and where they would not be compelled to work when they were not well. The establishment of such an industrial unit or center would indeed be a landmark in the development of the health conscience of the community, and in the progress of the mental hygiene movement.

(d) Psychopathic Hospital. The fourth element necessary to round out the program of work of a mental hygiene organization is a psychopathic hospital, to which might be admitted for observation and treatment cases of mild mental disturbance otherwise destined to go about neglected until they finally had to be sent to a state hospital. The need for such an institution is particularly apparent in a large cosmopolitan city like New York, with its thousands of admissions annually to the psychopathic wards of general hospitals, from which but comparatively few are discharged except to a state hospital. Such an institution as proposed would be in a position to treat patients long before they were in need of state hospital care, and only such patients as it was possible to help to mental health within a comparatively short time would be admitted for treatment.

The question of the utility of psychopathic or reception hospitals has been discussed elsewhere and will not be reopened. It is sufficient to state that in large communities such an institution is essential to a complete plan for the early care and treatment of mental and nervous cases, and that the work and results of the Boston Psychopathic Hospital as well as of the Phipps Institute in Baltimore have completely justified the hopes of the original sponsors of the idea.

It is felt by many students of the problem in New York City, that, due to the large Jewish population in New York, as well as to the peculiar psychology of the Jew and more especially of the recent immigrants among the Jews, it would be advisable to plan and erect a Jewish psychopathic hos

pital or institute, either as an independent unit or as a part of an already established general or special hospital. The organization of a committee representative of various elements of the community and interested primarily in preventive and reconstructive work along lines of mental hygiene, and the establishment of clinics, convalescent homes, workshops, and a psychopathic hospital, would be a great step forward in mental hygiene and psychiatric social work. Such a group has already been formed among the Jews of New York, but its efforts are still in their infancy. The plan outlined for a community program is applicable to any city, though it would have to be modified somewhat to meet local conditions.

VII. CONCLUSION

In attempting to point out and discuss the social aspects of the treatment of the insane, the primary aim of the writer has been to bring before those who are vitally interested in the whole and baffling question of insanity, whether from the viewpoint of the physician, minister, social worker or layman, facts which will lead to a better understanding of the various phases of the problem. The presentation of the development of legislation affecting the insane in New York State in the first chapter was intended as a background upon which to picture the other aspects which were later considered, for much of the care and treatment of the insane is integrally related to the question of legislation. The three subsequent chapters presented, first, the patient before coming to and while in the psychopathic ward of a general hospital as well as the disposition of such patients; second, the patient in the state hospital to which he was transferred from the psychopathic ward, and his disposition by the state hospital; and third, the patient after leaving the state hospital. These three chap

ters indicated what the city and state were doing for the insane who came under their care. The fifth chapter portrayed the activities of a privately supported social agency specializing in mental hygiene activities. The recommendations of the final chapter point out the lines the newer work for mental cases will have to follow in order to achieve a higher degree of success in preventing and curing insanity, With the public aroused to a deeper interest in all that pertains to the insane, improved methods of treating mental disorders would develop apace.

INDEX