AMERICAN

JOURNAL OF INSANITY

THE NEW GOVERNMENT HOSPITAL FOR THE

INSANE.

BY WILLIAM A. WHITE, M. D., SUPERINTENDEnt, Washington, D. C. Next May the American Medico-Psychological Association will meet in Washington. The Thursday afternoon session of the meeting will be held at the Government Hospital for the Insane and many of the members will, I trust, visit the hospital, so I am taking this opportunity of "writing up" a short account of the hospital, describing its principal features, particularly the medical and scientific organization, and setting forth those points that I think may be of interest to the members of the Association.

The hospital was created in 1855 by Act of Congress and since that time has been steadily growing. As might be supposed practically every type of asylum construction that has been in vogue for the past half century is represented in the several departments of the institution. While many of these features have a great deal of interest it is not the purpose of this article to dilate upon them but only to take up the more recent improvements in both construction and organization.

The new hospital extension, designed by Dr. Richardson, which has in large part made possible the improvements of recent years, comprises fifteen buildings which were under construction when I took charge October 1, 1903. These fifteen buildings include an administration building, a nurses' home for women, a detached kitchen, a power, heat and lighting plant, and eleven buildings for the accommodation of one thousand patients. The cost of this extension was approximately $1,500,000.

The first of these fifteen buildings was occupied in June, 1904. From that date the other cottages have been successively opened and this shifting of the patient population made it possible to remodel many of the older structures. Four buildings have been entirely remodeled; one made into a nurses' home for men, the

porches of several of the old buildings have been made into sun parlors (Fig. 1) and wards for the tubercular, a dispensary and circulating library established in the old administration quarters, two buildings abandoned, many small structures torn down, two buildings moved in their entirety to different locations, and an amusement hall with seating capacity of approximately 1200 erected. At the present time the three power plants of the hos pital are being consolidated and the electrical system changed from the direct to the alternating current.

The eleven new cottages for patients are of two general typessmall cottages for from 30 to 60 patients, and large cottages of four wards each for 120 patients. There are five cottages of this latter type, one each for the disturbed classes, male and female, one for the infirm and bed-ridden white men, and two psychopathic (receiving) buildings. These two psychopathic pavilions are located one on either side of the new administration building (Fig. 2) and have certain features of construction that are worth noting (Figs. 3, 4, 5, 6). These features are shown in the plans and are: the porches, enclosed on the second floor, large enough to accommodate the entire population of the wards—a special corridor for noisy patients which can be shut off completely from the rest of the ward and has a continuous bath at one end-a surgical department consisting of surgical amphitheater, anesthetizing room, sterilizing room, and surgeons' room-a hydrotherapeutic equipmentand a large proportion of single rooms.

For administrative purposes the hospital is divided into five departments, each with a chief, as follows: Steward, Disbursing Officer, Chief Clerk, Clinical Director, and Scientific Director. The! first three of these chiefs of departments have to do entirely with the administrative and business management of the institution and I will, therefore, not mention them further in this article.

The medical service of the hospital is presided over by the clinical director, a position which was created something over three years ago. His duties comprise the general supervision and oversight of the medical work of the hospital, and the charge of the hydrotherapeutic department, operating room, training school for nurses, and the clinical records. In general, his function is to bring into closer organic connection the different medical services and to that end he operates as a clearing house through which all transfers of patients from one service to another must be made.

As for the rest, the organization of the several services of the hospital is practically the same as in any other institution of this sort. There is, however, a large consulting staff of the best physicians in the city of Washington in the various departments of medicine. These gentlemen are called upon frequently by the hospital, especially the surgeons.

The scientific director presides over the scientific research work of the institution. The personnel of this department is as follows: A psychologist, pathologist, histopathologist, clinical pathologist, an assistant to the psychologist, and a technician.

The function of the scientific director are in the main to have administrative control of the laboratories and to direct the work therein with a view, so far as possible, of coordinating the efforts of the several investigators along similar lines of research.

The pathological laboratory building contains the mortuary, an anatomical amphitheater (Fig. 7), a museum, a photographic department, and laboratories for histopathology, clinical pathology, bacteriology, physiological chemistry, and a library and private laboratory for the pathologist.

In addition to the laboratories in the laboratory building, a psychological laboratory has been installed on the first floor of the Allison Building. This laboratory contains a library and private laboratory for the scientific director, a general laboratory room, and small rooms for special research work.

A special feature of the medical and scientific work is the medical library (Fig. 8), located in the administration building. While the library itself is small it contains a full set of the index of the Surgeon-General's library, and a duplicate card in its index of every medical book in the Library of Congress, which, with the Index Medicus, gives us a complete catalogue of practically all of the medical literature of the world. With all this literature, too, being right here in Washington it is available within two hours. In addition to the above the hospital subscribes for about forty of the leading journals which deal with psychiatry and related subjects.

Another special feature of the medical and scientific work is that six members of the medical and scientific staffs occupy teaching positions in the medical colleges of the city. This relationship with the medical colleges has always been encouraged, and it is believed to be an excellent thing for the hospital.

The unique position in which the Government Hospital stands in the country is such that its possibilities for usefulness are very great. An attempt has been made to develop these possibilities, particularly with reference to the federal departments. A few years ago an arrangement was made for interchange between the medical officers of the hospital and the Public Health and Marine Hospital Service for the purpose of securing men trained in psy chiatry to serve on Ellis Island in the detection of insane immigrants. For approximately two years now the hospital has had a man stationed on Ellis Island for that purpose.

For some years past I have been convinced of the importance of the problem of insanity in the military organization of the country and have finally succeeded in securing recognition of its importance in a material way. The surgeon-general of the army has detailed a medical officer to serve at the hospital, and his researches on the relations of the problem of insanity to the army have demonstrated fully the wisdom of this assignment. The Secretary of the Navy has recently also caused an assignment of a naval surgeon to the hospital.

In order that some idea of the work that is being carried on in the scientific department may be had, I will give a short sketch of the various investigations now being prosecuted in the several laboratories as follows:

Psychological Laboratory:

1. Psychogenic factors in certain mental disturbances.

2. Touch sensations in different bodily segments of normal people.

3. Sensation changes following local anesthesia.

4. Skin sensations following nerve division.

5. Comparative study of the reactions of different classes of the insane to stimuli of a painful character.

6. Sensory changes from trauma of the post-central cerebral convolutions.

7. The relation of visual sensations and perceptions to the occipital lobes.

8. Relation of the anterior and posterior cerebral association areas to the formation and retention of associations.

9. The character and time of associations in normal people.

10. The relation of sensory and motor defects to the education of certain feeble-minded.

II. The changes in volume and blood pressure of the cerebrum coincident with mental states.

Pathological Laboratory:

1. Study of the localized atrophies and scleroses of the brain in epilepsy.

2. Study of the idiopathic atrophies of the brain in various mental conditions, apparently not dependent upon arteriosclerosis, nor other vascular conditions.

3. A study of the various anatomical types of general paralysis, with special reference to the presence or absence of adhesions and decortications and hyperæmic and anæmic conditions.

4. Continued studies of the renal and adrenal growths, the hypernephric tumors especially.

5. Continued studies in the gross morbid anatomy of the epilepsies, and in pachymeningitis interna.

Histopathological Laboratory:

I. A study of the ventricular connective-tissue plaques.

2. The relationship between neuroglia cells and ganglion cells in the cerebral cortex. (Adaptation of the satellite cells with formation of Stäbchenzellen, Abräumzellen, and neuroglia baskets about the ganglion cells.)

3. Comparative study of the histological changes taking place in the Ammon's horn in epilepsy, paresis, senile processes and experimental conditions including hydrophobia.

4. Experimental study of the conditions leading to metachromatic changes of protoplasm.

5. Study of material of pellagra cases.

Clinico-Pathological Laboratory:

At the time of writing the clinical pathologist is in Vienna where, in collaboration with one of the University professors, he is prosecuting certain investigations into the changes brought about by syphilis in the central nervous system. These investigations are along the following lines: The syphilitic anaphylactic reaction, the cultivation of the treponema pallidum, and the globulin content of the blood.

Beginning with the first of the year a course of instruction was outlined to be given by the Scientific Department for the benefit