The Indianapolis journal., 1895-01-14
TREATMENT OF THE INSANE
Defects Caused by Partisan Manage
ment and Popular Ignorance.

DIR. w. B. Fletcher, in Indiana Medical
Journal.
I have been deeply interested in the vari-
Gus articles that have been published since
S. Weir Mitchells address before the SUI
perintendents of American Hospitals upon
the subject of .sAsylum mana cement and
mismanagement." and only regret that they
are not published in the general medical
press and secular papers where the discus
sion would throw the light where 1t would
do the most good.
One of the most singular inconsistencies
in scientific literature is that men will ven-
ture to write upon subjects OF which they
know little or nothing. Nearly all that has
been presented in the United States in
textbooks, lectures ana addresses upon the
subject of insanity, has emenated from men
who never spent a month with from. 800 to
1000 insane persons, and all that pertains
to their general management; and yet these
popularity eminent professional gentlemen
think themselves inspired to see through
all the mysteries of psychopathy and ven-
ture to lecture to men who have spent their
lives with the insane with the same assur-
ance that they spin fairy tale or write a
romance TO the newspaper or popular maga-
zine.
1t is these popular writer's upon psychical
phenomena who most frequently turn their
neurasthenic female patients over 70 the
gynecologist for radical cure by removal
of the ovaries, which the true alienist
knows have, as rule, as little to do with
insanity as corn upon the toe
DR.. H. A. Tomlnson is clearly right in
the statement that the medical profession
insane, know little, and the public nothing.
about hospital management The public
for making laws which viii compel the ap-
pSointbment of not not only I OF
pn e groued o naurn AT an
acquired fitness for their peculiar work.
There are few State institutions for insane
that are not political tid-bits for the party
in power, and where in every department
of management the spois system does not
prevail. The large harvest of pathological
material that would be of vast Importance
IN the comprehension of mental diseases Is
ngr ungarnered because of political eowardice.
medical man whose only qualification IS
that he has a diploma and a political
out by post-mortems and micro-pathology.
My own experience. when for some years
/ had daily average of 1000 patients and
over 800 employees to look after. was that I
was debarred the privilege of the proper
public prejudice, and debarred the right of
the selection of assistants well qualified to
do the work in a satisfactory manner. OF
the more than one hunderd post-mortems
made, nearly all had to be made surrepti-
tiously. The, public demands that the ply
sician shall know all about the disease he
is to treat but denies him the only means
he has of becoming acquainted with the
subject by not giving him the opportunity
examinations in each case and g. we'll paid
pathologist and thoroughly equipped path
illogical department to aid him.
The people also demand that they shall
see their friends in State hospital when
they choose, and expect to find them kept
in private room, better clothed better at
tended and betters fed than ever could
for at ALL and If they should find them COM
Portable beyond their expectations they then
talk of it with suspicion, that the super
lntendent had 1t all arranged to deceive
them, and that the patient not well
cared for.
1t is true that advances have been made
toward the remedy of some of these evils in
some of the States, Boards Of State Charities
being appointed to supervise the general
management of all the charitable and penal
institutions. These boards in few States
have some real power to act, but in many
cases are only advisory, and, as they are
apt to be changed by each new polticaf
wave, rarely attain sufficient knowledge of
fact they frequently are the cause of petty
mischief between superintendent, warden
and teachers. These boards to be of real
value, should be appointed for term of
should have direct power, taking the place
of trustees or managers.
Civil service examinations have been
adopted in some States as a means of
selection of all employees in hospitals for
insane. While this might work well in the
selection of engineers, carpenters. plumb
ers and many others, it is failure in the
selection of the attendants, whose oualifi-
cations can never be acquired from books
While a good education is an advantage, it
Is not always associated with the long-suf-
fering patience, the exact integrity the
honest sympathy and enduring labor re-
quired of the good attendant.
.There is not in the world class of pro-
fessonal men whose responsibilities are so
for the insane, and no class of professional
men are so meanly rewarded.