“Cases of nervous disease, with symptoms which simulate the ‘drunk’ in walk, speech and dull intellect, cases of coma, due to kidney disease, to hemorrhage, or injury of the brain, to exposure, to cold, to apoplexy, to sunstroke, meningitis, narcotic poisoning, etc. “Please understand this is not a criticism of our ambulance surgeons or our police department, ‘as they need more than a curbstone diagnosis’ but to give you an idea why you need an efficient medical department. A man may be sitting on a curb, or lying in the gutter in a collapsed condition, with cold clammy skin, unable to talk intelligently, with or without an alcoholic breath; he may be on the verge of delirium tremens, or his condition might also be due to heart disease, to arsenic or lead poisoning, to intestinal, kidney or liver colic, to intestinal obstructions, to sunstroke, to the rupture of an artery in his brain, to shock, to the onset of some acute disease, or to a plain fainting spell. “He may have had a tremor that looks like chronic alcoholism, but it may be a disease of the spine or brain, paralysis agitans or general paralysis of the insane. There was a time not very long ago when these cases were taken to the police station, locked up as drunks and died in a cell, when proper medical or surgical assistance would often have saved a life. Over one-half of our ‘no paper’ cases are not able to give any history of themselves; we know absolutely nothing except that the police brought in an unconscious man to us. This makes a diagnosis almost an impossibility in many cases. A printed history sheet was given to the police department, a sample of which is enclosed, which has been of great assistance to us in making a diagnosis. “A number of insane cases, which are not responsible to man or God, are sent here for violating some statute. Among them are violent cases who have tried to commit murder, or assault, and would be a danger to any city to have at large; these of course are sent to asylums. “Another type are unfortunates who are charged with being shiftless, who will not work to support themselves or their families. These are often unrecognized cases of brain or spinal diseases which leave the victim absolutely helpless and unable to work. These are often treated as worthless bums, when they need good medical care and kind treatment.”