Fortunately none of these cases of sudden mental irresponsibility resulted in loss of life or in any great amount of property, but each mau was a grave danger to life in operating trains. In a few moments I will suggest how similar cases can be detected in employes who are now apparently as well as all these men were on the day their mental symptoms appeared.

It is interesting to examine the records of the Cherokee State Hospital in reference to syphilis in railroad workers. I have examined all the cases that are on record here and it is found that in the last twenty years 282 cases of syphilis in males have been admitted. Of these male syphilitics 29 were railroad employes. They have been grouped into firemen, engineers, trainmen, conductors, dispatchers, and others. Unfortunately early in the hospital records the specific work is not mentioned, the occupation being classified as railroad workers. This makes a large group number which may mean either laborers, or may include some of the other positions. We find that 10.5 per cent are employes who have to do with the issuing, receiving, or carrying out of orders to run trains; as follows; 5 engineers, 5 firemen, 3 brakemen, 3 dispatchers, 2 conductors, 1 baggage man. The balance, 10 miscellaneous workers may be laborers. Please bear in mind that first; 10 per cent of all male syphilities are railroad workers; that second; 65 per cent of these railroad employes are in a position of grave responsibility in the issuing, receiving, delivering, and carrying out of orders, which if in any way mixed or changed or misunderstood may result in loss of life and property. Is it not plausible to believe that some of these hitherto mysterious accidents occurring to old trustworthy employes may be due to sudden onset of mental symptoms in syphilis of the central nervous system.

It is impossible for railroad executives to escape their regular ratio of syphilitics among their employes. We learn from the records of the Selective Service Act that of the drafted men it was found that taking the country (United States) as a whole a trifle more than 10 men per thousand aged eighteen to thirty years were infected with syphilis. (Defeets found in drafted men published by the War Department page 104.) Taking this as a basis any railroad executive can approximately state how many syphilitics he has in his employ.

A few years ago when the Adamson law was before Congress it was headlined in the papers that the four great brotherhoods representing over 400,000 men were vitally interested in the passage of this act. These are I believe the trainmen, the conductors, the firemen, and the engineers. These men with the dispatchers and undoubtedly others have to do with the safety of the traveling public. For argument let us assume the number is 400,000 men. We must look for and expect to find 4,000 of these men infected with syphilis at some time in their lives.

Syphilis is usually contracted during the ages of eighteen to thirty-five before most of us have arrived at positions of responsibility. It is a peculiar fact that while mental or nervous symptoms may come on at any time after the disease is fully developed yet the preponderance of cases

of syphilis of the central nervous system occur from ten to twenty-five years after the original infection. This well-known delay in appearance would account for its sudden onset in men in the fourth and fifth decade just as they had passed the meridian of life and while in positions of responsibility.

Fortunately not everyone who is infected with syphilis develops at any time mental or nervous symptoms. According to Mettler mental disease is found in about 2 per cent of all syphilitics. Now I believe that Mettler's figures are trustworthy, but I believe that mental symptoms develop more frequently in those syphilitics whose work is accompanied by mental and nervous strain. It is common knowledge that railroad engineers, firemen, trainmen, conductors, dispatchers, etc, continuously work under greater mental strain, than other workers. For this reason we can expect a greater frequency of mental cases among these syphilitics. However let us assume it is only 2 per cent then we may expect eighty men will develop mental symptoms of cerebral syphilis taking 400,000 as the whole number. All railroad cases at Cherokee broke down while at work, some it is true had some symptoms previous to giving up for good but do not forget the number cited who become insane without warning. How can this condition be met?

Let me cite a case of a fireman on the Milwaukee Railroad. It was this case that crystallized my observations of many years into this short paper.

Case 6 Y. O. K. thirty-four years of age, single, a fireman on various roads had been industrious, painstaking for several years. His work was good, his record was clear his habits of the best. He had changed roads a few times but always with a clean record. K. had been in service continually for a sufficient number of years to entitle him to go up for promotion to an engineer. For some reason his request for examination never seemed to be granted and he finally took up the matter through the grievance committee of his brotherhood, the firemen and his brotherhood believing he was being unjustly discriminated against by his superiors. In talking with an official whom I knew he mentioned this man and his case and said that every immediate superior had reported that he was a good faithful employe, but no one seemed to think he would make a good engineer. No one seemed to think he could assume responsibility. Since the fireman was known to both of us I suggested that possibly he might consent to being examined by me. He readily consented and he spent the better part of two days under my observation. He was given a complete physical, neurological, and mental examination. In making my report I stated that his physical condition was excellent; that there were no signs of neurological significance; that his blood was free from syphilis, but in giving him a mental examination by the Yerkes-Bridges method it was found that he had the mental capacity of a thirteen year old boy and I could readily understand why his superiors had not felt that he was suitable for promotion and that he would not make a good engineer. Now this mental age may seem low for a man who had been able to

support himself but we must bear in mind that the adult mental age is about sixteen years. It was recommended that he be kept as a fireman but that he be prevented from taking an examination for engineer because although he might learn parrot-like to pass an examination he never could have the mental capacity to assume the responsibility and have the judgment an engineer ought to have.

When I mentioned that his blood was free from syphilis the official asked me if I suspected he was syphilitic. I said: Not at all but that I did not think any physical examination was complete without a Wasserman of the blood. I was astonished to learn that in one railroad at least no blood test was given or required when candidates were up for promotion to positions of responsibility.

If it is customary for railroads throughout the United States to fail to test for syphilis all those men who have to do with the running of trains, it is my belief that railroad executives should consider this matter very seriously. The Wasserman test is simple and accurate. When an employe is found positive, that is infected, he should be treated for the protection of himself and the public. The Wasserman test shows that there is an active syphilitic process going on somewhere in the body. If no outward manifestation of disease is observed a lumbar puncture and Wasserman of the spinal fluid may reveal the seat of the trouble long before mental symptoms appear and proper treatment gives the person the only possible chance of escaping insanity.

While it might be a good thing for every applicant for a position of any kind to be subjected to a blood test and can do no harm to any one it is more important to know that every one responsible for running trains is not in need of treatment for this treacherous disease. I do not know anything about running a railroad and do not wish to formulate any plans, having confidence in the various medical men connected with railroads but am confident that if physical examinations for eye sight and color-blindness are repeated from time to time they could find no objecttion to a blood test being given at the same time. The employes would not resent it if it was put before them in the proper manner.

To return for a moment to the five cases cited. If blood tests had been made regularly on the various railroads that employed these men I am positive that every one of the five would have been discovered before they jeopardized the safety of the traveling public. If any railroad executive is interested I will be very glad to give other interesting details of other cases that have come under my observation.

OUTSIDE IN, INSIDE OUT.

O. S. Von Krog, Superintendent, Training School for Boys,

Eldora, Iowa.

The subject, "Outside In, Inside Out" may have brought to your mind many illusions. It may bring to your mind that things are not what they seem. We have all learned that some things are not what they seem. You may also think about the inside and outside of the institutions that we represent. If this be so, if you think of what the people on the outside think about the inside, and what the outside knows about the inside, and also what the inside knows about the outside, we may conclude many more illusions.

All of us have a different notion of life than we had ten or twenty years ago. "We began life with an entire outfit of wrong notions. Many things appear what they are not. The earth seems flat but is not, the sun appears to be revolving about the earth but it does not.

We must learn by experience. Trusting to inexperience will always deceive. We have all heard "The survival of the fittest," which is generally taken to mean "the survival of the strongest". Science and research have revealed that monsters in the past have lost out in the struggle of evolution, while we still have with us the cattle and the sheep, an index, "that the meek inherit the earth".

How often have we heard the delusion, "God is on the side of the strongest battalions". Alexander, Cæsar, Napoleon and later rulers believed it. The rulers in Russia now are establishing this rule by the sword. We even have advocates and believers of force in this country. Many still have the idea that force accomplished great things, but it is a delusion, for it has accomplished nothing permanent. The big stick eventually destroys the hand that wields it.

This is the age of unusual enlightenment and progress but still the world is full of suspicion and doubts and many of its people in ignorance. This is the reason so many come from the outside to the inside of institutions where special restrictions are observed. The outside views from the general public regarding the inside of our institutions reveal many illusions and delusions.

During a period of about twenty years in school work, some men, women and children eligible respectively to one of the institutions under the management of the board of control have come under my observation. I have seen the process under which each was committed to his proper future home.

The institutions here represented today are penal, detention and educational. Education should be stressed as much as possible in every one

of them. A large number sent to the state hospitals are never released until soul and body part, a still larger per cent of those placed in the institutions for subnormals remain their the rest of their days. The penal institutions are releasing a large number of their inmates as soon as they meet certain requirements and many of them have learned their lessons. The children's homes and the training schools are preparing all of their inmates for useful service and a large percentage of them become good citizens.

The general public does not distinguish these institutions as I enumerate them except those who by experience, know the differences. Most of the general public regard all institutions under state control as necessary evils for the detention of the vicious, unfortunate and neglected, 80 that the public may not be molested nor interrupted in their various activities.

Still all references and advancements have come from that same public and all future growth and enlightenment of reparation for the benefit of those unfortunates is going to come from the outside. We who are in the employ of those directing these institutions will advance as rapidly as the public demands. The history of all public officials in general do the bidding of their constituency. The larger rumbling of the prairies still directs our legislature in Des Moines and Congress 'n Washington. Our leaders when reaching the state of maturity, have learned that there are fundamentals underlying every activity. Fundamentals in education, fundamentals in religion, fundamentals in government, fundamentals in all natural walks of life. The important thing for advancement and progress is not where we stand but rather on what we stand and in what direction we move.

"It required the stern teachings of the 'War God' to reveal to the American people a fundamental weakness in their system of education. More than one-third of the men called to the colors were rejected and denied admission to the army because they were not physically fit to serve their country in its hour of supreme need. Only about ten per cent of the pupils in the schools of the republic have had the benefit of physical care; and the national government, as well as the state government, has neglected to give sufficient care and culture to the bodies of its citizens, as if oblivious to the fact that fine intellectual advance and lofty moral standards are both largely conditional upon good health, the outgrowth of careful physical education during the school year."'

Since we have no national educational system it is the duty of the states to fit its citizens for all fundamental office of peace as well as for the office of war. In a crisis, at great expense the government undertook to do what should have been done by faithful, careful prolonged training in the schools. One important part of the business of education that has been neglected is the promotion of health of all citizens.

Our society is organized fundamentally, to the highest extent of present human knowledge. All organizations are created by live organs as definitely as the human body is created by its digestive, circulatory