ago, receives all its patients without commitment, there being no law in Oregon for the private commitment of patients. I have talked with a number of people regarding the peculiar legal aspect of conditions in Oregon, and some of them expressed surprise that legal complications have not during these 15 years arisen to embarrass us in our work. We are of course on account of this law extremely careful in assuming the care of questionable cases. In all this time we have never had as much as a suspicion of litigation through charges of any unlawful restraint. We take these patients and restrain them, the same as typhoid fever patients in delirium would be restrained, assuming of course more responsibility than where regular commitments had been made, and exercising the limit of care.

Like the recoveries reported in Bellevue, these people are treated not as strictly insane individuals, but as those needing hospital treatment, and are returned to their homes without having gone through the court, an element of very great satisfaction to the patient and the families of the afflicted. I am prepared, therefore, to say that under the exercise of due diligence little annoyance need be feared because patients are restrained in psychopathic wards and hospitals without regular commitment.

DR. BURR.-Mr. President: I think this is a matter in which the association may becomingly take a lively interest. In Michigan we have much pride and satisfaction in the psychopathic hospital at Ann Arbor. I congratulate Dr. Barrett and the others on their good work in bringing this subject to the attention of the association. The psychopathic hospital at Ann Arbor was established almost without precedents to guide it. Notwithstanding this, pronounced success has already been attained, and the outlook for the future is bright with promise for students and practitioners and especially for assistant physicians in institutions for the care of the insane. Dr. Barrett has kindly permitted all assistants connected with institutions whether state hospitals or those of a private character to come under his tuition. They receive without cost the advantags of the psychopathic hospital, and for this consideration I especially feel thankful.

The psychopathic hospital is useful to me in more ways than one. Many patients come to the institution with which I am connected under a total misapprehension as to the length of time required to bring about restoration to health. Sometimes the idea that a week's, two weeks', three weeks' care, only, will be necessary is instilled into the minds of friends by the doctor; at all events, it is attributed to the doctor. I am satisfied, however, that the idea is often conceived in the minds of the friends of the patient, the wish being father to the thought. Naturally disappointment follows, and the patient is removed before any good is accomplished. Other patients whose means are limited come with the expectation of a short period of treatment. An adjustment between their pocketbook on the one hand and the provision of the hospital on the other is not practicable for any lengthy period. To me it is very comforting to say to the

friends of patients of either of these classes, or to the patients themselves, "Have you tried the psychopathic hospital at Ann Arbor?" I make such suggestion as this to patients directly. To one recently I gave the advice to apply to Dr. Barrett and place himself under care, if possible, in the psychopathic hospital. That institution has a wide field of usefulness, and is a decided acquisition to the curative and teaching equipment of Michigan. DR. STOCKTON.-About two years ago, at the State Hospital at Columbus, Ohio, we established a cottage for the care and treatment of the acute curable insane, and the results have been very good. By way of treatment we use hydrotherapy, massage, special diet, etc. It has been very interesting to me to hear this discussion to-day.

DR. CRUMBACKER.—I have been very deeply interested in the symposium on this subject of psychopathic hospitals. There was one point mentioned that I desire to enquire further about. If I understood Dr. Barrett, he made the statement that in cases where the insanity has already become well established or fully developed, we must not expect a larger percentage of recoveries at present from treatment in the psychopathic hospitals than in other institutions. This is a statement which I believe to be correct; and yet I have heard the reverse made time and again, without controverting it in any way, and I must admit without desiring to refute it.

There is no incentive so great with governing boards and legislative bodies ordinarily as the one of lessening expenses, and if it can be made apparent to them that the establishment of psychopathic hospitals, even while expensive in the beginning, will eventually tend to induce lower taxes, we are more likely to receive the proper encouragement from them and to be granted the appropriations necessary for their institution and maintenance. For this reason there is a great incentive for those who attempt to secure such appropriations from the legislatures to make statements with regard to this particular point which facts will hardly bear out. The desirability of maintaining well equipped hospitals for the insane, however, is so well recognized now as to render any extravagant claims for them unwise; but I am anxious to hear from Dr. Meyer concerning the statistics on this subject since the establishment of the psychopathic hospital on Ward's Island; that is, as to whether or not the percentage of recoveries since the opening of the department has really increased.

DR. MEYER.-Statistics are so fallacious that I have never tried to present the results in figures.

These matters have got to be decided in individual cases. With regard to this whole problem I have thought it especially important to insist on the fact that the public ought to feel that the hospitals that exist at present are doing what they can with their present opportunities, and that psychopathic hospitals will try to meet similar needs, and the demands of the community, location, etc. If they work efficiently they will also promote the work of the State hospitals, but under no circumstances should we make invidious comparisons between the new places and the State hos

pitals. We are trying to do what we can under present conditions: the State hospitals have to do their share; localities have to do theirs, and the medical colleges similarly.

DR. BARRETT.—It is very gratifying to learn of the growth of this movement, especially of the promising institution in Canada.

In regard to Dr. Crumbacker's question, I would say that it is a very dangerous thing to make comparisons unless one has control of his figures. The statement I made as to the fact that a certain number of patients had been treated and had recovered or improved without having been committed to the asylum was made in comparison with modern hospitals for the insane and with keen appreciation of methods of treatment. I think it is wrong to emphasize too much that the hospital psychopathic ward can do more than the asylum. It simply antagonizes people and at the same time gains very little support.

EXPERIMENTAL OBSERVATIONS INTO THE

ETIOLOGY AND TREATMENT OF

PARESIS.*

BY JOHN D. O'BRIEŃ, M. D.,

Pathologist and Assistant Physician, Massillon State Hospital, Massillon, O.

The uniform mortality of this type of mental disease and the fact that statistics go to show that it is increasing, lead me to offer for your consideration a discussion of its etiology.

In the consideration of a disease so long and so well recognized as "paresis," one is naturally asked the question, "Has any new light been shed upon its causation?" To the genetic relation of syphilis and alcoholism, I will make but passing reference, but will offer for your consideration a report of some work done in our laboratory for the past few years with reference to the bacterial origin of the disease.

About four years ago Ford Robertson called our attention to an organism, diphtheroid in nature, which, to a certain extent in its cultural and morphological properties, resembled the Klebs-Loffler bacillus, which has since been termed the B. paralyticans and undoubtedly exerts a pathogenic effect in this disease. I wish to state here that we have been able, in a great many instances, to confirm his observations and to add considerable evidence in support of the theory.

Our observations have been confined to the examination of cases of paresis during life; they comprise examination of the blood, the cerebro-spinal fluid and the respiratory and alimentary tracts. During the congestive seizure in five cases, from blood taken from the basilic vein we have isolated the B. paralyticans. In three cases pure cultures have been found.

From the cerebro-spinal fluid of 62 cases of paresis, we have isolated the B. paralyticans in 70 per cent of the cases. In several of the cases the recovery of the organism was repeated. In four

* Read at the sixty-fourth annual meeting of the American MedicoPsychological Association, Cincinnati, Ohio, May 12-15, 1908.

cases, the only contaminating organism present was a diplococcus, which grew poorly.

In conjunction with the above, 30 cases of different types of insanity and various nervous affections were examined and we failed to find this particular organism in any case.

From the respiratory tract, we have isolated the B. paralyticans in 95 per cent of the cases and in less than 2 per cent of the other insanities. The possibility of these latter cases being incipient paretics must be considered. In the stomach wash from 14 paretics, who were fasting for twenty-four hours, II cases contained enormous numbers of bacteria, the B. paralyticans predominating. As stated before, the cultural and morphological properties resemble the Klebs-Loeffler bacillus, being diphtheroid. This group is quite extensive, having been thoroughly studied during the past few years by different workers with respect to virulence and broth reaction. The results tend to show that this group is of far more importance than has heretofore been acknowledged and demands our further study.

We believe, however, in the differentiation and study of this species of organism; there are at least two types which are of some importance and undoubtedly bear a relation to paresis. They can be readily differentiated by cultural methods and tests of virulence on animals; this, with additional evidence, leads us to regard is as a special bacillus.

We have employed for experimental purposes the white rat, dogs and goats, all of which, within a certain period following inoculation, presented characteristic symptoms varying from drowsiness, stupor, muscular irritability, ataxia, reeling and stumbling gait, partial paralysis, to congestive seizures and death. Examination of the brains of a goat and two dogs revealed cortical changes closely resembling those seen in early cases of paresis. In two instances, the organism having been recovered from the vein. of a case of paresis during a congestive seizure, was inoculated into dogs. In a few weeks' time, the dogs developed varying symptoms, finally hemiplegia, and lay in a moribund condition for several days, finally dying in a long congestive attack. In one instance, during a seizure, the organism was recovered from a vein of a dog and successfully grown again.