Columbia itntoettffip mfteCiiptfOtogork College of iptpgtriang anb burgeons; ULibmvy Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/handbookofmentalOOnati HAND BOOK OF THE MENTAL HYGIENE MOVEMENT AND EXHIBIT ILLUSTRATED PUBLISHED BY THE NATIONAL COMMITTEE FOR MENTAL HYGIENE 50 UNION SQUARE NEW YORK CITY 1913 PRICE At Exhibits - 1 5 Cents Postpaid - - 20 Cents_ Publication No. 5 Columbia 33mber£rttp intf)eCitpofJ£eio§orfe College of $f)psicianfi anb gmrgeon* Reference Hihxaxv iLfTtV^ Compliments of Qty* Sfaitmtal (Einmrritttt for Mmtni fggim 50 Union Square New York PLEASE KEEP US ON YOUR MAILING LIST FOR EXCHANGE OF REPORTS. REPRINTS. ETC. A Nation's Greatness Depends upon the Efficiency of its Citizens •" 'PERSONAL EFFICIENCY AT/SOUND MIND ^ '..';:>•"'•.: AM® U;;/-:. ."•A SOUND BOOT ;.. THE " - . 3AMZATION rOOJD HABITS J i HAND BOOK OF THE MENTAL HYGIENE MOVEMENT AND EXHIBIT ILLUSTRATED PUBLISHED BY THE NATIONAL COMMITTEE FOR MENTAL HYGIENE 50 UNION SQUARE NEW YORK CITY 1913 PRICE At Exhibits - 1 5 Cents Postpaid - - 20 Cents Publication No. 5 Acknowledgments In the preparation of THE MENTAL HYGIENE EXHIBIT, valuable advice and assistance were given by a number of physicians, psychologists and social workers, for which we desire to make special acknowledgment to the following persons: Dr. C. Macfie Campbell, Associate Professor of Psychiatry, Johns Hopkins University; Dr. Henry A. Cotton, Superintendent, New Jersey State Hos- pital, Trenton; Mr. E. S. Elwood, Assistant Secretary, State Charities' Aid Asso- ciation, New York; Dr. Arthur P. Herring, Secretary, Maryland Lunacy Commission, Baltimore; Dr. August Hoch, Director, Psychiatric Institute, Ward's Island, New York; Professor E. R. Johnstone, Superintendent, New Jersey Training School, Vineland; Dr. James V. May, Medical member, New York State Hospital Commission, Albany; Dr. William L. Russell, Medical Superintendent, Bloomingdale Hospital, White Plains, New York; Dr. E. E. Southard, Director, Boston Psychopathic Hospital; Dr. Charles E. Thompson, Excutive Officer, Massachusetts State Board of Insanity, Boston ; Professor Howard C. Warren, Department of Psychology, Prince- ton University. A number of hospitals for the insane and institutions for the mentally defective have either donated or loaned photographs and other valu- able material which, without such generous co-operation, it would have been impossible to obtain. Practically the entire work connected with the organization and administration of the Exhibit has fallen upon my colleague, Dr. Thomas W. Salmon. STEWART PATON, M. D., Director of the Exhibit. 3 Contents I. THE INDIVIDUAL II. THE MENTAL HYGIENE MOVEMENT III. THE MENTAL HYGIENE EXHIBIT IV. CHARTS I. THE INDIVIDUAL I. The Individual Is it possible for a human being to know him or herself? What are the sources of physical and mental energy? How can physical and mental activities be measured and what are the means by which they may be directed so as to insure success and happiness and avert disaster and misery? How does prejudice of creed or race develop? Why does an idea become fixed, why do we strive without attainment, fear without cause or why do we attempt to shut out from our vision the world as we see it, like the ostrich which buries its head in the sands of the desert? Upon the answers to these questions may be based hopes for indi- vidual success, for national greatness, and for human progress. The Object of the Mental Hygiene Exhibit The object of the Mental Hygiene Exhibit is two-fold. First, to call attention to some sources of information from which the answers to these questions can be obtained, and, second, to present the imme- diate needs of a campaign directed to attack the most important and difficult series of problems confronting humanity. This plan can be effective in proportion to the sympathy and support of intelligent citizens. Success cannot be attained in a day or generation, but an organized effort may now be made to co-ordinate and direct the forces, which, left unguided by reason, might overthrow the foun- dations of our civilization. Failures in Adjustment Count the number of registered (temporary or permanent), failures in mental adjustment in the United States (Charts XI and XIV). Remember the financial cost of maintaining this host (as shown in Charts XII and XIII) or try to estimate the amount of human misery and despair to which these statistics bear testimony, and then deter- mine whether the importance of these problems can be exaggerated. 9 What is the significance of these statistics, and what are some of the lessons to be drawn from them? It is of great importance to each one of us, to the Nation, and to Humanity that these questions be answered correctly. These figures give us some idea of what an appalling number of people there are unable to adjust themselves to meet the conditions of life owing to a bad heredity, or to an unfavor- able environment created by unnatural social conditions, or to a faulty education. In order to understand the relations of human beings to their environment we must first have some idea of the methods suc- cessfully employed in the study of all living beings. Life a Process of Adjustment Plants like animals are alive, but the life processes in plants are relatively simple. Living beings possess certain activities. Thus the living plant or animal takes in food and converts part of it into energy. That is one form of activity seen in the conversion of potential energy into visible movement. A plant turns its leaves toward the light and in other ways is capable of adjusting itself to its surroundings. Some of the lower forms of animal life have simple activities resembling those of plants, but neither plants nor the lowest animal forms have that special mechanism of adjustment, the nervous system, which char- acterizes the higher forms of animal life. The Mechanism of Adjustment The mechanism of more complex adjustment is the nervous system, and the general plan of its structure, similar for all animals which possess one, is indicated in Charts III, IV, V and VI. The more complex the mechanism of adjustment becomes, the more varied are the potential activities of the animal. The area of the body in which the more complicated adjustments take place is the cortex or outside layer of the brain. Chart VI.) This part of the adult brain contains about 9,000,000,000 more nerve cells than does the same area of the brain of an anthropoid ape. This extraordinary complex arrangement makes it possible for a man successfully to adjust his activities to meet countless situations for which the brain-mechanism of the higher apes is entirely inadequate. 10 The types of activity of which different nervous systems are capable (Chart II) are: ( 1 ) Reflex ; the simplest movements depending on the presence of nervous systems, — such as narrowing of the pupil of the eye when it is exposed to the light; (2) Automatic; more complicated movements unattended by con- scious activity; (3) Volitional; most complicated forms, associated with conscious activity. These three types are intimately dependent on each other. We cannot understand one without knowing something about the others. Volitional activity may, after a great deal of repetition, become auto- matic. The beginner is painfully aware of his efforts to learn to ride a bicycle, while later he may become unconscious of these movements. The Study of Activities Activities may be brought into play by something happening at the present moment — the hand that touches a hot coal is suddenly withdrawn — or by special mechanism due to impressions stamped or engraved on the body by previous experience (memory). This is the basis of the learning process. Certain special mechanisms are handed on from one generation to another, in the form of compound reflex activities called instincts. The desire to live, instinct of self- preservation, and of reproduction (sexual instinct) are examples of such special kinds of activity. When the higher forms of activity are aroused we are generally aware of accompanying feelings such as pleasure or pain. The char- acter and intensity of the feelings vary in individuals, and in the same individual at different times. Some people feel deeply, others are relatively apathetic. Our moods vary; to-day we are gay and to- morrow sad. In health, a certain balance is maintained between activities and feelings, which we call " normal." Readjustments Life is a process of adjustment; of the individual to the environ- ment. Health is a state of mind and body in which the adjustments n are relatively good, while in disease, of which insanity is a special form, they are insufficient or imperfect. A person with an injured leg is an example of one form of dis- turbed adjustment. Nature makes an effort to readjust by forcing the uninjured leg to do extra work, and its muscles increase in size. Again, one person may have learned to play tennis well, or ride a horse easily, almost automatically, while the automatic activities of another attempting to play or ride are so defective that almost every movement is executed clumsily or with difficulty. A satisfactory adjustment can be made only by repeatedly arousing the higher forms of activity, acts of will; that is by consciously practicing until the voluntary movements become automatic. Readjustments in Higher Levels of Activity Attempts at readjustment are constantly being made within the field of the highest activities. An individual, conscious of a mental or physical defect, makes an effort to compensate for it; he tries to make the best of a bad situation; sometimes he attempts to divert attention from his infirmity by boasting; sometimes he tries to hide it by assuming a cynical air. In physical and mental health, the instincts are held sufficiently in check by the intellect and will, but when instincts are unduly re- pressed or ignored harm may result. When the balance among the various activities of the body is disturbed by disease, certain of the instincts may become so dominant as to control both thought and conduct; often mental conflicts arise which lead to serious mental breakdown. Life is a process in which we are constantly being forced to meet new and changing conditions. In health, not only is there, in general, a symmetrical balance maintained, but these activities are continually being readjusted to meet immediate needs. Disorders of Adjustment The difference between sanity and insanity is, in essence, a differ- ence of balance among the activities, a matter of degree, rather than of kind. If an individual's capacity for readjustment on meeting new 12 conditions be not seriously overtaxed an equilibrium may soon be restored, when unusual conditions tend to disturb the balance; but should the altered relationships among the activities transcend the capacity for readjustment then the disturbance may result in those unusual forms of thought, feeling or behavior which are designated as insanity. A false idea may temporarily tyrannize our thought process, disappointment may bring us to the verge of despair; and uncontrolled passion may temporarily hold reason in check, without raising a question as to our sanity. It is only when the idea becomes fixed or despondency is our customary mood, or anger or fear holds sway over all our emotions that we are, in the common acceptance of the term declared to be insane. There is no broad gap between - sanity and insanity. People have naively assumed too great a dis- parity between the mental process of the sane and of the insane. Their crude distinction between conditions which are essentially alike has brought untold misery upon the human race, has deprived thou- sands of hope, driven others to despair, and prevented us from knowing ourselves. The personality of an individual depends upon the adjustment, which he is capable of making and does make, of all his activities (reflex, automatic, volitional). Various inciting agencies, acting at different levels, may disturb these activities. (Chart VII.) There are, however, a great many disorders of adjustment occurring in the higher levels of activity which are not associated with recognizable structural changes in the nervous system. The failure to find changes in the nervous system may be the result of our imperfect methods of study. Many conflicts among the activities seem to occur because the individual has not been properly trained for healthy activity. Bad mental habits, depending often upon faulty mechanisms to begin with, or upon mechanisms made faulty by bad environmental influence, fre- quently undermine the mental and physical life of an individual. These faulty mechanisms result in imperfect adjustments; thus arise seclusiveness, brooding, day-dreaming, sentimentalism, outbursts of temper, experimenting with the sexual instincts, indulgence in fads, etc. Disorders of conduct often make their appearance when an individual has to face some difficult situation in life. In order fully to understand 13 the more complex mental reactions it is frequently necessary to have accurate information in regard to the early development, childhood, influence of the family atmosphere, the general education and social environment, the role of the sexual instinct and the habits of thought and action, of work and of play of the individual. Society's Greatest Problems Can life be made easier, happier and more efficient for the majority of human beings? Is it possible to control some of the causes which lead human beings to the commitment of crime? Can we prevent the unfit from propagating their kind? What measures may be adopted to insure the development of a race whose actions shall be directed more by reason, and less by either weakly sentiment or boisterous passion? May we by taking thought hasten the time when the minds of men will be capable of adjustments which will permit the spirit of humanity and charity to rule instead of envy and malice, vengeance to give way to justice, war to peace, despair to hope? It is to assist in the work of realizing these great objects by work in one important field that the National Committee for Mental Hygiene has been organ- ized. The expectation of ultimately attaining these ideals is a reason- able one, but their final triumph depends upon the degree of intelligent interest and effort that we put forth in the attempt to know ourselves. 14 II. THE MENTAL HYGIENE MOVEMENT II. Outline of the Mental Hygiene Movement A. PREVENTION 1. EUGENICS POSITIVE OR CONSTRUCTIVE Education of the people in the facts of heredity, and cultivation of ideals regarding marriage and parenthood which will extend to the welfare of the next generation. NEGATIVE OR RESTRICTIVE Legislation denying the privilege of parenthood to the manifestly unfit. 2. EDUCATION MEDICAL EDUCATION Increased facilities in medical schools for giving instruc- tion in mental hygiene and psychiatry. Especial provision in medical schools and hospitals for training investigators and teachers in this department of medicine. GENERAL EDUCATION Recognition of the general principle that development of good mental habits and not merely imparting in- formation is the chief aim of education. An educational system that takes cognizance of the fact that all our activities are deeply rooted in and inseparably connected with the practical issues of life. More objective methods of teaching. Especial de- velopment of the capacity for observation (drawing, nature study, etc.). Emphasis upon the importance of the manual arts as a means of developing and maintaining a healthful interest in life. 17 The cultivation of a frank emotional attitude in gen- eral and a frank attitude toward sexual matters in particular. Conferences and lectures on mental hygiene in schools, colleges and universities and general dissemination of knowledge regarding the basis for mental activity and the causes and prevention of mental disorders. Social departments in schools and universities where individuals may be assisted by skilled psychiatrists in dealing with personal problems. 3. SOCIAL SERVICE Assistance in securing adjustment of social and family difficulties as well as in the adaptation of employment to the capacity of individuals in danger of mental disorders. Perfection of present methods and the creation of better opportunities than those existing at present for the study of individuals in relation to their environ- ment. Advice and aid in effecting readjustments to those who have already suffered from mental disorders. 4. GENERAL MEASURES OF PREVENTION Movements for social and industrial betterment, to prevent unequal stress and to give wider opportunities for recreation and for individual improvement. Co-operation between all existing agencies which aim to control forms of illness and injury which may lead eventually to mental disorder (venereal prophylaxis, movements against alcoholism, prevention of infections, regulation of the sale of habit-forming drugs, safe- guarding workmen in dangerous trades, etc.). 18 Efficient and humane methods of examining immi- grants in order that those with mental diseases or de- fects may be excluded. B. TREATMENT 1 . PROVISION FOR EARLIER DIAGNOSIS AND TREAT- MENT Out-patient departments for mental cases in connec- tion with hospitals for mental diseases and general hospitals and independent of either of these agencies. Systematic psychiatric examination of school children. Provision for incipient and emergency cases in psycho- pathic wards of general hospitals. A psychopathic hospital in each of the 50 American cities of more than 100,000 population; such hospitals to be the centers of practical work in prevention and social service as well as for efficient treatment. 2. IMPROVEMENTS IN METHODS OF ADMISSION AND COMMITMENT Transfer of the responsibility for the care of patients pending commitment from overseers of the poor and police officials to physicians. Improvement in the legal steps necessary for admission to hospitals, especially elimination of court measures which often imperil patients' chances for recovery. Extension of the use of the " emergency " and " volun- tary " commitments. 3. STATE SYSTEMS FOR THE PUBLIC CARE OF THE INSANE AND MENTALLY DEFECTIVE Establishment of complete state care and state super- vision of private institutions, under strong central ad- ministration. 19 Elimination of politics from state institutions; all ap- pointments and promotions under strict civil service control. Adoption of a definite policy for caring for trie men- tally defective. Establishment of after-care and social service work under the direction or with the full co-operation of state institutions. 4. INSTITUTIONAL PROVISIONS Sanatoriums for early cases of mental disorders and especially for the psycho-neuroses. Hospitals of moderate size in cities, with facilities for active treatment of acute cases. Colonies in the countiy for more chronic cases where patients may be treated in small groups, under at- tractive and home-like surroundings. 5. SPECIAL FEATURES OF TREATMENT Increased number of physicians in state hospitals and especial provision for training young physicians who enter this work. Encouragement of research in many fields (patho- logical, statistical, clinical, field studies, etc.). Better pay, shorter hours and better housing for nurses. Especial provision for training nurses under efficient and well paid instructors. Especial attention to such measures of treatment as hydrotherapy, occupation, recreation, re-education, etc., under the supervision of trained instructors. Provision for the physical needs of patients by provid- ing care by surgeons, dentists, ophthalmologists, and other specialists. 20 III. THE MENTAL HYGIENE EXHIBIT III. The Mental Hygiene Exhibit The Mental Hygiene Exhibit was prepared by the National Com- mittee for Mental Hygiene for the purpose of directing attention to some of the practical applications of the study of human activities and of mental diseases and defects to problems of preventive medicine, economics and education. THE FIRST SECTION of the exhibit deals with the mechanism of adjustment (the nervous system) — its relation to the various bodily activities — and attention is directed to some of the simpler forms of adjustment. Different types of nervous systems, from the simplest to the most complex, are shown and the levels at which various disorders of adjustment originate or become manifest are indicated. A number of life-histories of patients with different types of those imperfect adjust- ments called insanity, alienation, or mental disease are shown and the section ends with charts illustrating the structural changes in the brain found in some types of mental disorders. As indicated in these charts, there are still other types of mental disorders in which no structural changes in the brain can be observed by available methods. THE SECOND SECTION presents statistical information. Charts, maps and models indicate the number of persons with mental disorders in institutions for the insane and the number of the mentally defective in the various states and also in foreign countries. These sta- tistics do not give an accurate idea of the incidence of mental diseases in different localities, for it is known that, even in those communities in which the most intelligent efforts are made to provide adequately for the insane, many remain uncared for. The number of patients in special institutions is to some extent an index of the status of the care of the insane in a community and roughly measures the incidence of mental impairment or individual failures of adjustment in different localities. There are, of course, many degrees of failure in adaptation to the con- ditions of life which are the result of causes similar to those leading to the graver and more easily recognized conditions requiring treat- 23 ment m special institutions for the insane. In the case of the mentally defective, no state provides adequate institutional care for more than one-tenth of these unfortunate persons. The cost of caring for the insane in institutions, the economic loss through mental disease, the apparent increase in the incidence of mental , disease and also some general statistical information, relating to age, sex, and other facts regarding the insane in institutions are also graphically presented. THE THIRD SECTION deals with some of the controllable causes of mental disease and deficiency, the incidence of which is shown in the preceding section. Figures show that immigration is a very large source of population and suggest the fact that wise and humane measures of excluding the insane and mentally defective immi- grants provide us with a very practical application of eugenics. At- tention is directed to the role played by syphilis and alcohol in the production of mental diseases and the relation between heredity and mental deficiency is also referred to. THE FOURTH SECTION deals with the treatment of those suffering from mental disorders or defects. A copy of Hogarth's drawing of Bedlam, the first institution in England for the care of the insane, marks the spot where the long struggle to ameliorate the con- dition of those suffering from mental diseases began. A copy of Fleury's painting of Philippe Pinel in the Salpetriere assists in per- petuating the name of this great man as one of the chief founders of the present era of hospital treatment and non-restraint. Portraits of Pinel, Benjamin Rush, Dorothea Lynde Dix and Wilhelm Griesinger and brief statements of their share in this great work serve to remind us that what has been accomplished in behalf of the insane has been due to the efforts of men and women who devoted themselves to improving the conditions of life for a group of unfortunate fellow beings. The section relating to the historical retrospect ends with pictures of the early private and public hospitals for the insane in this country including the first State Hospital, a type of institution of which more than 200 exist in the United States to-day. The " story of the insane " is continued by charts showing the conditions existing under asylum care which, in most states, is now happily a 24 matter of history. A series of photographs emphasizes the contrast between asylum care and modern hospital methods of treatment. A number of charts, which have been most carefully collected, bring out important phases of the modern treatment of the insane and mentally defective. Housing of patients and employees in public and private hospitals, farms and grounds, general medical features of treatment, provisions for special classes of patients, the use of hydro- therapy, recreation, diversion and occupation are some of the topics fully illustrated in this part of the section on " treatment." The sec- tion ends with pictures and plans of the psychiatric clinics and psycho- pathic wards and pavilions in general hospitals which break down the last barriers between the care of mental diseases and that of other illnesses. THE FIFTH SECTION deals particularly with the subject of mental deficiency. The incidence of mental deficiency (as in- dicated by the examination of school children and other special groups of population) the causes, evidences and classification of mental de- ficiency, the cost to the community of failure to provide for the mentally defective and the question of the semi-responsibility of the feeble-minded are some of the subjects discussed. THE SIXTH SECTION takes up the subject of prevention of the disorders of adjustment, the nature and treatment of which have been outlined in the preceding sections. The work and plans of the organizations available for work in mental hygiene (the National Committee for Mental Hygiene and the allied State Societies and the Committees for Mental Hygiene) are indicated in a series of charts. 25 IV. CHARTS Selected from the Mental Hygiene Exhibit to illustrate the preceding text. Life is a Process of Adjustment JCealtk is a condition of perfect adjustment; disease a amdilim f imperfect adjustment. Insanity (menial disease') is a Special Svrtrv of Disorder of adjustment. ( f/Jie fBrai/i and nervous sustem firm tkemecfm ism of a^usirrfnt. Diagrammatic Jffihe Individual. Respiration Brain and Nervous System- Organs of ^i£ahs$ vliocomotioii ImperfeAadjustaients or diseases are caused by 1- Inkferetw witktkmecAanim of adjustment (Jbrain and nervous system^ £. InterfkencewitJitkfunct^ Chart Xo. 2 Some Simple Forms of /Idjustment I. Reflex activity contraction of pupil when, exposed, to tiqh£. 2. /Futomatic activity TEore cortiplicodecL move- ments performed wlt/i^ ou£ ccmscioiLS ajciLviiu '. 3. Volitional activity TJIotz cairipLicaiecL J-otttl^s associated with, cotlscuxlls A. Higher forms of activity Dependent upon wilL concepts and judge TTieni , Mechanism of Adjustment Amoeta proteus i fjJreadlg magnified} One of the simplest forms of animal life. ^ 'single living cell; capable of 'responding or 'ita$u$twg wleti cksiurled. A Sem from a6i?ve. B Seen from (Ae side. n- nucleus vac* pulsating vacuole f* food rxwiicizs Mechanism of Adjustment Simple nervous systems (adjusting mechanism; A. Clam B. Snail &neentraii07igfwrve cells wio masses orgaxylaz fy roups of nerve eells) *7ri some ammals iAesefm?&z are scatter- ed ikroiy/iaul i/ie dodt/; ut oilers i/iey are located m eerizix defikife areas. Chart No. 5 nofjam?iia -'nerve cells J- ; 'jze shrt '' [v. 0n ( ':•/? &f ganglia . Chart No. 6 V) .6 CO c ■C u CD Chart No. 7 Levels at which Mental Diseases (PisonJers of Adjustment)^ fliise Schema Types Important Methods of the Levels of of Mental Causal ^ °l-_ Instinctive fsychoneuroses Mwc-dtymsk 'disorckft. Variw forms of Ikpitssion. Paranoic Conditions ?*"• Taultyfrainin ftohKOseAmek.. f or assimilation of VenwtiaPraecox. Instinctive life . not well ' u/utersiood;the following are important cduses- Heredity Certain traits of Character. faultylmining, iotk/rniwivd/htflewtftkMrabufll/i. Gooptmf&a of/^iaaas,fytM$ists{&idm necessary for this extension, JpedalJtpartmerits kScAoolfand uniyensitus to deaf mii ti&epatilons. Clinics, dispensaries, orStcvaus of advice, to af/bnd early assistance. euttivaiwn of a. ffranA £motwml aiiituc/t hgenerafandofakatltf arid open attitude towards sawl matters or particular: aide Social axd 6etucafieniif disorders >!, : 9Lsorairs of^oidglrmd. Syphilitic. Brain Disease. ■ Syphilis. General fFhralysis: Tubercle. Tubercular' Brauidisease. (Pellagra) Crusade against Syphilis. Crusade against 9ii6eraiks'is Chemical /Zleohouc ftyckoses.. JHeoholism. Crusade against JIlcvMism and Drug PsgcAoses. 2)rug Addiction. ®rag dddiction. Jkdmigif4?M%j$axs. TairftyJ^fodurimj Jndustria/ hygiene. yrawxtdic disorders} Injuries. Safe- guarding workmen, traffie regulation, etc. Chart Xo. Structural Changes inMenial Diseases The brainin general paresis-* H modal disease dependent upon, &tfphel£*s. Tin essentially normal brain Brain in general paresis. Chart No. 9 Structural Changes in Mental Diseases microscopic Plwtographs fortiori of cortex of an essentially normal bralw Portion of cortex in general par&sis. Chart Xo. io Structural Changes in Mental Diseases microscopic photograph of small portion of brain 'at st/pkilis. Brain in, arteriosclerosis, showing 'destruction of portion through obstruction of a small artery supply ingf it . Chart Xo. ii Number of Persons with Mental Disease Insane irv Institutions iru th& United States January 1,1910 1&7^M jj. Officers and Mis °kd m/i, ILSJr/ru/ 32,365 Officers and enlisted men, US. Ikvij 50,476 Officers and enlisted men, IIS. Ukrlne Corps t) , o5v lotal 142,695 I Students In Colleges ajwb Universities in the United States 1 Oi , 7 1 Z C. Vvpulaiion of (bhunhis r Ohio, the twenty-ninth city in popu- lation in ikUtutertSkks 181,543 Chart Xo. 12 Cost of Carin6 for the Insane Cost of Panama Canal. number ofaisa/ie i/t instLi-LvtajTzs Uruiual cost oj mainlenance &I7S. OO per capita) SsiuntLi£jcL cosi qj comnlctuicj the ^Panama CciticlL IS7A54 32,804,450 4325,201,000 lunc jar completion, ( 1904- 1914) ^leri years JljinuaL cosi of construction, * 32,520, 100 Chart No. 13 Chart No. 14 The Prevalence of Mental Defectiveness in tlxe United States ThimMer in, G^r special institutions for the mentally dej c eet'Ute £->Z)*\ L/L Thunder in 27 ' t^efornudorles j~,\J*jI Thimber in 17 hospitals fir the insane 1 j^fol Total in 108 Insiltutums 32~,830 Jhwiber'ui communities Cv-ncarecL for) Estimate by 'JkH<er^lwnaicL 166,000 EstimaMM^ 200,000 TMbtoTopidatiaTi 1 in 500 It is seen, tkat only about 10 per cent of all the mentally defective in the United Stales are under suitable inslitudional care . 'The fir disk ftoyal Commission has estimated t/wl but 10 per cent oftkc Tnentally defective in England. are under suitable irtstituiiaruiL care. ... Chart Xo. i Mental Examination of School Children Results of examz7iuiimv ) hy Butei-Sir/io/v tests, of 15 '36 school ehiletren l/v Tie pv Jersey £J£.J~C t G-oete6urct) "71 u me rats trc black type indicate, the mim,6er of ^Tierrmal " and "backward "chiUirerh. fin ttlerdat ez^es' is rmarut the, acje jUierrmriej^ £>t/ the Stszet- SimcrTL testes. c Uie childr&n examined were iatzzn, without selections from, the schools of a city of 5,000 population a/at from rural districts with the same popiitiztlOTV , "Tri£n.iaJL a-ges" C t/e.ccr'^s J? • 1 JLiuoL Hears n m IV V V] W ¥111 s x |n|xn|inr 1 \ 4- i 2 2 3 Brig hi 'Children, 5 5 2 4 8 40 40 \6 4 ( Menial Hge 2 or more years more than physical, age.) 114 6 1 3 29 48 69 9 o i 72or5% Io0 7 1 £ 8 15 114' 50 * 3 197 8 2 2 1 87 86 16 12. 3 209 9 Tl 54 56 : 58 4 2 201 10 3 !5:24!19il24 27 8 2 222. 11 1 4 IS xo 25 50 GO 12 I 166 12 4 \S 42 36 S3 144 \3 14 15 ^pefe TtUnta years aal) ciive" ChiLcLreru J- aye 3 err -mcrre, less -than iciactls 50 or 3.5% 1 5 6 30 19 121 ■ 7 89 1 1 6 5 4 |3 20 6 3 1 Z "Totals 3 6 T7 81 in 337 256 143 326 \55 88 13 1536 Chart JNo. id Alcohol and Mental Diseases JllcoholLc psucfuoses [-me.Tz£aL diseases hjbcwJTV £o be^ caused by alcokoL ) ul- cLiff&afrvess Fraciare, * Insane department" of a county almskoiise Day room in, a modern State J&spttal. Chart No. 29 Asylum Care vs. Hospital Treatment Treatment of excited patients Tlurses Ulastn (abandoned lit use ofrestmbit apparatus Patient \ iu continuous batk of tepid water (often, used corttiruzoizshf jor c&zz/& or LUeekjS^) Chart No. 30 Asylum Cue vs Hospital Treatment How the lon<5 days are spent 1 H ■■ ' MB? 'X Idleness and solitude [a County Hsylum) Occupation andannpanlmship (a State Hospital) Chart Xo. 31 The National Committee for Mental Hygiene 50 UNION SQUARE, NEW YORK CITY President DR. LEWELLYS F. BARKER Vice-Presidents DR. WILLIAM H. WELCH CHARLES W. ELIOT Treasurer OTTO T. BANNARD Director of Special Studies DR. THOMAS W. SALMON Secretary CLIFFORD W. BEERS DR. GEORGE BLUMER, Chairman, Executive Committee PROF. RUSSELL H. CHITTENDEN, Chairman, Finance Committee DR. WILLIAM L. RUSSELL, Chairman, Committee on Survey DR. STEWART PATON, Director of Mental Hygiene Exhibit MEMBERS Mrs. Milo M. Acker, Hornell, N. Y. Jane Addams, Chicago Edwin A. Alderman, Charlottesville, Va. James B. Angell, Ann Arbor, Mich. Dr. Pearce Bailey, New York Dr. Charles P. Bancroft, Concord, N. H. Otto T. Bannard, New York Dr. Lewellys F. Barker, Baltimore Dr. Albert M. Barrett, Ann Arbor, Mich. Dr. Frank Billings, Chicago Surg. -Gen. Rupert Blue, Washington Dr. George Blumer, New Haven Dr. G. Alder Blumer, Providence Russell H. Chittenden, New Haven Dr. L. Pierce Clark, New York Dr. William B. Coley, New York Dr. 0\Ven Copp, Philadelphia Dr. Charles L. Dana, New York Charles W. Eliot, Cambridge Dr. Charles P. Emerson, Indianapolis W. H. P. Faunce, Providence Dr. Henry B. Favill, Chicago Di. Walter E. Fernald, Waveriey, Msss. Catherine S. Felton, San Francisco Irving Fisher, New Haven Matthew C. Fleming, New York Horace Fletcher, New York Homer Folks, New York James, Cardinal Gibbons. Baltimore Arthur T. Hadley, New Haven Henry L. Higginson. Boston Dr. August Hoch, New York Mrs. William James, Cambridge David Starr Jordan, Palo Alto, Cal. Harry Pratt Judson, Chicago John Koren, Boston Julia C. Lathrop, Washington Samuel McCune Lindsay, New York George P. McLean, Simsbury, Conn. Dr. William Mabon, New York Marcus M. Marks, New York Lee Meriwether, St. Louis Mrs. Philip N. Moore, St. Louis Dr. J. Montgomery Mosher, Albany Cyrus Northrop, Minneapolis Dr. Stewart Paton, Princeton Francis G. Peabody, Cambridge Dr. Frederick Peterson, New York Henry Phipps, New York Gifford Pinchot, Washington Florence M. Rhett, New York Jacob A. Rus, New York Dr. William L. Russell, White Plains, N.Y Jacob Gould Schurman, Ithaca Dr. Elmer E. Southard, Boston Dr. M. Allen Starr, New York Anson Phelps Stokes, Jr., New Haven Melville E. Stone, New York Sherman D. Thacher, Nordhoff, Cal. Victor Morris Tyler, New Haven Henry van Dyke, D.D., Princeton Dr. Henry P. Walcott, Cambridge Dr. William H. Welch, Baltimore Benjamin Ide Wheeler, Berkeley. Cal. Dr. Henry Smith Williams, New York Robert A. AYoods, Boston The Chief Objects of the National Committee for Mental Hygiene are: To work for the protection of the mental health of the public: to help raise the standard of care for those threatened with mental disorder or actually ill; to promote the study of m;ntal disorders in all their forms and relations and to disseminate knowledge concerning their causes, treatment and prevention; to obtain from every source reliable data regarding conditions and methods of dealing with mental disorders; to enlist the aid of the Federal Government so far as may seem desirable; to co-ordinate existing agencies and help organize in each State in the Union an allied but independent Society for M;ntal Hygiene, similar to the existing Connecticut Society for Mental Hygiene. Inquiries re^ardin^ the work and requests for pamphlets issued by the organization should be addressed to Clifford W. Beers, Secretary, The National Committee for Mental Hygiene, Room 1914, No. 50 Union Square, New York City, or to Dr. Thomas W. Salmon, Director of Special Studies. COLUMBIA UNIVERSITY This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special ar- rangement with the Librarian in charge. C28'638)M50 PRESS OF THE BRANDOW PRINTING CO. ALBANY, N. Y. ±-mM[JaM~ 201-6503 I Printed In USA 0037548310 Vu<\C Rftr9o \u i<-*t€_