Page images
PDF
EPUB

(B) Partly owing to my illness, and partly owing to considerable interference with the work otherwise, the studies in clinical psychiatry were this year rather less well focused than in other years. However, many observations were added in the various fields in which work had been going on during the last few years. I am pleased to say in this connection that i am at present so situated that I shall have the time to bring to a conclusion the various studies I have just spoken of, and to round out the work so as to bring out, in the course of time, a series of publications which, although I am no longer connected with the Institute, hould and will be published as contributions from it, because the observations were made there. This will give me, I am frank to say, the agreeable feeling that, though no longer officially connected, I shall still have a certain affiliation with the New York State hospital service.

Regarding the work of the pathological laboratory, Dr. Dunlap reports as follows:

Twenty-eight specimens of nervous or other material were received at the pathological laboratory of the Psychiatric Institute. This small number of cases was due in part to requests from the Institute for cases especially bearing on the problem of Huntington's chorea, or related conditions involving the corpus striatum, which problem has continued to occupy the first place in the activity of the laboratory during this period.

Cases of bilateral lesions in the corpus striatum were especially sought for in order to determine the anatomical state of these regions and to determine whether such cases presented any syndromes that might be referred to this organ in the light of the modern literature concerning it.

The response from the hospitals was prompt and cordial, but material of this kind is evidently scanty in the State service, and only one case of this type was received. Nevertheless, seven new cases of Huntington's chorea, either with or without positive heredity, have been added to the series, also a very interesting case of old syphilis from Willard State Hospital, with marked intention tremor, was added to the list. This case had, besides the tremor, paraplegic symptoms with increased reflexes and difficulty in walking. The posterior columns of the spinal cord, and

the marginal portions of the cord next to the greatly thickened pia mater, showed old degenerative changes which were believed to have at least some influence in the production of the tremor.

Three cases of paralysis agitans, two of which were from Dr. J. Ramsay Hunt, and the other from the Manhattan State Hospital, should also be included in the groups studied in connection with Huntington's chorea. Two still more distinctly related cases were contributed by Professor Imamura, of Kyoto, Japan. To one of these, which was quite obscure, the clinical term of pseudo-sclerosis might be applied; the other was diagnosed multiple sclerosis.

The spinal cords and peripheral nerves from several cases diagnosed scurvy were received from Dr. Alfred F. Hess, of New York City; also some comparative material from animals fed on a special diet. The findings in this material were not only quite meagre, but also of doubtful interpretation.

In the group of miscellaneous cases are represented tubercular meningitis with the bacilli demonstrable; pellagra, with typical asonal changes in the Betz cells; an alcoholic paranoid condition; a cholesteatoma, from the base of the brain, showing squamouslike epithelial cells, and a case of senility with aphasia in which the brain showed no focal lesions in the parieto-temporal zones but an exaggerated degree of general and local atrophy and an enormous number of senile plaques throughout the different cortical areas and in the putamen as well.

While many problems which we set for ourselves in the study of Huntington's chorea still remain unsolved, the work has reached a stage where it seems best to put the definite results already obtained into form for publication.

The technical work of the laboratory has been carried on by two women assistants trained by us for this purpose. It is becoming increasingly evident that workers of this type cannot be held in their positions, in these days of increasing prices, at the salaries deemed adequate before the period of war prices. They must be paid better wages or they will leave; and it takes fully a year, often more, to train a woman of good capacity to do even fairly well the work required in this laboratory. They are skilled workers in a small field, and their places cannot be filled except

Ι

by training others at great expense of time and patience. strongly recommend that they be paid adequate salaries, which salaries should not be below those of well-trained stenographers in the State civil service, and these salaries should increase according to the regular schedule for stenographers in the civil service.

The scientific work in the serological department consisted in further investigations of the principles underlying the Wassermann reaction, studies which Dr. Morse embodied in lectures given at the Psychiatric Institute. He was prevented from publishing these by his enlisting in the national service.

In the chemical department the work was as follows: Two cases of general paralysis have been examined by analysis of uniform samples of the entire hemisphere, cerebellum, spinal cord, cortex and corpus callosum. Compared with the normal, the central nervous system in this disease is subject to a series of decided chemical changes involving principally certain lipoids such as the phosphatides. This indicates a destruction of the unsaturated lipoids to which belong lecithin and cephalin. There is considerable increase in the extractives (water soluble) which compensates for the loss of the lipoids, whereas the proteins are changed very little.

The different parts of the central nervous system in general paralysis are affected differently, in the sense that the cerebrum exhibits the most striking chemical changes, the cerebellum approaches it only in a measure, while the spinal cord shows the least change. Again the cortex of the cerebrum shows more pronounced changes than the corpus callosum. These findings confirm in a general way those obtained by a few other investigators. These two cases of general paralysis will be reported in greater detail in a paper to be published in the Psychiatric Bulletin.

A similar study was made on three cases of alcoholic Korsakoff psychosis. An analysis of uniform samples was made of the entire hemisphere, cerebellum and spinal cord. In one case the gray matter (cortex) and white matter (corpus callosum) were also examined. Compared with the normal, the central nervous system in this disease shows consistent variations, although not to the same extent as was found in general paralysis. The phos

phatides, for example, which were found to be most affected in general paralysis, have been found to be little changed in Korsakoff psychosis. The sulfatides appear to have undergone the greatest change. Whether or not this is typical for Korsakoff psychosis requires further confirmation and will be carefully followed in other cases studied.

In the continuation of the work on the chemistry of the central nervous system the following problems are receiving special attention (1) Perfecting the method for the oxidation of nerve tissue for the determination of sulfur and phosphorus. The direct oxidation method (using a Parr Illium bomb) is being substituted for the older fusion method. By this new method a great saving of time and reagents is accomplished. (2) Metabolic products of the nervous system. Working out of methods for the identification and study of the organic extractives present in the water soluble fraction. This is a rough index of the metabolic activity going on in the tissues.

Analyses and calculations of the two additional cases of Korsakoff psychosis, and of one case of dementia praecox, are nearing completion.

In the last part of the period reported, that is, since the time that Dr. Morse went to Washington, Miss Mathilde Koch, who has been doing the work on brain chemistry just detailed, has also taken over the carrying out of the routine Wassermann tests. Tempting as it might be, I purposely refrain from making any suggestions as to the further development of the work of the Institute, because I feel that this work is now in the hands of my extremely competent successor, who will and should develop the work along lines of his own.

Aside from the changes in the personnel which I have mentioned above in connection with the war, the only fact to record is that Dr. Lon O. Weldon resigned in September, 1916, and that his place was taken by Dr. Thomas J. Heldt.

In conclusion I wish to take this occasion to express, not only to you but to your predecessors, my deepfelt indebtedness for the helpful spirit which the Commission invariably showed toward the work of the Institute. I also wish to give expression to the appreciation which I and my colleagues feel toward the super

intendents and staffs of the various hospitals for the co-operation. which we continuously received from them during the entire time that I was director. All this and the friendships which I formed during my work in the State, together with the splendid opportunities for a thorough study of mental diseases that the position afforded, made the seven and a half years of my connection with the Psychiatric Institute the most enjoyable part of my professional career.

Respectfully yours,

Santa Barbara, Cal., January 1, 1918.

AUGUST HOCH.

REPORT OF THE BUREAU OF DEPORTATION

To the State Hospital Commission:

I beg to submit herewith the annual report of the Bureau of Deportation for the fiscal year ending June 30, 1917. Through the efforts of this department during the year the State has been relieved of the care and maintenance of 320 patients; 52 aliens and 268 nonresidents. Of this number 270 were removed from the hospitals after commitment. The remaining 50 were removed to their places of residence prior to commitment, 47 being from the Psychopathic Ward of Bellevue Hospital.

In view of existing conditions I consider these results quite gratifying. During the year the Immigration Department deported only 27 aliens; less than 7 per cent of the number deported under normal conditions. There were none deported since January, 1917. From July 1, 1916, to March 15, 1917, no funds were available for the repatriation of aliens or removal of nonresidents and, when funds became available, repatriations were no longer possible, in spite of the fact that many requests for repatriation had been made by friends and relatives of alien patients.

Within the past year circumstances materially affecting the Bureau's work, which necessitated readjustments, have arisen.

First, the new Immigration Law, which extends the period . for deportations from three to five years and is retroactive, has

« PreviousContinue »