The Century of Columbus Part 14

Unfortunately in English the general impression with regard to him is derived from George Eliot's "Romola," and that distinguished English novelist, in spite of her erudition, was least of all fitted by temperament or {186} intellectual training and eminently unfitted because of her religious ideas to write the life of Savonarola and his relation to his time. No one saw the social abuses so well as he and no one called attention to them so effectively. He recognized them as abuses, however, and not in any sense as consequences of the religious system. He would have been the last one in the world to have wished for serious disturbance of the Church. He had for years held high positions in the Dominican order and was in the most complete sympathy with the religious orders and the hierarchy of his time.

One of the greatest of the social workers of this century is undoubtedly Bartolome de Las Casas, who did so much to moderate the abuses in the treatment of the Indians, which had unfortunately crept in under the Spanish sovereignty in the early days. He was the son of Francisco Casas, who had accompanied Columbus on his second voyage and brought back an Indian boy, whom he left to his son as a servant.

Bartolome studied law at Salamanca, secured a high reputation as a lawyer and then became the counsel to the Spanish governors of the Antilles and later of the Island of Hispaniola. After some years of successful legal practice Las Casas became a priest and devoted himself to the alleviation of the condition of the Indians. In becoming a priest his position as a reformer became a.s.sured. Strange as that may seem to some who do not understand the period, he gained almost complete freedom of speech and, having no solicitude for his material needs, could devote all his time and energy untrammelled to his chosen life work. He made mistakes, he was eminently unpractical, but there is no doubt at all about his absolute devotion to the cause of humanity and his untiring activity and zeal in the cause of proper Christian treatment of the Indians. He aroused the attention of the men of his time and, above all, of the sovereigns of Spain and the most influential men and women of that country.

His crusade had much to do with the promulgation of the "New Laws" in 1542 and their amendments in 1543 and 1544. These did not abolish serfdom, but they greatly limited it, so that it was even said that a native enjoyed more privileges than a Creole. He refused the bishopric of Cuzco in Peru {187} declaring that he would never accept any Church dignity, and it was only after much urging that he consented to become bishop of Chiapas in Southern Mexico. His powers of administration did not prove as great as his humanitarian ideals and, while he talked much of abuses, he was not able to correct them as well as many others who did not set out to be so radical as he. He has written much and his books have appeared in many editions. His was a great soul that found a supreme purpose and devoted to it a long life of ninety years.

A less ardent advocate than he would almost surely have failed of accomplis.h.i.+ng the great reform that was needed. Like our own Abolitionists, he was too radical in many of his views, and yet his very enthusiasm carried others along into the execution of great good.

His writings have been a storehouse of information with regard to conditions in the colonies and, while they have to be discounted from the standpoint of his tendency to exaggeration of interest in the Indian questions, that exaggeration is justified to a great extent by the great humanitarian purpose that dictated it. Las Casas must undoubtedly be considered one of the world's great philanthropists.

An important social influence, if the name of social reformer does not quite suit him, was the Duke of Gandia, who is better known as St.

Francis Borgia. He was a great-grandson of Pope Alexander VI, and his grandfather, Juan Borgia, who had acquired the hereditary Duchy of Gandia in the kingdom of Valentia in Spain, was a.s.sa.s.sinated by an unknown hand, possibly that of his brother, Caesar Borgia. On the maternal side the Duke of Gandia was the great-grandson of Ferdinand the Catholic. His grandfather had been the Archbishop of Saragossa. He himself became a brilliant courtier at the Court of Charles V, and in the absence of the Emperor was considered the head of the Imperial household. He and his wife were the favorites of the Empress. After the death of the Empress he was commissioned to convey her remains to Granada and, having to identify them formally there before burial, was shocked on the opening of the coffin at the change which a few days of death had brought in the sovereign whom he had served so zealously. He turned {188} to make his life mean something, not for pa.s.sing honor but for the good of others. In fulfilment of this purpose he joined the Jesuits and eventually became the third General of the order. His change of life attracted wide attention and did almost more than anything else to lessen many selfish tendencies among the n.o.bility of the time due to the pagan spirit of the Renaissance. It was a social reform that made the Borgian name as much of an inspiration for good as it had been for ill.

Perhaps even more important for this period is what may be called the negative side of its social history. Apparently a great many people are quite convinced that the later Middle Ages and the Renaissance were witnesses of many severe cruelties and torturing practices, some of them legal, which reveal, if not an actual barbarity, a sad, almost inhuman, lack of kindliness and fellow-feeling on the part of the men and women of this time. Most people who have heard of cruelties and torture are quite sure that in general these reached their climax of bitterness in the later Middle Ages and that even the Renaissance time was not free from them. In the more recent centuries, particularly the seventeenth, eighteenth and nineteenth, men are supposed to be climbing out of the slough of despond in this matter into which humanity unfortunately had sunk during the mediaeval period. We rather pride ourselves on this evolution of humanity, quite forgetting for the moment how much greater than all the old-time barbarity is the suffering incident to our industrial development. This is, however, set down to inadvertence at most, while mediaeval and Renaissance cruelty is thought of as deliberate.

There are not many impressions more false than this in history, and it is entirely due to the ignorance of the date of a number of historical events which are sometimes ma.s.sed together as mediaeval or at least not modern, modern history being supposed to begin as a rule with the discovery of America. As a matter of fact, the refinements of torture all came after Columbus' Century. The Virgin of Nuremberg, the iron boots into which wedges were driven for torture purposes, the iron gauntlets in which the hands of living {189} people were roasted and many other of the hideous contrivances that rightly find a prominent place in history were made in the later sixteenth and seventeenth centuries, and not in Columbus' time nor during the mediaeval period.

The worst refinements of legal torture nearly all were devised in the course of the witchcraft delusion which swept over Europe in the later sixteenth and during the seventeenth century. There was comparatively little witch baiting and witch hunting and very few witches put to death during the earlier centuries. Witchcraft was a post-Reformation delusion.

The Encyclopedia Britannica (Ninth Edition), in its article on torture, emphasizes particularly the fact that: "It is the boast of the common law of England that it never recognized torture as legal.

Instances of torture as a means of obtaining evidence were invariably ordered by the Crown or Council, or by some tribunal of extraordinary authority such as the Star Chamber, not professing to be bound by the rules of the common law." "The infliction of torture became more common under the Tudor monarchs," this article continues. "Under Henry VIII it appears to have been in frequent use." May I add that its frequency is an incident of the end of his reign after the religious difficulties began. "Only two cases are recorded under Edward VI and eight under Mary. The reign of Elizabeth was its culminating point. In the words of Hallam, 'the rack stood seldom idle in the tower for all the latter part of Elizabeth's reign.' The varieties of torture used at this period are fully described by Lingard, and consisted of the rack, the scavenger's daughter, the iron gauntlets or bilboes, and the cell called 'little ease.' The registers of the council during the Tudor and early Stuart reigns are full of entries as to the use of torture, both for state and for ordinary offences."

Under Elizabeth and the Stuarts, and even later, there were cases fully recognized by the English common law which differed from torture only in name. To quote the Encyclopedia Britannica again:

"The _peine forte et dure_ was a notable example of this. If a prisoner stood mute of malice instead of pleading, he was {190} condemned to the peine, that is, to be stretched upon his back and to have iron laid upon him as much as he could bear, and more, and so to continue, fed upon bad bread and stagnant water through alternate days until he pleaded or died. It was abolished by George III, and George IV enacted that a plea of 'not guilty' should be entered for a prisoner so standing mute. A case of _peine_ occurred as lately as 1726. At times tying the thumbs with whipcords was used instead of the _peine_. This was said to be a common practice at the Old Bailey up to the last century. In trials for witchcraft the legal proceedings often partook of the nature of the torture, as in the throwing of the reputed witch into a pond to see whether she would sink or swim, in drawing her blood, and in thrusting pins into the body to try to find the insensible spot. Confessions, too, appear to have been often extorted by actual torture, and torture of an unusual nature, as the devil was supposed to protect his votaries from the effects of ordinary torture."

The seventeenth century particularly witnessed the deaths of many thousands of poor people who were thought to be witches. Persecutions for witchcraft took place more particularly in the countries most affected by the Reformation. Germany as well as England had many of them. Even the crudest forms of torture were invented with almost devilish ingenuity at this time. It was under the influence of this delusional psychic contagion and the dread of possession by the devil that the insane and sufferers from nervous diseases of all kinds came to be treated more inhumanly than ever before. A climax of inhumanity in their regard was reached in the eighteenth century, when manacles and chains and dungeons were employed, until at last the exaggeration of ill-treatment brought with it reaction and reform.

Humanitarianism shows a decline, marked and definite and progressive from the end of the sixteenth until the end of the eighteenth century.

Interest in religion sank as in England until John Wesley came to put a new spirit into it. The rights of men were less and less respected and the poor were oppressed by those above them until the awful conditions that developed in the _ancien regime_ came in France, and {191} nearly similar conditions in other countries. The French Revolution had to come. Men could stand no more. As Hilaire Belloc, one of the best of the modern historians of the French Revolution, says, "That movement was really an attempt to restore to men the rights which they had enjoyed during the Middle Ages."

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CHAPTER II

HOSPITALS, NURSING AND CARE FOR THE INSANE

An excellent criterion of the social status of any period in history is the genuine humanitarian purpose that animates it, and how seriously it takes the duty of caring for those who most need care is to be found in the character of its hospital buildings and their maintenance. Tried by this standard, Columbus' Century proves to be one of the greatest of the centuries of history. This will seem very surprising to most people, because the general impression has been that until our generation hospitals were rather ugly buildings of inst.i.tutional type, with small windows, sordid surroundings and very unsuitable internal arrangements for the ailing. There is no doubt at all that hospital buildings just before our generation--and some of them unfortunately remain over as living witnesses--were all that has been thus suggested and if possible worse. Indeed, some of the hospital buildings of two generations ago were about as unsuitable for their purpose as could well be imagined. The general feeling with regard to this fact, however, is not so much one of blame as of pity.

Most people a.s.sume that the older generations did not know how to build good hospitals. They did as well as they could, but until the development of modern knowledge of hygiene and sanitation, as well as the demand made on hospital administration by modern surgery, hospitals could scarcely be expected to be anything but the sordid piles of buildings they usually were, thought proper if they but furnished a protection from the weather and sustenance for the sick poor.

Anyone who will consult the real history of hospitals, however, will be surprised to find that the worst hospitals in the world's history were built in the first half of the nineteenth century. The usual impression is that, if the hospitals of a {193} century ago were so bad, those of the century preceding that must have been much worse and so on progressively more unsuitable until in the Middle Ages they must have been unspeakable. As a matter of fact, the hospitals of the thirteenth and fourteenth centuries were beautiful buildings as a rule, quite as charming structures for their purposes as all the other architecture of that time--churches, monasteries, abbeys, castles, town halls and the rest. They had at this time a period of wonderful surgical practice, of which we have learned from the republication of their text-books of surgery only in recent years, and there is a definite, direct ratio between surgery and proper hospital organization. Whenever there is good surgery there are good hospitals, and whenever there are good hospitals, surgery will be found occupying a prominent, progressive place in the history of medicine.

It is hard to understand the periods of decadence in hospital construction and maintenance and in nursing care and training, but not more difficult than to understand the ups and downs of surgery. That anaesthesia and antiseptic practice should obtain for a while and then gradually be lost is no harder to understand than that hospitals should gradually "sink to an almost indescribable level of degradation." Miss Nutting and Miss Dock, in their "History of Nursing," have described the century from 1750 to 1850 as "The Dark Period of Nursing."

They quote Jacobsohn, the well-known German writer about care for the ailing, who says "that it is a remarkable fact that attention to the well-being of the sick, improvements in hospitals and inst.i.tutions generally and to details of nursing care, had a period of complete and lasting stagnation after the middle of the seventeenth century, or from the close of the Thirty Years' War. Neither officials nor physicians took any interest in the elevation of the nursing or in improving the conditions of hospitals. During the first two-thirds of the eighteenth century he proceeds to say nothing was done to bring either construction or nursing to a better state. Solely among the religious orders did nursing remain an interest and some remnants of technique survive. The result was that in this period the general level of nursing fell far below that of earlier {194} periods. The hospitals of cities were like prisons, with bare, undecorated walls and little dark rooms, small windows where no sun could enter, and dismal wards where fifty or one hundred patients were crowded together, deprived of all comforts and even of necessities. In the munic.i.p.al and state inst.i.tutions of this period, the beautiful gardens, roomy halls and springs of water of the old cloister hospital of the Middle Ages were not heard of, still less the comforts of their friendly interiors."

It so happens that just about the beginning of Columbus' Century there was a great new development of hospital building. This was only what might have been expected, for a wonderful new period of architecture was just beginning and buildings of all kinds were being erected with a magnificence that has made them the admiration of the world ever since. Handsome basilicas, Renaissance palaces, town halls were being executed by the architects of the time so as to make them precious monuments for future generations. Hospitals came in for their share of this renewal of architectural interest, and a series of really beautiful hospital buildings were erected which we have come to admire very much since we ourselves have wakened up to the duty of building fine hospitals. The old munic.i.p.alities felt that buildings erected for the poorer citizens must not be planned with the idea that anything was good enough for the poor, but must be suitable to the dignity of the city.

One of the most beautiful hospitals of this time is the famous _Ospedale Santa Maria degli Innocenti,_ which has been called the finest and most interesting foundling asylum in the world. It was built under the patronage of the guild of silk merchants in the early part of the fifteenth century, being completed in 1451, and is a model of charming architecture, decorated with fine paintings and adorned with the well-known della Robbia blue medallions. The Italians did not, however, call it--as in our ruder Northern ways is our custom--a foundling asylum, thus stamping the tragedy of their existence on the children, but the Home of Innocents. Surely they were the innocent victims of the conditions which had brought about their abandonment by their parents. The {195} children were kept until the age of seven, and then they were placed about with families who promised to treat them as their own children. The boys were taught trades; the girls, trained in all domestic occupations, were, when married, given dowries by the hospital or the foster parents, or received into convents if they so wished. As showing how the spirit that organized it in Columbus' Century lives on, we may quote what Miss Nutting and Miss Dock say with regard to the hospital in their "History of Nursing" (p.

243):

[Ill.u.s.tration: BRAMANTE, GREAT COURT OF HOSPITAL (MILAN)]

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"To-day this richly historic house is in charge of the Sisters of St. Vincent de Paul, under the direction of a highly scientific and progressive council chiefly consisting of medical men, and is one of the most perfectly kept and well managed inst.i.tutions of the kind in existence, its union of mediaeval charm with modern science being a congenial and happy one."

Other hospitals in Florence are scarcely less interesting. The hospital where Romola went to nurse her patients is still in existence, but is no longer a hospital. It is now the very interesting Accademia dei Belli Arti. One of the beautiful hospitals erected at this time which may serve as a type of the buildings erected for hospital purposes is the great Ospedale Maggiore of Milan. Important portions of this were finished during Columbus' Century. One of its courts is so beautiful that it has been attributed to Michelangelo, though it seems more probable that it was due to that almost equally great architectural genius, Bramante. The famous Santo Spirito Hospital in the Borgo at Rome was rebuilt by Sixtus IV in the first half of Columbus' Century and had many of the characteristics of the best architecture of the time. Practically every city in Italy did some really fine hospital building at this time. Naples and Venice added to their beautiful mediaeval hospitals and everywhere there was high development of humanitarian purpose in this regard.

Italy, however, was not the only country of Europe to have fine hospitals. Indeed, every country had a share in this, and wherever there was a flouris.h.i.+ng period of architectural evolution hospitals came in for their share of the development. In the Low Countries and Northeastern France, where a series of beautiful cathedrals and churches were being rebuilt or newly erected, and above all where the magnificent town halls that have been such a subject for admiration ever since were being erected, hospitals received great attention. Not only were fine buildings erected, but a magnificent organization of nursing and care for the ailing occurred. There was great prosperity among the people, they were doing the trade of the world, they were democratic in their ideas and they felt that the dignity of the munic.i.p.alities required worthy care for the citizens no matter how poor they might be.

[Ill.u.s.tration: MEMLING, MARTYRDOM OF ST. URSULA (BRUGES. HOSPITAL OF ST. JEAN)]

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Above all, some of our own ideas in hospitals developed among them and many of the wealthy came to realize that they could be better cared for in the efficient hands of trained attendants in properly arranged hospital quarters than in their own homes. There was not that dread of hospitals which develops whenever they are exclusively for the poor--and deservedly, because the patients are inevitably the subject of many abuses.

That picturesque Belgian community, the Beguines, had charge of a number of hospitals at this time which became famous for their thorough organization and maintenance on a high level of efficiency.

One of these was founded at Beaune by Nicolas Rolin, chancellor of the Duke of Burgundy, just about the beginning of Columbus' Century. Miss Nutting and Miss Dock, in their "History of Nursing," have given a description (p. 269) of this, as well as some of the details of the nursing and management mainly taken from Helyot's "History of the Religious Orders":

"It was built with much magnificence, with long wards extending into a chapel, so that the sick could hear the services, and opening into square courts with galleries above and below. Patients of both s.e.xes and of all ranks and degrees were received, both rich and poor.

There was one ward for those most seriously ill, and back of all a building for the dead, with 'many lavatories and stone tables.' In the upper galleries were suites of apartments for wealthy patients, and the gentlefolk came from leagues around. The suites consisted of a bedroom, dressing-room, anteroom and cabinet. They were richly furnished, and each patient had three beds, that he might move from one to another. Each apartment had its own linen, utensils and furniture, 'and borrowed nothing from any other.' The suites and wards were named after the King, royal family, dukes of Burgundy, and other prominent personages. In the middle wards patients of the middle cla.s.s were received, and in the lower galleries the poor. The rich patients had their own food and wine sent to them, and paid for their medicines, but the rooms and the sisters' services were free.

Few, however, left without bestowing a gift. The poor were cared for without any cost, but if they wanted {198} anything special they had to buy it. A little river ran through the court and was carried in ca.n.a.ls past the different departments for drainage. It was noted that the hospital had no bad odors, such as were found in so many others, but was sweet and clean."

The conditions in these hospitals of Columbus' Century were so much better than we have had any idea of until recent historical studies revealed them to us, and so many people have somehow become persuaded that hospitals of the olden time were without proper provision for the care of the sick, such as we have elaborated again in our time, that descriptions of other hospitals seem necessary to make the hospital organization of the time clear. Miss Nutting and Miss Dock declare that "the hospital at Chalons sur Saone was also very magnificent, and there, too, there were no bad odors, but in winter delicate perfumes and in summer baskets of growing plants hung from the ceiling. It had a large garden with a stream running through it with little bridges over it." It is easy to understand what a charming place for convalescents and what a pleasant view for patients could be made out of such surroundings. There is no doubt that they were well taken advantage of, for this is the time of the beautiful Renaissance gardens, when everywhere natural beauty was cultivated to a good purpose.

Helyot, in his _"Les Ordres Monastiques."_ describes the beautiful drug rooms in these hospitals, where the various medicaments were prepared, many of them being grown in the hospital garden, and also the other rooms of the hospital, the quarters for the nursing sisters, and says that "the patients were nursed with all the skill and goodness of heart and refinement that might be expected from the conditions surrounding them." He appreciated very well that proper quarters for patients and nurses make strongly for such nursing conditions as are sure to be of the greatest possible help in the care of diseases.

A special nursing order of Beguines was formed at this time, and as these religious women were recruited as a rule from the better cla.s.ses of the population, bringing in with them such dowries as would enable them to support {199} themselves in whatever work they might undertake, it is easy to understand on what a high plane the nursing must have been. It would remind one of the conditions in the early days of the trained nurse in modern times, when so many of the applicants for nursing positions were prepared by their family life at home for devotion to a liberal profession rather than merely the taking up of an occupation necessary for livelihood.

How their efforts were appreciated by patients will be very well understood from what may still be seen at the hospital of St. Jean at Bruges. The great painter Memling was for a time a patient in the hospital. He felt that he owed his life to the good sisters who had done so much for him, and so he painted a great altar-piece for them and decorated the famous Shrine of St. Ursula. The pictures were painted just about the time that Columbus discovered America. They are among the most beautiful examples of religious painting ever made. The decorations of the shrine particularly are among the world's great works of art. They are almost miniatures and contain large numbers of faces, beautifully executed, but every detail has been worked out by the great painter, evidently as a labor of love. The texture of some of the garments as he reproduces them has proved a source of wonder to artist visitors ever since. Many thousands of visitors find their way to the hospital every year, and even the small sum of money (twenty cents) which is charged for admission to see them const.i.tutes in the annual aggregate an income of thousands of dollars. The hospital, which is very s.p.a.cious and has large gardens with the ca.n.a.l winding alongside of it, is enabled to carry on its work much better as a consequence of this notable addition to its revenues due to the grat.i.tude of a patient of over four hundred years ago.

Many of these hospitals had beautiful decorations. They understood very well at that time that patients' minds must be occupied if they are to be saved from the depressing effect of too much thinking about themselves, and they felt that staring at bare walls was not conducive to diversion of mind. In many of these hospitals then there were beautifully {200} decorated walls and great pictures in the corridors.

As these were painted directly on the wall, as a rule they did not collect dust nor present opportunities for dirt to gather.

Helyot has insisted on the ample water supply that they made it a rule to secure for these old-time hospitals. It was felt that the plentiful use of water was absolutely essential for maintaining healthy conditions in hospital work. In our modern time we have come more and more to realize that, while antiseptics are of great value once infection has taken place and dirt has found an entrance, soap and hot water are the best possible materials, especially when frequently applied, to maintain sanitary conditions.

Many of the habits worn by the religious who were devoted to nursing had certain features that made them much more hygienic for patients than ordinary feminine dress. As a rule, they were very simple, often made of washable materials, the head was always covered and spotless white was worn around the shoulders and at the wrist. This was sufficient of itself to keep constantly in mind the necessity for scrupulous cleanliness. Dirt showed very readily. When the nurses, or at least those who had the main duties to perform, came of refined families and wore these habits there could have been no neglect of cleanliness.

The best possible evidence for the proper appreciation of the place of hospitals in life at this time is to be found in Sir Thomas More's account of the hospitals in Utopia. It must not be forgotten that he was travelling in Flanders when he wrote it. He pictures the people of his ideal republic as possessed of fine large hospital buildings, providing ample accommodations so that even in times of epidemic there need be no danger of contagion and abundantly supplied with all that is necessary for the care of the ailing. The standard was not what was good enough for the ailing poor, but what was worthy of the dignity of the city caring for its citizens. The proof of the completeness of their arrangements for the care of patients is to be found in the added declaration that practically everyone who was sick preferred to go to the hospital rather than to be cared for at home. This is the condition of affairs which is now developing among us again, {201} after a long interval, during which hospitals were the dread of the poor and the detestation of those who had to go to them. The whole pa.s.sage is extremely interesting for this reason:

"But they take more care of their sick than of any others; these are lodged and provided for in public hospitals. They have belonging to every town four hospitals, that are built without their walls and are so large that they may pa.s.s for little towns; by this means, if they had ever such a number of sick persons, they could lodge them conveniently, and at such a distance that such of them as are sick from infectious diseases may be kept so far from the rest that there can be no danger of contagion. The hospitals are furnished and stored with all things that are convenient for the ease and recovery of the sick; and those that are put in them are looked after with such tender and watchful care, and are so constantly attended by their skilful physicians, that as none is sent to them against their will, so there is scarce one in a whole town that, if he should fall ill, would not choose rather to go thither than lie sick at home."

The spirit of the century and its power of organization of charity and good works is well expressed by the foundation of the Brothers of Mercy in Spain, in 1538, by a Portuguese soldier who had been wounded in battle, as was not infrequent in those days, and vowed to devote his life to G.o.d if he recovered. He rented a small house in Granada, where he gathered together a number of sick people and nursed them with the greatest care. In order to support them he went through the streets in the evening with a basket begging for his patients. After a time others came and joined him in his good work. Alms boxes were placed here and there through the city to remind people of the help that was needed. Gradually the scope of their work increased, they were given charge of hospitals, they visited the sick at their homes and the order spread not only over Europe but throughout the Spanish-American countries on this continent. Within a hundred years after the foundation the annual number of patients under their care was said to have been some two hundred thousand. A number of houses of the order was {202} founded in Italy, and over their alms boxes down there the sign was, _Fate bene, fratelli_, (Do good, little brothers).

From this sign they came to be known as the _Fate Bene Fratelli_, the Do Good Little Brothers.

The proper care of the insane is usually looked upon as a very modern phase of humanitarian evolution. Most people think that until the last hundred years the insane have been hideously neglected, when not treated with absolute barbarity, and that the rule has been simply to put them away so that they could not injure themselves or others, confining, manacling, and otherwise hampering their activities, regardless of their health or the mental effect on them. In this once more, as in most of the historical ideas with regard to humanitarian development, the erroneous notions are due to the fact that the care for the insane was at its lowest point during the eighteenth and the early part of the nineteenth century, and that there has been a magnificent improvement since, though it must not be forgotten that there has not been a single generation since when there have not been very serious complaints deservedly uttered of awful neglect of the insane in some part of the civilized world. We have had revelations with regard to the care of the insane in the country districts of even our Eastern States which have been almost incredible. The conditions that we have come to learn as existing in the South in the care of the insane, which have been brought to light by the recent investigation of pellagra, have been of a similar character. The epithet mediaeval which is applied so often to these conditions is absolutely unwarranted by our present knowledge of old-time care of the insane.