disease further than the fact that all bone and glandular cases reacted very vigorously.

In reviewing the literature several authors have tested equal numbers of cases with the ointment and the von Pirquet method and their results have been nearly identical and a very favorable comparison of the value of the tests is shown.

In conclusion it may be added that a positive reaction may take place in those patients in whom no tubercular lesion can be demonstrated. These cases are rare and if carefully watched may later show definite lesions.

BIBLIOGRAPHY.

1a. Moro, E.: Ueber eine diagnostich verwertbare Reaktion der Haut auf Einreibung mit Tuberkulinsalbe. Münchener medizinische Wochenschrift, Vol. LV, No. 5, 1908, p. 216.

b. Moro, E.: Valeur de la tuberculinisation percutanée au Moyen d'onguent à tuberculine. Presse med., Paris, Vol. XVI, 1908, P. 484.

2. Moro, E.: Tuberkulinreaktion und Nervensystem. Münchener medizinische Wochenschrift, Vol. LV, No. 39, 1908, p. 2025.

3. Lejeune, A.: Meine Erfahrungen mit der Moro' schen Reaktion. Berliner klinische Wochenschrift, Vol. XLV, No. 28, 1908.

4. Heinemann, H.: Vergleichende Untersuchungen mit der Konjunktivalreaktion nach Wolff-Eisner und der salbenreaktion nach Moro. Münchener medizinische Wochenschrift, Vol. LV, No. 11, 1908, p. 556.

5. Emmerich, E.: Ueber die klinische Bedeutung der kutanen und perkutanen Tuberkulinreaktion (nach von Pirquet und nach Moro) beim Erwachsenen. Münchener medizinische Wochenschrift, Vol. LV, No. 20, 1908, p. 1066.

6. Kanitz, H.: Untersuchungen über die perkutane Tuberkulin Reaktion nach Moro. Wiener klinische Wochenschrift, Vol. XXI, No. 28, 1908, p. 1011.

7. Alderson, H. E.: The Skin Reaction after the Use of Tuberculin Ointment. Calif. State Journal of Medicine, Vol. VII, No. 1, 1909.

8. Rothschild, M.: The Value of the Moro Skin Reaction as Compared with Other Methods of Using Tuberculin for Diagnosis of Tuberculosis. Calif. State Journal of Medicine, Vol. VII, No. 4, 1909.

9. Webb, G. B., and Williams, W. W.: The Integumental Tuberculin Reactions, with Report of 155 Moro Inunction Reactions. Colorado Medicine, Vol. VI, No. 1, 1909, pp. 26-35.

10. McHammel, S., Carpenter, H. C., and Cope, T. A.: A Comparison of the von Pirquet, Calamette and Moro Tuberculin Tests and Their Diagnostic Value. Archives of Internal Medicine, Vol. II, No. 5, 1908.

11a. Christian, F. L.: The von Pirquet and Moro Tests in the Diagnosis of Tuberculosis. American Medicine, Vol. IV, No. 3, 1909.

b. Stoll, H. F.: The Diagnostic Use of Tuberculin, with Special Reference to the Cutaneous and Percutaneous Tests. Medical Record, Vol. LXXV, No. 7, 1909.

c. Baldwin, E. R.: Conclusions from 1087 Conjunctival Tuberculin Tests by a Uniform Method. Journal of American Medical Association, Vol. LII, No. 8, 1909.

d. Tice, F.: Value of the Cutaneous Tuberculin Test. Illinois State Medical Society, Quincy, Ill., May, 1909.

e. Patterson, H. S.: The Moro and von Pirquet Tuberculin Reactions. Archives of Internal Medicine, Vol. III, No. 4, 1909.

12. Bucknill & Tuke: Psychological Medicine, 4th edition, p. 591. 13. Babcock, J. W.: Prevention of Tuberculosis in Hospitals for the Insane. American Journal of Insanity, Oct., 1894, p. 183.

14. Crookshank, F. G.: The Frequency, Causation, Prevention and Treatment of Phthisis Pulmonaris in Asylums for the Insane. Journal of Mental Sciences, Oct., 1899, p. 657.

Motes and Comment.

DR. MOSHER'S ANNUAL REPORT FROM THE DEPARTMENT FOR Mental Diseases at the ALBANY HOSPITAL.-This report shows that during the past year two hundred and twelve persons were admitted to this department and one hundred and ninety-nine persons have been discharged. From an analysis of 1583 patients admitted since the opening of the department in 1902 it is interesting to observe that 497 or thirty-one per cent suffered from acute delirium, confusional insanity, melancholia or mania, that is from the acute psychoses and that 406 or twenty-five per cent suffered from acute alcoholic delirium, alcoholism or drug addiction. The remaining 680 patients were divided among thirty-seven different forms of mental disease, mostly of a congenital or chronic character. It is evident that the true mission of the psychopathic ward of a general hospital is to provide speedy treatment for the first-named class of cases the acute psychoses-and that it is of little service. to place patients of the second class in general hospital wards. They should rather go at once to regularly organized institutions for the insane. While it is evident in the case of the former class that miracles cannot now be expected in behalf of the insane even in general hospital wards it is equally evident that patients suffering from acute psychoses should be given an opportunity to recover in hospital wards and thus escape the stigma which may apply to them if they are legally committed as insane to special hospitals. The author says in this connection:

Cases of mental disorder fall naturally into two groups, those representing an acute disease, from which recovery may be sought, and those representing a permanent degeneration of the mind. The latter group is recruited from two sources, first, those patients whose defect is inherent, revealing a natural incapacity of the mind to meet the demands and exigencies of life, and of contact and competition with society; and second, patients naturally competent, who have been afflicted with an acute mental disease, from which recovery has not followed. The defect remains as a permanent disorganization, and may be designated, for the purpose of

analogy with the results of purely physical disease, a "mental scar." The conduct of patients so afflicted is not consistent with commonly accepted standards, and must be regulated or controlled by a superior intelligence. It is so far removed from required conditions as to constitute either a menace to the safety of the community or a reflection upon its charity, and it is now an accepted fact of our civilization that a manifestly crippled or defective individual should not be permitted to suffer. The proper regulation and care of mental dependents has consequently long exercised the public conscience, and has been the subject of discussion and legislation. As the spirit of a community is thought to be represented by its laws, it is interesting to note how this class has been regarded at different epochs in legislative progress, and for that purpose a study has been made of the laws in force at different periods in the State of New York.

The author then gives a summary of the lunacy legislation in New York from 1788 until 1908 and adds:

The recital of these laws appears somewhat tedious at first glance, but is necessary for the revelation of the underlying principle. Starting with the chaining of dangerous persons they end with the judicial confinement of the insane under certificates of lunacy. Whatever the humane purpose, the ultimate result is a legal declaration of lunacy, from which every man, no matter how sorely pressed, revolts. They deal essentially with the class of persons who require custody, and are framed for this purpose rather than in regard of the enlightened consideration of a patient with an acute mental disease for whom early and proper treatment predicates recovery.

From 1788 to 1865, and even later, it was necessary to provide some place for detectives who were either at large or improperly maintained in poorhouses. There now appear acute cases of mental disease, following worry, strain, privation, fever, or other mental or physical ailment, who are restored to health by the removal of morbid conditions and the recovery of normal vital functions. The treatment of these patients is purely a medical question, and neither they nor their friends require the assistance of a court. Nor do they wish to be declared lunatics, and to have placed upon file in the State Capitol a certificate under oath of their friends and physicians, showing the peculiar words and actions of a harmless delirium, their habits and the records of their lives and of their ancestors—an array of facts which may at any time be brought forward to embarrass action in the making of documents, the execution of deeds, obtaining employment and the general conduct of business. "Whenever I hear anyone arguing for slavery," said President Lincoln, "I feel a strong impulse to see it tried on him personally."

The purpose of the law is the protection of the insane and of the community from the acts of the insane. It has been found difficult to send patients to hospitals for the insane because of the aversion from a declaration of lunacy with its attendant evils, and proper early treatment has been

neglected, until the disease is so far advanced as to prejudice or destroy the prospect of recovery. And there has been no general provision for early treatment. These facts led to the establishment of Pavilion F in 1902, as a department in a general hospital where patients threatened with mental disease, or in an early stage, might have the benefit of the resources of a first-class general hospital, where the mental symptoms of physical disease might have as full consideration as the physical disease itself, and where none of the complicated legal technicalities should operate to the detriment of the restoration of health. It was to emphasize the medical features of mental disease, as contradistinguished from the legal features of mental defect.

A review of the ages of patients reveals some interesting facts. From a psychological basis the epochs of life are those of adolescence, of maturity and of old age. The adolescent period may be stated to be from fifteen to twenty-five years. Considerable study has been given in the last ten years to the mental disorders of adolescence, and it is a peculiarly susceptible period. Some adolescents appear to yield to the violence of the emotions without definite exciting cause; others yield easily to slight causes. The nervous and mental symptoms are characteristic, and the outlook is uncertain. The attention of the Pavilion has been directed to adolescent cases on account of the unusual number of patients under twenty-five years of age. Thirty-three patients, or seventeen per cent of the admissions, were of this class. Of these thirty-three patients eight were congenitally defective, and had revealed lack of mental development through childhood. The others included four cases of hysteria, one of chlorosis, two of neurasthenia, one of alcoholism, one of general paralysis, the remaining sixteen presenting symptoms of acute mental disease. Of these sixteen cases eight were restored, and eight did not regain health during the short period under treatment. It is probable that some of these patients eventually recovered, giving a percentage of over fifty of satisfactory results. Adolescence differs from other periods of life in the absence of the stress and burden which later is productive of mental disorder. Its affections must be regarded as inability of the nervous system to meet the simple demands of growth. To condemn the adolescent to permanent disability appears a harsh judgment, and the experience of the year demonstrates that the general belief in incurability is not warranted.

The work which Dr. Mosher has done in connection with the Albany Hospital has attracted wide attention at home and abroad and has given rise to similar movements elsewhere. It is not too much to predict that it may eventually lead to a wide-spread change of policy in the treatment of the acute psychoses. The pioneer labor of Dr. Mosher has been of the utmost value and it is gratifying to observe that the Governors of the Albany Hospital have given hearty cooperation.