AMERICAN MEDICO-PSYCHOLOGICAL ASSOCIATION.

PROCEEDINGS OF THE FIFTIETH ANNUAL MEETING.

FIRST SESSION.

The Association convened at 10 A. M., May 15th, 1894, in Parlor C, at the Continental Hotel, Philadelphia.

The President, JOHN CURWEN, M. D., called the Association to order.

Prayer by Rev. T. C. YARNALL, D. D., of Philadelphia:

Almighty God, the Giver of every good and perfect gift, we bless Thy holy Name for all Thy mercies to the children of men. Especially would we now praise Thee for the knowledge which Thou hast permitted to be gathered for the relief of human sicknesses. We thank Thee that in the Gospel of Thy dear Son Thou hast taught us to sympathize with sorrow and suffering, and thus to imitate His example who went about doing good. We bless Thee that we are commanded, as Christ's followers, to bear one another's burdens, and fulfil His holy law.

We implore Thy gracious benediction upon those here gathered together to take counsel for the advancement of the interests of their high calling. Direct them, we beseech Thee, with Thy most gracious favor; enlighten and sanctify their minds; further them with Thy continual help; and grant that all their consultations here may be to Thy great glory.

We pray for Thy blessing upon those to whom they minister, and upon all whom Thou hast called to pass through deep sorrow. And grant, O most merciful GOD, that in all Thy dispensations towards us we may remember Thine infinite wisdom and Thy ever-enduring love; so that, putting our trust in Thy mercy, we may so live here that at last we may enter upon those fadeless joys which Thou hast prepared for them who unfeignedly love Thee.

Hear us we beseech Thee, in His Name who has taught us when we pray to say:

Our Father, who art in heaven, Hallowed be Thy Name. Thy kingdom come. Thy will be done on earth, As it is in heaven.

Give us this day our daily bread. And forgive us our trespasses, As we forgive those who trespass against us. And lead us not into temptation; But deliver us from evil: For thine is the kingdom, and the power, and the glory, for ever and ever. Amen.

Governor ROBERT E. PATTISON, of Pennsylvania, was introduced by the President and delivered an address of welcome as follows:

Mr. President and Members of the American Medico-Psychological Association :

I bid you welcome to Pennsylvania. I am sure that in doing so I express the sentiment of all the people of Pennsylvania. An organization such as yours, which has for more than half a century given its very best thought to the noblest interests of mankind, is certainly deserving of the highest commendation. I note with pleasure that the president of your Association is a distinguished citizen of Pennsylvania, that he during a half-century has given the best years of his life and the most thoughtful study to that which more than anything else closely concerns humanity. While the title to your Association will suggest thoughts concerning the treatment of the human soul or the mind generally, yet more specifically, I conclude, it refers to those who have been so unfortunate as to be deprived of reason. The half-century of your organization, representing half of the nineteenth century, has been more marked in the development of the treatment of the insane than any other period in the history of the world. Indeed, I doubt whether at any time much thought, except possibly by the individual philosopher, or the thoughtful and considerate and merciful citizen, was ever given to such unfortunate beings. It has remained, therefore, for the latter half of the nineteenth century to accomplish whatever has been done in the treatment of the insane, and I rejoice to be able to say to you as a citizen of Pennsylvania, that in no locality upon the face of the earth has more consideration or attention been given to this subject than in this great old Commonwealth of Pennsylvania. We had no State hospital in 1844 when your society was organized. The indigent insane, so far as their treatment was concerned, were largely confined to the private institutions and the local poorhouses. Since 1854, beginning with the hospital in Dauphin county known as the Harrisburg Insane

Asylum, organized through the efforts of Miss Dix, we have built five additional institutions. We have the institution at Harrisburg where to-day are, I think, more than 800 insane, or certainly between 700 and 800, which is largely in excess of the capacity of that institution. We have constructed an institution at Danville, with a like capacity-to-day overcrowded. We have an institution at Norristown with over 2,000 inmatesovercrowded. We have our institution at Warren with possibly between 800 and 900 patients-overcrowded. Then there is the institution at Dixmont whose capacity is fully tested to-day. Within the care of the Commonwealth of Pennsylvania there are between 5,000 and 6,000 indigent insane. The very best treatment possible within the knowledge of man, day in and day out, is given to these people. In addition to these institutions, I have noted with a considerable degree of gratification that it has been determined, and legislative effort has followed the determination, to construct a chronic insane institution at Wernersville. We will open that institution on the first, or certainly by the middle of June. That institution will have a capacity of 1,000 inmates. It is, to my mind, a step in advance of the treatment heretofore given to the insane. I refer to its classification. Now, if you will permit me as a layman, who has gone in and out among these institutions, to speak, I will say that the State of Pennsylvania may go on building institutions and may provide the most comfortable surroundings, yet something else is wanted besides constantly building asylums. The magnificent stride which has been made in the treatment of the insane is yet to have its climax, in my judgment, in the discovery and the treatment of the causes, so that we may be able through skilled treatment to reduce the number of the insane instead of providing further accommodation. I look forward to such an Association as this and the men who are enlisted in the interest which it covers, for the solution of this problem. I look forward to the time when in Pennsylvania we shall conclude that a nurse in the ward of an insane asylum, ought to be the equal in skill of the nurse in a surgical hospital ward. When the time comes that our people will conclude that these unfortunate creatures should have the same skilled attention given to them, through the nurses in the wards in the hospital, as is given to the patient in our general hospitals, then we may hope for that classification which will ultimately lead to the discovery of causes

we know nothing about to-day. I believe it would compensate the State of Pennsylvania, though the increased expense was a hundred fold over and above that now paid for nursing and attendance, to obtain skilled nurses, trained in schools, trained under the best intelligence, for the wards of the hospitals for the insane.

I have a thought, it may be crude, as it is simply the observation of a layman little familiar with many of the things which directly concern, from a medical standpoint, the treatment of the insane; I believe, next to the separation of the chronic from what you may call the curable insane, will come another separation upon nervous conditions. Nay, more, I believe that the time will come when there will be a separation based upon the temperature of the individual body taken from time to time, with the characteristics of individuals and the notes made up from hours of observation by skilled nurses in the wards of the hospital. Then, possibly, by analysis, we can ascertain the causes which we are endeavoring now to discover in order to better treat the unfortunate creatures who are subject to this horrible affliction. Then, verily, we will have reached a point in the history of the treatment of insanity surpassing that in all the history of the world. I believe that will come. I think, indeed, we are getting to the dawn of it. This is what we are looking for in Pennsylvania and we believe that Pennsylvania is simply an illustration of every other State in the Union upon this line. They are all pressing to the front moved by that spirit of humanity which is particularly characteristic of our age.

Let me in conclusion congratulate you upon this assembly on your fiftieth anniversary and I do bespeak for you a pleasant time. I wish it were possible, Mr. President, to take this Association to each of our institutions and let them see the method of our treatment and discover for themselves that we have reached the climax of physical treatment. I trust that the wisdom which has characterized the deliberations of this body from its organization will continue not only to benefit those who are present here and those who shall read the literature which shall go out from this society but shall contribute to the doing away of that dreadful shadow which stalks abroad in our midst and help us in our day and generation to treat the insane as we are treating other diseases and by treatment cause insanity to disappear from our midst.

We thank you,

President CURWEN responded as follows: Governor, for your kind words and for the suggestions which you have made. They are just in the line of what this Association should attempt to do and therefore they come with more force to us, coming as they do from you, to urge us onward in the line in which we should proceed. This Association in the last fifty years has been striving with all its efforts and all the influence it had for advance in the care and treatment of the insane. That is its past record. Now we propose to start on the other line, the prevention of disease as well as the cure of existing disease, and for that we pledge ourselves and we hope to be aided and directed by gentlemen who have as high views and as strong views as yours. We thank you for your suggestions.

The President then appointed the following committee to nominate officers of the Association for the ensuing year: Dr. Stearns, of Connecticut; Dr. Woodson, of Missouri, and Dr. Powell, of Georgia.

Upon motion of Dr. CHAPIN, of Philadelphia, the programme, which had been printed under the direction of the Committee of Arrangements, was adopted as the order of business to be followed during the sessions.

Upon motion of Dr. CHAPIN, an invitation was extended by the Association to the resident physicians of the city, to all officers of institutions for the insane, to members of boards of trustees and boards of State charities, and also to professors in the medical colleges and members of the State Medical Society now in session in Philadelphia, to sit with us and participate in the discussions..

Upon motion of Dr. CHAPIN an opportunity was given for the introduction of members of boards of trustees of the different hospitals, that they might be registered and take part in the deliberations.

The following gentlemen were then introduced: Judge F. O. Mason of Geneva, New York, trustee of Willard State Hospital; Judge Alfred J. Mills of Kalamazoo, Mich., trustee of the Michigan Asylum for the Insane; Dr. J. L. Cleary of Wisconsin, member of the State Board of Control.

A recess of fifteen minutes was taken for registration.

The following members were present:

Adams, Geo. S., M. D., Medical Superintendent Westborough Insane Hospital, Westborough, Mass.