valescing period when the acute insane are not so susceptible to morbid influences. But most important, because of the difficulty of determining at once in some cases the curability of the disease, is the possibility of keeping under observation doubtful cases until the character of their disease can be determined and they can be correctly classified. Transferences from the chronic to the acute buildings could also easily be made if any supposed chronic case should manifest signs of mental improvement.
The State has always recognized the principle that curable patients required more and better care and attention than the chronic cases. This was formerly shown by the greater sums per patient given to the hospitals for the acute insane. The same fact underlies the present allowance of $4.25 per week for the first three years of hospital residence, the presumably curable period, and $2.50 per week for the remaining time, when the patient would be regarded as chronic. This is an exceedingly poor, though probably under the circumstances the best, way to meet this problem, the difference in the character of the care required by the curable and the chronic patients. Only sixty per cent of the admissions are curable cases; the others can be diagnosed as incurable at the first meeting, and require only the simple care which chronic patients should receive. As the hospitals are now constituted, the acute cases are placed among the chronic, and of necessity can receive little more than the average care of the hospital. We have here a double injustice: first, greater sums are given for some patients (those whose recovery is hopeless from admission) than the character of care for their disease demands; second, many (those who are curable at admission) do not receive the extra care which their illness demands, and to which the increased sum ($4.25) entitles them. It practically means, therefore, that the increased sums received from the recent cases go to elevate the general standard of care of all the patients rather than to be expended exclusively on the acute cases for whom this increased amount is given. Thus the chronic cases get more care than it was designed that they should have, or than they really need, and the acute patients are deprived of the better care and attention which it was intended they should receive.
"The duty of the State is such provision as to accomplish the largest result in the restoration to health of curable cases, the element of expense being here a subordinate one, and for the remainder such comfortable provision as shall insure safety to the community and humane care to the sufferer."
- Address of Dr. W. W. Godding, Superintendent of the Government Hospital for the Insane, Washington, D. C, read before the National Conference of Charities and Corrections, September 16, 1880.