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WATSON, DR. WILLIAM SETH, Medical Director of Institute for Nervous and Mental

Diseases, at Fishkill-on-Hudson, N. Y., died May 26, 1918, aged 67. WEARNE, RAYMOND G., Assistant Physician at Willard State Hospital at Willard, N. Y.

promoted to Senior Assistant Physician at Brooklyn State Hospital at Brooklyn,

N. Y., September 1, 1918. WEISSMAN, DR. DAVID, appointed Assistant Physician at Kalamazoo State Hospital, at

Kalamazoo, Mich. WEST, DR. C. A., Assistant Physician at State Hospital for the Insane at Columbia,

S. C., resigned March 1, 1918, commissioned First Lieutenant, Medical Corps, U. S.

Army, and sent to Camp Jackson, Jacksonville, Fla. Weston, DR. PAUL G., Pathologist at State Hospital for the Insane, at Warren, Pa.,

was operated upon at the Warren General Hospital, August 26, 1918, and is

reported as recovering. WILLEY, DR. GOrdon F., Assistant Physician at Kalamazoo State Hospital, at Kalamazoo,

Mich. WILL, DR. ELSA B., Medical Interne at St. Elizabeth's Hospital, at Washington, D. C.,

promoted to Junior Assistant Physician, April 1, 1918. WILLEY, DR. GORDON F., Asisstant Physician at Kalamazoo State Hospital, at Kalamazoo,

Mich., commissioned Captain in Medical Corps, U. S. Army, and is on duty at

San Antonio, Texas. WILLIAMS, MAJOR FRANKWOOD E., was one of the speakers at the National Conference

of Social Work, at Kansas City, May 15-32, 1918. WILSON, Dr. John G., appointed Resident Physician at Hillside Sanitorium for Mental

Defectives and Indigents, near Scranton, Pa. YULE, DR. Lorne W., Assistant Physician at Northern Hospital for the Insane, at

Logansport, Ind., resigned.

AMERICAN
JOURNAL OF INSANITY

RECENT AMERICAN CLASSIFICATIONS OF MENTAL

DISEASES.*

By E E. SOUTHARD, M. D. The American Medico-Psychological Association has now adopted a classification of mental diseases which appears in general to be a highly satisfactory classification. This new standard American classification has been drawn up with the interests of district state hospitals largely in mind and is in some respects not suitable to the somewhat broader material confronted by the general practitioners and by the staffs of psychopathic hospitals. It is w.th the interests of general practice and of psychopathic hospital practice that I have been in recent years busy in the matter of early diagnosis. Accordingly, it was with great interest that the classification presented by the highly competent committee of the association was greeted by those of us who had to do with the task of diagnosticating the “incipient, acute and curable" group of mental diseases flowing through the psychopathic hospital wards and out-patient departments. It was with the last two groups (21 and 22 of the American Medico-Psychological Association's classification) that psychopathic hospitals obviously had most to do, namely, with the so-called “undiagnosed psychoses " and the so-called “not insane." Whereas the Association's committee evidently regards the group of “undiagnosed psychoses " as a comparatively small one and specifically states that the not insane" group should receive the occasional cases which, after investigation and observation, give no evidence of having had a psychosis, it is clear that psychopathic hospitals and out-patient departments will always find at least a minority of their cases in one or other of these groups of "undiagnosed

* Presented in Citline at the seventy-fourth annual meeting of the American Medico-Psychological Association, Chicago, June 4-7, 1918.

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psychoses” or “not insane.” It appears likely therefore that future developments in mental hygiene with the establishment of psychopathic hospital facilities attracting great numbers of

incipient, acute and curable cases ” into the psychiatric circle, will require some corresponding developments in the American Medico-Psychological Association's classification. The American Medico-Psychological Association's classification appears in short to be one dealing with the insane in the committable sense and not with psychopaths in the broader sense of modern mental hygiene. The committee terms this last group, namely, the “not insane," a group in which it is determined that no psychosis existed. It is doubtful whether the association committee should use the term psychosis in this narrow sense of a disease suitable for care in hospitals for the insane. It ought to be a task of this continuing committee, at least in the writer's opinion, to arrive at a decision whether the term psychosis should be used as equivalent to medicolegal insanity in the sense of at least potentially committable “ certifiable ") or whether the term psychosis should be used in a broader sense to cover cases of mental disease which are not even potentially committable. In our local Boston Psychopathic Hospital practice, we have fallen into the habit of specifying, in all instances where there can be the slightest doubt, whether we are dealing with,

A, a psychosis, committable,
B, a psychosis, not committable, or

C, a psychopathic condition too ill defined to warrant the term psychosis.

And beyond these psychopaths might be

D, a group of eccentrics or anomalous persons who only concern the psychiatrist remotely, amongst whom might be found, e. g., many of the so-called defective delinquents. Whatever the decision in this matter, it is clear that the vistas of diagnosis opened out by psychopathic hospital practice are far deeper than those of district state hospital practice in its usual sense.

Of course, the practising neurologist, who was in effect all the time a kind of psychiatrist, had always to deal with this penumbra of psychiatric diagnosis, and practical alienists in the medicolegal sense of that term had in point of fact to be the most delicate observers in the world of just these nuances of psychiatry.

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But one should not find so small a fly in the ointment of the new American Medico-Psychological Association's classification, and it would appear to me that in the course of a very few years, especially with the stimulation afforded by the neuropsychiatric problems of the war material, the American Medico-Psychological Association's classification will be whipped into a still more generally applicable shape.

Our own problem in the field of diagnosis of the incipient, acute and curable " group was not so much the nature and conditions of a classification as the method by which one should most speedily and accurately arrive at a diagnosis. It was not so much the nature and number of the entities in question as the processtypes of their diagnosis that formed the new task of the Psychopathic Hospital. Again, let me insist that by calling the task new, I do not mean to say that it is not in one sense a problem as old as the hills, confronting every general practitioner, every consulting neurologist and every specializing medicolegal alienist; but the problem is new in the sense that hardly any institutions in America, except the Psychopathic Ward of the University of Michigan at Ann Arbor, and the Psychopathic Hospital in Boston, had been so equipped as to confront a large mass of material with all modern diagnostic weapons. For, despite the relative accuracy and practical moment of the results attained in institutions like the Bellevue Hospital Psychopathic Ward and the Psychopathic Ward in Cook County, Illinois, it cannot be said that these institutions had been supplied by the local governmental authorities with enough means and large enough staffs to do justice to modern methods.

Again, let me insist that I do not decry the efforts of local governments in establishing such institutions as the Bellevue and Cook County institutions, which in their practical way may accomplish as much as or even more than institutions which are theoretically and scientifically better off. Nor can I think of any means of sharpening psychiatric diagnosis better than a four or six months' course in contact with the mobile and polychromatic material passing through the New York and Chicago institutions mentioned. However, in the interests of mental hygiene it seems that the local governmental authorities should strengthen such institutions as these by enlarging their staffs, greatly developing their laboratories, and immensely extending their social services. The tasks confronted by the four institutions mentioned, two of which have been properly equipped from the scientific point of view and two of which have served their practical turns even better than could have been expected, are tasks of diagnosis that any attempt at classification must take into account.

Stimulated by this problem in mental hygiene, a problem really of the greatest magnitude for almost everybody's future, and stimulated by the progress made by the American MedicoPsychological Association's committee on statistics, I examined recent American text-books of psychiatry with the aim of learning how many entities were considered by competent psychiatrists really to exist. I had blocked out a paper dealing with these classifications, anticipating most interesting divergences of opinion and hoping to learn something from the mutual critique which the various classifications would afford. There had indeed been a certain healthy disputatiousness in recent American psychiatry, or at least an interesting appearance of acrimony, which led one to hope much from a study of these supposed divergences of opinion. In point of fact, I found extraordinarily few genuine divergences. There were, to be sure, divergences of nomenclature and there are many amongst us who hardly distinguish between nomenclature and classification ; but setting on one side nomenclatural questions, the actual and fundamental differences which can be found, e. g., in a comparison of a text-book by Dercum with a text-book by White, are singularly few. I was somewhat disappointed to find so little actual theoretical controversy in American psychiatry. The only sign of healthy competition in hypotheses is to be found in the Freudian discussions which are certainly acrimonious enough, little as they frequently attack the central and underlying problems at stake. But, aside from the small Freudian unpleasantnesses, there is singularly little viable controversy over psychiatric theory in recent American work. Accordingly, I gave over my projected analysis of the supposed divergences in American theoretical psychiatry as shown in the favorite text-books (amongst which may be mentioned DeFursac in Rosanoff's latest modified edition; Dercum; Diefendorf; Knapp in Strümpell's “Practice of Medicine"; ; Peterson in Church and Peterson's Text-book; and White), and

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