IN 1871 there was no State hospital for the insane, in the world, under Homoeopathic management. To-day there are five. In that years there was no Homoeopathic member of the National Society of Asylum Superintendents; to-day there are six. In that year decided action was taken by that Association, which makes it almost a starting point in the newer methods of instruction in psychiatry. As none of the members of the Institute were then members of the Association, it seems to me desirable that its action and the subsequent changes in teaching should be brought to the attention of the Institute, for information and for directing our course in the future.
It was in 1871, then, that the Association of Medical Superintendents of American Institutions for the Insane passed the following resolutions:.
Resolved, That in view of the frequency of mental disorders among people of all classes, and in recognition of the fact that the first care of nearly all these cases devolves upon physicians engaged in general practice, and this at a period when sound views of the disease and judicious modes of treatment are especially important, it is the unanimous opinion of this Association that in every school conferring medical degrees, there should be delivered, by competent professors, a complete course of lectures on insanity and on medical jurisprudence, as connected with disorders of the mind.
Resolved, That these lectures should be delivered before all the students attending these schools, and that no one should be allowed to graduate without us through and examination on these subjects as on the other branches taught in the schools.
Resolved, That in connection with these lectures, whenever practicable, there should be clinical instruction, so arranged that, while giving the student practical illustrations of the different forms of insanity and the effects of treatment, it should in no way be detrimental to the patients.
This action of the Association has recently been quoted and endorsed by the New York State Commission in Lunacy, in a circular to the managers of hospitals, dated December 10, 1892.
In order, therefore, to ascertain as definitely as possible what had been done in the direction of these resolutions, I addressed a circular in January to the dean of each of the 144 medical colleges of the United States and Canada. Fearing that not all would respond, and hoping for additional information from another direction, I also sent a similar circular to each one of the superintendents of state hospitals for the insane and certain other members of the Association, one hundred and seventy in number. Most of the superintendents responded quickly and fully, and this information was added to that from the deans and secretaries of the faculties. Few sent no report, and fifty sent answer that they did not teach in any college.
O the other hand, the responses from the colleges were unsatisfactory as to number, and they could have been of little value if taken alone and without the information given by the superintendents. As it is, we shall observe what is done for teaching psychiatry in the United States and Canada in sixty-one colleges. Of the other eighty-three, it seems fair to suppose that most of them do nothing in this particular direction, and, therefore have nothing to report. (A list of the sixty-one colleges is appended.).
In all of the sixty-one colleges, with one exception for this year only, psychiatry is taught either by alienists or specialists. The apparent growth, in twenty-two years, has been from eight to sixty, for eight is the number reporting definitely that this subject was taught in 1871. The next interesting fact is that thirty-four of the sixty-one colleges have obtained the service of superintendents of hospitals for the insane as teachers, while two have obtained assistant physicians of hospitals; and twenty-four have filled the chairs with specialists, the latter class including many grades of fitness for their duties.
Our next inquiry will be whether students are examined in psychiatry as a requisite for graduation, the second of the resolutions. Of the sixty-one colleges, twenty have no examination in this branch; six are unknown; in five, the students are examined, but not by the lecturer; and in thirty the lecturer examines in his own specialty. The conclusion is, therefore, that in fifty-seven per cent. of the colleges where psychiatry is taught an examination is required.
The last of the three resolutions refers to clinical teaching. In forty-two of the sixty-one colleges, clinics are held; in fifteen there are none; and from four there was no answer to this question. That shows a majority, or sixty-seven per cent. in favor of illustrating the lectures on insanity by cases of insanity. Further, it seems fair to infer that the remaining thirty-three per cent. would be gland to furnish clinical material if circumstances allowed; and it is interesting to note that not one of the officials, replying for the college where clinical teaching has been tried, has referred to it in any way out with satisfaction and commendation.
If any one will look over the map of our country and see the location of our colleges and hospitals for the insane, he will be surprised that no more colleges have already made use of the enormous amount of material at their doors. He would be convinced that a large majority of the colleges could teach psychiatry as readily and as graphically as surgery if they only used their advantages and arranged with the state hospitals and their superintendents for lectures and clinics.
How this could be done is well shown at the Middletown State Homoeopathic Hospital, whose superintendent, Dr. Selden H. Talcott, is also professor of mental disease in the New York Homoeopathic Medical College. He delivers a course of lectures at the college, and, in addition, on one or two days he invites the whole senior class to spend a day at the hospital, sixty-six miles from New York. There they go through the whole hospital, become acquainted with its construction and the arrangement of the wards, and, under suitable circumstances, have selected cases presented to them. In addition to this general invitation, there may be further visits by sections of the class at other times.
The same method of teachings is practiced at the Boston University School of Medicine. Dr. N. Emmons Paine gives five lectures on the anatomy and physiology of the brain and nervous system, reviewing the work of an early portion of the course, and also gives five lectures on insanity at the college. Further, the students visit Westborough Insane Hospital, thirty-two miles from Boston, in a body, five times during the autumn for the fortnightly clinics, which alternate with the lectures at the college.
The superintendent of the hospital, Dr. George S. Adams, presents a variety of cases to them, as well as a large number. Perhaps, in one day, they will have brought before them ten or twenty cases of mania, and on another occasion as many persons with melancholia; so that, without any special study the students learn to diagnose readily and accurately the various forms of insanity, and, is better than all, this years. They hear, also, a large number of commitments read and criticized, and they become skilled in writing them by actual practice, with patients before them as models.
The trip to Westborough seems to be regarded with favor by the students, although not obligatory upon them, for the attendance is quite as full as at the lectures, and members of other classes accept the privilege of joining the seniors in these excursions, when their duties will permit. The only difficulty has been the cost, which must be added to the ordinary expenses of student life, but the railroad assists us by reducing its rate to one dollar for the round trip. A lady friend had given the beginning of a fund, the interest of which is used for defraying these travelling expenses, and which is hoped may become large enough eventually to remove this one and only drawback.
Another fact must not be overlooked, that aside from the ordinary forms of insanity with which they become familiar, the students may have introduced to them some of the rare and curious forms of disease. A hospital, with five hundred or a thousand insane, will probably have examples of myxoedema, cerebral syphilis, epilepsy of the Jacksonian type, locomotor ataxia, chronic alcoholism and multiple sclerosis; so that their clinical advantages are not limited solely to insanity.
Another State hospital to furnish an alienist as lecturer in a Homoeopathic college is the one at Fergus Falls, Minnesota. Dr. Alonzo P. Williamson, who recently resigned the superintendency, has been lecturing in the College of Homoeopathic Medicine and Surgery at Minneapolis, and has furnished some clinical cases at the college, but not at the hospital, as that is too far away.
In Michigan, Dr. Oscar R. Long, superintendent of the Michigan Asylum for Dangerous and Criminal Insane, lectures in the Homoeopathic Medical College at Ann Arbor, and he, too, cannot take his classes to the asylum, as the distance is more than a hundred miles in a straight line from the college.
