escent youth from taking his proper place in society, or lead him to exaggerate the difficulties he may encounter in school, college or work. Many a person, either through inheritance or through improper environment or training has become a psychopathic personality and is susceptible to unfavorable influences of all kinds. Such a person meets the ordinary problems of life with difficulty, and is very likely to break down completely when faced with a real crisis. Some who find ordinary life intolerable take refuge in a world of phantasy and sooner or later become patients in a hospital for mental disease; others, more impulsive, may seek relief by destroying themselves.

These are some of the ways self-destruction may be induced. We cannot tell from newspaper reports whether these or other causes were the determining factors in the recent student suicides. We feel that so distressing a series of events is worthy of more thorough study. Certainly no relief can be expected from idle gossip or casual opinions.

A PARIS INVESTIGATION

A recent issue of the Annales Médico-Psychologique contains an interesting description by Dr. Suzanne Serin, of study along the lines above suggested conducted by the staff of L'Hôpital Psychiatrique Henri Rousselle, extending over a period of twenty months, terminating in October, 1926, as to suicides and suicidal attempts occurring in the city of Paris within that period.

The inquiry was made along the following lines: As soon as mention of the occurrence of a suicide within the city appeared in a journal of standing, note was taken thereof. In cases where death supervened immediately a member of the hospital staff was detailed to visit the person's former domicile in an effort to collect information concerning his antecedents and as to the incidents immediately preceding the actual tragedy, to discover, if possible, the impelling motive for the act. In other cases, i. e., of attempted suicides, the author, Dr. Serin, visited the patient subsequently either at his home or at the hospital to which he had been committed, in an effort to make a mental study of the case. Her inquiry covered not only cases presenting evidence of mental disease necessitating commitment but also those in which no indication of actual mental disease existed. There remained a third class which the inquiry could

not reach, comprising suicides in the families of the well-to-do, where, as might be expected, it was kept entirely under cover by the relatives; unless, perchance, the suicide was committed in a sensational manner making it impossible to prevent publicity.

Some of these suffered from the sequelae of lethargic encephalitis and showed few psychotic symptoms.

Heredity played a minor positive rôle, as less than 8 per cent cases presented a psychotic hereditary taint.

In 420 suicides investigated in the period, 230 were men, 173 women, while 17 were children under 18 years of age. Two hundred were single, 138 married, 41 widowed and 24 divorced.

Although at the time of the inquiry both the hospitals and prisons of Paris contained large numbers of foreigners, very few suicides were found among certain of these inmates, being negligible among the Russian, Polish, Belgian and Italian residents therein.

Professions and trades represented largely in the people investigated were, in the order of frequency, artisans, journalists, laborers, housewives, factory operatives, pensioners or persons without occupation; there were also noted kept women and public prostitutes. Means of self-destruction comprised shooting, drowning, hanging, asphyxiation either by gas or charcoal, poison, cutting the throat and by running in front of railway trains.

Former French psychiatrists (and the list includes Esquirol, Falret and Moreau de Tours) maintained the opinion that every attempt at self-destruction indicated positive mental disturbance. Contemporary alienists, however, and among them Brierre de Boismont, Durkheim, Proal, and, still more recently, Pfersforff, are less positive.

In the cases under consideration a considerable proportion-onethird to be exact-of the suicides were planned and executed without any discoverable trace whatever of psychotic taint. In this class of non-psychotic cases the motives most commonly assigned were private sorrow, death of wife or husband, abandonment, betrayal and loss of children.

Fifty suicides, mostly of elderly people, and without any discoverable taint of mental trouble, were attributed to wretched living conditions and to reverses of fortune. Forty-four were attributed to fear of painful, lingering and incurable illness, such as cancer, tuberculosis, etc.

Seventeen children ranging in age from 7 to 18 appeared in Dr. Serin's list; nine of these were girls and seven boys. The majority of these suicides occurred around the age of puberty; the act was largely an impulsive one; and on several occasions presented theatrical elements and followed reprimands or threats of punishment. Dr. Serin's conclusions were:

In 117 cases the suicides might possibly have been prevented, i. e.. of those who had announced their plan of self-destruction or whose change of circumstances had been such as to motivate an attempt at suicide. Hospital treatment and tactful supervision would have been of service in these and other types suffering from mental and physical inferiority and depression, but not of a kind to justify commitment to a hospital.

Cases of mental instability due to faulty up-bringing were not so easy to help. The suicidal act was impulsive. Medical care would not meet the situation. Proper guidance in early childhood would alone have insured a better mental balance and obviated these tragedies. Suicides resulting from mental upsets were found to have been easily prevented through immediate action and a timely hospital internment. Even with the restricted activities of the committee of inquiry it was able to render very considerable help where the attempt at suicide had not been successful. Provision was made by the committee for the admission of these cases to the open wards of hospitals, and dispensary and clinic service was procured for them with beneficial results.

ESSENTIAL FACTORS IN HEALTH PROGRESS

The Review for 1926 recently issued by the Rockefeller Foundation sets forth the activities carried on in various parts of the world for the promotion of health and gives the following valuable summary of the essential factors in health progress from the presentday viewpoint.

"First of all, research must be encouraged and intercourse with world centers of investigation must be kept up, in order to have the essential scientific basis for effective work. In the second place the medical profession must be intelligent and sympathetic. The physicians of a country can make or break a public health program. It is they who diagnose maladies, report cases of communicable disease, educate their patients, make health examinations, give advice about personal hygiene, influence public opinion.

"It makes a world of difference whether practitioners are wholly devoted to individual ills and curative medicine or are committed to the modern idea of prevention. The progress of public health is largly due to the leadership of doctors of imagination and public spirit. To its medical schools a country must look for the kind of training and idealism which will produce doctors of the new type. Medical education is a vital factor in the development of public health.

"Again, the different kinds of officials and special workers must have technical professional training. Public health is not something to which anyone may turn without appropriate preparation. Furthermore central services of many kinds must be set up; statistical bureaus, laboratories for diagnosis and for the production of vaccines, sera, and antitoxins, departments of communicable diseases, infant welfare, public health nursing, venereal diseases, popular education, and others.

"Still further, a system of organization-rural, municipal, State, or provincial, as well as national-must be created and official relations of authority and cooperation, clearly laid down. Sanitary laws and codes must give authority. Appropriate salaries, protection against political influence, retiring allowances, social recognition must attract and hold men and women of the highest type of professional efficiency and personal character.

"Finally, the public must be brought, through the education of children, the wide diffusion of information, and the concrete services of clinics, health centers, and visiting nurses, to appreciate and support the idea of preventing disease and of promoting health. In a democracy at any rate, public opinion cannot be ignored, whatever the temptation of the health officer to envy the hygienic efficiency of military camps or of such an expert's paradise as the Panama Canal Zone.

"To sum up: The effectiveness of a national system of public health service depends upon the appropriate and cooperative development of scientific research; medical education; the training of health officers, laboratory workers, engineers and nurses; the creation of central services; the organization of administrative units; the enactment of appropriate legislation; the provision of adequate funds; and the development of sound public opinion.'