54 



THE CAEE AND TREATMENT OF THE INSANE. 



even with them the eyes and ears of the attendants are 

 made to take the place of the camisole and muff of 

 earlier days. Neither are large doses of stupifying 

 drugs given for the mere purpose of quieting a noisy and 

 troublesome patient. We have found a much better and 

 more satisfactory method in exercise and employment. 

 If a patient is physically strong but too destructive to 

 engage in any kind of occupation, he is taken for long 

 walks and kept in the open air in suitable weather until 

 nature calls for rest through sleep. If, however, he can 

 be induced to work, as nearly all can if the effort is per- 

 severed in, some suitable and congenial occupation is 

 provided in which a couple of hours are spent each 

 morning and afternoon. I have seen patients in the last 

 stages of dementia spending their time in picking their 

 clothing and bedding into shreds, who upon being taken 

 to the upholstery shop would quietly pick the curled 

 hair used in mattress making for hours at a time, thus 

 satisfying themselves while performing some useful 

 work. The amount of useful work performed, however, 

 is never the object sought. I have had women sew for 

 hours upon work which would have to be done over 

 again, and have had men wheel dirt and stones from one 

 spot to another simply for the sake of the exercise and 

 occupation thus obtained. 



There must be some outlet for the pent up nervous 

 energy, and if it does not find vent in occupation and 

 recreation, unprovoked attacks upon attendants and fel- 

 low patients and destruction of clothing and furniture 

 will follow. The recognition, and practical application, 

 of this fact accounts almost wholly for the difference in 

 the amount of violent excitement found in the asylums 

 of ten years ago and those of to-day. 



In the Hudson River State Hospital during the past 

 year sixty-five per cent, of the patients were engaged in 

 useful employment of some kind. This means that oc- 



