medical office their place of work will be finally exploded and exchanged for having a place of work in the wards in the midst of ward work; and when the autopsy laboratory will be a center mainly for the more highly specialized work.

A recognition of the varieties of medical work required in each hospital shows especially in the better definition of the work in the more chronic divisions. The chronic wards are centers not for less medical work, but for different medical work. The problem of therapeutic employment, as illustrated by the Rochester State Hospital, N. Y., shows clearly one direction of the work; also the growing prominence of the neurological problems in the infirmaries.

The more clearly it is possible to define the varieties and amount of medical work needed in an institution, the more clearly can the demand for enough physicians be put before the authorities governing the purse-strings. The more closely the superintendent brings his trustees into touch with the actual medical workers, the smaller will be the difficulty about getting what the patients and the organization of the work need. The excessive distance between hospital and boards of control cannot be bridged over in any other way.

The Nursing Problem.-The training schools for nurses are growing in number, but the actual results are difficult to size up and the rapid changes in the nursing force (up to over 100 per cent annually in several institutions, and 40-50 per cent on an average) give a picture of the inadequacy of the present conditions.

One of the informants says very justly, "I have found that many other hospitals with training schools would do better work if they abandoned them. A fair attendant is often spoiled by inefficient training. I have a high regard for the graduates of some of the schools, but our region is full of attendants whose chief asset is a diploma and a large hat."

As a matter of fact training in many of our hospitals has reached a fair degree of excellency, especially where some additional training in neighboring general hospitals can be enforced.

The provisional training of the attendants who do not take the full course for trained nursing would nevertheless seem to deserve a more careful study. There are a certain number of

helps which give a newcomer a safer footing, especially if he is given a certain inside knowledge of the mental state of the patients, a realization that the patient's attitude is not a mere product of disease and craziness, but an effort to right himself under his morbid conditions, that it is best to be helpful and not to disturb by reasoning and argument. Another point is some help concerning the handling of states of excitement and violence. Some knowledge in this direction will make the attendant less suspicious and fearful of harm and more likely to learn and less unnecessarily interfering.

In one respect the growing extent to which female nurses are put in charge of hospital wards for men can be looked upon as an index of the tone of care vs. mere supervision. Nearly one-half of the hospitals which reported have adopted the method for admission wards and infirmaries. One informant protests against the use of married couples. There is no record of the management by trained female nurses having been given up again.

The problem of restraint receives answers of varying value. No restraint is claimed in a large number of hospitals. In other places the policy is described as one of judgment, discretion and common sense, not adhering to any arbitrary rule which might work to the detriment of the patient. Accurate figures are given

in but few reports.

The weakest spot is no doubt the lack of work reaching beyond the hospital walls. This is due to a very defective policy of districting of the states and communities. New York to-day is in the lead with real attempts not only of after-care but of prevention through the State Charities Aid Association. Effective work in this line is hardly to be expected before we obtain a policy of small and manageable hospitals and hospital districts not for whole states, but for smaller units of population.

The care of the patients pending commitment and the aftercare, i. e., the attention to the conditions to be handled outside of the hospital walls, probably come closest to a broader interest going beyond mere care-taking and mending. So far very few states have any organized work in this direction; moreover, most states look upon admission to hospitals for the insane as a matter to be decided not by physicians, with a merely occasional appeal to legal authorities, but by judicial authority.

It is suggested that a few of the reports be published in toto, and that the hospitals be encouraged to complete the inquiry for a comprehensive report of the present status of practical psychiatry in this country to be worked out in the course of the coming year.

ADOLF MEYER, Chairman.

NOTE. Unfortunately the reports furnished as examples, together with the original report, were lost by the stenographer of the Denver meeting. Through chance this copy of the report came to light, and is herewith offered to the Association.

MEMORIAL NOTICES.

DR. GEORGE H. KNIGHT.

Connecticut has lost one of its most able citizens. Dr. Geo. H. Knight served the state as Superintendent of the Connecticut School for Imbeciles for twenty-seven years. His tragic death Oct. 4, 1912, on the platform at the close of a political speech, as he was about to be nominated for Congress, cut short an increasingly useful and broadening career.

Dr. Knight was born Nov. 24, 1855, at Lakeville, of very old and noble New England stock. His father, Dr. Henry Knight, a prominent country practitioner, with true pioneer spirit founded and for years maintained at great personal and financial sacrifice the first and only school for imbeciles in Connecticut. Reared in the atmosphere of this charitable undertaking, he passed a useful boyhood at school and on the farm. He entered Yale University in the class of 1887 and remained there two years, when he attended the University Medical College, receiving his degree in medicine in 1880. He at once became Superintendent of the State Institute for Imbeciles at Baribault, Minn. At the death of his father in 1885 he returned to take the superintendency of the Connecticut school.

During his continuous and faithful service of twenty-seven years the institution grew and prospered. Son, like father, gave freely of his money and his energy. An evidence of the appreciation of their unselfish devotion may be found in the fact that the state was willing to appropriate to their uses over $107,000, accepting as a security only a certain lien on the property in case at any time it should be used for other purposes. His life-long and intimate association with these unfortunate defectives eminently fitted him for his duties. Added to this, he possessed a certain instinctive human interest in the individual welfare of "the children," as he was wont to call them. Only one who has the opportunity to watch his life among them can appreciate his