In these words of the psalmist lay the germ of Mr. Beers' ambition and his book. As for the book itself, we have both internal evidence and the author's direct statement that it was not only conceived but also drafted during a condition of excitement which caused him not a little uneasiness, even to the extent of taking precautions against a possible further hospital internment. "I found myself writing with a facility which hitherto had obtained only during elation As the work progressed my facility increased-in fact, I soon called in an additional stenographer to help in the snaring of my flying thoughts. This excessive productivity caused me to pause and again to diagnose my condition. I could not fail now to recognise in myself symptoms hardly distinguishable from those which had obtained eight months earlier when it had been deemed expedient temporarily to restrict my freedom."

From what we know of the impaired insight of the protracted convalescence from maniac states, and of the possible more or less permanent mental changes which may result, and from his own testimony, we conclude that Mr. Beers' work cannot be taken without a liberal grain of salt.

It has been emphasised that his case followed a clinically wellknown course. Such cases regularly end in recovery from the acute phases of illness. Maniaco-depressive insanity is one of the best-known types of disease; its manifestations are banal. The author nevertheless speaks of his "rare experiences," his vellous escape from death and a miraculous return to health after an apparently fatal illness." The suspicion arises that all may not yet be well in Denmark, when one encounters the above sentence on the first page of the book, and this suspicion is strengthened as we proceed. In Romanesque reminiscence the author becomes a hero whose impressions of illness still have the weight of authority. In various tragic incidents which he contrived and in numerous unpleasant encounters, it was he who was calm and wellpoised, while the doctors or attendants were in discomfiture, visibly excited, "noticeably disconcerted," etc. He accepts the feelings which possessed him during the acme of his illness as criteria, and from his individual experiences he makes startling generalisations as to the proper management of mental cases. He demands

that preachers "be oftener seen working among the insane," although their presence is in many cases directly contraindicated. He counsels relatives in all cases to visit and write frequently to patients and demands that the latter's letters be forwarded without question and unopened. To any alienist reasons will at once suggest themselves why in certain cases, and at certain times, none of these things may be desirable, in the interest of both the patient and his family. The author quotes frequently from the statutes, as if they were an answer to the question of right, or judgment, or expediency in the treatment of mental cases.

In passing, a somewhat suggestive characteristic of the author's style may also be mentioned. He speaks of his depressive phase of twenty-six months as "seven hundred and ninety-eight days of depression." His first straight-jacket experience lasted fifteen hours. This period is specified as "nine hundred minutes." Instead of saying that the camisole was applied on twenty-one consecutive nights, he states that this occurred " each and every night on the following dates: October 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, and 31, as well as the nights of November 1, 2, 3, 4, 5, 6, and 7-twenty-one nights in all," or to be still more exact, "about three hundred hours."

Bearing in mind certain qualifications with which this book must be read, it still remains true that it is a very valuable and timely production. It is valuable first as a human document, an autopathography, presenting a vivid account from within of a definite type of psychosis. The main object of the author, however, is the righting of certain wrongs and abuses in the management of mental cases. Whatever one may think of the author's opinion and description of these abuses, it is only too true that they exist. We know that in many institutions patients are ill-treated, subjected repeatedly to physical punishment, occasionally even killed by brutal attendants. Such abuses cry to humanity for redress, but their final abolition seems, alas, a dim Utopian dream. In many of the larger institutions it will long remain impossible, for patent reasons, to secure attendants of such quality as can be schooled to render efficient and intelligent service in caring for their charges without a trace of cruelty. This state of affairs we cannot excuse, and we must view it with profound regret.

In a well-managed hospital cruelty to patients will hardly occur or will be reduced to the human minimum. To accomplish this requires in nurses and attendants qualities of heart little short of angelic. We may tell them that violent and troublesome patients are so because they are ill, that their evil propensities are the result of their disease; and this may all be true, but it is not necessarily the whole truth. That which we have been taught to call evil lurks in the soul of every man, including kings and popes. Under the license of alienation it may come to full fruition, and when the patient openly declares, as he frequently does, that being considered irresponsible he takes delight in showing himself as insubordinate as possible, it may be well-nigh impossible for the kindest attendant to see in his violent and treacherous acts nothing but “symptoms," especially when they take the form of unprovoked and unexpected assaults, as is also not uncommon.

Mr. Beers appropriately observes that the psychopathic hospital must be in a certain sense a kindergarten. The imperfect mind of the child and the deranged mind of the adult have certain features in common. Both require education. To this end much may be accomplished by love, but not all. Certain strict and categoric measures will also be required. These to the child and to the mental patient may appear as punishment, and therefore in a sense they are so, and their use is a legitimate and necessary one. We know, however, that sometimes the most essential and benign of these measures are looked upon even by convalescent patients as acts of cruelty.

The discussion of the work of Mr. Beers has been carried into some detail, as its importance seemed to justify. Many of the abuses he describes are wide-spread and should be easily remedied. The unlovely effects of politics and graft in the management of hospitals, both public and private, are exposed in a fair and unenviable light.

Whether or not the circulation of such a book among the general public be well-advised, it may be perused with profit by every doctor and every nurse who has to do with mental disease. To treat a patient properly we must know his individual view-point, to foresee as far as possible his reaction even to the most trifling circumstances, and regulate our own relations with him accord

ingly. In A Mind that Found Itself" there are abundant suggestions which lead in this desired direction, and reading the book cannot fail to reinforce the alienist in the individualising method, the importance of which was postulated at the outset of this discussion.

It was remarked above that the evils which obtain throughout the country in the general management and treatment of mental disease are to be laid at the door of faulty education and faulty legislation, and this is true. The position of psychiatry in American medical education has been unquestionably a disgrace. The average physician has no knowledge of mental diseases and no interest in them-and why? Because he has never been taught anything about them. Germany can boast some two dozen University psychiatric clinics, one in each medical school. Against this, what can America show? A single University clinic, that established at Ann Arbor two years ago. In mental pathology, this country lags a full generation behind Europe, in spite of the fact that the beginnings of the modern science were synchronous on both sides of the Atlantic. Was not Rush the contemporary of Pinel and Heinroth? And were not the three great pioneer organs, the AMERICAN JOURNAL OF INSANITY, the Annales Médico-psychologiques, and the Allgemeine Zeitschrift für Psychiatrie, founded almost within the same twelvemonth?

In Germany not only are the medical students taught psychiatry in the schools, but what is more to the point, the state has since 1901 required that they should be able to show a working knowledge of this science, before admitting them to the rank of practicing physicians. There is no need to bring proof that the mental health of the individual, and of the community, and of the state, is at least of equal importance with their physical well-being. No one will dispute this. And yet for the American state the science of psychiatry is as if it had no existence. Few schools give it any commensurate attention, and the state does not concern itself as to whether its practicing physicians have any knowledge of diseases of the mind, although to use a classic example, it may require of them a familiarity with the alkaloids of opium. At most we may perhaps discover in a state examination, hiding itself shamefacedly among the questions on bacteriology or materia medica, a lone

enquiry for the definition of hallucination or delusion. The perusal of the commitment papers on the strength of which patients are admitted and detained in hospitals, and a scrutiny of the "reasons which certifying physicians bring forward to support their view that the patient should be so detained, afford distressing proof of the state of neglect of American psychiatry. One physician gave as his reason for believing that a certain individual was insane and in need of hospital detention, the fact that his knee-jerks were exaggerated! The remedy for this backward state of affairs, and consequently for the anachronisms of treatment current in many institutions, lies first with the medical schools. Already beginnings have been made. We may hope that the good work inaugurated at Ann Arbor, encouraged at Toronto, made possible by the Phipps foundation in Baltimore, and carried forward in other similar clinics which are bound to follow, will within the next decade lead to widespread results in the rational treatment of mental disease, -results which we may with satisfaction compare with those long realized abroad.