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Aotes and Comment.
GERMAN TRANSLATION OF DR. PANDY'S BOOK.-In the issue for July, 1906, the work of Dr. Kalman Pandy, “Gondoskodás Az Elemebetegekröl Mis Allambokman Es Nálunk” (The Care of the Insane in Foreign Countries and in our Own) was reviewed. In this book he showed a very complete knowledge of the subject from personal observation and a remarkable familiarity with the encyclopedic works of Tucker (" Lunacy in Many Lands") and of Letchworth (“ The Insane in Foreign Countries "), whose authors had visited the same institutions. Unfortunately Pandy's work was published in Hungarian and consequently inaccessible to nearly all readers outside of Hungary. We are glad to be able to announce a second edition of the work revised and much enlarged by Dr. Pandy and translated into German by Dr. Engelken, Jun., of Alt-Scherbitz and published in a handsome volume of six hundred pages with fifty illustrations by Reimer of Berlin. It is practically a new work and deserves to be better known by all who are interested in the care of the insane in other countries. It is entitled “Die Irrenfürsorge in Europa" and gives a very full and carefully considered account of the care of the insane in Denmark, Sweden, Norway, Scotland, Ireland, England, Holland, Belgium, France, Germany, Austria, Hungary, Switzerland, Spain, Portugal, Italy, Greece, Roumania, Turkey, Russia, and Finland. There is also a final chapter on the “Family Care of the Insane Throughout Europe.”
.It is very interesting to observe how closely his conclusions confirm the painstaking accounts given by our own countryman, William Pryor Letchworth, who did so much by his admirable work to bring the methods of foreign hospitals for the insane to the knowledge of alienists in this and other English-speaking countries. It can but be most gratifying to him in reviewing the incidents of a life devoted to the betterment of the care of all sorts and conditions of men to feel that his self-denying labors in behalf of the insane are so widely known and appreciated both at home and abroad.
DR. WAGNER'S ADDRESS AT FARView.–Following in the footsteps of Earle, who delivered his address, “The Psychopathic Hospital of the Future," at the laying of the corner-stone of the Connecticut Hospital, at Middletown, and of Ray, who, on a similar occasion, at Danville, Pa., delivered an address on “The Care of the Insane," Dr. Charles G. Wagner, on July 24, 1909, gave an address at the laying of the corner-stone of the new Hospital for the Insane for northeastern Pennsylvania. The occasion was one of interest, and the address worthy of the occasion as will be seen from the following extracts. We regret that lack of space prevents a fuller publication of his able and timely address :
In 1751—forty years before the time of Pinel and Tuke-from your own province of Pennsylvania, the first human impulse appears to have proceeded. The people of Philadelphia petitioned their legislative government for some kind of public provision for the indigent insane, and so successfully did they plead their cause that in the same year—1751—an act was passed providing for the erection of a hospital for their benefit in Philadelphia, on condition that half the cost should be borne by private subscription. This condition was promptly complied with, and in the following year-1752—the first “ Pennsylvania Hospital” was opened for the reception of patients.
A century later this hospital was succeeded by the “New Pennsylvania Hospital,” which, under the able management of its distinguished superintendent, Dr. Thomas Kirkbride, became known for splendid achievements throughout the civilized world.
In 1773 the second hospital for the care of the insane in America was established at Williamsburg, Va. These two institutions were the only places in the thirteen colonies or in the United States of America where special provision was made for the insane poor prior to the close of the eighteenth century, and there were no private asylums or hospitals, such as had begun to appear in England, for this class of enterprises required knowledge of insanity not easily acquired by physicians of the time and an outlay of money which few of them possessed.
In 1791 the third hospital movement in the interest of the insane in this country was inaugurated when the “New York Hospital” began to receive a few insane patients, and in 1806 the governors of that institution obtained an appropriation from the legislature to build a new building, which was called “ The Lunatic Asylum.”
The asylum continued in active operation until 1821, when it was succeeded by the Bloomingdale Asylum, which also cared for a limited number of the friendless or poor insane; but the great majority of the mentally afflicted, even at this late date, were still detained in jails where they were treated as criminals, or, in the county poor houses where they were congregated in large numbers and were continually subjected to cruelty and neglect.
During all this time, however, public sentiment was being gradually aroused. In Pennsylvania, in 1817, the “ Society of Friends ” established an asylum at Frankford, near Philadelphia, with the avowed object of carrying out the system of treatment pursued in England at the “York Retreat,” and in the following year the McLean Asylum, at Somersville, Mass., was opened. Next, the Hartford Retreat, in Connecticut, was completed in 1824, and soon thereafter the State Asylum, in Columbia, South Carolina, was erected.
In the meantime a movement was started in the State of New York, which soon found expression in the important law of 1827, which directed that “no lunatic shall be confined in any prison, jail, or house of correction, or confined in the same room with any person charged with or convicted of any criminal offense." By this statute the State of New York took ground far in advance of her sister States and separated forever the insane from the criminal class.
Friends of the insane were now springing up on every side. The medical journals were urging further reforms. The New York State Medical Society, in 1836, memoralized the legislature with a strong plea for the erection of a State asylum where the insane poor might receive the best care and treatment that medical skill could devise. The result of this agitation was the erection of the State Lunatic Asylum, at Utica, which was opened for the reception of patients in January, 1843.
A few years later the Willard Asylum, on Seneca Lake, was created and then followed in rapid succession a series of splendid institutions until New York now possesses no less than 15 State hospitals costing nearly $30,000,000, in which are cared for 30,000 insane persons.
In 1893 the State of New York achieved its crowning success when the last insane patient was removed from a county poor house to a State hospital, and since that date the State has recognized the insane poor as her wards and has undertaken to care for all indigent persons suffering from mental disease within her borders, in State hospitals maintained at the State's expense.
Now, a word in regard to hospital construction and administration. The fundamental idea that should underlie this great department of public charity is to make our hospitals worthy of the name. To make them hospitals in reality, and not merely places of detention where the inmates may be comfortably housed and fed.
It should be borne in mind that the average life of an insane person is about 15 years, and that the cost of his maintenance is approximately $200 per annum. It requires small effort, therefore, to perceive that from the economic point of view it is enormously to the advantage of the State to cure as many patients as possible, for, besides the incalculable boon that restored health is to the patient and his family, there is also the great direct gain to the State in the relief afforded from the burden of caring for an
incurable who, by reason of chronic insanity, would otherwise become a permanent tax upon its charity.
Furthermore, it will be readily appreciated that when such a patient is restored to health and activity as a worker among his fellows there must be a corresponding gain as a result of his labor-all of which would be lost to the world if he were left to vegetate in hopeless mental oblivion.
The State, therefore, owes it to itself, as well as to the patient, to provide such care for its insane as will give the best chance of recovery to the unfortunate sufferer. Nor is the task as hopeless as is commonly believed, for, with proper surroundings and appropriate treatment, undertaken carly in the course of the disease, a large percentage of the insane may be cured of their infirmity.
The plans and specifications for your new hospital have been wisely prepared by competent architects and they have been approved by men of high standing in the medical profession. Your new structure will undoubtedly be in accord with the best ideas of construction obtainable at the present time—it will be equipped with thoroughly sanitary appliances, including complete bathing facilities--not only in the interest of cleanliness, but with a view to the use of the prolonged bath, the hot and cold shower, the spray, the douche, the plunge, and the many combinations of these, which, when skillfully used, exert such a profound and beneficial effect upon the nervous system.
Electro-therapeutics will have a place in your "armamentarium medicorum” and will play an important part in the restoration of the “mind diseased."
Your wards will be well ventilated apartments, lighted by electricity, heated by steam, and comfortably furnished, with carpetings on the floors, pictures on the walls and draperies at the windows—for all of these things help to banish the idea of prison bars and to make an environment that tends to aid the recovery of the patient.
Good food, and plenty of it, and proper clothing are essentials, and, above all, kind and competent nurses and physicians must undertake the great work of administering this splendid charity when it is completed and its doors are opened for those who need its friendly shelter.
Congenial occupation and recreation must not be overlooked in the scheme of treatment, for these patients are prone to think too much about themselves, and it not infrequently happens that they are started on the road to recovery when once they can be induced to occupy themselves with some kind of employment, or to take interest in some form of amusement.
Concentrated effort on behalf of the individual patient will be the watchword of the future. Schools of instruction will be organized on the wards, sewing classes, carpet weaving, mattress making, caning chairs, upholstery, shoe making, and a hundred other useful employments, now in their infancy, will find wider and wider scope until our hospitals become veritable hives of industry.
The treatment of insanity has been a process of steady evolution during
the past twenty years and no institution is considered complete to-day that does not provide special wards where the best facilities obtainable are at hand for the treatment of the acute or recoverable cases. For the care of this class of patients the best nurses should be detailed, the closest medical attention should be given, and every resource of the hospital should be taxed to the uttermost.
Next to the proper administration of institutions devoted exclusively to the insane, the most crying need of to-day is the establishment of psychopathic wards in connection with our general hospitals.
Every city or town that possesses a general hospital should have connected with it a psychopathic ward with trained nurses under the direction of competent physicians, where temporary care might be given to persons who have shown symptoms of mental derangement pending observation and commitment to a State hospital for the insane. Such care would often quickly restore the equilibrium of tottering reason and save the patient from much of the distress that almost inevitably attends commitment to a State hospital.
If there were places of this kind available there would be no longer any excuse for the deplorable practice of placing the insane temporarily in common jails where, often, regardless of sex or mental disturbance, they are grossly ill treated.
In conclusion, permit me to urge that our charitable institutions, one and all, be kept out of politics. The most competent physicians and nurses obtainable are essential to the proper administration of these institutions, and nothing could be more fatal to their usefulness than the frequent changes incident to the shifting of the political weather vane.
A HISTORY OF THE MEDICO-PSYCHOLOGICAL ASSOCIATION.-It will be remembered that last year, at Cincinnati, a fresh beginning was made in the above history, which for some reason had lingered ineffectually in the hands of a committee for several years, by the appointment of a new committee. Whether the change in the composition of the committee is calculated to hasten the progress of the work remains to be seen. It is altogether probable that the former committee was appalled by the magnitude of the task involved in the history, and no committee, however zealous to complete the task, can hope to do so single-handed. The labor is very great and the active co-operation of every member of the Association is urgently solicited. The History of the MedicoPsychological Association is in effect the history of the whole movement which has resulted in the modern care of the insane in the United States and Canada. It involves a careful history of each institution, whether asylum, hospital, retreat or sanita