Glimpses
of Canada and the United States.
By A. Helen Boyle, M.D., L.R.C.P., L.R.C.S., L.R.F.P.S. Those who are interested in the treatment of Nervous and Mental Disease and who want to know some of the best work that is being done on these lines should, certainly nowadays, visit America. Thus judging the situation I went. I did some lecturing in Canada and. came back through the States. This is a good order in which to take the countries, ?our own bit of the Empire first?where a very real tie of kinship exists and where you drop as far as possible any insular feelings and prejudices you may have, and, even more, your preconceived ideas of this new world?and then the States with the greatness of territory, of attempt and accomplishment. (Canada is actually larger in area, but not in inhabited land nor in population). One thing which struck me very much was the extraordinary variety of languages and in particular the heterogeneous nature of the human material which goes to make up these two countries, with their peculiar problems for the alienist. This material is very difficult to handle, to understand, to govern, but with wha immense possibilities! Surely there is not one fine human quality or capacity which should be absent in Canada or the United States! The honesty, reliability and steadiness of John Bull; the vivacity, gaiety and thrift of the French; the plodding, patient thoroughness of the Germans; the stoicism and emotional music of the Russian; the mechanical genius and capacity for enjoyment of the Italian; the enthusiasm and generosity of the Irish; the sobriety, hardworking power and love of family of the Jews; the industry, loyalty and truthfulness of the Chinese, and many more too?all these can be found in the American citizen. He need not be hampered by the absence of capacity
50
STUDIES IN MENTAL INEFFICIENCY.
for anything which the human race can anywhere master and create. He has, innate in him, the qualities of all the races who have contributed to people the land. Somewhere in that great country it should always be possible to find the man who can supply any quality or combination of qualities that may be needed, any mental, moral or physical make-up necessary to cope with a crisis or trouble, and to overcome it. Never before in the history of the world has a race arisen in like manner. Another striking feature is what appears to be the amazing readiness with which, when once a need is made clear, there arises a determination on the part of one or many to meet it and, at all costs, to meet it well and completely. Over and over again I heard of needs made plain by a few keen-sighted people, often through the National Committee for Mental Hygiene, and then quickly followed by the remedy, or better still by prevention. A third great beauty in America is the friendly way in which all the great men and women in charge of institutions and societies try to make your visit helpful, happy and instructive, and their interest in, and desire to hear about, anything in this country. They show you everything, spare you time, feed you, teach you and, even sometimes, ask questions and listen to you! To turn to the more medical aspect of things. Where so much is fine, thoughtful and scientific it would be impossible to single out any one person or institution as being pre-eminent. There is much outstanding work calling for hearty admiration and emulation. Perhaps the Scotsman, who knew the conditions on both sides of the Atlantic, summed the position up most truly when he said:?"Our average is a better one, but some of their highlights are brighter than ours.'' These highlights are distributed in various directions, and I will mention those which most caught my eye, alluding to them as a help to those who may be going over, and devoting most time to the National Committee for Mental Hygiene which, of all of them, is the one which I should most like to see established in this country, and which would lead not to advance on one line of mental and nervous work only, but would have a fostering influence on them all. Another reason for this course is that these splendid institutions would each require an article to itself to do them justice. These highlights are eight in number, and constitute the most striking demonstration I saw of the best methods which America is using to cope with the difficulties of these different types of work. They fall under the following headings: Mental Defectives, their care and treatment. 1. Nervous and Borderland patients, their care and treatment. 2. The Insane, their care and treatment. 3. Criminals and Delinquents, the relation between criminality and the 4. psychoses and neuroses. 5. Mentally and Nervously disabled soldiers, their care and treatment. 6. Psychiatry in relation to Education. 7. Psychiatry in relation to Social Service. 8. Last but not least, the fine organisation called the National Committee for Mental Hygiene. It is obvious that in the brief time of eleven weeks, which passed like a flash in the stimulating atmosphere of Canada and the States, it was hopeless to attempt to see everything and everybody of value. Want of time, not disinclination or lack of appreciation of their worth, must be the excuse for the omissions of which there were many and grievous,
STUDIES IN MENTAL INEFFICIENCY.
51
With regard to Mental Defect, the splendid Massachusetts School for the Feeble-Minded at Waverley, Waltham, was a joy to go over, and the most interesting time there was that spent with Dr. Fernald, hearing him talk and seeing him interview out-patients. He has himself recently contributed to this paper a scientific article on Mental Defect. The School began about 1840 with a blind school which showed many feeble-minded, and so these were provided for, and defectives who could see were also admitted. Now it has grown and can hold 1700, the inmates paying what they can each afford. This school seems to leave It provides for the culture no side of a mental defective's possibilities untouched. of any little bud of capacity that any one of them may show. Not least, their natures are encouraged to expand by understanding and sympathy so that every moral power may be utilised and the human creature developed mentally, morally The school for the training of the special senses, with its and physically. sounds and its smells and its shapes and materials all at different tables so that the children made a procession round them, was a fascinating place. Many go out and earn, and do not even sleep in, but in some cases are visited by a social worker, or report at intervals to the colony as advised. This boarding out is valuable. There is also the Templeton Colony Farm of 3,000 acres and about 300 boys It is not however self-supporting for much training has to take place there. on it. There is a farm near at hand to which some of the girls go. Thus many of the "less gifted," as they are rather beautifully called, really contribute an appreciable quota to the working world. The Nervous and Borderland Patients, which I feel strongly are the main pivot in the handling of Mental and Nervous Disease, are especially considered in two places. One is the Phipps Clinic under Professor Adolf Meyer working in close connection with the Johns Hopkins University and the General Hospital at Baltimore, and the other is the Boston Psychopathic Hospital under Professor Macfie Campbell. If these two are seen it will be admitted that the best Hospitals in this line in America have been visited. The Phipps Clinic owes its existence to the generosity of Mr. Phipps. It is a delightful building with open air loggias high up, and the necessary guarding of the sides camouflaged by attractive iron work and flowers. There are grounds in which the patients can walk and sit, these grounds being open to and used by people belonging to the General Hospita', but there is no gardening possible for the
patients.
In the space at my disposal no detailed description is possible, but the finest things about the institution are first, the understanding sympathetic tone of the whole of the medical staff with its very personal relation to each patient, and second, the corresponding trust and reliance of the patients. No one can see the gentle patience of the Medical Director and the keenness of his observation without realising how much this tone owes its existence to him. A third striking feature is the ease with which this department works with the rest of the Hospital; this enables the clinic to obtain a first-rate consulting opinion in any speciality and the Hospital to refer nervous cases to the Phipps Clinic. This is the ideal for this work, that it should be correlated with work in other diseases in a big Hospital with a School at hand for the teaching of students, and that it should share in the advantages of the most recent work in all departments. If it is permissible to criticise at all where there is so much that is admirable, it is to be regretted that thereare locked outer doors to the wards, and that cases, in which compulsory detention has to be resorted to, are admitted. This, to mv
52
STUDIES IN MENTAL INEFFICIENCY.
mind, must hamper, to some extent, the success of the Clinic as a place for early recoverable nervous and borderland patients. Already patients are refusing to go there in the early stages, citing the locked doors and the fact that some very As long acute cases of mental disease are treated there as making it unsuitable. as doors are locked and acute cases are admitted in which interference with liberty is necessary, so long will the bulk of early nervous and borderland patients refuse It is not clear why such mental cases should not be to go to these Hospitals. drafted at once to a Mental Hospital with careful grading of patients. It is true that these patients are convenient for demonstration purposes for students, but these students should in any case visit the Mental Hospital, and the fact that some early preventable cases will stay away is a great deprivation, because these early cases are those with which the students will be chiefly called upon to deal in their practices later. The out-patient department at the Phipps Clinic is splendid and there is a good staff of nine physicians, men and women, for 84 in-patients and the outpatients This should be a lesson to us. We attempt to do our nervous and mental work with grotesquely inadequate staffs. The in-patients pay what they can afford from nothing to 25 dollars a week, private patients paying 9 to 12 dollars a day. The actual cost per head, I was told, was about 6 dollars or 25s. a day. There is no doubt that here, at least, the early recoverable nervous and borderland patients have offered to them the very best that modern alienists can give. The Boston Psychopathic Hospital, under a Scotsman, Professor Macfie Campbell, is another noteworthy institution which like the Phipps Clinic is run in close connection with a large general Hospital and the Harvard University Medical School. Here, too, the same objection can be raised that there are locked outer doors, and that some of the cases admitted are acute mental ones. The kindly tone and careful scientific investigation of cases exist here no less than at the Phipps Clinic. I must say too, that I was much struck by the way in which our physical as well as mental hunger was appeased! At most institutions we were hospitably entertained. The Third division is the care of the Insane, and two very fine institutions stand out in my mind, i.e., St. Elizabeth's State Hospital at Washington under Dr. White, and the Pennsylvania Hospital, Department for Mental and Nervous Diseases, at Philadelphia under Dr. Copp. Both Hospitals are full of energy and progressive ideas and accomplishment, re-education methods are in full swing. Particularly I remember the toyshop at St. Elizabeth's, the beautiful surroundings and Dr. White's keen interest in all the new scientific methods, and, at the Pennsylvania Hospital, Dr. Copp's magnificent visions for the future. A well nigh perfect place is planned with every department thought out for patients, staff, and original work, including too an out-patient department in the Town, which is already doing notable work. As fine examples of smaller private Mental Hospitals, Bloomingdale, near New Yoik, and the Shephard Pratt at Baltimore are attractive, and the very large number of voluntary boarders is an enviable feature. It is a source of pride to have as many as possible. The Psychiatric work done for criminals and juvenile delinquents I saw first at Ottawa in Canada where Judge Archibald has a simple but attractive little detention home, where he can take both boys and girls, under a man and his wife who run it so that the heme ar.d not the detention is obvious. In this connection 111 Eig Bicil (i trd Sister Movement seemed nearly ideal in guarding and helping young offenders. .
STUDIES IN MENTAL INEFFICIENCY.
58
Judge Mott at Toronto is the first in Canada to have a special Psychiatrist attached to his Juvenile Court. Again at Baltimore and in New York excellent work is being done in Juvenile Courts, and the most intensive work of all is at Boston under Dr. Healy, and at New York under Dr. Glueck, each of whom has an able woman doctor working with him. Dr. Healy and Dr. Augusta Bronner, who have both written valuable papers, are most original workers, keen minded and enthusiastic and full of a delightful readiness to help and give of their know-
ledge
to any
enquiring colleague.
The care of the Mentally and Nervously disabled soldiers as at the Walter Reed Hospital, W. Washington, Psychiatry in relation to Education, the Special Schools, the Psychiatrist in Social Service, and other points of value must be despatched with the comment that any one of them would well repay a visit to the other side. Last, but not least, I come to the National Committee for Mental Hygiene which I briefly mentioned before. This was started mainly by Mr. Clifford Beers, who wrote a remarkable book called "A Mind that Found Itself." With enthusiasm, tolerance, and some humour he described his experiences as a mental patient, and having then arrested the attention of such men as Professor William James, Dr. E. E. Southard, Dr. William Welch and Dr. Adolf Meyer he, with It has no flavour of "anti" their aid, organised the National Committee. about it and, though aiming at reform in one sense, it has been steadily constructive from the first. It has had a hand in all the great advances made in Mental Hygiene since its inception and it has initiated several. It has "tried out" suggestions, published valuable work, stirred up interest, pulled all the workers formed a common meeting ground and, through its valuable paper together, ' 'Mental Hygiene,'' kept in touch with a wide public. This Committee has the warm support of all the keenest and best men and women, who, with ruth and sympathy, concern themselves with the fate of nervous and mental patients; who strive for the prevention of faulty methods of thought and education which tend to increase mental strain, and who are in the van of scientific work in these matters. It forms an important and necessary link between the public and the work in this speciality. The public very badly needs this link. Too often the man in the street knows amazingly little about insanity in proportion to its importance. He has, often, never seen a mental hospital, he has no idea that in one Mental Hospital alone there may be over 2000 patients, He does not know that in many Mental Hospitals there is a large recovery rate. He does not grasp at all the close relationship which nervous and mental stability and instability bear to all the daily problems he meets, industrial fatigue and unrest, war and peace, social difficulties such as crime and delinquency, thieving, divorce, the birth rate, etc. He pictures mental disease as a sea into which a man lands himself as it were by a plunge off a spring board?never was there a more fatal mistake. He thinks nerves are "all .ot." The War has helped a great deal in letting light and air into this subject, but there should be here, as in America, a permanent reliable mechanism for ventilation Such, the National Committee for Mental Hygiene is, there. Such, it would be, if introduced, here. The personnel of the Committee speaks for itself. Those who are well known experts, who have devoted their lives to the service of mental and nervous health, philanthropists, professors and others who are interested, combine to look at this subject as a whole, and to see that no aspect of it be neglected. .
54
STUDIES IN MENTAL INEFFICIENCY.
Another great contribution that this institution is making to the general and co-operation is the organisation of an International Comwhich both Canada and the United States already have subscribed for mittee, money. They have a fine vision of a future in which every original and helpful thought in this speciality, wherever in the world it may grow, shall be culled and distributed for the good of all. They desire that anyone, however far away, may be easily able to inform himself as to all the best ideas in this connection, and that help in carrying them out may be available. Already the States and Canada are co-operating, France is interested and considering, China, I think, is forming a committee, South Africa has started and it is to be hoped that we shall not be left behind.
understanding
of Canada and the United States.
By A. Helen Boyle, M.D., L.R.C.P., L.R.C.S., L.R.F.P.S. Those who are interested in the treatment of Nervous and Mental Disease and who want to know some of the best work that is being done on these lines should, certainly nowadays, visit America. Thus judging the situation I went. I did some lecturing in Canada and. came back through the States. This is a good order in which to take the countries, ?our own bit of the Empire first?where a very real tie of kinship exists and where you drop as far as possible any insular feelings and prejudices you may have, and, even more, your preconceived ideas of this new world?and then the States with the greatness of territory, of attempt and accomplishment. (Canada is actually larger in area, but not in inhabited land nor in population). One thing which struck me very much was the extraordinary variety of languages and in particular the heterogeneous nature of the human material which goes to make up these two countries, with their peculiar problems for the alienist. This material is very difficult to handle, to understand, to govern, but with wha immense possibilities! Surely there is not one fine human quality or capacity which should be absent in Canada or the United States! The honesty, reliability and steadiness of John Bull; the vivacity, gaiety and thrift of the French; the plodding, patient thoroughness of the Germans; the stoicism and emotional music of the Russian; the mechanical genius and capacity for enjoyment of the Italian; the enthusiasm and generosity of the Irish; the sobriety, hardworking power and love of family of the Jews; the industry, loyalty and truthfulness of the Chinese, and many more too?all these can be found in the American citizen. He need not be hampered by the absence of capacity
50
STUDIES IN MENTAL INEFFICIENCY.
for anything which the human race can anywhere master and create. He has, innate in him, the qualities of all the races who have contributed to people the land. Somewhere in that great country it should always be possible to find the man who can supply any quality or combination of qualities that may be needed, any mental, moral or physical make-up necessary to cope with a crisis or trouble, and to overcome it. Never before in the history of the world has a race arisen in like manner. Another striking feature is what appears to be the amazing readiness with which, when once a need is made clear, there arises a determination on the part of one or many to meet it and, at all costs, to meet it well and completely. Over and over again I heard of needs made plain by a few keen-sighted people, often through the National Committee for Mental Hygiene, and then quickly followed by the remedy, or better still by prevention. A third great beauty in America is the friendly way in which all the great men and women in charge of institutions and societies try to make your visit helpful, happy and instructive, and their interest in, and desire to hear about, anything in this country. They show you everything, spare you time, feed you, teach you and, even sometimes, ask questions and listen to you! To turn to the more medical aspect of things. Where so much is fine, thoughtful and scientific it would be impossible to single out any one person or institution as being pre-eminent. There is much outstanding work calling for hearty admiration and emulation. Perhaps the Scotsman, who knew the conditions on both sides of the Atlantic, summed the position up most truly when he said:?"Our average is a better one, but some of their highlights are brighter than ours.'' These highlights are distributed in various directions, and I will mention those which most caught my eye, alluding to them as a help to those who may be going over, and devoting most time to the National Committee for Mental Hygiene which, of all of them, is the one which I should most like to see established in this country, and which would lead not to advance on one line of mental and nervous work only, but would have a fostering influence on them all. Another reason for this course is that these splendid institutions would each require an article to itself to do them justice. These highlights are eight in number, and constitute the most striking demonstration I saw of the best methods which America is using to cope with the difficulties of these different types of work. They fall under the following headings: Mental Defectives, their care and treatment. 1. Nervous and Borderland patients, their care and treatment. 2. The Insane, their care and treatment. 3. Criminals and Delinquents, the relation between criminality and the 4. psychoses and neuroses. 5. Mentally and Nervously disabled soldiers, their care and treatment. 6. Psychiatry in relation to Education. 7. Psychiatry in relation to Social Service. 8. Last but not least, the fine organisation called the National Committee for Mental Hygiene. It is obvious that in the brief time of eleven weeks, which passed like a flash in the stimulating atmosphere of Canada and the States, it was hopeless to attempt to see everything and everybody of value. Want of time, not disinclination or lack of appreciation of their worth, must be the excuse for the omissions of which there were many and grievous,
STUDIES IN MENTAL INEFFICIENCY.
51
With regard to Mental Defect, the splendid Massachusetts School for the Feeble-Minded at Waverley, Waltham, was a joy to go over, and the most interesting time there was that spent with Dr. Fernald, hearing him talk and seeing him interview out-patients. He has himself recently contributed to this paper a scientific article on Mental Defect. The School began about 1840 with a blind school which showed many feeble-minded, and so these were provided for, and defectives who could see were also admitted. Now it has grown and can hold 1700, the inmates paying what they can each afford. This school seems to leave It provides for the culture no side of a mental defective's possibilities untouched. of any little bud of capacity that any one of them may show. Not least, their natures are encouraged to expand by understanding and sympathy so that every moral power may be utilised and the human creature developed mentally, morally The school for the training of the special senses, with its and physically. sounds and its smells and its shapes and materials all at different tables so that the children made a procession round them, was a fascinating place. Many go out and earn, and do not even sleep in, but in some cases are visited by a social worker, or report at intervals to the colony as advised. This boarding out is valuable. There is also the Templeton Colony Farm of 3,000 acres and about 300 boys It is not however self-supporting for much training has to take place there. on it. There is a farm near at hand to which some of the girls go. Thus many of the "less gifted," as they are rather beautifully called, really contribute an appreciable quota to the working world. The Nervous and Borderland Patients, which I feel strongly are the main pivot in the handling of Mental and Nervous Disease, are especially considered in two places. One is the Phipps Clinic under Professor Adolf Meyer working in close connection with the Johns Hopkins University and the General Hospital at Baltimore, and the other is the Boston Psychopathic Hospital under Professor Macfie Campbell. If these two are seen it will be admitted that the best Hospitals in this line in America have been visited. The Phipps Clinic owes its existence to the generosity of Mr. Phipps. It is a delightful building with open air loggias high up, and the necessary guarding of the sides camouflaged by attractive iron work and flowers. There are grounds in which the patients can walk and sit, these grounds being open to and used by people belonging to the General Hospita', but there is no gardening possible for the
patients.
In the space at my disposal no detailed description is possible, but the finest things about the institution are first, the understanding sympathetic tone of the whole of the medical staff with its very personal relation to each patient, and second, the corresponding trust and reliance of the patients. No one can see the gentle patience of the Medical Director and the keenness of his observation without realising how much this tone owes its existence to him. A third striking feature is the ease with which this department works with the rest of the Hospital; this enables the clinic to obtain a first-rate consulting opinion in any speciality and the Hospital to refer nervous cases to the Phipps Clinic. This is the ideal for this work, that it should be correlated with work in other diseases in a big Hospital with a School at hand for the teaching of students, and that it should share in the advantages of the most recent work in all departments. If it is permissible to criticise at all where there is so much that is admirable, it is to be regretted that thereare locked outer doors to the wards, and that cases, in which compulsory detention has to be resorted to, are admitted. This, to mv
52
STUDIES IN MENTAL INEFFICIENCY.
mind, must hamper, to some extent, the success of the Clinic as a place for early recoverable nervous and borderland patients. Already patients are refusing to go there in the early stages, citing the locked doors and the fact that some very As long acute cases of mental disease are treated there as making it unsuitable. as doors are locked and acute cases are admitted in which interference with liberty is necessary, so long will the bulk of early nervous and borderland patients refuse It is not clear why such mental cases should not be to go to these Hospitals. drafted at once to a Mental Hospital with careful grading of patients. It is true that these patients are convenient for demonstration purposes for students, but these students should in any case visit the Mental Hospital, and the fact that some early preventable cases will stay away is a great deprivation, because these early cases are those with which the students will be chiefly called upon to deal in their practices later. The out-patient department at the Phipps Clinic is splendid and there is a good staff of nine physicians, men and women, for 84 in-patients and the outpatients This should be a lesson to us. We attempt to do our nervous and mental work with grotesquely inadequate staffs. The in-patients pay what they can afford from nothing to 25 dollars a week, private patients paying 9 to 12 dollars a day. The actual cost per head, I was told, was about 6 dollars or 25s. a day. There is no doubt that here, at least, the early recoverable nervous and borderland patients have offered to them the very best that modern alienists can give. The Boston Psychopathic Hospital, under a Scotsman, Professor Macfie Campbell, is another noteworthy institution which like the Phipps Clinic is run in close connection with a large general Hospital and the Harvard University Medical School. Here, too, the same objection can be raised that there are locked outer doors, and that some of the cases admitted are acute mental ones. The kindly tone and careful scientific investigation of cases exist here no less than at the Phipps Clinic. I must say too, that I was much struck by the way in which our physical as well as mental hunger was appeased! At most institutions we were hospitably entertained. The Third division is the care of the Insane, and two very fine institutions stand out in my mind, i.e., St. Elizabeth's State Hospital at Washington under Dr. White, and the Pennsylvania Hospital, Department for Mental and Nervous Diseases, at Philadelphia under Dr. Copp. Both Hospitals are full of energy and progressive ideas and accomplishment, re-education methods are in full swing. Particularly I remember the toyshop at St. Elizabeth's, the beautiful surroundings and Dr. White's keen interest in all the new scientific methods, and, at the Pennsylvania Hospital, Dr. Copp's magnificent visions for the future. A well nigh perfect place is planned with every department thought out for patients, staff, and original work, including too an out-patient department in the Town, which is already doing notable work. As fine examples of smaller private Mental Hospitals, Bloomingdale, near New Yoik, and the Shephard Pratt at Baltimore are attractive, and the very large number of voluntary boarders is an enviable feature. It is a source of pride to have as many as possible. The Psychiatric work done for criminals and juvenile delinquents I saw first at Ottawa in Canada where Judge Archibald has a simple but attractive little detention home, where he can take both boys and girls, under a man and his wife who run it so that the heme ar.d not the detention is obvious. In this connection 111 Eig Bicil (i trd Sister Movement seemed nearly ideal in guarding and helping young offenders. .
STUDIES IN MENTAL INEFFICIENCY.
58
Judge Mott at Toronto is the first in Canada to have a special Psychiatrist attached to his Juvenile Court. Again at Baltimore and in New York excellent work is being done in Juvenile Courts, and the most intensive work of all is at Boston under Dr. Healy, and at New York under Dr. Glueck, each of whom has an able woman doctor working with him. Dr. Healy and Dr. Augusta Bronner, who have both written valuable papers, are most original workers, keen minded and enthusiastic and full of a delightful readiness to help and give of their know-
ledge
to any
enquiring colleague.
The care of the Mentally and Nervously disabled soldiers as at the Walter Reed Hospital, W. Washington, Psychiatry in relation to Education, the Special Schools, the Psychiatrist in Social Service, and other points of value must be despatched with the comment that any one of them would well repay a visit to the other side. Last, but not least, I come to the National Committee for Mental Hygiene which I briefly mentioned before. This was started mainly by Mr. Clifford Beers, who wrote a remarkable book called "A Mind that Found Itself." With enthusiasm, tolerance, and some humour he described his experiences as a mental patient, and having then arrested the attention of such men as Professor William James, Dr. E. E. Southard, Dr. William Welch and Dr. Adolf Meyer he, with It has no flavour of "anti" their aid, organised the National Committee. about it and, though aiming at reform in one sense, it has been steadily constructive from the first. It has had a hand in all the great advances made in Mental Hygiene since its inception and it has initiated several. It has "tried out" suggestions, published valuable work, stirred up interest, pulled all the workers formed a common meeting ground and, through its valuable paper together, ' 'Mental Hygiene,'' kept in touch with a wide public. This Committee has the warm support of all the keenest and best men and women, who, with ruth and sympathy, concern themselves with the fate of nervous and mental patients; who strive for the prevention of faulty methods of thought and education which tend to increase mental strain, and who are in the van of scientific work in these matters. It forms an important and necessary link between the public and the work in this speciality. The public very badly needs this link. Too often the man in the street knows amazingly little about insanity in proportion to its importance. He has, often, never seen a mental hospital, he has no idea that in one Mental Hospital alone there may be over 2000 patients, He does not know that in many Mental Hospitals there is a large recovery rate. He does not grasp at all the close relationship which nervous and mental stability and instability bear to all the daily problems he meets, industrial fatigue and unrest, war and peace, social difficulties such as crime and delinquency, thieving, divorce, the birth rate, etc. He pictures mental disease as a sea into which a man lands himself as it were by a plunge off a spring board?never was there a more fatal mistake. He thinks nerves are "all .ot." The War has helped a great deal in letting light and air into this subject, but there should be here, as in America, a permanent reliable mechanism for ventilation Such, the National Committee for Mental Hygiene is, there. Such, it would be, if introduced, here. The personnel of the Committee speaks for itself. Those who are well known experts, who have devoted their lives to the service of mental and nervous health, philanthropists, professors and others who are interested, combine to look at this subject as a whole, and to see that no aspect of it be neglected. .
54
STUDIES IN MENTAL INEFFICIENCY.
Another great contribution that this institution is making to the general and co-operation is the organisation of an International Comwhich both Canada and the United States already have subscribed for mittee, money. They have a fine vision of a future in which every original and helpful thought in this speciality, wherever in the world it may grow, shall be culled and distributed for the good of all. They desire that anyone, however far away, may be easily able to inform himself as to all the best ideas in this connection, and that help in carrying them out may be available. Already the States and Canada are co-operating, France is interested and considering, China, I think, is forming a committee, South Africa has started and it is to be hoped that we shall not be left behind.
understanding
