Probably about no one subject has there been more absurd conjecture and wild opinion, so little tempered by even partial knowledge of the facts, than that universally interesting subject — the inside workings of the average public insane asylum. There is a morbid fascination more or less developed in us all, concerning the unfortunate people who are mentally disordered. From the actions of some so called civilized persons, one would conclude that "crazy people" were an accursed race, not only to be set apart from society, but always to be carefully shunned and ignored. It often happens that families place their afflicted ones in asylums and never look upon their faces again for years. Such people consider insanity in the family an almost unendurable disgrace; but fortunately there are others whose grief at having a friend or relative so afflicted, wakens the sympathies and produces for the unfortunate insane friends and helpers, and for the asylum, substantial aid and encouragement.

      From five years' careful study and experience in the midst of the violently insane, I feel I can state much regarding their daily doings that will interest the sympathetic, but generally misinformed public. The man with the hobby, the ordinary crank and the disagreeable hypocondriac, are all familiar objects, met in every trade, profession and walk of life. I can tell my readers nothing new about them, for doubtless they have had personal experience with such eccentrics. If all the cranks were confined within the walls of asylums I am afraid that work would stop in every town not owning such an institution.

      That numbers of these people are incarcerated I can prove by many illustrations. I recall one patient whose only peculiarity, apparently, was manifested in the desire to purchase an unlimited number of tooth brushes. This person was promptly locked in an asylum, while the large number of people who have never bought or used this article of the toilet are allowed to go free. In quite as bad taste as the tooth brush mania is that of the alcoholic patients, and, I have seen intelligent, cultivated ladies, with minds perfectly clear on other points, drink hair oil if it were possible to detect the odor of alcohol about it.

      The exterior of the average asylum presents well kept grounds and out-buildings, and an imposing central main building, with solidly built wings. The interior of the central building contains the well furnished apartments of the doctors, the matron and the other officers. There is no suspicion of either poverty or misery here. Every comfort and much luxury is conspicuously present. The dining room has the customary glitter of silver, and there is no evidence of stale bread or thin soup on the doctors' table. Here let me say, that in my experience I have never even heard of a physician in an insane asylum complaining of his food, or growing thin or sick from it, while two-thirds of the patients and many originally robust attendants have been reduced to shadows of their former selves after a few months of this institution diet. A strange fact! as one stereotyped expression in the "set list" of every superintendant's remarks is, "We all have the same food, officers, nurses and patients!" Many and great have been the optical delusions that I have experienced when I have seen hash on the nurses' table and what I could almost have sworn was chicken on the doctors' table.

      The upper wards for quiet patients have the same characteristics in every public asylum, the rickety piano, cheap pictures, a few sofas and large chairs, some plants in an enclosure in the windows, a canary or two belonging to the nurses, and an old bookcase with the mildewed books of past ages. The halls resemble steamboat saloons with bedroom doors opening off like staterooms. These rooms are provided with plain heavy furniture, usually with no looking glass or anything else breakable. The patients sit in their rooms or in the hall, and occupy themselves very nearly as the rest of mankind would do with little that is imperative to be done and plenty of time to do it in; they read, knit, sew and do fancy work, talk, laugh or cry, as their thoughts or surroundings influence them. In private institutions where patients pay well, these wards are richly furnished and the patients' rooms are often fitted up with taste and elegance. Here the ladies observe the usual rules of etiquette in calling upon and entertaining each other, much as if they were in their own homes. Their vagaries are, as a rule, so slight as to be for months imperceptible to those about them.

      To return to the public, or so-called charitable institutions. The ordinary wards, where patients are periodically wild and excitable with, often, long intermissions of apparent lucidity and reason, are simple and even severe, the pictures hang higher, the gas brackets are well out of reach and very strong, and the windows and doors are well protected with bars and gratings. The scarcity of furniture in such places is noticeable. The patients in these wards are more to be pitied than any of the other insane, as, during their rational moments, horror at what they may have done, and dread of what the future may have in store for them, causes mental agony more intense than that experienced at the time of actual excitement.

      But it is in the wards where the acute and raving maniacs are confined that the so-called abuses and mismanagement, the blood curdling scenes and the hair raising shrieks, are supposed to, and occasionally do, occur. Here the insidious disease works its most curious and deplorable mischief. Here human nature in its crude, instinctive ferocity, unhampered by the judgment, caution, cultivation or any of the controlling forces of the well balanced brain, breaks out with all the fierceness of the beast, together with the satanic cunning of the scheming, treacherous and tantalizing human being. There is little furniture and that of the heaviest kind strongly fastened to the floor. Nothing movable is to be found either in the halls or in the rooms. The rooms are small, containing a heavy bed and small corner seat built into the wall. One heavily grated window opens upon the enclosed yard, and a small opening is used for handing in food from the hall when the patient's condition is such that it is not deemed advisable to open the door. Tin plates, or oftener none at all, is the style of service adopted on these occasions. Even with these precautions it is hardly possible to avoid receiving the patient's breakfast in your face before you can successfully close the window in the door. These patients are apt to be playful in this way and will have their joke no matter at who's expense. I recall one instance where my room-mate, whose hair was a beautiful shade of auburn, had deftly utilized a switch of false hair in the coil on top of her head. She hesitated a second too long before one of these small, open windows, when the patient, evidently taking a fancy to the color of the hair, promptly helped herself to a large handful. Hair pins flew in all directions, as she drew the switch in through the window together with a liberal quantity of hair that did not come so easily. The encounter to regain the switch was a marvel of "go-as-you-please" dexterity.

      Getting your hair pulled, your hands bitten and your body generally bruised by kicks and blows, furnish a few of the exciting experiences of asylum life that go to break up the general air of sadness and monotony that otherwise exists. An attendant would be held in high disdain who could not stoically bear these little unpleasantnesses. I am glad to say that in the last few years the straight jacket, muffs, bracelets, straps, etc., have become nearly obsolete. When a patient is violent he is promptly put in solitary confinement until the attack passes off. In my next article I shall relate a few of the peculiar tricks of the insane and the methods employed for controling them.

(To be Continued.)

      One of the marked peculiarity of the insane is that of refusing food. Enter an asylum when you will, in all probability there will be one or more patients who are "not eating." This may be merely the result of dislike for the food, or it may be due to temporary illness, obstinacy, or the fixed suicidal intent. The first causes are easily removed, inasmuch as a sharp attack of hunger will usually bring the patients to terms; while in the case or suicidal intent nothing is left undone to prevent its being carried out. Coaxing, punishment, and every possible influence is brought to bear, almost invariably to no purpose, until at last the stomach pump or injector, is brought into play.

      While it is true that there is much that might be improved in the quality and preparation of the food for insane asylums, it must be remembered that catering for several hundred people is no easy matter. Buying the best of everything is not to be thought of on account of expense, and it is so easy for shop keepers and grocers to work off "job lots" and stale goods in filling asylum orders that the temptation is entirely too strong to be resisted. This is made possible by an understanding with the steward. In this way much is received at the asylum which does not appear upon those books of the steward that he might be asked to show. The quality of the food is not readily detected at all times on account of the hurried manner of preparing and cooking it that is often displayed. Coffee, butter and eggs are always poor. I know of no exception to this rule. Fish is generally stale and meat almost always tough. Pastry is as poor as it is scarce.

      Each day in the week has its regular bill of fare. Thus by spending one week in the asylum you will become familiar with the dietary of the place which you know will not be changed during your stay. This plan has its advantages, for it enables the attendants to provide themselves from a neighboring grocery, against the time when a dinner will not be to their taste. The patients eat what is set before them, or go without. Frequently they insist upon going without. This leads to the most disagreeable and exciting of all performances enacted behind the bolts and bars of an asylum, namely, feeding with the stomach pump. This is a simple and easy operation if the patient is docile, but as he seldom is docile he heaps a world of trouble upon the nurses' heads. It is a hard matter to convince a sane person that he must eat when he has no desire for food; but it is very much harder to convince an insane person, by muscular force that he must have a pint or a quart of beef tea or milk injected into his stomach by means of a funnel and a rubber tube, when he has positively set his mind upon starving. Every particle of rebellion and pugilism in the patient's nature is aroused to action, and it frequently happens that a straight jacket must be put on, and the arms and feet carefully tied before the operation is a success. Even then many patients wriggle about sufficiently to deluge every one about them with the liquid intended for their sustenance. One case that I have in mind is that of a slight woman, weighing not more than eighty pounds, who had not eaten a mouthful of solid food or tasted water, voluntarily, for nearly two years. She would become so violent while being fed that the operation required plenty of time, skill, patience and strength, even after she was securely tied. It was impossible to bend her body to a sitting posture if she desired to offer resistence. To my knowledge, she had not sat down for six months, standing almost motionless, day and night. Occasionally she was locked in a crib bed, which forced her to lie prostrate or to sit in a very cramped position. These beds will be described later as they are important articles of asylum furniture.

      Another hobby of this patient was her strong dislike to being undressed at night. She would dress herself promptly in the morning, but at night it would require the combined strength of two attendants to remove her clothing, which was always more or less torn in the struggle. Skirts were made open from waistband to hem, but she would clinch her fingers on the sleeves, and her grip was simply marvellous. After exhausting their wit and strength for many weeks the attendants hit on a plan for overcoming this peculiarity that worked admirably. The patient was so slight that she could be easily raised from the ground, and by giving her a realistic impression that she was about to be stood upon her head she would without intending to do so immediately loosen her grip upon her sleeves. This experiment did no harm to the patient and was the means of saving the tired attendants many severe back aches. It may interest the reader to know that the last time I visited the asylum where this woman was confined, I saw her sitting in a doorway, looking well and talking rationally, and the attendant told me that her charge was eating her three meals daily. She was a woman of good family and that she was refined was evident, yet in the time she remained under my care, her retirement from the world was never disturbed by calls from either anxious relatives, or sympathetic friends.

      To return to the subject of "feeding." I should state that the old fashioned stomach pump, holding a pint or quart, is used by reversing the manner in which it is usually employed. Drawing the piston filled the barrel with the liquid to be administered, and a wooden plug having been inserted between the patient's teeth, and held there by an attendant, the rubber tube long enough to reach down the aesophagus to the cardiac extremity of the stomach is inserted and attached to the pump, which is then slowly manipulated, and the contents are injected into the stomach. Violent gagging and retching often force out the tube and the wooden plug is the means of breaking the teeth and otherwise injuring the mouth when the patient is violent. These accidents frequently make it necessary to use the nose tube, which is much simpler and more easily managed. A large bottle is filled with milk or beef tea and then fitted with a compression bulb, something like that of an atomizer. To this is attached a long rubber tube about the size of a catheter which is introduced up the nostril, and guided down past the pharynx to the aesophagus. The patient is absolutely helpless to prevent the insertion of the tube, and only rarely can prevent its perfect work, although occasionally one succeeds in coughing it out of the mouth. The operation is unpleasant, but thoroughly effective. I became so expert at feeding by this process that I frequently fed quiet patients in unlighted rooms.

      From sane persons who have experimented upon themselves with this apparatus, I learn, that though the sensation produced by it is not agreeable, it is not at all painful.

      When a very obstinate patient succeeds in throwing the milk from her stomach after it has been injected, it is customary to hold her down upon her back in bed and make a constant pressure on the stomach until digestion is fairly under way. Patients are kept alive for months in this way, with the only results that their misery is protracted, and every one about them is more or less disturbed and distressed; yet we chloroform an animal, or in some other way put an end to its sufferings.

      When the stomach pump has lost its efficacy, and the stomach, completely prostrated by its aggravated retching and straining, becomes too weak to retain the least nourishment, the last resort to prolong life is by the rectal injection of beef tea. In such a case the doctor is merely making a concession to the dictates of humanity as a patient at that stage of exhaustion rarely rallies, yet even on the death bed one will make an effort to reject the nourishment. In many cases I have had patients fall back dead in the height of a feeble attempt to struggle against the administration of medicine or stimulants.

      It does sometimes happen that they linger for days, and even for two or three weeks, on absolutely no nourishment other than that obtained by moistening the lips with brandy, and this after they are apparently "death-struck." The temperature of the body falls slowly hour by hour, although the patient lies on a "water-bed," and everything that skill and humanity can suggest has been done. I have used the term "water-bed," and fearing some lay reader may not be familiar with the appliance, I will describe it. A wooden tank about the size of an ordinary bed, lined with zinc, is covered loosely by a strong rubber sheet. Rubber tubes conduct both hot and cold water into the tank, and when the water is at the proper temperature the patient is laid upon the rubber sheet, the bed being "made up" like any bed for the sick, only omitting the mattrass. A mattrass for a water-bed has been lately invented, I believe, and if it serves its purpose it must be a boon to invalids. It is the one thing needed to make a water-bed complete.

      The duty of preparing the dead for burial devolves usually upon the matron or supervisor or their assistants. Yet it often happens that some attendant will have a particular taste for this work, and it is perhaps unnecessary to state that her services on such occasions are promptly accepted. Before I was nineteen years of age I had stood by many a death-bed and "laid-out" many a corpse, yet I recall one instance where there were five ladies present, all between thirty and forty years old, who had never done either and were almost as helpless as children.

      The utmost secrecy prevails in a ward which death has visited, as a knowledge of the event is apt to create more or less excitement among the patients. Everything is done quietly and methodically. There is no whispering among attendants, no undue haste, nor air of mystery discernable. The body is usually taken to the "dead room on the ground floor, while the patients are assembled in the dining-room at their meals, or after they have retired at night. When one more watchful and inquisitive than the others, asks the whereabouts of the missing patient, she is promptly informed that "she has gone home." The insane are apt to be incredulous, but if repeated inquiry brings no further information, they are forced to be satisfied and the subject in a short time drops from their memory.

      Relatives are usually notified when a patient is dying to enable them to call if they wish. Those living far away are frequently delayed when this occurs, so, if no instructions are received to the contrary, the patient is buried in the hospital burial ground until the body is claimed by friends.

      In my next article I will describe the crib bed, straight jacket, muffs, bracelets and other appliances for restraint which are rapidly disappearing from our best managed institutions.

      It is a well-known fact that standing motionless even for a short time is much more tiresome than long continued walking; therefore the discomfort experienced by the insane patient who thinks that she must stand hour after hour in the same position, will be readily understood. Delicate women, reduced to skin and bones stand motionless, and so rigid that it requires a great effort to move them, even when there is nothing for them to cling to. Frequently the habit of standing produces œdema, or bloating of the legs and body, so to counteract this peculiar mania, a bed, commonly called the "crib," has been devised. It stands on four legs at about the height of an ordinary bed, but is formed like a cage of iron rods, rather near together, set in a heavy wooden framework. The grated top can be raised while the front lets down like the side of a folding trunk. It has a wire mattress, covered with sheets and blankets. When the patient is put on the mattress the side is shut up, the top is let down, and these are fastened together with a spring lock. Patients shut up in these "cribs" seldom walk in their sleep. The "crib" is admirably adapted to old people who are given to falling out of bed, as it is only necessary to have the sides up to keep them in. Its principal use, however, is for violent patients and those who persist in standing constantly. I remember one delicate woman (whose insanity, I was told, was caused by a fall from a carriage during her bridal tour), who would stand motionless all day, swallowing the food put into her mouth, but not speaking a word until bed time; then it took three strong attendants to remove her clothing, convey her to a crib-bed and but her away in it for the night, during which undertaking she would scream "police!" at the top of her voice. That is the only word I heard her speak during the months she was under my care.

      The "straps" and "bracelets" are just what their names indicate. They are made of strong leather, lined with chamois or sheep skin. The strap, or belt, encircles the waist, and is tightly fastened at the back by a patent buckle. The bracelets are fastened around the wrists, and secured to steel links placed at the front of the belt for that purpose. This leaves the hands free but it is very tiresome for the arms. The "muff" is attached in the same manner, though the hands are concealed and secured.

      The muff is used when the patient is constantly picking and tearing at her hands or clothing.

      The straps are frequently used on patients who, though dangerous, are allowed to go about the yard or the halls. The straight jacket is a Garibaldi waist made of canvass, or heavy sail cloth. It is laced in the back with broad, strong strips of cloth, usually bed-ticking. The sleeves are several inches longer than the patient's arms, and are firmly stitched across at the ends so that the hands will not protrude. These sleeves are provided with strips of ticking, to tie them in the back. In front, from about the middle of this waist to the belt, is stitched outside a wide strip of canvass, so that in putting the jacket on a violent patient it is first laced in the back, and tied with a great number of hard knots. Next, the sleeves are drawn through the strip of canvass in front, thereby folding the arms, and the strings are tightly tied together in the back and frequently turned around the arms above the elbows, then drawn back again, tied firmly, and the ends interwoven with the other lacings. You will hardly believe it, but it daily happens that a patient will free herself from all these knots in a very few moments. How she does it can not always be understood, even by one who watches the performance. A patient will wriggle and twist, squirm and turn, pull and tug, until the strings are sufficiently loosened to extricate one arm. The rest is easily accomplished. Some patients can be got into a straight jacket as easily as into their shoes and stockings, while others make it a matter of scientific pugillism and dexterity to lace them into the detested garment.

      Many insane people are terribly destructive, tearing in pieces everything they can get their hands on, and their clothing is made accordingly. For this class of patients we have what is called the "Institution dress." This garment also is made of canvass, and is cut like the old "Gabrielle" dress. In some cases it has closed sleeves, in others, open sleeves. These dresses sometimes serve their purpose well, but often they are as soon In my next article I shall give a description of the routine of stripped into ribbons as if they were the flimsiest muslin. I recall one patient whose entrance into my ward was distinguished by the manner in which she bit a piece out of the heavy glass tumbler in which her first drink of water was served. She was, to all appearances, quiet, and asked for a drink of water. When she had finished drinking she promptly began on the tumbler, but after the first mouthful, her appetite for that sort of dainty was not gratified and her mouth was cleared of broken glass by means of a swab. Later she developed extraordinary destructive talents. She would quietly sit down by a heavy mattress with her hands tied, and would then patiently and systematically gnaw her way along its edges, pulling out the contents with her teeth and scattering them over the floor. I have seen this woman dressed in only an Institution dress, hands and feet carefully tied, fastened in a stationary chair with a sheet twisted around her shoulders and neck and tied at the back of the chair to keep her head up; yet she would, by quick movements of the knees, so loosen her feet as to be able to toss her dress up and catch it between her teeth, then, getting another portion of it between her knees, she would throw her head back and tear strip after strip from that heavy canvass in an incredibly short time.

      I shall refer again to this patient when I come to speak of the class known as "filthy patients. The habits of this class have never, to my knowledge, been written about to any extent, and while there is much in the subject that may unpleasantly affect the sensitive reader, I think the discussion of it is necessary in this series of articles in a medical paper.

      Frequently patients are so destructive that it is useless to provide covering of any kind; such patients are therefore left naked in warm rooms until their destructive attack passes away. Again, the straight jacket is the only successful way of preventing patients with a mania for suicide from accomplishing their purpose during the night. The night watch only visits each ward once every hour, so that she is of little use in preventing suicide. A special attendant in the patient's room might sleep too soundly, and, as many suicidal patients are quite capable of choking themselves with their hands, or with the bed clothes, there is always considerable risk in this expedient; but with a jacket firmly tied, and its condition carefully noted each hour by the night watch, there is little danger of a catastrophe.

      In all my experience, and I had many extreme cases, I was fortunate in having no such disagreeable episode as the suicide of one of my charges, although on several occasions it was necessary to do some lively work to save the life of a person determined to strangle herself. I shall never forget an instance of this kind. My room-mate was attacked by a particularly ugly patient, and as I rushed to her assistance, another patient who saw the opportunity, as she said, for squaring an old account with me, promptly intercepted me and detained me by a most persuasive grip upon my back hair. During the "scrimmage" that followed a desperate suicidal patient, who had previously been walking the floor and wailing, "Oh! that some hungry man would come and eat me," saw her chance and tearing a strip from her dress, quickly wound it around her neck, and pulled with all her might. I saw her face getting black, her eyes bulging, and her tongue beginning to protrude, and breaking away from my antagonist, — and a large lock of my hair at the same time, — I rushed to the would-be suicide. Before I reached her, however, an old woman whom we all called "Auntie," had calmly walked across the floor and was unwinding the cloth from her neck, muttering to herself as she did so, "I've a good mind to let you die, you poor thing! You've wanted to long enough." It will be enough to say in conclusion, that all of us survived this little excitement, though it was a very close rub for the suicidal patient.

      Another class for whom the jackets are a necessity, and among whom it is in constant use is that of the masturbators.

      These patients will be briefly spoken of at another time, as the number of young people of both sexes confined within asylum walls from the direct effects of this terrible evil, must act as a warning to parents in the care and instruction of their children.

      In my next article I shall give a description of the routine of ward work, including the episode of bathing day, and shall tell how we maneuver to avoid struggles with violent maniacs. It is quite important to preserve the health and strength of both nurses and patients under the abnormal strain produced by forcible control. Where a struggle is unavoidable it is gone through with all the vim required to insure victory, but in many instances a little skillful planning and diplomacy will obviate any muscle and nerve destroying exercise, and make smooth and easy what might otherwise prove a rough and tumble struggle.

      In theory, the daily routine of ward work in the asylum is usually divided between the two attendants in charge, one doing the sweeping, cleaning and bed-making, while the other attends to the dining-room work. In reality the patients do this work while the nurses superintend their efforts. This may be considered wrong by some, but if they will only think what a blessing the employment is to these mentally afflicted people, they will cease to regard the exchange as unreasonable. Assorting clothing for the laundry is usually done by both nurses, as one must write the list while the other calls out the number and kind of garments to be sent. The laundry building is usually separate from the main building, and has its regular overseer and assistants. Bathing patients is a labor also shared between the two nurses, as in many excited wards it is impossible for one to do the amount of hard work necessary to the success of this imperative duty. Patients whose naturally neat habits have not become altered by insanity are given every opportunity for a clean bath, and are allowed to take it by themselves if they are to be trusted. Here are some of the tricks which an attendant must constantly watch for: putting on soiled clothing after the bath; putting on no clothing at all; getting into the tub without removing the clothing; concealing the sponge, soap and towels about the clothing, etc. It will, therefore, be seen that the patient must be watched even though her modesty rebels. The majority of the patients can make no claim to neatness, hence it is frequently necessary to both disrobe and wash them by force. An average lively patient will splash two-thirds of the water out of the tub in less time than it takes to write about it. Then comes the trouble of getting her out, readjusting the faucet taps (which are always removed in these wards), refilling the tub and going through the entire performance again. Much horror has been expressed by the outside world at the bathing of several persons without a change of water. It does sound barbarous, yet I am positive, that if many of these persons who are ready to denounce the practice were called upon to perform the duty, they would be well content to stand behind the most convenient fence and manipulate a hose rather than act out their philanthropic and Christian theories regarding clean tubs, clean water and clean towels. "These patients are human beings!" you say were human beings, you mean. They are now grovelling in and eating of the filth of their own bodies and drinking the dirty suds from their own bathing water. They are watched over, cared for and restricted in their brutishness by human beings; their cunning and malicious tricks and manners, their vile habits and fiendish maneuvers have, in many instances, ruined forever the health and intellects of deserving persons whom unavoidable circumstances force to earn a livelihood as nurses and attendants. Where is the public sympathy for them? An occasional attendant, usually a man, hired without regard to his mental fitness, gives way to ungovernable temper at the ugliness or idiocy of an exasperating patient, and beats or otherwise injures him. Then attendants as a class are subject to the censure of the outside world.

      "Combing a hundred heads of hair with one comb!" It may not sound well, but do you think these patients regard each other's hair with suspicion? On the contrary, they have an absolute fondness for it; for not only do they allow their individual combs to be used upon the general hair, but on every possible occasion they weave their fingers into it, for reasons best known to and enjoyed by themselves. Cutting the nails is a much dreaded but exceedingly important part of the bathing day duty. Not but that many are cut more frequently, still it is a part of the regular bathing operation. It is a duty that an attendant rarely forgets — experience has taught her better. There are few personal adornments more objectionable to the feminine taste than the unmistakable mark of four sharp, poisonous finger-nails down the side of the face, worn for weeks at a time. The shrieks and groans from an excited ward during the nail-cutting performance would certainly give the inexperienced ear the impression that about seventeen "Jack the Rippers" were putting in their deadliest work. The most dangerous patient I ever saw was a young Irish woman about twenty-six years old. She was tall and straight, a handsome woman with jet black hair and eyes. Her mother told me that at one time she sang in a Catholic Church, but was thrown from a carriage and her head hurt on the sidewalk. It was absolutely useless to try to inpress this woman with the fear of anything. She was too crazy to know fear. There was nothing movable in her room, which was only opened for necessary cleaning and on bathing day. Her bath was always left until the last. Each patient in the hall was securely locked in her room and every door and window fastened. The bath was made ready, and soap and faucet taps removed — clean cloths were substituted for towels. Her necessary clothing was laid out for her, and then the attendants retired to their rooms to prepare for the fray. Aprons were removed and the hair twisted into a tight knot and covered with a towel. Then one attendant would place her keys in the door leading into the hall, in order to close it quickly should her room mate succeed in unlocking the patient's door and getting back without being attacked. If this was managed successfully they would wait until the patient saw fit to go into the bathroom. She would run bellowing around the hall, trying the doors and windows, jumping for the gas fixtures and looking everywhere for mischief. She would frequently go into the bathroom and just as an attendant started cautiously to lock her in, would bounce out again. When she at last ventured into the tub one attendant would slip quietly out in her stocking feet and lock the door on her. After that her room was cleaned and aired, and the same ruse was tried to get her back.

      In my first experience with this patient I had succeeded in reaching the bathroom door, with my key in hand for prompt action, when the lady silently but energetically appeared in the doorway to meet me. My room mate came immediately to my assistance.

      "Take a bath, Mary!" I said mildly.

      "Take one yourself!" she suggested with so forcible an argument that I took it. I did not intend to, — but "nothing ever happens but the unexpected." It took several of us to give Mary her bath, but she did take it immediately after mine and we did not change the water, either.

      The only way to manage this patient without injury to any one was by "sheeting her," as they call it — twisting a sheet, towel or other large cloth over her head, so as to shut off for a few seconds her sight and extraordinary biting ability. In that brief interval she could be rushed into her room with comparative ease. This expedient was in no way dangerous or cruel, and its efficiency can best be expressed by the remark she once made while enveloped in the folds of a large towel.

      "Mary," she was asked, "what makes you so quiet?"

      "Shure, ye little knows the power o' the hat I've got on!" was her prompt reply.

      This woman, like many others afflicted with general paresis, seemed totally unconscious of bodily pain. But the lack of power in her sensory nerves was amply overbalanced by the unusual activity of the motor nerves.

      It will be seen by the cases described, that the care of the insane presents extraordinary facilities for the wear and tear of muscle and nerve tissue; besides, consider the actual amount of work to be done, and the time and attention to be given to the exacting duties. There is work enough in any asylum to keep double the number of nurses and assistants employed, yet through a false idea of economy these duties are loaded upon a few and often totally inefficient shoulders. A person needs a peculiar ability to act efficiently and acceptably as a nurse for the insane, but as comparatively few have this fitness or ability, it will readily be seen that those who are unfit for their positions are the first to become irritable, and discharge their duties unsatisfactorily. Weak muscles give way before the strain of physical encounter, and poor women having no other resources struggle on year after year to their own ultimate disaster and the continual annoyance of those about them.

      Steady nerves, strong muscles and a cool head, are the most important requisites in the "make up" of an attendant, but how long is it to be expected that a woman possessing these requirements will keep them, if tied down to the dismal drudgery of asylum life, with but an occasional hour's recreation or a week's vacation yearly? Two-thirds of the insane asylums are situated at a distance from town, so that on an afternoon or evening off the attendant is forced to choose between a solitary walk on the grounds, or the sameness of her room, where, as likely as not, she will be called upon to assist in several unexpected encounters before her afternoon is over. There is absolutely no freedom or rest inside the building, and outside there is always a feeling of responsibility and anxiety on the mind of the truly efficient attendant. When a nurse is too ill to walk she will crawl about and try to help, rather than have the entire weight of a heavy day's work fall on her room-mate's shoulders. Relief attendants are scarce, and it is often as much trouble to direct a new attendant during a day's illness as it is to do the work yourself.

      There should be three attendants on every ward, constantly, and those who have demonstrated their fitness and worth should be allowed, or even obliged, to take more recreation and rest than is customary. A tired woman is as irritable and peevish as a hungry man, and neither would govern a ward of crack-brained individuals very successfully.

      The unreasonableness of superintendents is proverbial. In walking through the wards they will invariably fail to see or mention the ninety and nine things that are done satisfactorily, but will, as invariably, notice and find fault with the one thing left undone by the tired attendant. For instance, a patient will persist in gathering the odds and ends of every thing and putting them in her bed. Probably you have remade that bed ten or twelve times during the forenoon. You cannot lock the room door and keep her out because the superintendent wishes the door kept open. You cannot tie her hands because he will not allow it. You cannot stand and hold her for fear the other fifty or seventy-five patients will promptly proceed to tear their beds to pieces, and yet if the superintendent chances to see that bed in disorder there is no amount of explanation or excuse that will save you from reprimand.

      If nurses should determine upon carrying out a superintendent's instructions to the letter, there would be some strange proceedings in the wards. On general principles it may be advisable to absolutely follow the directions of employers, but men who give foolish and unreasonable instructions are always first to deny them when the results prove disastrous.

      Neglect of patients will in almost every instance be the result of over work and ill health on the part of the attendant, while abuse is the consequence of unstrung nerves, and of unhappy temperaments. In one asylum only, have I seen deliberate abuse. The attendants there were chosen from a class of women who were good housekeepers, and equally proficient at wood chopping, milking cows, riding bare-back and farming; girls who know nothing of sickness, and less of refinement. There, I have frequently seen violent patients knocked down and dragged by the hair, suffocated under pillows, and their wrists twisted until they succumbed from sheer bodily pain. I am not sorry to say that the superintendent who over-looked these peculiarities of government under his roof has now gone to his reward. He was a good farmer, and a careful financier, but his sudden death several years ago must have been a great relief to many invalids under his care.

      In most hospitals the mark of a bruise on a patient's body will bring forth a prompt investigation, and woe to the attendant who cannot reasonably explain its appearance. This carefulness on the part of officers renders the actual abuse of patients almost impossible.

      To strike a blow is an inexcusable offence and very justly so, as it is entirely unnecessary under any circumstances. There are always more or less patients on a ward who are called "Reporters," as they make it their business to inform the officers and visitors of every occurrence in their ward. It is almost impossible to keep anything from their prying eyes. Naturally there will be little done among the attendants in the way of abuse toward patients, if they value their positions. The story of an insane woman is, in nine cases out of ten, accepted when it involves the unfortunate attendant, but I have never seen an instance where it was accepted by the Trustees or Medical Staff when it might incriminate a brother officer.