CHAS. W. PILGRIM, M. D. 57 



regard to the " home treatment" of insanity. A noted 

 neurologist a short time ago in an address on the subject 

 of hospitals for the insane said that it was his belief that 

 they should "never be used save as a last resource." 

 Such advice is too frequently followed, and we who spend 

 our lives surrounded by the saddening influences of 

 " minds o'er thrown " know full well that in the majority 

 of cases when that " last resource " is reached, all hope 

 of cure has passed. I am quite willing to admit that in 

 the homes of the wealthy where expense need not be con- 

 sidered, where a sufficient number of nurses can be ob- 

 tained, and where hospital conditions can be closely ap- 

 proached, in fact where the home can be, for the time, 

 transformed into a hospital, that it may be desirable and 

 even advisable to undertake the home care of certain 

 forms of acute insanity. But the cases where all such 

 conditions can be provided are comparatively few, and 

 the fact still stands that the vast majority must sooner 

 or later find their way to the hospital. The sooner they 

 are sent the better it will certainly be for all concerned. 

 In a paper which I wrote a couple of years ago on "Com- 

 municated Insanity," I cited several cases where home 

 care resulted in the mental break down of other mem- 

 bers of the family and also showed that an analysis of 

 the cases with which I had had to do for the previ -us 

 ten years proved conclusively that from six to eight 

 persons recovered when placed under hospital treatment 

 during the first three months of the attack, where only 

 one recovered where hospital treatment was delayed a 

 year. 



I realize that even in this day and generation there is 

 a certain amount of stigma attached to insanity, but 

 much has been done during late years to remove this 

 unjust discrimination against sufferers from brain dis- 

 ease. I fear, however, that it will never be quite done 

 away with until the admission into hospitals for the in- 



