New Britain herald., 1918-04-23

be greatly different from that in
the counties nearest the hospital.
Unless, therefore, some other means
for obtaining hospital treatment are
available for the latter, many cases
for whom such treatment is indicated
must fail to receive it. The extent
to which a state hospital can be
utilized, even by the community in
which it is located, is also limited by
the conditions under which patients
may be admitted. Certain legal
definitions and formalities prevail in
determining the cases to be admitted
to a State hospital. The patients
must be insane in the meaning of the
law. This indicates that cases for
admission must be differentiated and
selected from a larger group of cases
of mental disorder which exists in the
community. The best system Of state
care which has yet been established
does not undertake to provide hos
pital treatment for all types and
grades Of mental disease. The acute
deliriums OF fevers and INVESTIGATIONS,
and the large groups Of cases which
are designated by the terms neuras-
thenia, hysteria and psychastheni
and several other forms of mental
disorder, are, with the exception Of
Il few of the cases in which the symp-
toms arc unusually severe, not or
dinarily included in the class Of cases
for which hospital trea tment is pro-,
Eided by the state. There must nee
essarily also, in all cases of mental
diorder, be a period in which OBJ
servations must be made, diagnosis
Il
for admission to a state hospital when
this is found to be necessary. This
may be a very critical period in the
course of the illness, and as first ala
applied in an injury case may de-
termine the final outcome, SO the
early treatment furnished a case Of
mental disorder may be Of the great
est Importance in determining the
further course and outcome. The
first treatment of a case of mental
disorder as of any other form of dis
case, must ordinarily be given wher~
ever the patient may happen to be
when the need becomes manifest. In
many instances the condition is only
recognized when the need OF treat
ment has become imperative. It
seems quite unlikely that any state
will at best be inclusive or elaborate
enough to provide for the needs OF
all grades and forms Of mental dis
ease which require hospital treatment.
Needs will still remain which will re-
quire that some organized provision
be made by each division Of the
state and each community.
Some Terrible Examples.
'-Thc best test of anv system of pro-
viding for the treatment Of persons
suffering from disease is to examine
its operation in a number Of indi-
vidual cases. A few years ago a study
of this kind was made in New York
for the purpose Of asCertaining the
methods and provision employed in
the treatment Of persons suffering
from mental disorder previous to
their admission to the state hospitals.
This study covered the admissions
during q period Of two years. 1t was
made easily possible because Of the
practice of sending nurses to bring
the patients from the communities TO
the state hospitals, which has been in
operation in New York since the
State Care Act was adopted many
years ago. These nurses were asked
to make reports concerning the con-
dition and environment in which they
found each patient. The state care
system of New York is considered I'd
be as good as any in the country il
not the best. The law under which
it was established defined the type.
Of cases which could be admitted to
the state hospitals and the conditions
of their admission. Tt was left to the
local authorities, however, and to
relatives and private physicians to
provide the means for observation,
first diagnosis and determination Of
the need Of hospital care, and for
temporary treatment. The study
which was made revealed that,
throughout the state, little advance
had been made In the local provision
and methods since the period when
the behavior disorder and dependency
OF an insane person were the only is
sues that received organized attention.
The poor law thoritieS and the po-
lice were still the only officials who
were required by law to see that All
insane person received attention, It