744 THE POPULAR SCIENCE MONTHLY. 



act went into effect. Each hospital is allowed $4.25 per week for 

 the first three years of residence of each patient, and $2.50 per 

 week for any period beyond three years. It is also intended that 

 one assistant physician should be assigned 'to every two hundred 

 patients. 



The thought now arises, What kind of medical care do insane 

 patients require, and what has and will be the effect of this huge 

 influx of chronic incurable insane upon the true object of a State 

 hospital, the cure of the insane ? 



The demand for and the recognition of the need of a more dis- 

 tinctively medical care for the insane is shown by the change in 

 the titles of institutions for the insane from asylums, a place of 

 refuge, to hospital, a place of cure; a movement which is so gen- 

 eral as not to be due to any local cause or influence, and also in 

 the recent pleas of some prominent alienists that the acute insane 

 should receive the same kind of medical care as patients suffering 

 from any other acute ailment. The latter go so far as to advise 

 the establishment of a hospital for the acute insane on the same 

 lines as those of any general hospital,* with its visiting staff and 

 thorough attention to all physical disorders in addition to the 

 mental disease. 



To-day the solution of this question lies either in a general 

 hospital for the acute insane or in the hospitalizing of the old 

 asylum or part of it. A general hospital for the acute insane 

 would not, I believe, be advisable, and could not be properly con- 

 ducted except in the large centers of population where there are 

 many specialists in insanity. The duration of the illness, the 

 need at certain stages of the disease of diversion or occupation, 

 because there comes a time when such influences are most power- 

 ful for good, the difficulty of determining at once whether the 

 disease is curable or not, thus tending to overcrowd such an insti- 

 tution or necessitating frequent changes ; all these would make 

 impracticable such an institution. Then, too, the fact that in our 

 present State hospitals most of the patients come from small cities 

 or the country, where there are poor or no hospital facilities and 

 certainly no specialists, would necessitate the erection of many 

 special small hospitals in these places or the transference of these 

 patients to large cities with all the attendant ill effects noise, ex- 

 citement, and close quarters. 



But that acute cases of insanity, however, need some kind of 

 hospital treatment is evident. No less an authority than Dr. J. 

 Batty Tuke has thus written : " The subjects of most of the insani- 



* By general hospital in this connection is meant a hospital constructed on the same 

 lines as other hospitals for special diseases or the establishment of special wards in a large 

 general hospital. 



