The mental and moral fitness of women for the management of insane women is beyond cavil. Their fidelity and devotion to their profession cannot be questioned. Their ability to successfully manage and control similar institutions in all their departments has been proven. We may instance the Woman's Prison at Sherborn, Mass., and the Woman's Prison and Girls' Reformatory in Indiana, both most successfully managed by women. This special field is not without its pioneers. In the Worcester Hospital, Mass., a woman was long and successfully employed as assistant physician. In March of this year (1879), a lady was appointed, by competitive examination, assistant physician at the Cook County Hospital for the Insane, Chicago.

Six years ago this spring, a lady was appointed assistant physician by the Board of Trustees at the State Hospital for the Insane, Mt. Pleasant, Io. We quote from the reports of that institution the following statement as indicative of the regard in which the movement is held there: "Experience has confirmed the conviction that a female physician, with proper qualifications, can accomplish a vast amount of good in such hospitals." The most eminent alienist in Pennsylvania, and one long connected with a hospital for the insane, has on several occasions requested eminent. female physicians to take charge for a brief time of patients in his institution, to gain their confidence, and to ascertain their physical condition, so that a proper treatment could be instituted. That man we honor. His confession of his powerlessness to act in such cases we regard as weighty proof of the desirability of the measure which we advocate.

At this writing, a bill for the employment of female assistant physicians in all the State hospitals for the insane, to have the care of female patients under the superintendent, which has been before the New York legislature, has passed the lower body of the assembly by a vote of seventy-five to twenty-four. Pennsylvania, however, moved first in this matter, and is even more progressive than her sister State. The Pennsylvania State Medical Society, one of the oldest, most influential, and perhaps most conservative, medical societies in the country, instigated the movement there by a memorial to the Pennsylvania legislature, which was also indorsed by the Board of Trustees of the Harrisburg Hospital for the Insane a vote of eight yeas to one nay being had. The bill before the Pennsylvania assembly aims to place the female departments of its insane-hospitals under the sole charge and

superintendence of women. It has at this time passed the lower body without a show of opposition, and its friends are hopeful of its passage in the senate. The latter plan seems to me far the best; but, although we live in an age when the world moves, we may not hope at one bound to accomplish what may yet take years of evolution and growth, but the coming of which is inevitable.

In a recent legislative investigation of the insane-hospital at Kalamazoo, Mich., regarded as one of the best-managed in the United States, the committee in their report made several practical suggestions for legislative action, one of which we quote, viz. : "That at least one female physician be appointed to act in the capacity of an assistant physician in the female department."

The employment of female assistant physicians in hospitals for the insane need cause no change in the management, need involve no extra expense, but will, we are confident, if the right women are selected, and given time and liberty to do for insane women all that exists to do, result in an increased efficiency and an enlarged curative capacity on the part of our hospitals. Strong in our convictions, sure of our purpose, we make this plea in behalf of the thousands of insane women throughout the world, believing that it is practicable, humane, and just.

To Dr. H. B. Wilbur of New York and Dr. Hiram Corson of Pennsylvania we are much indebted for reports and information concerning the recent legislative action had in this matter in their respective States.

Since writing the above, we have to note the passage of the bill before the Pennsylvania legislature which empowers the trustees to appoint a female physician to have charge of the female patients of hospitals for the insane, and directs that they shall report to the trustees.

HOSPITALS AND ASYLUMS FOR THE INSANE:

SHALL WE DISTINGUISH BETWEEN THEM, AND PROVIDE ASYLUMS AT LESS EXPENSE?

[Read by Henry W. Lord of Detroit, June 10, 1879.]

It is usual to use the words "hospital" and "asylum" interchangeably. They have several shades of meaning in common; both are defined as places of shelter, protection, and refuge. The word "hospital," however, includes in its meaning curative meas

ures for its inmates more distinctly than does the word "asylum.” Refuge, shelter, protection—these pertain, with fewer exceptions, to the idea of an asylum. An asylum may or may not afford curative processes, so far at least as its name implies. A hospital is, in its essential idea, a place where medical and surgical aid is rendered, and where cures are expected.

Most receptables for the insane in these days are in the nature of hospitals and asylums combined, if we except the jails and poorhouses, many of which are more like menageries for torture and exhibition.

Like steamboats, railways, and electric telegraph-lines, hospitals and asylums for the insane, on the present scale, are comparatively modern institutions; that is, modern as to Europeans. If we go back far enough, to Egyptian, Phoenician, and Grecian days, skipping the mediæval and later centuries entirely until the last, we find that in remote times enlightened views of insanity were entertained; intelligent and humane treatment was taught and practised, first by the learned priests of Egypt, and later by the great philosophers and physicians of Greece. In the former country, according to earliest records, melancholics were brought in considerable numbers to the temples. "Whatever gifts of nature or productions of art were calculated to impress the imagination were there united to the solemnities of an imposing superstition. Games and recreations were instituted. The most voluptuous productions of the painter and sculptor were exposed to public view. Groves and gardens surrounded these shady retreats, and invited the distracted devotee to refreshing and salubrious exercise. Gayly decorated boats sometimes transported him to breathe, amid rural concerts, the pure breezes of the Nile. In short, all his time was taken up by some pleasurable occupation, or by a system of diversified amusements enhanced and sanctioned by a pagan religion.”

This process of treatment passed from the priests of Egypt to the learned and accomplished physicians and philosophers of Greece. There, in treating mental diseases, "the early morning was divided between gentle exercises and reflection, music, and study; then conversation, followed by gymnastic exercises, and a simple and temperate diet; public interests were discussed, walking for exercise followed; a cold bath was had, then reading, music, and reflection concluded the day." This mode of treatment was not possible in all cases, but wherever it was practicable the method was continued for many centuries.

During the dark ages that immediately preceded our own, the insane, when cared for at all, were received into the monasteries, and again committed to the care of the priests—this time of the Christian religion, but whose views of insanity were worse clouded than those of the ancient superstition in the earliest times. A false notion that madmen were possessed of the Devil made it seem incumbent on those who held such an idea to resist the Evil One with all possible energy through the unfortunate person in whom he had assumed shape and habitation for the time being. "Idiots and imbeciles such as were harmless were permitted to wander about homeless and naked, the sport of the wanton and the wicked. The frantic and furious were chained in loathsome dungeons, and sometimes exhibited for money. The monomaniacs were, according to circumstances, regarded with reverence or horror, in either case superstitious. If supposed to be possessed of demons, they were subjected to priestly exorcism, or destroyed as wizards or witches. If thought to be inspired by the Deity, they were constituted leaders of various fanaticisms."

The hospitals were generally attached to monastic institutions. The monks, who often inflicted scourgings upon themselves where they even suspected the influence of the Tempter, not unnaturally treated his known and declared presence and possession of the distressed lunatic with great severity. Among the Franciscan Brothers the insane inmate received ten lashes a day for his regular allowance, and on this were based such other proceedings as could be devised against Satan; among which were chairs of restraint, bleeding with the lancet, whirling chairs revolving one hundred times per minute, confinement in iron cages suspended over tanks of water, with occasional submersion therein. This frightful treatment, with other worse things unmentioned, was continued later than the monasteries by men of all creeds in Europe; and barbarities little less censurable have existed among ourselves within the lifetime of persons now present, and have not yet been fully discarded.

Chains, loathsome cells more offensive than those in which domestic or wild animals are kept, are the not uncommon accessories and tortures that lunatics meet with in almshouses and other places now, and, it is to be feared, in several States here represented.

In the large hospitals and asylums for the insane at the present day, both in Europe and America (all honor to Philip Pinel, a French physician at the beginning of this century), we have in a

great measure, and with great improvements, returned to those scientific and humane measures practised by heathen philosophers and physicians three and four thousand years ago. The influence of music and quiet recreation, such moderate employments as are practicable, such pleasant social enjoyments and intercourse as can be decorously managed; dancing, pictures, lectures, games, educational and religious exercises, a generous diet calculated to restore physical strength, and great care to protect the patient from all mental frictions and disturbances, especially such as lead in the direction whence his madness comes, these constitute the main features of treatment.

We are now, in many of our States, making the most liberal provisions for the insane; we should seek to have our measures also the most enlightened. Expensive hospitals of magnificent exterior and costly finish throughout have been built, supplied with every requisite suggested by science, and conducted by men of special reputation in their several departments. Legislatures have voted, and the people paid, the cost both of structure and of administration with open-handed philanthropy, prompted by the hope of recovery for those upon whom had fallen the saddest of all afflictions. Meantime the mental malady goes on without abatement or diminution; and, if its increase is not in greater ratio than that of population, there is at least the appearance of it. Great institutions are no sooner ready for patients than instantly filled; and probably no State, however willing, has yet succeeded in meeting the demands upon its liberality put forth in behalf of its wards thus afflicted.

We submit that it is quite time to look closely into the phases as well as nature and condition of the disease for which we have to provide, and into the exact effects we seek not only, but may reasonably expect, to accomplish, and see if we are intelligent in the means provided; or, if we may not profitably dwell a little upon the distinctive uses of hospitals and asylums, more accurately restricting our use of the words to what they really mean; and, if asylums and hospitals be not convertible terms, perhaps we may discover that while we want and must use both, we do not want, or at least cannot afford, the two in one. In the examination we may find that we are incurring too much expense in cases comparatively hopeless, we use the language with painful sensibility, a class that comprises more than four-fifths of all the patients in our great monumental establishments.