cases admitted, the immediate danger of insanity was averted, a result which can, without difficulty, be reduplicated under similar circumstances in any general hospital when the cases come under treatment sufficiently early. No accident has occurred since the inception of these wards; there is no red tape in regard to admission; no difficulty in regard to detention, and finally, no stigma from being treated with the insane, which the laity so much dread. Again, and perhaps most important of all, clinical instruction has been given in these wards during the past winter. The house staff, the students and the nurses have all referred in warm terms to the value of their experience from the observation and study of these cases.

There now remains one other point to which I would like to direct your attention, and this is in regard to a suggestion which has been made to treat these cases in a psychiatric hospital. The attempt to do this would, I firmly believe, be a grievous mistake. Every alienist is well aware of the difficulty in getting the acute cases of insanity under treatment at an early date, owing to the prejudice of friends to have a near relative treated among the insane. How much greater then would be the prejudice when the patient was as yet suffering from nervous disease only! Practical experience has demonstrated in the wards of the Toronto general hospital that the presence for a short time only of a patient visibly insane has so disturbed the other patients in the same ward that the ill effects were felt for days, even after the removal of the patient from the building. Again, the influence of suggestion, induced by the presence of the insane in the same building, is most harmful, in view of the importance of psychic treatment of these cases, many of whom fear they will themselves become insane, and this fear would thus be kept constantly before them. If further practical results are desired, I may mention the last report of that most excellent department of the Albany Hospital, Pavilion F. The fifth report of this pavilion shows that only 2 per cent of the total cases admitted suffered from neurasthenia. Any attempt, therefore, to treat functional nervous disease in the same department of a hospital as the insane, will, I am assured, result practically in failure, and the nervous patients will return to the general medical wards of the hospital as of yore.

In conclusion, I may state that as a result of more than fifteen years of experience, devoted exclusively to the study (under exceptionally favorable conditions) of diseases of the nervous system, and of which these functional cases formed a large quota, I am convinced that for the true prophylaxis of acute insanity we must look to the general hospital, and that this result will be best accomplished here by the formation of neuropathic wards, especially equipped for the purpose.

Notes and Comment

PARESIS AS A MENACE TO PUBLIC SAFETY IN TRANSPORTATION. -The Boston Medical and Surgical Journal for February 6, 1908, contains a very suggestive and timely paper by Dr. Phillip Coombs Knapp, entitled "General Paralysis as a Menace to Public Safety in Transportation" in which the author refers to several cases of paresis he has seen among railroad employes, as well as other forms of chronic nervous disease of a character which impaired the ability of the patient to discharge the responsible duties of his position.

Doctor Knapp advocates "thorough examination by competent neurologists at regular intervals " in order to detect the presence of nervous disorders interfering with the capacity of the individual and thus prevent the risks incident to keeping such persons in positions of responsibility.

From an editorial in the same Journal we learn that a committee was appointed by the Boston Society of Psychiatry and Neurology, consisting of Drs. Knapp, C. G. Dewey, and G. A. Waterman, to inquire into the matter. After investigation it was recommended that a committee be appointed to confer with the Railroad Commission of Massachusetts and the heads of transportation companies and take such action as might be thought necessary. This is a move which might well be followed in other States and in which the members of the Medico-Psychological Association might take part as a civic duty.

In this connection attention is called to a series of articles which have appeared recently in the Atlantic Monthly under the title: "Confessions of a Railroad Signalman," in which there is much. food for thought, especially for those who would wish to see greater safeguards than at present exist, thrown around both those who travel and those who are employed by transportation companies.

The final paper of this series refers to the relief department of the Baltimore & Ohio Railroad as follows: "The company, through a corps of medical examiners and surgeons, closely supervises the health of its employes and the sanitary conditions of the places where their work is performed. This corps is in charge of a chief surgeon and a chief medical examiner, both prominent in their profession, and, although the number of men in their charge exceeds forty thousand, any complicated or persistent disability of an employe secures the personal supervision of the chief surgeon."

Many other railroads have organized medical and surgical supervision and service, and it would seem to be a fairly simple matter to add to the medical staff of each road a competent neurologist who could formulate brief but sufficiently comprehensive forms for physical and mental examination to be used by the general medical examiners, who should be instructed to refer all doubtful cases to the neurologist for personal examination.

It is not alone among the employes of railroad companies that the risk of unsuspected mental or nervous disease of a character which renders the affected employe a menace to public safety, exists. Means should be instituted, indeed should be required by law, to minimize this risk as far as possible in all lines of public travel whether by land or water.

No one of any extended experience among the insane but has observed paresis and other serious mental affections among railroad and steamboat employes, and has known of instances in which persons so afflicted have continued in service for some time before the malady was suspected or detected.

If the attention of transportation officials and of railroad commissions is directed to the danger which exists, steps will no doubt be taken to meet the emergency, and any advice or assistance from those competent to give it will, we are certain, be welcome.

MARYLAND PSYCHIATRIC SOCIETY.-At a meeting held on the afternoon of November 6, 1908, at the Sheppard and Enoch Pratt Hospital, at Towson, Md., a society was formed under the above name. Its membership includes the officials of the state and other institutions devoted to the care of the insane and defective, and

AMERICAN

JOURNAL OF INSANITY

A CLINICAL STUDY WITH BLOOD EXAMINATIONS OF TWO ATYPICAL CASES RELATED TO THE DEMENTIA PRECOX GROUP.

BY FRANCIS M. BARNES, JR., M. A., M. D.,

Assistant Physician and Director of the Clinical Laboratory, The Sheppard and Enoch Pratt Hospital, Towson, Md.

That the study of the blood of the insane has provided an attractive field for research during the past half century or more, may easily be determined by a casual glance over the literature accumulated during that time. Because of the inaccuracy of the methods known to the older workers, not much value can be placed on the results which they obtained. With the advances made in the clinical methods for examining the blood, there has been a coincident gain in a more accurate knowledge of the hematologic changes which occur, both in healthy and diseased states, so much so that a blood examination in certain maladies is essential to verify the diagnosis. Could it not reasonably be expected that in psychiatric medicine there might be some characteristic divergences from the normal in the blood picture? The older, and also some of the recent investigators in this field, concur in the opinion that there is in general, some deterioration, a mild secondary anemia, present in most cases. This, however, cannot be said to be characteristic of any one psychosis or of the psychoses as a whole, but is more probably the direct result of the mode of life among the insane, as was pointed out by Lindsay more than fifty years ago. More recent studies have apparently shown that undoubted changes occur in the number of leucocytes, and some observers, of which class Bruce is perhaps the foremost exponent, believe that factors of diagnostic importance can be ascertained from an estimation of the number of white blood cells.