general hospital experience should be sufficient to make such a nurse capable of undertaking the management of any surgical or medical cases; in fact where facilities exist for establishing reciprocity between general and psychiatric hospitals, a threeyears course would probably answer every requirement. Experience tends to show that nursing training begun among mental cases often produces nurses of the highest order. The development of resource, which must take place with the mental nurse, if she is to be successful in her career, is just what is required to emancipate the general nurse from the hamperings of rigid routine and machine methods.

In psychiatric hospitals the best type of mental nurse will be looked for, and the effects of reciprocity will be well worth studying, the impression being that the results will more than justify the experiment.

C.

"A MIND THAT FOUND ITSELF." THE NATIONAL COMMITTEE OF MENTAL HYGIENE.-When Miss Dix accomplished the purpose of her crusade against the detention of the insane in jails and almshouses, and the state system of care was established, a great and final end was thought to have been attained. But the organization of state asylums is now known to be only a step in the evolution of a principle, and the elusive ideal, like the ideal in all things mundane, slips farther away each time a step forward seems to bring it within reach. The achievements of the last halfcentury have been the recognition of the pathological nature of insanity and the charitable purpose to separate the insane from other defectives and place them in sanitary dwellings under medical care. The task has been an enormous one, and under the pressure of the increasing number seeking and entitled to the protecting care of the state, is now and again threatened with fail

It is well known and acknowledged that not over five per cent of the patients in so-called state hospitals belong in the curable class, and that the dominating aspect of our institutions is that of custodial care rather than treatment. Some would make shift to return to earlier methods; others look beyond the superficial utilitarian problem and study the defect at its origin. In any event the mile-stone has been reached and energies must now be directed toward attempts to prevent mental disorders and toward

their early recognition and treatment, if the appalling burden of chronicity and helplessness is to be diminished. As Miss Dix proved a potent force in correcting the abuses of the past, so the new era has its advocate of no less vigor, no less persistence, and an equal intensity of purpose born of personal experience.

In 1894, while a student in Yale University, Mr. Clifford Whittingham Beers had the care of a brother suffering from the convulsive seizures incident upon a tumor of the brain. This painful service resulted in a nervous breakdown and an apprehension of epilepsy which finally became a fixed idea. Mr. Beers was sent to a general hospital, afterward to a private sanitarium, later to a private hospital for the insane, and finally to a state institution. He passed from delirium into a condition characterized by active delusions of persecution with mental depression, and later became restless, obstinate and quarrelsome. Of the incidents of his sickness he retains a more or less perfect memory, and he has published the history of his experiences in a book with the sadly ironical and suggestive title, "A Mind that Found Itself: An Autobiography," which is destined to become one of the classics of psychological literature. It is well and forcibly written and deserves careful reading. It is no new thing for cured, and even for uncured patients, to publish their thoughts and reflections; but nowhere is there such an intelligent analysis as this, and Mr. Beers deserves the thanks of all who study insanity for his painstaking narrative. It carries the reader away from technical dissertations, and brings him face to face with the feelings and reactions. of a distorted mind, showing him the patient as a human being with a sentient soul and not as a case." It shows how doctors who were looking for a diagnosis may possibly have overlooked the undercurrent of thought, and how attendants provoked and irritated by his tantalizing words, did not comprehend his purposes, and reacted thereto and gave him the material for an arraignment of their work which might well have been a bitter invective, but is destined to become of great value to the afflicted, if read with an open mind by those having them under care.

1

66

The purposes of Mr. Beers' book are: first, to rob insanity of

1 For a critical analysis of this work see page 215 of this number of the JOURNAL.

its many terrors, and to exploit the humane and scientific principle of non-restraint; secondly, to found and secure the endowment of a national society to promote effectual reform and to ensure the correction of all abuses; and, thirdly, to induce the beneficent rich to aid the states and nation by supplying funds for the erection and endowment of model institutions wherein mental and nervous diseases, in their incipient and curable stages, may be treated with the maximum of efficiency. His ideas are practical, and though not in advance of the time, are well abreast of the most advanced thought.

Mr. Beers is now engaged in the formation of a "National Committee of Mental Hygiene," and has secured acceptances from the following proposed honorary members: Prof. William James, Harvard University; Rev. Anson Phelps Stokes, Jr., Secretary, Yale University; Prof. Russell H. Chittenden, Director, Sheffield Scientific School; Dr. Adolf Meyer, New York City, Director, Pathological Institute, N. Y. State Hospitals; Major Henry L. Higginson, Boston, Mass.; Dr. J. Montgomery Mosher, Albany, N. Y.; Prof. Francis G. Peabody, Harvard University; Dr. Henry Van Dyke, Princeton, N. J.; Prof. J. Mark Baldwin, Johns Hopkins University; Dr. Lewellys F. Barker, Johns Hopkins University; Judge Robert W. Taylor, U. S. Circuit Court, Cleveland, O.; Mr. Sherman D. Thacher, Nordhoff, Cal.; Dr. Henry B. Faville, Chicago, Ill.; Miss Julia C. Lathrop, Hull House, Chicago, Ill.; Miss Katherine Felton, San Francisco, Cal.; Miss Jane Addams, Hull House, Chicago, Ill.; Dr. August Hoch, Bloomingdale, White Plains, N. Y.; President David Starr Jordan, Leland Stanford Jr. University; Dr. Stewart Paton, Baltimore, Md.; Dr. William H. Welch, Johns Hopkins University; President Cyrus Northrop, University of Minnesota; Mr. Melville E. Stone, New York City; Mr. Horace Fletcher, New York City; President Jacob G. Schurman, Cornell University; Mr. Robert A. Woods, South End House, Boston, Mass.; President W. H. P. Faunce, Brown University; Mr. George Wharton Pepper, Philadelphia; President James B. Angell, University of Michigan; Hon. Gifford Pinchot, Washington, D. C.; Dr. Frederick Peterson, New York City; President Edwin A. Alderman, University of Virginia; Jacob A. Riis, New York City; President

Arthur T. Hadley, Yale University; Dr. Henry P. Walcott, Cambridge, Mass.; Mr. Lee Meriwether, St. Louis, Mo.

In May last was also issued the announcement of the first state organization, whose aims are stated as follows:

PRELIMINARY PROSPECTUS OF THE CONNECTICUT SOCIETY FOR
MENTAL HYGIENE.

It is the aim of the Society for Mental Hygiene to become a permanent agency for education and reform in the field of nervous and mental diseases; an agency for education always, for reform as long as radical changes may be needed.

The chief object of the Society for Mental Hygiene shall be the improvement of conditions among those actually insane and confined, and the protection of the mental health of the public at large.

Conditions in this neglected field may be bettered by arousing through press, pulpit and innumerable other channels, a sentiment against existing evils. Public sentiment thus aroused will eventually express itself through state legislatures in the form of adequate appropriations, and these intelligently expended will raise standards of treatment. As universal confidence in our institutions would soon overcome the now common dread of commitment and appreciably diminish the dread of insanity, the raising of standards of efficiency shall be a controlling factor in the policy of the society.

The society shall co-operate with hospital officials-especially with the physicians in charge of the patients. These, it is assumed, will take an active part in the work of the organization. This is most important, for the success of the planned campaign depends, in large measure, upon the hearty co-operation of those in authority in our institutions.

A most important function of the society will be the waging of an educative war against the prevailing ignorance regarding conditions and modes of living which tend to produce mental disorders. This common-sense prophylaxis-or work of prevention-will, in time, bring under control the now increasing population of our hospitals and asylums.

The society shall publish and distribute information which will warn and help rescue those threatened with nervous or mental collapse, and indicate the help at hand. Popular articles on mental disorders and the provisions for their management, written especially for the general public, will go far toward correcting mistaken conceptions now commonly held by laymen; and such knowledge, widely spread, will overcome many terrors now ignorantly associated with disturbed states of mind and the institutions provided for their treatment.

It shall be an aim of the society to devise a substitute for the usually ineffective and always disturbing "legislative investigation." In the opinion of those able to judge, this result can be best reached by a commission of experts who would prepare and report a plan which would serve as a basis for permanent improvement.

The society shall appoint a committee to study the question of making the legal protection of patients, both before and after commitment, less of a burden for all concerned. A committee composed of physicians, lawyers, hospital officials and well-informed laymen, should be able to frame a set of model statutes, applicable, with slight modifications, to the situation in all states of the Union. Such a set of statutes would do away with practices under which the afflicted now suffer needless annoyance and hardship. Patients should be given every deserved privilege and their rights should be protected by law. Except where effective supervision is assured, hospital rules, so easily made, set aside or broken, should not be accepted as adequate protection for inmates of our public and private hospitals where the mentaly afflicted are confined.

Viewed as a whole the problem of insanity may seem staggering, perhaps hopeless; but divided into its manageable elements the problem becomes susceptible of solution. It shall therefore be an aim of the society to formulate a plan, in the carrying out of which these controllable units may be reached.

The society shall endeavor to spread a knowledge of the principle of non-restraint, with a view to bringing about the universal adoption of this individualizing principle in the treatment of insanity.

The society shall appoint "after-care committees" for the purpose of assisting those who, without help of some kind at the time of their discharge, find the struggle for existence so severe as to cause a relapse, often necessitating re-commitment. This plan has long been in successful operation in Germany, Switzerland, France and Great Britain. In this country, the State of New York has taken the lead, several after-care committees having already been brought to a working perfection under the auspices of the State Charities Aid Association of New York City.

It shall be the business of the society to appoint a local committee to represent it in each city and town. Such a committee shall act as first-aid to the insane, and to the relatives and friends of those suddenly stricken. Not only shall it give instructions regarding the commitment and transfer of patients; it shall help bring under prompt control cases of threatened collapse. The committee shall also send to the hospital authorities information regarding the early history of committed persons, and upon the discharge of the patient, provided help be needed, it shall co-operate with the after-care committee and prepare the ground for his return and for a removal or remedy of the causes which precipitated his collapse.

Men and women, suited to the work, shall be delegated by the society to visit the hospitals and take an interest in friendless but responsive patients. In this work the co-operation of the hospital officials must be first secured, for the physicians in charge of the patients should control such visits.

It shall be an aim of the society to bring about the selection of persons, as trustees in state hospitals, who have shown an intelligent interest in the work.

It shall be an aim of the society to secure from the state legislature