of acquiring an ordinary school education. Of this group only twenty-five per cent, were Canadians, thirty-three per cent. were foreign born, and the remainder children of recently arrived immigrants. In one clinic alone, in a short time, 107 girls and twenty-four boys of the most defective and degenerate types, brought by one child-immigration society, have come before my notice. Nearly all the girls were persistently immoral, the majority unmarried mothers, many earning a living on the street; altogether they constituted a serious menace to the health and happiness of the community. It is said, of course, that they had been residents of the country for some time before they went astray; the reply is, that a careful inspection before sending them and a rigid sorting at the port of arrival would have weeded them out. To carry on the latter inspection is most difficult, but the point is that it should not be necessary.

THE POSITION OF PSYCHIATRY IN CANADA.

That research should have fallen by the wayside is not to be wondered at, and that psychiatry as a subject should for many years have occupied only a subordinate position in the medical curricula of the universities was inevitable. The relations between general medicine and psychiatry have been anything but intimate, and as a rule provincial governmental control of institutions resulted in a lowering of standards.

We passed through the various stages which marked the trail of the self-educated psychiatrist all the world over, and only too often adopted the numerous classifications which emanated from the fertile imaginations of those exploiting them. It was not unusual to find an enthusiast who had a new classification for every case he met indeed history is now repeating itself along these lines-and a panacea for mental disease was discovered a dozen times a year. On the other hand, it must be admitted that medical education ignored psychiatry to a great extent, and provided little or no instruction for the student. To read some of the modern writers qn vocational training and industrial pursuits in hospitals for the insane one could almost believe that these things were recent discoveries, and yet in October, 1862, Dr. Jarvis, of Dorchester, Mass., read a remarkable article before the Association of Medical Superintendents of American Institutions for

the Insane, entitled Mechanical and other Employments for Patients in the British Lunatic Asylums, in which he showed conclusively that in many of the British asylums occupational therapy (as it is now grandiloquently styled) was developed in a thorough manner. It proved that the experiment was carried on in Britain about 1840, or even earlier, and was continued with increasing confidence for many years.

PSYCHIATRIC EXPERIENCE IN TORONTO.

After the failure of our psychiatric hospital scheme in Toronto, we felt that it would be well to fight for ideals outside of a public service, to scan psychiatry from a new point of view, to lay the foundation for the broader teaching of students, and to educate public opinion along better lines. We established a psychiatric outdoor clinic at the Toronto General Hospital, and interested every social agency in the cityjuvenile court, public health, immigration and police departments, social service agencies of all kinds, school physicians and nurses, industrial homes and schools, etc. In a short time we had the whole city working for us, and the clinic has become a powerful factor in the control of juvenile criminality and prostitution, as well as the education of the public to the modern attitude of medicine towards the prevention of evils which have been so manifest and yet difficult to deal with heretofore.

It was felt wise to interest the department of psychology in the University of Toronto in the problem of mental defect. Psychology was ranked as a subdepartment of philosophy, and it did not seem possible to emancipate it from philosophy and physics. Eventually the tide turned and we succeeded in getting not only the co-operation of the psychologists, but their hearty backing, and a great deal of the measuring of intelligence of certain groups of children is being done by them in our clinic. Psychology is coming into its own, and while the wave of excitement, caused by the discovery that psychology has a part to take outside of abstruse speculation, has carried the hyper-enthusiasts too far, yet the well-balanced group, who always save such a situation, realize the true rôle of psychology in the future. No matter how much some psychiatrists may resent the claims of certain psychologists to divine inspiration along special lines of mental investigation, it must

be remembered that psychiatry itself has a good many sins and failures to answer for. Even with all the aid given by pathological and clinical investigation, as well as research, can we truthfully assert that psychiatry has kept pace with general medicine as a whole?

The fact that some criticism of psychology and the enthusiasms of psychologists is indulged in does not mean that the importance of psychology is not recognized; on the contrary, it is believed that every psychiatrist should be thoroughly grounded in psychology and psychological methods. Now that psychology has been placed on a footing which makes it rank as a valuable contributor in the study of mental action and behaviour, its claims to recognition cannot be denied, and we should make use of everything it has to offer.

PSYCHIATRY AND THE WAR.

We had our outbursts of enthusiasm in certain circles over psycho-analysis, Freudian theories, and sex problems ad nauseam, but it was when war broke out the neo-psychiatrists, neuro-psychiatrists, and psychological healers of all kinds found themselves. Shell-shock was their particular fad, and as each performer recited his recoveries, quite oblivious of the truth that the other fellows who employed totally opposite methods of treatment had also 100 per cent. of recoveries, the public stood in amazement at the miracles being performed, and wondered what psychiatry had been doing during all the centuries it had existed. Of course, there were some poseurs, but many of the young men were self-deluded, and, confounding cause with effect, really believed that they could set the whole world straight in a few weeks. Even yet the truth has not yet dawned on a moiety of perfectly honest observers.

Conscription in Canada bore heavily on groups of mental defectives and mildly insane young men who had found their niche in simple farm work or occupations of a routine nature, and the change resulting from the removal to a new environment requiring more mental agility than they possessed resulted in disaster after disaster. But possibly the most valuable fact gleaned from the experience was the discovery that there are many mentally diseased and handicapped persons capable of becoming useful hewers of wood and drawers of

water in communities, where, in the past, many were too regularly institutionalized. It means a further linking up of psychology and psychiatry and the using of men trained along psychological lines was applied to vocation and industrial fitness. We have recognized this side in our mental hygiene experiences, and have used with advantage a well-trained official. in connection with the development of this part of the work.

NARROWING TENDENCY OF INSTITUTIONAL WORK.

Emancipation from asylum life soon makes it plain that the institution physician is living in a contracted sphere, because after all his medical association is largely with terminal cases; he sees nothing of the evolution of mental disease, particularly in childhood, and is out of touch to a great extent with general medicine. Heads of institutions are necessarily occupied to a great extent with administrative duties, and taking the world as a whole, staffs of the great majority of asylums are so small that research and study cannot be carried on in the best way possible.

The public is really looking for the guidance we have denied it, and when in the past psychiatry has vouchsafed to respond to the request for further light, it has covered its message with a mass of scientific verbiage that no one without the pale could understand. In other words, the aloofness of psychiatrists shut up within the walls of custodial institutions has simply added to the popular misconception of mental disease and given a mysterious tinge to something that should be much better understood by the man on the street. It is only by following such lines as this the amateur dispensers of auto-suggestion and so-called psycho-analysis of similar type can be kept within bounds.

THE MENTAL HYGIENE MOVEMENT.

When one thinks of the mass of magnificent work done clinically by those who have had time to study the brilliant pathological findings by such investigators as Mott, it is a matter of wonder that so little has been accomplished in the way of actual cure. We must frankly confess that the progress made is not what might have been expected. Experience proves that we have neglected the first principles of preventive medicine, that the road to success lies in the direction of early prevention of mental disease.

It is recognized by the people, when the facts are placed before them, that many methods of the past are simply the outcome of a hopeless and pessimistic attitude that accepts the curse of mental disease as an inevitable and incurable disaster, not far removed from the realm of criminality. Governments not only look to mental hygiene committees for advice, but depend on them to outline and direct many public enterprises. It is true that while the better care of the insane was the motive of the work of Clifford W. Beers, who developed the original Mental Hygiene Committee in the United States, it has been found that this is only a small part of the work to be done. Psychiatrists must no longer be mere custodians of people overtaken by a dire calamity, but aggressive leaders ready to show their mettle in a great cause.

More good has been done by the mental hygiene movement in Canada in five years in the way of improving the care of the insane, the study of defectives, the education of the public opinion to a realization of the importance of these problems, than was accomplished in half a dozen decades preceding that period. Take, for example, an analysis of 3,442 cases under sixteen, met with in our clinic, and we learn that no less than eight per cent. could be definitely classed as suffering from mental disease or psychopathic inferiority.

If we are honest we must confess that psychiatry is merely at alpha in its book of knowledge, and that although brilliant work has been done in pathology and clinical investigation an increased recovery rate can scarcely justify us in saying that we have solved or even guessed at the causes of mental disease or indicate just how the law of prevention is to be applied.

DEMENTIA PRECOX.

Take the scrap-heap called dementia precox. Experience during recent years leads one to believe that careful investigation carried on in schools, psychiatric clinics, and juvenile courts, will demonstrate the fact that the victims of the psychosis may nearly always be detected at any early age. It is most important to learn how much prevention can do to steer the patients clear of the tragedy ordinarily awaiting them. At all events it is apparent that biochemical problems, studies in metabolism, in fact a whole series of laboratory investigations along the most advanced lines, are required.