The reports of the board for subsequent years also contain references to the neglect of the defective classes by the legislature. *78 In 1902 the state was badly in need of an asylum for the criminal insane and although the matter had been brought to the attention of the legislature several times, no appropriation had been made for such an institution. *79 Moreover, the General Agent of the board declared that so great was the overcrowding of institutions for defectives, such as the blind, the deaf mutes and the feeble-minded, that he often had difficulty in advising authorities where to place dependents belonging to these classes.80

The lack of accommodations for the indigent insane was emphasized by the report of the Committee on Lunacy in the same year (1902). "From every state hospital," they wrote, "comes the cry of overcrowding, and the almost supplication for much needed depletion." Wards were crowded by day; every available foot of floor space in corridors was utilized for for sleeping quarters; while in the dormitories beds were so closely placed that proper sanitation was almost out of the question. *81

It was alleged that funds for building additional asylums were not to be had. This excuse the Committee on Lunacy deemed weak, since the General Assembly found ample funds for the support of private hospitals. The committee gave full recognition to the responsibility of the state to classes other than the insane, but they deprecated lavish appropriations to local hospitals while the insane were so inadequately provided for. *82 In their opinion it was time the state eliminated some of these appropriations and devoted the funds thus released to needs more pressing and to services that affected the community at large. Furthermore, they asserted that many of the new hospitals were unnecessary and served only to duplicate existing accommodations. *83 During the years 1902-1915 additional accommodations for the insane and the feeble-minded were provided. But even now facilities are inadequate. *84

79 Board of Public Charities, Report (1902), p. 3. 80 Idem, Report (1902),p.4.

81 Idem, Report of the Committee on Lunacy, p. 8.

82 Ibid.

83 Idem, Report (1902), Report of the Committee on Lunacy, p. 8.

84 Idem, Report (1915), p. 271.

In 1914 a voluntary organization (The Public Charities Association of Pennsylvania) undertook an investigation of the care and treatment of the indigent insane. This organization secured the services of Dr. C. Floyd Haviland of the Kings Park State Hospital, of New York, to carry on the investigation. Dr. Haviland found that in none of the county or municipal asylums were the facilities for treatment of the insane equal to those of the state hospitals. He says, "The only results obtained in the State of Pennsylvania, which have been even approximately satisfactory have been in State hospitals. *85 This did not mean, of course, that the insane received and cared for by local asylums were maltreated or that they did not, in many instances, receive excellent custodial attention. What was lacking was accurate diagnosis and treatment by physicians who had made a special study of mental disorders. *86

Dr. Haviland's conclusion, after a thorough study of the asylums, both state and local, was that only in the state hospitals could completely satisfactory treatment be given, and that, if the purpose of the community was to effect the largest possible percentage of recoveries, all the insane should be committed to state institutions. But this course of action was impossible since these hospitals were already filled to capacity and in certain cases overcrowded. *87

The report condemned the county care system whereby the state assists the localities in maintaining local asylums. In only one respect was county care apparently superior to state hospitals: it was less costly. But, in Dr. Haviland's opinion, this was due to inferior treatment and poorer facilities in local institutions. As he put it, " Mere custodial care costs less than does remedial medical treatment. *88

The Report of the Committee on Lunacy for 1915 contained a few pages of comment on the report of Dr. Haviland in which the attempt was made to minimize the evils that his report had revealed. *89 The Secretary of the Committee, by whom the comment was written, admitted that Dr. Haviland's work had been thoroughly and carefully done, but he believed that the lack of adequate treatment in county asylums might be overcome by certain reforms in the conduct of those institutions and by increasing the capacity of state hospitals. For the most part his recommendations are concerned with the complete separation of the county asylums from the county almshouses. The asylums should in all cases have separate buildings and separate boards of managers, and no local asylum should be permitted to receive patients under the county care act until it had complied with the requirements established by the Board of Public Charities. In reply to Dr. Haviland's criticism of the medical treatment of patients in a majority of the local hospitals the secretary of the Committee on Lunacy proposed that each local asylum should be in charge of a competent physician. He thus admitted that the criticism was well-founded and that the insane in some asylums had not had proper medical care. Moreover, the secretary was of the opinion that closer co-operation between the local and the state asylums was necessary in order that acute cases in the early stages of mental disease might be properly diagnosed and transferred to the central asylums where the chances of their recovery would be greatly enhanced. *90

85 The Treatment and Care of the Insane in Pennsylvania, p. 82.

86 Idem, p. 90.

87 Idem, p. 12. 88 Idem, p. 88.

89 Board of Public Charities, Report (1915), pp. 279-284.

90 Board of Public Charities Report (1915), pp. 283-284.