CHAS. W. PILGRIM, M. D. 53 



enactment from asylums to hospitals. That is only one 

 evidence, however, that what were formerly asylums or 

 places of safety and detention have become, by gradual 

 evolution, hospitals, in fact as well as in name, where 

 skilled physicians and trained nurses put forth their best 

 efforts to " minister to the mind diseased." 



Probably nothing has done more to improve the ser- 

 vice in hospitals for the insane than the training of at- 

 tendants. About fifteen years ago this question began 

 to be agitated, but it is only within the last eight or ten 

 years that training schools in connection with hospitals 

 for the insane have obtained a solid foothold. To-day 

 there is scarcely an institution in any part of the United 

 States where efforts are not made to train the attendants. 

 In this State every hospital is obliged to have its train- 

 ing school, and graduates, who pass their final examina- 

 tions before a board of examiners composed of three 

 superintendents, are entitled to an increase in wages and 

 are always selected for promotion in preference to non- 

 graduates. 



This policy, together with a strict compliance with the 

 principles of Civil Service Reform, is beginning to tell. 

 We are now getting more intelligent employes and more 

 faithful service than it was possible to obtain a few years 

 ago. There are of course occasional exceptions, but in 

 the vast majority of instances attendants are kind and 

 conscientious and perform faithfully their arduous duties 

 under most trying and discouraging conditions. 



Since the practical abandonment of mechanical re- 

 straint the attendant has occupied a most important 

 place in hospital management. Even locks and window 

 guards are not always necessary, and in some wards of 

 nearly all institutions the doors are left oi3en through 

 the day, so that patients may come and go at will. There 

 is of courfee in every hospital a considerable number of 

 patients with destructive and suicidal tendencies, but 



