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I would not have it thought that I favor the building of Psychopathic Hospitals only where they may be brought under the control of a state hospital already established. My advice in that connection had to do only with appropriations that shall be made during the next few years by State Legislatures. When it comes to philanthropic work that may be done by individuals of vast wealth, or by bodies of public-spirited men and women for the benefit of their respective communities, the suggestion I have to make is quite different. At first, money secured from private sources should go toward the building and endowing of Psychopathic Hospitals, which preferably may be brought under the control of those universities which have medical departments.

Cities where there are universities, and the larger and wealthier cities throughout the country, will before long have such institutions; but the smaller cities -- even some having from one hundred to three hundred thousand inhabitants -- will be unable to secure or maintain independent Psychopathic Hospitals. As each community owes it to itself to make provision for the prompt treatment of cases of incipient insanity, and thus spare the individual the ordeal of commitment as an incompetent, it is fortunate that relief is at hand for such cities as cannot maintain a modern Psychopathic Hospital. Here the so-called General Hospital may be put to full use. Separate buildings, or pavilions, may be erected and maintained at comparatively slight cost, as has already been proved by the success of the Psychopathic Hospital at Ann Arbor, Michigan. That is to say, for considerably less than $100,000 an efficient department of Mental and Nervous diseases may be organized and brought under the control of any well managed General Hospital. Though there is but one General Hospital in the country where this problem has been worked out, the results of what five years ago was an experiment have justified the rather startling venture made by the pioneer in this important work. (21) Dr. J. Montgomery Mosher, Specialist in Nervous and Mental Diseases at the Albany Hospital, Albany, N. Y., is the man who has had the courage and good sense to go ahead and prove that a General Hospital should and can receive and treat mental diseases as successfully as the diseases which are now treated without question in such institutions. In Pavilion F, at the Albany Hospital, remarkable results have been obtained during the five years it has been in operation. This is proved by a passage from an address by Dr. Mosher delivered before the 34th National Conference of Charities and Corrections at Minneapolis, Minnesota, June i8th, 1907. He says:

"From February 18th, 1902, the day of the first admission, to February 28th, 1907, one thousand thirty patients have entered the building (Pavilion F). Of these five hundred and ninety-six have returned to their homes recovered and improved ; three hundred and sixteen have remained stationary, and eighty-six have died. Two hundred and forty-five have been transferred to institutions for the insane; of these, one hundred and twenty-six were sent to Pavilion F for detention during the legal proceedings, and one hundred and eighteen were committed after a period of observation. It thus appears that nine hundred and five patients have been under treatment without legal process, one hundred and eighteen of whom it became necessary to commit later to institutions for the insane.

"If this special provision for the treatment of the mentally deranged had not been made in the Albany Hospital, then these nine hundred and eight patients would either have had to be improperly treated at home, or would have been committed after a probably harmful development of the disease. It is impossible to judge how many have been saved from an unnecessary commitment."

I urge the reader to turn to Appendix IV where he will find Dr. Mosher's address in full. It will prove that General Hospitals throughout the country should begin to receive and treat nervous and mental diseases as is now being done with success at the General Hospital at Albany.

XXXVIII

GIVEN Psychopathic Hospitals and "Mental Wards" or "Pavilions" at our General Hospitals, there still remains another type of institution to be added if patients with a chance for recovery are to receive the treatment they deserve. Statistics show that twenty per cent of those who recover from an attack of insanity recover after having been confined in a hospital or asylum for a year or more. Obviously, recoverable cases cannot remain for that length of time in a Psychopathic Hospital or in a "Mental Ward" in a General Hospital. The hospital or "Pavilion" with a limited number of beds (and it will be many years before there are a sufficient number of Psychopathic Hospitals to supply the demand for accommodations) must, of necessity, keep its population moving if the acute cases occurring every day are to be received and given treatment at a time when the lives -- mental lives, at least -- of the afflicted ones hang in the balance. To make room for new cases, the hopeful and convalescent cases must be transferred to the homes of the patients -- there to disorganize and distress the households; or they must be transferred to an asylum; or, provided the expense can be borne, transferred to a private hospital or sanatorium. This state of affairs lays bare a fault which should be corrected without delay. It is evident, therefore, that an intermediate type of institution state-supported, co-operatively managed, or endowed, should be brought into the field.