willing to pay a reasonable amount for their care and treatment in a hospital.

46

A gentleman, in public position, once used this expression: Compel them to go on the county." That seemed a harsh statement to be made by a man of large wealth, but the answer was, "No, never." So long as they are willing to pay their full share to support their friends and thus maintain their liberty, their selfrespect and their independence, every effort should be made to encourage the feeling that they are men and citizens of an enlightened commonwealth.

There is an old proverb, written more than three thousand years ago, which has come down the centuries with steady and earnest verification, "Whoso stoppeth his ears at the cry of the poor, he also shall cry himself but shall not be heard." Let every member of this Association use his influence, whenever and wherever the opportunity may offer, to induce men to avoid the application of this proverb to themselves, and do all in their power to raise the fallen, cheer the faint and heal the broken-hearted."

The trials, the temptations and the labors of men, in every sphere of life, are sufficient to depress and cause to despond, many who are striving honestly and heartily to discharge the duties incumbent on them in the sphere in which they are called to act, and it behooves every man to cheer and encourage them and assist them in every reasonable effort they may make.

In this connection and in the face of the steady attempt to crowd together, and at the same time diminish the personal care of the insane, it is the duty of every member of this Association to use his utmost endeavor to introduce into every class and condition of those laboring under mental disorder, a more systematic course of individualized treatment, giving to each individual the attention needed by the constant companionship of a cheerful attendant, who shall be required to use all proper means to divert, interest, amuse and occupy such person, so as more effectually to draw the individual out of the mazes of mental disorder in which he may be involved and instill more hopeful, cheerful and practical views of duty and of life. It is worse than useless to advance the idea that the mind is too far disordered to be benefited. Hope never dies, and no one can ever know how soon a bright, healthy idea, implanted by steady perseverance and nourished by faith and love, may develop into such a mental condition as will cheer every one within the circle of

the acquaintance. This is no fanciful theory, but a plain fact which any one may verify by experiment, steadily and heartily carried out.

No one is so circumstanced that in some period of his life he may not be overtaken with trials and misfortunes which tend to try his faith and endurance, and it is therefore all the more incumbent to practice, in its fullest meaning, that rule which teaches, "whatsoever ye would that men should do to you, do ye even so to them."

ADDRESS BEFORE THE FIFTIETH ANNUAL MEETING OF THE AMERICAN MEDICO-PSYCHOLOGICAL

ASSOCIATION.

BY S. WEIR MITCHELL, M. D., LL. D.,
Philadelphia, Pa.

I am here to-day under circumstances so unusal, that I may be pardoned, if I explain them in order to justify the frank language of this address.

When your representative, Dr. Chapin, asked me to be your speaker on this important anniversary, I declined. It is customary on birthdays to say only pleasant things, and this I knew I could not altogether do. I foresaw a struggle between courteous desire to follow a kindly custom and the duty to greatly use a great occasion. When Dr. Chapin, after consulting some of you, came back to say it was still your desire that I should speak, I reflected that men who could thus ask the criticism, which they knew must come without mercy, were well worth talking to. I said, at last, that I would address you to-day, but that it would be boldly and with no regard to persons. That was a momentary insanity; I have been sorry ever since.

You are on the dividing year of your first century of life. You look back with just pride as alienists on the merciful changes made for the better in the management of the chronic insane. It is to be feared that you also have cause to recall the fact that as compared with the splendid advance in surgery, in the medicine of the eye and the steady approach to precision all along our ardent line, the alienist has won in proportion little. This is partly due to the nature of the maladies with which you have to deal; but there are many other causes at work to retard the wholesome progress. Just that which is impairing the usefulness of the lesser specialties in medicine has been more gravely enfeebling your value, and retarding your development. I mean the tendency to isolation from the mass of the active profession. At first, as concerned the eye for instance, this separation seemed but too complete-the new terms, the methods, the instruments of the ophthalmologist were for a time absurdly unfamiliar. It is not so at present. The general

practitioner has come again into touch of the occulist, and understands his terms and methods. In fact, every sudden advance of a brigade of our great line for a time appears to break our ranks; but soon we get up to it and go on as before.

With you it has been different. You were the first of the specialists and you have never come back into line. It is easy to see how this came about. You soon began to live

you still apart, and do so. Your hospitals are not our hospitals; your ways are not our ways. You live out of range of critical shot; you are not preceded and followed in your ward work by clever rivals, or watched by able residents fresh with the learning of the school.

I am strongly of opinion that the influence which for years led the general profession to the belief that no one could, or should, treat the insane except the special practitioner, have done us and you and many of our patients lasting wrong.

Standing here in the home of Rush, I cannot forget that he was an alienist and a general practitioner; nor can I cease to lament the day when the treatment of the insane passed too completely out of the hands of the profession at large, and into those of a group of physicians who constitute almost a sect apart from our more vitalized existence. What evil this has wrought, what harm it has done to us and to you I shall try to show. Why it has been so much more grave in its results here than in Europe is not clear to me, or would take too long to discuss.

I should, indeed, be easy enough in mind if I had only to criticise an uneducated public, ignorant legislators, and the boards which control our civic, State and endowed institutions. But I shall have frankly to reproach as to certain things many of those who still bear the absurd label of "medical superintendents." If any here think it pleasant to fire opinions into a crowd, not knowing who are hit, whether his shot finds out the right man, or only annoys the entirely efficient, I am not that man. Moreover abrupt statements are apt to be needlessly annoying, and to seem to lack good manners, and yet I have not time to be other than brief to abruptness.

But before I go on to the uncongenial task of being disagreeable, and, perhaps, of ending with criticism which some of you are reasonably certain to characterize as ignorant, I would say a word.

I at first meant this address to be weighty with statistics and with carefully gathered knowledge of the way in which the medicine of

After immense reading I

the alien mind grew up in this country. gave it up, but it left with me the conviction that within ten or fifteen years things have been improving, and that within your own ranks are men who had early seen and still see the need for much of what I urge to-day. Without this qualifying belief I should have hesitated still longer as to this ungracious work.

There were in this country in 1890, 120 public and some 40 private asylums; nor does this include insane wards of county almshouses, or those singular institutions known as sanitariums, which receive many insane and are, I fancy, little troubled by the lunacy commissioners. In 1889, the patients in these 160 hospitals numbered 91,152, and were treated at a cost of $10,692,000 over and above $2,209,000 spent that year in buildings.

The State and civic asylums are under boards appointed usually by Governors of States, or mayors, sometimes with as much regard to politics as to quality of useful fitness. The great endowed asylums are ruled by self-constituted bodies, which in certain cases have the ponderous task of also managing a general city hospital.

Then there are the private asylums which have no boards and manage themselves, and are commercial enterprises. Over all, in many States, is the more or less efficient machinery of the lunacy commissions. Usually good enough as collectors of statistics and as historians, these bodies are, as to visits and accurate inspection in the higher sense, most plainly ineffective. Too often they are made up without one member who can be called an expert in neurological medicine. Is this vast trust so handled as to satisfy the intelligent conscience of my profession? I have read and thought about its every phase an inconceivable amount. I saw that here or there some one had shown what could be done in the face of preconception, traditional usage or want of means, and was so much ahead of his fellows as to excite wonder that such intelligent examples should lack efficient following. Yet, after all I thus learned of growth and thoughtful gains, it did seem to me that the sowers of good seed were sadly few, the progress strangely slow. When indeed, I began to write what I had to urge, my charges appeared to me so grave as to require the expression of other opinions than those of a single thinker in order to give him the courage to speak them to the world. I, therefore, resolved to call a jury and use its decisions to modify or give force to my own.

The men before me see asylums from within.

Some live on