Proceedings of Societies.

AMERICAN MEDICO-PSYCHOLOGICAL

ASSOCIATION.

PROCEEDINGS OF THE SEVENTY-FOURTH ANNUAL MEETING. CHICAGO, ILL., TUESDAY, JUNE 4, 1918.

FIRST SESSION.

The Association convened at 10 a. m. in the red room of the Hotel La Salle, Chicago, Ill., and was called to order by the President, Dr. James V. Anglin, St. John, N. B.

THE PRESIDENT.-We are honored in having with us at this time one who appeals to us, as he has been with the regular United States Naval Training Station, and has already helped the Red Cross greatly by writing a play which has had wonderful vogue; I will ask Chaplain Charles W. Moore to pronounce the invocation.

Rev. Charles W. Moore, of the Great Lakes Naval Training Station, made the opening prayer.

THE PRESIDENT.-There are present with us to bid us welcome several distinguished gentlemen representing the state of Illinois and the city of Chicago as well as the medical profession. I would first call on Mr. W. T. Abbott, who has been delegated by His Excellency, Governor Lowden, to act as his substitute, the Governor being unable to be present.

MR. ABBOTT.-It is with mingled feelings of joy and regret that I bring you Governor Lowden's message. I share with the Governor and yourselves regret that he is unable to greet you in person. The only silver lining to that cloud is that it gives an opportunity to say some things which both his natural modesty and official discretion would forbid from his own lips.

So far as these brief remarks have any point outside of an unstudied and enthusiastic welcoming of your assembly to our city and state, they necessarily take this turn, the relation of the State to your Association. From time out of mind it has been assumed as the duty of every civilized state to care for its insane and feeble-minded. If a man loses a leg or arm he is not totally incapacitated for useful labor. He may even lose one or more of his five senses, yet be a helpful member of society and far from a burden to his family; but let reason desert her throne, then all present hope departs and the future is a wall of blackness, except as you and your fellow-workers set in motion the means to cure, or at least alleviate.

The manifest duty of the state as thus assumed, has in the past been executed with varying degrees of result, from the zenith of ability, honesty and efficiency to the nadir of absolute incompetence and brutality. It is largely due to the untiring efforts of your organization that many abuses of a generation ago exist no more.

There is a natural and inevitable limit to what the executive branch of any government can accomplish. It may take the necessary steps to raise and spend the money required to house and clothe the unfortunate, to provide them with suitable physical surroundings and to undertake the general financial and business administration. The problems of diagnosis, of research, of nursing, the administration of remedial agents of every kind, except physical surroundings, are purely professional, and lie beyond the proper scope of the political agencies of the state as such.

Little wonder, then, that such institutions have been the subject of complaint rather than commendation and have only occasionally been saved from total failure.

When each separate institution stood by itself, when, in Illinois, for example, all methods of housing and care, the purchase of all manner of supplies were scattered among 20 or more unorganized or disorganized heads, and the doctor in charge, besides his professional duties, was expected to participate in, if not absolutely direct, the business system and policy, it was asking too much of the best informed brain and the most enlightened conscience.

This plan of operation crowded to the limit upon the professional heads of our institutions the Biblical injunction: "Be ye therefore wise as serpents and harmless as doves." To be at least harmless in his professional diagnoses and remedial treatments, and in his business capacity, to combat successfully the ingenious wiles and schemes of politicians, contractors and purveyors of supplies, was a task at which the bravest might look askance or pass up utterly.

I need not speak for other states. In the last two years Illinois has laid the foundation for greater progress in the care of her defectives than in all her previous history. The ceaseless and well directed efforts of our Governor resulted, first, in the necessary legislative action, and, second, the administrative steps necessary to bring about a consolidation of the business management of all penal and charitable institutions under one efficient head, responsible only to the chief executive. This accomplishment requires at this time only the briefest mention, as I see it is to be the subject of a special paper. This goes a long way toward the solution of the problem so far as the state in its political capacity can secure improvement. Beyond this point, the attainment of perfection in such institutions in this state or elsewhere is your problem.

It may be true that so long as the appointment and tenure of office for professional heads of institutions is dependent upon the temporary success or set-back of political parties, the best men cannot always be found willing to accept those places. But is the remedy political? It certainly does not lie in a universal extension of civil service. What one of you

would accept such a place, knowing that the discharge of an incompetent, inhuman or personally offensive nurse or subordinate physician must be referred to some board or commission and an over-strained situation await weeks or months for decision.

It is for you to find the door out and to open it. In your researches you may discover that the only way out lies in a greater individual patriotism, a willingness on the part of your ablest men to accept these places, with all their drawbacks of uncertain tenure and at the temporary sacrifice of more adequate financial and professional returns from your private and personally conducted retreats.

I dare not remain long in attendance at your sessions. A mere reading of your program convinces me that I have all the symptoms of dementia praecox, which, to my lay mind, means anticipatory senility, and I am sure that a few hours' indulgence in the actual feast would provide me with more diseases than the youth of a generation ago had after reading Doctor Pierce's well known Yellow Book.

We shall watch your deliberations with honest interest, if not intelligence. That your stay in our midst may be both pleasant and profitable to yourselves, and that from your association here may result the greatest benefit to the helpless and unfortunate wards of our state, I know is the earnest wish of Governor Lowden, in whose name and behalf I have the honor to welcome you. (Applause.)

THE PRESIDENT.—Unfortunately Colonel Billings and Dr. Patrick, whose names appear on the program, are detained by military duty, but we are fortunate in having a substitute-Dr. Charles E. Humiston, President of the Chicago Medical Society.

DR. HUMISTON.-Mr. Chairman, Members of the American MedicoPsychological Association, Ladies and Gentlemen: It is a very pleasant duty to bring to you a word of greeting from the Chicago Medical Society. I am unable to say to you what Dr. Billings might wish to say, and shall not attempt to, but I shall attempt, and I expect to succeed, in a very few words to make you understand that we are glad you chose Chicago to hold this meeting in. As the family doctor is looked to for the cure of ills of physical health, so the profession in general looks to organizations such as yours and to your organization in particular for the solution of the problems to which you have addressed yourselves. Chicago is proud to welcome such distinguished visitors, and whatever we have of a medical nature is at your service, and when you have completed your deliberations I would in particular call your attention to the clinic which has been arranged at the Naval Training Station, and which is conducted by Dr. Hulbert, to which you are all most cordially welcome. (Applause.)

THE PRESIDENT.-Dr. H. Douglas Singer, representing the alienists of this district, and all of the state hospitals for the insane of Illinois, will say a few words to us.

DR. SINGER.-Mr. President and Fellow-Members of this Association: It gives me great pleasure to have the opportunity of welcoming you to

this state. As probably most of you know, Illinois is at the present time developing a new system of administration for its state institutions, concerning which I hope to have the pleasure of saying more to you tomorrow. The fact that this meeting is being held here at this particular time is consequently of the greatest value to this commonwealth. We expect to profit greatly from the deliberations of this body and to learn much which will assist us in planning the future of this new system which we believe will develop very great advantages as compared with that which we have had in the past. The system is still so new, having been in operation less than a year, that it is as yet not possible to make statements as to the results accomplished, but we do know that it is working smoothly.

There is one fact which might cause some hesitation with regard to starting such progressive work at this particular time—the fact that we are now at war. We all feel that perhaps under such circumstances nothing new ought to be undertaken; that, indeed, is one of the questions we have asked ourselves over and over again, but we feel that anything which will add to the efficiency with which the institutions are managed and which will result in economy of personnel and expenditures of various kinds is worth while during the war.

Doubtless many of you, like myself, have had much difficulty in deciding the question as to whether to stay in civil work or to enter the military service of the government. This is a question I should much like to hear discussed at this meeting. The sole consideration we all have in mind is that of doing the greatest service to the United States. At the present moment I personally feel that I am performing work which is essential but it is difficult, in the face of many appeals, to be entirely satisfied with this answer.

The work to which we are especially turning our energies is that of increasing efficiency; no attempt is being made to conduct scientific research in our institutions. I believe that the Department of Public Welfare of this state will receive great assistance from your deliberations and that this body can do a great service to those who remain at home by helping them to grasp the fact that they must be prepared to do more and better work while staying behind.

I wish to express to you a very hearty welcome from the Department of Public Welfare, and to say that the institutions of this state are open to you all and that you will be welcomed in any of them. There are several institutions in and near this city and we shall be glad to have any of you, who care to do so, pay them a visit.

THE PRESIDENT.—I am sure, ladies and gentlemen, that you will sanction my speaking when I say that we are all very grateful to these gentlemen for their hearty words of welcome. I think we have all decided that it was wise not to have altered our place of meeting this year, although some thought it would be best, owing to the restrictions placed on travel. Can we but for a few days become imbued with the spirit that dominates this western city, the meeting of 1918 will be a tremendous success. Again I thank you, gentlemen, on behalf of the Association for your kind words