io8 WILLIAM M. EDWARDS 



large ward for the treatment of general cases, bringing him into 

 contact with a body of insane people for perhaps the first time. 

 We have sought to create different conditions under which such 

 cases shall be received and treated. Within a few years past 

 there has been a strong tendency to break away from old meth- 

 ods and ideals and to establish new conditions for the reception 

 and first care of the recent, presumably curable or borderland 

 cases. Germany has been to a very large extent the pioneer in 

 this work. We owe not a little to German investigators, promi- 

 nent among whom are Kraepelin, Wernicke and Ziehen, for their 

 studies of mental diseases and the practical ideas they have 

 suggested. The teaching of psychiatry in the medical schools 

 of Germany seems far ahead of that in the United States. In 

 a number of German cities wards in general hospitals are set 

 apart for psychiatric purposes, but serve largely only as deten- 

 tion pavilions. From such wards clinical material is taken to 

 illustrate medical lectures. There are to-day eight psycho- 

 pathic hospitals in Germany. They are located at Heidelberg, 

 Strassburg, Leipsic, Halle, Freiburg, Wurtzburg, Giessen and 

 Kiel. At Heidelberg most of Kraepelin's work has been done. 

 Here is a small hospital having beds for only twenty five cases. 

 Patients are voluntarily committed to the psychopathic hos- 

 pitals or remanded by city magistrate pending examination. 

 A formal insanity certificate is only executed in transferring 

 cases from these hospitals to large state asylums. One of the 

 earliest attempts in this country to care for the insane outside 

 of the general asylums was at Albany, New York, where a ward 

 was connected with the general city hospital for the reception 

 of such cases. Into this ward were taken psychopaths and 

 neuropaths, borderland cases, the acute conditions of the least 

 pronounced type; and many of them recovered without the 

 necessity of being formally adjudged insane. Notwithstand- 

 ing the advances that have been made in psychiatry we can not 

 deny that the friends of the patients shrink from the notoriety 

 of having a relative adjudged insane and committed to a hos- 

 pital. So jealous are we of our constitutional right that no 

 person shall be deprived of his liberty except by due process of 

 law, that adjudication of insanity is still necessary in the great 

 majority of cases. There are, however, a considerable number 



