Frienfls o? the Insane and Other Essays BAYARD HOLMES THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES Gift of Dr. Gustav F. Buediger THE FRIENDS OF THE INSANE THE SOUL OF MEDICAL EDUCATION AND OTHER ESSAYS BY BAYARD HOLMES, M.D. CHICAGO CINCINNATI : THE LANCET-CLINIC PUBLISHING COMPANY 1911 Romedical Library w 1 H r / The following essays are corrected reprints from the pages of the Lancet-Clinic. Some brief additions have been made to them for completeness or clearness. They were written with a distinct purpose. It has seemed very unreasonable, not to say cruel, that the insane are cared for by the State, not for their own good, but, as Dr. George Webster, President of the Illinois State Board of Health once said at a ban- quet of a medical fraternity, for the good and safety of the sane. Millions are spent in custody, but not a dollar in cure, not a dollar in research. If the man of business, the stock farmer, for example, lost one out of every 300 of his creatures by an expensive disease or accident, and continued caring for these sick ani- mals at great expense, making no effort to discover the source of the disease or do away with the cause of the accident, he would be in the position of the forty sovereign States that care for the insane but make no effort to discover and eradicate the cause. For every thousand dollars spent in custody ten dol- lars ought to be spent in research. Economy might dictate that even a hundred dollars out of each thou- sand should be spent in research and cure. As it is, absolutely no effort is made by any department of State to shut off the need of an expense for custody of the insane, which is as much a burden to industry as a perpetual war. ."031 iv ESSAYS. It is my belief that this work of investigating the causes of insanity should be carried on by the univer- sity. The problem seems to be one of biologic chem- istry. The chemical libraries and trained chemists and biologists are already crowded about the university. The precedent of associating the agricultural experimental- stations with the State university has opened the way, and the prospect of great economic benefit to the State has been demonstrated by the work of the Department of Agriculture. If the various departments of State charity and correction could be under the scrutiny of a scientific body of imaginative investigators, the need of many millions for custody and correction could be eliminated (Rhodes). 1 The insane themselves cannot, for various and ob- vious reasons, present their claims. 2 The friends of the insane have never been organized for their own protection, education and consolation. There seems to be a strange isolation in the fact of insanity in the household. For death and for the bereaved by death there is ostentatious sympathy and consolation from friends and strangers and the world of literature. For the bereaved by insanity there is a fateful silence and turning away. There is every reason why the friends of the insane should be thoroughly organized into a great executive and educational body. The commit- ment of the insane is in many States a relic of bar- baric legal procedure and should be corrected. In 1 Rhodes: Internationaler Kongress fur Irrenpflege. Wien, Oct., 1908. Offizieller Bericht. 2 Beers, C. W. : A Mind that Found Itself. Macmillan & Co., 1908. 8vo, pp. 363. PREFACE. v every State the custody of the insane is conducted under ideal conditions for the promotion of tubercu- losis. There is no State institution where adequate encouragement is provided for the study of the causes of insanity or of the conditions of parasitism, hemol- ogy, nutrition and metabolism during the course of the disease. There is no State in which the insane are available for demonstration to medical societies and medical students. The ordinary means of studying in- sanity, which medical men have in studying all other diseases, is taken away from the medical profession by law, and no other provisions are made at all commen- surate with the importance and the complexity of the problem. The problem of the insane is intricately associated with the problems of crime, prostitution and poverty, as well as with the problems of hospital management, education and all political economies. A considerable proportion of the insane first manifest their disease by acts that bring them into conflict with the police. The courts should be provided by the friends of the insane with a questor or advocate for the insane, whose duty it should be to call the attention of the court to such evidence as might early lead to the treatment of cases of incipient insanity, such as the State now pro- vides, and thus save the judiciary from the bungling decisions which so often confound the officers of penal institutions. If an organization of the friends of the insane did nothing more than provide an advocate for the insane in criminal courts and police courts, the reason for such an organization would soon be ad- vi ESSAYS. mitted by all whose complacency would be disturbed by the innovation. When insanity comes to a household, there is noth- ing that is too expensive to be undertaken. The pri- vate sanitarium is recommended by alienists because the family dread and are terrified by the State insti- tutions. The expense at these private places is very high fifty to two hundred dollars a week. Nothing commensurate with the price is, however, furnished. The attendants work for fifteen to thirty dollars a month. There are no laboratories, baths or skilled attendants. The folks who look upon surroundings of luxury as more important than the researches which reason dictates will always patronize these places, where brass door knobs and Brussels carpets take the place of bolts and bare floors. If a small part of the largess poured out on the unsanitary, unnecessary and unappreciated display of the private rnad-houses was devoted to research, something could be accomplished by private initiative, and that promptly. It should be the duty of an organization of the friends of the in- sane to warn any but the very rich against the private sanitarium, and dissuade them from their prejudices against the State institutions. SUBJECT INDEX. PAGE Abortion, contagious, of cattle Ill Academy of Medicine of New York 151 Acute infections and insanity, before the court 10 Acetone in dementia precox 31 Adolescence dangers in 47 metabolic changes in 47 dementia precox in 7, 24, 48 Adolescent insanity (see dementia precox). Board of Administration of Illinois 113 Africa and the sleeping sickness 23 Agricultural Department and the hookworm disease 22 its experiment station 136, 159, 237 its expenses 136 Agglutinative tests in the diagnosis of diseases of ani- mals 89, 97 Acapnea 253 Admission to medical schools 165-168 Alcohol and insanity 21 Alkaptonuria, a recognizable error of metabolism 55, 93 Alienists (see psychiatrists). conceptions of insanities 4, 25, 44, 48, 50 Albinism, its analogies to the diseases of which insanity is symptomatic 59, 66 and Mendelism 61 American Medico-Psychological Association 24 American Medical Association its influence on literature 153 Anemia and insanity 20 Apnea and shock 253, 257 Arthritis deformans 38 Artificial hyperemia 41 Artificial streptococcus infection 40 Asiatic cholera, psychic origin 1 18 Asylum (see hospital). lunatic 43, 44 custodial 101 population in United States 86 expense of 86 waves of reform 101 attendants 2, 3. 113 orphan, death rate 'in 171 PAGE Association of American Medical Colleges 127 Atrocities of police on the uncommitted insane 18 Attendants at hospitals for insane 1 Australia without an orphan 201-206 problem of defective child 171 Baths and insanity 35 Bateson's translation of Mendel 208 Bedbugs in asylums and barracks 23 Beriberi 117-124 Bertillon identification 29 Bile-ducts, congenital obliteration 247 Blackwater fever 22 Blood of the insane. 37, 40, 45, 89 Board of Administration, Illinois 112 Books and bookstores 193 Boston Medical and Surgical Journal 157 Brain, concussion of, followed by hysteria 68 Bread line and crime against property 9 British Isles, educational system of 127 British Medical Journal 156 Burmah 23 Catatonia, recovery from 40 Causes of insanities, study of 27 Caxton's chivalry and orphans 169 Cerebro-spinal meningitis 84 Cholecystitis in degenerates 251 Cholera infantum 244 Christian Science 5, 21, 33, 44, 69, 111, 227 Chicago, commitment methods in Neurological Society 197 Tribune reoort of New York police methods 11 Cherry coal mine 112 Chemiotaxis 105 Chemistry, physiological 35 Charities, service of State institutions 113 China, University of 157 Cincinnati, new medical school 158 Civil Service in hospitals and State institutions 30, 145 Claim agents of railways 68 Coaguability of the blood in the polycythemia of the in- sane 41 Code of Charities in Illinois 108, 109. 113, 1 14 Cook County, Illinois 15, 17 INDEX. ix PAGE Cobra venom reaction in diagnosis of dementia precox 40 Colleges of agriculture 139 Coley's toxin 40 Commission, Royal of England, on defectives, delinquents and dependents 7 Commitment a horror 1, 17 legal practice of in Cook County, Illinois IS witness, rights not considered 17 Conscience of the State in university of State 142 Contagious abortion Ill Council of Medical Education of American Medical As- sociation 128 Courts, revenge of 10 Crimes, committed by insane 9 Cure or custody 30 Cure precedent to punishment 10 Cystinuria, a condition of error in metabolism 94 Dairymen's Association and epidemic contagious abortion of cattle Ill Detention hospital 15 Delinquent insane, torture of 7, 11 Dementia precox 29, 31, 33, 46, 48, 96, 117 Deforming osteitis 53 Delirium tremens 81 Defense, medical 149 histories of insane for 2 Department of Agriculture 237 Disease, physical signs of , 33 Diamines 93 Diaminuria, a symptom of an error in metabolism 95 Diphtheria 224 Divorces in Iowa 216 Donovan body in kala azar 23 Dope fiends and insanity 21 Doctors' opportunities 147, 240 Eclampsia a toxemia 46 Education, medical . 149 Emmanuel movement 44, 69, 227, 243 Epidemic .-. 40 Epilepsy relation to insanity and hysteria. 68 Erysipelas 26 Enteritis 250 Eugenics , 69 x ESSAYS. Expense of army and navy PAGE of agricultural schools 138 of agricultural department of custodv of insane t of engineering schools 139 of feeble-minded 78 of medical education 137 of research into diseases of animals and plants Farming as a profession 238 Fatigue a toxic process 35 Feeble-minded causes . . 71 civil rights i 77 prevention ... 73 ratio to normal 76 significance to labor problem 78 Fletcherism 669, 243 Focke, his reference to Mendel 209 Friends of insane. . 1 assessed in Cook County 16 duty to organize , -.... 5 establish fellowships of research 30 Fractures of the skull and the police 11 Fragillis osseum 38 Freud, theory of insanity -.110 French Republic educational system 127 Gangrene 43 hospital exterminated 224 Garfield, insane murderer revenged 10 General paresis not due to a twisted idea 21 Goiter exophthalmic 25 Gonorrhea . 218 Gumma, hepatic 73 Harrison street police court 16 Harvard Medical School 133 Head iniuries and disturbance of cerebration 68 Hematology 45 Hemolysis 105 Hepatic gumma 73 Heredity (see Mendelism). in defectives 25, 33 Hookworm disease 20, 92, 229 and insanity 85 INDEX. xi Hospitals for insane PAGE pyschppathic 36 rid of gangrene and erysipelas 43 Hyperpnea 255 Hyperthyroidism and insanity 21 Hypophepeal disease 104 Hysteria after injury of the head 68 Idiots (see feeble-minded). congenital 71 Immunization 105 Infantile paralysis 48 Inquisition of police on insane delinquents 13 Insane and insanity adolescent (see dementia precox). . . ,. . 48 asylums (see hospitals in China) 99 barbarous nations and 99 duty of State to cure 86 etiology 99 expense of custody 103 segregation 49 puerperal 47 pyschosjenitis origin of (see Freud). Institute of Pyschosity, code of charities 106, 110 Institution custodial 2 staff -.. 3 State and private 4 Illinois, treatment of insane 15, 18, 105 State Board of Health of 161 Iowa, decrease of population 213 Japanese and beriberi 1 19 Jaundice 247 congenital 56, 65, 247 chronic 55 malignant > 46 with overgrowth of bone 54 symptomatic 247 toxic, of pulmonary disease .... 55 Johns Honkins University 165 Journal of American Medical Association 106, 157 Jung inquisition 15, 110 Justice, administration of 9 Kala-azar , 20, 23 Kankakee, institution . 108 xii ESSAYS. PAGE Kitchen laboratory 34 Kneip nature cure 69 Laboratories 30, 31, 135-146 equipment of 112, 135-I4O Libraries 31 Lamziekte, a disease of cattle 90 Leucopenia 22 Lincoln, insane murderer of, revenged 10 Liver, acute yellow atrophy of 46, 47 Lunacy, psychogenetic, origin of 105 McKinley, insane murderer of, revenged 10 Mad houses 1, 43, 44, 48, 49, 85 Malaria cachexia 22 Malignant edema r . . 26 Medical education 125, 133, 170 medical hygiene 177 literature 56, 185, 194 pedagogy 133 research 187 schools, absence of physical examination on entrance. .177 cost of 169 entrance examinations 167, 168 relation of to the university 165 resources compared with other professional schools, 169, 170 students of, 169, 177. Medical School of University of Michigan 157 Medical teacher, necessary examination of 129, 155 profession, become unionized 158 Colleges, Association of American 151 societies 181, 185 Melena neonatorum 38 Mendel and Mendelism 61, 207 Mental diseases, study of etiology of 46 Mental tangles 44 Metabolism, errors of 55, 110 Methemoglobinemia in dementia precox 41 Methyllike toxemia 31 Michigan, Psychopathic Institute of 24, 104, 114 University of 157, 161 Mountain fever 23 Mutism diminished by preventing epidemics of scarlet fever 120 Myositis ossificans 38 INDEX. xiii PAGE Myxedema, insanity of 21 Neurasthenia 84 New York Psvchopathic Institute 24, 103, 109, 114 University of State of 161 Novelists' attitude toward insane 201 Nurses in hospitals for insane 2 Orphanotrophies 201 Orphanage 201-206 Osteitis def ormans 53 Osteomalacia 31, 38, 41 Osteophytes 53, 55 Paresis, general > 48 Pedagogic method in medical schools 136 Pellagra 26, 39, 85, 101, 110, 115, 125-134 Periarthritis, syphilitic 52 Paraostitis, ossifying 52 Pernicious anemia 38 Personal liberty 17 Philadelphia bookstore 158 Phipps endowment for the study of insanity 24 Piroplasma 22 Poisoning, phosphorous 46, 47 delaved chloroform 26 Police, their treatment of delinquents 11. 18 Polycythemia in dementia precox 41 Pseudo-sciences 69 Psychiatry, the new 102 Psychiatrists 1, 5. 45 Psychical manifestations 33 Psychological institutes and hospitals 109, 114 laboratory 135 Psychogenesis >. . 103 Pyosalpinx 218 Recovery of insane after tyohoid, erysipelas and other in- fections 39 Rural life, standards of 235 Responsibility of insane i . 9 Royal Commission, ei^ht blue books on insane 75 School houses in rural districts 239 Senility 35 Septic tank i 229 Serology 43 Sewerage disposal 230 Sleeping sickness 23, 35 xiv ESSAYS. PAGE Societies for homing children 172 Spirocheta pallida 33 Spondylosis rhizonelic 3, 6 Strangles ' 91 Starvation at the end of insanity 101 Stockmen Ill Syphilitic insanities 33, 81, 218, 248 Teas 22 Sweat-box 11 Tea ^ardens of Assam 23 Theological schools, endowments 169 Third desree for the insane 11 Tick fever 23 Torture illegal of insane suspects 11 Toxemias 27 in nregnancv 47, 38 unexplained 55 Tropical diseases 23 Trypanosome (see sleeping sickness) 20 Tuberculosis 26, 85, 101, 224 Typhoid 10, 26, 218, 223, 229 State universities, duty of toward defectives, delinquents and dependents 118, 141, 122, 119 United States, insane population of 34 public schools of 127 Virginia, University of 157 Von Langenbeck House in Berlin 151 Wasserman reaction 73, 248, 251 Water treatment 11 Wayne County, Iowa 213 Widal reaction 22 Welcome laboratory 23 Wisconsin, attitude toward the insane 101 Wisconsin, University of 138, 144, 157 West Point 138 Workshops 35 Wound infections 224 Yellow fever . . 23 INDEX. INDEX BY AUTHORS. PAGE PAGE Adler 63 Dussonville 91 ^Esculapius 158, 195 Ehrlich 81,113,143 Agassiz 207 Faraday 207 Agostini 37 Farabee 60 Allison 8 Fieux 46, 47 Amselee 68 Flexner 113, 143 Ashford 21 Focke 209 Austrezverels 85 Frerichs 47 Babcock 128 Freud 4, 31 Baelz 120 Gage 85 Bass 85 Galen 195 Bateson 60 Galvani 207 Bok 69 Geissner 247 Bonnier 209 Gibson 41 Boody 40 Golazzo 85 Boyle 81 Goddall 40 Brocksrnith 126 Gould 60, 61 Bullin 40 Green. 84 Burton 37 Grosskurth 54 Biittenmiller 54 Gunn 63 Buzzi 63 Haacke 62 Campbell 25, 40 Halcase 120 Carroll 153 Halstead 198 Castle 61, 62 Harrison 37 Caxton 203 Hecht ....199 Channing 243 Heighet 123 Cini 37 Heiser 122 Clark 131 Hektoen 143 Clark, Miss 204 Henderson 253, 256 Clarke 68 Herzog 120 Coinde 60 Heverech-Kobliha 37 Columbus 201 Hippocrates 195 Cuenot 61, 64 Holzman 40 Cuvier 207 Homer 202 Correns 207,210 Horiuchi 120 D'Abundo 37 Hyde 60 Darwin 60, 63, 81, 207 Imgaki 120 Darbishire 62 Janet 68 Davis 195 Johnson 205 Desottvry 91 Jung 31 De Vries 207 Kanavel 198, 199 Duncan 214 Keller 19,79 Durham, Miss 64 Koch 81, 117, 143