Well, I do not wonder that no one accepted the challenge. To a man who has practised medicine forty years and had many cases of appendicitis, has treated them all without operation and not lost one; to other men who are now using the oil treatment with certainly as good success as can be shown for operation, men whose ability to diagnose this disease ought not to be questioned, I say such a challenge ought not to be noticed or considered.

I am ready and willing to accord all honor to surgery and to call in the surgeon when I need him, but to assume that pus is present in every case in which fever is present to the degree that operation is necessary, I will not admit, and shall watch out sharp for the homoeopathic remedy to beat him out of a job.

Pardon this digression, and let me close this lecture with the advice that you experiment along the line of potencies, from the lowest to the highest, making as sure as possible that you have the similar first, then giving it a fair chance to act according to wellknown principles as laid down in the Organon, and illustrated by cures as performed by such men as Hering, Raue, Dunham and many other masters in the art of healing now gone to their rest, and many others who still live to corroborate the efficacy of such practice; and if you do not become satisfied that the potentized remedy is the best, and in the great majority of cases prefer it, your experience will be very different from mine.

PROVISION FOR THE INSANE IN GENERAL OR
PSYCHOPATHIC HOSPITALS.*

By George F. ADAMS, M.D.

Gowanda, N. Y.

'NASMUCH as the insane of the State of New York are now cared

INA

for under the State-Care Act, I want to call the attention of the Society to a recommendation of the State Commission in Lunacy in their last annual report. Referring to future construction for the insane the Commission advises:

"Small hospitals for the acutely insane, to be erected in cities. and colonies for the chronic or mixed classes of insane in the adjacent country. The hospital for the acute insane should be located as general hospitals are, in the most populous portions of the city, to afford convenient access from every quarter. It should have an

* Read before the Western New York Homœopathic Medical Society, Rochester, N. Y.

out-door department or dispensary, where mental cases may be seen in the very earliest stages. It should have its staff of internes and its attending or consulting physicians and surgeons, a well-equipped laboratory and auditorium for teaching, and opportunities should be given for the professors in medical schools in the city to utilize the hospital material for the instruction of students and physicians in the still neglected specialty of psychiatry. Patients should be received for diagnosis as emergency cases without commitment papers, legal forms to be made use of only after a specified time. has elapsed, and when it becomes evident that long detention will be necessary. Such psychopathic hospitals are now organized in every university town in Germany.

"The colony should be situated in the country where out-of-door employment, so useful as a remedial measure for long continued cases of insanity, can be provided. To the colony the reception hospital of the city may transfer the proper cases-convalescents, cases of slow progress, chronic cases and incurables.

"The State should therefore construct reception hospitals for the acutely insane in the cities and colonies, for the mixed classes of insane in the country. No State government should at this time undertake a system of care of the insane without careful consideration of this twentieth century method.

"In the older States where the methods of care of the insane have already been long established, modifications to follow along this line can only occasionally be undertaken. In new States this system should be organized from the first; but even in such a State as New York, where much progress has been made in the system of caring for the insane, we find that many changes are not only desirable but may readily be made.

"The large cities like New York and Brooklyn have an imperative need for reception hospitals for the insane. There should be one on Manhattan Island to accommodate 100 to 200 patients, and one in the center of Brooklyn to accommodate 50 to 100 patients. It will surprise many to learn that acute cases of insanity in many cities and towns in this State are still taken to jails and station houses until such time as they can be removed to a hospital. At Albany a reception hospital for the insane has been constructed by the county as a pavilion of the general hospital, and this is an excellent plan to follow in cities of the size of Albany. It seems an absurd arrangement, but the nearest hospital to which the acute insane of so large a city as Syracuse can at present be taken is situated at Ogdensburg, a weary journey of many hours, and it is stated that for the immediate reception of urgent cases in Syracuse the

station house must be employed. Even in Buffalo, which has a large State hospital in the city limits, emergency cases are taken to the station houses until commitment papers can be prepared. Buffalo has a population large enough to support a hospital for nervous diseases, and in the event of such a hospital being established in the populous center of the city, a pavilion for the reception of the acutely insane might be constructed in connection with it. In three other cities-Utica, Binghamton and Rochester-there are State hospitals within the city limits but no proper modern provision in any of them for the reception and treatment of the acutely insane. This state of affairs is shortly to be remedied in Rochester by the construction of a pavilion for acute cases, with every facility for treatment.

"The Commission hopes that at some future time arrangements may be made for our State hospitals and licensed private asylums to receive urgent cases for 48 to 72 hours upon an emergency certificate, to be signed by the family physician, while the regular lunacy certificates are being prepared. This would do away at least with the present use of jails and station houses as places of reception for persons ill of brain disease."

As evidence of the importance attached to the recommendation of the State Commission in Lunacy, I would also call attention to the message of Governor Odell to the legislature where he says: "With this recommendation I am in hearty accord."

From a recent personal interview with Dr. Frederick Peterson, President of the State Commission in Lunacy, I think we have every reason to believe that the present legislature will provide funds for the erection of two psychopathic hospitals, one in New York City and the other in Brooklyn. These institutions shall serve for these two cities as reception hospitals for all cases of insanity until their character and prognosis have been determined. Some time will elapse before these two psychopathic hospitals are ready to receive patients, and a greater length of time must pass before any similar provision can be made in any of the smaller cities of the State. Something should be done, and at once, for the care of insane persons while legal proceedings are being taken for their commitment to a State hospital. Rich and poor alike are afflicted. The sentimental side of the question is one that will appeal to most people. Heretofore, if a person developed acute insanity, he or she was usually arrested by the police charged with insanity and lodged in the station house or in jail to await examination and the commitment papers from the judge. The thought that a relative or friend was behind bars in a penal institution, was suffi

cient to cause many to criticise the lack of a proper place to detain the prospective and unfortunate patient. We shall have to turn to the general hospital for relief. No adequate provision exists at present for the right treatment of the early stages of such diseases as have mental disorder for their chief symptoms, or for the slighter or more transient insanities among the class who come to our general hospitals for advice or treatment.

Dr. Clouston, in a very able and exhaustive discussion of the Possibility of Providing Suitable Means of Treatment for Incipient and Transient Mental Diseases in our General Hospitals, at the Annual Meeting of the British Psychological Association, says in answer to the question, "Is it desirable to supply this want?"

"The whole history of modern hospitals and the whole trend of philanthropic efforts to cure diseases have of late years been in the direction of providing for the poor every means of treatment for diseases of every class. In regard to mental diseases, it is in the early and incipient stage that it is most curable. Every case of mental disease has an early and incipient stage. During that stage it is not a case of technical legal insanity. It is a condition where you require to make the patient realize that there is something wrong with him. It will be admitted that men on the point of insanity add daily to the risk of what I may call the organization of the morbid process, and every day adds to the difficulty of getting the case off the morbid and on to the normal mode of working. That, as neurologists and physiologists, none of us will deny. The rich can and do have such means of treatment; the poor at present cannot. This does not apply to any other class of disease. Mental disease is the most pitiable of all. To allow such mental symptoms to run to such a degree of disturbance that they can be officially certified as technical insanity, seems a cruel neglect as well as an expensive dereliction of duty on the part of society. For the man so afflicted ceases to be a producer and becomes incurable.

"Firstly, any one may go to seek advice at a hospital, or to be treated in one without losing any of his self-respect, injuring his prospects in life, or going counter to any special prejudice in his mind. Secondly, the treatment of this class of disease-I attach enormous importance to this argument—would educate our poorer population, and, indeed, the whole population into entertaining the belief that mental disease is on all-fours with other classes of disease, and that it in no way implies shame or repulsion. If this education should take place to any degree it would sweeten life to every family in which mental disease has occurred, and that would probably comprise every fourth or fifth family connection in the

land. Besides, it would diminish one of the most poignant terrors in the lives of those who have suffered from the disaase or fear its occurrence. The absence of this prejudice and fear would of itself greatly aid recovery."

Professor Pontoppidon, of the Copenhagen General Hospital where mental cases have been treated for the past forty years, says: "The adding of the pavilion as an integral part of the hospital for general somatic diseases has influenced public opinion in modern and scientific directions, and has done away with much of the mysticism which, in public opinion, too often clings to mental disorder. Patients and relations, as well as doctors, seldom hesitate to make use of the insane ward of the Commune Hospital in the hope that the patient will soon recover, knowing that he will at once be placed under rational treatment, which so often greatly improves the prognosis."

To meet this want our general hospitals must provide by the erection of special wards or pavilions. Until recently the pavilion for the insane at Bellevue Hospital, New York City, was the only provision of that kind in the United States. About a year ago a department was opened at the city hospital, Albany, N. Y. The attention of alienists through the United States has been attracted to this departure in general hospital construction. It is known as Pavilion F of the Albany Hospital system. I visited the hospital in July in company with Dr. J. Montgomery Mosher, who for ten years was connected with the State hospital system and is in charge of Pavilion F. I cannot speak in too high terms of the work he has accomplished. From an article read by Dr. Mosher at the Annual Meeting of the American Psychological Association at Richmond, I quote as follows:

"Under the stimulus of the repeated abuses that occur in the disposition of acute cases, the physicians of Albany represented to the county supervisors the need of this building, and have received a generous response in an appropriation of eighteen thousand dollars. The Albany Hospital is constructed upon the pavilion plan, permitting the annexation of an additional building. The administration is to be in the hands of the Governors of the Hospital, as a part of the general organization, the county's rights being protected by agreement to care for its patients at rates conforming to those of other public patients. (The plan of the new building, which owes its perfection to the suggestions of Dr. Chapin and Dr. Cowles, has been prepared by Mr. A. W. Fuller, architect of the hospital).

"The design provides a two-story building for the separation of the sexes, connected with the main hospital by a corridor and con