipment of our charitable institutions. He finds a good deal of overcrowding and he has established what is a normal standard of air space, so that we may measure with reasonable mathematical precision just what the normal capacity of each institution is. He also has made suggestions for mechanical ventilation to relieve conditions as they exist today. He also has marked the need of additional precautions against fire and taken up the item of plumt)ing. He has indi- cated such changes as are necessary to put our hospitals and other buildings in a more safe and sanitary condition. Complete State Care. It is apparent to me that the day is at hand when there must More ample be active steps taken to increase our capacity for taking care quarters of the insane. Insanity is growing in Illinois at the rate of 317 new cases in our State institutions each year. This very seri- ously taxes our present accommodations in the State hospitals. Furthermore, the insane in county almshouses should be re- moved and cared for by the State. I sincerely hope that you will give this item of complete State care full consideration. New Institutions. needed. necessary. In the way of new institutions there seems to be a pronounced Consensus of need for an epileptic village and for a State sanatorium for con- op'°*od sumptives. Experience with past Legislatures teaches very| clearly that there should be some consensus of opinion regarding the order of establishment of new institutions and the precise extent of each. All our pyhsical improvements are limited by the amount of money that can be appropriated. We must take this into serious consideration. Heretofore lack of agreement on the part of advocates of various new institutions has pro- voked controversy and has caused delay. Business Administbation. In regard to business administration, we should study this at first hand with a view to securing uniform management of the charitable institutions so far as such a thing is possible. We already have placed in operation a system of uniform book- keeping. We should consider whether it would be an advantage to have a board of control for these institutions. There cer- tainly should be a more rigorous supervision of State expendi- tures. For the maintenance and extension of hospitals for the in- sane nearly three million dollars has been received during the last two years. This is a large sum of money. The duties of the various institutional trustees and of the Board of Charities are not confined entirely to the care and comfort of the insane, but extend also to the economic expenditure of appropriations and funds raised for the maintenance of the institutions under their care. It is the duty of responsible boards to keep expendi- tures within reasonable limits just as much as it is the duty of the General Assembly to guard against excessive taxation. Uniformity and rigid supervision. 150 Co-operation of Insti- tution superin- tendents. Worl£ of civil service Board of Pbison Industries. The convicts in the penal and reformatory institutions of the State are now employed in some useful industry under the new convict labor law, as enacted by the Forty-third and amended by the Forty-fourth General Assembly. Under the operation of this law the products of all three penal and reformatory institu- tions for the year fr6m July 1, 1904, to June 30, 1905, were $102,456. During the next six months the products amounted to $180,453. For the three months, Jan. 1 to March 30, 190G, the products amounted to $173,512. So nearly have the penal insti- tutions been able to supply the demands of all the other State institutions that very few goods manufactured under the opera- tion of this law are purchased in the open market and these only when requisitions are made and released. This is a gratifying evidence of the fact that the State superintendents are cooperat- ing with the Board of Prison Industries in the enforcement of the law. There have been supplied during the year from Oct. 1, 1905, to Sept. 30, 1906, to the State institutions various articles aggregating in value nearly $96,000. Complaints of Political Interference. Heretofore complaints have been made about politics inter- fering with the management of our State charitable institutions. The last General Assembly, by the passage of the State Civil Service law, removed the internal management of these Insti- tutions from the influence of politics. Under this law the total changes of employes between Jan. 1, 1905, and Oct. 1, 1906, were 1,424, or 65 7-10 per cent of the total number of employes in the State charitable institutions. Sensational But politics still seriously interferes with the administration attacks for of these institutions through unfounded and unjust attacks by certain reckless and sensational newspapers and by individuals. These attacks are made for political purposes. That is why I say that politics still seriously interferes with the administra- tion of these institutions. For this latter evil the law can furnish no remedy. For its correction we must depend upon an enlight- ened public sentiment. The fact is, the institutions are well managed. Rarely is a complaints, complaint made to me charging mismanagement. When such complaints are made they are carefully investigated at once, and, when supported, are acted upon and the cause of complaint is removed. political reasons. Acts on Solicits co- operation. Interested in their success. High Aim of the Administration. It is the purpose of this administration to place the charitable institutions of this State on as high a level as that occupied by any in this country or elsewhere. To that end I solicit the coop- lieration of all our State boards and of all w-ell disposed citizens of the State. Approves Charity Board's Policies. I am glad of this opportunity to exi)ress my hearty approval of the carefully thought out policies of the State Board of Public Charities, which will be submitted to you today. I have read them and desire to declare my deep interest in seeing them suc- cessfully carried out. 151 BASIS FOR DISCUSSION SUBMITTED BY THE BOARD OF STATE COMMISSIONERS OF PUBLIC CHARITIES. After Governor Deneen had concluded his remarks Pres- ^"^|® bS ident Billings said: "The State Board of Charities pre- fj^f^^"^- sented to the Governor a paper which is intended to be the basis of discussion at this conference. I want to read some of this paper, so that we may have an outline of what is to come, aside from other numbers on the program. Copies of this 'Basis for Discussion' will be distributed in a few moments." Dr. Billings then read extracts from the following: Springfield, Illinois, October 18, 1906. To His Excellency, the Governor, to State Officials and Employes, and to Guests at the Superintendents'' Conference: Ladies and Gentlemen — By direction of his Excellency, the Purpose of Governor, the State Board of Public Charities, acting as a cen- tral body, has called this conference of State officials and others interested in public philanthropy, to discuss general problems of institutional service. This board desires to thank those present for coming and to urge them to take part freely in all discussions. Co-Oedination into Natural Groups. This confer- ence for first group. The charitable and reformatory institutions of Illinois may be co-ordinated in three groups, viz.: 1. Hospitals for the Insane and the hospital for the feeble-minded. 2. All other State charitable institutions. 3. Prisons and reformatories. The State Board of Public Charities feels that these groups differ too widely in their functions for this conference to take up satisfactorily a discussion of their several problems. There- fore, this meeting is called to deal primarily with the problems of the first co-ordinated group, except for general hospital fea- tures, which are of acute interest to all in the State charitable and reformatory service. The board recommends that the general problem of improve-' Begin at the ment of the service be approached for solution at the bottom and bottom worked upward, rather than at the top and worked downward. Therefore, the suggestions for discussion made herein are those that touch at once on broad general policies of local administra- tion, seeking improved conditions for inmates at the earliest possible date. Minor details can be worked out locally. Reads from papers. meeting Natural grouping of institu- tions. Insane and Feeble-minded Group. For convenience, the general heads for discussion touching hospitals for the insane and the hospital for the feeble-minded have been divided into the following: 1. State care. 2. Medical Administration. 3. Business Administration. 4. New Institutions. 5. Physical problems in existing institutions. Heads for discussion. 1^2 States more efficient than counties. Suggested uniform system. Qualifica- tions for superin- tendency. Presiding over natural depart- ments. State Cabe. In the care and treatment of groups of unfortunates like the insane, the epileptic, the feeble-minded, the consumptive and the dependent, the greater the governmental unit in charge the more perfect the care and treatment. The State of Illinois is better able to classify and treat and care for inefficient population than is any one of its counties. An insane patient, or other unfortu- nate, in one county is entitled, as a resident of the State, to as good care as another dependent receives in another county. But county care in Illinois today ranges from the primitive to approved modern methods. This is not fair to those receiving primitive care. State care is one of the humane evolutions based on experience, as best for all concerned, including the tax payer. Illinois has already made strides in advance in State care. For this great credit is due, but this board believes the time has arrived for complete care of all insane, epileptics and feeble- minded now in county almshouses; and of dependent consump- tives. Medical Administration. A system of local medical administration, which has succeeded elsewhere and therefore should be expected to succeed as a uni- form plan in Illinois hospitals for the insane, rests on the follow- ing frame work of positions and service which the State Board of Public Charities submits with its approval: 1. Medical superintendent in charge of the entire institution. 2. Senior physicians. 3. Paid internes. 4. Superintendent of nurses and a trained nursing and attendant service. 5. Dietetist. 6. Hydrotherapeutlc treatment for acute hopeful cases. 7. Industrial re-education for chronic types. Medical Supebintendent. The medical superintendent should be fitted by education and a natural endowments to manage a large institution. He should bo an expert in his specialty. He should possess creative, con- structive and administrative ability. He should take a heart interest In his patients and employes. He should have sound business judgment. He should be well paid for his service. The character of the medical superintendent is the vital element upon which the efficient administration of a State hospital must de- pend. He should be given a free rein to run his institution so long as he is successful and progressive. Seniob Physicians. Each natural department on the medical side should be pre- sided over by a senior physician. One senior physician should be a woman. One should be a surgeon skilled in gynecology. All should be interested in psychopathology. Arrangements should be made for periodical visits by an oculist and aurlst. Staff meetings should be held at regular intervals to compare inotes; to discuss methods of clinical examination and observa- jtion, methods of making records which shall embody accurate statement of facts, statements of the indications for action and opinions, also the nature of the disease, its probable course and the Indicated therapeutic measures; and to discuss current scien- tific literature. 153 Intekxes. A paid interne service should be established to relieve the senior physicians of the routine care of cases, to secure histories, and to keep thorough clinical records. There should be at least one dental interne with necessary mechanical equipment. Nurses, Attendants and Training School. In each institution there should be a superintendent of nurses iu charge of all supervisors, nurses and attendants. The super- intendent should be a woman and a graduate of a recognized training school. (Future superintendents may be chosen from the graduate nurses of the State hospitals. ) Female head nurses should be in charge of all wards. Each institution should have a high grade local training school, taught by the institution physicians and superintendent of nurses and by noted specialists in private practice. Attendance should be compulsory. Those found unfit for service should be eliminated. One of the pur- poses of a training school is to eliminate unfit employes. The nurses and attendants come into most intimate touch with patients. They are the medical staff's right arm in this service. The lack of proper training of nurses and attendants upon the insane undoubtedly results in imperfect, often totally erroneous, conceptions of symptoms of mental disease. It also of necessity leads to the employment of erroneous methods of treatment. The service should be made more attractive by larger salaries, more attendants, fewer hours of work and by an education that will fit those who are worthy of it for a vocation highly honor- able, humane, and better paid in private than in public service. This field of usefulness has been neglected in Illinois, but several of the State hospitals now have training schools. . DiETETIST. Each hospital should have a practical dietetist. His duties should be to select food of the proper kind and quality, to see that it is properly and economically prepared and served to groups of patients arranged so far as possible by their similarity of appetite and food consumption. A great deal is said about economy in buying food, but little heed is given to the prevention of waste in its preparation and consumption. This official should teach dietetics in the training school. He may be assigned to other duties than these pertaining to diet. Hydrotherapeutic Treatment. Experience has placed the hydrotherapeutic treatment of the acute insane beyond the experimental stage. It is time the State of Illinois adopted it as a practical and economic measure on the basis of the successful experience of others abroad and in America. Each hospital receiving acute cases should have a psy- chopathic ward, or building, equipped with modern apparatus. Necessary changes should be made in the law to allow temporary detention of hopeful cases, for a thorough trial of hydrotherapy, to be followed by release, if cured; and by commitment, if cure seems a matter of considerable time or not probable. Thus, in many cases, the misfortune of commitment as insane would be avoided. Paid service to aid senior physicians. Woman at the head. Compulsory training schools. Medical staff's right arm. More attract- ive service. Duties. Practical and economic measure. 154 Work for chronic types. Companion of work. Lazy attend- ant's friend. Kssentlal elements of life for insane. Source of Income. Uniform system suRgested. More discrim- ination. Industrial Re-Education. For the chronic Insane what is more horrible than almoct continuous incarceration and idleness? For this class work should be provided. Lace making, carpet and rug weaving, chair- caning, shoe making, upholstering, truck gardening, farm work, erection of institution buildings, etc., are crafts and emjiloyment to which the hands of the chronic insane can be adapted easily. Such re-education can be made the means of self-support outside of institutions for many chronic insane persons. Such employ- ment is a mercy to the patients and a source of economy to the State. This board realizes that considerable employment already is provided for the chronic insane, but recommends more of it Amusement and Recreation. The largest possible amount of amusement and recreation sheuld be provided for patients — dances, games, moving pictures, outings, books, music, etc., as a companion treatment of work. Illinois institutions already provide considerable amusement. Restraint. Hydrotherapeutic treatment, industrial re-education, and amuse- ment tend to the elimination of mechanical restraint and shotgun doses of soporifics. Restraint is the lazy attendant's friend. Hospital treatment, employment, recreation, human sympathy, and the elimination of prison features voice the modern scien- tific realization that the same elements of life are essential for the insane as are essential for persons in mental and nervous health. These elements should be provided, as far as institu- tional limitations will permit. Pay Patients. The attention of this board has been called to the fact that a source of income to the State could be provided by taking so called pay patients. Discussion of this subject is invited. Records. The State Board of Public Charities finds the medical records in nearly all the hosi)itals for the insane and other charitable Institutions extremely primitive and valueless. It recommends that a system of uniform, up-to-date medical records be drafted for use in all hospiUils for the insane and a system adapted for general hospitals be drafted for institutions having such hos- riitals, with special provision for service that is peculiarly local. Thorough records are the basis for the work of a psychopathic Institute. Classimcation. There is need of a more discriminating classification of insane patients into groups of Individuals who are least harmful to each other. General hospital features for the physically sick insane are inadequate. This condition should be remedied at the earliest possible date. A rough estimate is that about 200 in each 1,000 insane need hospital care for physical ills. 155 Business Administration. Acting under the medical superintendent, each institution Steward or should have a steward, or business manager, to relieve the super- manager intendent of the details of business administration. Under the care of this steward should be the buildings, machinery, farm, truck garden, store and all skilled mechanics and common labor- ers. Such a department, effectively organized, is essential, so that the general superintendent may devote the bulk of his atten- tion to the medical administration of the hospital. New Institution — State Psychopathic Institute. The present State Board of Public Charities, when its service began, found need of a stimulation of the scientific spirit among nearly all the physicians in State institutions. They lacked in- spiration from a central institution. Among other reasons, to remedy this condition, the State Board of Public Charities rec- ommends the creation of a State Psychopathic Institute, under the Civil Service, to be located by this board at one of the hos- pitals for the insane and with psychopathic laboratories in every State institution having a considerable hospital service. The local clinicians should be instructed at the central institution for service in all institutions. The State Psychopathologist in charge of the central institu- tion should be a recognized expert. He should be provided with a thoroughly equipped modern laboratory. He should be so experienced in clinical and pathological psychology that he may teach all members of the medical staff of the State hospitals meth- ods of examination, analyzing and criticising deductions drawn, criticising descriptive terms used in records as to their clearness, accuracy or ambiguity in the final summing up of the diagnosis; methods in making autopsies and accuracy of observation and of recording statements, etc. Each hospital should be supplied with the laboratories and the apparatus necessary for clinical and post-mortem study. Each student from the central institute should be a source of inspira- tion to the physicians in his institution and to local physicians outside of it. This service ought to develop in institutional physicians a thoroughness in examination, diagnosis, prognosis and treatment which will reflect beneficially upon the patients. Each physician, in fatal cases, will desire to make good, at the autopsy, his clinical work on the living patient. There should be a change in the autopsy law to make it more favorable to scientific research. This is necessary for the study in the dead material of the results of clinical data found in the living patient. It is by such study that knowledge of perplex ing diseases is acquired and pallatives or cures therefor discov ered. New Institution — Village fob Epileptics. Complete and modem State care would remove all epileptics from county almshouses. State hospitals for the insane and the hospital for the feeble-minded. The most careful statistics avail- able show there are in Illinois hospitals for the insane, 724 epilep- tics; in the Illinois hospital for the feeble-minded, 500 (estimate) epileptics; and in Illinois almshouses, 444 epileptics, or 1,668 epileptics now receiving some sort of institutional care. Efforts to learn how many there are in the State not receiving institu tional care have been fruitless of accurate results, but incomplete reports received by a previous State Board of Public Charities totaled 2,014 such persons. Need of scientific inspiration. Qualifica- tions of psycho- pathologist. Laboratories at each hospital. Stimulus to local physicians. Means of combating disease. Illinois statistics. ^bO Peculiarities Board favors' To care for these unfortunates properly would require the a'^'villaKe°^ establishment of an epileptic village on a farm of 1,500 acres. The State Board of Public Charities recommends the creation of a village for epileptics. In view of favorable action by the Legislature in 1.S99, concurrence in this recommendation Is a reasonable hope if a united front is presented. Epilepsy is a disease peculiar to itself. The seizures are hor- of epilepsy, rible to any person not an epileptic. In hospitals for the insane and feeble minded the presence of epileptics is a positive detri- ment to other patients. To epileptics themselves the seizures of other epileptics are not affecting. Therefore, segregation in a village is natural and proper. Furthermore, outdoor life and special diet are essential for epileptics. They can be treated tetter as a class than when mixed with insane persons or feeble- minded persons, or kept in primitive almshouses. Of course, the presence of insane and feeble-minded is harmful to epileptics. The cost of the epileptic at the Craig Colony at Sonyea, X. Y., is $40.00 per annum less than the cost of his maintenance in a hospital for the insane or feeble-minded. Separate care cheaper. Need of a second hospital. Managed by State Board of Health. Work by State Architect. New Institution.s — Hospital fob FEEiu.E-MiNnKD. The establishment of an epileptic village would provide relief for hospitals for the insane and for the feeble-minded. But the time is near at hand when Illinois will be called upon to erect a second hospital for the feeble-minded, one of the two to be used for the better class and another for custodial cases, with some adequate provision for the segregation of feeble-minded women of the child-bearing age. It even may be necessary, when this problem is more thoroughly studied, to ask the coming Legis- lature for aid along the lines indicated herein. The present asylum for feeble-minded children was established for the im- provable class, but has been forced to take custodial cases. New Ix.stitutioxs — Sanatorium fob Consumptives. The necessity for the establishment of a State sanatorium for consumptives needs no advocate before this joint session. Segre- gation and the sunlight, open air and dietetic treatment are recognized as essential in any thickly populated commonwealth. This enterprise should be managed by the State Board of Health, because it concerns a communicable disease. The State Board of Public Charities recommends the establishment of such san- atorium; also the erection of a building in connection with one of the prisons for the segregation and treatment along modern lines of all prisoners afflicted with tuberculosis; and also the segregation and treatment of the tuberculous insane and feeble- minded and other dependents. Buir.niNfis and Equipment. In the matter of buildings and equipment, the State Board of Public Charities on Aug. 4 last requested his Excellency, the Governor, to direct the superintendents of the various hospitals for the insane and hospital for feeble-niindod to cniiiloy the State Architect, Mr. \V. Carbys Zimmerman, to make surveys of build- ings and equipment to ascertain whether or not, and if so to what extent, the various institutions are overcrowded, by estab- lishing what is a reasonable standard of air space for each ])atient under varying conditions; also to ascertain what physical changes are necessary to put the institutions in a safe and satis- factory physical condition. This work has been done, except at the hospital for criminal insane. 157 The proper cubic feet air space allowance for one patient in the different rooms, taken on the basis of an arbitrary minimum standard ceiling height of ten (10) feet six (6) inches would be, according to the State Architect: Sq. ft. Height. Cubic ft. 50 60 100 10 ft. 6 in. 10 ft, 6 in. 10 ft. 6 in. 525 630 1050 Ventilation. The air in each room should be changed about three times an Changes of Lour. ^'' ^^"•^^*^- Surveyed on the basis of the State Architect's table, six of the six institu- seven Illinois institutions surveyed show overcrowding when tions over- each is taken as a whole, to the extent indicated in the following '^'""^ ^ ■ table of averages: AiB Space Figtjees in Seven Illinois Institutions. Name of Institution. Northern Eastern Central Western Incurable Feeble-minded Southern Day Rooms. M W S >-*CB < 2 D'tD C5« 103 261 104 260 257 162 000 Total shortage 1147 Average shortage in six of seven institutions 191 The Southern Hospital for the Insane at Anna shows the aver- age excess of eight cubic feet, but no computations were made on the infirmaary basis of 1,050 cubic feet per patient. The State Architect in a note says: "The sick patients at Anna are gathered together as much as possible; no separate wings or buildings are used as infirmaries." Owing to lack of time the State Architect made only a gen- eral survey of buildings and equipment, outside of ventilation features. Those he covered thoroughly. This board recommends that the State Architect be authorized to employ an expert engi- neer to make a thorough survey of all other physical factors than ventilation and that the superintendent of each institution submit to this board, at the earliest possible date, a statement of all improvements recommended by the State Architect with the estimated cost thereof, item by item, as the basis of specific appropriations to be asked of the Legislature. The cost of em- ploying the engineer should be pro-rated among the institutions. The board recommends that in all new buildngs for the insanej Cottage plan and like patients only the cottage or the pavilion plan be used.] favored. Why an exception" at Anna. Recom- mended expert survey of other physical factors. i5« Eliminate "Incurable.' Problem now under In- vestigation. Uniform grades of service. Words of en- dorsement. State care. Uniform medical admin- istration. Business admin- istration. Bath treat- ment. General hospital service. Employroent. Amusement. Restraint and soporifics. I'ny pntlentB. Uniform records. Change in Name of Bartonville Institution. This board recommends that the name of the Institution at South Bartonville be changed from the Asylum for the Incurable Insane to the Illinois General Hospital for the Insane. The reason is obvious. CO-OBDINATION. The State Board of Public Charities is making a careful study of the matter of a fixed coordination of State institutions into natural groups and of what is the best form of administration for them. It is not yet prepared to outline its recommendations. There is diversity of opinion. The adherents of different systems urge their views with great earnestness. This board has inter- viewed officials in fourteen states of the Union. It has conferred with financiers and the presidents of the great corporations. It would be grateful for free expressions of opinion by tho.se attend- ing this conference as to what is the best form of administration for the State institutions of Illinois. At a later date the board will make recommendations. At this time, however, the board is ready to recommend the establishment in the natural groups of institutions now operat- ing under the Civil Service law of uniform grades of service with a maximum and minimum salary limit for each such grade; of uniform general rules, with special rules to cover local condi- tions; and of uniform nomenclature of positions in the service. State Civil Service Commission. This board endorses without stint the work of the Civil Service Commission. Its plan for improvement in the classes of employes fits in with the general plan the State Board of Public Charities ubmits in this "report. Summary op Recommendations for Discxtssion. The foregoing suggestions are summarized as follows: 1. State care of all insane, epileptics and feeble- minded now in county almshouses; and of dependent consumptives, calling for the establishment of a State village for epileptics and a State sanatorium for con- sumptives. 2. Uniform local administration by a medical general superintendent in charge of each hospital with senior physicians, paid internes, sui)erintendont of nurses and sufl^cient nursing and attendant staff taught in a compul- sory, high grade training school, and a dietetist, on the medical side; and a steward, or business manager under the supervision of the medical general superintendent, on the business side. 3. Hydrotherapeutic treatment for acute hopeful cases of Insanity. 4. More ample hospital provision for physically sick Insane. 5. Industrial re-education for chronic types of In- sanity. 6. More amusement and recreation for patients. 7. The abolition of mechanical restraint and soporifics so far as practical. 8. Discussion of the subject of pay patients. 9. Uniform medical and other records. 159 Psychopathic institute. Feeble- minded. Ventilation, etc. Change of name. System of adminis- tration. Uniform grades, rules and nomencla- ture. logical moment. 10. More thorough classification of patients. i 11. Creation of a State Psychopathic Institute. 12. Consideration of the need of a second institution for feeble-minded, including feeble-minded women of the child-bearing age. 13. Consideration of physical changes to provide ade- quate ventilation and to put all buildings and equipment into satisfactory shape. 14. Change the name of the Asylum for Incurable Insane to the General Hospital for the Insane. 15. Consideration of systems of charity administra- tion for State institutions. 16. The establishment of uniform grades of service, with maximum and minimum salary limits in each grade; of uniform general rules, with special rules issued by the superintendent to cover local needs; and of a uni- form nomenclature of positions of employment. Appointment of Committees. The State Board of Public Charities recommends respectfully Reference to that the foregoing suggestions be referred to special committees committees, of this conference to consider the same, criticise the same, amend the same, and make reports at a meeting similar to this to be held before the Legislature sits; and this board recommends, as a requisite for success, that the officials and guests assembled here pledge themselves to a united effort before the Legislature to urge and work for the adoption of such part of the plan finally adopted as calls for legislative authority. Now is the time to try earnestly to elevate the service in Hli- The _psycho- nois State charitable institutions to a higher plane of efficiency. " Respectfully submitted, [Signed] Frank Billings, Emil G. Hirsch, John T. McAnally, Claba p. Boukland. The Board of State Commissioners of Public Charities. [Signed] William C. Graves, Secretary. Note— Miss Julia C. Lathrop is in Europe and has not seen this report. However, many of the suKtrestions contained herein are her verbal sugrpestions. and the board feels confident that, if she were here, she would approve the underlying policies outlined. Seeking Light on Charity Administrations. After reading the foregoing as a basis for discussion. Dr. Commenting Billings, commenting on that portion under the heading, "Coor- atlon*.""^ ^^' dination," said: "I want to say, while we invite superintendents and others in- 1 terested in State institutions to send us letters (to the secretary or to me as president), that we may consider this question of the possible recommendation of a change in the manner of conduct- ing our State institutions, the Board of Charities is not prepared to declare the present method in Illinois is not better than any other we could have. But, because other states have different methods, a study of the question is something certainly worthy of all of us. Perhaps some of our laws should be changed — the quegtion of our law for the commitment of the insane, for in- sLance, which we probably are not ready to take up for discus- sion in detail at this meeting. I desire the thoughtful consid- eration of those present of the whole question of charity admin- istration and that you write to us, or discuss it at this meeting, if you desire, that we may have the benefit of your opinions." Question open for study. i6o CIVIL SERVICE UNIFORMITY Paper by W. B. Moiilton. Guides for a committee. Similar names : dissimilar duties. Confusin;; to applicants. Meaning of "attend- ant" and "nurse." "Nurse" a more attractive name. I Mr. \V. B. Moulton. chairman of the State Civil Service ICommission. read the following paper on "Civil Service I Uniformity :" ' The substance of what I wish to say on the subject of uniform- ity lacks uniformity itself and is itself somewhat disorganized. It consists rather of suggestions that may be guides for the more detailed work of a committee. I hope such a committee will be appointed to straighten out some of the differences in names, duties and compensations of the 2,108 positions under the State civil service law. To give an illustration of the embarrassment caused the Civil Service Commission by the similarity of names and dissimilarity of duties, I wish to cite the instance of the position of matron. We have the position of matron at Normal, Lincoln, the schools for the blind and deaf at Jacksonville, and a similar position at Geneva called supervisor. These positions pay from $4.5.00 to $.10.00 per month. We also have positions of matron at the in- sane hospitals, at the Industrial Home for the Blind and the Eye i^ind Rar Infirmary — positions that pay from $40.00 to SCO. on. Manifestly the requirements of the applicant for the position of matron at Normal or Geneva should be quite different from those demanded of an applicant for the position of matron at Elgin. At Normal and Geneva, the term "matron" is the proper one to use, because the duties relate to the care of children. At Elgin the title should more properly be that of housekeeper, because the duties relate, not to the care of children, but to the manage- ment of the domestic establishment. In our examinations we have made this distinction, but to applicants the distinction is very confusing and must be ex- plained to each one. In our examination for housekeepers and matrons, in spite of a careful exi)lanation by the examiners in charge, several mistakes were made and several applicants for the position of matron took the wrong examination. If the names or' the positions of matron at the hosjiitals were changed to that of housekeeper, no such confusion would arise. Another source of confusion, arising from using the same names for different positions, exists in the use of the titles of supervisors and attendants. We have these positions in the in- stitutions for children and the hospitals for insane. Here again manifestly, the duties are quite different, and our requirements of applicants can not be the same. The word "attendant" does not convey to my mind the same meaning as the word "nurse." li' we are going to have real training schools in the State hos- pitals, there is no place for the attendant. Until the full training is received, you may call them pupil nurses, if you will, but can we not dispense with the "attendant" in the hospital? In the school for deaf or the blind, the word "attendant," to my mind, more properly describes the jwsitions of those who look after and attend to the ordinary wants of children who are not sick. .\,g:iin, I he stiperior oflicer in such places ran be more properly described as a supervisor or supervisorcss. These terms in the hospitals for the Insane could, it seems to me, .give way to the term "as- sistant superintendent of nurses," the line of promotion thet* be- ing superintendent of nurses, assistant superintendents, head ward nurses, nurses and pupil nurses. In this connection, jiermit me to say that the influence of a name and of sentiment has no little Inlluence in this world, and I believe that a position would be more attractive if called the position of "nurse" rather than that of "attendant." i6i Several other instances along this line I might cite; for in- Other con- stance, the positions of managing matrons, relief matrons and na'mes^ laundry matrons at Geneva, and cottage matrons at Normal, we call officially assistant matrons, and certify to all these positions from the same list. There is also, I believe, some little difference in the positions of steward and stewardess at several of the in- stitutions. I must pass on, however, to the more difficult question of differences in compensation. DiFFicxjLT Question of Compensation. The economic phase of the question of compensation in the State institutions of Illinois can be briefly stated to be a failure to^^oufsTde' to keep pace with the changing economic conditions on the out- side. The present salaries were fixed and determined at a time when salaries were much lower than now, and when the cost of living itself was much lower. In private enterprises, the require- ments and needs for effective competition made it necessary to keep pace with the changing conditions. These demands were not controlling in the State service. In the State service, more- over, all the influences, including the desire to make a good record on the matter of per capita expense, are conservative and have tended to keep the amount of salaries down to their original figures. Do not misunderstand me and infer that we are criti- cising a laudable desire to economize; providing, however, that such economy is a wise economy and is a real economy. Perhaps if we have a steam plant that no private concern would think of entrusting to an engineer of say less than $150.00 a month ability, and we are paying a man $80.00 a month and pre- sumably according to the laws of supply and demand, have a man who is worth about that figure, we may perhaps have a most expensive engineer, one who is costing the State, in repairs and abused machinery, many thousands a year, where a few hundreds would have answered. Perhaps also we may have a head farmer at $60.00 per month, who is costing the State four or five times his salary in not being a big enough man to see where he might save or make for the State in the conduct of his farm; where perhaps a $100.00 man would not only know how, but would feel the reciprocal interest to execute. It is true the State is saving $40.00 a month, but along this line there is an almost as certain law of increasing and diminishing returns as in the cultivation of land. These matters, we believe, are worthy of careful consideration. Medic.\l and Nursing Side. Up to the present time I have touched only upon the economic phase of tliT^ question. Let us take up another phase and let us consider the medical and nursing side of the children's institu- tions, the work that determines in the largest degree the actual results accomplished by these institutions. Does the State of Illinois desire to do this work and carry out its undertaking of these great responsibilities in a first class, second class, third class, or fourth class manner? This will be largely determined by the class, of employes— the physicians, nurses, teachers and matrons; you will only secure fourth class service from fourth class men. With the inauguration of the training schools, you have made greater demands on your assistant physicians in the hospitals. I am not going into the sufficiency of the compensation paid to the assistant physicians, but merely to set forth for you the facts in regard to lack in uniformity in salaries. At Anna, Barton- —II PC changes. Cheap men are poor economy. Farmer as an example. Determines actual re- sults. High grade employes necessary. Unequal pay for assistant physicians. l62 ville, Kankakee and Elgin, the first assistant physician receives $150.00 per month with living, of course, in addition. At Water- town, the three physicians each receive $150.00 per month. The assistants at these places receive salaries varying from $100.00 to $133.33 a month. The question of the living of the members of a family of a physician should be uniformly and rightfully adjusted. I have in mind two assistant physicians at the same salary: one was a single man and the other had a family of four or five living at the institution. Naturally, the single man. who was doing the same work as his married associate, felt as though he were not receiving as much for his work as the other. All such questions can and should be uniformly and equitably ad- justed. As TO THE Engineers and Firemen. Marked dls- j In the line of engineers we find a marked discrepancy in com- crepancies. jpensation. At Kankakee, with the largest plant, the salary is one of the lowest for chief engineer, being $83.33 i)er month; while the chief engineer at Elgin receives $115.00. At Jackson- ville insane, $108.33, and at Anna, Bartonville, Quincy and Water- town, $100.00. Again we find wide variations in the compensa- tion paid firemen — from $2.00 per day paid at Bartonville and Jacksonville insane, to $32.50 per month, with board, paid at El- gin. We would suggest that here again perhaps the right care an experienced man will give to a boiler would make it poor economy to pay $32.50 for iuferior men. Wide diver- gence. Uniformity la necessary. Like a great river. Civil service not to blame. S.\laries oi' TiiK Teachers. Our teaching force is paid higher at the School for the Deaf, where the salaries range from $400.00 to $1,200.00. At St. Charles and Normal, the State is paying fair salaries for teachers ( $5(t.oo per month). At the School for the Blind the salaries vary from $425.00 to $540.00. At Lincoln the teachers receive the lowest salaries paid, about the same salaries paid attendants, and hardly enough to pay for competent teachers. Attendants and Their Compensation. I have given the above instances of variations to show the necessity of some action towards uniformity. I pass by other examples to take up the matter of attendants and their compensa- tion — a subject that has given us more concern than all the others. As you i)erhaps all know, we have not been able to make the position of attendant a competive one, for the reason that we liave been living a hand to mouth existence in sujiplying the de- mand. The procession of attendants is like a great river going in one door of the hospital and going out the other all the time; with, however, a very, very marked difference in the flow at the different institutions. Certain institutions have checked, if they have not almost stopped the flow as a current; in others it is a continuous current without interrui>tion. Of course, if we are to have training schools, such a state of affairs would be fatal to any attempt at training. No hospital can turn out any trained nurses from such a changing mass of indiviuals as this and any system of training that is worth anything would be demoralized t)y it. Now what is the trouble? Some of our good friends lay it all to "civil service," but, so far as we have been able to discover the same difficulty in keeping up a connection between the supjily i63 and demand existed just the same in the "good old days," as witness the testimony of Dr. Corbus in the investigation at Kanka- kee in 1902. The conditions that cause the outflow are not con- trolled by this commission. Were the changes in this line of employment no greater than in any other, we would have suffi- cient applicants to make this position competitive, and to possess an adequate eligible list resulting from careful selection. To show the great number of changes in this branch of the ser- vice, I will state that since November 1st of last year there have been appointed 831 attendants in the State service. During the months of August and September there were 271 resignations and seventy-three discharges in the service, and all but about twenty-five of these were attendants. Other states have the same trouble. The states to the west of us are attempting to solve the problem by a marked increase in compensation — with what result I do not know. One superintendent in Minnesota suggests that this is not the remedy, but that we should make the hospital more attractive. This superintendent says: "There is much about an institution for the insane to discourage the desire to do good work, or for long ser vice. If an employe is criticised for the quality of his work his first thought is apt to be — how will it benefit me if I do better work? He is apt to feel discouraged at the outlook. He is on duty nearly thirteen hours daily under a severe mental strain, he sleeps, or attempts to sleep, in the wards with patients who are frequently ex- cited and noisy, where he is liable to a call for assistance at any moment, so that during the whole night there is no real sense of relaxation. He has no special place when ofl: duty to which he can retire for recreation or rest, so that he is really under the strain of his work almost constantly. If he is without friends in the neighbor- hood, the only place he can go for a full sense of freedom is to the city streets, or possibly the bar room. It is constantly impressed on his mind that everthing about the institution is for the patients. Consequently he comes to feel that he is held in very little consideration and he gives half-hearted work in return. Is it not possible, without sacrificing the interests of the patients to give more consideration to the well-being of our nurses. "Higher wages alone will never secure the best work. The nurse should be made to feel that his work is ap- preciated, that the success of the institution is in part directly due to his faithful service, that his official su- periors are interested in his welfare, that whatever privi- leges are granted — pleasant rooms removed from the patients, places for recreation and social intercourse to which he can retire when off duty, a better dietary, extra time occasionally, advancement to more responsible po- sitions^ — these he will receive if the character of his work warrants. Perhaps this appeal to self-interest is not a highly moral one, but it will certainly bring results, and when the employe becomes throughly impressed with the fact that loyalty and faithful service bring definite personal advantages, higher motives may be appealed to with a reasonable certainty of inducing further im- provement. "If our institutions were hospitals throughout in the true sense of the word, it would be easier to arouse in the nurses a deeper interest in the work and to secure Great number of changes. Words of Minnesota superin- tendent. Discouraging features. More than higher wages needed. True hospital service. 1 64 views In a nutshell. All branches of one service. Uniformity essential. Charity board rpcomraen- datlons. Words of en- dorsement. Calls on Dr. Carrlel a class of employes similar to that in the general hos- pitals, who come with the purpose of making nursing a life work and not simply as a means of earning a living during a dull season — a too frequent reason for seeking employment in a hospital for the insane. "To sum up, an indiscriminate increase of wages would not result in a proportionate increase in the efficiency of the nursing force. Your board has, since it has been in office, made a general increase of wages to a marked extent, and I think the salaries now paid are, as a whole, as high as could be expected. I believe a slight increase in a few directions would result in benefit to the in- stitution and also a length of service Increase as a re- ward for efficient work and an incentive to employes to remain in the employ of the State. The hours of work should be made shorter, the nurses should have better quarters and more home-like surroundings wlren off duty,- certain privileges could be granted to nurses above a given grade, who by efficient work had been advanced to responsible positions, without detriment to the institu- tion, and, above all, the nurses should be classified as far as possible and trained in accordance with the class of patients with which they had to do." This whole subject, however, will be taken up by Dr. Podstata at this conference. What I wish to set forth is the trouble caused by the lack of uniformity in compensation. Applicants will re- fuse to go to Jacksonivlle, for instance, where the men receive from $24.00 to $30.00, and the women from $16.00 to $22.00, and will ask to be assigned to Watertown, where the men receive from $28.00 to $35.00 and women from $22.00 to $27.00. Worse than this, however, is the spirit of discontentment at the in- stitution where the compensation is lower, and the attenii)t to be transferred, and, failing in this, employes will resign, hoping to enter the service again at the higher salaried place. This all, of course, is demoralizing to the service, as a whole. Each in- stitution is just as important as the other, and each is in fact only a branch of the same service and the salaries of employes of this class, and the arrangement of the service, should be uni- form and in every respect alike. Discussion is Invited. Dr. Billing^s: This subject of civil service iiuifonnity is open for discussion. The Board of Charities recommended some tilings which I desire to read again after the remarks made by Mr. Mouiton. At this time, however, the board is ready to recom- mend the establishment in the natural groups of insti- tutions now operating under the civil service law of uni- form grades of service with a maximum and minimum salary limit for each such grade; of uniform general rules, with special rules to cover local conditions; and of (iniform nomenclature of positions in the service. This board endorses without stint the work of the Civil Service Commission. Its plan for im))rovenient in the classes of employes fits in wi(h the general plan the State Board of Public Charities submits in this rejiort. The subject is open for discussion. I think perhaps the superintendents of some of our institulidiis can discuss it with feehnir. I know that Dr. farriel. when I was over at i65 Higher age limit. Jacksonville, spoke very feelingly about it. Perhaps he can tell why the stream is bigger at the outer end that at the entrance of the building. Discussion by Db. Gabriel. I might say this, that the Board of Civil Service Commissioners might improve their service somewhat by malting the age limit for attendants a little older than they do. A girl eighteen years old is not fit to take care of crazy people, either in her develop ment mentally or physically, and it is not fair to her nor just to the State to expect her to take care of the patients. She is there two or three weeks, gets homesick and she goes home. You can't hold her. That feature is not the only reason, but it is one of the reasons. Calls on Other Superintendents. ■ Dr. Billings, Chairman: This is a very practical subject. I ^r^.z^'Jer's I should think some of the superintendents have had suffi- asked, cient experience to enable them to say something very practical upon this subject before it is referred to a com- mittee. Dr. Zeller, won't you talk to us a little on that subject? Discussion by De. Zellek. I believe in uniformity, but I don't believe it is at all possible to accomplish it today, nor over 1-lOOth part of the suggestions that will come to mind of the various superintendents; but I do believe that this board ought to insist that every employe in the public service of Illinois should be paid exactly alike in every institution in the State, for like services, and that the determining power be in Springfield and not in the institution. There should be no deviation from it whatever. As to pay in proportion to time of service, it is not true, gen- erally, that with the passing of time, the efficiency of attendants increases. I believe that two or three years' experience is a good thing; but above that, I do not believe, in my observation, there is anything to be gained by inaucing these people to remain in the public service. I believe some convenient avenue to lessen the period of this service would be more beneficial than to coax attendants to stay beyond the years of their use- fulness. It is a very well known fact that in personal contact witn the insane, ward contact, in their daily life, seeing the paretic man, the man with chorea, and with the 10,000 move- ments of the insane, is bound to impress the sane person with them, especially under the present hours of thirteen and fifteen hours of continuous duty day in and day out. When the time comes for taking up these matters, I shall be very glad and have more to say. One Reason for Coordination. Dr. Billings: It has seemed to us, as a board, as we have in- vestigated the institutions, that this want of uniformity, in no- menclature of the employes, used in the classification of em- ployes is important, and Mr. Moulton's suggestions on that, I think, are good, that nurses be called nurses, when their ser- vice is attendance upon the sick; that they be called attendants Uniformity of pay de- termining power in Springfield. Element of time. Each institu- tion for Itself. i66 Refers to board's suggestion. All papers referred. What Is the experience elsewhere ? Method In Nebraska. Value of training Bchool. Equal wage for men and women when they serve individuals, lii^e the institutions for blind, etc., who are not ill, and that the classification can be made very much better. Another thing that struck us, as a board, is this difference in the salary, or wages, paid for the same indi- viduals or the same positions in the different institutions. The institutions appear to the Board of Charities to have been going by themselves, each one for itself. That is one of the reasons why we speak of coordination. Papers to be Referred to Committees. May I ask now how you. will receive these different papers? Will you take the suggestion of the Board of Charities that each one that is as important as this be referred to a snb-com- nittee? Will you refer them, as read, and have a committee ai)i)0inted? If so, how will you have the committee appointpd? The chair is ready for any motion or suggestion upon Mr. Moul- ton's paper. Mrs. Bourland moved that all papers read at the con- ference be referred to special committees to be appointed by the chair. The motion was put and unanimously car- ried. Governor Deneen Asks for Information. I do not rise to discuss the paper, but to ask some questions. The matter of the increase of salary is the one to be discussed before the uniformity, because it is plain enough that the sal- aries would be increased to the highest, rather than decreased to the minimum salaries, and, because of that, I am somewhat interested. I would like to hear from Dr. Greene and others who have had experience elsewhere, as to whether or not there is a uniformity of salary paid in institutions, under a super- visory board — whether they are the same in Massachusetts, New York and elsewhere. I know, as to salaries regarding all sorts of work, you can get the same service for less salary in southern Illinois than in northern; but the salary, to be uniform, would have to be the highest grade — the salary paid in northern Illi- nois. I would like to hear some suggestions, upon experience in other states and their results, as to whether the increase of salary has made the attendant remain longer and secured a better class of service? Discussion by J. L. Greene. In Nebraska, where my service has been, we have no local boards, neither do we have a board of control. In fact, we didn't have much of anything but the sui)erinten(lent. and be would go to the Legislature and lobby his api)ropriation through. A board of State ofTicers aiulits our bills, and it is left with the institution to shift for itself. I have found that the element that contributed more to raise the standard of tenure of employes, than all other things, was the training school that I established at Lincoln. The classifi- cation as to wages, there, was largely in proportion to the duties to which employes were assigned. We carry our nurses as cadet nurses and as nurses. Those who had charge of wards where there were greater degrees of labor were in the class Al. The persons who demonstrated the greatest capability were given char.t;e of the places where there was more moiiey. In some states there is a hard and fast rule that a woman shall receive the same salary as a man, in a like position. I think that prevails in Iowa. I believe in that sort of thing. If a 167 woman nurse is taking care of forty insane women patients, and a man is talking care of the same number of male patients, I can't see why the man should receive $50.00 a month and the woman $45.00. I traced a case, a few days ago, where a graduate nurse came to me. She had been at Kankakee four years, and was receiving $32.00 a month. She was filling a position of re- sponsibility on the female side of the .house, exactly commen- surate in every way with another graduate of the same school, on the men's side of the house". The compensation of the one on the man's side was $40.00. It happened that the party on the south side of the house had more political pull than the one on the north side. I heard it said that the one on the north side of the house had risen from the position of servant girl, and I told the party there was no such distinction of servants. We were all workers in a good cause. I believe that the system of classifying nurses into cadets, pupils and nurses, and establishing a class spirit among them, is the best incentive to get them to stick to work. My little boy has only been in the high school four weeks. He is 13 years old. He is a full fledged freshman in the high school. So in the nurses' school, there should be an absolute, distinguish- ing mark, so that you will know them when you meet them. At Kankakee there is a classification, and you can tell who are graduates of the training school. I can tell who are attendants, and who have had a course in the training school work. Uni- forming them gives them a definite badge, while in the uniform. You can impress upon them that the uniform is a badge of honor, and that they carry the reputation of the institution with them, when they are permitted to go outside of the institution, with this uniform. It establishes a strict decorum that makes them stick. There are some people, at Lincoln, who were there when they swept the shavings out of the house, they say. They have been getting a little more money each year. It looks impossible that a man could start in, when 22 years old, and put by a compet- ence before he is 50 years old, as a nurse in an insane hospital. But I know it can be done. I have seen it done. One man, who has been there his lifetime, one might say, and who is getting $40.00, has more money than I have — and I have been getting more than that for a long time. He has saved his and has kept at it. The reason they quit, many of them, is that they have no con- ception of what is required of them when they come to the in- sane hospital. They have no fitness, either by education or previous environment, to take up the responsibilities that are to be theirs. It is an ill organization, that is contaminated by any other purpose than the welfare of the patients, which will put in a position of responsibility the favorite of some political boss, or somebody else, until you proceed to smoke them out. It must be put, to my mind, upon a business basis, selecting the employes first with the understanding they are enlisting for the war, that is, for at least three years. Then they should be put in service six or eight months on probation, before the State wastes any time or energy in attempting to educate them in the art, or science and art, of caring for insane. In the oper- ation of our training school, we have hardly accomplished any- thing yet. It seems to us that nurses and graduates of the train- ing schools have been harder to find in that locality than any place. It is impossible to get superintendents of nurses for Kankakee. We have started the training school without a sup- erintendent nurse. A girl who can only write her name in- Case at Kankakee. Classification uniforms. Can save money. One reason for quit- ting. Probation first i68 Search the high Bcbools. Marriage a constant factor. (differently well, who can't spell the simplest English words, who is timid, a 17 or 18 year old girl, 30U miles from home, cannot be expected to stay. My theory would be for us to go to the high schools of Illi- nois. Let the Civil Service Commission start a crusade now, going to the high schools of this State. Many of them are ac- credited to your university, and the University of Chicago, and [in almost every high school I have ever known, there is some lyoung man and some young woman who has worked his or her jway through. It is not unusual at all for a young woman to do [domestic service while going to school. We always had such a girl when living at the university. The problem is presented: Is she going into the university, shall she begin to teach school, or learn stenography? Or is she going to Chicago, to take up work in a department store, at $3.75 a week? If it could be presented to her that the occupation of nurse is an honorable one, in which a life of usefulness could be spent, such a girl would aflaiiate with the training school. Once you get that kind of girl in the training school, the standard has advanced. Where there is a prospect of $20.00 for one year, $22.00 the next year, and $30.00 after graduation, that is better than teaching school, better than department store work. It is better than stenography, almost better than anything that offers in the way of compensation, because it carries with it instruction, and expenses, and the feature of permanency. It is a problem that requires much working out to bring it to the basis where permanency is established. If you keep a girl six months and let her go away, it is useless. You can't pre- vent her getting married and quitting the service. That is one fruitful source of the backdoor stream. Somebody from north- ern Illinois and somebody from southern Illinois are married, and gone away, in a little while. To start with better material, pay uniform wages and then increase the wages as increase of responsibility comes, seems to be a solution of the proposition. Almost all of the people in charge of all the wards of the in- stitution are graduates of our high schools. Discussion by Dr. Poust.xt.v. I wish to enter a protest against the direction this discussion has taken. Inasmuch as it is the ground 1 am to take up this evening. [Laughter.] As regards the uniformity, particularly in compensation, I should like to say this: Dr. Taylor at Watertown, and myself at Elgin, and to some extent Dr. ClrotMie at Kankakee, receive those people from southern Illinois, who 'at present form nearly the bulk of our nurses and attendants. Ilf we are going to pay just the same amount of salary as at Anna, and down in southern Illinois, the boys and girls from that district will not care to enter our institutions, which are probably several hundred miles farther way from their homes, if there is nothing to better tlioir situation, that is. if they re- Icelve no more in our institution, farther away, than they can get right at home, that is one argument. Differing In the second i)hue, I don't favor the idea of uniformity of service of salary received by physicians, according to the number of pa- physlcians. (jents. I cannot see how that would 1)0 jiist. I can easily find you forty or fifty patients who would give a physician vastly imore trouble than 300 or 400 of some other kind of patients. Therefore the kind of attention required by the forty or fifty jpatients would require a very good man indeed, and he should be well i)aid for such arduous work. Objection to uniform pay. 169 In the matter of nurses and attendants, I am somewhat in- clined, still, to retain the term "attendant," for instance, or some other term than "nurse," for certain positions. I cannot see why it should be necessary to require, in the first place, a trained nurse for the chronic insane, who number probably 50 per cent of our institution population. I shall go into my sub- ject tonight, however [Laughter], but since we are speaking of the various phases of nursing, I might just as well mention that in some positions there is required very little of trained nurs- ing. In those places wef require people, chiefly, who have patience. That is one of the elements of nursing, perhaps, but after all, it would be more of attendant service than nursing, with the chronic patients. I refer especially to those attend- ants who are sent out with patients into the fields, to the work shops, and to various other places. You don't require, neces- sarily, a trained nurse for that. It would hardly be necessary to call that kind of employe a nurse and give him any training especially, for that kind of service special training is not re- quired. Discussion by Dr. W. E. Taylor. I don't want to encroach on Dr. Podstata's subject, but I will say one word in regard to the uniformity of salary. I am firmly convinced, from our experience, that there is but one way to conduct the State institutions, and that is to conduct them exactly as you would any other great big business. If you are in any business, you are going to observe very strictly the law of the survival of the fittest. You are going to advance and pay more to those who are the best, the most faithful, the most competent, who demonstrate they are worth the most to you. You are going to pay them the most money. I believe that if a nurse comes into the hospital, and the mini- mum salary is $20.00 a month, if that nurse, or that attendant, develops within thirty days that she is worth $30.00 a month, we should pay her $30.00 a month. [Applause.] I know that we have . employes in our institution who started at $22.00 a month. They are still at $22.00 a month. They are still caught reading -novels. They are still caught stealing out of the kitchen. They are still caught violating some little rule, or regulation, and they stay at $22.00 a month, while their partner has advanced to $25.00, $30.00 and $40.00 a month. If you were to send for a physician, and choosing between Dr. Billings and myself, would it be fair to ask him to go for $1.50, as you would pay me $1.50? Not by a long shot [Laughter.] You would pay Dr. Billings $1,000 for a visit, and pay him cash, because of his ability, and you would give me $1.50, and tell me to put it on the book. [Laughter.] That is the way things are done in business. It is the way we are doing in our hospital. If our engineer saves coal, so that he keeps the per capita cost of coal and oil reduced down to a minimum, then it is because we have a competent engineer, and that competent engineer should receive $100.00, or $120.00, or even $150.00 a month, for he is actually worth it. I don't believe we should put a clerk in and pay him $150.00 a month unless he is a $150.00 man. Only a short time ago we took Dr Dolear, a young physician who had had some experience. We told the doctor we would give him $1,200 a year. That young man developed, before the end of the month, that he was an $1,800 man, and at the end of the month we gave him $150.00 Attendants for certain work. Business principles. Pay what service is worth. Gives an example. Reverts to business. 170 Vacillating as a class. Abolishing tramps. Pay for value received. Salary paid on entrance. In New York state. for his work. [Applause.] I believe if that incentive is held out to the employes iti the State institutions, and the superin- tendent, as a businesf man, is able to regulate the salaries, you are going to retain all that it is possible to retain in any kind o: Duslness. Attendants and nurses are a vacillating, changing sort of people. Some get married and leave on that account. Dr. Zel- ler has solved that problem in a large measure. He has no boys around. [Laughter.] They can't make the love matches as swift and readily as they can at the matrimonial bureau at Watertown. [Laughter.] Sometimes as soon as they accum- ulate $200.00 or $300.00, or so, they go into some little business for themselves and slip away. We have done away substantially with the "tramps" — that is, the migrating from one institution to another. They can't migrate from Watertown to Dr. Carriel. They can't come from Dr. Carriel to me. We have stopped that in a measure. Now, in my estimation, the only way to keep and maintain, and raise the standard of our employes in our institutions is to pay good employes what they are worth — and I don't know- but it ought to go as high as the superintendents, on ac- count of the change in the price of lard and all of that sort of thing, the increase in the price of shoes. I don't know but superintendents ought to receive more than they did ten years ago, when I commenced in the business. [Laughter.] I believe if we had the right and power to increase pay justly — iuas- mtich as we are held responsible for the contluct of our insti- tutions — I believe we would be able to succeed in retaining our employ6s as well as employers do in any other business. Discussion' by Joseph C. RIason. It seems the question is drifting away from the point Mr. Moulton made. The point on which we would wish to lay par- ticular stress is on the uniformity of compensation, that there should be a leveling of the inequality between institutions, in the salary paid when the employ^ enters. There is no reason why the Jacksonville institution should pay $lti.00 if the same employes are getting $17.00 at Anna, and Dr. Greene and Dr. Zeller pay $18.00 at Kankakee and Peoria, while Dr. Taylor pays $22.00 up at Watertown to start. Why, the other day an employs resigned, who had been for nine years an attendant in one of the institutions. There never had been a charge against her, there was no complaint, and yet she was drawing the munificent salary of $19.00 when she quit, and she quit in good standing. In New York they have uniformity of salary in the insti- tutions. In the northern part of that state they have the same conditions we have in the southern part. They can em- ploy help cheaper. I should say, they had uniformity of salary. The commission there was so cowardly it worked backward, just as this commission will be compelled to do imless you establish a uniformity, with a satisfactory sum. They were compelled to go back, let the superintendents — that is, making the positions of attendant non-competitive — and letting the superintendents appoint, as they do now. 171 BUILDINGS AND PHYSICAL EQUIPMENT. Mr. W. Carbys Zimmerman, the State Architect, read a paper on "Buildings and Physical Equipment." It fol- lows: It is with considerable hesitation and diffidence that I com- ply with the request to read a paper on " Buildings and Their Physical Equipment," a subject involving questions and prob- lems on which there is a great variety of opinion, and on which even experts and specialists differ greatly. There are, how- ever, certain definite well-established canons of architectural design and construction which are applicable to all classes of buildings and it is of these that I may safely venture to speak. First of all, the Site. In the planning of institutional buildings, the necessity for a proper site is of course all important. It may be said that in most instances considerable wisdom was shown in the selec- tion of locations having the natural beauty which is so de- sirable; the elevation insuring good air and proper drainage; and the extensive area making development and growth possible in any direction. On the other hand, there was less forethought shown in the laying out of the general or group plan, for the different buildings. Most of the institutions, as a whole, seem to have grown in a hap-hazard manner, instead of being the result of a definite, well-considered, prearranged plan. I would suggest that even at this late stage of development carefully drawn out group plans of all the institutions be made, plans which will show the situation of existing buildings, defi- nitely fix the position of those of the future, indicate the ex- act location of the underground work, distinctly marking the sewerage and heating pipes, and the electric and water systems. In consideration of the unavoidable changes in administration and employes, these plans should be made a matter of record. With a definite general plan of this character always in view, underground work can at the beginning be put in to take care of future growth, and expensive alterations and unnecessary re- ari'angements may be avoided. This general plan should, of course, also cover the landscape architecture of the site so that whatever planting is done from year to year as funds may be available, will always conform to some well conceived plan and not be subject to destruction on account of some new building project, or arrangement of drives or walks. It is all important that where the location of the institution is such as not to be assured of a plentiful flow of water at all times, storage tanks and towers be increased to an unquestionable capacity, to take care of any emergency of fire or otherwise. Construction of Buildings. Concerning the construction of the buildings, it would seem that the day for so-called "ordinary construction" for this type of building is past. Considering the class of inmates no other than fireproof buildings should, in my opinion, be longer con- sidered whenever further improvements are to be made. The high and constantly increasing cost of lumber on the one hand, and the great development and relative economy in fireproof Paper by Mr. Zim- merman. Based on well established canons. Wisdom shown. Plans should be recorded Should be fire proof. 172 Vertical extension not necessary. Fire escapes not satis- factory. construction on the other, make the difference in cost between the two methods no longer prohibitive. I consider it most un- fortunate that some of the older buildings of this ordinary non- fire resisting construction are so many stories in height. The danger of a calamity happening some day is apparent, for, no matter how complete the fire fighting system may be in these buildings, the loss of life on account of panic and smoke would necessarily be great. Even with the fireproof construction I would deem it wise to limit the height of these buildings in the future to two stories. At none of the institutions do city conditions exist with ex- pensive sites demanding vertical instead of lateral extension. The area of the buildings can be any desired dimension, the number of stories not more than one or two, and the difficulty of exit during a panic thereby lessened to a minimum. While it is evident that at all institutions considerable thought and attention has been given to fire escapes and exits, I doubt if any of them would pass a Chicago city building regu- lation in this respect, or would be allowed to remain opeo without further thorough remodeling. Fire escapes, as such, have been found again and again not to answer their purpose though normal people were affected. The tendency in the case of a panic is to rush to the customary exits. These are in sev- eral of the institutions insufficient, in my judgment, as to num- ber, capacity and location. Improper Use of Basements. In the ward buildings, though basements are, of course, neces- sary, they should not be made use of, even for storage. The air of a basement permeates to some extent the upper floors and being damp and affected by the exhalation from ground pipes and sewers, should have as many cross windows as pos- sible, which should be left open at all times. Again, articles stored in basements gather bacteria — breeding dust, which is objectionable and likely to be carried to other parts of the building. The use of basements for dining rooms seems to me unde- foVdinrng sirable, not alone for sanitary reasons, but on account of the rooms. general depressing effect these underground rooms are likely to produce on the occupants. Damp and dangerous. Depressing Let in the Sunlight. Ignored in The building should be so constructed or located that direct older sun rays may enter every room at least for a part of the day. The buildings, ^ffg^t of direct sun rays on the physical and mental well being of human beings is so well known today that it is not necessary to enlarge upon it. Nevertheless in some of the older institu- tional buildings this matter has been more or less ignored. Rooms and wards exist which have north exposure only and are without possibility of ever having direct sunlight enter them. In many, with a proper exposure, a sufficient glass sur- face was evidently not fully considered, and I think that in some instances the general well being of the patients would be ma- terially increased by doubling the number of windows now ex- isting. Screened i The exposure of inmates to direct sunlight and outside air porclies. hieing of such great importance, I would suggest building on jsome of the high, older structures, glazed screened porches iwith a capacity large enough to hold all the inmates in order that a certain out-of-door life would be made possible in even 173 the most inclement weather. In addition to this, these ver- andas would be of the greatest importance and value as fire escapes, as they would lessen the danger of panic and con- gestion, and make the way to outside air and comparative safety easy and simple at all times. In this connection I suggest that the exterior style of architecture be made merely a secondary consideration. Not one foot of glass surface should be sacrificed; the windows, porches and exits should be placed where needed and the ex- terior be an honest expression of the all important plan and its conditions. Treatment of the Interiors. As a matter of course the interior treatment and finish of these ward buildings should be as simple and as smooth as possible. Dust gathering niches and projections of all kinds should be avoided, and the walls and ceilings be smooth and hard; kept in perfect repair, and periodically painted with a washable, non-absorbent material. Corners wherever possible, be they woodwork, plastering, or flooring, should be rounded and smoothed off. Stamped, ornate dust-carrying iron ceilings, as found in one of the institutions, should be, in my opinion, torn off and replaced with smooth hard plaster. The ideal floor has not yet been invented; tile, marble, mosaic and various combinations of cement and other materials are too hard, too noisy and too cold. Wood at the present time seems to be the only material that can be made use of. This should, however, be hardwood, thoroughly kiln-dried and sea- soned, and laid in as narrow strips as possible. When thoroughly soaked in oil and constantly kept polished with wax or paraffine it answers all purposes reasonably well. On the other hand, when wood floors, as I find in several of the insti- tutions, are of wide soft wood, improperly laid and poorly sea- soned, with joints spread apart, they form ideal breeding places for germs and microbes. They should be torn up and relaid with proper material. Plumbing Appliances and Fixtures. The development and constant improvement made in plumb- ing appliances and fixtures is so decided that any one, to have his home what it should be, finds a change of fixtures neces- sary almost as often as he does repainting and redecorating. In the buildings under consideraiion, this attention to the plumbing; this attempt to keep the fixtures on a par with modern sanitary^ development is, of course, still greater im- portance. It is inexcusable that fixtures out of date fifteen years ago should still exist in them and that closets with old fashioned, unsanitary wood seats and uncleanable, disease breeding urinals should still be in use. There were even more serious conditions. I found in one institution closets of the most primitive type, flushable only at the will of some possibly absent attendant, located in sleeping rooms, without partitions of any kind around them. I am glad to say these have been removed, and that all the plumbing is being thoroughly remodeled. It goes without saying that the floors and walls about this plumbing should be of the highest sanitary type. Wood floors with open joints, as they now exist in some instances, should at once be removed and tile, mosaic, marble or some other non-absorbent floor substituted. Then again, these toilet rooms should be well separated from other rooms. It is highly objectionable Sacrifice no glass surface. Avoid niches and pro- jections. Hard wood best for floors. Frequent clianges necssary. Unsanitary conditions found. 174- Ventilation for most part unsat Isfactory. Central power plant. Automatic stokers. Smoke nuisance. K&8J to complain. from any point of view to have them enter directly into the day or sleeping rooms. Lobbies or vestibules cross lighted and ventilated should intervene between all toilets and the living or sleeping rooms. I consider this a matter of great importance and where this arrangement does not exist I would suggest that an attempt be made to correct the difficulty. Problem of Heating and Ventilation. The proper heating and ventilation of the building is. as we all know, an all important consideration. A proi)er artificial heat supply seems to be sufficient in all institutions. The ventila- tion, on the other hand, with the exception of one or possibly two cases, is in general unsatisfactory. While many of the buildings at all institutions have some kind of ventilating sys- tems, they are not of a character that can be relied upon under all conditions. I am well satisfied that a pressure system, a system which forces warm, fresh air into every part of a room, regardless of outside temperature and barometric conditions Is a satisfactory one. Such a system makes it i)ossible to supply any desired amount of air, medicated if needful, to any pa- tient, at any time, without causing disT green ble draughts. Where any large number of patients are being housed in one compartment a system of this kind is to my mind necessary, and I am sure will bring about noticeable imi)rovement in the general health and well being of those concerned. It goes without saying that without some such absolutely reliable sys- tem of ventilation in sleeping rooms containing a number of beds the closest attention possible should be given to the proper airing of the rooms, windows be kept wide open, even in the most inclement weather. The result of the unavoidable cold draughts cannot be as serious as the lack of a constant fresh air supply. The square and cubic foot space allowance for the patients, though a matter on which opinions vary decidedly, seems to be at best but ill proiiortioned and evidently a mini- mum allowonce denied in many instances. While the supply of artificial heat is sufficient the generating of it is not as economical in some instances as might be. There is a well recognized economy of operation to be obtained by establishing a central nower jilant and where more than one plant exists at an institution it is advisable to remodel it Into one unit. Automatic stokers in these plants have earned the cost of installation in a short time by the money saved in operation and cheap fuel. Thoy should be installed whenever feasible. In this connection it seems that the State should set an ex- ample to its citizens by not allowing the smoke nuisance so noticeable at some of the institutions. Proper, so called, smoke consumers should be installed wherever possible. Neither should the State pollute adjacent wnter courses with sewerage often of a dangerous chaiacter. The modern septic sewage tank system would, in my opinion, be a desirable addition to the physical equipment of the institutions. Om.v Di:sinK is to Assist. It is, of course, an easy matter to jioint. out faults and short comings. It goes without saying, that is done in this paper for the purpose of correcting them, wherever possible. I am well aware that different conditions existed years ago when some of the buildings were erected, and that some of the work 175 objected to was excusable and unavoidable at the time. It is to be hoped that funds may become available which will make it possible that an attempt can now be made to apply to build- ings and their equipment that knowledge of modern construc- tion, sanitary engineering, heating and ventilation and medical science which later day development has given us, and remodel, alter and rebuild the older buildings to conform to some extent to newer and more satisfactory conditions. If this can be done and at the same time the severe institu- ^^^^':. insti- tional nature of the institutions can be softened so as to give resernble more of the home character to the buildings, the rooms, their homes, furnishings and decoration, the grounds and their surroundings, I am quite sure that that calm and contentment which is so essential to the well being of us all will be quite marked in the condition of the unfortunates, whose welfare it is the sacred duty of us all to guard. CONSUMPTION IN PRISONS, ASYLUMS, JAILS, AND IN THE COMMUNITY AT LARGE. W. A. Evans, M. S.. M. D.. Prof. Pathology, University j^^P^f ^^^^ of Illinois, read the following- paper on "Consumption ini Prisons, Asylums. Jails and the Community at Large :'' j In the time at my disposal I shall discuss the relation of con- Relation to sumption to the care of the defective classes, and as a converse! care of proposition the relation of consumption in the defective classes to the spread of the disease amongst the people at large. We can assume that amongst defectives consumption is about twice as prevalent as it is in other groups of people at the same age period. According to Ransom, 40 to 60 per cent of all prison deaths are due to consumption. The percentage of deaths due to consumption to total deaths at the same age periods is about 30. About 18 per cent of all prison populations are actively tubercular. Jewett gives 13 per cent for Indiana. Hinsdale says that 75 per cent of deaths amongst prisoners in Pennsylvania in 1890 were due to consumption. The Texas statistics show 66 per cent. The same figures of prevalence though not of death rate are found amongst the insane. Reason for Prevalence Among Defectives. The reasons for this prevalence amongst defectives are: 1. The mental or moral defect is usually a physical defect as well. Says Ransom, 45 to 50 per cent of crim- inals may be said to be criminals born as to inheritance, environment or development. A number' of years ago Woods Hutchinson studying the chest of the tubercular found that there was an arrest of development and that the normal adult index of 71 was replaced by one of 79. The type of chest of the tubercular was that of adolesence. A series of measurements made by McHugh and Evans at Dun- ning showed approximately the same index. That is, the con- sumptive has a chest which is deep from before back, and nar- row from side to side. This is not due to consumption but in Physical de- fect as well. Chest meas- urements. 176 Bad environ- ment. Faulty care. Hot beds of Infection. Specific divisions of topic. Examination once a year. Reasons. Tnltorcnlid Is acciiintc. a certain sense consumption is due to it. When we came to measure the chest index of the inmates of the poor house located on the same grounds, we found approximately the same index. In a certain sense this discredits the observation of Hutchinson, yet it does not do so entirely. The inmate of the poor house is a defective and it is just amongst these that there is the largest death rate from consumption. 2. The previous environment of the defective, moral, mental and physical, has been bad. 3. His care of himself has been faulty. 4. Asylums, prisons, jails and the homes of defec- tives are hot beds of infection. B.\SIS FOR Dl.SCUSSIONS. We will discuss: 1. What should be done with the consumptives in the present institutions. a. Necessity for diagnosis. b. Care in asylums. c. Care in prisons. d. .Tails. 2. Should there be a consumptive hospital or hos- pitals? a. Hospitals for late cases. b. Sanitaria for early cases. 3. The need of some effort to control the disease. Tuberculin' as a Diagnostic Agent. Taking up head 1, subdivision a. The plan which I advocate is that once each year, preferably in the autumn, every inmate be "xamined for tuberculosis with tuberculin. My reasons are as follows: 1. Tn early cases of tiiberoilosis i)liysical examination and consideration of the symi)tomatology has about twenty per cent of inaccuracy (estimated.) 2. In defectives, especially mental, this percentage will be materially Increased. 3. In large institutions the amount of time required for accurate physical diagnosis is i>rohibitive. Let me discuss the advantages of tuberculin: 1. It is accurate. The Dunning experioncos of Wood, in which I have participated, are a fair index of the general consensus of opinion on this point. There is about ninety-four per cent of accuracy or six per cent of error. This perr-entage is divided as follows: Two per cent of cases of advanced tuberculosis do not respond to tuberculin. Those old cases, clinically, are cases of sepsis and, probably, a quite considerable tubercular immunity has been established. Whetbor or not this is the proper ex- planation, the phenomena has been frequently noted. The other four per cent of error is due to febrile reaction where there is no clinical tuberculosis or where none has developed within a short time thereafter, and in which there was some reasonable exi)lanation of the temperature other than tuberculosis. Syphi- lilics and hysterics and especially those strongly subject to sug- gestion are prone to give a febrile reaction when no tuberculosis is present. In these cases the jmssibility of a small focus is not to be lost sight of. This six per cent of error is to be contrasted with the more than 20 per cent of other plans of diagnosis. 177 2. It is convenient. The method advised is as follows: Take the temperature at eight, twelve, four and eight o'clock for three days prior to the test. Record it. Inject with ten minims of a solution of tuberculin in carbolic water (tuberculin O. 1 c. c, carbolic acid O. 5 c. c, water 9.5 c. c.) toward bedtime. Take the temperature every two hours during the following day. A temperature curve previously normal mounting after in- jection to 101 or over constitutes a reaction. The records of each case must be kept, of course, during this period of trial. This is, as you see, a nurse's proposition. It will increase the work of the nurse say ten per cent for four days and of the doctor a moderate degree for one day. It is not to be compared in point of time, care or skill required with physical diagnosis or careful weighing of symptoms or any other diagnostic procedure. 3. It is safe. Its use is advocated by Trudeau, Osier, Flick, Tinker, Baer and others. This is collateral proof of its safety. The theoretic objection to its use was due primarily to the hastily uttered dictum of Virchow at the time of Koch's discovery, was augmented by the failure of the general claims for curative action of tuberculin and has received support from time to time from isolated experiences. Each of these points will be analyzed in turn. Virchow's statement briefly was that tuberculin would produce necrosis of the peripheral tissue of the tubercule and the bacilli would be poured into the general circulation and miliary tuber- culosis would result. That Virchow's position was hastily as- sumed and based upon rather insufficient observation is recog- nized. The observation of Ribbert is that the arterial tubercle is usually in the media or deep intima and that there is a fair con- nective tissue covering, to which is added a clot covered by endothelium. Exceptionally there is an ulceration into the vessel with a fulminant miliary tuberculosis. But the usual form of miliary tuberculosis is the subacute variety, which is due to in- fection through the thoracic duct as has been shown by Whipple, (Johns Hopkins Bulletin, August, 1906) with which the use of tuberculin could have but slight connection. 4. The failure of the therapeutic use of tuberculin should have no bearing on this question. 5. Such individual experiences as that of Knopf, who saw a generalized tuberculosis follow the use of tuberculin in one case. Knopf says that he could see no relation of cause and effect, but that he could not exclude it. In the August American Journal Medical Sciences Trudeau cites a case in which he was about to use tuberculin and just then the disease became generalized. Had he used it there would have been no way by which he could have proven that the generalization was not due to the use of tuberculin. I know of no close observation tending to show that tuberculosis has ever been spread by the use of a diagnostic dose of tuberculin. I offer the following conclusions: 1. That all inmates of institutions should be ex- amined for tuberculosis on admission. 2. That a systematic examination of all inmates should be made once every year. ( Some writers say twice a year. New York Medical Record, 1906.) 3. This should be one with tuberculin. 4. Tuberculin is appreciably more accurate than phy- sical examination. 5. In defectives it is more advantageous than in other peoples. 6. It is the only agent practical with the present equipment of doctors and nurses of asylums and prisons. —12 PC Tuberculin Is con- venient. Tuberculin Is safe. Tuberculin not the cause. No argument in thera- peutic failure. Some indi- vidual experiences Statement of conclusions 178 Points SPnorally accopted. Experience in State institutions Among tlie insane. SegiPjiate late cases. Tii-atment of (>aily cases. Cost. 7. If its absolute safety Ijas not been demonstrated, and can not be demonstrated, a rational degree of safety can be inferred from such experiences as Pottenger's 9,500 cases. Tinker's 400. Trudeau, Baldwin and King- horn's, Ball and Kennard's, Reed's observation on 9G5 cases in i)risons (J. A. M. A., 2-40."j) or Neff's at the Pontiac Michigan asylum, or Wood and Evans' at Dun- ning, etc., or Jewett's in the Indiana prisons. How TO TkKAT CONSIMI'TIDN IX ASYI.VMS. The general principle of the outdoor care of consumptives is understood by you. We can assume that the following points !are both proven and generally accepted: a. Most cases of early tuberculosis and some cases of late tuberculosis can be cured by the combination, col- lectively called, the open air treatment of consumption. b. That about sixty-six per cent of those who are dis- charged as having the disease permanently arrested re- main symptoraatically well after the lapse of ten years. c. These cures do not become pensioners, but are productive members of society. People who are disposed to psychic invalidism seldom get well of consumption, and, when they do, do not remain well for long. The question then to discuss is the variation of the open air treatment demanded in the case of the insane. The experience had at Blackwell's Island, in other state in- stitutions and in this State, so far as it goes, shows that this treatment is available for asylums. That certain psychoses are benefitted by open air. Many insane do not cough. These not having the drainage of the lungs which coughing gives usually die rather promptly. Such cases are observed mostly amongst the melancholies. They are relatively not very dangerous from the standpoint of in- fection. They frequently imi)rove physically and mentally under open air infltiences. The insane with late consumption should be segregated in wards which can be readily cleaned and kept cleaned. The tem- perature and general environment should be such as to make for comfort rather than cure. The effort should be to prevent infection of surroundings and keep the patient comfortable. The early consumptive whose mental condition will allow should be treated like the early cases amongst the sane. The febrile cases should be keiU in bed during the days or weeks of fever. They should be up when free from fever. They will \noh- ably require more attention to constipation than in the case of the sane. Convalescents must be given physical work. The cases whose mental disturbance makes open air treatment impossible can be made to approximate such treatment in so far as the circumstances of the individual cases or of the group will allow. Hi ii,i)i.N(;s n)i{ CoNsiMrriVKs. Buildings for consumptives should cost from fifty to $200.00 per bed. The consumptive hosi)ital recently erected by Cook county, an excellent institution, architecttirally, cost $140.00 ner bed. Insane bosjiitals and a children's hos|)ital erected at the same lime cost $4iio.no to $t;(io.oo per bed. Shacks and tents, the api)rovod bousing at the i)r(>sont time, can be erected for $.'50.00 to $100.00 i>er patient. At Dunning the cost of food, nursing, administrntion and everything is still under fifty cents 179 a day. The total expense at Liberty in the annex is now $5.60 ai week. At Saranac, $9.61 per week; Rutland, $9.00 per week; St. Joseph's. $5.60; Seton, $5.52; Blackwell's Island, $5.92. Youj know how these items compare with the per capita cost of main- tenance of the insane. Consumption in Prisons. In my judgment we can expect great improvement in the tuberculosis situation amongst criminals. My reason for this hope lies in the importance of control in tuberculosis. The con- sumptive who is febrile — actually sick — is tractable. When he begins to improve, when his temperature has gone, when he has gained in weight and strength, he is usually uncontrollable except he is a man of unusual intelligence: This is the time of danger. "The time of the Truce of the Bear." The opportunity for con- trol in prisons is the only adequate meeting of this situation. The results with late cases at the United States hospitals at Ft. Bayard and Ft. Stanton are better than the results with the same grade of cases anywhere that I know. Earlier statistics from Ft. Bayard and Stanton show of the cases in the second and third stages: Thirteen per cent apparently cured. Fifty-one per cent improved. Three per cent unimproved. Twenty-six per cent died. These excellent results, in the later cases, mind j^ou, were pos- sible because the patients, being soldiers and sailors, could be controlled. If this logic is good, then the prison statistics should be even better. Ransom's report for New York shows from Oct. 1, 1902, to Nov. 1, 1904, 461 cases of consumption amongst prison- ers were treated. These 461 cases were divided as follows: Sixty- one had had the disease less than one year; fifty-five one year; 240 less than five and over one: 105 over five years: fifteen had died; 202 had been discharged from prison; the remainder were still in prison. Of the 202 discharged, twenty-five were appar- ently cured. In eightly-five the disease was arrested. In eight greatly improved; seventy-six improved: negative, eight. The death rate from consumption amongst consumptives in Clinton prison was 3.28 per cent, as compared with 14 per cent at Ft. Stanton. 20 per cent at Ft. Bayard and 29.68 per cent amongst the insane at the Metropolitan Infirmary in New York. I think that prolonged observation will demonstrate that the consumptive paupers in the second and third stages in county or city hospitals will practically all die. That the death rate amongst the insane taken in the second and third stages of con- sumption will be much lower, and the death rate amongst prison- ers will be lower still. The reason for this lies in the differing possibilities of control after the patient has begun to feel well. The prisoner with consumption is of especial importance be- cause at the end of an average of five years he goes back to the community and usually into an envifbnment that is fuel for consumption. When the pauperizing tendencies of his disease are added to the difficulties of his past, he can not maintain himself in a competitive society and he perforce remains a crim- inal or becomes confirmed as such. The farm plan for consumptive prisoners is peculiarly advan- tageous. The experiences of the southern states demonstrates that the cost of guarding is not prohibitive. That this cost would mount in northern communities near metropolitan cities can not be denied. The cost of guarding is purely an economic proposition. As such it never equals the gain from increased Expects im- provement in tubercu- losis situation. Statistics. Applies to prisoners. Practically all will die. Back to his community. Farm plan. i8o Uoad work. Effects of dust occu- pations. iproductiveness. By the farm plan the State gains financially and I in health of the convicts and in freedom from the influence of labor agitation. Road work, the making of public highways, is on the same plane of relative advantage as in farm work. In road work t;iiarding is easier than in farm work. The convict suffers much from the bad effects of dust occupa- tions. Likewise the hygiene of his cell is usually bad. Ransom l^^specially condemns the use of whitewash, furnishing as it jdoes so much of a bad grade of dust. The late consumptive in prison should be segregated and made safe and comfortable. He 'should be forced to expectorate in paper, to place this in bags, and to save these bags. The febrile prisoner should be in bed in the open air on roofs, porches and tents. The afebrile consump- tive should live ana work in the open. The fare of the con- sumptive prisoner should be doubly as nutritious, more varied land more inviting than that of the average prisoner. Consumption in Jails. Occasionally jail life is quite prolonged and many cases of con- sumption result from the happy-go-lucky jail conditions. Jails f-mpty their population much more frequently than once a year and the consumptive goes back usually into a most dangerous environment. Has not the community right to examine Inmates of jails community, for consumption and teach them how to live? If a man Is ac- cused of petty larceny or robbery, has the community the right to crowd him in with ignorant and careless consumptives and condemn him to consumption? If the community knows better and is careless, is it not responsible? Generalizing from this, why do we not have compulsory notification? I>et us say that a case of consumption is reported to the health department The department investigates and finds the party is taking such precautions as make him safe. He should have all the rights of any man. If the department investigates him and finds him ignorant or careless and therefore unsafe, the community has the same right to deprive him of his liberty as they have that of a criminal or insane. Every consumptive has the right to be judged on his merits. The remedy for phthisophobia is com- pulsory notification. Happy-go- lucky conditions Right of the For the mentally and mor- ally weJl. Danger during last dny.s. Functions of munici- palities and county boards. Sirmn.n There Be Hospit.\ls for Consumption? The second division of my subject is the hospitalization of the mentally and morally well who become consumptive. In my judgment, the proper disposition of these is as follows: 1. Supervised quarters for the late cases. 2. Sanataria for the early cases. During the last sixty to ninety days of most every case of consumption the patient is so weak that he can not help but In- fect his .surroundings. Most consumptives are ignorant or care- less enough to be dangerous earlier in the disease. Especially is this true of the uneducated and of the very pooor. All such in both groups need some assistance. Sometimes this can be left to the family and to nurses, .lust as frequently help is needed. The need, therefore, for hospitals for late cases is greater than is that for sanataria for early cases. Hospitals for late cases are the function of municipalities and county boards. Even the smallest and poorest of counties can have supervised quarters. General hospital equipment is not re- quired. The demand is for a place hygienically kept in which i8i Value as teaching Institu- tions. Pauperizing potential- ity of con- sumption next to insanity. the consumptive can be made comfortable and safe. The per bed expense should be less than in a general hospital. The board of Cook county were wiser than they thought in building such an institution as that at Dunning. The State should have a sanatarium. This institution should be reserved for early cases. It could justify its existence on the basis of cases cured and returned to a productive life as well as families saved from pauperization. The per bed cost indepenent of an administration building need not exceed $150.00. The great Saranac institution began with $350.00 total cost of installation. Two years at $500.00 per year is more than the average cost of restoring to produc- tivity a man who otherwise would have died after a protracted illness pauperizing his family — a man with an average life ex- pectancy of thirty-five years and worth to the community, ac- cording to the estimate of Hoffman. $1,700.00, and potentially worth to his family, according to Price, $18,067.50. But the overwhelming value of these sanataria is as teaching institutions. Saranac no longer stands for an institution; it is a section of country. For every patient who can get into the sanatarium there are scores who squat as near it as possible. What is true of Saranac is true of all the others. The number of people in the vicinity far surpasses those in the institution. Not only that, but they are great educational institutions for the sick and well of the entire State. Rutland as an educational institution, in good accomplished, compares favorably with Har- vard. And Saranac is no longer a place; it is a force. In pauperizing potentiality consumption is next to insanity. Its curability adds to its importance. Its preventability is a further addition. Price's calculation adapted to Illinois shows an actual loss to the family of $7,200,000.00 in wage yearly and a potential loss to the families of this State of $145,000,000.00. A great teaching, curing institution can save much of this. Is it not worth while? Does it not pay to be healthy — the individual — the community? And besides, the needless agony of it all. Discussion by Dr. Webster. It is a hopeful sign to those that are engaged in the crusade against tuberculosis, that this conference is concerning itself, not with the general ravages of the disease, but with certain special phases of the problem. I am particularly glad, therefore, of the opportunity to speak to you upon what I think is one of the most pressing needs of the situation and one of the most glaring of many neglects of which we are guilty, namely, tuberculosis in public institutions The field is so broad and so well covered by Dr. Evans, that I beg leave to consider only one class of institutions, the prisons. Inquiry by the State Board of Health. With a view to determining what the conditions are, partlcu- to determine larly at Joliet, where 1,200 to 1,400 prisoners are confined, thel conditions. State Board of Health conducted some examinations of the prison in April, 1905. Before detailing the results of the experiments, it should be iq the cells, stated that the cubic measure of each cell is 196 feet; that two prisoners are confined in each cell, and that after deducting space occupied by two cots, buckets, etc., that the cubic space per man is about seventy-five feet. There are no toilet facilities. The minimum number of cubic feet insisted upon by law in the poor- est lodging house of our large cities is 400 cubic feet. The minimum normal is 1,000 cubic feet, with facilities for renewal three times per hour. Hopeful sign. In the prisons. 1 82 Contamlna- I The nornml amount of carbonic acid gas, which is the measure tlon of tlieLf contamination of air, is three volumes in 10,000. While the prisoners were absent from the cells, the average contamination was about nine volumes. Two hours after the return the average volume of carbonic acid varied from 14.1 to ^'>A in different cells. Three and one-half hours after their return from dinner and with roof ventilators partially closed to approach cold weather conditions, the volume of gas arose to 21.3 volumes, seven times the normal. Quotps from .lollet report. Two con- victs In one cell. Pestilontial conditiuns Should leave fit to work Cell hoiipos at nlRlii. numane In its spirit. Bennett's statistics. Conditions in thk Ckll Housf. A description of the conditions existing in the cell house may well be quoted from .Joliet penitentiary report of 1902, quoting from the report of 1900. It is as follows: The two wings of the penitentiary contain 900 cells in which to take care of 1,200 or more prisoners. It is necessary, therefore, to put two prisoners in many of the cells, which are only seven feet long, seven feet high and four feet wide; and we feel that we can present the matter no more forcibly than to quote from our last biennial report and say that: When one thinks of two men spending never less than fourteen hours each day during six days of the week and on the seventh day nearly twenty-one hours, in a space so reduced, and with a slop bucket in the cell for their use in responding to calls of nature which no care can prevent from being offensive and pestilential in every sense of the word, he is compelled to ask what excuse the great State of Illinois can offer for compelling the management of this penitentiary to so deal with men wlio are required by law to serve sentences here, that they must eat, rest and sleep in quarters so con- tracted, so repellant, and so utterly unfit for the pur- pose that their very existence is a disgrace to the State that permits it. We are not believers in any system that would tend to pamper prisoners or to make the prison so attractive that confinement therein would have no terror for <^vil doers, but we are believers in a system that will pre- serve at least health and strength to the inmates, so that they can perform the daily tasks allotted to them here, and be enabled to leave the institution in such physical and mental condition that they will have no ex- cuse for not going to work us soon as occupation can be found for them. One visit to the coll houses during the night time, a few breaths of the atmos])hero coming from them, is all that is necessary to convince the most skeptical that the half has not been told by us, and we hero and now enter our solemn protest against the continuance of such a system of herding men together, to the detriment of their physical and moral natures. It will certainly be a matter of pardonable pride to any administration thai an improvement so just in it. conception, and so humane in its si)irit, was carried to a successful conclusion under ILs guidance. En KCT Upon thk Duatii Ratk. What is the effect of such conditions upon the death rate from iiberculosis? The following statistics are taken from the report if Dr. .1. O. Bennett of the Western Penitentiary of Pennsyl- i83 v-mia, in his paper on "Tuberculosis and Cellular Confinement." It shows that the average death rate from tuberculosis in six- teen of the state penitentiaries is 41 per cent. In Joliet, the aver- age since 1S89 has been 60 per cent. TABLE SHOWING INFLUENCE OF TUBERCULOSIS ON PKISON DEATH BATE. Prison. States. Years. (Inclusive.) c£ to te ft> & d B „0 C p §^ Si. ai : 3 : S : c • ff • 7 ll o p- ££.'■« Auburn New York . . do. 1891-1902 ..do 298 221 193 261 272 292 167 131 118 49 195 158 32 20 1,399 47 133 116 73 124 176 88 105 52 48 19 116 41 9 1 592 24 44 5 Sing Sing 52 Columbus Jefferson City Ohio Missouri Illinois Virginia P( nnsylvania. ..do 1898-1902 1892-1902 1891-95-98-99... 1891-1902 ..do. 37.8 47 5 Joliet 64 Richmond 30 Eastern 62 8 Western ..do.. 39 6 Wethersfleld.- Connecticut. .. Massachusetts West Virginia Kansas ..do. 38 9 Charleston ..do. 38 7 Moundsville ..do.. 58 9 Lansing ..do. 26 Fort Madison ..do.. 28 Central State and county prisons Toronto, Can. Alabama Minnesota 1893-1902 ..do 5 42 Stillwater 1891-1903 51 DEATHS FKOar TUBERCULOSIS AT JOLIET. Report of deaths from tuberculosis in Joliet since 1888, as shown by warden's report, 1902, p. 24, and personal letter from prison physician Oct. 16, 1906: From warden's report. All deaths. Tuberculosis. Per cent. Four years ending Sept. 30, 1892 130 160 95 31 6 16 10 77 112 56 17 3 6 5 59 Four years ending Sept. 30. 1896 70 Two years ending Sept. 30. 1900 58 Two years ending Sept. 30, 1902 51 Total deaths in 1903 Total deaths in 1904 50 37I2 Total deaths in 1905. 50 Woman's Prison a Redeeming Feature. The one redeeming feature of .Joliet is the woman's prison, iTuberculosis which is equipped with cells arranged for one person. The cells almost are amply large, ventilation facilities permit of change of air "° nown. every ten minutes; there is a permanent wash bowl and toilet facilities in every cell. There are no foul odors here and tuber- culosis among the feviale inmates is almost unknown. We thus see that in the old cell houses we have the conditions Remarkable most favorable for the development of tuberculosis, and in the game^vard same prison yard a remarkable contrast in the absence of the 1 84 What Is to be done? Remedies. Examination. One place for tuber- culous patients. Exampip of New York state. Monaco to society. disease among the female prisoners where hygienic and sanitary fonditions are reasonable. The only wonder is that the death rate among the males is as low as it is. This is due to the fact that the officials of the penitentiary have been absolutely unre- mitting in their efforts and have accomplished wonders with the miserable facilities with which they have been provided. Too much credit can not be given them. Problem of Society at Labge. I These are the conditions. What are we going to do about it? Some may argue that these men and women are criminals, dangerous to society, and that society is well rid of them, even though killed off by disease. Leaving aside for the moment the ethics of the question, it may be well to recall that statistics show that practically the entire prison population is released every five years. This means turning loose upon the community of thou- sands of infected individuals. To say nothing of danger of infec- tion by infected goods from the penitentiary. It is not then a prison problem at all; it is a problem of society at large. It is a public health measure. It becomes a matter of self preservation. Steps to be Taken. There are three things necessary: 1. A new cell house. 2. Recognition of the disease. 3. Isolation of all cases. Every prisoner should be examined with extreme care and where there is any doubt in regard to the diagnosis, tuberculin should be used, as this agent is efficient and accurate in over 95 per cent of cases and is harmless. Provision should be made at one of the prisons and all tuber- culous cases sent to it, and this should l)e preferably a tubercu- lous farm, as is done in Texas. This farm has thus far been self supporting and more, if the expense of guarding the prisoners is left out of account. New York has made partial provision at Clinton prison and a system is planned to provide for transfer of all tuberculous cases from all prisons and reformatories of the state to this one cen- tral institution. In conclusion, it may be said that present conditions are a disgrace to the State and are a menace to society, and that aside from ethical considerations, as a public health measure, reform is demanded. This can be accomplished by a new cell house at Joliet, recognition of all cases, segregation. ILLINOIS SHOULD FURNISH FREE DIPTHERIA ANTI- TOXIN TO ITS CITIZENS. Taper by Dr. Web- ster. From per- sonal charity to State care. Gcorcfe W. Webster. M. D.. president of the Illinois State Hoard of Health and president of the Chicac^o Medical So- ciety, read the followinc^ paper on "Illinois Should Furnish Diphtheria .\ntifoxin to Its Citizens:" It seems strange that all of the "muck rakers" of recent days have forgotten to say one word in favor of that altruism which is In many respects the most conspicuous feature of modern life. i85 Fifty years ago the care of the insane, the unfortunate, the de- pendent, the halt, the blind, was almost wholly a matter of personal charity. The most Impressive fact in our modern civili- zation is that the altruistic principle has passed from individuals to the state, and millions are now spent by the states in an attempt to uplift the unfortunate and relieve individuals from burdens beyond their strength to bear. It is one of the greatest glories of this age that it supplies the necessities of those who are utterly dependent. Brotherly love is a sentiment kept warm in the hearts of the vast majority of the American people. "We are learning to concentrate our attention and efforts upon our duties as citizens more than upon our interests as individuals. While we have met together today in obedience to this decree, For both and in recognition of the fact that in the spirit of charity we ^'*^^. ^°^ are indeed our brother's keeper, I appeal to you in behalf of a ^^ measure which not alone concerns the unfortunate sick, but the, welfare of those who are not sick. Following the example of Massachusetts and New York, the State of Illinois should authorize the State Board of Health to manufacture and furnish free of cost to all its citizens, all the diphtheria antitoxin needed for the treatment or prevention of diphtheria. It should do so for the following reasons: A Public Health Measure. First. It should be clearly understood at the outset that this is a public health measure designated primarily for the protection of the well who have a constitutional right to such protection. It is no more a matter of charity than is the building of battle ships or the maintenance of a standing army. The well have the same right to protection of their lives as they have to their per- son or property. It is not intended primarily for the free treat- ment of diphtheria by the State, but primarily for the purpose of protection, the cure really being secondary, and it is on this ground alone that it is justified by the State on the same prin- ciple that we maintain costly penitentiaries, insane asylums, pest houses, not primarily for the reformation of criminals, the care of the insane and smallpox patients, but for the protection of society against a preventable disease. There is nothing incon- sistent in the people being taxed to protect them from disease and premature death. A State that has spent forty millions of dollars for a drainage canal to provide Chicago with pure drinking water and prevent typhoid fever, can well afford a few thousand dollars to prevent diphtheria. Neither is it "paternalism," as I am sure will be argued by some, an argument which reveals a lamentable want of knowledge and proper conception of the fundamental prin- ciples both of the Federal Constitution and the sanitary rights of the people. It is not "paternalism," but "fraternalism." It should be supplied hy the State free to all citizens of the State who need it and want it. It will be argued that it should be supplied free to the poor only, as the rich can afford to pay for it. The latter fact is true, but irrevelant. The plenary, inalienable rights of the Constitu- tion have never been in proportion to the individual's tax paying ability. Furthermore, the rich man who pays the most taxes is certainly entitled to it, as he pays for it, but the rich would doubtless pay for it just as they do now. Make free antitoxin. Protection of society. Not paternal- ism, but fraternal- ism. Rich pay the bill. i86 Justifies uinkln^ and free (listril.u- tion. Exi)crlences In New York. I.«tter from Dr. I'ease. Cost of epidemics. Specific in- stances i)i use. Quick action. I It Is a Sube Preventive. ' Second. It is fhiefly on this ground that Its manufacture and free distrilnition by the State is justified. In Chicago, in the homes of the jjoor, 8,1:59 cases were given immunizing doses by the department of health. Only one-half of 1 per cent subse- quently acquired the disease, and none died. The reports of the New York State Board of Health show where over 1,000 nurses and inmates of one state institution were exposed to dijihtheria. all were given immunizing other week, will be found neither attractive nor even possible for intelligent, interested, and capable nurses. i .Most difficult to deal with. IntelllBonce and tact requlnd. .Must know symptoms and treat- ment Ready for any emer- gency. Competent nurses hard to And. Special Medical and Surgical Cases. 2. The special medical and surgical cases number from 5 to If^Requlrp less per cent. They require comparatively less attention. Good know attention, ledge of general nursing with at least elementary knowledge of mental diseases and about the same personal fitness required from every nurse, will answer well. Every training-school should easily | develop and train a sufficient number of suitable nurses. Cases of a Chronic Type. 3. The chronic more or less stationary class forms at least one ^''J*'. , half of all the insane. The requirements of service for this class nece^sa^y. are limited to elementary knowledge of mental, general and emer gency nursing, such as can be readily taught to a person of aver age Intellect in six or eight months training. There is, however, connected with this service a special require Provide em- ment of very great importance. I refer to the special fitness of P'oymeot. the individual attendant to employ the largest possible number of patients. It means to suggest work for those already capable and willing and to patiently, tactfully teach and stimulate to various employment all who possibly can be reached. This class of work dtcs not require any college education. A big warm heart, natural tact and perseverance, are the requirements. Patients are now being "broken in," as it is commonly called, to do work on the. 200 ward and elsewhere. The value of that kind of a "broken in" man or woman patient can easily be ascertained by suggesting to the attendant that he or she be transferred to some other depart- ment. If it is possible to "break in" and make valuable workers out of one or two by a crude, sometimes decidedly harsh, method, is it not possible lo "break in" or educate a large number by a ronsistent, intelligent effort? Kind CUB todial care. Ideals per fectly at talnable Unpbomising Remainder, Mainly Hopeless Cases. 4. The unpromising remainder, mainly the hopelessly de- mented patients, require mostly kind custodial care. It Is ap- parent that elementary knowledge of nursing is sufficient to qual ify an attendant for this class of service if the individual is pos- sessed of the always essential good habits and temperament. It may seem to some that I am aiming somewhat high, to others possibly that I do not look high enough. I believe, however, that whatever I have outlined so far, is perfectly attainable, although not without a determined effort. I am perfectly conscious of the fact that it seems sometimes impossible to get enough of any kind of attendants, to say nothing of careful selection. Let me also assure you that 1 have no designs whatever to bankrupt the State treasury. Furthermore, I realize that the fully satisfactory con- idltlons can not be attained the next week or next month. Hiief sum- ming up. Agreeable conditions Fewer work Ing bourn Kecreatlon. Rotter accommo- dation and board. Promotion and recog- nition of merit. Suggestions. Some of tuc methods which I suggest to be more generally and thoroughly followed are already in existence in State hospitals md I claim no originality for any of them. I am simply sum- ming them up. The suggestions are as follows: 1. Let us make the living condition of nurses and at- tendants not only bearable, but genuinely agreeable. To effect this we must a. Shorten the working hours. It Is totally impos- sible for a genuinely efficient, sensitive nurse to remain with the acute insane fourteen or sixteen hours a day without either rapid decline in efficiency or serious Im- pairment in health. The working hours there should not exceed 10, better yet 8, hours. Even in the wards for chronic patients more than 12 hours service should never be required. It is undoubtedly true that even when the number of attendants present on the ward at a given time has to be decreased to permit of shorter hours, the service is Improved by the Increased activity and effort of those on duty. b. The attendants and nurses must be given suitable and plentiful recreation. They should be allowed their dances and parties, should be supplied with good read- ing matter and given other privileges. c. More attention should be paid to the accommoda- tion and board furnished to nurses and attendants. Many better grade nurses are lost, or frightened away because of defficiencies of this kind. Not more than one nurse should ever be required to sleep in a ward, but special quiet and healthful quarters should be provided elsewhere. 2. More thorough system of promotion and recognition of merit should be provided and maintained. The rela- tive value of each position should be determined. Nurses capable of filling difficult positions creditably should be rewarded in proportion. The seniority in service should be recognized only when combined with superior effl- 20I ciency. It is totally wrong to pay attendants or nurse>^ one or two dollars more for every six or twelve months of service. Some new attendants because of bettei natural fitness, and other advantages, prove more effi cient after one or two weeks' service than others who have been at work for ten or twenty years. 3. The wanderings of the so-called chronic "hospital tramps" should be stopped. That does not mean that i\ transfer of a worthy attendant from one institution to another should be made impossible. It simply refers to the well-known type of "tramps" who wander from one institution to another leaving at best an indifferent record behind. Our duty to the patients requires further that the re-employment, in this line of work at least, is made difficult if not impossible for the brute and other wise undesirable. 4. Much is gained in the matter of securing and re- ^ taining valuable nurses, by securing for their immediate superior officers people whom they can respect, if not gen uinely admire, because of their evident superior knowl edge, tact and fair dealing. 5. The most important, however, is the establishment i of genuine, thorough training-schools. bollsh "hospital tramps." ompetent superior officers. lalninji schools. Value or Genuine Training Schools. There is, of course, no need of argument regarding the need of instructions for new attendants. There may be a question, how ever, as to how far the instructions should extend. I can not avoid at this point one simple comparison. If it is proper and necessary, as we all agree, to have only thoroughly well-trained people with a delirious typhoid or pneumonia patient, is it not equally, possi-j bly more, necessary to have only thoroughly capable people withj the delirious maniac? Further, if we require for our medical oj surgical sane patient a trained nurse and hospital atmosphere,; is it fair to detail for the insane surgical or medical case, a boy or girl fresh from the farm? Even the care of the chronic and the totally hopeless insane man and woman requires the knowledge of at least the elements of nursing, inasmuch as it is constantly necessary to look for possible symptoms of serious physical dis- ease among them. After what I have just stated, It Is scarcely necessary for me to affirm that I not only believe in training-schools, but consider at least the first year's training absolutely necessary, therefore believe it should be made compulsory. I am ready to go further and claim that a well established training-school, offering valuable courses of both theoretical and practical instructions, constitutes an attraction to the very classes of young men and women who are otherwise difficult to secure ■with the funds at our disposal. Let me assure you from pratcical experience that it pays to secure thoroughly competent instructors in massage, hydrothe- rapy, etc. It is also well to grant the members of the senior class the privilege of nursing for a short period in private cases out- side of the hospital, especially in obstetrical and children's cases, which are rather rare in hospitals for insane. They can be granted a leave of absence without pay and their additional ex- perience is of much value to them and to the State. I can not refrain from briefly mentioning another advantage of training-schools in hospitals for insane. Most of the young people do not remain long enough and really do not actually in- tend to become trained nurses. It can not be denied, however, that even the elementary knowledge of the human body, its Veed Is apparent. First year compulsory Attracts desirable persons. Outside expe- rience. Spreads knowledge outside of hospitals. 202 Open to ar^ment. Women nurses for male patients. With acute maniacal patients. Young people. Salaries must be larger. normal and abnormal working and particularly the study of the various causes of mental and other disease will be of value when carried to the many homes and neighborhoods. Thus each train- iing-school becomes an educational center of value as great as the instructions and practical training have been thorough. Questions not Yet Fully Answered. This outline would not be complete if I did not at least briefly mention several pending questions, most of them somewhat un- certain and open to argument. First of these in importance is the use of women nurses with male insane patients. Even superficial observation teaches us that genuine men nurses are rare, whereas good women nurses are decidedly plentiful. In other words man was not made a nurse in the large majority of cases. From this alone it would follow that women nurses should be employed in nursing in preference to men whenever possible. This is especially true of hospital wards and I can testify from practical experience that in such work they have proven to be of very great service. I am not quite prepared, however, to assert that I should favor anything like general displacement of men attendants by women. In wards for chronic patients I can not see any advantage, rather otherwise, if most patients are to be kept employed. I favor, however. In cottages for convalescing and the declining patients, placing a man and wife in charge, as such arrangement still further in- creases the homeL.ve appearance of the cottage. I can also personally testify that even acute maniacal patients may be much better dealt with by women than men in the matter of administration of food and in giving treatment. I must at once confess, however, that women suitable for that work are rare, as it requires very great tact and self-control under very trying conditions. The problem of age, at present at least, is largely determined by the predominating class of applicants. They are now mostly young people and I believe it should be so. They can more easily adapt themselves to the requirements of service and through their predominating cheerful disposition they produce a better effect upon the susceptible patients. The third and last consideration is that of salaries That they must be larger under existing conditions there is no question. What they need be in the future will largely depend upon how good or bad the times are and even more upon how attractive these positions can be made and how valuable the training, there- jfore, how much permanent benefit can be derived by the employes. Discussion by Mr. Moulton. Attractive service needed. When the Civil Service Commission first went into operation, we were much impressed by the problem of the attendant service. It has been the greatest bother we have had to keep the attend- ants in the hospitals. At first we had an idea that it must be a question of wages, and that people were attracted elsewhere. I think Dr. Podstata, tonight, has solved the question in a large degree. I don't believe it is, as he stated at the last part, a ques- tion of wages. I think the hospitals in Chicago and elsewhere secure enough applicnnt.s to become trained nurses without pay- ing them anything. If those trained nurses are going to be real tialned nurses, I think that will solve the question, as to the kind of people we shall receive, and the number, and that the Institu- tions will retain them. If it once becomes known, out through the country, that these training schools are giving the same train- 203 ing that the nurses are receiving in Chicago, in the hospitals, 1 think our applications will be doubled, and come from a different class of people. I know, in my talks throughout the State, when I mention to people the fact we are going to establish the training schools, they are at once interested. They often say, "I know of several girls who need that training. They don't feel, now, they can go to Chicago, where they ordinarily have to go, to secure that training." I believe that, when, in addition to the training, they are receiving the present wages, that will be such an addi- tional inducement the attendant question will be solved in the end. Discussion by Dr. Davis. I am only representing the vestibule, through which many patients pass into the institutions, being superintendent of the Cook County Detention Hospital. I can testify to the eflSciency of the proposed methods of Dr. Podstata. In my small institution, the 30 attendants only work an eight hour day of service. The women attendants never work the same eight hours longer than one month, successively. I mean by that, they will work one month from 8 to 4 in the afternoon, and the next month from i until midnight. Only once in three months they have the eight hours after midnight. They are giving good service. My women attendants don't care to get married. Some of them have re- mained there six, eight and twelve years. It is my conviction that the methods proposed by Dr. Podstata are the true methods to be followed in the State institutions. .Nursing at Cook County Detention Flospltal. need hospital care. Discussion by Dr. Billings. It seems surprising to me, as I have come recently in close insane peo- touch w'ith these State hospitals for the insane, that this question gi^k and of nursing has been put off so long. It seems to me like going back, now, 25 years in medical history, when the same questions were debated, bacK in 1876 or '80, in reference to trained nurses for ordinary medical cases in hospitals. The same arguments were used, for and against trained nurses. It does seem to me, too, that we have considered insane people as something else than sick people, and that the treatment of them should be different from the treatment of other people. After hearing what Dr. Podstata has to say upon the subject, it seems to me to be perfectly rational and right that we should have training schools for nurses in the State institutions, and! consider them hospitals, as other hospitals are considered, places! for the care of the sick. Furthermore, it appeals to me as a I rational idea that there should be a distinction between the people! who serve as nurses, and those who serve as attendants, for: these people. It is folly to take an individual, highly educated.! and naturally fitted to be a real trained nurse, to care for people! who are hopelessly, chronically insane. It is absolutely wrong. But, on the other hand, those people who are sick and insane should have the benefit of a trained, intelligent and kind-hearted nurse, just as one who has pneumonia, or any other ailment, who U not insane, has such expert service. It seems to me, too, if this differentiation is made in each of our institutions, there should be a differentiation made in wages. It seems to me, as I have heard our superintendents talk In private conversations, about the institutions, and what they paid, that there has not been a proper differentiation made as to the nature of the work. Some individual, a boy, or young man, who does nothing but drive a cart around the grounds, to use a simple illustration, who has no responsibility, may get $30 or $40 a month, while the 204 ; nurse, who is the right hand aud arm of the medical stall, gets '{22 or $2tj. This doesn't seem right. I believe Dr. Podstata's japer, together with the paper of the morning, by Mr. Moulton, )resents material for a committee to thresh out. If this con- ■ erence does nothing else out solve that problem, it would be 1 Aeli worth while. Civil service elloilna- tlons. ' Discussion bv Mr. Molltun. Dr. Podstata spoke about the number of hospital tramps turned out. I think he would be astonished at the number we have, cut out since November first. We have cut out 200 people, who here- tofore crowded from one institution to another. PROVED VALUE OF HYDROTHERAPEUTIC TREATMENT FOR CASES OF ACUTE INSANITY. ^"^uo'vey ^"^ ■^^- Richard Dewey, formerly superintendent of the Illi- nois Eastern Hospital for the Insane, gave a description of the equipment of a modern sanitarium. His talk was iUus- traled with lantern slides. Dr. Dewey described the construction of a new "Psychopathic Hospital" erected during the last year. It is a fire proof building for acute and curable cases of mental disease, provhled with rooms especially designed to meet the varying conditions of the patient when highly disturbed or delirious; or more quiet anJ rational as the case may be. These rooms have sliding doors shutting off an alcove when necessary and the window is pro- vided with adjustable shutters and screens. The construction of the building being of brick, steel beams and hollow tile, it is I not only fire proof but sound proof to a great extent, and so ar- ranged that one patient is not disturbed by any other. Descilbes psycho- paiblc hospital. CoDflniiotis wni in battia. Other nppar- atna. Bath Rooms and Apparatus T'here is also on each floor a bath room with a large tub ar- ranged for the "continuous warm baths" or "dauer-baeder" proven by German alienists to be so exceedingly valuable as a means of treatment in overcoming paroxysms of maniacal excitement, promoting improvement in nutritive processes, and in permanent sedation of nervous irritability. Dr. Dewey also described, somewhat in detail, the apparatus of the bath-house, especially the douche room with its "douche tables," the essential mechanism whereby water is controlled in temperature, pressure and quantity in a scientific manner and ai)plled for the treatment of patients in the form of sprays, jets, rain-bath, fountain sprays, "fan douches." etc.. as appropriate in each Individual case. The hot-air bath, or cabinet, whereby the 'Equivalent of a •Turkish" bath is i)ro(luced without the disad- vantage of the hot-room: the vapor or "Russian" bath: the elec- iric and hip batiis, sheet baths, electric-light baths and the pro- esses connected therewith were also described. 205 Glad to advocate use In Illinois State hospitals. Value is Understood by Specialists. Dr. Dewey stated that tnese various methods of applying water hydrotherapeutic treatment) no longer need advocacy as their value is universally unuerstood by all engaged in neurological and psychopatnic practice, and yet he believed that the State oi Illi- nois had thus far not installed in its institutions these important means of treatment and was "glad to advocate their use at a time when a spirit of progress seems to prevan." EMPLOYMENT AND RECREATION FOR CHRONIC INSANE. Dr. W. E. Taylor, superintendent of the Western Hos- Pagei' ^y pital for the Insane, read a paper on "Employment and Taylor'. Recreation for Chronic Insane." It follows : My subject, "Employment and Recreation for Chronic Insane," Z-*.'"^^'" deserves more than a passing consideration by those who are im- kindly, mediately interested in caring for those very unfortunate indi- viduals. It should oe understood that a large per cent of in- sane are incurable, also that a large per cent of the incurable have an aflSiction of such a nature that we can neither stop or even stay the progress of their disease. The brain may be afflicted with an acquired incurable malignant mala .y which progresses persistently until death claims the victim; or ..e may have in- 1 herited a condition whici is beyond L^e skill of man to repair. I With that class, employment, recreation and medical treatment! yield no satisfactory results. We can simply care for them kindly, i excellent results. Need of Mental Div£3sion. I We have another class which, in my opinion, can be benefited i 'an obtain and many cured by resorting to the proper recreation, employment ™ost and encouragement. I do not wish to be pessimistic in the mat- ter of medical treatment, or too optomistic in my subject, but by medical treatment, when deemed advisable, in conjunction with what I firmly advocate in the way of amusements, recreation, and employment, we can obtain most excellent results. Abnormal physiological conditions very often fail to respond to the indicated remedy, unless by some means the mental concentration is changed. Biochemic deficiencies may be restored by giving an inorganic salt, but a normal co-ordination will not follow unless we secure mental diversion. If, at stated times, we take our patients out for a walk, or Methods of permit them to spend a few hours in a shady grove; if the aiverslon. gardener or farmer selects a number from the ward to do manual labor on the farm; or ladies are taken to the laundry, sewing room, linen room, or any other department, and they are re-^ turned to the ward to eat and sleep with the other patients, we do not succeed in diverting the mind from the old trend or rut, which is responsible for their hallucinations and delusions. The diversion and subsequent surroundings should be of such a nature that they forget themselves, their environments and mental con-; dition, and that can only be done by offering some incentive which j appeals to them, if a spark of intelligence remains in their brain. I have known the blank countenance of a patient, who has beeni afflicted with melancnoly to disappear, the brain clear, the eye; brighten, and ambition return while he was on the floor dancing,; engaged in playing ball, or taking part in an exciting game of; bowling. I have learned that we should appeal to their pride, encourage them with a reward, flatter and applaud their efforts, and acquiesce in a measure to their whims; but, at the same time,, 2o6 control as far as possible what ever work or pleasure they may be engaged in. I selected a number of chronic patients, who at one time were expert carpenters, gave them plans and specifica- tions and requested them to build a cottage. As a result, they built two, which we are using for tubercular patients. They be- came interested in their undertaking; they worked industriously; and we have no better buildings than those which they con- structed. Seventy-five per cent of the patients thus employed I fully recovered and the others were greatly benefited. C.\MP FOR Df.MKNTKI), VIOLENT AND UNTIDY P.\TIENTS. Great Incurable, demented, violent and untidy patients to the extent benefit. of 100 were placed in a camp in the woods, where they were given the greatest freedom, allowed to roll in the dirt, climb trees, in- dulge in antics, encouraged to wrestle, foot race, and other things. They were fed, lodged, and enjoyed the privileges of a bath house in the camp, and before the summer was over, some of them had entirely recovered, and all were greatly benefited. Three or four succeeded In escaping, and subsequent reports indicate to us that they are all well enough to remain away. On the Fourth of July they formed a marching club, were trained by one of their own number; and made a very nice appearance in the parade. We are so well satisfied with our results, that another year, we will en- large our camp and will attempt to care for 300 or 400 in a similar way. Awakened pride. Construction of minor buildings. Stimulus Aitobdeu by Competition. Competition between patients who drive and care for the ceams has given splendid results; work on the farm, In the garden, among the hogs, cattle and chickens ha.'? been equally as satisfac- tory, especially where there was a competition between the patients as to which one would do the best. Pride to do fine and appreciated work in the printing office, shoe shop, shirts and pants factory, laundry, sewing room, and in fact every department, has i;iven equally as good results. I believe superintendents should be permitted, if considered feasible by trustees and the Board of Charities, to construct minor buildings, make ne 'ded changes, and improvement iii build' ings, machinery, etc., with any avaihible money that they may have without resorting to contracts or competitive bids. I be lieve superintendents should offer a reward to patients who excel in anything that they may undertake to do. Plane another step. Coi.oNi/,.\Ti()N lou .M.vi.i; Pahknts. I have been so favorably impressed with what I have seen and experienced in a limited way. that I purpose to carry the idea still farther; hoi)ing to obtain greater results. We are now planning to colonize o>ir male patients, jiroviding cottages or tents on the farm, giving to each colony one. two. three or four acres of ground for the p\iri)o.se of raising, in a scientific way. vegetables. We will, likewise allot to a number of patients, the care of hogs, cattle, sheep, goats, chickens, geese, ducks, etc. The same plan jwill l)e followed in the domestic (lei);irtnient. Public will be admit- ted. Will Ilol.l) AN I.N.STITt TION FaIIJ. In September wo will hold a fair, at which the products of the labor will be exhibited and prenihims will be offered to those who make the best showing. The fair will continue for three days. It 207 will be conducted and equipped in the same way as an ordinary county fair. The public will be admitted, and the income will be given to the patients as rewards or premiums. I believe that this plan will afford incentive, which no other one will, and I am con- vinced that, if carried out, the results will be far greater than we even anticipate. During the summer the fair grounds will be utilized for recreation and camping grounds. MECHANICAL AND MEDICINAL RESTRAINT. Dr. George A. Zeller, superintendent of the Asylum for ^^^l/Jgr^ °'^* Incurable Insane, read the following paper. "Mechanical and Medical Restraint :" When one cares to indulge his taste for the antique in legal ^'^^^|*^ i^*** literature and phraseology, he naturally looks up the blue laws! of the New England states or searches the musty tomes of the olden European libraries. He is rewarded by startling defi- nitions of what the intelligence of the age construed as crime' and by some of the penalties inflicted. Most of these laws have long since been repealed or have by common consent fallen into; disuse, but there still remains on the statute books of Illinois! one that, to my mind, is as out of place as a geography ofi forty years ago or a treatise on surgery of ten years ago wouldj be in the hands of the instructor of today. Most laws are! passed to abolish abuses or punish offenses against the security of property or the person, but this particular law does neither, in that it apparently legalizes the infliction of bodily Injury in a manner that the earliest Egyptian and Roman writers decried and against which the finer instincts of all times have rebelled. \ Cites the Illinois Law. Revised Conditions allowing restraint. The law referred to is paragraph 21, chapter 85, Statutes of Illinois, 1903, and reads as follows: No patient shall be placed in restraint or seclusion in any hospital or asylum for the insane in the State ex- cept by the order of the physician in charge; all such orders shall be entered upon a record kept for that pur- pose, which shall show the reason for the order in each case and which shall be subject to inspection by the State Commission of Public Charities and suchj record shall at all times be open to public inspection. j The law itself would appear as a safeguard against the over j Safeguard application of something in itself objectionable and herein lies against the absurdity of the law. If the application of mechanical re- straint is construed so serious a matter as to call for legisla- tion specifying under what conditions it may be practiced, then why tolerate it at ail and above all why give it legal sanction? Search the statutes of Illinois as you may and you will fall to find anywhere a clause legalizing the infliction of bodily in- jury except in the case of hangman alone and then only after a veruict has been rendered by a jury of his peers and the par- doning power of the Chief Executive has been sought in vain. When men are executed upon the order of an assistant phy- sician there will be some «xcus? for the restraint law of Illinois. somethinfi, objection- able. 2o8 Hi.sTuKV <>!• Mechanical Restkaint. Dffinltlon. First demon- Btraflon of useless- ness. Earl of Shafta- bury's work. Only motive. "Experienced employ^" restraint. Mechanical re.'d at this time by our superlnlciulonls. The ques- tion has come from the public, asking if it could be done, if it 215 is practical, and it seems to me that just at a meeting of this kind it should be discussed. The superintendents of our State institutions are the ones who might be able to say that such a scheme is impractical and can not be carried out, or perhaps they may say, on the other hand, that it could be carried out to some degree. What Dr. Davis has said is a question that comes to every practicing physician. A case of insanity develops in a family that has some means, yet not enough to send such a patient to a private institution, and yet enough, perhaps, to give that patient some advantage in the way of money, or what money can buy, in an institution. It is a question that seems to me to be prac- tical for discussion. I would like to hear our superintendents, especially, discuss this point. As to the question of attendants — special attendants — that is another thing. I think at Kankakee, as mentioned by Mr. Mason, special attendants have been used more than elsewhere. I think perhaps Dr. Greene could answer the question more practically, probably, than some of the other men. But these are practical questions. These are things we ought to hear about. We ought to be able to answer questions when they are asked in the future. Discussion by Dr. Carbiel. As Dr. Billings wishes an expression, I would say, as my opinion of it, that it seems to me that it would be far more satis- factory t^ the management of the institution, instead of having special attendants paid, or receiving pay, from private sources, that the institution provide all the special attendants necessary, and let the State pay for them. The duties of the special attend- ant — you will find some of the superintendents will say I am right about it — are not carried out as they might be in other, private institutions; that is to say, the attendants are not as attentive as they should be. They get into ways of their own. Instead of being out-of-doors with the patients, they are not there. They do not report on time, and do not pay as much atten- tion to their patients as they should, for the amount of work they are expected to give. I think, also, that there is some objec- tion to it, on the lines of discipline. Some attendants are given to shirking their duties in that respect, and the other attendants seem to think they have an "easy" time; that is to say, they do not conform to the rules of the institution, in regard to the hours of going out and coming in. They are a little different from the others. The others get into ways of doing the same things. For my part, I am in favor of the institutions supplying all the attendants, and paying for all the attendants required. Discussion by Dr. Athon. At our institution we have always discouraged the employment of special attendants. We have one case with a special attendant, and we have had very little trouble on that account. At one time there was a little jealousy, and many of the attendants thought he had an easier time than the others. It so happened, about that time, that the man resigned and went away. I tried three or four of the attendants who thought that would be a nice place. There wasn't one of them that kept it a week. Finally I secured the present special attendant, and there has been no further com- plaint among the attendants. Comes to every prac- ticing physician. Institution provide all special attendants. Experience at Anna. 2l6 Develops partiality. An incon- sistency. Three at- tendants to one patient. Trust fund. Two points of view. Discussion' uy Dr. W. E. Taylob. I don't believe it is policy to have paid special attendants. I tried it — once. There was a complaint, both from the friends and from the other employes, that partiality was shown, and that the attendant was not on duty at the time he should be. He was not amenable to the rules of the institution. He appeared to be more independent. The friends canie to me and si id: "This patient is not receiving special attention. We understand that this patient is allowed to associate, or is obliged to associate with other patients. We understand thaf our patient is eating at the same table with other patients, and substantially has the same food." Now, it is utterly impossible to have special atttendants, paid attendants, and give them privileges we do not give our other attendants. It is impossible to have a patient, and not classify that i)atient, and have him do and be as other patients. Such a patient should have the same diet as that prescribed for other patients of the same class. He should be compelled, if we deem it advisable, to sleep in a congregaie dormitory, or if necessary, in a single dormitory. I believe that whether the patient is a pauper or a millionaire, when he comes into the State institution it is our duty to give a special attendant, if needed, a trained nurse, or two, if necessary. I was in Dr. Podstata's institution the other day and I found three attendants with one patient, on the lawn. She was a violent patient and hard to care for. Still Dr. Pods- tata had three special attendants out with that patient on the lawn, attempting to take care of her. She was a pauper at that. I believe that is the policy to pursue. There is another scheme that we work at our place. We encour- age all that have money, and speak of special care for their friends, to place some money in a trust fund, which we have there, possibly $2,200.00 or $2,300.00. That fund is kept separ- ately. We put it in the State funds. We encourage jiatients who have that money to spend it. The doctors have a list. They are instructed 1o go to the patients and urge them to draw some of their money. The list is made out and brought to me. We give the money, not to exceed 25 cents at a time. Some draw 10 cents. Then the attendants or the nurse take the patients, in a bunch of five, six or more. They go down town to tlM' '•to'es. and j)ermit them to buy whatever they want at the store, choose it and buy it themselves. It gives the patients independence and it satisfies thei'ii. It is a very good scheme. At our place we are paying out in the neighborhood of $175.00 a month to patients in that way. I have found it works very nicely, and it Is much Letter than to attemiit to have a special paid nurse or a special paid attendant for them. Discussion- hv Dk. Hiksch. There are, of course, two ways of looking at this question. One is from tiie point of view of the family. The other is from the i)oint of view of the administration and the State. .\s all physicians will testify, and have toslilied here, whenever a mis- fortune of this kind comes to a family, the family, if at all able, would like to be in a position to feel that they were doing something for the unfortunate member of the family. If it were an ordinary case of sickness, where they would have sent the patient to a hospital, the family would pay for the treatment. Here, in this case, the nature of the disease is such that treat- ment in a hospital is not always feasible. Private institutions, 2J^ Will provoke jealousy. for certain cases, are not always within reach. The expenses connected with the private treatment are almost prohibitive to many families. It is the general opinion that in private in- stitutions, unless they are of rather an unusual degree of com- petency, and have a large number of patients, the proper classi- fication is not carried out; and so even physicians advise that certain patients be sent to the public institutions, thinking they will be better off there than in private institutions. Now, here is the family, and especially the "women-folks" of the family — a family of a certain degree of financial competency and a certain degree of refinement — they imagine that they are neglecting their own patient by not providing for him and not paying for him. That is the reason why so many feel something should be done in the direction of enabling the family to do something for the patient in the public institution. Of course there are ways of doing something, in the ways in- dicated by Dr. Taylor just now, but if there is jealousy to be feared, that very system will provoke it, as well as the pay system. In fact, it will provoke it more readily, for there the other patients see that this patient has fruit. You send that patient fruit. The superintendents and the attendants encourage the family to send fruit. Arrangements are made that the patient shall receive fruit regularly. It used to be done in Kankakee, and I suppose that is still done. The other patients see that this patient gets fruit and they don't get fruit. As to the system of having a trust fund there, against which the patient can draw, there must be patients in the institution that have no trust fund. They see the other patient goes down town and buys things, and they can't do it. This system, it seems to me, would open the door to jealousy much more readily and effectively than the other system, where the patients would not know who pays and who! does not pay. I Of course, if you accept the German system, then you open the German door to all sorts of jealousies, and it is a system that must be system not condemned. In Germany they have pay patients, but they classifyi them according to the money they pay, and those that pay the lowest fee get only primitive accommodations. Those that pay more are the second class patients, then comes the third class, and finally the fourth class patients. To be a fourth class patient generally means that he has two or three rooms at his disposal, has a special attendant and all the comforts possible. He doesn't mingle with the others. That system, of course, we can not intro- duce in America. It doesn't work well even in Europe, as the first speaker told us. The city of Hamburg is very much dissatis- fied with the way it works. It is thoroughly un-American, and we would not dream of having that. But this question is open to the superintendents for discussion. I hope they will take it up somewhat seriously, whether it would be possible to have families that are willing to pay, do so, giving the patients no special privilege, and to have that money consti- tute a sort of trust fund for the benefit of all, so that you can give little delicacies to all alike — not merely to one patient for whom somebody pays, but to all the patients. You would have some money to go out of the ordinary duty, and buy tobacco for such as want to smoke, and do little things for the patients. You have, even now, a discrimination. According to the law the family is held, when able, liable for the clothing. The bills for clothing are sent to the family. The family can buy the clothing needed, themselves, and send it down there. You see, there is already a discrimination. The patient sees that one patient is well clothed and the other patients not so well clothed. You have, even now, something approaching to that system. It suitable. Fund for benefit of all. Discrimina- tion at present. 2l8 Special attendants. Ought to be a general principle. Special care for special cases. Plan In New York. makes the family liable for a certain amount of expense; that Is, for the clothing. Couldn't it be done, for the sake of the family, that they may contribute, when they cheerfully would contribute for other things, too? As to the other question of the special attendant, of course I know the way it has developed in this State. To my idea, it is absolutely wrong. If you have a special attendant, he ought to be under the direct control of the superintendent, as much as any other within the house. You should not have him there as a guest at the house at all. He is on the force, and must be under discii)line and authority. He must come up to all the rules and regulations. I think that was a step backward, when the Kan- kakee trustees resolved to allow special attendants, but put them entirely outside of the regular force, even so far that they do not receive their meals there. If they do, they have to pay for them. That is entirely wrong, from a point of view of discipline. It doesn't give any guarantee to the family that the special attend- ant does his work, because the superintendent has scarcely any control over him. That is my opinion. If the State is to take care of its wards, regardless of the means of the family, in a case where there are special attendants required, and the superin- tendent and physician feel that he ought to have a special attend- ant, the State ought to provide that special attendant. If you take a man that has a fever to the Cook county hospital, and a special nurse is needed to watch over him, I dare say the patient receives a special nurse. That ought to be the general principle. If you adopt the system of allowing certain families to pay without having any special privileges the others don't have, and in a case like where the special attendant is needed, and the family is willing and able to provide the means, and let it go into the State, let the special attendant be paid on a per- fect equality, scarcely knowing he is a special attendant, I think you can make it work. Otherwise, if you make classifications, and assign rooms according to the pay, or if you allow special attendants that are outside of the regular force, and are not amenable to our laws and discipline. I think you make a mistake. If a person has been accustomed to out of door life, and he is confined in the asylum, the very fact that he is deprived of his ordinary freedom will increase the difficulty of treatment. In a case like the one quoted by Dr. Podstata, I should judge the State ought to provide the special attendant, if he has to be outside with the special attendant. It is my view that the State taking charge of these cases, ought to take good care of them. They say, ■'The State's means are limited." They are undoubtedly. We can't be extravagant, but perhaps it could be met by admitting certain pay patients, and making no discrimination between those that pay and those that do not pay — not adopting the German system, which is un-American and very questionable from the ethical or medical point of view. If you do that, it seems to me that you get a fund which will allow superintendents to do much for all the patients. For that reason 1 think I am a litle bit inclined to believe that in view of the fact how the families feel, and the possible good that may be done to all, the law might be amended to allow people to pay. They have such a plan in New York. 1 know that. In New York there are pay patients In state institutions. Whether they get privileges, I dont know. As a clergyman, I Have had occasion to carry on a correspondence for a family located in Illinois, that had a member of the family in New York in one of the state institutions. I know they paid every week $10.00; whether it was because he was really a citizen of Illinois, I don't know. I didn't look into it. I know they sent for years, through me, every month, a sum of money equivalent to $10.00 a week. The 219 patient didn't appear to have any special privileges. I went to see him once, and noticed he was on the same footing with the others, apparently. Mrs. Botjrland Reads the Law. Mrs. Bourland: May I read the statute? It is very brief. All residents of the State of Illinois who are or may become inmates of any of the State charitable institu- tions shall receive their board, tuition and treatment free of charge during their stay. The residents of other • states may be admitted to said institutions upon pay- ment of the just cost of said board, tuition and treat- ment: Provided, that no resident of another state shall be received or retained to the exclusion of any resident of the State of Illinois: And, provided, further, that should any inmate be unwilling to accept the gratuitous board, treatment or tuition, then any superintendent of a State charitable institution is hereby authorized to re- ceive pay therefor, and is required to account for the same in an itemized monthly or quarterly statement to the trustees, as donations, duly credited to the persons from whom they were received; and if any superintend- ent shall receive any moneys for the purpose of furnish- ing extra attention and comforts to any inmates of the institution under his charge, he shall account for the same, and for the expenditures, in like manner, to the trustees. More Discussion by Dr. W. E. Taylor. I want to offer a suggestion to you. In the matter of tobacco, 1 think all the institutions give the patients a limited amount of tobacco and cigars, but if your board, or whoever is in author- ity, would issue an order that State funds, available to State institutions, should receive 2 per cent upon daily balances, and that would go into a fund for the purpose of doing just what you are talking about, it would be a good thing, and I think it Is jus- tice that it should be done. I know, in my institution, if we received 2 per cent on our daily balances, we would be getting 2 per cent on $60,000.00. Dr. Zeller would be doing the same thing. It seems that money belonging to the institution should be yielding up an income that could be used for that purpose. Discussion of Dr. Taylor's Suggestion. Would you make Dr. Athon — I would like to ask a question, that an amusement fund? Dr. Taylor — I would make it an amusement fund, or make it a fund with which we could buy fruit, and equalize, as far as possible, this idea of giving special attention, using it for any purpose of giving special attention or luxuries or amusements to the patients that are not fortunate enough to Iiave such things provided. Dr. Hirsch — I suppose the best way is to refer the whole sub- ject to a committtee of experts, to report at the next meeting. Dr. Taylor — Somebody that could issue an order. I expect Gov- ernor Deneen could be pretty handy at that. Governor Deneen — I should think the superintendent ought to j^ power of be pretty handy at that. It is entirely within the power of the trustees, trustees, who have custody of the funds, who give bond there-l for. I call the attention of the trustees to that matter; but the Text of the statute. Offers a suggestion. Amusement fund. Equalize favors. Refer to committee. Order could issue. 220 Write a letter. Glad to. Interest on balances. Not the treasurer. Come to you. Does not come. Good critics. Trust fund for hM. System of rewards. Ordinary fund. superintendents and trustees have had that power for a long time. We get such a balance here, upon the funds that are in Charge of the State. I ordered them turned over. Last year we turned over to the general fund |9,000.(i0 interest on the funds in one of the departments here, the Insurance department. My own fluids are in the custody of the treasurer. Dr. Taylor — Suppose you write a letter to the trustees. Governor Deneen — Very well, I shall be glad to do it. Dr. Taylor — I would like to ask if any superintendent here receives interest on his daily balance? Do you Dr. Zeller — do you get interest on your daily balance? Dr. Zeller — I am not the treasurer of my institution. Dr. Taylor — Does it come to you? Discussion by Dr. Zkllf.k. Dr. Zeller — No, sir. The statement? Xo, sir. Our institution has no income. Mr. President, while listening to the discussion, it struck me we are getting down to the question of money, and treating this from an income-producing standpoint, and losing sight of the principle of State administration, of that true democracy, almost socialism, that the State practices in an in- stitution where it lias congregated the defectives and those re- quiring State care. It is not a question of how much money the State tiikes in, or what becomes of the money, because the State doesn't need the money. There is not an institution in Illinois today that has not a handsome balance on hand, unexpended. We have $75,000 00 in our institution, unexpended balance, today. Watertown has $20,000.00 or $30,000.00. Kankakee may have $100,00O.(i0! [ Laughter. 1 So that we have ample means at our hands, all the time. We would not deny the most pitiful, abject pauper in Illinois the right to one, two or three special attendants, if re- quired. It seems to me that we belittle the service when we get out and wonder if, whether somebody offers $10.00 or $15.00 a week, the State is going into the boarding house business and catering business, and give those patients better care than somebody who is unable to pay! I don't think we are called upon to consider the question. I think the service should be so good that tne most exacting family should be satisfied with the care given to their people. I want to say that the people who "have seen better days" jhave a good effect upon the management of an institution. They are hypercritical. They look to see how many pairs of socks there are; they note the condition of the clothing; they look at the bedding, at the service, at the table, and instinctively we learn something from them. We learn we are not particular enough, are not giving them enou.gh, that our daily service is not as good as it should he. We aim to bring it up, higher and higher, all the time. We have solved it in our institution, with over 1,800 peojile present, people graduated at Amherst College, who hold professional diplomas. There is, true, a large percent- age of the pauixT element. We have been able, successfully, for years, to escai)e even a demand for the employment of a special attendant for any of the i)aii("iits in that institution. It is very easy fo convince the family that it bad better not insist upon that privilege. The trust fund is one from which wo can draw for every "pa- tient. It is never a very lar.ge fund, but we are always glad to draw from it at any time, and for any other patient. Dr. Taylor has a system of rewards for his patients. He pays them a small iJrcniiuni. as a stimulant for some extra effort. That icomes out of the ordinary fund. 221 It is the most elastic fund in all the world. You can do any- thing from conducting a mill to burying a patient out of that fund. There is no limit to the use to which it can be put. It piles up in every institution, until we turn over, between us all, $100,000.00, possibly, by the time the next Legislature meets. PROPOSED STATE PSYCHOPATHIC INSTITUTE. Dr. Frank Billing's, speaking- of the "Proposed State Psychopathic Institute," said : In this country there is but one clinic in psychiatry. It has been in existence a short time. Efforts have been made in two or three other places, notably Boston, to develop such clinics. Because of this lack of knowledge of psychiatry American prac- titioners do not readily recognize insanity, are unable to classify insane patients, and do not have a proper understanding of what should be done in acute cases. Such patients frequently are kept at home and do not receive adequate primary attention. As a result many who could recover, do not, and become State charges. In Germany since 1874 some 22 psycopathic institutes, with clinics, have been established. Many are in connection with the universities, so that graduates in medicine commence practice with experience in this sort of work. There is no opportunity, in most of the states of the Union, for the young medical man to acquire a knowledge of psyco- pathy. The little he can learn is by going, with a teacher from the medical scnool, to a hospital for the insane for two or three trips through the wards, looking at patients and perhaps talking about them to some degree. The remainder of his information is gained from contact with mental and nervous diseases in his practice. In addition to this individual ignorance is the inevitable gen- eral ignorance which affects the State, because the State must draw upon imperfectly educated men for the medical staffs of its institutions. Our superintendents must take this deficient material and attempt to mold it for efficient medical work, or, rather, inefficient work. I use the word inefficient advisedly and broadly. Many of these individuals are capable of learning, un- der the wise direction of a good superintendent, and become good workers, in time, but they do not have half the advantages they should have. That is why I say inefficient work. The State Board of Charities favors a State Psycopathic Institute to supply the needed advantages. Both Clinical and Pathological Work. Now I desire to be understood, in recommending a psycho ;'^''°^,^^p^®°^ pathic institute, that this is not a mere autopsy making nor alone clinical work, fhe man who does clinical work examines blood, sputum, the feces, or does anything else from a mere routine standpomt, without the individual equation of the pa- tient viewed from all points, is doing unnecessary work and is not working toward an efficient staff or force. On the other hand, the individual who makes a post mortem, without a knowledge of the clinical history of the case, is gaining no practical effi- ciency. Both clinical and pathological data are essential for knowledge and satisfactory results. Such dual service is essen- tial, if we are to tone up the staffs in our State institutions. Remarks by Dr. Bil- lings. One Ameri- can clinic in psychia- try. Twenty-two in Ger- many. Scant oppor- tunity for study. Ignocance affects ttie State. plete symmetri- cal service. 222 Located near a big clt7- Qualifica- tions for director- ship. Post mortem to supple- ment cllnl cal service Awakened scientific spirit Benefit the pnlillr at large. Sebvice of the Psychopathic iNSTixtrrE. It is the opinion of your Board of Charities that there should be establislied in this State a Central i'sychopathic Institute to develop in our hospitals the symmetrical service I have de- scribed. Our idea is that this institute should be located at .)ne of the State institutions near a big city, like Chicago, be- cause of the natural advantages of such proximity. That insti- Mile should have a diagnostic, or clinical, laboratory. Over this should be placed a man who is, broadly speaking, a psychopathist and i)athologist in one, a man who knows how to work with the living, who has had experience in hospitals for the insane and understands psychiatry, who 4inows now to examine patients by well known diagnostic methods, to make blood, feces, sputum and other examinations, to make physical e.xaminations, to teach others to do these things, to express the terms of illness (symp- toms, etc.) so clearly the words mean something definite, to formulate what has been written of symptoms and signs so as to make the proper diagnosis, and, finally, to sum up all these factors into a rational prognosis and then determine the treat- ment. All this is done for the benefit of the patient. Now, if that patient dies, the director of the institute must be able, to supplement his clinical service, to make the proper post mortem examination, so that the organs may be examined for the good of medical science, which means for the benefit of suffering humanity. Let me say that the clinical examination, if one is more important than the other, is more important than the post mortem, because there is a limited time in which clinical work can be done. Having made the post mortem, the organs may be examined now, or ten years from now. But the examination of the organs is absolutely worthless, narrowly .^peaking, and we may speak narrowly of that particular thing, if the preliminary clinical work is not done. Training fob State Employes. To the State Psychopathic Institute the employes of our State institutions should go. Each superintendent could send one assistant to the institute, for a month, say, to receive instruc- tions. A clinic in psychiatry could be given for the benefit of these young men. Afterward they could go back to their In- stitutions and be sources of inspiration to others of the staff. Then another and another assistant physician could go from each hospital to the Psychopathic Institute. Ultimately the State would have its staffs of medical men upon a basis of higher efficiency than now, because, first of all, they would ki\ow how to do higher grade work. and. secondly, the scientific spirit would he so stimulated in them they would want to do it. No doctor in a hospital for the insane, who had that scientific spirit awaken- ed and knew how to work, would permit a patient under his charge to pass to the post mortem table, if he did not know all that could be learned during the life of the patient. This, of neces- sity, means better treatment of the unfortunates in our State hospitals. Education fok Physicians Generally. Furthermore, a State Psychopathic Institute would be a school to which medical men not in the State service could go. A I'linic in psychiatry and pathology would mean that the State would be teaching medical men. who could go out as practitioners to residents of the State, to benefit greatly the public at large. Many of the present mistakes in practice would be prevented. 223 Branch Service in the Institutions. In the State institutions there should be established branches of the central department. A mere pathologist should not be appointed to a position in a hospital branch. I should prefer to see the superintendent assign some member of the existing force to the work in hand, or, if he hasn't a man adapted for the work, or his man doesn't like it, to draw upon the civil ser- vice commission for a proper man. But that man should not be a "dead-house man," making the examinations for others, in sputum, urine and blood, turning over a blank to be filed away, without any knowledge of the patient himself; nor should the attending man be ignorant of what the blood, sputum, etc., were except as he sees entries upon the report. Every member of the staff should have specimens in the clinical laboratory and make examinations for himself. Little clinics should be started in each institution, presided over by the superintendent, if he has the opportunity, or by his chief of staff, or any other member of the staff. In this way the central institute would be the head with branches all over the State. Thus, starting from the cen tral institute a permeating and effective service would be de- veloped in all the hospitals. Easy to Make a Start. Now it doesn't need a great deal of money to start this psy- chopathic service. I don't believe it needs legislative action. 1 think, if we could agree that such an institution should be started, and where it should be, the superintendent of that in- stitution could prepare a room, or a building. If we could apply to the Civil Service Commission for an examination for the po- sition of a psychopathologist for the central institute we could begin the work as soon as the position has been filled. Perhaps it would be well to refer the matter to a committee, to be worked out at an early date. I hope we may have some expression from the superintendents upon this subject. I have talked with some of them. I think they are willing and glad, to have this aid in elevating their medical staffs to a higher standard, and bringing them to a higher grade of efficiency. If there is any objection to the plan. I think it ought to be brought out here today. I know we have the sanction of his Excellency, the Governor. This service was one of the first things about which he and I conversed, in my early connection with the Board of Charities. In closing I desire to emphasize the scope of the proposed State Psychopathic Institute. Perhaps the ordinary medical man, and quite certainly the layman, in thinking of such an in- stitution, would say what we needed was simply the opportunity to make post mortems — pathology. That is the one thing which of itself we do not want. What we want is a psychopathic in- stitute, with a director who is a good psychologist, who is a pathologist as well, who will bring to that place the opportunity for a study of psychiatry, as well as a study of pathology. Motion by Dr. W. E. Taylor. I think the idea evolved by Dr. Billings is the greatest and grandest one that has been brought otit at this con- ference. It is of so much importance, and such a brilliant idea, that we should take action at once ; and. in order to bring the matter to the house. I make a motion that Dr. Not a "dead bouse man." Effective and permeating service. Committee suggested. Sanction of the Gov- ernor. study of both psychiatry and pathology. Ready to help with cash. 224 Atbon seconds. SanctioDS the plan. Settle ques- tion of legality. Scarcity of good men. Civil service. Accredited to trusteen Billings be instructed to proceed at once to inaugurate and establish this department ; and I am willing to make a check for $500.00 or $1,000.00 to provide funds to carry this work on until the Legislature meets, if such action meets the approval of the State Board of Charities. My motion includes a request that the superintendents contribute, from their surplus funds, sufficient funds to carry on the work until the Legislature makes an appropriation. Dr. Athon seconded the motion. i j Discussion by Dr. Carbiel. I I thiuk the superintendents agree with Dr. Billings in every word he said as to the advisability of such a department. As I to the ways of starting it, I don't know. Some of us have bal- ,ances and some of us have not. That part would have to be ! looked into later. The idea is a good one. No one is going to [disagree with what Dr. Billings has said. I certainly sanction I the plan in every way I can. Dr. Billings Talks of the Cost, Etc. I don't think it would take much money to start it. I think it would be necessary to settle the question of the legality of starting it. We could very soon obtain an opinion from the Attorney General, and also from the Civil Service Commission as to whether they could create the position of State Psycho- pathologist under the law. If they can, it will be necessary to hold an examination. During a conversation with the Governor a month ago, I received the impression he thought we could go ahead and establish a psychopathic institute at once, provided it didn't cost too much, and provided one of the institutions had sufficient room for a oeginning, and then bring the matter before the next Legislature for an appropriation, not for the establish- ment of the institute, but that we might have the appropriation recognized. Discussion by Dr. Davis. While entirely agreeing with Dr. Billings' proposition as to the advisability and appropriateness of instituting a psychopathic clinic and laboratory, I think the suggestion that the Civil Ser- vice Commission hold an examination for a State psychopatholo- gist would be difficult to carry out. If the statement of Dr. Bill- ings is correct, that this country is very short of this class of men, I would make the suggestion that we don't call for any such examination, because we will not have hardly anyl)ody take it, but leave the matter entirely in the hands of Dr. Billings and his associates on the board, to seek and find such a man. They will find possibly one or two who wo\ild be willing to take up the work. A competitive examination at this time would be al- most valueless, because so few would dare to go into it. Dr. Billings — It has got to come under civil service. Discussion by Mr. Moii.ton. The director or State psychopathologist would have to be accredited to the board of trustees of the hospital where the in- stitute Is established. As to applicants, the greatest psycho- pathologist of this country, Adolph Meyer, was an Illinois boy, 225 who took the civil service examination in New York. We have already received applicants for this position enough to hold a competitive examination today, if we are ready for it. You need not fear that we should not get enough applicants. The examin- ing board would be the same as for our assistant physicians. We have sent abroad for applicants. I understand we have a number. Discussion by Dk. Podstata. Dr. Billings' suggestion speaks for itself. So far as I am concerned, and I am sure I can say, as far as the Elgin hospital is concerned, the need of such work has been so well and clearly planted. in the trustees' minds they have already started work at Elgin. We have a pathologist, and are doing the same kind of work Dr. Billings suggested. I mean by that we have a man who acts not as a "dead-house man," as Dr. Billings expressed it, but as a clinical man, whose chief duty is to assist in the regular physical examinations in the wards, as well as examining the blood and sputum and various secretions and excretions. That is the very work we need more than any other class of work. So it would b9 superfluous for any one to discuss the pi'oblem — as to whether we need it or not. The only question is, how to proceed so as to accomplish the purpose in the quickest and most effective manner. I am not sufficiently well acquainted with the law to pass upon the suggestion of Dr. Taylor, as to the contribution from various institutions, but, personally, I doubt if it could be done legally. Very likely there would have to be an arrangement made, by some one institution, that in- stitution to pay the expenses until such a time as an appropria- tion could be made. I think the funds of any separate institu- tion could be made available for such purpose. I don't doubt, in the least, if each institution could contribute, the board of trustees of Elgin would be very willing to do their share in that respect and would be willing to pay all, if the institute were located at Elgin. Discussion by Governor Deneen. I was, unfortunately, called to the long distance telephone. 1 haven't heard the discussion here, but discussed the matter with Dr. Billings and the members of the State Board of Charities a number of weeks ago, at the Union League Club. I don't think there is any necessity for action upon the part of the General Assembly in regard to providing funds for the establishment of the new department in any institution. It comes under the ordinary expense. We create positions of all sorts, as they are required, within that fund. I understand, if it should be lo cated at Kankakee, and I assume that will apply at Elgin, there will be a sufficient fund there, now, so that the matter could be acted upon at once, and the institution be^un within reasonable limits, and then, by the meeting of the General Assembly, in January, we would be able to forecast what it would cost to place the institute in a high state of efficiency. It would take some time to organize it. There is a very short time to elapse now, between this date and the convening of the General As sembly. I think the institute should be organized. Discussion by Dr. Woodworth. I may be intruding, but I speak as a trustee, and interested personally in the work. At Elgin we have already put in a pathologist, as Dr. Podstata has told you. The good effect has already been seen. In our medical library the books are missing, -IS PC iteady to take It at Elgin. )rdlnary expense. •flfers loca- tion at Elgin. 226 laad we have had to buy new books. Our medical staff is study- iug. We have infused new life there, into our medical staff. We see what it is doing for Elgin, and we hope it will do the same all over the State. If you want to bring the institute to Elgin, I think I can be confirmed by Mr. Rew that we will stand the expense for our institution. Offers loca- tion at Kankakee Insanity a KiDWlng luirden. I'otnts thp way. Question ax to cost Man behlml the gun most Iniportani Maki's new niotlon. Branches In all hos- pitals. D1SCU.SS10N BY Db. Greene. The necessity for progress in the investigation of the psycho- pathological problem that presents itself to the American public today is of such vast importance from an economic standpoint, that the small expense of instituting and maintaining a scientific laboratory of this sort ought not to be considered. My trustees are not here, but I am willing to bind them, in the face of the fact that we have a little deficit now, to take care of this in- stitute until the first day of next July. We will provide a room, a place for the man to live, and will feed him. In addition to that, we should be glad to give every support that can be given to the project. The conditions that confront us, in this State, and every other state in the Union, in the greatest of nations, is not measured by what it costs today, but what will be the cost 50 or 100 years from now. If there is a relative increase in the proportionate cost to society of maintaining v,he defective classes, which would compare with that at the end of the last century, the burden will become insuperable. Scientific means to restore the acute insane should disseminate knowledge through the medical pro- fession and through them to their clientele, of the possibility of the transmission of the hereditary tendency to be insane, and the possibility of avoiding it, and reach the avoidable cases of insanity in time. If we can have the medical profession in every village attain a knowledge of the scientific treatment of those cases, in which the stress of modern life develops into ac tivity a latent tendency to become insane, the burden would be, not now, perhaps, so greatly as later, materially decreased. If the man be selected, and the board see fit to send him to Kankakee, I would be glad to give my whole support to the work. I Remarks by Dr. Billings. It seems, from what the Governor said, that it is probably not legal to carry out the elements of the motion of Dr. Taylor, that the contributions from each institution go to the maintenance of a State Psychopathic Institute, but that it is perfectly legal to locate the institute at one of the existing State hospitals as a department of that institution, and to put the institute under the hospitals' present appropriation. Dr. Taylor^ — Wouldn't it cost considerable money to buy the instruments and implemonts? Dr. Billings — I think most of the places have a good many of the instruments now. The man behind the gun is most import- ant. We want the gun. but we want the man behind it, to start it. It seems to me. therefore, the motion I would rather have entertained would be that we accept the suggestion of the paper and that it be referred to a committee, to put it into operation at the earliest practical date. That is what I would like to see done. Dr. Taylor — I will withdraw my motion and make that motion. Dr. Billings — I would like to have it understood that this de partment is only one of eight, for we look for the establishment iof local laboratories and service in each of the hospitals for the 227 insane and feeble-minded. Every institution ought to have a department of the central institute. These departments should be established at the same time. I would like to have a com- mittee formed, not only to establish a central institute but to establish the branch institutes in the several hospitals. The motion was unanimously carried. Motion carried. NEED OF UNIFORM AND COMPLETE MEDICAL RECORDS. Candor and frankness. Dr. J. T. McAnally, Member of State Board of Charities,; ^'^^^y'-ess^ discussing the topic "Isleed of Uniform and Complete Medi-' McAnaiiy. cal Records." said : i The problems of our State charitable institutions are neverJNew quite solved. The rapid growth of population and more rapid Problems, increase of the dependent classes bring to us ever new problems, numerous and difficult, demanding our earnest consideration. , Any discussions of these problems in all their varied aspects as related to the mere humane and scientific care of the wards i of the State o'r as related to the interests of society at large, | should be characterized by the utmost candor and frankness oni the part of all who are attempting to do conscientious work and achieve the best results. In this conference are assembled men of large experience in the: Stimulus to management of charitable institutions in this and other states,' ^^l'^ able and competent observers who have given intelligent consider- ation to all phases of the work as carried on in these institu- tions and it is our duty here to make comparison of methods and establish standards of efficiency for these institutions that will serve as a guide and stimulus for better work. Need of Uniformity. We have belonging to this State seven hospitals for the care of insane patients, each of which has its own board of trustees and is conducted entirely independent of the others. The pur- pose for which these institutions are carried on is the same; but the spirit manifested in the work, the methods adopted, the ideals that govern, differ widely. These in a large measure can and should be harmonized. There should be unification of standards, a co-ordination of methods and a certain cooperation in management which will not only improve the quality of work done but will contribute to the economic management of the institution. The immediate work of our institutions is that of relief. We must care for the weak, the sick, the helpless, the wrecks, those who by reason of infirmity have become wards of the State. This is no light or easy task. It is a burden undertaken by the State which grows in magnitude from year to year. The ultimate idea in all charitable work is Proader. It em- braces more than relief of distress or suffering, more than medi- cal treatment of the sick. Prevention is better than cure. We should seek, therefore, to know the causes; to undertstand all the etiological factors that lie back of those diseases that make de- pendents and fill our charitable institutions to overflowing. Sta- tistics indicate that insanity is increasing in this country at a greater per cent than is tne population. Who can say how long it will be until we are a nation of lunatics? This is a distressing situation. The all important question is, "What are the causes of the alarming increase of insanity?" Purpose the same ; methods different. Immediate work is reiief. Knowledge leading to prevention. 228 Hl^h stand ards of efficiency necessary. Contribute to more thorough work. Uniform classifica- tion. Uniform records. Complete for each patient. System for eacb physlcinn. romplete medical records. Our State institutions liave a work to do in ascertaining these causes more definitely than it has ever been done, in getting deeper into the question of etiology, and so tabulating and stating these factors that they may more readily be comprehended and understood by society at large. When this is done we will be in a posiLion to more successfully combat disease and to elimin- ate the caifses of disease. This greatly enlarges the field of utility of our hospitals for insane. It is a subject of vital im- portance to the State. The public recognizes it and there is a demand for the highest grade of medical work in our institu- tions, and for the establishment of the highest and best stand- lards of efficiency. Suggestions Looking to Improvement. The following suggestions are offered, therefore, believing that they will, in a measure, contribute to a more scientific, more thorough and more satisfactory work, especially in our hospitals for the care and treatment for the insane: First. We should have a uniform classincation of mental diseases. This should be adopted by all our State institutions and would add greatly to the scientific value of our statistics. Second. \.e should have a uniform system of medical records. This point I wish to lay especial emphasis upon. A uniform system of records is necessary in order that we may use them intelligently, that we may study them easily and that we may make deductions from the large number of patients that are being treated in this State. I understand that the records of our institutions, so far as the business and financial side is concerned, [have been uniform for a number of years. If that is the best [business method it is also the best from the scientific and medi- cal standpoint. I have recently had occasion to ask the superin- itendents for the blanks that are in use in the various institu- tions. These I have not had opportunity to study carefully, but casual observance shows that they differ in all the institutions. jl think it will be readily conceded by all that it will add to the lvalue of our medical records if they are made uniform. Third. There should be a loose leaf or card system of records. [There should be a complete set for each patient. This should be provided with a folder which should contain all the examina- tion blanks, all legal papers and all letters pertaining to the patient, and should be in a convenient form for filing. Fourth. There should be a card system for each physician in charge of patients. He should have this with a record for each individual patient, for his own use. This is absolutely necessary in order that the physician may keep in constant touch with each j patient in his care, and that ho may be able to recognize changes In the condition of his patients from time to time and more In- Itelllgently to direct appropriate treatment for them. j Fifth. The medical records should he complete. They ought jto be perfect or as nearly so as they can be made. There should be a preliminary examination made of each patient on admis- sion to the hospital, or as soon thereafter as possible. A record should he made of this examination and of the subsequent ex- aminations from day to day, which should be as thorough and complete as can be made. There should be a dally clinical record of each patient during the first two weeks following admission, or until such time as .a satisfactory diagnosis can be made. It is the practice in some of the best Institutions in this country, after the preliminary examination is made by the attending phy- sician, to bring the patient before the whole medical staff, and that the phy.siclan give the patient's history, the result of his examination and study of the case, his diagnosis and reasons for the same, and let the case be studied and discussed by the entire medical staff. 229 purely cn»- todial idea. I most heartily commend this practice. From time to time Clinical there should be clinical records, made of all patients. There are in- records or stances in some of our institutions in which months, and even patients, years, have elapsed without any records, clinical or otherwise, being made of some of the patients. In acute cases there should be daily records, and even in chronic cases a recprd should be made at least once a month. These records, properly made, would be of great value. They will be of benefit to the patient and they will be of benefit to the medical staff, and tend to im- prove the medical service. Study Leads to Efficient Treatment. The more thoroughly a case is studied and understood the Corps of more efficient will the treatment be. The matter of medical re- internes, ports is largely in the hands of the superintendents. You should have a corps of internes or assistants capable of doing this work and you should insist upon the records being thoroughly kept and made complete in every possible detail. This kind of work would improve the efficiency of the service. It will make it necessary for the assistant physician to study each case with all possible thor/)ughness until he knows all that can be found out in regard to the case, and when so studied in detail and the case understood as completely as may be, the treatment to be applied may be given in a more exact and scientific manner. The purely custodial work of our hospitals for insane should Get away become less from time to time and more attention given to the from scientific treatment of the patients, with a view to curing them or improving their mental and physical conditions. An insane person should be treated as a sick person. Instead of coming! to the Legislature from year to year, asking for funds to build' new wards and enlarge our institutions to accommodate the in-j creasing number of new patients, it would be better to ask for! funds for better equipment to enlarge and improve the quality of the medical service. We should insist upon the very best ser- vice possible in our hospital work, but the medical service will be handicapped and will be unable to do the best work unless; supplied wita the necessary equipment with which to do the work. In conclusion, gentlemen, I would suggest that a committee committee be appointed to consider this subject and formulate and recom- suggested, mend for adoption a uniform system oi medical records. Discussion by Dk. Willhite. I think this is a very important question, and until our medi- Records cal records are rendered accurate, nothing but harm can come ™ccurate. from the compilation of them. We of times find, in our medical records, trifling, and even nonsensical things, which become factors in solving the problem involved. Now, why do we find these conditions? In my experience I believe it is largely duej to the fact that the medical men have not had the proper train- ing, before entering upon such work, as they do in taking up institution work, and the establishment of a psychopathic hos- pital certainly is a most important thing for the medical man today. It is not a matter of recording as we oftimes find in our his- Medicate tory, and especially subsequent histories, such things as the pa- psycho- tient being noisy or violent, or some such thing, which many records contain and nothing else, but we need something in ourl records which indicates the changes, the psychopathic process, which takes place in that individual from time to time. We have all observed, on the post mortem table, pathological changes ' pathlc process. 230 Authority of Board of Charities Seconded. Superintend- ents as members. Amendment accepted. Motion carried. We take the clinical hLstory. We find nothing from which we can draw any definite conclusions or deductions. It contains nothing to help us to do this, though our post mortem findings would In- dicate there was something, at some time, which should have made a clinical history. I think the matter of filling our blanks and our records should be largely from individual cases, specific cases. We can not expect to accomplish the best results by making a complete examination of all the cases, and of all the faculties of the mind, you might say, in each Individual case. Good results have not come from such work, such as the exam- ination of the blood. All the good work we have accomplished in that respect has been done by taking individual cases, and finally drawing definite or general conclusions. So, I think, with the work we are dealing with, we must begin with individual cases, studying each individual case, and, after a time, we can draw conclusions from the number of cases we have examined. Until we do this, It seems to me, our blanks win be nothing but spaces filled with empty phrases. Motion by Dr. Athon. As I understand it, the Board of Charities, under the law. has the authority to adopt any form as it might see fit, and then it would become the duty of the superintendents to carry out the ideas. That is the way the uniformity was adopted, in regard to keeping the accounts of the institution, after the Board worked out the plan ; and unless the Board of Charities would get up that system it wanted adopted, it would still not be uniform, and if a motion would be in order, I would make the motion that the Board of Charities prepare such forms as it desires to put in use in all the in- stitutions. Seconded by Dr. Carriel. Dr. McAnally — Of course, the Board of Charities may have the authority to do that, but it seems to me it would be better a committee prepare a system and to have at least two members of the committee superintendents of hos- pitals. I make an amendment to that effect. Dr. Athon accepted the amendment. Thereupon Dr. Hirsch, presiding, put the motion. It was carried. THE CARE .\ND TRE.ATMENT OF EPILEPTICS. Pnpor by Dr. Frank S. Churchill of Chicago spoke upon the sub- riuirchiii. ject, "The Care and Treatment of Epileptics." He said: Nobody can be more despondent than I am that Dr. Patrick la not here to present this subject to you, and I must confess to feeling some embarrassment, to be given the dlsciisslon of such an important subject before men far more competent to discuss It than I am. However. I come as a private individual and as the secretary of the Children's Hospital Society, to plead the RpRi-etfl Dr I'ntrlck's absence. 231 cause of the epileptic, and to touch very briefly upon the num- ber and present condition and care of the epileptics in Illinois, and to touch upon some remedy, if we can find such, for that con- dition. It has been my lot, since I haVe been in practice, for twelve or fourteen years, to see, at one of the largest clinics in Chicago, a considerable number of epileptic children, and I have been impressed with one or two things. I have been impressed with the number, the large number of cases that one sees. I have been impressed with the utter hopelessness of attempting to take care of them in their homes. I have been impressed with the lack of proper care, at public expense, for these unfortu- nate individuals. This, of course, has been the experience of all physicians, whether they be neurologists and alienists, or whether they be general physicians dealing with purely nervous dis- eases or dealing with children. That has been the experience, of course, of physicians all over the Stale. Pbeliminaky Statistics in Illinois. In regard to the total number of epileptics, in our State, it is rather a difficult matter to get at, accurately, at least as far as the number of cases in private life are concerned. But upon the general basis, that is accepted in this country, of about one epileptic to every 500 of population, we have over 8,000 epileptics in our State. That is the basis that is accepted by such men as Spratling and Peterson of New York, Flood of Massachusetts, who has also established a proportion as high as one to 300, which would increase the number within our State. In regard to the number at present living in our public in- stitutions, the latest statistics which are now available, and for which I am indebted to Mr. Graves and Dr. Zeller, place the number at 1,500, distributed, in the almshouses, over 444; in the insane asylums, 724, and at Lincoln, about 500 cases. Some of these figures are estimates, but I am informed that a census is being taken with a view to obtaining more accurate data. Based on the figures now available there are more than 1,500 epileptics at present in our public institutions. The rest of the 8,000 or 10,000 live, or rather, exist, in homes good, bad and in- different, most of them, especially in our large cities, bad and indifferent, rather than good. The Adult Epileptic. Whether we look at the situation from the point of view of the adult, or of the child, the condition of the epileptic, living, existing, in private life, is most unfortunate. If the adult be a man of family, and the bread-winner, the condition hardly needs to be described. He is very apt to be dangerous, as you know, and a source of danger to the rest of the family. The influence of the epileptic upon other members of the family, you are all familiar with. An epileptic may get a job between his attacks, but after his first attack, as a rule, his job is gone. No business man wants an epileptic around his premises. So there is the bread-winner out again, and he and his family too often become a burden to society. If it be the mother who is afflicted with epilepsy, why the condition is almost as bad. Those of you who have been in the home of a family where the mother was an epileptic, know what a sad and pathetic sight it is. The children are neglected. The whole home is one of the most sad and depressing scenes into which an individual can go. Impressions from experience. More than 8,000. in Illinois institutions 1,500. Reduces efficiency of bread- winner and home- maker. 232 Butt ot ridicule. Co'ony Idea the best Provides normal f<>rulltlnr "f life. SUFKEBINGS OF EP1I.EPTIC CHU.UREX. . Now, from a point of view of the children, the picture is even more sad and more pathetic. 1 dou't know of any sadder sight that a phj'sician sees than the epileptic child. Nobody wants him. I He is excluded from the public schools, and very properly. It is not fair to the rest of the children in the public schools that they should be exposed to seeing the contortions and writhings of an jepileptic child. If he goes out into the playground he is too often pointed out with scorn and ridicule, by his playmates, as one who I "has fits." Children, you know, are perfect savages to each other. It is in one sense a good thing, and it helps to rub off the angles 'of other children, but when it comes to the epileptic child, it 'seems hardly fair or just. He is very apt to be the butt of the scorn and ridicule of his playmates. Even in his own home. I am sorry to say, he is, .too often, not treated with the consider- ation, patience, and affection which his condition demands. In some other homes, he takes up so much of the time and care and attention of the mother, that the rest of her household du- ties are neglected, and the other children do not receive the care which they ought to receive. Again, during the seizures, as you well know, he may suffer very great damage. He may fall into the hot washtub, on Monday morning, or fall against the hot stove and be terribly burned at any time, and may receive harm from all sorts of accidents to which the epileptic is exposed, especially if he be a child in the home. There is no opportunity in the home for the proper care of any epileptic, whether an adult or child. Care of Epileptics in Illinois Institutions. Now, with regard to the care which epileptics can receive in the institutions of our State under the present conditions, you know very much better than I do. I hope, in the discussion, the utter impossibility of treating epileptics, according to the most modern lights and methods, will be brought out by the gentle- men who are well qualified to speak on it. Now, the condition of this unfortunate class in the community, I think, I have not exaggerated a bit It is impossible at least for me to describe the conditions, and to picture them as they actually are. What can be done with the epileptics? Obviously, these patients are wards of the State. The State must take care of them. How are we going to do it? The best way, and the best remedy for this condition of things, is by the grouping together, and the segregation of all epileptics into a community by themselves, that is to say, the establishment of a so-called epileptic colony or village. The idea has now passed beyond the experimental stage. As you all know, it is accepted as the very best way to meet this problem. Description of the Colony System. The colony system, very briefly, consists in the grouping to- gether all epileptics in a large community, preferably on a large farm, with many vocations, the patients being grouped and classified in various ways; first, in regard to sex, the men on one part of the farm and the women on the other. Then a further classficatlon, according to the severity of the case, mental condition, etc., and a.ge. Those details I won't go into. They are familiar to most of you. The essential feature and prin- ciple of the colony system should be to establish, for the epi- leptic, a home. That is the nnderlyin.g principle of the colony system, to give these poor people as happy a life as we possibly 233 colony at Sonyea. can, considering the malady from which they are suffering; tol give them as much of the home surroundings as it is possible to give. Now, that means, grouping them and housing them prop I erly, having them properly segregated, and above all, having the adults work, and having the children sent to school. The colony system has been in vogue now for a matter of at in vogue least forty years. As far as I know, the first colony in the world years "^^^ was at biederfeld, Germany, in 1867. It was established with only four epileptics, and now, I believe, has a membership ot 1,000. In our own country there are a considerable number of epileptic colonies, some private and some sustained by states. Only four state colonies have been instituted. The first one was started by Ohio, in 1893; then followed New York in 1896, then New Jersey and Massachusetts, in 1898. Pennsylvania also has a colony, but it is run entirely by private management. Other steps have been taken, in other states, in Texas, Virginia, and some others. Perhaps the best known colony in this country is the Craig Best known colony, at Sonyea, New York, the superintendent of which is American Dr. Spratling. Perhaps I can give an idea of the colony life by a short description of that colony. At Sonyea there are a few over 1,000 patients, men, women and children. They are housed, grouped and classified along the line which I have already in- dicated, and everything is done to promote the home surround- ings of the patients. Great stress is laid upon leading as happy a life as possible. For this purpose the patients are housed in pleasant and delightful surroundings. They are given a great deal of amusement. Dancing and other forms of recreation are provided for all. Games, such as baseball and football, are pro- vided for the younger members. They have organized athletic teams. Everything is done to try and promote the happiness of the individual epileptic. With regard to the work which these individuals do, I can Nature of best give you an idea of it by quoting from the last report of the t**® work. Craig colony. We find, in the summary of industries, these trades: Cafpentry, blacksmithing, tailoring, dress making, a shoe shop, brick yard, plumbing shop, mattress shop, and others. Prac- tically every ordinary trade is represented by the epileptics in this colony. As you all know, that is the most humane way to treat the epileptic adult, giving him work. When it comes to the chil- dren of this colony, there are teachers, specially trained for teaching the epileptic children, and schools well adapted to that training. The manual element plays a very important part. The purely intellectual side of education is not neglected, but great stress is laid upon the manual training those children are to receive. They also are grouped and classified according to their mental capacity, and the severity of the cases. So much for the humane side. Costs Less Than Cabe of Insane. There is another part of it which must appeal to the trustees of public funds, and that is the element of the cost. You can readily see that a colony like this, composed of physically, at least, sane adults, can be made very largely, or to a considerable extent, self supporting, and that is the case with all of the epi- leptic colonies. The products of their labor are sold in the public market, if there be any in excess of what is used in the colony itself. The Massachusetts colony, for example, in 1904, received $22,000 from the sale of its products; but perhaps the most significant figures are those which obtain in the manage ment of the Craig colony in New York. There it is estimated, by very careful statistics and figures, that the average cost to G^arnlngs. 234 the state of the eprleptic is $40.00 a year less than the cost of the average insane person, that is to say, the cost to the state of New York, of the average insane, is $185.00 a year, and the average cost of one epileptic at the Craig colony is $145.00, a saving of $40.00 per capita. I am tol*.* that in this State the saving would not be as great. Perhaps we might save as much as $30.00 a year per capita by the grouping of the epileptics, taking them iout of the insane asylums, and grouping them where they could do productive work. If this be so, and we are now supporting about 1,500 epileptics, and we can make them save $30.00 at any rate, it would be a saving of $45,000 a year to the State. This seems to be an additional and very weighty argument in favor of grouping and segregating those people by themselves. I do not wish to be understood as advancing that as the main argu- ment for the establishment of a State colony for epileptics. It lis an important one. To my mind, however, it is secondary to the humane side of the system, the greater care, more kindly jcare, and more homelike surroundings we can give to these epileptics. Other states now have their epileptic colonies. I am sure that we ought not to be very much behind the other states of the Union in this matter. It is a matter, and must be, a matter of State pride, to us, aside from our duty toward, and sympathy for, these poor people, to have established such a colony as now exists in other parts of the country and abroad. And I am very sure that his Excellency, our present Governor, must be in sym- pathy with such a movement. I know that the State Board of Charities is in sympathy with it, and, if we can have established some such a colony, it will redound very greatly to the credit I of the whole State, and to the credit of the officials who put it i through. ' I do not wi.sh to suggest, in detail, what could be done, but, InstltutloD if nothing else could be done, it seems to me it would be pos- as nucleus. |8ible to take one of our present institutions, and take out the i insane and feeble minded, and others, and put the epileptics all into that one Institution. There would be thus secured a nu- icleus for a colony, and little by little there could be built up a isplendid, well equipped and well managed institution of this kind. Illinois should have a colony. Existing Out of place with insane. Discussion by Dr. Podstata. I desire to say that the epileptics are certainly not well pro- vided for In the hospitals for the insane. It Is not fair to the epileptics, most of whom, at least, are usually In almost normal condition of mind, to be associated with the insane, many of whom are full of delusions, and many of whom are continually showing In their actions and talk, the Insanity from which they suffer. On the other hand, it is not fair to the insane, particu- larly to the acute, curable Insane, to witness the horrible con- [vulsions of the epileptic. If it is sufficient for the norninl mind jto be badly affected by such a sight, it is even more detrimental 'to the mind abnormally sensitive, and imusually easy to affect, iheoretlcally This matter of establishing a colony has been taken up In no effect jj^jg state at every recent session of the Legislature. With regard to the enactment of a law by the General Assembly, I wish to state that there Is one In effect now theoretically. All that Is neces- sary now Is to secure an approin-iation to put the law Into effect. The original appropriation amountod to $2,500, for the puriiose of investigating for a suitable ;>lto for the colony, and then for suitable plans, to be submitted, later on, to the State Board of Charities, and, through the State Board of Charities, to the 235 Legislature. Investigation was made at that time, but, un- fortunately, two reports were made, a majority and a minority report, which did not agree on esential details, in the matter of a suitable site. That was the reason the matter was dropped at that time. It is not necessary, now, to pass a law to establish a colony, but simply necessary to obtain sufficient funds to begin the work. I thoroughly agree with Dr. Churchill, on this proposition — that the care of epileptics can certainly be accomplished at much less cost than the care of the insane. The epileptics, even those we are dealing with in the hospitals for the insane, are largely able to contribute to their self-support, and they can contribute just in proportion as we enable them to do the kind of work for which they are especially adapted. I heartily concur in everything Dr. Churchill has said, and feel quite certain the establishment of such a colony will contribute to the welfare of the institutions for insane, and particularly to the welfare of the poor ep^.eptics that need special care so badly. Less cost than for Insane. SURGERY AMONG THE INSANE. connec- tions. Dr. J. L. Greene, superintendent of the Eastern Hospital ^^g^"" ^^ for the Insane, read the following paper on "Surgery Greenp. Among the Insane :" The direction to prepare this paper came to me only one Expression week ago. In that short time, with my other duties, I have of personal found it impossible to make a research of the literature of the subject. What follows, therefore, is largely an expression of my personal convictions, derived from some years of reading,; observation and contemplation of the general subject of the in- sane and their diseases. The fundamental principles upon which all rational practice of Fundamental the healing art depends are accurate scientific knowledge of principles, the human body — its various tissues and organs, together with knowledge of their functional activities, when in health. But more important still is investigation and research into that field which furnishes knowledge of the causes leading to, and re- sponsible for, a departure from bodily ease and the establish- ment of a condition we call disease; which condition, so far as its underlying cause is concerned, may be expressed by a single word — pathology — and any system of medicine, or practice of the healing art in any of its branches or specialties, not based upon a sound pathology cannot long endure. Pathology of Mental Disease. The scientific study of pathology, in general, is exceedingly modern and the study of the pathology of mental disease can be said to have only just begun. Indeed, it is not a far cry, nor does it require a retrospection leading to a remotely distant day. to bring us to a time when mental disease was considered to be only the manifestation of evil spirits, or being possessed of witches, if, indeed, it can be said that this period has yet passed. Only last week I had a letter from an attorney, residing in one of the counties of the Eastern Hospital district, telling me that the parents of one of our partially recovered and paroled pa- tients said that their daughter was only bewitched, but that the patient's husband insisted that she be returned to the hospital Study just begun. 236 Surgery one of the cures. Slow progress toward solution. for further treatment as a sick person. Inasmuch as the last expressed view of the unfortunate woman's state coincides with my conception of what constitues mental disease in general, viz., that ail insane person is physically ill, I trust that a further word of digression from the main subject may be allowed, in order that I may make my position clear. Insanity Result of Pathologic Process. Insanity, as I understand it, is but a manifestation of a pathologic process, or condition, in the brain, or a like con- dition in some remote organ or system of organs. Its manifes- tation may arise from a true brain pathology, or be brought into activity by a pathologic condition in remote organs; irritation from such remote pathologic states being transmitted to the brain through the general or sympathetic nervous system, or be brought about by toxic influences due, in the main, to faulty metabolism or the introduction through the blood current of toxic or irritant material from without. Assuming that the last stated proposition is correct, the problems presented in the se- lection of remedial agents, intended to palliate or relieve the insane condition, contemplate an exhaustive investigation into every discoverable pathologic condition present and the applica- tion of such remedies as have the approval of a modern and rational system of treatment. This, at times, brings us to the consideration of surgical intervention as a palliative or curative measure. Surgical Intervention During Insane State. A thorough research of the literature of this subject, with a tabulation of all available statistics, would have a certain value, only, in reaching a definite' conclusion as to the general effect of surgical intervention during the insane state, for this reason. During the last past five or six years so much has been written and said upon the subject; there has been so much controversy, much of it of an acrimonious nature; so many discordant sta- tistics, coming in a large degree from members of the profes- sion not identified with insane hospital work, and all too fre- quently not founded upon accurate observation or correct in- formation, that little, if any, progress toward a definite solu- tion of the problem has been made. Two incidents briefly stated will serve to illustrate: The Philadelphia Medical Journal or June, 1903, commenting upon the fact that Dr. Robert Jones of Claybury Asylum (London), had reported two ca.ses of abdomi- nal section, expressed a doubt whether anything of this kind could occur in an American institution for the insane. During a discussion at Atlantic City in June, 1900, a prominent mem- ber of the profession, from one of the large eastern cities, said that only a few years before he had written to nearly all the hos- pitals for the insane in America to ascertain if gyna?co!ogical examinations were made in them, and found that such procedure was not dene in any of them. Those of us who have knowledge of the subject covering the last twenty years, and of the litera- ture of the subject In general, know that such statements are not founded on facts and that thoy may have bom prompted by malice. Indeed, the very first reported abdominal section for the removal of a foreign body from the alimentary tract was done almost a century ago; to be exact, in ISO?, by Dr. White, an in- sane hospital supeilntendent, who removed a spoon from an Insane patient's small Intestine by laparotomy, closing the in- testinal wound with silk. I know from personal observation 237 treatment where necessary. and practice that gynaecological examinations, with appropriate treatment, was a routine procedure in some institutions twelve or fourteen years ago. Same Treatment as Outside of a Hospital. During the years that I have been actively identified with in- Surgical sane hospital work it has been my belief that every patient ad- mitted was entitled to just as good treatment as could be pro- cured for him were he outside a hospital for the insane, and that each case rested on its individual merit; that the examination! should be thorough and searching, and that if it revealed ai pathologic condition calling for surgical intervention, with a view of relieving either physical suffering or sources of irritation i possibly responsible, in whole or in part, for an abnormal mental state, the doctor should act, and I have acted, and furnished such surgical treatment as seemed necessary, in the hope that the surgical procedure would improve the patient's general | health, and thereby increase i.ne chances for mental recovery. Ij have no patience with the man who aavocates wholesale pelvic, eviseration, orificial interference, or craniectomy after years of mental disease in the belief tuat the surgery per se could have' any effect upon the insane condition, regardless of the then present neuropathologic findings. , Concubbence of Experts Necessary. Surgery for the insane based upon anything other than ar Merits ol opinion, concurred in by a physician, a pathologist, an alienist. ''^^^ '^^^®- and a surgeon, as to the merits of that particular case, is neither safe nor sane. A little while ago Dr. Marcy of Boston said: The science and art of medicine has advanced during Day of the present generation with such tremendous strides that it is impossible for any man to be wisely con vers-: ant with it in all its subdivisions and detail. In the vista of the future many unexplored fields are inviting keener research, with a promise of fruitfulness to the race none can prophesy. It is my belief that every man and every woman, denied their, Regrets of specialists. liberty and forcibly consigned to, and detained in a public in- stitution, for no reason other than that they are ill, suffering from a disease, the intelligent management of which requires: the combined skill of so many of the special branches of the! healing art, has a right to have his or her case referred to such! a board of specialists as that mentioned above. That the staff; of every large hospital for the insane shor.d be selected with! sole reference to assembling a corps of co-workers, skilled m\ the various specialities, whose community of interest would bring to e/ery case the intelligent application of every remedial! agent known to the healing art, surgery among the rest. | the patient. 238 PSYCHOPATHIC WARDS AND TEMPORARY COM M 11- MENTS THERETO. I'aper by Dr. Carrlel. Not enough curable patieDtB. FlgureB from Central Hospital- Imperative need of action. Dr. H. B. Carriel, superintendent of the Central Hos- pital for the Insane, read the following paper on "Psycho- pathic Wards and Temporary Commitments Thereto :" It has long seemed to me that one of the principal troubles with the insane hospitals in Illinois, from statistical reports, etc., was that they were not getting patients to treat that were curable. Liiie Dr. Greene, I only received word, about getting something up on this subject, six days ago, and have been un- able to get anything in the way of answers to letters on the sub- ject, and have been unable to find anything that was satisfactory, from reports that I could obtain. Therefore, what 1 have to say is largely on the suggestive order, as to reasons why, what should, or can be aone, to obtain better results. I have just jotted down a few ideas, which I will read. Of the patients admitted to the Central Hospital for the period included between July, 19U2, and July, 1904, 80 per cent be- longed to the incurable class. Of those patients admitted be- tween July, 1904, and July, 1905, in which the duration of the disease was stated as being not over six weeks, 44 per cent have been discharged as cured, and I have no doubt but that If the statements regarding duration had been more accurate the per- centage of cures would have been greater. With the knowledge of these facts it seems imperative that something should be done to impress upon the people of this State the importance of bringing their friends to the hospitals. With such a large proportion of incurable cases being admitjted annually, who afterward become wards of the State as long as they live, does it not become the duty of the State to take some action that will encourage, or even compel, these cases to be brought under treatment, while . ere Is yet some hope for a cure? The hosi)it:ils for the insane should be what their name Implies, hospitals, and not places of refuge or last resort, as Is too oft'm the case. Chief Reasons for Delay. The two chief reasons for delay may be given as, First.. Because of the publicity given the case by a court trial. Second. The recommendation of the local physician. To devise some plan that will lessen the prejudice the people have In regard to our hospitals brings us to the subject, "Psycho- pathic Wards and Temporary Commitment Thereto." Formerly Recommended Psychopathic Wards. Three years ago in looking over the records of the hospital ,wlth reference to admissions and discharges, I was very much To^^ures ° Impressed with the fact that the hospital was not doing good work; that the number of admissions was all out of proportion to the number of cures. In this respect it did not compare with reports from other institutions and did not compare even Publldtj. Docfor'B advice. Plan to loHsen prejudice. Adml.sslons out of 239 New en- vironment. In New York and Albany. with the reports of former years. With a view of improving this condition of affairs, I recommended in a report to the trus- tees, printed in 1904, the establishment of a psychopathic ward in connection with the hospital where recent or border-line cases might be admitted for a limited time without the formality of a court trial. As changes would first have to be made in the law regarding commitment, nothing came of the suggestion. The establishment of such a ward would, I believe, to a great extent, hasten the treatment of these cases As to the recommendation of the physician, if the people could only be made to know that the first and very best treatment that can be given an insane person is to remove him or her from accustomed surroundings, even placing the patient among strangers, the recommendation of the physician would not be so often unheeded. Psychopathic Wards in Other Cities In accepting the invitation of Secretary Graves I hoped to be able to present some statistics that would show that the establish ing of such a psychopathic ward in connection with our State institutions would not only bring cases under treatment early but would result in a decided increase in the number of cures. I regret to say that in the limited time given me I have been unable to collect this data. At Bellevue Hospital, New York City, and the General Hospital at Albany there is such a ward where patients are admitted upon application of their friends. The ward at Bellevue is more of a detention hospital where these cases may be admitted for a limited time and later transferred to other hospitals in the state for treatment. During my visit to New York this summer special inquiry was made in regard to this matter at the different hospitals visited and all spoke in most glowing terms of the good work that was being done. Dr. Everts, at Ward's Island, stated that 40 per cent of those admitted were cured. No superintendent in Illinois dares make such a statement. If Ward's Island, with its large foreign popu- lation, which it has been my experience do not recover, can re- port such a claim, what is to be expected from such a plan in Illinois? One in Each Hospitax. In the establishing of a psychopathic hospital it is quite im- portant that it be easy of access from all parts of the State. For this reason it seems better to have a psychopathic ward in connection with each of our five hospitals than to have a single hospital situated in some certain portion of the State. In build- ing such a hospital it would be my plan to have it removed from the other buildings and so constructed that all kinds of cases, including violent and noisy, could be admitted and Iso- lated so as not to disturb those about them. Caution should be used that the wards be not too large. A ward that will accom- modate ten or fifteen patients would be found more advantage- ous, I believe, than a larger one. Foundation for Good hIanagement. The foundation for good management in all institutions of ^-, ^^ . this kind is careful classification of patients "" ' ' '""^ " Easy ol access. This applies to all classes, but is especially desirable in border-line cases and those nervous, anemic people who are always afraid that some- thing is going to happen. Besides good classification it is also classlflca- Uon. 240 important that suca cases be isolated; that tuoy do not come in contact with the older or chronic cases; that they be impressed with the idea that they are sick and that their surroundings be in keeping with those of a well regulated general hospital. IsolatluD and hospital treatment Important factors. Cases at Cook County Detention ?Iospital. DnnRer of iivercrowd Injj with alcohollrs. Successful With Women Patients. During the past two years we have made an effort to carry out the hospital and isolation idea in the treatment of all female pa- tients. These patients are put to bed for periods varying from a few days to two or three weeks, depending upon their physical and mental condition. As we become acquainted with them they are transferred to the infirmary, a building entirely separate from the rest of the institution. Without going further into the subject of treatment at this time, I wish to state that the result has been all that could be wished for and the number of cures re- ported at the close of our last biennial period shows a gain of 1 25 per cent over the number reported two years ago. lE-MPOBABY Treatment Without Coubt Tbial. In the treatment of insanity drugs are useful, but in my opin- ion proper surroundings, massage, hydrotherapy, fresh air. kind treatment and good food are quite as important. If we are not to continue building homes for our insane, we must do some- thing to bring them under early treatment. The plan of estab- lishing a psychopathic ward in connection with our institutions where patients may be admitted for a limited time without the formality of a trial seems most practical. It is meeting with success in otlier states. I trust it will receive consideration in Illinois and at least be given a trial. Discussion by Dr. Davis. Of as much importance as the subject of improved and earliest possible treatment of insane cases may be, I wish to state that tK)body. possibly, gentlemen, of the superintendents of institu- tions here, has opportunities to see cases as early as I can see them right along. If I may use the vernacular expression, I see maniacal cases, or cases of acute delirium, right while they are "flying off the handle." They are brought to our institution very often, and properly so, by the police, picked up on the streets, dragged, often bound hand and foot, from a wagon, or brought in in much the same condition by their relatives. The whole question of the need of psychopathic wards, and, for that matter, the establishment of psychopathic institutes, could be very easily and plainly seen by any disinterested person, by spending from six to twelve hours in the Detention Hospital of Cook county. Patients are brought In, In such acute condition, maniacal condition, or delirium, that we are compelled to adopt the treatment of a hospital. We have to put them to bed. These matters have so forced themselves upon us at the Detention Hospital, which by so many is considered a homo of detention only, that I have occasion, very often, to advise the court that the patients remain five or six days longer, when, after the proper treatment, they may be permitted to return to their or- dinary duties, or entrusted to their relatives, and to proper care. I wish to raise one other question. In connection with the psychopathic hospitals, in large cities, and In the county hospi- tal of Chicago. Wp must devise some means to guard our psy- chopathic hospitals from being overcrowded, especially If we 241 City ought to handle drunkards. are to follow your idea. Dr. Carriel, that patients be admitted without being committed by the court, by a large class of un- desirable patients — I mean alcoholics. If we should have a hos pital where relatives could bring in their patients, for tempor ary detention, to be taken care of, we would be overcrowded with simple "drunks." My statistics show me I am taking care of, every month, from twelve to fifteen cases of acute delirium. As far as the city of Chicago is concerned, I, personally, was always in favor of compelling the city to take care of this class of patients. The city of Chicago, at the present time, is deriving a revenue of nearly $7,000,000 a year from saloon licenses. In my judg- ment, it would l3e proper for the city to establish an alcoholic ward. In this regard, I wish to state that the success of the psychopathic ward of Bellevue Hospital, in New York, is so great because of the fact that institution does have alcoholic wards, as you know, doctor. The city of Chicago ought to establish an alcoholic ward, at the Bridewell say, to keep such patients there, under proper care and treatment, until thej" are cured, so to say, and even making them pay, if not in casu, then by their labor. Only then will psychopathic hospitals be successful, and only then, doctor, shall the proper class of patients come in, of their own volition, or be brought by the family. That proper treatment, in acute cases, often in the first forty-eight hours, is very important, goes without saying, because not only the ultimate recovery of the patient, but very o-i:en the life of the patient depends upon such treatment. Reply by Dr. Carriel. The object of the paper — I can hardly call it paper — sug- gested by me, was not so much to take care of drunks, or any thing of that kind, but to provide a place where the insane would come, and not hesitate, on account of the stigma of the court trial, in order to get there. I believe that many of those cases detained at home for six months, or until the chance of their geting well is past, would, if they could, without any court trial, be brought in without hesitation. The result would be, we would not have so many chronic people to take care of. They would get well and go home, in many cases. Motion BY Dr. Davis. I move, Mr. Chairman, that in connection vv^ith this whole question, the committee you appoint, at the same time| ^'^f'^e'ommit- take up the discussion of our present lav^s as to the commit-' ment law. ment of insane persons, because of the probable benefit of discussing the systems in vogue in other states. It might be proper to bring to the next Legislature such amendments to our laws as would further this idea of admitting patients, without trial, in the institutions throughout the State. Seconded bv Dr. Carriel. Places for hopeful Insane cases. Dr. Billings, Chairman : The motion of Dr. Davis is that the committee to whom this paper shall be assigned is instructed to endeavor to modify, through the Legisla- ture, the present system, and permit of temporary commit- ment without court trial. Unanimously carried. — i6PC Motion carried. 242 WHAT SYSTEM OF CHARITY ADMINISTRATION IS BEST SUITED TO THE Nl-.EDS OF ILLINOIS? Some seek a change Investigation In the Bast. Present charity law. VarlniiR siiK- goatlona. President Billings, speaking of the general subject "What System of Charity Administration Is Best Suited to the Needs of Illinois," said : This question has been brought to the attention of the State Board of Charities, because there are citizens of Illinois and societies as well, that think the present method of adminis- tering the charitable institutions and prisons and reformatories of Illinois is not adequate or modern. They have made sug- gestions that we should bring before the Legislature a method of changing this system. New York, Massachusetts, and other states have laws governing the administration of the charitable institutions, penal institutions, and so on, which differ from our own. In New York there is a very radical difference. Our board has looked into this question and has brought before you in the basis for discussion a suggestion that time be taken for very careful inquiry before making a recommendation. Mr. Graves investigated in the east and discussed the matter with representatives from fourteen states. I have written letters to many physicians and have received answers from some, and expect to receive answers from others, concerning the practical working of the New York law, as well as the laws of other states. Now, our board does not bring this to you with the idea that it thinks a change should be made, but It realizes the matter is going to be discussed. It may be brought by some individual before the Legislature, without the consent or without the di- rection of this board; and we desire, therefore, that it be brought before you, as a matter for thought and consideration, and ask you to write for our information yoilr own ideas of what is the best system and why you thiuK so. Briefly stated, our present law is this (without the statutes before me), that our charitable institutions are governed by local bodies, that is, that "home rule" exists, by trustees, three for each institution, appointed by the Executive of the State, that board of trustees being empowered, without the consent of the Executive, to appoint the superintendent, audit the accounts, and ask for appropriations through the Board of Charities, and so on. Second, a board of Charities, which is a committee rep- resenting the Governor. It is a body of men and women chosen by him. The only power conferred upon us is that we may gain entrance to any charitable institution in this State, examine its methods of administration, methods of medical con- duct in institutions and hosi)itals, and report our findings and recommendations to the Governor. This board has. of course, more or less of moral force, and its benefits to the State depend almost altogether on the amount of moral force it has, plus the status of the Governor, and what his intentions are. That is good, under ordinary conditions, of course. Now, in Illinois, shall we let well enough alone or try some system new to us? The suggestion from some people is that there should be a central hoard of control, that that central hoard of control should iiave. with or without local boards, power concerning purchases: or. Instead of a board of control, there should be a board of chnrltiea. with a purchasing agent, or that there should be. with local boards as they now are, a com- mission in lunacy, which should have power in reference to the 243 hospitals for the insane, and regulation of those institutions, and a penal commission, something like the Board of Pardons, with its power increased, to have control of the prisons and reforma- tories, including hygienic conditions, as for instance, we have discussed here regarding Joliet. Another board, different from these two, would have control over the charitable institutions other than hospitals for the insane and feeble-minded. Now we, as a board, are not going to suggest any changes unless we find, studying the situation in our own State and elsewhere, that something we believe is better can be suggested. We bring this before you not for oral discussion today, but to ask you to write, and give us your opinion of the con- ditions in Illinois, and, as you may have experience in other states. Write to the secretary, or to me. If we are to make any" changes do not suggest taem for this Legislature, but let us all study this problem as a matter to be presented two years from now, if we then believe a change should be made. Study for two years BUSINESS SESSION AND CONCLUSION OF CONFERENCE. Following is a report of the business session, which came after the reading of papers, and concluded the conference : President Billings announced the appointment of the following committees to consider the items in the Board of Charities basis of discussion and other items brought before the conference: State Cakk, Including New Institutions, No. Assigned to Special Committees: Miss Lathrop, Dr Evans, Dr. Webster, Mr. Bicknell, Dr. Churchill, Mrs. Bourland. Medical Administration, Including Internes and Uniform Records. Dr. McAnally, Dr. Podstata, Dr. Zeller, Dr. Willhite, Dr. Davis. Hydrotherapy and Industrial Re-education and Recreation. Dr. Podstata, Dr. McAnally, Dr. Carriel, Dr. Songer. State Psychopathic Institute. Dr. Greene, Dr. Podstata, Dr. W. E. Taylor. Improvement of Buildings and Grounds and Equipment. Dr. Hirsch, Mr. Zimmermap, Dr. W. E. Taylor. Systems of Charity Administration. Dr. Hirsch, Miss Lathrop, Dr. McAnally, Mrs. Bourland. Close of meeting. Appointment of com- mittees. 244 Uniform Grades, Rules, Salaries and Nomenclature. Mr. Moulton, Dr. Athon, Dr. Podstata, Dr. W. E. Taylor. Dr. Zeller. I Problem of the Feeble-Mi nded. Mrs. Bourland, Dr. C. B. Taylor, Dr. Willhite, Dr. Zeller. Tlbercllosis in State Institutions. Pr. Zeller, Dr. Carriel, Dr. W. E. Taylor, Dr. Webster. Ex-officlo members. Suggest another meeting. Reconvene to bear reports. Epileptics. Consump- tives. Special Committee on Joliet Prison. Dr. Hirsch, Dr. Webster, Mr. /iimmerman. I Dr. Carriel — I would like to make a motion that the presi- dent and secretary of the Board of Charities be made ex officio members of all the committees. Unanimously i carried. I ' Work for Committees to Do. President Billings — I think we may all feel that this meeting, so far as the subjects brought before us, has been a success. It will not be a complete success if we let it rest here. It will be a success if these subjects, referred to committees, are worked out In the committees and brought back to us. I suggest a motion 'that this meeting be adjourned to some date before the 1st of January, before the Legislature meets, to receive the reports of these committees and formulate definite plans as to what shall be [done. Statement and Motion bt the Governor. Governor Deneen — I move that the conference reconvene early in December to listen to the reports, and that the various com- .ralttees appointed to consider policies which will require the expenditure of money — those dealing with the consumptives and leiilleptlcs, for instance — be requested to formulate by that time plans showing the expense, the cost of maintenance, the number of persons who will receive treatment and the number of per- sons of that order within the State. In the case of epileptics, I think we should have a report of the aumber of epileptics in each institution, also a more accurate estimate of those at large. As to the matter of dealing with consumptives, I have been in- lormed, as I recollect, that about 8,000 persons die of consumption in this State each year. Perhaps I am well within, and maybe I overstate the number. It is. in any event, a very large number. I think the committees handling this subject should state. In addi- tion to the cost of establishing the hospital for consumptives and sanatoria, the number that can be treated and the cost per capita, the number of that class in the State, so that we would have that information and we could mature our policies In advance of the convening of the General Assembly. We expect those having to do with subjects involving a large expenditure of money — aside from the charitable institutions — to have the estimates of expen- diture in definite form early In December, as the University of Illinois and penal institutions, so that we can have the partlcu lars of each case well In hand. 245 I think that early preparation is a very important thing. I have had considerable experience in observing legislation, and a limited experience in taking part in it, having been a member of the House at one time. The Legislature is frequently abused by the people of the State for an alleged lack of intelligent action regarding measures. The truth is that policies are suggested to the Legislature which are good in themselves, but, when pre- sented to the Legislature, are so lacking in detail, in facts essen- tial, that they may understand the scope of the new measure that is to be crystallized into a law later in the administration, that the legislators are loth to act regarding it, especially in those cases which require a fixed annual charge upon the State, a charge which is to grow. Therefore, I think all of this information should be at hand First, the initial cost; then their cost of maintenance and the scope of the work for which such an institution is to be created, so that we may have intelligent action among ourselves in reference to the recommendations to the Legis'ature. The Legislature initi- ates nothing. It passes upon matters initiated by outside persons, and it passes upon them intelligently when the full facts are be- fore it; and not intelligently when inaccurate statements are before it. Those from Chicago will remember what occurred at the last meeting of the General Assembly regarding the charter. The Legislature was prepared to do anything that was reasonable. It was abused by a number of our friends in Chicago roundly be- cause it did not act. Finally they called a charter convention to agree upon a measure. It has ample work to keep it busy until next session. "When the consensus of opinion is once reached, it is not a difficult matter here. So I say, I think we should have this accurate data early in December, so that it can be published, through the bulletin and through the press, and people can begin to form their views upon this matter and can be represented by their Representatives in the Legislature, who, I think, will repre- sent the people fairly and act upon their views. President Billings — I would ask, Governor, if you Include in that the question of the establishment of the hydrotherapeutic department in the hospitals for the insane? Governor Deneen — All matters that relate to money. Then we will see the thing accurately and determine whether or not al) can be done; and if not, the order of precedence. We can tell that later. First, find what we have to do and the money we have to do it with. The motion of the Governor was carried unanimously. Cost of the Meeting. Governor Deneen — Just one other motion. I recommend, or move, that the cost of this meeting and the one in December be distributed among the various institutions represented here — the insane hospitals and the hospital for feeble minded — pro rata, if it can be done within the law. I will have that investigated by the Secretary of the Board of Charities and the Attorney General. President Billings — That means publication of the proceedings? Governor Deneen — The publication? Yes. The appropriation was made for this Board of Charities, assuming it would do as boards have done heretofore. This board has enlarged the scope of usefulness of the board ai^i the members, and because of that the expenses were enlarged accordingly. That was not foreseen when the Legislature made the appropriation. It think it is fair as the benefit comes to each institution, it should pay its pro- portionate part. Therefore, I make that motion. The motion was carried unanimously. Rarly pre- paration. Items to be presented. Uecalls Chicago charter. Include hydrothe- rapy? All matters relating to money. Pro-rate the expense. Board of Ch.irlties Fui d too small. Motion carried. 246 Additional work. Governor moves en- gineers l)e employed. More tban boilers. Everything. Carriel lias report Not care- fully prepared. Motion carried. Motion by Dr. Ilirsch Motion Carried. AUTUOBITY FOR PHYSICAL SUBVEYS. Secretary Graves — There is one matter recommended by the State Board of Charities, in the basis for discussion, which has not been touched upon here. That is that the State Architect, In making certiiin surveys which the Governor called upon him to make, covered the problem of ventilation very thoroughly, hui was able to make only a superficial survey of other physical con- ditions, like boilers, water supply, sewerage and things of that kind. In the basis for discussion there was a suggestion that the different superintendents authorize the State Architect to employ nn expert engineer, to go over all their physical property and make recommendations to them, and that they pass the recom raendations and the cost thereof to the State Board of Charities iis the basis for such appropriations as are found necessary. I think somebody ought to make a motion to have this done. Governor Deneen — I move that an engineer be employed to make such investigation of the heating plants of the different institutions here represented, and that the cost of the Investiga- tion be proportionate to the work; and I will say in reference to that, that the head of that department at the University of Illinois will either undertake the work or assign some competent person so to do. He informed me it would take about one year to com- plete the work. In that event, I think two or three engineers should be appointed, in order that the next General Assembly may act in making appropriations. Therefore, I make the motion that an engineer — or engineers — be employed, under the direction of the Board of Charities, as we will have to have some general body make these investigations. I am quite sure, from the in- formation I have received, it will not be an expensive matter. It will be found that the $2,500.00 or so of cost will be more than saved, over and over each year. President Billings — That includes the investigation, not only into boilers, but plumbing and sewerage, etc.? Governor Deneen — Everything. Doctor Carriel — The State Architect has made such report in some cases as in mine. Secretary Graves — The State Architect himself Is not satisfied with his report on anything except ventilation. He stated to me that the report was made hastily — the Inspection made hastily and superficially and unsatisfactorily, and he wants it done more in detail. In a more painstaking manner, and that Is the reason why, in the Board of Charities' basis for discussion, a suggestion of that kind was made. The motion was carried unanimously. Vote of Thanks to the Govebnob. Doctor Hlrsch — I know that I merely express the sentiments of ill of us when I propose that a vote of thanks be given to the Governor for having called us together, for uniform kindness and cooperation with us; and I desire to go on record that the Gov- ernor has shown himself In full sympathy in all that tends toward the improvement of the service and enlargement of the service of the Institutions now existing, or to be called Into existence. In this State. I move that a vote of thanks be extended to the Gov- ernor. Seconded by Mrs. Bourland. Carried unanimously by a rising vote. 247 Doctor Hirsch. — I move that this conference now adjourn, sub- ject to the call of the Governor. i Governor Deneen — The Board of Charities will be more familiarj with the work, and I suggest it would be better to make reconven ing at the call of the Board of Charities. The amendment was accepted. The motion as amended was carried unanimously. Call of Governor. .Amendment. Adjourn- ment. 248 DECEMBER, 1906, CONEERENCE OF SUPERINTENDENTS. INTRODUCTION. Committee Reports Adopted. Results of two Con- ferences. Psychopathic Institute. Ilydrother- any. Re-education. Uniform No- jnenclature, and wages. Uniform Rpcords. Uniform Cur- riculum. Only fire- proof build- in Rs. Tile floors. Iron beds. Free diph- theria anti- toxin. Epileptic vil- lage. Sanatorium for con- sumptives. Cottage plan Board to Introduce npproprla- tlonb. Reports of the various committees appointed at the October, 1906, conference of superintendents, were made and adopted at the second conference held in Chicago on Decem- ber 14, 1906. This conference was attended by his Excel- lency, the Governor, the superintendents of the hospitals in the insane group, and some of the trustees of the institu- tions, the State Board of Charities, representatives of the Civil Service Commission and the State Board of Health, and by certain citizens not in the public service. Agreements and Understanding. The result of formal action by and understanding of those attending both conferences may be stated briefly as follows : 1. To establish the State Psychopathic Institute. 2. To favor installation of hydrotherapeutic apparatus. 3. To encourage industrial re-education. 4. To establish uniformity of nomenclature and positions of service in the hospitals for the insane and to recommend that trustees establish a uniform maximum and minimum wage scale in all hospitals for the insane. Such wage scale was submitted. 5. To adopt uniform complete medical records. 6. To draft a uniform curriculum for training schools In hospitals for the insane. 7. To erect only fire proof buildings in the future. 8. To use tile floors in all toilet rooms. 9. To replace wooden beds with Iron beds. 10. To support the State Board of Health in its en- deavor to secure an approi)riation of $15,000 a year for free diphthoria antitoxin, as a purely economic item in hospital service, not to mention its manifest humanity. 11. To favor and work for an appropriation of $265,000 for a State Colony for Epileptics. 12. To favor and work for an appropriation of $150,000 for a State sanatorium for curable consumptives. 13. To use the cottage plan in new institutions. 14. For the Board of Charities to introduce the institu- tion appropriation bills into the Legislature. 249 Program of the Conference. The program of the conference, as carried out, each sub- ject being a committee report presented by the chairman, follows : State Care. New Institutions: (a) Colony for Epileptics, Dr. F. S. Churchill. (b) Sanatorium for Consumptives, Mr. Ernest P. Bicknell. (c) Free Diphtheria Antitoxin, Dr. George W. Webster. Problem of the Feeble-minded, Mrs. Clara P. Bourland. Tuberculosis in State Institutions, Dr. George A. Zeller. Improvement of Buildings and Grounds and Equipment, Dr. Emil G. Hirsch. State Psychopathic Institute, Dr. James L. Greene. Hydrotherapy and Industrial Re-education and Recreation, Dr. V. H. Podstata. Medical Administration and Uniform Records, Internes, Dr. J. T. McAnally. Uniform Grades, Rules, Salaries and Nomenclature, Mr. W. B. Moulton. Review of Appropriation Requests, all superintendents. Appropriations. The items in the appropriation bills were gone over and reduced very materially in the amounts asked. Each super- intendent was requested to absorb all items of rehabilitation into the usual special appropriations, so far as possible, and to classify the others as surplus appropriations, i. e., those which should be made in view of the State surplus, if the Legislature should see fit. Superintendents were requested to report their revised appropriation requests to the Board of Charities for presentation to a final conference of all superintendents and trustees in January. It was decided to invite the chairman of the Appropriation Committees of the Senate and House to attend the January conference, to be held in Springfield, that they might have a foreknowledge of the condition of the charity service and property of the State and of the recommendations of the State Board of Charities looking to improvements. Those Who Attended the Conference. Following is a list of those attending the December con- ference : Dr. W. L. Athon, Superintendent Southern Hospital for the Insane. Dr. Frank Billings, President of the Board of State Com- missioners of Public Charities. Mrs. Clara P. Bourland, member of the Board of State Commissioners of Public Charities. Mr. Ernest P. Bicknell, Superintendent Chicago Bureau of Charities. Dr. H. B. Carriel, Superintendent Central Hospital for the Insane. Mr. Charles A. Chapman, Consulting Engineer. Dr. Frank S. Churchill, Secretary Childrens' Hospital So- ciety of Chicago. Dr. William A. Evans of Chicago, member consulting staff Cook County Hospital for the Insane, (Dunning). Program. Approprla tlons con- sidered. January con- ference. Senate and House committee chairmen invited. Those present. 250 Dr. James L. Greene, Superintendent Eastern Hospital for the Insane. Mr. William C. Graves, Secretary Board of State Com- missioners of Public Charities. Dr. Emil G. Hirsch, member of the Board of State Commis- sioners of Public Charities. Dr. H. H. Hart, Superintendent Illinois Childrens' Home and Aid Society of Chicago. Mr. S. C. Kingsley, Superintendent Chicago Relief and Aid Society, Chicago. Mr. W. B. Moulton, President State Civil Service Commis- sion. Mr. Joseph C. Mason, Secretary State Civil Service Commis- sion. Dr. V. H. Podstata, Superintendent Northern Hospital for the Insane. Mr. Robert Rew, President Trustees Northern Hospital for Insane. Dr. Walter E. Songer, Superintendent Asylum for Insane Criminals. Dr. W. E. Taylor, Superintendent Western Hospital for the Insane. Dr. C. B. Taylor, Superintendent Asylum Feeble-minded Children. Dr. George W. Webster, President State Board of Health. Dr. P. M. Woodworth, trustee of the Northern Hospital for the Insane. Dr. O. C. Willhite, General Superintendent Cook County Institutions at Dunning. Mr. John Wagner, trustee Asylum for Feeble-minded Children. Dr. George A. Zeller, Superintendent Asylum for Incura- ble Insane. Mr. W. Carbys Zimmerman, State Architect. Miscellaneous Statements. The first part of this report is devoted to committee re- ports made at the December conference. Because of the immense amount of discussion, especially of appropriation items, the cost of printing a full report of the conference is prohibitive. Therefore discussion is omitted. The ap- propriations and the general policies of the board growing out of the conferences are reviewed in the first part of this volume in the Board of Charities biennial rept^rt to the Governor. The committee on State Care divided itself into sub-com- ^'sub-commit niittees to cover the various subjects assigned to it. The tees. committee members are: Miss Julia C. Latbrop. Dr. A\'il- liam A. Evans, Dr. George \V. Webster. Mr. Rrnest P. ieicknell, Dr. Frank S. Churcbill. and .Mrs. Clara V. P..nir- jland. Sf board of trustoos for such colony iintil otherwise provided by law. I presume that, pursuant to said Act, plans and specifications have been prepared, the only thing lacking being an appro- priation by the General Assembly. The Board of State Com- Board of Clinrltlps may proceed. 265 missioners of Public Charities being ex officio trustees of said colony, it will be entirely proper for said trustees to bring the matter of an appropriation for said colony be- fore the Forty-fifth General Assembly in any wa/ or in any manner that the board, in its judgment, may deem proper and appropriate. Very respectfully, (Signed) W. H. Sthad, Attorney General. It only remains to obtain from the General Assembly an ap- propriation to carry out the intent of this Act. How large an appropriation will be required? Study of the colonies established In other states of the Union and Investigation into conditions in our own State, as to value of land, present cost of building, cost of maintenance, etc., show that a colony for epileptics can be started properly and maintained for a little less than a year for $265,000.00. It is recommended that the General Assembly be re- quested to appropriate this sum for the purpose. The various items are as follows: Land— 800 to 1, 000 acres at $100 per acre Surveying, etc., with building of power house, etc Five cottages, at $10, 000 each Each cottage with a capacity for 20 colonists. . . Two buildings, at $20, 000 each Each building with a capacity for 50 colonists. . Total 200 colonists. Maintenance till 1909 .• 100 colonists. 100 colonists. $80,000 65.000 50,000 40.000 $235,000 30.000 $265,000 Appropria- tion required. Estimates of the State Architect. Item of Land. Study of the experience of other colonies shows the necessity of plenty of land for farming and gardening purposes and for future growth. The following statistics are of interest in this connection: Original Tract. Ohio colony, 101 acres New York colony, 1, 895 acres . . . New Jersey colony, 187 acres Massachusetts colony, 230 acres. Indiana colony, 1, 228 acres Texas Present tract — acres. 500 1,895 779 658 1,228 Present population. 1.300 1,050 232 521 Just started 232 Large tract needed. Our State with a total population of over 5,000,000 and with Need about 10,837 epileptics must make ample provision for a right start 1,000 acres, with room for growth. We should start our colony with 800 to 1,000 acres. Land of suitable quality and in a desirable location can be bought at a figure not exceeding $100 an acre. Certain characteristics in the land selected are greatly to be character- desired. It should have first of all a good water supply; it should istics. be well drained, it should be diversified in character, part being fertile and suitable for truck gardening and farming, and part being suitable for pasturage to maintain a dairy, part being 266 Preparation. Colleges. $30,000.00. First occupants. Kenson for selection. woody. Deposits of clay are important, brick making beln-4 oiie of the most profitable industries carried on by an epileptic colony. Gravel beds and plenty of sand are also desirable to be utilized in the making of cobble stones and concrete. It is perhaps not likely that we shall find a tract of land fulfilling all these condi- tions, but in a State as diversified as our own, we can undoubt- edly find a tract on which at least one of the above industries can be carried on. It is important to bear this in mind for the future economical management of the colony. It must be made as pro- ductive and self supporting as possible. Much of the preparation of the land should be done by the colo- nists themselves, preparing the land for cultivation, the laying out of the walks, drives, etc. Considerable work, however, must be done before occupation to make ready the tract, such as the ; building of a power house, the laying of sewers, underground electric and heating systems, etc., and for this purpose we should i require $65,000.00. Item of Buildings. In the number and kind of buildings which we put up shall we show our appreciation or lack of appreciation as to the true in tent and character of the colony. The patients must be chissified; the home element must prevail as much as possible. For this purpose, small, attractive cosy cottages should be built, and not hideous, unattractive monuments of stone and mortar. Cottages to accommodate from 18 to 20 colonists can be built for $10,000.00 apiece. We should have five of these, giving us accommodation for 100 colonists of Class 1. Patients of the second and third classes can be grouped in larger numbers; we should build for these latter two buildings each, to cost $20,000.00, with accom modations for 50 patients each. Of these buildings the five cot- tages should all be occupied by men for reasons which will be de- tailed below. Of the two larger buildings, one can be occupied by men, the other by women. Item of Maintenance. The total of the various Items; purchase and preparation of land and construction of buildings amounts to $235,000.00, leaving a balance of $30,000.00 for the maintenance of 200 colo- nists for a certain portion of the year 1908. (The selection of a suitable site, the preparation of the land, the construction of the buildings will take considerable time and it is improbable that the colony would be ready for occupancy bf^foro the spring of 1908, say in March. For the remaining ten months then, we should have a balance of $30,000.00 for 200 colonists, or at the rate of $180.00 per capita per year, an estimate well within bounds. Selection ok Patients. In the plan thus briefly detailed two factors need further men- tion: (a) The selection of a large number of adult male epi- leptics of the first class as the first occupants of the colony; (b) the absence of provision for epileptic children. (a) Selection of male patients of the first class. This is done for two reasons: humane and economical. The colony Is essen- tially for this class of patients, male and female: thev are the ones best adapted to, and most liable to profit by. the colony life. They are the ones who need it most. Sane between their at- tacks, they are the ones who suffer most by being housed, as at present, in our Insane asylums and almshouses. They are the ones who are in most urgent need of rescue from th'^ir present 267 surroundings. For humane reasons, then, they should come first. Furthermore, their selection is wise from an economical point of view. There will be much constructive work to be done during the first year of the colony's existence. This must be done as eco- nomically as possible. If we exercise great care in selecting the first occupants and put into the colony 100 men in the best con- dition physically and mentally, we shall start with an excellent nucleus of productive laborers, who by their work will do much to support themselves and the 100 patients of the second and third classes, and thus lower the cost of maintenance at the very start. Obviously this can be done better with men than with women. (b) The absence of children. As already said, during the first year of occupancy of the colony, much constructive work must be done, and we shall want able bodied men to do much of this constructive work. The enrollment of a considerable num- ber of children as colonists would entail the building of a proper school house at a cost of $15,000.00, and would raise the cost of maintenance by obliging us to carry in the colony a certain number of patients, wholly or almost wholly, non-productive Teachers would have to be employed. Furthermore, the presence of children and of the school would add another problem to the superintendent's work at a time when he will need to devote all his energies and power to the proper and thorough organiza- tion of the colony. It is a time of building and constructing and the more freely the superintendent can give his time to this side of the question, the more satisfactory will be our start To one whose chief interest in an epileptic colony is on behalf of the children and who has worked for the cause chiefly with the object of providing for these unforutnate little ones, it is difficult to take this stand and to make this recommendation, and it is only slowly and reluctantly after months of study on the problem that I have come to this opinion. I do it, however, for the reasons already given and with the firm belief that it is in the long run the best arrangement for all concerned. The State, the patients first selected and the children themselves. We must build the colony first before we can take proper care of the children. Respectfully submitted, Frank S. Chuechill, M. D., Sub-committee on State Colony for Epileptics To perform construct- ive work. Absence of children. Take the children later. 268 Census of E})ilc}>li(s in Illinois Shilc ( 'liorihihlc I iisfihifions, 1906. [As reported by institution officials during November.) Name of Institutions. s t D M a 09 1 : 1 s Sane male Ml \ Totul sane 2 a : 1 5 ^5 a a BZ ; 1 . (I f s D S. o a 1 % i Northern Insane. Eljrin 17 56 90 75 24 77 3 14 28 43 50 13 71 31 84 133 125 37 148 3 3 3 6 1 ....! ^1 38 84 1 133 125 Western Insane, Watertown Incurable Insane. South Barton- 1 2 3 14 1 10 21 64 148 3 Ueaf and Dumb School. Jackson- ville I 1 1 1 1 1 195 188 383 383 Soldiers' and Sailors' Home, 28 28 28 1 1 1 1 1 1 Soldiers' Widows' Home, Wil- 1 1 State Training School for Girls, 3 3 3 ;j St. Charles School for Boys. St. Charles .. r 3 .. ! 3 ^ 210 370 219 589 7 11 18 198 406 1,015 STATE CARE— STATE SANATORIUM FOR CONSUMPTIVES. Subcommittee report. I Eight thou- sand deaths per annum in IlliDOlS. Chicago, Dec, 14, 1906. To the Honorable, the Board of State Commissioners of Public Charities: The following report upon the care by the State of Illi- nois of those of her citizens afllicted by the disease of tuber- culosis has been prepared by direction of the Committee on State Care appointed at the conference of superintendents and trustees of State institutions held in Springfield in the latter part of October, 1906: Tuberculosis in Illinois. It has been estimated that about 8,000 deaths are caused annually in Illinois by tuberculosis and the statement is made tliat about one death in seven from all causes Is the result of this disease. The loss to the State from tuberculosis alone is many-sided and beyond statistical computation. It is impossible to apply a monetary gauge to the losses which are annually caused in the State by broken and destroyed homes, by despair and discouragement and by the deterioration and disintegration of the families who are dependent upon the victims of this disease. Some attempt has been made to estimate the economic losses 269 which the State suffers. These losses are the result of the re- duced earning power of the patient himself during the months or years which intervene between the contraction of the disease and its termination, the total loss of earnings thereafter, the cost of care of the sick and burial of the dead and the cost of supporting orphans and widows and other dependents. The total loss to the State amounts annually to a staggering sum, running far into the millions. The Sanitabium, Its Value and Cost. The value of the sanitarium method of treating tuberculosis has been demonstrated in many different localities and climates. It is held that the ordinary climate in almost any part of the temperate zone is favorable for the sanitarium of outdoor treat- ment of this disease. This belief is apparently supported by the success which has attended sanitariums in Germany and France and the eastern states of this country. The work of such institu- tions in Massachusetts, New York and other states has been of a character to give strong impetus to the movement toward the establishment of similar institutions elsewhere. Massa- chusetts, New York, New Jersey, Pennsylvania, Ohio, Indiana and other states have either created sanitariums as state institu- tions or have taken the preliminary steps toward such establish- ment. The initial cost of erecting a sanitarium is smaller than that required in creating any other class of state institutions. This is due to the fact that buildings for sanitarium purposes should preferably be of inexpensive construction. Experience has shown that the initial cost need not exceed $250.00 per capita of capac- ity. The cost of maintenance of such a sanitarium, however, is comparatively expensive. This is because of the necessity for providing special foods of high nourishing quality and in liberal quantities. In the State Sanitarium for the Treatment of Tuber- culosis in Massachusetts the cost of maintenance amounts to about $9.00 per week per patient. In some sanitariums, the weekly per capita cost is lower, but it would be unsafe to esab- lish a sanitarium on the theory that it could be supported at a cost per patient comparable to the cost of maintaining inmates in the ordinary state institution. Whether the state should meet the entire expense of maintenance is a question which may well be considered. In Massachusetts, the state bears one-half the cost of maintenance and the other half is paid by the county or town in which the patient lives. The patient himself or his friends may or may not reimburse the county or town for this expenditure. The method of gaining admittance to the sanitarium is a matter of detail which does not require extended attention in this report. It may be stated, however, that in Massachusetts, a sys- tem is in operation through which certain selected examining phy- sicians in different cities of the state are required to pass upon the condition of all the applicants and the decision as to their admittance depends upon the reports of their examinations which these physicians file with the management of the sanitarium. The value of the sanitarium system is shown in the results which have been observed in communities in which sanitariums have been maintained for a series of years. It is found that of the patients who are admitted during the incipient stages of tuberculosis, from 10 to 20 per cent are permanently and thorough- ly cured; that the disease is checked so as to restore the patient to a position of economic independence for periods varying from one to two years to many years in 60 per cent or more of the cases. Value dem- onstrated. Building cost compara- tively low. Maintenance compara- tively high. Method of admittance. Results. 270 Based on experience of others. Appeal to Legislature Land. Buildings. Total askeu $150,000. Analysis of figures. The educational value of a sanitarium is such that the statement has been frequently made that a tuberculosis sanitarium is pri- marily an educational institution. Every patient who enters the sanitarium is given the most thorough and enduring training in the importance of a generous supply of pure air, of wholesome and properly prepared foods, of outdoor exercise and of moder- ation and temperance in all the habits of life. He carries these lessons hojne with him and because his own future depends upon his faithfulness in obeying them, he enforces their obser- vance upon the other members of his family. His home, in fact, becomes in itself a small educational center in the care and prevention of tuberculosis. Recommendations. In view of the results which have been obtained from the sani- tarium treatment of tuberculosis in other states and countries and with full consideration of the terrible social and economic losses annually sustained by the people of this State from the ravages of tuberculosis, your committee submits the following recommendations : 1. That the General Assembly of the State of Illinois at the regular session to be held in 1907 be urged to create a State sanitarium for the treatment of incipient tuberculosis and the dissemination, among the people of the State, of infor- mation and instruction in methods of prevention and cure. 2. That for the purpose of accomplishing this object in accordance with the dictates of experience and the teach- ings of science, a tract of high, well-drained, easily-acces- sible land be obtained, to contain an area of not less than 320 acres and to be sufficiently remote from any city or large town to assure an abundant supply of pure air and water. 3. That buildings to be erected shall be of inexpensive type and material and that the teachings of experience in other states shall be given due regard in determining the size, style and location. 4. That for the purchase of the necessary tract of land, the erection of buildings and the maintenance of the sani- tarium, the sum of $150,000 will be required, and it is, there- fo're urged that that amount be appropriated by the General Assembly for this purpose. The following is a rough analysis of thp forogoing figures: Land % 32.000 00 Buildings and equipment 100,000 00 Maintenance, etc 18,000 00 Total $150,000 00 Capacity of sanitarium proposed. 400. Per capita cost for buildings and equipment, $250.00 Respectfully submitted, EUNEST P. BiCKNKM,. Suh-Committee on State Sanitarium for Consumptives. 271 STATE CARE— FREE DIPHTHERIA ANTITOXIN. Chicago, Dec. 14, 1906. ] To the Honorable, the Board of State Commissioners of Public\ Charities: | Following the example of Massachusetts and New York, the Example of State of Illinois should authorize the State Board of Health to states, manufacture and furnish free of cost to all its citizens, all the diphtheria antitoxin needed for the treatment or prevention of diphtheria. It should do so for the following reasons: First — It should be clearly understood at the outset that this Public health is a public health measure designed primarily for the protection! measure, of the well who have a constitutional right to such protection.! It is no more a matter of charity than is the building of battle j ships or the maintenance oi a standing army. The well have thei same right to protection of their lives as they have to their person or property. It is not intended primarily for the free treatment of diptheria by the State, but primarily for the pur- pose of protection, the cure really being secondary, and it is on this ground alone that it is justified by the State on the same\ principle that we maintain costly penitentiaries, insane asylums,. pest houses, not primarily for the reformation of criminals, the care of the insane and small pox patient, but for the protection of society against a preventable disease. There is nothing incon-' sistent in the people being taxed to protect them from disease andi premature death. A state that has spent forty millions of dollars! for a drainage canal in order to provide Chicago with pure drink-] ing water and prevent typhoid fever, can wea afford a few thou-! sand dollars to prevent diphtheria. Neither is it "paternalism" as: I am sure will be argued by some, an argument which reveals a| lamentable want of knowledge and proper conception of the fun- 1 damental principles, both of the Federal Constitution and the} sanitary rights of the people. It is not "paternalism" but "fra- ternalism." It should be supplied by the State free to all citizens of the State who need it and want it. It will be argued that it should be supplied free to the poor only. Rich pay as the rich can afford to pay for it. The latter fact is true, but the bill, irrelevant; inalienable rights of the Constitution have never been in proportion to the individual's tax paying ability. Furthermore, the rich i^an who pays the most taxes is certainly entitled to it as he pays for it, but the rich would doubtless pay for it just as they do now. Used as a Preventive. Free distribu- tion justi- fied. Second — It is chiefly on this ground that its manufacture and free distribution by the State is justified. In Chicago, in the homes of the poor, 8139 cases were given immunizing doses by the Department of Health. Only one half of one per cent subse- quently acquired the disease, and none died. The reports of the New York State Board of Health show where over one thousand nurses and inmates of one state institution were exposed to diph- theria, all were given immunizing doses of antitoxin and only three developed the disease within four weeks, which is the usual period of protection resulting from a single protective immuniz-j ing injection. | Dr. H. D. Pease, director of laboratory. New York State Depart- better from ment of Health, says, in a personal communication to me, June Dr. Pease. 18, 1906: To obtain all the antitoxin which a superintendent requires Quick action, to abort a beginning epidemic in a public institution of 1,000] to 1,500 inmates without having to consider for one momentj 272 Saves money and trouble, too. More New York- records. Antitoxin cures. Record Id Massachu- setts. Pays in dollars and cents. Rducatlonal value. its cost, or even to do anj'thing but send a telegram to our lab- oratory, renaoves entirely all the cumbersome red tape which is such a terrible hindrance to effective work at such a time. I think that at the least calculation the State would have had to pay out, directly or indirectly, the full amount of our appropria- tion for a year to cover the cost of the management of the epi- demics, which would have obtained a full headway if they had been obliged to go through the usual routine procedures for obtaining supplies before they could have obtained the antitoxin which they needed from some commercial source. In addition to the saving of expense is the saving of a vast amount of worry and trouble, which always accompany such disasters, and which effect everybody from the governor down to the inmates to a greater or less degree. New York has' records of 11,358 cases in which the immunizing doses were administered. Of these but thirty-three persons sub- sequently developed diphtheria within one month. It is thus demonstrated that antitoxin protects 99 per cent of those well but exposed who receive prophlactic injections of it. It Will Cube Diphtheria. Third — Previous to the use of antitoxin the average mortality from diphtheria was about 33 per cent. Dr. Herbert D. Pease, Director of the Antitoxin Laboratory of New York State De- partment of Health, reports (North American Journal of Homeo pathy, May, 1906) 4,000 cases treated Wii.ii antitoxin with a mortality of only 8.3 per cent. In 822 cases in which the antitoxin was used on the first day of the disease, the mortality was only 1.7 per cent, and his report for 1905 of 330 cases shows a mortalitv of less than one per cent for those in which the antitoxin was used on the first day of the disease. The reports of the Massa- chusetts State Board of Health are equally convincing and satis- factory. The 1906 report of the Chicago Health- Department shows 8,003 cases with a mortality of oniy 6.48 per cent. Of those treated on the first day, less than one-half of one per cent died; second uay, 1.66 per cent, and after fourth day over 21 per cent. In Massachusetts the whole number of positive cases treated In the nine years ending Sept. 30. 1904, was 13,753; deaths, 1.316. 9.6 per cent. This covers the whole period and includes Its ad- ; ministration up to the 8th day of the disease and even later. , In 1904 the number of cases in which i" was used on the first and second days was 59.4 per cent of the whole number and the mortality for these cases was only 2.5 per cent. Every life saved is an economic asset to the State. Statement of Other Reasons. Fourth — It will pay. "The prolongation of life by the suppres sion of preventable disease is of much greater value to the State |than iho cost of the means employed." It will pay in dollars and cents. The commonwealth of Massachusetts has provided free antitoxin to the peopie for the past ten years. The average annual cost to the state Is $10,000.00, and last year the amount of antitoxin actually used, if paid for at current rates would have cost the people $135,000.00, thus making an annua! saving to the people of the state of $125,000.00. New York state produces nearly $45,000.00 worth of serum with an annual appropriation of $14,000.00, and Dr. Pease informs me that they could double their present output of antitoxin with an increase of one thousand dollars In the annual expenditure. Fifth — It will be valuable as an educational institution both to the physicians and the people. Properly conducted, an antitoxin 273 laboratory directly and Indirectly, spreads broadcast reliable information concerning the real character of infectious diseases and the best and surest methods of preventing and curing them) It enables use to wage a successful warfare against the trade of quacks and to destroy the sale of nostrums offered for sale for the alleged cure of persons suffering from infectious diseases. Sixth — It will prevent the possibility of serious epidemics of diphtheria in any of the State or other public institutions. The experience of New Yerk is doubtless the experience of other states. To be able to obtain a sufficient supply of antitoxin for any emergency and if need be to immunize every attendant and inmate, with no red tape but a telegram to the State Board of Health and with the additional expense to the institution, would be to save many lives as well as much money to the State every year. One epidemic in a large institution would cost the State as much as the amount of the needed annual appropriation. In the same way it will render impossible any epidemic of any magni- tude in the schools, or anywhere else in the State. Seventh — It will save many lives now lost because the dose of the antitoxin has been too small. The report of the Massa- chusetts board for 1904 shows that 315 cases each received over 20,000 units; 93 received 15,000 to 20,000 units of antitoxin. 20,000 units have been administered as an initial dose and 100,000 units during the treatment, thus establishing the fact of its harmless- ness and value. Promise of Very Advantageous Prices. What would it cost to furnish free antitoxin to the State outside of Chicago? I am informed by Dr. Chas. J. Whalen, Commis- sioner of Health of the city of Chicago, that the city will continue to supply antitoxin just as at present, even though the State Board of Health should furnish it free to the remainder of the State. Last year the state of Massachusetts furnished about 75,000 one-thousand unit packages to the entire state and it is conservatively estimated that Illinois outside of the city of Chi- cago would require much less than this; probably not over 50,000 one-thousand unit packages. A reliable non-commercial institution today offers to supply an unlimited amount at 28 cents per thousand unit, the regular commercial price of which, to the consumer is $2.00. Fifty thousand one-thousand packages at $2.00— $100,000. It would cost the State $12,000 to furnish it. The saving is $88,000. It is conservatively estimated that $15,000 per annum will frrnish all the antitoxin in that will be needed for the entire Stt.te, outside of Chicago., and that for the ehtire State, includiiig Chicago, considerable less than $30,000 will be required. Conclusion and Summary. In conclusion, to summarize, the State should provide an abundance of high grade antitoxin free to all on the grounds that "an ounce of prevention is worth a pound of cure;" that it will pay; that it is not a charity but a duty; that it is primarily not for curing but for preventing the disease; that it is a legitimate duty of the State; that it is good business sense; that it is a proper legitimate exercise of the police power, that it will save many lives and much suffering and prevent any important epidemic in schools or in State institutions. It is not "paternal- ism" but "fraternalism" and answers with an affirmative the question of Cain, "Am I my brother's keeper?" Respectfully submitted, George W. Webster, M. D., Sub-Committee on Free Diphtheria Antitoxin. Prevents epidemics. rermits large doses. I.ow cost assured. Srmmai-y. -i8 P C 274 PROBLEM OF THE FEEBLE-MINDED. Two meet- ings held. BtatlBtlcs. Age. Tuberculosis. Epileptics. Death rate. Classification. Chicago, Dec. 14, 1906. To the Honorable, the Board of State Commissioners of Public Charities: Your committee on the Problem of the Feeble-minded held two meetings, the first at the Illinois Asylum for the Feebleminded, November 17, 19nC: the second at Bartonville. November 24. Be- sides the chairman, Pr. C. B Taylor and Dr. George A. Zeller were present at Lincoln; at Bartonville the committee waa repre- sented by Dr. Zeller, Secretary W. C. Graves and the chairman. The institutional authorities at Lincoln supplied the follow- ing information: Total number of inmates Absentees (on a vacation) included in the above. Karm colony included in the above 1,45a 140 35 More than four hundred of the Inmates are between forty and fifty years of age. The youngest inmate is four years old, the oldest seventy. According to the asylum officials sixty per cent of the patients have tuberculosis in some form. With twenty per cent of them the type is pulmonary. Three eighty-three of the patients are epileptics — 188 females, 195 males. The annual death rate is ovor five per cent. The following is the classification of the patients: Number of low trrade iml)eciles (wholly custodial). Numtxjr of middle t:rade imbeciles (employed) Number of hiKb<'r trrade imbeciles (in school) 670 345 4:« Helping force For this large number of feeble minded, old and physically Inadequate, defective children the helping force is painfully inadequate. There are but three physicians, no trained nurses, no dentists, no drug- |glst. The attendants number sixty-one (CD and there are fifteen teachers. Most of the teachers have teachers' certificates, but this lis not compulsory. The principal of the school receives $35.00 per month with board and quarters. Other teachers are paid $25,00. Interdepend ence of physician and teacher. Points to be considered In the training oi the feeble minded. Two Specialties are Required. In the cure and training of the feeble-minded the work of the I)hy8ician precedes and is closely associated with the work of the teacher, and the work of the teacher follows closely and should depend upon the indications given by the doctor, who should test every avenue to the senses. He will often by correcting one defect be able to modify exaggerated conditions. For Instance among the children at Lincoln ihere are many cases of enlarged tonsils and adnoid growths, both fruitful of defective speech, as well as defective mentality, which a simple operation would re lieve. This is seldom or never attempted, owing doubtless to the fact that the medical staff is too small and overworked, and also that in the modern operating room of the infirmary there are no conveniences for operating, no table nor cases of in- struments, nor sterilizer. There is no pathological laboratory. In the opinion of experts. Dr. Barr and others, the period of receptivity in the feeble-minded extends only from the seventh (o the sixteenth year. Also, four times the period of normal practice Is required, to insure independent work. It follows that to insure results the instruction must be from the very begin- ning adapted to the child and his peculiar individuality. It Is at this moment in the history of the child that the work of an 275 expert teacher is indispensable. Intuition born of sympathy, clear Expert intelligence, and the patience of a saint are the qualities required j training, to awaken and nurse the feeble spark. And here the question] arises whether, even among the middle and higher grades of in- telligence the possibilities of development would warrant the added expenditure of energy and money required for individual] training. The value of manual training over the work of the school Manual room is very apparent. At Lincoln excellent work is done in' training, the industrial school rooms. Besides a good quality of plain sewing, hemming towels, napkins, etc., girls of the middle and. higher g^ade attain much proficiency in embroidery and lacCj making. The work shops turn out more mattresses and brushes of all sorts than the institution can use. Some of the finest work shown in the brush factory was done by a boy who cannot speak his own name. The shoe factory furnishes fifty per cent of the institutional needs. This includes also the shoes for deformed feet which if made elsewhere would cost a great deal. Obviously the scope of the manual training could be greatly widened to the advantage of the children and a corresponding profit to the| State. i Prevention of Feeble-Minuedness. The problem of the feeble-minded is, in its last analysis, the Ultimate problem of prevention. As there is no law in Illinois to prevent' ^^'^ ^™' a parent or guardian from removing his child from custodial care whf-never he may see fit to do so, it follows that many, espe- cially of the higher grade, are thus removed. The greatest menace' to the State comes from the freedom allowed to this class of defectives. In the case of 126 feeble-minded persons parentage can be traced directly through either the father or mother to former inmates of the asylum at Lincoln. While it is the duty of the State to provide protection and scientific treatment for the least of its unfortunate wards, legislation to prevent the increase of this growing family of dependents would be both wise and merciful. The state of Connecticut has had since July 4, 1895, a law pro- Connecticut, hibiting the marriage of epileptics, inbeciles or feeble-minded when the woman is under forty-five years of age. The penalty for violating this law is imprisonment in the state prison for not less than three years. t In 1901 a bill for the prevention of idiocy by a sexualization lennsylTania. was presented to the legislature of Pennsylvania. It passed both houses, but being returned by the Governor for the correction of some technicality, was lost and failed to become a law. An ap- peal urging the passage of the bill was signed by Dr. DeForest Willard, Dr. Samuel Risley, surgeons of repute, and Dr. Martin W. Barr, chief physician of the Pennsylvania Training School for Feeme-minded at Elwyn, Pennsylvania, who took the ground that, as the state must always care for the feeble-minded and de- fective, and as heredity plays such an important part in their increase, the State has a right to take measures to prevent their propagation. This, it appears to your committee, is the para- mount question suggested by the problem of the feeble-minded. How shall their increase be prevented in Illinois? The State has at Lincoln the possibilities of an absolutely up possibilities to date institution. The acreage is large and the present build- at Lincoln, ings would probably house most of the feeble-minded in the State.] should the epileptics be colonized. A moderate appropriation at' the coming session of the Legislature for scientific care, train- ing and medical treatment would probably be sufficient for present needs. 276 Becominenda- tloiia. Internes. Dentist Training school. Surgical equipment. Laboratory. Play room. New Indus- tries. Committees of doctors. Committee of physi- cians authorized. Recommendations. Your committee respectfully recommends: 1. The addition of three or more internes to the staff, one to be a dentist. 2. A training school for nurses. 3. Proper equipment of the operating room. 4. A pathological laboratory. 5. A large play room, furnished with toys, playthings and simple gymnastic apparatus, for the younger children of all grades. 6. New occupations and industries (such as basket-mak- ing, weaving, etc.) 7. A committee of physicians to take under consideration the question of State legislation for the prevention of idiocy. Respectfully submitted, Cl.\b.\ p. Boubland, Chairman, C. B. Tayix)B, O. C. WiLLHITE, George A. Zelleb. XOTE. i ! In the motion to adopt this committee report, which motion was carried unanimously, the President of the Board of Charities was authorized and requested to appoint a committee of physicians to consider legislative steps look- 'ing to the prevention of the growth of idiocy and to rept^rt [recommendations to the State Board of Charities. TUBERCULOSIS IX ST.VTE INSTITUTIONS. Chicago. Dec. 14. 1906. \To the Honorable, the Board of State Coin mis si oners of Public Charities: Statistics. ' The Committee on "Tuberculosis In State Institutions" in defer- lence to Mr. Bicknell's committee dealing with the State sana- torium for consumptives and Dr. Hlrsch's special investigation !of Jollet prison decided to confine itself principally to statistics and herewith presents them as given by the institutional author- ities. In asylums. ; Taking the seven insane asylums, with a total population of nine thousand, three hundred and twenty-five, we find two hun dred and fifty roi)orted cases of tuberculosis or a percentajie of two and sixty-eight hundredths. I'rlsons ami ^^^ penal and correctionary Institutions and schools with a other instl-! total population of four thousand and eighty-six show a total tiitlona. of sixty six cases or a per centage of one and sixty-two hundreths or about thrpc-fifths as ureat as that of the insane while all other I Institutions such as the Soldiers' Home, School for the Blind. with a total population of two thousand, seven hundred and nineteen show but nine cases of tuberculosis In all or £ pef centago of three-tenths of one per cent, only one-flfth as great aj ihe penal and one-ninth the percentage of the Institutions for tht insane. 277 If we could stop with these figures we could feel that condi-; Heavy among tions are not so deplorable, but we have omitted one institution not properly classed with those above named. It is the Asylum for Feeble Minded Children at Lincoln, and here the astonish- ing information is brought out by the officials that of a popula- tion of one thousand, two hundred and fifty-two, a percentage of sixty-three and seventy-four hundredths, or a total of seven hundred and ninety-nine of the inmates are afflicted with some form of tuberculosis. These added to the others, naturally modify the entire esti- mate of the prevalence of the disease among the public charges of the State and for that reason are given separately and a free discussion of this remarkable revelation is invited, even if it intrudes upon the topic assigned Mrs. Bourland. The tables, for which we are indebted to Mr. Graves, the Secretary of the State Board of Charities, are hereto appended for the minute study of those interested. Need of Peevention and Cube. As for recommendations, this committee can but emphasize the immediate necessity of every institution adopting every prophylactic and curative measure. In the face of the popular interest in this matter, an interest that has reached the legis- lative bodies of all cities and many remote villages, public offi- cials cannot hope to retain public confidence if they fail to con- tribute their share toward the prevention of this now recog- nized preventable disease. Reports show that feeble efforts at segregation have been attempted in most of the institutions, but we feel that the situ- ation demands immediate attention, and that any other feature of institutional life can for the time being be permitted to rest until this all important matter has received attention. In the two institutions where segregation is absolute, separate wooden cottages in one case and eleven canvas houses in the other have been erected and equipped out of the ordinary fund with- out perceptible increase in the cost of maintenance. A series of outdoor tents can be attached as an annex to any ward or hospital at a cost of less than fifty dollars per bed and no institution is so poor that it cannot spare from its funds a sufficient amount to meet what we consider an emergency. Mere outdoor treatment in summer with the patients reverting back to the wards in the winter will not be deemed sufficient and is as idle as for the surgeon to prepare his field with every aseptic precaution and then operate without washing his hands. Both at Bartonville and Watertown the consumptives spent the entire winter in these open air influences without detriment and in many instances w^ith marked improvement and even the in- side of prison walls would render such treatment safe. Such an annex would consist of a wall tent eighteen by twenty-four feet, connected with the ward by means of a covered passageway at one end. Along each side two nine by nine can- vas houses could be ranged and a similar one at the other end all connected by covered passageways. The large tent thus becomes a day or living room and the smaller tents sleeping rooms accommodating two patients each. A stove with wood fire is gratefully appreciated by the convalescents and enough heat enters the sleeping tents to break the chill. It is an easy matter to add another large tent for a dinning room and if it is not deemed desirable to use the toilet facilities of the ward another adjoining tent can be equipped and connected with a sewer and another can be as easily arranged as a serving room and diet kitchen. feeble minded. Modifies other figures. Tables. Duty of public officials. Feeble efforts at seeregatton. Typical. annex. 278 Kxl^'n^inIl•■ easy. Porch colony. bepaiate prison plan. It Is easy to extend such a colony to meet the needs of an In- stitution and artistically arranged it constitutes a decided relief from the brick and stone and is pleasing to every sense. Or if the expense is prohibitive a convenient substitute is the porch colony. Any porch with south or west exposure will answer and an expenditure of fifty dollars will enclose it with canvas that can be rolled up in pleasant weather and strapped down in cold. If there is a door leading into the ward the toilet facilities may be shared but it is better to provide separately for those aflaicted with tuberculosis and the necessary equipment will suggest itself. Recommendation fob Benefit of Convicts. It ii recommended that in the case of the prisons there be but one designated to care for consumptives and that it be thoroughly equipped and that some provision be made for the interchange of sick prisoners when physical conditions indicate such a move. Like Recommendation for Asylums. Oik- asylum This is equally true of the inmates of the insane asylum. In- stead of spasmodic efforts of varying fitness in the individual , institutions some authority should designate the asylum best ; qualified by reason of climatic and geographical location to offer I the best results in the treatment of tuberculosis and to this place all consumptive insane could be transferred immediately ' upon the discovery of the disease. This central colony for consumptives would be equipped far better than the smaller annexes to the asylums and by reason of the larger number to be treated there would naturally be a concentration of medical talent and the special die: prepara- tion, and administration would be in more competent hands. In the presence of the medical men comprising this conference Vigilance it would be idle to speak of prophylaxis and the necessity of necessary, bringing to bear every diagnostic agent. These things are de- manded of the every day practitioners, and their omission on the part of the medical direction of a State institution is doubly censurable. Respectfully submitted, George A. Zelleb, Chairman, H. B. Cauriel, W. E. Taylor, George W. Webster. 279 Census of Cases of Suspected, Curable, and Advanced Tuberculosis in Illinois State Charitable, Penal and Reformatory Institu- tions October, 1906. [As reported by institution Dflflcials.] Suspected. Curable. Advanced. Total. Popula- tion. Per- centage INSANE AND FEEBLE- MINDED. Elgin 14 6 9 25 34 23 8 399 10 7 9 19 5 4 12 10 33 32 14 45 76 42 8 798 1,250 2,242 1,375 1,198 1,230 1,826 204 1.252 2 64 Kankakee 1.43 1 02 Anna 16 30 9 3 76 Waterlown Peoria Chester 6.18 2.30 3 92 Lincoln 327 72 63.74 Total 518 399 131 1,048 10,677 9.96 PENITENTIARIES, RE- FORMATORY AND SCHOOLS FOR DELIN- QUENTS. Joliet 12 7 7 12 1 8 - 20 12 14 15 5 1,521 1.016 1,007 222 320 1 32 Chester 5 1 1 18 Pontiac St. Charles 6 3 4 1.39 6 76 Geneva 1.56 Total 39 21 6 66 4.086 1.62 OTHER INSTITUTIONS. Soldiers' Home. . . 6 6 1,488 75 300 407 190 73 186 04 1 1 2 03 School for Deaf 2 .05 School for Blind Industrial Home for Blind i Eye and Ear Infirmary . . Total 2 1 6 9 2,719 .03 Grand total 559 421 143 1,123 17.382 6.47 IMPROVEMENT OF BUILDINGS AND GROUNDS AND EQUIPMENT. Chicago, Dec. 14, 1906. To the Board of State Commissioners of Public Charities: Your Committee on the Improvement of Buildings, Grounds and Submits Equipment beg to report as follows: report. It being found that the University of Illinois was not in posi- Division of tion to undertake the work of making the desired survey, Mr. the work. Charles A. Chapman and his organization were engaged to report on engineering matters, and the State Architect's office undertook the work of making a report on all architectural and building mat- ters. It was found that the structural parts of the buildings, old and Conditions new, are in as good a condition and repair as can reasonably bei found, expected. It would appear, however, that in the older buildingsl 28o Kon-ti reproof construc- tion. VeotUation. Power plants Coat Order of Improve- ment. the fixtures, the equipment and the finish, viz: the non-structural part of the buildings, have in some of the institutions been allowed to run down, are antiquated, obsolete and worn out, so that these features are dangerous and unsanitary in many instances. This is especially true of the plumbing, floors, and In the majority of cases of the machinery and electrical work. Your committee was unpleasantly impressed by the fact that with very few exceptions all of the institutional buildings, old and new, are of ordinary non-fireproof construction. This regrettable fact would, in view of the number and character of the occupants, necessarily demand the most complete system of fire escapes, exits and fire extinguishing arrangements possible to arrange for. It was found, however, that a most lamentable condition existed In most institutions regarding this matter. In very few institutions are there sufficient exits and fire escape arrangements, or is there a fire extinguishing system with a suflicient water supply that would, in case of emergency, answer the purpose and prevent a catastrophe too fearful to think of. While the heating is in the main quite satisfactory, the proper ventilation of rooms occupied by many has been either entirely ignored, or but ill provided for in all but one institution. In view of the relative great number and character of the occupants and the purpose of the institutions, it is most essential and imperative that there be furnished at all times an unlimited supply of fresh, clean, warm air, obtainable only by the installation of a powe." ventilating system. It was found that only in a few of the institutions is there a power plant with an equipment insuring the highest eflBciency and the lowest cost of operation so desirable in all larger plants. While it is evident that an immediate remedy of these and other conditions is highly desirable, and in some instances imperative, the cost of the alterations, reconstruction and re-equipment on the other is such that it might impose unjustifiable hardships and burdens upon the State. It would seem proper, therefore, that the improvements to be made be undertaken in the order of their im- portance, that vital matters be corrected at the earliest moment possible, and that features of lesser importance be taken care of at a later period. After due consideration and In view of the purposes of the ir.stitutions, it seems to your committee that the following order of importance of rehabilitation of the physical condition of the various institutions would be desirable. (a) The physical operation of the institutions. (b) The safety of the inmates. (c) The well being and comfort of the inmates. (d) Improved sanitary and general conditions. (e) Economy and efllciency of operation. Your board is in possession of the detailed estimates of cost of needed Improvements at each of the several State charitable insti- tutions. Respectfully submitted. Emil G. Htrscii, W. CaHIIV.S ZniMEBMAN. W. E. Taylok 28l STATE PSYCHOPATHIC INSTITUTE. Chicago, III., Dec. 14, 1906. To the Honorable Board of State Commissioners of Public Char- ities: Your committee, to whom was referred the matter of formulat- ing plans for the establishment of a State Psychophatic Institute, begs leave to report that we have had the matter under consider- ation and respectfully report that an opinion of the Attorney Gen- eral, a copy of which is hereto attached and made a part of this report, has been procured in which he says that the establishment of a central institute at one of the State hospitals with branches in the several institutions , with the expenses of each branch locally borne, is not only legal, but an essential part of the service t) provide which these hospitals were created. The trustees of the Illinois Eastern Hospital for the Insane have tendered the use of a building ample in dimensions to meet all the immediate requirements of the institute. A floor plan sketch of this building is attached and made a part of this report The trustees of the Illinois Eastern Hospital for the Insane agree to assume and bear the expense of tuis institute for the re- mainder of this fiscal year. It is therefore respectfully recommended that there be estab- lished at the Illinois Eastern Hospital for the Insane a branch of its-, service to be known as "the Illinois State Psychopathic Insti- tute," and that concurrently there be established similar psycho- pathic departments at each of the State hospitals for the insane where such service is not now in operation, and in the Asylum for Feeble Minded Children. Scope of the Institute's Wokk. The scope of the work of this institute and its branches has been most fully set forth by Dr. Billings in his address at the recent superintendents' meeting in Springfield. The institute is to Lo under the supervision of a competent psycho-pathologist whose duty it will be to outline and to give special instruction to the physicians connected with all the State institutions, as to meth- ods of examination, the analysis and criticism of deductions, the preparation of uniform case histories, the making of diagnoses and the conducting of autopsies. The object of the institute is to give to the medical staffs of the State institutions the special train- ing in mental diseases which is not obtainable in medical colleges or in general hospital training; that a spirit of investigation and progress may be established in each of the State institutions ; that a clinic may grow at each hospital to which physicians in the sur- rounding territory are to be invited so that a general knowledge of the causes leading to defective development, nervous and mental diseases may be disseminated throughout the State, thus b'-inging directly to the patients of general practitioners the benefit of the most modern knowledge a^-- the most scientific treatment for mental and nervous diseases, in their early stages, when the largest percentage of cures is possible. It is a reason- able hope that, as a result of the psychopathic investigations ^erein recommended, additional knowledge may be acquired vhich will be of benefit to persons suffering frona mental and ner- vous diseases. For the Central Institute. For the State Psychopathic Institute it is recommended that a director be employed at a salary not to exceed $5,000 per annum; r^etrality. Building. Kxpense pending appropria- tions. rCstablish- ment recom- mended. Plan and objects of the Insti- tute. Appropria- tlone. 282 Branches. Statement of the propo- sition. Cllps the Inw. tiiai this director, who shall be well grounded in general medi- cine, be selected with reference to his special preparation and fitness to lead and to teach neurology, psychiatry and pathology; that the director formulate specific rules for the State Psycho- pathic Institute and its brancues; that a aboratory assistant at an annual salary of |1,200, and a stenographer at an annual sal- ary of $480 be provided. For the Several Branches. Ihe committee further recommends that each of the insti- tutions ai which branches of the State Psychopithic Institute are to be located include in their estimates for appropriations asked of the incoming Legislature, funds suffici«?ul to equip the branch with the ordinary instruments of precision required for making clinico-pathologic investigations. As all of the Institu- tions have part of the necessary equipment, it is thought that $1,000.00 for each branch, or $8,000.00 for all branches, would be sufficient to procure the necessary instruments. An appropriation of $30,000.00 will be needed to establish and maintain the State Psychopathic Institute for a period of two years, which amount should be appropriated as a special fund under the control of the trustees of the Illinois Eastern Hospital for the Insane. Where funds are now available, it is recommended that purchases for the branches be made at the earliest possible moment. Respectfully submitted. J. L. Greene. W. E. Taylor. V. H. PonSTATA. Duty of the authorities. OPINION OF THE ATTORNEY GENERAL. Nov. 10, 1906. Honorable WilUam O. Oraves. Secretary Board of State Commia»1oner» of Public Charities. S!prinr) field , Illinois: Dear Sir — I have your favor of the 9th Inst., requestlnR my opinion as to whether a State Psychopathic Institute could be started at one of the institutions alonp the lines indicated in the address of Dr. BIlllnKB without legislative authority, and you say the proposition Is : 1. To create the position of State Psychopatholopist and fill same by civil service examination. 2. To locate the State Psychopathic Institute at one of the hospitals as a department of that institution, the cost being borne out of the ordinary fund of that hospital, bill with similar departments, virtually branch departments, in eacn of the other hospitals, maintained by the hospitals separately. In reply, permit me to sav that the object and purpose of the creation and maintenance of hospitals for the insane, as set forth In section 21, chapter 23, Ilurd's Revised Statutes, Is as follows: "The object of the ho.spltals for the Insane shall be to receive and care for all Insane or distracted persons residing in the State of Illinois who may be committed to their care In accord- ance with law, and to furnish all needed medical tmatement. seclusion, rest, restraint, attendance, amusement, occupation and support which may tend to restore their health and recover thetn from Insanity, or "to alleviate their sufTerlng. ••••••" The object and purpose of these hospitals, expressed In such general language would seem to give authority— and. Indeed, to make It the dntjf of those In charge of the Institutions — to adopt such measures and poli- cies as would accomplish the purposes of the establishment and main- tenance of these Institutions as expressed In the statute quoted. If. to accomplish the necessarv medical treatment and the proper attendance, amusement, etc.. as will tend to restore the health of the Inmates. It Bhould be necessarv to establish In connection with any of the State insti- tutions a State Psychopathic Instlttite ivlth branches thereof In the other State Institutions. It would .seem not only within the power of the authorities governing such Institutions, but to be their d\ity to establish such State l'svchor«athlc Institute, as they are charged liy the statute with the performance of all the duties enjoined upon them by the statute. 283 Again, if it is necessary that such State Psychopathic Institute should ]■ roper be established and maintained In order that the most efficient treatment charge to be given to the inmates of the institutions, It would seem to follow that the maintenance of such institutes wuold be one of the necessary expenses of the maintenance of the institutions and properly paid out of the appro- priation for the ordinary expenses of such institutions. ^ It is suggested in the discussion of this matter by the speakers at the Meed of late conference, a report of which you enclosed with your letter, that such sufficient Psychopathic Institutes may be established without Increasing the capacity of the buildings now occupied by the various institutions of the State ; and that being true, the only question, it seems to me, to be determined is whether or not the appropriations are sufficient to meet the expenses at this time. That, however, is an administrative question upon which this office need express no opinion. Trusting that this may be satisfactory to your board, I am. Yours truly, (Signed) W. H. Stead, Attorney General. ordinary expense. appropria- tions. MEDICAL ADMINISTRATION AND UNIFORM RECORDS, INTERNES. The Committee on Medical Administration and Uniform Records, Internes, composed of Dr. J. T, McAnally, Dr. V. H. Podstata, Dr. George A. Zeller, Dr. O. C. Willhite and Dr. Haim I. Davis, reported that the paper read by Dr. McAnally at the October conference, "Need of Uniform and Complete Medical Records," October Bulletin State Board of Charities, pages 86-89, covered the scope of the committee's work as to the needs and scope of records;! that the committee on "Uniform Grades, Rules, Salaries' and Nomenclature," had provided for the positions neces- sary for a satisfactory medical administration, including in- terne service; and submitted the following set of blanks, which should be printed (except the patient's card) on sheets 8^x11 inches in size, for use in the hospitals for the insane : Summary Of report 285 PATIENT'S CARD. Name of patient Reg. No . Admitted 190 Age Sex Color Occupation Religion . . . Civil state County Support No. of admissions , Psychosis Physical diagnosis Known causes Address of friends Relationship Ward [Front side.l 286 Clinical notes (Reverse side.1 287 RECORD OF EXAMINATIONS. General Information and Classification. Name Admission No Ward Admitted 19 Examined by M, D. Psychosis ..." Physical diagnosis General Data. County Bonded or county charge. Nativity Occupation Civil condition Education . Religion No. of attacks Duration of insanity . Address of bondsmen Address of friends (and relationship) [Front side. 288 Classification of Patients. A. Acquired mental disorders: 1. Conditions of exhaustion: a. Collapse delirium. b. Acute confusion. c. Acquired neurasthenia. 2. Toxic psychoses: a. Alcoholic insanity. b. Morphinism. c. Cocainism, 3. Insanities due to diseased metamorphosis of tissues: a. Myxoedema. b. Cretinism. c. Dementia praecox (primary mental deterioration). d. Dementia resulting from (specify) e. Paretic dementia. 4. Insanity of coarse brain disease. (Specify.) 5. Insanities at age of retrogression. a. Pre-senile Insanity. b. Senile melancholia. c. Senile dementia. B. Mental disease due mainly to inherited predisposition: 1. Constitutional psychoses: a. Mania. b. Melancholia. c. Periodical insanities. (Specify.) d. Paranoia. 2. General Neuroses: a. Rplleptlc insanity. b. Hysteric Insanity, etc. 3. Psychopathic conditions (Degeneracies, specify): 4. Impediments in development: a. Imbecility. b. Idiocy. ' I Reverse side. 1 289 Genebai, Appeabance. Case No Name Height and weight ratio Apparent age Actual age Abnormalties of shape of body; Rachitis, acromegaly, myxoedema, pulmonary osteoarthropathy, ostitis deformans, osteomalacia. Attitude Mode of moving Development of body; bony frame Size of head Muscles Contour of head Condition of joints Fontanelles and sutures Ears; size, shape Nose; size, shape Neck; shape Nutrition; amount and quality of fat Quality of muscles Nails Fingers Hands Appearance of skin Heat of skin Appearance of mucous membranes (Conjunctiva, etc.) Evidence of disease on surface: Color, moisture, hemorrhages, oedema, em- physema, eruptions, scars, deformities, missing parts, etc. Abdomen (shape, size, swelling, veins) Condition of lymphatic glands: Cervical Inguinal Other glands Body temperature (Compare right and left sides if indicated.) [Front side.] -19 P c I. Head: Circumference 2. Naso-occlpital arc. Bin-auricular arc. 290 AmrmopoMEn-Bio Data. ( Normal male . ' Normal female \ Normal male . . ' Normal female \ Normal male . I Normal female II. Body: 1. Weight. 2. Height of Vertex. 3. Extended arms ( Right. "/ Left. . Circumferences: a. Circumferences of neck (over larynx) b. Circumference of chest (at rest) ,. . . . c. Circumference of chest (forced inspiration) d. Circumference of chest (forced expiration) e. Circumference of waist Circumference of hips g. Ci rcumference of thighs R L . h. Circumference of calves R L. i. ('ircuiiifcrence of arms R L. III. Mouth: 1. Shape of palate 2. Teeth (a) Development (b) Condition ... IV. Ear: 1. Shape 2. Size 3. Darwinian Tubercle. (Reverse side.] 291 History. Case No Name '. Family History: Father's birthplace Mother's birthplace Defections : Paternal Maternal Collateral Alcoholism Other drug habits Ssrphllis . Tuberculosis Crime Habits Dependent on charity. Other data: Personal history up to outbreak of mental disease: Birthplace Civil condition No. children Age youngest child Defectlre children Mental development in Infancy Syphilis Alcoholic habit Other drug habits Epileptic Criminal Dependent on charity Other data: [Front side.] 292 History of present Illness previous to admission: [Reverse side.] ^93 Case No. Etiological Factobs of Psychosis. Name BoptTjY Causes. Meningitis Morphine Suustrolte Cocaine Congestion of brain Tobacco Anaemia of brain Antipyrin . . . . , Increase of intracranial pressure Benzine Injuries to head Ether Venous stasis of brain Chloroform . . . , Peripheral nervous disease Bromides , Multiple neuritis Mercury General neuroses, epilepsy, chorea, Lead ^^^ Phosphorus Exhaustion Arsenic Parturition injuries Carbon Dioxide Hyoscyamus . . . Acute infectious disease Syphilis Tuberculosis Autointoxication Myxoedema Atropine . . . . Quinine Salicylic acid Iodoform . . . . Basedow's disease Chloral hydrate Ergotism Alcohol Illuminating gas Diseases of eyes Diseases of ears Diseases of lungs Disi^ases of the heart Diseases of arteries Diseases or digestive organs. Diseases of urinary organs.. Genital diseases: Excess Masturbation Total abstinence Menstrual disturbances Pregnancy Puerperium Nursing [Front side ] 294- Psychical causes: Acute emotional disturbances Chronic emotional disturbances • Overworli Worry Psychical Infection Psychical epidemics Psychical family epidemics Post hypnotic Intebnax Causes. I. General Predisposition. II. Personal Predisposition. Age. Hereditary (see history). Sex. Disturbances of development. Climate. Rearing. General Condition of Life. Educational Standard. City life. Occupation. Country life. Civil state. [Reverse side.] 295 PHYSICAL EXAMINATION. Digestion, Genebation and Elimination. No Name 1. Teeth 2. Tongue 3. Odor of breath (if foeted the cause) 4. Appetite 5. Mastication 6. Fauces and pharynx 7. Abdomen : Form Parietes . 8. Stomach 9. Liver Use chart diagram. 10. Spleen. 11. Rectum Anus 12. General condition of bowels. 13. Stools 14. Special note: [Front side.] 296 Genlto-Urlnary Syetem: Development of Organs: Scare Nutrition Sexual function Disease Urinalysis See record , Gynecological examination See record . [Reverse siilel 297 Case No. Respibation and Circulation. Name Diagraphm of Chest and Abdomen. 1 Nose (deformity or disease) .' 2. Pharynx (deformity or disease) 3. LarjTix (deformity or disease) 4. Thorax: Shape Symmetry Size • Respiratory movements Sensitive areas Outlines on percussions. (Mark on chart) Results of auscultations , Vocal Fremitus 5. Cough: Dry, moist, character of sound 6. Expectoration : Characteristics , 7. Heart: Results of inspection , Palpation Percussion Ausculation : Character of sounds Endocardial sounds Aenemic sounds Pericardial sounds 8. Arteries, Pulses : Frequency, quantity, quality, rhythm, symmetry . Thickening of walls Tortuosity Sphygmographic tracings 9. Veins: Size Varicosities . , Thrombosis . . Ulcers 10. Capillary Circulation [Front side.] 299 PHYSICAL EXAMINATION. Nervous System. Case No Name 1. Skull (deformity or disease) , 2. Vertebral column (deformity or disease) 3. Extremities (deformity, wasting, contractures) 4. Gait: Ataxis, spastic, shuffling, steppage, reeling, limping. 5. Co-ordination 6. Paralysis or paresis (describe) 7. Muscle Tonus: Spasticity, flaccidity, resistance to passive motion. Tremor (describe location and character) Spasm (describe location and character) Twitching (describe location and character) Athetoid movements (describe location and character) Excess of associated movement (describe location and character) Catalepsy (describe location and character) Pain, tenderness, parasthesia (locate and describe) 10. Sensation: Touch Pain Temperature Position Motion Pressure 11. Reflexes : Superficial Deep 12. Mechanical irritability of muscles Nerves 13. Electrical reaction (describe) 14. Vision-Pupils : Size Reaction, etc Movements of eyeballs, nystagmus, strabimus. Visual fields [Front side.l 300 15. Hearing: R L 16. Smell: R L 17. Taste: Sweet Bitter Salty 18. Speech: Aphasia motor Seusory Alalia Bradylalia Stammering , Scanning 19. Vasomotor disturbances 20. Secretory disturbances 21. Organic reflexes: Micturition Defecation Conclusions from Neurological Examination. Localization. Process. Cerebrum. Trauma. Cerebellum. Hemorrhage. Pons Medulla Softening. Spinal cord. Inflammation. Peripheral nerves. New growths. Congenital defects. Sclerosis. Degeneration. I Reverse side.] 30I MiCBO Chemical. Name Psychosis Date Urine Examiner Time voided Time examined Quantity in 24 hours Color Reaction Odor Total solids Specific g. . / Remarks , Urea Uric acid Mucin Urobilin Indican Remarks Test used Results . . , Test used Albumen ^^^^^^^^^ ^^^- .Amount %, Sugar ^ Results Amount % . Bile pigments Bile acids Haemoglobin Acetone MicEoscopiCAL Examination. Organized Sediment. Organic Sediment. f Pus Uric acid Cells J Epithelial ,^ [Blood Urates ...Crystalline.... I Amorphous . . . r Hyaline Epithelial Calcium oxalate Casts I Granular Leucine and tyrosine 1 Blood Cystin I Fatty Mucus Inorganic Sediment. f Triple Spermatozoa Phosphates \ Amorphous [Alka'me Micro-organisms Sputum : Examiner Date Quantity Color Odor Tissue Blood cells Pus cells Bacteria Stain used Remarks [Front side. 302 Blood: No Name Psychosis Examiner Date Vol. per cent Red Corp Vol. per cent White Corp Vol. per cent Serum Haemoglobin ( method used ) No. Red Corp No. White Corp Blood plates Staining (method used) Normal White Corp Polynucleated Neutrophilic Lymphocytes Transitional t Mononucleated Eosinophiles ' Pathological Myelocytes Mycrocytes Macrocytes Normoblasts Megaloblasts Poikllocytes Bacteria Parasites Special examinations Widal Blood cultures, etc. Remarks Stomach contents : Meal given Time given Removed Residue Degree of digestion Reaction Color Odor Total acidity Free HCI ^ Combined acid and acid salts Lactic acid MIcroscoplal examination Remarks I Keverse side. ] 303 PsYCHiOAii Examination. Case No Name Sensory deceptions Disturbances of consciousness Disturbances of perception Disturbances of memory Temporary Partial Progressive Permanent • Disturbances of flow of ideas Disturbances of judgment Rapidity of association Capacity for mental work Emotional excitability: Increased Decreased Pathological emotions: Fear, anxiety, mental pain, elation, euphoria, ecstacy, etc. General feelings: Volitional impulses: Inceased Decreased Pathological impulses: Contrary sexual Sadisms Masochisms Fetishisms Kleptomania Pyromania Impulsive actions Imperative actions Automatism • Stereotypic actions [Front side.] 304 Disturbances of expression (describe) : Gestures Speech Writing Actions from Pathological Motives.... Patient's Own Story: [Reverse side. 305 SUMMARY. No Name Examiner. Physical Condition Signs of Internal Weakness Psychical and Physical. Etiological Factors Signs of Toxic or Exhaustive Disease. Signs of Functional Nervous Disease Signs of Organic Nervous Disease Diagnosis Prognosis Differentiated from By the following . . [Front side. J —20 P c Differentiated from By the following . . 306 Complications Treatment . Approvod Medical Superintendent. [Reverse side.] 307 llEAD NURSE OR SUPERVISOR'S REPORT. (To be filed with medical history.) Name of patient Admitted 190 . Ward Report rendered hours after admission. Heights Weight Color of eyes Color of hair Bruises Recent injuries Marks of old injuries Eruptions Colored markings Vermin Condition of body as to cleanliness Restraint used on patient at the time of admission Attitude of patient (resistence, passive, violent, etc.) Condition of clothing as to cleanliness and value. Articles found on person Head Nurse or Supervisor. ♦Note — This examination must be made not later than four hours after the arrival of the patient. 3o8 UNIFORM GRADES, RULES, SALARIES AND NOMENCLA- TURE. Meeting at Hamilton Club. Class A. Class B. Class C. Steward. Class D. Chicago, Dec. 14, 1906, To the Honorable, the Board of State Commissioners of Public Charities: Your Committee on Uniform Grades, Rules, Salaries and ; Nomenclature met in conference at the Hamilton Club in 'this city on November 22d. A full attendance of the com- mittee was present. I UNIFORMITY OF GRADES, POSITIONS AND NOMENCLA- TURE. ! The committee respectfully report that in the Civil Service classification known as "Class A," or the Medical Service, they have classified the assistant physicians into a first assistant, second assistant, and a third class in which are grouped all other assistants, including the local pathologist, who is to be known as a clinical assistant. The positions of first assistant phy- sician are to be filled by promotional examination given by the Civil Service Commission. This examination is to be open to all assistant physicians in the different hospitals, and a general I list is to be secured, from which all vacancies In such positions are to be filled. The new positions of interne were also created. The positions of druggist in this class. It was determined to 'abolish, and all prescriptions are to be filled by assistant phy- !sicians. ] In "Class B," instead of the variations of record clerk and I history clerk, these positions are to be designated simply as the positions of clerk, and are to be filled from the list of the Civil Service Commission known as clerks. In "Class C," the position of matron was changed to that of housekeeper. This is done in order to prevent the confusion with a different position of the same name in the institutions for children. All other positions of a similar kind, such as steward- iess at Bartonville, are to bj changed to assistant housekeepers. A new position was agreed upon, in accordance wiih the recom- mendation of the State Poard of Charities, namely, Steward. This position is created in order to relieve the superintendent of all care in connection with the management of the kitchen and many general business matters, so that he may have more time to devote to his real line of duty — that of chief medical of- ficer of the institution. It was agreed that the steward should be paid a minimum salary of $1,500. In "Class D," or the nursing service, the positions arc to con- sist of a chief nurse, graduate nurses, supervisors, pupil nurses, and attendants. The pupil nurses are to be graded according I to results made in the training school. UNIFORMITY OF SALARIES. In regard to uniformity of salaries, your committee report the following schedule: Suporin tendon t — minimum, $.3,000.00, lucroasInK •Sioo.oo ppi- year of service to $4. .500 00 Chief clerk l.TiOO oo to $1,800 00 Stenographer ^o 00 to GO 00 309 Class A. ASSISTANT PHYSICIANS. I'Mist assistant $1,800 00 to $2,100 00 Second assistant 1,500 00 to 1,800 00 Other assistants (including clinical assistants) . . . 1,200 00 to 1,500 00 (Salaries of assistant physicians to be increased $100.00 per year to raaximum. Positions of first assistant to be tilled by promotional exam- ination, open to all assistant physicians.) Internes (one to be a dentist) $ 300 00 Druggist, to be abolished Class B. Bookkeeper .* $900 00 to $1,500 00 Clerk 40 00 to GO 00 Treasurer No salary Class C. matron changed to housekeepeu. Housekeeper $ 40 00 to $60 00 Assistant housekeeper 25 00 to 40 00 Storekeeper (should be bonded) 50 00 to 80 00 Steward 1,500 00 Class D. Chief nurse . $60 00 to $80 00 Graduate nurses 40 00 to 50 00 Supervisors 40 00 to 50 00 Pupil nurses 25 00 to 35 00 Attendants Men 27 00 to 35 00 Women 20 00 to 25 00 Nurses to be graded according to results in training school. Class F. Chief engineer $1,200 00 (minimum) Assistant engineer $00 00 Firemen $35 00 (with board) to $60 00 (without board) Electrician $45 00 to $60 (JO Class G. Butcher $40 00 to $60 00 Baker 40 00 to CO 00 Assistant baker 30 00 to 40 00 Chief cook CO 00 to 80 00 Assistant cooks 20 00 to 45 00 Laundryman 35 00 to CO 00 Tailor 35 00 to 45 00 Shoemaker 35 00 to 45 00 Uead carpenter 65 00 to 75 00 Assistant carpenters 50 00 to 65 00 Tinsmith 50 00 to 60 00 Upholsterer 30 00 to 40 00 Mason 70 00 to 75 00 Steamfitter 40 00 to 60 00 Painter 45 00 to 65 00 Class H. Head farmer $50 00 to $125 00 Gardener 45 00 to 60 00 Florist 40 00 to 60 00 UNIFORMITY OF RULES. The committee did not take up the question of uniformity of Vacations. rules at its meeting, but we should like to suggest, for the con- sideration of this meeting, the matter of uniformity of vacations, and to receive suggestions from all the superintendents as to the advisibility of making the vacations uniform for the different positions. 310 rayment of salaries. Met out of ordinary funds. Also, from the standpoint of the Civil Service Commission, we should like to advise a uniform method of paying all salaries on the lOlh of each month, and holding back from each employ6 ten days' pay. This, we think, would have a salutary effect in pre- venting employes leaving without giving the required ten days' notice. ESTIMATED COST OF CHANGES. We have annexed to this report a letter from each superintend- ent, giving the estimated cost of the changes as outlined in thia report. There is a wide variance in these estimates, the maxi- mum estimate being based upon a fla't rate at the maximum amount. It seems, however, to be the general opinion among the superintendents that the increased cost due to the suggested changes can be met within an appropriation of $140.00 per capita. Respectfully submitted, W. B. MotJLTOX, W. L. Athon, V. H. PODSTAT.\, W. E. Taylor. George A. Zeller. Note. The motion on the adoption of this report, which was carried, recommended that the trustees of all hospitals for the insane estabhsh the maximum and minimum wage scale submitted in the committee report. ADDEXD.V. LETTERS PROM SUrERINTENDENTS SHOWING COST. Illinois WE.STEmN Hospital for the Ins.inb. Watertown, Ilu, Nov. 29, 1900. Honorable Joseph C. Mason, care Civil Service Commission, Springfield, Illinois: Dear Sir — Under the new arrangement our payroll will be Increased, Including extra employes, approximately $5,000.00 a year. This, however, will not cause us to aak for a greater appropriation than we have had heretofore. Very truly, (Sgd) W. E. Taylor, Superintendent. It.LiNoi.s Northern Hospital for the Insane. Elgin, Nov. 2S, 1900. Honorable Joseph C. Mason. Secretary, State Civil Service Commission, Sprinafleld, Illinois : Dear Sir — I desire to acknowledge receipt of your letter of Nov. 20 and enclosed copy of Rchodule adopted by the commission appointed by the State Doard of Charities at the last superlntPiidonts' mcfilng at SprlnKlleld. I have carefullv Koue over the schedule, and 1 llnd that the only geuiilne Increase In the salary list would be the newly created position of a steward, which means. In accordance with the schedule, $1,500.00 per year. The several other changes, such as a slight Increase In the wage* of tlreraen and in the salary of the present pafholonlsf, who Is to be considered as assistant physician, are of too small an nmoiint to iiuMlt serious consideration. Aside from that there will be a small reduction lii one or two positions. I may say at this time that there are several other changes contemplated by the trustees and myself, which will possibly more than counteract the additional outlay for the steward. All changes contemplated arc entlrelv within the limits as outlined. I do not anticipate, therefore, that there will be any Increase In the salaries paid as 311 compared with what Is being paid at present. At any rate, no Increase In the appro- priation for maintenance is being aslied for by this institution. Not only that, but It an increase in the population is provided for by additional buildngs, the institution agrees to decidedly lower the per capita cost for all patients, as It wlli not be necessary to increase the salary list, excepting the addition of the necessary nurses and attendants. Very truly yours, (Sgd) V. H. Podstata, Superintendent, Illinois Eastern Hospital for the Insane. Hospital, III., Dec. 7, 190G. Honorable Joseph C. Mason, Secretary, Illinois Civil Service Commission, Springfield, Illinois: Dear Sir — Responding to your letter of some days ago, I beg to say that the new classification, if put into effect at this hospital, would result in a net annual increase of $9,004.00, based upon the present pay roll. At a later date it is my intention to get the classification and the number of employes on a more business like basis. It seems to me that things come slow with me here, but I assure you I am doing my best. Very respectfully yours, (Sgd) J. L. Greene. Illinois Asylum for the Incurable Insane. Peoria, III., Nov. 30, 1906. Honorable Joseph C. Mason, Civil Service Commission: Dear Sir — I have the honor to acknowledge your letter of Nov. 26. There is nothing to base calculations upon in determining the increased expense involved in the new schedule except to adopt the maximum, less than which would not be satisfactory to the employes of the second in size of the seventeen charitable institutions of the State. I herewith submit a comparative table, showing the present and maximum pay, with additions and deductions. If our policy of a non-resident force Is carried out it will add $10.00 month to the maximum. Increase. Decrease. $ 300 00 300 00 1. 200 00 1, 800 00 120 00 120 00 300 00 One second assistant physician from $1, 500 to $1, 800 Four assistant physicians from $1, 200 to $1, 500 One chief clerk from $1. 680to 51. 800 One stenographer from $600 to $720 One chief bookkeeper from $1, 200 to $1, 500 One assistant bookkeeper (clerk) from $960 to $720 $240 00 One treasurer from $500 to 600 00' 120 00 60 00 1,500 00 480 00 4, 800 00 2.400 00 360 00 5. 400 00 One storekeeper from $900 to $960 One steward (if added ( from to $1, 50iO One chief nurse from $480 to $960. Twenty (graduate nurses (head attendants)from $360 to $600 Twenty pupil nurses (asst. head attendants) from $300 to $420 Ten attendants (men) from $324 to $360 Ninety attendants (women) from $240 to $300 Three assistant engineers from $780 to $720 180 00 One butcher from $600 to 1720 120 00 180 00 One gardener from $540 to $720 $19, 560 00 $1. 020 00 Very respectfully. (Sgd) George A. Zbller, Superintendent. Illinois Southern Hospital for the Insane. Anna, III., Nov. 28, 1906. Honorable Joseph C. Mason, State House, Springfield, Illinois: Dear Sir — In reply to your letter, would say that I have gone over our pay roll and find that if the proposed uniform scale is adopted, that the present employes of this hospital will receive an increase amounting to $400.00 per month. New positions created would increase the amount as follows : Psycho-pathologist, per month $12.') 00 Steward, per month 125 00 Superintendent of nurses, per month 75 00 Four (4) internes, per month 100 00 Total increase per month $825 00 312 I will further state that we can do this on an appropriation of $140.00 per capita, which wciild amount to J175. 000.00 per annum for the nest two years. Very truly, (Sgd) W. L. ArnoN. Ii.Li.Nois Cextr.\l Hospital fob the Insanb. Jackso.sville, III., Dec. 3, 1906. Mr. Joseph C. Maann, Secretary, IlUnoia Civil Service Commission, Spritif/ field, lUinoit: Dear Sir — I beg to acknowledKe receipt of your letter of the 20th ult, endoslnz copy of change proposed in the uniformity of salaries and positions in hospitals for the Insane, with the request that I send you an estimate of how much the proposed change would increase our expenses. In reply would say that the minimum Increase propoaed would make a few dollars difference between that and what we are now paying, while the maximum would be estimated as $7,940.00 more per annum. The proposed chance seems to me to be a good one. There are some things, however, that perhaps would not apply to all institutions alike. Yours very truly, (Sgd) H. B. Cakriel, Superintendent. 3^3 PART II. DEPARTMENT FOR THE VISITATION OF CHILDREN. BEGINNING OF THE WORK. The law placing dependent and neglected children under the supervision of the State and making them subject to visitation by a State agent, appointed for that purpose by and acting under the direction of the State Board of Pub- lic Charities, had been in force one year on July i, 1906. The Rev. Charles Virden, who was appointed State agent, assumed the duties of that position on Oct. i, 1905. Much of the nine months remaining of the first year of the new law was spent in organizing the department. After a tour through Kentucky and Indiana, studying the meth- ods employed by those states in like work, the State agent began a personal inspection of homes in and about Chicago, acquainting himself with the methods of the institutions and of the juvenile court. Two assistants to the State agent, provided for in the law, were appointed by civil service on April i, 1906. The appointees were Miss Katherine Gallagher of Canton, and Mr. W. R. Blackwelder, of Gardner, both teachers for a number of years in the high schools of this State. These appointments were the first fruits of State civil service in Illinois. War on Abuse of Children. The State Board of Public Charities enlarged the possi- bilities of the ofifice by encouraging a general and special oversight of that class of children who are the subject of abuse and brutal treatment at the hands of foster-parents, as is sometimes the case. The State agent has been active in following up all cases of this kind that have come to his notice and has acted in unison with the local authorities in bringing the offenders to justice. New law one year old. State agent appointed. First fruits of civil service. Enlarged scope. 3«^. Inspections. Unauthorized shifting. Wards may mar be visited. Officials nnd others with In the law. Prlvntp Insti- tutions. Adoptions nnd pa- roles. Outside the State. Lnspection of Orphanages. A careful inspection of orphanages and child-saving in- stitutions also has been made a part of the work in this department. Inspection has proven that the insitutions, with very few exceptions, are doing good, honest work ; and to all such as comply with the law, the recommenda- tion has been made for issuing a State certificate by the State Board of Public Charities. It is the purpose of this department to work in hearty co-operation with each and every institution and local authorities and to aid in better- ing the condition of the child, who. because of its unfor- tunate condition, is unable to help itself. Official Co-operation Asked. The State agent recommends careful compliance with the law by the courts and societies in the matter of reporting the names of children placed in family homes, as prescribed in section i, of the Visitation Act. Failure to comply greatly embarasses the work of this department. The unauthorized shifting of children from one family to another has re- sulted in a loss of several wards of the State. This depart- ment will insist on greater care on this subject in the future and that all children may be moved only by consent of the court or institution. All institutions incorporated for the purpose of caring for dependent, neglected and delinquent children receiving any part of the public moneys from any public treasury are required to report quarterly to the State Board of Public Charities in manner and form as provided under the law ; said reports to be made out on a uniform blank furnished by the State Board of Public Charities. Any circuit court judge, county judge, county supervisor or overseer of the poor, any public official, or any individ- ual not a public official or an official of an institution re- ceiving pulDlic money from any public treasury to provide or assist in providing for any child as above stated, or who may place any child, not his own offspring, in a family home, is within the provision of this law. Institutions not receiving public funds may be listed for visitation by making a written application to the State Board of Public Charities. The 1.310 children in the State already listed for the fractional first year will doubtless be multi- plied as institutions and courts fall into lino with the new law. Children who are given in adoption are not reported to the State Board of Public Charities. Those who are par- oled to parents, although reix)rtc(l to the State Board of Public Charities, are not listed for regular visitation. Because of the limited number of assistants and lack of funds to carry out the plans of the department, children who are placed outside of the State arc not visited. 315 Annual Report of Department of Visitation of Children, from July 1, 1905, to July 1, 1906. The following is a list of counties and towns where children were visited ; number in each county and town or community ; month when visited; institution placing child, and name of visitor. ADAMS COUNTY— 5. Town pr Community. No. Month Visited. No. Institution Placing Child. [No. Coatsburg Golden Mendon . . Quincy Richfield. . 1 May, 1906. 2 1 4 1 Illinois H. and A. Society. Whitehall Orph Visitor— Katharine A. Gallagher. BUREAU COUNTY— 1. Tiskilwa 1 May. 1906. 1 Illinois H. and A. Society Visitor — Miss Gallagher. CHAMPAIGN COUNTY-3. 3 1 2 6 Mav, 1906 1 5 Illinois H. and A. Society 5 Mohomet June, 1906 Cunningham Dea. Orph 1 6 Visitor — Miss Gallagher. COOK COUNTY— 5. Chicago Chicago Heights Evanston Harvey Homewood 121 November, 1905. 5| December, 1905,. 11 January, 1906... ll February, 1906.. November, 1906. April. 1906 May. 1906 129 2 111. H. and A. Society... 25 Chicago Ind 19 111. Ind. (Evanston) 291 St. Vincent Inf. Asylum. 2! A. M. H. F. A 41 1 Huddelson Home 11 H. of (3. S. (Peoria) Juvenile Court 25 57 16 17 7 1 1 5 129 Visitors— Mr. Virden, 86; Mr. Blackwelder, 21; Miss Gallagher, 22. 3i6 Counties and Towns ivhcre Children zvere Visited — Continued. ddpage county— 2. Town or Community. No. Month Visited. No. Institution PlacioK Child. No. Wayne West Chioatro. June, 1906. St. Vincent. Feehanville. Geneva Visitor — Mr. Blackwelder. GRUNDY COUNTY— 2. Visitor— Mr. Blackwelder. HANCOCK COUNTY— 2. Visitor— Miss Gallai^her. HENDERSON COUNTY-2. Blggsvllle. Media May. 1906. 111. H. and A. Society Bethany Protective Assn. Visitor— Miss Gallagher. HENRY COUNTY-4. Cambridge . Alpha Hoopole Kewanee... May, 1906. 111. H. and A. Society Feehanville Bethany I'rotectivt' Assn. A. H. F. Association Visitor— Miss Qallaifher. IROQUOIS COITNTV— 6. Oilman Martlnton. Onari^a. . . . Thawvillc. Walseka.. June. 1906. Illinois Home and A. Lake BlulT Orph Visitor— Miss Gallagher. 317 Counties and Tozvns zvhere Children zvere Visited — Continued. KANE COUNTY— 6. Town or Community. No. Month Visited. No. Institution Placing Child. No. Aurora 3 2 3 1 5 3 17 June, 1906 17 Illinois C. H. and A 4 Geneva , 13 Elgin 17 St. Charles Wasco Visitor — Mr. Blackwelder. KANKAKEE COUNTY— 4. Burbonnais 1 2 1 2 6 May. 1906 6 St. Vincent 1 1 Reddlck. Illinois C. H. and A 4 St. Anne 6 Visitor— Mr. Blackwelder. KNOX COUNTY— 4. Abingdon. Galesburg Knoxville Rio April, 1906. May, 1906... Illinois H. and A. Society. Feehanville Visitor— Miss Gallagher. LaSALLE COUNTY— 4. Mendota 1 3 1 3 8 May, 1906.. 4 4 Illinois H. and A. Society ?. Ottawa June, 1906 Huddelson Home 1 Feehanville 5 Streator S Visitor— Mr. Blackwelder. LEE COUNTY— 3. Amboy . . Dixon Pawpaw. June, 1906. Chicago Ind. School 111. C.H.& A A. H. F. A Feehanville Visitor— Mr. Blackwelder. 3i8 Counties and Tozvns zchcre Children were Visited — Continued. LIVINGSTOfl COUNT Y-5. Town or Community. No. Month Visited. No. Institution Plucinif Children. Ns. Campus 1 May, 1906.. in 1 GraymoDt Illinois H. andA. S 7 Odel 3 1 2 10 A. H. F. A. 1 PoDtiac Feehanville 1 Strawn 10 Visitor— Mr. Blackwelder. MARSHALL COUNT Y-1. Camp Grove. liMay. 1906. 1 H. of G. S. (Peoria). Visitor — Miss Qalhii^her. Mcdonough county-s. Colchester BUindinsville. Macomb April. 1906. Illinois C. H. and A. Visitor— Miss Gallafrber. McHENRV COUNTY— 5. Alden 5 4 1 1 5 16 May, 1906 16 Chicago Ind s Harvard 111. C. H. and A ? Harlland Feehanville 11 Marengo Woodstock 16 Visitor— Mr. Blackwelder. McLEAN COUNTY-2. BloomiDfrton 6 1 6 June, 1906 6 Illinois C. H. and A 9 Dan vers Girl's School (Hloomin»rton) Cook County Juvenile Court « 2 6 Vlsitoi^Miss Gallairher. MERCER COUNTY— 8. Aledo 2 1 1 4 March. 1906 May. 1906 1 S Illinois C. H. and A 4 Kiel hsburif Ni;w lioston Vlsltoi^-Mlss Gallagher. 319 Counties and Tozvns zvhere Children were Visited — Continued. PEORIA COUNTY— 4. Town or Communitj'. No. Month Visited. No. Institution Placing Child. No. Chillicothe . . 1 1 4 1 May, 1906 June, 1906 6 1 111. C. H. and A 2 FeehanviUe 8 1 Bartlett. . 1 7 7 Visitor— Miss Gallagher. ROCK ISLAND COUNTY— 4. Hillsdale 1 1 1 3 6 May, 1906 6 Bethany Protective Assn 4 Moline St . Vincent 1 1 Rock Island 6 Visitor — Miss Gallagher. SANGAMON COUNTY— 3. Divernon . . . lUiopolis. .. Snringfleld. 11 November, 1905, January. 1906 June, 1906 3[I11. H. and A 1 County Court 7 S, H. for Friendless. Visitors — Mr. Virden, 4; Miss Gallagher, 7. SCHUYLER COUNTY -3. Camden.... Frederick . Rushville . May. 1906. Schuyler Co. Farm. Visitor— Miss Gallagher. STEPHENSON COUNTY— 2. Freeport. Lena November, 1905. December, 1905. Ill, C, H. and A Stephenson County Court, Visitor— Mr. Virden. TAZEWELL COUNTY— 1. Washington. 1 May, 1906. 1 Peoria Ind. School . Visitoi"— Miss Gallagher. 320 Counties ami Tonnis where Children were Visited — Concluded. WILL COUNTY— 7. Town or Community. No. Month Visited. No. Institution Placing Children. No. Braidwood 4 May, 1906 4 8 5 1 111. C. H. and A g Crete 1 1 4 5 April, 1906 A. H. F. A. 5 Frankfort Mav, 1906 Glenwood 4 Joliet .June. 1906 Keehanville . 2 Lockport St. Vincent 1 SpoDcer 1 2 18 > — „ Wllmint'ton 18 Visitors— Mr. Blackwelder, 14; Mr. Virden, 4. WINNEBAGM3 COUNTY— 1. Durand. 1 November. 1905 1 Feehanville Visitor— Mr. Virden. WOODFORD COUNTY— 3. Eureka... Metamora Roanoke . U&y, 1906. 111. C. H. and A. Visitor— Mr. Blackwelder. INSTITUTIONS PLACING CHILDREN VISITED DURING THE YEAH. American Home Pinilinfr Association 15 Mcthuny Proti-ctivc .\ssoci;ilion 6 CunDlnk'liiim Desiconess ()ri>lianat.'e 1 Cliicairo Industrial School 66 Cook ( 'ouniy .Juvenile Court 7 Girls Indusiriiil Home 2 Home of the ( looU Shepherd 2 HiiUdelson Home 2 Illinois Industrial School (Evunslon) 16 Illinois (,'hililren's Home and Aid Society. 108 Illinois Manual Traininu' School Farm 4 Meihodisl Deaconess Orphanakte 1 Sani,'amon County Court 4 Schuyler County Farm 6 Sprinu'tlelU Home for Friendless 5 Stale Industrial School (Peoria) 1 .State Trainintr School for Girls 16 Stephenson County Court 1 St. Mary's Trainin^r School 88 .St. \'incent's Infant Asylum 22 Whitehall (^rphanaue 1 Total . . 324 iQ.stitutions and orphanaifcs inspected 15 Cerlillcates jfriinted 12 Certlllcates refused 3 Institutions insi)ected for incorporation. .. 4 .Special cases investigated 52 Pro.secution of crimes uitainst orphans and wards of the State 8 Pro.secution of baby farms and lying-in hosi>itals 2 Children returned to parents in other states 4 Children returned to parents in Illinois 15 Children i>iaced In homes and schools for special trainin^.' 40 Investigation of orphanages 1 321 SUMMARY OF ANNUAL REPORT, DEPARTMENT VISITA- TION OF CHILDREN. REGULAR VISITATION. Counties visited. Number. Adams 9 Bureau 1 Champaign 6 Cook 129 DuPagre 4 Grundy 7 Hancock 3 Henderson 3 Henry 4 Irociuois 10 Kane 17 Kankakee 6 Knox 9 LaSalle 8 Lee 10 Livingston 10 Marshall 1 Counties visited. Visits. McDonough ! 4 McHenry 16 McLean 6 Mercer 4 Peoria T Rock Island 6 Sangamon ; 11 Schuyler 6 Stephenson 2 Tazewell 1 Will 18 Winnebago 1 Woodford . 5 Total 324 Number of towns visited 99 Visits per month of November, 1905 7 Visits per month of December, 1905 26 Visits per month of January, 1906 20 Visits per month of February, 1906 .' 29 Visits per month of March, 1906 23 Visits per month of April, 1906 68 Visits per month of May, 1906 86 Visits per month of June, 1906 65 Total '. 324 Visited by— . No. Children. Mr. Virden 97 Miss Gallagher 109 Mr. Blackwelder 118 Total 324 No. Counties. 5 18 11 *34 No. Towns. 11 50 43 *104 Grand total visits— 324. Counties— 30, Towns— 93. Institutions and courts placing children— 21. State agent appointed Oct. 1, 1905. Period covering actual work ei^ht months. Home visitors appointed April 1. 1906. Period covering actual work, three months. * The report shows that four counties and five towns have been visited by more than one representative. -21 P C 322 REPORT OF INSPECTIONS OF INSTITUTIONS AND SOCIETIES CARING FOR CHILDREN. The following' are reports of inspections of institutions caring for dependent, neglected and deliquent children : AMANDA SMITH ORPHANAGE. HARVEY, ILLINOIS. [Date of Report, May 25, 1906.] Pursuant to your request, at the last meeting of the board at Springfield, I made a careful investigation into the methods employed and the work done by the Amanda Smith Industrial Home at Harvey 111., and would respectfully submit the following report: Following the last meeting of your board, the newly selected members of the board of trustees of the Amanda Smith Industrial Home met and or- ganized. By their request I met with them and outlined what I felt was nec- essary to be done that the Board of Commissioners of Public Charities might sanction the apiilication for their new charter and issue their certificate. 1st. A thorough renovation of the whole house and premises. 2d. New beds and bedsteads with few exceptions. 3rd. A change in the matron of the boys' department and the discharge of the secretary whose every act militated against the best interests of the home. 4th. The putting of what Is known as cottage No. 3 in shape for occupancy that room might be made for more children. .^)th. That the warranty deed to the property which has been purchased by collections and donations from the people, be transferred from Amanda Smith to the trustees of the Amanda Smith Industrial Home as soon as the ch;irt<'r is granted. •;th. That the system of ( hild jilacing be established and made a permanent condition of the home. While the work moved on slowly at first because of the scarcity of help, the whole institution has undergone a most thorough renovation. The store rooms were cleaned out and two wagon loads of rags were disposed of. The good clothing was sorted out and the children well clothed, other clothing f^t for use stored away for the future. These rooms were placed in a good sanitary condition and made two good dormitories for boys. Three painters were at work and a fourth man and tbro<» women were cleaning the wood work which is receiving a good coat of paint. The rooms throughout the three buildings are being newly papered and painted. Many of the old beds have been destroyed and twelve new ones purchased; twelve more will be ordered at once. The matron of the boys' department has been discharged and Miss Cole- man's books audited and she will be discharged in another week. 323 Cottage No. 3 has been vacated and is also being renovated. The property is ready for transfer as soon as the charter is granted. All necessary papers being now ready for signature as soon as their actions can be legalized. I gave the whole premises a thorough inspection yesterday (May 24th) and found the children clean and tidy and the above mentioned improvements going on. Rev. Purnel, the newly appointed superintendent, is an energetic man and will doubtless, with the aid of a new board, make this institution a success. I would recommend that the charter be granted and the certificate asked for be now issued. AMERICAN HOME-FINDING ASSOCIATION, 167 DEARBORN STREET, CHICAGO. [Inspected March 5 and March 12, 1906.] The superintendent of the American Home-Finding Association, having made application from time to time for a certificate, to the State Board of Public Charities and having charged the State Board of Public Charities with unfairness and discrimination against them, a thorough inspection was made of the society's receiving home and of the business methods employed by them. The receiving home or nursery, located at 3235 Forest ave., Chicago, was a frame building with two stories, attic and basement, at the time of in- spection. The building was found to be in need of repairs but the sanitary condition was good. While the building has been constructed for residence purposes, it served very acceptably for the purpose for which it was used. Eight children were present, ranging in age from three weeks to five years old, and one girl about fifteen years old assisted with the house work. Mrs. Rony, the matron, reported that they were short of help; that she and her assistant were compelled to be on duty both night and day. I reported the same to Mr. Hoover, the superintendent, who at once employed another assistant. The association did not own the property and were talking of removing to other quarters in a short time. In company with Mr. Harry S. Moore, Assistant Secretary of the State Board of Public Charities, we made a thorough inspection of the record and books of the association at their office, Monday, Mar. 12, 1906, with the following results: The records of placement of children were very vague and incomplete. We found in many instances where children had been lost and no account could be given of them; that many were never reported to the State Board of Charities as required by law; that money had been received from county authorities for the care and placement of children, who were immediately turned over to relatives in the same town and the money not accounted for. One case cited in Olney, Richland county, wherein five children were received from one home, for which the county paid to Mr. Hoover $150.00, he signing a contract to remove the children to Chicago and place them in good family homes, and that the county should be relieved from all responsibility there- after. On receipt of the money, the children were turned over to an uncle residing in same county, Mr. Hoover instructing the uncle that it was his duty to care for them. It was further found that considerable money was obtained, at the same time, from residents of Olney by Mr. Hoover for the benefit of these same children. When this was reported to the authorities of Richland county by the State agent, they condemned Mr. Hoover for his actions. A careful inspection of the books of the association revealed gross neglect and a lack of system in conducting their business. The books could not be made to balance and the financial condition was chaotic. Mr. George K. Hoover, the superintendent, at once placed two expert bookkeepers on the books to prepare a report. Three days later we went over the statement ren- dered by Mr. Henry Millard, the accountant, one of the experts employed 324 by Mr. Hoover, at which time the accountant stated that he had failed in striking a balance and reported that it was imixtssible to do so. and in a letter attached to the report and made a part of same, he criticised severely the methods emjjloj'ed by Mr. Hoover and his associates. Upon examination it was found that the last eight pages of the report which had been previously bound togther, had been removed and the name of the ac- countant had been removed with the papers. Mr. Hoover's attention was called to this fact. He at first denied any knowledge of it, but subsequently acknowledged that he had had them removed by the Rev. R. D. Scoii. vice- president of the association and manager of "Our Homes and Our Homeless;" that this was done under his instruction and the leaves thus removed were in possession of a friend, who would be absent from the city for several days. This was proved to be false and the leaves were immediately produced by Mr. Hedrick, one of the expert bookkeepers who had gone over the books and had seen Mr. Scott conceal them in a desk in an adjoining room. Mr. Scott afterwards admitted that the leaves were removed at George E. Cole's book- store at 8G-88 Dearborn street and that he had gone to this place from 167 Dearborn street after our arrival at the office and that Mr. Hoover knew that they were not removed from the office. Mr. Hoover had repeatedly stated that the leaves were not in the city; that he had given them to this friend who would not return for a week. He stated that he would make an affidavit to this effect. In view of the facts mentioned in this report, all of which are substantiated, we would not only recommend that the certificate asked for be denied but condemn the methods of the American Home Finding Association, and would place our stamp of disapproval upon those who, wilfully, are party to the same, and further, that an investigation be made of the homes where the wards of the American Home Finding Association have been placed and that the associa- tion be required to furnish a complete and intelligent record of all the children handled by them. ANXA B. MILT.IKEX HOME AND MACOX COI'XTY IXDUSTRIAL SCHOOL FOR GIRLS, DECATUR. ILL. [Inspected July 6, 1906.] The officers of the Anna B. Milliken Home, Decatur. 111., having made ap- plication to the State Board of Public Charities for the renewal of thoir certificate, I made the usual inspection pursuant to your request and submit the following report: The home consists of a two and a half story red brick building, located on a i)lat of fifteen acres In the west edge of Decatur, Illinois. The building is thoroughly fitted with modern conveniences, steam boated and lighted by gas. The wafer supply is furnished from the city water works and cisterns for washing purposes on the premises. There is a bath room on each floor. The floors are of hard wood covered with rugs throughout the building. The purpose of the home Is to care for old people and dependent children, the children and aged women being segregated, excejit at meal time where they all meet in the dining room but at different tables. The old ladles are admitted to the home on life membership fee, ranging In amount according to age. Af the time of my inspection of the building there were five aged women and fourtpZ^ The main building of brick, fronting Adams street, consists of fourteen rooms. The house is three stories and basement with an annex at the rear where the boys are kept The purpose of this home is to care for dependent and delinquent children until disposition is made of them by the Juvenile court. It is supported by contributions from the county and city and voluntary gifts. The basement of the main building is used as a dining room and kitchen and furnace room: the first story for oflBce and superintendent's living rooms; the second and third stories, nursery and sleeping rooms for the girls. All rooms are furnished with hot and cold water and a toilet room on each floor. The sanitary condition of the institution is good. The building is lighted by gas and with the exception of the top floor, which is heated with gas and coal stoves, the building is heated by a furnace. The capacity is estimated to be from thirty to forty in the main building. The largest number in the house at any one time was 314, the smallest num- ber 140, while 3,33G have passed through the home in sixteen months. The annex is built of brick and though intended at first as a carriage house, it is a thoroughly equipped two story brick building of three rooms, two baths and closets. The lower floor is used as reception, dining and school room. Miss Florence E. Scully, employed by the Chicago board of education, is in charge of the school and all children of school age are required to attend, and though the shifting condition of the inmates makes the school problem a very difficult one, Miss Skully is making a good showing* with these children. The boys' dormitory is clean, light and airy and the bedding in good con- dition. It is the purpose of the superintendent to supplement all wooden cots and bedsteads with iron beds as soon as possible. The institution is governed by the .Juvenile court committee, consisting of a number of ladies, of whom Miss Julia Lathrop, a member of your honor- able body, is the vice president. They pay a rental of $1,000 per year for the building. They are out of debt and two months since had $10,000 in the bank, and a move is on foot for the erection of a larger and more modern building for this purpose. The value of the work of this institution may be estimated when It Is authoritively stated, that three years prior to the enactment of the Juvenile court law, 1,705 boys were incarcerated in Cook county jails and city prisons, while during the last two years only twenty-four have been incarcer- ated in the jail. The inmates are given the same food as is placed on the family table. I would recommend that the certificate asked for be granted. LINCOLN C0L0RP:D HOME, SPRINGFIELD, ILL. [Inspected July 0. loor,.] Having received application from the Lincoln Colored Home for a cer- tificate, I made an Inspection of this Institution and submit the following report: The home is a two, story twelve room brick house located at 427 South Twelfth street, Springfield. 111. It is located on a lot 0.0x160 feet. The pur- pose Is for the care of old people and dependent colored orphan children. At the time of my inspection there were four old people In the institution, three of whom had paid $2.^.00 each for their care and one assisted in the work of the bouse. There were thirty-two children: foiirteen boys and eighteen girls, ranging In age from 1 to Ifi years, all of whom were committed by the court. It Is the purpose of the home to care for the children of Sangamon county alone. 333 Six hundred dollars a year is paid to this home by the court for the care of their wards. The children attend the St. John's Methodist and Baptist churches. Those of school age attend the Lincoln school regularly. They have placed about 89 children during the year in homes and these are visited by the superintendent of the institution at regular intervals. The home is in very good repair, neat and clean, and throughout in good sanitary condition. It has hard wood floors and is heated with furnace and lighted by electricity. I recommend that the certificate asked for be granted. ORPHANS' HOME ASSOCIATION OF THE SOUTHERN ILLINOIS DIS- TRICT OP THE GERMAN EVANGELICAL SYNOD OF NORTH AMERICA, HOYLETON, ILL. [Date of Report, April 18, 1906.] In accordance with instructions I made a visit of inspection to the Or- phans' Home at Hoyleton, March 24, 1906, with the following results: The home consisting of twenty-five room frame house, is located in the center of a block of ground. Considerable repairs have been made recently, a part of which is a coat of paint inside and out. The sanitary condition is good. All closets are outside. Water is fur- nished from one well and two cisterns. The building is provided with fii'e escapes reaching from the upper windows to the ground. The capacity of the institution is estimated to be about 100. Mr. J. H. Koenig and wife are in charge and report 72 children in the home. One hun- dred and sixteen have been admitted to the institution since it was founded. The object of the institution is to take care of and educate orphan children up to the age of 18 years. There have been no commitments from the court. A thoroughly equipped school is conducted by Mr. Koenig ten months of the year. The children attend regularly Zion Sunday school and church. On an inspection of the sleeping rooms I found the beds clean and rooms well ventilated. The boys and girls are separated in different parts of the building. I remained over night at the orphanage and had supper and breakfast with the children and family. The food was of the best quality, and each child given all he wanted. At the close of each meal a chapter is read from the bible by the superin- tendent and all the children join in devotional service. Liberal donations have been received during the year, and the superin- tendent reports that the society will be out of debt in another year, and more improvements will be made on the building. Dr. Klosterman is the attending physician and answers calls night and day without charge. The institution is doing good work and I recommend that the certificate asked for be renewed. SPRINGFIELD HOME FOR THE FRIENDLESS. [Inspected July 7, 1906.] Have received application for renewal of certificate of the Springfield Home for Friendless. I made inspection of this home pursuant to your re- quest and would submit the following report: The building consists of a four story house with an annex of three stories and has about thirty rooms. It is located on a block of ground on South Eighth street. 334 I was Informed by the matron, Mrs. Viola Dinsmore. that it has a capacity of about 200, and at the time of insi)ection contained about eighty-nine In- mates, the youngest of whom was 5 weeks old and the oldest 14 or 15 years old. All children of school age attend the public school across the street from the home. Religious training Is received at different churches in the city. About two-thirds of the inmates were said to be boarders for the care of whom a nominal sum is received from the parents or guardians; others are commitments from the court, for whom a small amount is paid by the board of supervisors of the county. The house is furnished with city water, electric lights and steam heat. The heat has, up to the present time been furnished by the city, but not being satisfactory, a change is to be made before the wintefT The cooking is done with coke and gas. There are five assistants besides the matron. A new laundry fully equipped with the latest machinery is in process of con- struction and will be completed in a very short time. A good garden furnishes vegetables for the table throughout all the sum- mer months. They have four cows which furnish milk for the children. Their menu is as follows: Breakfast — Hash brown potatoes, bread and butter, coffee, cream of wheat. Dinner — Meat, potatoes, bread and butter, milk and coffee. Supper — Mush and milk, bread and butter, vegetables, often cake and fruit. This menu varies from time to time. The sanitary condition of the liouse is good. They have placed a large number of children in family homes dur- ing the past year, almost all of which have proven satisfactory. I consider the home a necessity and that the work done has been of good type of character, and I most heartily recommend the issuance of certificate asked for. STATE INDUSTRIAL SCHOOL FOR GIRLS. PEORIA, ILLINOIS. [Date of Report. .July 19. 1900.] Pursuant to your request, I made an inspection of the State Industrial School for Girls at Peoria, 111., and would respectfully submit the following report: The home is a three story brick building of thirteen rooms and basement, located at 1.503 North Madison avenue, Peoria, 111. The property has a 67 foot frontage. The house is old and much in need of repairs. It is heated with hot air furnace, has city water and is lighted with gas. The property was purchased at a cost of $7,200; $1,000 was paid at the time of purchase and the balance is owing the Building and Loan Society. The matron in- formed me that they paid their interest monthly in the form of a rental value of $40.00; this she said was raised by contributions from frionda of the school. No payments have been made on thfe debt but they hoped to pay something during this year. The beds were poor and furniture old; no carpets on the chamber floors. Mrs. .lennie Waterhouse. the matron, in- formed me that extensive repairs would be made diirlng the summer in the form of i)ainting and papering. A new furnace has recently been placed In the basement and the heating appliances are in good order. The repairs cost $200 and add much to the comfort of tlie building. The sanitary con- dition of the building is good. There wore thirty inmates in the building at the time of my visit, ranging in age from S months to 17 years. School is conducted in the building nine months in the year under direction of Miss Irving. The children are instructed in the first seven grades and use the same books that are used in the public schools. The matron reported the health of the Inmates as good. Dr. Wild, the attending physician, donates his services and most of the medicines. The following was given me as the bill of fare: Breakfast, oat meal, coffee, bread and butter, potatoes. Dinner, soup, meat, vegetables, canned goods, bread and butter. 335 Supper, bread and butter and sauce. Sundays, cold roast beef for supper. I did not see the books of the association as they were not at the home. A visit to the county building and an interview with judges, State's attorney and members of the board of supervisors brought out the facts that there is much dissatisfaction regarding the management of the school. The court has placed no children in the home for four years and will place no more while conditions remain as they are. They claim that no effort is made to place children in family homes, and that for, from four to ten years the county has paid for the keeping of many of these wards. The judge and supervisors appealed to me to know of a way to be relieved of paying to an institution that they knew to be in- judiciously managed. Later complaints came to me from different sources to the effect that the children were cruelly treated by the matron. Written statements were given me declaring that the children were often punished by being fed on bread and water for a week at a time, while the matron and other officers ate good wholesome food in the same room and at the same time. Statements are also made that the children are lousy and poorly clad. I am informed by the assistant State's attorney that they had decided to investigate the condition of the home at an early date and asked for an opinion as to what was best to be done. There are other charges of a grave character, of which I do not care to mention in this report, that if true, calls for an investigation. If not true the parties should be vindicated. I would recommend that the certificate be withheld until the county au- thorities are satisfied and the numerous charges are cleaned up. WHITE HALL ORPHANAGE HOME SOCIETY. [Date of Report, April 18 and May 24, 1906.] Having received a request for the corporation papers and State certificate, I visited the While Hall Orphanage March 26, 1906, in pursuance with your request and would respectfully submit the following report: The home consists of a two-story frame building of thirty rooms, located between the C. & A. and C, B. & Q. railroad tracks at Whitehall, Illinois. The capacity is estimated to be about fifty. The property consists of one block of land. The house was formerly built for hotel purposes and has no modern improvements whatever. While the furniture throughout the whole build- ing is old, the sanitary conditions appear to be good. Se-veral of the rooms were not furnished at all. There were no carpets in the bedrooms. There are four rooms in a wing of the building, also, a small building in the rear, which is rented to tenants who assist with the work of the house. There were six children in the home; five boys and one girl. The youngest four weeks and the oldest eight years. I took dinner at the home and all the children were at the table and ate with the family. The food was plentiful and well cooked. The treasurer reported that an allowance of $2.25 per week for each child is made to the home. The maximum salary of $100.00 per month is paid to the superintendent. No other officers are paid, except the secretary and bookkeeper, who receives a nominal sum for his services. The children of school age are sent to the public school. All homes are inspected by Mr. Dewell both before and after the place- ment of children. I found that Mr. Dewell had been receiving commitments from the court to himself in person, and adopting children out in the name of the society, which is illegal, and requested him to return to the treasury all moneys received from such adoptions, which he promises to do. The members of the board who were present concurred unanimously with me in this claim. I found the directors to be among the leading business men of the town and each of them anxious to have the institution placed on the accedited list. There is one district superintendent. Mr. J. T. Green, who receives a compensation for his services. First, his expenses, then one-half net of all the moneys collected. I advised in this, as in other cases, that the officers be placed as soon as possible on the straight salary basis. The books showed that $2,823.13 had been received during the year and that 27 children had been placed in homes, maliing an expense of $104.56 per child for placement. It appears that Mr. Dewell, the superintendent, has been advertising that his orphanage was organized under State law, and had authority to receive commitments from the court and authorized to adopt children out. which is not true. I asked him to explain how he happened to make this statement. He promised to explain it fully and satisfactorily in a letter, but I have failed to receive it up to the present time. On my visit to the home. May 23, 1901;, I failed to find the superintendent. Mr. Dewell. at home, as both he and Mrs. Dewell were at that time looking after the interests of children in the adjoining counties. As to Mr. Dewell's method of advertising to which your attention was called at your meeting in Springfield, he made no explanation other than that made before your board, in which he appeared more inclined to evade the real issue than to answer the questions asked. I learned on further investigation that the same advertising matter had been circulated by him and his workers at a recent date. I had a conversation with the president over the telephone and brought the matter again to his attention. He replied that he was sorry that Mr. Dewell had done as he did in this matter, and that the board had advised him from time to time not to use any such methods, but to proceed with his work and let the society stand on its own merits. On visiting the orphanage Mr. Dewell's daughter informed me that several agents were about to be placed in charge of the field work at different parts of the State. The scope and quality of work accomplished by this society, in my opinion, shows that the people have done fairly well for the help they have had at their disposal. The methods of advertising as mentioned in my former re- port and restated in this, I can not conscientiously recommend or endorse. TluM-e ai)i)e:irs to be a division of opinion retjarding the institution, the friends of the orphanage recommending it and its superintendent in the highest terms and others condemning him and his methods even to the extent of claims of misrepresentations in securing money from the public. I suggested the transfer of the property of the ori)hanage to the trustees as a condition to be considered. Mr. Dewell claims that although the people of Whitehall raised about $500.00 for rei)airs on the building, they did it with the understanding that the property belonged to Mr. Dewell and that they desire no such transfer to be made. I have made a very careful investigation of each matter ingkided and would recommend that the board do not endorsp their application for papers of incori)oral('d and ilial the ccrtificaie ask(>d for he not issued. 337 REPORTS MADE BY INSTITUTIONS AND SOCIETIES CARING FOR CHILDREN. AMANDA SMITH INDUSTRIAL HOME. (Northeast cor. 147tb and DesPlaines sts.) Of Harvey, Illinois. J. A. BURHANS President L. N. MOYER Vice President GEORGE M. METCALF Secretary EDWIN S. GAMBLE Treasurer REV. D. H. V. PURNELL Superintendent Financial Condition May 15, 1906. Assets. Amount. Liabilities. Amount. Buildings Furniture and stationery Cash on hand $15, 000 00 1, 500 00 52 35 Bills payable $1,300 00 (Report incomplete) Total liabilities $16. 552 35 $1, 300 00 Object of organization is to shelter, train in letters and industry and find homes for dependent, neglected and needy children. Remainder of report incomplete. AMERICAN CONGREGATIONAL DEACONESS ASSOCIATION. Of Dover, Illinois. Incorported October 15, 1901. THOMAS A. MacMILLAN President REV. W. A. BARTT-ETT Vice President REV. W. B. THORP Secretary DEMING H. PRESTON Treasurer Financial Condition March 31, 1906. Assets. Amount. Liabilities. Amount. Lands $ 700 00 6, 200 00 700 00 None reported. Bu ildings Furniture and stationery Total assets, $7, 600 00 Receipts and Disbursements for the Year Ending March 31, 1906. Receipts. Amount. Disbursements. Amount. Cash on hand at beginning of fiscal year $196 09 100 00 747 41 $1. 043 50 Cash on hand at end of fiscal year. . Salaries S541 14 120 00 From donations lot her expenses — fuel 50 00 From churches 332 36 Total disbursements Total receipts $1, 043 50 -22 P C 338 Movement of Population for Year Ending March 31, 1906. Children. S B ? Children. Z S. * B E Present at beirinnlnjr of year 1 3 4 7 5 8 8 8 '"7 3 .l^laoetl in in.siuutions 1 2 1 4 1 9 Present at end of year 2 3 Total 12! 16 Total 121 16 ANNA B. MILLIKEN HOME AND MACON COUNTY INDUSTRIAL SCHOOL FOR GIRLS. Of Decatur, Illinois. Incorporated September, 1892. Mi:S. I:LIZ.\ M. CRAKY rn'.sldent MI!S. .1. <;. R.ADKNMIAUSEN Vico I'resld.'Ut Mils. K. A. MOKGAN Secritary MRS. S. D. HILL Treasurer MRS. CLARA II. CAMPBELI Superintendent Financial Condition May 1, 1906. Assets. Amount. |, 11 Liabilities. Amount. Lands Buildjni^s $ 3,000 00 28.000 00 1.000 00 1,700 00 22 29 1 None reported. Furniiure and stationery Cash on hand Total assets $33,722 29 i 11 Receipts and Disbursements for Year Ending May 1, 1906. Receipts. . Amount. Disbursements. Amount. Cash on hand at beKinning of fiscal $ 81 00 Cash on hand at end of fiscal year.. Huildinifs $ 22 29 las 46 1.232 STi 1.1 2;< 3,-) 3.004 36 1.3.V) 98 3,612 S3 Total dlsbvirsi-mi'nis Total receipts $5,391 56 $5,391 56 1 Movement of ]?opulation for Year Ending May 1, 1906. Children. E. 2" B S. 1 E Children. B E. o Preseiit at betrinnintc of year 1R 18 5 24 47 'Placi'd in homes 5 3 2 ~10 12 "is 12 .87 17 I 4 8 21 1 48 Placed In insiltuiions 1 Returned iKi:\V Sl'KTZ Treasurer KKV ANDltlCW Sl'KTZ Manager Financial Condition December 31, 1905. Assets. 1 Amount. Liabilities. Amount. $12,000 00 35.000 00 3.500 00 Loans 123.000 00 (Report incomplete.) Total liabilities Furniture and stationery Total assets . $50.500 00 $23,000 00 Receipts and Disbursements for Year Ending December 31, 1905. Receipts. Amount. Disbursements. Amount. From donations— ueneral public . From other sources— pay members. { 918 3a t. 355 50 6. 144 40 1.631 70 950 00 1 Buildintrs, taxes and repairs $ 750 00 212 04 (^ther expenses— litrht and fuel 1.525 66 950 00 Hoard 5.527 85 Miscellaneous 2.948 81 (Report incomplete.) Total disbursements $11,999 93 $11,914 36 Movement of Population for Year Ending December 31, 1905. Children. a B 1 Children. ST 5 B * g £ : Present at beifinning of year Received otherwise 49 31 80 87 22 69 86 63 139 Placed in homes SI i 12 1 43 18 ■'is ■32 3 61 84 1 25 Died 1 76 8 Total Total 78 139 Note — Kvery child Is to be. visited by n slater onee dnrlng the yenr, and special visits are made 11 deemed necessary for the welfare of the child. THE DANISH LUTHERAN CHURCH EDUCATIONAL ASSOCIATION. (534 N. Sacramento av.) Of Chicago, Illinois. Incorporated August 2, 1884. H. C. RORDAN President N. OHLRICK Secretary M. RASMUSSEN Treasurer MRS. A. HANSEN Matron Financial Condition May 31, 1905. Assets. Amount. 1 Liabilities Amount. Lands $2, 200 00 1.000 00 1, 225 18 Not reported. Buildings Cash on hand Total assets $4, 425 18 Receipts and Disbursements for Year Ending May 31, 1905. Receipts. Amount. Disbursements. Amount. Cash on hand at beginning of fiscal $1,088 44 1. 886 87 128 00 Not reported. From other sources — church Total receipts . $3, 103 31 Movement of Population for Year Ending May 31, 1905. Children. CO B o Children. 2 CD 3 E 1 E Committed by court 15 15 13 13 28 28 Present at end of year. 15 15 13 13 ?8 Total Total '8 348 DEUTSCHER EVANGELISCHER WEISENHAUS AND VEREIN VON NORD, ILLINOIS. ALTENHEIM— Of Bensonville, Illinois. Incorporated October 22, 1894. KEV. H. WOLF ■ • • . .rres (l.nt UKV. J. H. KI.LKNnHAKK Mce IToRkU-nt KEV. JL'I>. KIIUMIEU Secretary run. SCIIOENSTEDT • Treasurer KEV. H. STACHLIN Superintendent Financial Condition June 1, 1905. Assets. Lands Buildintrs Investm<'nts Furniture and stationery Cash on hand Total S 4.800 00 25.000 00 12.544 92 2.000 00 182 88 $44. 527 80 Liabilities. Bills payable (Report incomplete.) Total liabilities r.soo 00 $7,500 00 Receipts and Disbursements for Year Ending June 1, 1905. Receipts. Amount. Cash on hand at beginninK of Hscal From donations— treneral public — From other sources— pay members. From church From loans From c-onlrlbulions Disbursements. I Cash on hand at end of fiscal year. i 217 71' Investments l,2iS 11 Salaries and waires 1. iss S6 Other exitenses— fuel 4.7tJ'.t :U Subsistence 5. ir)0 (to Sundries 17H 79 .Miscellaneous Total receipts $12, 727 81 Total disbursements. Amount. I 182 88 393 87 1.494 50 1.233 67 3.697 89 187 54 5.537 46 $12. 727 81 Movement of Population for Year Ending June 1, 1905. Children. B g s I'hildren. E. B E. Present at beirinnini; of year 43 9 62 1 1 44' 87 11 20 1 9 2 8 46 66 11 Keturiiecl to friends 8 Total.. 55 107 I'resent at end of year Total 43 62 88 107 NoTB — Number of children under guardianship at bcRlnnlng of year, 87 ; working for wages and supervised by society, 26. Boys 14 years and over mostiv work on farms; when 11;, j;ei w.iyes for themselves. Girls 14 to 18 work In Institution and get wages after 10 years of age. 349 EDGAR COUNTY CHILDREN'S HOME. Of Paris. Illinois. Incorporated February 9, 1898. MRS. R. L. SCOTT President MRS. JENNIE C. BISHOP Vice President JAMES MARLEY Secretary GEORGE W. BROWN • • . • .Treasurer MARGARET R. WICKENS Superintendent Financial Condition December 31, 1905. Assets. Liabilities. Lands Building's Furniture and stationery Loans on real estate Cash on hand Total assets $ 1,000 00 IC. 000 00 500 00 5.000 00 297 74 $16,797 74 Surplus S16, 797 74 Totalliabilities. $16, 797 74 Receipts and Disbursements for Year Ending December 31, 1905. Receipts. Disbursements. Cash on hand at beginning of fiscal year From public funds From donations From interest on bequest From rummage sale From board of children From membership fees Total receipts $ 356 39 1, 819 26 44 54 132 50 96 05 120 00 123 00 2,691 74 Cash on hand at end of fiscal year Salaries Other expenses — janitor Subsistence Total disbursements. I 297 74 834 00 240 00 1, 320 00 .691 74 Movement of Population for Year Ending December 31, 1905. Children. («)Present at beginning of year. .. /rx I Committed by court * ' I Received otherwise Total. 19 22 Children. 23 Placed in homes 5 Placed in institutions.. 13 Returned to friends Present at end of year. 41 Total , B n> 3 10 1 6 3 9 9 19 22 Notes— a. In actual possession of society, ment. 6. Of above 13 were new cases: five for replace- 350 EVANGELICAL LUTHERAN "KINDERFREUND" SOCIETY OF ILLINOIS. (209 11 Maloiu- av.) Of Peoria, Illinois. Incorporated August 13, 1902. riEKMAXN ZAGEI. President GEOHCE K. HAHMS Vice President REV. KKi:nr:iEU-H W. .IASS Secretary EDWAIU) KKUMSIEG Treasurer CHUISTOI'JIKK DltOEGKMUELLEU Superintendent Financial Condition June 13, 1906. Assets. Amount. 1 Liabilities. 1 Amount. Lands $1,000 00 7.000 00 1.000 00 707 00 Not reported. Buildint;s Furniture and stationery Cash on band Total assets *9. 707 90 Xo report is made on receipts and disbursements. Movement of Population for Year Ending June 13, 1906. Children. 5! 1 S i E Children. s. 9 o p (a)Pres('nl at betfinnint; of year. .. R Placed in homes 13 1 1 IS 9 "i 13 n (6) .' t'ommiiied by court ( KcCfiveil otherwise 6 5 11 4 6 10 10 11 Died 1 Present at end of year fi (Report incomplete.) Total ^ Total ?R NoTKS— n. In actual possession of society, b. Of above 23 were new cases; three for replace- ment. Number of children under ^'aardianship to date — IP4. Number of children supervised in families at present date— 104. Adopted to date— 76. Total number placed in homes since Aug. 13, 1902—180. FLORENCE CRITTENTON PEORIA HOME. (415 Richiiiond av.) Of Peoria, Illinois. Incorporated, 1902. MRS. .TIII.IA I". WHITE President MRS. CARRIE MIM,ER Vice President MRS. MINA STIM.WELL Vice President MRS. KI.ORA R. RYAN CorrespondlnR Secretary MRS. .MARY II. MARTIN Rpcrdlng Secretary MRS. I.ADORAH TODUHNTKR Treasurer MISS CECELIA KING Superintendent Financial Condition April 1. 1906. Assets. Amount. Liabilities. Amount. Furniture anil stationery ISOOOO 4 36 Bills pavnblo $49 77 Cash on band ( Report incomplete. ) Total liabilities Total assets $504 36 $49 77 351 Receipts and Disbursements for Year Ending April 1, 1906. Receipts. Amount. Disbursements. Amount. ^ash on hand at beginning of year.. '"rom public funds <'rom donations— general expenses 5'rom other sources — pay members $ 94 48 44 49 403 95 212 50 145 85 150 00 26 00 104 85 12 00 30 00 Cash on hand at end of fiscal year. . Buildings, repairs $ 4 36 14 00 600 00 Other expenses— fuel Subsistence and miscellan v 38 68 652 08 Kailroad fares 5 00 Water tax Total disbursements 10 00 "■rom W. C. T. Unions "'rom rt'cept ion and sale ^'rom advertising $1,224 12 $1,224 12 Movement of Population for Year Ending April 1, 1906. Children. 3 & 1^ o E Children. ''I B o E ^resent at beginning of year ■lecei ved otherwise 2 5 14 21 2 1 5 8 4 Placed in institutions 1 15 3 2 21 ■ 6 1 1 8 1 Left with mothers ?A 3orn 19: Died Present at end af year 4 8 Total •29 Total 29 The matron's salary is .$25.00 per month, s a balance due from former year. The extra $200.00 shown in salary report :}ERMAN EVANGELICAL LUTHERAN ORPHAN ASYLUM SOCIETY OF NORTHERN ILLINOIS. Of Addison, Illinois. Incorporated August 13, 1873. REV. T. JOHANNES GROSSE President REV. LOTj IS LOCHNER Vice President riEV. EMIL ZAPF Secretary PAUL HAITMER Treasurer lENR Y MERZ Superintendent Condition June 25, 1906. The purpose of this organization is to provide for and educate orphan and half orphan 3nd keep control until the children arrive at the age of 18 years. They place no chll- 3ren in family homes. Report so incomplete that it could not be published. 352 GIRLS' INDUSTRIAL HOME OF McLEAN COUNTY. Of Bloomlngton, Illinois. Incorporated March 12, 1889. MRS. KANNIi: MKANS President MKS. W. SMITH Vice President S.\H.\ri .T. DkMOTTK Secretary MRS. FKANCIS ELA Treasurer MRS. KATE GUILKEY Superintendent Financial Condition January 1, 1905. Assets. Amount. Liabilities. 1 Amount. Lands and buildings Total assets $9.000 00 S9.000 00 Not reported. Receipts and Disbursements for Year Ending January 1, 1905. Receipts. Amount. Disbursements. Amount. Cash on hand at bef^inning of fiscal year From public funds From donaiions Total receipts I Cash on hand at end of fiscal year. . $ 464 14' Siilurifs . I 2, 493 73 I.,ast pa.vmi'ni on mortgage ] 900 00 Current expenses $3,857 87 Total disbursements. I 186 39 980 00 927 00 1.784 48 13.857 87 Movement of Population for Year EMding January 1, 1905. Children. £ 1 i Children. 3 S. t » Present at betfinninir of year 22 4 12 38 1 22 4 12, 88 1 8 8 22 ~88 8 (loniniittccl bv court Ueturned to friends 8 Received otherwise Present at end of year r' Total Total 38 TIIK HAVEN. Of Chicago, Illinois. Incorporated January 24, 1901. OEOUOE C. AM»ItICII I'r.sldent .1. IIKNUY RENTZ Vice President A. I> KINC Secrelnry 'I'linM.vS I.N'NKS Treasurer MUS. K. It. ("UPM Superintendent Reported I>ecember 31, 1905. The purpose of (his orpnnl/ntlon la lo provide n home for worthy dependent young women nnd for homelesa <'hlIdron : to Inenlrnte n hljrher spiritual and social life. Hej>ort so Incomplete that It could not he published. 353 HOME OF THE GOOD SHEPHERD. (Cor. Star and Farraday sts.) Of Peoria, Illinois. Incorporated April 11, 1890. ANNA TELLUS President JOHANNA CUMIN Secretary ANNA HUGHES Treasurer ANNA HUGHES Superintendent Financial Condition December 31, 1905. Assets. Amount. Liabilities. Amount. Lands and buildings $65,000 00 5.000 00 53 60 12, 600 00 Bills payable $ 600 00 Investments Loans 12,000 00 Cash on hand Surplus 70, 053 60 Deficit Total assets $82. 653 60 $82. 653 60 Receipts and Disbursements for Year Ending December 31, 1905. Receipts. Amount. Disbursements. Amount. Cash on hand at beginning of fiscal year Cash on hand at end of fiscal year. . $ 887 30 iBuildings 168 10 Investments $ 53 60 3.419 52 Prom public funds 904 11 From donations, general public From other sources, pay members. 3,484 17 2,009 64 1.350 00 Other expenses, fuel and light Subsistence 1. 576 49 4,381 09 From bequests 968 00 From labor of inmates and sale of 5,714 14 973 57 $14,686 92 Paid on loans 1, 153 41 needle work Clothing Fire insurance 1, 549 25 From concert 581 45 Total receipts Total disbursements $14 586 92 Movement of Population for Year Ending December 31, 1905. Children. "5 B 1 E Children. ro B E E Present at beginning of vear 67 2 85 154 67 2 85 154 Placed in homes 5 85 64 154 5 Committed by court 85 Received otherwise Present at end of year 64 Total ! Total 154 The report shows thirty-six adult inmates at beginning of year, eight admitted during the year, four discharged and forty present at end of year. -23 P C 354 HOUSE OF THE GOOD SHEPHERD. (Orleans und Hill sts.) Of Chicago, Illinois. Incorporated May, 1859. MOTHRIJ MAHY OF T.ORFTT.\ President Pn. MARY OF THF INPAItXATION Vice President SH. MAItY OF THE ASST'MrriON Secretary SR. MARY OF ST. JOSFPHIXK Treasurer MOTHER MARY OF LORETTO Superintendent Financial Condition December 31, 1906. Assets. Amount. Liabilities. Amount. Lands SI8O.OOOO0' 20.000 00 Loans $140,000 00 Buildings (Report incomplete.) Total assets $200.000 00 1 Total liabilities $140. 000 00 Receipts and Disbursements for Year Ending December 31, 1906. Receipts. Amount. Disbursements. Amount. Cash on hand at beirinning of fiscal year From public funds ( Juvenile wards From docations, I City fines Be(iuests Laundry F.mbroidery and fancy work ManufacturinkT work Proceeds public entertainment Loans Total receipts 'Cash on hand at end of fiscal year . . i S 3. 600 86 2,684 37 Buildings 126.032 36 10, 000 00 Fuel 2. 000 00 Subsistence 1,117 00 Other expenses 5,000 00 (Report incomplete.) 8,000 00 4.000 00 783 85 140.000 00 $173,585 22 Total disbursements. 6, 428 34 21,205 62 12,717 18 9169.984 36 Movement of Population for Year Ending December 31, 1906. Children. S 9 B p Children. 2 Total... Female. Present at beginning of year 378 167 20 565 167 1 ^ 23! 23 3< 3 Placed in institutions 20 565 Returned to friends 211 211 Died 1 1 Present at end of year 327 327 Total Total 565 565 355 ILLINOIS CHILDREN'S HOME AND AID SOCIETY. (79 Dearborn st.) Of Chicago, Illinois. Incorporated 1897. ROBERT J. BENNETT President FRANKLIN MacVEAGH Vice President REV. E. M. WILLIAMS Secretary FRANK B. TOBBY Treasurer HASTINGS H. HART Superintendent Financial Condition December 31, 1905. Assets. Amount. Liabilities. Amount. Lands and buildings $15, 503 96 1, 750 00 394 40 2,600 18 130 00 101 75 40 89 Bills payable '. $ 6.305 37 Furnitui'e and stationery Loans 1,000 00 Bills receivable Surplus Total liabilities 13, 215 81 Cash on hand Cemetery lots Unearned insurance ■. . . Total assets $20,521 18 $20,521 18 Receipts and Disbursements for Year Ending December 31, 1905. Receipts. Disbursements. Amount. Cash on hand at beginning of fiscal year Prom public funds Prom donations Friends, for care of children Institutions for care of children Childrens' Home Finder Accounts receivable Miscellaneous receipts Total receipts Traveling and miscellaneous exp. $ 1, 191 92 Home finder 1, 928 00 : Board of children ■34,980 57' Postage, printing and stationery. 1.014 17i iEnglewood nursery expense 7,342 70! Rantoul Home expense 203 07i:Rent 8,595 51 Miscellaneous expense 75 15 I Accounts payable Middlesworth Home expense (Report incomplete.) $55,331 09 Total disbursements. $7, 794 72 377 69 1,718 76 2,308 76 2, 627 08 3, 658 74 1.200 00 2.014 92 5, 163 45 2,846 47 $29,710 59 Movement of Population for Year Ending December 31, 1905. Children. B 9 o E Children. E CD a B E a> o E Present at beginning of year 92 594 Placed in homes 443 m Returned to friends 11 Died 14 Present at end of year.. 104 Total Total 594 Note — Number of children under guardianship at beginning of year, 2,399 ; number of children supervised in families, 2,294. In foregoing report 594 are counted but once. Total number of placements and replacements during the year, 606. Different children placed and replaced, 443. 356 ILLINOIS INDUSTRIAL SCHOOL FOR GIRLS. (Office 79 Dearborn st.. Chlcat'o.) Of South Evanston. Illinois. Incorporated October, 22, 1877. ALICE M. BOND President MARV E. MORGAN Vice President MARY C. VAN BENSCHOTEN Secretary CLARA HUNT Treasurer LOUISE C. JOHNSON Superintendent Financial Condition October 1, 1905. Assets. Amount. Liabilities. , Amount. $80,000 00 12.000 00 1,000 00 Loans $30,000 00 Buildings - Park Ridge (Report incomplete.) Investments . / Vacant lots Total assets $93,000 00 Total liabilities 130,000 00 Receipts and Disbursements for Year Ending October 1, 1905. Receipts. Amount. Disbursements. Amount. Cash on band at betfinnintf of fiscal veur .. f 1,438 04 9,999 96 1.0H6 49 98 40 2.251 41 4.itO!) 00 Cash on hand at end of fiscal year . . $2,731 53 5.400 00 2. 435 27 5.124 00 6.013 33 1.550 00 From public funds, Cook county. . . From donations, friends and public Other expenses, fuel Membership fee Outside counties Interest on mortgaires Sale of lots at Austin Watres returned, fare and phones.. Cash in office 3, 354 50 69 05 47 28 $23,254 13 $23,254 13 Movement of Population for Year Ending October 1, 1905. Children. E. B E. a Children. a B 1 Present at beif Inning of year Committed hv court 168 76 34 11 289 168 76 34 11 289 Placed in homes and returned to 158 160 i.w Received otherwise— boarders Present at end of year 160 Outside counties (Report incomplete.) Total Children under rruardlanshlp at beginning of year, 168; Bapenrlsed In families at beginning of year, 3G ; total number of girls bandied or arrangea for, 482. 357 ILLINOIS MANUAL TRAINING SCHOOL FARM. (Office 713-169 E. Jackson boul., Chicago.) Of Glenwood, Illinois. Incorporated February, 1887. EDWARD B. BUTLER President FREDERICK T. HASKELL Vice President OSCAR L. DUDLEY Secretary EDWIN G. FOREMAN Treasurer OSCAR L. DUDLEY Superintendent Financial Condition April 30, 1906. Assets. Amount. Liabilities. Amount. Lands . . $ 90, 000 00 217, 990 18 91,533 12 14 70 1. 197 59 4,607 37 Bills payable j $ 10. 000 00 Building, heating and electric plant Open and other accounts 8.410 34 Due on salaries and wages Net worth 1.836 02 385, 096 59 Cash on hand .«. . Total liabilities . Due from Cook and other county Total assets.. $405, 342 96 $405, 342 96 Receipts and Disbursements for Year Ending April 30, 1906. Receipts. Disbursements. Cash on hand at beginning of fiscal year From public funds From donations— general public. . . From other sources— pay members. Income investments T. D. Lowther, endowment N. P. Taylor estate Bills payable Manual training shop sales Boys caddying Miscellaneous Total receipts S 756 38 24, 685 86 7, 713 57 10,081 25 3, 625 48 6.000 00 5, 311 22 5, 000 00 1.405 18 1,027 90 594 30 $66,201 14 Cash on hand at end of fiscal year Buildings, greenhouse Salaries Miscellaneous (Report incomplete.) $ 1, 197 59 1.000 00 24.572 92 32.234 42 Total disbursements $59, 004 93 Movement of Population for Year Ending April 30, 1906. Children. i o Children. B o E Present at beginning of year 368 187 124 679 1111 368 187 124 679 Placed in homes 54 284 341 679 1111 .54 Committed by court Returned to friends ?84 Present at end of year 341 Total Total 679 Report states that there are 341 at the schoool ; 180 supervised in families at the beginning of the year. 358 ILLINOIS MASONIC ORPHANS' HOME. (Masonic Temple.) Of Chicago, Illinois. Incorporated March, 1886. OWKN SCOTT President (.llAKLES V. HITCHCOCK Vice President .TAMES A. STERLE Secretary LAHOY A. GODDARD Treasurer JOHN G. STEBBINS Superintendent Financial Condition September 30, 1905. $50,000 00 20.000 00 2.933 61 Total assets $72,933 61 Lands Buildings Cash on hand. Amount. Liabilities. (Not reported.) Amount. Receipts and Disbursements for Year Ending September 30, 1905. Receipts. 1 Amount. Disbursements. Amount. Cash on hand at beginning of fiscal $ 2.903 77 1,200 30 Cash on hand at end of fiscal year.. Salaries $ 2,933 61 1.140 00 Other expenses, miscellaneous 13.476 16 Grand Loil^^e A. F. and A. M Interest (not on investments) 15,000 00, (Report incomplete.) 3 671 7 15 Total receipts . $19. 115 09 Total disbursements tl7. 549 77 Movement of Population for Year Ending September 30, 1905. Children. Children. Present at beginning of year Received otherwise Total 41 Returned to friends Present at end of year Total 44 7 14 39 76 46, 90 Number of children under guardianship at beginning of year, 83. Report states that "We are Just ready to befiln the home flndlflg part of our work." There are twelve adult inmates reported. 359 JEWISH TRAINING SCHOOL OF CHICAGO. (199 W. 12th place.) Of Chicago, Illinois. Incorporated June 14, 1887. HENRY L. FRANK President MRS. E. MANDEL Vice President DR. JOSEPH K'. ARNOLD Secretary LEO FOX Treasurer O. J. MILLIKEN Superintendent Financial Condition April 30, 1906. Assets. Amount. Liabilities. Amount. Lands and buildings $ 72.000 00 118. 000 00 421 00 (Not reported.) Investments Total assets $190, 421 00 Receipts and Disbursements for Year Ending April 30, 1906. Receipts Amount. Disbursements. Amount. From Associated Jewish Charities. From income investments $16. 500 00 5,800 00 Salaries Other expenses, subsistence (Report incomplete.) $17, 600 00 4, 279 00 Total receipts $22,300 00 $21, 879 00 Movement of Population for Year Ending April 30, 1906. ^ "^ H 2 1 "^ H a o o Children. a p Children. cT p Present at end end of year 225 218 448 (Report incomplete.) Total ??5 ?18 443 The report states that much of the data required cannot be given. Pupils are accepted much in the same manner as those in public schools, except that we give preference to those who lately came from Russia. 36o Of Chicago, Illinois. JOHN WORTHY SCHOOL. (26th anil Culifornia av.) Juvenile Department of the House of Correction. Doard of Directors GEORGE .MASON. President. JOHN J. UDKH.M. S. HOCKKS Tol'HY. JOHN J. SLOAN Superintendent Financial Condition December 31, 1904. Amount. Liabilities. Lands Building's Furniture and stationery Total assets f 15.000 00 140,000 00 7,500 00 S162. .SCO 00 (Not reporti'd.) Receipts and Disbursements for Year Ending December 31, 1904. Receipts. (Report states tbat they do not receive or disburse any cash. All bills paid by city comptroller from appropriation made by city council. Disbursements. Amount. Teachers and manual training in structors Engineers and janitors Oftlcers and matron Miscellaneous Total u isbursements $17. 969 00 6.303 00 11.920 00 29.858 00 t65.050 00 Movement of Population for Year Ending December 31, 1904. Children. i E. CO 1 Children. S 1 1 1 E Present at beKinninu' of year 348.... 590 348 Paroled Died eos!.... 1 .... 329 .... 606 1 938 — 938 Present at end of year 37!9 Total Total 938 ... . 938 JUVENILE COURT COMMITTEE. Of Chicago, Illinoi.s. Incorporated March 2G, 1904. .MRS. JOSEPH T. BOWEN • • • • • r/'^ll^"' MRS. CHARLES IIENROTIN Mc*" Prosidont MRS. GEORC!': R. DEAN Secretary JAMES II. ECKELS Treasurer MRS. SARA FRANKLIN Superintendent Financial Condition November 1, 1905. No report made on assets and liabilities. 36i Receipts and Disbursements for Year Ending November 1, 1905. Receipts. Amount. Disbursements. Amount. Cash on hand at beginning of fiscal $ 3, 137 84 4, 300 00 11,299 00 1, 162 50 183 41 6,579 01 $26,661 76 Cash on hand at end of fiscal year . . Salaries Expense for home $ 8, 989 85 10, 079 86 From public funds 7, 246 76 Prom donations — general public Miscellaneous 315 29 Total disbursements Interest and small contributions. .. From concerts Total receipt* $26,661 76 Movement of Population for Year Ending November 1, 1905. Children. In home during the year November, 1904 to November, 1905 — Dependents Deliniiuents 499 Total 2279 2279 499 2279 2778 Note — The purpose of this organization is to provide a suitable home for dependent and delinquent children until disposition is made of them by the juvenile court. LINCOLN COLORED HOME. Of Springfield, Illinois. Incorporated March 8, 1898. JOHN BROWN President JOSEPH BUNN Vice President MRS. J. C. McCLAINE Secretary MISS MARGARET ROBINSON Treasurer MRS. EVA MONROE Superintendent Financial Condition February 1, 1906. This organization was formed for the purpose of caring for homeless children and aged women. The report shows $90.34 assets and no llaibilities. Receipts from various sources, $1,237.34, and no report of disbursements. Movement of Population for Year Ending February 1, 1906. Children. CD B Children. B 1 s Present at beginning of year Committed by court 20 21 41 21 10 72 Placed in homes 1 2 18 19 ?, Returned to friends 18 (Incomplete). Died a Present at end of year 31 Total (Incomplete.) Total 72 Number of children under guardianship at beginning of yeai^7. Number of children supervised in families at beginning of year — 0. 362 MARGARET ETTER CRECHE.. (2421 VVubasli uv.) Of Chicago. Illinois. Incorporated 1891. MRS. E. F. ROBBIXS President MRS. E. C. DUDLEY Vice President MRS. L. M. COY Secretary MRS I^ .T. I,.\MSOX Treasurer •NiRS. SARAH M. STEDMAN Superintendent Financial Condition October 1, 1905. 1 Assets. Amount. Liabilities. Amount. $12,000 00 300 00 Loans $2 00 (ReDort incoiDDlete. ) 213 74 $12,513 74 j Total liabilities n 00 Receipts and Disbursements for Year Ending October 1, 1905. Receipts. Amount. Disbursements. Amount. Cash on hand at befrinninir of fiscal year From donations— ireneral public From other sources — dues from members From investment From beiiuest Horace P. Taylor estate From fines for absence From endowment of beds From annual support of beds. . . . From miscellaneous From rent for laundry Total receipts Cash on hand at end of fiscal year. S 213 74 Huildinvrs. repairs 2. 249 20 Investments Salaries 27 00 Other expenses— fuel and light 3 50 Subsistence Interest 5.000 00 Paid on mortt'aire 16 75 Entlowment of beds and plates 175 00 Miscellaneous 30 00 1,378 70 420 00 $9,513 89 Total disbursements. S 319 16 192 14 Ihl 00 2.338 .SO ■.m 25 769 98 2;i3 ;« 5.000 00 24 69 172 84 9.513 88 Movement of Population for Year Ending October 1, 1905. AKk'retfale attendance 13. 840 Ajfif rrttate number of visitors per month 67 Aififreifale number daily attendance 45 Note — The purpose of the day niirscrv Is to assist workinR women In the care and education of their children and lind employment for these women. 363 METHODIST DEACONESS ORPHANAGE. (Office 108 Dearborn St., Chicago, III.) Of Lake Bluff, Illinois. Incorporated April 12, 1894. JAMES B. HOBBS President J. A. BUHHAUS Vice President GEORGE W. YORK Secretary 0. A. OLIVER Treasurer LUCY J. JUDSON Superintendent Financial Condition September, 1904. Assets. Amount. Liabilities. Amount. $25,000 00 25, 000 00 1.000 00 5,000 00 242 22 (Not reported.) Buildings Furniture and stationery . Cash on hand Total assets $56. 242 22 Receipts and Disbursements for Year Ending September, 1904. Receipts. Amount. Disbursements. Amount. Cash on hand at beginning of fiscal $ 67 62 7,512 67, 3, 775 00 Cash on hand at end of fiscal year. . Buildings, repairs 242 22 142 44 Wages, expenses 875 11 From other sources — board Salaries, Deaconess allowances — Other expenses, fuel Petty expenses 1. 729 26 1, 860 27 4, 418 96 Miscellaneous expenses 2.087 03 Total disbursements $11, 355 29 $11,355 29 Movement of Population for Year Ending September, 1904. Children. 1^ "n £ a » a 49 .59 3 6 44 34 96 99 Children. (a) Present at beginning of year.. j Committed by court I Received otherwise (6) Total., 108 Placed in homes 9 Returned to friends 78 Died Present at end of year. 195 Total . 28 50 2 115 195 Notes— (a) In actual possession on society, replacement. (b) Of above, 74 were new cases, and 13 for 364 MISSION OF LADY OF MERCY. Of Chicago, Illinois. Incorporated Februarj' 9, 1904. RT. REV. JAMES E. QDIGLEY President KT. RKV. P. J. MULDOON Vice Presldont P. D. GILL Socretary REV. D. S. A. MAIIONY Treasurer REV. U. S. A. MAHONY Superintendent Financial Condition December 31, 1905. The object of this organization Is to care for working boys, newsboys and waifs of Chicago. No financial report given. Movement of Population for Year Ending December 31, 1905. Children. E. 1 E Children. 5" § P t £ Present at beginnlnsr of year Received otherwise 25 .... 26 . ... 25 26 61 Returned to friends Present at end of year 28 23 51 1111 28 n Total 61 Total 51 NACHUSA LUTHERAN ORPHANAGE. Of Nachusa, Illinois. Incorporated December, 1903. UBV. L. P. HIDDEN President REV. F. W. SCHNEIDER Vice President REV. J. A. Mcculloch secretary A. L. MILLER Treasurer Miss ELIZA EICHOLZ Superintendent Financial Condition June 30, 1906. Assets. Amount. LiabUitles. Amount. Lands $4.000 00 2.000 00 125 00 1.000 00 (Not reported.) Huildini^s Furnlturt" and stationery Total assets 87, 125 00 Receipts and Disbursements for Year Ending June 30, 1906. Receipts. Amount. Disbursements. Amount. Cash on hand at beirlnnlnfr of llscal year 11.539 38 2.222 86 176 00 Cash on h:in(l at end of Hscul year.. Other expenses not itemized (Report incomplete.) Total disbursements % 101 24 2 085 96 From donatiDns from church From farm products Total receipts $3,937 2i $2,187 20 365 Movement of Population for Year Ending June 30, 1906. Children. CD B CB Children. (5* CD B CO 1 Present at beginning of year (Report incomplete.) Total 7 7 12 12 19 19 1 7 8 2 12 14 R Present at end of year Total 19 ?1< ORPHANS' HOME AND FARM SCHOOL OF THE LUTHERAN AUGUSTINA SYNOD. SCANDINAVIAN Of Andover, Illinois. Incorporated November 13, 1873. REV. P. J. BRODINE President REV. AUG. JOHNSON Vice President REV. P. MARTINSON Secretary A G. ANDERSON Treasurer REV. N. GIBSON Superintendent Financial Condition 1905. Assets. Amount. Liabilities. Amount. $42, 400 00 7, 288 00 2,328 00 129 86 $ 1, 000 00 9. 500 00 41,645 86 Cash on hand Total liabilities $52, 145 86 $52. 145 86 Receipts and Disbursements for Year Ending 1905. Receipts. Amount. Disbursements. Amount. Cash on hand at beginning of fiscal year $ 394 06 1.313 54 2. 978 73 3, 870 64 Cash on hand at end of fiscal year.. Lands, implements and tools BuildingSi repairs and light fix- $ 129 86 1, 085 48 From donations— general public 521 24 Salaries 1.687 54 Other expenses — fuel. 204 96 674 60 1, 100 00 1.847 06 109 49 1, 196 74 Total disbursements Total receipts.. $8, 556 97 $8, 556 97 366 Movement of Population for Year Ending 1905. Children. 5 5 & CD 1 E Children. £. CB Present at beif inninif of year 1 1 41 19 60 Returned to friends 7 41 48 1 22 23 8 7 4 11! A3 Total 48 23 71 Total 71 ORPHAN HOME ASSOCIATION OF THE SOUTHERN ILLINOIS DIS- TRICT OF THE GERMAN EVANGELICAL SYNOD OF NORTH AMERICA. Of Hoyleton, Illinois. Incorporated July 29, 1896. REV. J. N. DINKMEIER President REV. G. KOIlNsrKNOEL Vice President REV. C. KKICI'CII.MIN Secretary REV. M. S('llU()i:i)EL Treasurer J. ri. KOENIG Superintendent Financial Condition March 31, 1905. Assets. Amount. Liabilities. Amount. Lands $2,000 00 16.000 00 4.000 00 171 18 $22. 171 18 Loans $ 3. 750 00 Buildintrs 18.421 18 Furniture and stationery Total liabilities Cash on hand Total assets $22,171 18 Receipts and Disbursements for Year Ending March 31, 1905. Receipts. Amount. Disbursements. Amount. Cash on hand at beKinnintr of ilscal $ 22 49 3. 1!W :« Cash on han.l at end of tlscal year.. $ 171 18 ;™ 00 Inlorest aw 70 KSH ISI 1.C24 0(') < >n delits d-Vy 84 i.;<6;} 88 $6.704 06 [Miseolliineous 2,877 46 Total receipts Total disbursements $5,704 06 3f>7 Movement of Population for Year Ending March 31, 1905. Children. p; >n H O) B C3 CO 20 18 38 15 17 32 35 35 70 Children. Present at beginning of year Received otherwise Total Returned to friends Present at end of year. Total. 70 ORPHANS HOME OF THE EVANGELICAL LUTHERAN CONFERENCE OF THE AUGUSTINA SYNOD IN JOLIET, WILL COUNTY, ILL. Of Joliet, Illinois. Incorporated February 11, 1896. REV. A. W. STARK President REV. G. LINDAITL Vice President REV. H. COLLTANDBR Secretary P. E. HOLMSTROM Treasurer Miss FREDA SCHSCLANDER superintendent Financial Condition 1905. Assets. Amount Liabilities. Amount. $25,250 00 700 00 6, 200 00 202 20 Loans $4, 000 00 Investments (Report incomplete.) Total liabilities Cash on hand. Total assets S32.352 20 $4, 000 00 Receipts and Disbursements for Year Ending 1905. Receipts. Disbursements. Amount. Cash on hand at beginning of fiscal year From public funds From other sources— pay members. From church From loan. National Bank, Joliet.. Total receipts. Cash on hand at end of fiscal year. $2,349 05 Laundry machinery 2.637 03; Buildings 2. 330 50; Salaries and wages 871 35 2,000 00 $12, 187 93 Other expenses — fuel National Bank loan Extras Groceries Dry goods and clothing Total disbursements $ 202 20 950 00 2. 735 00 2, 026 20 492 25 1,000 00 1, 816 09 2, 410 93 555 26 $12, 187 93 Movement of Population for Year Ending 1905. Report of children shows ninety-two at beginning of year ; sixteen received during the year, and eighty-two present at time of this report. 368 ORPHANAGE OF THE HOLY CHILD OF THE PROVINCE OF ILLINOIS. (220 E. Ailums St.) Of Springfield. Illinois. Incorporated March 5, 1881. HON. CHAHLKS E. HAY President H. D. MOSS Secretary JAMES T. JONES Treasurer SISTEK GEHALDINE Superintendent REV. FREDEHICK A. DeROSSET Financial Agent and Priest In Charge Financial Condition December 31, 1905. Assets. Amount. Liabiliiies. Amount. Lands $11.000 00 4.000 00' 781 00; 1.950 00 971 66, $18,702 66 Surplus $18. 702 66 Buildings Total liabilities Furniture and stationery Loans on real estate Cash on hand $18,702 66 Receipts and Disbursements for Year Ending December 31, 1905. Receipts. Amount. Disbursements. Amount. Cash on hand at beifinninfr of tlscal $647 87 230 00 443 ss 30(1 11) till !t5 25 00 400 00 393 30 iCash on hand at end of fiscal year . . Buildings, repairs $971 66 377 15 From public funds, entertainmfnt, etc 550 00 .Siilaries. housi- mother 180 00 1 )iht'r expenst's, boatini; 273 45 From income investments .Subsistence Doniit ions returned 598 47 11 55 95 91 Total liabilities From board for children $3,058 19 $3,058 19 Movement of Population for Year Ending December 31, 1905. Children. •n H n o Z ;» 17 17 1 1 3 3 21 21 Children. Present at beiflnnlns of year. Committed by court Received otherwise Total. Placed in homes Returned to friends Present at end of year. Total. 21 21 Number Number of children under iruardianshlp at bcirinnlnir of year— 20. of children supervised In families at beifinnintr of .vear— 2. 3^9 SAINT JOSEPH'S PROVINCE ORPHAN ASYLUM. (North 40th St. and Belmont av.) Of Chicago, Illinois. Incorporated August 10, 1885. SISTER DANIEL LYNCH President SISTER BERNADINE LANMGAN Vice President SISTER JOS. MARIE SWAN Secretary SISTER F. XAVIER MAHONEY Treasurer SISTER F. XAVIER MAHONEY Superintendent Financial Condition December 31, 1905. No report was made of assets and liabilities. Receipts and Disbursements for Year Ending December 31, 1905. Receipts. Disbursements. Cash on hand at beginning of fiscal year From donations from church From other sources — pay members. From bequests and donations Total receipts Cash on hand at end of fiscal year. $ 46 41 I Buildings, repairs 6.000 00 [Salaries 4,195 65; [Other expenses, fuel 2.482 53 I Subsistence I Miscellaneous expenses $12, 727 59 $ 582 85 1,274 94 1,006 00 996 71 6, 865 81 2.001 28 Total disbursements. $12, 727 59 Movement of Population for Year Ending December 31, 1905. Children. i^ 1 H a> B p CD 245 245 120 120 365 365 Children. ft) B a 7 1,55 203 365 Present at beginning of year Received otherwise Total Placed in homes Returned to friends Present at end of year . Total 7 155 203 365 Number of children under guardianship at beginning of year — 245. Number of children supervised in families at beginning of year— 7. -24 P C 370 SAINT VINCENT'S INFANT ASYLUM. (191 LaSalk- av.) Of Chicago, Illinois. Incorporated June 29, 1888. SISTER .TUI.IA WOELFEL President SISTKK A(;.\ES PADGETT Secretary SISTEU THEUKSA KUEHN Treasurer SISTEU JII.IA WOELFEL Superintendent Financial Condition January 1. 1906. Assets and liabilities not reported. Receipts and Disbursements for Year Ending January 1, 1906. Receipts. Disbursements. Cash on band at be»;inning of tlscal year From public funds From donations From children and patients From rents From bazaars From let^acies From sundry sources Total receipts Cash on hand at end of fiscal year. I 5. 69;j 42 Huildini^s. improvements and 12.000 00 pairs. 1,104 94 Investments, miscellaneous 10. 9:il 37 Wiiges. general 940 33 (HlitT expenses— fuel and light. 2. 123 0! Furniture 2,984 2!) Interest 39 40 Doctor's salary i Taxes Insurance t 4.385 70 $35,816 761 064 10 955 79 413 00 292 07 921 00 611 23 468 00 389 71 316 16 Total disbursements $35.816 76 Movement of Population for Year Ending January 1, 1906. Children. B ? Children. Total... Female. Male.... Present at beifinninjf of year 2 67i 68 .... 79 79 90 90 I57I 159 Pied 3 8 2 2 75 2 157 1 77 Total 159 371 SA1.EM ORPHANAGE. Of Flanagan, Illinois. • . Incorporated 1896. BENJAMIN RUPP President JOHN SLAGLE Secretary BENJAMIN RUPP Treasurer BENJAMIN RUPP Superintendent Financial Condition December 31, 1906. Assets. Amount. Liabilities. Lands Buildings Furniture and stationery Cash on hand Live stock and farna implements. Total assets $16,000 00 13, 000 00 600 00 309 84 1,500 00 $31. 409 84 (Not reported.) Receipts and Disbursements for Year Ending December 31, 1906. Receipts. Amount. Disbursements. Amount. Cash on hand at beginning of fiscal year $ 211 01 1, 282 96 1, 290 60 Cash on hand at end of fiscal year.. Other expenses in general $ 309 84 2, 474 73 From donations Total disbursements From other sources, income farm. . Total receipts $2, 784 78 $2,784 57 Movement of Population for Year Ending December 31, 1906. Children. CD B E 9 E Children. E a 1 E Present at beginning of year 24 17 17 41 41 Placed in homes . 2 3 18 23 « 8 23 31 11 41 Total Total 54 Number of children under guardianship at beginning of year — 6. 372 SPRINGFIELD HOME FOR THE FRIENDLESS. Of Springfield, Illinois, Incorporated 1863. HIONUY DAVIS President ALKUED OKENDORFF Vice President MRS. KUANCIS O. lOE Secretary EI (WAIU > KEYS Treasurer MRS. VIOLA DINSMORE Superintendent Financial Condition January 2, 1906. Assets. Amount. Liabilities. Amount. 1 $ 5.000 00 30.000 00! Surplus 1180.300 00 Huildings 2.500 00 42.800 00 $80,300 00| Total liabilities $80,300 00 Receipts and Disbursement.s for Year Ending January 2, 1906. Receipts. * Amount. Disbursements. Amount. Cash on hand at beginning of fiscal I4.a31 76 $ 75 57 2.557 M 445 00 Other expenses, fuel 1.719 59 From donations, general public .... Subsistence Miscellaneous expenses 686 78 3.200 92 From income investmeni.s 2.310 17 986 75 8 30 159 43 233 22 2.863 58 Total disbursements From refund on bills paid $9.639 05 $9,639 05 Movement of Population for Year Ending January 2, 1906. Children. 1 § E t'hiUlren. S 1 5" Present at beginning of year 60 16 27 93 25 7>; « i 37 3 40 86 13 1 22 1 20 S7 17 r> 21 20 17 1 Miuvd in institutions 8 [{■■turned to friends Uitil 50 4 60 j 60 Total . . 143 Total 143 373 STATE INDUSTRIAL SCHOOL FOR GIRLS. (1503 N. Madisoa av.) Of Peoria, Illinois. Incorporated April 30, 1892. MRS. SARAH M. HAMILTON President MARY POTTER Vice President JENNIE WATERHOUSE Secretary MISS HATTIB SCHRIMPFF Treasurer MRS. SARAH P. KIMBALL Superintendent Financial Condition May 31, 1906. Assets. Amount. Liabilities. Amount. Lands, buildings, (estimated) $8,000 00 200 00 292 50 89 95 Loans on buildings $6 130 58 Furniture and stationery Outstanding bills 275 78 Bills receivable 2 176 09 Cash on hand Total liabilities . Total assets $8, 582 45 $8, 582 45 Receipts and Disbursements for Year Ending May 31, 1906. Receipts. Amount. Disbursements. Amount. Cash on hand at beginning of fiscal $ 365 19 1, 142 50 19 75 487 50 8 00 1,258 55 111 75 Cash on hand at end of fiscal year . . $ 89 95 474 20 From public funds Salaries 1 049 65 Prom donations Subsistence and fuel 1,779 44 From other sources— general public Total disbursements Membership fees $3, 393 24 $3, 393 24 Movement of Population for Year Ending May 31, 1906. Children. r Children. B E 1 Present at beginning of year 15 4 19 15 4 19 Placed in homes 10 2 7 19 10 Returned to friends ?. Total . Present at end of year Total 1111 7 19 (6). Of above fifteen were new cases; four for replacement. 374 ST. JOSEPH BOHEMIAN ORPHANAGE. Of Lisle, Illinois. Incorporated November 23, 1901. REV. MOTHER NEPONNICENE President VKN SISTKK M. I.. NK.NSII SecnTary VEN. SISTER M. JOSEPHINE Vice President YEN. SISTKK M. .TOSEI'IIINE PRINCE Treasurer REV. PROSKEP NENSIL Superintendent Financial Condition 1905. Assets. Amount. Liabilities. Lands Buildings Furniture and stationery. Bills receivable Total assets . II $1,800 00 1.600 00 300 00 6.000 00 ! $9,700 00 1 (Not reported). Receipts and Disbursements for Year Ending 1905. Cash on hand at beginnine of fiscal year Prom donations, general public — Prom other sources, pay members.. From ihcome investments Prom other sources Total receipts Cash on band at end of fiscal year. $ 707 77 Lands 5,854 89 Buildings. 398 00 Salaries 134 14 lother expenses, subsistence. 556 04 : $7.650 841 Total disbursements. 17.650 84 Movement of Population for Year Ending 1905. Children. CD 5" B E. s. Children. E. 5 E. 1 E Present at beginning of year Received otherwise Total 20 7 27 11 9 20 31 16 47 1 15 16 1 Returned to friends ifi (Report incomplete.) Total 16 Number of children under guardianship at beginning of year— 31. Number of children supervised in families at t)ek;inning of year— 5 375 ST. JOSEPH HOME FOR THE FRIENDLESS. Of Chicago, Illinois. Incorporated August 2, 1876. MARIE VANTE President MARGARET COSGROVE Vice President MATILDA BOUCHER Secretary MARGARET COSGROVE Treasurer MARGARET COSGROVE Superintendent Report Made April 19, 1906. The object of this organization Is to give temporary homes to friendless females while out of employment. Report Is so Incomplete that It cannot be published. ST. MARY'S HOME FOR CHLIDREN AND DISPENSARY FOR THE POOR OF CHICAGO. (1251 Jackson boul.) Of Chicago, Illinois. Incorporated May 17, 1901. MOTHER SUP. MARGARET CLARE President SISTER SUP. SISTER FRANCES Vice President D. D. C. STREET Treasurer THE SISTER SUPERIOR Superintendent Report September 30, 1905. The object of this organization Is for the training and care of those children whose parent or parents cannot properly care for them. Movement of Population for Year Ending September 30, 1905. Children. p 3 £. o £ Children. S (X) B & E Present at beginning of year 91 35 126 91 35 126 Placed in homes 2 1 28 1 94 1?!fi « Received otherwise Placed in institutions . . .... 1 w Died 1 Total Present at end of year Total Llil 94 1?« Note — No financial report given. 376 ST. MARY'S INDUSTRIAL SCHOOL OF METAMORA. Of Metamora, Illinois. Incorporated December 21, 1905. SISTER M. TERESA Superintendent Report Made January 1, 1906. The object of this organization is to give temporary homes to orphans and dependent cliildren. Annual report shows a total of flfty-one present at the beginning and thirty-seven present at the end of the year. The report is incomplete. ST. MARY'S TRAINING SCHOOL. (Postofflce DesPlaines. 111.) Of Feehanville, Illinois. Incorporated August 14, 1883. D. I". liKHMNER I'resldent JOHN LYN'CH Vice President JOHN nuUKE Secretary GEORGE F. McCarthy Treasurer GEORGE F. MCCARTHY Superintendent Financial Condition December 31, 1905. Assets. Amount. Liabilities. Amount. Lands $300,000 00 80.000 00 15.000 00 $ 500 00 50.000 00 Investments (Report incomplete). 708 73 1 $395,706 73 Total liabilities $60,500 00 Receipts and Disbursements for Year Ending December 31, 1905. Receipts. Amount. Disbursements. Amount. Cash on band at beirinnlnK of tlsoal $ 496 31 Cash on hand at end of ilsc^il year. . (Report incomplete.) $708 73 H.i59 01 1< 24 8fi 27.077 92 Total disbursements $42,058 lO' $708 73 377 Movement of Population for Year Ending December 31, 1905. Children. B E Children. m B E 9 E Present at beginning of year 274 278 47 599 274 278 47 599 1 53 176 1 369 W9 53 Returned to friends Died 176 1 369 Total Total 599 Number of children under guardianship at beginning of year — 274. Number of children supervised in familes at beginning of year — 84. UHLICH EVANGELICAL LUTHERAN ORPHAN ASYLUM. (221 Burling St.) Of Chicago, Illinois. Incorporated March 10, 1869. FRED KRESSMAN President JOHN B AUR Secretary ADOLF KURST Treasurer MISS MINA PFEIFNER Superintendent Financial Condition June 30, 1904. Assets. Amount. Liabilities. Amount. $ 75.000 00 230, 000 00 300 00 400 00 5.972 22 Surplus $7,909 93 Buildings Furniture and stationery (Report incomplete. ) 1 Total liabilities $311, 672 22 $7, 909 93 Receipts and Disbursements for Year Ending June 30, 1904. Receipts. Amount. Disbursements. Cash on hand at beginning of fiscal year From donations From other sources, bequests From board for children From ground rents From house rents From interest From return of court costs From sundries Total receipts Cash on hand at end of fiscal year. $5,972 22 Lands, paving of street 430 41 Buildings 1, 000 00 Salaries 2,823 79 Other expenses, coal and light 2, 979 54 Repairs on buildings 9.854 G7; [Sundries 207 00 Miscellaneous expenses. 193 07 47 72 i $23. 508 42 Total disbursements. $7. 909 93 2, 070 92 2.885 62 4, 114 95 1,092 10 1, 740 44 153 80 3, 540 66 3,508 42 378 Movement of Population for Year Ehiding June 80, 1904. Children. S p 5 B £ 9 £. Children. S •»1 ►^ » o S ? .* : Present at beKinninj: of year 31 20 36 67 48 115 Placed in homes j Placed in insiiiutioDs : 1 20 12 32 3i 1 4 5ll 64 Present at end of year 281 51 79 Total.. ■ . Total 51! 641 115 1 Of above 51 were new cases; none for replacement. UNION MISSION ASSOCIATION. (12th and Edwards sts.) Of Springfield, Illinois. Incorporated November 25, 1903. REV. H. A. LEHWALD President \V. H. HUNT Secretary W. H. HUNT Treasurer MRS. W. II. HUNT Superintendent Financial Condition June 15, 1906. Assets. Amount. Liabilities. Amount. $2,500 00 200 00 S2.700 00 Loans.. $1,499 52 35 00 315 00 82 14 Furniture and stationery Interest due iProvisions. etc jPainting and paperintr (Report incomplete.) Total liabilities Total assets SI. 931 66 Receipts and Disbursements for Year Ending June 15, 1906 • Receipts. Amount. Disbursements. Amount. Cash on hand at beginning of fiscal II Lands $ 66 74 (H her expenses, fuel . . t 350 48 15 00 From public funds 150 (X) .Subsistence 1 711 64 1.449 90 Back taxes and interest 199 52 60 00 650 00 For building fund Total receipts $2.276 64] Total disbursements $2,276 64 Movement of Population for Year Ending June 15, 1906. children. ? g 5 I CTilldren. E. 5" 5 B S. Pre.sent at beginning of year 6 14 20 8 15 23 u 29 43 Placed in homes 4 3 7 Committed bj' court and received Placed in institutions ? in Died 3 2 f> Present at end of year i» Total (Report incomplete.) Total 43 379 WHITE HALL ORPHANAGE HOME SOCIETY. Of White Hall, Illinois. Organized November 15, 1902. FRANCIS FOWLER President H. C. BELL Vice President E. J. PEARCE Vice President J. F. GREER Secretary J. F. GREER Treasurer J. N. DEWELL Superintendent Financial Condition December 31. Assets. Amount. Liabilities. Amount. $225 32 $225 32 Surplus $225 32 Total liabilities $225 32 Receipts and Disbursements for Year Ending December 31, 1905. Receipts. Amount. Disbursements. Amount. Cash on hand at beginning of fiscal $ 308 43 2.823 13 Cash on hand at end of fiscal year . . Salaries — Supt. and helpers $ 225 32' 1, 382 54 Board of children 850 66 Expense of solicitors 500 02 142 77 Medical service 30 25 Total disbursements $3. 131 56 $3, 131 56 Movement of Population for Year Ending December 31, 1905. Children. sr •^ H a> B p a> 2 2 22 16 38 24 16 40 Children. s P » (B 16 8 2 1 6 7 24 16 (a) Present at beginning of year. (h) Received otherwise Total Placed in homes Returned to friends. . . Present at end of year. Total (a) In actual possession of society, (b) Of above 33 were new cases; 7 for replacement Note — The amounts received from public treasuries are included in "donations." 38o CERTIFIED ORPHANAGES AND CHILD SAVING INSTITUTIONS. (As Of June ;iO. 1906.1 The Illinois Children's Home and Aid Society (79 Dearborn Street). Officers: President, Robt. J. Bennett. Vice President, Franklin MacVeagh. Vice President, Kpv. K. A. White. Secretary, Rev. E. M. Williams. Treasurer, Frank B. Toby. Superintendent, Hastings II. Hart. Executive Committee: R. J. Bennett, Chicago. Henry Augustine, Chicago. John Carpenter, Chicago. Ezra J. Warner, Jr., Chicago, Frederick W. Greeley, Chicago. Rev. E. M. Williams, Chicago. Akn.\ B. Mim.iken Home and Macon CoDNTY Industrial School. (Decatur.) Officrra : Mrs. Eliza M. Crary, President. Mrs. J. G. Bodenhouse, Vice President. Mrs. K. A Morgan, Secretary Mr.s. S. A. Hill, Treasurer Mrs. Clara H. Campbell, Superintendent. Executive Committee: . Mrs. F^llza Crary. Mr.s. J. G. Bodenhouse. Mrs. Anna B. Mllllkon Mrs. H. .Mowry Mrs S. A. Hill. Si'UiNi^KiKi.K Home kou the Friendless. (South Seventh Street.) Officers : President, Henry Davis. Vice l'i-i^*fi(li'nt, Alfred OrendorlT. Secretary, Mrs. I''rances 1*. Ide. 'I'reasurer, Edward Keys. Superintendent, Mrs. viola Dlnsniore Executive Committee: Mrs. .\. N. .Malhony. Sprlnird.'ld. Mrs. George Paslh-ld, Sprliiglleld. Mrs. George Souther, Sprlnglleld. Mrs. Jiihn Cook, Sprlnglldd. Mrs. William Shutt. Springfleld. Mrs. John Peters. Sprlngllold. Mrs. Alfred OrcndorfT, Springfield. Methodist Deaconess Orphanaob. (Lake Bluff, Illinois.) Officers : President, James B. Hobbs. Vice I'resldent, A. Burhans. Secretary, Geo. W. York. Treasurer, Lucy J. Judson. Superintendent, Lucy J. Judson. Executive Committee: James B. Hobbs, Chicago. James Burhans, Chicago. Geo. W. York, Chicago. Dr. J. G. Wolfe. Chicago. Wilbur R. Davis, Chicago. Amanda Smith Inddstrial Home. (147th and DesPlaines Street.) Officers: President, J. A. Burhans. Vice I'resldent, L. N. Mayer. Secretary. George M. Metcalf. Treasurer, I-^dwin S. Gamble. Superintendent, D. II. V. Purnell. Juvenile Detention Home. (625 W. Adams, Chicago.) Officers: President. Mrs. Joseph T. Bowcn. Vice Presldi'nt, Mrs. ("has. llrnrotln. Secretary. .Mrs. Geo. U. Dean. Treasurer, James H. Eckels. Superintendent, Mrs. Laura Franklin. Ewccuiivc Committer: Mrs. Chas. M. Walker, 39:; I>aSalle avenue, Chicago. I>eI{oy 1). Thomas. Miss Julia I>athrop. Mru. (Jeo. Bass. Mrs. H. Hooper. Mrs. Harry Hart. Mrs. F. K. Tra. Mrs. Joseph T. Bowen. Mrs. Chas. Henrotin. Mrs. Geo. R. Dean. 38i Orphanages and Child Saving Institictions — Continued. Chicago Refuge for Girls. (5024 Indiana avenue, Chicago.) Officers ' President, L. B. Dowd, Chicago. 1 Vice President, Mrs. Wm. H. Reid. 2 Vice President, Mrs. C. R. Henderson. Secretarjs Mrs. G. B. Shaw. Treasurer, Mrs. E. V. F. Rolle. Superintendent, Miss Elizabeth Stone. Trustees: Noble B. Judah, Chicago. Gilbert B. Shaw, Chicago. E. B. Butler, Chicago. L. B. Chapin, Chicago. Geo. A. Sanderson. Chicago. John C. McCord. Chicago. W. R. Linn, Chicago. Samuel Baker, Chicago. Florence Crittenton Peoria Home. (Richmond avenue, Peoria, Illinois.) Officers and Executive Committee: President, Mrs. Julia P. White. Vice President, Mrs. Carrie Miller. Vice President, Mrs. Minnie Stillwell. Rec. Secretary, Mrs. Mary H. Martin. Cor. Secretary, Mrs. Flora R. Ryan. Treasurer, Mrs. I.adorah Todhunter. Matron, Mrs. Cecelia King. Chairman of Executive Committee: Mrs. Emily Bowers, Peoria. Jilrs. Walker. Peoria. Mrs. Lura Boleyn, Peoria. Illinois Manual Training School Farm. (Glenwood, Illinois.) Offlcers: President, Edward B. Butler. Vice President, Frederick T. Haskell. Secretary, Oscar L. Dudley. Treasurer, Edwin G. Foreman. Superintendent, Oscar L. Dudley. Executive Committee: Edwin B. Butler, Chicago. Frederick T. Haskell, Chicago. Oscar L. Dudley, Glenwood. Edwin G. Foreman, Chicago. Clarence Buckingham, Chicago. John G. Shedd, Chicago. Sisters of the Good Shepherd. (4900 Prairie avenue, Chicago.) Officers: President, Charles A. Mair. Vice President, David F. Brenner. Vice President, Edwin F. Brown. Secretary. Imclda (1. Bi'enuHr. Treasurer. Elizabeth Coffey. Matron, Elizabeth Coffey. Directors : C. A. Mair. D. F. Brenner. E. O. Brown. T. D. Hurley. Z. P. Brosseau. Dr. John Guerin. , Dr. J. L. Reilly. S. C. Scotten. Mrs. D. F Brenner Mrs. E. O. Brown. Mrs. C. A. Mair. Mrs. D. F. Brenner, Jr. Miss Alice Moran. Mrs. P. J. O'Keefe. Elizabeth Coffey. Miss Adelaid Walsh. Bethany Protective Association. (Rock Island, Illinois.) Offlcers : President, Mrs. W. C. Bennett. Vice President, Mrs. J. J. Worker. Secretary, Geo. C. Wenger. Treasurer, H. T. Casteel. Superintendent, Miss Dina Ramser. Directors : Miss Susanne C. Denkmann, Rock Isl- and. Mrs. J. S. Gillmore, Moline. Mrs. Ada Stephens Jordan, Moline. Mrs. E. W. Hurst, Rock Island. Mrs. C. L. Walker, Rock Island. Mrs. W. C. Bennett, Moline. Mrs. J. J. \Vorker, Rock Island. Geo. McMaster, Moline. H. E. Casteel, Rock Island. Geo. C. Wenger.. Rock Island. J. T. Shields, Rock Island. G. W. Gamble, Moline. Mrs. W. II. Gest, Rock Island. Mrs. E. H. Sleight, Moline. Mrs. A. Mosenfelder, Rock Island. Emil Peterson, Rock Island. C. E. White, Moline. Mrs. G. A. Stephens, Moline. Thomas Campbell. S. Rock Island. Mrs. E. F. Bartholomew, Rock Island. Mrs. Mary Metzgar, Moline. Chicago Orphan Asylum. (5120 South Park avenue, Chicago.) Offlcers : President, Charles K Hutchinson. Vice President, John M. Clark. Secretary, Frederick B. Tuttle. Treasurer, William A. Fuller. Trustees : Edwin B. Butler. Chas. P. Corwith. Wm. A. Fuller. J. J. Glessner. Chas. S. Holt. Myron L. Pearce. Martin A. Rverson. Edward F. Swift. Caryl Young. Otto Young. Byron L. Smith. Evangelical Li'theran Kinderfrednd Society of Illinois. (Peoria, Illinois.) Offlcers : President, H. Zagel. First Vice President. Geo. E. Harms. 2d Vice President, R. J. Neddermann. Treasurer, Edward Krumseig. Secretary, Rev. Frederick W. Jass. Superintendent, Rev. Chr. Droegemuel- ler. Home op the Good Shepherd. (Peoria, Illinois. > Offlcers: President, Anna Tellus. Secretary. Johanna Cumin. Treasurer, Anna Hughes. Superintendent, Anna Hughes. 382 Orphanages and Child Saving Institutions — CJoncluded. Chicago Industrial Home fob CiiiI/- DRBN. (Woodstock, Illinois. Offices, 14-16 N. May Street, Chicago.) O/Jlcera : President, S. K. J. Chesbro. Vice I'resldont, Hev. J. D. Kelsey. Secretary, Rev. J. D. Marsh. Treasurer, Kev. F. D. Brooke. Superintendent, Kev. K. B. Arnold. Asst. Superintendent. Uev. W. I*. Ferris. Managers: Rev. J. D. Kelsey, Woodstock. Kev. S. K. J. Chesbro, Chicago. Rev. J. D. Marsh, Evanston. Kev. F. D. Brooke, Chicago. Kev. W. P. Ferris. Evanston. Kev. T. B. Arnold, Glen Ellyn. Amekican Congregational Deaconess Association,* Dover, Illinois. (Office. 153 LaSalle street, Chicago, III.) Officers : President, Rev. Wm. A. Bartlett. Vice I'resldent. Rev. George II. Wilson. Vice President, Rev. Wm. Anderson. Vice President. Rev. Wllliard B. Thorp. Treasurer, D. H. Preston. Treasurer, Rev. A. M. Brodle. Managers: Mrs. Edith C. Hancock, Chicago. Mrs. W. E. Barton, Oak I'ark. Hon. T. C. McMillan. Chicago. Mrs. C. W. McCuUoch, Chicago. Rev. B. M. Southgate. Sycamore. Rev. D. Beaton, Chicago. Mrs. Mary Ferris, Princeton. Mrs. Frank Elliott, Evanston. Rev. J. H. George, Chicago. Mrs. O. N. Carter, Chicago. Rev. W. A. Bartlett, Chicago. Rev. G. 11. Wilson, DeKalb. Rev. Wm. Anderson. Dover. Kev. Wllliard. B. Thorp. Chicago. Rev. A. M. Brodle, Chicago. St. Vincent's Infant Astluu. (191 LaSalle street, Chicago.) Officers : President. Sister .Tulla Woelfel. S('( ii'Inry. Sister Agnes Padgett. Treasurer, Sister Theresa Kuehn. Superlnlondent, Sister .Tulln Woelfel. Trustei-s: Sister Julia Woelfel. 101 I^Salle st. Sister Theresa Kuehn, 101 I.*Salle st. Sister Vincent O'Rafferty, 191 LaSalle st Sister Martina Connolly. 191 I^Salle st Sister Agnes Padgett, 101 LaSalle at Ori'hanage of the Holy Child. (220 E. Adams St., SprlngHeld, III.) Officers : President, Hon. Chas. E. Hay. Secretary, II. D. Moss. Treasurer. James T. Jones. Financial Agent and Priest in Charge ; the Venerable Frederick A. DeRosset, Archdeacon of Springfield. House Mother, Sister CJeraldlne. Executives: Hon. Chas. E. Hay, Springfield. H. D. Moss. SpringlJeld. James T. Jones, Springfield. Central Baptist Orphanage. (May wood, Illinois.) •Office. 1213 Tacoma Bldg., Chicago, 111. Officers : President, Rev. A. K. DeBlols. First Vice President, Rev. J. S. Kirtley. Second Vice President. F. M. Buck. Secretary, James I'. Thomas. Treasurer, Frank B. I'ease. Dlst. Secretary, Rev. Geo. Creasy. Executive Board: Rev. A. K. DeBlols, Chicago. Rev. J. S. Kirtley, Elgin. James P. Thomas, Chicago. F. M. Buck, Chicago. F. B. Pease, Chicago. Rev. Geo. Cressy, Morgan Park. Evangelical Orphan's Roue. (Hoyleton.) Officers : President. Rev. J. II. Dlnkmeyer. First Vice Pres., Kev. G. Bohnstengel. Secretary, Kev. W. Blasberg. Treasurer, Rev. Max Schroedel. Superintendent, J. N. Koeulg. Executive Committee: Rev. G. Bohnstengel, Centralla. Rev. J. I). Nickel, Nashville. T. (Jaebe, Addl.>vllle. Fred Tonsing. okawvllle. Ily Hongoernieler, Irvlngton. IIi'DBi-soN Home. (Ewlng.) Superintendent. Alfred C. Kelly. 7605 t^nlon avenue, Chicago, III. 383 Total . . . "5 Nt-io;D«c *-H 1.^ tH C" »hcJth.w — TH ^ (NtOOCMNT- 8Sg Mich.... T-i*.* OOt-i CO • .'^ '^ CO N. Y.... '^ '^ Penn.... ■^ 1 "^ Texas... ^ ^ . N Florida. '^ ^ Okla.... ^~* ^ Calif.... ■^ '^ Ark : : : .'^ : SM CO Minn.... "^ : N '^ •w Neb .... C4 . '.'.'.'* ^ M CO Can .... C4 . ■ N ^ Iowa ''"' '^ : .r-lr-( gs ^^ T-llO OS Ky '^ "^ La 1*^ "^ Mo '. '^ ^ N '^ in Ind .CJ tH »-( e<5 lO '^ CO Ohio.... "^ : i"^ : N Wis .... TIN .50 lO.>*T-( ..« CO . . ^ Illinois . -H O 1-1 <-< M t- CO to tH N .(MOlOOOONt-N«OOevlOS'r-lr-( OtHCO 1 OS 1 s- c .a c c a u c : D • ■ •So; : : bubt . .Q o a o-r t- — cS 1) s II o c 3.i c c 2t a c cni-3 c a. (5 2 t, c 0. > a. a! o: c E £ 2 a. > c C "3 2 »5 C o 3 0] a M •a a a 05 'S o ; c • c «.£ 'H.I 11 a, E c a: c 5 g c c < c C c c 0- < a. ;. c c i: p : it a :3 a "3 a a> a s or > X c 4J o I i 1 r^W -H to l~ 1..J O U ^ §2gS a5s ii> 2- o o © * • -at^.- o CQ o o.t: xi' a till £« !»£ , en a to ^1h- J 3 *? avls. President. Jacksonville. Henry .Miner, Winchester. iicoVKc W. Ross. Carrollton. Siiperintendi-nt, H. H. Carriel, M. D. Secretary and Treasurer, Mrs. Annie C. Dickson. Southern Hospital for the Insane, Anna. Created 1860. H. II. Kohn, President, Anna. W. II. Wood, Cairo. Sup<'rlnt<'ndcnt, W. T>. Athon, M. D. Secretary, C. K. Kirki)atrlck. Treasurer, John B. Jackson. Western Hosi)ilal for the Insane, Watertown. Created 1895. Trnnk W. Could. I'resldent, Moilne. .Mli'H M. (lenient, 'Jl!) I.aSalle street, Chicago. William Trenibor, Kreeport. Supirlnttiidenl. W. K. Taylor, M. D. .Secretary, A. II. Kohler, Moilne. Treasurer, ('. K. Lynde, Rock Island. Asylum for the Incurable Insane, Peoria. Created 1895. S. O. Sprlnir, President, Peoria. K. M. Wliitham, Secretary, Alcdo. K. W. Wayne, Delavan. Sup<'rlntend«'nt. Oorge A. Zeller, M. D. Treasurer, W. T. Sloan. 385 Asylum for Insane Criminals, Chester. Created 1889. Thomas J. Clark, President, Quiucy. James E. McCIure, Carlinville. Rufiis Neeley, Marion. Superintendent, Walter E. Songer, M. D. Treasurer, Louis H. Glister. School for the Deaf, Jacksonville. Created 1839. W. W. Watson, President, Barry. Francis H. Wemple, Waverly. John R. Robertson, Jacksonville. Superintendent, Charles P. Gillett. Secretary and Treasurer, George L. Merrill. School for the Blind, Jacksonville. Created 1849. C. D. Babb. President, Homer. George W. Moore, Arnold. Charles A. Hammond, Stockton. Superintendent and Secretary, J. H. Freeman. Treasurer, C. S. Black. Industrial Home for the Blind, Chicago, Corner Douglas Boulevard and 19th Street. Created 1893. Joseph E. Otis, President, 2832 Prairie ave., Chicago. Edward J. Nolan, 3186 Dover st., Chicago. Charles M. Reiser, 309 W. 60th st, Chicago. William J. Jackman, 15.52 W. Adams st.. Chicago. Edward R. Litzinger, 3519 S. Western Boulevard, Chicago. Superintendent, W. W. Carnes. Treasurer, Lawrence Nelson. Asylum for Feeble-Minded Children, Lincoln. Created 1865. James W. Gibson, President. Newton. John Wagner, McLean. Carl E. Bartling, Litchfield. Superintendent. C. B. Tavlor, M. D. Secretary, Charles T. Hoblit. Treasurer, John S. Haller. Soldiers' and Sailors' Home, Quincy. Created 1885. Joseph B. Messick, President, East St. Louis. Charles V. Chandler, Macomb. Caleb C. Johnson. Sterling. Superintendent. Capt. William Somerville. Treasurer, E. H. Osborn. Soldiers' Orphans Home, Normal. Created 1865. Benson Wood, Effingham. N. B. Thistlewood, Cairo. A. S. Wright. Woodstock. Superintendent. Richard N. McCauley. Secretary, George H. Harris. Treasurer, J. O. Wilson. Soldiers' Widows' Home, Wilmington. Created 1895. Gen. Walter C. Newberry, President, 79 Kinzie st., Chicago. Mrs. Martha K. Baxter, Secretary, Pawnee. Charles A. Ramsey. Hillsboro. Mrs. Margaret I. "Sandes, 653 Park ave., Chicago. Matron. Mrs. Flo .Jamison Miller. Treasurer, Archibald J. Mclntyre. Charitable Eye and Ear Infirmary, 227 W. Adams Street, Chicago. Created 1865. Dr. W. T. Montgomery, President, 725-731 Washington st., Chicago. Dr. Harold Evensen, Ottawa. , Dr. Arthur E. Prince, Secretary, Springfield. Superintendent. Charles T. Garrard, Chicago. Treasurer, Arthur B. Fleager. State Training School for Girls, Geneva. Created 1893. Ernest P. Bicknell, 79 Dearborn st., Chicago. Mrs. Flora G. Moulton. 2119 Calumet ave., Chicago. Chai^les E. Smiley, West Chicago. Mrs. Fanny J. Howe. 1922 Barry ave., Chicago. William P. Early. Edwardsville. Superintendent, Mrs. Ophelia L. Amlgh. Treasurer, Charles F. Field. -25 P C ^86 8L Charles School for Boys', St. Charles. Created 1901. Klchard S. Tuthlll, County Building, Chicago. Ilarley J. Hrndley, Chicago. Mrs. Klla W. Italiiey, Carrollton. Benjamin Carpenter, Chicago. T. 1>. lliirl.y. liilty liiillding, Chicago. Henry Davis, Sprlnglield. William J. Conzelman, I'ckln. Superintendent, C. W. Hart Treasurer, Ilelge A. Ilaugan. 38; Table II. Board of Auxiliary Visitors of County Almshouses, fails, Etc. Adams County. Mrs. Rosa Wood Govert, Quincy. William H. Baker, Quincy. Edward W. McClure, Quincy. Alexander County. Dr. W. F. Grinstead, President, Cairo. Mrs. Samuel White, Scretary, Cairo. Bond County. S. A. Phelps, President, Greenville. Mrs. Alice Lindly, Secretary, Greenville. Dr. W. T. Easley, Greenville. Boone County. R. W. Mclhness, President, Belvldere. J. H. Cook, Belvldere. Mrs. Georgia Wltbeck, Belvidere. Brown County. Dr. William Parker. Pres., Mt. Sterling. Mrs. Mary Larkin, Sec, Mt. Sterling. Col. H. M. Condee, Mt. Sterling. Bureau County. John E. Nash, President. Princeton. Mrs. Emma D. Bailey, Sec, Princeton. Dr. O. J. Flint, Princeton. Calhoun County. Arthur D. Fowler, President, Hardin. Dr. W. F. Runde, Sec'v, Kampville. Mrs. G. A. Williams, Hardin. Carroll County. D. C. Busell, President, Shannon. Mrs. Fred S. Smith. Sec'y, Mt. Carroll. Dr. R. C. Miller, Shannon. Cass County. Dr. Walter Bly, Secretary, Beardstown. James A. Schaeffer, Virginia. Ed. Hunter, Bluff Springs. Champaign County. , Rev. W. W. Steadman, Pres., Champaign. Mrs. Louis Shuck, Secretary, Urbana. Christian County. W. T. Baker. President, Taylorvllle. Lon E. Martin, Secretary. Taylorvllle Dr. C. R. Carroll, Taylorvllle. Clark County. Hector B. Dulaney. President, Marshall. Mrs. James W. Graham, Marshall. Clay County. , J. R. Bonney, President, Louisville. Thomas McCullom, Sec'y, Louisville. Dr. George W. Steely, Louisville. Clinton County. Dr. W. P. Gordon, Carlyle. Miss Clara Truesdale, Carlyle. Rev. A. A. Cairns, Carlyle. Coles County. Mrs. M. B. Spears, President. Charleston. O. L. Minter, secretary, Oakland. A. T. Robertson, Ashmore. Crawford County. Dr. Jonas M. Carlisle, Pres., Robinson. Mrs. Nora F. Berry, Sec'y, Robinson. John Olwin, Robinson. Cumberland County. , Mrs. Alice Hanker, Pres., Toledo. C. M. Connor, Secretary, Toledo. Dr. R. F. Stephens, Toledo. DeKalb County. Chas. D. Brown, Sycamore. Dr. John B. Nesbitt, Sec'y, Sycamore. Dr. J. M. Everett, DeKalb. DeWitt County. Dr. C. S. Edmonson, President, Clinton. R. F. Hull, Secretary, Clinton. Mrs. America Wheeler Carter, Clinton. Douglas County. Dr. C. W. Rutherford, Pres., Newman. Mrs. Kate Moore, Tuscola. W. A. Wiseman, Camargo. DuPage County. H. W. Vanlerhof, Wheaton. Mrs. Chas. W. Hadley, Glen Ellyn. L. C. Cooper, Glen Ellyn. Edgar County. Dr. W. H. Hoff, President, Paris. Mrs. Maggie Stout. Secretary, Paris. Chas. H. Lamb, Paris. Edwards County. Dr. H. C. Moss, President, Albion. Mrs. Annie Gooch. Secretary, Albion. Dr. J. H. Tracy, Albion. EflBngham County. Mrs. Alice Gwln Tilton, Sec, Effingham. W. S. Homles, Effingham. ^88 Board of Auxilary Visitors — Continued. Fayette County. Dr. L. L, Morey, President. Vandalla. Ira D. I>acon, Secretary, Vandalla. Ford County. Dr. Elmer Kelso, President, Paxton. E. P. Oleson, Secretary, I'axton. Franklin County. Dr. C. M. lindgeons. Thonipsonvllk'. W. W. MeCreery, Ren ton. Mrs. Martha N. Dillon, Benton. Fulton County. R. A. Savin. President. Canton. Dr. W. T. Zeigler, Secretary, Canton. Dr. J. M. Nelles, Canton. Gallatin County. Dr. A. II. Colvard, Shawneetown. May Itoedel. Shawneetown. lidward Klce, Kldgeway. Green County. , Dr. II. A. Chapln, President, Whitehall. Mrs. Lucy A. Hodges, Sec'y, Carrollton. Stuart E. Plerson, Carrollton. Grundy County. Dr. .\. E. Palmer, President, Morris. Mrs. Ell Johnson, Morris. U. S. Allison, Gardner. Hamilton County. Dr. C. II. Anderson. Pres., Mclycanslxtro. Mrs. Lucy liovls, Sec'y. Mcl^eansboro. Dr. E. A. Ilogan, McLeansboro. Hancock County. Dr. F. .T. Tower, Pres., Carthage. Mrs. C. B. Newcomer, Sec'y, Carthage. C. L. Ferris, Carthage. Harding County. J. E. Server, Pres., Ellzabethtown. Ilattic Ultlenhouse, Sec'y, Peters Creek. P. O. Dr. K. II. Wnilngham, Ellzabelhtown. Henderson County. Frank IJeeder, Terre Haute. (Jeorge .7. .Morgan, Sironglinrst. Dr. Walter (J. DuEoiir, 0r. Amln-w Hall, Secn-tary. Mt. Vernon. Dr. John II. Mitchell, Mt. Vernon. Jersey County. Dr. Henry K. Bledhlll, Sec'y. Jerseyvllle. W. II. Fulkerson, Jerseyvllle. Mrs. M. B. Trabue, Jerseyvllle. JoDavless County. Eugene W. Montgomery. 1're.s., Galena. Annie E. Felt. Secretary, Galena. Dr. F. J. Stafford, Stockton. Johnson County. Mrs. Maggie A. Simpson, sec'y, Vienna. Kane County. Mrs. John T. Mason, Aurora. Dr. C. E. Sisson, Elgin. Kankakee County. Emory Cobb, I'res., Kankakee. Mrs. Nettle M. Kenaga. Sec'y. Kankakee. Martha Ij. Hutton, Kankakee. Kendall County. Dr. R. A. McClellan. Yorkvllle. II. B. Barnes, Bristol. N. M. Barnard, Newark. Knox County. Dr. J. V. N. Standlsh. Pres., Galesburg. Dr. G. S. Chalmers. Soe'y, Galesburg. Elizabeth Mars, tialesburg. Lake County. Dr. P. C. Knights, Waukegan. Dr. E. H. Ames, Antloch. C. R. Galloway, Llbertyville. LaSalle County. P. M. Burke, LaSalle. Lawrence County. Rev. Wm. Carson. Pres., Lawrencevllle. Dr. Ralph R. Trueblowl. Sec, Lawrence- vllle. Rev. James E. Mayer, I^awrencevllle. I Lee County. I Mrs. Emma R. Brookuer, Pres., Dixon. ' E. W. Smith. Seereiarv. Dixon. I Dr. O. B. Blackman, Dixon. Livingston County. Dr. J. J. Slltes, Pres.. Tontlac. Mrs. C, E. liCgg, Pontiac. Emil A. Simmons, I'ontlac. Logan County. J. V.\w\ M«>loy. Pres.. Lincoln. Mrs. Canillne Lnt/. Secretary, Lincoln. George I/nyman, Lincoln. Macon County. Mllion Johnson. Pres., Decatur. Dr. E. J. Brown. Seo'v. Decatur. Mrs. Kale Harwood, Decatur. Macoupin County. Dr. J. S. Collins, Pres., Carlinvllle. Dr. I.uclnda H. Corr, Sec'y, Carlinvllle. William .M. Chiles, Carlinvllle. 389 Board of Auxiliary Visitors — Continued. Madison County. Mrs. Sophia DeMuth, Chairman, Alton. Dr. E. W. Feeganbaum, Sec'y, Edwards- ville. G. M. McCormicli, Collinsville. Mason County. Dr. O. P. Hopping, President, Havana^. • Amanda M. Brown, Havana. Massac County. J. A. Orr, President, Metropolis. Mrs. C. P. Treat, Secretary, Metropolis. F. R. Young, Metropolis. McDonough County. John W. Watson, Macomb. W. C. McKamy, Macomb. Dr. J. H. Davis, Macomb. McHenry County. W. A. Nason. President, Algonquin. Mrs. H. B. Minear, Secretary, Harvard. Charles Irwin, Nunda. McLean County. Dr. A. W. Meyer, Pres., Bloomington. Mrs. M. H. Newton, Sec'y, Bloomington. Wolf Greisheim, Bloomington. Menard County. Dr. Irvin Newcomer, Pres., Petersburg. H. H. Schirding, Petersburg. Mercer County. Horace Bigelow, Secretary, Aledo. Mrs. Mary C. Holmes, Aledo. Monroe County. Henry Niebruegge, Pres., Waterloo. L. Adelsberger, Sec'y, Waterloo. Mrs. Hugh Murphy, Waterloo. Montgomery County. Dr. Geo. Clotfelter, Pres., Hillsboro. Edward C. Richards, Sec'y, Hillsboro. Mrs. Anna Linton Sawyer, Hillsboro. Morgan County. H. C. Campbell, Pres., Jacksonville. Mrs. Mary R. Parsons, Sec, Jacksonville. Rev. C. M. Brown, Jacksonville. Moultrie County. Dr. S. W. Johnson, Sullivan. A. K. Campbell, Sullivan. Mrs. Mattie Harris, Sullivan. Ogle County. Mrs. James C. Fessler, Sec'y, Oregon. Z. A. Landers, Oregon. Dr. W. K. Farley, Oregon. Peoria County. Mrs. A. E. D. Petheridge, Sec'y, Peoria. J. B. Barton, Bartonville. Dr. Sumner Miller, Peoria. Perry County. Mrs. Mary McNeil, Pres., Pinckneyville. Dr. George F. Mead, Sec'y, Pinckneyville. Mrs. S. B. Eaton, Pinckneyville. Piatt County. Mrs. T. M. Plunk, Pres., Montlcello. Mrs. C. J. Bear, Secretary, Montlcello. Dr. W. F. Matsen. Pike County. Dr. Henry T. Duffield, Pres., Plttsfield. Mrs. Mary Yates, Plttsfield. Rev. J. C. Handy, Plttsfield. Pope County. Mrs. H. W. McCoy, Sec'y, Golconda. Dr. Alonzo Glass, Eddyville. Randolph County. Robert Gant, Pres., Chester. Dr. William R. McKenzie, Chester. Richland County. Dr. J. W. Spain, Olney. Samuel Baker, Olney. Lucina E. Landenberger, Olney. Rock Island County. Dr. James F. Myers, Pres., Rock Island. Dr. Chas. E. Whiteside, Sec'y, Moline. F. H. Caldwell, Milan. Sangamon County. Dr. George Pasfield, Pres., Springfield. Mrs. John M. Palmer, Springfield. Dr. H. R. Riddle, Mechanicsburg. Schuyler County. Dr. Fred Harvey, Pres., Rushville. Maxwell Kennedy, Rushville. Mrs. John S. Bagby, Rushville. Stark County. W. H. Cottom, President, Toulon. Mrs. S. W. Smith. Secretary, Toulon. Dr. E. V. Pocker, Toulon. Stephenson County. Miss Winnie L. Taylor, Sec'y, Freeport. Dr. J. F. Fair, Freeport. Dr. Louis G. Voigt, Freeport. Tazewell County. E. F. Unland. President, Pekin. Dr. William E. Schenk, Sec'y, Pekin. Elica Hodgson, Pekin. Union County. Dr. J. C. Stewart, President, Anna. Mrs. Emly W. Norris. Secretary, Anna. George C. Parks, Anna. Vermilion County. Walter J. Brown, President, Danville. Mrs. George B. Mabin, Danville. Wabash County. Mrs. Henry T. Goddard, President, ML Carmel. George C. Kingsbury. Sec'y, Mt. Carmel. Jacob Zimmermdn, Mt. Carmel. Warren County. Dr. J. R. Ebersole, Pres., Monmouth. Mrs. Emma Kilgore, Sec'y, Monmouth. Flrney Jones, Monmouth. 390 Boards of Auoiliary Visitors — Concluded. Washington County. Dr. W. D. Carter, Pres., Nashville. Mrs. HebPcca I>and, Socretary, Nashville. Newton F. Jones, Nashville. Wayne County. Dr. Francis Bean. Chairman, Fairfield. Mrs. H. N. Jessiip, Sec'y, Fairfield. (Joorse M. Norrls, Fairfield. White County. Mrs. Lucy C. Berry, President, Carml. Clarence M. Meade, Carml. Whiteside County. Dr. R. A. Matthew, Pres. and Sec'y, Morrison. Robert Wallace, Morrison. Mrs. J. H. Green, Morrison. Will County. Dr. J. F. Courtney, Lockport. John Beckwith. Jollet. E. K. Naterhoffer, Jollet Winnebago County. Dr. William H. Fitch, Pres., Rockford. • Mrs. Nellie T. Rew. A. Thornsten Llndgren, Rockford. Woodford County. Dr. Jos. I. Noblanch, Pres., Metamora. John L. MacGuIre, Sec'y, Metamora. Mrs. Susie M. Elkin, Eureka. 391 Table III. List of Superintendents of County Almshouses and Their PostofUce Addresses Counties. Name of Superintendent. P. O. Address. Jake B. Wolf William Chllders. John H. Thompson. Frank Johnston . George Barrett. Hiram Hayes. Adams . . Alexander Bond I Robert Hurst . . Boone F. M. Leach . . . Brown Casper Bowen. . Bureau Frank Kramer. Calhoun A. D. Ruyle Carroll Ellja ^au^ey. Cass .... Champaig Christian Clark . . . Clay .... Clinton Joseph Moehlman . Coles Martin Carnes. . . . Cook Dr. O. C. Wlllhlte.. Crawford Aaron Maddox. . . . Cumberland J. A. Russell DeKalb Frank Bastean . . . . DeWitt J. W. Foster Douglas Joshua Cambridge. DuPage E. B. Howe Edgar J. M. Sims Edwards ! Robert Donohue . . . Effingham G. W. McCabe. Fayette . Ford Franklin Fulton . . . Gallatin . . Greene . . . Grundy . . Hamilton . Hancock . . Hardin . . , Henderson Henry W. L. Wilkinson . Iroquois John Wills Jackson John Turner .... Jasper T. J. Ernest Jefferson W. P. Ford Jersey .1. R. Mourning. . JoDavless M. F. Collins. . . . Johnson Ike Casper Kane John Mlchaelson . Kankakee I A. C. McCarl. . . . Kendall \< Knux John Cooke Lake C. A. Appley.... LaSalle | L. Morrissey .... A. D. Sefton. C. W. McRUl. J. B. Hutchens... J. Lewis Weller. . . Robert Morris. . . . Samuel T. Stone. . Thomas Slkes. . . . [O. M. Schuster. . . S. D. Welser Mat McMurphy... George M. Brown. Lawrence Lee Livingston Logan . . . . Macon . . . Bruce T. Mayo. . . Clyde Wicher N. J. Myer Edward Spellman. C. L. Holman . . . . Paloma Unity .: Greenville, R. R. No. 6. Belvidere Timewell Princeton Hardin Mt. Carroll Bluff Springs Owaneco Marshall , Louisville, R. R. No. 1 Carlyle , Ashmore Dunning Trimble Toledo , DeKalb Hallville , Tuscola, R. R. No. 5 Wheaton , Paris, R. R. No. 9 Albion Effingham, R. R. No. 1 Vandalla, R. R. No. 3 Paxton Benton Canton Omaha, R. R. No. 3 Carrollton Morris McLeansboro, R. R. No. 1 . Carthage Elizabethtown Oquawka Geneseo Watseka Carbondale Newton, R. R. No. 5 Mt. Vernon Jerseyville Galena Vienna Batavla Kankakee KnoxvIIIe Llbertyvllle Ottawa Lawrenceville, R. R. No. 4. Dixon Pontiac, R. R. No. 4 Lincoln Decatur, R. R. No. 7 392 List of Superintendents — Concluded. Counties. Macoupin . . . . Madison Mari'in Marshall Mason Massac McDonough . McIIenry . . . , Mcl/'an .... Menard Mercer Monroe MontRomery . Morpan Moultrie ... Ofrle I'porla Perry Piatt Pike *Pope Pulaski Putnam .... Randolph . . . Richland . . . Rock Island. . Saline Sangamon . . . Sehuvler . . . Scott Shelby Stark St. Clair Stephenson . . Tazewell Union Vprmlllon . . Wabash .... Warron Washinj^ton . Wavne White Wlilteslde . . . WUi Williamson . AVinnobago . . Woodrord . . Name of Superintendent. P. O. Address. John Caveny O. H. Hermann R. II. PiRff Conrad Suft S. A. Armstrong .lohn Uecknian J. M. Matthews George R. Mills P. A. Karr .Tohn II. Cox W. P. Zentmlre N. B. Panthler S. E. Barrlnger \V. II. Evans William Warren Charles Betterbenner. F. V. Watson V M. Watts Ben Cole (Jeorge W. Main Carlinvllle Edwardsvlllo Salem Sparland Teheran Metropolis McComb Ilartland BliMiinington Petersburg i Aledo Waterloo lliilsboro Jacksonville, R. R. No. 7 Sullivan ' Oregon Ilanna City I'inckneyville Monticfllo Plttsfleld , .Tohn R. Whlfrwell. . . . A. R. I.ockhead , S. I'. Bowers , J. C. Swank . John Douglas . S. T. Metcalf . 'Jerrv Leary .Nathan S. Hamilton. .:l. p. Selnrz .'Fred Cleming . W. G. Hill .J. A. Eells .J. I. Ilollinsworth. . . . r.^ra Hogue . William M. Morris. . . • Joseph Pohl . .lonas Mower . .\I. L. Merker . George H. Anderson. . It. M. Miller . Ira Wllsey . Chas. Rost . John F. Qulnn . Kva M. Miller . ,F. R. Murray Hennepin Chester Oln.v. R. R. No. 4 . . . . Coal Valley llarrisburg Buffalo Rushville ' Winchester Shelbvville Toulon Belleville Freeport Tremont Anna Danville Mt. Carmel Monmouth. R. R. No. ^ .Nashville Fairfield. R. R. No. C. 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ITS lit m 1- X i4 oo "» X — I 350Mt-0»M-<»HmiOOtOaDMtO §oiQOiore3CM:^-»opOOs*' — O'^QOQMO-^-^OO'OOM OOnOc50M«CXrTOMI^i''^tO o JO o o" n ^ ri x" n lo" M o ^" ri -^ .^ > a si a _: •-»_ O X S'O a 1) ., c e9 a S c9 I" * S '• B ~ 5 a a'-'« B *- B— *- « U rt i iii;a-Ho s_ c , p or, J- « HH -3 :i-i B ^ "~ B 1 — — ° o5y 3 _ J. », ^ -r •"- ; CQ 9 => CHrOO m tr* n t^ iCi Oi fO ^ ■^ t^ t^ Ift ?C M ccc^ o CD o^ re -^ «o t-ao MM'-'O •wad m T-.' ;£ ^' ^ 395 . ^ W CT> -H ■» lO OS 3 00 CM CMloc^o■^o^-o-*occ^J050^''^»-'co 0OCMt-t-iCrO00^t-«C^:O00aJC^3M0D OO00?5?0Q0aS'^^MO00iOt-rCi03Q0 OS in o-i o o iV c4 o m' lo ■^' re t-^ o •* ;d 887 75 116 42 450 27 385 99 899 74 425 41 870 32 833 83 440 79 418 00 137 11 901 14 549 29 >-cl« -W CiuieviNOO'-iNOO'-i'pHt-o-w §?53 H — CCCDOOOOcec-Mt-WOOiTSM- 'M lO'-iOSOC-CO^MaSCB'Ht-t-MOirO i-i03oooit-r2^-(cvit-ooaoai05i:^r-i:ccc »-ie>l TlOS N rlrl »-i ^ OJOO coo P ao ?SS8 ooooo ooooo ooooooooo t-oooooooo 000100300C-. Ol« t<5 IM >• <-" CJ N N i-H coo-.o CO •rtrt I CD •CO :, s >-■ cM!»aooo^»oo - — -- - IC «D iO IC »-< CD ^H 00 ^ -^ rq OS ?D O ?0 00 CM 00 c o « ^-t -^ 'J" cct- o in t- in cc ■«s' CO t^ CO os ccxcoc-ascs'-'t-oinMsct-c-i-tcooo oq re rl in'cd^-^ t^ ^1-I^'t^ccco csin I i^ iauc(OS i s ,-2 ^ ^ o o^ » s <>) ^J 5s R -<>, "xs <. i^ ^ <3. > ^ -§ «o "R « 4iJ •^ « \i CO ^ "io ■^ •>C i « P _ 't** V s ^ ^ •« '^ ^ V) S" « •t, "^ \l "•.4 vo ^) ■J-. Offlic a ^ <-» 6 ,-, v s u Si%i> <-> cs a o pS^ «-i -J— b tsas 0)'"' un -.3 4j t: ' 3 O t- J S « a^ "3 iu'5'S o *-» c8 ri r; a -: u » cs _• J= 08 p 2 396 s?? m 00 z^ s; iS;28 Si U 2 I OS M sss ^ OS ••..-««» o -» ir; t~ -» ui ;s WW -* ^- t^ ^ ^ 2 I? :SS3 J2 • a I 5 5 ? -— : H "i 9 i; OS ej-.-3 e a, m •<-J NN •inaaac^ i-tw ■ lO lO(MCO • w inooia 00 la 00 lO •OCO 050 .,-( '^D^ccf-'t^ oome^'-Hco wo^DOOo o^Oi^asgs oD»^^^50co •CC lOIT'CClCOO NCCOOCCO rHOS^DQOOO l« 05 ** O O CS »n 00 lO t- •CO CO00'-l»^-l i-<05C ■iS'C X 4) CS a a oau} fcc "Eena K O S5S-5-3 Ss;5*5 ^aog^ "gfeo-g* 5Sa«« I $^ o « ||*«S fafefefao OOffiDSffi ffiKw-^t? t^t^t^iSw tiitsJW>-lHJ hJtJ^aJS SSi«5SS 3 t»> HISS'S es t) o o o 5» = 3 w a a te£BQ5 w£0| B| 398 ■.SP SS osco t~rs 8 : 8 2 : § cSSs i-o2» *" a> o — BScng C' S C3 t- 5 f S d ooassJfc-' «ao M — -^ M ?J N ^H tSI^ CO :8SSS a -i © « ,. 4) d _■ U 4) cS ■ 03 s- ^K si lill S5 K^ 1- * 01 o E _ Ou= it^-o «; a 400 a d o O ^ 1 S 7i 1 o y: 2 3 r. S 1 c c 1 8 1 s St. Charles School for Boys. St. Charles. Training School for Girls. Geneva. Charitable Eye and Ear Infirmary, Chicago. Soldiers' Widows' Home. Wilmington. Soldiers' Orphans' Home, Normal. Soldiers' and Sailors' Home, Quincy. Asylum for Feeble- Minded. Lincoln. 1- 2SS SI lo m in o CO «o S8 S§S ?5S Industrial Home for the Blind. Chicago. oi £ a a 5 a E a u c c B y c c C a 1 c El E q: t. c c a _ c a C o o c C 1 c E a .= ' c e t. a c c • c o a c C L. is c :- 1 c a c c o C! t c C ■I. a t o L ? Ctf t a a u a e 401 - 1-HO 83?g wo 00*0-^00: r^ c; CD t rHOr-toc© cor^osMO 5 1- N o; c; t- O CO O 00 w >in •-locrtoii- e-Jt-i^'>*ao co ttOONQC «OM coi- M S toi-cao'w ■ om mo MIOIOCOO o ■ZO MtOCDCOOb »-l •OWiki^ OCOmOkA 05»rtU5»AO •WC-^* t-OOOCDt^ COOOt-^'OO 'CO ^-l^lCC'tH OOWMWC- ^■^ OilOt'OCO t-00t-^»CC ,^ , >.*- >, J*?^ Q-e-r- i; r- S5 O 1- = —26 ffi rt « oi si ■='-5 - ^c •^-C X C C3 a c c-^K cS Q. O ee c: <-,^fcfO — w — — «. ►.: hi •-! 1-2 ^ ^^,«5j^S ^ c c S j; ^ c a^ ?■ z kCmi— a 03 O c; C, i. ^ s ?? s ^. 402 "3 1 SJPSi^S S32???S ?:.S5L-!r: ?V. 1.202 IS 216 91 76 41 900 00 I'll Tt 669 15 1.415 81 274 76 ,107 26 517 78 St. Charles School for Boys. St. Charles. Trainintr School for Girls, Geneva. Charitable Eye and Ear Infirmary, Chicago. Soldiers' Widows' Home, Wilmintrton. Soldiers' Orphans' Home, Normal. Soldiers' . and Sailors' Home, Quincy. Asylum for Feeble- Mlnded, Lincoln. g?2 S :i 2S ^ 1 CO 157 15 6 80 31 85 74 15 Industrial Home for the Blind, Chlcairo. o a 3 O O ■ ! o ■ B t, 0. o t. a a s, c o C; ! >^.yi O i. i- o-g or: t «— c e 2:K dtr.o Scott ; ; ; ; Shelby ; B ■ I. = a D • C • c u a c £S u or. e e SJtS ■ 05 l>- »n Oi M ^ CO ■ 00 C5 O ;0 CO CS N ■ao'*»o **^co ^ ■ »0 lO <0 Oi •* CM 403 12 ;-W00 .Ho ■ IB a; "a ■ S fl Oi c ea €5 2 " ca eijx:.= SS ^Ss^^is iSbii 404 0\ ^ "^ ~ ex I e Institution for the Blind. Jacks'nville. s 3 s School for t he Deaf. Jacks'nville. to ss sssas S3 22S«^S tog Asylum for Insane Criminals. Chester. c- 7i U3 s Asylum for Incurable In- sane, South Barton ville. s I3^S 3SS3S3 l^iSSSS SS^SE 53^ s?s2S a'-a^s gassa s-^ssr: ggg ei - i r. i S S 1 8 Soulht-rn Insane Hospital. Anna. S3 si §11 o gs 4) s «» 3 i 3 i s - i"»N M> •M C-050 ■oi aou5to NCCOOOOO ^mo^oo PJOO • aoMOos ■mi-i so •i-iai CO ■ana rt •- ■/. s- : — ji 2. ■ 5 ^ t^ ; S cs ci .-I-:'-} .^ w O O 5 c a CS «^ c g =■ c c S '^ ? ~ ~ "a c 2 , a V ^tj a a 40C SS2 2S 8 2 3S3 :8S5 Bo * ^ — 2 a * < o ^ 3 « u o ^J r- o ^H CO c*j 100 •-*0 '^ oaoj •00 11 eI>«. - P3a SCHrJ C t. — ?;= ■ C t> o o o ccHCLrCi.CH CHCMbets v.v.ir.v.v. = c , jl ^ - .c f ■ c c e 407 in •< m •« 27 66 60 65 6 94 1 • •< ; ^e ; -C 62 60 18 98 64 12 00 Ir- as ■ Oi ■ lO • -^ ■ -^ ;tH ; CM s 5 5 5,-( . COO -CO N -00 • looo -eo 00 510 ; t-o ;00 ■» CO • cmt-i -o in j N to' : :§ 5 . . CO i COT* • •-* • -co .«o . • ow ■ "c-os • OOiO ; CO 00 CM Is 807 94 14 37 14 25 2,'376'37 00 CO S : 8 « : ?3 • 00 in • in • CO •05 in o a; EC q 0) C >)— •- will c o 5J • ti ■ ce.'o cS-S 4o8 -3 1 S ;5S •» ■ 3 SS a r 2 1^ ? c 5 5 5 ^ 2 *" s CM X 1 » s St. Charles School for Boys, St. Charles. Training School for Girls. Geneva. Charitable Eye and Ear Infirmary. Chicai;o. .Soldiers' Widows' Home. Wilminerion. Soldiers' Orphans' Home. Normal. Soldiers' and Sailors' Home. tjuiney. Asylum for Feeble- Minded. Lincoln. : • : "' Industrial Home for the Blind. ChicaKO. 1 a 1 a E e •0 a ■<2: a B a C « tr er ea 1 £ .M e • C c r. ^ ^ c u ^ C 1 '.2 a 5 r e: is B t E 1 a C e B e: c c 409 t-t-oc dOOOOl ■ o«om Nos^j^ao osooccso «0 5>i^t-M Mt-ooeoN OS a> CO M 00 ao«>— "t-» CC JOOiOO-H NQ0"Ot-lffl "inxM ooooao^ I" ^* t- ^ 00 :oo5co?occ io<-cNo wc^ N «DMiomo O O O CS 1^ o to «DOIOMN CONIOIO OIOIOO^ toooon to;su:iMto 0; >':§la O 3 g g S S o '=^ «: ^^oa -io^s ■ c c S ^ - ~ - a, ? — - -''C - ■- r. a — — — C _ : o c o — — I *^ 1* 'U -» s O en ,• 2 Sa a> t. an 6 £•33 = a-S 9 ^ -2-2 ^ S5cc V o2 o !r, " «* ^ — 'r. rr c 1! © 2i 'r* II tl 2Sa.Sf S5Sw 55 W •Sin — — o-»r'. r. y. -»3«B 8 :Z «0 N W UJ t~ •- » p;Z S3SS3 i^SS ^ SS3 Bs S2!S ^ : :a 8 : » . . ."" t~ • ... ;o ■ SS^i3g £SSS^ ^3S3£ iS^S^'2 S£S t~N ^ ^ — -T — ■« ^ CMMQ ^1 ■<o 26 13 24 04 151 64 62 01 6 84 18 28 47 86 287 62 6 75 44 74 §3 is§§ SSS5S sggssg gggjss sssss? sssfsa iCCC G^ -«*< ^^ y~t ■^ ZO m ■^CCiW^* <0 -cDOi -Horocoro oot-oo-- IOC- ooo ^o loio N»» OOt- - , 03 — — S: = = c a _ u •B ^>-i5 ** X t. 'A S^H . ^^ a Oi.p ai -~^S3 >i C C c a c; c ?, _ 5- o a « a J. o ?~T K cd o o a^o iJ a 414 Institution for the Blind. Jacks'nville. S 10 44 29 262 98 21 88 8 86 i2 e «0«D School for the Deaf, Jacks'nuille. ( 40 67 19 90 30 34 2 64 25 17 49 67 13 84 4 99 3 98 48 16 82 49 3 48 34 83 69 10 18 22 t:a 25 99 77 3 40 17 28 4 14 174 24 11 91 8 16 179 43 4 80 5 33 3 44 .52 41 Asylum for Insane Criminals Chester. $ 6 35 22 60 24 75 o ass 3 ^2 o Asylum for Incurable In- sane, South Bartonville. *202 80 50 10 152 44 192 80 •20 35 170 90 557 50 35 50 115 00 48 60 67 82 gs ssss^ g^ass ffi8S!!?g ^*o wcc^csao os*^^co»rt cox=cwiO Western Insane Hospital. Wiitertown. S3 S5 s N W g M g 5 : Souihcrn Insane Hospital, Anna. t- • • oira . r O •waot- ■»* • ^t- lO ot^o CO • r- LO CvIMrt so • ^" CM ■ ;| CO oooo SS Sto ,.H E- >ncoN 05 M OSOJ-H WCO OCVI O 35 «c-o ON ^co -O M CM CM o -■J 3S - • ^< ^5 ;0 M •O a • to ; M F-4 i coc- • .^» ^ •«*eo • •o c toS ^ :S : 3 • ■Ot-05 S » 30t-00 •< • £>COCO u 3 S"*in t rio;^ u S * 5 . lOO -"ll C 5 3 ; O'W ;rH C 5 ■ !^ - • lOLO -O '■ ■^ H . -^ a ■ -5 3 ■ -lo a : :- % 9 ■ -e > • CO • .a: 1 o 5 :* » - lO • -t- tt 5 • ;C > • OS • -o c- ^ : g - - -5 3 i ! 6 • ta : a o t< « 00 ! a* •2 "a I. c lamso nebagi dford e at la vidual Total >a— *^^^ = 5oSS tiA^::: ^5 :b^ ^ ^c^ :3?^ 13 4i6 1 8SS •• 3S vJsy s3 iSr; c p r s - ?5 = S Sf28 o — n St. Charles School for Boys, St. Charles. TraininK School for Girls, Geneva. Charitable Eye and Ear Infirmary, ChicaKO. Soldiers' Widows' Home. Wilmington. Soldiers' Orphans' Home, Normal. Soldiers' and .Sailors' Home. Quincy. Asylum for Feeble- Minded. Lincoln. g : :!5a ■o >coo i :a 5 .g .8 Industrial Home for the Blind, Chicaifo. : : : S : Mi §! • ; : * : 1 a 5 ■ 4. X a • ' - S- : c «-— I 5 t. = S < sssa s:^; - ! S 5 " rll ill ml >" i- CS — — 5 : s- = a 417 SiSgSJg SSSSS g?3^SS Sffi22!5 S2»"0 MN.^coco !SE;^'iS2 coNsio: o aoo5«> w o ^H -^ ro j O O tj ^_ 0^ ^ cS es oo--aa H ■a £"3 « :- s. £ 0) 0, c c n E B .a c •c c c a "o a: e o E a a 1 u "t K B c .c •7 i. e "e a c £ 1 S ■ a • c c c 01 — u~ 01 01 o e o X E 5 419 * "- ^ 3 C -g-- OlM ^^ -2 ^ ^ ^j ^ ^^ R 5 ^ 0}- a o (» . escS 2 3 ""■ t- "SB a ^ b V cS ■ en m a _- u zi — 420 SI coin as ss s ect- ?2 E 3S ^ S *_- O D 3 a ~ is o a '4 ■a 3 on tn a B 55 C.C. c c &83 'S" S82 ss= tno V 58 « =s?s ;J ^' t-' m' O ' ^"5 i 5!Si 2.2 ox.*- "O ^ tr ») 4) i 2 £ '^ sJ a « gt/;x33 c e.S xsESEEES »; o o o o o o CQ u u u u u u 421 oo© coco «» >o 0"5 00 CO t-to tr-O ss 00 O) CO eori^co •"XQOCIO ^ » CO CO OJOCO 1-1 eg ■ cgosio •OSOOrt aocooo 00 go 00 *«rtCO ^OCO?'!^ CJCOOS -1* 0-"10CO 1-ICS CO eotoiot-^ o;o:OkOio noo mo ;50>0 •cor- •OON •C . >. O ■a a O 3 o2- tn 0) ■S'O to fc 3 a a^ O. 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Ph Ocnfc< 2 S8 4«r-iO I to oe* I ^ ssz >oo - u s 5 B o < ss " s !3S3|S SSg NniA oo ram t- P88 ism atom -»oi 001 SSsg a> 32 6 o 00 coo' oom I >o 9d5'« at 090>« I o gS3« g C5 2 bo a o* o CO a a 3 .J )» ^ OJ •O 3 " a a a o_c o poo C U b <<< ;sss SS o y. 3 ; b ^ si o »! 2 o o »-,o5 •=223-= -cS gcncflO o o.2d §£££2££2 433 cat-eoO'* I to O) 4f7 U2 ^ o ^ — rtlOOS ^*t^-i '♦coco 0?5 C«OM C-SD 00 05 IC in t^ to lO^-H • to lO »-> I l^ >-IOO" 00 00 tOTl eomomio 00T00O5 1O ^OI^CO'» t-00M«lO oorc ccm ui lo ^' « ooo NOO 00 lO WTO 005 C<3CO 00 00 t-to OlO CO 00 t-'o> C3 O-'O o O. tr. 0) 0) O. s^ ■ £ o 3 o g »: 0, — Soso -28 PC aoo-< M> ^ t- osoeo lOi «e >-icot- T-OCO MOON oino ^oc- 01 00 ocom lOlO t- ccoc- t^oo in CO oco «e ooco OO-HCO ^coco NCO"JI nooM t-^ino c© .MCO 05 — — O 3 coco CO COCO CO 00 -^ ocd oco ^co w a !X 5^533 • ea CO 4) 0.0) to ° 't-; (p Q> ^ 3^ O-O ^ a a a a *: m a, aj oj H ^ X « !< X IM 000 TlO I ^ -HCM ^CO ■^"00' ^ -. oico I in coco I C^] c-eqo ClOJi-l OCO'* 00 '«0 . *-tO» ^ t-"o'-r COCO 001 OCDC t-O L in in ■ 3 o : t. o 3 m'J-' 3 :3 '=' = ,. 3— t->bJi ^ ^ 3 P in>-i cor- 09 CO coco By.-. 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O C 439 i4 N cm' m m c4 m CO oo w ^' ic o iri cid CO CO t^o c-" i--" od 06 od od a: ai o o <-<' '-* :^i yi 01 "C >--'t: -s XI cc^ u 00 4> ca - aD en 2 22o-g 5^ n i^ 2 E«0 ^ *- ° ? .2 o'S o I|5| Sw^ ^^ ^H »-( »-i th cv] c^i csi re CO'*Tjlt:-;O?Ot-l:'00t*O5'^WM?C?O«CC^*-'CCCO»n^3«-iMWCO'*ir5t-HOi ■OOt^t'tOCDCD^H^ c*ou:jwc»o M CO W N CO CO CO C^ M CO CO CO CO CO CO CO CO CO CO CO ^* CO ^* ^ CO CO CO CO CO CO CO c^ •oococ;C'i:DOt'C>cOOCOO«»!OCXllO-HC:OCCOCOOCOOCOlO-i* •c^i'*;^t-ooooxoio*-'C'*- « 10 CO CO Oi t^ O 05 ' rHC^IC^C^MC^C^COCOCOCOCO' (lOlClTJlOCOCDC^C-OOC ■?jooa5'-ic-ioc-3Cc-e»)co ■iciri*s-ic»A!:ocDco«ot^t^ l/iCOC^OOOSO-^C^ICO-^lOCOC-aOOSO-^MCO'^mCOt'QCCtO'^C^CO-rflrtCO -009OQQ0O^C3O3C 500c:osO5C2a5C;oiOic 3:0000000 aoaoooooaooooDa5aoooooaoo656ooaooo3oaooDoooct»oconci50>c»0505*cn o o a a a a tl it c3 cS o g £; t; 440 Si ^ « » o )^ <■> On ^ S '^r » 8* 8 < ■^ .•v» ^k. ■v. rt -W <; ■<' %i O « ^ ■v» %\ ^ •ji l-i « "S o :5Qj — '■ C 9J t: a H s S2a^ ■t;o.2x: wi'"' ur) < O^ B ® c" I da a — . a a) o •J o a) S <« !> feS Oh en S nil «§ ll'tl ^ WW *- a^ 73 r- 55^W ao<-ie4«-ie) « r^n M M M '^ M ri — — W ^o» ••iO««-i - a '8 '^'- cd a] B O o ^— t. n 04 ■O— O O u S at as s3d iS ■ -a »«-iPJ T^^^ -C* ^i ! a — -^ X ° s di 41 ^■OUUU UUUCQ QCKKK 441 NN . -N ••«< r1 -rtrlN ■ .-1 OJ -^ US 50 > rtCO .-^i-C CQM^OOtH '« n to C>1 n •eOeO NNrHrHt- ^ M lO «0 t- rHTOMOi- •CO r-lTHOSOSr-l ■»-c • M •O t^ TjtlftlOO •Tl T-1 N t- ■ aoeoto o»0D ■CMCO W ^H a, .5 fl >>■- «s — — a) c u S as ■a r^s K a) :?o •Mr: .M-o t^ M^ «'Em!:2 ea o o o 0) oSffiffiffi ffia.H^^ ;?^^^M wt2w22 5222s ssiiss ss^sa 442 -^ o O Institution for the Blind. Jacks'nviUe. MO «o to M «OM K School for the Deaf, Jacks'nvUle. lOtncoM «ao c > t " c c c ■I I t 5 C a c a . a c c z c £ c c a X c c c c E c b C c •J u t : 5. > J £ J K L. u z c c c c c E > c s. u I. o: a o ti c 7. a 443 otn«« Soldiers' Widows' Home. Wilmington. in Soldiers' Orphans' Home, Normal. IO«H t- Soldiers' and Sailors' Home, Quincy. gUS»».^0O t-»<^aOO> OOrl lOOO MtHNMN NN<4N lOCO — N Asylum for Peeble- Minded. Lincoln. 05 y-l M ~" 5 m«H MM ■ Industrial Home for the Blind. Chicago. »-l " a a o o E CE 1. a •c c 1 -< c c PC a 1 ec c it c 1. 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S5 00 N Southern Insane Hospital, Anna. t-t- "2*° M la ; Central Insane Hospital. Jacksonville s «o '* 2 ;; X Eastern Insane Hospital. Kankakee. 00 in N "o^j;; North<;rn Insane Hospital. Klifin. a> - S N oa a 3 8 K E a < t. a B « < 1 c B a B C c c or tr ee 1 e E cd ^ e or a > C >B c a c c c •a c is e B e :- i E 'X c a c C tr a E es j= U c E K 449 ■i-IMM « -CJIMm »-»-crH .^ ^OCi-C «^lOO»-l MN^NN • rtin ia?4»-«c- i-iNmt-^ ot~o»»-i^ T-iMi-it-»H • CO CC Oi ** oo cc iid Ofg "O I. S —29 P C •■-esq »HM 0) • Mq fl t^*^-2^1i) UiUi'^^^ Jh^wh^S i^S'S^S SSS cj: a a: o rn C. at <.f^ t£ C - C3 CJ o i; o I o-a fr,^^^fii 450 a a o O Institution for the Blind. Jacks'nviUe. rj iC M lO « lO M ta School for tne Deaf, Jacks'nviUe. [^■^f^ eOC-NNCO ^eOMWtO 09«OjJ»" MMMMSO «0»»t^»"» Asylum for In.sanc Criminals. Chester. (N J Asylum for Incurable In- sane. South Bartonville. N CD N «ot-« S n Western Insane Hospital, Watertown. r- S5 00 o 2 : Southern Insane Hospital, Anna. jio NOO oo> cc s; U5 CO •o Central Insane Hospital, Jacksonville ss:: N-H •S»'- :: S3 Eastern Insane Hospital. Kankakee. g Northern Insane Hospital. 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(DO 075 - i^ m a o 5 o a; 5 000 Sow O) o 1-1 Si 9 000 470 S5«!i'<^ ??-£SB S?I"S ????2 f^? = ^5 S?fiS3s ■• 5 ■» 3 1- M c. a o '■; rf •-■; y X — •?; -^ a tc 5 to n r; -» r: r: V S t- o r; -j' m' irt X OS ■ - •rj o si jM ri m i- o — ' r: ci o ri ^ ■■: •«' aj ri ai ■»' •r; i-' — ' *^M ao 'H SH :|§ -^ :; s n :S 1-c >ON lO -"Nrt ••• 2S3 ^1 CO o ssss T3 O O Si s men .H ■SoQa 0) »i .^ •Sgaa tno !z; IggSlg . 2 §g ggSg 2g : g52S£J e9 f-MX-H-J ?SS5 25385 g^" MN^NtO '"X NM -«t-i^^ < f^SQ^ laionQX U3Q3QQ1Q QuimcoN a>sira>oco «Drat-e4k >QtpAmN 90>o>An ^Sc)3o;o«t CMOtNNCO <^<-< <-■«• 'Wi-iN<-l iH<-icOMCO CQIA <-i CO •« » CO CO ca -3J3 -* #-* o cs (Hi iiii: o 3 = «^ ^^ P O W ta- Ql d — c _ ti g c ea UJ= cfc«5.« s 471 oot-o oSoS ?5 1 too r-cc 00 3 |S 2 in g o g« 00 CO g c a e c '1 c 1 I I r 0' c V c 472 s v: ^■^ Institution for the Blind. Jacks'nville. School for the Deaf, Jacks'nville. Asylum for Insane Criminals, Chester. 03 N Asylum for Incurable In- sane, South Bartonville. io<«ncoc- »>H«e«io loianeo^ N^t>'««o rauso) « Western Insane HosDital, Watertown. s JO CO ?5 Southern Insane Hospital, Anna. !SI3 SS^ S^ 5g Central / Insane Hospital, Jacksonville o» S " OS m Eastern Insane Hospital, Kankakee. M s :g 1 SS s? s Northern Insane Hospital, Elgin. SI s ^ ^ 1 a I s < u •0 a ed H a a o n a a o o n a o 3 a 3 £ o U ed (J to 5 g B a cd a (J ° a » .a U u od U a c 'C 5 m 3 O O o •a u c is oi t- CJ ■a B _e a; 1 £ Q Q m I o Q ■o K tn u d •o K a cS a til a e Ed 473 CO N u « cc :*: N « MCO lO eOeJTHJOCO C^H- d SS5SS Sgols ^lolS Sgd^'g SSJ^oS 5S55S S'tt'SS OOKWK fflffiS^^ ^^►^^M Swm55 J.S23s SSSSS SSSSS 474 0; I d o Q Institution for the Ulintl. Jacks'nvillt Sthool for the Deaf. Jacks'avlUe. Asylum for Insane Criminals. Chester. eo N ■r^ta Asylum for Incurable In- sane. South Bartonville. S2S§5'^ S3 wo «<-ii-iec^ cc — tot-M "• — (£[-« ^^to^^^^^^ Western Insane Hospital, Wtttertown. S 00 - eo ^ « ; Southern Insane Hospital, Anna. e^ CO £J=3 5S M S S s? Central Insane Hospital, Jacksonville S5« lO00» »-" O '^ *-* ^ o Eastern Insane Hospital, Kankakee. <-lr1 C4 § Northern Insane Hospital. ElKin. 1 ** a a 6 t. t c u C c t a, E c it c c c c a I c— c 7 1 > L. _0 a a C c a 1 £ r c c c C c ■;? •- c a c OS c c E g c s X u c [ = c a c > £ .c K a: 1- B C er c a x: c 4 a it .a a c c c 1 > c u a o M B cd 475 CO 1-1 CO oor-itDoed eoeo s ^ lO in CO OS MO CO i g2 E2 c- a. c > a !5 i c c cr s i 1 c > C ■c C t- a 1 V c 476 -3 1 CO in x: o [j 5S s s U5 s 2 PC x: 1- 5 5 S M 3 « 4^ 2 St. Charles School for Boys. St. Charles. Training School for Girls. Geneva. •-i^ eo N « t^^MC>| •• j Charitable Bye and Ear Inflrmary, Chicago. «H •H^ 8« e4 >-• CO Soldiers' Widows' Home. Wilmington. TH •-( N Soldiers' Orphans' Home. Normal. 0>r^ » N f-t NCOfH gc- 00 CJ '■ Soldiers' and Sailors' Home, Quincy. ^U5^»H"* tCmOO^-O r-5C«OCD t-h-huso y-m'^y-tf t~fiy->Ne^ Asylum for Feeble- Minded. Lincoln. NMUJIOCO •W loooto ffc-nniof oin-"rc?5 -»t-t~row «mioooN Industrial Home for the Blind. Chicaifo. tH « S V a 1 9 E e < u a •z ) c ,1 I 1 i c ■1 90 It ICC 1 ; < > t c a St- _ t s C 1 J a C 3 ' C i a s. — 5 t c c ■•f I a c > I ) c u c Ei .£ c a £ s a t c C L R cii E c E > e •c c c c c u c a * "5 a 477 t-CO^O'-l OS^HOSOO^O CO in -^ T~t i-i CMWCOCDCO O*-H00 OOiOCCWr-t OQOOIr-O cDutit-^as cmm:dioto ccqO'-hoc'I i-»rot^rj»co ^ooo'^ 1-t r-1 T-t C^ i »-l rH IHG^J >-l«> IOt-H O lOrtOrH N ^HM T-(C"Ca aoN to eg CO 1 rHTOrH rHT-<.H M '-I'HNtH CM cq •pHM lO •^ CO '-' 'S* com m CO ^-t^i-li^CO CDiH^O»H m^t^CO** NC*rHW COt^^lOt^ OOOitT-CgrH O5oajc-ao cgin-^-^cg cmcoooo--* •^•^mooirt ; .2 a J t>,o o u •a £7s "^ <*> ^> o ?ca » .MtS M 0) cS 5 ca o T hrO a „ to o.a o "'^«>5«' ^'=^SdS ^Zoa'^ csSots^ SS.Sooi =2e3«eJ OCffiffiW Kffii-^* ^^^^;4 MWt^JJ J^JJS SSS;S i c a , ■ y o c^ c sssss sss t, C O 1- 3 1; O O O O 478 S H S?si?3 P. u -5 ^^s ^ 5S ss s ri s •K <£ gg ^ 3 St. Charles School for Boys. St. Charles. Training School for Girls, Geneva. CD^ <-l '» C4 WM S NN Charitable Eye and Ear Inflrmary, Chicago. Oi^ N CONMiH^ ^'« c = X «. cr c c a 1 c ; C. it u s c c c c y — a & .«: a c c C c 1 > a c a a c c bi c X ir a is : a c t" a [J ; a ''Sx § S 479 1 n CO o 1 ? ^ eoia '■_ QUI' ; •>* t- s cd JO a, P C O c« < 48o -a >^ >J V c> ■5^ )C «o « KJ O cx s ^"^ ^^ ^ V ^ ^^ K- ~^ 5: K* <: - >< ■^ "^ w ro 1 ,-3 '■V- ,<:> aa ^ "o < Eh S: "^^ Si! ^ 5 ^ Institution for the Blind. Jacks'nville. School for the Deaf. Jacks'nville. Asylum for Insane Criminals. Chester. « M ^-W" ; Asylum for Incurable In- sane, South Bartonville. •-•»eo 9 en a 3 • 09 B 3 ." 3 . a o a § a o a u 3 a c 5 C L. U O 1 a E d J3 U a B e a o a. OC o ■V u c it eS u u o e 1 E 6 a; C Q K O D C l2 ■ 0) •C s * 3>0 B C3 U a B 48 1 * rH cc N in CO MMM 5MNMM ■*t~ •* ^05^^U3M rH^rH ea> ti OS-" — el O u S ai ■"•O H o feaj-rScj S!'ai;'"o aiQCiJa rr^cSojoa I'O/OsS '"'-'-■Scti oaSaoi^i SS^ocS *oS«5ojeS esotioo) ooHma kS^^^ ^^►S,?^ mw5>33 5^3jI salsl sssss 31— P C 482 Institution for the Blind. Jacks'nTllle. : :♦ School for the Deaf. Jacks'nTllle. Asylum fur Insane Criminals. Chester. •.HP I..4M .-tcD '■^ N ; : ej 1 OON MIO e» — Asylum for Incurable In- sane. South Bartonville. 10 t- 10 « — WW e>5^ >" S-5-'= " : SCO N wpi»-ec Western Insane Hospital, Watertown. OS ; : : : :* 'Mb t~ :igS ;0 ; Southern Insane Hospital, Anna. :a Mi M^ CJ« ■gS : = ic ] n 00 £^ s§ Central Insane Hospital. Jacksonville : ■" 58 •: i . S§§ : .■S22 S i s Eastern Insane Hospital. Kankakee. »H \ et 8 Northern Insane Hospital. Elgin. ::**:: •»-l S a 1 ■ a t, a> u a a d, Morgan Moultrie Ogh, Peoria Perry Piatt Pulaski Putnam Randolph ■ a • C u 5 us - CJ3 d 08 303 00 2 ^ "S 1 a 'a; Es OI N ce Eh a a E > cr. s u c u B 483 OOt-i «*05N ■Wrt g 01 ai ej O «3 to H'5 © ^ a2- ^ES^^^ ^^ P C3 484 a o O i 1 i {: « u- u- «u- i^ ^ c S S SS - ^S s S5S ?5 .r: S r-* St. Charles School for Boys, St. Charles. M ^ 04 eo —« — s M M Traininjf School for Girls. Geneva. •OM U3 •• 10 CO •0 1 Charitable Eye and Ear Infirmary, Chicago. M .« g« «•-• ; Soldiers' Widows' Home, Wilmington. N SS Soldiers' Orphans' Home, Normal. to "I N — •>» NM»-i ••M — « 10 PJ Soldiers' and Sailors' Home, Quincy. QIONMin «ON-jN Asylum for Feeble- Minded. Lincoln. no -»"»M n -TOON inonoscm t-m — ovoi- tc«D>«->'X tcroi-^M Industrial Home for the Blind. Chicago. V a aj •0 < 1H eo s Counties. t. a * « ■< 0. B C C CO a Es L. CQ c £ 'J 1.1 ed (J 5 1 C E m « x: CJ u a a a c CJ .M § c •0 VI tf ed CJ a 1 E c £ Cd \£ 01 Ol Q n a ■5 3 Q 3 Q eOrH •>* N « NrH rHN ■ Q e>3 ; 5i| <-ic- rttOrt 05 00 03«*!V1 OSr-H-CN r-clOM 05 CO t- rt-« '■ »HN «* to OS •<* ^m Nil M«0'W •># a> M taui 10 10 to e>5 M CO XI 09 lOOO N s ro »>ccotoio r-Cil iINi ,0 O Li ^> o ?s5 « OS ed _ •i^'O M 4) 03 a a ojijos H ea o a _ g 00 OJ3 a tX) aiax_: a 5 ►Siisss ^Soo,'=5 «s Pea's ss^o^ ,s*«** 5,a.s^5 K KKi;,^,^ -^^i^»?M MMMJ^ hJjJ^JS SSSSS SSSSS u a a u s 00000 486 as o O o i a 3 S 5 g e> s s ao» t^ s 8 ss g SSS S s " fs S ss X SS| a St. Charles School for Boys. St. Charles. »U3 e>> — eo to COM lOM Traininjf School for Girls. Geneva. «-»N 10^ moo U3 «M Charitable Eye and Ear InUrmary, Cbicairo. 04 MM MMV^ • Soldiers' Widows' Home, Wilmington. CO M M — ?5«~ M CO j Soldiers' Orphans' Home, Normal. riiaetr^ MM MMMN «CM M«O«0O'« es M Soldiers" and Sailors' Home. Quincy. ■"SS-S osffOW'" lo — CM-.^5 -rto-^'-Si ■nX'-aC'* — .-^rj?j Asylum for Feeble- Minded, Lincoln. t-cD« Industrial Home for the Blind. Cblcairo. 1 1 a § C « o > _e 0. c c tr a e c C c 1 CC ^1 8! 1 c R c 0. c £ a d 7: 1. E c CC > "3 a C c c c a a c a 1 > 1 a 1? 01 c c Ol a «: s "? 1 j5 a a G a 487 Sg2 1 I N.M •-' 05 s ?a o» 00 113 ?5'W 1 10 0> s M C C 1 1 a z r a 1 « c E- >1 ex R •V. ^ 488 SS; O-J ■71 Cflt! ts "3 « c = ii ^ r- C %i rr C a J- S3 *g? o a> — ■Ji ot -r-te ;:sas S3^S^3S^^S a _: w C -^ ^ — :J'- a *^ "^ ?? fl "3 2 2? 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Female. >o M o »"0> to "^ g~ •^uiioeo j Male.... ee •H t- ».eu Meo 2 : •ao-. •• J^NPJ . g.... -.-, 1 Male.... ^OMIDte «s ■ «gao - " S ^ee »;3SS3 >ogjeoao • Female. - -' - - - "* : Male.... •o 09 - — N e«»« ««09 j d CO Female. Male... l-lT-l »-lN N «« 0« M - •F* THMC*" MOO " M " 0! D Female. — - :- Male.... «^ '^ " -" " oS sa a. Female . 9«-iso e, jg '^ rt« 00 Female. « - coo c« - lO>4'N Pf w j Male.... J3 K eg c a cc a c ti c !c is 531 r2°»?s^ 5 !005 1 aaoc-a>N ^t:- m 1 "^ C4N i- 8 jcc > - S S>) »H CM 1 - - -^ 5 ec s -^-^ 00 CM 8 »-lN»N» eo« a N t- C4 rtrt m j S -- • CM • ! C>ICO s BE 4 ^ a O CO E a s M a B o o 3 o s 532 -J OQ I ft "2 5v >3b ■5 52 a r X X < — H O2 nujNW COM— 00 •—t-cJr- MWO •laNMN OSM^ ■ M eooo ■•CO M • ■• •N :>>■•• — M«-i <-l 3?lf2"8 ■ fl «, a <<»o ccoo^hioco ^*ioos^ti:' Oicoc^t COM ^CO lOOrtC- >^t ^co w w w CD t- eg "-H .-I ■Nrt i-HDi-"M eoocooto 1-Hiooooeo e<550tD«*o imoomn^ ihioi-km HMOSi-l M-^ Noaooin ■MIO M^rtOm S •— a— 9> ^~ 5:^ a (»>t: rt— = S; = " ° t- *■ a- ° ^ S ■^^ « * CD hsi-grsi-.tjj ;4^:^-;>j >-;,j_]^S £■= c 2 - c~.il K o — ■- ai c: a rt s o c, c 0) 534 z2 <8 e^«-* ir: X OJ ro c^ :- R-^S- ■?'-•■= -a -^a o O ^ a; cc lA re cp 03 to ^^ -N -NtCi-l :S : — i •it-im vc ■ «eg CO • lO m N M > =-ss= : M I- 05 » eflio<-ioO"» B 1,010 a-r ^EBl s-^s :S "§ n « >»*j txamiii ociuai— -« O3P0-. «q^a.«S O£hC>im0l< OiCmChOSQJ slip ^5|^s £t^'-ag §i|li Q^COCGCCGO CQXXXH 535 In • lO •o :S : 2 : S ' : i • i :" »S3 : : \* ^2^ 5 JS H g CO •IT lO • \l i: T- .1 N : : s JJ o \ ! '•a o .00 aj Lri g a) 4> " ea gxj ^33=5 a§ 536 Table XXIX. Sliowing a Statement of Expoiditurcs by the Illinois Board of State Commissioners of Public Charities on account of all funds, the names of Firms and Individuals, Total Cost of Supplies Purchased, or Services Rendered, during the tzvo years ending June ?o. /pod. >Jame of Firm or Individual. Classification of Articles Purchased or Services Rendered. Year endini; June 30. 1905. Year ending June 30. 1906. Adams Exi)ress Co American Kxpress Co .American Medical Association Hlackwelder. VV. R Blackwelder, W. R Boards of Auxiliary Visitors Bressmer. John & Co Brown. Emma Burroiit'hs Adding Machine Co Capital Planintf Mill Central Union Telephone Co C'harit.v Oriranization Society Coe Bros Compressed Air House CleanintrCo Dirksen. A. & Co DurtU-ld. Wm Dumpld. Wm Fairhrother. H. C Franklin Enfrravinj? Co Frisch, J. & Co Qallai-'hcr. Katherine A Gallanher. Kaiherine A Gcori:. Victor Qlohe Enuravintr Co Graves. Wm. C Graves. Wm. C Haas. R. Electric and Mfg. Co Hanmann Ed. F. & Co Hirsch. Em'l Q U S.T. V. V Illinois Medical Journal Illinois I'rintin;: f^n Illinois State .Journal Co Illinois Slate Kcformatory Illinois State Kt-trister Co InlfT-State Telephone Co Jayn<'. Pcrrv Jayne. I'-Try Jayne. Louis P Javne. Wm John Hopkins Press Johnson. Alex.. Secretary Johnson. Alex Kelly. E A Klaliolt, J C Kinifsley. S. C Lartrent. Moody Lehr. Mahpl Mc(;riie. H O Mi'rchants Transfer Co Moore, Ensley Express charges do. Su bscription to journal Travelintr expenses Salary as visitor Travelint: exiienses Carpet for ofBce Services as stenographer ., Adding m:ichine Repairs on shelving Ri-nial and tolls Subscription to charities Office supplies ^leaning office Repairing chair Salarv as janitor Washing oftlc« towels Traveling expenses One zinc cut Snap for oftlce , Traveling expenses Salary as visitor Photograph One copper plate Traveling expenses Salary us .secretary Battery for clock Ortice supi^lies and printing Traveling expenses Kxpenses to State conference Subscription to journal Printing .Subscription and printing Printing Siiliscription Tolls and rental Traveling expenses Salarv as bookkeeper Work in basenicnt Traveling exjienses Subscrifii ion to journal Memtiership to national conference. Expenses to State conference Traveling expenses K pairs on clock Expenses to state conference S;ilii'-v as janitor Services as stenographer N'ew partitions in oHlce Freight and hauling , Traveling expenses 75 77 39 48 763 90 375 00 4 20 76 70 2 00 14 90 75 40 00 74 00 1 50 2 30 1 50 12 40 70 81 80 184 57 6 76 27 00 101 73 1.100 00 112 07 35 00 lai 90 3 50 75 00 5 00 222 99 J 7 60 5 70 5 00 157 80 96 00 1.442 41 119 25 3 00 94 60 4 00 107 45 11 00 120 00 19 00 236 00 195 09 ISO 00 275 26 591 67 86 62 170 45 5 71 2 00 76 35 443 10 (■• 76 :a m 46 60 1,100 00 5 00 101 23 7 00 37 62 114 25 800 22.1 .50 7 30 248 79 537 Table XX/X— Concluded. Mame of Firm or Individual. Classification of Articles Purchased or Services Rendered. Moore. H. S Moore, H. S Mullen. Daisy McLeod. Eben E Owens, W. W P.icifle Express Co Phillips Bros Polk, R. L. & Co Postal Telegraph Co Pure Ice and Cold Storage Co. Remington Typewriter Co Rennick, Frank L Sehon, Geo. L Simmons. Frank Singleton. John Smith, L. C. & Bros Springfield Transfer Co Tanner. J. Mack Tanner. J. Mack Thayer. J. & Co U. S. Express Co Virden, Chas Western Union Telegraph Co. Wheeler. L. E., Postmaster. . Whipp, F. D Whipp. F. D Wright, A. S Wyatt, Mamie Wyatt, Mamie Total Traveling expenses Salary as assistant secretary . Services as stenographer Joint agents fees Services as janitor Express charges Printing City directory Telegrams Ice Typewriter supplies One office map Expenses to State conference. Office supplies Services as janitor Typewriter Freight and hauling Traveling expenses Salary as secretary Towels for office Express charges Traveling expenses Telegrams Postage, etc Traveling expenses Salary as assistant secretary . Traveling expenses ..do Salary as stenographer Year ending June 30, 1905. 52 00 11 00 30 00 9 31 39 75 4 00 40 00 7 20 1 50 50 239 90 3,000 00 60 13 38 54 235 00 202 34 2,000 00 321 76 22 00 720 00 $10. 620 35 Year ending June 30. 1906. $ 158 20 786 85 86 00 48 5 00 95 30 00 23 95 10 25 93 43 4 07 404 09 2.408 33 6 00 18 66 643 42 28 39 315 00 163 69 500 00 511 79 23 06 720 00 $13, 324 39 538 The statement which follows shows the amount of money to be ac- counted for b\ the seventeen institutions, and the disposition made of it from July i. 1904 to June ;o, 1906. DR. On the 1st of July. 1904, there were in the hands of local treasurers of seventeen Institutions cash balances amounting to $242,863.23. Seventeen institutions had to their credit in the State Treasury July 1. 1904, unexpended balances of appropriations to the amount of $2,703,137.88. The Forty-fourth General Assembly appropriated for the use of the seven- teen institutions the sum of $5,149,620.00. The income derived from the proceeds of sales of farm produce, material, stock and manufactured articles, collections from counties, and indivldiials for clothing, etc. was $415,538.12. The Northern Hospital for the Insane at Elgin received $6,377.25 on ac- count of Burr fund, and the Training School for Girls received $42t;.r)l on account of a refund of the shortage of C. W. Spaulding. an ex-treasurer. The income from friends and relatives on account of trust fund was $30,046.94. CR. The cash disbursements by seventeen institutions amounted to $5,452,899.52. On June 30, 1906, the local treasurers had $297,504.74 cash on hand. The appropriations undrawn in the State treasury, June 30, 1906, amounted to $2,724,481.13. The sum of $18,729.40 lapsed into the State treasury on September 30, 1905. On June 30, 1906, the sum of $4,395.14 was in transit between the local treasurer of the Soldiers" and Sailors' Home and the State treasury. During the year ending June 30, 1906, the local treasurer of the Eastern Hospital for the Insane returned $50,000.00 to the State treasury. DEBIT .^ND CREDIT SUMMARY. The following tables show these debits and credits distributed amdiig the institutions : 539 U5 N CO lO r^ 50 ▼-• iC 05 wi 05 o in **" :d t- aa c- OS ^f< ;o •-•»-- oc CO -*" r- r^ (M o c-co ^ »-owi'-»coaoasaoot-cot^'^OT-icoo ^ti lO ^1 c^ t- w ^s« OS t- m *-< 05 M r- ^" o iftin^'ccoco^^'o'co'co'co' Csi(D CO OS CO ^ CQ 00 *^ ^~* C^ ^# tH OOOOOOOOOOQOOOOOO 000000C50000OO0000 OOOOOOOOOOOOOOOQO t-OOOOOOOOOOOOOOOiO oooioasoooiomoocMcoocoasw o 00 '^* c4" o r^ c^' o 00 o CO* o W" cc" c^'od 00 •lOCOOWJWt-COCOPOJOCO^iC ■ '(Ji CO CO lO ^ N *-t HrH 1-HC^JiM »OC0C^Ji-<05ClCCiC<)i>l-HC^'^^H00Ol000 i-liOOOCCir'^'OSOSCOCOCOOONOOCDOlO €0C0l0l0C0OC^t-'t-»nW05t-Ot-^M OC^COCO^tCCO'«-t005'-nC:005i-'OCO OOOOCOO'^CS^Ir-iO^Ot-T-i-^^OOOOO 00 05 o" os" CO* ei t-" co ctT o ^" ^^ o* os cm' os o" O'-iCMC-'COOOCO-^iOCOCMOOO'-i'^U^O W^fi^^^T-.CO ^ CMCM C^ •OS ©a tOWtOOOtOOOOOOlOOOOlOOWWO'H ■ 2 a _ E-: _Sai-ioofc-t- oi-Im a _'""^-' o o aj u-^ -j3— .0 ■^ P :S v^ >* K -^^ O C C a a :S g m o o o ,-^ fc. . ^ A r. r, 72 , c5 cr^ eg tfl 5 « t'- » irt ff; — -^ fj M I - « M rj fj *«• »ft b s ^ ^ i ai < = J5S 10 10 10 MOD ecfS — — r? X 4« 55 — ttl — ^M'^ rct^3cror;>-':iBm"»ox« — r? M?5 M " — M SaoNno — P3 — ?o MMfJrtS — — 0«5t^ — MtC"WM — -H M o; >.': ^' i~^ ci M -- o »<5 ■ >.fl .Erta ?. B- = ■? .B = BDiia« es-: o; ^|5 , 0) 4J ? > _— o O o t^*- --"Eb ~ O y: 3 O 3 — ■O-C-O b O i; c 5 ass.-iBQ T. V, V. TS 5f "j u I- u Q a :9 S .2 iJ s a -a o c o ,';> *^ X c/3 y; K H cfl 3& S 541 PROCEEDINGS OF THE ELEVENTH ANNUAL MEET- ING OF THE ILLINOIS CONFERENCE OF CHARITIES. Officers and Committees for 1907. OFFICERS. President, Dr. Frank P. Norbury, Jacksonville ; Vice President, F. S. O'Reilly, Peoria; Secretary, William C. Graves, Springfield. COMMITTEES. Executive Committee — W. B. Moulton, Chicago, Chair- man ; Mrs. George Watkins, Chicago ; Mrs. James A. Par- sons, Jacksonville; Thomas J. Clark, Quincy; Rabbi A. Traugott, Springfield. Children — Mrs. Ophelia L. Amigh, Geneva, Chairman; W. L. Bodine, Chicago; Edward L. Bradley. Lake Villa; Mrs. Lillian Danskin, Jacksonville ; Rev. C. C. Knobel, Chicago ; Rev. J. C. Quille, Chicago ; Dr. W. H. C. Smith, Godfrey ; Mrs. Eleanor Tobie, Quincy ; Rev. Charles Vir- den, Evanston. Penology — John L. Whitman, Chicago, Chairman; Joseph Brodman, Peoria ; Mrs. Sophia DeMuth, Alton ; Fay Lewis, Rockford ; F. Emory Lyon, Chicago ; M. M. Mallary, Pontiac; Mrs. John M. Palmer, Springfield. Etiology of Dependence — Dr. V. H. Podstata, Elgin, Chairman ; Mrs. Alice E. Bates, Chicago ; Dr. H. B. Carriel, Jacksonville; Dr. Josephine Milligan, Jacksonville; Dr. H. T. Patrick, Chicago. Business Administration of Public Institutions — Colonel Henry Davis, Springfield, Chairman ; G. DeForest Kinney, Peoria ; Mrs. Rosina Wells. Geneva ; Frank D. Whipp, Springfield ; William Wickersham, Joliet. Public Care of Poor — Mrs. James J. Armstrong, Ottawa, Chairman ; John W. Belmont, Chicago ; J. R. Leary, Rush- ville ; J. W. Matthew, Macomb ; S. T. Metcalf, Buffalo : Dr. W. A. Nason, Algonquin. Voluntary Agency and the Needy Family — Mrs. R. B. Holmes, Chicago, Chairman ; Miss Ellen C. Babbitt, Chi- cago; Stuart Brown, Springfield; Emory Cobb, Kankakee; Walter C. Cosper, Peoria; Nannie M. Dunkin, Bloomington; Miss Harriet Fulmer, Chicago. Legislation — Dr. Frank P. Norbury, Jacksonville, Chair- man; Miss Sarah L. Montgomery, Springfield; Mrs. Plan- nah G. Solomon, Chicago; Judge C. 15. AlcCrory, Quincy; Dr. H. H. Hart, Chicago; Sherman C. Kingsley, Chicago; E. P. Bicknell, Chicago. 542 The Program. FIRST SESSION OF THE CONFERENCE. (Oct. 2, S:00 P. M., Sherman House Club Room.) Address of Welcome Hon. Edward F. Dunne (Mayor of Chicago.) Response and President's Address Ernest P. Bickneli (President of Conference.) "Service in Illinois Charitable Institutions". . .Dr. Frank Billings (President State Board of Charities.) "Charity Service in European Institutions". . .Dr. Emil G. Hirsch (Member State Board of Charities.) "National Conference of Charities" Amos W. Butler (President National Conference.) SECOND SESSION OF THE CONFERENCE— EPILEPTICS AND FEEBLE-MINDED. (Oct. 25, 10:00 A. M., at Hull House.) Welcome Miss Jane Addams Report of Committee on Epileptics and Feeble-Minded. . . Dr. George A. Zeller "The Proper Treatment and Care of Epileptics" Dr. Hugh T. Patrick Discussion, Opened by Dr. Frank S. Churchill THIRD SESSION OF THE CONFERENCE— PROBLEMS PRE- SENTED AT DUNNING. (Oct. 25, 2:00 P. M., Cook County htstitutions at Dunninfj.i Cook County Charity Service". . . .The Hon. Edward J. Brundage (President of the Board of Cook County Commissioners.) Flelatlon of Alcohol to the Dunnine; Population" Dr. O. C. Willhito, General Superintendent I'iconomy in the Care of Tuberculous Patients in Small Sanatoria" Mrs. L. A. Hamlin 1 5>iscu8sion. 543 FOURTH SESSION OF THE CONFERENCE— CIVIL SERVICE —NURSING. (Oct. 25, 8:00 P. M., Chicago Commons.) Welcome Prof. Graham Taylor Report of Committee on Civil Service. . .Chairman W. B. Moulton Nursing and Attendant Service and Compulsory Training Schools Dr. V. H. Podstata, Supt. Northern Hospital for the Insane. Discussion. FIFTH SESSION OF THE CONFERENCE— CHILDREN. (Oct. 26, Morning and Afternoon, Sherman Park Neighborhood Center Building.) "Service in South Park Neighborhood Center Buildings" Hon. Henry G. Foreman (Member South Park Commissioners.) "Visitation of Children" Report by Rev. Charles Virden (Chairman of Committee.) "Experience of a State Agent in Visiting Children" Miss Katherine Gallagher (Visitor State Board of Charities.) "Juvenile Court Work Outside of Cook County" Report of Mrs. James A. Parsons (Chairman of Committee.) "Juvenile Court Law as Applied Outside of Cook County in Illinois" Hon. C. B. McCrory (County Judge, Quincy, Illinois.) Discussion. Business Session. Committee Reports. Election of Officers. 544 Introduction. Theory and practice. Acute Inter- eRt In Memorable in the annals of the Illinois State Conference of Charities is the eleventh annual meeting, because of the object lessons it afforded. The program was interesting. The sessions were held in places in four parts of Chicago, each affording opportunities for charity devotees and soci- ologists to study their work not only in theory, but prac- tically. Hull House, with its many settlement features ; the great Cook county institutions at Dunning, with their three- fold public charity service ; the Chicago Commons, with its varied work in a different part of the city from that served by Hull House ; and the neighborhood Center building in the new Sherman Park, gave practical demonstrations of great value. Furthermore, the time of the meeting fell in a period lie chad"^ when a great effort to improve the public charity service in *'^*- Illinois State institutions was approaching a test in the Gen- eral Assembly. Attendance. The attendance at all these sessions was large, especially that on the opening night, when 275 persons were present. The smallest attendance was 140. Committee on Legislation. A new departure was the appointment of a special com- mittee on legislation to aid the State Board of Charities with bills during the then approaching session of the Gen- eral Assembly. Ne.xt Meeting of Conference. Die Committece on Time and Place decided that the next meeting of the conference shall be held in Jacksom'illc the first week in October, igoy. The Executive Committee was instructed to fix the exact dates, which have been fixed as Oct. 0, evcnitii^ ; Oct. ro. moruiif(^ afternoon and evening: \and Oct 11, woruin^^ and afternoon. Details of the program will be furnished later, but reference to the title of the sev- eral committees will indicate the nature of the program. Many are present. Aid to Board of Charltled, At .InckHon- villo In OctolxT. 545 Almshouse Superintendents. [ • A special effort will be made at the Jacksonville meeting to hcive a session devoted to almshouses. Chairmen of alms- ^fatfon."^' house committees and superintendents of these institutions are cordially invited to attend and take part. Boards of supervisors and county boards are respectfully requested to authorize their almshouse committee chairman and alms- house superintendents to attend, at county expense. This request is made in the firm belief that, if the county officials of the different counties, having to do with the care of the poor, will meet and discuss their work, they can help each other to ways of more eiUcient and more economical admin- istration. Membership. Any person who is genuinely interested in improving the condition of the dependent and delinquent and criminal classes can become a member of the Illinois State Confer- ence of Charities. There is no membership nor any other fee. Just come to the conference and register your name and address. There are 260 members at present. FIRST SESSION OF THE CONFERENCE. (Oct. 24, 8:00 p. m., Sherman House Club Room.) THE PROGRAM. Address of Welcome Hon. Edward F. Dunne, Mayor of Chicago Response and President's Address Ernest P. Biclefpctlves know the exact number now, but I quote the latest figures we houses" dependent populatioB. H8 [have — of the Insane there were 2390 in the almshouses of the counties of the State. I have separated Cook county from these remaining counties, because it is so large, and has such an enor- mous number. There were 1C15 in the Dunning inetitution on July first, I'JUo. leaving in other counties. 775 in the almshouses. Of the feeble-minded there were 544 In the almhouses, 104 at Dunning, and 440 in other county almshouses; of the epileptics, a census that Is not at all correct, 289 of which ICl were at Dun- Ing, and 128 In other Institutions. We find, from another census, there are 484 epileptics in the almshouses. Of the deaf mutes there were 37 In almshouses, five at Dunning, and 32 in the other counties; blind, 142, 27 in Cook county and 115 in the oilier counties. Making a total of 3402 Inefficient dependents in county almshouses, 1912 In Cook county, at Dunning, and 1490 in other counties. Alms bouses should be emptied. Primitive conditions. i Should Care for Ai.l Depkndents. I "First of all, the State Board of Charities believes that the State should take charge of all of these dependents. Inefficient dependents, now in almshouses, for the reason that the State i institutions, as I said a moment ago that the State Is better able Ito care for these people, to classify them and treat them, than is jany single county in the State. That is true with one exception jat this time, at Dunning. There is no hospital In this State, and ll doubt if many hospitals elsewhere In this country, that is better iable to care efficiently for the dependents of this county, or of the ! State, than Is the Institution at Dunning for the care of the In- Isane; and that Is due to the fact that within recent years a moral [force has been aroused in this community, which made changes 'in that Institution, which made»the authorities discharge a lay isuperintendent, and place In charge there a medical superintend- ent, which established a training school for nurses, of high grade, jto care for the jihysically sick and acutely insane sick: which igave a staff under civil service; which fortunately placed in Icharge of that institution a very efficient medical superintendent, land therefore resulted in an Improvement in the Institution which ll shall be glad indeed if we are able to bring about In the State llnstltutions themselves, of equal degree. [Applause.] "But In other almshouses, and all but two of the counties have almshouses, where we have made visits, we found primitive con- ditions. By primitive conditions, I mean no hospital care, prac- tically speaking; and many of the insane, restrained In dark, Ill- ventilated rooms, unsanitary conditions, and in some instances chained with a chain and ball; Indeed, within a few months, one patient was taken to one State institution with his chain and ball upon his ankle. This primitive treatment of the Insane, of the feeble-minded, of the c])ilcptlcs. In almshouses. Is a disgrace to the State of Illinois [ Applause! and we as a Board of Charities, de- sire, this session, to bring before the legislature, a law which shall place all of the Inefficient dependents now in almshouses under State care, and we hope, that the moral force of this audience, and of all that you may come in contact with, will stand back of that measure. Institution for the Epileptics. Mixed with "The State institutions caro for Its Insane, for Its feehle- in«nn(? and tiiinded, for its epileptics. In hnsidtals which were erected orl- mfnded. ^in-'iHy for the Insane and for the feeble-minded alone, and the rplleptlc has to live as the insane, when so assigned to the hos- 549 pital for the insane, or as feeble-minded in the institution for the feeble-minded, and receives treatment as an inmate of an institu- tion which is an asylum. There are in the almshouses, I have said, upon a not perfectly accurate census, 484 epileptics. There, are in the State, outside of institutions, many other epileptics, the number of which we do not know. In other states it has been estimated there is one epileptic to from 300 or 500 of population. With a population of five millions in Illinois, you see what that brings, as the number of epileptics in the State. Not one-tenth, [ certainly not one-eighth, of the epileptics of the State are cared for in State institutions, and while there are many of the epilep- tics cared for by families able to support them, able to give them treatment, private treatment and care that is efficient, there are a great number of epileptics of the State who are not assigned now to institutions, that do not receive adequate care. "If modern medicine and research have shown anything, they proper treat- have shown that the treatment of epilepsy, based upon medicine ment. alone, is a failure; that the epileptic who can be in the open air, who can have occupation upon mother earth, who can delve in the earth and can have plenty of fresh air, who can have good ventilated sleeping rooms, and can have this outdoor occupation, in many instances, recovers. If he does not recover, he does not progress into that state of dementia which is so common among ♦he epileptics who remain at home, and who rely upon medical treatment, or drug treatment, for an attempt to cure; and be- sides that, many of them can be taught in crafts, manual labor of different kinds, which enables them to become useful citizens, if they do not become entirely cured. And one of the measures we| feel should be pushed this winter is the establishment of the col- ony for epileptics, and the separation of the epileptics now in' State institutions from the insane, and from the feeble-minded.! They should be placed among their fellows. [Applause.] I "In 1899 the Legislature passed an act establishing a colony forJLaw for epileptics. Only a small sum was appropriated to look for the Epileptic site, and prepare plans and specifications. That money was ex- pended in looking for sites, and nothing else [laughter], and noth- ing has been done. Inasmuch as the Legislature already has legalized the establishment of such a colony, our efforts may be expended this winter in the attempt to have the Legislature ap- propriate a sum of money, and at the same time appoint a com- mission which shall establish this colony. "We hope, if the ap- propriation is made, that the Legislature may also be influenced to appoint a commission that will be sensible, in the establish- ment of the farm, with buildings appropriate for it, not monu- ments for an architect, but buildings suited, in cottage form, for the treatment of such people, with proper shops for the manual training of these people. SAX.\T0RrUM FOR CONSUMPTR-ES. "We have also considered, because it has been a question before ^^^^j us for so many years, the treatment of pulmonary consumption., disease. This is a subject so trite, so much has been said and written upon it, that it is not necessary that I take your time to speak of it to- night. It is the disease, as you know, that kills more of mankind, probably, than any other. It is next to insanity, or next to alco- holism, perhaps the most pauperizing of all of the diseases of mankind. It is the disease that fastens upon those that are forced to live in unhygienic conditions, and it is largely among those people that it claims its victims, for those that are well-to-do can afford to spend the money, and can afford to send their friends Colony. 550 Chronic cases. Acutely 8i<± liliyslcally. Acutely iDHane. where proper climate and treatment can be obtained. Further- more we know that drugs have failed in the attempt to benefit peoi)ie suffering from consumption. Furthermore we know that sunlight, good air, good food and rest do more for the consump- tive, and cure many of them, when the treatment is taken early enough. The care of the.se victims is a charity, a State neei, a thing that the State should take up. This would mean, again, a farm. It would not mean large buildings. It would mean build- ings of .administration, with good cottages, and good lavatories, toilet facilities for these people, with shacks to live in. It would not cost much to start it, and the only reason perhaps that we Will not press this question this time, is that question of expendi- Iture. The State has a large tax each year, so the members of the Legislature seem to feel that when they come to appropriate money, especially for the poor. [Laughter.] Hospital Cabe for I.nsa.ne a.nd Feeble-Minded. •■.\dw, in saying that much of some of the things we desire to do, I want to speak a moment of the State institutions, and espec- ially of our hospitals for the treatment of the sick, of the insane, I feeble-minded, and so on. There are two classes of people that are sent to these institutions, without regard, in one sense, to their mental condition. There are those that are chronically sick, men-, tally, the feeble-minded, who cannot be made better, under any [management. Those can not be made well. There are also the feeble-minded who can be improved and made better, can be taught certain things, perhaps things in books. There are others that cannot. Many of them can be taught what to do in a manual way. Some of them are physically sick and need care. Among the insane there are probably sixty per cent who are chronically and incurably insane. They never become better. They are of different degrees. Some of those people are hopelessly insane and helpless, and are mere charges on the State, to be cared for in a custodial way. There are others who, though incurably sick, and can never be well, yet can be taught to do certain manual things. While they can never become well, they are better off, because of their capacity in that respect. They can do certain things, and ought to be taught to do them. There is another class of Insane that is physically sick, and I am afraid even some of our superintendents in the hospitals have never considered the question sufficiently. .Among the population of Insane of over nine thousand, in the hospitals, on .Tuly first, there was just as large a proportion of those physically sick as among any other nine thousand people you might select — more of them, because they are invalids already, and they are physically sick; they need care. "Then there are those who are acutely sick In some brain way. or acutely Insane They need physical care. So that a hospital for the insane, or Institution for the feeble-minded. Is. in reality. a dual affair. It Is an institution for custodial care, and must be, In every sense of the word. It also is an institution for the treat- ment of the physically sick, and for the treatment of those men- tally sick and acutely sick, and, therefore, its administration must bo thorough. The other day. in a conference at Springfield, these questions were discussed; first of all. the medical administration. Let me tell you something of what was said, and how it was agreed to by all those present. First of all, the medical adminis- tration. There should be a superintendent, and that superintend- ent should be an educated man, educated as an alienist, should have experience, be progressive, broad, sympathetic; he should 551 search. bave character, for, as they said, upon the character of the super- intendent depends the efficiency of the institution, above every- thing else. He should have his way, as long as he is progressive, and if he ceases to be of benefit to his institution and to man- kind, it is time for him to go. He should be the chief. He should have absolute sway. No other man, as long as he is efficient, should say him nay in his institution. He should have, under him, an efficient medical staff, and we feel that in every institu- tion where women are cared for, there should be a woman phy- sician. He should have a chief of staff, who stands next to him and who shall be his mouthpiece, in many instances, in staff gatherings. He should have a sufficient staff to care for his patients, and especially those physically sick and his acutely insane patients. In such an institution the superintendent, in the division of his work, must recognize the fact that in the custodial care of those incurably sick, there may be a great number of them assigned to one physician, and very many less assigned, when physically sick or acutely insane, to physicians. State Psychopathic Institute. I "There should be in this State something that does not exist inlpor study any other state in the country except one, a State Psycopathic In-; ^°<^ re- stitute; and by that we mean an institution which shall be one of research, presided over by a man in one of the institutions, who is, first of all, an alienist, by education and by experience, who is expert as an diagnostician, and in all of the measures of modern medicine in making the diagnosis, whether in ordinary sickness or in insanity, and at the same time is expert as a path- ologist, who should be the leaven which would leaven not only the medical staff of that institution in teaching them how to work upon the living, more perfectly and more thoroughly than upon the dead; but every medical employe of any state institution who could go to this institute for any length of time, to receive in- struction of the modern character. "I am glad to say to you that, with the acquiescence of the Governor Governor, the Institute for Psychopathology has been es- favors It tablished in Illinois. [Applause.] One of our hospitals will have established that institute before the first of January. We have been promised that the funds of that institution shall go for the establishment of it, and that we shall have the support of the administration in securing an appropriation to carry that work on efficiently. I "Now this means to every medical employe in the State institu-ljyjgyg^.g ^^^.^ tions a source of instruction and pleasure that nothing else could in New give him. One institution in this country is at Ward's Island, York. New York, presided over by Dr. Adolph Meyer, who at one time was the pathologist at Kankakee. If this State had treated Dr. Meyer right, as it should have done, we would have had the in- stitute long before this. Ward's Island would not have had Meyer. Last year, in his report, he makes the statement that he had, at the institute at Ward's Island, sixty doctors from the State insti- tutions of New York, who were there as pupils. Think of it, what ir means! It means research. It means looking into everything that is connected with psychiatry, causes of insanity. It means better nomenclature of disease in the hospitals than we have had. It means properly written records. It means uniform records, because this man will not stand for records differing in every in- stitution. It means expressions in those records which throw some light on the diagnosis. It means something in those records of prognosis, based upon the diagnosis, and then, if that Individ- 552 Benefit to doctore In general practice. Soma good ; some bad. iial comes to post mortem, it means something when the brain is examined, because the physician will have made an examination of the living individual, and will have down in an orderly way the symptoms from which he suffered. So that we see, it speaks much for our institutions, and it speaks much for the administra- tion of the State when we say that this early we have established a psychopathic institute. "A satisfactory clinic in psychiatry, such as we plan to estab- lish, means not only teaching the doctors in the State service, but teaching doctors in general practice who, as a rule, know little about insanity. It means that our medical students can gain a knowledge of insanity before they graduate, a knowledge that would mean sometUing. It would mean that all over the State would go out pupils who had the benefit of that clinic in psychia- try, who would recognize insanity, and recognize its causes. For. as much as we talk about insanity and its causes, we do not know as much about it as we should, and such pupils going out every- where would perhaps be able to stem the tide, for, as you know, insanity is increasing. It is estimated in the New England states — we haven't an estimate in the west, because we have had no census as yet — but the increase in insanity in the New England [states, according to the census made, is about three per cent per annum. I Physical Condition of Institutions. "The present phy.sical condition of our State institutions, some of them, is good. Some of them are new. They are built under the charge of sensible men, and while we might differ as to the best plan, as to whether it should be a pavilion or the cottage jplan, still same of those buildings, built upon both plans, are in igood condition. Some of the older institutions are not in good i physical condition. That is due to the fact that some of the ! buildings are old, and also due to the fact that they have not been kept up. There has been a laissez nous faire sentiment, so far as the State institutions are concerned, apparently. What was no group of men's business was apparently nobody's business, and, as a result of it. some of the older institutions are in bad physical condition,, bad physical condition because of want of air space for patients, and indeed most of them are lacking in that, but the older ones are worse, lacking in proper plumbing facilities, drain- age and all that, some of them are deplorable in that respect: lacking in proper furniture, old wood beds are still used in some of the older institutions, notably at Kankakee and Elgin, because no one has made it his business to get better ones, that is all. They have let it go. It is fully half, isn't it. Dr. Greene, at Kan- kakee [answer: "More"] more than half of the 2.300 beds at Kan- kakee are the old wood beds put in 20 or 2.^ years ago. The spring is gone, and in i)lace of a spring, boards are nailed to the bed. That is the spring they give the insane patient. These boards are covered with a straw mattress, made of rye straw. That soft kind of rye straw. fLaughter.] As you know rye straw is the roughest of all. This was covered over with one sheet, and one blanket, for over half of the patients of this state institution. Elgin is practically as bad. When we had spoken about that re- cently, those in charge of the administration said, we want iron beds, and we are going to have iron bods, in time, for these insti- tutions, but it is going to take a long time to get everything in the condition where it should bo. The institutions are overcrowded. We nood now buildings. There are more patients to the cubic air space than there should be. This must be remedied, and will be Iremedled In time, but cannot be remedied at once. 553 "The patients are there. The superintendents are endeavoring Patients out to get them out in the summer time, and we can but give a world tTme"™™^"^ of praise to the superintendents of the hospitals, particularly those who have taken an interest in it, and are getting the pa- tients out. At Watertown where they had this good feeling, they encouraged the patients, and they were put out in the woods, in the fields, where the conditions are such they could not escape, and left perfectly free. They become very much better in that open-air treatment, eating there, sleeping there. And in other in- stitutions, they are. in much the same way, put at work out in the fields, as I have understood the superintendent down there for instance — not quoting that to say that is The One, and all the rest are not so good — but that the big truck garden there at Water- town, run with patients, with only two hired employes, raised enough garden truck to supply the whole institution; and then, ^o°^"°^P' recognizing tuberculosis, and its need of good air. Dr. Zeller at tents. Bartonville has 26 patients in tents. Other institutions are doing the same things. It will be done, furthermore, at Kankakee, and other places, just as it is done there. So far as the mere adminis- tration, with the lack of facilities, is concerned, things are better then they were, and are growing better, every day. Tbaijjing School for Nurses. "The need of a training school I only wish to emphasize, and ^"^L^s'*^^ in emphasizing that, to say what I think is in the mind of every superintendent today, if it was not formerly, I think it is today, after our conference, that there should be a training school for nurses in every institution, but that that training school should be to train nurses to care for the physically sick and acutely sick Insane. It would be wrong, absolutely wrong, to ask any women, educated and intelligent enough to be a good nurse, to train to take care of a lot of incurably, hopelessly insane patients; but in every institution there are anywhere from 20 to 40 per cent of patients who are physically sick and acutely sick, and they need the same care in nursing that you and I do when we are sick, and when we are not insane. [Applause.] And in these institutions we have the word of the trustees and superintendents of every hospital, that that training school shall be established and of the administration that it shall be done, and for the remainder of the patients that there should be attendants — good kindly women and men, who would care for them as they would care for sick child- ren, the attendants are not trained nurses. By that means we will have trained nurses, who receive exactly the same training' they receive in the best hospitals of the land, that are not insane * hospitals, so that we are not doing injustice to the young womer who are asked to take the training, and are arranging, at the same time, efficient care and nursing for those physically sick in the insane hospitals, and also for nurses that may go out, to you and to me. Survey of Physical Conditions. "We are having a survey made, of the physical condition of the buildings, by the State architect. He has already made a survey insufficient, so far as ventilation goes, and has found, as I say in general, de- ficiencies worse in some institutions than in others. He has madel recommendations concerning the improvement of them. About the first of December we shall have a survey made concerning the hygienic conditions, concerning the heating, the lighting plants,' and all that, as to their deficiencies, and be able before another 554 Obliterated from with- in. Moral force necessary. conference to make data concerning the cost of placing these in- stitutions in a better physical condition, and that we hope to have I done, as soon as the money can be appropriated for it, and as 'soon as the work can be done. It will take time. Dr. Greene, sup criiiiciKleiit at Kankakee, told me the other day he thought it would require two years to do half of the work at Kankakee, and place it in good condition, but it will be commenced at once. Ele.ment of Politics. "Mr. Bicknell said he felt that politics was obliterated from the institutions. I want to second that, that it is obliterated from within. I doubt if, under the present regime, we shall ever hear of politics within an institution, but as Governor Deneen said the other day, in addressing us, we can not abolish external politics as easily. That will go on. more or less, and to render that as little as possible, to render it harmless, we must have moral sup- port, and without conceit may I say to you that I believe that your present Board of Charities can arouse a moral support to aid that. [Laughter.] I speak for the members, not myself [applause], and I think that no other word is necessary, to put it in thiit way, concerning the honesty and sincerity of purpose of the Chief Executive of this State, than that he appointed those people as members of the State Board of Charities. [Applause.] [""'urthermore we have his word, and I believe it. "I belifve, as Mr. Bicknell has said, that a new era has come, but it won't remain with us, nor do anything, unless this moral force which has been awakened will go on and do something. Our State charities and institutions differ from our private charities, in that they are governed by the State, and under a certain poli- tical control. In the past it has been the business of those in control to look after them, and if anything went wrong, it ap- parently was no man's business to set it right. Apparently there has not been a moral force awakened in this State, for a long time, to direct and awaken a sentiment against deterioration, but I believe that it is more the fault of the community than it is the fault of the i)olitici;iii. that our State institutions got into the rut into which they went. I oelieve if the proper direction had been given, long before this, and proper sentiment expressed, jiroper direction given of the moral energies, this work would not have been delayed until now. I thank you." [Applause.] latroductlon. Trip abrond. I>RmpooDR an Ameri- can Idon. CH.AKn^' SI-RX'ICK IN EUROPEAN INSTITUi I TIONS. Dr. Emil G. Hirsch, member of the State Board of Chari- ties, followed Dr. Billings with an address tm "Charity Ser- Ivicc in European Institutions." In introducini;^ Dr. Hirsch, President Bicknell said : "Dr. Hirsch, whom you all know well, has had special oppor- tunities this past summer, when he has been abroad, to see what peoi)lo in other countries arc doing in charitable work, and the fact that he had, a short time before going abroad, become a member of the Board of State Charities, lent a double interest to his trip. He has very kindly consented to talk to us tonight ial){)iit that trip. T, therefore, am very happy to introduce Dr. Hirsch." Dr. Hirsch said : "I am afraid Mr. Bicknell promised you more than I can de- liver, but, being of foreign birth myself — a crime which is occa- sionally not forgiven in America, but in my own case I plead extenuating circumstances — I was not consulted as to the place 555 where I would be born [I^aughter] — I have still somewhat the; suspicion that even Americans can occasionally learn something from Europe. The strangest thing is that they have charitable institutions in Europe, for, to believe the common talk of the genuine Americans, every pauper and every insane, every de- pendent and every defective person has been shipped from Europe to America. [Laughter.] And foreigners fill the peni- tentiaries, though occasionally a genuine American banker will insist upon being admitted to this exclusive club, but, otherwise, the foreigners fill the penitentiary. We foreigners are constitut- ing the largest percentage of the population of the almshouses. If it were not for these blasted foreigners there would be no in- mates of our insane asylums. [Laughter.] Indeed, it is strange when you hear that in almost every American publication, when you are familiar with the fact that even clergymen in their weekly assemblies — you can spell that weakly, whichever way you choose, and hit it — in their weekly assemblies ring their changes on this thing — that we ought to attempt to stop the in- flux of these foreigners. It is really strange when you go to Europe you find they have yet a surplus stock left on hands there, that they know how to take care of. I "Instead of building ships and sending them to New York, theyL, , . . .. are building model institutions, and are busy studying all the nition^^ problems bearing on the perplexities of dependency or of de- ficiency. Of course, these institutions are run on the entirely un- American plan. Politics are not known. They never ask which party the employe belongs to, and which ticket he has voted at the last election. They don't buy their supplies at the party store, and it is a matter of the greatest indifference to them whether the bread used in the institution is baked by the Demo- cratic baker that belongs to the proper faction. It used to be an essential element of proper administration here that the bread should go from the proper Democratic or proper Republican baker, and belong to the proper faction of the party. It was essential that the power of the machine should, by absorption of material food, also be absorbed as the proper political faith — I Laughter] — perhaps because of the homeopathic theory that like cures like, by introducing political insanity they might drive out physical defects of the brain, or functional disturbances of the nervous organization. In Europe they haven't had the light yet. They are still believing that insanity and all kindred ills of humanity are worthy of serious study. Two Classes of Employes. "So, after you get used to this totally un-American atmosphere i.ower grade in the European institutions, anfl you look around a little, you for old find they have two distinct classes of employes, that the lower service, the manual service, so to speak, the service of attendants, which does not require special professional preparation, is left largely in the hands of those that come from the army. In Ger- many especially is this the case. The German army needs a number of non-commissioned oflBcers, and in order to make the service attractice, the German government promises those that stay in the army nine years, or twelve years, employment after their discharge from the army, with the public Institutions, and so these ex-sergeants are drafted into the railroad service. If you travel on the German railroads you are sometimes reminded that the conductor was a sergeant, for he looks upon you some- times as if you were a raw recruit. So, also, in these public in- stitutions, the lower grades of the service are filled by those who soldiers. 55& Bl«meut of p«rma- ■•titled to pensions. Hlcher ger- Tlce. come from the army. Where no special professional preparation is required, they draw upon the supply of those who have filled itheir contract with the government to serve in the army nine or twelve years. This system, of course, supplies a constant stream of employes. "Here in our own State the difficulty has already been appar- ent — under the new system more especially than it was under the old. How shall we get men and women to enter into the ser- vice. The service is not very attractive; the pay is not very high. In Europe especially in Germany and France they find this con dition. Those that come from the army are glad to get a refuge in the institutions, in the lower grades of service. There is one 'element, even for these lower grades of service, if I may so speak of them, that makes for permanency. They pay is not much, but the positions are permanent As long as they are faithful and efTiciPut, even the German emperor can not remove them. The 'German emperor has less power to remove anyone than has the jmayor of this city, or the sheriff of any county in the United States. Once a man is in the civil service of Germany, he has a right to his position, and he cannot be discharged without due I process of law, and they have special courts for that. Unless the charge is proven, he is by law entitled to retain his position. JThis element of permanency extends even to the lower grades of the service. Besides this, these persons, even in the lower grades !are looked upon by the general public, not in the light of men that occupy a lower station; but the very fact that they are in the employment of the public institutions gives them something of social caste. "The third element is that these men feel that after they have discharged their duties faithfully and have become old, they are entitled to a pension. So it is in the interest of the individual to do his duty well, to obey the superior most implicitly, to be faithful, for he knows that having once been in this work. It all ; depends upon him whether he shall stay in it, and he stays In it jif he chooses to be loyal to his obligations. ' "As to the higher services In Europe, they demand professional training. They have courses In the universities and they have {cultivated other means for imparting instructions, where the problems or the science, as well as the art of public administra- tion is made the main subject of study, and the higher grades of the services are only filled by men or women that have shown, by examination, that they have profited from this course of In- struction. The moment you leave the ordinary manual service of the institution you are face to face with a man or woman that has had a professional training, that knows all about the work that is to be done, knows it not merely experimentally, knows it scientifically, and the service in France and Germany Is unified. You don't come upon one institution that has one set of principles and another institution with another set. That is due to the fact that through a perfect administrative system — up to the ministry of instriiction and religion, as they call it in Prussia — through a perfect, graduated system of subordinate and co-ordinate chan- nels of administration, this pyramid finally culminates in the 'pex of one in:in in charge of the whole svsteni under the juiblir ministry. He Is there, charged with looking after every Institii- tlon. Every question of administration Is brought to him: he jdecldea. And he is an expert man, too. He has received train- ing in the university In the subject which they have distinctively In Europe as the science of administration. He Is the man who Is In charge of questions of that kind, and as superior officer Ihas only the minister of Instruction. He reports to him. and the 557 minister of instruction and public administration gives the final decisions. So you see, the whole thing is based upon a scientific appreciation of the fact that men must be trained for special work. That Americans have shown a wonderful versatility, I know. I must say, you Americans have, because I am not an American by birth. I like that versatility. You Americans, by birth have, essentially, a wonderful versatility. You can fit into any place, if you choose. So, therefore, possibly, for many years you thought it not necessary to prepare .men for special work. But in late years I believe we have come to understand that with the complexity of modern life there are many things that cannot be well done except by men and women specially trained. The day for Jacks-of-all-Trades has gone, and it has gone even in the administration of our public institutions. CivEL Service Examinations. "Our civil service examinations, perhaps, need a little modifica-'j^p^^ modl- tion. I am not a believer absolutely in the test that makes ac- ticatlon. curacy of spelling, for instance, one of the decisive factors. I believe a great many men are much more adapted to do a cer- tain kind of work who spell phonetically, and have their own phonetic system at that [Laughter] than are others who spell correctly. This mere test of spelling is not the test after all. There is always an element that might be called the personal equation. But if we handle our civil service examinations, — and they will develop in course of time, — and get them so arranged as to ascertain whether or not the candidate has thoroughly ac- quainted himself with the literature and science of that special work he is to undertake, then the civil service examinations will be of much more practical good to the State, and many objections now raised to them will fall to the ground. The Bubeaucratic Atmosphere. "We have taken the very first step in the right direction, as I hope. The administration of the German institutions, for this s'^tftuMoSi leason. Ijpins nnifierl, throughout the Prussian kingdom at least unified — the other minor principalities and kingdoms have almost the same system — the Prussian system being insistent upon expert knowledge on the part of those that enter the service, has made it possible for Germany and Prussia to have institutions that on the administrative side leave but little to desire. Of course there is a bureaucratic atmosphere about them; but I believe if we have an alternative between two evils — of an atmosphere which reeks of the ward meeting, and where speech and manners of the ward heeler are dominant, or the atmosphere that has a taint of bureaucracy, I think in the interest of the poor dependents thei latter is the lesser evil. Germany has this bureaucratic atmos-| phere. The visitor must be very careful to ascertain the proper' title of the gentlemen with whom he is to speak. If one happens to use a wrong title, he is soon set to rights. If the attache has six titles, the gentleman is very careful to give him the six titles. I paraded all my titles in Germany. I even paraded as member of the State Board of Charities, when it was necessary. [Laugh- ter.] That is the German atmosphere. Of course, that goes too far, but, as I said, so long as these high feeling gentlemen do their work, and do it faithfully, we can overlook their little idiosyn- crasies about being properly labeled. Medical Administration. "The medical administration of the great hospitals and institu- Special tions of a quasi or directlv medical character, is also based upon '"^'llSf the idea that a man, to be at the head, or in any capacity, of. 558 Cblef physJ dans are alienists. these institutious, must have the proper professional traiuiug and experience. In other words, at the head of all these institutions is the medical director. As far as the medical administration goes, he is the supreme chief. He has only that central office in Berlin above liiiu. In cases of doubt and dispute he has to refer the matters to them. Then over in that centralized office is an expert physician, who knows all about the matters of medicine, surgery and science that come into play. The chief medical di rector is in Europe not entrusted with the physical care of the people. The chief administrator of all these institutions, who has charge of the physical administration, the man of the material ;needs, is not a medical expert, but he has made the science of physical administration his specialty. He buys the supplies, and they are bought according to government regulations. They are supplied from a central office, the whole thing being wonderfully well systematized. But the medical director has charge of all medical needs, and most of these public institutions, and for that matter the private institutions throughout Europe, maintain a very close connection with the university. The university spirit of research is found in almost all of them. The medical director who would not keep abreast with the latest theories, and latest university researches, would soon find himself out of sympathy with all his surroundings and be relegated to the rear. The medi- cal director and the staff are anxious to keep up their scientific attainments. Most of the medical institutions are placed for clinical study. Students of the universities are brought there and instructed by the chief physician and his staff. None of the phy- sicians in these institutions is merely taken because he is an M.D. They know the M.D. may be a very good man and still be not competent to have charge of an institution devoted to a spe- Iclal work. "The chief physicians in charge of all these insane hospitals are alienists. Their assistants are alienists. They make this their special study, and so in their institutions for the feeble minded. I happened to look, with another physician, over a set of so-called records, in one of our institutions. They must have come from the days of Noah, must have been saved from the flood. The nomenclature was something wonderful, the diag- nosis based on the symptoms recorded. Such terras I never heard. That was an M.D. who probably had had the medical education, hut having to do so much with feeble-minded children, probably ,hls own mind was a little bit affected by his environment. In all these institutions in Europe, at the head of these institutions and the whole medical staff, you find men that make things their specialty. An alienist is not put in charge of the children's insti- tution, a surgeon is not put in charge of the institution for the Insane. Of course, wherever there is need for the surgeon, one Is callod in. and to every one of those institutions is attached a special visiting staff. They have experts in the treatment of the eyes, they have experts in the treatment of the nose and throat, they have experts in dentistry. In all these Institutions. Indlvl(l(inll/o •ftcb pa tlptit Small Institi;tions. ■•.\iiollnr tiling that strikes a visitor is that the institutions are not on a very largo scale. They don't like these immense Institutions. We In America believe that everything must be big. If wo can say we have so many inmates in our Insane asylum, we think we have a big state. That reminds me of what happened In Baltimore. I began my career in Baltimore. The Jews of iBaltlmore Instituted, shortly after I went there, an orphan 559 asylum. It was a very small affair at the beginning. They had may be twenty inmates. The mayor of Baltimore began his ad- dress, complimenting as they always do on those occasions, the Hebrews, for their charitable inclinations and such things. They forget those things the day after, but they complimented us on those days, always. He said he hoped this institution would, within a very few years, — mind you, it was an orphan asylum, — grow to immense proportions. [Laughter.] That was in Balti- more, in the year 1877. He believed in those large institutions. In Europe they don't. They attempt to reduce the institutions in magnitude, so that they can individualize, if possible, the patient. Of course, these institutions are not a fac simile of ours. They even have pay patients. The pay patients are classified according to the amount they can afford to pay, and they receive comforts in keeping with the sum that is paid. That is, of course, thor- oughly un-American and unnecessary. In that regard our institu- tions are much better than they are in Europe. Abchitectube. "Now, another thing, — as to the architecture. I hope we are getting out of the idea that an institution of that kind must have ^^^j^ p^*^^*^"" a picture front. Of course, we lack in ruins, here in America. We have no Norman castles, no old robber baronial mansions. Therefore, in order to supply that deficiency our architects be- lieve a penitentiary must be a baronial mansion and our insane asylums must remind one of a castle in Normandy. That is the way the old institutions were built — picture architecture. The front was the main thing. Usefulness was a minor consideration. We have outgrown the boy days of our development, and have come to understand that buildings must be fitted to the purpose, and not the purpose curtailed to the front of the building. And so we are advancing along the lines they have long since adopted in Europe, that is to say, that these Institutions shall be built so that they can be destroyed, if necessary, and rebuilt at little cost. "I believe Dr. Billings will not say that I am venturing on dangerous ground. I believe I have heard physicians say. and have read it, that a building used for hospital purposes becomes Impregnated after a while. The best thing to do to that building Is to put the torch to it. They have these institutions now in Europe, built on the barrack or cottage plan. They are rude buildings, constructed of very cheap material, possibly only one story in height. They are built with the view that, if one of these cottages becomes too much saturated with germs they can burn It and put up another. It Is statistically proven that hospital! buildings become useless after twenty years. It is folly, indeed,! to build a building to cost $400,000 that should be torn down and remodeled at a greater cost twenty years hence. They have ini Europe adopted the cottage plan. In fact they are getting away! from the Institutional plan as much as possible. "Even the Insane patients are sent among the common people, insane as soon as they are able to go. You know that in Belgium this placed system Is especially in vogtie. They have villages in Belgium where the insane roam about. They are boarders in families there. They are treated like guests. No particular harm has re- sulted. They are trying to get away from the Institutional plan In France, Germany and Belgium, as far as possible. America Ahead as to Nubses. "Of course, we can learn something from the Europeans, but Better In one respect we are far ahead of them. They haven't what we