range of movement, and that huddling them together in close proximity produces constant excitement, noise, quarreling and collision utterly preventive of recovery or comfort.

The evils of this crowded condition became so obvious that the municipal government ordered the erection of two more buildings capable of lodging in a proper way 144 patients. They were opened about two years ago, but as the annual increase of patients, during the last five or six years, has been about 77, the relative capacity of the institution is no larger than it was when this addition was made.

In regard to another of the above-named requisites in the management of a hospital for the insane, viz., means of occupation, the deficiency could scarcely be greater, while its ordinary consequences are rendered all the more deplorable by the crowded state of the house. There can be few more pitiable spectacles than that witnessed there every day, of hundreds of men overcharged with nervous excitement, whose restless movements are confined to the limits of a narrow hall, and of as many more, silent and depressed, crouching down in corners and by-places-all of them worrying one another, and speedily losing from sheer inaction whatever of mind their disease may have left. If there is anything well settled in regard to the management of the insane, it is the paramount importance of occupation, the restorative effect of which surpasses that of any other agency, or, I might safely say, of all other agencies together. In every hospital in France, Germany and Great Britain, every patient is employed who has the slightest inclination for employment, while those who are listless and indifferent and self-absorbed, become interested in what is passing around them, and are more easily lured into some active and healthful exercise of mind. On the ample farm or in the numerous workshops, every patient is employed except such as are prostrated by sickness or deprived of all self-control by the violence of mental excitement. In this country the employment most favored is that of farming and gardening, because it is that which requires the least preparatory training and has the advantage which all out-of-door employment has over that which is pursued within doors. In this part of the country it has the additional merit of being the most profitable pecuniarily. Accordingly, no hospital has been erected here of late years without a

considerable quantity of land attached to it—not one, if I recollect aright, with less than one acre to every male patient. Our duty to the insane committed to our charge will not be performed in the manner required by the advanced sentiment of our time, without giving them the means of agricultural employment; and that implies a removal of the hospital some ten or twelve miles into the country, and a farm of at least 400 acres.

Again, the close proximity of our hospital to a large city exposes the patients to the interference of a multitude of people who, as loafers, idlers, or sight-seers, are always ready to bestow their leisure upon others. They take up the time of the employes, they give the patients what they ought not to have, such as money, tobacco, matches; they tell them what they ought not to hear, such as news about their domestic affairs; and make remarks about patients which reach their friends and cause anxiety and distress. Some, bent on a higher degree of iniquity, break into the building, through doors or windows.

Another reason for removal is that the present association of the insane with paupers is attended with no benefit to either class, but with much discomfort and trouble to both. We have no right to subject the respectable poor to the constant spectacle of misery more deplorable than their own, nor ought the misfortune of being insane to draw upon any one the pains and penalties of pauperism. There are many insane in this community, whose friends, unable to pay the high prices of the corporate hospitals, would gladly avail themselves of the privileges of our hospital, and pay according to their means, if it could be done without virtually acknowledging themselves to be paupers.

I might mention other evils incident to our present method of caring for the insane, but my limits oblige me to hasten to another part of the subject.

The paupers proper are subjected to the same kind of interference from outsiders, that the insane are, adding much to the difficulty incident to their care under the most favorable circumstances. But the principal evil is the unavoidable idleness arising from the lack of suitable means of employment. True, some are employed in manufactures; such as making shoes, weaving cloth, making tin and wooden ware, accomplishing some iron-work and plumbing, but there still remains a considerable number who are

unfitted for any handicraft, but who might do good service on the land. Besides, all this work, except that which is done in repairs, is unprofitable, costing for the most part nearly if not quite as much as it would to buy the articles in the market. It is supposed, I know, that the House of Correction now building will make large drafts upon the almshouse, and probably it will, but it is difficult to see how that will remove the evil we complain of. Those who are idle here because ignorant of any skilled work, and incapable of learning, would be idle there, for the same reason, so that nothing would be gained economically by separating them from the general mass of paupers.

For the various reasons mentioned, I regard it as necessary to the best interests of all concerned that this department of the almshouse, as well as the insane, should be separated from the others, and placed in the country, within an easy distance of the city, with plenty of land to till.

Among the various departments of the almshouse is the general hospital for the subjects of bodily illness. The number of patients at this time is about one thousand. The medical staff, unexceptionally, is composed of men eminently qualified for their duties, by their skill, zeal and fidelity. The city hospital in such a community as this, should be second to no other in the country, in its power to promote the comfort and restoration of its patients. It should be an establishment which, in all its appointments and appliances, should be a model worthy of imitation, and an object of honest pride to the city. Such, however, is not the fact. The institution does not, by any means, fulfill in the highest degree the proper purposes of a hospital, and is not one which we may be fond of showing to visitors acquainted with the hospitals of other cities. I have time to indicate only very briefly its principal defects.

First and foremost is its crowded condition. With a capacity for about five hundred patients, it now has under care nearly one thousand. Not only are beds placed as closely as possible along the sides of the wards, but a large proportion of the patients lie on beds laid about on the floor in every available corner. There can be no surer way of making well people sick than that of crowding them together in their sleeping-rooms at night. For a still stronger reason such arrangements must be followed by simi

lar effects when applied to the sick, and our hospital furnishes no exception to the general rule, and the evil thus produced is not alleviated by any of those contrivances for frequently changing the air, such as steam-coils, or fires in the air-flues, or fans. Hotair furnaces furnish the only artificial ventilation; and, when they are not in use, the only dependence is on the doors and windows; and when these are closed at night, as they must be most of the time, the same air is repeatedly breathed by the patients. It needs no stretch of wisdom to see that such a state of things-crowded dormitories, and no artificial ventilation-must be a serious drawback on the curative influences of the hospital. It is well understood by medical men that the sanitary condition of a hospital is affected by the state of the air within the wards, more than by any other agency, and it is only folly to prepare for every other requirement and leave the air to take care of itself. I would not have it understood that the air of the Blockley Hospital is less pure than it might be expected in the absence of any artificial ventilation, because, considering the means used, it is uncommonly free from impurity. Still, we cannot ignore the evidence of its presence, in some degree. There, as everywhere else, bad air impairs the vital energies of the sick, thus thwarting the restorative influence of other measures, and depriving the system of that conservative power which is especially required after surgical operations.

Another adverse circumstance is found in the condition of the floors, walls and ceilings. The floors, badly laid in the first place, have been steadily suffering a process of deterioration, which now appears in the shape of holes, knots, splinters, and wide cracks necessarily filled with dirt, and sending out noxious exhalations after every washing. The walls, originally rough, have not been deprived by annual whitewashings of their power to retain effluvia full of the latent germs of disease. However trivial these things may seem at first sight, no thinking person connected with hospitals will deny the fact of their immense influence upon the hygienic state of the house.

Another adverse circumstance is indicated by the character of the nursing, which is performed chiefly by discharged patients who are ostensibly restored, but who are hardly adequate to any steady employment, and are willing for little or no pay to help in

the wards. By means of a few good nurses they are made as efficient as any people can be who are poorly compensated, and who feel only a corresponding degree of responsibility. If any service under the sun requires, in the highest degree, vigor of body and soundness of mind, it is that of attending upon the sick. No hospital can achieve the highest measure of success, whose attendants are not well paid, and in possession of all the strength and elasticity which only good health can supply. I ought to state that this kind of service is the result of economical considerations proceeding from the natural principle of saving the public from each and every expense that can possibly be dispensed with. I have no fault to find with the motive, but I doubt if the public are not, in the long run, actual losers by the arrangement.

From this same mistaken but imperative economy, very little has been done toward producing those mental influences so favorable to the recovery of the sick. Very often it is not so much the pills. or the potions which the patient takes that determine the result of the case, as it is the feelings and thoughts that he entertains. Especially is this so with the victim of chronic disease. His own troubles, which are bad enough, are not likely to be lightened by the constant sight of others as wretched as himself, and, as a matter of course, he becomes despondent and little cares whether he lives or dies. This is the great obstacle which the hospital phy sician is obliged to encounter, and which is sufficient very often to thwart his most skillful efforts to effect recovery. He knows that whatever tends to draw his patient's thoughts off from himself, to suggest cheerful reflections, to excite a healthy interest in matters foreign to himself and his surroundings, it is one of the legitimate functions of a hospital to provide. Pictures on the walls, flowers in their season on the tables, books and newspapers without stint, the means of playing at popular games—all have a restorative influence, and no hospital that lacks them can claim to be considered as fully prepared for its allotted work. The reproach of such imperfection our hospital must bear, for it has scarcely any of those things.

Last, but not least, is that great crowning evil which, sooner or later, blasts all hospitals which have not met the deteriorating effects of long-continued use by an increasing process of repairs and improvements. It is a curious fact, but none the less true,