desiderata
which are universally conceded to be most necessary for the
improvement of present conditions in our management of mental
diseases, were anticipated by the generations of the thirteenth to the
fifteenth centuries. It is not hard, for instance, to show that such
eminently desirable conditions as the {367} open door for mild cases,
the combination of the ordinary hospital with a ward for psychic
cases, the colony system for the treatment of those of lower
mentality, were all in existence in the Middle Ages and did good work.
The colony system particularly, as it comes to us from the Middle
Ages, has recently been studied very carefully, and this has given us
many valuable hints as to the methods that will have to be adopted in
other countries in modern times.

The conditions which developed at Gheel in Belgium have deservedly
attracted much attention in recent times, and have been the subject of
articles in the medical journals of nearly every country in the world,
because of the poignant realization by our generation that large
institutions, meaning by this large single buildings or closely
associated groups of buildings, are very unfavorable for the care of
the insane. In America, one of these articles was published in the
Journal of Nervous and Mental Diseases, and a second, written by my
friend, Dr. Jelliffe, who is the Professor of Mental Diseases in
Fordham University School of Medicine, was written after a special
visit paid to Gheel by him, in order to investigate conditions there.
Though the situation at Gheel now is practically identical with that
which originated there at least five centuries ago, there are many who
consider that similar conditions would be ideal for the treatment of
certain classes of the insane even in our own day. It is this sort of
interpretation of the work of these old-time philanthropists and
physicians that we need, and not the cheap condemnation which makes it
necessary for us to begin all over again in each generation.

In the light of this unexpected revelation and the {368} consequent
revolution of thought it suggests, a short review of the treatment of
the insane will not be out of place. It is usual for our
self-complacent generation to consider that it was not until our own
time that rational measures for the care of the insane were taken.
Most of the text-books on mental diseases that touch at all on the
historical aspects of the treatment question, are apt to say