Twelve

fat necrosis of pancreas. Pancreas twenty centimeters long. centimeters from the tail, over an area two and a half centimeters in diameter, the capsule is greatly thickened; beneath the capsule the pancreas presents a congested area containing many small yellowishwhite areas of soft cheese-like consistence. A few similar areas are found elsewhere in the pancreas.

Histological examination reveals a slight localized interlobular pancreatitis, with typical fat necrosis.

It is possible that the first of these cases belongs to the group described by Chiari, in which, in his opinion, self digestion of the pancreas occurs shortly before death as an agonal change and allows the escape of the fat splitting ferment and the development of fat necrosis with associated minute haemorrhages. That fat necroses may develop very quickly is shown in one of the experiments of the series carried out by Dr. Flexner and myself, in which necroses were evident eight hours after injection of a one per cent. solution of hydrochloric acid into the pancreatic duct. Wells has observed their occurrence three to five hours after the application of "pancreatin."

The theory that postmortem digestion of the pancreas may set free the pancreatic secretion and allow the development of fat necrosis has little evidence to support it. In connection with these agonal necroses Opie believes it is possible that shortly before death, owing to alt erations in the character of the pancreatic juice, it may become thick and viscid, in consequence of which it flows slowly. Stagnation and slight diffusion of the secretion may result and cause the insignificant necroses occasionally seen.

ALBANY HOSPITAL.

SECOND ANNUAL REPORT OF PAVILION F, DEPARTMENT FOR MENTAL DISEASES, FOR THE YEAR ENDING

FEBRUARY 29, 1904.

By J. MONTGOMERY MOSHER, M. D.,

Attending Specialist in Mental Diseases.

To the Board of Governors:

I have the honor to present the second annual report of the operations of Pavilion F, for the year ending February 29, 1904.

There remained in the Pavilion on March 1, 1903, fourteen patients, eight men and six women. There have been admitted during the year ninety men and sixty-seven women. The whole number of patients under treatment during the year was, therefore, one hundred and seventy-one.

There have been discharged one hundred and fifty-seven patients, ninety-one men and sixty-six women; and there remain in the Pavilion at the end of the year seven men and

seven women.

The following tables show the forms of disease and the results of treatment for the year, and since the opening of the Pavilion:

TABLE I-SHOWING THE FORMS OF DISease and the RESULTS OF TREATMENT FOR THE YEAR.

TABLE 2 SHOWING THE FORMS OF DISEASE, AND THE RESULTS OF TREATMENT SINCE THE OPENING OF THE PAVILION, FEBRUARY 18, 1902.

The conditions upon which patients may be admitted and detained have been at times a source of anxiety, and at several conferences of the Board of Governors and the executive officers of the Hospital have had careful consideration. A person may not appreciate in himself the presence of mental disorder of a degree requiring treatment, and this deficiency must be supplied by the good offices of family or friends. It becomes their duty to provide means for the restoration of mental health, without harm to the patient or violation of his rights, and elaborate laws have been evolved for protection of the victims of mental disease against errors of judgment or the evil purposes of designing people. Under their ope

ration and the systems of official supervision of institutions there is little opportunity for the unjust detention of any individual capable of appreciating and respecting his liberty. But the statutory exactions which so protect one person do injury to another. For the patient in whom a sudden and critical state of delirium develops the delays of the law may prove fatal. In such cases the delirium often follows a preliminary stage of nervous and mental debility, for which treatment is not sought because of aversion from the declaration of mental incompetency preliminary to hospital care. From the medical standpoint this situation is most unfortunate; applied to purely physical diseases it could not occur. We may imagine, for example, a requirement involving a delay of two or three days, or one day, or even twelve hours, for the decision of a court, before a patient suffering with appendicitis or pneumonia could be placed under proper medical treatment! And yet the mental case is just as acute and critical, requires as much skill and care, and with this skill and care, promises as good results, as the case of appendicitis or pneumonia. The legal commitment of such a patient is often sought, because proper treatment can only be had in institutions permitted to receive patients upon this basis.

Under the conviction that mental patients are entitled to the consideration of a general hospital, Pavilion F was projected.

As illustrating the fellowship of mental and physical disease, attention may be directed to the fact that twenty-four patients have been transferred to Pavilion F from other wards of the Hospital.

Another class of patients for whom Pavilion F has proved a convenience are those who have been legally declared incompetent and are under commitment to a hospital for the insane. They have been properly and comfortably provided for during the few days pending transfer.

There remains a small number of patients for whom Pavilior F unfortunately cannot provide. They resent detention and decline to be held. They are in an abnormal mental condition, but their final disposition is a delicate question, and one which is much more safely left for judicial determination than for personal opinion. It is surely beyond the authority of the Hospital to lay forcible hands upon any individual. The Hospital has not only not sought but has declined any license or