May 18, 1900.] 



SCIENCE. 



781 



ular medical visiting staff, supplemented by 

 salaried house-oflScers and trained nurses, 

 is most gratifying and promissory of still 

 better conditions. 



The same influence is at work in the do- 

 main of penology ; prisons everj'where are 

 steadily coming to be less punitive, more 

 reformatory, and the in determinate sen- 

 tence is a recognition, not only of the possi- 

 ble good underlying apparent evil, but also of 

 the fact that betterment of the physical con- 

 dition, as well as of the mental point of view, 

 is a uecessary basis for a healthy morality. 



Dr. Coulston, of the Royal Edinburgh 

 Asylum, illustrates the fact that purely 

 mental and moral causes play but a small 

 part in the production of insanity, as com- 

 pared with causes bodily and physical, by 

 the statement that of cases examined by 

 him only 11.5 per cent, were due to mental 

 shock, the remainder being the outcome of 

 causes acting on the brain through the 

 body ; drink and dissolute living, faulty de- 

 velopment, hereditary disposition and the 

 like ; furthermore, he gives it as his opinion 

 that the late epidemic of influenza caused 

 more insanity than all the public and pri- 

 vate anxiety in connection with the war in 

 Africa. 



The weakness of will and the inabilitj' to 

 sustain healthy mental exertion, evident in 

 asylums for the insane, are found also, 

 though in lesser degree, in houses of refuge, 

 almshouses and prisons, and the parallelism 

 of conditions of the mentally, morally and 

 physically defective, with the interchange- 

 ability of their classification, are nowhere 

 more compactly observable, more readily 

 made subject of study, than in the public 

 institutions departments of our gi*eat cities 

 with their shifting population passing from 

 one institution to another, a pauper, a 

 drunkard, a malefactor in succession, but 

 always a public charge. 



These departments, classed in the civic 

 roster with the departments of public works 



as channels of expenditure, fiscal adminis- 

 tration and possible political preferment, 

 have come to be regarded, because of their 

 humanitarian function, as fields for' the ex- 

 ploitation of philanthropic effort. 



AVorthy and commendable as this is and 

 most welcome as opening the waj' to still 

 better defined conditions, it fails of its fullest 

 efliciency because it lacks the necessary 

 foundation of accurate information in regard 

 to the subjects with which it has to deal 

 and, under the ordinaril^^ existing political 

 conditions, fails of continuity of effort. 



The care of the physically, mentallj', and 

 morally sick is so verjr serious a part of the 

 business of life, its judicious exercise so 

 important to the welfare of the whole com- 

 munity, that it is best placed, unreservedly, 

 in the hands of those whose training has 

 fitted them for its obligations and who have 

 learned, by repeated experiences, that an 

 emotion however good, or an impulse how- 

 ever philanthropic, unexpressed in care- 

 fully considered and continuously beneficial 

 work, sinks to the level of a personal grat- 

 ification. 



The ideal institutions department is that 

 which, removed entirely from political con- 

 trol, but still a part of the city government, 

 is adjusted and administered upon the hos- 

 pital basis, bringing to its service, as does 

 the hospital, the conjoint efforts of the man 

 of business and the physician. The actual 

 work is in the hands of a general superin- 

 tendent or commissioner, a medical man of 

 large fexperience and institution-training at 

 a salary enabling him to devote his whole 

 time to the duties of his oflBce ; under him, 

 as the heads of subdepartments, salaried 

 ofiicials, among them medical men and wo- 

 men and house ofiicers, either senior med- 

 ical students or recent graduates, holding 

 positions the equivalents of those in general 

 hospitals. 



The whole under control, both as to ap- 

 pointment, general management and ex- 



