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

NOTES AND COMMENT

analogy with the results of purely physical disease, a “mental scar.” Th 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 t defective individual should not be permitted to suffer. The proper reg:lation 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. for slavery," said President Lincoln, "I feel a strong impulse to see it 'Whenever I hear anyone arguing tried on him personally."

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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 de 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.

MERCIER AND THE TOXINS OF SYPHILIS-In Volume 3 of A System of Syphilis" issued by the Oxford Press an excelent a count is given by Dr. Charles Mercier of the present state of ver knowledge of the relations of syphilis to general paralysis of the insane. He believes that syphilis is the aetiological factor in 8) per cent of all cases of general paralysis, which is practically all of them, because of the fact that in fully 20 per cent ci dis eases, unquestionably syphilitic, it is impossible to get a history of syphilis or to discover the stigmata of the disease. We conse quently have as large a proportion of cases of undoubted syphilis in general paresis as we have in any other manifestation of syphilitic disease. Syphilis then is undoubtedly the most importan factor but it manifestly is not the sole factor, as only about two per cent of syphilitics develop general paralysis. There is evi dently some unknown factor present in two per cent of syphilitics which produces general paralysis and absent in the remaining 98 per cent of them which may develop other manifestations. This cannot be regarded as militating against the theory of a syphilitic aetiology of general paralysis, as it is well known that the percentage of cases in which syphilis has not been ascertained is constantly diminishing and cases where syphilis is absolutely excluded as an aetiological factor are very rare. There must, however, be an additional contributing factor, since in China and Japan where syphilis is very common, general paralysis is rare. This factor, he believes, is to be found in the fact that the brain has been subjected to excessive wear and tear and he dwells upon the observation that general paralysis seems to prefer active, energetic, strenuous, successful busy men. It affects those who use their brains much just as tabes affects laborers or those who use their brains very little, but who have used their hands or limbs much. He also views with favor Mott's theory that there may be a special variety of spirochaete of syphilis which has the peculiar power of producing general paralysis. He does not consider that Forbes Robertson has made good his theory of the causative efficiency of the so-called B. paralyticans and believes that our present attitude towards this theory must be one of suspense.

He calls attention to the fact that crises in general paralysis have a great influence upon the cause of the disease and that after each crisis the patient is permanently worse and in fact never regains

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his former condition. There may be a partial recovery from the effect of the crisis but it is never a complete one. Whether the disease be from a syphilitic causation or not it is evident that the destruction of the nerve elements, characteristic of the disease, is due to the action of a poison conveyed to them by the blood. This poison may be formed and retained in the system and fail to produce any effect until the point of saturation is reached when the crisis is developed or it may be poured into the blood in intermittent gushes which correspond with the times of the crisis. If the poison be the result of syphilis it may be secreted in some hidden recess of the body by living spirochaete which are unaffected by ordinary anti-syphilitic remedies or which have become immune to anti-syphilitic remedies in consequence of early treatment. If the toxin is continuously secreted and affects the system only when the blood has become saturated it is less easy to explain the occurrence of crisis. If on the other hand the poison is poured into the blood intermittently it is easy to understand how its elimination or subsequent destruction may be followed by the improvement in condition so frequently observed in this disease. The crisis may even in some instances be averted or mitigated in severity by intestinal disinfection. The theory advanced is very suggestive and it is to be hoped that the workers in some of our recently established psychiatric laboratories may undertake a series of observations and experiments to test its value. If the syphilitic character of general paralysis is well established a fresh argument is furnished too for the early, continuous and thorough treatment of syphilis with the hope of thus preventing the development of this hopeless mental disorder.

PSYCHICAL CAUSES OF TUBERCULOSIS AMONG INDIAN TRIBES.— In a recent Bulletin of the Bureau of Ethnology, Dr. Ales Hrdlicka gives an interesting account of the investigations as to the prevalence of tuberculosis among five selected Indian tribes in the United States carried on by himself and an assistant during the summer of 1908. He believes that tuberculosis did not prevail to any extent among Indians until the beginning of the 19th century and that the disease was unknown in pre-Columbian times. For this reason, because the Indian has no acquired or racial immunity the disease is even more fatal than among the negroes, who are