act went into effect. Each hospital is allowed $4.25 per week for the first three years of residence of each patient, and $2.50 per week for any period beyond three years. It is also intended that one assistant physician should be assigned to every two hundred patients.
The thought now arises, What kind of medical care do insane patients require, and what has and will be the effect of this huge influx of chronic incurable insane upon the true object of a State hospital, the cure of the insane?
The demand for and the recognition of the need of a more distinctively medical care for the insane is shown by the change in the titles of institutions for the insane from asylums, a place of refuge, to hospital, a place of cure; a movement which is so general as not to be due to any local cause or influence, and also in the recent pleas of some prominent alienists that the acute insane should receive the same kind of medical care as patients suffering from any other acute ailment. The latter go so far as to advise the establishment of a hospital for the acute insane on the same lines as those of any general hospital, with its visiting staff and thorough attention to all physical disorders in addition to the mental disease.
To-day the solution of this question lies either in a general hospital for the acute insane or in the hospitalizing of the old asylum or part of it. A general hospital for the acute insane would not, I believe, be advisable, and could not be properly conducted except in the large centers of population where there are many specialists in insanity. The duration of the illness, the need at certain stages of the disease of diversion or occupation, because there comes a time when such influences are most powerful for good, the difficulty of determining at once whether the disease is curable or not, thus tending to overcrowd such an institution or necessitating frequent changes; all these would make impracticable such an institution. Then, too, the fact that in our present State hospitals most of the patients come from small cities or the country, where there are poor or no hospital facilities and certainly no specialists, would necessitate the erection of many special small hospitals in these places or the transference of these patients to large cities with all the attendant ill effects—noise, excitement, and close quarters.
But that acute cases of insanity, however, need some kind of hospital treatment is evident. No less an authority than Dr. J. Batty Tuke has thus written: "The subjects of most of the insani-
- By general hospital in this connection is meant a hospital constructed on the same lines as other hospitals for special diseases or the establishment of special wards in a large general hospital.