THE DUTY OF THE STATE TO THE INSANE. 747 



In justice, it must be said that every asylum physician seeks 

 to give the acute cases the larger part of his time, but the press of 

 other matters, non-medical, so encroach upon his time that he 

 usually finds that he has neglected, or at least has not done as 

 much for them as he might have accomplished under other cir- 

 cumstances. What, then, are these other circumstances, and how 

 can a State hospital take better care of acute cases than a general 

 hospital ? 



Let us take, for example, a State hospital of one thousand pa- 

 tients. The staff would consist of a medical superintendent, five 

 assistant physicians, and a woman physician. In a hospital of 

 that capacity there would never be more than one hundred patients 

 who would be considered curable, and the number would probably 

 not exceed sixty. More than nine hundred patients would be 

 hopelessly incurable, for the most part the wrecks of past disease, 

 who practically need nothing but kindly custodial care with inci- 

 dental medical treatment. Two, or at most three, physicians 

 could easily do all that a humanitarian spirit might deem neces- 

 sary for such a number of this class of patients. Three or four 

 physicians would thus be left to devote themselves to the curable 

 patients. Instead of constructing annexes for the harmless 

 patients, let these be lodged and cared for in the huge barracks- 

 like main buildings, the creation and legacy of a former genera- 

 tion. Then erect at suitable distances from the main building 

 three or four houses for the treatment of the curable patients. 

 These should be built simply and comfortably, so constructed as 

 to do away with the huge institutional feeling and to give them 

 a homelike appearance, and so furnished as to take away as much 

 as possible all indications of confinement and restraint. They 

 should contain no wards, but plainly furnished single rooms with 

 sitting-rooms, thus permitting the utmost privacy, with the op- 

 portunity of intercourse when deemed beneficial. 



Here the real medical work of the hospital should be done, and 

 no labor should be spared which would in any way tend to the 

 recovery of a patient or help to solve any of the unknown prob- 

 lems of insanity. 



Electricity, massage, baths of all kinds, thorough examination 

 of the blood and the various excretions, the use of the sphygmo- 

 graph and ophthalmoscope, together with a very thorough phys- 

 ical examination would easily and most profitably keep employed 

 the number of physicians assigned to the acute cases. For it is in 

 this acute and presumably curable period that the case should 

 have everything that medical skill and unremitting attention 

 under the most favorable circumstances can confer. The disease 

 must be arrested in this beginning stage if it be in our power to 

 arrest it. 



