cation; second, waking suggestions; third, spiritual hypnosis. The most menacing disorders that the movement undertakes to cure are melancholia, moral fatigue, hysteria, suicidal mania, psychopathia sexualis, kleptomania and psycho-neurosis. The foundation of all these diseases may be expressed in this one idea: "Deadly poison lies in evil thoughts which the most searching drugs are powerless to reach." "

Of the spread of this movement little need be said because much was to be expected. Following in the wake of orthodox Christian Science and advancing into the broader areas explored by the socalled New-Thought, Emmanuelism in two years reached from Boston to Brooklyn, from Philadelphia to Denver. But what were the safeguards in the utilizing of this powerful force? At the beginning of the movement it was ruled that before coming under the treatment of Emmanuelism the patient must be examined by a regular practicing physician, and if his trouble was organic, he must be turned over to the surgeon. At the outset a diagnosis as thorough as that given at the Massachusetts General Hospital was required, but latterly there has been a tendency for the doctor of divinity to do without the services of the doctor of medicine. This led to such articles as that in the New York Medical Journal of December, 1908, which brought there four points of criticism against the movement: That Emmanuelism is nothing but NewEddyism; that it makes the clergy irregular physicians, and, therefore, illegal practitioners; that it leads the ignorant to trust the amateur rather than the professional; finally that if patients confide in the clergymen for healing, why should they not confide in the lawyer whose services are equally confidential? Against these four points the leaders of the movement made reply to the following effect: First, that Emmanuelism is not an after-clap of Eddyism, that it is more witty than wise to call it "Christian Science with Worcestershire sauce "; second, that such leading churches as those of Boston, Northampton and New York require a certifi cate of medical examination; third, that it is not the ignorant but the intelligent that require the higher psychic treatment; and, finally, as the Medical Journal itself acknowledges, without the clergy mental healing would lose the powerful therapeutic forces that reside in religion.

17 McComb and Worcester: "Religion and Medicine," 1908, passim.

These are the replies given by the Emmanuelists. But it should be noted that they do not fully deal with the difficulties inherent in any mystical system of faith healing. In the first place there is too much demanded of the so-called subconscious self. In the official hand-book the following claims are made for that overworked faculty: That it carries on the automatic functions of the body; that it contains the vis mediatrix naturae; that in it inheres a flawless memory; that it is the organ of genius; finally, that it is more sensitive to good than to evil. Here indeed is the deification of a dubious faculty; in its claims it is like a general electric company, which supplies light, heat and power. With such mystical and wide reaching claims it is hardly probable that Emmanuelism will meet the requirements of the scientist, or that it can lead to a revival of legitimate mental healing in America unless by indirectly stimulating the public. Of course that public is anything but ignorant, for the class to which this medico-religious movement appeals is not the submerged tenth, but the neglected ten thousand. Here it would be interesting to show an increasing scale of intelligence, as this public has emerged from the twilight of the newer New Thought, and has passed in succession through such works as Hudson's "Laws of Psychic Phenomena," Trine's "In Tune with the Infinite" and William James' “Energies of Man." All this betokens not so much a diluted Christian Science as an inchoate immaterialism. Whether such a tendency can be utilized towards a legitimate psycho-therapeutics depends largely on the medical fraternity. If, as is to be hoped, the legitimate practitioner is to monopolize mental healing, what is to supply the necessary element of faith? The educated classes in America know comparatively little of the possibilities of suggestive therapeutics; if the profession put little trust in that form of treatment, how should the laity be expected to believe in the adequacy of second causes without the implication of a supernatural first cause, such as the so-called sublimal self? It remains for an association such as this to educate the public, to lead them from their blind worship of the magical in medicine, to substitute for a supernormal subconsciousness the principle of psycho-physical parallelism, and thus to revive that doctrine of the early American school of mental healing, that there is a coordinate value in the study of mind as well as body.

THE MEDICAL SERVICE OF STATE HOSPITALS FOR

THE INSANE.*

BY WILLIAM L. RUSSELL, M. D.,

Medical Inspector for the State Commission in Lunacy, New York.

In the development of institutional care of the insane, one of the chief problems has been to provide for the individual the attention needed to bring about cure, and at the same time to furnish for the large and rapidly increasing numbers a shelter or asylum from neglect and brutality. This problem has not yet been fully solved, and the more urgent need of the many seems at times to dominate every other consideration. The care and treatment of insane persons in properly organized medical institutions was, until after the middle of the nineteenth century, not carried out very extensively in this country. Of the present State hospitals only twenty were established previous to 1850. After that, progress was more rapid, and on December 31, 1903, the United States census tabulations showed that there were, in all, 328 institutions for the insane throughout the states and territories. Of these 226 were public and 102 private. The number of State hospitals was 148, and, during the five years that have since passed, this number has no doubt been increased. State care and State supervision are gradually taking the place of local provision for the insane, and wherever this has been accomplished, greater attention to the medical needs of the cases has invariably followed. The unenlightened and merely custodial methods of the past, and the great expense and difficulties which attend such a rapid development as has occurred, continue, however, to influence the present standards and rate of progress. In fact, the public has not yet grasped the facts clearly enough to have learned to demand for the insane much more than protection from abuse and gross

*Read at the Fourteenth Illinois State Conference of Charities and Correction, October 11, 1909.

privation. Only a comparatively few persons have given sufficient attention to the subject to have gained an intelligent insight into the conditions from which the inmates of the institutions really suffer and as to what should be done to bring about cure, ameliora tion, and prevention. The consequence is that the representations made to legislatures and administrative boards in regard to the value and needs of the medical features of the work too frequently fail to prove sufficiently clear and convincing to overcome the ignorance and indifference which prevail so generally. The lack of knowledge and skill concerning mental disorders which the public tolerates in general physicians and nurses, and the consequent neglect of so many cases in the early stages; the almost total lack of provision for the temporary care of insane persons previous to their commitment or for their safe return to ordinary life after their discharge; the delays and injurious irritations which result from legal methods based on groundless fears for the liberties of persons of sound mind; the inadequate return which people are willing to pay well for at the inferior grades of private institutions; the neglect of preventive measures; and the enormous aggregations of insane persons which are being accumulated in single institutions without sufficient regard to the effect on individuals, all furnish evidence that the public has not yet clearly grasped the known facts relating to mental disease or to the best methods of dealing with it. So much progress has, however, been made, that, were it not for the obvious need of further improve ments, it would be easier to speak only words of congratulation and praise.

PROGRESS OF MEDICAL ADMINISTRATION.

The history of institutional development shows that, in spite of all difficulties and obstacles, recognition of the medical character of the disorders of insane persons and of their needs has, for a hundred years, been shaping the internal administration of the institutions towards better and better medical attention to the individual cases. One of the most distinctive features of State care is that it brings the cases into institutions which are under medical management. Medical administration of the whole institution is the method which is found to be most satisfactory throughout the world. And this can be readily understood, for mental disease