is the foundation upon which has been created the modern elaboration of practical psychology, as suggested by Dr. Meyer.

Maudsley has gone on during all of these years in his clinical psychology, and very recently added to his classic contributions a book called "Life in Mind and Conduct," which is a reiteration of his practical conceptions of mind and establishes the fact that conduct is the criterion of mental disorder, thus elaborating facts upon which we may base the doctrine of psychogenic origin of many mental maladies.

The study of mental distinctions, the psychic analysis and synthetic considerations marks the advances in clinical psychology and gives us the lead that will aid in instituting preventive measures. As I said the other night, the work of Witmer, of the University of Pennsylvania, is an advance in clinical psychology as applied to child life, and these same methods, when applied to the promising clinical field to be found in psychiatry, offer great rewards. Clinical psychiatry is just coming into its own, and it is our duty to create the opportunities in this direction that will give it the same footing and value as that now given to pathology. I may be too sanguine, but yet, I believe the time is coming when we will have resident psychologists as well as resident pathologists, for the purpose of developing a clinical psychiatry, and the clinical analytical methods, too, will solve many of the problems of etiology and give value to therapeutical measures. Especially in borderline States, a field in which my work largely is confined, cases seen before they reach large hospitals, and too many are office cases; here is a rich harvest awaiting the clinician, and we must encourage and promote this great and useful work in clinical psychology.

DR. MEYER.-The activity of the individual, as a whole, connected as it is by the central processes of which we are subjectively aware, is mind; the activity as a whole, including everything that leads up to and clinches the activities in conduct.

DR. BANCROFT.-I think Dr. Meyer has opened up a large and interesting field for future study, that has a direct bearing on our efforts for the prevention of insanity. Sometimes I long for the days when the oldfashioned country practitioner was a power; I wish we could recall him, a man who knew the individuals, and the families, among whom he practised, and, understanding them, would recognize that these people would have varying reactions to their environment and conditions in life. In these days of modern specialism, I think there is a danger of neglecting the study of the individual, the personality, and in our future efforts towards the prevention of insanity, this is a subject that I believe is vital.

The ancients were not so far from the right track when they attempted to solve these complicated disease questions by establishing a doctrine of temperaments. This temperament reacted in one way and that temperament in another way. I believe that in our future studies and practice it will be necessary for us to study the temperamental make-up of the individual in order to start a rational prophylaxis. I should be glad to hear from Dr. Meyer, in conclusion, his views on the subject.

DR. MEYER.-Just a word of thanks to the gentlemen who have discussed the paper, and especially should I like to emphasize this, that I always have held that a man like John P. Gray could not help himself if he tried with regard to this question. He wrote a paper in 1870 which I have read from one end to the other, with the realization that he has his own doubt in banishing all the moral causes-they were first 40 per cent, and then ignored completely in the statistical paper, but I am sure never ignored in his practice. If you read the chapter on dementia præcox in such a book as that by Dana, you find all sorts of intangible things under etiology which nobody can help-sex, age, etc. We all have sex and a certain age. The real issues are not mentioned until you come to the latter part of the article, where he begins to speak of the sexual factors, the masturbation, and habit disorders-Why not speak of them in the first place? By dropping certain words and traditions, we open for ourselves a much freer field of thought and direct action.

DR. DE JARNETTE.-A woman hears bad news and drops dead. Does the mind kill the body, or the body kill the mind?

DR. MEYER.-It seems to me that the question is put wholly at variance with my interpretation, and is therefore difficult to answer. Certainly that woman was exposed to a mental reaction which involved her heart probably to an extent to which her heart was not equal. Now you can express that as you may; you can say the heart function as part of her mental reaction killed the rest of the activity of the heart, or you can say that the whole mental reaction killed it. The fact remains she actually died because there was a strain of mental origin on her circulation, on her heart; that mental and physical mechanism, which ought to have been ready to meet an occasion of that sort, failed.

DR. DE JARNETTE.-The brain reacted on the heart, but is it not a fact that the heart can act while the brain is not acting-when the subject is unconscious?

DR. MEYER-I intended to show that, by saying that every individual organ has a specific and independent function by itself, so to speak, where, as in the mental activity, the activity of the person as a whole with the help of mental associations, the organs adjust themselves in a special way to work together in the reaction of conduct.

DR. BLUMER. I know I am very much out of order in rising to my feet again, but I should like to come to Dr. Meyer's assistance with a supplementary answer to his questioner.

I happened a year or two ago to be in the company of Professor Woodrow Wilson, president of Princeton University, when he told this story: On one occasion he was delivering a lecture in a small town in Pennsylvania on Aristotle, when he announced, somewhat rashly, at the outset of his address, that he was prepared to be interrogated at its close. After he had finished there arose in the back part of the audience a lady, tall

and gaunt, with steel-bowed spectacles, who said to him in an aggressive voice, "Mr. President, do you think the world has made as much progress as it might?" Mr. Wilson was completely nonplused by the singular inquiry and not knowing how to get hold of it, and by way of sparring for wind, said, “Madam, I beg your pardon." She repeated the question in precisely the same words. Then came his wits to him as he replied, “Madam, you are evidently laboring under a great misapprehension. This is a lecture on Aristotle, not by Aristotle."

RECEPTION HOSPITALS AND PSYCHOPATHIC
WARDS IN STATE HOSPITALS FOR

THE INSANE.*

By C. P. BANCROFT, M. D.,

Superintendent N. H. State Hospital.

By whatever name we designate the subject, whether we speak of reception hospital, observation or psychopathic ward, we are merely striving to express in divers language a thought that has preoccupied the mind of the psychiatrist for many years. Ever since the days of Pinel the disease idea underlying our conception of insanity has influenced more or less strongly everything that has been said or written on the subject. At first vaguely but year by year more clearly have conceptions of mental disease become crystallized. And so modern thought readily and naturally centers round the disease idea of insanity, the hospital care and nursing of the disease, and hospital construction and management have conformed to the prevailing conception of insanity as a disease correlated in many ways with physical disease in general. Combat the conception as much as we choose the thought will return that insanity is disease and the hospital idea must shape our treatment of its various phases and our construction of the buildings in which we undertake its cure.

Hospital or psychopathic wards in connection with institutions for the insane are not new conceptions by any means. About thirty years ago Dr. Clouston advocated and adopted special hospital wards in the Morningside institution. Model plans adopted by the General Board of Lunacy of Scotland in 1880, provided hospital buildings for the care of recent acute and physically sick cases among the insane patients of the larger institutions. From that time to the present the desirability of hospital wards for recent cases and infirmary wards for the physically disabled has met with favorable recognition. The earlier attempt to divide all state hospitals into two classes, one for the acute and the other for the chronic insane, has not proved practicable for economic as well

* Read at the sixty-third annual meeting of the American Medico-Psychological Association, Washington, D. C., May 7-10, 1907.

as numerical and geographical reasons. In districting a state the so-called acute hospitals were located near the more populous centers; new cases were constantly pressing for admission and the institution soon became crowded with chronic cases faster than the chronic asylums could be erected. The acute hospital itself became an institution for chronic cases. The State could ill afford to erect and equip small independent psychopathic hospitals with their expensive equipment and extra cost of separate management in addition to the larger institutions already provided. Hence it has resulted that the psychopathic ward and the detached reception hospital in connection with the existing state hospitals, have become the recognized solution of the difficulty. These smaller detached hospital buildings can be more economically erected in connection with existing plants, and can be operated at less cost than if they are distinct units by themselves. The transfer of patients to and from the larger institution can be more readily and economically effected when the two classes of buildings are on the same grounds and under one management. In recent years the establishment of psychopathic wards in connection with general hospitals in the larger cities has prevailed abroad, especially in Germany, and is meeting favorable recognition in this country. Such departments are practicable in large metropolitan centers and deserve a readier adoption by general hospital managements than has thus far been accorded them.

Reception hospitals and psychopathic wards in connection with existing state hospitals have other arguments for their general adoption than the one of mere economy. Properly constructed, equipped and staffed, such buildings, afford the very greatest facility for the study and proper classification of new patients as well as the most efficient treatment under conditions the most favorable.

Local conditions must modify the specific detail of their construction. With abundant financial resources at command the reception hospital can be small with a capacity of only 50 or 100 at the most. But ordinarily economical reasons such as per capita cost of construction and equipment as well as per capita cost of maintenance will necessitate the erection of a somewhat larger building with provisions for the reception and treatment of the