THE AMERICAN 677 LOUIS MEDICAL SOCIET LIENARY JOURNAL OF INSANITY PUBLISHED UNDER THE AUSPICES OF THE AMERICAN MEDICO-PSYCHOLOGICAL ASSOCIATION "The care of the human mind is the most noble branch of medicine."-GROTIUS BALTIMORE THE JOHNS HOPKINS PRESS 1919-1920 XXMMYLIMDARYM UNIVERSITY CALIFORN DAVIS AMERICAN JOURNAL OF INSANITY AN ADMINISTRATIVE IDEAL IN PUBLIC WELFARE WORK.* BY OWEN COPP, M. D., Physician-in-Chief and Administrator, Pennsylvania Hospital, Department for Mental and Nervous Diseases. The ideal is probably never fully realized. It may, however, set a definite goal whose persistent quest might be worth while. It may embody some prerequisites of worthy achievement. At least it may possess elements of suggestion. ELEMENTS OF INDIVIDUAL EFFICIENCY. Every great enterprise bears the impress of some dominant personality, a Lincoln in moral issues, a Pasteur in science, a Webster in statesmanship, a Rockefeller in big business. The man of brains and proved efficiency is always sought by captains of industry to initiate and direct an undertaking. They cull from the technical schools and universities capable graduates to train in every detail of constructive process and management. The trained man has become the basic factor in the evolution of successful business. He holds an individual place, a definite sphere of duty, an open field for self-expression and accomplishment, which are the only criteria of his capacity and worth. Nothing from without is imposed by experimentalist. Growth proceeds from within as of a living organism in harmony with natural laws discerned, interpreted and applied by the intelligence acquired through training and experience. Big business is the expression of such individuality and growth. The man tried out by such a method is valued by his chief. No ordinary inducement can separate them. Both recognize that stability and continuity of wise planning and right effort are essential to highest attainment. * Read at the seventy-fifth annual meeting of The American MedicoPsychological Association, Philadelphia, Pa., June 18-20, 1919. A SYSTEM OF ADMINISTRATION, however perfect in theory, which fails to attract such men, to develop them under such conditions and retain them in stable service, lacks the primary requisite of high achievement. Furthermore, no individual nor local unit of administration long remains in isolation. Both are multiple or become multiple and operate in combination varied and innumerable. But no combination or system ever rises above the standard and quality of its individual components. Hence the inter- and extra-relationships of the individuals and local units constituting a system of administration must be governed by the same principles as promote individual development and efficiency. THESE PRINCIPLES OF ADMINISTRATION and their requirements may be stated briefly as follows: r. Each local unit, institution or department should be a complete mechanism of administration in both professional and business fields under the conditions described relative to the individual. 2. The sphere of duties of each local unit of a system of administration should be clear cut in relation to other units and general interests, in order that their inter- and extrarelationships may be clearly defined. 3. The correlation of such inter- and extra-relationships should be effected through a general board having investigatory, advisory and supervisory authority, but no power of direct control except enforcement of decisions of appeal. 4. True uniformity of product and method which recognizes and reconciles essential differences of conditions results from accurate knowledge acquired by impartial and expert investigation. 5. Co-ordinated action of associated units results from such information conveyed on time in definite and easily comparable form, which reveals deficiencies and offers helpful suggestion and constructive criticism. 6. Enlightened publicity based on such knowledge and method is a sharper spur to action and a more potent agency of compulsion than the dictation of any control board. It is a driving force acting through reason, competency, facts and good will. It never fails. 7. Appeal in final disagreement should be made to the general board of supervision, whose decision should be absolute and binding. These principles and methods are fundamental in successful business. They are democratic in spirit and equally fundamental in the great economic and humanitarian undertakings of state government under a democracy. STATE GOVERNMENT should not be a mere aggregation of departments in haphazard association. It should be constituted as a living organism with inherent forces manifest in growth and development in every department whose activities, correlated according to similarity of function and harmony of action, should promote the public welfare in the broadest sense. An evasive attitude of government that shirks all duties, which are not obvious and unavoidable, is unwise and wasteful. The right spirit is constructive, alert in foresight and prevention, virile of initiative and zealous in searching out public needs and formulating the practicable and economical plans for their satisfaction. This conception of government, based on the foregoing principles and methods of administration, is especially applicable in FOUR ALLIED FIELDS having intimate relation to the public welfare. These comprise, in the usual nomenclature, the departments of public health, of insanity, of charities and of correction. In the beginnings of state government and in small states these departments may be variously combined as a temporary and practical matter, but in every large state each is big enough and special enough in requirement to justify, in my judgment, separation from the others and autonomy under general regulation of state organization. It is frankly conceded, however, that distinct trend in the opposite direction toward |