cxxxiv Journal of Comparative Neurology. 



tendents of the nation's Insane Hospitals, Dr. Mitchell urges in a 

 kind but fearless manner some of the abuses of our present asylum 

 management. His positions are supported by letters from some thirty 

 of the ablest neurologists and consultants of our larger cities and the 

 text of many of these letters appended to the published discourse 

 comprises by no means the least instructive part of the article. No 

 one, whether physician or layman, who really has at heart the interest 

 of the thousands of insane confined like criminals in that absolute 

 idleness which would soon prove fatal even to a sound mind in the 

 crowded wards of our large asylums (they are often not "hospi- 

 tals") can afford to allow this address to pass without at least a careful 

 reading. The responsibility for many of these abuses must rest with 

 the managing boards and the political dictators behind them. Econ- 

 omy of administration seems to be the criterion by which all excel- 

 lence is gauged; hence it is that the " Medical Superintendent" is too 

 often more of a business manager than of a physician; hence also the 

 immense structures in which the patients are quartered instead of cot- 

 tages so constructed as to admit of the most perfect classification, the 

 terrible crowding of patients into great dreary wards with barred win- 

 dows and locked doors with perhaps only two attendants to a 

 hundred patients, the attendants themselves mere overseers designed 

 to keep order rather than trained nurses qualified to assist the over- 

 worked physicians in the arduous task of treating daily hundreds of 

 cases of the most difficult nature known to medical science. 



As correctives, the most urgent are the utter divorcement of the 

 management from politics and the appointment of business managers 

 whose duties shall have nothing whatever to do with those of the phy- 

 sician in charge. This will leave the latter time to attend to his legit- 

 imate duties, in which he should have the constant assistance of con- 

 sulting physicians from outside. It is also very encouraging to note 

 that these neurologists, all of them immersed in the practical duties of 

 a large practice, with singular unanimity urge that the physician in 

 charge must be an investigator and that his whole institution must be 

 charged with the spirit of active investigation. Every physician down 

 to the intern, even to the nurse, should be somewhat of a neurolo- 

 gist and a psychologist as well. In this way alone can the profes- 

 sional life of the hospital be kept above the low water mark, to say 

 nothing of the fact that the vast scientific possibilities now heedlessly 

 ignored in nearly all of our great asylums would thus be saved to 

 science. 



Of course it must be borne in mind that these abuses do not ex- 



