y. This procedure seemed to be a part of
the established code of dishonor. The attendants imagined that the best
way to gain control of a patient was to cow him from the first. In
fact, these fellows--nearly all of them ignorant and untrained--seemed
to believe that "violent cases" could not be handled in any other way.
One attendant, on the very day he had been discharged for choking a
patient into an insensibility so profound that it had been necessary to
call a physician to restore him, said to me, "They are getting pretty
damned strict these days, discharging a man simply for _choking_ a
patient." This illustrates the attitude of many attendants. On the
other hand, that the discharged employe soon secured a position in a
similar institution not twenty miles distant illustrates the attitude
of some hospital managements.

I recall the advent of a new attendant--a young man studying to become
a physician. At first he seemed inclined to treat patients kindly, but
he soon fell into brutal ways. His change of heart was due partly to
the brutalizing environment, but more directly to the attitude of the
three hardened attendants who mistook his consideration for cowardice
and taunted him for it. Just to prove his mettle he began to assault
patients, and one day knocked me down simply for refusing to stop my
prattle at his command. That the environment in some institutions is
brutalizing, was strikingly shown in the testimony of an attendant at a
public investigation in Kentucky, who said, "When I came here, if
anyone had told me I would be guilty of striking patients I would have
called him crazy himself, but now I take delight in punching hell out
of them."

I found also that an unnecessary and continued lack of out-door
exercise tended to multiply deeds of violence. Patients were supposed
to be taken for a walk at least once a day, and twice, when the weather
permitted. Yet those in the violent ward (and it is they who most need
the exercise) usually got out of doors only when the attendants saw fit
to take them. For weeks a ward-mate--a man sane enough to enjoy
freedom, had he had a home to go to--kept a record of the number of our
walks. It showed that we averaged not more than one or two a week for a
period of two months. This, too, in the face of many pleasant days,
which made the close confinement doubly irksome. The lazy fellows on
whose leisure we waited preferred to remain in the ward, playing cards,
smoking, an