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TENTH BIENNIAL REPORT.

CHAPTER I.

INTRODUCTORY.

The people of the State of Illinois have reason to be proud of their charitable institutions, and we believe that they are proud of them. During the late political canvass in this state, their operations and results were freely discussed, upon the stump and in the press. Some complaint was made of their enormous cost in the aggregate. But, so far as we know, no charge was brought against the integrity of the management of any one of them; no remediable defect in their organization was pointed out; no assertion was made that any inmate of any one of them has been in any way abused or neglected; and no scandal was brought to light affecting the personal reputation of any of their officers or employes. We conclude that, notwithstanding the minute and thorough scrutiny, by the families and friends of their inmates, by county officers, by the throngs of visitors to whom they are always open, and by the accredited representatives of the daily and weekly newspapers, nothing is known or can be alleged, which would tend to discredit the honor, humanity and efficiency by which the public charitable system of Illinois is, and has for many years, been distinguished.

The great and increasing cost of these institutions is not due to any diversion of the funds appropriated for their support from a proper use. Nor is it due to any extravagance in their management, nor to any disposition on the part of the legislature needlessly to multiply institutions, nor to the crowding into them of persons not legally entitled to the benefit of care and treatment or tuition in them. It may be much more simply and satisfactorily explained. In the first place, the population of the state is increasing. Again, wide statistical research has demonstrated the fact that insanity, at least, is increasing in the United States out

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of proportion to the growth of the population at large. The demand for the relief afforded by institutions is everywhere a growing demand; and, although Illinois has manifested a liberal disposition to meet this demand, it has not yet made provision for its unfortunates commensurate with the existing demand, nor is it likely to do so in the near future. The number of persons adjudged to be insane, in the county courts of this state, each year, is about fifteen hundred. The chronic insane do not recover, and they do not die. There is therefore a perpetual addition to the mass of incurable lunatics, who must in some way be cared for. We have made sufficient examination of this question to enable us to say confidently that, if the General Assembly should, at every session of the legislature, increase the capacity of our state institutions for the insane by five hundred beds, we should not more than keep pace with the increased demand for hospital accommodation. We speak of the insane particularly, because the claim of the insane seems to be regarded by the public as paramount to that of any other class of the afflicted. But the most neglected class of unfortunates are the idiots, for whom little has yet been done. The census of 1880 makes it clearly apparent that there are very many deaf-mutes, of school age, who are not pupils in the institution at Jacksonville, and have never received any special instruction. And the question of the duties of the state toward dependent, abandoned or neglected children, within her boundaries, has thus far received the smallest possible amount of attention at the hands of the legislature.

We may also refer, in passing, to the fact that the Federal Government has failed to make the necessary provision, in national soldiers' homes, for the care of the old and worn-out veterans of the civil war who are without personal means of support; and that Illinois is only one of many states in which the patriotic and humane instincts of the people have prompted the establishment of a state soldiers' home, to relieve the suffering occasioned by the apathy or parsimony of our national congress. Obviously, the duty of making adequate provision for ex-soldiers and sailors, who risked their lives in defence of the nation, and not of the states, is a national obligation, which does not rest upon the states as such.

The increased cost, in the aggregate, of the system of public charities, is due to the expansion of that system. When, in 1869,— nearly twenty years ago, the act was passed creating this board, the institutions for the education of the deaf and dumb and of the blind, at Jacksonville, were both comparatively small establishments; there was but one hospital for the insane, which was also at Jacksonville, and had a capacity of not more than five hundred patients; the soldiers' orphans' home, at Normal, had just moved into the building erected for its accommodation; and the asylum for feeble-minded children was still a small, experimental school, occupying a rented house. This constituted the entire circle of state charitable institutions. The state reform school, at Pontiac,

was not yet opened, though the building was in process of erection. The charitable eye and ear infirmary was then a private establishment, which received a very small annual grant from the state treasury. The general assembly made an appropriation, in 1869, to begin the erection of two new institutions for the insane, one at Elgin, and one at Anna, but work upon them had not yet been begun. Such was the condition and extent of this branch of the public service, when the work of developing and systematizing it was entrusted to the state commissioners of public charities.

We look back upon the history of the past twenty years of our labors with almost unmingled satisfaction. Not all has been done that we should have been glad to see done; but so much has been accomplished, that the people of the state may well congratulate themselves on the amount of progress realized. On the first of June, 1871, the state reform school at Pontiac was opened. The great fire in Chicago, which occurred on the 9th of October, the same year, swept away the old eye and ear infirmary, on Pearson street, and in 1873, the legislature made an appropriation for the erection of a building for this institution on its present site, and accepted it as a state institution. The hospital for the insane at Elgin received its first patient April 3, 1872; that at Anna was thrown open to patients December 15, 1873. In 1875, the legislature made an appropriation for the erection of a permanent building for the asylum for feeble-minded children, and it was located, by a commission, at the town of Lincoln. The act creating the hospital for the insane at Kankakee was passed in 1877. The soldiers and sailors' home was established in 1887. We are unable to state the number of inmates of the state institutions in 1869: but the average number, in all the institutions, for the year 1875, when the regulating act was passed, under which they have since been operated, was 1,795. The average number, during the fiscal year 1887-88, (which closed on the 30th of June last), was 5,930. The institution for the deaf and dumb is now the largest in the world, and, we believe, take it all in all, probably the best. The hospital for the insane at Kankakee, which was constructed on the village plan, and marked a new era in asylum building, at least in this country, is the largest institution of its class in the United States, with one or two exceptions. The number of insane persons cared for by the state, which averaged 925 in 1875, averaged 3,640 in 1888. The growth of the institutions since 1875 is shown in the following table:

Table showing the average number of inmates in each of eleven state institutions, each year, for fourteen years:

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The fiscal year 1875 began December 1, 1874, and ended September 30, 1875; it therefore included only ten months. The fiscal year 1888 began October 1, 1887, and ended June 30, 1888; it therefore included only nine months. The date of The date of closing the fiscal year has been twice changed, during the period covered by the table.

Of course such an increase in the number of inmates of the state charitable institution has necessitated a corresponding increase in the aggregate amount of appropriations required for their support. But the per capita cost has diminished, from $250.02 in 1875 to $181.81 in 1888, as shown in the following table:

Table showing the per capita cost in each of eleven state institutions, each year, for fourteen years:

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In the foregoing table the actual per capita cost for 1875 has been increased by one-fifth, and that for 1888 by one-third, in order to obtain the rate for twelve months, to compare it with those given for full years.

The number of inmates for the year 1888 which was (5,930) would have cost, at the per capita rate for 1875, $1,432,618.60. At the rate for 1888, they would have cost, in twelve months, $1,020,851.54 a saving, in consequence of improved management, of more than $400,000 per annum. And yet the appropriation for the expense of supervision by the state board of public charities is grudgingly given.

As compared with the expenditures in other states, those made by the Illinois institutions show as large a degree of economy as is consistent with the liberal and efficient care of their inmates. The mathematical demonstration of the truth of this proposition would only encumber these pages. But, by y of illustration, we mention the fact that a careful examination of the reports of seventy-eight hospitals for the insane in the United States, in 1886, shows that these institutions cared for an average number of 47,554 patients at a total cost of $8,925,621.24, or $187.69 per capita. During that year, the per capita cost of the Kankakee hospital was $169.07; of the Anna hospital, $170.99; of the Jacksonville hospital, $178.94; and of the Elgin hospital, $215.87; or, for the four hospitals taken together, $178.87, or about nine dollars less than the average in the country at large. Yet we venture to say that there are no institutions in the country which maintain a higher standard of efficiency and comfort. We believe that the people of this state derive from their institutions a higher grade of service at a lower rate of expenditure than those of any state in the Union.

The figures furnished by persons unfamiliar with institution accounts are not trustworthy, since the methods of computing them in different states are very dissimilar. In some states the gross cost is given, and in others the net cost, after deducting receipts from various sources; the ordinary are not always separated from the extraordinary expenses; and the average number of inmates is not always stated, or it may be calculated upon an erroneous principle. The figures given above have been prepared by the expert accountant employed in our own office, and their accuracy can be depended upon.

Complaint has been made, by persons unfamiliar with the organization and management of institutions, that too much of the money expended by them is paid to officers and employes. It is true that the expenditures in this direction are large. But it is necessary that they should be so. The following table exhibits the total expenditure, on current account, (or for maintenance of the state institutions), each year, and the amount expended for salaries and wages, with the percentages:

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