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 SOME PROBLEMS OF THE INSTITUTION 
 LIBRARY ORGANIZER IN 
 
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 SOME PROBLEMS OF THE INSTITUTION LIBRARY ORGANIZER IN 
 
 THE STATE HOSPITALS* 
 
 By EDITH KATHLEEN JONES, 
 
 Librarian at McLean Hospital, Waverley, Mass. 
 
 Last year I had the pleasure of telling 
 you something of library work in one of 
 the large private hospitals for the insane; 
 this year I want to speak of some of the 
 problems the institution organizer will 
 meet when she undertakes to set in order 
 the libraries of the state hospitals. 
 
 In the first place, unless she is fortunate 
 enough to be appointed by the State Board 
 of Control or State Board of Insanity or 
 their equivalent, she may at times feel 
 that she is looked upon a little bit as an 
 outsider by the hospital staff, as one who 
 does not understand hospital conditions 
 and who belongs to an entirely different 
 order of things. She may even meet what 
 seems to her indifference or actual antag- 
 onism on the part of a few superintendents. 
 
 The fact is, the library to librarians is 
 of supreme importance, but the library 
 to the average hospital superintendent is 
 merely one method of providing entertain- 
 ment or employment for his patients. He 
 is much more interested in the new social 
 service movement and the study of eugen- 
 ics and heredity than he is in the general 
 library, which, to his mind, is simply a 
 part of the therapeutic system and even 
 as such ranks far below useful employment 
 and arts and crafts work. 
 
 This indifference or antagonism does not 
 arise from any personal feeling nor is it 
 confined to the library. It is the natural 
 outcome of the peculiar organization de- 
 manded in a hospital for the insane, a 
 general distrust of any outside interference 
 in any department, and a thorough con- 
 viction that each hospital is entirely com- 
 petent to manage its own affairs. In one 
 state the state board refused the offer of 
 the state library committee to organize 
 its institution libraries for these very rea- 
 sons. In another state, where the possi- 
 bility of the state board appointing an 
 
 *Read before the League of Library Com- 
 missions, at the Conference of the American 
 Library Association, Kaaterskill, N. Y., June, 
 1913. 
 
 institution librarian of its own is under 
 discussion, one superintendent remarked 
 that he “could only say this; if it must 
 come he was thankful it was coming from 
 the inside, through the board and from one 
 who knew hospital conditions.” 
 
 Another reason for this seeming indif- 
 ference on the part of the superintendents 
 is that, in the East at any rate, a state 
 hospital is always poor. It is poor and it 
 is crowded, and its superintendent is har- 
 rassed with having his requests for better 
 accommodations for his patients, a new 
 power house, larger kitchens and laundries, 
 or quarters for his married men nurses 
 turned down; with trying to get larger ap- 
 propriations from the state legislature; 
 with endeavoring to feed and clothe and 
 house 1,200 patients on an appropriation 
 and in quarters designed for 1,000 at the 
 most. He probably has cut down his ex- 
 penses in every conceivable direction, and 
 he can not see the use of spending money 
 for books which the majority of his pa- 
 tients will not read. And there is this to 
 be said for his point of view, that while 
 there are many educated and cultivated 
 persons in all the state hospitals, the ma- 
 jority of them are foreigners and illiterates 
 from the mill and factory-hand classes and 
 from the slums of the cities. In New York 
 state alone, in 1906, forty-six per cent of 
 the whole number of patients admitted to 
 the New York hospitals were of foreign 
 birth. And I might add, to show the 
 menace of the class of people we are let- 
 ting into our country, that forty-six per 
 cent of the insane were aliens, while only 
 twenty-six per cent of the whole popula- 
 tion of the state were of foreign birth. Add 
 to these the outcasts from the slums and 
 you have a good idea of the make-up of 
 the state hospitals and asylums, and you 
 will not wonder that many superintendents 
 shake their heads when libraries are men- 
 tioned. 
 
 It would, therefore, seem to be one of the 
 duties of the organizer to prove to the 
 
superintendent that even if three-fifths of 
 his patients are illiterate, reading should 
 be provided for the educated two-fifths; 
 that she, from her knowledge of books and 
 editions, can provide a thoroughly readable 
 library which will meet the requirements 
 of all classes, from college professors to 
 the dregs of humanity, for a much less 
 sum than he can do it, and from her 
 experience she can interest the patients in 
 hooks. For after you have the library, you 
 still have a set of people to deal with 
 who lack initiative and must be aroused 
 to interest in anything. She must also 
 impress upon him that shelf-and-book or 
 even accession numbers mean nothing, and 
 that when, as in one library I know, all 
 the books are covered and there is no hint 
 of author or title on the back, the library 
 is converted into a sort of literary grab-bag 
 which is funny to the librarian but exas- 
 perating to the patient. She must con- 
 vince him that an unclassified library rep- 
 resents a tremendous waste, especially 
 when it is not supplemented by a subject 
 catalog. She must be able to prove to 
 him from the experience of other hospitals 
 that the old-fashioned method of letting a 
 library run itself is not conducive to 
 growth and that there must be some one 
 whose chief duties are to the library. She 
 can assure him from figures that he is not 
 ‘getting out of his library what he should, 
 if out of 1,000 patients only 60 use the 
 library during the year and 50 books a 
 week is a large circulation. She can tell 
 him of one hospital of 220 patients which 
 has from 75 to 100 regular readers, not 
 counting nurses and employees, and aver- 
 ages 25 books a day, or 8,900 a year; of an- 
 other of about the same size which often 
 gives out 50 books a day; of a third, which, 
 with a population of 2,000 gave out last 
 year 15,862 volumes to 344 persons. She 
 can guarantee him that if he will let her 
 weed out obsolete stuff and fill in with the 
 sort of books the patients want and train 
 some patient, nurse or stenographer to act 
 as librarian in her absence at other hospi- 
 tals, his library circulation will be doubled 
 or trebled the first year. 
 
 Having convinced the superintendent of 
 the utility of the organized, central library, 
 the institution librarian is now free to 
 turn her attention to the patients, getting 
 
 acquainted with them, learning their tastes 
 in books, interesting them in reading and 
 in pictures. And just here I would say 
 that in the state hospitals the doctors are 
 always glad to have anything new suggest- 
 ed in the way of employment, and that if 
 the organizer can manage it so that the 
 patients can help her in the care of the 
 charging-system, mending and cataloging, 
 her efforts will be much appreciated by all 
 concerned. 
 
 The institution organizer will soon find 
 that each hospital differs from every other 
 in construction, management, and especial- 
 ly in the character of illness. The asylums 
 for the chronic insane present the most 
 hopeless feature, yet even here there are 
 enough who read- to make it worth while 
 to furnish libraries. Moreover, in the asy- 
 lums, the nurses have to be taken into 
 account. Their work is so hopeless and 
 uninteresting compared with that in hos- 
 pitals for acute and recoverable cases that 
 more must be done for them in order to 
 get and keep even ordinarily good attend- 
 ants. And where, as in many cases, the 
 chronic insane are being transferred to 
 farm colonies way out in the country, far 
 from any city or even large town, the li- 
 brary can, if it will, help very decidedly by 
 offering means of study and education to 
 the nurses and staff as well as diversion 
 to the patients. Therefore, one can ven- 
 ture to buy for an asylum a much better 
 selection of books from the point of view 
 of general culture than for the ordinary 
 hospital. 
 
 I have said so often that a hospital li- 
 brary must be formed for entertainment, 
 not for education, that it must be simple in 
 organization and carried along on uncon- 
 ventional lines, that I speak of these points 
 again only to emphasize them. If one 
 looks upon institutional work from the 
 point of view of educative influence it is 
 discouraging work; but if one thinks of 
 it as an adjunct to the therapeutic service 
 of the hospital, as a means of bringing 
 some pleasure or at least forgetfulness of 
 self for a time to an afflicted class and em- 
 ployment for hours which otherwise would 
 be passed in complete idleness and utter 
 dejection, it is inspiring work. But in the 
 selection of books this point of view must 
 be kept always in mind. 
 
Yet this is just what those unaccustomed 
 to hospital conditions fail to grasp. Not 
 three months ago a hospital in a far-off 
 western city sent a representative to see 
 our library and get all the information he 
 could in regard to the sort of books they 
 should put into their beautiful and expen- 
 sive new buildings. I showed him a list 
 of some 1,200 of our most popular books 
 selected as a basis for the little catalog 
 Miss Carey, Miss Robinson, Miss Waugh 
 and I have made out and annotated, and 
 which is now being printed by the A. L. A. 
 Publishing Board. The first thing he 
 noticed was the omissions. “Why,” said 
 he, looking at Science, “you have nothing 
 by Spencer, or Darwin or Huxley on this 
 list. Aren’t they the standard thing? 
 Oughtn’t I to get them for our library?” 
 “Not if you want a library which will be 
 read,” was my prompt reply, and I showed 
 him the records of our sets of these scien- 
 tists, taken out at the most three or four 
 times in the history of the library. 
 
 A year or so ago I attempted to find out 
 from our cards just what was the most 
 popular sort of fiction in our library. Of 
 course the book of the moment is the one 
 read at the moment, so it would be mani- 
 festly unfair to include these and I took 
 only those books published prior to 1901. 
 It may interest you to know in their order 
 the 25 most read books, that is, of the old 
 favorites. The date unfortunately excludes 
 Mr. Pratt, the Virginian, Kim, Rex Beach 
 and Oppenheim. They are, The Choir In- 
 visible, Janice Meredith, Saracinesca, Sant’ 
 Ilario, Don Orsino, Vanity Fair, The Lilac 
 Sunbonnet, Old Chester Tales, Dr. Laven- 
 der’s People, When Knighthood was in 
 Flower, The Sowers — taken out 20 times 
 in the last three years; The Seats of the 
 Mighty, The Battle of the Strong, Adven- 
 tures of Sherlock Holmes, Memoirs of Sher- 
 lock Holmes, Treasure Island, Cape Cod 
 Folks and The Right of Way, 22 times; 
 A Little Moorland Princess, Dorothy Ver- 
 non, Kidnapped and The Cardinal’s Snuff 
 Box 25 times; Richard Carvel 29 times; 
 The Old Ma’amselle’s Secret 40 times and 
 The Second Wife by Miss Marlitt 43 times. 
 This shows pretty conclusively that even 
 our people, all of whom belong to the cul- 
 tivated and educated class, want light, in- 
 teresting stories of romance and adven- 
 
 ture, and the average state hospital reader 
 wants something even lighter than these. 
 
 I have been asked again and again if 
 the right reading really cures. One dare 
 not affirm this; its influence is negative 
 rather than positive. But I can say this: 
 I have known of many cases outside as 
 well as in the hospital where persons have 
 been positively harmed by morbid or hys- 
 terically sentimental books. Our people 
 are inclined to be pretty emotional anyway, 
 and whatever appeals to that side is to be 
 deplored. 
 
 To sum up the qualities which determine 
 the suitability of books for a hospital li- 
 brary, I can do no better than quote from 
 the “Foreword” of the catalog mentioned 
 above: 
 
 “In making this list the editors have en- 
 deavored to keep in mind the following 
 points: 
 
 1. Books in a hospital are for recrea- 
 tion, not for instruction, and therefore 
 should consist principally of fiction, pic- 
 ture books, travel, biography, light and 
 popular science and outdoor books. 
 
 2. They must be wholesome — not mor- 
 bid, or gruesome, or depressing. Good de- 
 tective stories and tales of adventure, how- 
 ever thrilling, if not horrible, and if they 
 do not make vice attractive, are to be rec- 
 ommended, as they, more than almost any- 
 thing else, hold the attention. 
 
 3. Illustrated books and books of pic- 
 tures are invaluable, as a patient often will 
 look at pictures when he is too ill to read. 
 
 4. The newest fiction is called for and 
 read, yet the old favorites remain much 
 in demand. With so much ephemeral stuff 
 among the “best sellers,” it is a delicate 
 task to select the really good novels which 
 will last, and there is a great temptation 
 to fall back on the old and tried books 
 to the exclusion of the more modern. 
 The editors have tried to combine the two 
 in just proportion, and also to give a few 
 titles of the better class of the “second 
 rate” which have proved popular. 
 
 5. It is not enough to provide books for 
 those who wish to read. There are always 
 many patients who are unable to take any 
 initiative towards selecting any form of 
 entertainment or employment for them- 
 selves, and for these should be provided 
 
light and simple stories which will not tax 
 the brain or require any concentration of 
 attention, but which will serve to stimulate 
 their interest in things outside themselves. 
 These are not necessarily children’s books, 
 but often the simple language and quiet 
 wholesomeness of certain books for young 
 people will bridge a patient over this period 
 of mental inadequacy and pave the way to- 
 wards a real enjoyment of maturer reading. 
 
 In addition to these five simple rules for 
 selecting the reading for a hospital library, 
 the editors would emphasize another very 
 important point: Many of the readers will 
 be elderly persons with failing eyesight, 
 who demand large, clear type. This is 
 hard to procure in cheap editions of stand- 
 ard authors and old favorites, but it is 
 suggested that it is well worth while to 
 take a little pains in selection and even 
 to pay a higher price, in order to get an 
 edition of convenient size, shape and 
 weight, in serviceable binding, with large, 
 clear type. Such an edition will last longer 
 and will invite, not repel the reader. 
 
 Complete sets of the works of standard 
 authors, with the exception of Shakespeare, 
 Scott, Dickens, and possibly George Eliot, 
 are not recommended for hospitals. Only 
 a few of the more popular stories of each 
 will be read.” 
 
 I want to say just a word in regard to 
 he housing of hospital libraries. Of course 
 the ideal arrangement is a separate build- 
 ing which is open all the time, but I know 
 of only three or four such in the country. 
 In most state hospitals the library was an 
 afterthought and the books are crowded 
 into one or two more or less inaccessible 
 rooms to which the patients can come only 
 once or twice a week and which can not 
 possibly be made attractive. Often there is 
 absolutely no other room to be had in the 
 hospital and the librarian must make the 
 most of it and do her utmost to beautify 
 it with rugs and baskets made by the pa- 
 tients and flowers from the hospital green- 
 houses. But sometimes a little ingenuity 
 will solve the problem in some such unique 
 
 *This prophecy has come true sooner than 
 was expected. In October, 1913, McLean 
 Hospital introduced into its training-school 
 for nurses a course on “The History of the 
 English novel,” given by the librarian and 
 designed as a foundation on which to base 
 criticism of current fiction and help the 
 nurses in selecting books for patients. 
 
 way as in the State Infirmary at Tewks- 
 bury, Mass., where the superintendent con- 
 ceived the idea of moving their very good 
 little library (classified and cataloged too) 
 from its one small dark, inaccessible room 
 in the administration house to the large, 
 light chapel which hitherto stood idle six 
 days in the week. Here low shelves have 
 been built in between the windows on the 
 wide side aisles and stacks fitted into the 
 alcove rooms each side the chancel. Long 
 narrow tables with plenty of books and 
 magazines have been placed in these aisles 
 and the library is now open practically all 
 the time. 
 
 The Hospital for Epileptics at Monson, 
 Mass., has met its problem somewhat dif- 
 ferently. The superintendent here is hav- 
 ing two large sunny rooms fitted up with 
 bookshelves, one for the men where they 
 can smoke and one for the women where 
 they can sew. These shelves will be kept 
 filled with books from the central library 
 (in an office in the administration house 
 which it shares with the medical library) 
 administered by the stenographer-librarian, 
 but under the direct supervision of a pa- 
 tient for each room. The patients them- 
 selves are very enthusiastic over the pro- 
 posed change and have made out lists of 
 books they want. 
 
 In Massachusetts, the ideal so far as use 
 of the library goes, is found at the Fox- 
 borough Hospital for Inebriates, where 
 only men patients are admitted. Here they 
 have a separate building containing one 
 large room with low bookcases all around 
 it and two tables covered with periodicals 
 and newspapers in the center. Here the 
 men can come when their day’s work is 
 over or at the noon hour and read and 
 smoke. 
 
 I wish I had time to speak of the im- 
 portance of interesting the nurses in the 
 library and getting their co-operation, and 
 of the possibility of holding classes on 
 books and reading for them. I know of no 
 hospital where they have time for such 
 classes at present, but there is a movement 
 on foot towards requiring better educa- 
 tion as a condition for entering the train- 
 ing schools for the general hospitals, and 
 some day some hospital will inaugurate 
 classes in literature.*