Neurasthénié et Névroses leur guérison définitive et cure libre. By Paul Émile Lévy. (Paris: Alcan, 1909.)-Nervous and Mental Diseases. By Archibald Church, M. D., and Fred- erick Peterson, M. D. (Philadelphia and London: W. B. Saunders Company, 1908.)-Diseases of the Nervous System. AMERICAN JOURNAL OF INSANITY PRESIDENTIAL ADDRESS: HOPEFUL AND DISCOURAGING ASPECTS OF THE PSYCHIATRIC OUTLOOK.* BY CHARLES P. BANCROFT, M. D., Medical Superintendent N. H. State Hospital, Concord, N. H. It is to be hoped that your president may be pardoned for selecting as a topic for the annual address anything suggestive of historical résumé or presumptuous prophecy. Fully cognizant of the great honor that the Association has conferred upon me it is not my desire to reciprocate by submitting a wearisome retrospect, nor a too imaginative prognostication. The occasion has seemed opportune however for a brief consideration of the probable trend of psychiatry viewed from the vantage-ground of present achieve ment. On the purely scientific side psychiatry has made during the last few years remarkable progress. The pathologist and the clinician have co-operated most efficiently. The psychopathology of mental diseases has received the most searching scrutiny from trained, skilled observers. This uniformly careful study of every phase of morbid mind has illumined our conception of insanity and allied mental conditions. The underlying disease process is more clearly understood than ever before. The old idea of numerous specific disease-entities to which this or that name was attached has given place to another idea, that of a few definite disease-processes with varying symptoms disappearing and reappearing in the same person. At one time depression, at another time elation, again confusion, and still again * Delivered at the sixty-fourth annual meeting of the American MedicoPsychological Association, Cincinnati, Ohio, May 12-15, 1908. stupor occurs, not only in different individuals but in the same person at different times in his disease. The changes are rung on these and other symptoms in the same and in different types of insanity so that a classification by symptoms alone has become meaningless. We have learned to avoid making a diagnosis on any one of these superficial phenomena, for such symptomatology may be found in almost any variety of insanity in an adolescent as well as a senile form, in a toxic functional psychosis, a systematized delusional form or an organic brain disease like paresis. We have made a distinct advance, founded on careful scientific research, when we disregard all these kaleidoscopic symptoms and dig down deep into the morbid process underlying these outward expressions and endeavor to ascertain just what is occurring in the mind itself and its organ, the brain. Neurology, Psychiatry is no longer a circumscribed field. psychology and sociology are now closely related with psychiatry. As mind is the latest and most perfect expression of evolution in the universe, so the study of its morbid variations must necessarily concern every part of the nervous system through whose functioning its present evolutionary attainment has been reached. As mind is modified by environment, so social conditions become identified with and oftentimes responsible for its morbid manifestation. The psychiatrist cannot afford to neglect the science of sociology in his study of the cause, development and treatment of mental diseases. Psychology is assuming an increasingly important position in psychiatry, because, dealing as it does with mental processes, it enables the psychiatrist to apply the principles of normal psychic laws to the operations of diseased mind and thereby form a clearer conception of the complex mental phenomena of the insane mind that underlie abnormal conduct. While scientific psychiatry has made such creditable advance it is interesting to note that the welfare of the patient has not been neglected. Hospital management and methods have been receiving the most careful study for the past twenty-five years and many important modifications have resulted that place the equipment of the hospital for the insane on the same high plane as that of the general hospital. The old block construction has given place to the detached pavilion plan. The acute psychopathic ward, or wards, the reception hospital, the convalescent villa, the farm colony, the detached groups of buildings for better segregation and care of the different types of insanity are an expression of the better understanding of the disease and its requirements. The movement toward the better training of nurses as witnessed in the very general establishment of training-schools for nurses in hospitals for the insane, with the not infrequent attempts at affiliation with the general hospitals, thereby permitting mutual interchange of nurses; the participation of nurses in hospitals for the insane in district nursing, thereby stimulating an interest in the nurses themselves and eliminating the old idea that a nurse in this specialty is separated from the general nursing profession outside these special hospitals; these and similar steps in the better training of nurses for the work in the hospital for the insane are distinct advances and emphasize the growing conception in the popular mind of the solidarity of all diseases, of which insanity is only one but a very important part. The establishment of psychopathic wards and pavilions in connection with general hospitals in the large metropolitan centers, as in Germany, France and Italy abroad, and in New York at Bellevue, and Pavilion F at Albany, is another evidence of the tendency toward the realization of the hospital treatment of the disease. But especially noteworthy is the connection of psychopathic wards with general hospitals in cities that contain one or more medical schools, because of the facility such association gives for the better clinical instruction of the medical student in the acute psychoses. Every attempt that has been made to break down the barrier in the mind of the medical student that separates insanity from all other diseases, every attempt that is made to familiarize the student with the clinical features of mental alienation in its earlier stages, is sure to be helpful in the future. For every medical student thus trained is better able to detect in his practice during later years the early development of insanity, and presumably his advice and management of such cases will be of direct advantage to any community in which he may be located. Unquestionably the interest and attention of the student will be more readily enlisted if he can in connection with his general hospital clinic visit the wards for insane patients. Clinical accessibility for the observa |