The nurses, too, should be especially selected for this service among the curable insane. Those who have, by work among the chronic insane, shown that they possess the aptitude and tact necessary to care intelligently for such patients could easily be selected for this special work. Then with these nurses could be placed several nurses who have had general hospital training and who would therefore be more apt to regard insane patients from the purely medical side. The number of nurses, too, should depend upon the need of each case; if necessary, a single nurse should be assigned to a patient, though this, probably, would rarely be required. The criterion, however, should be. What will be most helpful in a curative way to the patient? The nurses would thus feel the great importance of the work they were doing, because every case would be considered as a curable case, and there is no greater incentive to good work than the feeling that the work is of great value. By a slight increase in the wages in addition to the importance attached to the work, the very best nurses employed in the hospital could be secured for this work, and easily made most enthusiastic about it. The effect also upon the medical staff would be most beneficial. Any one who has seen the tendency to the undermining of the medical spirit in talented, brilliant, and ambitious physicians who have accepted State hospital positions, will appreciate the importance of anything that would increase the medical spirit in State hospitals.
In a discussion before the British Medico-Psychological Society on the subject How can the medical spirit best be kept up in asylums for the insane? the following means were most strongly dwelt upon:
1. Classification—that is, separation of the curable from the incurable asylum population.
2. Necessity for hospital treatment for the curable.
3. Necessity for training the attendants.
4. Necessity for more physicians to asylums, and a rearrangement of their duties.
Such purely medical treatment of the curable insane can be best carried out in annexes to the present State hospitals and under the same management. The State in each State hospital has a most valuable plant, with large, handsome grounds, conveniently situated to the section of country from which it receives its patients. They are in charge of well-equipped and competent medical officers who have given their lives to this work, and especially appreciate the needs of this class of patients. Then, too, there is the body of trained nurses from whom the special nurses could be selected. There are also in existence various industries and means of amusement, which, though hurtful in certain stages for some, might be and are used with great advantage in the con-