244 PSYCHIATRY 



I do not know how one can very well entirely separate these topics 

 from each other, and I must be excused if I sometimes slip from speak- 

 ing of a relation to dealing with a problem. After all, the thing 

 desired in such an address as this is, I assume, to find out how 

 psychiatry stands as a science now, what dependence it has on other 

 sciences, and what help it needs from them or can give to them. 



Twenty years ago I was a member of an organization for securing 

 reforms in the care of the insane. It fell to me to present the situa- 

 tion then of psychiatry in America. It may be said that at that time 

 little science of this kind existed here. This was so much the case 

 that the superintendents of the insane asylums had withdrawn from 

 affiliation with the American Medical Association, and had for years 

 kept out of formal touch with general medicine and the activities 

 of medical science. Psychiatry had mainly one side : the business of 

 administration and custodial care. Only four medical schools pre- 

 tended to give any teaching in mental disease in the whole country. 

 There were then only 74 state asylums, with a population of 39,145 

 insane and considerably less than half of the insane of the country 

 were in institutions designed for their care. The cost of running 

 these institutions was about $200 per capita yearly, which is perhaps 

 a fifth greater than it is now. So that psychiatry represented a busi- 

 ness conducted in some places well, in some ill, as sentiment demanded 

 or as money was supplied. 



This situation was a natural one considering the state of public 

 feeling and of medical science at that time; for the thing to do with 

 the alienated, when only one thing can be done, is to take good care 

 of them; after this we can study them and build up a science and an 

 art. And this is what has happened. 



During the last twenty years there has been steadily developing 

 a science which deals with mental disease. Largely through the 

 influence of certain clear-sighted administrators of our hospitals, our 

 knowledge has developed until now we are justified in classifying 

 psychiatry among the medi'cal sciences, surpassing in exactness some, 

 and in importance, interest, and difficulty perhaps all, of the other 

 branches of medicine. For we are dealing in its study with the ulti- 

 mate and finest and most elaborately differentiated product of organic 

 life, and our task with it is not only to study and to classify, but to 

 prevent and to save that which is most essential to human progress 

 the human mind. 



During these past twenty years the administrative care of the 

 insane has also steadily improved, so that now in our best semi-pri- 

 vate and endowed institutions there is really little more that human- 

 ity could suggest or ingenuity devise for the comfort and care of the 

 patient. In many of our state institutions there has been also a 

 steady progress, which is hampered in some states by poverty and 



