The Washington herald., 1914-01-18
BY THOMAS w. SALMON, NJ. D.,

National Committee for Mental Hygiene.
Exclusive Service the Surrey Press Bureaul
A bill was passed, practically unnoticed.
in the closing days of the last session of
the New York legislature which marked
as important a step in the care of the
insane as has been taken in a generation.
This BILL which is now a law and in
effect, permits each State hospital for the
insane TO establish an out-patient depart
ment.
This opens a way for efficient treat
ment in the earliest stages of persons
i'll with mental diseases and at the same
time makes it possible to discharge con-
valescing patients who previously had to
be kept from the friends and families
because it was impossible to provide
skilled observation and advice after they
had left the hospitals.
The records of 5000 patients admitted
for the first time TO New York hospitals
for the insane in 1911 show that in nearly
a third of all cases the mental diseases
had existed at least a year before admis-
sion. Thus the State spends, more or
less willingly, several million dollars
year for the care and treatment of in
sane patients whose chances of recovery
have been already very seriously i'm
paired, while it ignores entirely provis-
ron for their treatment.
The treatment of mental diseases in
out-patient departments is not an untried
experiment. There are already three
such clinics in New York and a very
few widely scattered in other States.
To these clinics come cases rarely seen
by physicians in institutions for the in
sane-a child brought by mother whose
quick intuition has told her that he is
different" from the others; man who
has found his accustomed work grown
suddenly difficult and in conscious of loss
of memory and rapidly rising irritabil-
ity: depressed old lady who realizes
that some small misfortunes cannot be
wholly responsible for the new anxiety
which is dominating her life; a youth
who fears that he is hopelessly entan-
gled in some sexual difficulty but thinks
that there is just possibility that
good mind doctor might help him see
a way out of 1t, the anxious wife Of
man who was always a good husband
although he drank a Bit" but has lately
become morose and suspicious and has
lost four jobs in quick succession because
people are all against him. the brother
of a patient in a State hospital who
anxiously inquiries IL il is absolutely
sure" that he will become insane be-
cause his brother did and who has wor-
ried SO much about it that he can think
of nothing else.
1t would be unfortunate, however, to |
give the impression that early diagnosis |
and early treatment insure recovery in |
all cases of mental diseases or even in |
the greater proportion Of them.
There are several large groups of men |
tai diseases in which early diagnosis and !
treatment are quite powerless to in
fuence in any way an inevitably unfa-
vorable outcome. The most important is
general paresis, a mental disease re-
sponsible for about one-sixth of all ad-
missions to hospitals for the insane from
American cities.
Four hundred and ninety-nine persons
died from typhoid fever in Greater New
York in 1872, but more than 500 cases OF
general paresis, all certain to die Of their
disease, were admitted to the State hos
pitfalls from the same population in the
same period. The history Of the early
stages of general paresis is often a pitt
full story of family estrangement, busi-
ness ENHANCEMENT or personal disgrace
and yet the diagnosis of this disease can
usually be made by the trained psychia-
trist at very early period. and it is
aided by a very accurate laboratory test.
know Of the cashier of a bank, whose
business life had been irreproachable, who
became careless and untidy in his dress
and wasted the funds in his custody in
the most foolish ways. He was con-
victed Of embezzlement and died in dis
grace short time afterward. Fortu-
nately his family. recognizing that his
conduct could be accounted for only by
mental disease, had the courage and
good sense to demand necropsy, and the
necropsy showed conclusively that heI
died of general paresis. Even although
such cases may be incurable their exist
tence should be recognized in order that
serious social troubles may be averted.
Establishment OF out-patient depart-i ,