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A Mind That Found Itself: An Autobiography

Creator: Clifford Whittingham Beers (author)
Date: 1910
Publisher: Longmans, Green, and Co., New York
Source: Available at selected libraries

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The shock of it all is frightful. In this age of ideals and stress, many who strive for the highest rewards of cultivation of the nervous system, the attainment of a lofty ambition, suffer moments of fatigue and depression, the penalty of overwork. The impending calamity, in which individuality is felt to be slipping away and merging into incompetency and lunacy, is apprehended and feared. Relief is sought, too often in vain, for men and measures are not provided. Here lies the opportunity of individual prophylaxis, and here, between the home and the asylum, the general hospital may intervene.


Fortunately for the proposed project, conditions at the Albany hospital were peculiarly favorable. A new institution had been constructed, consisting of a series of buildings on either side of a central corridor or axis, providing wards for public and private patients, an operating theater, nurses' house and administration. The pavilion for mental cases was placed in the rear of the nurses' house, distant from the general wards, and from the publicity of the central corridor.


The floor plan was designed with an eye to the needs of all classes of patients. It was anticipated that both turbulent and quiet cases would be received, and that the comfort of each must be promoted. There were two departments, separated by a heavy partition wall and double doors, in the rear of which were two guarded rooms, where noise might be confined. At the end of the first year it was found that this provision was inadequate and the rear section was enlarged to provide ten rooms, with a day room or sitting room on each floor. Six of these rooms were approached by a communicating cross hall, so that the disturbed patients are removed from the general ward. This plan serves the double purpose of adequate provision for the excited patient and protection for others. Shouting, rattling of doors and windows, striking the walls, are manifestations of mental disorder just as elevation of temperature is a symptom of fever, and mental disorder, as fever, is often self-limiting. The patient should be placed under proper conditions and carried intelligently through the attack. Excretion of waste products is to be promoted, the state of nutrition improved, and normal functional activity of the organism restored. These are medical problems of transcendent importance and direct the attention and the therapeutic efforts to the patient himself. Methods sought to be justified under the vicious plea of expediency are anticipated, and forcible suppression of symptoms is avoided unless for his good. Harmful sedatives and other coercive measures for preventing disturbance are too often used, to the detriment of the patient and for the benefit of others.


The first consideration is consequently architectural, and Pavilion F has been so constructed as to afford means of isolation and, at the same time, proper personal attendance. Much of its best work has been accomplished in the treatment of acute cases of a very active character; and such cases, when properly managed, afford the quickest and most satisfactory recoveries, and have a legitimate claim upon the general hospital.


The administration of Pavilion F is based upon that of the other departments, except that the attending physician has continuous service and is held to strict accountability to the governors of the hospital. He visits at least once a day, and exercises supervision and medical power. For a few months after its opening the pavilion received patients in the care of other physicians, but this was soon found to threaten disturbance, discord, and even danger, from both medical and legal points of view, and concentration of responsibility was inevitable. The physicians of the community have generally co-operated with the hospital, and have assisted in the management of critical cases, realizing the greater difficulties experienced before the creation of this department, and the delicate questions involved.


The attending physician is assisted by two internes on the medical service, whose duties are the taking of histories and examination of the patients under his direction. The greatest instrument for good, however, is the nursing care.


Some ninety nurses are under training in the hospital. The course is of three years and includes every department. In Pavilion F at least ten weeks are required, on day and night duty on the men's and women's wards. The pupil nurses are directed and supervised by the head nurse, who is a woman of experience in mental work, co-operates with the training school, is a part of it, and is an assistant to the superintendent of nurses.


The standard of nursing is that established by the hospital, and this in turn reflects the requirements of the most exacting patronage of the community. The service given by the nurses in the mental department has proved the most substantial factor in establishing its high ideals. Nor is the pavilion under an excess of obligation, as educational elements are supplied which count largely in the equipment of the nurse for the work in general medicine and surgery. Clinical instruction is also given to the students of the Albany Medical College, who attend a weekly bedside course during the college year.

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