I have been asked to talk about two things to-night,--our library
at McLean Hospital in Waverley, Massachusetts, and my idea for
organization among the state hospitals of the different states. By
dint of considerable money, much thought and labor and an unlimited
amount of interest and coöperation with the librarian on the part of
superintendent and trustees, we have been able to build up at the
McLean Hospital something which approaches pretty near our ideal of
what a library in a hospital for the insane should be. But in regard to
the second subject I feel a little diffident, since there are several
among you who have actually organized the institution libraries of
your different states and combined them under one head, while I have
only dreamed about it. Still, the dream and the vision must always be
forerunners of accomplishment, and you also must have dreamed before
you were able to build.
At McLean Hospital we have two libraries,--one for the use of the
patients, which was started in 1835 with 160 volumes and now numbers
over 7,000, and a medical library organized in 1887 and containing
over 5,000 volumes. The two are kept entirely distinct with separate
accession-book, catalog, classification and finances. The medical
library comprises a fairly good department in general medicine and a
very fine one in chemistry; but of course, its principal features are
books and periodicals in psychology and psychiatry. We take 85 medical
and chemical journals, most of them German, and the care of these
periodicals alone is no slight task for the librarian. I will just
say incidentally that, unable to find any classification for medical
books which seemed at all adequate to our needs we have evolved one
for ourselves, using the decimal idea in numbering. It is a thoroughly
satisfactory scheme for us and we hope some time to print it for the
benefit of the medical libraries in other hospitals for the insane.
Although our general library for the patients has been in existence
for seventy-five years and more, for the first six decades it was
conducted in a rather desultory manner, as indeed, most libraries were
at that time. It was not till 1895 that any attempt at classification
and cataloging was made, and not until 1904 was a trained librarian
installed and the whole department put on a business basis. The
expenditure of the annual appropriation was at that time put into the
librarian's hands with directions to build up the library at her own
discretion, subject, of course, to the approval of the superintendent
and trustees. That the business basis is the only successful one, these
figures show:--in 1904, after seventy years, the library numbered only
4,000 volumes, with few new books but a large assortment of old sermons
and evangelical biography, and its circulation was about 5,000. During
the eight years of the new regime, more than 3,000 volumes have been
added and the circulation has increased to over 8,500.
During its seventy-five years of service our library has exemplified
at least four important things:--first, as has been shown, that
one cannot get such good results from the old desultory method of
having a few books on the wards looked after by nurses, or even in a
central library run by a stenographer in her spare moments, as from
an organized, central library with a trained librarian at its head.
Second, that although the business basis is the only successful one,
the administration of it should be as simple and free from "red tape"
as possible. The nearer a hospital librarian can keep her library to
the idea of the private library and the more friendly and personal
relations she can establish with the patients the more good she can
accomplish. The third point I would make is that unless they are very
ill and destructive, books are treated as carefully by the insane as
by the users of the public libraries. Last year, out of 8,686 volumes
taken out by patients and nurses, only 9 were lost or destroyed, and
of these only two were charged to patients. It is the proud boast of
one of our head nurses who has under him the next to the most violent
and destructive ward on the men's side, that he has had out for his
patients over 450 volumes in the last two years, and has not lost or
had mutilated one single book!
The fourth and most important lesson we have learned is that the
value of a well-selected library can hardly be over-estimated as a
therapeutic agent. I do not mean by this that a cure can be effected
simply by reading the right books; that of course is absurd. But it
is a fact recognized by all psychiatrists and at the basis of the
treatment of the insane in all hospitals today, that whatever takes
a patient's mind off himself and his own troubles and directs his
thoughts into other and more wholesome channels, contributes to his
recovery. And when amusement pall, handicrafts tire and golf and
tennis are too strenuous, books and pictures will almost always help.
It is for this reason that we have to be so careful of the kind of
reading, especially of fiction, which we put into the hands of our
patients. They must be wholesome stories; anything dealing with suicide
or insanity is strictly tabu; also stories which are morbid or would
be apt to arouse a morbid train of thought. With these exceptions
the insane want and should have the same books which you and I read.
Moreover, and I wish I could say this loudly and emphatically enough to
be heard over the whole country, the insane are not imbeciles and they
are not children, and they resent it when they are treated as such just
as much as you or I would. If the old ladies like to reread the stories
they loved when they were young, so do old ladies everywhere, but they
do not want kindergarten stories. And they are as interested in what is
going on in the world and in keeping up with the times as anyone.
About once a week I go to Boston, look over the new books, select the
ones I like the looks of and have them sent out "on approval." Every
book of fiction is read by me, or if it is distinctly a man's book,
by someone of the staff in whose literary judgment I can rely. The
books which are kept are then classified and cataloged and either sent
directly to some patient or ward where I know they will be appreciated,
or else placed on the "new book shelves." Neither staff nor nurses
are allowed to have the new books until the patients have read them.
The patients come over four evenings a week to the library, the men
Mondays and Fridays and the women Wednesdays and Saturdays. Our library
consists of two large and very beautiful rooms with open shelves and
open fires. Some of the patients roam about and browse among the
books, others sit at the tables and look at pictures and magazines,
while still others join the ladies of the house who generally sit in
the front library in the evening with their fancy-work and the fire.
Sometimes we play cards with them.
Besides these four evenings, certain patients are sometimes allowed
to come over in the daytime, and the nurses come in at any time of
day to get books for some particular patient or for their ward. These
"traveling libraries" on the wards are our most successful means of
reaching those patients who are too feeble, or too ill, or who lack
the initiative to come to the library and select their own books, but
who will often get interested in a book which lies on the sitting-room
table of their ward.
I am often asked what kind of books aside from fiction the patients
call for. I suppose books with pictures would rank first, for patients
who are too ill to read will often look at these by the hour. These
picture-books comprise art books, of which we have a very fine
collection bought and added to each year with money from a bequest to
the hospital; Black's travel books; Country Life in America, etc. Next
come the nature and out-of-door books; then literature, especially
Longfellow, Whittier and Tennyson. History is seldom called for by the
patients,--sociology and economics never; yet our nurses, especially
our Canadian nurses who want to know about conditions in the States,
frequently ask for these, and we have books on all these subjects; for,
though our hospital motto is "Patients first," we find that whatever
increases the intelligence of the nurses increases their efficiency,
and we are glad to have them avail themselves of every opportunity for
reading and study.
Frankly humorous books I have learned never to give to a depressed
patient, and Miss Carey tells me she has had the same experience. If
a patient is much depressed he seems to resent being cheered up if
he knows it, and we all have realized in ourselves that unless we
are in the mood for it there is nothing in the world so dreary as an
avowedly funny story. Neither is there any call for collections like
the "International library of famous literature," and the "Library of
American literature," and in this matter too, Miss Carey agrees with
me. Short stories also are at a discount here. The patients want novels
which shall grip and hold their attention in spite of themselves. We
all know that the complete librarian is supposed to have an extra sense
of intuition, and I think I unconsciously say to myself in selecting
books for the patients, "If I felt the way that patient looks as if he
felt, what kind of books would I want?" Sometimes, though, one makes
mistakes. For instance,--we have one patient, a dear old lady, somewhat
prim, a little austere, a typical New England aristocrat of the old
school, with whom one immediately associates "Cranford" and "Oldfield"
and Mrs. de la Pasture. But this dear lady wants detective stories,
if you please, and the more gruesome and bloodier they are the more
she revels in them. In her estimation, "The Marathon mystery" and "The
Boule cabinet" and "The Mystery of the yellow room" totally eclipse
"Down our street" and "Queed" any day.
But while short stories are seldom called for, the "short story in
long dresses" and bound by itself, is very popular with patients who
are physically weak and unable to hold large volumes or to read very
long at a time. I always keep a collection of these little books
in a special bookrack so I can lay my hands on them at any moment.
They comprise such titles as "Pigs is pigs," "The good Samaritan,"
"Philosophy Four," "Stickeen," "The perfect tribute," "Songs from
Vagabondia," "The friendly craft," etc. Then I have other racks on
tables and window shelves which I keep filled with different books,
changing them often. And I find that shifting the books on the shelves
every little while brings into prominence some which have heretofore
been overlooked. In short, I try to keep something new in the library
all the time, even if only a new plant or arrangement of flowers, for
the patients in a hospital of this sort are very dependent on outside
agencies for diversion and interest, and their attention must be caught
and held by some means or other.
So much for the reality: now for the dream.
Because the library in our hospital has been such a success, because
it has so thoroughly proved its therapeutic value, I dream of the time
when one as efficient shall be in every hospital in the country. The
fact that ours is a private hospital means that we are not helped by
the state; it also means that most of our patients, but by no means
all, are on a paying basis; it most emphatically does not mean that
we have the monopoly of the educated class. While it is true that
there are many illiterates in the state hospitals, it is also true
that there are in them thousands of men and women as well educated, as
refined, as great lovers of books as those in our private hospital.
For the majority, it is the question of money, not of education, which
determines a patient's place in the state or the private institution.
If our people value our library so highly, what must be their
deprivation when because of lack of funds they have to go to state
institutions where there are no books and periodicals or at best only a
few old ones, never changed and seldom added to.
The state says it cannot afford to appropriate for each of its
hospitals and asylums an annual sum sufficient to build up such a
library as ours and maintain so many trained librarians, and the state
is justified. But I have dreamed of a coöperation by means of which
there shall be in every state one trained librarian who shall organize
into a library what books there already are in each institution,
advise and train in library methods those in charge, and buy from an
annual appropriation such as the state can afford, new books which
shall be sent from one hospital to another in the form of traveling
libraries, and after they have gone the round be divided up among the
individual institutions,--thus slowly building up each library. This
organizer should be in the employ either of the State Board of Insanity
(or its equivalent) or else of the State Library Commission. It would
seem that the former would be more satisfactory and less complicated,
as the state institutions already are under their control, but in
some states the library commission seems to have have been entirely
successful in co-operating with the state board. One thing seems
certain, that unless the state board and the hospital superintendents
can be interested in the scheme little can be done; while with their
interest and coöperation success is insured.
That this dream is practical has been proved in Iowa, Minnesota,
Nebraska and a few other states. In New York, most of the state
hospitals seem to have fairly good libraries, and the one at
Middletown, N. Y., ranks very nearly with McLean in the number of
volumes, and seems to be carried on very efficiently. In Trenton, N.
J., there is a state hospital which has a memorial library with a good
annual appropriation and which adds about one hundred and fifty books a
year. I have with me the figures of the hospital libraries in nineteen
states, if anyone cares to see them.
In my dream I see equal library advantages to every state hospital in
the country, and I hear from them all the words they will say to you
who are able to realize these dreams,--words our patients at McLean
have said to us over and over again,--"You don't know what this library
has meant to me!" This is an opportunity for intimate helpfulness and
real, practical usefulness which I hope everyone of you will try to
introduce into his state.
In the discussion that followed, Miss Jones said the McLean Hospital
library had an appropriation of about $300 a year for books alone for
the patients, but thought that a state hospital library could get on
nicely with less. Miss Templeton gave an account of state institutional
work in Nebraska where the policy has been to get library work in these
institutions under the control of the state library commission.
Mr. Dudgeon said that a list of simple industrial books had been
prepared with much care for the prisoners in the Wisconsin state
prison. Also that the chaplain helped in recommending reading for the
prisoners, those who expected to get out being especially anxious to
keep up with events and not be Rip Van Winkles when released.
Miss Carey, of Minnesota, said their state commission has made special
efforts to know what the libraries of the institutions were doing, how
many readers they had, and how many books they circulate. She said this
familiarized the institutions with the commission and so the officers
were glad to put the burden off on the commission. She thought it was
impossible to do anything until the officers of the institutions were
on your side; that this must be worked for until secured.
After discussion the session adjourned.