The Alienist and Neurologist A4- "Quantam ego qulden video motus morbosi fere omnes a motfbus in systemate nervorum Ita pendent ul morbi fere omnes quodammodo Nervosi dici queant."—Cullen's NOSOLOGY: BOOK II, P, 181 —Edinburo Ed., 1780. A JOURNAL OF . Scientific, Clinical and Forensic NEUROLOGY AND PSYCHOLOGY, PSYCHIATRY AND NBURIATRY. Intended Especially to Subserve the Wants of the General Practitioner of Medicine. THE VOLUME XXVIII. CHARLES H. HUGHES, M. D., Editor. MARC RAY HUGHES, M. D., Associate Editor. HENRY L. HUGHES, Manager and Publisher. 3872 Washington Boul., ST. LOUIS, MO. 1907. CONTRIBUTORS AND COLLABORATORS. TO VOLUME XXVIII. HARRIET C. B. ALEXANDER, Chicago. ALBERT S. ASHMEAD, New York. JOSEPH COLLINS, New York. EDWIN G. ZABRISKIE, New York. G. F. ADAMS, Kenosha, Wis. R. W. SHUFELDT, New York. HAROLD N. MOYER, Chicago. HAVELOCK ELLIS, Cornwall, Eng. JAS. G. KIERNAN, DR. GIERL1CH, Chicago. Weisbaden. THEODORE SCHROEDER, New York. WHARTON SINKLER, Philadelphia. C. H. HUGHES, St. Louis. Index. iii INDEX. ORIGINAL CONTRIBUTIONS. Alcohol in Therapeutics 72 .\ Psychological Medico-Legal Study 168 A Mistaken Diagnosis of Dementia Senilis 464 Case of Canine Hermaphrodism.. . . 189 Erotic Symbolism 18 Erotism (Normal and Morbid) and the Unwritten Law in Our Courts 205 Erotogenesis of Religion 330 Erotism (Normal and Morbid) and the Unwritten Law in Our Courts 378 Electrical Sleep 443 Homo-Sexual Complexion Perverts in St. Louis 487 Is Genius a Sport, A Neurosis, or a Child Potentiality Developed? 139 Is Sexual Perversion Insanity?.... 193 Neurones in the Light of our Pres- ent Knowledge 34 Psychological Studies of Man's Mor- al Evolution 177 Periodical Paranoia and the Origin of Paranoiac Delusions 303 Psychological Studies of Man's Moral Evolution 367 Recurrent Functional as Distin- guished from the Typical Or- ganic Dementia Senilis of the Literature 81 Some Psychological Studies of Man's Moral Evolution 1 Some Psychological Studies on Man's Moral Evolution 449 The Tramp as a Social Morbidity.. 157 The Entoning of the Neurones in the Practice of Medicine and Surgery 164 Thaw's Paranoiac Morbid Egoism. .224 The Relation of Cerebro-Spinal Fluid to Epilepsy 342 The Alienist on the Witness Stand. Unscientific Ruling of the Court in the Thaw Case. Fallacy of the Legal "Knowledge of Right and Wrong Test of Insanity," etc 346 The Growth of Neurology 484 234291 iv Index. EDITORIALS. An Illustration of Psychokinesia.. . 90 A Psychic Block System for Rail- roads 95 A Righteous Judgment 97 Appeal by Edward S. Morse 98 Adequate Timely Sleep for the Nor- mal Mind 102 An Alcoholic Drunk Theft Obses- sion 100 All Night and Eight Hour Labor Shifts for the Canal Zone 100 An Android Woman Homosexually Conjugally Mated 108 A Psychic Spasm of Unwritten Law Homicide 110 Acknowledgment of Invitation .... 11(1 A Strange Proceeding 234 Apropos of H. K. Thaw 236 A Rational and Villainous Brain Storm 237 An Over Brain Strained Signal Man became Insane 241 An Extremely Young Girl Suicide 248 A Rare Note of Thankful Obligation From a Rare Attorney 258 A Rigid and Right Investiga- tion 260 A Just Court Decision. Hot Water in Ear is "External" Injury, Rules the Court 262 American Editors Association 262 A Victim of Bromidia Self-Medica- tion Folly 400 A Rhapsody on Exody 40G A Deadly Lively 407 Antivivisection Defeat—Thanks to Dr. S. Weir Mitchell 411 A Pitiable Cocaine Slave 411 A Would-be Patricide of St. Louis 417 A Bee Sting Causing Fatal Tetanus 418 A Vision at the Vatican 418 A Deluded Christopath 4 IS A Peculiar Display of Psychic Ep- ilepsy 121 A Relapse to Barbarism 422 A Case of Folic Raisonante—Com- mitting a Sane Man to an Asy- lum 424 An Eastern Rabbi 494 A Cruelty Working Law. . . - 501 Aged Authors, the Temperate Life and Louis Cornaro 503 Another Insane Stabber 505 Alexander Smith 500 A New Journal 511 A Street Car Roadside Illusion and Delusion 511 American Superlatives and Dr. Men- del 512 Beverly Farm School 109 "Brain Storms, the 'Exaggerated Ego,' A Layman's View.". . . . 244 Brutal Vivisection by a Brutal Med- ical Student 490 Barnes Medical College 501 "Baffling to Medical Science" 505 Correspondence—Feinting, Faint- ing Bertha 205 Condition of Cuban Insane Asylum 10G Chronology of Dowie and Zion City 238 Christian Science has a Rival 254 Criticism of the Rulings of Judge Fitzgerald 403 Chorea Considered as a Neurohu- moral Disorder 254 Cruel and Absurd Treatment 413 Dr. Burrel, the President Elect of the A. M. A 500 Dr. C. C. Wiley 99 Index. v Dr. James L. Greene 110 Death of R. Harvey Reed of Wy- oming 236 Dr. Clarence Martin 2-18 Dr. Perry on the Pathology of Dia- betes 251 Dr. Herman A. Sante 262 Dr. Kiihn 418 Depressive Insanity 495 Dr. Edward K. Taylor 514 Dr. Albert Warren Ferris 514 Dr. Julius Grinker 514 Etiology of Speed Mania 101 Evelyn Thaw and Her Drugged Drink 246 Erotically Inspired or Erotopath- ically Impelled Virtue and Vice 5(15 Failure to Recognize Nervous Influ- ence in Hand-Writing 416 Hedonic Erotopathic Perversion . . 513 Hysterical Monopalsies 107 Hysterical Stigmata in Court. .. : . 251 In Line With the Address of Victor Horsely 101 It is Unfair to the Insane 235 It is Unfair to an Insane Person.. . 235 In Insanity, Appearances are De- ceptive 235 Inadequately Qualified Psycholog- ical Experts 242 Insanity is a Disease 243 International Congress on Psychia- try, urology and Psychology 252 Insanity and Responsibility 409 Improved Health Conditions on the Panama Canal Zone 410 Is it an Evidence of Psychic De- cadence? 509 John Alexander Dowie 238 Judicial Misconception and Wrong Definition of a Wound and of Insanity 414 Kuroki and Gages Skull 402 Knepelin's Critic, Dreyfus 494 Lombroso and Thaw 96 '' Legislative Schemes of The Amer- ican Medical Association.". . . 104 Lord Rosebery's Brilliant Idea of the Cause of the Increase of Insanity 108 Life Sacrifice of a Surgeon and Phy- sician 502 Lay Appreciation of Physicians.. . . 508 Lithium is a Degradation from Copper 513 Labor's Right to Rest 417 Minimum and Non-Alcohol Pre- scribing 250 Making Steel and Killing Men 511 Mendel, Sanson), Hitzig, Steffani, Foster, Broadbent and At- water 514 Now it is the President 216 Night Medical School not Satisfac- tory to State Board 493 Noah Webster as a Spelling Re- former 504 Numerical Race Suicide 508 Xew Phase of Psychological Expert Testimony 514 Our Proprietary Pharmaceutical Allies 103 Ohio Insane Asylum Ex-Employes Indicted ..' 239 One of Those Erotopathic Women 245 Opium-Bromid Treatment of Ep- ilepsy 247 Overcrowding in Hospital for the Insane 498 Placebo Philosophers and the Bis- marck Archipeligo Experiment 92 Physiology and the Physician 93 Psychic Sanitary Sense Corning to the Senate 100 Index. Police Euthanasia in San Francisco. 110 Pyrophiles and Pyrophobes 233 aranoiac, Pyromaniac and Hom- icide 233 Po Old Dr. Dowie 240 Public Recognition of Medical Men 258 Promoting the Unstable and Con- serving the Stable Neurone. . . 422 Poliomyelitis Anterior 496 Quinine as a Defense of Crime 110 Refusing Epileptics Table Salt.... 248 Right, Mr. Times 410 Recuperation From Cerebrospinal Meningitis 502 "Sight Unsen" Lawyer and Doc- tor Choosing 105 Shall State go Backward with its Insane? 400 Sometimes in Our Social Life 419 Sclerosed Blood Vessels (New View) 420 Suicide Pacts 423 State Fair—New Features 424 Stuttering Treatment According to Scripture 495 Some Alienist Medical Opinion. . . . 502 Sajous Says the Source of the Op- sonins 510 The Alienist and Neurologist 90 The Professional Endeavor 101 The Aching Tooth and the Motor- man 107 The Name of the Journal 108 The Study of Mental Diseases 109 The Life Courteous 109 To Awaken Every Psychic Neurone 109 Two Insane Fratricides in One Family Ill The Unqualified Exaggerated Ego. 230 The Journal of Inebriety 232 The St. Louis Alamagordo Tuber- culosis Sanatorium 233 There May be Grave But Masked Delusion 235 Toxic Insanoid States and Delirium With Consciousness 240 The Strenuous Unrestful Life 241 The Farcical Trial 243 The Paratereseomaniac 245 The Spread of the Impulsive In- sanity Idea 246 The Tetanic and Septic Dangers of Gelatin 248 The Childs Physiological Magna Charta 249 The Public Conscience 250 The Unstable Psychic Neurone. . . . 250 Thaw's Insanoid Morbid Egoism ... 255 The Kith International Medical Congress 256 The Cinemetograph Demonstration 257 The Blood Pressure in Cases of Par- etic Dementia 259 10,937 Railway Casualties 260 The Calingas of Luzon 401 The Insanity of King Otto 401 The Purposes of the Public Health Defense League 402 The St. Louis Censor and the Thaw Trial 408 The Time is Now Propitious 413 The Nudity Fad 414 The Unstable Neurone at Blees Academy 419 The Farmer's Wife and Insanity. . 419 The Arizona Man-Woman 421 The Death of Theodore Tilton 422 The Weekly Medical Review 424 The American Association for the Study of the Feeble Minded . . 425 The Amsterdam Congress 894 The Twenty-Ninth Year 493 The New Science-Eugenics 496 Index. vii The Million Mark 496 The Last Almshouse Lunatic 496 Therapeutically Enjoined Self- Denial 496 The Cocaine Fiend 497 The Health Rights of the Citizen 501 The Egoism of the Insane 504 The Nervous System and Diabetes Was Pavy's 500 The Alternating Insane Automat- ism of Suddenly Suppressed Epilepsy 507 The Testimony of a Woman 510 Two Hoboken Doctors 510 The Force of Mind in Medicine. ... 511 The Fiction Serial 515 IN MEMORIAM. Alexander E. Macdonald 115 Dr. A. V. L. Brokaw 112 Dr. Alonzo Garcelon 114 Dr. William James Herdman 114 119 Clinical Neurology— Chorea Double Consciousness Before the American Neurological Asso- ciation 117 Juvenile Albuminuria 270 Nervous Phenomena During Pass- age of Chyme Through Pylorus 207 Rabies 120 Rare Affection of the Pyramidal Tract With Spastic Spinal Paral- ysis and Bulbar Symptoms.. . . 527 The Pathogenesis of Facial Hemi- atrophy 268 The Insanity of Inebriety 269 The Tarsophalangeal Reflex 526 Three Cases of Lingual Neuralgia... 528 Clinical Psychiatry— Emotional Control of Japanese Women 525 Meeting of N. Y. Hospital Physi- cians for the Insane 524 Neurophysiology— Cause of Soft-Shelled Eggs 431 Neuropathology— Brain Tumor 529 Death of Theodore Buhl 263 Dr. A. E. Sansom 516 Dr. F. V. L. Brokaw 510 The Death of John F. Magner 113 SELECTIONS. The Microbe of Poliomyelitis 529 Neurotherapy— Alcohol in Diabetes 277 Biers Congestion Treatment 522 Dionin 274 Dr. Hawkins 277 Extensive Lumbar Anesthesia. ... 521 For the Last Few Years Pharma- cists and Physicians 517 Further Experience With Opsonins 273 High Intensity Galvanic Current in Trigeminal Neuralgia 518 Loaf Sugar in Diabetes 523 On Sedative and Hypnotic Therapy 520 Pharmacological Properties of Syn- thetic Suprarenin (Adrenalin) 519 Spinal Anaesthesia in Tetanus 518 The Treatment of Noises in the Ear Upon a Diet Free from Salt.. 275 Veronal in Tremor 432 Neurosurgery— Some Mental Symptoms due to Disease of Nasal Accessory Sinuses 281 viii Index. Surgical Treatment of Paralysis. . 523 Psychiatry— Potomania in a Child 524 Neuroophthalmy— The Tenotomomaniac 271 Neurosemiopathy— Abortion as a Cause of Tetanus. . . 273 REVIEWS, BOOK A Study of the Motor Phenomena in Chorea 123 An Illustrated Announcement 128 Advancing St. Louis Art Value in Developing a City 538 Anatomy of the Brain and Spinal Cord 539 A Brief Sketch 540 A Plea for the More Energetic Treatment of the Insane 541 Anales Del Cuarto Congrcso Medico Pan-Americano 542 Conservative Gynecology and Elec- tro-Therapeutics 127 Clinical Psychiatry 434 Dictionaire de Medicine et de Thera- peutique Medicale et Chirur- gicale 531 Diseases of the Rectum, their Con- sequences and Non-Surgical Treatment 537 Folia Therapeutica 434 Historic Notes of Canadian Med- ical Lore and Lecture Mem- oranda 120 Humanity 128 Internal Secretions and the Princi- ples of Medicine 532 International Congress 537 L'Aime et le Systeme Nerveux . . . 531 Nervous and Mental Diseases 130 Neurographs, a Series of Neurolog- ical Studies, Cases and Notes 283 Paton 537 Public Health 538 Patons' Psychiatry 285 Preliminary Medical Education. . . . 536 Recollections of a Gold Cure Grad- uate . 125 H.«MONEUROTHERAPY— Opsonic Therapy 278 Neurovascular Pathology— Hemotoxic Etiology of Atheroma and Arteriosclerosis 430 Senator on the Causes of Arterio- sclerosis 426 Neuro hematology—: Blood in Asthmatics 431 NOTICES, ETC. Rhythmotherapy 285 Saunders Complete Catalogue 121 Starr on Nervous Diseases 122 State of New York 539 The Christian Register 124 Text Book of Psychiatry 124 The St. Louis Courier of Medicine 126 The National Geographic Magazine 126 The Hesperian 127 The Spectator 127 The Program of the Fourth Annual Meeting of the Philippine Is- lands Medical Association .... 282 The Open Air Treatment in Psy- chiatry 283 The N. Y. State Commission in Lunacy 284 Text Book of Psychiatry.—A Psy- , chological Study of Insanity for Practitioners and Students 284 The Subconscious 285 The Nervous System of the Verte- brates 433 The Diseases of the Rectum 433 The Proceedings 534 The Diagnosis of the Nervous Sys- tem 534 The Asylum News 535 The Nervous System of Vertebrates 536 The Nature and Treatment of Pter- ygia 536 "The Hospital" 540 The Integrative Action of the Ner- vous System 542 Woman 121 W. B. Saunders Company 284 Wellcome's Photographic Exposure Record 286 THE ALIENIST AND NEUROLOGIST VOL. XXV1II. ST. LOUIS, FEBRUARY, 1907. No. 1. SOME PSYCHOLOGICAL STUDIES OF MAN'S MORAL EVOLUTION. By ALBERT S. ASHMEAD, M. D., New York. I. THE MYSTERY OF OUR KNOWLEDGE OF GOOD AND EVIL—ITS ZENITH AND ITS NADIR.• THE occult power of evil is remembered also in an in- cident 1 have before related, of the breaking of a goblet by a little black imp, seen only by the mother of an absent child. This mother was tying on her couch and the goblet v\ as upon a table. She saw the black elf, stand- ing on the table beside the goblet, raise a hammer as if to strike the goblet rim. She cried out, "He is going to break it;" "He will break it;" "He has broken it." And it fell in a thousand pieces to the floor. At that very moment the breath of her dearly beloved child had left its body, in a distant city. I recall also the story of the voice which a gentleman heard, who was traveling eastward from San Francisco. It commanded him to "Go back." Finally by its persist- ing, on going to the baggage car, at some stopping station, where he had determined to obey the strange command, and •Continued (rom November, 1906. 2 Albert S. Ashmead. where he supposed he would meet with much trouble to find his trunk among the multitudinous baggage, he found the baggage car door open and the baggage master with his identical trunk awaiting him. The baggage man stood there, with his hand resting on his trunK ready to pass it out to him. Upon his return to San Francisco, by the back bound train which passed the station where he got off a few min- utes after he had left the east bound train, he found his old father breathing his last. He lived but two hours after his son's return. "Ah!" says the Fatalist or the Occultist, "I have neither faith nor reverence. There is no Free-will. We are all helpless." It is worthy of note here that the advance of hu- man insight into natural law is accompanied by the cast of thought indicated by the Buddhist's belief in Nirvana. The occult must be approached by the path of Reason. All that happened to Dr. Love for instance, is happen- ing daily to everybody. On the doctrine of chances, could there have been a concentration upon his family? or, was there a Direction, an Intention? Another case, that of a Dr. Patterson, is likewise here pertinent, and directly in line with the theory of involun- tarism; and the review of this case by the alienist, Dr. Mc- Guire, shows in mentality, all the mind phenomena; the same simulation, dissimulation, and later determination, that Nature exhibits in bodily ills that our medical profession devotes itself to studying. Dr. Patterson, of Colorado, gloried in his criminality. "When a child," he says, "I felt the influence of heredity, felt that I was born to be a thief." "It is necessary," he says further, "for society to protect itself against men of my class." 1 agree with him, and I also believe that he states the truth as to his feelings. Society must protect itself against lunatics, without conscience and without remorse. But are these beings really lunatics because evil, as we know it, has obtained possession of their bodies, brains and other cells? For years a careful student of criminology, taking the deepest interest in the study, because he recognized in himself the proof of the theory that a criminal is what he Man's Moral Evolution. 3 .s because he is born with instincts, the development of which neither environment, fear of punishment, social os- tracism nor anything else can prevent, this Dr. Patterson, now confined in a cell in the jail at Denver, was arrested on a charge of forgery. In his early years he fought against his inherent desire to take what belonged to his fellow man, because of the disgrace that he feared his father, mother, and other loved ones would suffer from his actions, and for the sake of his wife and children, he continued to wage the unequal battle. It was heredity versus environment, he de- clares, and heredity won. This is the excuse he gives for his present condition. From a man of prominence and an heir to great wealth, the police found that his fall was so complete that he was living in the most abject poverty in a dingy room in the lowest quarter of the city. "My one great regret in life," he says, "is that I have fallen a slave to the morphine habit and, unable to resist its use, have failed in my ambition to become the greatest criminal of the age." "I glory in crime and am a criminal because it is im- possible for me to be anything else. 1 have tried and failed, and am glad of it. The fight was unequal at best, and I am glad that I finally started out in a career of crime and that 1 have committed thefts and burglaries, have stolen into houses at night time and taken property that belonged to others, for the pure love of it. "I did not need the money, did not want the booty that I took away after I got it, but there was a satisfaction too deep for words, too self-satisfying for explanation. 1 imagine that a woman who has held her lover at arm's length and perhaps for the best of reasons, has refused to surrender to him for a long time, must feel much as 1 did when 1 committed my first theft. It was not much, too little a thing to notice, yet it was the beginning of a career that I mapped out for myself after 1 fully realized that there was nothing in the world that could prevent my be- ing anything but a thief. I was in a fellow physician's office and I saw a pocket book lying on the table. He was 4 Albert S. Ashmead. busy with a patient and I opened the wallet and found two dollars in it. I then had plenty of money and the contents of the purse could do me little good, but resist the desire to take the money I could not and did not. I knew that the high character 1 bore would protect me from the possibility of exposure, and the cunning, which I have since learned and which I use to protect me from being found out when I succumbed to my desire to take possession of that which does not belong to me, was not necessary in that case. That was years ago, how many 1 do not know. It was the beginning. "My father and mother were of the highest character. The desire which impelled me to take the marbles of other little boys, to filch the pockets of my school-mates, when their coats hung in the coat-room, came from further back than my immediate ancestors, just as the genius of a great painter, or that of a great writer or poet, is inherited from ancestors further back than can be remembered. The de- sire to commit crime is similar to the desire of a genius to develop the talents which are his. It is often the strongest passion of his life and for which he will give up every thing else, just as an artist will struggle along for years, going without the necessities that he might have in some other walk of life, that he may develop the talent which he feels within himself. "Born a criminal and forced by a power which cannot be understood to commit crime, I am no more responsible for what I am than are any of the geniuses of the age for what they are. The world honors these men and gives them credit for the work they do because it adds to the world's store of knowledge, but the men who do great things do not do them because they wish to add to the comfort and enjoyment of their fellowman, but because they can do nothing else. They have to do these things because they are made to do them. They do not deserve credit for what they accomplish, and a thief does not deserve censure for the harm he does to society. We can do nothing else. It is a part of him, of his very nature, to steal. "It is as impossible for me to lead an honest life as it Man's Moral Evolution. 5 is for some other men to become criminals. The criminal instinct, however, is more common than the instinct or de- sire to accomplish great things for the world's good. All criminals are not alike and all are not affected by the same impelling force. Some are murderers and cut-throats, others are sneak thieves and porch climbers, and then there are men and women, too, who take the greatest satisfaction in robbing the less wary by their greater wit and cleverness. No class of mechanics take greater pride in their work than first-class cracksmen, who overcome the thousands of ob- stacles put in their way when they wish to open a vault. So marvelously skillful are many of these men that if they used the same energy and talent at honest employment they would be great inventors and would receive money and fame for what they accomplished, instead of being so- cial outcasts and always in danger of a policeman's bullet, or of a jail sentence. The risks they take in comparison to the rewards of their work are so great that, considered from a practical standpoint, the business does not pay. "Doubtless there are many robbers and thieves made so by necessity, but such men never become experts, and when the opportunity offers go back into legitimate lines of work if not captured by the police. Some among them have the criminal instinct in a degree, and when necessity compels them for the first time to commit a crime, it awak- ens the heretofore dormant instinct in them, and from that time on they are confirmed enemies of society." The questions connected with the case here cited, which criminologists are most deeply interested in are these: Did Dr. Patterson's constant association with criminals, his deep interest in their lives and the trend of their thoughts wear down his powers of resistance? Did the use of morphine during the later years of his life warp his mentality and blunt his perceptions? Were his criminal acts the result of rapidly approach- ing senility or, were they the result of congenital in- heritance as claimed by him? In answer to a hypothetical question Dr. Frank Mc- Guire, one of the best known alienists and criminologists, 6 Albert S. Ashmead. said: "It is held by a number of celebrated alienists that the moral and intellectual spheres of thought are separate and distinct. I cannot think so. 1 do not believe that you can have the moral sphere seriously involved without in- volving to a certain degree the intellectual sphere. They may not be closely linked, but there is a certain connection between them. "The instinctive moral sentiment of a person will often rise above adverse environments. Children, when young, will show the moral sphere instinctively. Place many men in bad surroundings and they will still be moral. Take a man whose morals are blunted, for instance his intellect may be above the ordinary, but he may be a criminal from acquired habit. "The man referred to in this question, Dr. Patterson, is evidently a congenital criminal with a high grade of in- tellectuality, with which he covered up his crimes. This intellect led him to be careful. It placed him in a position which made his crimes safer and made him a much more dangerous man. He concealed his congenital moral defect under the garb of eminent respectability, because he had intellect enough to carry out the deception along that line. "That he was a forger was most natural. The more intellect a criminal posseses the higher the class of crime he will engage in. The only inconsistent thing about this case is the fact that the man committed burglary. This crime belongs naturally to a lower grade of intellect. It re- quires brute courage. Forgery or embezzlement, or high class sneak thievery would be more in line with his intellect. "Certainly morphine may have had something to do with it. Again it sometimes happens that there is evidence of moral defects in senility. "The man's instructive nature evidently exercised a considerably greater influence upon his actions than did his intellectual nature. The defect of his moral sentiment might have been the result of defective organization, as he claims. "The instructive moral sentiment as a rule rises above defective environment although the moral attibutes of the mind are equally as transmissible as the physical. Man's Moral Evolution. 7 "Criminals, as a whole, may be divided into four classes as follows: First—Criminals whose moral sentiment is absent, or slightly developed and the intellect poor. These may be called born delinquents. Second—The insane delinquents whose moral sentiment is absent and the intellect so far developed as to be above the ordinary. Included in this class are congenital criminals and criminals from acquired habit. The criminal Patterson is probably of this class. Third—The moral sentiment is developed and guides the ordinary condition of the individual, but has feeble pow- ers of resistance. The mind is influenced by emotions. These are passional delinquents. Fourth—The moral is more or less developed, but be- comes perverted by a mental defect, epilepsy or alcoholism, the diseased brain giving new factors influencing the con- duct of the individual in his relation to society. "You may find all criminals under one or the other of these classifications, and 1 am pretty sure that the man we are speaking of comes under the second head. He resisted crime so long because his instructive sphere was stronger than his inherited tendencies. "Amputalion of criminals' brains? Oh, no! Not until they begin to come into the world with a tag on each con- volution of the brain telling just what it is for." Dr. McGuire's closing remark on brain amputation is, to my understanding, an expression that Nature (or God) is Drooerlv oresentod bv the story of Eden, a heartless malefactor, whose evil worK Physicians and Pulpits have ever tried to undo. Vain labor! Individuals are comforted bv them. But always a throng toward a Mecca. Faith is an utility, not an evidence—a mixture nine parts Resignation, one part Hope. It is a matter of Temperament and not of Will. Many appear to have faith, who have it not—it is with such a business asset. Ingersoll has said: "No man has eone beyond the hor- 8 Albert S. Ashmead. izon of the Natural. I do not know whether the grave is a door or a wall." Youth is the only period when we bound over rough waters; as the age of 60 approaches, or is reached, a ma- lignity and persistence appears which is disastrous, though it may not be any more serious or portentous than the stumbling blocks of the earlier decades of life. All the day, like a cataractous one, we look through a fog. Yet we walk along freely using no more care than is required of the life pedestrian usually. But when the night time comes, we see more clearly, and do not feel that we have eyes. We are indifferent. Faith perhaps we have not. Resignation we possess, certain of a fixed and active principle of Evil to Nature, to which each being is to some degree and from time to time, a victim; the world has no more interest for us—it is the daily Eden and the creeping Serpent, with the Master looking on. Aided by the cool foggy air of late life, and the gray dawn of the approaching day, we may read the most interest- ing revelations like that of immorality in Japanese life, (which 1 published in the Journal of Dermatology, July, 1906.) Only the more hopeless does it cause to appear the plan of the Natual Law. The two human civilizations, Occidental and Oriental, are now inpinging each upon the other—in obedience to the great principle of dissemination, the indiscriminate dis- semination everywhere seen. The plan of the union of the White races against the Yellow as suggested by the paper of Mr. Stein, of our de- partment of Commerce and Lnbor (Pan-Arya) would cer- tainly introduce among Occidentals the most dreaded feat- ure of Oriental life. The military success of Japan in the late war will be used to show that there is no God, or no Christian God, and that immorality has not weakened a people—no thought being bestowed upon the fact of Negro and Malay parent stock, the great animal base of the pres- ent human pyramid being there seen. In striking (and strange) contrast to the evil side of Oriental character 1 quote here a lyric and an extract from Man's Moral Evolution. 9 Lafcadio Hearn's latest work. They are so beautiful (no matter what their source) that 1 have selected them for the comparison:— JAPANESE LYRIC. My little bird, My bird born in my mother's tears, She flies, stretching her wings so, And from under her wings she drops my mother's message:— "Come home, Beloved!" Running out from my mother's bosom my little river, She suddenly stopped her song And looking up to the sun, She in her ripples flashed my mother's message:— "Come home, Beloved!" My roses, My little roses grow in my mother's breath; They are sad today, Casting their faces down, In their petals I read my mother's message: — "Come home, Beloved!" (Youe Noguchi, in National Magazine.) In his book "Kotoro," in the chapter entitled "After the War," Lafcadio Hearn, who was present at the return of the victorious troops at the close of the war (the Chinese- Japanese War) said to his old servant Manvenon: "Today you will be in Osaka and Nagoya. You will hear the bugle call and with its appeal you will think of vour poor comrades who shall never again see home." The old man replied with quiet earnestness: "The people of the West believe, perhaps, that the dead never return. But we think otherwise: the Japanese dead all return, they know the way. From China and from Choisu they will come, and those who rest on the bottom of the sea, they all turn back—all. And when the darkness comes they will assemble together and impatiently await the signal call." In our last analysis of the Visible we see it is the Beauty and the Beast that has passed before us on the Kialto of life. That which the Great Playwright hath wrought the actors must do—their parts in life are not of their seek- 10 Albert S. Ashmead. ing and they cannot escape that from which they would later flee. Mr. Layton Crippen, a recent reviewer of Mr. Hight's book "The Unity of the Will,"* makes himself more con- spicuous than the book, that he leads the reader to expect would be presented. If I correctly apprehend the so-called review, the reviewer hides his incompetency under a garb of flippancy. Mr. Crippen is the author of "Olympus, and Fuji-Yami" (the Japanese Holy Mountain). He calls his review of Mr. Hight's work "The Mystery of the Human Will." Mr. Hight takes it for granted that the Will is the pri- mary reality; that the intellect is its instrument, and he gives credit to Schopenhauer for being the first philosopher to make this plain. Surely one can object to this conten- tion. Schopenhauer's philosophy was that of Buddha, it was that of Paracelsus, it was that of Jacob Boehme, it was that of the Oriental and Occidental mystics for thou- sands of years. "For God is but a great will pervading all things by nature of its intentness"—it is not necessary to say whence that quotation is taken. The sense of the Will inspired the greatest poets of the world; they, like Mr. Hight, feel that "all creation is permeated through and through and animated by an all- ruling Will, which is eternally striving to actualize itself in phenomenal life." This is Mr. Hight's central thought, and his argument is carried forward with a directness, a logic, a careful avoidance of unnecessary technicalities that are admirable. When it is said that on reading the work one fails to find a page that is superfluous it will be evident that even to give a bare outline of the thought in a brief review would be impossible. Here are one or two sentences from the chapter that takes its title from the title of the book, which will give some help to a realization of the idea: "A miraculous force is seen welling up from the depths of nature, shaping, adjusting, creating; whether we call it "vital force" or "psychical law" matters very little; that •The Unity of the Will. Studies of an Irrationalist. By George Aiiislie Hight. New York: E. P. Dutton & Co. $8. Man's Moral Evolution. 11 depends upon our own individual standpoint, but the im- portant thing is that it is one, and is tending to one end through all the varied means, through adaptation, strife, failure, better adjustment, and final survival of the fittest; often failing and again beginning with renewed effort till the end is gained. No one can see the will; but what if does we see, and if it cease the action also will cease. Our consciousness, the onlooker, shows it as a judge, 01 referee, allowing or disallowing, but taking no part in the action, only using physical causality as the instrument of its projection into objectivity. Every action is possible to the will; it is all-creative; as every pattern is possible to the lacemaker sitting with her bobbins before her, and weav- ing, by simple movement of one thread and another, just that web which she desires; as all literature is open to the typewriter, who produces the sentences he wishes for by touching the levers in turn, never breaking the causal se- quence, but simply pressing or abstaining. Thus do the varied causal actions of the Universe lie readv before the will to allow or disallow as it pleases; the levers are in do sition, and as it presses with the mechanism ot a human brain now one and then another of them, as it reacts me- chanically to an impression, or lays it by for the future, furnishes or withholds a supply to meet a demand, so it brings forth the harmony of active life. For that harmony which enables each thing to fulfill its functions among oth- ers around it, which makes it appear as if designed to ful- fill a purpose, that, and not the material composition of its substance, is its true being." Such, briefly and quite inadequately suggested in this review, is the main idea of Mr. Hight's book. But there is another purpose in the work—a purpose to which the development of this main idea is perhaps only incidental in the author's mind. "The Unity of Will" is a bitter, pow- erful attack on modern science. In grave words, Mr. Hight warns civilization of the peril, which in his opinion, threat- ens it: "Science now assumes the control of civilization, as once did theology, and its career will be the same. Wi" anw 12 Albert S. Ashmead. one deny that rationalist science commits the sophistry of seeking to prove and disprove by words alone things for which no data exist, that it assumes artificial concepts of things unknown, or that logical theory in upholding the su- premacy of reason abets it therein? A glance at any aca- demical journal will show what our universities understand by knowledge. Questions are discussed which never can be answered; views expanded which never can be tested, because they deal with things long passed away and un- verifiable; "authority" means the opinion of one who has read most of the opinions of others, anJ this is called eru- dition. * * * "It will doubtless be urged that there is nothing in mod- ern science to contradict the existence of an unseen world; the evidence for it has often been dwelt upon by scientific writers themselves. Only the two worlds are separate; science merely regards the one as lying beyond her sphere, because to confuse the two would hinder her own special work. "What can be more innocent than agnosticism?" says the follower of science: "I do not choose to say that I know what 1 do not know." It is not the modest con- fession of ignorance that one wishes to find fault with, but the aggressive, intolerant attitude which science adopts to- wards those who go elsewhere than to her for inspiration; who choose other methods than those which she prescribes; her aggressive controversies, made to rest upon words for things which do not exist, such as the word miracle. If to think that what is wonderful must be the work of God be a thing so dreadful that the whole artillery of science must be brought to destroy it, then Heaven help us, for we all think it!" I do not understand that the author considers the "Mys- tery of the Human Will," but, rather the question, whether there is to be seen evidence of the Supreme Will of an In- telligent Designer; who has ordained and instituted a Plan and left the details of the operation, indifferent towards the fates of individuals—in which case there exists no mystery of the human will—for human will does not exist. Man's Moral Evolution. 13 My view of the Plan is quite definite, and, I believe, consistent in all its parts. It has come to be admitted that Nature is Energy. But energy and force are confusedly used. Let me present the following: Force is localized Energy. Under that form- ula, Unity is seen. The diffused heat and light of the sun is localized as to results of animate and still life on earth according to soil, latitude, altitude. It is the Plan with which we come in contact; the Plan that we can in a small degree, as to its relation to our daily fortunes, get a glimpse of. But its Creator we are not permitted to approach. Before the Great Unknown we can only grovel and cry: O, God where art thou! Why go so far afield? We are not wanted there until the ultimate is reached. Looking and longing we are no more advanced in the knowledge of God than isthe dullest or the wickedest savage. All that is refined and pleasant in this communal life of men has been wrested from the brutality of nature in the efforts of man to con- struct ethics and codes for the protection of himself and his posterity. Let man apply himself to work, and pass theory. To some extent (perhaps wholly) I continue the thoughts dimly expressed, evoked by the "review" or notice of Dr. Hight's book "Unity of the Will." It is the "work" of the world in which each human atom is individually engaged without the slightest will of his or her own. It is the evidence of involuntary "Natural Selection." To me (if'I may not be deemed as making myself too prominent) has come the joy of unmasking (from my experience) the duplicity of the Divine Order of things. To me it is in addition to the humanity of my profession, its solaces, etc., the war upon Japanese monstrosity, and the enlightenment for the social system, as to what is com- ing against them, and as to which, the West, in its Chris- tian altruism and egotism it is surely coming in contact. Professor Cook's Evolution (Kinetic) in man (see Relation of Man to Nature [Medical Fortnightly] by myself) involves kinetic Evolution: and the agents on each side are as in- voluntary as are the seeds of food, or of famine that are wafted over the face of the earth by the airs of Heaven. 14 Albeit S. Ashmead. If sentience to some degree exists in everything (as some horticulturists have come to assert, and as Haeckel in his "Insulinde" as to particular vegetable growth suggests ex- perimentally), can the green and later rich and glowing grain have altruistic satisfaction at the contemplation of the process that it must undergo in its mission towards the amelioration of the life of contemporaries, all looking under the belief (and truth) of a Divine Plan for a glorious outcome for all millions of years hence? It is against this egregious Fallacy that I protest—a Fallacy because in no relation except that of the Unknown is it tolerated. It may be (and is) said that the universality of such a belief or trust or hope (with its varied and often grotesque expressions) is an indication of the probable benign purpose. But, what is benignity in futuro? Bah! It is but a word with which to conjure. It is the juggler's trick. Sup- pose we assume confidently that it is of serious import, leading towards and finally to, a substantiality. Shall 1, for instance, be content; shall I, for instance, roll my vi- carious blood as a sweet morsel under my tongue, and die with the contorted face of agony, content to have it inter- preted by the favored onlookers as the smile of rapture? No! Ever No! That which is not just between man and man, is not just between God and man. 1 stand for a "square deal" and for it I will stand ever while on earth, as between God and myself, I fear not. Under what is called The Divine Plan, what is Life except a play of Harpies? What is the preaching of the pulpit except a gloze, or a shiny glaze, upon the surface of a treacherous interior, of God ordained? What does that gloze, or glaze, except to conceal the devilishness of the system? What system? The System Divine. What mortal can successfully contend against it? Not one. Shall it be further insisted that Christ (of the Occidentals) was the Son of God, sent to redeem the world and bring it back to God, when surely as the sun will con- tinue to rise day after day, Orientalism in its hideous feat- ures will come out and make hold upon and pervert that from which it has been hoped the world was free— Man's Moral Evolution. 15 the New World? Indeed, that which was known only sub- rosa (of Japanese, for instance). Yet only by such laying bare can the world be fore- warned. The discouraging feature is that while the "Di- vine Plan" will thus (hopedly) exterminate the Evil by showing the Japanese the quality of their fancies, thousands upon thousands of the anti-pathetics will themselves become victims. This is the devilishness of the Natural Law, the law of God. It is the devilishness of our Occidental God Himself if God there be. These be temperate and sober words, and by them I will stand. I feel an earnestness I cannot suppress. Omar Khay-Yham asks God "to man's forgiveness give—and take." God, I make bold to say, is to be pardoned; it is not for Him to pardon man. And such is the lesson of the Story of Eden. The Kaiser of Germany was right in warning the people of Europe to preserve their "highest treasures". ("Volken Europas, wahret eure hochsten Giiten." Wilhelm II). But what does it mean except bloody war or heart- rending silence? Doctors and Reverends, out with the sickly sentimental idea of God and Heaven! Let us teach what God is as developed by His contact with the face of the earth; let us no longer conceal His "true inwardness." Let us take the Proverbs of Soloman, and hang them upon the walls of our dwellings, of our schools, of our lecture rooms. Let us be a serious people. Let us do away with sickly namby-pamby pulpit-pratings, or pulpit-platitudes and pretences. Let us have common sense. When the son takes up the catechism and reads a page of questions and answers, and looks at his father and says: "Do you believe that?" and the father makes no reply; and the boy says: "If you do not believe it, how can I?" and shuts the book and leaves the room never to open that book again, what has been the result of that Church nonsense except to put the child wholly at the mercy of the world as it is, which is not the world that the goody-goody gush has poured into his ears. 16 Albert S. Ashmead. We know that "The System" is such a tangled web that in the warp and the woof, good and evil are inextri- cably mixed. Let us say so. The responsibility is with God Almighty. Man is to be blamed for nothing. As I have fre- quently pointed out, pagan and immoral Japan has become the bete-noire of the modern civilized world. Herein is to be found again, as always, the aggravation inflicted upon mankind. But all this lament, and energy of thought is but waste. All is naught, joy and jest: travail and tears: the old, old story. All crime is the crime of Nature against man and man- kind. But man, the individual, takes upon himself the blameworthiness for the result. Let us be reasonable; let us be as logical as our reason- ing powers shall permit. If we are not responsible for the activity of our brain and tissue cells (as believers in heredity of crime tell us), then are we indeed involuntaries, and are immediately brought to stand with Calvin, who preached that a certain number of infants are born to be damned. He meant a per cent, of course. What difference between him and Karma (the Sanscrit merit and demerit of intelligent existence) as I understand the teaching of Karma? Each presents a con- tinuing Good and a continuing Evil. But in the operation of The Plan the good is not immune against evil, and the work of demolition goes ever on. Here and there Good modifies Evil, and Evil deterioriates Good, where it does not destroy the Good that it attacks. But Good perseveres in reproducing Good, and Evil perpetuates itself. If they are relative terms then indeed is man unfortunate in all his speculations as to a Divine Immaculate, for the Immaculate is not deemed to be in charge of man's welfare on earth. Then our God is not Purity, Goodness and Truth. Indeed, what fair argumentative ground have we for supposing that we have such a Divine Governor? Man is a product of evolution. His statutory and social laws he has made to protoct himself against the great principles ac- knowledged by Calvin and Karma—the Occidental and the Man's Moral Evolution. 17 Oriental. The one is aggressive; the other passive. Ex- tremes meet. Calvin would use fire and sword; Karma would sigh and fold the hands with conviction of utter helplessness. And the one would be as effective as the other. The Creator is alone responsible for every feature of life. Two refuges are presented: (1) Faith and the aban- donment of Reason; (2) Reason and the abandonment of Faith. The Rationalist has chosen the latter, and is content. Again extremes meet. When direct opposites come at last . to the same point—being the intended and desired destina- tion, then where shall man look for a guide? For a guide to calm? The Pulpit (a Religion) is best for the manv. Relig- ion is an emotion. The members of the congregation en- courage each other by the Sunday assembly. The Church must remain. We need it, as a community; as a nation we need it. . . Rationalism is for the individual. Each is an utility. We must select that which is to each the most useful. I look upon my underlined declaration in a previous paragraph: "All Crime is Crime of Nature against Man and Mankind," as final definitive of all my views (if my views are worthy of consideration); and I give it as a challenge to the world. 1 look upon it as a Crux, from which is de- pendent on all sides the spectacle that man is COMPELLED to behold. I have no apology to make for the definition; look upon it only as a form logical that has never before been thus plainly put. I do not in the slightest sense suggest that any one reply either with or against. It is my fight; and 1 believe 1 shall never be beatm. I am not a "crank." I recognize utilities; and I know so- ciety needs utilities. It is "utility" that makes society useful to individuals, without any dwelling upon the finally utile. This is not a "kick." It is a period. (To be continued.) EROTIC SYMBOLISM.* BY HAVELOCK ELLIS, M. D., Carbos Water, Lelant, Cornwall, England. There is ample evidence to show that, either as a habitual or more usually an occasional act, the impulse to bestow a symbolic value on the act of urination in a be- loved person, is not extremely uncommon; it has been noted by men of high intellectual distinction; it occurs in women as well as men; it must be regarded as within the normal limits of variation of sexual emotion. The occasional cases in which the urine is drunk may possibly suggest that the motive lies in the properties of the fluid acting on the system. Support for this supposi- tion might be found in the fact that urine actually does possess, apart altogether from its magic virtue embodied in folk-lore, the properties of a general stimulant. In compo- sition (as Masterman first pointed out) "beef tea differs very little from healthy urine," containing exactly the same constituents, except that in beef tea there is Jess urea and uric acid. Fresh urine—more especially that of children and young women—is taken as a medicine in nearly all parts of the world for various disorders, such as epistaxis, malaria and hysteria, with benefit, this benefit being almost certain- ly due to its qualities as a general stimulant and restora- tive. William Salmon's Dispensatory, 1678, shows that in the seventeenth century urine still occupied an important place as a medicine, and it entered largely into the compo- sition of Aqua Divina. Its use has been known even in England in the nine- •Oontinued from November, 1906. 18 Erotic Symbolism. 19 teenth century.* Bourke brings together a great deal of evidence as to the therapeutic uses of urine in his Scatalogic Rites; Lusinit has shown that normal urine invariably in- creases the frequency of the heart beats. But it is an error to suppose that these facts account for the urolagnic drinking of urine. As in the gratification of a normal sexual impulse, the intense excitement of grat- ifying a scatalogic sexual impulse itself produces a degree of emotional stimulation far greater than the ingestion of a small amount of animal extractives would be adequate to effect. In such cases, as much as in normal sexuality, the stimulation is clearly psychic. When, as is most commonly the case, it is the process of urination and not the urine itself which is attractive, there occurs a symbolism of act and not the fetichistic at- traction of an excretion. When the excretion apart from the act provides the attraction, we seem usually to be con- cerned with an olfactory fetichism. These fetichisms in the case of the excretia, seem to be experienced chiefly by in- dividuals who are somewhat weak-minded, which is not necessarily the case in regard to those persons for whom the act, rather than its product apart from the beloved . person, is the attractive symbol. The sexually symbolic nature of the act of urination for many people is indicated by the fact that Bloch, in enumerating various kinds of indecent photographs, refers to a group which he terms "the notorious pisseuses." It is further indicated by several of the reproductions in Fuch's Erotische Element in der Karikatur, such as Delorme's "La Necessite n'a point de Loi." (It should be added that such a scene by no means necessarily possesses any erotic symbolism, as we may see in Rembrandt's etching com- monly called "La Femme qui Pisse" in which the reflected lights on the partly shadowed stream furnish an artistic motive which is obviously free from any trace of obscenity.) The case in which Krafft-Ebing quotes from Maschka of a •Masterman, Lancet, i Oct. 1880; R. Neale, Urine as a Medicine," Practitiontr, Not. 1881. XArchivio di Famutcologia, fasos 19-21, 1893. 20 Havelock Ellis. young man who would induce young girls to dance naked in his room, to leap, and to urinate in his presence, whereupon seminal ejaculation would take place in himself, is a typical example of urolagnic symbolism in a form ade- quate to produce complete gratification. A case in which the urolagnic form of scatalogic sym- bolism reached its fullest sexual development as a sexual perversion has been described in Russia by Sukhanoff.* A young man of 27, of neuropathic temperament, who when he once chanced to witness a woman urinating, experienced voluptuous sensations. From that moment he sought close contact with women urinating, the maximum of gratification be- ing reached when he could place himself in such a position that a woman, in all innocence, would urinate into his mouth. All his amorous adventures were concerned with the search for opportunities for procuring this difficult grati- fication. Closets, in which he was able to hide winter weather and dull days, he found most favorable to success.t In a case communicated to me, a young man of aristo- cratic family, was accustomed to watch the movements of lady guests and, after they had visited their bed-rooms, immediately seek and remove to his own room vessels con- taining freshly voided urine. One day he was met by a lady who unexpectedly returned to the room she had just left. He was placed under medical observation, but was undoubtedly sane. In the apparently similar case of a robust man of neuropathic heredity recorded by Pelanda, there was mas- turbation up to the age of 16, when he abandoned the practice and, up to the age of 30, found complete satis- faction in drinking the still hot urine of women. When a lady or girl in the house went to her room to satisfy a need of this kind, she had hardly left it but he hastened in, overcome by extreme excitement, culminating in spon- taneous ejaculation. The younger the woman the greater the transport he experienced. It is noteworthy that in •Arckivu d' Anlhropolotie Crimintllc. Nov. 19, and AnnalUs Medico-psychologiques, February, 1901. t A somewhat similar case is recorded in the Archives dt Nturologit, 1902, p. 482. Erotic Symbolism. 21 this, as possibly in all similar cases, there was no sensory perversion and no morbid attraction of taste or smell; he stated that the action of his senses was suspended by his excitement, and that he was quite unable to perceive the odor or taste of the fluid.* It is in the emotional symbol- ism that the fascination lies, and not in the sensory per- version. Magnant records the spontaneous development of this sexual symbolism in a girl of eleven, of good intellectual development but alcoholic heredity, who seduced a boy younger than herself to mutual masturbation, and on one occasion lying on the ground and raising her clothes asked him to urinate on her. This case (except for the early age of the subject) is a fairly typical example of a sporadi- cally occurring urolagnic symbolism in a woman, to whom such symbolism is fairly obvious on account of the close resemblance between the emission of urine and the ejacu- lation of semen in the man, and the fact that the same conduit serves for both fluids.! A urolagnic day-dream of this kind is recorded in the history of a lady contained in Appendix B. History. The natural inevitable character of this symbolism is shown by the fact that among primitive peoples urine is sometimes supposed to possess the fertilizing virtues of semen. J. G. Frazer§ brings together various stories of women impregnated by urine. Hartlandll also records legends of women impregnated by accidentally or intentionally drinking urine. The symbolic sexual significance of urolagnia has hith- erto usually been confused with the fetichistic and mainly olfactory perversion by which the excretion itself becomes a source of sexual excitement. Long since Tardieu referred, under the name of "renifleurs," to persons who were said to haunt the neighborhood of quiet passages, more especially in the neighborhood of theatres, and who when they per- •"Pornopatioi," Arckivio di Ptickiatria, ta.sc. 111-iv., 1889, p. 866. tlnternational Congress of Criminal Anthropology, 1889. tPsychology of Sex, Vol. III. SPausanlas, Vol. IV, p. 189. WLtttni of Perms. Vol. I, pp. 76, 92. 22 Havelock Ellis. ceived a woman emerge after urination, would hasten to excite themselves by the odor of the excretion. Possibly a fetichism of this kind existed in a case recorded by Belletrud and Mercier; a weak-minded, timid youth who was very sexual but not attractive to women, would watch for women who were about to urinate and immediately they had passed would go and lick the spot they had moistened, at the same time masturbating. Such a fetichistic perversion is strictly analogous to the fetichism by which woman's handkerchiefs, aprons or underlinen became capable of affording sexual gratification. A very complete case of such urolagnic fetichism—complete because separated from association with the person accomplishing the act of urina- tion—has been recorded by Moraglia in a woman. It is the case of a beautiful and attractive young woman of eighteen, with thick black hair, and expressive, vivacious eyes, but sallow complexion. Married a year previously but childless, she experienced a certain amount of pleasure in coitus but she preferred masturbation, and frankly acknowledged that she was highly excited by the odor of fermented urine. So strong was this fetichism that when, for instance, she passed a street urinal she was often obliged to go aside and masturbate; once she went for this purpose into the urinal itself and was almost discovered in the act, and on another occasion into a church. Her perversion caused her much worry because of the fear of detection. She preferred, when she could, to obtain a bottle of urine—which must be old and a man's (this, she said, she could detect by the smell)—and to shut herself up in her own room, holding the bottle in one hand and repeatedly masturbating with the other.t This case is of especial interest because of the great rarity of fully developed fetichism in women. In a slight and germinal degree I believe that cases of fetichism are not uncommon in women, but they are certainly rare in a well-marked form, and Krafft-Ebing declared, even in the late editions of his Psychopathia Sexualis, that he knew of no cases in women. •Annates d'Hyglene Publique, June 1901, p. 48. tArchlrio di Psichlatria, (Vol. XIII, fasc. 6. p. 267,1892.) Erotic Symbolism. 23 So far we have been concerned with the urolagnic rather than the coprolagnic variety of scatalogical symbolism. Although the two are sometimes associated there is no necessary connection and most usually there is no tendency for the one to involve the other. Urolagnia is certainly much the more frequently found; the act of urination is far more apt to suggest erotically symbolical ideas than the idea of defecation. It is not difficult to understand why this should be so. The act of urination lends itself more easily to sexual symbolism; it is more intimately associated with the genital function; its repetition is necessary at more frequent intervals so that it is more in evidence; moreover its product is much less offensive to the senses than that of the act of defecation, and the act of urination has sometimes furnished a motive to the painter. Still coprolagnia occurs and not so very infrequently, Burton remarked, that even the normal lover is affected by this feeling: "immo nec ipsum amicae sterols foetet."* Of Caligula who, however was scarcely sane, it was said ~'et quidem stercus uxoris degustavit." In Parisian brothels (according to Taxil and others) provision is made for those who are sexually excited by the spectacle of the act of defecationt (without reference to contact or odor) by means of a "tabouret de verre," from under the glass floor, from where the spectacle of the defecating women may be closely observed. It may be added that the pleasure of such a spectacle is referred to in the Marquis de Sade's novels. The stercoraires are described by Borouordel as watchers of women's urinals. There is one motive for the existence of coprolagnia which must not be passed over because it has doubtless frequently served as a mode of transition to what, taken by itself, may well seem the least aesthetically attractive of erotic symbols. I refer to the tendency of the nates to become a sexual fetich. The nates have in all ages and in all parts of the world been frequently regarded as one •Anatomj of Melancholy, Part 111, Sect. 11, Mem. Ill, Subs. 1. tOazette des Hopitano, 1888. 24 Havelock Ellis. of the most aesthetically beautiful parts of the feminine body.* It is probable that on the basis of this entirely normal attraction more than one form of erotic symbolism is at all events in part supported. Duhren and others have considered that the aesthetic charm of the nates is one of the motives which prompt the desire to inflict flag- ellation on women. In the same way—certainly in some and probably in many cases—the sexual charm of the nates progressively extends to the anal region, to the act of defecation, and finally to the excreta. It may be remarked that while the eating of excrement (apart from its former use and as a magic charm and as a ther- apeutic agent) is in civilization now confined to sexual perverts and the insane, among some animals it is normal as a measure of hygiene in relation to their young. Thus, as, e. g. the Rev. Arthur East writes, the mistle thrush swal- lows the droppings of its young.t In the dog 1 have observed that the bitch licks her puppies shortly after birth as they urinate, absorbing the fluid. In a case of Krafft-Ebing's the subject, when a child of six, accidentally placed his hand in contact with the nates of the little girl who sat next to him in school and experi- enced so great a pleasure in this contact that he frequently repeated it; when he was ten a nursery governess to gratify her own desire placed his finger in her vagina; in adult life he developed urolagnic tendencies. In a case of Moll's the development of a youthful admiration for the nates in a coprolagnic direction may be still more clearly traced. In this case a young man, a merchant in a good position, sought to come in contact with women defecating; and with this object would seek to conceal himself in closets; the excretal odor was pleas- urable to him but was not essential to gratification, and the sight of the nates was also exciting and at the same time not essential to gratification; the act of defecation appears, however, to have been regarded as essential. He •8ee, e. c the previous volume of these Studict, "Sexual Selection in Man," pp. 165 il icq., and Duhren, GeschlccktiUbtn in Entland,, Bd. 11, pp. 158 et stq. tEnowledge, June 1,1892. Erotic Symbolism. 25 never sought to witness prostitutes in this situation; he was only attracted to young, pretty and innocent women. The coprolagnia here, however, had its source in a childish impression of admiration for the nates. When five or six years old he crawled under the clothes of a servant girl, his face coming in contact with her nates, an impression that remained associated in his mind with pleasure. Three or four years later he used to experience much pleasure when a young girl cousin sat on his face; thus was strengthened an association which developed naturally into coprolagnia.* It is scarcely necessary to remark that an admiration for the nates, even when reaching a fetichistic degree, by no means necessarily involves, even after many years, any attraction to the excreta. A correspondent for whom the nates have constituted a fetich for many years writes: "I find my craving for women with profuse pelvic or posterior development is growing and I wish to copulate from behind; but I would feel a sickening feeling if any part of my person came in contact with the female anus. It is more pleasing to me to see the nates than the mons, yet I loathe everything associated with the anal region." Moll has recorded in detail a case of what may be described as "ideal coprolagnia—that is to say, where the symbolism, though fully developed in imagination, was not carried into real life—which is of great interest because it shows how in a highly intelligent subject the deviated sym- bolism may become highly developed and irradiate all the views of life in the same way as the normal impulse. (The subject's desires were also inverted but from the present point of view the psychological interest of the case is not thereby impaired.) Moll's case was one of symbolism of act, the excreta offering no attraction apart from the pro.ess of defecation. In a case which has been commu- nicated to me there was, on the other hand, an olfactory fetichistic attraction to the excreta even in the absence of the person. In Moll's case, the patient X, twenty-three years of •Untersuchungen uber die Libido Sexaalls, Bd. 1, p. 887. 26 Havelock Ellis. age, belongs to a family which he himself describes as nervous. His mother, who is anaemic, has long suffered from almost periodical attacks of excitement, weakness, syncope and palpitation. A brother of the mother died in a lunatic asylum and several other brothers complain much of their nerves. The mother's sisters are very good-natured but liable to break out in furious passions; this they In- herit from their father. There appears to be no nervous disease on the patient's father's side. X's sisters are also healthy. X. himself is of powerful, undersized build and enjoys good health, injured by no excesses. He considers himself nervous. He worked hard at school and was always the first in his class; he adds, however, that this is due less to his own abilities than the laziness of his school-fellows. He is, as he remarks, very religious and prays frequently, but seldom goes to church. During his school-days he had periodic fits of depres- sion and misanthropic depression. He refers also to his extreme pedantry at this period. These fits are now much less marked. In society he is not communicative. In regard to his psychic character he says that he has no specially prominent talent, but is much inter- ested in languages, mathematics, physics and philoso- phy, in fact in abstract subjects generally. "While I take a lively interest in every kind of intellectual work," he says, "it is only recently that I have been attracted to real life and its requirements. 1 have never had much skill in physical exercises. For external things, until recently, 1 have only had contempt. I have a delicately constituted nature, loving solitude, and only associating with a few se- lect persons. I have a decided taste for fiction, poetry and music; my temperament is idealistic and religious, with strict conceptions of duty and morality and aspirations to- wards the good and beautiful. I detest all that is common and coarse, and yet 1 can think and act in the way you will learn from the following pages." Regarding his sexual life X has made the following Erotic Symbolism. 27 communication: "During the last two years 1 have become convinced of perversion of my sexual instinct. I had often previously thought that in me the impulse was not quite normal, but it is only lately that I have become convinced of my complete perversion. I have never read or heard of any case in which the sexual feelings were of the same kind. Although I can feel a lively inclination towards su- perior representatives of the female sex, and have twice felt something like love, the sight or the recollection even of a beautiful woman have never caused sexual excitement." In the two exceptional instances mentioned, it appears that X. had an inclination to kiss the women in question, but that the thought of coitus had no attraction. "In my voluptuous dreams, connected with the emission of semen, women in seductive situations have never appeared. have never had any desire to visit a harlot. The love stories of my fellow-students seemed very silly, dances and balls were a horror to me, and only on very rare occasions could I be persuaded to go into society. It will be easy to guess the diagnosis in my case: 1 suffer from the sexual attraction of my own sex, I am a lover of boys. "You cannot imagine what a world of thoughts, wishes, feelings and impulses the words 'Knabe,' 'garcon,' 'boy,' 'ragazzo' have for me; one of these words, even in an un- meaning clause of the translation-book, calls before me the whole sum of associations, which in course of time have be- come bound up with this idea, and it is only with an ef- fort that I can scare away the wild band. This group of thoughts shows a wonderful mixture of warm sensuality and ideal love; it unites my lowest and highest impulses, the strength and weakness of my nature, my curse and my blessing. My inclination is especially towards boys of the age of 12 to 15; though they may be rather younger or older. That I should prefer beautifu and intelligent boys is comprehensible. I do not want a prostitute, but a friend or a son, whose soul 1 love; whom I can help to become a more perfect man, such as I myself would willingly be. "When I, myself, belonged to that happy age (i. e. be- 28 Havelock Bllis. low 15) I had no dearer wish than to possess a friend of similar tastes. 1 have sought, hoped, waited, grieved, and been at last disillusioned, overcome by desire and despair, and have not found that friend. Even later the hope often reappeared, but always in vain, and I cannot boast of that sure recognition which one reads of in the autobiographies of Urnings. I do not know personally a single fellow- sufferer. It is also doubtful whether such an acquaintance- ship would greatly help me, for 1 have a very peculiar con- ception of homosexuality. As you will see, I have little more in common with what are called paederasts, than sex- ual indifference to the female sex, and I often ask myself: 'Does any other man in the whole world feel like you? Are you alone in the earth with your morbid desires? Are you a pariah among pariahs, or is there perhaps another soul with similar longings living near you?' How often in summer have I gone to the lakes and streams outside cit- ies to seek boys bathing; but I always came back unsatis- fied, whether I found any or not. And in winter I have been irresistibly impelled to return to the same spots as if it were sanctified by the boys, but my darlings had van- ished and cold winds blew over the icy floods, so that I would return feeling as though I had buried all my happi- ness. "It must be borne in mind, therefore, that what 1 have to say regarding my sexual impulses only refers to fancies and never to their practical realization. My sensual im- pulses are not connected with the sexual organs; all my voluptuous ideas are not in the least connected with these parts. For this reason I have never practiced onanism and immissio membri in anum is repulsive to me as to normal man. Even every imitation of coitus is, for me, without at- traction. In a boy's body two things especially excite me: his belly and his nates, the first as containing the digest- ive tract, the second as holding the opening of the bowels. Of the vegetable processes of life in the boy, none inter- est me nearly so much as the progress of his digestion and the process of defecation. It is incredible to what an ex- Erotic Symbolism. 29 tent this part of physiology has occupied me from youth. If, as a boy, I wanted to read something of a piquantly ex- citing character, I sought in my father's encyclopaedia for articles like: Obstruction, Constipation, Haemorrhoids, Faeces, etc. No function of the body seemed to be so sig- nificant as this, and I regarded its disturbances as the most important in the whole mechanism of life. The description of other disorders I could read in cold blood, but intussus- ception of the bowels makes me ill even to-day. I am al- ways extremely pleased to hear that the digestion of peo- ple around me is in good condition. A man who did not sufficiently watch over his digestion aroused distrust in me and 1 imagined that wicked men must be horribly indiffer- ent regarding this weighty matter. Even more than in or- dinary persons was I interested in the digestion of more mysterious beings, like magicians in legends, or men of other nations. 1 would willingly have made an anthropo- logical study of my favorite subject, only to my annoyance books nearly always pass over the matter in silence. In history and fiction 1 regretted the absence of information concerning the state of my heroes' digestion when they languished in prison, or in some unaccustomed or unhealthy spot. For this reason 1 held no book more precious than the one which describes how a young man, after being ship- wrecked, lived for a long time in a narrow snow-hut, and it was conscientiously stated that he became conscious of digestive disturbances. No immorality angers me more than the foolish practice of ladies who in society neglect the satisfaction of their natural needs from misplaced motives of modesty. On a railway journey 1 suffer horribly from the thought that one of my fellow-travellers may be pre- vented from fulfilling some imperative natural necessity. "I naturally devote the greatest attention to my own digestion. With painful conscientiousness 1 go to stool every day at the same hour; if the operation does not come off to my satisfaction, I feel not so much physical as mental discomfort. To this quite useful hygienic interest became associated at puberty a sensual interest. Since 30 Have lock Ellis. my fourteenth year I have had no greater enjoyment than to defecate undressed (1 do not do so now) after having first carefully examined the distention of my abdomen. In summer I would go into the woods, undress myself in a secluded spot and indulge in the voluptuous pleasures of de- faecation. 1 would sometimes combine with this a bath in a stream. 1 would exhaust my imagination in the effort to invent specially enjoyable variations, longed for a desert island where I could go about naked, fill my body with much nourishing food, hold in the excrement as long as possible, and then discharge it in some subtly thought- out spot. These practices and ideas often caused erections and later on emissions, but the genitals played no part in my conceptions; their movements were uncomfortable and gave no pleasure. "I soon longed to be associated in these orgies with some boy of the same age, but 1 wanted not only a com- panion in my passion but also a real friend. Since there could be no question of masturbation or paedicatis, our love would have been limited to kisses, embraces, and—as a compensation for coitus—defaecation together. That would have been perfect bliss to me. I will spare you the un- aesthetic contents of my voluptuous dreams. But 1 re- mained without a companion and therefore without real en- joyment. (He has, however, on various occasions, experi- enced erections, and even emissions, on seeing by chance men or boys defaecate.) Hinc illae lacrimae, the excite- ment over my own defaecation, only took place faute de mieux. "I knew very well that my thoughts and practices were impure and contemptible. Ah! how often, when the intox- ication was over, have I thrown myself remorsefully on my knees, praying to God for pardon! For some weeks I re- pressed my longing; but at last it was too strong for me, I tried to justify myself and fell into my vice anew. That 1 was guilty of licentiousness and loved boys sexually first became clear to me later on, when 1 knew the significance of erection as a sign of sexual excitement. Erotic Symbolism. 31 "No one can imagine with what demoniacal joy I am possessed at the thought of a beautiful naked boy whose abdomen is filled as the result of long abstinence from stool. The thought powerfully excites me, a flood of pas- sion goes through my blood and my limbs tremble. 1 never would grow tired of feeling that belly and looking at it. My passion would express itself in tempestuous ca- resses, and the boy would have to assume various positions in order to show off the beauty of his form, i. e., to bring the parts in question into better view. To observe defae- cation would still further increase this peculiar enjoyment. If the boy's bowels were not sufficiently filled I would feed him with all sorts of food which produces much excre- ment, such as potatoes, coarse bread, etc. If possible I would seek to delay defaecation for two or three days, so that it might be as copious as possible. When at last it occurred, it would be an unspeakable joy for me to watch the dung—which would have to be fairly firm—emerging from the anus." X. would like to be a teacher and thinks he could ex- ert a beneficial influence on boys. In spite of the pain he has suffered, he does not think he would like to be cured of his perverse inclinations, for they have given him joy as well as pain, and the pain has chiefly been owing to the fact that he could not gratify his inclinations. X. smokes and drinks in moderation and has no feminine habits.* The case of coprolagnia communicated to me is tha of a married man, normal in all other respects, intellectually brilliant and filling successfully a very responsible position. When a child the women of his household were always in- different as to his presence in their bedrooms and would satisfy all 'natural calls without reserve before him. He would dream of this with erections. His sexual interests became slowly centered in the act of defaecation, and his fetich throughout life never appealed to him so powerfully as when associated with the particular type of household •Moll, Kontrart Stmualatfindant. 8rd ed. p 32 Havelock Ellis. furniture which was used for this purpose in his own house. The act of defaecation in the opposite sex, or anything pertaining to or suggesting the same, caused uncontrollable sexual excitement; the nates also exerted a great attraction. The slime excreta exerted this influence even in the ab- sence of the woman; it was, however, necessary that she should be a sexually desirable person. The perversion in this case was not complete; that is to say that the excite- ment produced by the act of defaecation, or the excretion itself, was not actually preferred to coitus, the sexual idea was normal coitus in the normal manner, but preceded by the visual and olfactory enjoyment of the exciting fetich. When coitus was not possible, the enjoyment of the fetich was accompanied by masturbation (as in the analogous case of urolae;nia in the woman summarized.) On one occasion he was discovered by a friend in a bedroom belonging to a woman, engaged in the act of masturbation over a vessel containing the desired fetich. In an agony of shame he begged the mercy of silence concerning this episode, at the same time revealing his life-history. He has constantly been haunted by the dread of detection, as well as by remorse and the consciousness of degradation, also by the fear that his unconquerable obsession may lead him to the asylum. The scatalogic groups of sexual perversions, urolagnic and coprolagnic, as may be sufficiently seen in this brief summary, are not merely olfactory fetiches. They are in a larger proportion of cases dynamic symbols, a preoccupa- tion with physiological acts, which by associations of con- tiguity and still more of resemblance, have gained the vir- tue of stimulating in slight cases and replacing in more ex- treme cases the normal preoccupation with the central physiological act itself. We have seen that there are various considerations which amply suffice to furnish a basis for such associations. And when we reflect that in the popular mind, and to some extent in actual fact, the sexual act is like urination and defaecation, an excretory Erotic Symbolism. 33 act, we can understand that the true excretory acts may easily become symbols of the pseudo-excretory act. It is indeed in the muscular release of accumulated pressures and tensions, involved by the act of liberating the stored-up excretion, that we have the simulacrum of the tumescence and detumescence of the sexual process.* In this way the erotic symbolism of urolagnia and cop- rolagnia is perfectly analogous with that dynamic symbol- ism of the clinging and swinging garments, which Herrick has so accurately described, with the complex symbolism of flaggellation and its play of the rod against the blushing and trembling nates, or with the symbols of sexual strain which are embodied in the foot and the act of treading. (To be concluded.) •In the study of Lovt and Pain in a previous volume (p. ISO) I have quoted the remarks of a lady who describes the analogy between »ezual tension and vesi- cal tension. "Oette volupte que ressentent les bords de lamer, d'etre toujour! pleins sans Jamais deborder"—and its erotic significance. NEURONES IN THE LIGHT OF OUR PRES- ENT KNOWLEDGE. By JOSEPH COLLINS, M. D •i New York. Professor of Neurology at the New York Post-Graduate Medical New York. Instructor in Neurology at the New \ ork Post-Graduate Medical School and Hospital. EN years ago the "Neuron theory,"' i. e. the theory * that the nervous system was made up of a collection of anatomical and genetic nerve entities or units constituted of cell, fiber and terminal ramifications, having no connec- tion save by contiguity, was generally accepted. In 1891, Waldeyer, the Berlin anatomist, set forth the idea of the neuron based largely upon the conception of Gerlach and Deiters and upon work that had l een done by means of the Golgi and Cajal methods of staining, which, as is well known, reveal particularly the outlines of nerve cells. He maintained that nerve fibers are collections of axis cylinders which emerge directly from nerve cells, that there is no relationship to a fiber network at the point of origin, and that all nerve fibers end free in terminal ramifications without anastomosis or network formation of any kind. The neuron theory seemed entirely to harmonize with the cell theory, and the application of it to the problems of neuropathology seemed to divest many of them, particularly the systemic and combined systemic diseases, of their obscurities. In School and Hospital, and EDWIN G. ZABRISKIE, M. D 'I 34 Neurones in the Light of Our Present Knowledge. 35 short, it appeared to harmonize so well with physiological, histological, and pathological teachings that it soon became almost universally accepted. It is not our purpose to call particular attention to the wide application of the neuron theory to clinical medicine and to psychology, nor to the fact that in some instances it has been carried to an absurd degree. Gradually in latter years an increasing interest has developed in the histology and microchemistry of the ner- vous system; and with this has come from many workers in these fields a decided opposition to the neuron theory so that to-day it is in the strict sense partially or wholly rejected by many of the most trustworthy workers in the fields of neurohistology and biology. Apathy, Bethe, Nissl, and others have sought to establish that the fibrils of nerve cells form a continuous system, without beginning, without end, like the vascular system, binding one cell body with another and thus uniting the neurons between them. Without in any sense holding a brief for those who oppose the neuron theory, we propose briefly to review some of the more important evidence that now exists to show that the nervous system is not made up of a collection of units, of invariable constitution with free endings, having no connection with one another save by contiguity, and to attempt a judgment of the evidence thus reviewed. The temporal evolution of our knowledge of the nervous system falls into periods. The work that was done from 1835 to 1885—fifty years—and the work that has been done since 1885—twenty years. After the discovery of the nerve cells by the zoologist Ehrenberg, and the study of them by Valentin, Purkinje, Wagner, and others, it was demonstrated by Deiters that nerve cells were made up of a cell-body and prolongations, protoplasmic and axis-cylinder prolongations, unlike in structure and behavior; the former being of the same con- stitution as the cell, split up soon after their origin, and terminate not far from the cell. The latter, of much more compact structure, were directly continuous, Deiters main- tained, as nerve-fibers. 36 Joseph Collins—Ed-win G. Zabriskie. When Remak depicted axis-cylinders, or, as he called them, the "primitive bundles," he described them as finely- striated structures, but not distinctly fibrillated as did Fromann in 1864. The latter depicted fine fibrillary stria- tions in the cells of the anterior horns and in their proto- plasmic prolongations, especially distinct in the latter. The opinion generally held at that time by anatomists was that axis-cylinders or "primitive bundles" were homogeneous in structure and that their peripheral terminations, at least in case of muscle plates, were in ends external to or beneath the sarcolemma. In 1859 Lionel S. Beale, Professor of Physiology and Pathology in King's College, London (whose death was recently announced,) published an article in the Philosoph- ical Transactions (i860, page 611) in which he maintained that complete nerve circuits existed, i. e. that there was no free ending of nerve fibers anywhere. Nerve fibers, he said, passing to a muscle, divide into a vast number of exceed- ingly fine pale granular fibers which ramify upon the external surface of the sarcolemma, connected with which fibers at certain intervals are oval nuclei; and these fine fibers, after an extensive, and in many cases very circuitous course, join with other fibers to form dark bordered fibers which at length pass toward the nervous center either in the same bundle as the dark bordered fibers passing toward the mus- cles, or in other bundles. He prepared tissues for examination by soaking them in or injecting them with some highly refractive fluid such as simple syrup or glycerin to which a little chromic acid had been added. Beale did an enormous amount of work in support of his claims, published various articles, illus- trating them with excellent drawings, and offered to dem- onstrate his specimens to anyone who would take the trouble to look at them. He concluded from his work upon the different tissues of the body that nerve fibers never end or terminate by free extremities, but that in all cases complete circuits exist and that the circuit is the fundamental origin of the nervous apparatus. In other words, his position was Neurones in the Light of Our Present Knowledge. 37 almost identical with that of those who hold to the neuro- fibril theory of to-day. Beale was treated with scant cour- tesy by his contemporaries and apparently even that was accorded to him only because of personal friendship with some of the leading German anatomists. Kuhne, KSIliker, Margo, and Engelmann all denied the accuracy of his dia- grams and the reality of his descriptions, while some of the French anatomists, notably Rouget, essayed disdainfulness and superiority, saying: "It is easy to assure one's self that the description of Beale is wholly inexact and no time should be wasted upon it by the experienced and attentive observer." Time has shown that Beale was accurate to a degree that can scarcely be believed when one remembers that the only reagents that he worked with were syrup and glycerin. It is largely due to Joris, in his prize essay published by the Belgian Royal Academy of Medicine, "Nouvelles Recherches sur les Rapports Anatomiques des Neurones," that attention has been called to the remarkable work of Beale. In the hundreds of articles, monographs, and reviews that have been written on neurons and neuro- fibrils in the past ten years, Beale's name is not mentioned. For instance, Bethe, in the third chapter of his "Allgemeine Anatomie und Physiologie des Nervensystems," says that the fibrillary structure of the nerve cells and its prolonga- tions received its first great impetus from Schultze. In reality Schultze confirmed the discoveries of Beale while demonstrating the existence of isolated nerve fibrils and showing that they were specific elements of the nervous tissue. His article formed a chapter in Stricker's Hanclbuch der Geweblehre, 1871, which, being the most popular text- book of histology in the German language, was widely read and became very generally known. On the other hand, Beale's articles were published in the Philosophical Trans- actions, a vehicle rarely encountered by German savants, it would seem, and in the Archives of Medicine, of which he was editor. His position as a teacher, his membership in the R y Soci y, hs repute as a master of microscopical technique, apparently did not help him to a serious hearing. That Beale was master of the situation, however, and that 38 Joseph Collins—Edwin G. Zabriskie. he believed firmly in his findings, can be proven to anyone who will take the trouble to read the article in the Archives of Medicine, Volume IV., 1863-1870, entitled "An Anatom- ical Controversy," in which he deals with those who sat in judgment upon him in a most masterful manner.* There is no doubt whatsoever that Max Schultze extended Beale's ideas very materially, but Schultze had the advantage of examining cells of tissues that had been hardened in chrome salts, in iodized serum, and in nsmic acid and bichromate of potash. Schultze showed that the "primitive bundles." as he called them, constituted the specific structural ele- ment of the nervous substance. He demonstrated the distinct fibrillary striations which are entirely indepen- dent and parallel both in the protoplasmic and in the axis-cylinder prolongations. He pointed out that the non-medullated fibers split up at the end so as to form a bush like condition of the finest fibrils. In ganglion cells treated with iodized serum he was able to see the finest striations and to trace these striations through the entire cell from one side where they came in to the other side where they passed out through other prolongations. In other words, he showed to his own satisfaction that the fibrils did not originate in the body of the cell. These discoveries led him to the conclusion that the fibrils were the essential thing in the construction of the nervous system, and that ganglion cells were no more than stations for the fibrils, which stations served to make it possible for fibrils coursing in a prolongation to get into connection with many other pro- longations and also with axis-cylinders. His idea was that the nerve fibers were simple fibrillary bundles, and he there- fore divided them into two classes—naked fibrillary bundles •In Vol. V. of the same journal will be found an unsigned article entitled "German Criticism and British Medical Science," undoubtedly from the pen of Dr. Beale, which throw» an interesting side light upon the controversy: "It has been said that science is of no nationality.. .. Such dreams must be dispelled; Germany has spoken; the investigation of Nature's minutest and most delicate secrets is ker prerogative only. Anatomical observations are made in Germany only, and it is not possible to discover any structure elsewhere. Other countries must expect and listen to the story of what she finds. To her alone belongs the right to discover! Nay, it is doubtful if light for microscopical illumination is to be obtained elsewhere." Neurones in he Light of Our Present Knowledge. 39 and fibrillary bundles with medullary sheaths. Despite the fact that this line of investigation was pursued with much success by other investigators, and notably by Kuppfer (who, by the way, Apathy states, was the real discoverer of the neurofibrils, Sitzungsber. d. Naturwissenschaft. Atlas d. Bayerish Acad. d. Wissensch. Med., 1883, page473.) H. Schultze, Dogiel, Flem- ming, and many others, it was not until 1897 when Apathy made his contribution entitled "Das Leitende Element des Nervensystems und seine Beziehungen zu den Zellen" (Mitteilhungen der coologischen Station, Neapel, Volume XII.), that neurofibrils began to have an important place in the literature of neurology and histology. In several communications dating back to 1883, he had pointed out the fundamental facts of his observations and conclusions, but these were published principally in the Hungarian language and were unnoticed. In the volume that ap- peared in 1897 the pen pictures and verbal descriptions were so distinct and comprehensive that at once the mat- ter was given the attention which it demanded. He main- tained that the neurofibril is the essential and specific constituent of the nervous system. He had studied in de- tail the nervous system of the leech by the aid of a method, now well known, which depicted the nerve fibrils with such distinctness that they could be followed from one end of the preparation to the other. These neurofibrils appeared as deep dark threads on a slightly tinged back- ground, or, as Bethe says, like telegraph wires against a clear sky. On cross-section of sensory or motor fibers they appear as dark spots or small, somewhat spiral lines, indicative of their spiral course. These neurofibrils were found wherever there w s nerve organization, i e. in nerve fibers, in ganglion a s, in sensory epithelial cells, in glandular cells, and in all these tissues they were sharply differentiated. There was no vagueness about their outline, they were well- defined, individual morphological elements and nowhere could an ending of one of the neurofibrils be found. Apathy believed the individuality of the neurofibril, the un- nterrupted course, and the endlessness to be its most striking 40 Joseph Collins—Edwin G. Zabriskie. features. In end organs, such as muscle fibers, sensory epithelial cells, glandular cells, etc., the fibrils interlace so as to form networks. In ganglion cells they seem to term- inate in a similar way. The majority of the fibrils which enter ganglion cells through the protoplasmic prolon- gations of unipolar cells or through the many prolonga- tions of the multipolar cells, interlace in such a ashion as to form a very intricate network. A similar network form- ation is found in the neuropil (the nerve cell in contra- distinction to the ganglion cell), only the very fine net- work occupying the center of the cell, is made up of very many more fibrils. Conducting primitive fibrils pass into the interior of the ganglion cell, and just as many element- ary fibers leave it after the "trellis formation." Termina- tion, dissolution in or connection with the cell nucleus the fibril does not have. n nis conception of Apathy, the neurofibrils either go toward centers and penetrate ganglion cells, or they go to- ward the periphery and ramify around muscle cells and penetrate sensory or secretory cells. In invertebrates Apathy demonstrated motor fibers which extend from the cell to the muscle to which they go, and sensory fibers very much thinner than the motor which pass into the "elementary trellis" and from there into the cell. Apathy di- vides the cells of the nervous system into two distinct classes— nerve cells and ganglion cells. The former are analogous to muscle cells; they produce the material that conducts, i. e. the material that produces fibrils. The ganglion cells are interpolated in conductive paths like cells in an electric circuit; they produce that which is to be con- ducted. In ganglia these ganglion cells are arranged around the periphery and are of two kinds, large and small. Neurofibrils entering the large cells form at once an intramedullary net- work and from this network new fibrils detach themselves and go out through the same prolongation. Thus a pro- longation conducts in two directions. Primitive fibrils may pass through a number of ganglion cells before they enter into the formation of networks. In the prolongation of the Neurones in the Light of Our Present Knowledge 41 Pio. i.—Apathy's Schema of course and communication of the ton- ducting pathway in cross-section of a cornite of Hirudo. The two gan- glion valves with motor m*, and eensory or merely connecting gst ganglion cells. The three kinds of nerve spindles or nerve fibers sbtsschJ, runs, their arrangement in the center, distribution in the central mass of fibers and connections with the ganglion cells: their arrangement at the periphery: muscle fibers, epidermal and subepidermal sensor> cells with their terminal branching in its epidermis (fre), usschJ wh^re a sensory tube sba, where a sensory bundle curves into the central mass of fibers in a longi- tudinal direction, mbt conducting bridges between muscle fibers. We see from the upper right the perceptive sensory surface, the centripetal con- ducting febru path, which enters into the elementary putter and thence in the ganglion cell and its mesh work. Thicker fibers which later become united in bundles as the motor nerves pass from the motor gan- glion cells to muscle (lower right) end branch in the manner already described.—(From Hartm&nn, *'Die rtewofibriJUnUlir*.' ) small cells there is to be found an individual fiber which is characterized by its considerable volume: this is the motor fiber. All fibrils coming out from ganglion cells enter the formation of a common network occupying the center of 42 Joseph Collins—Edwin G. Zabriskie. Fig. 2.—B elementary network of Golgi net, from which the neurofibrils develop and pass into the cell. The same at M N with the fibrile. L elementary fibers passing from the nervous grey into the Golgi net. A nervous gray; C axone hillock without Golgi net. X axone; H myeline sheath; I K connection of axone with nervous grey after Nissl. Neurones in the Light o! Our Present Knowledge. 43 the ganglion. This common network is the "elementar gitter" of Apathy, or, as it may be translated, elementary trellis or screen. In some instances fibrils come directly from,the cell without passing through this central network. At the periphery of the body there is a very similar dis- position of the nervous element. The neurofibril forms in the secretory cell an intracellular network, whose branches leave the cell and anastomose with fibrils coming from neighboring cells to form intercellular networks. In 1896 the teachings of Apathy were accepted by Bethe, who confirmed his findings in invertebrates by the use of other methods of investigation. Extending Apathy's conception, Bethe attempted to show that in the phyloge- netic development of animal life, so called plasmatic nerve- nets constitute the lowest method of connection of nerve cells. The fibrils of these plasmatic networks form only the intercellular trellis which constitutes the direct connection between the peripheral sensorium and the muscles. In the nervous system of all higher animals there occurs some- where a mixture of the fibrils coming anywhere from the surface which make up the fibril trellises, and, according to Bethe, it is the position of this trellis which constitutes the difference between the different forms. As we ascend in the scale of the vertebrates we find that the fibril gets more and more outside the cell, until finally it gets entirely out between the cells, so that accord- ing to Bethe's view, within cells fibrils merely pass through having no more intimate relation than that caused by such passing. Either the fibril trellises remain near each other and have long pathways to receptory and effectory organs, or long pathways form between remote fibril trellises. Recent work done according to the methods of Cajal and Biel- chowsky seems to corroborate in general Bethe's opinions, but it is difficult to obtain reliable information of the fibrils in central cells with these methods. Apathy maintains that there is an intercellular trellis formation in vertebrates. Hartmann (Die Neurofibrillenlehre, Braumuller, Vienna and Leipzig, 1905) is inclined to accept this inasmuch 44 Joseph Collins—Edwin G. Zabriskie. as his preparations showed that a part of the fibrils which pass into many ganglion cells have a trellis forma* tion which, in the large pyramidal cells, for example, lies near the basal part of the cell; in the smaller cells this takes up nearly the entire cell. Fig. 3.—Large multipolar cell from the reticular formation of the medulla of a rabbit. (Cajal method.) In addition, fibrils in variable numbers go from dendrite to dendrite and from axis cylinder to dendrite through the cell without perceptible relation one to another. Bethe also found by his method that ganglion cells of vertebrates are surrounded by a close-meshed net-form trel- Neurones in the Light of Our Present Knowledge. 45 lis which he calls the Golgi net and which he believes is of nervous nature. He has framed an hypothesis concerning the transmis- sion of the nervous current from this network to the cell and to the dendrites. The dendrites, i. «., the protoplas- mic processes, of the cells end blind. Probably the fibrils pass into Golgi nets and unite with the fibrils which pro- ceed from the splitting up of the centripetal nerve fibrils to form network formations as in invertebrates. Nissl agrees that the Golgi net is a new important structural element of the nervous system, but he does not believe that the neurofibrils go out from the protoplasmic prolongations unchanged into the terminal endings of the centripetal medullated fibers. This Golgi network Bethe finds at the surface of all the cells of the central nervous system. In the cerebrum, cerebellum, Ammon's horn, and in the gelatinous substance it extends diffusely. In other regions such as the motor nuclei, the dentate nucleus, the olives, etc., it confines itself to the surface of the cell, but where two cells or two dendrites touch the Golgi network reaches from one directly to the other. It is limited to the gray matter. It does not seem to have any relationship to the vessels, the neuroglia, or the pia. But the nervous na- ture of this Golgi network, unfortunately for Bethe's theory, has not been proven. Gajal, Lugaro, Donnagio, Marinesco, and others maintain that this network represents nothing else than artificial coagulations of certain albuminoid sub- stances in the interior of vessels. Nissl changes Bethe's hypothesis so that the neurofibrils of the cell border and in the terminal ramifications undergo a change which permits their colorability, a condition previously impossible. (See Fig. 2.) Bethe's conclusion is that the nerve fibril is a multi- cellular formation in which the ganglion cells and the end organs are united by neurofibrils, the ganglion cells them- selves being of slight functional value. The neurofibrils are the essential specific constituent of the nerves and they are the nerve substance in general. Engelmann's opinion that 46 Joseph Collins—Edwin G. Zabriskie. the axis cylinder section of medullary substance and the nucleus of Schwann, situated between two nodes of Ran- vier may be looked upon as a cell, it has been thought, has received corroboration from Bethe, who found, he main- tains, that at Ranvier's nodes the fibrils alone pass through a sieve-like membrane. This, he thinks, fortifies the opin- ion that these constitute the confines of the cell. Retzius insists that at the above-mentioned places not only the neurofibrils but also the perifibrillary substance is seen to pass through, that the number of the neurofibrils and also the perifibrillary substance is decreased, therefore a rarefaction of the entire substance of the axis-cylinder takes place at the nodes of Ranvier. Nissl maintains that the complex called a neuron is not the sole nerve element. There are cellular elements which do not have their origin from ganglion cells, and there is a specific tissue of as yet unknown texture lying outside the cells, the so-called "nervous gray." (Fig. 2.) This sub- stance is of a fibrillary nature. According to him, dendrites as well as axis-cylinders terminate blind in this gray sub- stance. Therefore, something must exist which is inter- polated between the end of the axis-cylinder which is synonymous with the cessation of the medullary sheaths, and the Golgi nets and the nerve cells situated in the vi- cinity of the axis-cylinder termination. This is the ner- vous gray. He has never been able to demonstrate it, but he has attempted to show mathematically that this ner- vous substance must exist. He says that if the demon- strable cortical elements are added together a large portion of space remains unoccupied, but the work of Beilchowsky and Wolff on the cerebellum by the use of the former's silver method which impregnates neurofibrils and plasma with a remarkable clearness and which demonstrates the continuous' transition of axis-cylinder fibrils and closely united peri- and intracellular nets, would tend to upset this. Ansalone has pointed out (Contributo alio studio delle Neurofibrille nella midolla spinale dei vertebrati superiori, Annali di Neurologia, Ann. XXII., fasc 3, 1904) that the Neurones in the Light of Our Present Knowledge. 47 neurofibrils of the cells in the spinal cord vary in appear- ance according to the region of the cell which is under in- spection. The prolongations also present very variable pictures. In the peripheral portion of the cell there is no network in the proper sense of the term, the neurofibrils running in the shape of thick cords from one pole to the cell to the other, without dividing or anastomosing. The cellular element is not at all differentiated from the surrounding tissue; and it stands in connection with fine fibrils which reach it in a direction nearly perpendicular to that of the neurofibrils. In the deeper regions of the cell the neuro- fibrils form a network, the communications of which with the nucleus vary according to the section plane of the cell. The fibrillary network may either cover the nucleus completely, presenting a greater condensation and a finer quality of mesh at this level, or it may pass over it like a bridge in the form of more delicate threads. Again, it may be strictly limited to the nuclear outlines where it terminates. Schaffer, who has recently published a paper on the subject (Recherches sur la structure dite fibrillaire de la cellule nerveuse, Revue Neurologique, No. 21, 1905) comes to somewhat different conclusions. The author investigated the finer fibrillary structure of the nerve cells in the spinal cord, the oblongata, and the pyramidal cells of the cortex and concluded that there are two systems of reticular structures in the nerve cells; first, a pericellular external network with thicker meshes at the periphery of the cell - body and in the protoplasmic processes, which is identical with Golgi's net; the beams of this network which repre- sent a sort of cortical substance of the cell, form the mesh- work of the cell process also, which become more plainly outlined in the presence of swelling from the general paral- lell arrangement of the fibrils. All the fibrils of the cell - body as well as the processes anastomose with each other and the fibrillary cellular structure is therefore really a pseudofibrillary structure of a reticulai character, although presenting a parallel striped appearance in certain locali- ties. Another net is formed by fine fibrils, which form a polygonal wide meshwork, by branching off from the cross- 48 Joseph Collins—Edwin G. Zabriskie. beams of the first net towards the interior. This internal reticular system appears denser around the nucleus; it also sends its prolongations into the protoplasmic processes. The internal and the external intracellular network stand in close connection with each other. The author finally ob- served extracellular fibrils which approach the cell-body in a Y-shaped oblique direction, or parallel to the pericellular network, blending with the body. The Y-shaped branch- ing of the fibrils he also considers with Bethe as suffi- cient proof of the existence of an endoce u ar network. Donnagio, working with an original method (Anatomia e fisiologia delle vie di conduzione endocellulari Atti del XII Congresso della Societa freniatrica Ital. in Riv. sperim. di Fren., Volume 31, T. 1, 1905), concludes that "the exis- tence of a network of fibrils in the ganglion cell, besides the long fibrils which traverse the cell chiefly at the periphery, must be accepted a6 conclusively proven. It still remains doubtful whether or not these long fibrils anastomose with each other." According to struc- ture, two types of ganglion cells may be distinguished: Cells containing only a network of fibers, and cells con- taining long fibrils in addition to a network. The axis- cylinder receives fibrils from the network principally. That endocellular nets exist has been demonstrated again and again but whether this is always true or that Donaggio's conclusions are certain, is by no means defi- nitely established. Fig. 3 gives a fair representation of one of our own specimens, and as can readily be seen, there is no evidence of an endocellular network. Fig. 4, on the other hand shows one of the horizontal cells from the retina, with an indisputable perinuclear net. We have also seen undoubted net formations in the reticular cells of the tegmentum and corpura quadrigemina. Although the observation of others and that we ourselves have seen would tend to support the view of independence of the axome fibrils from those of the dendrites, still we cannot accept, at least from the evidence offered, the views of Schaffer regarding the fine fibrillary netwoik of the cell body and Neurones in the Light of Our Present Knowledge. 49 dendrites in contra-distinction to the perinuclear and axonal meshes. He practically rests his case on the Y- shaped branching, which, when we stop to consider that we are dealing with almost ultra-microscopic structures, and therefore exposed to many possibilities of error, are altogether too uncertain to be of such fundamental value. The relationship existing between cell fibrils and axis- cylinder fibrils is still a matter that - requires very great Fig. 4.—Horizontal cell from retina of cat of eight days. A ax- one; B perinuclaar network. (After Cajal.) elucidation. Held and Wolff maintain that they have seen fibrils leave the terminations of the axis-cylinders and enter the body of ganglion cells, by means of Cajal's method and Bielchowsky's method respectively. Mahaim studied the nervous system of the cat, the crow and the human sub- ject, by the various Cajal methods. He did not in a single instance observe fibrils penetrating into the cell body. He is of the opinion that Wolff's reticulum is the result of faulty technique; this is not, however, true, for the rela- 50 Joseph Collins—Edwin G. Zabriskie. tively thick fibers which Held saw penetrating the cell. The author believes that this is an anatomical "semblance," for the experimental methods show by chromatolysis the marked difference existing between sections of axis-cylin- ders arising from a cellular nucleus, and sections of axis- cylinders penetrating into a nucleus. The relation between the pericellular terminations and the body of the cells can- not, therefore, be very intimate; and it may be stated that these terminations "are not a part of the cells." The au- thor hopes that it will prove possible by means of appro- priate experimental methods to observe degenerated peri- cellular masses surrounding an intact cellular body. Bartels, studying the fibrillary structure of the ganglion cell layer of the retina by means of Bielchowsky's fibril method, maintains that he has succeded in demonstrating the presence of fibrils which pass from a protoplasmic pro- cess through the cell and into the axis-cylinder process. He also observed other fibrils passing from one dendrite into the other, without traversing the cellular body itself. Fin- ally fibrils were noted connecting the processes of different cells. On the other hand, Vermes (Ueber die Neuro- fibrillen der Retina, Anat. Ang., Volume 26, Heft 22-23, 1905), who studied the retina of the horse, dog, rabbit, cat, guinea-pig, and also of the human subject by means of the Cajal and Bielchowsky fibrillary methods, does not consider that the continuity of the neurofibrillary layer has been demonstrated. Ramon y Cajal (Trabajos del Laborator de investigacion biol. de la Universidad de Madrid, III., 4, dic. 1904) shows that the differentiation of the fibrils in the cells of the retina begins within the plasma zone from which the dendrites arise, and they begin with the begin- ning of function; they are begotten by function from the cell protoplasm. The field in which the question of contact or contin- uity has been most hotly contested, however, is that of the terminal arborizations of axone at fibrils about the cells. The recent investigations of Cajal, Bielchowsky, Holm- gren, Michotte, and others, show that the neurofibrils ap- Neurones in the Light of Our Present Knowledge. 51 pearing on the surface of the cell come in contact with it by means of bulbous formations known as the terminal buttons. Bielchowsky, Held and Holmgren believe that the terminal buttons are fibril net-like structures and that the fibrils of the buttons pass into the interior of the cells. But the terminal buttons are in intimate relationship on the surface of the cell through anastomosing fibrils which form a close network. Bielchowsky holds that this form- ation is identical to that which Held calls the pericellular Golgi nets. Fig. 5. Multipolar cell with terminal buttons (Cajal method.) Cajal divides the terminal buttons, or terminal masses, as;he calls them, which were discovered by means of his method into two forms, the end club and the transition club. The former come from the vicinity of the cell in form of a fine thread which swells up as soon as it reaches the cell body and closely hugs the cell membrane or the dendrite with its basis. The transition form are fusiform thickenings of certain fibrils, which also become applied to the cell membrane. The end-dubs are found in large numbers at the cell body, sometimes giving it a mottled aspect like a tiger skin. They are never absent at the 52 Joseph Collins—Edwin G. Zabtiskie. dendrites. Only isolated end-clubs occur at the root cone of the axis-cylinder. ' VanGehuchten and Marinesco have corroborated (Boutons terminaux et reseau pericellulaire, Le Nevraxe, Volume VI.) these observations of Cajal's. In specimens prepared according to Cajal's method, these end-clubs were observed to be independent of each other as well as of the cell. Cajal's method being an elec- tive nerve fibril method, the pericellular nets, if they exist at all, can only consist of protoplasmic substance. Fig. 5. Held (Zur weiteren Kenntniss der Nerven-endfusse und zur Structur der Senzellen. Abh. der K. Sachs. Ges. d. Wiss. Mat. Phys. Ll. No. 2, Volume 29, 1903-1904) found nets in the ganglion cells by means of Cajal's method. He disagrees with Cajal concerning the connection of the so- called terminal feet or buttons, and shows by photographs of his preparations that the terminal buttons are in con- tinuity with the protoplasmic substance of the cell body; and that the fibrillary net which exists in the term- inal button communicates with that of the cell. Hence the terminal buttons really constitute connecting links between locally remote ganglion cells of the central nervous system, in the longer or shorter path of their axis-cylinder pro- cesses. But, as we have said above, Held's views in this matter have not been accepted, neither have they been corroborated by acceptable investigators. Fig. 5 shows fairly well the formation of these termi- nal buttons as they appear in Cajal preparations. No single plane, however, such as the drawing must neces- sarily represent, can give an adequate idea of the enor- mous number which literally cover the cell and dendrites. This and other preparations which we have carefully studied, seem to bear out Cajal's views very forcibly, in as far as we have been quite unable to demonstrate fibrils passing from the end feet into the interior of the cell. Even successful Bielchowsky preparations, or the illustra- tions of Wolff, do not establish the continuity question firmly enough in our estimation to make their position sure. One should not forget that we are dealing with very Neurones in the Light of Our Present Knowledge. 53 minute structures only to be seen with very high magnifi- cation, and there is such a dense network of similar structures that it becomes quite impossible to determine absolutely their ultimate destruction. The more important communications that have appeared during the past few years on the subject of the disposition of the neurofibrils of the periphery of the body must now be briefly reviewed. Ruffini (Ultraterminal Neurofibrils in Human Motor End- plates. Rivista di Fathologta nervosa e 'mentale, Firenze, October, 1900. Vol. V. Fac. X) states that he reexamined his old gold-chloride specimens of human motor endplates with the result that certain details were discovered, which lead him to believe that in man as well as in lower animals a closed system of anastomoses may originate from the motor ramifications (as discovered by Apathy in Hirudinea.) It is quite possible, he believes, that sensory nerve fibrils enter also in connection with this anastomotic system. Ruffini noticed that extremely fine fibrils, of variable length supplied with small "varicosities" sometimes originate from the endplates. These "ultraterminal fibers" seem to ter- minate after a longer or shorter course within the same muscle-fiber, or more commonly in an adjacent muscle-fiber, either with a varicosity or without one. Occasionally the fibril terminates in a small secondary endplate, from which another thin fibril may take its origin. This goes to show that in man "the so-called "motor endplates" are not the real termination of the motor nerve fibers; since other fine fibrils arise from them, the fate of which cannot be defi- nitely determined. Apathy, in discussing this communication limits himself to some very general theoretical considerations upon the importance of this fact as an argument against the neuron theory. He says that Ruffini's preparations afford proof that nerves do not terminate (or at least, do not invariably terminate—he, for his part, believing that they never do) in the endplates of the muscle; just as in the Hirudinea they do not terminate in the "terminal crests" described 54 Joseph Collins—Edwin G. Zabriskie. by him and which correspond exactly to the motor-plates of vertebrates. In vertebrates also, and in a very superior vertebrate at that—exceedingly fine nerve paths emerge from the terminal plate, passing in various directions through the muscle-fiber, branching and entering into adjacent muscle- fibers, just as they behave in the Hirudinea. If it is permissible to judge from experiments made upon animals of such "inferiority," Apathy continues, his observations lead him to predicate the probable ulterior fate of the ultraterminal branches in the following fashion: In part they may pass through some neighboring muscle fibers —in their way as yet unseen—and in part they branch immediately in the interstitial substance between the muscle- fibers, becoming isolated elementary fibrils. These elemen- tary fibrils then pass to the elementary peripheral net which spreads its large and uneven meshes in the interstitial substance between the muscle fibers. But the elementary net receives in its turn other elementary fibrils which come both from other motor plates, and from nonmotor nerves, from the nerves of general nonspecialized sensation (here perhaps from the nerves of muscular sense.) It is another question, which nerves, in vertebrates, are those nerves of general sensation. In the Hirudinea, Apathy was recently able to recognize those nerves in a special type of nerves described by him in 1897, and designated as "sensory tubes." Dogiel (Der fibrillare Bau der Nerven End-Apparate in der Haut des Menschen, und der Saugethiere; und die Neuronen-Theorie. Anat. Auz. Vol. 27, Nos. 4-5, 1905) describes the termination of neurofibrils in tactile disks, the typical and modified Vater-Pacini corpuscles, the typical and modified Meissner corpuscles, and the papillary bundles of Ruffini, with the assistance of specimens obtained by means of Cajal's neurofibril method from the human skin and from the skin and mesentery of the cat. He concludes that all sensory end-ramifications consist of more or less small-meshed and completely closed nets of neurofibrils, which are placed in a larger or smaller mass of perifibrillary substance. The shape alone varies in the individual end- Neurones in the Light of Our Present Knowledge. 55 apparatus; round, sometimes curved, small disks of variable diameter (tactile disks, Grandry's corpuscles, swellings at the axis-cylinder ramifications of the typical and modified Meissner corpuscles,) angular scales (human skin, tree-like terminations of sensory nerves of the cutis, mucous and serous membranes, intermuscular connective tissue, tendon); fusiform, club-shaped, round or oval, sometimes flattened, formations (Herbst corpuscles, typical and modified Vater- Pacini corpuscles.) The neurofibril nets are either in direct contact with their surroundings (connective tissue, fibril bundles,) or with special cells (tactile disks) or they have a special sheath. The most marked difference lies in the number of neurofibrils constituting the aggregate of all nets together, in which terminate the processes of a sensory cell, not in the shape of the terminal apparatus. These either reunite by means of individual neurofibrils, or by means of twigs consisting of several neurofibrils; all, together, or a certain portion, forming other end-nets in such a way that the individual terminal apparatus seems to be connected with its fellow (tactile disks, Grandry's corpuscles, leaf- shaped terminations, tree-like ramifications.) All the neuro- fibrils of a peripheral process stand in direct communication with the intracellular net; the perifibrillary substance con- tinues to the process, together with all its terminal nets, where it reaches the maximum amount, as that portion of the cell body which is not differentiated into fibrils. The central process differs in no important feature from the behavior of the peripheral process; the small, club-shaped thickenings, with which the terminal ramifications rest upon the motor cells and their dendrites likewise consist of closed nets of this character. The neurofibrils do not, however, enter into organic connection with the intracellular net or the undifferentiated protoplasm; simply resting immediately upon the cell. Each sensory cell represents a neuron, which communicates neither with other cells of the central nervous system, nor with other units. The neurofibrils belonging to a neuron, form at least three, closed and firmly united nets: the intracellular, the peripheral, and the central net. Cell colonies exist beyond a doubt in the central nervous 56 loseph Collins—Edwin G. Zabriskie. system, meaning that cells of the same type unite by means of their dendrite ramifications. According to their function the closed terminal nets rest either upon the body, or the dendrites, of another colony, or of an individual neuron, or upon non-nervous elements (muscle cells.) In contradistinction to the Apathy-Bethe neurofibril theory, the author points out that the neurofibrils are to be interpreted simply as products of the differentiation of the nerve-cell protoplasm, and that they serve to build all the terminal apparatus and ramifications, assisted by a portion of the non-differentiated plasm, the perifibrillary substance. The different psychomotor and psychosensory functions belong not only to the neurofibrils, but also to the nerve cell, and all its parts. It is not at present possible to pronounce upon the function and importance of the neurofibrils. Klomer, working on the crista of the mouse ("Zur Kenntniss des Verhaltens der Neurofibrillen an der Peri- pherie," Anat. Ani., Nos. 16-17, Vol. 27, 1905,) says the fibrils are seen to approach the cells, entering to a moderate degree into plexus-like ramifications. They then penetrate into the cell at the lower pole, and diverge in shape of a ball, sometimes dividing into branches. The interior of the cell presents a trellis of narrow meshes, which is especially dense directly toward the base of the nucleus. Imperfect staining with methylene blue and Golgi results in the pic- ture of the so-called terminal calices. The fibrils are seen to traverse the ceJls of the spinal ganglion with a distinct trellis formation, after which they pass to the habenula perforata. Especially in embryos (rodents and mice,) nuclei may be seen very plainly enclosed by very fine neuro- fibrils. At their egress from the habenula the fibrils diverge at blunt angles. From this point on, fibrils begin to pass in a spiral, rarely in a radiating direction, to the basis of the innermost cells. The others pass in regular flexions of approximately a right angle toward the three outer spiral fiber columns, in such a manner that the fibrils which pass to the first column present one flexion, those passing to Neurones in the Light of Our Present Knowledge. 57 the second two, and those passing to the third three flexions. From the fibrous strands the fibers run upward in a curve to the bases of the outermost cells, and enter the cell, forming a very fine trelliswork in the basal portion especially. Free nerve terminations could not be made out at all. The author points out that the behavior of the nerves varies surprisingly in the crista aud macula of different animals. The neurofibrils in the Pacinian body are rather numerous, the perifibrillary substance staining deeply and forming a distinct plate at the peripheral end, under which lies a small trellis of neurofibrils with distinct meshed formation. Concerning the effectory terminations, the author assumes a similar structure, supporting his views by the description and illustration of motor endplates and the intracellular ends of the glandular nerves from the skin of amphibia. The author was unable to discover special terminations in the myocardium, the fibrils invariably returning to form strands of parallel fibers, however fine they may have grown before. Neurofibrils do not occur anywhere without being accom- panied by their matrix, the perifibrillary substance, which may be either the protoplasm of a nerve cell, of a receptory or effectory cell. Both plasma and fibrils are capable of conducting, perhaps to a different degree, just as special contractile fibrils still occur in contractile protist plasm. Schiefferdecker (Nerven und Muskelfibrillen, das Neuron, und der Zusammenhang der Neuronen. Sitfungsbericht der Niederrheinischen des. fur Natur-Heilkunde, Bonn, December 12, 1904) observed that not only do the fibrils increase in size during the contraction of a muscle fiber, but also the strips of sarcoplasm between them, the latter contracting more strongly than the former. Accordingly the sarcoplasm can no longer be considered as an indifferent substance in the muscle fiber. The conditions existing in the muscle fiber resemble those of the nerve fiber and nerve cell- Here neither the fibrils nor the plasm serve independently for conduction; but the entire nervous activity is to be interpreted as a chemical or chemicophysical process, resulting from a mutual action of the plasm upon the fibrillary sub- stance. The chemical interaction increases in direct ratio 58 Joseph Collins—Edwin G. Zabriskie. to the surface of the fibrils. Accordingly, the intensity of the process constantly decreases from the cell-body toward the nerve termination. The author suggests a number of new terms. The indifferent protoplasm becomes "myo- plasm" as soon as the cell is plainly recognizable as a muscle cell, and it gradually matures into "sarcoplasm" with the formation of fibrils. In a corresponding fashion it is permissible to speak of successive "protoplasm," "neuroplasm," and "myoplasm," in the evolution of nerve cells. To the axoplasm and the axofibrils of the axis-cylinder correspond the teloplasm, and the telofibrils in the nerve termination. The alterations caused by experiments and by disease have laterly been carefully studied. These investigations have been directed mostly along two lines, namely: the changes occurring in the neurofibrils within the cells under abnormal conditions and those which take place in the peripheral nerves after resection and during regeneration. Marinesco (Revue Neurologique, p. 5, 1905) studied by Cajal's fibril method the cells of the twelfth neuclei after cutting the nerve, and noted during the first stages of reaction and reparation disappearance of the fibril network, the fibrils arranging themselves in bundles or in streaks. Later the net makes its reappearance centrally around the nucleus, with simultaneous thickening of the fibrils (increase of the reduction capacity of the fibrils.) Marinesco saw similar pictures in the spinal ganglion cells after section of the sciatic in rabbits, only in this case the changes occurred earlier and disappeared later. According to Cajal, in the hungry, resting hirudo and in resting animals while digesting, the fibril apparatus is very thick. The fibrils are thin when one warms the animals and immediately after they eat. If the animal starves the fibrils are destroyed and in part reabsorbed. Tello (Trabajos del Laborator de investigacion Biol, de la Universidad de Madrid, III, 2-3, p. 113, 1904) says that in the lizard, during its winter sleep, the disposition and the number of fibrils are very unlike those in the lizard during its activity. Neurones in the Light of Out Present Knowledge. 59 In the hibernating adder and the lizard, the fibrils in the cell are enormously thick. They stretch themselves out in the spring to extraordinary fine threads, and all transitional states may be seen in one cell. One never fails to see in these animals the passage of fibrils out from the cells; they go only in the dendrites and the axis- cylinders. It would seem that in these lower vertebrates, as in Hirudinea, the perinuclear fibril apparatus is the most mighty. Fig. 6. Ramon y Cajal ("Variations Morphologiques du Reti- Fig. 6.—Funiculear cell from medulla of rabbit; death by rabies. A swollen neurofibril. After Cajal culum Neurofibrillaire dans certains Etats Narmaux et Path- ologiques," Comp. rend, de la Soc. de Biol., LVI, 8, p. 372, 1904) shows that the fibrils do not all behave in the same way. The ganglion cells in the cord of the hiber- nating lizard show definite changes in the neurofibrils when exposed to heat. They become finer, more abundant and lose their bundle formation. The terminal buttons remain unchanged. The condition of the neurofibrils in the brains of cases 60 Joseph Collins—Edwin G. Zabriskie. of general paresis have been studied considerably. Jansky ("Neurofibrils Under Normal and Pathological Conditions," Casopais Uk., 1905) shows that the structure of the neuro- fibrils is definitely altered in progressive paralysis. The findings consist in hypertrophy, varicosity, granular trans- formation, and refraction of the fibrils, more especially in the smaller ganglion cells. Nothing of special interest could be made out in a case of senile dementia; while in another case of catatonic dementia praecox of several years' duration the histological examination yielded the following results only: A distinct, diffuse chromatolysis seen by the Nissl stain, the silver impregnation showing apparently normal conditions. The same striking difference was observed in another case of dementia, in which also a marked chroma- rolytic change in the cells accompanied an unaltered struc- ture of the fibrils. Advanced alterations with breaking down of the chromatic substance are thus seen to be in no way dependent upon destructive disturbances of the fibrils, nor to determine the latter, since the two histological elements stand in no demonstrable relationship to each other. Jansky's findings are not in harmony with those of Dagonet (La persistance des neurofibrilles dans la paralysie generate, Comp. rend, de la Soc. de Biol., Vol. 57, 1904.) He examined the brains of three patients who had died of general paralysis, using the Ramon y Cajal method. Por- tions of the cortex taken were from different regions (parietal lobe, central and third frontal convolutions, ante- rior portion of the third frontal lobe, occipital lobe, cere- bellum, vermis, oblongata, and cord.) The extracellular fibrils were found to be universally preserved in all portions, including those in which the brain substance presented marked changes, the fibrils being normal in character. The intracellular or secondary fibrils could also be plainly seen and demonstrated. In the most marked atrophic cells the fibrils formed undulating bundles around granular masses. There was no granulation or pigmentation of the fibrils. The fibrils of the Purkinje cells and cord cells were equally well preserved. Neurones in the Light of Our Present Knowledge. 61 On the other hand, Marchand (Lesions des Neuro- fibrilles des cellules pyramidales dans quelques maladies mentales, Comp. Rend, de la Soc. de Biol., Vol. 57, 1904) has found very distinct alterations. The neurofibrils were examined according to the Ramon y Cajal method, in the pyramidal cells in the left ascending frontal convolution, central portion, and also of the second left frontal convolu- tion, central portion, in the following diseases: Paralytic dementia (two cases,) senile dementia, dementia prsecox, idiocy, acute delirium, insanity, and paranoia (one case.) In the third case of progressive paralysis the lesions of the neurofibrils were most marked in the cells lying close to the meninges. Around the nucleus the neurofibrils were seen to disappear. A rather diffuse but distinct alteration of the fibrils around the perinuclear zone, consisting in atrophy of the protoplasmic processes, with disappearance of the fibrils, was observed in senile dementia. The lesions of dementia praecox were less extensive, presenting numerous pyramidal cells with normal fibrils side by side with cells whose fibrils were partially destroyed. In idiocy and micro- cephalus the cells were observed to contain many fibrils, but were small and had few protoplasmic processes. The lesions of insanity and acute delirium were rather similar; an irregular atrophy of the primitive fibrils, beginning around the perinuclear zone and spreading irregularly toward the sides. The amount of fibrils was found to be normal in paranoia. Ballet and Laignel-Lavastine (Revue Neurologique, 1904) have likewise observed certain modifications of the neuro- fibrils in the cortical nerve cells of a patient having general paralysis, which were not found in the cortical cells of three patients who had died of pulmonary tuberculosis. The modifications of neurofibrils which might be expected a priori in general paralysis are not visible in all the cells. Like Marinesco, they noted the marked contrast between the fragmentation, granular transformation, and rarefaction of the fibrils of the medium and small pyramidal cells on the one hand, and the integrity of similar fibrils of the large pyramidal cells on the other hand. In most of the 62 Joseph Collins—Edwin G. Zabriskie. small and medium pyramidal cells the more or less clear perinuclear region is devoid of fibrils. At the base of the prolongations the fibrils are often torn asunder, wavy, or reduced to black points—some of which seem to be rods as the microscope is being adjusted. These configurations are found in a few large pyramidal cells also. Generally, however, only a rarefaction of the fibrils in the vicinity of the nucleus is visible. Finally, it was demonstrated that in control brains the fibrillary network surrounding each cell is much richer and denser than in the brain of a general paralytic. From this point of view it is necessary to guard against error by comparing sections of exactly the same tint only, since silver impregnation increases in intensity as fields lying closer to the margins are examined. Marinesco (Lesions of the neurofibrils in certain patho- logical conditions, Comp. Rend, de la Soc. de Biol., 1905) believes the majority of those pathological conditions in which the chromatophil substance of the ganglion cells is markedly altered, likewise present corresponding lesions of the neurofibrils. The author was able to demonstrate such lesions in acute myelitis, purulent meningitis, foci of soft- ening and atrophic convolutions; the neurofibrils showing variations differing in degree, imperfect staining capacity, diminution in size, complete atrophy, granular degeneration, or thickening and disintegration. In hemiplegia and para- plegia the pyramidal cells present secondary changes analo- gous to those following division of the axis-cylinder in peripheral nerves. Where the disease runs a rapid course, the neurofibrils likewise undergo rapid alteration. The primary seat of the lesion is also of importance, the neuro- fibrils rapidly degenerating and entirely disappearing in subcortical lesions and in lesions of the internal capsule. The first neurofibrils to be involved are those in the vicinity of the nucleus; the neurofibrils of the processes following in grave lesions only. Parhon and Papinian (Note sur reiteration des neuro- fibrilles, etc., Comp. Rend, de la Soc. de Biol., 1905.) The Neurones in the Light ot Our Present Knowledge. 63 neurofibrils of the ganglion cells of the brain were found to be more or less altered in patients having pellagra with marked cerebrospinal symptoms. As a rule the neurofibrils of the small ganglion cells presented slight changes only, while they were almost entirely absent in large cells, such as the pyramidal cells. The nucleus also was markedly altered in the large pyramidal cells. The cervical portion of the cord was more seriously affected than the lower portions, and the root cells worse than the cells of the columns. The anterior horn cells were most deeply involved, presenting alterations resembling those of the pyramidal cells in the zone of Rolando. Gentes et Bellot (Alterations des neurofibrilles des cellules pyramidales de l'ecorce cerebrals dans l'hemiplegie, Comb. Rend, de la Soc. de Biol., 1905) state that in cases of hemiplegia, where the pyramidal tract has been destroyed by the hemorrhage, a number of normal pyramidal cells are found side by side with cells whose fibrils are dimin- ished in number, thickened, fragmented at the periphery, or entirely destroyed, especially in the central portion of the cell. No alteration was observed in a case where there was only a compression of the pyramidal tract. Wimmer (Investigations concerning the neurofibrils in the cerebral cortex in pathological conditions, Hospital- stidende, No. 30, 1905) examined cases of general paralysis, delirum tremens, senile dementia, idiocy, and also one case of chronic trional intoxication by means of the Ramon y Cajal method, with Bokay's modification. In all these cases he observed a more or less marked degeneration of the fibrils in the pyramidal cells, especially in the small and medium-sized cells. A form of degeneration character- istic of each individual disease could not be demonstrated. Bielchowsky and Brodmann (Journal of Psychology and Neurology, V, 1905, p. 173), in discussing the changes in the fibrils in pathological conditions, say that the scanty histo- pathological examinations chiefly consider the qualitative alterations in individual cells only. These procedures, how- ever, are capable also of furnishing reliable data for the 64 Joseph Collins—Edwin G. Zabriskie. quantitative defects caused by pathological processes, and moreover they afford a view of the nervous fiber belt situ- ated between the cells. The author's findings were ob- tained exclusively by means of the Bielchowsky method. For the purpose of obtaining control specimens they began by examining definite areas of three normal brains, fol- lowed by the examination of exactly the same convolutions in seven pathological cases of an absolutely typical clinical course (dementia paralytica, dementia senilis, and idiocy). The results of their observations are proof positive of the reliability of the Bielchowsky method, the authors attach- ing special importance to the following points: 1. With reference to the normal histology of the cer- ebral cortex, the silver image is capable of completing and improving the customary parenchyma methods in various ways. The entire cortical structure appears much better differentiated in regard to the formation of fibers as well as of cells, (a) The nervous fiber-felt is much denser in the outer cortical layers, notably the first, second, and third layers, than in the medullary sheath specimen. Be- sides the medullated fibers, exceedingly numerous nonmed- ullated elements, especially in ramifying protoplasmic pro- cesses of the ganglion cells, participate in its formation. (b) The shape of the cells is very manifold, on account of the large number and great extent of the dendrites which are represented. The Bielchowsky method permits the dif- ferentiation of new types of cells, and based upon this, a finer differentiation of the layers in various segments of the convolutions, (c) The fibrillary structure of the cells per- mits the division of cell types hitherto considered as homol- ogous, for instance, various forms of giant pyramidal cells. (d) The last-named properties result in greater varia- bility of the cortical arrangement in general within individ- ual layers as well as entire cortical areas. 2. For the pathological histology of organic psychoses, the fibril preparation furnishes results applicable in the uni- form valuation of all nervous components. Pathognomonic characteristics of individual elements of the cortical paren- chyma cannot be recognized in the fibrillary picture. Neurones in the Light of Our Present Knowledge. 65 (a) As the principal characteristic of progressive pa- ralysis, the parenchyma presents remarkably profound alterations in all the cells even to the disappearance of entire cellular layers with relatively fair preservation of the fibrous constituents. This circumstance is important for the functional valuation of the cell, the significance of which has of late been underrated. The cell of general paresis is generally characterized by the early and extensive destruction of the processes and by the resolution of the fibrils, with temporary persistence of individual fibers in the body of the cell. The fibrous felt is markedly thinned out, especially in the finest ele- ments. (b) In senile dementia, in contradistinction to general paralysis, the outer shape of the cell with its dendrites is well preserved, as are likewise the cortical layers. The cellular structure is characterized by enlargement and bunching of the fibrils. The intercellular loss of fibers is less pronounced and affects coarser and finer constituents more uniformly than in general paralysis. (c) In idiocy the shrunken convolutions presented rad- cally different findings. The arrangement of the layers, the forms of the cells and the fibrillary structure were quite atypical. The number of fibers and cells was notably decreased. Studies of the fibril changes in peripheral nerves after resection and during regeneration has produced two groups of observers who combat each others' views almost as bitterly as the opponents and defenders of the continuity theory. Waller established his law of regeneration a long time ago. But even in the early eighties Vulpian and Phillippeaux claimed to have seen axis-cylinders developing in the peripheral ends of severed nerves where they con- sidered there was absolutely no chance of communication between the central and peripheral stumps. Since then their observations have been corroborated by Modena, Bethe, Howell-Huber, Marinesco, Van Gehuchten and others. These latter, by means of the various silver methods have found 66 Joseph Collins—Edwin G. Zabriskie. innumerable fine nerve fibrils in the peripheral stumps where there was no chance of communication with the central portion. These fibrils develop from the protoplasmic bands which arise from the cells of the sheath of Schwann, and can be seen as delicate fibrils lying in these bands. This view has been further supported by the embryological studies of Bethe and Schaffer who claim that the axones of peripheral nerves are not outgrowths of the anterior horn cells but develop independently with the bands of cells from the neural ledge which ultimately forms Schwann's sheath. Unfortunately for this view however their claims have been completely upset by the recent brilliant experiments of Harrison, to which we will refer later on. This manner of regeneration has been termed auto- genous and has become very popular with the rank and Fig. 7.—Psotoplasmic band containing tous nuclei, and in the interior can be seen fibres crossing or fusing at different points of their course. After Marinesco. file of neurologists. A certain number of investigators, including Stroebe Vanlair, Lugaro and Cajal vigorously deny this manner of regeneration. Their studies have demon- strated the central outgrowth of the fibres through the intermediary connected tissue into the peripheral stump and then on to their terminals. The fusiform cells and proto- plasmic bands in whose vicinity the newly formed fibres are found to perform either nutritive functions or else are endowed with certain phagocytic properties for the absorp- tion of the broken down sheaths and fibres. Cajal has ascribed to them certain properties which he calls chemio- tactic in that they have the power to attract the outgrowing fibrils in their direction. Marinesco (Journal f. Psychologie u. Neurologie, Bd. VIII, Heft 3-4, 1906) after further researches has recently been obliged to completely modify his views on this subject. He finds he can no longer support the claims of Bethe, et al. Use of the Cajal method has convinced him that Neurones in the Light of Our Present Knowledge. 67 while there are many terminal masses and globules in the central stump there is always a large number of fine fibrils, a veritable plexus which pushes swiftly through the inter- mediary mass of tissue into the peripheral portion of the nerve. He contends that serial sections show diminished activity in the process, the further away we get from the central portion, (a fact also observed by Bethe,) and that there are always fibrils in the intermediary tissue between the two stumps. In concluding, however, he rather spoils his own cause by citing certain cases where after tearing out the central portion, fibrils could be demonstrated in the peripheral stump despite very decided atrophy of the cor- responding anterior horn cells. Our own observations have led us to conclude that one should be very cautious in accepting the various descrip- tions of alteration in the neurofibrils. That alterations do exist in pathologic states is probable enough to be almost certain, and it is only against the tendency to accept too readily the attempts to classify them that we advise. This seems specially true of the Cajal method, depending as it does upon the well-known, rather uncertain, powers of pen- etration which silver salts possess. In the most successful preparations by this method there are always two zones, where the staining is absolutely unsuccessful; even in the middle zone, where the stain is most successful, all the cells are not impregnated regularly and evenly, and we have found not infrequently badly stained cells in normal preparations which resemble quite closely some of those described as pathologically altered. Marinesco has given elaborate descriptions of the changes in the neurofibrils after tearing out the hypoglossus of rabbits. His records show changes from the forty-eighth hour up to thirty days, whereas our own preparations of the hypoglossa nucleus fail to show even at the end of the fifth day the changes he describes as having already taken place at the end of the thirty-sixth hour. We can corroborate his obser- vation that only the anterior external group is affecttd, but the only alteration in the fibrils themselves seems to lie in 68 Joseph Collins—Edwin G. Zabriskie. a paler and more delicate stain. They no longer possess the dark, sharply differentiated outlines of the neighboring cells, and the contrast is quite marked. We are unable to see that granulation and loss of structure, he so graphi- cally describes, or a tendency of the fibrils to arrange themselves in bundles. The Bielchowsky method, on the other hand, is much more logical in that it gives us a more constant stain of all the elements in the section, and the modifications have rendered it simple enough to permit most workers to become conversant with and rely on it. But here also there is need of much corroboration before the evidence can be accepted as final. The new teachings ask us to imagine a fiber without a cell—a thing which we cannot do unless we give up the cellular theory. Although there seems to be a necessity to modify the neuron theory, nothing has yet been done to cause it to be abandoned. In fact, some of the later work of Cajal, carried out according to his new method of staining, has strength- ened the position of those who adhere to the neuron theory. For instance, Cajal and Retzius have both demonstrated the existence of a neurofibrillary network in the ganglion cells of vertebrates. Cajal maintains that these neurofibrils remain in the ganglion cells and their processes; they do not leave it as claimed by Apathy and Bethe, they do not emerge freely, they do not form connections with each other and accordingly they do not form a true network in the dotted substance, but merely an intimate interlacing. Cajal, Retzius and other investigators maintain that the neuro- fibrils in invertebrates belong to the cellular structure of the ganglion cells and their processes, being formed within them in situ instead of having migrated into them from without as described by Apathy and Bethe. If this is so, and at the present time it must be accepted, it tends materially to strengthen the neuron theory, for no proof has been furnished, apart from their mere existence of their extracellular appearance, and their seeming endlessness. Neurones in the Light of Our Present Knowledge. 69 That the neurofibrils are the actual and only conducting element of the nervous system has been assumed, but the assumption is based upon the correctness of the evidence furnished by Apathy, Bethe, et at., and has been contra- dicted from most reliable sources. Even though it is granted for the sake of argument that there is an intercommunication of the neurofibrils belonging to the motor and sensory system by means of networks in the cell-body, this is not adequate ground for asking us to abandon the neuron theory. There is no proof whatsoever that the fibrils have the function of conducting. That is an assumption just as the existence of a fibrillary acid by Bethe as the condition of nervous conduction is an assumption. On the other hand, the neuron theory does not get all its support from histological study of vertebrates or inver- tebrates, by any means. As we shall point out later, it receives some of its strongest corroboration from embryology. But even though it were so dependent there would still be much histological evidence in support of it. For instance, the relation of the collaterals in the spinal cord, the free terminations of which can readily be demonstrated, the relation of the end-baskets around the Purkinje cells, and the granular cells of the cerebellum which Michotte (Le Ntvraxe, Vol. VI., No. 3) has particularly studied, many of which we have previously mentioned, and the results of study of the retina. Cajal has been able to demonstrate in the retina fibrillary network within the cell-body, also the anastomosis formation of the fibrils within the dendrites, but he was not able to see the anastomosis between two ganglion cells which Dogiel and Graef described. One of the strongest supports of the neuron theory has been the teachings of embryology as set forth by His and his school. Those who oppose this theory look upon peripheral nerve fibers as the product of innumerable cells arranged one after another in chains which remain in fully developed nerves in the shape of Schwann's cells (Dorn, Apathy, Bethe, Schultze.) But a recent work of R. G. 70 Joseph Collins—Edwin G. Zabriskie. Harrison of Baltimore (Sit^unsber. der Niederrhein. Ges. f. Naiur. Heilk. zu Bonn, 1904,) which has been received most favorably by embryologists and anatomists, gives the most unequivocal support to His' teachings that every nerve fiber is the outgrowth of an individual ganglion cell. Harrison shows, from many observations on the larvae of amphibia, that Schwann's cells, like the spinal ganglion cells, are of ectodermal origin and come from the so-called ganglion ledge of the neural canal. When this ganglion ledge is removed from the body at a certain stage of embryonal development and then the nerves develop in the normal way, it gives incontestable evidence that Schwann's cells as well as their cells of origin have no participation or significance in the formation of axis-cylinders. In other words, the peripheral spina] nerves may develop when the sheath-cells are entirely absent. This idea Harrison believes is substantiated by the fact that after complete extirpation of the ganglion ledge he has observed the development of naked fibers in the periphery. His conclusions are: The axis-cylinders of motor nerves develop in a normal way in embryo frogs in which the development of Schwann's cells are prevented by cutting out early the ganglion ledge. The nerve consists in these cases of naked fibers which may be followed as such to the ventral portion of the thigh and tail muscles. The sensory nerves of the tail in Triton larvae, naked ramifying fibers, which, from their origin in the posterior cells, and the cells of the spinal ganglia to their ending, show no Schwann's cells. The latter are to be seen for the first time only after fibers have formed; they proceed gradually from the center toward the periphery, as is evident from a comparison of different stages, and also from direct observation of the fins of living frog-larvae. The Rohon- Beard's posterior cells of the frog embryo consist of early protoplasmic formations, which gradually stretch themselves under the skin to nerve fibers. The termination of nerve fibers so constituted consists of a thickening with fine pseudo podii prolongations. The nerve Neurones in the Light of Our Present Knowledge. 71 fibers are first of all simple, later they intertwine and eventually through interlacing with neighboring cells con- stitute a plexus. From the beginning to the end there are no Schwann's cells in these nerves. From which it appears that nerve fibers come exclusively from nerve cells. Carrying the experiments a step further, Harrison excised in young embryo of Rana sylvatica and Rana palustra the ventral portion of the neural tubes from the cells of which develop the neuraxons of the spinal motor nerves. He left the neural ledge from which develop the spinal ganglia and sheath-cells intact. The result was that the latter developed normally, but of the former not a trace. Thus he proved incontestably, and in a way reflecting the greatest credit upon his insight and ingenuity, that the motor neuraxons are processes of the anterior horn-cells, and that the sheath-cells cannot by themselves originate these fibers. The one thing that is needed by the opponents of the neuron theory is to show the transition of a sensory, cen- tripetal impulse, to a motor centrifugal tract without the intermediation of a ganglion cell. If they could do that their claims would be established. Whether they first go in or come out of the cell, whether the elementary trellis formation is originally extracellular or intracellular, whether the fibrils are at all interrupted at Ranvier's nodes, or whether there is a free peripheral termination, are all matters of trivial importance compared with this, for then the neuron theory would lose its applicability and useful- ness to the problems of physiology and histology. 37 West 54th St. ALCOHOL IN THERAPEUTICS. By C. H. HUGHES, M. D. St. Louis. THIS important subject received much and significant attention at the late dinner of the Dominion Alliance against Alcohol of the British Medical Association, Mr. Victor Horsley delivering one of the principal addresses. Our friends, Murdock Cameron, of Glasgow, and Henry O. Marcy, of Boston, also Professor Woodhead of England, be- ing equally forceful in their presentation of the indictment against alcohol as a beverage and too common therapeutic agent. Sir Victor Horsley took very strong ground in favor of lessening the use of alcohol in connection with surgical operations, and Professor Woodhead, of Cambridge Univer- sity, was equally pronounced in his opinion that good would result from using less alcohol in the practice of medicine. They assert that a great change has passed over both branches of the medical profession toward alcohol as a drug. Horsley stated that when he was a student it was the custom to give alcohol freely to each patient before the performance of an operation. Since the discovery by Lord Lister of the principles of antiseptic surgery this custom has largely died out, and a year ago a well-known practi- tioner said he had not used alcohol in seven years in gen- eral practice. It was formerly the custom to give patients alcohol also after operations, but its place has been taken by other drugs better adapted to serve the purpose in view. Professor Woodhead's testimony was equally emphatic and satisfactory as to the progress made in the same direction by British medical practitioners. Men who formerly looked upon alcohol as necessary in the treatment of various diseases (72) Alcohol in Therapeutics. 73 are now satisfied that it produces an injurious effect on the patient's power to resist disease. Men who have made laboratory investigations regarding the actual value of alco- hol as a medicine have generally come definitely to the conclusion that its use tends to lessen rather than increase resistance to disease. Dr. Marcy, of Boston, whose experience dates back to the time when he was an army surgeon during the civil war, and Dr. Murdock Cameron, of Glasgow, added the information that hot water or milk and soda had been used with advantage, instead of the alcohol formerly given so freely to patients about to undergo surgical opera- tions. By hospital statistics Sir Victor Horsley showed that in seven great London hospitals the annual expendi- ture on alcohol had decreased in forty years from forty thousand to fifteen thousand dollars, while the annual ex- penditure on milk had in the same interval increased from fifteen thousand to forty thousand. He showed also that during twenty-five years in the Royal Infirmary at Salis- bury the annual expenditure on alcohol had fallen off from fifteen hundred dollars to thirty-five dollars. If alcohol is harmful as a drug in general, it is worth- less as a drink. The marked and sometimes fatal affinity that alcohol has for the water of the tissues and cerebro- spinal and interventricular fluids and the fluid bathing the nerves and neurones, ought to suggest the the danger of its extensive use,even when largely diluted in readily eliminatable form, as in beer and wine and highballs, though when well chaperoned on its way through the system to the emuncto- ries with large quantities of water, its harmfulnes of courses, is thereby diminished. Yet it is always a menace to organic integrity and vasomotor stability, in therapeutics and should be pre- scribed sparingly and cautiously with these facts in view; under the wisest of skilled physiological precautions, in hands of utmost therapeutic wisdom, and while alcohol in- creases thirst and promotes elimination when largely di- luted, as in ale and beer, or with plenty of water, it 74 Charles H. Hushes. nevertheless clings tenaciously to the organism and only the largest quantities of water can dislodge it in cases of transient alcoholic toxhemia. This fact should always be considered in administering it therapeutically and especially when contemplating its use as a beverage. This fact gener- ally contraindicates its prescription. It tends to parch the tissues and impair tissue and viscera functions. Regarding alcohol in any form as an habitual beverage, wisdom dictates abstention from its use as an exhilarant, in the light of the now well-known perverted physiology and pathological anatomy resulting from its use. It is in the main a patho-physiological and anatomical mocker, as it was long ago wisely pronounced before the discovery of its vasomotor paralytic powers, its arteriole, hepatic and other viscera and tissue destructive influence. The mentally and morally degenerating influence of habit- ual excessive alcoholic indulgence, though now a matter of common observation, has also long been well known to the medical profession since the researches of Morel called special attention through close observation of alcoholized individuals and their descendants, to the vicious evolution therefrom and therein of the neuropathic diathesis and its destructive train of fatal results to posterity, through which so many of the epilpsias, imbecilities, idiocies, and insanities are en- gendered. We now know too sadly and too well through confirm- atory observation, of the psychic neurone depressing power of persistent and excessive alcoholism, to look lightly upon the careless use of this potently harmful nerve center poison. The alcoholic multiple neuritides, affecting the peri- pheral nervous system, through morbid changes, also at their centers, added to our knowledge of the alterations of the psychic and psychic-motor neurones and the changed quality of the ventricular fluids under its prolonged use, admonish us to caution. Its potent influences too in coun- teracting the poison of the crotulus on the central nervous system is significant of its sometime therapeutic power.* •The neuritides of alcohol are probably due to its power of abstracting th s fluid surrounding the axis cylinder beneath and nourishing the neurilemma. Alcohol in Therapeutics. 75 The insidious hold that alcohol takes of the psychic neurones and all the pathologic changes demonstrated by Bevan Lewis and his co-workers, predecessors and followers, carry an especial caution to scientific observers and thinkers in the domain of practical medicine, causing them to beware how alcohol's fatal potency for harm to the organism may be established through its fatal instrumentality, as that of opium, has been, largely through indiscreet, careless, incautious, indiscriminate prescribing.especially by druggists,and the reck- less, thoughtless or venal refilling of prescriptions by crafty pharmacists, etc. The unfortunately and often fatally endowed man and woman with the inborn or morbidly acquired aptitude to fatal alcoholic excess is always with us, and, as it would be harmful to ask such a one to take even a sip of wine, as is often done at social parties and at the family table, it is imperative upon us to be especially cautious in such cases as to the giving of alcoholic medication in our prescript- ions. Several thousands of years have elapsed since it was said by the wise man of holy writ, "Woe unto him that putteth the bottle to his neighbor's lips," yet the treating habtt continues, the insidious beer canning, making incipient inebriates, is growing, light wines are considered harmless habitual beverages, to be taken at meals ad libitum. We prescribe the alcoholics verbally and undisguised, our banquets are now much more moderate in the serving of alcoholics, yet continue to serve alcoholic drinks first and coffee last; whereas the rational way would be to first offer the exhilaration of coffee and tea and offer, if they offer them at all, the alcoholics last. The better way would be to omit the alcohols altogether or serve them on a side- board or from the bar to those whose already formed habits are such that their psychic neurones can not be brought into convivial action without the coursing of the poison through their circulation to toxically arouse the otherwise dormant brain activity. Set them only for those who, by force of long alcoholic imbibing habit must have the toxic scourge, or think they must, to bring their psychic neu- rones into vivacious action. 76 Charles H. Hughes. It was not "Luke the good physician" who in the earlier Christian days prescribed "a little wine for the stomach's sake" of *Timothy, but Paul who himself often needed a physician. St. Paul in the cerebrasthenic periods of his glorious but often over-strenuous life, probably found in the wine of his day, much of it unfermented, a grateful relief to his cerebrally dyspeptic stomach and a restful diversion from his over-anxiousthought and duty well-done toward God and man. But, like the cruel crucifiers of his Master, he knew, not what he did to posterity through that brief, uninspired therapeutically wrong admonition to his suffering colleague in Christian work, although the advice sprung from a natural and very common human impulse to help heal an afflicted associate by remedial suggestion. This advice to Timothy, his brother in Christ, has been quoted and acted upon millions of times, both by the saintly and the ungodly, to the harm of man- kind, regardless and ignorant of the inherent oinopathic proclivities of many with whom the alcoholic road once taken, even for relief of disease, and sometimes at the com- munion, is never forsaken. It is not long since a man of New York, clad in the holy vestments of his sacred office, more thoughtless and less pious probably than Paul of Corinth, but a counsellor in the name of the blessed Christ, invoked in His holy name the blessing of God on moderate daily alcoholic beverage drinking, the end whereof is usually moral as well as physical and mental degradation, degeneration and ruin through ultimate demonstrable damage of brain and other organic tissues and viscera. The medical profession in times past has done its share in this form of unwise counsel along with the clergy and the rest of mankind. Let it do no more of it, but admonish •It does not appear in biblical record that Timothy was an oinopath or that he ever became a dipsomaniac in consequence of St. Paul's advice. He was not so fatefully endowed in his cerebro-psychic centers, nor was Paul. But what if either had been. Many a gifted Divine has gone the road to ruin from following Paul's advice to Timothy and that other biblical encomium on wine that "it maketh the heart glad." Wine indulged in as a daily beverage has saddened the hearts of millions and maddened the minds of men since this fatal encomium was uttered. Paul's consent to the stoning of the protomartyr Stephen, which through remorse contributed to bring about his own atoning conversion, could have worked no greater,harm to mankind than that consented to but repented act of the good apostle. Alcohol in Therapeutics. 77 and practice in the light of later observation and scientific teaching concerning alcohol used as a beverage. The oinopathic diathesis confronts us as never before and the latent drink-crave stricken, needs from us as much consid- eration as we would give the "pestilence that walketh in darkness" to destroy. Bacchus will reign the supreme monarch over the lives of many men long after we shall have gone from earth, but let us not promote the perpetuation of his power over the human brain and mind by friendly aid and counsel against our knowledge and conviction, revealed to us by experience and the unerring teachings of science, as to alcohol's morbid destroying marks made on the human anatomy. We are bound to consider the unfortunate psycho- path, to whom alcohol in quantities which would not markedly impress another, acts as an immediate poison to the brain, developing the instability of delirium and even of marked insanity. He astonishes his friends who are imbibing with him by becoming crazy drunk within a few minutes after taking a few social glasses. This is the man from whom his companions wish then to get away, but often cannot, until some untoward denouement happens to require his restraint. This is the sort of oinapath in whom a little liquor is a dangerous thing and is diagnostic of the psycho- pathic diathesis, causing abnormal conduct, unnatural to the same individual in a non-alcoholized state. This property of alcohol, so harmful if this vaso-motor im- pression and sequent arteriole dilation be excessive and too long continued, as in cases of habitual inebriety, making the once well man diseased, may come often to our aid if we use it aright, by compensating for the vaso-motor de- pression by substantial chemico-nurrient support, and by chaperoning it well on its way through the circulation by an ample supply of water for the protection of the tissues, without the patients having knowledge of or discre- tion in, the dosage or repetition of the prescription. Conditions of blood stasis, atheromatous vascular con- tractures and many other states of vessel and blood de- mand its therapeutic employment, because of its undoubted 78 Charles H. Hughes. physiopathologial vaso-dilation at times, its power of arteriole relaxation, as well as in certain states of toxhaemia (often autotoxic) heart depression, that suggest its opportune and helpful use to the physician. We should so employ it al- ways, however, in such manner as will prevent secondary alcoholic disease developing, as we employ other toxic agents, the cautious employment of opium or its salts, for example. Rightly given it may do good then as a medicine, but it is always bad as a beverage. Bad if used by the pa- tient at his discretion and taken ad libitum. Only a judi- cious physician, conscientiously and with right information, alert and alive regarding its ultimate dangers, as a possibly pathic and fatal habit developer, should prescribe and regulate its use. It should have place in the medical mind only as a medicine, toxic to the organism like many other medicines when given in quantities and at intervals beyond legiti- mate therapeutic indications. The fear of alcohol as a beverage is the beginning, and the abstention therefrom by the oinopath, the psychopath and the doctor who prescribes for them, the conclusion of wisdom. The vasodilator value of the alcoholics must be con- sidered just as carefully as we regard the vasoconstrictor influence of the bromide salts over the arterioles in thera- peutic problems. These properties make both exceedingly valuable in certain features of medical practice not enough considered, as we may glean from therapeutic recommenda- tions of treatment from the present-day literature, though we must regard the danger of the drink habit in giving alcohol and the inherent neuropathic aptitude, while the drug habit of bromide prescriptions is nil, or at most, in- significant. Bromides may be cut off at any time without inconvenience to the user, while alcoholics usually can not, if the patient be well of his malady and it has been long employed. One exceedingly valuable as well as harmful transient use of alcohol, is in its employment for overcoming sudden Alcohol in Therapeutics. 79 heart failure, syncope and impaired or lost consciousness. If the pulse is perceptible it is better to let the prone po- sition restore to consciousness, with but little alcoholic stimulation nicely adjusted in dosage to the accomplish- ment of gradual restoration without undue vasomotor dila- tion, giving the shocked and damaged cerebral neurones and vasomotor centers a chance at physiological recuperation without undue cerebral congestion, especially if the cause be a blow upon the head, which may have caused an or- ganic cerebral traumatism. But the frequent practice of young, inexperienced physicians not specially skilled in traumatic brain diseases or rightly regardful of the vasomotor paralyzing and brain-flushing power of alcoholic liquors, is to give those stimulants while the man is down, too liber- ally in quantity and repetition for the after good of the brain. And the first thing that suggests itself to the know- ing bystander, who may have a bottle or be accustomed to daily alcoholic drinking, is to too liberally give the pros- trate victim of head violence too much whiskey or other alcoholics, to the imperilment or aggravation of brain con- gestion or inflammation after the reaction sets in. We may put many bad agencies and things to good use, and so may we do in prescribing the alcoholics, but they should be handled, as we may discover from even this incomplete survey of its powers, with a clear insight as to their therapeutic, toxic and ultimate brain-enthralling and disease-engendering potentialities and possibilities, even in prescription form or form of patent medicine. Indeed, the insidious peril of the alcoholized patent or popularly used proprietary medicine is among the greatest of alcohol's dangers. They clandestinely destroy the victim be- fore he is aware of his thraldom, if he pitifully be among that unfortunate class who, by reason of inherent neuro- pathic infirmity, which too often blindly seeks surcease of neurotic irritability and neurasthenia in these disguised al- coholics. Unlike one ofthe most venomous of serpents, to which a great man has compared the worm of the still and its product, they give no warning of their concealed, en- 80 Charles H. Hughes. thralling, fatal poison to the neurone unstables and non-resist- ing who, once well started in alcohol-taking, can never turn back. I mean the dipsopath, the oinopath, the dipso- maniac. In fact, the aim of all treatment, where narcotics or stimulants of any sort are employed, should be to con- serve the integrity of the central neurones, especially the psychic, after the conclusion of the treatment and the re- covery of the patient. This is important in the manage- ment of chronic alcoholism and acute periodic inebriety, wherein the so-called Keely method, popularized though not originally devised by that surgeon, finally fails, because the neurological knowledge which dismisses a chronic alcoholic after six weeks more or less of brief treatment, is insuffi- cient for the right remedy of the neuropathic antecedents and sequences of chronic alcoholic toxhemia, etc. In conclusion, let me not be understood as dis- countenancing the prescription of alcoholic preparations or combinations in minimum dose for therapeutic indica- tion in all proper cases, and always well diluted, to mini- mize incident alcoholic tissue damage, as in diabetes, melan- cholia and some fevers but in concealed prescription form. My plea is for physiological and psychological discretion and discrimination in its use, as to dosage, method of pre- scription and the discountenancing of the erroneous unsan- itary beverage idea for the sick, and for the prevention of the alcoholic beverage danger to the well, that may come to certain, and many persons from its needlessly prolonged and voluntary use, especially during and after convalescence. RECURRENT FUNCTIONAL AS DISTINGUISHED FROM THE TYPICAL ORGANIC DEMENTIA SENILIS OF THE LITERATURE. BY C. H. HUGHES, M. D. ST. LOUIS. rMENTlA of the aged has come down to us from the fathers in psychiatry as generally regarded as an organic, chronic and incurable condition of cerebral and coincident psychic decadence, and described as caused by the invariable arterial, arteriole, or brain cell, atrophic changes of senile decay or as the sequence of other organic brain disease. Dementia senilis has been mostly described to us as it appears in most chronic forms within hospitals for the insane. The autopsic findings of pure senile dementia as described in the literature have not always been differen- tiated from terminal dementia in the aged, appearing as the result of previous (and acute) mental disease or a conse- quence of cerebral sclerosis or of tabes dorsalis or as due to the combined excesses of tobacco, alcohol or other narco- stimulants and as age decadence. But there exists beyond a doubt, for the evidence is convincing if we but closely watch and question our cases, a form of senile dementia which is merely a transient func- (81) 82 Charles H. Hughes. tional cerebrastheniac dementia, capable of recovery and recurrence, as functional and curable and as liable to recur- rence as dementia praecox, a term misleading, inexact and unmeaning, like dementia paralytica, for the paretic is not more demented in the earlier stages of his malady than the paranoiac in the earlier periods of this remarkable cerebro-mental malady, misnamed "dementia paranoides." Dementia praecox, with some others, might be decently interred, as the Journal of Menial Science has recently sug- gested, in a verbal cemetery. It is an adolescent insanity.* The term "dementia," in strict psychopathic language should designate the cerebro-mental morbid state its deri- vation implies—dementia—the deprivation or absence of mind, paralysis of mind, not the simple morbid mental perver- sion with mental debility or anurgia which some authors term "dementia." But these terms have been scientifically sanctified by long accepted usage of the masters and the savants in our ranks and we shall perhaps long continue to use them. The recognition of a condition of psychopathic neuras- thenia resembling organic dementia senilis is important from therapeutic, prognostic and medico-legal points of view in which the patient and his friends, his heirs and the phy- sicians' standing are alike interested. Because the brain of an aged, debilitated person collapses in involuntarily simulated dementia under mental stress unusual to him, we should not conclude that he is therefore to be permanently demented, even though he may have passed the three score and ten limit, or be yet older and regarded as extremely aged and old enough to die, especially by anxious waiting heirs. Cerebrasthenia comes to the aged as well as to the young and a transient or permanent impairment of memory and understanding and mental spontaneity of thought and volition may follow therefrom, simulating dementia of the aged and under judicious treatment this form of dementia may be caused to disappear. Shakespeare, in the character •In this connection the Journal nr tes on this subject in the April, 1905, Journal 0} Mental Science and Dr. McCanahey's paper on Adolescent Insanity in the same number will prove interesting and instructive reading on this subject and inciden- tally on the subject of my present paper. functional vs. Organic Dementia Senilis. 83 of King Lear, has depicted alternating normal and abnormal senility, as he shows in Hamlet both the insanity of neuras- thenia and the recuperated capacity for simulation. In fact neurasthenic aged persons, if they be financially well circumstanced and can be placed congenially from the standpoint of a wise psycho-therapy, conducted by right psycho and neurotherapeutic skill, may recover their mental equilibrium under treatment as readily as the passion or ambition or evil habit deranged young man or woman. More than three decades of special observation of neu- rasthenically demented old people, and comparing results with the general run of the organically demented of the asylums for the insane, has led to this conclusion, based on cases both within and without insane hospital practice. 1 have drawn my conclusions of the curability and differ- entiation, (from personal clinical observation in certain of my own cases) of functional and curable from organic incurable dementia in the aged, being content on this occasion to cite but one of my own, after noting the remarkable tabulated results given by T. S. Clouston, from the records of the Royal Edinburgh Asylum for the Insane. Dementia senilis has appeared to me in the trinominal forms—first, the progressive perverted senile neurone invo- lution symptomatically shown in prolonged and progressive psychic departure from normal mental character of the aged person and marked mental enfeeblement of speech, action and conduct of mind. "It is a progressive mental enfeeblement at the period of senile involution," dependent upon organic changes in the brain, therefore a chronic organic psychosis and we might well add that it is in its true typical form a pro- gressive chronic organic psychosis of brain decay and unre- mittingly exhausted brain function. The true typical organic dement has no marked lucid intervals, so-called, of mental vigor and capacity up to the normal average of the sane old man. Once demented always demented, when the cause of the dementia is solely organic psychic neurone involution. Not so with the functional cerebrasthenic form. The second form is likewise cerebrally organic to so 84 Charles H. Hughes. with the functional cerebrasthenic form, but secondary and dependent upon precedent organic brain disease, as upon a previously existing mania of brain destroying origin. We then call it secondary or terminal dementia. The third form is the one we are now discussing. It is a gradually and normally involuted brain plus an unac- customed brain stress, a transient psychasthenia or neuras- thenia involving the brain in weakness, not necessarily permanent, and causing amnesia and other symptoms of dementia not due to organic neurone irrecoverable decad- ence, but recoverable back to the normal state of the old person under right recuperable influences. With this differ- entiation between the hopeless and hopeful possibilities in dementia of the aged so long and so erroneously regarded as entirely incurable, Jet us now examine Clouston's record and results. Ages. Total Nos. Recovered 60 to 65 62 24 65 to 70 63 21 70 to 75 40 15 75 to 80 30 9 80 to 85 3 1 85 to 90 5 2 203 72 Clouston does not make the differentiation we here offer as an explanation of his recovered cases, but confesses that one of the most interesting and important of the results he obtained from an analysis of those 203 senile cases was a clearer idea than he had before of the course of such cases, their duration, and the results of treatment. The general result was that seventy-two of the cases, that is thirty-five per cent of them, were discharged from the hos- pital "recovered;" and sixty-nine cases, that is thirty-three per cent, have died; while thirty-three cases were discharged more or less improved, or not at all improved, leaving twenty-nine cases under treatment. The striking fact is the number of recoveries. He explains that the "recovery" Functional vs. Organic Dementia Senilis. 85 from any form of senile insanity need not necessarily be. and is not as a matter of fact, an absolute restoration to pristine vigor of mind. Some such complete recoveries there were, men who went out and earned their own livelihood, women who went out and governed their households. Esquirol, after citing Pinel's statement in his Treatise on Mania, of spontaneous cure of dementia, says that what nature effected in the case which this celebrated teacher speaks of, art accomplished for a case he records of what would, in our day, be called dementia praecox.* This author of the early nineteenth century, following Calmiel, Baile and Guislain, conceding the curability of acute dementia of adolescence and mental and acute alcoholism, admitted only the retardation of the progress of senile dementia and to some extent its termination, under country air, moderate exercise and tonic regimen, as he saw chronic senile dementia in the halls of the Maison Royal des Aliens of Charenton. But acute dementia, his first variety, as he saw it, "resulting from temporary errors of regimen, from fever, hemorrhage, metastasis, the suppression of habitual evacu- ation or from the debilitating treatment of mania 'with' sudden invasion exempt from any lesion of motion" is easily cured by the combined agency of regimen and tonic treatment.t And so may the exacerbations of acute and transient seizures of dementia senilis, functional in form, as other varieties of acute dementia are curable, if the transient brain strain is removed and the general organism and the viscera are relieved and rested and restored to normal status of the abnormally oppressed and excessively anurgic burdened old person. Lighten the oppressed brain of the old man or woman of its needless burden of grief or worry, anxiety or care, and it may resume again its accus- tomed work, feebly as comports with the brain's age, but not abnormally and without dementia. Andrew Combe who had a clearer conception of the true nature of insanity than any other alienist of his day •Mental Maladies, Hunt's translation, 1845. tOpus Oitat, p. 47*. 86 Charles H. Hughes. said: "Dementia is a form of mental affection, not in itself a distinct disease, but arising from a variety of path- ological states each requiring a corresponding treatment. It is characterized by general weakness of mind, involving all the faculties equally." Dementia is a morbid condition of the brain and mind, a symptomatic expression of disease. It may be sympto- matic of epilepsy or a sequel of apoplexy or fever or alcoholism or profound cerebrasthenia, especially in the aged. "Sometimes it appears from cerebral debility more than from the continuance of actual diseases and then recovery may take place. In the asylum at Milan, cases of dementia from inanition, and which are cured by nourishing food and tonics, are not rare; but, in ordinary circumstances, its appearance indicates incurable disturbance, or actual disor- ganization of the brain." Before neurasthenia was named he recognized the senile dementia that results from it, cerebral exhaustion. His dementia of inanition was a neurasthenic recurrable form of dementia caused by psychic stress and exhaustion and curable under rest, etc. This is the form of dementia in the aged of which we are writing. Dr. Samuel E. Smith, Medical Superintendent of the Eastern Indiana Hospital for the Insane, in hit last report, 1905, reflects the experience of other hospital alienists, as well as his and my own, in the following clinical prognostic observation: "Chronic cases are not entirely without hope and promise something, and they must not be abandoned to the darkness of complete dementia. "Every alienist knows something of the gratifying results and surprises which occasionally come from the management of so-called incurables, not excepting even the psychoses of degeneration, which are sometimes checked in their downward progress for a period of time, rarely indefinite, and it follows naturally that, as such experiences multiply, the tendency to narrow the incurable class grows." Hugh H. was a patient admitted to the Fulton, Mis- Functional vs. Organic Dementia Senilis. 87 souri Asylum for the Insane with a delusional form of acute mania in 1852, resulting from over brain-strain and disap- pointment in the mining ventures at Galena, 11I. He improved after years of restraint and rest of brain with good sleep and nutrition, as Dr. Smith the Superintendent informed me, during that and succeeding years up to 1861, and passed with age into a state which was called by my predecessors in the management of this institution, Drs. Smith and Abbot, chronic dementia. He was, however, after fourteen years' residence when I first saw him, a quiet, gentlemanly old man, having the freedom of the outside premises and of the neighboring city, going and coming each day and with regularity and punctuality, to meals and to his room and bed at night. He was not "a restless, sleepless dotard without memory, without true affectiveness." He was not slovenly and uncleanly in dress or person and showed no profound persistent general failure of all of his faculties as chronic dements do. He was neat in dress and cleanly in person and far from that morbid unmanageable second childhood, common to his class, when grave organic degeneracy has made its destructive dementing mark on the aged brain, though he was older and feebler in brain under strained endurance, prolonged physical exercise or the long mental efforts he would sometimes indulge in, when overtaxed by converse with his sane friends. He would then collapse, at times, displaying amnesia and weak delusions and imbecility of mind till recuperated by enforced rest and a period of exclusion from friends and denial of his accustomed visits to town for awhile. When in this state of neurasthenic dementia, his early delusions of running a steamboat under the house at night (owning the premises, etc.) and of his great wealth would appear. Under the above treatment, however, he would return to his normal state of senile mindedness without amnesia or delusions such as accorded with his age. On one of these occasions, after the asylum had been robbed of its blankets by one of the contending armies in the state, it 88 Charles H. Hughes. was decided to send all the patients, because of lack of maintenance funds, back to their home counties. The country was on fire with excitement but the Major was tranquil and while out again with his friends was asked if the management was going to send him home. To this he responded "yes' The whole country has gone crazy and the managers wisely concluded it was useless to keep us few lunatics confined. We are coming out to join the rest of you." There was no insanity in this opinion for a wildfire of unreasoning passion was prevailing at that time throughout Missouri and the entire land, brother was arrayed against brother and son against parent or sister, wife and husband were not in harmony, families and neighbors were arrayed in deadly feud against each other and the lately best of friends spoke not or spoke uncivilly as they passed each other by. Senselessness of speech and conduct of dementia appeared at times during my daily knowledge of him for five years under varying brain tone states. He died of rheumatism and erysipelas in 1880 after 1 left the institution. His exact age was not known, though he was an old man with very white hair and stooped over when I first saw him in 1867, thirteen years before his demise. This communication has been lately inspired by hearing the testimony of a number of medical men in an important will case, to the effect that senile dementia was always a continuously and progressively hopeless loss of the faculties of the mind, with but one inevitable ending in mental extinction, and it is to correct this unscientific error for which the literature of insane asylums is largely responsible, that this brief protest and presentation of the functional and curable phase of dementia senilis is presented. There is a true neurasthenic or cerebrasthenic dementia senilis as there is also in the aged a preponderance of organic senile decay, ending in dementia which is hopeless in its outcome. There are transient and curable states of senile dementia, in the treatment of which we should be on our guard, lest we consign the curable to hopelessness, and make no effort for their mental rescue. Functional vs. Organic Dementia senilis. 89 To classify all aged neurasthenic functional dements as doomed, would be like signing an unwarranted burial cer- tificate in a case of profound shock from which the patient might rally and live. Mary C, past the menopause, was a patient from the lower walks of life whom 1 had classed as an incurable dement, she having come from among the insane pauper class sent by St. Louis County. When the new St. Louis County Insane Asylum was completed and she was taken to Dr. Stevens, the first superintendent of that institution, the transfer involving an overland trip of fifteen miles in a carriage, a ferry ride of several miles, a hundred-mile railway ride and an early autumn moonlight wagon ride, she was put to work in the laundry, beginning with the simplest routine rinsing work. She continued at work in the laundry, rising from grade to grade higher in occupation there, till she graduated through the mangle and drying room as a first class hand ironer and with reason restored and dismissal. She had done laundry work before the access of her insanity, which had apparently passed on to dementia. In conclusion let me say, this paper is written mainly with a view to correct a common misapprehension among amateur alienists especially, who without adequate clinical experience in the wide domain of psychiatry, conclude that once dementia appears in the aged it must continue to the finale of life. This, like the hopeless view of that psychic misnomer, dementia pra?cox, a term sanctioned even by Kraepelin, is a prognostic error for adolescent insanity which, with Brower and precedent authorities, 1 regard as the better and less misleading designation, because it is only a sus- pension and not a destruction of mental power and mani- festation, which may be and is restored under changed environment, altered psychic impression and further cerebro- psychic evolution. Under right circumstances of surroundings, medical management and therapeutics, neither dementia senilis nor dementia praecox are always incurable. They may both be intermittent and recoverable cerebro-psych- asthenia senilis of juveniles and should be treated accordingly and not therapeutically neglected as hopeless of recovery. THE ALIENIST AND NEUROLOGIST. VOL. XXVIII. ST. LOUIS, FEBRUARY, 1907. NO. 1. Sabscriptlon $5.00 per Annum in Advance. $1.25 Single Co»r CHAS. H. HUGHES. M. D., Editor. HENRY L. HUGHES. Manager and Publisher. Editorial Rooms. 3872 Washington Boul. Business Office. 3872 Washington Boul. This Journal Is published between the first and fifteenth of February, May, August and November, and subscribers falling to receive the Journal by the 20th of the month of Issue will please notify us promptly. Entered at the Postofnce in St. Louis as second-class mall matter. EDITORIAL. [All Unsigned Editorials mrt written kf the Editor.] THE ALIENIST AND NEUROLOGIST, entering the twenty-seventh year of its successful history, gives thanks to its many able contributors, collaborators and subscribers for valuable and cordial support in making it the now acknowledged first exponent of American psychiatry and neuriatry. Its aim has always been to be helpful to the general practitioner, as well as to the Alienist and Neurologist expert, and to the savant in morbid psy- chology and neurology. It acknowledges with gratitude many personal letters of cordial appreciation, especially during the past year, and promises to endeavor to continue to merit during the pres- ent year the good opinion of the profession interested in its peculiarly useful work. AN ILLUSTRATION OF PSYCHOKINESIA occurred about the close of the past year in one of our city courts, displayed in the firing of a revolver in the direction of the ( oo ) Editorial. 91 judge by one of two sister contestants in a will case, in which they claimed injustice in the judge's ruling ap- portioning a part of the property to a prenuptial but legit- imatized heir of the deceased, and the perpetrator and abettor of the uncontrollable, if not premeditated act, was admitted to bail. Our courts ought to learn something of the medico-legal aspect ot these psychokinesias and im- perative homicidal conceptions, where explosive psycho- cerebral action dependent upon defective cerebropsychic in- hibition are liable to be repeated, like thunderbolts are to come from sometimes fair skies, and rule accordingly. Se- questration for homicidal, suicidal, pyromaniacal and other psychokinesias is the proper treatment, where these im- pulses are not rational, voluntary and purely criminal. It may be that these girls were overwrought by the strain of the trial, the reflection that an illegitimate was getting a share of their legitimate legacy, and perhaps a non self- restraint training from their childhood, which is now-a-days the cause of much psychokinesia, which should not be ex- tenuated as abnormal and exempting from penal legal con- sequences. Little-enliehtened, self-styled experts in alienism now-a-days often mistake the culmination in crime of lives of unrestraint for the disease form of psychokinesia. The latter being insanity, the former being the wanton wilfullness of pure cussedness, not deserving of the mercy demanded by morbidly engendered psycho- kinesia. Great criminals, committing the most heinous and revolting crimes, sometimes escape merited legal punish- ment through pseudo-insanity experts, unable to rightly diagnosticate insanity from gross criminality, because of ill- acquaintance with the clear data of true psychiatry, being unable to discern or exclude the disease element whose presence or absence alone should convict or set free for a home in an insane asylum. A pyrophile or a kleptophile, who would attempt to set fire to the court house or steal an attorney's pocket- book, would be charged with incendiarism or petit larceny, and have the question of pyromania or kleptomania or plain incendiarism or theft settled while the perpetrator was kept in custody. 92 Editorial. PLACEBO PHILOSOPHERS AND THE BISMARCK ARCH- 1PELIGO EXPERIMENT appear to have proven a failure, one of the enthusiasts having died from inadequate raiment and food, exhaustion and exposure, another having been murdered by the savages. This colony was to have been a primitive, simple life paradise, inhabited by a coterie of German authors who were to live "close to nature" like primeval man. They were to be a body of sol fraters or sun brothers, who, living and bathing continually in the sunlight, without clothing, on the fruits of the forest and the product of the sweat of their faces, tilled soil and tended herds. It is recorded from Berlin that Herren, Lutzow, Engelhardt and Battman per- ished of the causes above named, causing the other victims of this delusive Utopian dream to return in despair to civi- lization, convinced, no doubt, as the deluded enthusiasts of Topolabampo were, that it is "better to endure the ills we have than to fly to others we know not of," probably convinced also that a long life through many generations of routine civilized habit, with its luxuries and laissez faire, cannot be exchanged for the food, clothing and indulgence limitation of a non-policed forest life in a non-tropical country. And so the Island of Kabakon must get along yet awhile longer without Utopian philosophers among its population and Deutschland must endure them yet awhile longer at home. The primitive Arcadians, who apotheosized Pelasgus for having taught them the superior nutrient properties of acorns or herbs, their former diet, were not so cultivated as this coterie of misguided German savants, but they were no bigger fools, though they began their exclusive vege- tarian foolishness five or more centurics earlier, even a century or two before Oenotras and several centuries after the singular segregation of Evander. The breakfast chips and nut foods of the vegetarians of our day originated along way back in gastronomic his- tory. The food cranks are not the sanitary innovators some of them think they are. They are even antedated by the alchemists and the kdttorial. 93 fountain of perpetual youth prospectors. The human mind often verges on insanity in its search after Arcadias, Eldo- rados, Sanitorias and placebos for the mind ill at ease. The discontent of that tired, depressed and dissatisfied feeling of cerebrasthenia prompts and promotes the seeking of many changes of environment. The hope of relief from the monotony and weariness of life probably prompted tho bizarre seclusion experiment of these philosophers of Berlin. Before departing they should have consulted an alienist and neurologist like Mendel and his confreres in psychiatry and neuriatry there. PHYSIOLOGY AND THE PHYSICIAN.—Dr. Wesley Mills, author of Animal Physiology and professor of phys- iology, McGill University, in a recent forceful essay read before the June, 1906, meeting of the A. M. A., on the subject, "a physician's creed, past and present, as to the physiology of the heart," a subject upon which, from study of his work and personal familiarity with his methods, we re- gard him as expert, expresses the opinion "that physiolo- gists and physicians have stood too much apart. Although the American Physiological Society has held meetings for a great many years in the different great centers of the country, but few physicians ever attend those meetings or •ven read the reports of the papers presented, probably be- cause they are usually published in periodicals other than medical. In most instances teachers of physiology today are not men in active medical practice, while many never were doctors, except academically. This has its advantages, but also some disadvantages. Physiology as such, even yet, it is to be feared, is only occasionally brought before the student in the wards of the hospital or elsewhere when once he has passed the examinations on the primary sub- ject; while the medical investigator has been so occupied with morbid anatomy and bacteriologv that a physiologic medicine in the sense of one pervaded through and through with the conception that disease is altered function and the whole of medicine a study of this changed function, can not 94 Editorial. be said to be the dominant state of mind even yet, though one sees hopeful signs that progress is being made to- ward it." Referring to practicing physicians and surgeons, he says further: "For the latter, still more than the former, is apt to indulge in the belief that physiology is somewhat superfluous for his purpose, though I may point out that the surgeon who in our time has contributed most to the advancement of his art, Sir Joseph Lister, was himself a practical investigating physiologist, a fact which has made itself felt throughout his whole career." To all of which, the Alienist and Neurologist subscribes its full con- currence. At an earlier day, when taking official part by invita- tion in the conduct of the section on physiology of the Philadelphia Centennial Congress, the propriety of our so doing was questioned by some because we were not then an exclusive laboratory worker. The editor's address in medicine, in its neurophysio- logical aspects, at the California meeting A. IW. A., was unfavorably criticised by some medical friends, of whom the author expected better things. Some of them know better now. They have made some neurophysiological ad- vances since then in the interpretation of the neural rela- tions and therapeutics of disease. But times have changed and men have changed and are yet changing with them. The consideration of morbid processes and pathologi- cal results and the relation of physiology to them, espec- ially in relation to the neurophysiology is more general in the profession now> than then, though Cullen, whose dic- tum we adopted as our shibboleth at the founding of this journal in 1880, took a markedly neurological view of the processes of disease, a view to which the medical profes- sion must come again with the beaming sun soon to break into a flood of neurological light on the "movements of the organism in disease," as Cullen saw them. We hope later to find time and space to further dis- Editorial. 95 cuss this interesting contribution to current medical litera- ture. In the meantime we commend it to readers of the Alienist and Neurologist. We take a personal pleasure in expressing our long indebtedness to our friend for the helping hand we have psychically held so long through his physiological researches. Dr. R. O. Beard, of Minneapolis, who also considers the subject (including microscopy) in its relation to the practice of medicine (St. Paul Med. lour., Jan.,) says "that in the service of surgery and internal medicine alike, this branch of physiologic science is destined to fill an im- portant role. It offers to the general practitioner an ele- ment of added interest and accuracy in clinical observation. To the expert it offers an opportunity which will become greater, etc." And Krehl, discussing myocardial and neurogenic cardi- ac disturbances, urges more thorough study of these cases from a psychological and psychiatrical standpoint.— Muenchen - Mediiinische Wochenschrijt. And so medicine moves forward on neurophysiological, as on other lines of observation, discovery and conclusion, for the betterment of mankind. A PSYCHIC BLOCK SYSTEM FOR RAILROADS — The accident bulletin issued from Washington by the Interstate Commerce Commission for the three months ending March 31, 1906, shows the total num- ber of casualties to passengers and employes to be 18,296— 1,126 killed and 17,170 injured. The number of passengers and employes killed in train accidents was 274. The total number of collisions and derailments was 3,490 (1,921 collisions and 1,569 derailments) of which 289 collisions and 167 derailments affected passenger trains. The most disastrous accident reported, a collision caus- ing thirty-four deaths and injuring twenty-four, was due to a striking failure of the train dispatching system, according to the commission. A telegraph operator at a small station, who had been on duty all day and more than half the 96 Editorial. night, fell asleep, and on awakening, misinformed the train dispatcher as to what had occurred while he slept. The commission concludes after the statement "that the block system repeatedly advocated by the Com- mission is the true means that ought to be adopted for the prevention of such disasters, especially such as that caused by the over-time-exhausted and sleeping telegraph oper- ator." There is another and quite as important a block sys- tem for the prevention of accidents, and that is a rigidly enforced psychic block system that will block brain-tired and brain-weakened incompetency for all railway positions, when and where inaccuracy of brain work may menace life or mean death. A block system that blocks overtime work and off duty dissipation or other neglect of rest and sleep, is the need of the hour in railway and other responsible service. Neurasthenic, sleep-needing brains are out of place where insomnia is a duty and not a disease. Railway companies that secure adequate sleep to em- ployees will increase net earnings and diminish the injuries they inflict upon people who must travel on their now too heartlessly managed railroads. LOMBROSO AND THAW.—Caesare Lombroso has made a long range, premature and mistaken diagnosis of the men- tal state of Harry Kendall Thaw, the murderer of Stan- ford White, from an anthropological standpoint. Lombroso pronounces Thaw an epileptic moral maniac, a conclusion from the slight symptoms and mostly slight signs de- tailed by Lombroso, in which the clinically skilled alienist cannot concur on the evidence (?) given by Lombroso. Thaw's sisters, brothers and his mother, now attend- ing the trial, show the facial and aural resemblances in features characterized as evidences of degeneracy and raising the presumption of epilepsy and moral mania by Lombroso, yet they have never displayed the "jealous homicidal obsession" which M. L. says was displayed by Thaw. To become a slave to one's passions may proceed Editorial. 97 from persistent indisposition to exercise proper inhibition and not necessarily from overmastering degeneracy. Dal- liance with sin by one pecuniarily above the necessity of daily counteracting labor is not prima facie degeneracy. But we shall have to defer criticism of this remarkable faux pas of the well-known criminologist for a more ex- tended and critical analysis, to be presented in our next issue. Thaw's madness can not be traced to an "unconquer- able instinct, or epileptiform" state due to the fact that "his father, in a few years, made himself from nothing to a millionaire." Such reasoning is supremely specious and fallacious, and unworthy of the true science .of criminology or alienism. Deviations of form and feature through accidents or de- fects of evolution and development, and likewise psychic eccentricities are not necessarily evidences of moral de- generacy, and anthropological inference of mental or moral perversion from them, are not always sound psychiatry. Even as we write, this "homicidally obsessed, degen- erate, moral maniac," is aiding his counsel in selecting the witnesses who are to judge him and his fatal act. Lombroso makes the same mistake here that he has made on another occasion concerning the degeneracy of Columbus. A RIGHTEOUS JUDGMENT!—A righteous St. Louis City Judge lately decided that hot water in the external ear is a violent external injury. Suits like this reveal the unfeeling resistance to the just demands of those who place their trust and money in insurance companies and the trick juggling with the term "accidental violent external injury." Hot water in the external ear is certainly an external injury, but it is also internal and all external injuries that cause death must also act internally and become internal injuries. It's a wonder the insurance com- pany in its subterfuge resort, did not contest on the ground also that it was not the external injury, but the internal that killed. 98 Editorial. But there is a hidden, sinister purpose and rank injus- tice in this insurance phrase "violent external injury" and that is to bar out the many really violent concussional and cerebro-psychic shocks of accident to the neuraxis that undo one for life or a long period life, changing the mental nature and neurophysical ability for accustomed avocations, resulting from accidents on railway trains, automobiles, explosions, electric shocks and other collisions and other catastrophes that ruin the nervous systems and yet make no sign visible to the mind of the average railway surgeon and insurance medical examiner, or if mentally discernable by such medical men of wide knowledge of the nervou ssystem, they are not expected by their employing directing masters to see it, only through "violent external injury." It is a reproach to railway and insurance medical advisers and an evidence of unscientific knowledge of the susceptibility of the nervous system, that companies employing them have been erroneously advised that grave injury to the brain or spinal cord and peripheral nervous system, including the sympathetic, that injury to these nervous systems so vital to the life, liberty and happiness of individuals, can not occur without "violent external injury." Mentally lame medical monitors make vicious insurance company rulings. It is fortunate for insured humanity that we yet have courts to rectify such miserable medical mis- takes of conclusion. A better knowledge of the nervous system and the causes of its diseases would save the medical profession humiliation and the insurance companies such just judicial rebuke. APPEAL BY EDWARD S. MORSE, in Boston Herald, to stop steam whistles, and advising us of the painful fact that "within a few years there has come to us on steam railways a series of whistle signals which, in some towns, at least, have rendered life for many unendurable." In the appeal our attention is called to ordinance of city of Cleveland, Ohio, section 841. "Engine whistles. No whistles connected with any railway engine shall be sounded Editorial. 99 or used within the limits of the city of Cleveland, except as a signal to apply the brakes in case of immediate or impending danger. "Section 843. Stationary engines. No person shall blow or cause to be blown within the limits of the city of Cleveland the steam whistle of any stationary engine as a signal for commencing or suspending work or for any other purpose except as specified in the next following section. "Section 844. Nothing in this subdivision contained shall be construed as forbidding the use of steam whistles as alarm signals in case of fire or collision or other immi- nent danger, nor for the necessary signals by the steam en- gines of the fire department of the city." Detroit, Michigan and Newcastle, Penn., have passed similar ordinances, with penalties of fines and imprisonment for infringement. Mr. Morse would be pleased to know of any other town or city in which similar laws have been enacted. We hope St. Louis will soon be in the list of anti-needless noise cities. Great noises shock the nerves and injure the health of people, and should be abolished whenever practicable. Dr. C. C. Wiley of Pittsburg, Thaw's family physician, testifying as an expert en insanity, which few family physicians are capable of doing, is reported to have become badly confused under the merciless cross-examination of District Attorney Jerome and admitted that he was not familiar with the Romberg test for insanity, though he apparently, at first made the impression that he knew what it was. Now the Romberg test or the Brach-Romberg sign, as it is also called, is not a symptom of insanity, but one of locomotor ataxia or spinal sclerosis especially. Only the ataxic insane could have it and they are rare. An alienist might be expert in insanity and not know the significance in spinal sclerosis to which it especially belongs. He is also reported as "falling down" on the neural 100 Editorial. relations of the cardiac nerve, a branch of the pneumogas- tric, with cervical sympathetic relation. There are so many hundreds of nerves and more branches that any man might miss in such anatomical memory and yet understand the brain in relation to insanity. Both of these were irrelevant catch neurological and not psychiatrical questions, just as the Argyll-Robertson pupil question was. None of them were germane nor fair and would have been ruled out by the court, if court and attorneys knew how irrelevant they were to any question in psychiatry. Dr. Wiley certainly made a grave mistake in saying a dilated artery was not diseased. The walls of an artery may dilate through direct disease, as in aneurism or hyper- aemia from direct cardiac over-pressure or vasomotor pare- sis, etc. The district attorney did not however help his cause by confusing this witness. The facts observed will be noted by the jury. PSYCHIC SANITARY SENSE COMING TO THE SEN- ATE..—Daily Time Limit to Railway Service.—By a vote of 70 to 1, the Senate January 10th passed a bill providing that railway employes engaged in handling trains shall not work more than sixteen consecutive hours, which period is to be followed by ten hours off duty. The one negative vote was cast by Senator Pettus. The act, unfortunately, only applies to "trains doing an interstate or foreign commerce business." Amendments provide for extraordinary exigencies, as for accidents and delays and obstructions in consequence thereof. Such a law should be among the statutes of every state, in the interests of health and life of employes and the public. Railway management efforts to annihilate time of brain rest and make the brain a perpetual motion machine should cease. Smart railway management should seek economyi'and the making of dividends in other ways than by overstraining, unresting, and prematurely wearing out and weakening, for train wreck results, the brains of railway employes. Editorial. 101 The people as well as the railway service have rights to healthy, clear acting, vigorous railway service brains, that can always do the right thing, at the right time, for the traveling public's safety. Some American railways' managers appear respecting the demand upon employes as if they were themselves brain-weakened by water on the brain. THE PROFESSIONAL ENDEAVOR in the direction of abstention from the far too liberal alcohol prescribing of the past, coupled with popular awakening to the brain, body and mind damage of alcoholic daily drink, gives hope of escape from what has been and still is a menace to man- hood and national decadence, among the causes that threaten the undermining of civilized mankind. Wise political communities seeing alcohol's destructive power in the portrayals of pathological science, revealing alcohol's organic ravages of brain, other viscera and the blood vessels and the blood's disordered quality and movements, are taking, or have taken, defensive action. Science only reiterates the teaching that wine, as a health promoter is a mocker, and "whosoever is deceived thereby is not wise." Who hath redness of eyes and blossoming nose and florid face from daily drink hath also redness and more or less congestion of brain and stomach and other organs, because of morbid vasomotor dilation and the "wounds without cause" external, of the inebriate, are wounds from morbid states of brain. An agency that causes paresis and instability of psy- chic and psycho-motor neurones and their later more de- structive consequences is not an agent for the safe and sane of thought to habitually use, nor is it fit for indiscrim- inate prescription by physician, priest, trained nurse or patient. ETIOLOGY OF SPEED MANIA. -The St. Louis Repub- lic, noted for its forceful editorial utterances, makes the fol- lowing comment on a recent communication by Dr. Lee Howard, quoted in the British Medical Journal, referring to the motor speed mania: 102 Editorial. Doctor Lee Howard, is quoted in the British Medical Journal to the effect that the delight in fast automobiling and the craving for strong drink are etiologically the same thing. A feature of the present age, he believes, is the in- creasing tendency toward explosions of psychic energy, one objective symptom of which is the mania for high speed, and others the drug mania and the alcohol mania. It is observable that explosions of psychic energy corres- pond with those of gasoline, which fact suggests the advisa- bility of carrying some sort of a spark-plug in the hat of those dangerous beings whose psychic excess energy pre- disposes them toward reckless driving. But, it is doubtful in point of fact—which seems to contradict the eminent physician's theory—whether a crazy chauffeur has an excess of real psychic energy. His cere- bral coils probably generate very little. But it is conceiv- able that buck beer or rye highballs might stimulate his convolutions and excite a craving for speed, while fast driving is known to have a pronounced effect on thirst. Thus, we suggest for the distinguished doctor's consid- eration, a vicious circle might be created. Etiologically the relation of booze, benzine and the bughouse is plain enough if we adopt the more practical and less scientific viewpoint. ADEQUATE TIMELY SLEEP FOR THE NORMAL MIND, as well as the abnormal, is a recognized essential of psychic sanitation in the estimation of alienists, neurologists and physicians in general, though it does not yet appear to have received the consideration it deserves from those who demand and dispose of the mental work of others, especially in the railway service, - witness whereof we cite the fol- lowing, to be added to many other and more disastrous brain strain requirements of our American railway manage- ment, but none more cruel and criminal on the line of unremitting brain work demanded. Last November, seven men, the crew of a Lehigh & Hudson freight engine, who had been in continuous service three Editorial. 103 days and three nights, went to sleep on the locomotive while it was on its way from Franklin Junction to Phillips- burg. All hands were asleep when the engine went through the yard at this place, passing the red light turned against them. The telegraph operator here wired a message to the operator at Martin's Creek, the next station down the line, to be on the lookout for the engine. Its speed was con- siderably reduced when it reached that station, and the operator succeeded in boarding it, and preventing a collision by running the locomotive to a siding. The fire was hastily pulled from under the boiler to prevent an explosion, the water having reached a very low point. OUR PROPRIETARY PHARMACEUTICAL ALLIES.—It is conceded the world over that the best sort of proprietary therapeutic firms have given to the medical profession many elegant and agreeable formulae, of valuable but other- wise unpalatable medicines. Among these can be men- tioned pleasant combinations of cod liver oil and the pepsins and the enzyme class. Certain pharmacists have advanced the profession a century in knowledge and use of certain drugs, such as the Parke-Davis specialties. Others have given us American products where we had before relied on foreign markets, such as the Powers & WHghtman quinine, the Fairchild Brothers & Foster's enzymes, Squibb's chemicals, etc. Combinations of definite and certain strength, like Bat- tle's bromidia and Peacock's bromides, have especially helped the young country doctor not perfected in phar- macy and looking about for plain, palatable, ready pre- pared formulae of certain ingredients easily dispensable. The danger in the use of these agencies is not in the drug, but in their unwise prescribing in ordering them by the bottle, to be taken at the discretion of the patient. But the same danger exists in ordering any drug of the hypnotic class, or in fact of almost any kind, and leaving its renewal and continuance to the dis- 104 Editorial. cretion of the patient. Medicine prescribed for repetition at the discretion of patient or druggist almost always proves a source of greater harm than final benefit. IN LINE WITH THE ADDRESS OF VICTOR HORSELY, before the Canadian meeting of the B. M. A., is the appeal for more milk and less beer for the babes and mothers of England and Wales, in the face of the infant mortality of last year, viz: one hundred and twenty thousand babies dying there last year, making even the fittest unfit to live, as Sir Henry Campbell Bannerman said. Pure milk depots for babies and mothers in lieu of beer are the remedies, and the medical advice for nursing mothers of beer in lieu of better nutrition is an exploded fallacy. The milk depots have already done much good, as Minister John Burns lately attested. He found that the deaths in the sterilized milk fed area ranged from 50 to 100, while in other areas the death-rate was from 100 to 273. In the face of figures like that it seemed to him that the milk depots experiment, incomplete though it had been, was an experiment that warranted careful development and rapid extension. The bill on the subject is now .in draft. He said that one of the chief contributing factors to- wards the high mortality was the tendency on the part of people to spend on beer what they should spend on food for their infants, and on leisure and rest for the mother. It is gratifying to medical science to see more cor- rect common sense and enlightenment taking hold of and swaying the people in regard to the too long enter- tained delusion that alcohol is a sort of support and food substitute in its many seductive beverage forms, as if any blood and brain cell poison could be good for habitual daily use. "LEGISLATIVE SCHEMES OF THE AMERICAN MEDICAL ASSOCIATION."—In nearly if not all the State Legislatures now in session, bills have been introduccd which seek to compel manufacturers of proprietary and patent medicines Editorial. 105 to make public the formulas and private processes by which their preparations are made. A bill of similar im- port, dealing with interstate traffic in medicines of this class, has also been proposed in the House of Representa- tives at Washington. The large number of these bills, their apparent spon- taneity, and the noisy clamor of their advocates, would make it appear that the American people had suddenly awakened to the realization that they have long been vic- tims of some monstrous wrong.—Abstracted from "Legis- lative Schemes," sent out by the American Journalist. And this is the monstrous truth so far as concerns a certain number of the many new name-blind combinations offered to the medical profession for prescription on faith rather than that definite knowledge of composition neces- sary for intelligent prescription and the gleaning of ac- curate therapeutic knowledge. "SIGHT-UNSEEN" LAWYER AND DOCTOR CHOOS- ING.—Secretary Shaw tells this story on Congressman Smith, of Iowa, according to the St. Paul Pioneer Post. A prisoner arraigned before the criminal court. Present in court room: Lawyers Smith, Brown and Greer. "Where is your lawyer?" inquired the Judge. "lhave none," responded prisoner. Haven't any money. "Do you want a lawyer?" asked the Judge. "Yes, Your Honor." "There is Mr. Smith, Mr. Brown and Mr. Greer," said the Judge, pointing to the young attorneys awaiting brief- less and breathless for something to turn up, "and Mr. Alexander is out in the corridor." The prisoner eyed the budding attorneys in the court- room, and after a critical survey stroked his chin and said, "Well, 1 guess I will take Mr. Alexander." And this is the way many people also select their phy- sician. They wait until some emergency demands immediate medical aid, and then they have some one suggested on the spot and of whom they know only that he belongs to the profession. 106 Editorial. AN ALCOHOLIC DRUNK THEFT OBSESSION.—A young minor, Geoffrey Ryan by name, of St. Louis, without previous criminal record of the kind, after several drinks of whisky unlawfully sold to him, stole a buggy in the West End and proceeded to hold up (with a pistol that would not go off) and rob, under influence of a daring, alcoholically-excited frenzy, one pedestrian after another, till he had robbed on the streets more than half a dozen in the short space of a few hours in the evening, when he was taken into custody by the police. His predatory performance was not characterized by much more discretion than a procursive epileptic might dis- play, save that being in a buggy and stopping to halt and hold up his victims, served unwillingly to disarm pedestrians of suspicion of the robber. Excise Commissioner Mulvihill is acting the part of the good psychiatrist and Samaritan by seeking to find and annul the licenses of the saloons who unlawfully furnished the boy drink. ALL NIGHT AND EIGHT HOUR LABOR SHIFTS FOR THE CANAL ZONE.—We are approaching the time when there will be, as there should be now, with the aid cap- ital and invention have given to labor, three daily shifts for the world's work. It should be inaugurated for humanity's sake and the best of sanitary reasons at the Panama Canal. The work there for all is arduous, the atmosphere is not salubrious, to say nothing of the anophile mosquito that breeds the deadly Chagres haematuric malarial fever and the stegomia faciata that causes yellow fever, now happily nearing extinction there through the sanitary work of the U. S. government through Colonel Gorgas and his medical co-workers. The facility with which electric light can now be made and placed, would make possible the working of night shifts on the Canal route, and light all night would be salutary to health throughout the entire canal zone. CONDITION OF CUBAN INSANE ASYLUM.—One thous- and six hundred patients crowded into quarters with ca- pacity for but four hundred. Last October Governor Editorial. 107 Magoon visited the National Insane Asylum at Havana and discovered a deplorable state of affairs there. "One thousand six hundred and sixty persons of both sexes were crowded into filthy and dilapidated buildings, with a capacity for four hundred persons only. They are sleeping on broken cots, relics of the last American occu- pation. "Congress made an appropriation to enlarge the asy- lum, but the money was never expended." We note with pleasure that Governor Magoon will take steps to erect a decent building and remedy the de- fects in provision. HYSTERICAL MONOPALSIES.—It is well to continue the record of these cases as they are sure to keep alive the fact of mind cure, possibilities and the explanation of the marvellous (!) results of mind and faith cure christopathic, osteopathic, and other methods of psychic impression. Three cases of this kind were reported by Dr. C. C. Hersman in Jour. A. M. A. last year, one resulting from fright and the other two from traumatic shock. The arm, leg and diaphragm were the seat of the local manifestations. The spasms would last for several hours. These cases prompted Dr. H. to ask if there is an irritating or para- lysing center within the cortical psychomotor centers. Are these nerve center neurones at this time bathed in irritating cerebro-spinal fluid? In other words does some decrease in metabolic elimination cause transient increase of cytotoxins? This question has been asked before in regard to epilepsy and affirmatively answered in the minds of some neurologists. THE ACHING TOOTH AND THE MOTORMAN.—An Eastern street car motorman stopped and left his car to get his tooth pulled. On his return, minus the tooth, the patient, sympathetic passengers cheered and the car moved joyously on, the crowded sitters and swaying strap-hangers forgetting their own misery in the happiness of the man whose distraction was relieved by the extraction. And the 108 Editotial. company continues to "pull the public's leg," as usual, with the customary, inadequate accommodation. The pull of a traction company with the "powers" of most American cities is stronger than a dentist's tug at a tooth that won't come out, except when they tackle the dens sapientiae. Dens sapientiae is easy in the dentist's hands, like the public in the hands of the traction manage- ment. AN ANDROID WOMAN HOMOSEXUALITY CONJU- GALLY MATED to a woman, or a gynesiac man, has been lately puzzling the daily press, especially in Chicago, in the person of Nicolai de Raylan, husband of Mrs. Anna Da- vison de Kaylan. Nicolai de Raylan is described as beard- less and otherwise effeminate in appearance, and with the usual reportorial embellishment, he is described as shaving four times a day, ineffectually endeavoring to develop a beard. He was for thirteen years secretary to Baron Schlip- penback, Russian Consul. He is reported to have died at Phoenix, Arizona, where through a coroner's autopsy his true sex was discovered. THE NAME OF THE JOURNAL OF The Association of Military Surgeons of the U. S. has been changed with the issue for January, 1907, to "The Military Surgeon," and we take pleasure in noting the fact, as the abbreviated name sounds better and means as much. This good journal has been highly successful in its brief career of six years as the pioneer military medical journal in the English language, under the able and judicious editorial direction of its secre- tary and editor, Maj. James Evelyn Pilcher, Brigade Surgeon, U. S. V., Captain (Retired) U. S. A. and its distinguished managing corps of military medical men. LORD ROSEBERY'S BRILLIANT IDEA OF THE CAUSE OF THE INCREASE OF INSANITY.—The London Spectator reports the distinguished Englishman as saying at the ded- ication of a hospital for the insane, he found it extremely difficult to discover any convincing reason for the increase Editorial. 109 of insane, and he could only suggest that the asylums be- came fuller because it was impossible for the people with slow-moving brains to keep pace with the times in which we lived. BEVERLY FARM SCHOOL, located at Godfrey, Illinois, for the rearing of backward children, sends out an attract- ive illustrated pamphlet, showing its advantages in loca- tion, building and equipment. Dr. W. H. C. Smith, the able superintendent, and his capable and accomplished wife, the matron, have been long and faithfully engaged in this important work. Their former experiences were at Elwyn, Pennsylvania, and at the Illinois State Institution, at Lincoln. THE STUDY OF MENTAL DISEASES.—We endorse the following from the Medical World: In no other department of medicine is the great major- ity of general practicians so deficient and so negligent and so absolutely ignorant, as in the domain of mental affec- tions. The average physician has never been taught any- thing about mental diseases, and consequently he does not know anything about them. The recent failure of Dr. Wiley, as an expert in the Thaw trial, is an illustration, THE LIFE COURTEOUS—It is the little courtesies that we have learned, as human beings, to extend to one another that, almost more than anything else, make life worth living. Bad manners and bad breeding are among the offenses that make the way we travel the harder to endure. And the worst of it is that men ap- pear to be no better in this respect now than they were before they had books to read, forks to eat with and street cars to ride in. TO AWAKEN EVERY PSYCHIC NEURONE in collateral chains of thought, the neurologist may read with profit and pleasure "Internal Secretion," by E. C. Hooper, B. A., M. B., Asst. Dem. Anat., University of Toronto, it being the president's address before the Toronto Medical Society. 110 Editorial. A PSYCHIC SPASM OF UNWRITTEN LAW HOMICIDE is traversing the country, and in St. Louis it has reached the colored people. A negro proprietor of a city saloon stabbed to death another negro because of the latter's being too attentive to his wife. See our next issue for paper on the subject. ACKNOWLEDGMENT OF INVITATION to be present at the commencement exercises of the Training School for Attendants in the State Hospital at Danville, Pa., Thursday evening, July 12, 1906, is here recorded with expressions of thanks and gratification that this good work continues in this and other similar American hospitals. POLICE EUTHANASIA IN SAN FRANCISCO.—In San Francisco, during the great earthquake and fire, a policeman was seen futilely struggling with others to rescue a man pinioned in burning wreckage. The helpless man felt the fire begin burning his feet and begged to be killed. The officer took his name and address and shot him through the head, killing him instantly. QUININE AS A DEFENSE OF CRIME found recent ex- emplification in the plea of a mother for her 18-year old son before a St. Louis city criminal court, convicted of stealing a horse and buggy and accomplishing seven "hold-ups" and found "with the goods," in one night. The prisoner admitted taking whisky after the qui- nine, and was arrested in a saloon. DR. JAMES L. GREENE, for five years superintendent of the Nebraska Hospital for the Insane, at Lincoln, has tendered his resignation to Governor Mickey, to take effect July 16. Editorial. Ill Dr. Greene has accepted the tender of the super- intendency of the Illinois Hospital for the Insane at Kan- kakee. TWO INSANE FRATRICIDES IN ONE FAMILY and mur- derous deeds done near the same time, but in different places in St. Louis, are on record for 1906, as per the fol- lowing verified news item of January 23rd, 1907: "John C. Straub, who killed his brother, Charles, in Caesar's Cafe, and Edward Croissant, who killed his brother, Albert, at Fourth and Locust streets last summer, were taken to Farmington yesterday to be confined in the State Asylum for the Insane." IN MEMORIAM. DR. A. V. L. Brokaw died at his home of gastric hemorrhage, a sequel of La Grippe, the fatal sequellae of which have not as yet been named. The treacherous character of the grip as a toxic neu- rosis, impairing the arteriole control and damaging the vascular coats, is revealed in the history of our dead friend, for he had arranged for a recuperative trip to New York City day before yesterday, and yesterday January 25th he died. He contracted his malady last spring, but heedless, as too many, even medical men, are of the insidious, con- tinuing toxic hold of this persisting disease of the vital nerve centers, he continued his important onerous work as chief surgeon of the United Railways company and surgical head of St. Johns Hospital staff and "fell in the line of duty." He was stricken, as it were, with the knife of his art in his hand. For his years (but 43) he was preeminent in his pro- fession, his surgical judgment and skill were excellent and he had made his mark on the profession as a man of large opportunities and extensive work, equal to all of the exacting demands of his arduous positions. It has never been said of him by those who knew him, as has been and can be said of too many operating sur- geons, that he was a better operator than diagnostician, that the skill of his hand exceeded the judgment of his head. He was a cautious but bold and successful operator. Kindly in his personal and family relations, charitable toward his needy patients, appreciative of his own surgical skill, yet modest in his estimate thereof, and of his personal merit, the profession misses and mourns him. He was an honored member of many medical bodies who will miss him from their councils. He has fallen from the ladder of surgical fame he seemed ( 112 ) In Memoriam. 113 securely climbing, all too soon for the hopes of his friends. For the top was in sight and now he is down and dead. We tender his aged father, our boyhood's senior colleague as interne in the U. S. Marine hospital and to his wife and all of his bereaved family, the sympathy of an appreciative personal and professional friend. The death of John F. Magner, editor of the Star- Chronicle, January 27th, takes from St. Louis and the world a prominent and forceful figure in the right sort of jour- nalism, a journalism that always considered and plead for the good of the people. He was ever on the alert against the forces of evil and was preeminently mindful of the moral, sanitary and political welfare of St. Louis. He was well trained by liberal education and a culti- vated knowledge of men, for his sphere of action. With his pen he fought for the true, the good and the pure, with the rigorous valor of one "not mailed in scorn, but clothed in the armor of a pure intent," hence the force and pungency of what he wrote. No pandering to evil, "no unjust gain increased his substance." He was the true type of editorial writer for true lovers of the right and good in personal and public life. The sun of his journalistic usefulness "set while it was yet day," and with the setting sun he dropped from the zenith of highest journalism "like a falling star." Had he the opportunity and a longer lease of life he would have been another McCullough in American jour- nalism. Who lives and writes as Magner did, lives not and dies not in vain. From a long and familiar acquaintance in most intimate relations from the time he first began to break with that hyperemic yielding to brain-strain common, in varying degrees, to great and constant writers, especially editors forced to think much and fast under merciless coercive brain pressure by imperative environing demand, we learned 114 In Memoriam. much of Magner's purity of purpose, his power of brain and mind and his fidelity to the duties of his great pro- fession. From relationship we regarded him as not only great and good in our humble esteem, but he was pro- nounced great and good by mouths of wisest censure in his profession and even those living under the gilded glamor of evil, who felt the sting and smart of his blows for the right, approved their virtue, while seeking to escape. He was built too strong for the foes of virtue "ever to expugn." Dr. Alonzo Garcelon, the nonogenarian Nester of general medical practice, is dead and strangest of all dead because of an accidental gas asphyxiation. Born in Lewiston, Maine, n 1813 and a graduate of a famous Maine medical college (Bowdoin) he lived his life mostly and died in his native city. He spent a part of his life as Representative, Senator, Surgeon General and Governor of his native state. He had always been a worthy and prominent figure in the profession and the politics of his state. His friends were many, his enemies few and feeble and those who loved him loved him well for his virtues, his warm-hearted attachments and for the sort of enemies he made. The most prominent surviving member of his family is our friend, the retired Vice-President and Superintendent of the Pullman Palace Car Company, to whom with all who may yet remain of this veteran physician's and noble man's family we tender our sympathy. We feel yet the last impress of his kindly eye and cordial hand as we felt them, not long ago, at a meeting of the A. M. A., which he loved so much. Dr. William James Herdman, professor of nervous dis- eases and electrotherapeutics in the University of Michigan, died on December 14th at the age of fifty-eight years in a private sanatorium in Baltimore, where he had gone to have an operation performed. A good man gone too soon. Herdman was genial in personality, capable as a teacher, competent and enthusi- In Memoriam. 115 astic in practice, broad of culture and true and hearty in his friendship. As we miss him so we tender to those who were nearer to him our condolence. Alexander E. Macdonald, LL. B., M. D., a member of the New York Psychiatrical Society, died December 10th, 1906. For thirty-five years Dr. Macdonald had been intimately associated with the insane. He commenced the study of medicine at Toronto University and graduated M. D., Med- ical Department, New York University, 1870, LL. B., Law School, New York University, 1881. Lecturer upon Medical Jurisprudence in 1874; subsequently, Professor of Medical Jurisprudence, Professor of Psychological Medicine and Med- ical Jurisprudence, and was Emeritus Professor at the time of his death. House Physician Hospital for Epileptics and Paralytics, Blackwell's Island, 1870; chief of staff, Charity and Allied Hospitals, Blackwell's Island, 1871. Resident physician, New York City Asylum for the Insane, Ward's Island, 1874. Medical superintendent of the same from 1874 to 1904, the title of the asylum having been changed in the meantime to Manhattan State Hospital, East, Ward's Island. In 1901 he established the tent treatment of the tuber- culous insane, removing them from all communication with any unaffected patients. The principles underlying this undertaking are now universally accepted by the medical profession here and abroad. An article on this subject was published by the Charity Organization of New York City and the National Associa- tion for the Study and Prevention of Tuberculosis. Dr. Macdonald was a delegate from the American Medico-Psychological Association to the Fourteenth Inter- national Medical Congress at Madrid in 1903; President of the American Medico-Psychological Association in 1904; delegate to the Congress of American Physicians and Sur- geons, to be held in Washington in 1907; honorary member of the Medico-Psychological Association of Great Britain 116 In Memoriam. and Ireland, and of other continental medical associations. His splendid administrative abilities made him familiar with every detail in the care of the insane, seven thousand at one time being under his direction. He possessed the rare gift of attracting to himself experienced, trusty and loyal officers and friends. Dr. Macdonald was one of the most distinguished alienists of this country, and a man of striking force of character. He had a hatred of cant and pretense. His far-seeing powers, his unswerving integrity and great executive ability qualified him in an extraordinary degree for his responsibilities. At all prominent medical meetings his activities were conspicuous. His commanding presence and lofty sense of duty will always be remembered by those who had the privilege to be acquainted with him, and his pupils in all parts of the country will pay many tributes to his memory. We join in condolence. The deceased was, as from long acquaintance we can attest, a man of distinguished merit in the ranks of psychiatry and a true physician and friend, adorning his profession and society. SELECTIONS. CLINICAL NEUROLOGY. DOUBLE CONSCIOUSNESS BEFORE THE AMERICAN NEUROLOGICAL ASSOCIATION.—The following cases were recorded and discussed at the June, 1906, meeting at Boston: A Case of Double Consciousness, Amnesic Type. By Dr. Edward B. Angell. The subject of the sketch, a frank, open-hearted Englishman, was married on Christmas last, and within a few days had disappeared from home. Some ten days later a somewhat incoherent letter from him to his wife located him, and he was brought h«me in a dazed and somewhat confused state of mind. The mental condition so closely resembled hypnotic state that it suggested a means of treatment. Under hypnosis, easily induced, the suggestion was made that on awaken- ing his mind would be clear. Such was the result, and gradually he became alert, clear-minded and able to dis- criminate between the unreal, dreamy states of conscious- ness and the real facts of normal existence. For a dreamer of dreams his altered personality disclosed him to be. The tale he told first differed materially from a later one, while both became radically changed when normal consciousness had become established. He had assumed, a name under which he was married, different from his own, insisted upon a genealogy, which was fictitious, claimed a college educa- tion and a service in South Africa, which he had not ex- perienced; in fact, much of his memory registration was absolutely wrong. Careful investigation disproved most of his experiences. His tales were but creatures of an unstable imagination. His consciousness, when in the abnormal state so akin to hysteria, registered fact and fiction alike; no discrimination being made between ("7) 118 Selections. objective fact and subjective image. Such is the condition of the hypnotic. There is a subjective, unconscious falsi- fication of memory, a species of amnesia, for the real events of an uneventful existence and the gap is filled with visions, with real unrealities, with plausible impossi- bilities. If the facts of such dual existence could be proven much that has been accepted as actual occurrences during the dispossession of the ego would be found illus- ions. They are but shadows of reality, misty radiographs which rapidly fade from the mind when Richard is himself again. In the present instance the honesty of purpose and frankness of mind are unquestionable. Whatever be the nature of this disturbance of mind it is real, not fictitious. Memory is unstable, not character. A Case of Alteration of Personality.—By Dr. Richard Dewey. An alteration of consciousness of sixteen days' duration in a girl of twenty-three, not amounting to double personality, being incomplete and of rudimentary form. The symptom-complex embracing a history of migraine, hys- teria and an eroto-mania of homo-sexual character. The altered consciousness being preceded by an evolution of systematized delusions (or pseudo-systematized delusions invented by the patient.) The altered personality consist- ing in an assumption by the patient of the name and character of a person known to her and in authority over her. There being also a total change of handwriting dur- ing the sixteen days, the same being vertically upside down and horizontally reversed; i. e. running from right to left. A Case of Double Consciousness.—By Dr. Edward B. Angell. Dr. Gordon said in the April number of the American Journal of the Medical Sciences will be found an article by him on double ego that deals with a case much like the cases described today. It was the case of a young man above the average intelligence. It happened several times that the manager of the place where he worked would give him an order to do a certain thing and he would not obey, while" in other circumstances he would do it at once. Selections. 119 Sometimes he would raise his hand to strike his wife, while at other times he was known as a most loving hus- band. When reminded of it, he would be surprised. The amnesia was complete. At the present time the patient presents this peculiar condition. By a process of mental analysis he has arrived at the conclusion that probably he is composed of two beings. There is No. 1 and No. 2, and No. 2 is independent of No. 1. He gave a number of instances in which he heard No. 2 ordering him to do a certain act. Now the question is in all these cases: What is the nature of the disease which is responsible for this peculiar condition? Dr. Gordon believed the case which he re- ported to be one of epilepsy. Dr. Angell's case he be- lieved to be a case of epilepsy. The attacks of motor aphasia are very suggestive of epilepsy. Dr. Dewey's case, it seemed to Dr. Gordon, is a clear case of hysteria. Dr. Angell said he appreciated the possibility of masked epilepsy as being the cause of this condition. However, careful investigation failed to reveal any indication of the motor symptoms of epilepsy, or even any symptoms sug- gestive of petit mal. CHOREA.—Poynton and Holmes come to the conclus- ion that chorea is a manifestation of acute rheumatism and that the diplococcus rhematicus is the infective agent in rheumatism. Duckworth regards chorea as a neurohumeral disorder. He contends that the predisposing factor which determines an attack of chorea in a rheumatic subject is the neurotic element. Chorea is considered to be cerebral rheumatism. Langevin advocates absolute rest in bed, a strict meat diet, hydrotherapy and gradually increasing doses of anti- pyrin. The administration of antipyrin must be carefully watched, and its use should be superseded in the event of albuminuria, weakness of the pulse or other toxic mani- festations. Thayer found that of 689 cases of chorea observed during one or more attacks, 25.4 per cent showed evidences of 120 Selections. cardiac involvement. In many cases fever was pres- ent. Thayer concludes that there is good reason to be- lieve that the presence of fever in otherwise uncompli- cated chorea is, in a large percentage of cases, associated with a complicating endocarditis.—Courier of Medicine. RABIES.—Babes accepts as the actual parasite certain fine granules—round, black or blue (with the Cajal-Geim- sen stain), found exclusively in the protoplasm of the de- generated nerve cells in the most severely affected parts of the nervous system. Babes looks upon Negri's bodies as representing encapsulated forms of the parasite, in a phase of involution or transformation. It must be admitted that Negri's bodies are generallv conceded by investigators to be the cause of rabies.—Courier of Medicine. REVIEWS, BOOK NOTICES, REPRINTS, ETC. SAUNDERS' COMPLETE CATALOGUE of medical and sur- gical books, revised January, 1907; illustrated. W. B. Saunders Company, 925 Walnut street, Philadelphia, Pa. Every illustration shows how to do something and is on this account alone especially valuable. All the books are by the best of authors, and the entire catalogue is worth a worthy place in your library. WOMAN. A treatise on the Normal and Pathological Emo- tion of Feminine Love, by Bernard S. Talmey, M.'D. Published by Practitioners Publishing Co., 62 West 126th St.. New York City. Price: Small octavo, with flexible leather covers, $3.00. The pathology of the female sexual life and functions from the psychical point of view are of more importance than has been generally considered both within and with- out the profession. There is no concise scientific work treating this subject like the present book, exclusively de- signed for use by the general practitioner. The physician seeking elucidation on anv pathological phenomenon of fe- male amatory emotions has to work his way through big volumes on psychiatry, legal medicine, philosophy, etc., before he can find more or less complete information on the subject in question. Many a family tragedy, having had its origin in an anomaly of some female sexual function, might have been averted by judicious advice and treatment from the family physician if he had understood the root of the evil. The author of Woman has endeavored to provide the medical, and to some extent also, the legal profession with a work especially devoted to this one subject, "Feminine Love," facilitating the study of the physiological and path- ological phenomena of the feminine sexual functions. ( 121 ) 122 Reviews, Book Notices, Reprints, Etc. This work is useful tu the physiologist, gynecologist, alienist, neurologist, general philosopher and anthropological savant. The sexual instinct, libidio and its symptoms, orgasm, sexual potency, frigidity, nymphomania, masturbation, homo- sexuality, bestiality, essentials for a happy union, hygienic duration of intercourse, sexual life in relation to offspring, morality, etc., are among the subjects treated. The book deals cursorily with conditions of sexual perversion and degeneracy in woman, as Krafft-Ebing, Moll and others have done with both sexes, but in less indelicate detail. Twashtri? conception of the creation of woman, the psychological and utilitarian reasons for chastity, eros and libido, the prevention of masturbation. The author justly decrys the excessive lasciviousness and voluptuousness of the day and the causes thereof in the abuse of liquors among women, which has reached alarm- ing proportions among them, the modern dance and stage, nude and vulgar art, impure literature, "the modern novelist, who delights in descending to the gutter for his heroes," but we do not notice that he mentions the bill board and the newspaper. "All these artificial excitements tend to create volupt- uousness and this, says Scott, has as its .^indispensable consequence, degradation of a large number of women." STARR ON NERVOUS DISEASES.—Organic and Functional Nervous Diseases. By M. Allen Starr, M. D., Ph. D., LL. D., Professor of Neurology in the College of Phy- sicians and Surgeons, New York; ex-President of the American Neurological Ass'n. Second edition, thor- oughly revised. Octavo, 824 pages, with 282 engrav- ings and 26 full-page plates. Cloth, $6.00, net; leath- er, $7.00, net. Lea Brothers & Co., Philadelphia & New York, 1907. We welcome with pleasure and anticipation of es- pecial profit to our cerebral cortex areas, the second re- vised edition of this much esteemed work, the first edition Reviews, Book Notices, Reprints, Etc. 123 having proven a profitable contribution to our understanding of the subjects on which this valuable book treats. This book is prefaced with an interesting color show- ing of the relation of the neurones. The book being the output of the well-known medical publishing house of Lea Brothers & Co., of New York and Philadelphia, is always a guarantee of good type, press- work, paper and binding. The subject matter is arranged, illustrated and dis- cussed by an expert of demonstrated and approved ability in the medical profession. Besides the present work, Dr. Starr is the author of Familiar Forms of Nervous Disease, Brain Surgery and an Atlas of Nerve Cells; all well received by the profession. A STUDY OF THE MOTOR PHENOMENA IN CHOREA. By Dr. G. M. Parker, New York. Reprinted from the Psychological Review. This paper is a study of the movements observed in chorea. This is done with a complete awareness of the narrow field implied, yet with the intention of developing through this limited objective, certain definite, though differ- ent views of the pathology or psychopathology of chorea. The study is not one involving the basic pathological causes, but it is rather an analysis of its predominant man- ifestations, with the aim of more clearly defining the ex- istent physiological conditions through a psychological and biological interpretation of the motor phenomena. The author concludes the interesting subiect thus: "Whatever be the fundamental pathological cause of chorea, it is not simply a cortical irritation. The pathology is one which distinctly concerns the motor neurones as systems. That the results of the pathological process are not displayed as irritative neurone discharge; that rather analysis has shown them to be such as would result from the inhibition of the physiological functioning of higher systems, coincident with a hyperfunctioning of the motor neurone systems subordinate to the higher, from which the higher has been evolved and integrated." 124 Reviews, Book Notices, heprints, Etc. THE CHRISTIAN REGISTER, liberal in religion, strong in its moral and sanitary editorials, enlightening and vig- orous in matters of world government, its defense of the right and assaults upon wrong, forceful, witty and pure in every matter it discusses has withal, no patent quack or soul-polluting advertisement in its pages. It is a periodical fit for any hospital or asylum, where only pure reading matter should go to the halls or bed- rooms of patients. TEXT BOOK OF PSYCHIATRY—A Physiological Study of Insanity for Practitioners and Students by Dr. E. Mendel, A. O. Professor in the University of Berlin. Authorized Translation edited and enlarged by Wm. C. Krauss, M. D., Buffalo, N. Y., President Board of Managers, Buffalo State Hospital for the Insane; Medical Super- intendent Providence Retreat for Insane, Neurologist to many hospitals, etc. F. A. Davis Co., Publishers, Philadelphia, 1907. This is a very complete analysis and unique presen- tation of the characteristic diagnostic features of insanity from an experienced and authoritative source. Professor Mendel of the University of Boston, being well-known to the medical profession of the world and especially to the profession of the United States since 1876, when he first visited this country and the writer of this review had the pleasure of first making his acquaintance. This valuable book is an excellent psychological analysis of the salient features of insanity, a psychological study as the author terms it, and psychological analysis as the trans- lation expresses it, done by a master mind in psychiatric observation and practice. The presentation and discussion of the pathological disturbance in the condition of the body—"the cranium and so-called signs of physical degeneration—the stigmata is interestingly and uniquely done. The organic psychoses( paresis, atrophy, arterio-sclerosis and senile dementia, apoplexy and post apoplectic psychoses, the intoxication psychoses, suicide, anti-toxic, alcohol, morphine, the hys- Reviews, Book Notices. Rebrints, Etc. 125 teric and epileptic and idiotic psychoses are well discussed and remarkably well presented for the limited space as- signed them. These and other features we have not space to present. These in with the treatment presented and the analysis of the genersl symptom etiology, the study of consciousness, memory, sensory feelings, associations, delusions, etc., which complete this valuable book, make the whole one which we can cordially commend to practitioners and students for whom the work is expressly designed and to the ana- lytically minded alienist and neurologist as well. The distinguished author, the translator and the equally well-known publisher have done their work well in the making of this commendable volume. "RECOLLECTIONS OF A GOLD CURE GRADUATE."— A grave subject humorously treated as reviewed by a humorous litterateur. Newton Newkirk, a Boston humorist, is the author of this rollicking little volume, with which the most sober-minded may laugh an hour away. It is all there, from the first round to the head- ache, and the illustrations by Wallace Goldsmith include everything from purple snakes to the tracks of the man who cannot believe he ever made them. Booze is not a nice subject, perhaps, but in the hands of a clever workman like Mr. Newkirk it can be a very funny one. The editor of The Alienist and Neurologist disclaims any part in the above review but he would here wish to remark, not upon "the purple snakes" etc., but upon "the tracks of the man who cannot believe he ever made them." Aye, there's the rub!—the psychic foot prints or rather brain imprints of mental deterioration and well recognized diseases that follow after the drunkard who does not know and can not yet be made to believe he could or ever did make them. The restored periodic, that is the inebriate recuperated again in his nerve centers and sound, rested and rebuilt in his neurones, that his brain-centers are stable and appetite abeyant to his enlightened will for awhile. The inebriate should graduate through a home and school for the imbeciles 126 Reviews, Book Notices, Reprints, Etc. and idiots, and hospitals for the insane, many of whom show the conjugal progeny and congenital handiwork of his vicious degenerating habit. Such a view would not engender facetious facility of description nor fondness for further humorous recollections, but it would certainly unfold a tale of hereditary alcoholic woe that ought to set any married or matrimonially inclined drunkard or habitual alcoholic beverage imbiber to serious thinking on the criminality of inebriety. THE ST. LOUIS COURIER OF MEDICINE has changed having gone under the control of a company of well- known physicians with Dr. Zahorsky as editor-in-chief. The January number presents all the features of a first- class digest of medicine. HISTORIC NOTES OF CANADIAN MEDICAL LORE AND LECTURE MEMORANDA prepared for and distributed to the British Medical Association by Burroughs, Welcome & Co., is multum in parvo mine of rare an ) entertaining information concerning primitive medical methods, early Canadian history, Indian medicine men, medicines, incantations, Indian faith cures, phlebotomy, etc. THE NATIONAL GEOGRAPHIC MAGAZINE is a periodical of interest and instruction for all Americans and in fact for all the civilized world. It is ably edited, well- illustrated and strongly supported by articles of merit from eminently capable pens. The December number for instance gives the present conditions in China by Hon. John W. Foster, former U. S. Sec't'y of State; Latin America and Columbia by John Barrett, U. S. Minister there and the Greatest Hunt in the world, by Eliza Ruhamah Scidmore, Foreign Sec't'y of the National Geographical Society, author of Life in India, China—the long lived Empire, Janirikisha Days in Japan, etc. Gilbert H. Grosvenor and fourteen eminent collaborators including WJ. McGee, Director of the Public Museum of St. Louis, constitute the Associate Editorial Staff. Reviews, Book Notices, Reprints, Etc. 127 THE HESPERIAN is a Western literary periodical of decided but modest, unostentatious merit, now entering the sixth year of its quiet, meritorious existence. It "lives and loves" for literature alone, its editor and pub- lisher, Alexander N. de Menil, being financially on easy street. He is known in literary circles not only because of his editorship of The Hesperian, but by his authorship of "Songs in Minority," the "Literature of Louisiana," etc. Published at 7th and Pine St., at 15c per copy and 50c per year. For sale also at St. Louis News Co. "THE SPECTATOR" will interest the many readers of the Alienist who sojourn abroad a part of each year, as well as our host of intelligent home readers who interest themselves in all matters anthropological, as well as medi- cal and medico-legal, in the limited sense of these latter terms. Moral training, and the making of patriots, the trust system in England, Adonis, Attis Osinis and Sabine (Sabian?) forms are among the matters of interest in the last October 7th number, besides the discussion of British government affairs, poetry, music, letters to the editor, re- views, notes on current literature, etc. Later numbers are equally interesting. CONSERVATIVE GYNECOLOGY AND ELECTRO-THERA- PEUTICS.—A Practical Treatise on the Diseases of Women and their Treatment by Electricity. By G. Betton Massey, M. D., Attending Surgeon to the American Oncologic Hospital, Philadelphia; Fellow and ex-President of the American Electro-Therapeutic Association, etc., etc. Fifth, Carefully Revised Edition. Illustrated with Twelve (12) Original Full-page Chromo-lithographic Plates of Drawings and Paintings, Fifteen (15) Full-page Half-tone Plates of Photo- graphs made from Nature, and 157 Half-tone and Photo-engravings in the text. Complete in one Royal Octavo Volume of 467 pages. Extra Cloth and Beveled Edges. Price, $4.00 net. F. A. Davis Com- pany, Publishers, 1914-16 Cherry Street, Philadelphia. 128 Reviews, Book Notices, keprints, Etc. We can not now, as we reach the close of the' Feb- uary number of the Alienist and Neurologist go over the entire scope of this valuable volume. The well-known repute of the author in electrotherapy, general and special, his fame in the electro-therapeutics of gynecology,our familiar- ity with the preceding editions and comparative examination of the present justify commendation of the present book to those seeking a practical treatise of the special diseases of women and their treatment by electricity. The author's notes on neurasthenia, pp. 91, et seq., on portable batteries, pp. 245, et seq., his discussion and illustrations on the Roentgen rays, fluroscopy, the handling of currents, electrodes, dos- age, resistance, etc., the neuroses of urethra and vulva, sterility, impotence, carcinoma, ovaritis, congestion, senile uteritis will all, as heretofore, interest and hold the atten- tion of the broadly intelligent class of readers who count the Alienist and Neurologist among their regular magazines. AN ILLUSTRATED ANNOUNCEMENT of "Beverly Farm," Private Home and School for nervous and backward children, conducted by W. H. C. Smith, M. D.. Super- tendent, at Godfrey, Madison County, Illinois, comes to us, showing continued prosperity and well-merited sup- port. Dr. Smith was in charge of the Collective Exhibit of the Association of American Institutions for the Feeble Minded, located in Section 5 of the Social Economy Divis- ion, in the Education Building at the World's Fair, and was awarded a Grand Prize, Diploma and Medal as a collaborator of this Exhibit by the Grand Jury of the Louisiana Purchase Exposition. "HUMANITY," which comes irregularly to our sanctum, is a collection of short and interesting stories and dis- sertations of merit and well illustrated. Its motto, "humanity covers the whole field," is illustrated on the front cover in colors which a bill poster is about to paste on the wall. An article in the October number, entitled "For Profes- Reviews, Book Notices, Reprints, Etc. 129 sional Services, The fine art of graft among physicians" may possibly apply to some among a certain society pandering criminal class, but does not describe any set of physicians or surgeons with which the editor of this Journal is familiar. There may be such as these, as sandbaggers, confidence swindlers, thieves and murderers among men in other walks of life, but we have not encountered them among our fellows of the regular medical profession. The writer of the article is Richard Jones. He admits that data for his statements of medical villainy and deceit "is" (are "of course") "almost wholly unprocurable" and his concluding paragraphs, conceding that there exist instances of "isolated God- inspired cases of eminent specialists and respectable family physicians," that "there are in a hundred other instances partners in a scheme for graft"—a sure thing game from start to finish because "it (the profession trades in mystery and threatens death)" suggests the old court reproof "honi soit qui mat y pense" and one wonders what sort of crafty quack such a writer might have made, had humanity been cursed with him as a member of the medical profession to hishonor the calling and disgrace the noble name of honest humanity. The review department, after giving well-merited notes of commendation to the Boer War, General Viljoens' inter- esting book and "Hawaii and Yesterday" by Henry J. Lyman, who as the son of a missionary among the Hawaiians, speaks thus of "Enigmas of Psychical Research," by Prof. James H. Hyslop. "Probably no subject is attracting more attention in the religious and scientific sphere of activity than the truths which are being explained as a result of psychical research. "The objection that can be put forward regarding nearly all works on the subject, i. e., they are filled with bad reasoning and forced conclusions because of the over- anxiety of the authors in this field, will not apply to Prof. Hyslop's work, as he rarely attempts to draw any conclu- sions from the facts that he brings out and when he does it is with great caution that his conclusions are thoroughly 130 Reviews, Book Notices, Reprints, Etc. founded upon good reasoning. His principal idea in the work is not so much to show what has been done in this line as it is to show the virtue and value of the study of Psychological Phenomena." Save for the one article unjust to the medical profes- sion, which we have criticized, the magazine will please you. Its price is ten cents per copy. NERVOUS AND MENTAL DISEASES. By Archibald Church, M. D., Professor of Nervous and Mental Diseases and Medical Jurisprudence in Northwestern University Med- ical School, Chicago; and Frederick Peterson, M. D., President of the State Commission in Lunacy, New York; Clinical Professor of Neurology and Psychiatry, Columbia University. Fifth edition, revised and enlarged. Octavo volume of 937 pages, with 341 illustrations. Philadelphia and London. W. B. Saunders & Company, 1905. Cloth, $5.00 net; Half Morocco, $6.00 net. We can only reiterate the former favorably expressed opinion of this valuable contribution to the literature which is, in each succeeding edition, revised up-to-date. Its authors men who keep themselves abreast of neurologic, neuriatric, psychologic and psychiatric advance. This book is worthy of a prominent, accessible place in any medical library. Report of the Department of Health of the Isthmian Canal Commission for the month of October, 1906. W. C. Gorgas, U. S. A. Chief Sanitary Officer. The Growing Years. By William Seaman Bainbridge, A. M., M. D., New York. A Brief Resume of the World's Recent Cancer Re- search. By William Seaman Bainbridge, M. D., New York. Mysophobia, with Report of Case. By John Punton, M. D., Kansas City, Mo. Prolessor of Nervous and Mental Diseases, University Medical College, etc. Was Percival Pott Really Entitled to the Honor of Having a Certain Spinal Disease Called by His Name? By A. J. Steele, M. D., St. Louis. Reviews, Book Notices, Reprints, Etc. 131 And Dr. Steel, after citing Percival Potts' well-known description and interestingly giving somewhat of Dr. Potts' biography, answers that "he was." This brochure is de- serving of a place in every medical man's library. Copies of the discoverer's original illustrations and an engraving of Percival Potts, from a painting by Reynolds, accompany this valuable monograph. Presidential Address. The Physician as a Character in Fiction. By C. B. Burr, M. D., Medical Director Oak Grove, Flint, Mich. The Bulletin of the University of Nebraska College of Medicine. Contents: I. The Microscope in its Relation to Medicine. By James Cawoll, Washington, D. C. 1I. A Study of Filtration in thej; Lung of the Frog. By A. E. Guenther and R. A. Lyman, Lincoln, Neb. Report of Five More Apparent Cures of Pulmonary Tuberculosis Occurring in Working People, who were Treated at a Dispensary Without Interruption to their Work. By John F. Russell, M. D., New York. Principles of Spelling Reform. By F. Sturges Allen, New York. Clinical Psychology. By Frank Parsons Norbury, A. M., M. D. Jacksonville, ill. An excellent and timely contribution to the subject, es- pecially appropriate to be imparted to a general medical society. The profession needs, and is sensibly seeking, more light on this important subject, in the general practice of medicine from sources of right clinical experi- ence, a source from which this communication comes. Second Biennial Report of the Parsons State Hospital for Epileptics, Parsons, Kansas. A Clinical Lecture on Malignant and Non-Malignant Growths. By Wm. Seaman Bainbridge, A. M., M. D., New York. The Ralph Sanitarium For the Treatment of Alcoholism and Drug Addictions THE method of treatment is new and very successful. The withdrawal of the drug is not attended by any suffering, and the oure is i omplete in a few weeks' time. The treatment is varied ac- cording to the requirements of each individual case, and the res- toration to normal condition is hastened by the use of electricity, massage, electric light baths, hot and cold tub and shower baths, vibratory massage, and a liberal, well-cooked, digestible diet. A modern, carefully conducted home sanitarium, with spacious surroundings, and attractive drives and walks. Electro- and Hydro-iberapeutic advantages are unexcelled. Trained nurses, hot water heat, electric lights. Special rates to physicians. For reprints from Medicaljournals and full details of treatment, address DR. B. B. RALPH ^JSSr- Kansas City, Mo. PUBLISHER'S DEPARTMENT. THE SOUTHWEST MISSOURI IDEA OF MEDICAL PRAC- TICE STATE REGULATION.—At a special meeting of the Gasconade-Maries-Osage Counties Medical Association at Bland, Mo., December last, the following appended resolu- tions adopted for the consideration of the Missouri State Legislature, were adopted: "We favor just and honorable medical legislation, to the end that all citizens be protected against incompetent pretenders, and that our laws be so amended that honest, industrious aspirants, with a fair education and good moral character, though with limited means, be enabled to enter the profession after due preparation. "We believe that in the past medical students have been compelled to carry the financial burden of the Mis~ souri state board of health by being compelled to pay an examination fee of $15.00 for an examination and license to practice, which we consider unjust, inasmuch as this class, is not well prepared to carry this burden. "We believe that there should be created a state health office, presided over by a state health commissioner, and that in all matters of public health he have juris- diction; that the law should be so changed that the cor- oner of each county should be the county health officer; that the state health commissioner and the county coroner have cojurisdiction in all matters of public health and san- itation, and that these officers supplant the present state and county boards of health. "We believe that the law should be so changed as to provide for a state examining board,* appointed by the governor, who should examine and license applicants to practice medicine, surgery and midwifery in the state. •Independent of the State Board of Health. ( 132 ) Free to Physician A new book, Diet after Weaninf We have issued this book in response to a constantly increas ing demand for suggestions on the feeding and care of the chil between the ages of one and two years. We believe you will find it a useful book to put in the hand of the young mother. The book is handsomely printed, fully illustrated and i bound in cloth. We shall be glad to furnish you copies fo patients entirely free. A postal card with your name and address on it will brinj you a copy by return mail. MELLIN'S FOOD COMPANY, BOSTON, MASS Publisher's Department. 133 "We favor the taking and recording of vital and mort- uary statistics, and we favor that the law be so amended that these statistics be taken by the county assessor at the time he is listing the taxable wealth of the county. "We favor that the time for the commencement of mal- practice suits should be reduced from five to one year, and that all malpractice suits should be barred by the statutes of limitation after expiration of one year." THE NOBEL PRIZE AWARDS.—The Nobel Prize in Medicine was divided between Prof. Golgi, of the Pavia University, and Prof. Ramon y Cajal, of Madrid. Prof. Moissan, of Paris, received the chemistry prize for his ex- periments in the isolation of fluorine and his researches in- to its nature, also for his application of the electric furnace to scientific uses. Prof. Thompson, of Cambridge Univer- sity, received the physics prize for his researches into the nature of electricity. The King of Sweden formally pre- sented the prizes and medals on December 10th. MALARIAL CACHEXIA.—The cachexia resulting from malaria is often persistent, even after the active cause has been controlled. In such cases, Gray's Glycerine Tonic Compound proves of great service in stimulating the re- constructive powers of the blood. The toxins resulting from the malarial hemolysis are rapidly eliminated, and in- creased impetus is given to the restoration of normal red blood cells. OUR CONFIDENTIAL FRIENDS.—We would not ban- ish opium. Far from it. There are times when it becomes our refuge. But we would restrict it to its proper sphere. In the acute stage of most inflammations, and in the clos- ing painful phases of some few chronic disorders, opium in galenic or alKaloidal derivatives, is our grandest remedy — our confidential friend. It is here also that the compound coal-tar products step in to claim their share in the domain of therapy. Among the latter, perhaps, none has met with so grateful a reception as "Antikamnia and Codeine Tablets," WE SUPPLIED ALL THE CITY INSTITUTIONS WITH DRY GOODS LAST YEAR. WM. BARR GOODS CO. Keep the Largest Stock of Goods suitable for HOSPITAL PURPOSES TO BE FOUND IN ST. LOUIS, And Special Terms will be made with all Institutions ordering from them. BEDDING MATERIALS OF ALL KINDS, UNDERCLOTHING, !N SILK, WOOL AND COTTON, LADIES' AND CHILDRENS' READY-MADE CLOTHING, FLANNELS AND UPHOLSTERY, TABLE AND BED ROOM LINENS, SOAPS, NOTIONS AND PERFUMERIES, AJRE ALL SPECIALTIES AX THE; WM. BARR goods GO'S NEW BUILDING, SIXTH, OLIVE AND LOCUST, - - ST. LOUIS. P. S. Write and find out our special terms to Hospitals. HALL-BROOKE A Licensed Private Hos- pital for Mental and Nervous Diseases. CASES OF ALCOHOLISM AND DRUG HABIT. TDEAUTIFULLY situated on Long Island Sound one hour from New York. The Grounds consisting of over ioo acres laid out in walks and drives are inviting and retired. The houses are equipped with every Modern Appli- ance for the treatment and comfort of their guests. Patients received from any location. Terms Moderate. DR. D. W. McFARLAND, GREEN'S FARMS. CONN. Telephone 67-5, Westport, Conn. THE NATIONAL MEDICAL EXCHANGE —Physicians', 0«nlUti 'and Druggists' Locations and Property bought, sold rented and exchanged. Partnerships arranged Assistants and substitutes provided. Business strictly confidential. Medical, pharmaceutical and scientific books supplied at lowest rates. Send ten cents tor Monthly Bulletin containing terms, locations, and list of books. All inquiries promptly answered. Address. H, A. AtUMAW, M. D. Elkhart, lnd. THE NATIONAL Surgical and Dental Chair Exchange. All kinds of new and second-hand Chairs, Bought, Sold and Exchanged. S«TSEND FOR OUR BARGAIN LIST"** Address with stamp, Dr. H. A. MUMAW, Elkhart, lnd. LARGE DIVIDENDS Are assured stockholders of the SIERRA- PACIFIC SMELTING CO., Sonora, Old Mexico. Easy Payments. Agents Wanted. Write for terms. Address, HENRY MUMAW, Elkhart, lnd. Pub inker's Department. 134 and justly so. Given a frontal, temporal, vertical or occipi- tal neuralgia, they will almost invariably arrest the head- pain. In the terrific fronto-parietal neuralgia of glaucoma, or in rheumatic or post-operative iritis, they are of signal service, contributing much to the comfort of the patient. Their range of application is wide. They are of positive value in certain forms of dysmenorrhoea; they have served well in the pleuritic pains of advancing pneumonia and in the arthralgias of acute rheumatism. They have been found to allay the lightning, lancinating pains of locomotor ataxia, but nowhere may they be employed with such con- fidence as in the neuralgias limited to the distribution of the fifth nerve. Here their action is almost specific, sur- passing even the effect of aconite over this nerve. "OUR READERS will note from the New Antikamnia advertisement which appears in this issue, that the Anti- kamnia Chemical Co., was prompt to file its Guaranty un- der the New Pure Food and Drugs Act, their Guaranty number being 10; which means that of all the Food and Drug Manufacturers in the United States, only nine filed their Guaranty in Washington before that of the Antikam- nia Chemical Company. This shows the usual Antikamnia disposition to pro- tect the dealer and prescriber of Antikamnia under the law and gives assurance of the absolute reliability of the Anti- kamnia preparations." AS THE COLDER WEATHER APPROACHES, certain diseases and remedies will be more on the mind of the profession. Among the remedies will be cod liver oil. Hagee's cordial of the extract of cod liver oil compound is not only one of the most popular cod liver oil preparations on the market, but one of the very best if not, indeed, the best itself. All the nutritive properties of the oil are re- tained and the disgusting and nauseating elements are eliminated. Combined with hypophosphites of lime and soda, it offers to the profession a reconstructive of great value. The writer has for some years prescribed it freely, and with great satisfaction.—Massachusetts Medical Journal. The Perfect Food Digestor FORBES DIASTASE will digest a far greater quantity of starch food and thus through the formation of dextrines, both albuminoids and fats than any product extant; acting in acid, alkaline or neutral media. Giving perfect Digestion, Assimilation, Metabolism and Nutrition. DOSE: ONE TEASPOONFUL A Palatable Concentrated Solution of Diastase from Malt without sugar. A large bottle (or several if requested) clinical trial. THE FORBES DIASTASE CO. will be delivered free for Marietta, Ohio. Impotency Cases It matters not how hopeless; cured or relieved by our combination. Helantha Compound. Hellanthus annuus [sunflower.] Fr. root, bark.H. Australian. Plain or with diuretic. Has a powerful action upon the blood and entire organism Is in- dicated in all cases complicated with Malaria, Scrofula, im- poverished Blood. Anaemia, etc.. etc.,In conjunction with Pil Orient- alls (Thompson), will control the most obstinate cases of Impo- tency, 1 Drink Cure" cases, saturated with Strychnine, "Weak Men" cases, who tried all the advertised "cures" for impotency, and were poisoned with Phosphorus compounds readily yield to this treatment. Pil Orlentalls (Thompson) contains the Extract Ambrosia Orientalis. The Therapeutical value of this Extract as a powerful Nerve and Brain tonic, and powerful stimulant of the Repro- ductive Organs In both Sexes, cannot be over-esti- mated. It is not an irritant to the organs of generation, but A RBCUPERATOR and SUPPORTER, and has been known to the native Priests of India, Burmah and Ceylon for ages, and has been a harem secret in all countries where the Islam has planted the standard of Polygamy. It Is Impossible to send free samples to exhibit in Impotency cases, requiring several weeks treatment, but we are always willing to send complimentary packages of each preparation (with formulas and medical testimonials) to physicians who are not acquainted with their merits. d,i-».. / Helantha Compound, $1.85 per 02. Powder or Capsules, prices. | p)| Orlentalis(Thompson)$1.00 per box. THE IMMUNE TABLET COMPANY, WASHINC.TON. D. C. AGENTSs Meyer Bros. Drug Co., St. Louis. Lord, Owen a Co., Chicago. Evans-Smith Drug Co., Kansas City. Redlngton A Co., San Francisco. J. L. Lyons A Co., New Orleans. CLARK ^ ENGRAVING CO. MEANS-THAT YOU CAN GET HIGH GRADE CUTS FOR ANY KIND OF LETTER PRESS PRINTING AT 8 4 MASON ST M I LWA UKEE HALFTONES ON ZINC OR COPPER WOOD ENGRAVING W&VSMU&tk ORIGINAL DESIGNERS fi ARTISTS Publisher's Depattment. 135 DR. F. E. DANIEL, of Austin, Texas, in his presi- dential address before the last Tuberculosis Congress, at New York, among other pertinent things, said: "The keynote of the convention is to be 'the pre vention or tuberculosis by legislation.' The Government succeeds from time to time in eradicating yellow fever and cholera. Why not consumption, which causes ore-seventh of our deaths? "Unnatural living in cities is a productive cause. Whiskey and consumption follow the flag and the Bible in the march of civilization. Churches are veritable 'black holes of Calcutta.' I attended a church where, according to my calculation, the same air was breathed and re- breathed by each of the 500 members of the congregation every twelve minutes, or twelve times in the course of the service." The medical profession has done its part well in re- vealing and warning against this deadly, but conquerable foe of health and life; now let the people profit by our admonition and enforce strenuous legal measures,the elimina- tion of this menace against health and life, from among the people. The indifferent disseminations of this dis- ease must be made different, the unconcerned brutes that expectorate when they ought not, should be treated like those who would defecate or urinate in improper public places. The street car and register spitter and the dirty expectorator in decent places should be restrained within bounds of propriety, or exterminated from public places, street car conductors, motormen, policemen and hotel em- ployes and church janitors, and all who use heat registers, stoves, etc,, included. AN EFFICIENT MEANS OF RELIEVING PAIN.—The pain which accompanies the intestinal diseases resulting from grippe colds is often severe and requires the use of an effective anodyne. Papine is peculiarly adapted to such needs, as it represents all of the pain relieving properties of opium without its narcotic and nauseating effects. It is apparent that such a remedy has a wide range of useful- CACTINA SENG PILLETS A Cardiac Tonic Stimulant From Cereus Grandiflora(Mexicana) Each Piilel containing One One- Hundredth of a grain of Cactina Indicated in functional cardiac troubles, such as tachycardia, palpi- tation, feebleness; and to sustain the heart in chronic and febrile diseases- It is not cumulative in its action. DOSE-One to three Pillels three or four times a day. . Put up la bottles of 100 pillels Frav samples lo Phystelaroe upon requeal Sultan Drug Co., St. Louis, Mo. Pharmaceutical Chermsts _________ ■ "^MmmmmmamammmmmmmmmmmmmsmmmrimBamm PEACOCK'S BROMIDES THE BEST FORM OF BROMIDES Each fluid drachm contains 15 grains of the neutral and pure bromides of Potassium, Sodium, Ammonium, Cal- cium and Lithium. In Epilepsy and all cases demanding continued bromide treatment, its purity, uniformity and definite thera- peutic action, insures the maximum bromide results with the minimum danger of bromism or nausea. DOSE One to three leaspoontuls ac- cording to the amount of Bromides deslrea. Put up ln 1-2 pound bot- tles only. Free samples to the profession upon request Peacock Chemical Co., St. Louis, Mo. Pharmaceutical Chemists. A Digestive Secernent A preparation of Panax (Ginseng} which is being successfully em- ployed to stimulate the secretory glands of the alimentary canal. Indicated in Indigestion, Malnutri- tion, and all conditions arising from a lack of digestive fluids. DOSE One or two teaspooofuls three or more times a day PDT UP IN 10 OZ. BOTTLES l>r.l.Y F:tc samples to Physicians upon reqwst Sultan Drug Co., St. Louis, Mo. Pharmaceutical Chemists The Hepatic Stimulant Prepared from Chionanthus Virginica Expressly for Physicians' Prescriptions Chionia is a gentle but certain stim- ulant to the hepatic functions and overcomes suppressed biliary secre- tions. It is particularly indicated in the treatment of Biliousness, Jaun- dice, Constipation and all conditions caused by hepatic torpor. DOSE- One to two teaspoon- fuls three times a day. Pot up in 1-2 pound bottles only Free sample* to Physicians upon request Peacock Chemical Co., St. Louis, Mo. Pharmaceutical Chemists. Publisher's Department. 136 ness, and that Papine is well appreciated by the medical profession, is shown by the place it has occupied in the medical armamentarium for so many years.— The International Journal of Surgery. THE POETRY OF MEDICAL MEN.—That medical men are not devoid of sentiment and wit, we have from time to time given samples in these pages. The following is our friend of the Medical Review, Kenneth W. Millican's Christmas and New Year's greeting to his friends: A CHRISTMAS SONNET. Christmas once more? How the swift years glide by! Bring in the blazing Yule log. Close the door And draw the curtains on the chill blast's roar And warring elements. Light up, and vie, Young folks and old, in Christmas revelry. Games, stories, dancing when the feasting's o'er, (But crafty mistletoe thrills young maidens more). Attune all hearts to mirth and jollity. Yet not alone at home, but in the soul, Kindle the glowing fire of kindliness. Shut out the chilling blasts of self, the stress Of worldly strife, and then, to crown the whole A merry Christmas and a glad New Year, Light up the mind with helpful rays of cheer. K. W. M. DYING OF A ROSE IN AROMATIC PAIN came near being the fate, according to the exuberant imagination of a newspaper reporter, of some of the lady customers in a New York drug store December last. A three-hundred bottle full of perfumery exploded in the show window of a Park Row drug store with a loud report and scattered broken glass all over the store. The odor almost overcame the clerks and a number of shoppers. No one was struck by the flying fragments. Fifty customers in the store, most of them women, were too frightened to move. The perfume was highly concentrated and almost suffocated everyone. The manager hastily opened the doors and windows, allowing the scent to mingle River Crest Sanitarium %ZT£Z£L Astoaia, L. I., New York City. in Lunacy. FOR NERVOUS AND MENTAL, DISEASES. Home-like private retreat. Beautifully located. Easily accessible. Detached buildingffor alcoholic and drug habitues. Hydrotherapy, Electricity, Massage. J. JOS. KINDRED, M. D., WM. E. DOLD, M. D., President. Physician in Charge. New York office 616 Madison ave., cor. 59th St.; hours, 3 to 4 and by appointment, Phone, 1470 Plaza. Sanitarium Phone, 36 Astoria. The Richard Gundry Home, CATONSVILLE, BALTIMORE CO., MD. A private Home for the treatment of Mental and Nervous Diseases, Opium and Alco- holic addictions. For Circulars, Rates, etc., Address, DR. RICHARD F. GRUNDY, Catonsville, Aid References—Dr. Henry M. Hurd, Dr. Wm. Osier, Johns Hopkins Hospital, Baltimore. Md. Dr Thomas A. Ashby, Dr. Francis T. Miles and Dr. Geo. Preston, Baltimore, Md. Dr. George H. Rohe, Sykesville, Md. Dr. Charles H. Hughes, St. Louis. THE BLUE HILLS SANITARIUM MILTON MASSACHUSETTS. A PRIVATE HOSPITAL AND IDEAL RESORT. All classes of patients admitted. Separate department for the victims of ALCOHOL. OPIUM. COCAINE AND OTHER DRUG HABITS. All de»lre for liquors or the baneful drugs overcome within three days after entrance, and without hardship or suffering. A well-equipped Gymnasium, with competent Instructors and Masseurs, for the administration of purely hygienic treatment; also a Ten-plate Static Electrical Machine, with X-Ray, and all the various attachments. J. FRANK PERRY. M. D„ Supt. THE ALPHA SANITARIUM, LAKE FOREST, ILLS. Established for the treatment of the Functional Derangements and Morbid Psychologies that occur during Adolescence. For further particulars address W. XAVIER SVDDUTH, M. D., 100 State St., CHICAGO. Publisher's Department. 137 with the odors of Park Row, which had a diluting and neutralizing effect. COCA A TRUE HEART TONIC—(1) Coca is a depur- ative of the blood stream, favoring the elimination of the products of tissue waste. (2) Coca renders the muscular structure of the heart free to perform its functions untrammeled by a clogging of waste products in the blood which would otherwise impede function both mechanically and chemically. (3) Coca acts directly on the cardiac muscle. (4) Coca is a tonic to the vaso-motor nerves. (5) Coca is a stimulant to the vagus centre. The value of Coca as a heart tonic should not be lost sight of. Unlike digitalis, Coca does not upset the stomach, is not cumulative, does not abnormally slow the pulse nor injure the heart muscle. It is not injurious or harmful in any way. Coca is useful in disease of the cardiac valves or of the heart muscle itself, as well as in allied troubles of the organs of respiration and of the kidneys. In mere cardiac weakness, whether from emotional irritation, infec- tious disease or overstrain, it is an invaluable remedy; and unlike digitalis, it is particularly serviceable when the cardiac nerves are at fault. Besides Vin Mariani, the form advocated is the concentrated fluid extract, Mariani Tea, of which a drachm or two should be given at a dose about every three or four hours. When cardiac tonics are indi- cated enforced rest and a regulated dietary should be preliminary to all forms of treatment.— The Coca Leaf, May, 1905. The MILWAUKEE SANITARIUM Wauwatosa, Wis. FOR NERVOUS AND MENTAL DISEASES Wauwatosa is a suburb of Milwaukee on the Chicago, Milwaukee and St. Paul Rail- way, 2% hours from Chicago, S minutes' walk from all cars and trains. Physician in charge: RICHARD DEWEY, A.M., M.D. CHICAGO OFFICE, 34 Washington St., Wednesdays 2 to 4 P. M., (except in July and August). Telephone connections, Chicago and Milwaukee. Greenmont-on-the-Hudson. For NERVOUS and MENTAL DISEASES. RALPH LYMANS PARSONS, M.D. RALPH WAIT PARSONS, MX). City Office, 21 East 44th St., SING SING, P. O., N- Y. Mondays and Fridays, 3:30 to 4:30.p.m. Long Distance Tel., Hart, 140A, Sing Sing, N.Y CREST VIEW SANITARIUM, GREENWICH, CONN. A quiet refined home for the treatment of Chronic and Nervous Diseases, In the midst of beautiful scenery, 28 miles from New York. H. M. HITCHCOCK, 1W. D. Pfll K'S MEDICAL REGISTER I ULI\ O AND DIRECTORY EUGENE fiivenfree FIELD'S i POEMS*I A $7.00 to each person interested ln subscribing to the Eugene Field Monument Souvenir Fund. Subscribe any amount desired. Subscriptions as low as 91.00 will entitle donor to bis daintily «rti*tlc volume afktsa m a t ."Field Flowchs" •P^ fflfl ♦ n years. Louis II. of Hungary was crowned in his second year, at fourteen had a complete beard, at fifteen was married, at eighteen had gray hair, and at twenty died. A ten-year-old boy, reported by Rhodiginus, impregnated a female. A boy born in 1741 had external marks of puberty at twelve months, and died senile at five years. Of six cases of early puberty in boys cited by Gould,X one viril at one year, died senile at five years. Cazeaux reports the case of a girl who menstruated at two, became pregnant at eight, and a grandmother and senile at twenty-five. Another child of three, with the breasts of a woman and genitals of a nubile girl, had a senile appearance. She menstruated regularly at two. In a case described by Woodruff a girl regularly menstruated from two years, and at six years was tall, with well developed breasts and a hairy mons veneris. In a girl reported by Van der Veer menstruation began at four months and continued regularly for over two years. She had the features of a child of ten. The labia majora and minora were well formed, and the mons veneris was covered with hair. Premature senility may evince itself In atheroma of the arteries at the periods of extra-uterine stress. This has been observed rather frequently in the children of vegetarians and after the essential fevers. Sex, as Drusing's biologic studies have shown, is not inherited, but is the result of various factors acting not only at the time of impregnation, but at various times •Dental Pathology: Talbot. tDegeneracy: Its Causes, Signs and Results. tGould's Anomalies. iProtrtt Medical, July IB, 1888. 154 J as. G. Kiernan. light has been lost, and before the organ has been far re- duced by phylogenetic destruction, a veil of black pigment is formed over it, completely shutting it off from outer light. The nerve disappears completely before birth, its degener- ate cells becoming lost in the mesoblastic skeletel tissue of that region. At the time of birth the whole eye is en- closed in a thick membrane which isolates it. The depo- sition of pigment has destroyed any functional activity in the lens and retina, but these parts none the less retain traces of a complicated structure recalling their condition when functional. Similar stress has at the proper period, arrested devel- opment of brain types in idiots at stages like the brains of Sauropsidae (bird and reptilian type). The fetal periods of stress of the human organism which most deserve attention are those of the senile (or sinnan) (Figure II) period of intra-uterine life (which occurs about four and a half months after conception) and the period of sex differentia- tion. Arrest at this period of senile intra-uterine de- velopment, through any of the processes which check development, may exercise peculiar influences on the extra-uterine development of the child. When produced by syphilis (which so fre- quently causes the senile appearance of new-born children) the child, because of organs which have un- dergone premature senes- cence, fails to pass through the first dentition, or read- ily falls a victim to second- ary infections. Precocity, Fig. II. whether of the intellectual or physical type, is an expression of arrest of ^development at the senile period which causes the child to pass Is Genius a Sport? 155 of the optic lobes (mesencephalon). In the human em- bryo of the middle of the third month, same. In mammals the hemispheres cover the thalmen- cephalon (cerebellum and medulla) and the olfactory lobes. In the human embryo of the fifth month, same. In some mammals even of higher orders (e. g., some Hapalidae) the hemispheres are smooth. In the human em- bryo of the middle of the fifth month, same. Arrested development of the neurons would imply im- perfect power of association and consequeutly imperfect po- tentialities for education. As the power of passing through the fetal period of stress will depend on the condition in which the fetal or- ganism is at the time of the period of stress, and as this condition of the fetal organism will depend partly on factors inherited and partly on the maternal condition, it must be obvious that defect in either at these periods of stress may so disarrange the struggle for existence be- tween the fetal organs that reversionary conditions will gain the ascendancy. This is true of even such grave conditions as cyclopia, in which the pineal body becomes an actual eye, as in cer- tain lizards like the sphenodon; while the structures of the embryonic eyes normal in men disappear. In the lizard the pineal eye passes through the following stages of develop- ment: Formation of a hollow outgrowth from the roof of the third ventricle of the brain. This little sac elongates, changes its direction, and becomes divided into a proximal and distal portion. The cells lining the distal part farthest from the brain become differentiated into the cell which will form the lens, and the cells which will form the retina. The distal parts become specialized; the lens, the retina, and the stalk of the optic nerve are mapped out. The lens, the retina, and the optic nerve become fully formed. At this stage the third eye has reached its limit of development. There is a well formed retina connected with the brain by a special optic nerve. The organ projects strongly from the surface of the head, but from this point, owing to the de- velopment of the cerebral hemispheres, degeneration be- gins. The nerve becomes broken and fatty, and pigmentary degeneration occurs in it. At the same time the pineal eye having become useless or even harmful to the animal possessed of it, before the power of receiving^perceptions of 156 Jas. G. Kiernan. thereafter. Long after impregnation, when the embryo is already developed, nutrition is still influential and may change the tendency even after the sexual organs have de- veloped. Poor maternal nutrition may arrest female de- velopment, causing reversion to the male type. The psychic side of sexual differences should normally, as it often does, remain undifferentiated until adolescence. Adolescence is affected by the atavistic tendency to simian senility, which implies its early onset. This psychic side in the sex is ignored, yet the "instincts which are transmitted from gen- eration to generation (especially those so fundamental and universal as the reproductive instincts) may appear even where there is congenital absence or rudimentary develop- ment of organs upon which the manifestations depend.* The psychic manifestations of the sexual appetite may re- main indifferent until adolesence, like the indifferent type of sexual organs may be of homosexual type (to the same sex), of heterosexual (to the opposite sex), or may be her- maphroditic (both sexes.) Three conditions (infantilism, masculinism and feminin- ism) and a mixed state may result from arrest of develop- ment before, at, and after sex differentiation in intra-uterine life. As the inferior organs and sex nerves are differen- tiated ere the psychic phase, this side of sex may be de- termined only in extra-uterine life. Practically all three are arrested developments of child potentialities. (To be continued.) •Barrus: American Journal ol lmaniiy. 1895. THE TRAMP AS A SOCIAL MORBIDITY.* By HARRIET C. B. ALEXANDER, A. B., (VASSAR) M. D. Fellow Chicago Academy of Medicine, Member International Medical Congress 1906, Physician to Internal Medicine Department Mary Thompson Hospital. MEDICAL demography, dealing with state medicine and state hygiene from the view-point of society organ- ization, necessarily takes the tramp, as a social morbidity, under its purview. This morbidity involves the questions of diagnosis, causation and remedy. Acccepting the everyday conception, the tramp is a so- cial parasite, which, while in part the result of social forces, like tolerance of begging, like great wars, like sudden de- struction of industries, (by financial revolutions or by ma- chinery) is very frequently also the product of congenital ten- dencies, aided by bad environment during growth stress, as well by breakdowns from nervous and other protracted dis- eases. The tramp's wandering tendency is a return to prim- itive nomadism. The petty thefts and other anti-social ten- dencies are an expression of the spirit which males the negro conscienceless as to the hen roost of the white. Vagabondage, the salient characteristic of the tramp, is anti-social but wandering tendencies are not necessarily vagabondage. "Home keeping youth Have ever homely wits," remarks Shakespeare and the term 'journeyman' preserves the old value set upon wandering as a training. The Ger- man Wandenja.hr—for 'journeyman year' tells the tale more strongly. The English-speaking race has developed because of its wandering tendencies. •Read before the Civic Conference of the Beform Department Chicago Wo- man's Club, Oct. 15, 1904. ( 157 ) 158 Hatriet C. B. Alexander. Vice and virtue, disease and health, always shade into each other and where one ends and the other begins must be determined by relative, not absolute tests. At the out- set of tramp medical demography such tests are demanded for demarcation. Tramps include, according to Josiah Flynt,* "out-of- works" and "hoboes," which last are the parasitic or anti- social class. Both "out of works" and "hoboes" include sev- eral types; some verging on the sociologic norm, some trenching on the criminal and some approximating the mor- bid. The last type implies that there is evidence that wandering tendencies may proceed from disease or defect. Certain forms of insanity so notoriously produce wan- dering tendencies that their victims are called errabund lunatics. The degenerative and acquired types of suspi- cional delusion are notoriously errabund. The periodic, hysteric and epileptic insane are likewise errabund, as are also paretic, secondary and senile dements. The restlessness born of nerve tire and lessened checks on excessive energy in neurasthenia likewise causes erra- bund tendencies. The nerve breakdowns of puberty and adolescence through transmutation of the normal activity of childhood, youth and early manhood, have the same effect. The tramp classes therefore contain morbid elements to an enormous extent. This is very strikingly shown in the late researches of Willmanns.t of Heidelburg, who found that of 120 old professional tramps sent from jails to an insane hospital, there were but 27 that had escaped the workhouse. The number of sentences was high, some having a hundred or more. There ws?re 66 cases of puberty breakdown; 19 of epilepsy; 6 of hysteria; 5 of paranoia; 4 of periodic in- sanity; 3 of imbecility and one of cretenism. There were 7 alcoholic dements, 4 paretic dements, and 1 luetic dement. In other words, 104 of 120 cases of insanity among tramps were of long existing, unrecognized types. The cases were divisible into three groups. Patients in the first group were originally sound, mentally and phys- • El lis: Sexual Inversion, Appendix I. tNeurologischea Oentralblatt, Dee. IB, 1908. The Tramp as a Social Morbidity. 159 ically, with proper social tendencies and leading orderly lives until after the close of adolescence, when a nervous break- down occurred and they became tramps and outcasts. The second group consists of normal persons who suddenly or gradually, without recognizable cause, adopted an unstable, irregular errabund life. The third group is composed of un- balanced degenerates, who early in life, evinced moral im- becility, could not be schooled or trained to a trade, but started on a career of vagabondage. Dops the existence of these groups justify the creation of a tramp type? Anthropometric measurements indicate that the tramp class has merely characteristics common to the congenitally defective. The skull type does not differ from that of the races to which the tramp belongs. Dental and cranial anomalies approximate closely in number and kind to those of the harlot class. Harlotry and hoboism are mental and moral defects taking lines of least resistance in an "ego" of primitive type. The hobo combines the restless wandering tenden- cies of the nenrasthenic and suspicional degenerate with the parasitic tendencies of the pauper and the egotism of the moral imbecile. He therefore fuses several degenerative types, while most approximating the harlot pauper, as found in Bridewell, workhouse and almshouse. The percentage of puberty breakdowns and the per- centage of congenital defectives, like that among harlots, is greater among tramps than among criminals. All moral, intellectual, socialogic and physical expres- sions of birth defect occur in tramps. These, under the law of heredity transformation occur in all buds of the de- generate tree. Pauperism, harlotry, insanity, hysteria, id- iocy, moral imbecility, and haemophilia occur in the same family and present the same physical stigmata. Besides congenital defects, tramps, as shown by Will - mann's analysis, present morbid factors acquired after birth. Alcoholism, like the vagabond tendency, is very frequently an effect, not a cause. Those who have been sunstruck, have sustained skull injuries, or have met with railroad accidents, become intolerant of alcohol. 160 Harriet C. B. Alexander. Sunstroke, skull injury and railroad accidents suffice by themselves to produce suspicional errabund states. A large proportion of the suspicional insane who reach insane hos- pitals through almshouses are of this mixed origin—alcohol- ism, sunstroke, skull injury, and railroad accidents. Tramp breakdowns far from rarely occur among firemen, stokers, stationary engineers, cooks and those exposed to great heat. Exposure of Americans to tropical climates must of necessity, for this reason, increase the tramp class. The influence of institutionalism in making the class parasitic is at once evident. What is true of skull injury, sunstroke and railroad accidents is likewise true of protracted invalidism .which always tends to parasitic mentality. Patients for this rea- son are often pauperized by hospitals and henceforth live on the community. Medical charity is therefore a great factor in the producton of "hobo" tendencies. The great fevers produce, at times, permanent change in character by which the patient's relations to his sur- roundings are changed in a degenerative direction. Periods of financial and other stress shock many into apathy, inevitably tending to parasitism likely to be erra- bund. The restlessness of the bankrupt merchant is an old proverbial observation. The sex factor in the production of "hoboism" markedly looms up in the fact that but 1/10 of Willmann's cases were women. As one-half of these were puberty break- downs, it is easy to see how the breakdown led to indis- cretions and indiscretions to outlawry. The percentage of women tramps in standing army countries is greater than in the United States. Woman being altruistically built, is of necessity, the great preserver of social institutions. She maintains the type from which man ever tends to depart. In primitive society, men as hunter, fisher and warrior was the nomad, while woman was the home-builder, artisan and agriculturist. When militarism declines man approxi- mates woman, but tends more to nomadic tendencies, whence the tramp tendencies after great wars. The Tramp as a Social Morbidity). 161 The remedy for vagabondage universally popular is that of Dogberry: "You shall comprehend all vagrom men." This remedy has proved a source of the very evils it pro- poses to cure. It is obvious from Willmann's figures that strain at adolescence plays a large part in the ethical breakdown of the tramp. Child labor looms up here as a potent factor, as European sociologists and poets have re- peatedly pointed out. If this labor be such as exposes the child to unhygienic surroundings (glass houses, match- making, fur-pulling, sweat shops and lead grinding) sus- picional errabund states readily occur. Struggle for school standing is a fertile source of puberty breakdown, espe- cially since mechanical teaching has become the vogue. Medical charity, like all charity, indiscriminately admin- istered, creates the mind which believes Society owes it a living. The hobo problem in the United States is largely of European creation since before the revolution the bond servant system introduced an enormous population of de- fectives which, through contract labor up to the days of emigrant restriction, was constantly increased. Owing to such restrictions the burden of the defective classes has greatly increased in Europe of late. The influence of labor conditions in producing the tramp include not merely strikes, lock-outs and black lists, but likewise the dangerous trades. The steel industries cause an undue proportion of nerve breakdowns, as do the mining and all industries where accidents are a probability. Lead industries produce suspicional states. The same is likewise the case with industries where dust is a constant factor. One social danger from tramps is that of homosexuality in boys decoyed from home. The tramps gain possession of these boys in various ways. A common method is to stop for awhile in some town, and gain acquaintance with the slum children. They tell these children all sorts of stories about life on the road, how they can ride on the rail- roads for nothing, shoot Indians, and be "perfeshunnels" (professionals), and they choose some boy who especially 162 Harriet C. B. Alexander. pleases them. By smiles and flattering caresses they let him know that the stories are meant for him alone, and before long, if the boy is a suitable subject, he smiles back just as slyly. In time he learns to think that he is the favorite of the tramp, who will take him on his travels, and he begins to plan secret meetings with the man. The tramp continues, of course, to excite his imagination with stories and caresses, and some fine night there is one less boy in the town. On the road the lad is called a "prushun," and his protector a "jocker." This condition, however, occurs among the boys who usually otherwise find their way into the reform schools of the various states and cities. Among these, as Hamilton Wey of Elmira, New York, Randolph Winslow, of Baltimore, Md,. and Kuflewski, of Chicago, have shown, homosexuality frequently occurs without outside suggestion. What, therefore, are the social remedies for the medical aspects of vagabondage? First and foremost comes the prevention of congenital defects; as most of these defects are potentialities rather than actual existences they can be largely corrected by proper environment before birth and during the periods of growth stress. Among proper envir- onment is sanitation of residences and of food, water, dress, etc. Even slight improvements in sanitation effect remark- able results. A very slight improvement in a tenement house system in New York begun in 1881 had resulted in 1891, not only in an enormous decrease in infantile mortal- ity, but the saloons in the districts affected decreased one- third. Improper food during childhood and youth is the source of suspicional breakdowns like those of dyspepsia in the adult. Impure water causes greatly debilitating diseases like typhoid fever, with, as a consequence, neurasthenia and brain artery change. While most great fevers are of germ origin, the germ needs a soil, which sanitations weeps away. One remedy suggests itself for the labor phase of the tramp problem—increased belief in the mutuality of contracts on the part of employer and employed. Importation of defec- tives for labor purposes requires more stringent supervision The Tramp as a Social Morbidity. 163 since, as shown by Willmann, the suspicional and periodic insane long pass muster. More rigid inspection of workshops and rolling mills and greater damages for personal injury would cure the accident evil. Society has created its vagabonds, as it has created other defective classes. When it alters favorably the environment of its youth the creation of defectives will markedly diminish. I ONING OF THE NEURONES IN THE ICE OF MEDICINE AND SURGERY.* By C. H. HUGHES, M. D. St. Louis. Mo. *THE entoning of the neurones means the sustaining and * rebuilding of the sources and the final conservation of nerve center energy. The psychic neurones, occupying the highest place and exerting the greatest influence in the neuraxis, may be impressed on automatically evolved thought. A word fitly spoken to the patient, an auto or an external suggestion from another and healthier and more active brain and mind; or from an environing in- fluence, such as even a picture on the wall, cheerful or depressing as the case may be; a well or illy-digested or a predigested meal, agreeable or disagreeable to the taste or appetite; a primavia clogged or freely opened, a torpid liver, congested or freely acting, or other disease oppressed, or wrong acting viscera or emunctory, and these impres- sing the higher or central presiding neurones exalt or lower their vital activity as the case may be, and con- tribute to the relief and hopeful exaltation or more or less hopeless oppression and depression of the man through his psychic and other neurones and the organs they influence towards convalescence or fatal functioning and vice versa. These neurones in their functioning are the higher powers of the organism through which the masterful vis medicatrix of the human economy builds up or destroys. In my earlier experience as an army surgeon 1 have marvelled at the varying results of insignificant and grave gunshot wounds received under apparently similar circum- stances and environment of the men; the hopefully psychic •Read at Hot Springs Meeting Mississippi Valley Medical Association. ( 164 ) The Entoning of the Neurones. 165 neurone entoned one with the grave penetrating abdominal wound recovering, the hopeless psychically depressed and despairing, speedily dying, though treated in a similar way externally, are illustrations in point from clinical experience, especially our own in the days when we practiced surgery. These unexpectedly variant results made in my earlier days a profound and searchful impression, and 1 have sought ever since for a revelation of the underlying cause thereof. And the cause has come to my knowledge, as it has to others, in the entoning or the reverse of the central neurones that contribute to the makeup of the neuraxis and the man. Our predecessors in the healing art saw less clearly than we do in the light of present-day psycho- neurological illumination and the opsonic index, but they discerned it in the dynamia or 'adynamia of the strong or feeble vis medicatrix natures, and believed in its existence, though in more restricted sense than is now demonstrable. But so far back as in the days of Cullen the view of the marked influence of the nerve centers, though not then so well known as in our day, over the processes of disease was accepted, for he said that "from all that he could see of the movements of disease they might in a manner be called nervous." This view for a time obscured the humeral or blood pathologists, and was later penumbrated further by the omnipresent bacteriological explanation as the causes of nearly all morbid action now somewhat on the wane, for these are causes and conditions of the coming of the bacteria. Neural influences and relations are found in the organism which makes even the bacilli and bacteria fail or fall or flee before them. The mysterious yet demonstrable exaltation, acceleration, retardation or depression or sup- pression of function, as in the cardiac, respiratory or intes- tinal effect of certain emotions, the Kloptversacht experiment of Golz with his frogs; the apepsia through descending vagus influence, the cardiac arrest through the same influence once too often attempted, by Colonel Townsend's self- experiment; the influence of the diabetic center in the floor of the fourth ventricle of the brain and its influence on 166 Charles H. Hughes. abdominal viscera, the tachycardia, bradtcardia, etc., through various involuntary emotions, all remind us of the impor- tance of entoning and promoting the stability of the higher neurones of the cerebro-spinal axis in the management of disease, and in the promotion of its cure, yet we often overlook ihese demonstrable facts and well-known relations between disease processes and the neuronic and psychoneuronic in- strumentalities and helps toward cure, notwithstanding the proofs that sometimes also come before us from empirical non-medical sources, as in the mind and faith cures in- numerable, etc. The lesson of all this, not to make this essay too prolix, is that there is a therapy favorable or adverse in all we say or do to or for the patient, and that we should look well to the entoning of the psychic neurones and guard against impairing their potent power by allowing no depressing lodgment of despair in the patient's mind while treating him, by discoursing of the recovery and not the death of others similarly afflicted, by permitting no pessimistic visitors or nurses to talk of the shroud and the hearse, and those like afflicted who have filled them; to promote ample rest and reasonable cheerfulness of mind in the patient and those who visit him; to avoid overtax of neurone energy and secure as much sleep, mental tranquility and nerve center repair as possible in every case; to save the centers from all possible toxine damage, whether in medical or surgical cases, whether auto-toxin or poison from without. We should avoid the long, taxing visit, the so-called candid but cruel discussion, pro and con, of chances for recovery in the. patient's presence; the display of hideous keen- cutting surgical instruments before the anaesthetic is ad- ministered; the flourishing of the hypodermic needle or too slowly using it; the long brain taxing, sometimes alarm- ing explanations of possible proceedures for relief. In short, when disease has prostrated the patient and nature pleads for help for all the controlling centers of vital action, let us harken unto the voice of vis medicatrix naturce and obey it in the entoning, reconstructing, tranquilization of the higher central neurones, that can do so much to aid and much, also, if wrongly treated, to harm our patients. The Entoning of the Neurones. 167 Whatever view we now or may ultimately hold of the neurones, especially the cerebro-psychic complete cell, whether we shall continue to hold the present general, though mooted, Cajalian view of its independent, though juxtaposed and intimately related cell anatomy, or accept the recent cytological criticism as correct and go back to former or on to a newer morphography of cell morphology, my plea is for the paramount care of the neurones, especially those which are aggregated in the construction and function of the neuraxis. In every case of disease I would seek, as now, a cor- rect localizing diagnosis, and minister to the organ, viscus or special system; but I would exercise, in addition, a watchful care over the tone and integrity of the nervous system, especially in its higher central neurones. In short, I would treat the whole man as well as the special spot or organ claiming attention. 1 would endeavor to keep the neurones well entoned and thus save the patient through those psychically sustaining influences in addition to coarser medication, which has sometimes saved him in other and unscientific hands, acting under the supreme confidence of ignorance, without medicine. We have a double armamen- tarium at our command if we combine real and true psychic rest and hope with our chemical reconstruction and nerve center therapeutics, The right acting neurone is the physiological unit of organic integrity and power; when it fails, anatomical pathology begins. For salvation of the patient conserve his neurones.* •A more elaborate yet not complete presentation of this view, as I hope yet to have opportunity to make, may be (ound in my first book on the "Neurological Practice of Medicine." A PSYCHOLOGICAL MEDICO-LEGAL STUDY. The Case of William Rodawald. BY G. F. ADAMS, M. D. KENOSHA, WIS. WE READ in the public print of the "Crime of Amal- gamated" and high finance. Public speakers and editorial writers tell us that the country is money mad. We are almost daily startled by reports of criminal acts committed by people heretofore law-abiding, many of whom have enjoyed a state and national reputation as trusted citizens. We have had startling examples in our immediate vicinity during the past year. For instance: The Bigelow case at Milwaukee, the Dougherty defalcation at Peoria, and in Chicago we had the Bank of America. This leads up to the question: Why do men and women commit crime? To be able to consider this ques- tion at all, we must know not only the details of the criminal act, but we must know more. We must be familiar with the normal mental state of the criminal, and the environment that surrounded the law-breaker prior to his or her departure from the straight and narrow path. After the crime has become a public act, and the law steps in to prosecute, we have only too frequently the defense—insanity. In cases of this kind, the professions of law and medicine must work together to justly determine the question of responsibility, so that society shall be pro- tected, and the majesty of the law upheld. How this was done in the case of William Rodawald will be the Medico- Legal part of this paper. The crime for which William Rodawald paid the full penalty of the law was committed in the village of Sala- manca, N. Y,, April 7th, 1903. ( 168 ) A Psychological Medico-Legal Study. 169 At that time I was connected with the New York State Hospital service. Ten days after the murder 1 received the following letter from the Dist. Attorney. Office of the George W. Cole, DISTRICT ATTORNEY District Attorney. of Cattaraugus County, Salamanca, N. Y. SALAMANCA, N. Y., April 17th, 1903. DR. G. F. ADAMS, Gowanda, N. Y. Dear Sir: — A murder recently occurred at West Salamanca in this County, in which William Rodawald, a German, or Polander, shot and instantly killed a young man by the name of Jesse F. Bayer. I apprehend that the defense will claim that Rodawald was insane, although 1 have known him for some time, and know him to be simply a high-strung, vicious man, with an ungovernable temper, and no disposi- tion to control it. I think it would be well to have him examined now by an expert alienist, and if that defense is set up, to have such testimony at the trial, which will doubtless oc- cur the latter part of May or the latter part of June. If I desire, would you come to Little Valley (where Rodawald is confined in the jail) and make an examination quite soon, when notified, and would you testify at the trial, if your testimony should be of service to the prosecution after making your examination? Kindly let me hear from you, letting me know if you will make the examination, and if you will be at liberty to be a witness if desired. Yours very truly, G. W. COLE, Dist. Atty. My reply to this letter was a provisional acceptance that Dist. Attorney Cole met more than half way. I told the District Attorney that I would examine Rodawald in the county jail at Little Valley, N. Y., on condition that if I found the prisoner insane that he would not prosecute him 170 G. F. Adams. for the crime of murder, or if he did try him, 1 was to be free to appear for the defense. His reply was that "all he was after was justice." "That he did not seek to con- vict a man of a crime when he was not responsible for his act, and that his only wish was to be advised about the proper course to pursue." Soon after 1 visited the prisoner in the county jail, and spent the entire day with him. My official report to Dis- trict Attorney Cole will cover the salient details of the crime, and give my opinion of the prisoner's mental state. EXAMINATION OF WILLIAM RODAWALD AT THE REQUEST OF GEORGE W. COLE, DISTRICT ATTORNEY OF CATTARAUGUS COUNTY. William Rodawald. Age 49. Occupation, tannery la- borer. Born in Germany. In this country about 14 years. Married. Now living with his third wife. In jail at Little Valley awaiting the action of the Grand Jury for shooting Jesse F. Bayer at Salamanca, N. Y., April 7th, 1903. I first saw Rodawald in the jail corridor, having been admitted with two of his friends, and there had an oppor- tunity to observe him while visiting with them. He was quiet, collected, in no sense excited, nor was he depressed. Later 1 saw him in the presence of the turnkey in the sheriff's office; was simply introduced to him as a physician. He did not ask who I was, nor express any interest why I was there; talked freely and was quiet and easy in his manner. Gave me information concerning his birth, occu- pation in Germany, when he came to this country, where he had worked and common facts concerning his family, and how long he had been in jail. Many of these facts I have since confirmed by inquiry from other sources. PHYSICAL EXAMINATION. His general appearance good; muscles hard; hands show that he is accustomed to hard labor; tongue clear and steady; eyes bright and react to light and accommodation. When asked to stand, close his eyes and turn around or A Psychological Medico-Legal Study. 171 walk from one side of the room to the other, was a little uncertain but did not stumble. Knee reflexes slightly ex- aggerated; no particular zones of skin anaesthesia. Says that his appetite is good, though when first ad- mitted to the jail he felt discouraged, realized his position and for a few days he did not eat as much as usual. Now sleeps well. His physical health from his point of view was good; very seldom has he ever been sick. He gives a history of having been injured about fifteen years ago; not very cer- tain about the date, but while he was living in Germany. He was struck on the head with a spade and this blow left a scar over an inch and a half long in the left temporal- parietal region. He claims that he was unconscious for several hours after this injury and that he was confined to his bed for six weeks. He understands that his skull was fractured at the time he was struck, but from an external examination no line of fracture can be determined now. He is tender from pressure in the region of the injury. Since the injury to his head, has occasionally had severe headaches. The most severe attack of headache he ever had was about one year ago, when he states that for two weeks he was too ill to work. During attacks of headache he suffers most in the region of the head injury. (His wife says she has no remembrance of his having been sick and unable to work for two weeks in the twelve years they have been married.) 1 spent over an hour with him alone. He described in detail the shooting of Bayer, in substance as follows: He had finished his work in the tannery, drew his pay and on his way home stepped into a saloon and drank two glasses of beer. His wife and boy, thirteen years old, met him before he arrived at his home and they picked up some railroad fence posts lying beside the railroad and started to take them to the house. A neighbor woman called to him to let them alone, that the posts were her property. He claims that the section boss gave the posts to him and he continued on towards the house with the posts; that a man (Bayer) he cannot recall his name, but 172 G. F. Adams. he refers to him as the "sailor man," came out about the time the woman spoke to him and told him to let the posts alone, made threats and when he refused to drop the posts, drew a knife; that the woman returned to her house and soon came out with a butcher knife, and that about that time a negro who lived near by also became mixed up in the quarrel. He dropped the posts, ran into the house, picked up a revolver that belonged to his son and came out to protect his wife and son. He claims he believed the "sailor man" and "the woman with the butcher knife" were likely to do them harm. He says he did not present the revolver to Bayer as if to shoot, but in the rush towards him he stumbled and Bayer placed his hand upon his shoulder, or his coat collar, and the revolver went off accidentally and shot the "sailor man;" that he had no intention of shooting him; that now he regrets it very much and appreciates the fact that he must face a grave charge in court. In regard to his ideas, he does not claim to know of any enemies that he has and says that he never had any trouble with the man whom he shot, in fact barely knew that there was such a man living in Salamanca. He admits having seen him before. He had at one time some trouble with the woman. He said that he went to the police justice to swear out a warrant for her, but he failed to get the warrant. He claims that he is a man of peaceful disposi- tion, does not fight and is on amiable terms with his asso- ciates. He does not believe that he is being persecuted. He takes up general subjects and discusses them freely and frankly; spoke of being a subscriber to a German newspaper; said that he did not read English but that he liked to read his German paper; spoke freely of his work at the tannery and of the different kinds of labor that he had been doing since he lived in Salamanca; spoke of his family; referred to his three marriages; told about getting into trouble in Germany and as a result was sent to jail for nine months; explained the trouble as having been a general fight among laborers, and said there were about fif- teen men all sent up for the same length of time. A Psychological Medico-Legal Study. 173 He is entirely free from everything in the line of a de- lusion; he is able to reason correctly from his point of view; has no hallucinations. His general perceptive faculties for one of his education and environment are good. I again saw him in the presence of his wife and son, and she corroborated a number of the statements that he made to me at the time of the first examination. Again I saw him alone, and I went over with him in detail the time of the homicide, and he did not change or vary his statements in any material way. I also saw a man who called on him in the jail—a man who had known him for several years and at times had worked with him—and asked him how Rodawald im- pressed him at the present time. His statement was un- qualified in saying that he could not see any difference in him now from any time. This man also saw Rodawald a very short time, half an hour, before the shooting. He met him going from his work to his home that night and stopped and talked with him, and at that time he appeared to be as he had always known him. CONCLUSION. From my examination of William Rodawald, I am un- qualifiedly of the opinion that he is in his normal mental condition, that he is able to realize his position, and that he does appreciate that he has committed a crime in shoot- ing Jesse F. Bayer, and was in every respect responsible for his act at the time of the shooting. Dated, Gowanda, N. Y., April 24th, 1903. (Signed) G. F. ADAMS. The evidence at the trial as given by five eye wit- nesses was positive that Bayer did not have a knife in his possession at the time of the shooting; nor did the woman who claimed the posts have a butcher knife or any other knife or weapon. The witnesses for the prosecution also swore positively that Rodawald went into his house saying that he was going for a gun to shoot the "sailor man," and when he came out of the house with the revolver in his hand, he rushed up to Bayer and fired point blank at him, 174 G. F. Adams. and after Bayer fell shot through the head, Rodawald stood over him swearing, flourishing his revolver and threatening to shoot again, if the shot he had already fired had not done its deadly work. Soon after the shooting Rodawald said to those present, that he would give himself up, and he did so as soon as he could find an officer; remarking that he had shot a man and wanted to be locked up. The trial did not develop any special incident of note. The defense did not try to prove the prisoner was insane except by inference. Rodawald was sworn in his own defense and made a good appearance on the stand, relating the same story to the court and jury that he did to me at the time 1 exam- ined him in jail only more in detail, under the careful ques- tioning of the attorneys. The jury took but a short time to decide that the prisoner was guilty of murder in the first degree. As the judge pronounced sentence of death by electro- cution upon him, he collapsed but soon recovered and from that time was a model prisoner all the time of his residence in the death house in Auburn prison. THE PSYCHOLOGICAL QUESTION. Let us go back in the history of William Rodawald three or four years. He was employed by the same tan- nery piling bark. His attention was attracted to three young men running across an open field near the bark pile he was on. A man was pursuing them and calling them to stop. He ceased his work and watched carefully the ac- tions of the pursued and the pursuer. He saw three young fellows, about eighteen or twenty years old, evidently try- ing to get away from an older man who was shouting to them to surrender, and when they did not stop, the older man raised a revolver and fired at the three boys. One of them fell fatally wounded. Rodawald saw all this for he was only a short distance away. He had never seen a man shot to death before, and the tragedy made a profound impression on him. He was the only person who saw the whole of the shooting. A Psychological Medico-Legal Study. 175 The facts pertaining to the shooting are in substance as follows: The Erie R. R. that runs through Salamanca, N. Y., had been losing freight from its cars. Thieving was so very bold and common that the Railroad Company sent a special detective, by the name of Wheeler, to protect its property. One day Wheeler was patrolling the R. R. yard when he saw three boys by some loaded freight cars, and thinking he had probably discovered a gang of thieves, started in pursuit. The boys ran out of the yard across the field with Wheeler close after them, calling to them to sur- render. As a matter of fact they were not thieves, and at the worst, in the eye of the law, could only be considered as simple trespassers. When the shot was fired the young men were not on the railroad property. Soon after Wheeler was arrested and tried for the killing of the young man. Rodawald was the star witness in the trial. The jury dis- agreed, which necessitated a second trial of the case, and the jury brought in a verdict of assault; so the judge im- posed as the only punishment a fine of $600. This fine was paid, and Wheeler was a free man. When Rodawald heard the result of this conviction of assault, and that only a fine of $600 had been imposed, he threw up his hands in disgust, and exclaimed: "Hell of a country—shoot a man —fine him £600—hell of a country." What do you think of Rodawald's conclusion? William Rodawald was born and reared in Germany, where the law of the land is enforced. He had met the stern hand of the German law, had been arrested, con- victed and served a term in prison for no greater crime than a free fight among a gang of laborers. He had a most pro- found and wholesome respect for law and order. More than all this, he had tried to do his duty, as he saw it, by ap- pearing in court as a witness in a murder case, and yet in spite of the fact that a murder had been committed, and he knew of this murder more fully than any other person, the only punishment inflicted was a small fine. Do you wonder that he said "Hell of a country?" If you had been brought up as Rodawald was to respect and fear the law, had witnessed a murder as he did, been the 176 G. F. Adams. star witness in two trials of the murderer, and the whole at- tempt of the majesty of the law to punish the criminal had resulted practically in his acquittal, do you not believe—do you not know a great and lasting impression would have been made on you? Would William Rodawald have shot Jesse F. Bayer if he had not been impressed that this was a "Hell of a country?" THE PENNOYER, Kenosha, Wis. PSYCHOLOGICAL STUDIES OF MAN'S MORAL EVOLUTION.* THE CREEPING SERPENT IN OUR GARDEN OF EDEN. By ALBERT S. ASHMEAD, M. D., NEW YORK. GROPING in the dark, like a blind man, I cannot see plainly. Yet the light of Christian day is perhaps the most favorable that "Kind Nature" is able to present. 1 use "blue" ink in analyzing this subject, for the reason that 1 can see it reasonably well. The blacker ink of utter despair would require straining effort. 1 cannot much longer escape "the knife," unless I decide to do with- out it. My light then would be entirely out. The Dogmatist will say '"Nemesis." Let him remem- ber Milburn, the blind preacher, and Dr. Love and his fatality. The term "Law of Evil" is good, but not all embrac- ing as is the term "Law of Demolition." All sickness is the dastardly work of the organic Law against Man and Mankind. It is the principle of destruc- tion at work. Matter, Mind and Morals ever under attack, and man quarrelling with man labors in vain for self-pres- ervation, for harmonious life until the admitted necessary total darkness of death. The blind lead the blind toward altruism, and find it not. The Law of Demolition admits no division of responsi- bility. The Great Cause is the cause of all features of life, and Man, individually and collectively, is only an exhihit of the work of Nature, The Great Criminal, that "can smile and smile, and be a villain still." 1 know no difference of meaning between the term God and the term Nature. •Continued from February, 1907. ( 177 ) 178 Albert S. Ashmead. Rasselas states it well:—"The angels of affliction spread their toils alike for the virtuous and the wicked; the mighty and the mean." But we see that the virtuous are continually assailed and perverted, becoming themselves, agents of and for the destroying quality. So where is the sensible reason for as- suming that a kind God exists when we see that Evil is a feature of the Organic Law? One half of it. No—it is All One. I believe that as to the essential views 1 have ex- pressed from time to time there can be no dissent upon any one's part. We go our respective ways at the signboard "Faith": One way leads to the ever receding sun mock- ing the birth of a new day of life. Mine leads to the dark- ness into which I deliberately go, wholly heartbroken, with the delusions and illusions, and treacheries of that God, that was preached to me as a Harbor and a Guardian. 1 will be no longer a credulous listener. If one finds comfort in Faith, it is one's duty to support it and be by it sup- ported. As my days near their close, I become more bitter. "There is no God" said the Psalmist. Let us see what "words, idle words" or language, can tell us of our subject. In the "dark backward and abyss of time," animals and man had the power of speech. For Talmudic tradition tells us this, also Biblical history. In the account of Man's creation and his fall in the book of Genesis, we read that the Serpent, more subtle than any beast of the field, said unto the woman: 'Yea, hath God said; Ye shall not eat of every tree of the Gar- den,' and the woman said unto the Serpent; 'we may eat of the fruit of the trees of the Garden. But the fruit of the tree which is in the midst of the Garden, God hath said, Ye shall not eat of it. Neither shall ye touch it, lest ye die. And the Serpent said unto the woman, Ye shall not surely die. For God doth know that on the day ye eat thereof then your eyes shall be as God's, knowing good and evil, etc,' and they ate of the fruit and the eyes of them were opened. Man's Moral Evolution. 179 And the curse of the Lord was to the woman; in sorrow thou shalt bring forth children. And to the man, in sorrow shalt thou eat of it all the days of thy life. Thorns also and thistles shall it bring forth to thee. And thou shalt eat the herb of the field. In the sweat of thy face shalt thou eat bread, till thou return unto the ground; for out of it wast thou taken: from dust thou art, and unto dust shalt thou return. Herein we discover no surprise at the power of speech residing in the serpent. God even addresses a special curse to him; and his subtlety over the other beasts is alluded to: "Thou art cursed above every beast of the field; upon thy belly shalt thou go." What was the curse of those other beasts of the field? Was it denial to them, or abolition of speech? In the world's history, down to the dispersion of the human race at the building of the Tower of Babel, language is sup- posed by some philologists and antiquarians to have been Mayan. And this language, if any at all, if it was really the oldest, was that spoken by those beasts of the field, or only the serpent, in the "Garden of Eden?" And as the serpent understood what was said to him there, this must have been the language of God in the Garden, that is if language then, was really sound of tongue and notmere signs, or inarticulate sounds. After the dispersion, men's tongues became confused; mankind multiplied, and through numerous individualizations, types of particular men or communities, became narrowed, the more peculiarization of types, the narrower became each of them. These allusions to speech in beasts are handed down to us through the Hebraic tongue, a race which has maintained its purity of type free, from the time of the Christ we know in our Christian era. The Christ was a Jew. While the God of the Hebrew, his Father, spake to the serpent in the oldest language, the Mayan tongue, Christ, his Son, spoke to the Jews, in Hebrew. These two languages then, so widely separated by time, are the only ones inspired of God in this Christian-Jewish- Greek religious world of other days. Dr. Brinton, in his ethnological and philological studies 180 Albert S. Ashmead. in Yucatan and Central American civilization, and whose manuscript dictionaries of the Maya language are the finest in the anthropological world, has deciphered among the Mayan tribe, a Mayan origin for the last words of Christ on the cross "Eli, Eli, Lama, Sabach thani," which, inter- preted not in Hebrew as most theologians do, as "My God, My God, why hast thou forsaken me?" but in Mayan, as "it is dark, it is dark, this must be death;" or "there is no light" is a much purer interpretation of the last words of the Son of God, (which naturally would be in his Father's tongue) than is a lament that his Father had deserted him in his supremest hour. All knowledge came to us from the tree of knowledge of good and evil. Some of our knowledge we call good ac- cording to the light or power of interpretation that is in us, at a certain period of world existence; some we call evil, according to our lesser capacity, or necessity of judgment, of education, of environment, or lack of power to be "good," in one country or another, or race, or under one or another religious bringing up, circumstances of life, over which we have no more control than we do over the question of birth. Now Mayan, in Hindostan, means the personified active will of the Creator. This allusion is personified as a Ce- lestial Maiden (woman) taking the place of the older Avidya or Nescience. Avidya is Sanscrit and means ignorance, which is '"Maya" the condition in which every one must be at birth, and remain until he "eat" of the fruit of the tree of knowledge of Good and Evil. According to the dictionary, philosophical nescience re- gards the mind or soul as cognizable only as successive states of consciousness and with no ultimate ideas of its own. Cosmological nescience denies or ignores the exist- ence of soul, matter, and God,—one or all. Ontological nescience denies that anything can be known in itself. There may even be distinct degrees of nescience, as (1) that nothing is knowable beyond cogitation; (2) that noth- ing is knowable beyond the cogitative Ego; (3) that if any- thing is knowable beyond that, it cannot be known with Man's Moral Evolution. 181 certainty. In all forms, nescience may be positive or neg- ative. In David Grieve Mrs. Humphrey Ward says: The new English phase Kantian and Hegelian thought is the outlet of men who can neither hand themselves over to authority like Newman, nor to a scientific materialist like Clifford and Haeckel, nor to a more patient nescience in the sphere of metaphysics like Herbert Spencer. Bacon says: "We do not meditate or propose a catalepsy, but en-catalepsy, for we do not derogate from sense, but help it, and we do not despise the understanding but direct it." Acatalepsy is the incomprehensibleness of things; the doctrine of the ancient skeptics, that things are such that no certain knowledge of them is possible. Agnosticism was the creed of a sect of the 3d century, who held that God does not know all things. In general, the doctrine was of nescience, or that theory of knowledge which maintains that man cannot have, or at least has not any real or absolute knowledge of anything, but can know only "impressions." Contemplated in its philosophical side agnosticism is a professed exposition of the limits of human knowledge and thought, maintaining the impossibility of knowledge of the Infinite, in opposition to the theory of a restricted but true knowledge of the First Cause, as infinite and absolute. (Relig. Encyclop.) Epistemology is the theory of the grounds of knowledge. Experimentalism is the theory that all knowledge is based on and must be tested by sense and experience as distinguished from intuition: opposed to intuitionalism. Gnosiology is the branch of philosophy that treats of the principles of cognition; the theory of knowledge or of the philosophic principles underlying knowledge, or the activities of the cognitive faculties. Gnosis means the higher knowledge of mysteries. Gnosticism was an eclectic system of religion, and philosophy existing from the 1st to the 6th century. It occupied a middle ground between paganism and Christianity; teaching that knowledge rather than faith or philosophy was the key to salvation; and in- 182 Albert S. Ashmead. corporating some of the features af Platonism, Orientalism and Dualism with Christianity. The Gnostics held that all existences, material and spiritual, are derived from the Deity, by successive emanations or eons. Christ was merely a superior eon. Eon is the personification of a divine at- tribute, especially one of the higher class of emanations from the deity whose substantial powers, embraced in the divine essence, constituted the divine plenitude or pleroma. The pleroma consisted of God, (silence or conception,) from which emanated pairs in a downward scale, mind, truth, word and life, man, church. With eleven other pairs, these constitute the divine pleroma or fulness. These beings are called Eons. (Relig. Encyclop.) Intuition is quick perception of truth without conscious attention or reasoning, or the possession of such perception; knowledge from within, instinctive knowledge or feeling. Genius works less by a process of conscious reasoning, than by a flash of intuition, and less by abstract concep- tion, than by a prophetic beholding of results. (Poetry and Duty, Imagination.) In psychology, intuition is the power of gaining im- mediate knowledge whether by sense-perception, by con- sciousness, or by rational apprehension; especially the power of gaining such knowledge of necessary truths. In philosophy intuition is any immediate knowledge, espe- cially the knowledge of the first or necessary truths or principles underlying all other and mediate knowledge. Intuitionalism is that general system of philosophy in which the immediate perception of truth, and especially of necessary truth, is recognized as an original endowment of the intellect and as the foundation of all knowledge. Dr. McCosh, of Princeton, suggested the term Mero- gnostic for one who claims to know in part as distinguished from gnostic and agnostic. Joseph Cook says it is not true that we know everything. Nor is it true that we know nothing. It is true that we know in part. Between gnos- ticism and agnosticism stands the sound philosophy of mero-gnosticism. A cautious and well-informed man will be neither gnostic nor agnostic, but a mero-gnostic. Man's Moral Evolution. 183 Metagnosticism is the doctrine that there is a positive knowledge of the absolute attained, not by the logical reason, but by a higher religious consciousness, introduced in opposition to the negation of agnosticism. Metagnostics, imply a metaphysics, a going beyond ordinary knowledge. Skepticism is the doubt, or entertainment of a doubt concerning something. It is the state of being a skeptic or the doctrines of skeptics. An attitude of doubt towards the doctrines of historical religions is called skepticism. It implies doubt concerning all propositions whatever. Pyrrhonism was a system of gnosiology inculcating skepticism, taught by Pyrrho about 360—270 B. C. He was the founder of the first and inspirer of the second skeptical schools of Greek philosophy—hence absolute skep- ticism. Pyrrhonism affirms that both the senses and con- sciousness as sources of knowledge are absolutely untrust- worthy, and that just as much can be said against the truth of any opinion whatever as in favor of it, and it ad- vocated holding the judgment in permanent suspense on all subjects. Mysticism implies obscurity, mysteriousness. In gnosi- ology it is the doctrine that truth is attainable without the aid of the senses and the processes of thought or reason. Mysticism, according to Morell, (Speculative Philosophy) is that which refusing to admit that we can gain truth with absolute certainty either from sense or reason, points us to faith feeling, or inspiration, as the only valid source. Mysticism is the doctrine and belief that man may attain to an immediate direct consciousness or knowledge of God, as the real and absolute principle of all truth and of all essential divine truth in him. The term is applied to a system of thought and life of which the chief feature is an extreme development of meditative and intuitive meth- ods, as distinguished from the definitive and scholastic. It takes different forms as it maintains that truth is gained (1) by a mode of faith or of intuition as held by Coleridge, Thos. Taylor, Bronson Alcott and others; (2) by a fixed supernatural channel, as the Bible, the church, or the sacra- ments; (3) by extraordinary supernatural means, as by the 184 Albert S. Ashmead. immediate action of God upon the mind, as maintained by Friends, Quietists, etc. Philosophers and Monks alike employ the word mys- ticism and its cognate terms as involving the idea, not merely of initiation into something hidden, but, beyond this, of an internal manifestation of the Divine to the intuition or in the feeling of the secluded soul (Hours with the Mystics). Quietism is the doctrine that spiritual exaltation is at- tained by self-abnegation, and withdrawing of the soul from outward activities; fixing it on passive religious contempla- tion; mystic meditation or introspection, as cultivated by the Molinists, or by Buddhists. Miguel de Molinos, a Spanish priest of the 17th cen- tury, was the expounder of this system. As the Hindus steadily pressed down the valley of the Ganges, into warmer regions, their love of repose and contemplative quietism, would continually deepen (The Two Faiths). Hence its origin or continuance in Brahminism and Buddhism. The modern school of Nescientists maintain that it is not com- petent for the finite intelligence to ascribe motives to the unknowable (Science and Religion). Experience is knowledge derived from proof furnished by one's own faculties or senses; experimental knowledge, especially the state of such knowledge in an individual as an index of wisdom or skill. In the associationist or experimentalist philosophy, it is the immediate perception of simple or historical fact, espe- cially perception of the senses, excluding perception of the necessary relations of fact and intuitive truths, the exist- ence of this mode of perception being denied. The process (and the power) of inductive observation and conclusion, especially as resulting practical wisdom. Faith is a firm conviction of the truth of what is de- clared by another by way either of testimony or authority without other evidence; belief in what another states, affirms or testifies, simply on the ground of his truth or veracity (especially as distinguished from mere belief), practical de- pendence on a person, statement or thing as trustworthy— Man's Moral Evolution. 185 fiducial as opposed to merely intellectual belief—trust. In theology specifically (1) the assent of the mind or understanding to the truth of what God has revealed; be- lief in the testimony of God as contained in the Scriptures; (2) a divinely wrought, loving and hearty reliance upon God, and his promise of salvation through Christ or upon the Christian religion, as revealing the grace of God, in Christ; sometimes callel justifying or saving faith, as we are saved through faith. The first conscious exercise of the renewed soul is faith. (Systematic Theology.) More widely it is operative belief in the truths of re- ligion; practical realization of the power and excellence of Christian doctrine; as a serene and blessed faith. Intel- lectual conviction in general on whatever based, including even an approach to absolute knowledge; faith in Herodotus; faith in the nebular hypothesis; faith in mathematical demon- stration or axiom; a doctrine or system of doctrine, or a proposition or set of propositions, that one holds to be true; specifically a religious creed or article of belief, as the Lutheran faith, a man's political faith. Thackeray says in Henry Esmond: "'Tis not the dy- ing for a faith, that's so hard, Master Harry, 'tis the living up to it, that is difficult." In religion it is common to distinguish between intel- lectual belief of religious truth, as any other truth might be believed, and belief of the heart, or saving faith. The Latin word "fido" from which faith comes, means trust. Le Plongeon says of Yucatan: "One-third of the Mayan tongue is pure Greek. Who brought the dialect of Homer to America? Or who took to Greece that of the Mayas? Greek is the offspring of the Sanscrit. Is Maya? Or are they co-eval? The Maya is not devoid of words from the Assyrian." According to Dr. Max Muller, if we confine ourselves to the Asiatic continent, with its important penin- sula of Europe, we find in that vast desert of drifting hu- man speech three, and only three oases, have been formed in which, before the beginning of all history, language be- came permanent and traditional—assumed in fact a new 186 Albert S. Ashmead. character, a character totally different from the original character of the floating and constantly varying speech of human beings. These three oases of language are known by the name of Turanian, Aryan and Semitic. In these three centres, more particularly in the Aryan and Semitic, language ceased to be natural; its growth was arrested, and it became permanent, solid, petrified, or if you like, historical speech. I have always maintained that this cen- tralization and traditional conservation of language could only have been the result of religious and political influ- ences; and I now mean to show that we really have clear evidence of three independent settlements of religion, the Turanian, and Aryan and the Semitic—concomitantly with the three great settlements of language. There can be no doubt that the Aryan and another branch, which Muller called Semitic, but which may more properly be called Ham- ite, radiated from Noah; it is a question yet to be decided whether the Turanian or Mongolian is also a branch of the Noachic or Mayan stock. Max Muller says further: If it can only be proved that the religions of the Aryan nations are united by the same bonds of real relationship which have enabled us to treat their languages as so many varieties of the same type, and so also of the Semitic, the field thus opened is vast enough and its careful clearing and cultivation will occupy several generations of scholars. Names of the principal deities, words, also expressions of the most essential elements of religion, such as prayer, sacrifice, altar, Spirit, law and faith, have been preserved among the Aryan and among the Semitic nations; and these relics admit of one expla- nation only. After that a comparative study of the Tura- nian religions may be approached with better hope of suc- cess; for that there was not only a primitive Aryan and a primitive Semitic religion, but likewise a primitive Tura- nian religion, before each of these primeval races was broken up, and became separated in language, worship and national sentiment, admits, 1 believe, of little doubt. There was a period during which the ancestors of the Semitic family had not yet been divided whether in language or religion. That Man's Moral Evolution. 187 period transcends the recollection of every one of the Semitic races, in the same way as neither Hindoos, Greeks nor Romans have any recollection of the time when they spoke a common language and worshipped their Father in heaven by a name that was as yet neither Sanscrit nor Greek, nor Latin. But 1 do not hesitate to call this prehistoric period historical in the best sense of the word. It was a real' period, because, unless it was real, all the realities of the Semitic languages and the Semitic religions, such as we find them after their separation, would be unintelligible. Hebrew, Syriac, and Arabic point to a common source as much as Sanscrit, Greek and Latin; and unless we can bring our- selves to doubt that the Hindoos, the Greeks the Ro- mans, and the Teutons derived the worship of their principal deity from their common Aryan sanctuary, we shall not be able to deny that there was likewise a primitive religion of the whole Semitic race, and that El, the strong one in heaven, was invoked by the ancestors of all the Semitic races before there were Babylonians in Babylon, Phoenicians in Sidon and Tyre—before there were Jews in Mesopotamia or Jerusalem. The evidence of the Semitic is the same as that of the Aryan language; the conclusion cannot be different. These three classes of religion are not to be mistaken— as little as the three classes of language, the Turanian, the Semitic and the Aryan. They make three events in the most ancient history of the world; events which have de- termined the whole fate of the human race, and of which we ourselves still feel the consequences in our language, in our thought, and in our religion. 'The original seat of the Phoenician Hebrew family is supposed by some to have been in the Central American situation. The Great God of the so-called Semites was El, the Strong One, from whose name comes the biblical Beth-el ("house of God"), Ha-el ("the Strong One"), El-ohim ("the God"), El-oah ("God"); and the Arabian names of God, Allah and Ba-bel. The Tower of Babel was the Tower of God. The original "language" of the earth was Mayan (ig- 188 Albert S. Ashmead. norance), from which grew all human expressions of intel- ligence, either by growth of language, by words of speech, or pictorial signs, and with these expansions, have come to us, all our conceptions, intellectual or moral, of whatever has been, is, or will be. Muller says that Ignorance (Maya- Avidya) is really the primary cause of all that seems to exist. Death, then, is the blotting out of all the individual's knowledge. From Nescience we came, and to Nescience we shall return. With knowledge, we acquired conception of the fact, of death. (To be continued.) « CASE OF CANINE HERMAPHRODISM. BY R. W. SHUFELDT, M. D., Major Med. Dept. U. S. Army, (Ret.) Member [Medico Legal Soc. N. Y. City. Cor. Member Zool. Soc.London,etc., etc., etc. CARLY in the month of September, 1906, my attention was invited by Dr, Sam'l E. Weber, of Lancaster, Pa., to the case of a Boston terrier, then in the wards of the New York Veterinary Hospital (117 West 25th Street), that presented certain anomalies of the genital organs. The animal was owned by a lady in New York City, and it was entered as an "out patient case" to be cured, if possible, of a persistent and annoying habit. It was claimed that the dog was apparently possessed of a (Fig. i. Hermaphrodite Dog.) very amorous disposition, and when at liberty and brought in association with others of its kind, it immediately availed itself of the opportunity to gratify its inordinate sexual desires upon them, and this quite irrespective of the sex of the comers. On the 7th of the above mentioned month, in company with Doctor Weber, I visited the Veterinary Hospital to examine the case. I took with me an 8x10 camera and (189) 190 R. W. Shufeldt. the necessary materials to make photographs if required. At the institution in question, Doctor Armstrong was the surgeon in charge, and through his courtesy every possible facility was extended to me to make as full a record of the case as one could desire. It was soon ascertained that the animal under observation was of the breed known as the Boston terrier, and one not quite two years old. (See Figure 1). There was nothing peculiar about it upon superficial examination; confiding in its behavior and gentle in disposition, it resembled most other dogs of its kind that I had seen. Moreover, the color of its coat resembled what we see in most of the breed, being of a general smoky brown, with white paws, a white medium frontal stripe and collar, with white encircling the entire muzzle including the anterior part of the lower jaw. Its tail and ears had been cropped, and it was in excellent general health. Proceeding to the examination, in which Doctors Weber and Armstrong took part, it was demonstrated that the genital fissure in this animal was unusually small for a subject of its age and size. On the other hand the vaginal labia were prominent, puffy, and somewhat enlarged. They were likewise to a degree congested and exhibited evidences of undue excitation. What was more remarkable than anything else however, was the anatomy of the clitoris. Here we were presented with a structure, which for size and peculiarities, exceeded anything of the kind 1 had ever witnessed in a canine. It was not only voluminous in proportions, but upon the slightest provocation it became erect, at which time it measured fully two centimetres or more in length and harbored in its central medium longi- tudinal structure a firm, dense morphilogical element that was either composed of true bone or else was composed of a corresponding cartilaginous constituent homologous with the Canine Hermaphrodism. 191 os penis as found among the Canidce generally. Through the kindness of Doctor Weber and an assistant, I was enabled to photograph this structure, and a print from the resulting negative is herewith reproduced in Figure 2. This large clitoris was semi-erect when photographed, (Fig. 2. External genitals in a Hermaphrodite Dog.) and we all being on the roof of the hospital at the time, there was a strong overhead light, and this accounts for the deep shadow beneath and in continuation with the structure. 192 R. W. Shujeldt. As the vagina was of small calibre it was impossible to make any satisfactory examination of the internal organs of generation, but it is fair to presume that it is quite possible they do not depart much from the structures as they are found normally. It is fair to imagine that they were to some extent aborted. The mammary glands were much reduced, and the animal had never littered. As this terrier was under my observation less than an hour 1 had no proper opportunity to study the psycho- logical side of its nature, something 1 should very much liked to have done. I deem it more than probable that its sexual instincts and the methods resorted to, to gratify them would, everything else being equal, be quite similar to those of a human hemaphrodite with a like abnormality of the parts involved. IS SEXUAL PERVERSION INSANITY?* By HAROLD N. MOYER, M. D., Chicago. THE problems raised in the title of this paper depend for solution on the conception of the two psychic phe- nomena mentioned. As all conditions in science being pro- ducts of development are relative, no absolute standard can be employed. Insanity cannot be a product of education, of mental environment or even of strong outside sug- gestion. It must be a condition dependent on factors in- herent in the individual, not the result of adequate ex- ternal causes, and furthermore, must prevent the individual from recognizing its morbid nature. The imperative con- ception of neurasthenia and allied states, whose morbid na- ture is recognized by its victim and whose expression is checked by him, is not considered for these reasons insan- ity. The first postulate of a scientific conception of insan- ity, is therefore, a morbid mental condition, based on brain disease, disorder or defect. These three elements represent the pathology of all types of insanity, since the patho- physiologic basis is either teratologic, as in all the congeni- tal types, or circulatory and destitute of demonstrable pa- thologic results or, finally, characterized by these last. Another element necessary to the conception of insanity is that no adequate external cause of mental type shall be present. Many strange customs and beliefs, which in a civilized 20th century human being suggest insanity, even at present are but too often survivals of the folklore of primitive man. Less than a quarter of a century ago a German and his wife were sentenced to the penitentiary • Transactions, Chicago Academy of Medicine, Nov. 1906. (193) 194 Harold N. Moyer. for assaulting a young girl to cure themselves of gonorrhea, in accordance with the folklore belief that disease can be cured by giving it to another. A little over a decade ago, many prominent North Side Germans of Chicago were gulled by a "doctor," who professed to cure disease by putting money into a magic tree. Some of his dupes, with the mixture of suspicion and stupidity so characteristic of the superstitious, marked the money given him, and found that in lieu of worshiping Dryads, he had been worshiping Gambrinus. In consequence, he was sent to the peni- tentiary for obtaining money under false pretenses. An element necessary to the conception of sanity is that the balance of the will, however disturbed, shall not be de- stroyed and that the individual shall be able to control as well as recognize the expression and results of his morbid condition. Sexual perrsion is an alteration of the normal sexual appetite, either as to the object of the appetite, or as to the method of its expression. This may occur in accord- ance with the ordinary physiologic law that a nerve too frequently excited by one irritant, ceases to respond to that irritant and requires a new excitant. In sexual perversion therefore occur conditions where the state is fully recog- nized and new excitants are consciously and willingly em- ployed to rouse a fading passion. Sexual perversions may therefore be divided, as they affect the expression or the object into sexual perversion, which dominates the expres- sion; inversions which dominate the object and perversi- ties, where the method of excitation is voluntarily used to rouse a sated appetite. The perversions include what Havelock Ellist has called erotic symbolism, usually desig- nated fetichisms. This may affect methods of conjugation. The primitive appetite was hunger and sexuality first ex- pressed itself in the cannibalistic conjugation of the ameba. This creates a condition, where pain inflicted or suffered as an expression of affection, is an essential part of conjugation. In accordance with the ordinary law of psychic evolution, the symbol takes the place of the thing \Medicint. 1006. Alitnut and Nturologist, 1S06. Is Sexual Perversion Insanity? 195 symbolized. Here, as in the allied domain of religious emo- tion, the symbol often becomes all important to enjoyment. In this state the individual may fully recognize the signifi- cance of his acts, may be fully able to restrain them, but still prefers the enjoyment given by them. The two con- ditions coming under this category are variously designated as active and passive algophily, active and passive algo- lagnia, sadism and masochism. These erotic symbolisms may take a normal (hetero-sexual) direction or an inverted (homo-sexual) direction. The inverted type may be an expression of arrested development at the indifferent period of intra-uterine life, whereby the nervous system takes one ply while the sexual organs take another; still the individ- ual recognizes the same general irural code and can comply with it as easily as the ordinary well-developed human being. He recognizes that, however different from others, his sexual expressions are still sexual expressions, and must for moral considerations have the same limitation as those of normal appetite. In addition to the classifica- tions just given, others worthy of mention occur in the lit- erature. J. G. Kiernan* classified perversions as: Those which originate in imperative conceptions. Those due to congenital defect. Those which are incident to insanity, periods of involution, or to neurotic states. Those which result from vice. These last arise from the fact that nerves too frequently irritated by a given stimulus require a new stimulus to rouse them. Those who have a neuropathic diathesis and whose sexual functions are not normally per- formed. G. Frank Lydstont classifies them thus: Congenital and perhaps hereditary sexual perversion. Acquired sexual perversion. a. Sexual perversion without structural defect of the sexual organs. b. Sexual perversion with defect of genital structure, e. g., hermaphroditism. c. Sexual perversion with obvious cerebral defect, like idiocy. "Detroit Lancet, 1884. (Essays: 1889. 196 Harold N. Mover. a. Sexual perversion from pregnancy, the menopause, ovarian disease, hysteria, etc. b. Sexual perversion from acquired cerebral disease, with or without recognized insanity. c. Sexual perversion (?) from vice. d. Sexual perversion from over-stimulation of the nerves of sexual sensibility and the receptive sexual centres incidental to sexual excesses and masturbation. Krafft-Ebing* divides the abnormal manifestations of the sexual appetite into: Peripheral Neuroses Spinal Neuroses Cerebral Neuroses. Sensory \ I Motor Secretory < Erection Ejaculation Paradoxal Anaesthetic Hyperaes- thetic . Anasthesiae Hyperathesiae Neuralgiae Nymphomania Satyriasis. Spasms Pollutions Paralysis Spermatorrhea. Aspermia Polyspermia. Disorders Disorders Neuroses Neuroses Neuroses. Aberrant but normal appetite. Diminution or abolition of normal appetite. f Sadism \ Masochism ', Fetichism I Necrophilism f Congenital I sexual per- i version. Acquired sexual perversion. Sexual perversion proper -{ i Psychical hermaphroditism or hetero- sexuals. Pure homosexuals. Effemination or viragininity. Gynandry and androgyny. According to Sommers, the endogenous nature of a certain mental state is not sufficient to establish the ex- istence of mental disease. This is especially the case in the domain of psycho-sexual anomalies. When it is proven that a person, from endogenous disposition, is per- verse, e.g., when a man is excited (sexually) by another, he should be punished for a corresponding act, when the act falls within those that are punishable. "Human so- ciety has the same right to demand control of the en- *l"»ychopathia Bezualis. /s Sexual Perversion Insanity? 197 dogenous impulse in general that it has to demand it in cases of congenital allo-sexual instinct when it is directed against a child of the opposite sex; or that the impulses to possess the property of others be repressed. There- fore, if these perverts are to be made free from punish- ment, this is not to be done during the existence of the present laws by declaring them insane, but by changing the laws. The decision of this question is not to be made by psychiatry, but by public opinion, in so far as it may be the expression of the actual moral ideas of the majority of the people. As long as the moral ideas of the majority of the people are opposed to homosexual acts and the laws give expression to these ideas, the so-called contrary sex- ual persons must control their impulses, as the man who, hungry, must control his impulse to possess himself of the property of others. At most, it might be said that the gratification of homosexual inclinations was a private mat- ter between two persons, which did not harm society as long as scandal is not excited by it. There seems to be no doubt, however, that among those persons that indulge in homosexual acts, there are many insane individuals. The mere existence of endogenous anti-social impulses (among which those in question are to be reckoned), like en- dogenous instincts, should not be punished, but they should not be taken as evidence of! insanity." Schrenck-Notzing* remarks that there are three possi- ble etiologic developmental factors in the production of contrary sexual instinct: (1) original cerebral constitution; (2) a neuropathic disposition with educational influence; (3) puie cultivation in normal individuals. Class 2 is by far the most numerous. "The fact of disease of the sexual instinct does not in itself render the individual affected irresponsible. Only the proof that the individual has committed a criminal act as a result of organic necessity, as if forced to it, and ow- ing to his cerebral constitution, was incapable of developing (or acquiring) the necessary inhibitory (or restraining) ideas, will allow him to be held as devoid of free will. •Psychopathla Sexualie. 198 Harold N. Moyer Very many individuals of contrary sexuality are well able to control their impulses." The broad leniency which Moll accords such patients, in this respect, naturally appears to Schrenk-Notzing unjustified by the canons of psychiatry, or the principles which demand in a given case the com- plete exclusion of the alternative hypothesis. Joseph Zeissler,* in a discussion before the Academy fifteen years ago, took ground with the jurisprudent Hoffman, that sexual perversion is an insanity. At the time, Kiernan pointed out that Hoffman had not taken into account the survivals of racial customs, which made perversion a prod- uct of education, nor taken into account the distinction between desire and irresistible impulse. The existence of mixed cases where mental disorder co-exists with and even produces perversions, have occasioned much of the differences in opinion. The types where the issue of insanity is raised in sex- ual perversion, are usually the sadistic or active algo- philiac, necrophilism or the hair-cutters. These types have been most frequently the subject of judicial determination. Necroph- ilism is a symbolism whereby the necrophiliac symbolizes pain to secure excitement by desecrating the dead. The last Illinois case of this kind occurred in a paroled inmate of the Pontiac penitentiary, aged 18, who desecrated the body of a recently buried girl at Danville, in 1901. The crimi- nal displayed no other sign of mental disorder, but seemed to enjoy the notoriety of the occurrence. The algophiliac type is not uncommon in its minor expressions in women who are otherwise normal. Indeed, in biology, active algo- phillies are found more frequently in the female animal than in the male. The active algophily of the queen bee, so charmingly described by Maeterlinckt and the algophily to which Emersont compares introspection: As That demon spider that devours her mate, Scarce freed from her embraces, are instances of this. In certain hermaphroditic snails the •Alitmtt and Nturologist, 1891. tLife of the Bee. {Poems. Is Sexual Perversion Insanity? 199 ejection of a limy dart (spicula amoris) is a necessary preliminary to conjugation. That these conditions should crop up in woman inverts, especially those in whom auto- erotism has dulled the normal excitability, is not surprising. While woman is normally the least anti-social of the sexes, she naturally becomes more anti-social than man when she departs from her type. The case to which 1 am about to call special atten- tion was one of sadism, which occurred in a woman de- voted to church society and charity work, the mother of children and the seemingly devoted wife of a man of stand- ing in the community where she lived. There were defect- ives among both the paternal and maternal ancestors. Psychic abnormality was far from infrequent. The external life was seemingly correct. The criminal episode was one apparently at variance with the life previously led by the accused. It consisted in the infliction of wounds on a girl taken from a Home-finding Society. There were over 200 wounds inflicted in various fashions; several attacks had been made on the genitals and breasts under conditions which showed realization at once of the unlawful nature of the assault and its voluptuous origin. The girl was, moreover, very parsimoniously treated as to food and cloth- ing. At the outset, therefore, it must be admitted that there are suggestions of insanity. Sadism in women, while as pointed out already as exceptional, is not so exces- sively rare as might be inferred from the statements on the subject. Indeed, under the ordinary laws of reversion it must occur among women. Among many species, as Have- lock Ellis* points out, wounding and rending normally take place at or immediately after coitus; at the beginning of animal life in the protozoa, sexual conjugation itself is sometimes found to present the similitude, if not the act- uality, of the complete devouring of one organism by another. Over a very large part of nature, as it has been truly said, but a thin veil divides love from death. There is, indeed, on the whole, a point of difference. In that ab- normal sadism which appears from time to time among civ •Psychology of Sex. Love nd Pain. Harold N. Mover ilized human beings, it is nearly always the female who becomes the victim of the male. But in the normal sad- ism, which occurs throughout a large portion of nature, it is nearly always the male who is the victim of the fe- male. It is the male spider who impregnates the female at the risk of his life and sometimes perishes in the attempt; it is the male bee who, after intercourse with the queen, falls dead from that fatal embrace, leaving her to fling aside his entrails and calmly pursue her course. If it seem to some that the course of inquiry leads one to contem- plate with equanimity, as a natural phenomenon, a certain semblance of cruelty in man in his relations with woman, they may, if they will, reflect that this phenomenon is but a very slight counterpoise to that cruelty which has been naturally exerted by the female on the male long even before man began to be. The history obtainable of the accused, since indict- ment, indicates that element of satiety which seeks per- vert conditions as a source of new excitation. The ac- cused, despite her marital possibilities of sex satisfaction, was addicted to masturbation to such a degree as to be- lieve it had been noticed, and that sermons had been preached at her by the very clergyman who testified to her good character. This belief had none of the mental characteristics of a delusion, but was the product of intro- spection quite common in sane masturbators. She also caressed dogs and, acccording to her admissions, these ca- resses had extended very far. Penis manipulation of the dog preceded coitus. The mental state, as near as could be determined, was that of a desire for a new sensation so common in roues, hysterics and sated voluptuaries. The girl victim was about fourteen years old at the time she was sent to the accused by a Home-finding Society. She was given quarters indicating parsimony rather than phi- lanthropy in her care. The application sent to the Home- finding Society agreed to treat the girl as a member of the family, and to clothe her and care for her accordingly. A contract was signed to this effect, which was not carried Is Sexual Perversion Insanity? 201 out despite the wealth of the family. The accused was in the habit of running a toasting fork and scissors into the. girl's body when excited. At times she would strike her with a switch or club. The girl's eye at one time was blackened by a blow of the accused, who told her husband that the girl had run against something. At times she used to scratch the girl on her back, neck, face, hips and legs. She would throw the girl on the floor, grab at the girl's breasts and say she wanted to tear them off. At times she would manipulate the genitals, so that the girl felt as if everything was being torn out of her body. She was careful to have the door locked at such times, and even attempted to direct her husband's attention away from any incriminating circumstances. Were there any disturbance that implied the approach of outsiders, the manipulation, stabs, scratches or blows would immediately cease. After indictment and before trial the accused was sent to a sani- tarium, where she is said to have presented manic-depres- sive-insanity. This was not shown in the trial nor in the period immediately following it, nor at the second trial and proved undetectable to the superintendent of the State in- sane hospital, to which she was sent after the second trial. At the first trial, the jury found her guilty and gave her a penitentiary sentence. The judge granted a new trial, which was held in another county. This resulted in the verdict of guilty and sane at the time of assault, and a verdict also of having become insane since the assaults. There was no evidence of insanity in the acts themselves, and they clearly demonstrated a full knowledge of the nature of the act, as well as full power to refrain. The testimony as to good character offset any evidence as to insanity at the time and before the acts alleged. This testimony was as to the standing in church, society and philanthropic work by people who were in frequent communication with the accused, but who failed to recognize any mental defect. The case presents some parallelism with that of Mrs. Brownrigg.* In her case, however, while there was equal cruelty, also seem - ingly of a voluptuous character, there was more parsimony. * Remarkable Trials. 202 Harold N. Mover. Cruelty to servants was not then viewed with public dis- approval. Mrs. Brownrigg took two girls from the Found- ling hospital, who at first were treated with some degree of consideration and attention, but as soon as they became familiar with their mistress and their situation, the slight- est inattention was sufficient to call down upon them the most severe chastisement. The first girl who experienced this brutal treatment upon the smallest possible seeming provocation, Mrs. Brownrigg would lay across two chairs in the kitchen and then whirr her, until compelled from mere weariness to desist. The mistress would then throw water over the victim, or dip her head into a bucket of water, and then dismiss her to her own apartment. The room appointed for the girl to sleep in adjoined the passage leading to the street door; after she had suffered this maltreatment for a considerable time, as she had re- ceived many wounds on the head, shoulders and various parts of the body, the other girl was similarly treated. One day having been stripped to the skin, she was kept naked during the whole day, and repeatedly beaten with the butt end of a whip. In the course of this barbarous conduct, Mrs. Brownrigg fastened a jack-chain round her neck so tight as almost to strangle her, and confined by its means to the yard-door in order to prevent her escape, so that in case of her mistress' strength reviving she could renew the severities which she was inflicting. A day passed in the exercise of these most atrocious cruelties, the miserable girl was remanded to her cellar, her hands being tied behind her, and the chain being still around her neck, to be ready for a renewal of the cruelties on the following day. Determined then upon pursuing the wretched girl still further, Mrs. Brownrigg tied her hands together with a cord and, fixing a rope to her wrists, drew her up to a water-pipe which ran across the kitchen ceil- ing, and commenced a most unmerciful castieation. The pipe giving way in the midst of it, she made her husband fix a hook in the beam and, then again hoisting up her miserable victim, she horsewhipped her until she was weary, the blood flowing at nearly every stroke. Nor was Is Sexual Perversion Insanity? 203 Mrs. Brownri^g the only tormentor of this wretched being. Her elder son having one day ordered the girl to put up a bedstead, her strength was so far gone that she was un- able to obey him, for which he whipped her until she sank insensible under the lash. At length the unhappy girl, be- ing unable any longer to bear these unheard of cruelties, com- plained to a French lady lodger, who appealed to Mrs. Brown- rigg. The only result was a volley of abuse at the person who interposed, and an attempt to cut out the tongue of her apprentice with a pair of scissors, in the course of which she wounded her in two places. The girl was rescued and taken to a workhouse, where she was found to be in a most wretched state, and succumbed soon after. Her body was covered with ulcerated sores: and in taking off her leathern bodice, it stuck so fast to her wounds that she shrieked with the pain. On necropsy the vagina was found badly torn and the uterus dragged out of place. Similar manipulations had been practiced on the other girl. Mrs. Brownrigg was found guilty of murder and executed. In this case the old idea of the ownership of servants played a part in inducing a defiance of humane remon- strance, which would not have in the early 19th century the same significance it does now. Taking all the circum- stances of the first case into account, it demonstrates that sexual perversion per se cannot be considered insanity. In the discussion, G. F. Butler said he had under- stood nymphomaniac offers had been made to physicians by the Illinois accused woman. J. G. Kiernan said these were simply harlot offers to take medical bills out in "trade," showing a mental state not exceptionally rare in inverts, with regards to normal indulgence. Emory Lanphear, of St. Louis, had noticed that many perverts, noticeably exhibitionists, brought face to face with the legal significance of their acts and not shown too much sympathy as irresponsibilities, could control themselves. He believed with E. C. Spitzka * that all the sexual per- versities existed at times in persons of indubitable sanity. •Journal of Nervous and Mental Diseasett 1888, 204 Harald N, Moyer. He had under care a case of sadistic fetichism in a woman. She had learned masturbation in a convent. She married but found coitus insufficient to satisfy her. After being entered by her husband she was simply excited and had to arise, catch and caress a chicken, and finally wring its neck ere orgasm could occur. J. G. Kiernan said he had for years held that per- version per se was no evidence of insanity.* He thought sadistic perversions were more common in woman than was usually suspected. He had been consulted in the case of an Indiana girl, whom neither masturbation nor coitus sat- isfied; who enjoyed canine copulation after the dog's penis had been first manipulated, then osculated, then cun- nilinctus done by it, then the dog was beaten. She per- verted another girl into tribadism and canine copulation, but the last had to precede the tribadism with her. The woman in the case cited by Dr. Moyer showed traces of a similar association of ideas. W. G. Stearns agreed with Dr. Moyer that sexual perversion per se was not insanity. Erotic fetichism of the sadistic type took many quaint forms. A patient under his observation had masturbated to excess and copulated freely. He desired to see his wife delivered of a child, and felt the sight would be intensely voluptuous. Later, the idea became dominant, and he was impotent without it. He was able to be present at many deliveries. He enjoyed most volupty at the delivery of a primipara, where the suffering was greatest. •Detroit Lancet, 1884. EROTISM (NORMAL AND MORBID) AND THE UNWRITTEN LAW IN OUR COURTS. By CHAS. H. HUGHES, M. D., St. Louis. THE Unwritten Law, upon which our legal brethren seek to secure acquittal for the killing of adulterers, often en- ticed into improper sexual relations through the siren seductions of confessed adulteresses, as well as without such entice- ment, is not founded on any psychic law of justice and absolution for the woman. The wiles of women are quite equal in seductive power and quite as freely, frequently and adroitly exercised for the betrayal of men, as the blandishments and promises of men are toward women. The sex is not sinless and psychological science can not so declare. The power of inhibition of appetite has not been stronger in men than in women since the apple episode in the garden. There woman took the initiative and she has done so a good deal in that direction since, though she assumes otherwise, through a naivete which the persisting adulteress does not actually possess. Minds of men moved to extenuate or acquit the mur- derer on the confession of a voluntary mistress, not the victim of masculine violence, do not act under the sway of normal emotion, nor of stable cold reason, but of erotic prejudice against their own and of over-leniency towards the opposite sex. The true psychologist could not sanction such psychically unjust verdicts of this nature as are now becoming too frequent under the so-called unwritten law, which is non-existent ( 205 ) 206 Charles H. Hughes. as municipal and not correct as psychological law, or the right law of cerebro-mental conclusion. Twelve tender-hearted men in a jury box, themselves under the subconscious sway of a woman's silent, erotic power at the time perhaps, and the lawyer's vivid, eloquent portrayal of a ruined home to which the probably seduced seducer has gone, under passion fanned to resistless im- pulse, and to which the feminine seducer has willingly contributed as particeps criminis, sometimes confessing the same, condemn the man, acquit the slayer and let the often equal and associate criminal female go free, and think it a righteous and logical decision. In ancient heathen mythological conception, the Gor- gons, as well as the Sirens, were not engaged in conferring benefit on mankind, and they have not yet in reality all been metamorphozed into saints and angels of goodness to- ward mankind or toward themselves. Juries of mere men in the goodness of their hearts, the erotic hypnotism of their own better home influence, are apt at times to forget the psychological truth that evil mingles with the good in the female mind and heart, as it does in working the eroto mental machinery of masculine mortals. Some mythologist doubted if the mythical Gorgons could have been women. The psychic neurones and blood of these mycologists must have been transmitted to some of our weak-minded American juries, if some of their fool- ish verdicts in certain erotically inspired murders by women and women-impelled men, may be taken as a basis for diagnosis. The three vicious sisters: illicit love, jeal- ousy and love revenge, or woman spurned and love turned to hate in man or woman, have done much harm in this world, in and without courts of justice. As an illustration of woman's sometime influence and indifference to the fate of her lovers at times, the fol- lowing may be noted: As the result of a duel fought at Wharton, New Jersey, lately, over Rosa Latzsky, an 18-year-old Hungarian girl, who told her suitors they would have to fight for her, The Unwritten Law in Our Courts. 207 Henry Waldee is in the hospital in a badly damaged con- dition. Rosa helped to arrange the duel, which was to take place with clubs, in the presence of no witnesses save Rosa and a young man, whom she asked to accompany her to the place. She watched her admirers cudgel each other with their clubs until neither could stand, when she de- parted with her other friend, and they were married by a justice of the peace. The duellists were found later by mine employes, both unconscious, and Waldee so badly bruised that he was brought to the hospital. A similar indifference, to masculine fate and erotic se- lection, on the "go it husband; go it bear" principle, may be seen any fine day in a barn yard, in the relation of the hens of the family towards two fighting cocks engaged in combat and subsequently by assent, if not by mutual consent. Women who confess to adultery to their husbands do not usually make confession till they have become con- vinced that they have by plausible statement, that is plaus- ible to the husband, freed themselves from blame in the mind of the husband. Some do so recklessly, as they may have entered into the adultery, or from remorse or pique and vengefulness at not getting the appreciation or reward sought or happiness expected, especially financial, as hap- pened in one case in Missouri, where revelation of illicit relations followed a failure of compliance for satisfactory finan- cial recompense demanded and threat of exposure, re- / suiting in the duped cuccolded husband killing the adulterer, when the woman herself had been the seducer. Confessing his persuasive and magnificent personality, they may call the man whom they have helped in the mutual seduction, a brute, a blackguard or other vile epithet, and profit from the jealousy excited, even though it may lead the confiding husband to later insanity or murder of the adulterer, wife and suicide. Women are frail, uncertain and coy, as the poet has written. They are likewise true, faithful and reliable. But 208 Charles H. Hughes. they are not all to be considered as innocent, stable and true. Infidelity is not exclusively a masculine trait, and when uxoriously inspired murderous tragedy occurs, be- cause of adultery, it were well if justice were not some- times so erotically illusioned as to see only a feminine angel wronged ("ruined," as the attorney phrases it) by a lecher- ous fiend in human form, who has met with just retribu- tion at the hands of an avenging masculine angel, though he, himself, may not have been without the sin of neglect or connivance that may have led the unsuspecting, weak and too confiding victim to untimely unwarranted slaughter. Men may be weak and impure; women may be weak and impure in their erotic spheres of action. The erot- ically blind lead the blind and both fall into the ditch to- gether, often. Juries are likewise often weak, and when there is a woman in the case, they may be erotically blinded by the radiant emotion of subjective beauty and domestic joy and peace shining in their own hearts, re- flected from their own homes of wifely fidelity and see as through a smoked glass only the dark images of the stealthy, ruthless, lecherous destroyer of the fancied peace of another's home, imagined to be only like unto their sacred, happy abodes, but for the ruthless, resistless intrusion of the home-destroying, domestic peace-blasting, happiness-killing adulterer, who ought to be and was righteously shot upon the spot, law or no law of man's contrivance to the contrary not- withstanding, for in the will of the great Jehovah, the work of the fatal bullet, as in the mind of the para- noid, if not paranoiac, Thaw, was, in the view of some, the will and way of God. Violent, passionate emotion, not induced by over- mastering disease, even though it leads to murder, is not essentially insanity. Emotion and passion, though they often go together, are normal qualities of mind and brain. Disease of brain, exciting abnormal emotion or impelling otherwise unaccountable or unjustifiable passion and con- duct must exist to constitute emotional or other form of insanity. A brain and mind disordering congestion or other brain disorder must exist to impel beyond the normal re- The Unwritten Law in Our Courts. 209 straint powers of the will, to constitute insanity that exten- uates or excuses crime. Juries often divide or agree and decide under the varying influences of strong emotion. They sometimes de- cide against the law and the evidence and the instructions of the court, from emotional influence, as well as prejudice or favoritism. The true criterion, therefore, for guaging re- sponsibility in a case of homicide, where the unwritten law of so-called justifiable vengeance has been appealed to and ex- ecuted in reckless anger for a real or supposed injury, should be—did disease of brain and not passion for vengeance, so impel the mind, its governing disturbing creature under dis- ease, as to make the deed irresistible. Was the act the result of a whirlwind or cyclone of unrestrainable violence, because of resistlessly morbid impelling state of brain, ab- solutely beyond the control of the normal and to the indi- vidual's natural state of mind, even though the diseased crime impelling brain had knowledge that the act was wrong? New York law to the contrary notwithstanding. If a limb is broken, the arm or leg cannot be moved aright; if the eye or an ear fail, seeing or hearing is de- fective or lost. If the brain and its related mind are dis- eased, its functions are not normal and no law made for the sane and sound of mind and brain can rightly hold to accountability. But impulse and passion, revenge and hate and all acts from normal motive are sane acts. All acts plainly conformable to motive of gain or passion of what- ever kind, are prima facie acts of sanity. However revolting and disregardful of moral or lawful propriety they may ap- pear, such acts be those of a sane, though morally self- perverted mind. Many of the cases that appeal to the unwritten law come under this latter classification, and demand the most rigid inquiry from a psychological standpoint, and consideration of all facts, surface or hidden. The study of the woman, as well as the man, should be equal, in the inquiry and the inquiry should be cold and unbiased, as though eunuchs were considering the cause, and it were better if blended with a few eunuchs and men past the prime of life there 210 Charles H. Hughes. were a mixed remnant of middle aged men and women on the jury with the young man, where the lex non scripta is pleaded. The possible sway of erotic emotion were better ex- cluded from a trial wherein the chief cause is erotism, and their swayed and swaying or attendant passions of jeal- ousy, revenge, etc., especially where a tragedy has culmi- nated and is involved in the cause of action. Cool blood, calm brains, strong deliberate brains should be selected for judgment in such cases. Sound psychic conditions should exist in all such juries. In fact, the judicial mind should be in the jury box as well as on the bench. When shall we ever have them in American petit juries? Shall we ever have such a jury when one man shoots another about an asserted wrong to a young and handsome woman? Since "man's first disobedience and the fruit of that forbidden tree," the overpowering influence of woman has, in certain directions, prevailed with man and no court, ap- pellate or others, has prevailed to lessen that influence. Her influence is generally acknowledged as in the main a good one, but alas! it has been too often an evil one for man's highest welfare. And when she influences man in wrong directions, man marvels at the unexpected evil in her, so "fair, God's eye could look with pleasure upon her face, and so pure." "Oh! if she had proclivity to sin, Nature may leer behind a gracious mask and God him- self may be,"—and a giddy blind doubt even of God, over- comes man often when a question as to the purity and fidelity of the woman he loves, flits like a phantom across his trusting mind, such as overwhelmed and astounded Walter, in the "Life Drama." The "eternal tale" of woman's influence, as well as of her prior sin, has been "repeated in the lives of all her sons," and it behooves men on juries to be cautious as to her story and her power, for there is often an element of doubt, sometimes real, sometimes partially hysterically col- ored in her testimony, to be taken into consideration by the calmly, judicially minded juryman, when the unwritten law is appealed to in behalf of the man who has taken her en- The Unwritten Law in Our Courts. 211 tirely at her word, and without corroborating testimony, kills her supposed paramour. Juries cannot be selected, except from a panel of the average man, with his natural charitable and protective leaning toward the tenderly regarded, fragile and physically weaker, though often mentally stronger woman, and the legally phrased "sanctity of the home." Judge, jury and the average citizen justly feel that "he, who would lay hand upon woman, save in kindness, is a wretch," and should be treated with due vengeance. But what, if after all, the man be really inno- cent. The too easily yielding victim of only a woman's wiles—a creature helpless and destined for destruction through her seductive power, as the strong Sampson was, under the powerful, pliant sway of the physically weak, but eroto-psychically strong and designing Delilah. A blacksmith in East St. Louis sees another man from across the street attracting the attention of his wife at her toilet in her own bedroom, by those gestures and body movements called flirting. Her husband noticing the pro- ceeding goes across the street, accosts the man, a stranger to him, has a few words with him, strikes him down and the man dies. The husband knew not what encourage- ment the wife may have given. He makes no prudent inquiry before proceeding with the fatal blow, and the prosecuting attorney of the place declines to prosecute on the ostensible grounds that it would be no use, because public sentiment, he said, would let the man go free. He is poisoned into disregarding his lawful duty to secure this arrogant, ignorant murderer, who made himself ex parte judge, jury and executioner, in a cause he holds in con- tempt of the law, which his fellowmen, who protect him by other laws, have made against the crime of murder. This prosecuting attorney, who has ignored the law against murder, is yet permitted to hold his position as a legal guardian and enforcer of the law. Such men are paranoiac in the sense of being beside themselves in their right appreciation of duty, of obedience to law and the peo- ple who make the laws. Such dereliction should be legally punished. . 212 Charles H. Hughes. Two men lately in a Virginia city, for a wrong to their sister righted by enforced marriage, together combine after the ceremony, to murder the man because they be- lieve he is seeking to abandon the girl whom they have made him marry. No one has ever learned the man's side of the story. Absolute innocence is assumed for the woman and flagrant outrage for the man, too outrageous for any remedy of law, and the unwritten law is pleaded. The judge wisely advises that such a plea is not entertainable in a court of justice because not lawful, and that dernier resort of otherwise inexcusable criminality, insanity, in most peculiar dual form, is pleaded. And a peculiar sort of med- ical expert appears to extenuate the crime. Let us here introduce some points in the record: The trial of James and Philip Strother, at Culpepper, Va., March 2, charged with the killing of their brother-in- law, William F. Bywaters, moved rapidly toward its conclusion after completion of the expert testimony of Dr. Charles Clark, the alienist. "Doctor Clark's testimony is regarded as of vital im- portance to the defense, although the prosecution claims to have enough rebuttal evidence to prove the theory unten- able." The prosecution will put on several witnesses to rebut several statements made on the stand by the Strother brothers that Bywaters had no intention of marrying their sister, Viola, prior to the time they declare they forced him to do so. The tedium of the trial was forgotten in the in- terest which attached to the appearance of Doctor Clark, whose presence was known to mean a bringing out by the defense of all the possibilities of its new plea that the Strother brothers were seized with uncontrollable emotional insanity on the night of the shooting—dual reciprocal emo- tional insanity? "In my opinion," said Dr. Clark slowly, as Attorney Moore, for the defense, ceased reading the hypothetical question, "the act was an irresistible impulse, and it can also be designated scientifically as impulsive insanity, the The Unwritten Law in Our Courts. 213 result of a highly emotional state, brought on by many in- sults to which the accused had been subjected." "I framed my opinion in this case on the hypothetical question, and I believe it can be logically put into two separate acts. The first when they had received informa- tion at various times of wrong-doing on the part of the deceased, and the information {accumulated. As 1 under- stand, they had a consultation, met and considered, and waited and reasoned and determined finally to tell this young man he must marry their sister or they would kill him." This was an exceedingly deliberate, emotional psy- chlampsia, not to be found in the domain of clinical alienism. "Between the execution of the act from the time they made their decision there was an interval. During that in- terval the mental process was one of peace, as is evi- denced by the fact that they congratulated him, and took his hand and kissed their sister. And there the mental process ended. The new process was due entirely to a sudden impulse." (Wonderful psychology!) "The emotions they had labored under as a result of the insults were dormant in them and became aroused again. I think the emotional condition overwhelmed the intellectual process, and that the act was not committed under full volitional power." (Psychic harmony in psychlam- psia!) "The witness said he thought that from the time the deceased made a sudden break to get out of the room— from that time on until the end of the crime—there was mental derangement." (In both — a marital murderous psychokinesia, so to speak!) With the conclusion of Dr. Clark's testimony, the de- fense rested its case. The State then called Dr. W. F. Drewery, of Peters- burg, to rebut Dr. Clark's testimony. Dr. Drewery's experience as an alienist had been in treating patients at the State Hospital for insane negroes. Dr. Drewery was asked whether the effort of the 214 Charles H. Hughes. Strother brothers to restrain Bywaters from leaving the house had materially affected their mental condition. "I should say," said Doctor Drewtry, "that they were angry—almost to the last degree." "Were these men, in your opinion, insane?" asked Mr. Keith. "No," he replied, "I don't think they were insane." Attorney Lee, for the defense, then asked: "Is the or- ganism of a Virginia gentleman's mind as sensitive as that of any other human being you ever came in contact with?" "I think so." "You say violent anger, and in almost the last degree. What is the last degree?" "I don't understand." "Can you draw the line of distinction between the last degree and that immediately before?" "I don't think that can be done with certainty." The succeeding questions were mainly about the differ- ent degrees of mental derangement. No disease impairing the minds of the brothers is ap- parent in the testimony of either expert, such as might cripple the mind's power of control and force it out of normal harmony with environment, or out of appreciation of duty to God and the state and people, or depriving of knowledge of right and wrong. There is no impairment of their wills by disease-destroying inhibitory power in the brain's higher centers shown, that might cause uncontroll- able morbid impulse. Nothing appears but the ignoring of the normal re- straints and the healthy, but unhallowed display of angry, vengeful, murderous passion, mocking, at the commandment of God and the law of man made in obedience thereto. Unbridled vengeance, that kills a fellowman or woman is not emotional insanity. The most violent play of the pas- sions in any direction is not insanity, though it may simu- late an insane passion, which is disease-impelled and not willful, and without motive of vengeance. The jury in the Strother case* returned a verdict of •Tho Commonwealth of Virginia v«. James and Philip Strother for the mur- der of William F. Bywatere, February term; Culpepper Court, 1907. The Unwritten Law in Our Courts. 215 not guilty; the judge ordered the crowd to receive the ver- dict without demonstration. Notwithstanding, there was much handclapping and shouting when the foreman an- nounced, "not guilty," after but one hour and a half's de- liberation. Immediately afterward there was a wild scramble over benches and chairs to shake hands with the acquitted murderers. Mrs. James Strother fell weeping into the lap of her husband, and James also cried. Judge Harrison rapped for order, and addressed the jury, several members of which were crying. The judge's voice shook and tears coursed down his cheeks, saying: "Gentlemen, 1 am glad to hear you say that the chastity of our women is to be protected; that no punishment shall be meted to those who deal with a man who invades the sanctity of the home. 1 have no censure for your verditt. Go to your homes, and I hope you will find them as you left them." Attorneys for the defense were first to shake the de- fendant's hands. James and Philip Strother, the murderers, said: "It is just what we expected. We knew that we had not done wrong." Commonwealth's attorney, Wood, apologetically said: "We are perfectly satisfied with the finding of the jury. We did our best to present the commonwealth's side of the case and feel that our whole duty has been done." This trial was but a judicially organized mob, acces- sory after the fact to the murder and vindicating it. The jury, judge, attorneys of both sides, medical experts for the prosecution and the crowd vindicating and applauding the murderous deed, with no one to speak in behalf of the dead man. Who knows what possible secrets the dead man may have held, or what motives other than the one proclaimed as the woman's honor and the honor of the family, may have moved the brothers to murder. Here is the remarkable spectacle of two remorseless brothers pleading insanity and rational justification of un- lawful murder at the same time, the jury acquiescing in the double plea, and contradictory, all the attorneys approving and the people applauding the verdict in a high court of law, and 216 Charles H. Hughes. the law of the land saying with holy writ, "thou shalt not kill." What a spectacle in an American court of justice, her scales over-balanced by a burst of erotopathic emotion and the rape of the law justified and approved by judge, by jury, by medical expert and prosecuting attorney, with apol- ogies from the prosecuting attorney. Apropos of this subject, we give place to a layman's view, as presented by Paul Thieman for Baron Pawel, in the Denver Post: "The acquittal of the Strother brothers in Virginia, who killed their newly made brother-in-law for attempting to leave his bride, presents some curious phases of the 'un- written law' theory. It is true there was a pretense in the trial of showing emotional insanity, but, as the judge thanked the jury and extolled their verdict, it is hardly pre- tended that it is anything but justification of the exercise of family or private revenge * * * The facts estab- lished beyond dispute in the evidence were that the slain man had wronged the sister of the defendants; that he had been induced, probably under compulsion, to repair the wrong by marriage, and that he attempted, at once, to leave on the plea of business in town, whereupon the en- raged brothers shot him. The most unfavorable con- struction of his attempt to go away after the wedding is that he intended to desert his bride. Therefore the 'un- written law' works out, in this case, to be that wife deser- tion is an offense for which the relatives of the deserted wife had the privilege of inflicting capital punishment, and, moreover, to act as prosecutor, judge, jury and execu- tioners, all in the length of time that it takes to draw a revolver and get it in full action. * * * Another notice- able feature is that the judge who thanked and indorsed the jury for this verdict had in the earlier stages of the same trial emphasized, most emphatically, that no unwritten law would be recognized in his court; that he and the jury were sworn to enforce the statute law, and that would be the only test in the case. As it would be impossible to produce any statute enacting the theory of private capital The Unwritten Law in Our Courts. 217 punishment for wife desertion, it does not seem that this judge's law is like that 'of the Medes and Persians, which altereth not'." * * * Well said Baron. * * * it is an illustration of the vagaries of any law that is not a statute law. * * * While the "unwritten law" is quite specific, the fact that it is not written enables its code to be distorted and misused and, out of sympathy for the ac~ cused, its protecting sentiment may nevertheless be in- voked. * * * The Strother brothers broke the "unwrit- ten law" itself, for, according to the "code," they had ac- cepted marriage as reparation and Bywaters was entitled to a decent chance to act like a man. * * * But a dis- pute arose, hard words were passed and, in mere rage, he was killed. * * * Public sympathy, however, gave to the Strothers the immunity of the "unwritten law." Solomon, with all his wisdom and familiarity with women, confessed his inability to understand the way of a man with a maid. The way of a maid with a man is often quite as incomprehensible, and the way of petit juries with this unwritten law plea and a women in the case is peculiar. There appear to be times and seasons and places with the American people when and where deliberate reason for- sakes them in the face of certain crimes against the law, when an insanoid sort of judgment supplants the cold reason of judge and jury, and this unwritten law craze is one of them. These crimes of insanoid emotion displayed in such jury verdicts against the law of the commonwealth, which assumes to "command what is right and prohibit what is wrong," and in the present instance approved by the court, ap- pears strange and unaccountable to the psychologist, as coming from supposedly sane and well-balanced minds, with the law to guide them and the command of God to deter them. If this craze to kill in these cases, on the assumption that "woman can do no wrong," goes on increasing, better extend the application of the lex talionis to gradually in- clude them, than make a farce of law and a travesty of 218 Charles H. Hughes. cool-headed justice with subterfuges of non-existent emotional insanity, as a plea in vindication. There are base, insidious, slimy lechers in this land, as in every other, who creep into the chambers of a woman's soul, "like a foul toad, polluting" as they go, for whom shooting is reward rather than punishment. But how are such to be separated from the weak, unwary man se- duced, if the seducer is dead and only the woman's testi- mony is taken, with none to dispute, and what becomes of the right of the murdered one to have had a hearing and to confront witnesses and charges against him. The man who with overmastering violence or stealthy drug giving, with wine or otherwise harmless beverage vio- lates an unwilling woman, should meet with condign pun- ishment by law, under fair legal inquiry and decision but never by private vengeance. It is lame psychology and bad logic that assumes al- ways the sanctity of the home, forcefully, ruthlessly invaded by resistless lechers, before whom virtue must inevitably succumb like a voyager, to "pirate monarch of the main." The sanctity of the home is, save in exceptional in- stances, maintained by the true and, many of them saintly women, within the home. The sin of erotic unsanctity, or speaking in terms of less specious sophism, the sin of erotic conjugal infidelity is prima facie, a mutual sin in the fully mature not where one is under puberty or lawful age of consent and sexually innocent and no one better knows this fact than the cold, reasoning psychologist and physician familiar with all the phases of the erotic sexual life of man and woman and, as that life is familiar to the student of morbid erotopsychology, such as the alienist, under whose eye so often comes the extremes of sexual eroto- pathy in man and woman from erotic hypaesthesia and hyperkinesia to sexual apathy senile and premature. The "ruin of innocence and virtue," "the polluting of the home" are facts that arouse right manhood's vengeful ire and the threatened or violated "sanctity of the home" from erotic, lustful, polluting invasion from without, stirs the innermost feelings of destroying vengeance leading to trag- The Unwritten Law in Our Courts. 219 edy. But before juries these phrases are often misapplied. Used as specious catchwords of forensic suasion, not supported by justifying evidence, where the unwritten law is appealed to, and one of the principal and most essential witnesses is dead, and his or her character and possible crime are being passed upon ex parte. Here, more than anywhere else, in view of the dominance of the sexual over the other passions and over the mental stability and inhibitory powers of the brain, too often is the medico-legal difficulty of providing for right law and evi- dence. One thing is certain, the law should not be in the hip pocket or under the plaquette of the emotionally dis- ordered party, who believes he or she has been wronged beyond remedy, save that of self-decided and executed bloody vengeance. The line of demarkation between sanity and insanity is often so shadowy that even largely experienced ex- perts in alienism can not always promptly detect it. But when, in a case where the unwritten law for a crime con- nected with erotism is appealed to in justification of sum- mary murder, jointly planned, a jury immediately acquits, the presiding judge commends, the prosecuting attorney apologizes, the whole audience applauds and the murder- ers are acquitted on the woman's and their own testi- mony, thank the jury with expressions of confidence in the righteousness of their act, a state of unseemly emotional and semi-hysteric excitement pervades the audience, not compatable with a normal, steady, unmoved judgment, and Justice is wronged in the sacred temple. Vengeance be- yond the law commended, murder rejoiced in; such a place, such circumstances, such scenes of inordinate emotional sympathy do not promise that equal and exact justice, which should always and only appear in our courts of justice from cool, calm, unbiased deliberation upon a matter of such character to man or woman, and when a like and equal justice to all are at stake. An American jury box, American bench or bar or seat for auditors, are not the places for insanoid emotional dis- plays that lack only the unestablished element of disease 220 Charles H. Hughes. of the psychic neurones to constitute the mental instability of insanity. From the standpoint of a neuropsychologist's observa- tion in provision for neurone stability, and in right penal- ties perhaps, for causes and trials of this kind, this subject would appear to require further attention from municipal law-making powers. The anthropology of man and woman are similar, com- plementary and anthropopathically reciprocal, as their an- thropology is much alike, both neuroanatomically and neuro- physiologically in their eroto-sexual spheres, with the super addition to woman of her especially receptive generative apparatus and the ovi complementing the testes. "As unto the bow the cord is, so unto man is woman" in neuroanatomical and neurophysiological life and laws for trials in which she is directly or indirectly concerned, es- pecially where capital crime is the issue, should be made accordingly. Her testimony and its motives should be weighed with extreme knowledge and caution, from the standpoint of a correct knowledge of erotopsychology. The anthroposophy of this subject, demands a full and real, not an erotic delusional knowledge of woman's nature, so like unto man in passion, yet variant in display and more se- cretive. This knowledge is what we ask in these trials, embracing the anthroposcopy of her artful, artistic and seductive powers of speech and manner to sway man's overpartial judgment on the witness stand, in these erotic murder cases or through what we know of her merit and beauty of character in our own homes, and of her real nature in general, as she really is, so different from, yet so like unto man himself, in her passions, some supremely good, some supremely bad, some indifferent, as men are. This should be considered in every cause wherein the unwritten law is concerned. Not that the woman should be regarded as only good and pure and true, and only man as base and vile. Juries should re- gard them and their testimony in the light of true, un- jllusioned, psychological anthropology. The Unwritten Law in Our Courts. 221 When there is, or has been a woman prominent in the cause, it is well for the man to severely and strenuously train his logical inhibitions on his judgment,lest he be unduly swayed by overbiased, erotopsychic emotion and mistake the same for sound, impartial judgment. Recently a man repeats the often recurring domestic trag- tragedy of killing himself, his wife and child under the eroto- pathic, psychlampsic impulse of homicidal jealousy. No law but the law of extermination for him, the destruction of the unfit to live and he unconsciously thereby saves the good of his race in thus summarily destroying himself as a breeding focus of psychic morbidity, inimical to the eroto- mental stability of generation that might have directly or atavically come out of the mentally unstable and mismated combination, for like breeds like, in neuropathy and psycho- pathy, as in generations of a sounder, steadier-neuroned cerebro - psychogenesis. The constant in and in breeding of the psychically unfit to live for the welfare of the race, is a source of solicitude to the patriotic psychologist and alienist, and thought of remedy of prevention has often presented itself, but how to apply it has been as much of a problem as the belling of the cat to a council of rats. Nature's remedy in the often suicidal violences of morbid jealousy, is a harsh one, but effective, and the race is benefited in the survival of the more stable and normal in erotic neurone life, and consequently more fit to live. This remedy of inexorable nature, remedying its erotic life defects by pyschophysical de- generation or suicide is revolting to our tender sense of re- gard for the life of others. But it is Nature's unfeeling, effective way, the way that prevents idiocy and misce- genation or other defectives going too far in continuation of their vicious kind to the peril of the general brain stabil- ity of mankind. The unfit to live thus fall by the way and perish through erotopathically begun and continued degen- erative impotential decadence. Here are some other aspects from England of the unwrit- ten law, so-called, which we give without entirely endorsing the criticism of the paper from which we abstract it. 222 Charles H. Hughes. "Public indignation has followed the sentence of death upon the young man, Rayner, for the murder of William Whiteley, known as the "universal provider." Before the trial and while it lasted English law very properly prevented an expression of public opinion. "To print any opinion which might have its effect upon the minds of the jury while a case is subjudice is held to be contempt of court, rendering the offender liable to a severe term of imprisonment, but now that the trial is over the newspapers are full of angry letters denoun- cing the sentence of death, especially as the judge said the prisoner need not expect any reprieve. "Raynor claimed that he was an illegitimate son of Whiteley, and had his mother's evidence in support of the allegation. In fact, he called himself Cecil Whiteley, when he was charged with the murder. "He was married, and, with his delicate wife and two children, he came to London, starving, and went to White- ley for assistance, hoping that his father would help him obtain employment. "He had a revolver with him, with which, he said, he meant to blow out his own brains in the event of his father's not doing anything for him. He did not want money, but work. "Whiteley declined to help him, and, so Rayner says, told him to go to the Salvation army for assistance. In his weak, nervous, and starving state that made his blood boil, and he was raised to greater passion when WJiiteley sent for a policeman to have him removed. He then fired at Whiteley and followed that up with shooting himself through the head, blowing out one of his eyes. Whiteley died, but Rayner was nursed back to life. "Was Rayner justified in taking the life of this man, whom he called father? The controversy, through the medium of the country's press, is heated, but a great ma- jority of opinion is on the side of the condemned man. The country is horrified that a young man should have to undergo torture under the surgeon's knife and be nursed back to life only to be given up to the hangman, The Unwritten Law in Our Courts. 223 "Laurence Irving, son of the late Sir Henry Irving, thus voices the general feeling throughout the country when he asks 'if Rayner, under the stress of hunger and its attend- ant miseries, having pawned everything down to a woolen muffler, believing that the man to whom at last he ap- pealed for help was his father, or, in any case, knowing that he had been connected with his mother's family to its dishonor, and that, being refused assistance, he shoots Wil- liam Whiteley and then himself, can anyone question that in the moments when he lay moaning on the floor asking only to be allowed to die, and in the succeeding days and weeks, when that sad, wrecked, loathsome thing, his life, was being given back to him, can any one question that in that interval he suffered all and far more than all pangs of hanging.' "'An idea at which public conscience revolts is that of Rayner undergoing a more awful measure of punishment than Chapman or Deming, who tortured their victim to death, or that hideous Jack the Ripper would have done had he been caught. To the plain nonlegal mind this is not justice.' "Thousands of letters written in the same strain say if Rayner is hanged it certainly will afford a strange ex- emplification of the peculiar workings of English criminal law. Only a month or two ago a young man in Brixton, one of London's suburbs, stabbed to death a girl who did not reciprocate his affection as he wished; yet his story was considered so pathetic that the death sentence was commuted on the ground that he was insane at the time he committed the act, and in six months' time he will be a free man again."—N. Y. Herald. A candid consideration of the above and the views of other popular writers and persons on these and similar features of the unwritten law sentiment, suggest that there is something even in the normal psychology of the subject, which has not yet been adequately met by such legal provision as would take proper punitive law, lex talionis and lex non scripta out of personal hands and place them in the courts of justice. (To be continued.) / THAW'S PARANOIAC MORBID EGOISM. By C. H. HUGHES, M. D. St. Louis. APRESS REPORTER sitting in the court room of this famous trial has builded better than he knew, one of the foundations of Thaw's abnormal mental state. It is that morbid state of mind which, in Thaw's speech and conduct shows intense abnormal egotism, the exaggerated egotism as testified to by medical experts Evans, Wagner and others, founded in the delusion that he has done a justifiable, righteous deed of retributive vengeance approved of God and applauded of men and women, in slaying the demon who has menaced his mind and his life. "When the world shall know in full the motive of the deed and the character of his victim, the de- spicably damned, stealty destroyer of the virtue of trustful maidenly innocence, it and God will, in his morbidly eroto- pathic delusion, justify and applaud the taking of White's life and the violation of the law, and set him free with honor and gratitude." Here is the potent press portrayal, unconscious of its alienistic significance, of that picture which marks mental disease upon the thought and action of this man. "Something of the pomp of a general suggests itself in the demeanor of Harry K. Thaw in his trial for the murder of Stanford White. He seems ambitious to push the cam- paign. There is no listlessness, no timidity. He is impa- tient for the crux of the trial, else his manner belies him. He can hardly wait for the climax. He is the same Harry (224) Thaw's Paranoiac Morbid Egoism. 225 Thaw he was on the night of the Madison Square garden tragedy, when he strode into the police station with his head up, his shoulders back. He slapped his breast with his hand, "I am the man who did it,—no, proclaimed it!" "Modified, of course, his attitude is the same. He marches into the court room with the alacrity of one who is used to the center of the stage as his right. The eyes bent upon him from the thronged court room are so many spotlights. He sees them all. He looks around to see if they are there. "Over to one side are tables creaking under the fever- ish writing of a host of reporters, correspondents. This is the press. Ah, the press is another spotlight. "The man who "did it" is here. He has waited since last June to tell it. He thinks he is going to tell it in a few days, and is more eager than ever. Maybe, his law- yers will say differently, but he does not dream of that. He feels that he is there to re-enact the tragedy. "Behind Thaw, the ambitious general, sits his first reserve. "There are five women sitting behind there, three in somber garb, the other two flashing with purple in their attire. "Of the latter, the small, insignificant one, with a pair of startled eyes peering out through a thick, smothering veil? What of her! For her he slew. , "is Harry Thaw's sense of importance felt toward the public, or is it all to impress the mite of humanity? (The trial shows both.) "There are the other women. That white-haired one is his mother. She has a clear eye and a good color. She has courage. "He never had to pose to her as a hero. She always thought he was one, where even his most indulgent friends realized the bitter truth. She is the most loyal one of all, the most hopeful, perhaps. She is his mother. "There is another woman, a countess, made so by marriage. 226 Charles H. Hughes. "There is another, a sister, one more commonplace. "Now the other woman. The other one wears colors. She comes from the chorus girl ranks where the wife grad- uated." These five women make up the feminine part of the auditors in whom he is most interested and whom most of all he wishes to behold his triumphant vindication. But there are others, the great audience of onlooking women for whose virtue he has valiantly stood, and men who have wives and daughters, and the jury who will weigh the scales of justice, and read the weight of evi- dence of his valor, and the judge and attorneys, who will help in the weighing, and the witnesses who are to tip the scales so pronouncedly in favor of his great and meritori- ous achievement of avenging blood." No show or line of remorseful regret mantles the face of this egoistic paranoiac, as he looks with exhuberantly conscious assurance, though that assurance be that of morbid delusion not yet justified by the revealed facts, upon the great audience of the crowded court room, ready and eager in his morbid imagination to proclaim the glory of his great act of retribution. "His act and God's." The world is full of egotists who, without just warrant in personal ability or merit, esteem themselves far above all reasonable warrant. The reckless plungers in finance, the despicable, obnoxious, smart-Alex's and egotists of society who obtrude, out of their proper place, in so many spheres of action where sensible men only should be, are of this class, but here is the egotism of a morbid egoism, which makes a remorseless delusive merit of shedding human blood, for a delusional personal danger and an old wrong, real or apochryphal, told of, and if real, condoned in con- jugal alliance and passionate love of the woman wronged after two years of illicit amour. This mentally deranged man of morbid egoism and fear of enemies and persecution, distrustful of his own counsel, autocratically dismissing and changing them because they wished to establish exculpatory insanity, is fearful that Thaw's Paranoiac Morbid Egoism. 227 he will be pronounced insane when he knows he is not mentally deranged. He doubts the sanity of the medical experts who observe him and are testifying to his insanity. "They do not understand him." These opinion witnesses had, in the beginning, great difficulty in getting audience with him. Later he courts the examination of the lunacy commission because "he knows he is perfectly sane." When the experts first visited him he regarded them with suspicion, though introduced by a friend in whom he had yet faith (Mr. Hartridge) and left them abruptly without asking to be excused, though he has been gentlemanly reared and accus- tomed to the manners of a gentleman. He looks with delusional confidence and pride upon the judge, the jury, the audience and his family and upon the insanity commission. "He has done a righteous deed." He is confident, hopeful and anticipating triumphant vindication. "The murder was of providence, an inspiration and his wife an angel, not fallen but cast down by treachery and violence. He is the greatest and the best of heroes, an avenging nemesis who before all the people, killed the infamous one and with weapon in hand and uplifted arm had let all see and know he did it. Openly done as Booth's shooting of the good Lin- coln, boldly proclaimed and with no attempt at escape. He now sits satisfied before the tribunal of the people, hopefully awaiting their plaudits of well done, after the jury shall have set him free for his glorious deed of providentially directed vengence. He industriously and interestedly exam- ines and attends to his correspondence, paying no attention, most of the time, to what the medical experts are saying about him, because in his self-laudatory delusion the end will be a sure vindication. It is all right anyway; in his mind, all will be, must be right. He will be acquitted with applause for the righteous murder of the man who, before he knew her carnally or had conjugal claim upon her, had also carnal unlawful commerce with his wife as he had later himself, and for two years before his marriage to her." He faces the commission of inquiry into his sanity or insanity 228 Charles H. Hughes. of mind with confidence of a verdict of sanity and he is right in his egotistical conviction, "for the inquiring commis- sion are men, like himself, though one is a physician, and would have acted the same, had they the same knowledge, the same courage, the same wrong to avenge, the same conviction, the same support of Heaven." In ad- vance of their decision he complacently receives the righteous verdict as he regards it, of his sanity and the jury's just verdict of acquittal, for in his own mind he has done a glorious, heroic deed. But lo! the jury has in his delu- sioned view, made a grave mistake. "It has failed to see the glamour and the glory of his great and meritorious deed of death and salvation. But the commission of inquiry has concluded aright. He is sane! The jury did not see aright. They were divided, some of them even thought him guilty, though he had removed from the earth a malefactor who to his certain knowledge had dishonored his wife in her girlhood before he himself took her as his concubine and traveled with her for two years under an alias." In his exaggerated morbid egoism what he did was alright. All and every one who came across the mental orbit of his morbid egoism were all wrong and he has a way of righting every evil and will use it. "He will go to jail to be bailed out soon, he thinks, and a new trial with new attorneys and new judge with broader views and a more appreciative, sensible and sympathetic jury will see him and his cause aright and indicate both in a just verdict of freedom cum laude." To these insane convictions we add another reporter's view in contrast to that the delusioned Thaw had of his deed of blood and this reporter's view is the view Thaw would have held of himself had he been sane. But had he been sane, though the same deed of blood might have been done by him, he would have done it at another time and place and if possible, with reasonable effort at concealment and escape. Thaw's delusion of his wrong and his insane state of brain, did the deed in the manner and place in which it was done. It was done when, where and in the manner it was, because in his morbidly delusioned state of mind it Thaw's Paranoiac Morbid Egoism. 229 was the time and place and he the heaven chosen actor of a great and glorious deed. "Jealousy of his beautiful wife, whose lustrous eyes and artist model figure thrilled even the pampered profli- gates of the Rialto, led Harry Kendall Thaw, the spoiled scion of a wealthy and indulgent family, to kill Stanford White at Madison Square Garden on the night of June 25, 1906. The young millionaire believed White was seeking to separate him from his wife and emotional (?) insanity is the plea on which his attorneys hope to save him from the electric chair. "No mystery veils this remarkable case. Thaw killed his man where all might see, and held the smoking revolver in his hand until a policeman took him by the arm. The openness of the deed incited the greatest speculation as to the nature of the defense. Not once in the long seven months which passed after the prison doors had closed behind Harry Thaw has the slightest intimation been given as to the plea that would be offered. One million dollars may be spent to save Thaw from the death penalty— half the sum already has been spent.(?) An assistant district attorney remarked at the time of the killing: "This man thinks he can get out of this scrape as he would avoid trouble after he broke a barroom mirror—by paying for it." If Thaw goes free, he will re-enact perhaps another tragedy of horror, if similar adequate or fancied provocation shall again disturb his paranoically unstable brain and provoke another deadly mental explosion. Such may be confidently looked for, if his future like the past, be an unbridled career of self-indulgence without asylum control and treatment to restrain his hitherto unregulated and abnor- mal inhibitions. It will be a misfortune for him and his family or friends who may come intimately near this paranoid psychopath if he should not be subjected to a long period of mind steadying restraint, free from all the vicious indul- gences and non-regulation to which he has become accus- tomed by an erratic paranoid life, that brooked no restraint and knew no guidance but the impulses, propensities and dominating passions of his own "sweet" and erring will. THE ALIENIST AND NEUROLOGIST- VOL. XXVIII. ST. LOUIS, MAY, 1907. NO. 2. Subscription $5.00 per Annum in Advance. $1.25 Single Copy. CHAS. H. HUGHES. M. D.. Editor. HENRY L. HUGHES, Manager and Publisher. Editorial Rooms, 3872 Washington Boul. Business Office, 3872 Washington Boul. This Journal Is published between the first and fifteenth or February, May, August and November, and subscribers falling to receive the Journal by the 20th of the month of Issue will please notify us promptly. Entered at the Postoffice In St. Louis as second-class mall matter. EDITORIAL. [All Unsigned Editorials mrt written kf the Editor.] THE UNQUALIFIED EXAGGERATED EGO as a defense of erotic brain-storm murder was brought into requisition at a recent murder and unwritten law defense trial at Carthage, Mo., in the case of the State vs. Sanderson. In this case the prosecuting attorney said there was evidence of an exaggerated ego, in that the defendant thought himself providentially called upon to avenge the ravishment of his wife. Sanderson shot Doctor Meredith at the Sanderson home early in the morning of January 2, after having telephoned for the physician to come to his home to prescribe for Mrs. Sanderson. In his defense Sanderson claimed that Meredith was advancing upon him with an upraised medicine case and his right hand to his hip pocket when he shot him. Mrs. Sanderson told the jury and the jury accepted the improb- (230 Editorial. 231 able, if not impossible statement, unless Ur. Meredith was ambidextrous, of Meredith's alleged advances to her and corroborated the statement of her husband, the defendant, in regard to the shooting. She testified that Doctor Meredith, who had been their family physician, had made love to her when she went to his office to consult him. Later, when one of the Sanderson children was ill and Sanderson wanted to send for Meredith, Mrs. Sanderson had demurred and said that some other physician should be called. Sanderson insisted upon knowing why she objected to Meredith, and Mrs. Sanderson detailed her experiences with him. Sanderson immediately left the house and soon returned with Doctor Meredith. Before Mrs. Sanderson, he accused the physician of ruining his home and shot and killed him. In his dying statement Dr. Meredith denied criminal relations with Mrs. Sanderson, which was probably the truth. The woman had probably made a derogatory state- ment about Dr. Meredith, for a woman's reason, which after the disastrous result and to save her husband, she exagger- ated probably into coerced adultery which, though unsup- ported, the jury accepted as absolute truth and justification. While protecting the purity of the home it would be well if juries would consider the possible purity and honor of medical men in spite of erotopathically framed stories of morbid hysterical women, eager to make impressions on their husbands of other men's attentions. There is a kind of morbidly-minded, overly erotic woman who sees the masher and the flirt in every genteel man they meet who innocently looks upon her. Such women are ready, for motives peculiar to this peculiar class of the sex, to say to their husbands and lovers for jealousy exciting effects, that such and such men lust after them. Such giddy fem- inines, to whom love is their whole existence, do not realize what they do sometimes with the passion of certain impres- sible men who sustain the closest of human relations to them, when they disclose hysterically colored, illusory 232 Editorial. romances of erotic adventures from forbidden sources, till the unexpected awful tragedy happens. Then, in some instances at least, they tell of their shame, which may never have happened, to save the life of the rash, impetuous loved one.who under the unwritten law then regards no other life as sacred that really, or in feminine fabrication, passes between him and the woman. Making a clean breast of infidelity and ruin, as if women were babes and men were beasts, going back to the wronged, forgiving husband and saving his life by the terrible sacrifice of really or falsely testifying to her own shame and weakness and the man's great over-powering wrong, and swaying a jury into forgetting the law and their obligations to society and logical truth in their deliberations, is becoming a problem in psychological anomaly closely verging upon the morbid. Brain-storms are "sudden and severe paroxysms of cerebral disturbance." Psychokinesia and psychlampsia are the technical terms of this state of mind connected with insanity. Explosions of violence, in the height of passion, may be sane displays of temper, but when morbid, with a well-laid foundation of disease affecting the brain, they are evidences of insanity. To constitute insanity, psychlampsias, psychokinesias, brain-storms, or plain explosions, of blind passion must have a brain affecting disease basis. Other- wise they are just plain giving way to violent reason - blinding, punishable passion. THE JOURNAL OF INEBRIETY, is now united with The Archives of Physiological Therapy. It will hereafter be pub- lished as a part of The Journal of Inebriety. These two very able periodicals will move on as two souls with but a single thought and two hearts that beat as one, in editorial man- agement. The management thinks the scientific value of both will be greatly enhanced by this concentration. The merit of the high contracting parties make the marriage appear auspicious and our auguring mind, knowing both sources, assures success for the joint adventure. Editorial. 233 PYROPHILES AND PYROPHOBES are not uncommon among the insane, who love to see and make fire or dread and fear fire from pure love or aversion of a diseased brain, without special delusion on these subjects. The diseased impulse with them to burn or see fire or to dread fire is a simple delusive feeling. PARANOIAC, PYROMANIAC AND HOMICIDE are rarely combined in one person. Such a case is lately recorded by the Associated Press as occurring at New Martins, Virginia, where on January 30th, claiming that God had instructed him to burn the town of Smithfield, Harry Howard was arrested there recently as he was emerging from a hotel, which, it was said, he had attempted to fire along with three other buildings, from which flames were bursting. The fires, however, were extinguished. Howard resisted arrest, and before he was captured, shot and probably fatally wounded one man and injured others, including the Chief of Police. THE ST. LOUIS ALAMAGORDO TUBERCULOSIS SAN- ATORIUM, located in New Mexico, represents a practical philanthropy worthy of ample support by St. Louis philan- thropists and emulation by other cities. The atmosphere of New Mexico admits of curative open air treatment most of the year and the promoters of this merciful movement are wisely constructing a forty-room building in addition to the tents provided in order that the patients may get the right sort of fresh air at all seasons. The exclusive tent idea for every day in the year is a fatal fad and has caused many early deaths of consumptives forced to live in unfloored, unheatable and too lightly walled tents in inclement weather such as would make a well man ill. The rates for medical attention and maintenance will be as low as seven dollars per week. Detached from building, canvas tents and a main admin- istrative building are in the plan. A Sanatorium Magazine is contemplated, to explain the 234 Editorial. work and disseminate special information concerning this praiseworthy institution. The present directors and promoters include Mayor Wells of St. Louis, Paul Brown, E. Wilkerson, Geo. Frankel, C. F. Hatfield, M. P. Moody and others. If this scheme is carried on from the start on perfectly antiseptic lines, so that it will not become a nucleus for the dissemination of tuberculosis, as Mentone and other places have, and as a pure philanthropy it can be made more than sustaining and do a world of good to moderately circumstanced people, who have upon them the great incubus, mental and pecuniary of one or more tuberculotics in their families. The depressing influence of a tuberculotic to himself and to those bound to him by ties of consanguinity and natural associate sympathy, can thus be removed and that psychic buoyancy so essential to the promotion of recovery in any disease can be brought to bear by removal from home to the better sanitary environment of a New Mexico mostly out-door home. The meats and milk, as well as the atmosphere of New Mexico, are less likely to be tuberculotic than those of large Eastern cities. The Government's Inspector last January, at Trenton, New Jersey, found twenty-five out of fifty hogs tuberculotics and they probably were not fed on garbage as infected as that of our St. Louis Chesley Island either. Devising distant sanatoria for tuberculotics and feeding people infected food and drink and on the foul germ filled air of city street cars, etc. is essaying sanitation at but one end and that not the most effective. The best time to quench the fire of disease is to not let it get a start. Chesley Island hog feeding is an unsan- itary and murderous blunder and crime. To whose tables do the hogs go or to what use are they put that are fed on Chesley Island garbage? A STRANGE PROCEEDING in the Thaw trial required the experts to establish insanity . fore testimony would be admitted on the subject. Editorial. 235 Experts should have all the facts, whether obtainable from lay or professional source, whether from personal obser- vation or the testimony of others. The claim of insanity should have the chance of proof from all the testimony. The hypothetic case should be a complete life biography. IT IS UNFAIR TO THE INSANE to have lawyers or laymen on a commission of inquiry as to a strictly medical question. Such a commission should be composed only of clinically experienced alienists to do justice to a supposed insane person. Insanity is a disease of brain disordering the mind and should be diagnosticated, as other diseases are, by doctors of medicine, not by lawyers and laymen. No one would think of diagnosticating any other disease after the manner of the New York commission in lunacy. IT IS UNFAIR TO AN INSANE PERSON to pronounce him sane because he may appear to be able to advise with his counsel as to the conduct of his case. This is the unfair criterion in Thaw's case. IN INSANITY, APPEARANCES ARE DECEPTIVE to the non-expert. The "knowledge of right and wrong test of insanity" is a wrong and unjust criterion for insanity. Insane persons may appear to have that knowledge and acknowledge that they have, as they will insist that they are sane, while yet they do not have the knowledge of right or wrong as a sane man does. THERE MAY BE GRAVE BUT MASKED DELUSION behind an insane man's abstract knowledge of right and wrong. In insane psychlampsia insane persons have been resistlessly impelled to murderous deeds they knew were wrong and against their normal inclination even while imploring to be restrained and prevented. "The existence of this form of insanity is now too well established to be questioned by those who have any scientific reputation to lose,"—/. Ray, Med. Juris. Insan. 236 Editorial. f APROPOS OF H. K. THAW "It must not be forgotten that the author of our being has endowed us with certain moral faculties comprising the various sentiments, propensities and affections, which, like the intellect being connected with the brain, are necessarily affected by path- ological actions in that organism. The abnormal condition thus produced may exert an astounding influence on the conduct, changing the peaceful and retiring individual into a demon of fury or at least turning him from the calm and quiet of his lawful and innocent occupations, into a career of shameless dissipation and debauchery, while the intel- lectual perceptions seem to have lost none of their ordinary soundness and vigor."—/. Ray. DEATH OF R. HARVEY REED OF WYOMING.—Dr. Harvey Reed of Rock Springs, a former member of the Wyoming state legislature and a prominent Republican politician of Sweetwater county, committed suicide in a hotel at Los Angeles, Cal., by sending a bullet into his right temple. The suicide is attributed to ill-health and despondency. Reed had been living at the hotel for several weeks, and during this time he had been confined to his room in charge of a nurse, who accompanied him from Wyoming. It is said that while the nurse left the patient for a few moments to-day, Reed procured a revolver in the room and ended his life. For several years Dr. Reed was surgeon for the Union Pacific Coal Company. He was superintendent of the Wyoming general hospital at Rock Springs for several years and was surgeon general on the staffs of Governors W. A. Richards, Deforest Richards and Fenimore Chatterton. Dr. Reed was a self-made man of great force of char- acter. A good surgeon and a good friend. We send his family and associates the condolences of a friend. He was our traveling companion along with Drs. Senn and Grif- fiths from this section of the country to the last Inter- national Congress of Medicine at Madrid, Editorial. 237 A RATIONAL AND VILLAINOUS BRAIN STORM.— A St. Louis restaurant employee expecting fifteen cents more pay than was paid him for a day's work went into the restaurant with his knife open because he "expected trouble" as he confesses and "was mad" and fatally slashed the proprietor in the back and side. This is another phase of the unwritten law that should be written plainly in the severest legal punishment. There is a wide field for legal punitive education here as in other forms of the personal practice of lex taliones. Because he believed he was being cheated out of 15 cents, Roy Spurgeon, of No. 2647 Olive street stabbed William Amenda, manager of the restaurant at the Portland Hotel, No. 1817 Market street, five times. The restaurant was crowded with people at the time. One patron sprang to the door and locked it as Spurgeon was trying to escape. Another, whose identity was not learned, struck Spurgeon on the head with a chair, ren- dering him unconscious and gashing his scalp. Blood flowed freely over the floor of the restaurant and excitement prevailed for a few moments. Sergeant Fields, of the Central District, and two patrolmen took charge almost immediately. The trouble arose from a misunderstanding about the amount of wages to be paid. Spurgeon said that the agreement was $7 a week, while Amenda contended that it was $6. He was paid 85 cents, the amount for one day at the lower rate. He demanded $1. "1 went into the restaurant with my knife open because I expected trouble," said Spurgeon last night. "I was mad, and when he started to push me towards the door I began to slash." 238 Editorial. JOHN ALEXANDER DOW1E, the new prophet Elijah and founder of the New Zion, before death was translated from the overseership of the Church of Zion to the realms of senility and dementia senilis, where the wicked cease from troubling and the weary are at rest. Here is the record or his career. CHRONOLOGY OF DOWIE AND ZION CITY. Lands in San Francisco penniless, 1888. Locates in Chicago, 1890. Launches religious crusade, 1892. Wins a large following, 1893-1898. Buys site of Zion City, Sept. 3, 1900. Dedicates the city, May 30, 1901. Declares himself Elijah II., June 2, 1901. Spectacular crusade for "restoration" of New York, Oct. 14-Nov. 8, 1903. Zion City temporarily in hands of receivers, Nov. 24- Dec. 6, 1903. Shows statement of $14,000,000 assets over liabilities. Begins tour of world, Jan. 1, 1904. Visits Australia and returns through Europe, January to June, 1904. Announces Mexican colonization plans, May 22, 1905. Suffers stroke of partial paralysis, Oct. 1, 1905. Second stroke leads him to deputize overseers to care for Zion City, Dec. 19, 1905. Goes South for his health. Removes Overseer Speicher, Jan. 20, 1906. Reported dying in Jamaica, Jan. 29, 1906. Appoints Wilbur G. Voliva executive head of Zion City, Feb. 8, 1906. Said to have mortgaged his home and stable at Zion City, March 7, 1906. Zion Bank declines to honor his drafts, March 11, 1906. Overseers determine to ignore his orders, April 1, 1906. Editorial. 239 The whole ending in a receivership appointed by a civil court and the rational disposition and settlement, sees illusion, hallucination or delusion, of this modern miracle of folly. Truly the unstable neurone is abroad in the land, for other similar follies are yet alive and people termed sane embrace them. OHIO INSANE ASYLUM EX-EMPLOYES INDICTED.— The Athens, Ohio, County Grand Jury, Feb. 23, returned five indictments against former employes of the State Insane Asylum for alleged cruelties practiced against inmates of the institution. Three of the men were indicted for second-degree murder in "tramping out" an inmate. This is what should be done with men or women who strike the insane. Cruelty to the insane often comes of ignorant retaliation and a disposition on the part of some green attendants to display their physical powers. New attendants often do not realize that violent acts and foul insulting language of ordinarily apparently sane acting and speaking insane, are the outward expression often of some silent delusion. These violences suggest that only trained nurses should be employed to attend the insane and that every hospital for the insane should have its training school for attendants upon the insane who should be trained in the gentle hand- ling of these peculiar patients and in understanding of them and their claims to sympathy, tender care and exten- uation of wrong acts and speech. "He that would lay hand upon a lunatic 'save in kind- ness,' as he who would strike a woman, except when in peril and in self-defense, is a wretch whom it were base flattery to call a coward." The remedy for this evil and crime against humanity, is to train nurses for the insane and employ only such, paying them good wages and debarring the politicians from naming them. The day of the political management of insane hospitals is past, for our day and generation, of an awakened and active public conscience. 240 Editorial. TOXIC INSANOID STATES AND DELIRIUM WITH CON- SCIOUSNESS. CROTHERS in Vol. 28, No. 2, of his journal of inebriety, which is a journal whose aim is the promotion of sobriety, gives a number of instances well worth reading of what he is pleased to term unrecognized toxic insanities, a rather too broad a term perhaps for the clinical facts related, but the facts are worthy of record and study. Alienists know about them, but medical men in general do not always recognize them as they ought and even some alienists. These alcoholized brain conditions are insanoid states or delirium modified by more or less of consciousness. POOR OLD DR. DOWIE, says the Christian Register, "has gone the way of all the earth, and his deluded followers will gradually sink back into the mass of the populace, and be lost to view. Whatever property is left under the control of the church will, as in all such cases in the past, gradually become a trust, and finally disappear from public viev. Dr. Dowie was half-deceived, no doubt, in regard to himself; and he was wholly mistaken in his belief that his claims to inspiration and healing power were sufficient to give him such popular currency as Christian Science has had under Mrs. Eddy. He caught a multitude, but not the people at large. There was always to the general public something of the grotesque in his attitude and claims which made it impossible for him to win general confidence. Since time began men of this kind have arisen in such numbers that the world is never without a representative of the class. They will continue to come until common sense, one of the rarest of gifts, becomes universal," and let us add until that class of people that flies off at a neurotic emotional tangent, at every new "wind of doctrine" be- comes less in number than now, through a more trained stability of mind and brain beginning in the cultivation of neurone stability in school life and ab initio vitce, ante partem, at conception and before. When the clergy enjoin that what God has joined together let-no man put asunder, let them be sure that God and not violated and perverted Editorial. 241 nature hath not through them, joined in God's name psy- chical and physical incompatables, the baleful point of whose conjugal union may not be psychic neurone instability and psychic caprice and even, in social, moral and religious affinities and conduct. AN OVER BRAIN STRAINED SIGNAL MAN BECAME INSANE, stopping the traffic on the Great Northern between Leeds and Bradford, England, for a time, but his insanity was fortunately discovered in time to avert great possible calamity. His wife thought he became unbalanced by overstudy on social and economic questions, but this was simply the direction his over-worked mind took as he was breaking, these questions of the day being in the line of his intel- lectual taste. Men must think about something. He is said to have been a man of exceptional thoughtfulness and knowledge, for his station, on social and economical subjects, believing he had a divine call from work. The man went mad suddenly in his box, but fortunately set all the signals at "danger" before deserting it. He locked the door at midday, walked down the line, and told a plate layer that God had commanded him, in a vision, to go out and preach the gospel to all the world. The laborer paid no attention to him, thinking he was joking, and Storey went on till he came to another signal box. There he repeated his story to the signalman, who promptly wired to the stationmaster at Laisterdyke. In the meantime about a dozen trains had drawn up on the line near Laisterdyke, and the wildest rumors began to circulate among the passengers. A new man was put in Storey's place and the line was quickly cleared. Brain disorder in its prodromal state should be looked for as well as color blindness, and guarded against by railway officials. THE STRENUOUS UNRESTFUL LIFE of railway engi- neers has many untimely endings like the following though not in precisely the same way. When will the right influ- ence of the medical profession be felt and good financial 242 Editorial. sense as well as right charity toward employes, prevail among railway managers? The brain has its limits of endurance beyond which it can not go, as the less delicate machinery of man's con- trivance. Over-tired brains are dangerous at the throttle or the keyboard. In this instance it destroyed the- engineer. In others it destroys the trustful travelling people. "J. F. Dunn, an engineer on the Illinois Central Railroad, on the fast train between East St. Louis and Carbondale for sixteen years, committed suicide Saturday night in his room at Carbondale by taking cyanide of potassium. "Dunn and his brother-in-law, Charles Wright, who had been acting as his fireman, retired at the end of their run Saturday night, and Dunn, who had been despondent for a week because of an accident to his engine said he would take some medicine and go to bed. "Wright soon knew that Dunn had taken poison and summoned a physician, but to no avail." Not suicide, but brain strain self-destruction. INADEQUATELY QUALIFIED PSYCHOLOGICAL EX- PERTS—In the criminal jurisprudence of insanity one of the gravest dangers of the day is the acceptance by the courts of witnesses as experts who are inadequately qualified because of insufficient clinical experience or profound study of the subject. In questions of homicidal insanity, medical fools, with scarce a scintilla of proper qualification may always be found willing to rush in and testify as experts, where the angel of an honest conscience and the counsel of a properly trained judgment and experience would fear to tread. Such medical men see in any extreme mental makeup of conduct and brutal violence which would not be possible to themselves, evidences of insanity and boldly so testify and characterize as insanity only, that which is heartless or reck- less violence. Their criterion is simply their inner conscious- ness and not experienced observation; what they imagine ought or ought not to be. They offer this under their solemn oath as experience founded expert opinion. Editorial. 243 And alas for justice, and the welfare of communities and the moral progress of society, learned judges often admit and sustain as legal evidence such ill-founded and usually erroneous medical guesses which then pass as legally scientific opinions. Under such wrong proceedures the innocent, by judicial connivance, are often hung, while the guilty as often go free. Great crime is thus sometimes condoned by immunity from the righteous vengeance of the law and innocence is male to suffer its direct penalties. Dishonest or consciously ignorant expert medical testimony is perjury. THE FARCIAL TRIAL of Thaw's sanity before a mixed commission, such as the New York law sanctions for determining the question of mental disease or mental soundness, by asking Thaw only such questions as bear upon his capacity to advise rationally with his counsel, is coram non judici, and ought to be so declared by revision of the New York statutes. INSANITY IS A DISEASE for doctors to decide by some- thing more than asking questions, and by asking questions not subject to limitation by the court. Thaw should have been questioned as to why he shot White, and as to the time and place and the manner he did, and what he thought about the dead now and thought then, and why he did not have White indicted instead of killing him, and how he felt and thought about the deed after, at the trial and before. A personal examination by medical men for all possible objective symptoms should have been made medically of a patient as to insomnia, constipation and other symptoms, as any other person afflicted with a similar disease would be. If the question is not one of possible mental disease, physicians should have nothing to do with it; if it is a disease, the question of mental disease diagnosis is beyond a lawyer or a layman's province. The latter should not have been on a medical diagnosis commission. A com- 244 Editorial. missio de lunatico inquirendo should be one of medical men only, employing medical methods of examination without restriction through order of judge, or of objection from attor- neys. Insanity is a medical question. Mental soundness or insanity is a medico-psychological question. "'BRAIN STORMS, THE 'EXAGGERATED EGO,' A LAYMAN'S VIEW if it is a mark of insanity, did not leave much of the insanity in or out of the Thaw case unex- plained. Now another expert has covered everything that was left with the 'brain storm.' "What juries are expected to believe is that people with exaggerated egos who have brain storms, are not re- sponsible for their actions. But the history of this coun- try and of every other is wholly contrary to that theory. "History shows that most of the trouble in tire world has been caused by people with exaggerated egos, who de- liberately formed the habit of having brain storms as a method of having their own way. "They discovered that their symptoms of brain storm are terrible to the timid. The storm might have been genuine at first, but they learned to have it at their own convenience, until it became a fixed habit of their exagger- ated ego. Then it is 'automatic.' They have it whether it is convenient for their own purposes and comfort or not. "This was known to Darwin. It interested him greatly. He studied it all the way down to the large, green cabbage worm, which after its "ego" becomes highly exaggerated by its rich diet, has a habit when interfered with, of swel- ling up and "looking terrible." It is really harmless, but its photographs, taken and published in various scientific works, show that when it is having one of its stomach- storms, it looks more dangerous than a rattlesnake. "A great step forward was made when it was found that by locking up people with exaggerated egos and teaching them the soothing rythm of the lockstep in going to and from useful labor, their habit of having brain storms can be relieved. This opens the way for indefinite Editorial. 245 progress in spite of the exaggerated ego."—Post-Dispatch, March 6, 1907. (The exaggerated ego of insanity is a dis- ease engendered egoism. ED.) THE PARATERESEOMANIAC might have his mind occu- pied to exhaustion with seeing new sights of gigantic sky- scrapers just now going up in St. Louis, of many styles of architecture and designed for many different uses. ONE OF THOSE EROTOPATHIC WOMEN, such as are prone to fix upon doctors, divines, lawyers or other men of growing prominence as their legitimate, erotic prey, is re- sponsible for the recent death of a leading, most reputable physician of a nearby city. Going to the doctor for treat- ment, and these women are always neuropathic as well as psychopathic with neurogenital erethism, she became im- portunate in requiring the doctor's attention by frequent telephone calls, and needless, until as is usual in such cases, the doctor protested and complained. The matter culminated in what appears to have been a jealous eroto- pathic engagement announcement by the lady, either under nymphomaniacal delusion or from nymphomaniacal design, to circumvent a possible engagement to another on the part of the erotopathically victimized doctor. The killing of the doctor by the disease dominated woman, and her own suicide at the same time and by the same means resulted. She shot the doctor and herself. These morbidly erotic women should have female doc- tors, but they will not accept them when you suggest them, and there are not as yet a sufficient number of capable lady neurologists, who could rightly manage them if they would. The only possible promise of freedom from annoyance of the male physician from these persisting erotopaths, is a freely opened and cleansed prima via and an anesthetized psy- chogenital tract, much as if treated for epilepsia, putting hyperesthesia and hyperkinesia in abeyance. The female erotopath in the physician's office is an annoying menace to the peace of mind of the medical practitioner as she is also often to priests, clergy and other men. 246 Editorial. EVELYN THAW AND HER DRUGGED DRINK?—Mrs. Evelyn Nesbit Thaw, in giving the details of her drugging at the hands of Stanford White, said that within two or three minutes after she had taken the glass of champagne, with the drug in it, she lost all consciousness. Now chloral hydrat in a full dose upon a specially susceptible person may act very briefly. Sitting at the bedside, 1 have been surprised often at the exceeding rapidity of its sleep- inducing effect in a thirty or twenty-five grain dose given largely diluted. I have seen a patient under such a dose pass into sleep within five minutes of its administration, just as if from a full 3/100, not abortiv ', dose of hyoscine hydrobromate. A patient's own estimate, however, of the time re- quired to produce sleep is modified by the drug's influence, and would be much like the estimate of time in normal dreams. THE SPREAD OF THE IMPULSIVE INSANITY IDEA. "Nifty in the Noodle."—An Irish criminal prisoner, fifty- four years old, defending himself before the Court of Crim- inal Correction, St. Louis, against a charge of petit lar- ceny, and acting as his own attorney and proving that he had a fool for a client, plead that he was emotionally and impulsively insane, "nifty in the noodle," as he expressed, and "couldn't help the theft." On this ground he asked the lenient judgment of the court, so That his friends might come to his rescue and pay his fine, which he con- sidered ought to be moderate, in view of his over-master- ing mental affliction. Judge Taylor was evidently touched with the "nifty- noodled" prisoner and, in charitable extenuation for his remarkable mental affliction, made the fine five dol- lars. "Nifty in the Noodle" is a rather new term to alien- ists for kleptomaniac psychokinesia, but it meant the same to Mr. Murphy, at least Murphy meant to please and pla- cate his honor, the judge, with this plea, for no criminal lawyer could make plea of insanity couldn't help it, more Editorial. 247 resistant for his client than the. same pauper criminal, who probably stole like Judge Baldwin's pig-stealing client, in "self-defense," of the gastric necessities of his hungry life. OPIUM-BROM1D TREATMENT OF EPILEPSY.—Kellner has treated 85 epileptics at the Alsterdorf asylum for idiots and epileptics with a special course of opium and bromid, which has resulted, he states, in the cure of 22 of the 54 patients who completed the course. In 13 others the seizures have become very much less frequent and less severe, with intervals of several months and without con- tractions. Only 6 patients failed to profit by the treat- ment. He gives for 50 days 0.05 gm. extract of opium three times a day, increasing gradually until the maximum of 0.29 gm. is reached the fiftieth day, the next morning 0.3 gm. is given and the opium discontinued. He then commences with 2 gm. of a mixture of one gm. each of potassium bromid and sodium bromid with half a grain of ammonium bromid, taken in a glass of fresh seltzer water. This dose is taken at noon and again at night from the fifty-first to the fifty-eighth day, gradually increasing it to the maximum of 9 gm. daily, which is continued for months. During the course of opium he gives three times a day a tablespoonful of 1 per cent, solution of hydro- chloric acid, and Carlsbad salts at need, with a light and predominantly vegetable diet, and a daily bath at 24 C. (75 F.) for 10 minutes the first day; 23 C. for 9 minutes the second day, and so on to a bath of 17 C. (62 F.) for 3 minutes the eighth day, repeating this without change for a week and then lengthening the bath by one minute until the maximum of 6 minutes is reached by the end of the 50 days of the opium course. The above dosage is for otherwise healthy adults.—Munchener Mediiinische Wochen- schrift. We give this place to condemn the opium in this method. Bromides and brain support, with autotoxine elimination without opium, will do fully as well in results. Epileptic suppression and cure are different. Time must elapse before you may know as to cure and, in a chronic trouble, such 248 Editorial. as epilepsy is, the long continued use of opium is unwise therapeutics. The success is in the full dosage of the bromide. All the results above may be secured without the opium and better with mercurials alternating with salines, whether Carlsbad or Epsom, etc. REFUSING EPILEPTICS TABLE SALT in their dietary appears unwise therapeutics, in view of the now plausibly established autotoxine and ptomaine conception of convulsive excitation therefrom, and the well-known antiseptic and antitoxic power of ingested chloride of sodium in minimum quantities. AN EXTREMELY YOUNG GIRL SUICIDE trying to form a suicide compact with another schoolmate, was discovered in St. Louis, March the fifteenth. The child was eleven years old, and bought and swal- lowed a dime's worth of carbolic acid, unlawfully sold to her by a thoughtless and law-defying drug clerk, who knew the law required a written order for minors. Neurotic instability is quite as apparent here as in some of the recent cases of unwritten law psychopathy, DR. CLARENCE MARTIN, of St. Louis Mo., has re- cently acquired the Medical Mirror and consolidated it with his own journal, the Medical Era. The Medical Mirror, the journal of the late lamented and talented Dr. I. N. Love, had a prosperous and successful career, and was one of the best known medical journals in the country. By consolidating it with the Medical Era the usefulness of the Era will be enlarged. The April issue of the Medical Era, the first number of the consolidated journals, and full of interest, is before us. We wish continued and increased prosperity to the Medical Era under the consolidation. THE TETANIC AND SEPTIC DANGERS OF GELATIN. A Government Note of Warning. Dr. Harvey W. Wiley, Chief Editorial. 249 of the Chemistry Bureau of the Government Agricultural De- partment testifying to the deterioration of cold storage food- stuffs, says that the Marine Hospital Service found tetanus germs in gelatin; that gelatin is made from the scrapings of hides "that smell to heaven" and that the gelatin factories are exceedingly dirty. He reminds us that our capsules, as well as deserts and candies, are often made from gelly. While these facts are not specially new, and are rather sensational, and while the treatment of hides with alkalies to prevent decomposition is proper enough, it is well to re- peatedly arouse the public to the importance of aseptic food factories, packing houses, and especially, clean- habited and disinfected workmen. Filth and food ought not to be mixed. THE CHILD'S PHYSIOLOGICAL MAGNA CHARTA— What Robert Rentoul in his latest work terms the "Chil- drens' Magna Charta" is the birthright to be born physi- cally and mentally healthy, the birthright to be happy, the birthright to be useful citizens and healthy parents. To secure these rights, sacred, saving and inalienable, society and the state should suppress the chronic brain disease engendering inebriate, as chief among the victims of the vicious neurone degeneracy or prevent his having progeny doomed to defect and misery. It should sequester the idiot and all congenital mental defectives and stop promoting the propagation, through lawfully authorized mar- riage of the degenerate, of abortive brains that handicap the creature, the state and society. Babes and children yet to be And grow to place among mankind, Have right to be, by traduction free, Of taint of blood or taint of mind, Science rightly enjoins the way And true charity should obey. (C. H. Hughes.) 250 Editorial. THE PUBLIC CONSCIENCE is now being aroused as to political and combined capitalistic criminality and the wrongs of organized greed. It must be aroused as to the crimes against the human mind and its normal integrity and against the causes, which engender defective and degen- erate organisms unfit for the requirements of civilized life. Lives like some of those of the "tenderloin bunch" and trag- edies like the White murder and lives like those of Thaw, Gui- teau and others who live on the paranoiac border line or in the swim of paranoia with paroxysms of psychlampsia and brain-storms, should be lived amidst judicious lawful sur- veilience. THE UNSTABLE PSYCHIC NEURONE, fearful, fatal, though also often only injudicious,whose instability is repeat edly brought to light anew to the Alienist and Neurologist, in the records of the daily press and in the writings of some of the daily press reporters to whom life seems to be only a series of abnormal psychic sensations and explosions, who seem to be troubled with a pathopsychokinesiac calamus scriptorius, has been justly made the subject of judicial strictures from the New York and Chicago courts. The Yellow Press sensationalists are doing the brains of the people no little harm by the way they dish up and promulgate the news of crime, the doings of criminals and the divorce court proceedings. The vaudeville and lower class of amusement caterers and the libidinous bill boards, are doing enough to promote neuropathic insta- bility and depravity and develop a morbid erotism among the people, without the powerful assistance of an over- sensational Press in facilitating psychic decadence among the people. It is pleasing however to note that some antidotal influences are at work in the better class of newspapers. In this connection we take pleasure in noting salutary reformatory and vicariously atoning efforts of the Press of St. Louis. The daily Press should endeavor to be more discreet in its sensational selections and act more on the side of Editorial. 251 sound morals and a sound, stable, self-governing psychology, with a view to strengthening rather than unstabling brains of an already (crime, pleasure and excitement) overwrought people. These United States have political duties now and the destiny before them demands and will demand steady brains and strong, as well as aims to answer great demands. DR. PERRY ON THE PATHOLOGY OF DIABETES at the Portugal Congress gave great and just prominence to the neuropathic element in this disease, a view in advance of former deliverances on this subject which has almost been in a measure the author's life work, a view advanced many years ago by the editor of this journal. The time is fast approaching when neurology will reign paramount in medical thought, as announced when the Alienist and Neurologist was founded in 1880. See editorial of initial number and volume. HYSTERICAL STIGMATA IN COURT.—A curious use of science was made in the St. Louis courts * * to explain what were alleged to be "knuckle marks" made on the person of one woman by a blow from another. It was alleged on expert testimony that they might have been "stigmata" due to the effects of highly wrought imagina- tion. Something over twenty years ago experiments were made in the "Charcot School," in Paris to find the possible effects of the imagination on the body. It was alleged in the reports of such experiments at the time, that a woman of highly nervous temperament was blistered by a wet rag on her back which she was made to believe was a mustard plaster. When these results of science are brought into court in Missouri, Missouri justice is entitled to know full details of every scientific step involved. But an important point in the testimony is the acknowledgment of physicians and scientists of the power of mind to create or modify conditions of the body. This field of research has scarcely been touched as yet, although its vital bearing upon health and upon the cure of disease is admitted. Science, instead of seeking the whole truth, is inclined to sneer at 252 Editorial. those who assert the discovery of truth in this field.—St. Louis Republic, March 3, 1906. As the alienist and neurologist expert in this case we have to say that stigmata were described as one of the possible symptoms of hysteria. The defending lawyer made the application to explain to the jury what he claimed as a delusive occurrance unsupported by other than the complainants' testimony. Physicians have never doubted the minds' influence over the body in disease. Their injunctions to nurses and all who come in contact with the patient is not to impair its influence and resistance by depressing demeanor or speech. The terms known to neurological medicine such as sug- gestive therapeutics, psychiatry, etc., are standing confirma- tions. It is the exclusive use of faith to the ignoring of natural methods and in lieu of experience that general medicine condemns. It regards medication as essential as diet, sun- light, air, sanitary surroundings and mental rest and hope in managing disease. The rational helps and supports of nature and sugges- tions of experience are as essential to the cure of disease, as the teachings of experience in eating, clothing, navigation or business management or as keeping a hotel. The "bless me this is richness" plan of Dickens' "Dotheby's Hall" does not always sustain bodies any better than it cures disease, with all people, though it may work on public credulity for awhile. The hopeful spirit of Mulberry Sellers is not to be discouraged in ministering to the sick, if the patient pos- sesses it. Cheerful optimism is always an aid to medical ministration, if the patient does not omit his medicine or take too great chances with adverse environment. But as faith is not a good substitute for physic when the bowels need a purge, it is not a good exclusive alternative for other physical states that need medication. INTERNATIONAL CONGRESS ON PSYCHIATRY, NEU- ROLOGY AND PSYCHOLOGY to be held at Amsterdam, 2nd-7th, September, 1907. At its meeting held on July Editorial. 253 24th, 1903, The Netherlands Psychiatry and Neurology Society unanimously decided to organize an International Congress on Psychiatry, Neurology, Psychology and the Care of the Insane. The eminent position, which the study of nervous and mental diseases to-day holds in the sphere of Medical science, and the great social interests, bound up in a com- plete knowledge of all the psychical manifestations of man, render it imperative (in order to afford scope for an inter- change of opinions) to have recourse from time to time to a wider and more specialized field than can be found in the narrow confines of sections of a General Medical Congress. While admitting the great importance of National Socie- ties for the study and development of Psychical and Neurological Science, it is incontestable that International Congresses are unique in their facilities for the complete examination of modern science and for the international collaboration, which Is indispensable to the real progress of Science. In the organization of the projected Congress the tradi- tions of the Congresses at Brussels and Paris have been followed. It is thought, however, that the importance of the Congress will be enhanced by the introduction of a section for Psychology, which by reason of its influence on our conceptions and methods of psychical examination, is entitled to occupy a prominent position at any Congress, dealing with the different manifestations of Psychical Life. It will be endeavoured as regards the section of The Care of the Insane, to follow in the footsteps of the Con- gresses at Antwerp and Milan. We thus earnestly solicit your attendance on our Con- gress, which will be held in Amsterdam, 2nd-7th, September, 1907. Under the Patronage of Her Most Gracious Majesty the Queen Wilhelmina and of His Royal Highness Prince Hendrik of the Netherlands. Honorary Presidents: H. E. The Minister for Home Affairs, Dr, P, Rink, H. E. The 254 Editorial. Minister of Justice, Dr. E. E. van Raalte; Dr. G. van Tienhoven, Commissary of Her Majesty the Queen in the Province of North Holland. Dr. W. F. van Leeuwen, Burgomaster of Amsterdam. International Propaganda Committee for the U. S. A. are as follows: New York: Drs. Carlos F. MacDonald, William Mabon, Charles Pilgrim, M. G. Schlapp, W. B. Pritchard, and Louise G. Robinovitch. Philadelphia: Drs. S. Weir Mitchell, John K. Mitchell, Charles K. Mills and W. G. Spiller. Providence, R. I.: Dr. G. Alder Blumer. Boston (Cambridge,) Mass.: Prof. William James. Madison, Wis.: Prof. Joseph Jastrow. St. Louis, Mo.: Prof. C. H. Hughes. Chicago, III.: Prof. Hugh Patrick. Montreal, Canada: Dr. T. Burgess. CHRISTIAN SCIENCE HAS A RIVAL in remarkable cures in a certain brand of whiskey, testimonials to the virtues of which may be seen in all of the daily papers, of people rescued from the doctors and undertakers by the hundreds, especially in the resussitation of old people rescued from the grave through its virtue and power. Some of them will probably live till they are translated under its inspiring spiritual influence. They will go on getting better, like the man with the fractured and shortened thigh under absent Christian Science treatment, whose leg began to grow and kept on growing till it made the other leg look short, because he lost the name and address of the scien- tist who started the miracle. CHOREA CONSIDERED AS A NEUROHUMORAL DIS- ORDER—Read at the Portugal International Congress by Sir Dyce Duckworth, a paper on "Chorea considered as Cerebral Rheumatism." in which he concluded: 1. That chorea (of Sydenham) is now regarded as a disease caused by an infective agency, and not as the Editorial. result merely of shock or fright occurring in persons of neurotic instability. 2. That the peccant matter of rheumatism, which is now recognized as of microbic origin, is certainly the most frequent if not the sole cause of the infection. 3. That no other microbic element than this diplococcus has been discovered in those cases of chorea which are believed to be unconnected with rheumatism and independent of rheumatic influence. 4. That the infecting agent appears to be somewhat akin to but distinct from other varieties of streptococcus which induce ordinary forms of pyaemia. 5. That chorea is therefore to be regarded as a form of rheumatism involving the membranes and cartical struc- ture of the brain, and is in fact cerebral rheumatism. 6. That there is a neurotic element in the pathogeny of chorea predisposing subjects thus impressed to this man- ifestation, amongst others, of rheumatism. 7. That chorea is thus a neuro-humoral disorder." Whatever be the relation of the diplococcus infection above referred to there is no doubt in our experience of the depressing and exciting cause on influence of psychic shock. Too many well proven instances have come under our personal observation and recovered under neurotic tranquili- zation and reconstruction treatment without anti-rheumatic treatment to permit us to doubt the prime importance of the element of cortex-instability in the functional display of this disease. ED. THAW'S 1NSANOID MORBID EGOISM—We may not say, in the hearing of the court, paranoiac morbid egoism, for though able experts have called Thaw a paranoiac, others have denied the paranoia and the jury of two laymen and one doctor have pronounced him sane. Real paranoiacs seldom, if ever, recover except in outward appearance. We must therefore improvise a new term—paranoiad (like para- noia) as paranoia is so near, so like other forms of insanity and yet so different, so like the folie raisonante, itself so 256 Editorial. * like sanity, because its victims can reason, that it was for long disputed till the Germans found this latter term for this very similar condition. Paranoiacs are always ready under stress of strong or slight exciting influences, to display the innate latent psycho- kinesiac aptitudes and slumbering tendencies to imperative conceptions and fulminations, breaking the monotony of quiescent delusion and abiding morbid mentality, in revealed mental disease when and where not looked for by the non- expert. The startling psychlampsias of paranoia and paranoid, like the morbid brain-storms of other cerebro-mental diseases, serve to show insanity, as the lightnings in the approaching cloud serve to show that electricity is in the atmosphere. MINIMUM AND NON-ALCOHOL PRESCRIBING re- ceived much proper consideration at the late meeting of the British Medical Association. The medical profession has had its day of intemperance in prescribing the alcoholics, as was there clearly shown in the addresses of Victor Horsley and others. Intelligent people likewise, appear to have had their day in the intemperate drinking of alcoholics, and the tide of liquor drinking among the well-informed is ebbing. Alco- holics unwisely prescribed are as much a mockery in re- sults as when unwisely imbibed. THE XVITH INTERNATIONAL MEDICAL CONGRESS at Budapest in 1909.—The XVth International Medical Con- gress, held in Lisbon, have chosen Budapest, the capital and residence of Hungary, for the site of their next assembly, and the preliminaries are already in process. His Imperial and Apostolic Royal Majesty the King has graciously taken upon himself the patronage of the ensuing congress. The state and town have each contributed 100,000 crowns to defray the expenses. The committee for the organization, execution, disburse- Editorial. ments and reception, as also for the sections is already formed and the statutes are drawn up. There are 21 sections, each branch of science having a separate section assigned to it. The date of the opening is fixed for the 29th August 1909, and the sessions will be continued till the 4th of Sep- tember. There is every reason to presume that the congress will be well attended. Hitherto they have shown an at- tendance of from 3000 to 8000 participants. Judging from the geographical situation of Budapest, at least from 4000 to 5000 participants may safely be reckoned upon. The managers of course, attach the utmost importance to the scientific activity of the congress, and every effort is being made to win over the most prominent representatives of medical science. The first circular, which will contain every necessary information as well as the statutes, will be ready for circu- lation in the course of the year 1907. Meanwhile the Secretary-general of the congress (16th International Medi- cal Congress, Budapest, Hungary, VIII., Esterhazy-utcza 7), will have much pleasure in giving information to inquirers. Emil Gr<5z, M. D., Professor to the University; Secretary- general of the Congress. Caiman Miiller, M. D., Profes- sor to the University, Member of the House of Magnats; President of the Congress.—Budapest, March 1, 1907. THE CINEMETOGRAPH DEMONSTRATION of various forms of Epilepsy, Athetosis and other nervous diseases by Dr. Chase, of Boston, before the Portugal Congress and the last meeting of the American Medical Association at Toronto is a novel and excellent method of showing symp- toms of spasmodic diseases, and a great help in certain clinical lectures, as on epilepsy, for instance, where the subject fails to make a timely demonstration for us. 258 hditorial. A RARE NOTE OF THANKFUL OBLIGATION FROM A RARE ATTORNEY. DR. C. H. HUGHES, 3872 Washington Blvd., City. Dear Doctor:— Herewith we hand you our check as agreed, in full payment for your professional service ren- dered as expert in case of , et al. Kindly send us receipt, and permit us here and again to express our appreciation of your patient willingness to enlighten the ignorance of, Yours truly, * * * This sense of obligation to a psychoneurological expert is rare. The diligent inquiry of the attorney before the trial as to the essential facts to be proved in order to es- tablish the nervous disease existing, is exceptional. Usually the medical expert has to thrust his knowledge upon the attorney and insist on a certain line of diligent inquiry in the right line of testimony, and upon the line of questions to ask, and on showing the answers, in order to awaken the lawyer to a full realization as to what to do in order to establish disease. Too many await possible developments on the days of the trial. PUBLIC RECOGNITION OF MEDICAL MEN comes grudgingly on strictly medical lines. He may bring to light and put back "the pestilence that walketh in darkness and stay the destruction that wasteth at noonday," and his good work is too often overlooked or accepted as a matter of course, as the dishes of a cook are received or the work of any servant. But when a medical man steps aside into literature and makes a mark, as many do, and more could, it is noted. Weir Mitchell's fiction has made him more fame with the public than all his valuable facts contributed to neuro- logical science, and so with Oliver Wendell Holmes. He discovered the contagiousness of puerperal fever and con- Editorial. 259 tributed thereby to the saving of thousands of human lives, but Autocrat of the Breakfast Table alone gave him far more fame than that. And so we hear of Brunton, Conan Doyle, Hammond and others. Yet as a contemporary of Mitchell, Bartholow, Sequin, Amadon and others, the latter contrib- uted his share to medical discovery and resources in the field of neurology. If a medical man imprudently ventures into literature, while yet aspiring for patronage in practice, he imperils his professional reputation and there are not wanting those in the ranks of his guild who will uncharitably say "he is a good writer, but not much of a practitioner," as though a competent medical man could not fit himself for forceful thoughtful expression on matters of human concern, as well as wear good clothes and rightly-fitting on his frame. The medical man who well and rightly sees and thinks and speaks concerning his profession, should neither be blind nor incapable concerning the rest of his environ- ment. The observant , well-educated physician is well in- formed in the collateral sciences and should be the broad- est of anthropologists. THE BLOOD PRESSURE IN CASES OF PARETIC DEMENTIA.—The preponderance of opinion inclines toward the view that the pressure is low in the later stages of the disease, although the evidence adduced is not altogether conclusive. With the view of determining this point on the basis of personal knowledge, Dr. G. L. Walton (Journal of the American Medical Association, October 27, 1906, p. 1341) made an examination of 108 male patients, and he has found that the average blood pressure in cases of paretic dementia is on the whole high, probably as a result of atheroma and its cardiac and renal accompaniments. On the other hand when atheroma, cardiac enlargement and renal disease are absent the average blood pressure appeared to be somewhat lower than that of health, although the variations were so marked that the pressure could not be said to be uniformly low. Accordingly it will be seen that 260 Editorial. this test is not likely to prove of great value in the differ- entiation of paretic dementia from other disorders of the nervous system. The observations tended further to indicate that the excited states of paretic dementia are as likely to be accompanied by high as by low pressure, that mental depression is accompanied by high oftener than by low -pressure, although it is not incompatible with a low pres- sure, and that while the average pressure in the presence of euphoria is perhaps somewhat lower than in the presence of other mental states accompanying paretic dementia, it is not inconsistent with high blood pressure or with pronounced atheroma, with its cardiac and renal accompaniments.— Editorial, Pennsylvania Medical Journal, January. A RIGID AND RIGHT INVESTIGATION of the late ter- rible'collision disaster at Terra Cotta Station, near Washing- ton, D. C, would probably reveal a wearied, not well-acting brain, from too little sleep. Maybe with drink-weariness added, a custom too common to the season with men who have life-caring duties to perform, or loss of sleep and im- paired powers of attention from other cause. Nearly every investigation of every railway accident in- quires into the question of sleep. It should be known if the inspector of wheels and brakes and trucks has had the sleep he needed, and if not, why. On the engineer and the train dispatcher depend such consequences to life that the hand that moves the throttle and sends train-moving or detaining dispatches, should be the highest style of man, with mind capable and alert to the importance 'and means of keeping at all times a clear, strong head and mind for unerring work, and he should be treated accordingly by himself in all his habits of life and by railway management. Treated right as to tax on their vitality and liberally as to salary for such important service. 16,937 RAILWAY CASUALTIES, 194 directly caused rail- way deaths in three months in the United States for the quarter ending June 30th, 1906 and 274 deaths for the pre- Editorial. 261 ceding quarter, and almost a like number for the following quarter, suggest the need of a rigid official inquiry and remedy, not only into the safety of railway construction and equipment, but into the mental condition of the man- agement and men that make such enormous maiming and death lists possible. Mental inadequacy and moral obliquity must be largely to blame for such horridly inhumane and fatal railway management. Weak brains, over-wearied and worn brains, wrong thinking and wrong feeling, inhumane brains, with avarice, fiendish dividend-making and greedy charity-killing brains, dollar-saving, life-destroying brains, overworked and overborne brains are too much in evidence in our railway management and service for the good of humanity, espec- ially that part which goes to make up the railway suffer- ing and destroyed American people. NOW IT IS THE PRESIDENT, the corypheus of the strenuous life, who has reached the result of ceaseless cerebro-psychic strain and approached so near the verge of grave cerebrasthenia that he is to take a timely rest at Oyster Bay, with a very quiet domestic program arranged for him there, if he can be permitted to carry it out, which would seem scarcely a possibility. A visit incognito to Alaska or to Iceland, or a long sea voyage beyond the reach of news even by wireless aero- gram, would have been and would yet be best. Presidents need brain rest like other mortals and should cultivate, through adequate, quiet retirement and relaxation, that re- cuperation of psychic neurone stability which gives the mental poise and equanimity and freedom from the neurone irritability of cerebrasthenia so essential to the brain of the chief executive of a people, who kill presidents by over- work demands upon them, as well as by direct assassina- tion. His excellency may perhaps be now blissfully thinking some of the things Pope said in his farewell to London: "Dear, D , distracting town, farewell, Thy fools no more I'll tease; Now in peace let critics dwell And pitchforks rest at ease.'' 262 Editorial. A JUST COURT DECISION. HOT WATER IN EAR IS "EXTERNAL " INJURY, RULES THE COURT.—Last March the Kansas City Court of Appeals decided that the chance injection of scalding water into a man's ear was "An accidental, violent and external injury." John D. Driskell died from the effects of scalding water dripping into his ear from an engine around "which he was working in the Missouri Pacific shops in Sedalia. He held an accident policy in the United States health and accidental insurance company, but that company re- fused to pay the policy upon the ground that an injury from the dripping of water in the ear was not an external, violent and accidental injury. But the appellate court de- clares that it is. The case is sent back to Pettis county for trial. AMERICAN MEDICAL EDITORS' ASSOCIATION.—The 38th Annual meeting of this Association will be held at Atlantic City on Saturday, June 1st, and Monday June 3rd, with Headquarters at the Marlborough-Blenheim Hotel. This active Association now numbers nearly 150 members with many applications in hand for action at the coming meeting. An interesting programme has been prepared. Besides the President's address many valuable papers will be read. It is anticipated that the coming meeting will exceed any prior meeting in point of attendance. The Annual Editors' Banquet, the social event of the week, will be held at the Marlborough-Blenheim Hotel on Monday evening, June 3rd. DR. HERMAN A. SANTE married to Mrs. Mary A. Sante ought to prove a healthy union in the salubrious climate of St. Louis. Bon Sante, doctor and Mrs. Sante. IN MEM0RIAIY1. DEATH OF THEODORE BUHL.—The great medical manufacturing firm of Parke, Davis & Company, lias lost its efficient and most worthy president, and we join in ex- pression of the general regret that Mr. Theodore D. Buhl is no more. His death occurred April 7th of the present year. In his loss the medical profession and business world, as well as his family and friends, lose a good man, genial, personal associate and forceful factor in business and professional circles. "Ten and a half years ago Theodore D. Buhl cast in his lot with this house. Throughout that period he has given us the benefit of his large experience, his sound judgment, his great power in the commercial world, his granite credit reared on an unwavering honesty. As presi- dent of the house he was the perfect type of in- tegrity and fidelity to all the stockholders. His high sense of duty as a trustee pledged to administer the property and guard the interests'of others, was ever uppermost in his thoughts. The peculiar responsibilities and hazards of our work—our obligations as purveyors to the medical profession and to suffering humanity, were to him always a solemn appeal. The ultimate triumph of character in busi- ness was with him a conviction as deep and strong as in- stinct. The remote future and the distant prize concerned him more than the present gain. The strength which he gave this house and all the many enterprises in which he shared, signally exhibits what the world should realize especially at this hour—that rich men of unflinching honesty and sound judgment are of inestimable value to their communities. They are the em- ployers of labor, the authors of new industries, the creators (263) 264 In Memoriam. of new values, the pioneers who open up vast avenues of opportunity for their followers. As they succeed or fail, the comfort, the very bread, of thousands is assured or en- dangered. We hear much these days of unscrupulous, pre- daceous wealth, but what of the type of Theodore Buhl— what of the men who consider the trust of their fellow- men the best of their possessions, who have a horror of stock-jobbing methods, who never seek unfair advantage, who never lend their name to a dubious enterprise. As a director Mr. Buhl was the soul of courtesy, kind- ness and deference. As an employer he was considerate, thoughtful, mindful of the comfort, interests and claims of his employes. To their grievances he gave always a pa- tient and attentive ear. He encouraged the manly ex- pression of honest opinion, and when it differed from his own his effort was to convince and persuade, not to invoke his authority or impose his will. On behalf of the stockholders, employes and executives of Parke, Davis & Company we record this testimony to the lasting service rendered us by our lamented President. To the members of the bereaved family we offer our warm and heartfelt sympathy. May strength be theirs to bear their sorrow. May they find much comfort in the memory of a life rich in well-doing and in good repute." CORRESPONDENCE. FEINTING, FAINTING BERTHA.—Following is a cor- rected version of the woman known to the police as Fainting Bertha: We are advised that the newspaper statements con- cerning this case are not correct in several important details. The essential facts are as follows: Bertha originally came from Omaha, Nebraska. When quite young she showed a certain moral defect, which made it necessary for her people to send her to an institution for feeble-minded, where she could be kept under close control. She was kept there for sometime but either escaped or was dis- charged. Soon afterwards, when she was about eighteen, she became acquainted with a man. who, as she claims, taught her stealing and also was instrumental in inducing her to engage in immoral pursuits. Sometime afterwards she was adjudged insane and sent to one of the State Institutions in Iowa. She escaped from that Institution, also from another institution in the same state, to which she was again committed. After that she visited very many large cities in the country, but mostly Chicago, which she seemed to prefer. She was arrested on several occasions and sent to the Joliet prison. From there, because of her excitement and immoral conduct, she was declared insane and sent to the State Hospital at Kankakee, Illinois. She escaped from that institution on two different occasions and was later sent to the Illinois Southern Hospital, from which she also escaped twice. The first time she was captured in the vicinity of the hospital and the second time succeeded in getting as far as Peoria, Illinois. At the request of the Superintendent of the Asylum for Incurable (265) 266 Correspondence. Insane at Peoria, she was re-committed to that Institution and is there at present. According to the history, also according to the patient's own statement, the girl was always backward in school and always had shown a very poor emotional control, being practically a creature of impulses. She was diag- nosed a case of moral imbecility by Dr. Witte of Iowa. Other physicians agreed with his diagnosis. As regards the "fainting," which gave her the name of "Fainting Bertha," according to the statement of the patient herself, she was taught the method by a profes- sional thief, but did not practice it so much in the stores, but frequently in the open by "fainting" into the arms of men carrying heavy gold-chains and apparently generally well to do and while they caught her and held her she succeeded in obtaining all articles of value and concealing them in her dress. Aside from this "fainting" method, she is also an expert shoplifter, being very quick in con- cealing silk and other valuable articles under her clothing. Her escape from the Northern Illinois Hospital for the Insane was accomplished in the following manner: In going to a regular entertainment she succeeded in diverting the attention of a new attendant, who had been in the institution only about two days. While talking to her and walking with her she appropriated the attendant's key. A short time after she entered the hall she became decidedly excited and it was necessary to have her taken back to the ward. She quieted down as soon as she was brought back and apparently went to sleep. When the attendants returned to the ward after the entertainment she was gone. There was no fainting about this last affair.— Hospital Interne. SELECTIONS. CLINICAL NEUROLOGY. NERVOUS PHENOMENA DURING PASSAGE OF CHYME THROUGH PYLORUS.—(Nervose Erscheinungen beim Ueber- gang des Mageninhaltes in den Darm.) F. A. Kehrer. Kehrer urges study of the phenomena that occur in some persons as the stomach content is passed along into the duodenum. He thinks that regulation of the diet might prevent the annoying phenomena. He speaks of three phases, the phase of sensation of over-loading of the stomach; the digestive phase, during which the stomach is quiet, and the phase of expulsion of the stomach content. During the phase of expulsion local phenomena occur in the stomach, heart and lungs. They consist in oppression in the epigastrium, oppression or pain in the heart region, especially when lying on the left side, palpitation and suffocation. These symptoms are probably due to direct mechanico-chemical irritation of the ramifica- tions of the vagus, or reflex action from the stomach nerves on the nerves of the heart. The oppression causes night- mare. Any mechanical interference with the respiration, for example, by a blanket covering the face of the sleeper, may cause nightmare. Another group of nervous phenomena at the beginning of the phase of expulsion consists in waking out of the first sleep with bad dreams. Kehrer thinks that the changes in the circulation of the brain from the flow of blood to the digestive organs, causing compara- tive anemia of the brain, are not so important a factor in these phenomena as generally supposed. More probable, he thinks, is the assumption that some of the chyme (267) 268 Selections. passing into the intestines is absorbed immediately by tlie mucosa of the small intestine, and is passed by way of the blood to the brain and there induces the above phenomena of irritation. Whether it is the peptones, the fat acids or the bile pouring out into the duodenum, or whether with morbid digestion abnormal products are generated, or whether irritating substances from the food are the cause of the disturbances is a question still undecided.—Ex. Jour. A. M. A. Kehrer concludes with some precautions as to ever- loading the stomach, at night with tardily digestible food, etc* Much depends in these cases upon the erothesen of the nervous system including the brain, for a full meal and particular foods that disturb at one time do not do so at another in the same person. A full dose, say sixty grains of bromide of sodium and two fluid drachms each of ess. pepsine and essence pancreates, will, immediately after or during the meal, abort these unpleasant symptoms.—Ed. THE PATHOGENESIS OF FACIAL HEMIATROPHY.— A. Gordon reports a case occurring in a negro male, aged forty-two years. He cannot believe in the exclusivism of the sympathetic origin of the malady, as his own case seems to controvert such a theory. According to some observers a primary atrophy of the subcutaneous cellular tissue is the essential feature of the coadition. Others believe that it is of a nervous origin and may follow affec- tions of either the sympathetic, trigeminus, or facial nerves. The majority of cases reported point to an involvement of the inferior sympathetic ganglion. Concemitant pulmonary lesions are found at the apex in many of these cases. This is accounted for by the relations between this ganglion and the pleura at its apex. The author's case presented not only a trophic disturbance of the facial muscles, but also sensory disturbances over the area covering these muscles. That the lewer cervical ganglion did not play a role in the causation of the disease in this case was evident from the fact that there were no pupillary changes nor vasomotor disturbances on the affected side. It is possible that the sympathetic fibers found in the fifth nerve may Selections. 269 play a certain role in the disturbance of nutrition of the facial muscles, but association of sensory disturbances and the neuralgic pain in the same area immediately preceding the beginning of atrophy present a strong presumption in favor of the trigeminal pathogenesis of the affection. As to the question of facial nerve it cannot be admitted in this case, as there was no genuine palsy of the affected muscles. The patient had preserved the ability of con- tracting them, but the degree of contraction was, of course, smaller by reason of the atrophy. The sensory disturbances also were against this view. The author concludes that hemiatrophy of the face may be caused by the lower sym- pathetic ganglion with its nerve, by the fifth nerve, by the Gasserian ganglion, finally by a central lesion. The ten- dency of some writers to attribute Romberg's trophoneurosis exclusively to the sympathetic nerve fibers is erroneous.— New York Medical JournaX. THE INSANITY OF INEBRIETY.—According to T. D. Crothers the term inebriety describes a pathological con- dition demanding alcohol for its anesthetic effect and refers to some depressed state or psychic condition which con- sciously or unconsciously calls for relief which alcohol gives with satisfaction. Alcohol is not the cause, but merely a symptom. Hence the condition must be one of disease and organized degeneration. The author then goes on to describe various types of this form of insanity and the proper methods which should be followed in controlling it. He notes that to all ordinary observation a periodical drinker resembles the insane in conduct and reasoning. Such persons use spirits to extreme toxic states for a brief period, then rigorously abstain for awhile and then relapse. This resembles acute mania in the dominance of the drink impulse overwhelming the mind and body for a period, then subsiding. It also resembles epilepsy in its sudden convulsive onset, and inability to reason and control up to a certain point. Often the periodical drinker is unconscious of the import and meaning of these symptoms. He will suffer from insomnia, headaches, great irritability, intense 270 Selections. nervous anxiety, and dread of loss. He will consult phy- sicians, believing he has serious organic diseases, go off on vacations, make changes in his surroundings and business relations, then all unexpectedly, will drink to great excess, when all these symptoms will disappear. In most cases there are distinct premonitions of the drink storm in conduct, reasoning, and appearance, which the friends recognize, but the victim does not. A large class of the periodical drinkers seem to have some consciousness of the coming attack, and use means to avert it. They often go to hospitals and sanatoria, particularly where they have had some experience before, appearing in a state of great fear and excitement, which quickly disappears. The storm is averted for the time being, and such cases are always very hopeful. In many persons of this class of periodical drinkers, the premonitory symptoms take on the form of reasoning manias. Thus they make elaborate preparations in business affairs, providing for their absence during drink attacks. Many of these persons are active in social and religious work, but a period of unusual fervor is often a precursor of a drink storm. Some show great exaltation of mental activity; others take on a different personality while drinking. With some certain atmospheric and electric conditions bring on an attack. In all there is an unstable highly sensitive brain and nerve organization with a tendency to exhaustion on the slightest occasions. A clinical history shows that heredity is a very large factor in this instability and feeble pain resistance, it also shows that injuries, irregularities of living, defective nutrition, sleep, and excessive strains and drains with other causes predispose to a convulsive con- dition of nerve energy and depression, for which spirits is a grateful narcotic. JUVENILE ALBUMINURIA—Ullmann (Ber. Klin. Noch.) examined the urine of 42 school children a number of times and found albumin in a third of the cases, although the children were all healthy. Only one had passed through scarlet fever; 9 had had measles, and one recurring tonsil- litis. In 3 instances the parents stated that the children Selections. had never had an acute infectious disease. On the other hand, a considerable proportion of the children free from albuminuria had a history of scarlet fever or measles'in the past. The amount of albumin ranged from traces to 10 per thousand—this largest proportion being found in the urine of a girl in apparently robust health. He remarks that this juvenile physiologic albuminuria usually vanishes without treatment or persists whatever treatment may be instituted. It does not seem to have any effect on the general health or life expectancy.—Cum. Med. Lit. J. A. M. A. NEUROOPHTHALMY. THE TENOTOMOMAN1AC who operates on the eye- museles for Morton's Toe, Rheumatoid arthritis, phlebitis, choroiditis, for all reflex ocular neuroses, for all diseases, for anything you please, is a remarkable product of our time and conditions. For snipping a tendon (or the conjuc- tiva) he secures several hundred dollars, and for doing it on the same patient a score or more times he charges several thousand dollars. He operates on every patient that enters his office, and no one knows whether the oper- ation is on the tendon or upon the conjunctiva only. One thing is certain:—a tremendous effect is made upon the patient, his friends, and upon pocket-books. Usually one operation suffices to scare the eye or the patient into non- complaint or silence. If the subsequent result is good it comes through the correction of the ametropia by means of glasses prescribed soon after the operation. First the fee; second, the operation; third, refract; fourth, credit the cure to the operation. From a careful physician in a distant state 1 have just received the following letter: "Dr. in this town, a specialist in eye diseases, a pleasant man personally, but curiously constituted men- tally, so far as his fellow practitioner is concerned, has for some years made, as people call it, a specialty of the eye- 272 Selections. muscles, and, when he finds imbalances, which he finds in a great many cases, he sends them to Dr. for operation. He claims that Dr. is poor and has never made over ten thousand a year. He has gone farther than that and got another tenotomist into this state as a licensed practitioner and that man comes here every summer and operates indiscriminately on cases Dr. has reserved for him during the winter. This past summer he has been here and, as I hear, performed some 70 operations, most of them without much benefit. Now what shall be done about this charlatanism? How can it be stopped? I hear that this man does not pretend to test the refraction at all, UNTIL he has done the operation for the fee. 1 now have in my office an instance which passes comprehension had 1 not seen it. A woman of 55 had retinitis with choroiditis and small retinal hemorrhages resulting in meta- morphosia; O. D. light perception only; O. S. H. with Ast. He fitted her to lens O. S. getting 0. 7 V.; O. D. did his best getting 0. 2, and then claiming that she had exophoria he operated on both eyes twice with no benefit to the exophoria, nor, of course, improvement to vision of O. D. - with its hemorrhages and chorioretinitis. Now why on earth any decent man. would operate oh muscles to cure or relieve intense photophobia resulting from chorioretinitis, passes my ideas of medical honesty. The condition is due to car- diac disease or an old traumatism of the skull. This is indeed muscle-snipping with a vengeance, is it not?" In the same mail I receive a letter from a critic who urges that the profession must be united against ophthalmic quacks outside of the profession. 1 answer that this is a most desirable thing, and that 1 have urged it every year, in season and out of season, for all the years of my life as an oculist. But I add the query: What about the quacks within the profession, shall they be asked to join in the crusade against those outside? Our own little Augean Stable is pretty mirey. Do we care less for the mire than we do for getting the professional stabling? Good medicine as well as cunning astuteness would appear to counsel the cleaning of the professional stables. The scientific blunder Selections. 273 which explains the vogue of the tenotomomaniac is the nonrecognition of the truth that heterophoria is primarily and almost always the result of uncorrected and malcorrected ametropia. Prevent the eyestrain and the heterophoria is prevented. Neutralize the eyestrain of ametropia and tenotomy is unnecessary. Surgicalizing the effect does not cure the cause. The addition of quackery to the surgery scarcely lessens the evil-doing.—From Types of Ophthalmic Charlatanism, by Geo. IV. Gould, Dec. No. Cleveland Med. Jour. NEUROSEMEIOPATHY. ABORTION AS A CAUSE OF TETANUS.—Tetanus and other nervous disorders may follow abortion. The follow- ing instances are recorded in lately arrived medical dictionary: "Case of tetanus following abortion at the fourth month. Brownlee (New England Med. Monthly, Nov. '91). "Case of Hemiplegia following abortion. The cervix had been dilated with tampons to remove an adherent portion of the placenta. Fenwick (American Jour, of Obst., Apr., '91). "Case in which, twelve days after a supposed artificially produced abortion, a 30-year-woman suffered from trismus and tetanus, the convulsions being severe and frequent. Successful treatment by means of antitoxin. Ch. F. With - ington (Boston Med. and Surg. Jour., vol. cxxxiv, No. 3, '96)." NEUROTHERAPY. FURTHER EXPERIENCE WITH OPSONINS.—Reports are now beginning to come in from various observers relative to the matter of opsonins and the positive value of the new theory. In the Lancet of January 5 is a report of a recent meeting of the Manchester Pathological Society, at which Professor A. H. White of Dublin related the results of his experiences of inoculation on the lines laid down by Wright, 274 Selections. and explained the necessity of repeated blood examinations in order (a) to regulate the size of the dose and thus to eliminate the negative phase effect as far as possible; and (b) to determine the length of time its effects lasted. He detailed the effects of surgical procedure on the opsonic in- dex and showed how clinical improvement following a sur- gical operation where only a part of the disease was re- moved was coincident with a rise of opsonic index, and that relapse with involvement of a fresh area resulted when a fall in the index occurred. Moreover, he showed that such cases might be completely cured by inoculation, as soon as the opsonic index fell, of suitable and properly interspaced doses of tuberculin. In the course of the dis- cussion, Dr. Loveday showed that an attempt to find a small dose of tuberculin which could be used empirically in all cases failed. Different doses of T. R. had very differ- ent actions in the same person. A very small dose might give a curve of opsonic indices very similar to that obtained by too large a dose. In some cases it was really too large and still smaller doses were required, while in others a larger dose gave satisfactory results. There was an op- timum dose for each patient only to be determined by fre- quent observations of the opsonic index. The question was still further discussed by Dr. Ramsbolton, who spoke of the therapeutic use of inoculations of staphylococcus vaccine in certain common affections, and emphasized their value in cases of furunculosis and the severer forms of acne, when the pustular eruption was plentiful and the individual pus- tules were large, in contrast to the milder cases of acne consisting of a "few spots on the face" which did not seem to yield so readily to this treatment. In quoting the actual cases treated stress was laid on the fact that the opsonic index, before treatment, in the cases of furunculosis and the severer forms of acne, was below normal, whereas in the milder forms of the latter affection the index was about, or just above, normal.—Ed. Med. Rec, Jan. 26, 1907. DIONIN.—In Merck's Archives for October, (from Ophthalmic Record), G. C. Savage observes that since Selections. dionin is neither a mydriatic nor a myotic, it has been hard to understand how it can help atropin to dilate the pupil in iritis, and also aid eserin in contracting the pupil in glaucoma. Recent observations on cases of iritis in which there was not only complete adhesion of the pupil- lary margin to the lens capsule, but the pupillary opening was also filled with plasma, and a solution of dionin was used five minutes after the instillation of the atropin, showed the plasma disappearing from day to day and at the end of one week it had entirely disappeared. The pupil dilated slowly, but in all there was practically com- plete dilatation. The disappearance of the plasma that could be seen was proof that the unseen plasma binding the iris to the capsule had also disappeared,—that it had been lissolved and carried out of the eye by way of the lymph channels. There is no room for doubting that dionin did this work. It is reasonable to conclude that dionin helps to dilate the pupil in iritis by its solvent effect on the plasma that would cause and maintain adhesions, and that it hurries out of the eye the the dissolved plasma by open- ing the lymph channels. The relief of pain is another very desirable effect to the credit of dionin. In the treatment of iritis this drug is invaluable when used, of course, in con- junction with atropin. How dionin aids eserin in contract- ing the pupil in glaucoma and how some contraction might be effected by dionin alone, would not seem hard to under- stand. By opening the lymph channels, thus encouraging the outflow of the watery contents of the globe, it lessens intraocular pressure, this allowing a freer flow of nerve stimulation to the sphincter muscle of the iris. THE TREATMENT OF NOISES IN THE EAR UPON A DIET FREE FROM SALT.—Lermoyez records (Ann. d. mat. de Voreille, du larynx, etc., Paris, 1906, November) the case of a man, £et. 76, who had suffered for eight months from noises in his left ear resembling the crackling of parch- ment. They were intermittent in character, but they be- came almost unbearable. Sometimes at their onset they caused vertigo, so that the patient was obliged to support 276 Selections. himself. The noises could not be heard by the examiner, even with the auscultating tube. There was no evidence that either the tensor tympani or stapedius muscle was concerned in the production of the tinnitus. The hearing was defective, and low tones were rather better perceived in the left ear, in which were the noises, than in the right, which was free from them. The difficulty was in determining the cause of the tinnitus, and, under the impression that it arose from extra- aural influences, no local treatment was applied, but the patient was instructed to modify his diet and improve his hygiene. As the result of adopting a salt-free diet, an ex- cellent result was obtained: the tinnitus became less marked, and finally disappeared. Pierre Bonnier, who some years ago studied the influence of Bright's disease upon the ear, published an observation, which apparently did not receive much attention. In the case of a young girl who suffered from spasmodic contractions of the tensor tympani, the exhibition of a milk diet caused the total disappearance of her ear symptoms. He attributed this tonic contraction as due to some degree of renal insufficiency. In Lermoyez's case, albumin was found in the urine. He did not put his patient upon a purely milk diet, but contented himself with eliminating the chlorides. This restriction, as already in- dicated, proved most successful. This question of diet has already been the subject of more than one communication in connection with affections of the ear, nose and throat. Thus Jaquet (Ann. d. mal. de I'oreille, du larynx, etc., Paris, 1904,) drew attention to the remarkable effect of a salt-free diet in the treatment of chronic obstructive nasal catarrh. It proved of more value in patients suffering from Bright's disease than did any local treatment. At a more recent date, Chauveau (Arch, Internat. Laryngol., Rhinol., u. Otol., 1905,) has been able to modify a chronic pharyngitis by similar means, and at- tempted to improve the dry form of pharyngitis by increas- ing the chlorides in the diet. The whole subject seems worthy of further attention.—Edinburgh Medical Journal. Selections. 277 ALCOHOL IN DIABETES is advocated by American Medicine on the ground that there is reason to believe that the first step in sugar metabolism by the cells is to con- vert it into alcohol. During the period then that the sugar and starches are withheld it is believed to be well to de- liver alcohol to the cells in minute doses and frequently, in order that the body may, by being built up, secure con- trol of sugar metabolism. Small doses frequently repeated and well diluted appear to give excellent results.—Medical Fortnightly. DR. HAWKINS, of the Denver Medical Times, makes the following interesting observation on Quinine, excepting only the commendation of grain doses, which are excessive in any but the extremely depressed stages of the pernicious forms of plasmodial imprisonment when absorption is slow and the entire alimentary tract may be loaded with the salt without harm: "Quinin is a general protoplasm poison, having a destructive predilection for protozoa, particularly the Plas- modium of malaria, which is destroyed by this alkaloid in as weak a dilution as 1:20,000. It is therefore a specific against malaria and is best given in a gram dose four or five hours before the expected chill, that is, during the ameboid stage of sporulation. Quinin is excreted, mostly unchanged, in the urine, appearing here within a half hour, and disappearing mainly within 48 hours. Small doses (1 to 3 grains) raise blood pressure and strengthen the heart beat; large doses (1 or two grams) have an opposite effect. The leucocytes are lessened in number, diapedesis prevented, red blood cells relatively increased, and urea and uric acid diminished. The effects of excessive dosage (cinchonism), including tinnitus aurium, deafness, headache, epistaxis and blindness, appear to depend chiefly on cere- bral congestion and are controllable with bromids. Erythema is often noted in idiosyncratic cases. Quinine is contrain- dicated in acute diseases of brain and ear. "Many members of the laity take quinin as a 'tonic'— often with a dash of whisky—whenever they have 'caught Selections. cold' or are otherwise depressed. The custom is not a bad one, providing only small doses (say 2 grains t. i. d.) are used for a few days. Laxitives and restricted diet, how- ever, are more essential. The treatment of lobar pneumonia with large doses of quinine, followed hy Juergensen thirty years ago and recently revived by Galbraith and others, is but another illustration of the cyclic nature or fads. It proves, if nothing else, that the average patient of sound constitution and between the extremes of life, will recover from pneumonia despite a 'whole lot of dosing.' Quinin is serviceable in most conditions of vasomotor instability, chills, for example." Hawkins conducts one of the best journals of the Rocky Mountain region and is so thoroughly accurate in his edi- torial statements that we have never before differed from him and even in this the difference there is probably in sacrificing qualification to terseness of statement. HAEMONEUROTHERAPY. OPSONIC THERAPY.—Charles D. Aaron, M. D., of De- troit, has contributed to the New York Medical Journal a valuable account of the work of Sir A. E. Wright, together with that of Stewart R. Douglass and J. Freeman, in the pathological laboratory of St. Mary's Hospital in raising the antibacterial power of the blood over invading microbes. According to the revised views which Wright now holds, and which came step by step through his use of various bacterial substances in the form of vaccines, op- sonin is an ingredient of the blood serum which aids phagocytosis by its inhibiting action on a given micro- organism. That is to say, it acts on the microbe and pre- pares it to be ingested by the protective body cells or phagocytes, chief among which are the polynuclear leuco- cytes of the circulating blood. The blood serum of man contains opsonins for various pathogenic bacteria, and in a state of health this opsonic content, or "opsonic index" as it is called, is at a certain or normal level. By an ingen- Selections. 279 ious method which Wright and Douglass have devised the opsonic index for any particular pathogenic microbe can be determined. This method consists essentially in mixing with fresh human leucocytes, the serum to be tested, and an emulsion of the particular bacterium under investiga- tion. After a short incubation this mixture is spread as in making a blood film, stained appropriately, and then examined with suitable microscopic power. The phagocytic leuco- cytes will now be revealed containing the bacteria in their substance, and by counting the contained bacteria in a sufficient number of leucocytes, striking an average, and comparing it with a normal serum, the opsonic index for that particular serum and that particular microbe is ob- tained. In actual practice the determination of the opsonic index can be satisfactorily executed only by a properly equipped laboratory expert sufficiently experienced in bacteriology and serum pathology, and the same considera- tion applies to the production of the various vaccines, and further, of course, to such steps as the isolation and identi- fication of a given infecting microorganism and the prepara- tion of a vaccine from it. Now, the opsonic power, or, in other words, the op- sonic index fluctuates, rises and falls. During infection by a certain bacterial species the opsonic index for this partic- ular species is usually below normal, or to use one of Wright's phrases, the individual serum is in a "negative phase" of opsonic power. Thus in chronic staphyloccus disease, as, for example, acne vulgaris, or furunculosis, the staphylo-opsonic index is depressed, and in pulmonary tuberculosis or osseous tuberculosis or glandular tuber- culosis the tuberculo-opsonic index is low. By its natural recuperative power, that is, by its spontaneous active im- munity, the infected individual may generate opsonins of sufficiently increased potency to overcome the invading bacteria and to permit the phagocytes to destroy them, when natural recovery ensues. Similarly, by hygienic or therapeutical measures this opsonic activity of the blood serum may be increased. But the chief merit of Wright's work lies in the fact that he succeeds, by the use of his 280 Selections. bacterial vaccines, properly dosed and properly spaced, in artificially stimulating the flagging opsonic power of the in- fected individual's blood and of arousing it to a point, at which healing processes begin and progress to recovery. As prepared at the present time these vaccines are sus- pensions in sterile normal salt solution of pure cultures of various bacteria grown on the surface of agar only to the height of vegetative activity, and killed by heating for thirty to sixty minutes at 60° C. To guard against sub- sequent contamination lysol is added to the finished emulsion. Dosage is determined by administering an ascertained number of the bacteria, and for counting bacteria in a vaccine emulsion Wright has devised a very ingenius method. An exception to the vaccines prepared as just described is that against tuberculosis, for which Koch's new tuberulin in very minute doses is used. To illustrate the practical working of Wright's opsonic therapy let us take as an example a case of chronic stapylococcus infection, say one of long standing furuncu- losis, which fails to yield to any of the usual hy- gienic or medicinal measures. An examination reveals a low opsonic index for stapylococcus, that is to say, the pa- tient's serum does not excite a phagocytosis of staphy- lococci to the same extent as that of a healthy individual; or expressing the condition in other phraseology, the pa- tient is in a negative phase of resistance to staphylococci. A vaccine is prepared from Staphylococcus aureus, either of extraneous origin, or better still, that obtained from the victims own furuncles. A subcutaneous injection of about 200 million of these staphylococci is administered. Now, if repeated observations of the opsonic index are made it will be found that the immediate consequence of the inoculation usually is a further depression of the opsonic index, that is, a negative phase ensues. After this brief fall and gen- erally within the first three days, the opsonic index rises, reaching the normal level and often exceeding it; this is Wright's "positive phase" of immunity, and it lasts for several days, for longer periods, or even indefinitely, though it gradually recedes after attaining a maximum Selections. 281 point. It is very essential in the event that two or more injections of vaccine are required to treat a given case, to introduce these additional doses when the opsonic index is tending downward, or during the negative phase which follows the primary increase of opsonic power. This means that the dose of vaccine should only be re- peated after the stimulating effects of the previous inocula- tion are passing off. Coincidentally with the negative phase of the inoculation the patient usually feels indis- posed, and the boils may appear aggravated, but with the inauguration of the positive phase a feeling of general well being and a pronounced improvement of the furuncles is noted. Proper doses of correctly prepared vaccines are absolutely devoid of danger, and should excite no marked local re-action nor disagreeable constitutional disturbance. NEUROSURGERY. SOME MENTAL SYPMTOMS DUE TO DISEASE OF NASAL ACCESSORY SINUSES.—J. A. Stucky, November 24, 1906, shows by the reports of various cases that acute or chronic diseases of the nasal accessory sinuses often gives rise to serious forms of mental disturbance. The cases which he has especially observed gave every evidence of chronicity. All gave the prominent characteristic symptoms of suppuration. All were operated upon after the Killian method of entering the frontal sinus, removing the floor of the sinus, or enlarging the infundibulum, as well as removing the middle turbinate and the anterior ethmoid cells, and as many of the posterior cells as could be found which gave evidence of suppuration. In these cases the ethmoid cells were extensively involved. The mental symptoms were very marked. Insomnia, mental depression, indifference to conditions or surroundings, morbid suspicions, morbid fears and suicidal inclination are among the symptoms described. As to their cause, toxin- producing bacteria in the gastro-intestinal tract, combined with the sepsis from pus absorption, the influence of which acts upon the cortical cells and nerve fibers of the brain, are probably the chief agents causing the mental disturb- ance.—Medical Record. REVIEWS, BOOK NOTICES, REPRINTS, ETC. THE PROGRAM OF THE FOURTH ANNUAL MEETING OF THE PHILIPPINE ISLANDS MEDICAL ASSOCIATION, held at Manilla, February 27th, 28th, and March 1st, 2nd, shows medical interest in organization and progress. A Social Meeting and Smoker at the University Club, had for Guest of Honor: The Governor General and the Members of the Philippine Commission; Major General Leonard Wood; The Chief Surgeon, Division of the Philip- pines; The Fleet Surgeon, U. S. Asiatic Squadron; The Director of Health and Chief Quarantine Officer U. S. P. H. & M. H. Service; The Director of the Bureau of Science; All Foreign Delegates and Invited Guests and The Reverend S. B. Rossiter, D. D. The regular membership is about sixty. The papers and addresses were: Mosquitoes in the Philippines, their Breeding and Habits, with Methods for their Suppression (Illustrated); A Picture-talk on Russian Sanitary Ways and Means in Manchuria, 1905; Hydrophobia in the Philippine Islands; Clinical Observations on Uncinariasis; Necator Americanus in Natives of the Philippine Islands; The Phy- siologically Active Constituents of Some Philippine Medicinal Plants, Arrow Poisons and Fish Poisons; Native Medicinal Plants; The Transmission of Leprosy to Apes; The Fate of the Agglutinins upon Filtering an Immune Serum; The Filtration of Antiserums; Address, Dr. W. V. M. Koch, Medical Officer in Charge Infectious Diseases Hospitals> Hongkong; Leprosy in the Philippine Islands and the Present Methods of Combating the Disease; The Habitual Use of Opium as a Factor in the Production of Disease Among Chinese; Quantitative Investigations of the Phe- nomena of Agglutination (Agglutinin and Agglutinoid); Observations on the Etiology of Dengue Fever, (a) Appen- ( 382 ) Reviews, Book Notices, Reprints, Etc. 283 dicostomy, (b) Additional Report on Result of X-Ray Treatment of Hemato-Chyluria due to Filaria Sanguinis Hominis; Infant Feeding in the Tropics; Address; The Recent Trend of Immunity Research; A Summary of Some Experimental Work in Plague Immunity and addressed by distinguished representatives of Chinese, Japanese, Russian and U. S. Army medical interests. The program is well executed typographically. THE OPEN AIR TREATMENT IN PSYCHIATRY, by William Mabon, M. D., New York. Reprinted from the New York Medical Journal, for February 9th, 1907. This is an interesting, valuable and timely contribution to an important matter concerning the welfare of the insane. It belongs to the therapy of non-restraint, which, conducted by an Alienist of right clinical experience and discriminative judgment such as Dr. Mabon, it ought always to be bene- ficial to rightly selected patients. NEUROGRAPHS, A SERIES OF NEUROLOGICAL STUDIES CASES AND NOTES. Editor, William Browning, Ph.B., M. D.; Associates, R. M. Elliott, M. D , E. G. Za- briskie, M. D., F. C. Eastman, A. B., M. D. and F. Tilney, A. B., M. D., Vol. 1, No. 1, March 20, 1907. Germany: Th. Stauffer, Universitat-Strasse 26, Leipsic Brooklyn-New York, Albert T. Huntington, 1907. The copy before us contains: A Case of Brain Abscess; Localization; Operation; Recovery, by J. E. Sheppard, M. D.; Cephalic Tetanus in America, by F. C. Eastman, M. D.; A Case of Myasthenia Gravis Pseudoparalytica with Adenoma of the Pituitary Body, by F. Tilney, M. D.; Some Remarks on the Facial Nucleus, by E. G. Zabriskie, M. D.; Clinical Studies of the Pressure Effects of Some Cardio-Vascular Agents. Part 1. Observations on the Hypodermatic Use (Single Injections) of Aconitine; Gel- seminine and Water, by F. Tilney, M. D., and R. O. Brockway, M. D.; A Family Form of Progressive Muscular Atrophy (Myelogenic Type) Beginning Late in Life, by W. 284 Reviews, Book Notices, Reprints, Etc. Browning, M. D.; Note on the Administration of Arsenic and An Illustration of Spondylolisthesis. THE N. Y. STATE COMMISSION IN LUNACY, for 1905, Wm. Mabon, M. D., Prest., makes an interesting and valuable showing on the subject with an analysis of cases and deductions profitable to Alienists. The analysis of cases discussed under headings of dementia precox, paranoiac conditions, depressive hallu- cinosis, anxiety psychoses, mania—depressive insanity, psychoesthenic disorders, hysterical psychoses, epileptic psychoses, etc., notes of conference of State Superin- tendents and Dr. Russell's paper, etc., are good material for psychiatric thought. W. B. SAUNDERS COMPANY, Philadelphia and London, have just issued a revision of their handsome illustrated catalogue of medical, surgical and scientific publications. This is a most elaborate and useful catalogue. The descrip- tions of the books are full, the specimen illustrations are accurately representative of the context of books, and the mechanical makeup is in keeping with the high order of the context. The authors are all men of recognized eminence in each branch and specialty of medical science. A copy of this catalogue will be sent free on request. TEXT-BOOK OF PSYCHIATRY.—A PSYCHOLOGICAL STUDY OF INSANITY FOR PRACTITIONERS AND STUDENTS. By Dr. E. Mendel, A. O. Professor in the University of Berlin. Authorized Translation. Edited and enlarged by William C. Krauss, M. D., Buffalo, N. Y. President Board of Managers Buffalo State Hospital for Insane; Medical Superintendent Providence Retreat for Insane; Neurologist to Buffalo General, Erie County, German, Emergency Hospitals, etc.; Member of the American Neu- rological Association. 311 Pages. Crown Octavo. Extra Cloth. $2.00 net. F. A. Davis Company, Publishers, 1914-16 Cherry Street, Philadelphia, Pa. Knowing the author's merit we heartily commend this book. Reviews, Book Notices, Reprints, Etc. 285 PATONS' PSYCHIATRY is a useful and exceedingly valuable book to all students of the subject, from a masterful source of right clinical experience. Its author has obeyed the injunction of the great Esquirol by living with the insane to learn of them in the right clinical way and has in consequence produced a book more practical than speculative, full of the lessons of experience. The author's precepts for the examination of patients are excel- lent. Some of them might well have been added to the examination of the Thaw case. THE SUBCONSCIOUS by Jastrow would likewise help the Thaw commission. There are features of the subcon- scious life of H. K. Thaw that require critical consideration on the part of those whose duty it is now to know of a truth the exact state of this man's mind. RHYTHMOTHERAPY.—A discussion of the Physiologic Basis and a Therapeutic Potency of Mechano-Vital Vibration, to which is added a Dictionary of Diseases with Sug- gestions as to the Technic or Vibratory Therapeutics. By Samuel S. Wallian, A. M., M. D., President Amer- ican Medico-Pharmaceutical League. Illustrated. Pp. 210. Chicago: The Ouellette Press. 1906. "This volume attempts to place on a scientific basis the much vaunted recent treatment of various ills by vibra- tion. It is doubtful whether all can be accomplished which is claimed, but exaggeration is to be expected in the exploiting of any single method of treatment. No doubt vibration has its uses, but they are somewhat sharply circumscribed as our increasing experience serves to demon- strate. The list of diseases, according to the writer, treat- able by means of vibration is long and unreasonable. It is, for example, a waste of time to discuss the treatment of dementia or of diabetes mellitus or of epilepsy by this means." We cordially concur in the above estimate of this book which we extract from the review department of the Boston 286 Reviews, Book Notices, keprints, Etc. Medical and Surgical Journal. Rhythmotherapy and vibrio- therapy have their uses in torpid atrophic states, where a course of judicious therapy has preceded and accompanies and the possibilities of normal neurotic reconstructive response exist in the organism to the form of excitation, yet, unwisely or untimely employed the result may be harmful. There are cases where the psychic and physical impression may be salutary, but seldom as an exclusive method of treatment. The wiser and more widely experienced the physician the better the possible results. WELLCOME'S PHOTOGRAPHIC EXPOSURE RECORD is a vest pocket edition of value to photographers in making negatives, insuring certainty and uniformity of result. The chief features, Exposure Calendar and Calcula- tions, Tabloid Developers and Development by the time method. Price, cloth 50c. Burroughs, Wellcome & Co., New York, N. Y. Vaginal Tampon?: Some Points of Practical Interest. By Charles T. Souther, M. D., Cincinnati. American Civic Association. Department of City Making. Public Comfort Stations. By Frederick L. Ford, Hartford, Conn, Ectopic Gestation; with Report of Cases. By O. B. Campbell, A. M., M. D., St. Joseph, Mo. Some Remarks on Prostatic Hypertrophy. By Charles H. Chetwood, M. D., Professor Genito-urinary Surgery, New York Polyclinic Medical School and Hospital; Con- sulting Surgeon, St. John's Hospital. Electricity in the Treatment of Disease. By John V. Shoemaker, M. D., LL. D., Philadelphia. An Interesting Case of Pernicious Ansemia. By John V. Shoemaker, M. D., LL. D., Philadelphia. The Scientific Foundation of Modern Treatment of Disease. By John V. Shoemaker, M. D., LL. D., Phila- delphia. Reviews, Book Notices, Reprints, Etc. 287 The Open Air Treatment in Psychiatry. By William Mabon, M. D., New York. The Removal of Overhead Wires. By Frederick L. Ford, Hartford, Conn. Treatment of Croupous Pneumonia in Children. By Joseph E. Winters, M. D., New York. Some Practical Hints Regarding Medical Postgraduate Study in Berlin. By James N. Vander Veer, M. D., Al- bany, New York. * A Case of Heteroplastic Ovarian Grafting, Followed by Pregnancy, and the Delivery of a Living Child. By Rob- ert T. Morris, M. D., New York. Clinical Physiopathology. The Need of a New Classi- fication of Diseases of the Nervous System. By L. Harri- son Mettler, A. M., M. D., Chicago. Report of Cases of Uterine Fibroids Associated with Gallstones. By Albert Vander Veer, M. D., Albany, N. Y. Paresis: A Research Contribution to its Bacteriology. By F. W. Langdon, M. D., Cincinnati. Surgery of the Stomach, with Report of Cases: One Case of Gastrostomy. Two Cases of Gastrectomy. By Albert Vander Veer, M. D., Albany, N. Y. Report of Cases Treated by a Modified Bier-Klapp Method of Hyperemia. By James N. Vander Veer, M. D., Albany, New York. Sarcoma of the Nose, with a Consideration of the Spontaneous Disappearance of Malignant Growths. By Robert Levy, M. D., Denver, Col. The Cure of Psoriasis, with a Study of 500 Cases of the Disease, Observed in Private Practice. By L. Duncan Bulkley, A. M., M. D., New York City. 288 Reviews, Book Notices, Reprints, Etc. Surgical Treatment of Tuberculosis of the Upper Air Passages and the Ear. By Robert Levy, M. D., Denver, Col. Prostatectomy in Two Stages; A Conservative Opera- tion with Minimum Hazard. By Charles H. Chetwood, M. D., of New York. In Refutation of Statements made by the Editor of the Bulletin of the American Pharmaceutical Association, as published in the issue for November, 1906, and republished in the Journal of the American Medical Association. Solutions Dobell. By Edwin Pynchon, M. D., Chi- cago. Reciprocity in Medical Licensure. By Regent Albert Vander Veer, M. D., Albany, N. Y. End Results in Surgery of the Kidney, Based on a Study of Ninety Cases, with One Hundred and Twenty- three Operations. By Albert Vander Veer, M, D., Al- bany, N. Y.. Four Cases of Gangrene. By Albert Vander Veer, M. D., and Edgar A. Vander Veer, M. D., Albany, N. Y. Feeding in the First Year of Infancy. By Joseph D. Winters, M. D., New York. The Teaching of Laryngology and Rhinology in the Denver and Gross College of Medicine. By Robert Levy, M. D., Denver, Col. Symposium on Amebic Dysentery. By John L. Jelks, M. D., Memphis, A. A. McClendon, M. D., Marianna, Ark., and J. A. Crisler, M. D., Memphis. Thirty-third Annual Report of the Medical Director of the Cincinnati Sanitarium for the Year ending Novem- ber 30th, 1936. Reviews, Book Notices, Reprints, Etc. 289 Report of the Department of Health of the Isthmian Canal Commission for the Month of January, 1907. W. C. Gorgas. Colonel, Medical Corps, U. S. Army. Chief San- tary Officer. Annual Report of the Department of Health of the Isthmian Canal Commission for the Year 1906. W. C. Gorgas. A new book, Diet after Weaning' We have issued this book in response to a constantly increas- ing demand for suggestions on the feeding and care of the child between the ages of one and two years. We believe you will find it a useful book to put in the hands of the young mother. The book is handsomely printed, fully illustrated and is bound in cloth. We shall be glad to furnish you copies for patients entirely free. A postal card with your name and address on k will bring you a copy by return mail. MELLIN'S FOOD COMPANY, BOSTON, MASS. PUBLISHER'S DEPARTMENT. WITH OUR MARCH 1907 pamphlet, we commence the issue of a series of 18 illustrations of dislocations, the first being bilateral dislocation of the jaw. These illustrations will complement our illustrations of long bone fractures, and the two series will make a valuable collection for the busy practitioner. Physicians who are not on our mailing list can get them free, by application to Battle & Co., St. Louis. THE BEST HYPNOTIC—A patient who would sleep but cannot sleep should be made to sleep. In the choice of a hypnotic the physician should always seek that one which not alone is most effective, but which presents the fewest disadvantages in the way of after effects. For years Bromidia has been the standard hypnotic prepared at the command of the profession. Through all the time that it has been known it has never failed in composition or effi- ciency. Its constituents have been of the purest, and in fact, Bromidia has been the standard by which similar preparations have been measured. That the medical pro- fession has appreciated its worth and thorough reliability is well apparent, from the place it holds in the regard of every physician who appreciates stability and honesty.— The International Journal of Surgery. AI.ETRIS CORDIAL RIO represents one of our most re- liable indigenous agents for uterine ailments. Reports of its efficacy in numerous cases of amenorrhea, dysme- norrhea and menorrhagia affirm its value in the treatment of these cases. AN ANNUAL VISITOR.—We have just passed through our annual epidemic of la grippe, which as usual, claimed its victims among all classps and conditions, mainly, how- ( 290 ) ITS COVER PORTRAITS AGE: TWENTY-FIVE YEARS have made it famous —and still growing! 7246 PROGRESSIVE PHYSICIANS READ THE MEDICAL HERALD OFFICIAL JuURNAL MEDICALSOCIETY OF MISSOURI VALLEY YOU MAY BECOME ONE OF THIS CLASS FOR ONE DOLLAR . . . Clean, Ethical, Newsy, Original. Un- trammelled by trade connections—unbiased in its utterances—and broad enough to re- nounce illogical traditions and narrow dogmas Its Original Department reflects the progress ol the stalwart Prac- titioners of the great Middle West. The Oldest Independent Medical Monthly- west of the Mississippi River EDITED AND PUB- LISHED BY MEDICAL MEN: ITS AIM TO AD- VANCE THE CAUSE OF SCIENTIFIC MEDICINE CIRCULATES IN A FIELD PECULIARLY ITS OWN $1.00 the year For specimen copy, premium list and schedule for game "500" address DR. CHAS. WOOD FASSETT, Managing Editor, ST. JOSEPH, MO. Publisher's Department. 291 ever, among the classes where the resisting power was below par, or among sufferers from some chronic ailment. While the sequelae and complications of this disease may assume almost any phase of accute inflammatory character, its primary effect is upon the nervous system. Therefore, we have no hesitancy in saying, no matter what the local inflammation may require as a medicine, by all means give antikamnia tablets as a nerve sedative and to relieve the muscular pains always present. We have seen a violent cough of bronchitis treated upon the general plan, with the cough as distressing at the end of twenty-four hours as at the beginning, promptly yield to six antikamnia tablets during an interval of six hours. La grippe usually requires a double treatment, one directed to the influenza, and the other devoted to the complications present, be they of the respiratory organs or digestive tract. In all cases anti- kamnia tablets will be found to perform a prominent and successful part and purpose.—Medical Reprints. THE PHYSICIAN who employs Peacock's Bromides can depend upon best possible bromide results. This prepara- tion never varies in strength, and eminent American and English analytical chemists have testified to the extra purity of the salts entering its composition. It has long been and will continue to be an important consideration to neurologists and general practitioners who wish to resort to a continued bromide treatment. TO GUARD the functions of the heart is characteristic of the therapeutic action of Cactina Pillets. This conclu- sion reached by Myers more than fifteen years ago has been fully sustained by clinical experience. According to Myers, its power to increase that musculomotot energy of the heart, elevating the arterial tention and increasing the height of the pulse wave, makes it a cardiac tonic stimulant of importance in the treatment of irregular and feeble heart action. ADMINISTERED AFTER OPERATION, Fellow's Hypo- phosphites exercises a most beneficial influence upon the Alcoholism and Drug Addictions THE method of treatment is new and very successful. The withdrawal of the drug is not attended by any suffering, and the cure is complete in a few weeks' time. The treatment is varied ac- cording to the requirements of each individual case, and the res- toration to normal condition is hastened by the use of electricity, I massage, electric light baths, hot __^J and cold tub and shower baths, vibratory massage, and a liberali well-cooked, digestible diet. A modern, carefully conducted home sanitarium, with spacious surroundings, and attractive drives and walks. Electro- and Hydro-therapeutic advantages are unexcelled. Trained nurses, hot water heat, electric lights. Special rates to physicians. For reprints from Medical Journals and full details of treatment, address DR. B. B. RALPH 529A!TuLand Kansas City, Mo. THE MAN WHO KNOWS goes after deer and all big game with a Marlin. He backs his own skill with Marlin accuracy. Marlin Repeaters have original fea- tures shown by no other make. They shoot truer, stand harder service and are absolutely dependable. The Model 1893 Marlins have "Spicial Smokeless Steel" Barrels using powerful smokeless loads. The .32-40 and .38-55 sizes are also made with the highest grade of soft steel barrels for black powder. The .30-30. .32-40 and 38-55 repeaters re the guns for deer and similar game. The Men Who Know have told a lot of good Marlin stories in our Experience Book—Free—with our catalogue (our best so far) for 3 stamps postage. THE MARLIN TIRE ARMS CO. 4 2 Willow St.. New Haven, Conn, Publisher's Department. 292 patient's nutrition, fortifying the recuperative powers, and thereby hastening convalesence. DANGEROUS USE OF CURRANTS.—An English physi- cian, James Cantile, speaks in strong terms of condemna- tion of the growing custom of using currants in bread and cake. The baking, he says, makes them wholly impervious to any digestive fluid, wherefore they result in serious in- testinal disturbances, especially in children. COCA AND THE SALICYLATES.—J. H., Cincinnati, O., writes to the editor of The Coca Leaf: "Following a sug- gestion in The Coca Leaf as to the depurative action of Coca, 1 have used Vin Mariani to assist the elimination of uric acid, giving the wine either alone or alternately with the salicylates. I wish to express my appreciation of this remedy, which has opened a field of usefulness to me." It is equally pleasant to record as to give kindly sug- gestions. Attention directed to the applications of Coca, based upon its physiological action, will indicate many uses for this remedy which will prove satisfying to both patient and physician. The indescribably depressing action upon the stomach, often complained of by patients who take salicylates, may be obviated by using Vin Mariani as a vehicle. Fifteen or twenty grains of salicylate of soda in two ounces of Vin Mariani affords a palatable and efficient remedy in the elimination of uric acid. This dose may be found service- able twice daily, after eating, and again at bed time if indicated.—The Coca Leaf. IMPENDING HYPOCHONDRIAC DEATH BY SUGGES- TION.—Modern Eloquence relates the following: An English traveler once met a companion sitting in a state of the most woeful despair, and apparently near the last agonies, by the side of one of the mountain lakes of Switzerland. He inquired the cause of his sufferings. "Oh," said the latter, "I was very hot and thirsty and took a large draught of the clear water of the lake, and then sat down on this stone to consult my guide-book. To my astonishment I WE SUPPLIED ALL THE CITY INSTITUTIONS WITH DRY 600DS LAST YEAR. \V\I. BARR GOODS CO. Keep the Largest Stock of Goods suitable for HOSPITAL PURPOSES TO BE FOUND IN ST. LOUIS, And Special Terms will be made with all Institutions ordering from them. BEDDING MATERIALS OF ALL KINDS, UNDERCLOTHING, IN SILK, WOOL AND COTTON, LADIES' AND CHILDRENS' READY-MADE CLOTHING, FLANNELS AND UPHOLSTERY, TABLE AND BED ROOM LINENS, SOAPS, NOTIONS AND PERFUMERIES, ARE ALL SPECIALTIES AT THE; VVM. BARR gooos GO'S NEW BUILDING, SIXTH, OLIVE AND LOCUST, .... ST. LOUIS. P. S. Write and find out our special terms to Hospitals. HALL-BROOKE A Licensed Private Hos- pital for Mental and Nervous Diseases. CASES OF ALCOHOLISM AND DRUG HABIT. DEAUTIFULLY situated on Long Island Sound one hour from New York. The Grounds consisting of over ioo acres laid out in walks and drives are inviting and retired. The houses are equipped w th every Modern Appli- ance for the treatment and comfort of their guests. Patients received from any location. Terms Moderate. OR. D. W. McFARLAND, GREEN'S FARMS. CONN. Telephone 67-5. Westport, Conn. THE NATIONAL MEDICAL EICrlANGE-Plrjslclsns', Dentists' 1 »d Druggists' Locations and Properly bought, sold rented and exchanged. Partnerships arranged Assistants and substitutes provided. Business strictly confidential. Medical, pharmaceutical and scientific books supplied at lowest rates. Send ten cents tor Monthly Bulletin containing terms, locations, and list of books. All inquiries promptly answered. Address, H. A. MUMAW. M. D. Elkhart, lnd. THE NATIONAL Surgical and Dental Chair Exchange. All kinds of new and second-hand Chairs, Bought, Sold and Exchanged. •9-SEND FOR OUR BARGAIN USTm Address with stamp, Dr. H. A. MUMAW, Elkhart, lnd. LARGE DIVIDENDS Are assured stockholders of the SIERRA- PACIFIC SMELTING CO., Sonora, Old Mexico. Easy Payments. Agents Wanted. Write (or terms. Address, HENRY MUMAW, Elkhart, lnd. Publisher's Department. 293 found that the water of this lake is very poisonous! Oh, I am a gone man—I feel it running all over me. I have only a few minutes to live! Remember me to—" "Let me see the guide-book," said his friend. Turning to the passage, he found, "L eau du lac est bien poissoneux."* (The water of this lake abounds in fish.) "Is that the meaning of it?" "Certainly." The dying man looked up with radiant countenance. "What would have become of you," said his friend, "if 1 had not met you?" "I should have died of imperfect knowledge of the French language." LONDON BRAIN-FAG—In London the rush and con- centration of business life are yearly exacting a heavier toll in brain and nerve disease. The admission waiting list of the National Hospital for Paralyzed and Epileptics is one hundred acute cases. Sir Edgar Speyer, a financier, declared at the dinner in aid of the hospital that modern life, with its hurry and bustle, constitutes a great strain on the nervous system, and that there is a consequent increase in diseases of the nerves and brain. In four days every week from two hundred to three hundred persons may be seen sitting in the out-patient department of the hospital in Queen Square, Bloomsbury. Most of them are suffering from some form of brain ailment or of "nerves." There were nearly 50,000 attendances of out-patients last year. Out of the 1100 who were treated as in-patients, 69 were doomed to die, while 200 were discharged as either cured or as much Relieved. Who are the persons who make up the army of pa- tients? Godfrey Hamilton, secretary of the hospital, says they are in a large degree a rather different class from the patients to be seen at the Ordinary General Hospital. There are clerks, governesses, shop workers and cashiers and in the paying wards there are solicitors and doctors. "What is wrong is that Londoners nowadays have too •LiberaMy translated: The water of thi» lake is very fishy or good for fishing. St. Louis Baptist Hospital, patients. It has a well equipped Bacteriolog- ical and Pathological Laboratory under the supervision of a physician well trained in these branches, surgical cases are given special attention Address all communications to DR. C. C. MORRIS, Supt. Impotency Cases It matters not how hopeless; cured or relieved by our combination. Helantha Compound. Helianthus annuus [sunflower.] Fr. root. bark.H. Australian. Plain or with diuretic. Has a powerful action upon the blood and entire organism Is in- dicated in all cases complicated with Malaria, Scrofula, im- poverished Blood, Anaemia, etc.. etc..in conjunction with Pit Orient- alls (Thompson), will control the most obstinate cases of Impo- tency. "Drink Cure" cases, saturated with Strychnine, "Weak Men" cases, who tried all the advertised "cures" for impotency, and were poisoned with Phosphorus compounds readily yield to this treatment. Pll Orlentalls (Thompson) contains the Extract Ambrosia Orientalis. The Therapeutical value of this Extract as a powerful Nerve and Brain tonic, and powerful stimulant of the Repro- ductive Organs In both Sexes, cannot be over-esti- mated. It Is not an Irritant to the organs of generation, but A RBCUPERATOR and SUPPORTER, and has been known to the native Priests of India, Burmah and Ceylon for ages, and has been a harem secret in all countries where the Islam has planted the standard of Poly earn y. It Is impossible to send free samples to exhibit in Impotency cases, requiring several weeks treatment, but we are always willing to send complimentary packages of each preparation :with formulas and medical testimonials) to physicians who are not acquainted with their merits. i> / Helantha Compound, $1.85 per oz. Powder or Capsules. Knees. ^ pj| Orlentalis(Thompson)$1.00 per box. THE IMMUNE TABLET COMPANY, WASHINGTON. D. C. AGENTS: Meyer Bros. Drug Co., St. Louis. Lord, Owen & Co., Chicago. Rvans-Smlth Drug Co., Kansas City. Redtngton A Co., San Francisco. J. L. Lyons & Co., New Orleans. ENGRAVING CO. MEANS-THAT YOU CAN GET HIGH GRADE CUTS FOR ANY KIND OF LETTER PRESS PRINTING AT 8 4 MASON ST. M I LW A U KEE HALFTONES ON ZINC OR COPPER WOOD ENGRAVING MMF.HCU' OTO GRAPH"- ORIGINAL DESIGNERS & ARTISTS Publislier'i Department. 294 little holiday, and the thing that is needed to counteract the tendency to 'nerves' and brain trouble is a universal 'week-end,'" said a nerve specialist. "Twenty years ago the Londoner lived nearer his work, and his work was less exacting. He was able to get sufficient recreation and rest Saturday afternoon and Sunday. "But nowadays it is different. All London is engaged in a daily rush to and from the suburbs, in motor-omni- buses or underground trains, and most people crowd more work into less time. There is much more worry and more responsibility. The result is seen in brain-fag and nervous breakdown." NEURASTHENIA.—To-day it is generally recognized that neurasthenia is a real morbid condition. It is not the re- sult of modern civilization, as many writers would have us believe, but an actual disease that has probably existed as long as society. The name is not a generic term and when so used implies ignorance of the real condition it describes. Instead, it represents a specific malady with a -definite etiology, pathology and symptomatology. There can be no question but that the trend of modern life, particularly under certain conditions, tends to aggravate and multiply cases of this disease. Overwork is unques- tionably one of the principal causes, coupled with anxiety, worry or persistent excitement. It is a fact that the nerv- ous system or the mental economy of any person can stand only about so much. When overtaxed the results are bound to be disastrous, just as a muscle will suffer from excessive work. Add to overwork, individual habits, including excesse-s of all character, and neuropathic ten- dencies which are all too often the result of hereditary in- fluences, and it can be readily seen that nerve tire is of prime importance in the development of neurasthenia. Within later years certain toxic states, such as syphilis, rheumatism, malaria, or the auto-intoxication of chronic constipation, have been recognized as important factors in the etiology of the disease. At any rate close study points CACTINA SENG PILLETS A Cardiac Tonic Stimulant From Csreus Grandiflora (Mexicana) Each Pillel containing One One- Hundredth of a grain of Cactina Indicated in functional cardiac troubles, such as tachycardia, palpi- tation, feebleness; and to sustain the heart in chronic and febrile diseases. It is not cumulative in its action. DOSE One to three Pillets three or four times a day. Put up in bottles of 100 pillets Free samples to Phystelans upon request Sultan Drug Co., St. Louis, Mo. pharmeeevricel Chemists PEACOCK'S BROMIDES THE BEST FORM OF BROMIDES Each fluid drachm contains 15 grains of the neutral and pure bromides ot Potassium, Sodium, Ammonium, Cal- cium and Lithium. in Epilepsy and all cases demanding continued bromide treatment, its purity, uniformity and definite thera- peutic action, insures the maximum bromide results with the minimum danger of bromism or nausea. DOSE - One to three leaspoontuls ac- cording to the amount of Bromides desired. Put up ln 1-2 pound but- ties only. Free samples to the profession upon request Peacock Chemical Co., St. Louis, Mo. Pharmaceutical Chemists. A Digestive Secernent A preparation of Panax (Ginseng) which is being successfully em- ployed to stimulate the secretory glands of the alimentary canal. Indicated in Indigestion, Malnutri- tion, and all conditions arising from a lack of digestive fluids.% DOSE One or two teaspooofuls rhree or more times a day PDT UP IN 10 OZ. BOTTLES ONLY Free- samples to Physicians upon request Sultan Drug Co.. St. Louts, Mo. Pharmaceutical Chemists The Hepatic Stimulant Prepared from Chionanthus Vtrginiea Expressly for Physicians' Prescriptions Chionia is a gentle but certain stim- ulant to the hepatic functions and overcomes suppressed biliary secre- tions. It is particularly indicated in the treatment of Biliousness, Jaun- dice, Constipation and all conditions caused by hepatic torpor. DOSE One to two teaspoon- fnla three times a day. Put tip in 1-2 pound bottles only Fr»« sampies fc> Physicians upon request Peacock Chemical Co., St. Louis, Mo. Pharmaceutical Chemists. BSBBBBBBBSBBBBBBBBBBBBBBBSS«SBBBB««M.^«SMS^BS«aS^»BS™ Publisher's Department. 295 to this important fact, that not one, but several causes unite to produce the group of symptoms ascribed to neurasthenia. The prime object in treating this distressing condition is to restore nerve balance. Change of scene, regulation of the diet and correction of habits and faulty hygienic conditions are desirable features. But something more is always needed, and without the administration of some efficient tonic the neurasthenic will make little or no sub- stantial improvement. The principal desideratum is to choose a tonic that goes further than mere temporary stimulation, one that will assuredly impart vigor to the nervous system, and at the same time assist each weak- ened organ in the re-establishment of its functions. Such a tonic is Gray's Glycerine Tonic Compound. Clinical ex- perience has proven the therapeutic value of this well known product and under its administration the various conditions incident to neurasthenia are corrected and over- come. The nerve balance is restored, the digestive organs take up their work, normal elimination is promoted, and the various symptoms characteristic of nerve exhaustion are dissipated without the slightest evidence of undue stimu- lation. Gray's Glycerine Tonic Compound moveover has this very important advantage, it not only aids worn out, tired cells and organs to do their work, but it does more—it helps them to help themselves. The results obtained, therefore, are permanent, not transitory. AN OLD SOUTH CAROLINA DARKY was sent to the hospital of St. Xavier in Charleston. One of the gentle, black-robed sisters put a thermometer in his mouth to take his temperature. Presently, when the doctor made his rounds, he said, "Well, Nathan, how do you feel?" "1 feel right tol'ble, boss." "Have you had any nourish- ment?" "Yassir." "What did you have?" "A lady done gimme a piece uf glass ter suck, boss."—Lippincott's. "WHAT'S THE MATTER across the way?" asked the tailor of a bystander, as the ambulance backed up to the River Crest Sanitarium Astoaia, L. I., New York City. Licensed by the State Commission in Lunacy. FOB NERVOUS AND MENTAL, DISEASES. Home-like private retreat. Beautifully located. Easily accessible. Detached buildingjfor alcoholic and drug habitues. Hydrotherapy, Electricity, Massage. J. JOS. KINDRED, M. D., WM, E. DOLD, M. D., President. Physician in Charge. New York office 616 Madison ave., cor. 59th st.; hours, 3 to 4 and by appointment Phone, 1470 Plaza. Sanitarium Phone, 36 Astoria. The Richard Gundry Home, CATONSVILLE, BALTIMORE CO., MD. A private Home for the treatment of Mental and Nervous Diseases, Opium and Alco- holic addictions. For Circulars, Rates, etc., Address, DR. RICHARD F. GRUNDY, Catonsville, Md References—Dr. Henry M. Hurd, Dr. Wm. Osier, Johns Hopkins Hospital, Baltimore. -Md. Dr Thomas A. Ashby, Dr. Francis T. Miles and Dr. Geo. Preston, Baltimore, Md. -Or. George H. Rohe, Sykesville, Md. Dr. Charles H. Hughes, St. Louis. THE BLUE HILLS SANITARIUM MILTON 'MASSACHUSETTS. A PRIVATE HOSPITAL AND IDEAL RESORT. All classes of patients admitted. Separate department for the victims of ALCOHOL. OPIUM, COCAINE AND OTHER DRUG HABITS. All desire for liquors or the baneful drugs overcome within three days after entrance, and without hardship or suffering. A well-equipped Gymnasium, with competent Instructors and Masseurs, for the administration of purely hyelenlc treatment; also a Ten-plate Static Electrical Machine, with X-Ray. ar.d all the various attachments. J. FRANK PERRY. M. D., Supt. THE ALPHA SANITARIUM, LAKE FOREST, ILLS. Established for the treatment of the Functional Derangements and Morbid Psychologies that occur during Adolescence. For further particulars address W. XAVIBR SUDDUTH, M. D., 100 State St., CHICAGO, Publisher's Department. 296 door of his rival. "A customer fell in a fit, and they are taking him to the hospital," was the reply. "That's strange," said the tailor. "I never knew a customer ot get a fit in that establishment before!"—Church Register. A MlLFORD, O., PAPER tells us that Henry Sigmore was held up by two footpads who hit him with a sandbag in the neighborhood of the pump station. Nephritis or cystitis probably followed. A CHAUFFEUR'S RECOMMENDATIONS.—Studied medi- cine and law for three years, good experience, capital witness, summoned thirteen times without conviction, seeks position with 100-horse power motor-car.—Fliegende Blaetter. A SMALL BOY threw a rock and hit Jeremiah Plowden, of Cleveland, on the boulevard, which compelled him to take to his bed as he probably could not sit down after such a blow in such a place. VARIATIONS IN BLOOD PRESSURE.—In some condi- tions the tension which is above normal is not rarely present in moderate degree as an endeavor on the body to meet a need. A moderate degree of hypotensin is physiologic in some illnesses, and should not be interfered with. To whip up the circulation at this time solely be- cause the tension is low, forces a wasteful and dangerous expenditure of energy. Only when overaction of the heart is due to low tension, or when renal or pulmonary stasis results from this cause, is interference required.— Thera- peutic Gazette. COLLIER'S WEEKLY ON SCHOOLS—The function of education varies with the population. The rule of the three R's is no longer absolute. Education is compulsory throughout the country, but it may mean one thing in a New England village and another in a large city congested from immigration. The age is one of specialization. Of music and drawing many common schools now give enough to start any talent that may exist in those directions. The high schools which fit girls as well as boys for commerce The MILWAUKEE SANITARIUM Wauwatosa, Wis. FOR NERVOUS AND MENTAL DISEASES Wauwatosa is a suburb of Milwaukee on the Chicago, Milwaukee and St. Paul Rail- way, Z1., hours from Chicago, 5 minutes' walk from all cars and trains. Physician in charge: RICHARD DEWEY, A.M.. M.D. CHICAGO OFFICE, 34 Washington St., Wednesdays 2 t> 4 P. M., (except in July and August). Telephone connections, Chicago and Milwaukee. Greenmon t-on-th e-Hu dson. For NERVOUS and MENTAL DISEASES. RALPH LYMANS PARSONS, M.D. RALPH WAIT PARSONS, NLD. City Office, 21 East 44th St., SING SING, P. O., N- Y. Mondays and Fridays, 3:30 to4:30,p.m. Long Distance Tel., Hart, 140A,Sing Sing, N.Y CREST VIEW SANITARIUM, GREENWICH, CONN. A quiet refined home for the treatment of Chronic and Nervous Diseases, In the midst of beautiful scenery, 28 miles from New York. H. M. HITCHCOCK, M. D. PHI UK MEDICAL REGISTER I ULI\ O AND DIRECTORY EUGENE! G'*en Free FIELD'S POEMS* k $7.00 G00K to each person interested in subscribing to the Eugene Field Monument Souvenir Fund. Subscribe any amount desired. Subscriptions as low as $1.00 will entitle donor to hta daintily ert.Hic volume Field Flowers" (cloth bound, 8x11), u ■m f nil J certificate of subscription to ■ GIwGf^GF £ fund. Book contains a selee- tion of Field's best and most representative works and ls ready for delivery. But for the noble contri- bution of the world's greatest artists this book could not have been manufactured for less than 97.00. The Fnnd created ls dl- •qually between the family of the iate Eugene Field and the Fund for the building of a monument to lbs mem- ory of the beloved poet of childhood. Address EUGENE FIELD MONUMENT SOUVENIR FUND, (Ass* at Book Stores) IQ4 Clinton St., Chicago ^^^Jjf v^u^also wuh to tend rutUge, •nclosc 10 ets. THE Book of the century Handsomely lllus- trated by thirty- two of the World's Greatest Artists. WAS ESTABLISHED IN 1886. Do Not Be Deceived By Imitators. See that the name K. 1Y POLK A CO. IS ON THE ORDER BEFORE YOU SKIN IT. POLK'N is the only complete Medical Directory POLK'S is the only Medical Directory having an index to all physicians in the United States. POLK'S has stood the crucial test of time with increasing popularity. It thoroughly coven* the field. R. L. POLK & CO., Publishers, DETROlT. MlCHICAN. SUBSCRIBE SOW. This is the Best Medium for — Sanitaria— Publisher's Department. 297 increase in numbers every year. Normal schools prepare our teachers. In some cities the child may be carried, on the taxpayers' money, from the kindergarten through a college course. Lately we have gone a step further, and, not satisfied with elaborate opportunities for the sound, average or normal child, have been developing training for those who come maimed into this world—crippled in body or handicapped in faculty. The crippled, the blind, the dumb have been excluded from the public schools, but the less definitely helpless, but still defective children, have been allowed to clog the wheels of progress. THE JAMESTOWN EXPOSITION. (By Charles W. Kohlsaat, Commissioner General.)—Norfolk, Va.—To com- memorate the most important event in our Nation's exis- tence, there is to be held in the coming year a great Inter- national Naval, Marine and Military Celebration on Hamp- ton Roads, Virginia, and contemporaneously therewith and in close accord, a great historical, educational and industrial Exposition, beginning April 26th—the anniversary of the day the intrepid voyagers first put foot on American soil— and ending November 30th. Our President, Theodore Roosevelt thus speaks of it in his proclamation: "Com- memorating in a fitting and appropriate manner, the birth of the American nation, the first permanent settlement of English speaking people on the American continent, made at Jamestown, Virginia, on the 13th day of May, 1607; and in order that the great events of American history which have resulted therefrom may be accentuated to the present and future generations of American citizens." Let us for a moment go back three hundred years, to December 19th, 1606, the day when a little band of in- trepid pioneers sailed away from the precincts of London (Blackwall, on the Thames) bound for an unknown land, there to fight fever, famine, and treacherous foes, in en- deavoring to establish a foothold in the land of promise, endeavors which have been fulfilled beyond the dream of prophet. That a great and powerful nation should have sprung 298 Publisher's Department. Publisher's Department 299 from the little settlement made by these pioneers in 1607, on the banks of the James River, in the State named in honor of the Virgin Queen of England, would seem a fancy of a disordered brain, did not fact assure it. The genesis of all the older nations are shrouded in obscurity, adorned with fable. The great American Republic traces its beginning to a definite spot where events hap- pened and deeds were done, as thrilling and impressive as any that mark the pages of poesy or mythology. It was Jamestown that blazed the way for all the blessings we now enjoy in our great and glorious country, and I may even venture to go so far as to say, that but for Jamestown being permanently settled, we would not be able to give thanks annually to the Almighty for all bless- ing bestowed upon our Nation. It is true, the Thanks- giving custom dates from the landing of the Pilgrims, but had Jamestown failed, had that handful of brave men deserted that settlement, perchance the expedition which landed many years later on Pilgrim Rock, would never have embarked. Who knows? To digress for a moment, let me speak of woman. It is eminently proper that women play a prominent part in the great celebration since it commemorates an event made possible by a woman's act three centuries ago, for, had not the Indian princess, Pocahontas, saved the life of Captain John Smith, the dauntless leader of the first English colony in America, when condemned to death by his captors, the settlement of Jamestown Island would, un- questionably, have been abandoned, the despondent and demoralized pioneers returning to England, the new world would have been left to the Indians and the early Spanish settlers. Woman's work saved Jamestown, and women's work is to play an important part in celebrating the three hundredth anniversary of the Jamestown settlement, the real beginning of the United States. And again, it is to women we owe it, that the celebration and the great ex- position are to assume such gigantic proportions. To them, and more particularly to the Virginia Women's Society for the Preservation of Antiquities, who petitioned Congress 300 Publisher's Deparlment. Publisher's Department. 301 to preserve Jamestown Island and its historic ruins—is due the credit for inaugurating the movement from which has sprung the forthcoming celebration and exposition. Hence all gratitude and homage to our noble women, especially in this instance, to the daughters of Old Virginia. Quoting from a late address in Congress, by an elo- quent orator, Hon. Charles A. Towne, "No more momentous circumstance has ever been celebrated in this (our) country than that which is the subject of the proposed observance. It would be difficult to over-estimate the significance of the event which it is proposed to celebrate. It is one of the events that has a consecrated place of imperishable glory. In a reverend spirit we shall turn our steps in the May time of another year towards the little island in the James River, peopled not only by memories, but dedicated forever to the respect and homage of mankind, by its associations with the advent upon the continent of those heroic souls, who, three hundred years ago, braved the perils of the sea to raise their altars in a wilderness—"and be a fair be- ginning of a time." Let us therefore, when the spring shall come again, gather in Old Virginia about the earliest altar erected to our civic worship in this brave new world, and there, Americans all, take upon our lips again the holy natal vows of our peculiar nationality, strong in the hope and resolute in the purpose that in the words of John Adams to Thomas Jefferson, "Our pure, virtuous, public-spirited, federative republic shall last forever, govern the globe, and introduce the perfection of man." Let me say in Virginia's name, that in all that Vir- ginia has of heritage and tradition, of ideals and aspira- tions, the country and all the world has full share, for neither a place nor a people can hold alone those things which are eternal, and when Virginia opens her gates to welcome the world she will open as well her heart and share her best 'with all who come to do her reverance. THE ALIENIST AND NEUROLOGIST. VOL. XXVIII. ST. LOUIS, AUGUST, 1907. No. 3. PERIODICAL PARANOIA AND THE ORIGIN OF PARANOIAC DELUSIONS.* By DR. GIERLICH, of Weisbaden. [Translated bv Smith Ely Jelliffe, M. D., Ph. D.] PARANOIA undoubtedly is one of the most pressing problems of psychiatrical investigation. The views formerly held must be tested and modified in various di- rections, both as regards the causative factors which permit the occurrence of primary delusions under full consciousness and in the absence of melancholy and maniacal moods; secondly from the viewpoint of the course and prognosis of the disease. As regards the etiology, there are two rather divergent views. For a long time, Westphal's view [prevailed and remained uncontradicted, after he had expressed himself in 1876. (Naturforscher-Versammulung in Magdeburg) to the effect that paranoia is caused by abnormal processes in the sphere of conc«ption (ideation), whereas the moods and emotions are merely dependent upon the contents of these conceptions, without playing a part in tne evolution of the pathological psychic phenomena. When the paranoia prob- lem was brought "up by Cramer, in 1894, in the Berlin Psychiatric Society, strictly in accordance with Westphal, •Art»iv fur Psychiatric, 40. 1905. ( 303 ) 304 Dr. Gierlich. paranoia being contrasted as a purely intellectual psychosis with the emotional form—dissenting voices were raised in the discussion (Moeli), which ascribed to the emotions a contributing influence for the origin of paranoia. At a later date, Neisser refers to the significance of the effect of emotions upon the relations to the ego. Friedmann attri- butes a special part, though not the decisive one, to the emotions as concerned in the origin of delusions. Wer- nicke describes the influence of emotion upon the formation of exaggerated ideas, Hitrig points out the fact that the ex- traordinary influence of the emotions upon the development of relations towards indifferent occurrences in the surround- ings is a matter of every-day experience. Tiling and Storring likewise advocate the importance of the emotions in the early stage of delusion. Quite recently, Specht, Bresler, and still more convincingly, Margulies, based upon extensive experience, endeavored to prove that in paranoia the emotional sphere is primarily affected, the characteristic picture of the disease developing upon this foundation ex- clusively. These views were criticized and not accepted by Bleuler and Berze. Simultaneously with these investigations as to the causative factor of paranoia, the time-honored teachings of the gloomy outcome, — gradually passing from paranoiac delusions to delusions of grandeur, and terminating in dementia,—were seriously shaken. Friedmann, for instance, described a number of cases with mild, brief delusions end- ing in recovery, although the insight and appreciation of the disease was not absolute in all cases. Margulies also reports three cases of paranoia terminating in recovery, in which full appreciation was well maintained in the course of fur- ther observation. A series of authors, such as Mendel, Meschede, Gia- nelli, Kausch. Bechterew, Zeinen, Hamilton—observed cases of periodical paranoia with absolutely free intervals and perfect appreciation of the disease. It has been pointed out by Friedmann that the milder cases do not as a rule enter the institutions for the insane. Hence their true character is frequently not recognized, they are misin- The Origin of Paranoiac Delusions. 305 terpreted and therefore appear much less numerous than they actually are. Precisely these cages, in which the ob- servation of the initial symptoms also is especially favor- able under certain conditions, are the ones permitting a thorough study of the pending questions as to the prog- nosis and etiology of systematized delusions. The author is in possession of three case histories be- longing under this heading. The patients have been for several years under his observation, and he has been en- abled to observe at least two attacks and two entirely free intervals, with perfect accuracy, in each individual case. CASE I. JOURNAL NO. 12. Anamnesis and Status, January 24th, 1896. Mr. X., high government official, mar- ried for 19 years. Two children, 17 and 14 years of age. Wife healthy, no abortions. Patient is descended from a nervous family, the mother and, especially the father, are said to have been markedly neurasthenic. Mother died from some acute internal affection, father supposedly from some spinal disease. Two casas of mental disturbance in father's family. Particulars not known. Patient's birth said to have been normal. He graduated from the Gymnasium and chose a government career. Study did not come easy, mathematics proving es- pecially troublesome, but he was unusually ambitious from childhood. Said to have led the simple life, very little re- sistance towards alcohol; moderate also in smoking. Ca- reer took customary course, only on one occasion the pa- tient was not advanced, much to his regret, about a year ago. He always had periods of lassitude lasting for days, especially after prolonged work; was excitable, complained much of constipation, but did not present any other seri- ous disturbance of his general condition. After his return from a month's fatiguing trip, connected with irregular hours and poor quarters, patient complained of insomnia, fatigue, heaviness in the head, anorexia, sluggish digestion, arrested for 2-3 days, nervousness, irritability, con- stant restlessness. Meanwhile, he was able to attend to his business, though at the expense of all his will- 306 Dr. Gierlich. power. He recently showed a suddenly developing mistrust towards his surroundings, but without a visible anomaly of disposition, and his behavior was perfectly correct. About two weeks ago, he expressed for the first time some de- lusions, in speaking to his wife: He thought he was no longer persona grata, and that he was to be supplanted in his position, whereas the exact contrary was true. More- over, he thought he had compromised the wife of a col- league, namely, the one who had been advanced in prefer- ence to him; by gazing at her for a long time, though un- intentionally, at some social gathering; this had attracted attention, and the woman was compromised by him, who had rendered himself impossible. The husband of this lady, gradually becoming surrounded by an actual plot, was anxious to drive him away from his post and out of the town, in order to destroy him. The patient called upon the lady to beg her pardon. Of course she had no idea what he wanted. He thereupon handed in his resignation on two occasions, which was twice graciously refused by the president. Finally, he explained to his wife that he could not continue to live with her, because she also had been compromised by him. It was his duty to give her satisfaction by instituting divorce proceedings. Status: Patient is entirely dominated by his delusions, which he expresses with great animation, in the form previ- ously stated. Said he must leave the country, the police were liable to come at any moment in order to arrest him. A perfect army of opponents was working against him, his wife also had joined the plot. Meanwhile, the patient was well informed as to the time, place, surroundings, etc. Pathological euphoria or depression and psychomotor inhib- ition had never been noted, neither did they exist at this time. The only anomaly besides well-marked mistrust was great irascibility. This was directly parallel to the delus- ions, and entirely dependent upon them. There was no sign of hallucinations and illusions, which were not ob- served in the entire course of the disease. Physical examination: Large man, with strong, osseous system, much emaciated; said to have lost 15 pounds in The Origin of Paranoiac Delusions. 307 last few months. Facial features, left half of face betted developed than right, especially frontal eminence. No ab- normality in skull. High pointed palate, small ears, sug- gestion of "handle" ear. Tendon reflexes in arms and legs lively, skin reflexes normal, sensation and motion, no disturbance. Pupils equal, somewhat below medium width, react to light, convergence and accommodation. Fundus normal, internal organs, negative findings. No albumen, no sugar in the urine, no phosphaturia, no uric acid dia- thesis. The condition remained for nine more days at this level. Patient had absolutely no insight into his delusions. No hallucinations and illusions could be determined, not- withstanding accurate investigation and observation in this direction. Then the entire threatening condition rather suddenly subsided. Patient could be talked to concerning one or the other of his delusions, at least he began to discuss them, his irascibility diminished, and after 3-4 days more, he showed perfect insight into his condition, together with the arrival of an amiable letter from the president. Patient fully appreciates the delusionary character of his ideas and remembers all details. No amnesia. Does not know how these delusions came to him. No indications of hallucinations or illusions at time of attack. The body weight had already begun to rise and soon reached normal; the general condition visibly improved; patient resumed his professional activity at the end of a few weeks, and everything remained well until the atumn of 1896. After his return from the customary fatiguing business trip, the general nervous disturbances reappeared in shape of lassitude, headache, insomnia, anorexia, constipation, rest- lessness, irritability. By the end of November, the patient again developed the same delusions as in the previous year, without any maniacal or melancholy fore-runners. The attack promptly rose to the former level. The plot was again under way, under the guidance of the lady's husband. He was to be ousted from his position and ruined. Again he handed in his resignation in order to get rid of his persecutors, which again was not accepted. 308 Dr. Gierlich. Claimed he could not continue to live with his wife, he had compromised her too seriously—started divorce pro- ceedings. Again, a marked loss of weight. Prompt re- moval from his surroundings had such a favorable in- fluence upon the attack that the condition cleared up rather suddenly within 3-4 days, after the persecutory ideas had existed during four weeks. The patient gained complete insight into the system of his delusions, without the slightest amnesia, and without being able to understand at all how these two ideas had come about. It proved perma- nently impossible to determine hallucinations and illusions. Patient soon attended to his obligations as before. In the summer of 1897, he had a substitute for his professional trip and in the fall took a long vacation, which he spent in the mountains. No nervous restlessness and delusions were noted. He returned about Christmas, feeling so well that he could not be prevailed upon to give up a very fatiguing business trip in the summer of 1898. Thus the delusions returned precisely as in the preceding years, after initial general nervous disturbances in the fal of 1898. As before, he remained very self-absorbed for some time, and then suddedly aired his delusions. The plot with the husband of the compromised lady at its head, was again in full sway, in order to ruin him and rob him of his position and his honor. His resignation was once again handed in, and the di- vorce prepared for, etc., etc. Prompt removal from his home, and appropriate management, caused the delusions to subside about three weeks later, and after 3-4 days more, the patient had complete insight into his condition. There was no amnesia, and absolutely nothing to point to hallu- cinations and interpretations based on illusions. Neither is there any reason for assuming discrimination on the pa- tient's part in the free interval. At those times, he would meet the wife of his colleague without any embarrassment, and stated that he felt quite unconcerned towards this lady. In the summer of 1899, the patient was physically dis- abled, but no paranoiac delusions were noted. He died in The Origin of Paranoiac Delusions. 309 1900 of carcinoma, probably originating from the bladder. The somatic status of the nerves remained unaltered. Pu- pils, reflexes, sensation and motion presented no disturb- ances. There never was a reactionary hyperthemia. He was free from pathological fluctuations of the psychic sphere. His intelligence had not diminished to a notable extent; on the contrary, the patient always promptly met the requirements of his position. CASE 1I. JOURNAL NO 36. Anamnesis and Status, April 17th, 1896. Mr. X. Aet. 35 years, merchant, mar- ried since two years, no children, wife healthy, no history of abortion. Patient is descended from neurotic stock, father was under author's treatment, for chronic constitu- tional moodiness with compulsory ideas. Father's condition said to have been even worse in early time of married life when there was a severe struggle for business existence (about the time the patient was conceived). Two brothers of father markedly nervous, one of "peculiar" disposition. A younger sister of the patient is said to be hysterical. His birth was apparently normal. Patient went to school until he passed his final examinations, then took a part in his father's business. Studied with tolerable facility, once was not promoted to higher class. States that everything connected with memory work, such as languages and history, came rather easy, whereas thought in abstract conceptions was very hard for him. He learned certain theses by heart, in a mechanical manner. Was not draughted as a soldier, ostensibly on account of a tendency to flatfoot. Patient at an early age gave an impression of inde- pendence, showed great ambition. Was hasty and hurried in all his undertakings. Presented no psychical anomalies, especially no anomalies of temper. Never lived a fast life, had small resistance against alcohol, smoked 2-3 cigars daily. Moderate intercourse with girls. When he was 26 years old his father made him the manager of a large sawmill, which had been seriously neglected by poor administration. Patient started his new activity with extreme zeal, raising the business to a flourishing and remunerative investment 310 Dr. Gierlich. Showed considerable mercantile skill, was always sober, and is much esteemed in his native town. Married at the age of 33, from pure mutual affection. Wife brought him no money. Marriage was perfectly happy, wife of a gentle yielding disposition and uniformly cheerful temperament. This harmony was recently very seriously disturbed without external cause. In the early part of each year the patient is obliged to buy forests on a large scale, for the lumber, the year's business essentially depending upon the profit of these investments. Patient at this time is much on the road, eats irregularly, and has insufficient rest at night. Complained much of headache, anorexia, constipation, was very irascible and irritable, hurried and restless. He did not act toward his wife with the customary frankness, was reserved, quiet and self-absorbed. Ten days ago he abruptly overwhelmed his wife with the most violent delusions of jealousy and persecution. She neglected him, doing everything wrong, intentionally and knowingly, she was in league with other men, preferring everybody to him, she was tired of him, wanted to put him aside by killing him, cared only for his money, for which alone she had married him. Corresponding to his delusions, patient acts most insultingly towards his wife, whom he over- whelms with reproaches, saying that she never cared for him, married him only for his money, etc. All begging and imploring on her part proved useless. Patient is extremely irascible, contradiction especially irritating him to the last degree. He shrugs his shoulders and expecto- rates in front of his wife, unmindful of the presence of strange ladies and gentlemen. Once he became aggressive, so that the wife lives in constant anxiety and was several times obliged to escape by night to her relations. Patient takes his meals outside, when eating at home he forces his wife to taste of everything before his eyes. Status: Patient is entirely dominated by his jealous delusions about his wife, inaccessible to reasoning, ex- presses his ideas volubly and is extremely irritable. When his wife tried to convince him he roughly repelled her and spat upon her dress. Meanwhile, he is perfectly conscious The Origin of Paranoiac Delusions. 311 of place, time, persons, surroundings, etc. Aside from his delusions, his behavior is entirely normal. Nothing can be discovered and observed in the line of hallucinations or illusionary interpretations. A change of disposition to abnormal cheerfulness or sadness does not exist, and was never noted. Alcoholism is excluded. Physically, patient appears as a medium-sized man, with delicate bony frame- work and narrow chest. Thorax unusually long, no pigeon breast, short receding forehead, remarkable development and projection of occipital protuberance, sutures plainly palpable. Dolicocephalic. Ears large and projecting, flabby without disproportion. Face evenly innervated on both sides during rest, when in mimic motion strikingly more so on left than on right. Slight degree of blepharocloria, pupils equal, medium width, prompt reaction to light, con- vergence, accommodation. No nystagmus, hippus, or eye- muscle disturbance. Ocuclar fundus normal. Tendon re- flexes in arms and legs lively, no ankle clonus, skin re- flexes normal. Sensation, motion O. K. No speech disturb- ance, no marked tremor, heart normal, pulse 78, evenly full and soft. No albumen or sugar in urine. Internal organs negative findings; on both sides moderate flatfoot. This condition remained at this level for eight days longer, after which time the patient became more quiet in the expression of his delusions. At least he entered into discussions concerning them, and ceased to act as absolutely non-committal and irresponsive as heretofore. In about three to four days complete insight into his condition manifested itself. He now appreciates the delusionary character of his ideas, is dreadfully ashamed of his con- duct, does not know what pushed him to these ideas, and tries with all his power to undo his wrong towards his wife. In this case also, there had been a reduction of the body weight (10 pounds) during the attack, which was soon recovered from. Patient has no amnesia, on the contrary is perfectly familiar with every detail during the attack. Nothing to be made out in regard to hallucinations and illusions. There were no reactionary changes of his frame of mind, his mood was perfectly normal, according 312 Dr. Gierlich. to the conditions present, neither euphorious nor depressed. The irascibility subsided together with the delusions. Intellectual deficiency was excluded. He soon felt entirely well. Suggestions of the above condition are said to have returned in the fall of 1896, but were aborted by a journey to the South, which had been previously arranged for. Patient believed himself safe after this recreation, became active in political affairs and towards the early spring of 1897 again visited the lumber auction sales. The general nervous complaints promptly returned. Nervous lassitude, pressure in head, heaviness, anorexia, torpid digestion, restlessness, irritability. Patient soon became permanently ill-humored, and again showed a change in his manner towards his wife. Before she succeeded in getting him away from his business, the former jealous delusions returned with their old violence. The author found the patient entirely beset with his former delusions. He overwhelmed his wife with the most horrible reproaches, accused her of adultery, of purposeful neglect, said she had only married him for a home, she wanted to kill him, was after his money only. These ideas he uttered in an animated manner, was absolutely inaccessible to reasoniug, became much excited when this was tried, cast contemptuous glances and gestures at his wife, spat out in front of her, and again became actively aggressive. There was no pathological mood aside from irascibility and excitement in the sense of his delusions, nor was there any acceleration or inhibition as regards the course of psychic functions. Patient is neither particularly hilarious nor depressed. The attack was abridged by the use of baths and sulphonal, when necessary. Two weeks after the first expression of his delusions patient already showed a certain willingness to accept reasoning with him. In two or three days more he had perfect insight, without any amnesia or reactionary change. He soon devoted himself to his business with the same old energy. A son was born in December, 1897, to the great satisfaction of the father. The wife asked for a long trip early in 1898, for The Origin of Paranoiac Delusions. 313 she had always held the fatiguing lumber investments in the spring responsible for the nervous prostration and jealous delusions. The pleasure trip was carried out, and nothing turned up in the line of severe nervous disturb- ances and jealous delusions. At his return the patient found very unsatisfactory lumber investments. In the fall the wife worried for seme time about the changed manner of her husband, but he developed no attack. However, another severe attack occurred in 1899. Again, as before, general nervous disturbances appeared as above, after the lumber investments, followed by changes in his manner and delusions of jealousy. The author saw the patient entirely taken up by his delusions, as in his previous attacks, without any insight. This time he believed a business acquaintance of his to be leagued with his wife against him, and he abruptly and without cause, broke off valuable business connections, much to his later regret. This attack lasted about twelve days. The patient then gained com- plete insight within two or three days, precisely as in the former attacks. He resumed his business to its entire extent. In the spring of 1900 he took very good care of himself. The lumber investments had been entrusted to others, and according to the wife's statements, there were only certain suggessions of the above-described condition. The outbreak was prevented by a short journey. In the fall of 1900 he was overjoyed by the birth of a daughter. In 1901 he believed himself to have entirely recovered, and returned with his old zeal to the lumber auction-sales. Again the introductory general nervous disturbances were followed without a recognizable external cause, by the out- break of his delusion. Patient again was entirely under the dominion of his delusions. Said his wife was bad, she treated him abominably, tried to deceive him, and to get rid of him. He scolded his wife in most vulgar terms. Again his business friends were leagued with her against him, he broke off another business connection in an insult- ing letter to a business company who happened to send in an offer at this time. Duration of attack, about twelve days, then gradual giving in, quieter behavior, and about 314 Dr. Gierlich, three days later insight into his condition, to a complete extent. In the summer of 1902, patient was seen by the author, looking perfectly well and prosperous. A suggestion of the terrible condition had manifested itself in the spring of that year, but they promptly took a journey to see their parents, thus aborting the attack. To repeat briefly: Hallucinations and illusions must be positively excluded. Dissimulation cannot be assumed. What reason would there be for the patient's dissimulating in the free interval? On the other hand, he was perfectly familiar with all details. This psychic alteration has nothing in common with maniacal or depressive states. The delusions are the primary feature, and the emotion is dependent upon the delusions alone. Great irascibility prevailed during the attack, there was no somatic disturb- ance, pupillary reflexes, etc., O. K. The intellect was not impaired. Patient managed his extensive business affairs with ease, and was moreover very active politically. Alcohol was excluded as a cause of the attacks, patient was always sober, limited his daily allowance of wine to about half a bottle, not exceeding this amount during the lumber auctions. CASE III. JOURNAL NO. 134. Anamnesis and Status, October 12th, 1898. Miss X. Aet. 43 years, single. Mother living, 72 years old, well. Father died in 1884, of chronic spinal disease. A brother died of acute disease in early life, one sister living, very nervous. Father's family nervous, especially the father and one of his brothers, said to have been unusually irritable individuals, not easy to get along with. Patient's birth was normal. She was very delicate as a child, developed normally later on, readily recovered from childrea's diseases, Menstruated at 13, period regular and painless. As a child she had a tendency to outbursts of anger, was irascible. This improved later on, and her education met with no difficulties. Was a moderate student at school, not particularly gifted, but diligent. Refused several offers of marriage because she saw her aim in life in nursing her sick father and cheering The Origin of Paranoiac Delusions. 315 him in his protracted severe disease. When he died in 1884, her sorrow was extreme, and patient appeared so exhausted mentally and physically, that her mother was seriously worried. A recreation was secured by prolonged trips. Patient said to have been in good health up to 1898- In the spring of this year she moved to Weisbaden. Since father's death she had lived with her mother, whom she loved devotedly, the relation between mother and daughter being everywhere acknowledged as exemplary. The ladies had extensive agreeable social connections and were universal favorites. The climate did not at all agree with the patient. She suffered very much from the great exhausting heat in the summer of 1898, and complained of a number of nervous disturbances: insomnia, heaviness in the head, prostration, a dislike for mental exertion, anorexia, sluggish digestion. Became visibly worse, lost in weight. The condition dragged over several months, and changes in her behavior began to manifest themselves. She was extremely irritable, always restless, hurried and discontented. Withdrew more and more from society and showed an otherwise unknown mistrust. For days together she could not be prevailed upon to leave the house, and the mother was particularly struck with the fact that she would no longer tolerate religious assistance, which on the contrary excited her very much, so that she avoided church, entirely against her habits. About the end of September, she first gave her mother an insight into the condition of her mind. She accused two ladies of their acquaintance of hostilities, as follows: ''They are false friends, of course they do not let anything b_e seen in public, but they have forgad an entire plot to push me out of the social circle, to drive me away from here by calumnies, and to throw me into despair. They will not rest until 1 am dead." Every- body was contriving to let her see that she had lost all esteem. Everything was being done towards her ruin. Moreover, she was no longer able to pray, as she had been fond of doing, without ever pondering over it. "I can no longer pray nor collect myself, they have robbed me of my faith, they have estranged me from the Lord, and now 316 Dr. Gierlich. they are taking advantage of it." Patient remained much of the time in bed, could not be prevailed upon to leave the house. Status: Patient describes with great animation how her best friends turned out to be false and aggressive enemies. They were both at work to render her impos- sible, to ruin her good name, and then to destroy her. The two had already formed an entire plot, and they kept on calumniating until the whole town knew of it. One would not notice it to speak to them, they acted in a very friendly manner. She neither sees nor hears it, nor does she observe it from signs or movements. She had been estranged from the Lord, robbed of her faith, she is now unable to pray. She must get away from here, she will not go out here. "They would be capable of anything." Patient is perfectly clear as to time, place, persons, speaks quite calmly and readily about things outside her delusions, there is no fluctuation towards abnormal hilarity (euphoria) or sadness. She is only extremely angry and furious in the sense of her delusions and becomes violent to a degree otherwise unknown in her upon contradiction, especially towards her mother. "My mother permits everything, she does not defend me, she is also in the plot." She actually pulled her old mother's hair a few times, which would have been unthinkable outside her disease. Halluci- nations and illusions could not be determined. There was nothing of importance on the somatic side. Patient some- what below medium height, well made. Temporarily under-nourished. Near-sighted since her youth, No bodily anomilies. Pupils O, K. Sensation, motion, reflexes normal. Pulse 82, regular, full, not hard. Heart, kidneys, etc., without any pathological fundings. This condition persisted at the same degree until the middle of December, notwithstanding baths and narcotics. Then a perfect insight into the condition developed within five or six days. Patient was entirely transformed, became a refined and amiable lady, who could not understand how she had ever gotten such "crazy" ideas, and how she could have treated her mother, her dearest and best, in The Origin of Paranoiac Delusions. 317 such a fashion. No harsh word had ever been dropped before. She resumed her social relations, took a share in charity organizations, and acted quite naturally. There was no amnesia no reactionary hyperthemia, She was again at peace with the Lord and with religion. In the summer of 1899, the author advised that she should leave Weisbaden at an early date, in order to visit a hydrothera- peutic institution in Switzerland, at a higher level. This was done, and her health was fair. The summer of 1900 was passed by the ladies in Weisbaden, with the same unfortunate outcome as in 1898. About the middle of August the general nervous disturbances returned in the former manner: insomnia, pressure in the head, anorexia, constipation, prostration, irritability, restlessness, etc. Before a trip had been decided upon, about the end of Sep- tember, the author found the patient again under the sway of her delusions. The two friends, surrounded by a perfect plot of strangers and acquaintances, were again using all means to destroy the patient by calumny, robbing her of her honor and her name. Patient always placed a very high valuation upon her (historically famed) title of nobility. The mother also was in the plot. At the same time, the incapacity for religious duties again manifested itself. She cannot pray,—so much they have been able to accomplish. Patient is extremely irascible and angry when her delusions are contradicted, becomes aggressive towards her aged mother. There is no depression, self-accusation or euphoria. Patent is perfectly clear and acts entirely in the sense of her delusions. She locks herself in, does not go out for fear she might be hurt in some way. "They are capable of anything; would instigate anybody." Following the author's advice, the ladies promptly went to the same place in Switzerland, as in the previous summer. This plan proved a complete failure. The threads had already been open far enough. Certain per- sons from Wiesbaden, whom the patient knew only by sight, and who happened to be in the sanitarium, had already been at work to spread the net of calumny. Every- body had been told, and nothing but contempt was shown 318 Dr. Gierlich. her. The ladies soon returned and remained at home, The condition persisted at this level up to the third of Decem- ber. The patient then became quieter, could be talked to without violent outbreaks upon contradiction of her de- lusions, and in about eight days her insight was perfect. Patient is ashamed of her ideas, and unhappy about her conduct, especially towards her mother. Is again reconciled to the Lord and religion. Her insight is perfect. Patient began to resume her customary social relations, and had no feeling of interference. Hallucinations and illusions were never noted, patient denying them in both good and bad days. Somatic findings always negative. There is no reason to assume a deterioration of intellect, nor had the mother noticed anything in this direction. No abnormal fluctuations of temper. Patient was last seen by the author in April, 1901, in perfect health. She left town. All three cases concern individuals with faulty heredity, moderately gifted, but possessed by a high ambition, which endeavored to manifest itself according to individual conditions. In the prime of life, under the influence of general factors affecting the nervous system in particular, systematized delusions manifest themselves, as delusions of persecution, jealousy, etc., appearing abrubtly at certain periods, without melancholia or maniacal disturbances, after the patiente had been for two or three months under the sway of very severe neurasthenic symptoms. The pa- tient is entirely under the influence of his delusions, so that his disposition and actions are governed by them. The former is expressed by great irritability and irascibility, upon the slightest attempt to oppose the delusions. Other- wise, the patients are perfectly clear during these attacks, in regard to persons, time, place, etc. There were no de- lusions of grandeur. The delusions persisted at ful strength for several weeks, then the patients became amenable to reason, perfect insight appearing with relative rapidity, within two to four days, with subsidence of the irascibility, and without any reac- tionary anomalies. It was possible to prevent the return of the attacks by suitable measures, guarding against weak- The Origin of Paranoiac Delusions. 319 ening of the patient at a certain season, or at least the severity of the attacks could be considerably lessened. Under neglect of these precautionary measures, the attacks returned in their typical form with striking similarity, without evidence of a progress in the system of delusions. The second and third attacks presented a less violent reaction than the original attack. This may be partly referable to the better training of the surroundings, who were more calm in their interpretation of the condition and more san- guine about the prognosis. In part, the author is of the opinion that the patients were somewhat more accessible to professional influence, notwithstanding their absolute adher- ence to their systematized delusions. Deepseated, progres- sive disturbances of a psychical or somatic character were not observed. The intelligence was not demonstrably diminished. There was nothing in favor of paralysis. The attacks are accompanied by a marked decrease in weight. Among similar observations reported in the literature, the first parallel must be drawn with Ziehen's case. Here also we find systematized persecutory delusions with great irascibility, without the influence of hallucinations, appearing periodically, with perfect insight in the intervals. Hamilton's case probably also belongs under this heading, periodical ap- pearance of persecutory delusions in a woman having Basedow's disease. Bechterew's patient likewise belongs here, since the occasional hallucinations and illusions were devoid of influence upon the systematization of the periodical delusions. This case is especially characterized by the ap- pearance of delusions of grandeur side by side with per- secutory delusions. In the other cases of periodical paranoia, hallucinations existed at the beginning of the disease, and were not without influence upon the systematized delu- sions. However, it is stated by Kausch, that his patient's lack of judgment, and therefore the formation of the sys- tematized delusions could hardly be caused solely by the hallucinations—which were chiefly of an auditory char- acter—without the patient's even attempting to convince herself with the assistance of other senses. Kausch also accordingly does not hold the hallucinations alone respon- sible for the origin of the delusions. 320 Dr. Gierlich. Bleuler recently described 11 cases of periodical de- usions, 10 of which presented more or less marked symp- toms of manic-depressive insanity in the anamnesis, only one case being entirely free. Blueler inclines to subjoin these cases entirely under manic-depressive insanity in the sense of Kraepelin. Chronic paranoia likewise is fre- quently introduced by depressive symptoms. Bleuler's point of view is possibly justified, and a favorable prognosis to be anticipated, whenever manic or manic-depressive mixed forms are demonstrable in chronic delusions. In those cases, however, in which the delusions, the salient feature of these conditions, develop gradually, entirely along the lines of paranoia, in the absence of manic or manic-depressive mixed symptoms—the course cannot be determined at the present day, and accordingly a separation of the mild forms from the unfavorable ones is not feasible in the opinion of the author. What do we learn from the above observations in re- gard to paranoia and its etiology? There are cases pre- senting the picture of paranoia, developing systematized persecuting delusions, with great irascibility, without fluctuations of hilarity and sadness, lasting for several weeks without sensory impairment, passing rather rapidly to perfect insight into the condition, with a tendency to periodical recurrence. The prognosis is favorable as re- gards the individual attack, but unfavorable as regards re- currence. When periodical paranoia is designated by Krspelin as a contradictio in adjecto, this presumably means merely a difference of opinion in the naming of the above conditions; namely, are they to be summed up under the name paranoia or not. The author thinks that the con- ditions under present discussion cannot be distinguished from paranoia at the time of the attack, and are merely characterized by the absence of progression and the mild- ness of the course. Similar conditions prevail, as in the case of dementia praecox, the character of which was form- erly assumed to be invariably unfavorable, but appears less and less serious in the light of recent observations (Otto Diem) so that Kraepelin also mentions an outcome in re- The Origin of Paranoiac Delusions. 321 covery, without or with deficiencies. Nevertheless, the designation has been retained. In a similar way, these mild, systematized delusions are sufficiently differentiated by the qualifying term "abortive" for some, and "periodi- cal" for others, from the severe forms of paranoia which pass from persecutory delusions to delusions of grandeur, and finally into dementia. Do these observations furnish information concerning the genesis of the delusions? Margulies discusses the divisibility of conscious processes into two com- ponents, namely, memories 'and emotions. Complex con- ceptions are formed by the solid junction of similar mem- ory pictures, associated in times or space, with the corres- ponding emotions. The emotions'are at least twofold: firstly, those associated with the sensory impression of the memory pictuie; secondly, more accidental ones, depending upon the individual's frame of mind during the acquisition of the memory. Margulies endeavors to furnish this proof to the effect that some disturbances in the degree and course of these emotions constitute the source of the delusions at the outset of paranoia. Are these presumptions correct in the cases of these three patients? The first patient, about a year before the outbreak of the disease, was hurt by being passed over in certain promotions, showing that his official career was at an end. Given his ambitious character, he remained for a long time under the painful impression of this slight and under- estimation of his merit. He states that he often experi- enced difficulty in overcoming a feeling of incompetence, coupled with envy towards his fortunate rival, but suc- ceeded in doing so by comparisons with the amiable de- lightful manner of his colleagues and superiors. "We are poorly promoted, but well treated." When patient felt bodily and mentally worn out after the strenuous summer, these painful, tormenting feelings returned with greater strength and frequency. He would remain for days to- gether under their way, without being able to shake them off. Next, he believed he discovered changes and unkindness in the behavior of his superiors towards him, and thus one 322 Dr. Gierlich. fine day, the suppositous affair with the wife of his for- tunate colleague led to the outbreak of his delusions of injury and persecution. In the second case, the patient, a wealthy saw-mill proprietor, had married a poor girl, to the general surprise of the community. Patient states that he always sought extreme happiness in marriage and made his choice from pure affection, assuming the same to be true on his wife's part, for else marriage would be intolerable to him. Off and on, certain doubts would arise in the sense of the gos- siping neighbors, whether or not his wife had actually married him for love, or for the sake of a home, so that now he was in her way. As soon as he was together with her, and realized her gentle, clinging manner towards him, his doubts as to her affection disappeared entirely. In the months when he was tired and worn out, these doubts as to his wife's affection attacked him more frequently and severely. For awhile, he fought against these painful feel- ings, but soon looked at everything she did from another point of view, and promptly stood entirely under the in- fluence of the jealous delusions. The patent mentioned under III is a society woman proud of her name, anxious to keep her title and social" position free from blemish, very ambitious to play a leading part in her social circles and to arrange festivities in the interest of charity. These habits were seriously interfered with by the severe neurasthenia from which she suffered after the hot summer. She felt her incompetence, and saw herself forced upon several occasions to leave social gath- erings. Neither was she able to attend to her duties as president of various associations, all of which deeply grieved and annoyed her. She regarded her successor with bitter envy, got into a highly irritated condition, and was finally unable to repudiate the idea that her friends rejoiced over her misfortune and profited of the situation, in order to drive her away from her position and out of the town, ruining her by all sorts of calumnies. In this manner, she developed her persecutory delusions. The author was unable to ascertain definite particulars concerning certain The Origin of Paranoiac Delusions. 323 especially striking social "breaks" of the patient's, domi- nating the emotional sphere, but a number of painful situations were admitted, which troubled the patient for a long time, and over which she pondered considerably. The above observations, especially case 1 and 2, concern imaginations, corruptions which even in health are associated with a peculiarly distressing and troubled frame of mind, as they enter into consciousness. This frame of mind increases to such a degree in neurasthenic dispositions, which are especially susceptible to all negative emotions, that it dominates the individual in the sense of a compul- sory idea emotion. This conception is burdened with an intensely distressing sensation of unhappiness, anger, or envy, dominating the psychical behavior of the individual to such an extent that no associative or perceptive activitly (in the sense of Wundt) is capable of exerting a corrective and diverting influence by comparison or contrasting concep- tions, such as is constantly the case in physiological error. Moreover, the pronounced degrees of emotion do not permit the conception to drop below the threshold of consciousness. We are dealing in the first place with a process, with which we are familiar enough in a similar manner, as a compul- sory idea conception. On closer consideration it is seen, however, that it is not so much the conception which here forces itself upon the patient, as rather the associated frame of mind, which dominates the scene, and serves to distress the patient. "I could not get rid of my anger and unhap- piness, as soon as the idea appeared." When on the other hand, the conception entered into consciousness in well days, without the weighty, overwhelming emotion sensation, the patient readily succeeded in banishing it below the threshold of consciousness. Hence, we are here dealing with a compulsory emotion. Compulsory conceptions are known to pass over in certain cases into so-called insanity with compulsory conceptions, closely related to delusional conceptions; and this was extensively described by Bins- wanger (Neurasthenia.) The closer relations of compulsory ideas towards delusional ideas are further discussed bj Cramer, and especially by Friedmann. The latter says: 324 Dr. Gierlich. "Whether an object thought of becomes a compulsory idea or a delusional idea, is not dependent upon the kind and mechanism of its appearance, but depends in the first place upon the type of mind and the temporary mental condition of the thinking person." Loewenfeld expresses himself as follows: "Psychical compulsory phenomena constitute an extensive boundary region between mental health and the pronounced mental diseases, into which they pass only very rarely however, even in their severest forms." Accord- ingly, we might reach the conclusion that a similar compul- sory emotion, be it anxiety, expectancy, slight error, envy, etc., would lead to systematized delusions, provided it has the sufficient strength and duration. But there are certain weighty objections to this view, in the opinion of the author. It is a rather wide and arbitrary step from the objective interpretation of the situation, which appreciates the whole as a pathological irresistible coercion, to a failure to recog- nize this point of view, in the absence of all criticism. Every practitioner is acquainted with a number of cases in which severe disturbances in the emotional sphere (described by Margulies as the source of delusions) are observed to follow an accentuated conception in the sense of expectancy, anxiety, etc.; dominating the individual for a long time without leading to delusions. These conditions are fre- quently observed in officers of the army. Cases. A captain, patient of the author's, Aet. 41 years, nervous ascendancy, himself generally nervous for years, was severely criticised by his highest superior at a review. He developed a highly neurasthenic condition, standing continuously under the painful impression of the occurrence, always in fear of his discharge, which would be his death. This condition lasted for years, without leading to delusions. A colonel, slight nervous heredity, was unlucky in the army exercises at the annual mancevre, and was criticised without having deserved reproof. He had hardly been nervous before, but soon developed a severe neurasthenic condition. Of high ambition—father of five children—not a wealthy man—he lived in constant fear and anxiety in regard to his discharge. Although this condition The Origin of Paranoiac Delusions. 325 was maintained for months at the same level, no delusions were noted. The following case even more closely resembles the observations of Margulies: A merchant from Holland, Aet. 39, not much faulty heredity, self-made man, now has extensive business, which he manages with his wife. Patient became nervously irritable without visible cause, had insom- nia, gradually developed severe neurasthenia, was extremely restless and irritable. At the height of this state, he said that prosecution by the district attorney was threatening him, that he had ruined his business and his family. Patient made several attempts at suicide, tried to jump out of a moving train, and could only be restrained by violence. No signs of paralysis. After a short time, patient admitted under urgent persuasion that a year previously he had signed a blank check for a business acquaintance, without the knowledge of his wife. This acquaintance had meanwhile been declared in bankruptcy, and a prolongation of the check was impossible. He, the patient, being unable to meet the amount, he would be prosecuted by the district attorney and punished with imprisonment. The sum amounted to 15,000 florins. Payment of the debt was promised per telegram by his relatives, with the result that the pathological picture underwent an abrupt change, although the neurasthenia subsided gradually only. No delusions were observed notwithstanding the high degree of the anxiety and expectancy. Other cases are known, in which compulsory ideas persisted for a long time the patient always remaining aware of the outside abnormal compulsion. A gentleman, patient of the author's, has been suffering from this kind of an emotion for over ten years. He had accompanied his mother to a concert. Ten days later, she had an attack of pneumonia, from which she died. The patient has since remained under the impression of the sad reproachful feeling that he had not assisted his mother with the desirable promptitude in putting on her coat when leaving the con- cert hall, and that he had thereby caused her death. As a matter of fact, there was nothing to support this view. 326 Dr. Gitrlich. Although the patient suffered severely under the weight of this emotion, there was no transition to delusions. Recently, Berze endeavored to prove in an important dissertation, based upon Westphal's views, that the leading part in the origin of delusions must be attributed to the intellectual rather than the emotional activity. Berze closely follows Wundt, explaining that "the psychopathological foun- dation of chronic delusions is a disturbance of the percep- tion, which consists in an interference with the process of raising a psychic conception into the internal viewpoint. This interference is said to induce primarily the idea of passiveness as a sequel to passive perception. In the second place, this interference results in the suspension of a series of perceptive acts, which take place without difficulty in the normal individual. In the third place, this interference results in delay of the sinking of (conscious) psychic con- cepts below the threshold of consciousness. This prevention of appreciated concepts from sinking below the threshold of consciousness, combined with the limitation of the con- scious concepts, is said to lead to compulsory faulty asso- ciations." The participation of "the idea of passiveness results in, erroneous relations to associations with the ego." The argumentation of these principles from the psycho- logical point of view is clever and convincing throughout; only the question arises why delusions do not occur with greater frequency in the course of neurasthenia, in which disturbances in the mechanism of the intellectual functions, as above described, are the rule (difficulty of raising a given conception into consciousness; interference with sinking below threshold of consciousness, without emotional basis.) The idea of passiveness, during the process of psychic perception, is shared by the healthy individual, according to Wundt; it is simply intensified in the above condition. It is a common complaint of neurasthenics that they suffer a good deal with difficulties in thinking and the course or sequence of thoughts; this disturbance causing them much distress. Again, it must be admitted that suggestions of systematized delusions are by no means rare in these cases, if attention is directed towards them: The Origin of Paranoiac Delusions. 327 Mr. X, assessor, Aet. 33, nervous family history, good mental equipment, led a very fast life as a young man, worked very hard between whiles, had influenza before his final examination, which he passed with a good mark a week after leaving his bed. This was followed by a severe attack of nervous prostration. Patient is unable to think, therefore does not care to converse, cannot discuss subjects relating to the law, which used to be mere child's play to him. Abstract thought is very difficult and painful. Memory good. Patient frequently shows suggestions of systematized associated delusions. One day he refused to enter the consulting room and began to pack his trunk. When finally persuaded, he said: "1 must ask you first of all, if you are still willing to treat me. 1 notice that I am troubling and disturbing you." "What makes you think so?" "It became perfectly evident to me as you came into the room this morning." (Author says that he was always particularly amiable towards the patient, knowing his sensitiveness.) He allowed himself to be talked out of his idea, but every few days he had some notion towards one or other of the patients, to the effect that they wilfully neglected him, that he was uncongenial and unwelcome, that they showed this by all sorts of hints, etc. Twice he confronted a gen- tleman in his room, asking him directly for an explanation. The others, of course, did not know how the patient got these ideas. After an explanation, peaceful relations were always re-established. This conduct was diametrically opposed to the gentle amiable character of the man. Patient at present does not work and lives under very favorable conditions. Author says he can readily imagine that in this case the ground would be well prepared for the develop- ment of systematized premonitory delusions under a strong emotional impetus, combined for months with a feeling of anxiety, expectancy, envy, etc. After all these observations and deliberations, it is intelligible that the author cannot identify himself with either of the two groups which at the present day are arrayed against each other as regards the origin of delusions in paranoia. This seems to him neither a purely intellectual disease, nor primarily referable to the emotions alone. 328 Dr. Gierlich. The correct solution of this problem probably lies in the middle. The foundations of the delusions, in the author's opinion, consist in disturbances of the frame of mind by violent protracted emotions of expectancy, suspense, anxiety, anger, envy, etc., in combination with an existing weakness of judgment towards these highly accentuated ideas. On the other hand, the associations and perceptive connections must take place in the normal manner, both per se and in their mutual relations (the foundations of the critical faculty) towards the less accentuated emotional ideas and conceptions. Mistrust is not an emotion in the above sense. It originates only as the result of the delusional interpretations, as pointed out by Bleuler and Specht, more recently by Schultze. The further course, as leading to recovery, arrest, or progression (delusions of grandeur and dementia,) depends essentially upon the brain-power, which determines whether or not the delusional interpretation extends later on to ideas not accentuated in the above sense, and whether or not it continues after the subsidence of the emotion. In which one of the three above mentioned components of normal judgment the disturbance first asserts itself, is still a matter of purely theoretical consideration. Friedmann assumes thinking in short associations, whereas Berze refers the primary impetus to the passive perception. As a matter of fact, the function of perceptive synthesis and analysis, imagination and intellectual activity in the sense of Wundt, is probably responsible in the first place, as the most important mental function. Being inhibited in its function, due to the strong outside sensation, the perceptive faculty presumably loses its objective standpoint towards the complex conceptions, as they arise with all the force of a suggestion, in mild otherwise not recognisable disturb- ances—leading to delusional conclusions in the sense of the conception. The cases so often quoted by Cramer, Berze and others, in which the emotional foundation cannot be demon- strated to the above degree at the onset of the delusions, become more intelligible on the basis of the author's assumption. It is intelligible that the two requirements The Origin of Paranoiac Delusion. 329 for the formation of delusions may approximately supplement each other, in such a way that the perceptive exhaustion in the above sense manifests itself only in connection with a very marked emotional accentuation, or in milder accen- tuations, respectively. As the author's article was being concluded, he received a paper by Ernst Schultze, in Bonn, in which the writer in his lucid manner urgently advocates the causative impor- tance of the emotions at the onset of paranoia, but proceeds to recognize a disturbance in the intellectual sphere in the sense of Gierlich's arguments: "Of course it is not main- tained that every intellectual disturbance is excluded in the development of paranoia, for it goes without saying that there exists a disturbance, under the influence of the emo- tional disturbances, the impressions are fixed from one point of view only, are rendered erroneous, resulting in observations which do not correspond to the actual facts. However, this does not imply a defect in the intellectual sphere, or a quantitative disturbance. The emotional accentuation of the newly developed conceptions is far too intense to admit of correction." Schultze further explains that paranoia in the true sense does not develop in imbe- cility and idiocy. These delusions are characterized by the absence of assimilation according to great uniform prin- ciples, and the condition is preferably referred to as idiocy with delusions. Hence, the paranoiac must be a "past master in the architecture of thought," who loses his power of correction towards the strongly accentuated emotional conceptions, the balance of his critical faculty remaining normal. EROTOGENESIS OF RELIGION. BY THEODORE SCHROEDER, 63 East 59th Street, New York City. EVERY definition of religion is resolvable into this: Re- ligion is man's conception of his relation to those among the supposed objects of his dependence, to which his relations seem so mysterious that he deems his ac- quaintance with them due to transcendental experiences. Man's gods are his conception of such objects of depen- dence, which, in turn, involve his explanations of the mystery. Symbolism and institutionalism in religion are but man's imperfect objectivations of these concepts. Idolatry is the worship of a man-made symbol in lieu of the concept symbolized, and is developed by a process of gradual and unconscious substitution, with a final conse- cration, and a belief in its being an incarnation of the diety. The God idea, like the idea of the good and the beautiful, is a mere abstraction, not an objective reality cognizable to man as such, but wholly, solely and unalter- ably subjective, finding its only justification in the feelings of man, though seldom so understood. The history of re- ligion is, therefore, but a record of man's objective mani- festations of such subjective states. Thus viewed, the study of religious phenomena is essentially a branch of psychology, and the methods of material science, adjusted to the order and relations of objective phenomena, are ap- plicable so long as we are examining the religion of others. The scientist must study the manifestations of religion as the alienist studies the utterances of-the insane, namely: as a means of classification, and for the discovery of causal conditions within, as well as without, the individual. ( 330 ) Erotogenesis of Religion. 331 Variety of religions is the product of evolution, a part of universal evolution. The difference between the individ- ual worshipfulness of some primitive peoples and our modern, highly-diversified, religious organizations, only exemplifies the law of evolution, which is ever a transition "from an indefinite, incoherent homogeneity to a definite, coherent heterogeneity." In criticism of Spencer, Lang, Taylor and others, in their efforts to interpret religion in terms of the law of evolution, it has been justly said: "However interesting these [their] theories may be, however much light they may shed upon the religious life of primitive and civilized peoples, the question, 'How did primitive man obtain con- ceptions that we call religious?' is not solved."* However, by applying the law of evolution to the known facts, we may be able to retrace the evolutionary process to the beginnings of religion, and having thus found the initial object of worship, we are in a better situation to answer the inquiries as to how, whence and why man acquired religious experiences and concepts. If we desire to retrace the evolutionary processes of religion^ to their origin, we begin by arranging the ob- jects of worship according to their evolutionary chronology. This is accomplished by classifying them as relatively close to or far evolved from the beginnings, according to the degree of complexity implied in the religious concepts, and the degree of conscious knowledge of man's relationship to his environment, which is implied from his choice of the objects of worship. Since continuing evolution is conditioned upon an ever widening mental horizon, that religion is nearest the primal deviation from the non-religious which implies the least knowledge of our environment. Because the worship of an infinite, purposeful, divine imminence implies a wider knowledge of the world and of the universe, than does the worship of isolated natural phenomena, therefore theism, as now defined, is conclusively proven to be a later evolution- ary development than the worship of a mountain or of •First Principle', Spencer, p. 407. Appleton Edition. 332 Theodore Schroeder. lightning. The first among the religions of which we have knowledge must be that one which implies the least or no conscious acquaintance with the objective. Judged by that test, it follows beyond all reasonable doubt that sex-worship must have been the very first form of our known religions, since the conditions of its development are wholly within each individual. When unconscious automatism was transforming to human self-consciousness, beyond all doubt one of its very first cognitions must have been the primal impulse that makes for progeny an accompaniment of sex-ecstacy. This is so for many reasons, and among them the conspicuous changes and periodicity of its manifestations, would compel an attention which a more uniform activity would escape. Then was the age of racial adolescence. Savages and ichildren animate all things with a psychic life, and ascribe 'to a special volition all activities which excite their sorrow, joy, hope or fear.^ It is a necessary inference that in primitive man this tendency was at least as pronounced as in present-day children. Becoming conscious that sex-impulse was uncontrollable by his own act of volition, man naturally assumed that the generative organs had a psychic life of their own, by which they know the how and why of their own activity, seen to be so well adjusted to the end of procreation. Necessarily such a man ascribed the phenomena of sex-excitement and sex-functioning to an intelligence not his own. Because he had not yet become conscious of his relation to his environment, he naturally gave that intelligence a local habitation within the virile member. As late as 1729, 1 find a Christian clergyman writing of it as the "receptacle of a manly soul."t Phallic worship was inevitable. To primitive man in racial adolescence the sexual mechanism and functioning is the first conscious, the greatest, and almost the only intense joy of his experience; the first visible and most •Chas. F. Hemingway, in v. II. Am. Anthropologist, p. 876. tSe* Hibbert Lectures, 1891, pp. 62-S8. Also Fact and Fable in Psychology and Taylor's Primitive Culture, for illustrative facts. Erotogenesis of Religion. 333 immediate course of life, the first object of conscious de- pendence; the first mystery presented to consciousness demanding solution and inspiring awe; the first sense per- ceived associate of his highest, his deepest and almost his only hopes, longings and joys, as well as the instrumen- tality of their realization. It was unavoidable that the solemn awe of sex-mystery, the seeming transcendence of sex-ecstacy, and the pre- dominance of a conscious-dependence upon sex for joy and life, all combined with the supposed intelligence ascribed to the sex-organs, would fuse into a worshipful reverence of the phallus, as the original, objective, intelligent and ultimate source of all that to primitive man was worth having. In the nature of things, therefore, these elements made sex-worship the first religion, and they are the essentials of all religion, even to this day. A growing knowledge has caused us often to change our opinions as to the situs of that other intelligence which controls our destiny, but the essence is still the same. When we shall have solved the mystery of generation, abolished the awe of ignorance, and no longer experience the ecstacy of love, religion will have ceased to be. In these considerations we find a complete answer to the question, "How did primitive man become religious?" Prehistoric archaeology has also contributed evidence to show that phallic worship is the oldest religion. A modern writer has this to say about our theme: "There appears to be a chance of this [phallic] worship being claimed for a very early period in the history of the human race. It has been recently stated in the Moniteur that in the province of Venice in Italy, excavations in a bone cave have brought to light, beneath ten feet of stalagmite, bones of animals mostly posttertiary, of the usual description found in such places, flint implements, with a needle of bone having an eye and point, and a plate of an argilla- ceous compound on which was scratched a rude drawing of a phallus."* There can be no objectivation of a concept, as in a The Moniteur, Jane, 1865, quoted in The Worship of the Generative Powers. 334 Theodore Schroeder. drawing, until man has become self-conscious. It, there- fore, follows from the very nature of our thinking processes, that man could not make a drawing of the phallus until after he had become definitely self-conscious of some of the phenomena of sexuality. Since with the genesis of such a consciousness the primal phallicism must have come into being, it follows that the drawing above referred to was made after the beginning and probably because of sex- worship. This easily fixes the existence of phallic religion, ages anterior to the known existence of every other kind of religious manifestation. Since the course of evolution is marked by a change "from incoherent homogeneity to a coherent heterogeneity," it follows that we are retracing the course of religious de- velopment so long as the proportionate homogeneity and its incoherence are on the increase. The end of this re- tracing cannot have been reached so long as the object of worship is an abstraction or a generalization, since both necessarily imply a prior acquaintance with, and probably a worship of the concrete. It would seem, therefore, that -', the initial object of worship must have been concrete. Neither could it have been the same identical con- crete object that first induced religion in each primitive man, since a conscious relation of the whole human family to the same object implies a very high degree of coherence between all. The ultimate of religious incoherence is reached only when the indulgence of religious sentiments is that of each man in a state of absolute religious isolation. Among all the historically known concrete objects of religious reverence only one will admit of the hypothesis, that all the conditions of its religious adoration were present in and for every man, and with him wherever he is, on every part of the earth, at the age of religious awakening, either individually or racially considered, and at every other time as well. That one object is the sexual mechanism. Only in the primal sex-worship of racial adolescence, when every man finds a part of himself to be the source of every religious essence and the object of his religious sentiments, can we find that ultimate incoherence and homogeneity Erotogenesis of Religion. 335 which the law of evolution conditions as existing at the time of religious inchoation. By this test, we again reach ". the conclusion -that sex-worship must have been the first of all religions. The religious homogeneity which the law of evolution postulates as the condition of the primal deviation from the non-religious, demands that if sex is the generant of re- ligion, and this came about as an unavoidable consequence of the conditions of racial adolescence, that then all peoples, where religion has come into being, must have had some form of sex-worship at and near their religious beginnings. This means that at the times of its inchoation, a religion with a distinctive sexual foundation must have been geographically universal over the portions of the globe' inhabited by native religious humans. That phallic wor- ship was thus geographically universal is the testimony of . every serious student of this cult. Says Richard Payne Knight: "Those who wish to know how generally the symbol [of the phallus] and the religion which it represented once prevailed, will consult the great and elaborate work of Mr. D'Hancarville, who, with infinite learning and ingenuity, has traced its progress over the whole world."* Another student of the subject, adds this testimony: "Of the extensive prevalence of this worship [of the human organs of generation] we have ample evidence. It''occurs in Egypt with the diety Khem, in India with Siva, in Assyria with Vul, in Greece with Pan and Priapus, in the Scandinavian and Teutonic nations with Fricco, in Spain with Hortanes. It has been found in different parts of the American continent, in Mexico, in Peru and Hayti; in both these latter places numerous phalli, modelled in clay have been discovered, and in the islands of the Pacific Ocean on festive occasions, a phallus highly ornamented, called by the natives Tinas, is carried in the procession."t Clifford Howard, another student of sex-worship, con- tributes this statement: While the highest development of •The Worship of Priapus, p. 15. tNature Worship, p. 12. 336 Theodore Schroeder. phallicism was reached by the ancient Egyptians, Assyrians, Hindoos, Greeks and Romans, proof of the existence of this form of religion is to be found in every part of the earth in- habited by man.'(Persia, India, Ceylon, China, Japan, Burmah, Java, Arabia, Syria, Asia Minor, Egypt, Ethiopia, Europe and the British Isles, together with Mexico, Central America, Peru and various other portions of the Western Hemisphere—all yield abundant evidence in support of the universality of phallic worship as a primitive form of re- ligion, and of the common origin of theological creeds."**; These facts again confirm our former conclusion that sex-worship is the primal religion from which all others have evolved. We must further verify our conclusion, by determining whether the sequence of events implied in it corresponds with the natural order otherwise determined. In other words, can we verify the implication that emotional religion preceded the rational form. In the course of evolution the emotional life precedes that of conscious reason. Affinity and aversion, feelings of pleasure and pain, existed as an automatic reaction upon environment, long before they were the basis of conscious ratiocination. It is not thinkable that in its specialization as to religion, this order of events should be reversed, and rational religion antedate and develop the emotional. The spontaneous unreflecting feelings of joy and terror which are displayed by even lower animals in the presence of certain natural and mysterious phenomena, is a funda- mental fact of religion, and the first mysterious joy to arise into consciousness would be that connected with sex. When in the course of evolution man attributed to it a psychic personality, analogous to, but more exalted than his own, the sentiment he experienced toward it and his instinctive groping in quest of an agreeable relation with that mysterious being constituted his religion. Conscious reasoning was not invoked until long after. When man has become self-conscious and capable of introspection, and when he seeks to explain his emotions and his relation to •Sex Worship, p. 12. Erotogenesis of Religion. 337 their supposed source, he first begins conscious reasoning as to any phase of his religion. Not until then can he seek for the establishment of any ideal relation with a mysterious higher power. Thus science and philosophy are but the rationalized expurgations of religion. What is still unexplained is the only exclusive property of the church. As we can draw no exact line between health and disease, so neither can we draw such between the unreligious and the religious stages of evolution, because they so gradually shade into each other. The infant in its cradle automatically responding to an agreeable stimulus when its mother ap- proaches, stretches forth its arm imploringly with the at- titude of mind that would propitiate, long before it has taken to reasoning either as to its relation to, or the char- acter of its mother. So did man in obedience to his emo- tions automatically seek an adjustment to the mysterious, at first within and later without himself, which consciously- sought adjustment is religion, long before he expended any conscious effort toward the solution of the mystery,—the contemplation of his object of adoration,—his God. Therefore we must conclude that !the conception of divinity did not engender religious sentiment, but rather that the presence of mysterious emotions brought man to believe in the existence of gods and subsequently, in ex- planation of his emotional states, to reason as to the divine nature. "The truth is that in the metaphysical and religious sphere, articulate reasons are cogent for us only when our inarticulate feelings of reality have already been impressed in favor of the same conclusion."* No matter how we define religion, its emotional states long preceded the effort at a rational explanation for their existence and relations. Religious emotionalism, preceded rational religion, and this, again is as it must be if religion had its beginning in sex-ecstacy. Among all the objects of religious worship, only the phallus can supply all the conditions necessary for a subjective emotional religion, such as must always precede a reasoned view of man's 'James' Varieties of Religious Experience, p. 74; also Prof. T. Thomas' Sex and Society, p. 118. 338 Theodore Schroeder. relation to his physical environment, such as could induce the worship of any portion of it. 1 In the return from the zeal of intolerance back to rationality, hospitality is extended to differences of opinion as to economics, science, government, etc. The last two fortresses of bigotry are the belief in spiritual existence and sexual ethics. Even with persons in whom all semblance of religious doctrine or observance is dissipated, and an unlimited hospitality for intellectual differences is allowed upon practically all questions, the last remnant of bigotry will be certain to be an intolerance for differences of opin- ion as to sex ethics. It is a significant feature that the only inter-human relation not of necessity associ.iied with or developed through religious theories, and which is accredited "sacred" or "spiritual" is the relation of men and women. Even the scientific religionist who can find "spirituality" almost nowhere else, can still discover a "spiritual" significance and "sacramental" character in marriage. If our theory is correct we should find it so. All the frenzy of fanaticism would then be a mere religious superstructure to disordered nerves, finding its religious element in the passional centeis of physical organism. Since it is the law of devolution that the last acquired functions are the first to disappear, it follows from the fact that sex-superstition is the most persistent of all superstitions, that it is the source of all superstitions. If, racially speaking, religion had its origin in a misin- terpretation of an unidentified sex-ecstacy, it would seem to follow that some of this essence must be still present as one of the unrecognized elements in the individual experi- ences of the religious enthusiast. That is true, as also is this, that whatever is conspicuously true of all great re- ligious enthusiasm is in lesser degree true of all distinctively religious experience. What are the facts in this respect? Many years, devoted to the historical study of religious revivals, enthusiasms and abnormities leads me to this conclusion: Every intense and widespread religious revival has produced increased sexual irregularity. Every concerted Erotogenesis of Religion. 339 effort at the establishment of compulsory sexual excesses, -s either of repression or indulgence, has found its warrant in religion and its beginnings amid religious excitement.' t Every known type of sexual perversion, from salist lust- murder—up and down—has been credited with the en- dorsement of some god, and advocated and practiced by some religious society. Every organized effort toward ostentatious sexuality has found its justification in religion. Here, 1 have in mind those numerous small sects, such as the Adamites, with whom parade or worship in nudity was esteemed a duty to God, and those other anomalous creat- ures who go about wearing badges or uniforms, which un- ceasingly and ostentatiously advertise their "chastity." Were persons to announce through the newspapers their unseducible virginity, we would believe them sexually in- sane. When the same end is accomplished by conventional monastic methods of giving publicity to the same boast, we think nothing of it, only because we have become accus- tomed to it. From the time of the pre-historic sex-worship of primi- tive peoples to this very hour, the desire to regulate other people's sexual affairs has been the most zealously pur- sued of all the ambitions of religious societies. If then this mad overvaluation of the divinity, sacred- ness, spirituality or sinfulness of sex is a universal con- comitant of the frenzy of religious fanaticism, it would seem to follow that there must be a good deal of undifferen- tiated sensuality in all religious enthusiasm of lesser de- gree, and this again confirms the conclusion, that in so far as religion is still a personal experience, an emotion, in- stead of cold and passionless science, to the extent that it is a matter of "love," as is often proclaimed, it is again of erotic origin. Once realizing fully that man's religion found its origin and warrant within himself, and that of necessity the evo- lutionary modifications were impelled by similar environing conditions, it follows that these facts will explain the similarity of the religious product on various parts of the earth. This involves a reversal of our method of studying 340 Theodore Schroeder. the migrations of man. Owing to the myths about the the creation, it was once thought necessary to explain all similarity, whether religious or otherwise, as the product and evidence of a common Adamic origin. Now, that we accept universal evolution, we must come more fully to appreciate the fact that the evolutionary development of life may have reached the human, self- conscious stage in many different places at substantially the same era, and ihat the similarities which we find among different peoples are the result of a likeness in evolutionary materials and forces, and not evidence of a common ancestor; nor will they hereafter submit to being tortured into an explanation consistent with such discarded Adamistic monogenism. It used to be argued that the various systems of wor- ship in different parts of the world corresponded so closely, both in their evident import and in numerous points of arbitrary resemblance, that they cannot have been struck out independently in the several countries where they have been established, but must have all originated from one common source. The latter part of the argument is good. The error consisted in assuming that the common source must have been geographical, instead of looking for it in the very nature of every individual man, in the general and all important sex instinct. The practical universality of Ophiolatreia, demonstrates only its evolutionary proximity to the primal sex-worship. The probative force of a general similarity in myths con- cerning the fall of man, through the seduction of a serpent- tempter, only tends to show the sex-origin of serpent wor- ship, and to illustrate the uniformity of evolution. Same- ness in these myths no longer conduces toward their ac- ceptance as different relations of the same historical fact. There is still another consequence which follows from the subjective origin of religion. It furnishes a new ex- planation for that, all but, universality of religion. Heretofore this fact, because its relation to the sex-feeling was unrecognized, induced the conviction that religious ideas are innate. Out of this was evolved the notion Erotogenesis of Religion. 341 about the existence of certain intuitive first principles of which, or through which, because of their supposed origin, we were said to have inherent direct knowledge of God. The subjective and sex-origin of religion explains this universality and alleged innateness, so as to destroy utterly the deduction formerly made as to their infallibility of such testimony in favor of the objective verity of religious concepts. For the foregoing reasons, among many others, I con- clude that religion came into being by ascribing to the sexual mechanism a separate, local intelligence, which, coupled with a misinterpretation of the seeming transcen- dence of sex-ecstacy, resulted in the apotheosis of sex- functioning, and the sexual organs, and that all the mani- fold forms of religion are to be accounted for only as the diversified products of evolution, resulting wholly from physical factors and forces, operating upon man under different conditions. THE RELATION OF CEREBRO-SPINAL FLUID TO EPILEPSY. BY C. H. HUGHES, M. D. HOUSE (etiology and pathology of epilepsy major, Phila. Med. hur., Vol. v., 1900) found in five autopsies, after status epilepticus an excess of cerebro- spinal fluid in each, and regards this excess of interventri- cular fluid as the cause of the convulsions and status. He compares the symptoms of epilepsy with those of other diseases which produce or are accompanied by convulsive seizures resembling more or less the seizures of epilepsy, hysteria, tetany, infantile, puerperal and uremic eclampsia, alcoholism, cerebral hemorrhage, and the apoplectiform and epileptiform convulsions of general paresis. Epileptic seizure, epileptiform paretic convulsion, alcoholic convulsion, or cerebral hemorrhage convulsion present marked similarity. "In the brair> of an alcoholic there is an excessive quantity of cerebrospinal fluid, the ventricles are distended, the brain substance drips with fluid, and the membranes are dropsical. This is called the 'wet brain.' In general paresis the ventricles are distended with fluid, there is an increased quantity of fluid in the subdural space, and the whole brain is surrounded with an excessive quantity of turbid cerebrospinal fluid." In these conditions the excessive fluid seems to House to be the logical cause of the symp- toms of these diseases, which he regards as pressure caused results. Besides these necroscopics, House's conclusions are drawn from a large number—approaching three hundred— epileptics, alcoholics and paretics. Bonar, in the December number Jour, of Ment. and Nev. Dis., has, with rare ( 34 grn.) every evening for several weeks. REVIEWS, BOOK NOTICES, REPRINTS, ETC. THE NERVOUS SYSTEM OF THE VERTEBRATES by J. B. Johnston, Ph.D., Professor of Zoology in West Virginia University. Price with one hundred and eighty illus- trations $3.00. P. Blakiston's Son & Co., 1012 Walnut St., Philadelphia. The author lucidly and intelligently discusses Waldeyer's neurone theory, tentatively states it in six propositions, the last of which viz: that the form and position of the neurones, especially the connection and disposition of their processes determining the pathways of impulses and hence the work done by the nervous system, includes, in his judgment its entire practical value. He considers "A knowl- edge of how neurones are linked together in functional systems is necessary for the pathologist and psychologist. The factors which determine the manner of linking neurones are the chief interest of the social psychologist, the educator and the social reformer." The entire book with its numerous, copious neuro- anatomical illustrations and elucidating context will entertain and repay in agreeably and profitably imparted knowledge of the authors subject any reader of the Alienist and Neurologist. We may recur to this valuable book again. THE DISEASES OF THE RECTUM: Their consequences and non-surgical treatment. By W. C. Brinkerhoff, M. D., Chicago, 111. Price $2. Orban Publishing Company, Chicago, 1907. Those who may have in their possession the greater works of Tuttle or Mathews or even of Bodenheimer and others will not specially need this little book, though there are some things in it which might be regarded as valuable addenda. ( 433 ) 434 Reviews, Book Notices, keprints, Etc. The author's reference to the right use and kind of rectal syringe tubes and his cautions against the evils of the enema habit are worthy of approbation and his non- germane chapter on the legal limitations of medical practice, mat appropos as it is to the scope of the book, will amuse the reader, especially if he should happen to be a professor in a medical school. CLINICAL PSYCHIATRY, a text book for students and physicians. Abstracted and adapted from the seventh German edition of Kraepelin's "Lehrbuch der Psychia- tric" By A. Ross Diefendorf, M. D. New edition, revised and augmented. The MacMillan Company, New York. This is a timely new edition abstract for the American and English reader of Kraepelin's Lehrbuch de Psychiatrie, the only omissions being "The general etiology, diagnosis and treatment in the first volume" of the distinguished author, the revisor deciding upon such points as are of the most importance and adding them to this department. The book will prove of value to the American physician interested in the study of psychiatry but we regret to see that so many of the author's methods of treatment are omitted, especially without the author's special sanction. FOLIA THERAPEUT1CA.—A copy of the second number of a new journal on therapeutics entitled the "Folia Therapeutica'' has come to our notice. It will be the aim of this journal to devote itself to publications on the progress of modern therapeutics and pharmacology, and to present in a brief and concise manner the methods of treatment and preparations which can be safely recommended for use, and which constitute a real advance in therapeutics; and the evidence given for the reliability of any treatment or drug will consist in the unquestionable authority of the authors by whom, or under whose supervision, the investigations have been made. The names of the editors Baginsky and Snowman guarantee the worthy character of the journal. Reviews, Book Notices, Reprints, Etc. 435 We take pleasure in putting the same on our exchange list as requested. It is issued from 83-91, Great Titchfield Street, London, W. This new applicant for professional favor is published by Messrs. John Bale, Sons & Danielsson Ltd., Oxford House, Great Titchfield Street, London, W. The names of Sawyer, Senator, Taylor & MacKenna, Schmieden, Arnold Edwards, Barendt, Gossman and Brieger appear among the contributors to number two of these therapeutic folia of most excellent promise. A Plea for the Earlier Diagnosis and Treatment of Epilepsy. By M. L. Perry, M. D., Superintendent State Hospital for Epileptics, Parsons, Kas. Thirteenth Annual Report of the Craig Colony for Epileptics, Sonyea, N. Y., 1906. Medical Expert Evidence and the Bill Pending before the Legislature of Maine. By Clark Bell, Esq., LL.D., President of the Medico-Legal Society of New York. Therapeutischer Notizkalender fur Praktische Aerzte. Vierteljahrsbeilage zu Deutsche Medizinalzeitung. XXVI. Jahrgang 1905. 2 Heft. April bis Juni. Verlag von Eugen Grosser in Berlin SW. A Critical Analysis of the Expert Testimony in the Jack the Stabbcr Case. By David S. Booth, M. D., St. Louis. Neurasthenia, Traumatic and Idopathic; its Pathology and Prognosis. By David S. Booth, M. D., St. Louis. Alcoholism and the Narcotic Drug Habits. By B. B. Ralph, M. D., 529 Highland Ave., Kansas City, Mo. The Radical Mastoid Operation for Chronic Suppurative Otitis Media. By Hanau W. Loeb, A. M., M. D., St. Louis, Professor of Diseases of the Nose and Throat in St. Louis University. 27th Annual Report of the State Hospital for Insane, S. E. District of Pennsylvania, Norristown, Pa., for the Year Ending September 30th, 1906. 436 Reviews, Book Notices, Reprints, Etc. Abnormality in Amniotic Secretion in its Relation to Fetal Malformation. By Joseph Brown Cooke, M. D., Adjunct Professor of Obstretics in the New York Polyclinic Medical School and Hospital, Surgeon to the New York Maternity Hospital; Visiting Obstretric Surgeon to the Misericordia Hospital; Fellow of the New York Obstetrical Society, etc. A Case of Landry's Paralysis with Recovery. By Wharton Sinkler, M. D., of Philadelphia. Protestant Hospital for the Insane, Verdun, Montreal, Que. Annual Report for the Year 1906. Central Indiana Hospital for Insane. To the Governor. 1906. A Plea for the Simple Round-Ligament Ventrosuspen- sion. By B. S. Talmey, M. D., New York. The Food and Drugs Act as it Relates to Drugs. Examined and Explained in Connection with the Rules and Regulations for its Enforcement. Indiana Medical College, the School of Medicine of Purdue University. Report of the Department of Health of the Isthmian Canal Commission for the Month of February, 1907. By W. C. Gorgas, Colonel, Medical Corps, U. S. Army Chief Sanitary officer. The Growth of Neurology. Chairman's Address Before the Section on Nervous and Mental Diseases, at the Fifty- Seventh Annual Session of the American Medical Associa- tion, Boston, June 5-8, 1906. By Wharton Sinkler, M. D., Philadelphia. Monstrosities vs. Maternal Impressions. By George S. Courtright, M. D., Lithopolis, Ohio. Read before the Ohio State Medical Society and Published in the Transactions. Reviews, Book Notices, Reprints, Etc. 437 Carcinoma. By J. P. Oawford, M. D., Davenpoit, Iowa. Oration on Surgery Read Before the Iowa State Medical Society, Des Moines, May 17th, 1906. Opening with the statement that there is no disease afflicting the human family that continues to be of greater concern than carcinoma, and noting the growing distrust in the efficacy of all therapeusis, surgical as well. At present the vision of success is not inspiring. To this vast company of suf- ferers this beautiful world is likely to continue a veritable charnel-house in the midst of life. The author thus gloomily concludes an able survey of this therapeutically discour- aging subject. The auahor's surgical technique is admirable. A Review of the Opsonins and Bacterial Vaccines. By E. M. Houghton, Ph.C, M. D., Junior Director, Bio- logical Laboratories, Parke, Davis & Co., and Special Lecturer in Medical Department, University of Michigan. Directions for Determining the Opsonic Index of the Blood. By E. C. L. Miller, M. D., Research Bacteriologist, Depart- ment of Experimental Medicine, Parke, Davis & Co., Detroit, Mich. This is a good presentation of an interesting subject which every physician should read. It comes with compliments and approbation of P., D. & Co., which con- stitute a guarantee of merit. The Feeding of Infants in Diarrhoea, Cholera Infantum, etc. Mellin's Food is a preparation for the modification of fresh cow's milk. In diarrhoea or in pronounced digestive disturbances when milk is contra-indicated, Mellin's Food dissolved in water may be used tempo- rarily or Mellin's Food in whey. As soon as the stomach regains tone, a small quantity of milk should be gradually added, until the proper proportions of Mellin's Food, milk and water, adapted to the age of the child, are reached. Mellin's Food in these cases is much to be pre- ferred to barley or other cereal gruels, as it is free from starch, and therefore does not set up, but actual- ly allays, intestinal irritation. We will gladly send samples free to you, Doctor, on request. Mellin's Food Co., Boston, Mass. PUBLISHER'S DEPARTMENT. NERVOUS EXHAUSTION.—Just as the continued ad- ministration of the Hypophosphites produces more solid bones whose chemical composition is "natural," so there are good grounds for holding that the steady, persistent use of the Hypophosphites will tend to produce a more complete development of an imperfectly evolving nervous system. TO INCREASE the muscular activity of the stomach walls, Gray's Glycerine Tonic Comp. has valuable properties. THE MEDICAL ERA'S SPECIAL EDITIONS.—The Med- ical Era, of St. Louis, Missouri, will conform to its usual custom and issue its yearly series of special Gastro-Intes- tinal numbers embracing July and August. The August issue will be given over entirely to the consideration of every phase of Typhoid Fever. The series will contain about 35 or 40 practical papers and will contain a large amount of valuable information. IN THE TREATMENT of the chronic skin inflamations, following in the wake of attacks of toxic dermatitis, at- tention to the general condition of the health, avoidance of anything irritating to the skin, a carefully selected diet and proper care of the skin are important features which must not be neglected. In addition, Battle's preparation of echinacea augustifolii and thuja occidentalis, which goes under the trade name of Ecthol, should be used both locally and internally, a drachm should be taken four times a day.—American Journal of Dermatology. BROMIDE TREATMENT.—No form of bromide treat- ment will prove successful unless the very purest salts are employed. ( 438 ) ITS COVER PORTRAITS AGE: TWENTY-FIVE YEARS have made it famous —and still growing! 7246 PROGRESSIVE PHYSICIANS READ THE MEDICAL HERALD OFFICIAL JOURNAL MEDICAL SOCIETY OF MISSOURI VALLEY YOU NAY BECOME ONE OF THIS CLASS FOR ONE DOLLAR . . . Clean, Ethical, Newsy, Original. Un- trammelled by trade connections—unbiased in its utterances—and broad enough to re- nounce illogical traditions and narrow dogmas . Its Original Department reflects tbe progress of the stalwart Prac- titioners of the great Middle West. The Oldest Independent Medical Monthly west of the Mississippi River EDITED AND PUB- LISHED BY MEDICAL MEN: ITS AIM TO AD- VANCE THE CAUSE OF SCIENTIFIC MEDICINE CIRCULATES IN A FIELD PECULIARLY ITS OWN $1.00 the year 1 For specimen copy, premium list and schedule for game "500" address DR. CHAS. WOOD FASSETT, Managing Editor, ST. JOSEPH, MO. The Ralph Sanitarium Alcoholism and Drug Addictions THE method of treatment is new and very successful. The withdrawal of the drug ia not attended by any suffering, and the cure is complete In a few weeks' time. The treatment is varied ac- cording to the requirements of each Individual case, and the res- toration to normal condition is hastened by the use of electricity, massage, electric light baths, hot and cold tub and shower baths, vibratory massage, and a liberal, well-cooked, digestible diet. A modern, carefully conducted home sanitarium, with spacious surroundings, and attractive drives and walks. Eieotro-and Hydro-therapeutic advantages are unexcelled. Trained nurses, hot water heat, electric lights. Special rates to physicians. For reprints from Medicaljournals and full details of treatment, address DR. B. B. RALPH 52«hu?nd Kansas City, Mo. Publisher's Department. 440 he joined fortunes with the house seven years ago. He left the faculty of the Philadelphia College of Pharmacy in the spring of 1900 to become Chief Pharmacist of Paike, Davis & Co. At the enJ of three years he had made himself so valuable in the councils of the house that he was elected to membership on the Board of Directors. A year and a half later he was given the important post of secretary. Six months later still he was elevated to the vice-presidency. And now, after barely another year, he is given the very highest position within the gift of the house, and one might say without fear of contradiction, the greatest and most responsible position yet created in the drug trade of the country. Born in 1861 in Marcellus Falls, New York, Mr. Ryan was educated in the public schools of Elmira, and then spent three years in the well-known pharmacy of Brown & Dawson in Syracuse. In 1882 he entered the Philadel- phia College of Pharmacy and was graduated two years later at the age of 23. Two or three years were next spent in various Philadelphia stores, and then he was made assistant professor of pharmacy in his alma mater. In 1898 he was given charge of the course in commercial training then established in the P. C. P., and in the meantime he had been made lecturer on pharmacy in the Woman's Medical College of Philadelphia. In June, 1900, Prof. Ryan resigned all his connections in Philadelphia and went into the house of Parke, Davis & Co. Tne secret of a man's success is never easily analyzed, but it may be said of Frank G. Ryan that he represents that rare, that ideal combination of technical knowledge and experience on the one hand, and business grasp and executive ability on the other. These qualities are all but incompatible, and he who unites them successfully has discovered a philosopher's stone. As president of Parke, Davis & Co., Mr. Ryan will be capable of understanding thoroughly every scientific detail of the vast business now confided to his care, and he will also exhibit that larger vision and that greater capacity for administration which will carry the house forward to conquests even more brilliant than those which have been registered in the past. WE SUPPLIED ALL THE CITY INSTITUTIONS WITH DRY GOODS LAST YEAR. W M. BARR GOODS CO. Keep the Largest Stock of Goods suitable for HOSPITAL PURPOSES TO BE FOUND IN ST. LOUIS, And Special Terms will be made with all Institutions ordering from them. BEDDING MATERIALS OF ALL KINDS, UNDERCLOTHING, IN SILK, WOOL AND COTTON, LADIES' AND CHILDRENS' READY-MADE CLOTHING, FLANNELS AND UPHOLSTERY, TABLE AND BED ROOM LINENS, SOAPS, NOTIONS AND PERFUMERIES, ARE ALL SPECIALTIES AX THE; WM. BARR goods COS NEW BUILDING, SIXTH, OLIVE AND LOCUST, .... ST. LOUIS, P. S. Write and find out our special terms to Hospitals. HALL-BROOKE A Licensed Private Hos- pital for Mental and Nervous Diseases. CASES OF ALCOHOLISM AND DRUG HABIT. DEAUTIFULLY situated on Long Island Sound one hour from New York. The Grounds consisting of over ioo acres laid out in walks and drives are inviting and retired. The houses are equipped with every Modern Appli- ance for the treatment and comfort of their guests. Patients received from any location. Terms Moderate. DR. D. W. McPARLAND, GREEN'S FARMS. CONN. Telephone 67-5 Westport Conn THE MTIOML MEDICAL EXCHANGE -Physicians'. Dentists' 'ind Oruggitti' Locations and Property bought, sold rented and exchanged. Partnerships arranged Assistants and substitutes provided. Business strictly confidential. Medical, pharmaceutical and scientific books supplied at lowest rates. Send ten cents fur Monthly Bulletin containing terms, locations, and list of books. All inquiries promptly answered. Address, H. A. MUMAW. M. D. Elkhart. Ind. THE NATIONAL Surgical and Dental Chair Exchange. All kinds of new and second-hand Chairs, Bought, Sold and Exchanged. BBS-SEND FOR OUR BARGAIN LIST"** Address with stamp, Dr. H. A. MUMAW, Elkhart, Ind. LARGE DIVIDENDS Are assured stockholders of the SIERRA- PACIFIC SMELTING CO., Sonora, Old Mexico. Easy Payments. Agents Wanted. Write for terms. Address, HENRY MUMAW, Elkhart, Ind. Publisher's Department. 441 Mr. Ryan, accompanied by his daughter Helen, had returned from a seven months' trip around the world only a week or two before his election to the presidency. His main object was to further the interests of his house in Japan, China and India, but he also visited Manila, Ceylon, Egypt, Paris, and London. In Manila an agency was established, which adds another to the considerable list of foreign branches now conducted by the house. In London, on his way back, Mr. Ryan was the guest of honor at two banquets attended by men prominent in British pharmacy and medicine, and when he landed in New York he was greeted at a large reception held at the house of Dr. Jokichi Takamine.—Reprinted from the Bulletin of Pharmacy, May, 1907. DIGESTIVE SECRETIONS.—The stimulation of the secretory glands produced by the action of Seng, is a most excellent method to restart the process of digestion. In those run down and emaciated patients, and after lingering diseases, Seng will prove most serviceable in building up a normal digestion. It can also be advantage- ously used as a vehicle in general treatment when a digestive secernent seems desirable and indicated. The good results following this form of treatment has been very favorably mentioned by many practitioners. EVERY PHYSICIAN KNOWS full well the advantages to be derived from the use of antikamnia in very many diseases, but a number of them are still lacking a knowledge of the fact that antikamnia in combination with various remedies, has a peculiarly happy effect; particularly is this the case when combined with salol. Salol is a most valuable remedy in many affections; and its useful- ness seems to be enhanced by combining it with anti- kamnia. The rheumatoid conditions so often seen in various manifestations are wonderfully relieved by the use of this combination. After fevers, inflamations, etc., there frequently remain various painful and annoying conditions which may continue, namely: the severe headaches which occur after meningitis, a "stitch in the side" following St. Louis Baptist Hospital, DR. C. C. MORRIS, Supt. N. E. COR. GARRISON & FRANKLIN AVES.. St. Louis, Mo. This hospital is open to the medical pro- fession generally, and physicians who bring their patients here are guaranteed every courtesy and the exclusive control of their patients. It has a well equipped Bacteriolog- ical and Pathological Laboratory under the supervision of a physician well trained in these branches. Surgical cases are given special attention Address all communications to DR. C. C. MORRIS, Supt. lmpotency Cases It matters not how hopeless; cured or relieved by our combination. Helantha Compound. Helianthus annuus [sunflower.] Fr. root, bark.H. Australian. Plain or with diuretic. Has a powerful action upon the blood and er.tire organism is in- dicated in all cases complicated with Malaria, Scrofula, im- poverished Blood. Anaemia, etc.. etc..in conjunction with Pil Orient- alls (Thompson), will control the most obstinate cases of lmpo- tency. "Drink Cure" cases, saturated with Strychnine, "Weak Men" cases, who tried all the advertised "cures" for impotencv. and were poisoned with Phosphorus compounds readily yield to this treatment. Pil Orientails (Thompson.) contains the Extract Ambrosia Orientails. The Therapeutical value of this Extract as a powerful Nerve and Brain tonic, and powerful stimulant of the Repro- ductive Organs In both Sexes, cannot be over-esti- mated. It Is not an irritant to the organs of generation, but A RBCUPERATOR and SUPPORTER, and has been known to the native Priests of India, Burmah and Ceylon for ages, and has been a harem secret in all countries where the Islam has planted the standard of Polygamy. It Is impossible to send free samples to exhibit in lmpotency cases, requiring several weeks treatment, but we are always willing to send complimentary packages of each preparation (with formulas and medical testimonials) to physicians who are not acquainted with their merits. prir*c / Helantha Compound, $1.85 per oz. Powder or Capsules, rrices. j p)| OrientalIs(Thompson)$1.00 per box. THE IMMUNE TABLET COMPANY, Washington. AGENTS: Meyer Bros. Drug Co., St. Louis. Lord, Owen & Co., Chicago. Evans-Smith Drug Co., Kansas City. Redington A Co., San Francisco. J. L. Lyons & Co., New Orleans. CLARK ENGRAVING CO. MEANS-THAT YOU CAN GET HIGH GRADE CUTS FOR ANY KIND OF LETTER PRESS PRINTING AT 8 4 MASON ST. M I LWA UKEE HALFTONES ON ZINC OR COPPER WOOD ENGRAVING S„° spacious ™™^tfJ^™™"hSt?^ and walks. Eieotro-and Hydro-therapeutic advantages are nnexo^UeO.JXTa^pq nnn^»u. heat, electric lights. Special rates to physicians. For reprints from Medical J ournaisanu iuu uc»u3 of treatment, address DR. B. B. RALPH 529 Highland Avenue Kansas City, Mo. Publisher's Department. 550 vigor and make men capable of strenuous service to their country. "I also hope that there will be legislation increasing the power of the national government to deal with certain matters concerning the health of our people everywhere. 1 hope to see the national government stand abreast of the foremost state governments." Letter to Com. of A. S. for Advance of Science. MRS. IWAYBR1CK ON UNSANITARY AND CRUEL PRISONS.—Mrs. Florence Maybrick, who, it will be remem- bered was many years in English prisons unjustly convicted of having poisoned, by arsenic, her arsenic eating husband is now condemning and endeavoring to reform the peniten- tiaries of America. Before the Young Men's Club of Dr. Parkhurst's church, New York, she said: "I claim for all men, human rights, and the right to sunshine, to ordinary decencies, to labor. At Sing Sing strong men are shut up in cells six feet by three without ventilation, sanitary provisions or water for thirteen hours a day. She said she knew what it meant in England. For nine months she had solitary confinement in a cell seven feet by four, with a log for a seat and her food passed in through a trap in the door. They do these things there for the salvation of souls that lead to damnation." She said the Eastern Penitentiary of Philadelphia was the worst of the 24 prisons she had visited in America. These prisoners, she said, are practically buried alive. But at Trenton, N. J., she found strong contradictions. There they still have underground dungeons where never the step of the warden can be heard. She visited them and heard one poor man call: 'For the love of God, let me out. I have been in here five days and can't bear it any longer.' Yet, as 1 came up I heard a sound I had never heard in a prison before. "'Yes,' said the warden, 'that's our string band prac- ticing.'" Mrs. Maybrick declared prisoners must have more sun- WE SUPPLIED ALL THE CITY INSTITUTIONS WITH DRY 600DS LAST YEAR. WM. BARR GOODS CO. Keep the Largest Stock of Goods suitable for HOSPITAL PURPOSES TO BE FOUND IN ST. LOUIS, And Special Terms will be made with all Institutions ordering from them. BEDDING MATERIALS OF ALL KINDS, UNDERCLOTHING, !N SILK, WOOL AND COTTON, LADIES' AND CHILDRENS' READY-MADE CLOTHING, FLANNELS AND UPHOLSTERY, TABLE AND BED ROOM LINENS, SOAPS, NOTIONS AND PERFUMERIES. AJRE ALL SPECIALTIES AX THEi WM. BARR go^ds COS NEW BUILDING, SIXTH, OLIVE AND LOCUST, .... ST. LOUIS. P. S. Write and find out our special terms to Hospitals. HALL-BROOKE A Licensed Private Hos- pital for Mental and Nervous Diseases. CASES OF ALCOHOLISM AND DRUG HABIT. 'pEAUTIFULLY situated on Long Island Sound one hour from New York. The Grounds consisting of over ioo acres laid out in walks and drives are inviting and retired. The houses are equipped with every Modern Appli- ance for the treatment and comfort of their guests. Patients received from any location. Terms Moderate. DR. D. W. McFARLAND, GREEN'S FARMS. CONN. Telephone 67-5 Westporl Conn THE NATIONAL MEDICAL EXCHMGE-Physlcliu'. Dinliitt' 1 lid Druggists' Locations and Fropsrti bought, sold rented and exchanged. Partnerships arranged Assistants and substitutes provided. Business strictly confidential. Medical, pharmaceutical and scientific books supplied at lowest rates. Send ten cents tor Monthly Bulletin containing terms, locations, and list of books. All inquiries promptly answered. Address, H. A. MUMAW. M. D. Elkhart. Ind. THE NATIONAL Surgical and Dental Chair Exchange. All kinds of new and second-hand Chairs, Bought, Sold and Exchanged. SfeTSEND FOR OUR BARGAIN LIST'S. Address with stamp. Dr. H. A. MUMAW, Elkhart, Ind. LARGE DIVIDENDS Are assured stockholders of the SIERRA- PACIFIC SMELTING CO., Sonora, Old Mexico. Easy Payments. Agents Wanted. Write for terms. Address, HENRY MUMAW, Elkhart, Ind. Publisher's Department. 551 shine. She asserted that at Sing Sing at high tide one could write one's name on the wall in the moisture. She said she had put forward an earnest plea for such an awakening of public sentiment for reform as had already brought about the separation of the first offender and the habitual criminal. Mrs. Maybrick is engaged in good humanitarian work and Dr. Hughes does not regret having joined in asking or her pardon. THE INTERSTATE MEDICAL JOURNAL has absorbed the St. Louis Courier of Medicine. This is the fourth medical periodical absorbed by the Interstate Medical Journal during the past few years. Next? A DEFECT OF POPULAR EDUCATION.—Dr. Harold Williams, in Annals of Gynecology and Pediatry, noting the failure of popular education, says the failure is "because, in our leading American universities fifteen hours per week are devoted to Greek, while not a single hour per week is devoted to the study of the etiology and prevention of disease." Undue time has been spent in imparting knowl- edge of comparatively little importance in life, and none has been spent in inculcating the lessons necessary to develop their instinct of self-preservation, which includes the Knowledge how to prevent infection of every sort. Classical education leads to refinement and to gentility, and the graces of life must be cultivated. * * * And yet, if the over-educated young person ignorantly contracts an infectious disease which may ruin his entire life all his laboriously acquired knowledge of the Greek author and of the theorems of Euclid will not prevent his being miser- able and unhappy. He thinks the curriculum in our high schools and colleges should be changed. We think Dr. W. is right. More hygiene, less geography and classics, would promote the "Mens sana in corpore sano," so essen- tial to sustain in the after-battle of life. FOR NERVOUSNESS, SLEEPLESSNESS AND SEXUAL St. Louis Baptist Hospital, DR. C. C. MORRIS, Supt. N. E. COR. 6ARRIS0N & FRANKLIN AYES., St. Louis, Mo. This hospital is open to the medical pro- fession generally, and physicians who bring their patients here are guaranteed every courtesy and the exclusive control of their patients. It has a well equipped Bacteriolog- ical and Pathological Laboratory under the supervision of a physician well trained in these branches. Surgical cases are given special attention Address all communications to .DR. C. C. MORRIS, Supt. Impotency Cases It matters not how hopeless; cured or relieved by our combination. Helantha Compound. Hellanthus annuus [sunflower.] Fr. root, bark.H. Australian. Plain or with diuretic. Has a powerful action upon the blood and entire organism Is In- dicated in all cases complicated with Malaria, Scrofula, im- poverished Blood, Anaemia, etc.. etc..in conjunction with Pll Orient- alls (Thompson), will control the most obstinate cases of Impo- tency* "Drink Cure" cases, saturated with Strychnine, "Weak Men" cases, who tried all the advertised "cures" for impotency. and were poisoned with Phosphorus compounds, readily yield to this treatment. Pil Orlentalis (Thompson) contains the Extract Ambrosia Orlentalis. The Therapeutical value of this Extract as a powerful Nerve and Brain tonic, and powerful stimulant of the Repro- ductive Organs In both Sexes, cannot be over-esti- mated. It Is not an Irritant to the organs of generation, but A RECUPERATOR and SUPPORTER, and has been known to the native Priests of India. Burmah and Ceylon for ages, and has been a harem secret In all countries where the Islam has planted the standard of Polygamy. It Is Impossible to send free samples to exhibit in Impotency cases, requiring several weeks treatment, but we are always willing to send complimentary packages of each preparation (with formulas and medical testimonials) to physicians who are not acquainted with their merits. t> i / Helanlha Compound, $1.85 per oz. Powder or Capsules, rnces. | pn Orlentalis(Thompson)$1.00 per box. THE IMMUNE TABLET COMPANY, Washington. AGENTS: Meyer Bros. Drug Co., St. Louis. Lord, Owen & Co.. Chicago. Evans-Smith Drug Co.. Kansas City. Redlntfton A Co., San Francisco. J. L. Lyons A Co., New Orleans. ENGRAVING CO. MEANS-THAT YOU CAN GET HIGH GRADE CUTS FOR ANY KIND OF LETTER PRESS PRINTING AT 8 4 MASON ST M I LWAU KEE HALFTONES ON ZINC OR COPPER WOOD ENGRAVING $if$Z&?£ r & ORIGINAL DESIGNERS & ARTISTS ^Publisher's Department. 552 EXCITEMENT, characterized by erections or even chordee, various authorities vary in their recommendations. Ringer recommends the use of aconite and camphor. Bartholow and Phillips both advise the administration of lupulin. The value of Hyoscyamus has been appreciated by many medical men for a long time, and is quite valuable. Bromidia is to be highly recommended, since it consists of chloral, bromide, hyoscyamus and cannabis indica, and acts as a somnifacient, spinal sedative and hypnotic. The dose is a drachm to two drachms an hour before bed time.— American Journal Detmatology. This is the best and safest time to give this combina- tion if its precise proportions suit the indications. The day time use of this good combination given to a walking patient in our experience developed a slavery to its use hard to shake off by the patient. We have never so administered and it would be well if Battle & Co. would send out a precaution that it is not wise to give a patient the discretion of repetition in day time, while going about especially. CAUGHT BY A COLD.—Newspapers sometimes give some very true medical advice notwithstanding the bane of their quack advertising columns. Note the following from the St. Louis Post• Dispatch in confirmation. The chief addendum we would make would be to avoid draughts, especially in the sleeping room, feed abundantly of heat- producing food in cold or damp weather and clothe well, especially about the neck and feet and for the mental entonement enjoined by the paper referred to, to take life easily is as important an injunction for the conservation of the health as it is to the highwayman in his death-dealing business. You say you have caught cold. But the fact is, the sickness known as a cold has caught you. You don't know how, perhaps. Of course not. Cold usually catches us unawares. And yet we may be sure we have invited it. We invite a cold every time we neglect our general CACTINA SENG PILLETS A Cardiac Tonic Stimulant From Csreus Grandiflora(Mexicana) Each Pillet containing One One- Hundredth of a grain of Cactina Indicated in functional cardiac troubles, such as tachycardia, palpi- tation, feebleness; and to sustain the heart in chronic and febrile diseases. It is not cumulative in its action. DOSE One to three Pillets three or four times a day. Put up io bottles of 100 pillets Fro. samples to Phy»telam* upon request Sultan Drug Co., St. Louts, Mo. Pharmaceutical Chemists A Digestive Secernent A preparation of Panax (GinsenoJ which is being successfully em- ployed to stimulate the secretory glands of the alimentary canal. Indicated in Indigestion, Malnutri- tion, and all conditions arising from a lack of digestive fluids. DOSE One or two teaspooufuls three or more times a day PUT UP IN 10 OZ. BOTTLES ONLY Fn-e samples to Physicians upon roQUcst Sultan Drug Co.. St. Louis, Mo. Pharmaceutical Chemist* PEACOCK'S BROMIDES THE BEST FORM OF BROMIDES Each fluid drachm contains lS grains ol the neutral and pure bromides ol Potassium, Sodium, Ammonium, Cat- otum and Lithium. In Epilepsy and all cases demanding continued bromide treatment, its purity, uniformity and definite thera- peutic action, insures the maximum bromide results with the minimum danger of bromism or nausea. DOSE -One to three leaspoonluls ac- cording to the amount of Bromides desired. Put up In 1-2 pound bol- lies only. Free samples to the profession upon request Peacock Chemical Co., St. Louis, Mo. Pharmaceutical Chemists. CHIONIA The Hepatic Stimula n t Prepared from Chionanthus Virginici Expressly for Physicians' Prescriptions Chionia is a gentle but certain stim- ulant to the hepatic functions and overcomes suppressed biliary secre- tions. It is particularly indicated in the treatment of Biliousness, Jaun- dice, Constipation and all conditions caused by hepatic torpor. DOSE One to two teaspoon* fiils three times a day. Pot up in 1-2 pound bottles only Free umpleo W PhytJctani- upon fciuix Peacock Chemical Co.,St. Louis, Mo. Publisher's Department. 553 health. Physicians look upon a cold as congestion in some part of the body. And congestion always indicates neglect. You have been too busy, with work or play or shop- ping, to look after your health. And neglect at this time of the year is doubly dangerous, because of the sudden changes of temperature, and because of the prevalence of dampness outside and dry, heated air indoors. What exercise you have taken has been hurried. Worry has, perhaps, sapped your vitality. You have eaten more than you could assimilate. The rush for Christmas presents and entertainment has made you nervous and deprived you of sleep. And then the cold has caught you. Plenty of people you know have been caught at the same time. But some have escaped. How? By being in a better physical and mental condition. "And mental." We are beginning to take note of the mental factor in health conditions. Some insist that this is the only factor. But common sense and general experience tell us that it is unwise to lose sight of any of the conditions. Mens sana in corpore sano—a sane mind in a sound body—is as true now as it ever was. You must use every faculty to get well and keep well. Stop worrying. Stop hurrying. Cleanse the body and mind of all impurities. Eat to live, instead of living to eat. Take plenty of exercise in the open air. Breathe deeply. Love your neighbor. And call upon doctor for aid if you must. Health is simplicity. It is because you have permitted your life to become complicated in many things that you are a victim to colds. SECTION 401 OF THE AMENDED PENAL CODE of New York reads: Any person putting up any drug, medicine or food or preparation used in medical practice, or making up any prescription, or filling any order for drugs, medicines, food or preparation who puts any untrue label, stamp or other River Crest Sanitarium s£r£»LiL Astoaia, L. I., New York City. in Lunacy. FOR NERVOUS AND MENTAL, DISEASES. Home-like private retreat. Beautifully located. Easily accessible. Detached building for alcoholic and drug habitues. Hydrotherapy, Electricity, Massage. J. JOS. KINDRED, M. D., WM. E. DOLD, M. D., President. Physician in Charge, New York office 616 Madison ave., cor. 59th St.; hours, 3 to 4 and by appointment. Phone, 1470 Plaza. Sanitarium Phone, 36 Astoria. The Richard Gundry Home, CATONSV1LLE, BALTIMORE CO., MD. A private Home for the treatment of Mental and Nervous Diseases, Opium and Alco- holic addictions. For Circulars, Rates, etc., Address, DR. RICHARD F. GRUNDY, Catonsville, Md References—Dr. Henry M. Hurd, Dr. Wm. Osier, Johns Hopkins Hospital, Baltimore, Md. Dr Thomas A. Ashby, Dr. Francis T. Miles an>l Dr. Geo. Preston, Baltimore, Md. Dr. George H. Rohe, Sykesville, Md. Dr. Charles H. Hughes, St. Louis. THE BLUE HILLS SANITARIUM MILTON 'MASSACHUSETTS. A PRIVATE HOSPITAL AND IDEAL RESORT. Alt classes of patients admitted. Separate department for the victims of ALCOHOL. OPIUM, COCAINE AND OTHER DRUG HABITS. All desire for liquors or the baneful drugs overcome within Hiree days after entrance, and without hardship or suffering. A well-equipped Gymnasium, with competent Instructors and Masseurs, for the administration of purely hygienic treatment; also a Ten-plate Static Electrical Machine, with X-Ray, and all the various attachments. J. FRANK PERRY. M. D., Supt. THE ALPHA SANITARIUM, LAKE FOREST, ILLS: Established for the treatment of the Functional Derangements and Morbid Psychologies that occur during Adolescence. For further particulars address W. XAVTBR SUDDUTH, M. D., 100 State St., CHICAGO. Publisher's Department. 554 designation of contents upon any box, bottle or other pack- age containing a drug, medicine, food or preparation used in medical practice, or substitutes or dispenses a different article for or in lieu of any article prescribed, ordered or demanded, or puts up a greater or less quantity of any ingredient specified in any such prescription, order or demand than that prescribed, ordered or demanded, or otherwise deviates from the terms of the prescription, order or demand, by substituting one drug for another, is guilty of a misdemeanor. EVIDENCE OF THE SERVICE.—A physician, on pre- senting his bill to the executor of the estate of a deceased patient, asked; "Do you wish to have by bill sworn to?" "No," replied the executor, "the death of the deceased is sufficient evidence that you attended him professionally.— The Doctor. JAPANESE ARE LEGAL PRACTITIONERS.—The Attor- ney-General has announced that the medical statute does not require that an applicant for a license shall be a citizen of the United States. If he be a graduate of a duly authorized Japanese medical college, with the requisite four years' course of study, and if he be otherwise quali- fied, a license shall be issued if he pass the requisite grade.—Northwest Med. The Doctor. THE CHRISTIAN REGISTER AND PATENT MEDICINE ADS.—"'Let the galled jade wince, our withers are un- wrung.' Let Collier's expose the fakes and frauds of quacks and pretenders, we do not fear the result. Let the inconsistency of religious papers that preach morality and advertise corruption be shown and proved, we can offer a clean record. For eighty-five years no advertisement has been accepted by either of the two publishers (who have covered nearly the whole of that long period), which they believed was written with intent to debase or deceive the reader. A lawyer said last week that ministers were not quick to see the difference between right and wrong. SANITARIUM 154 East 72d Street, NEW YORK CITY. Telephone 1212-79. Cable Marcurran (via Commercial) Your attention is invited to the Sanitarium established 1898, at 154 East 72nd Street. Physicians retain entire charge of their patients. M. W. CURRAN, M. D. Nerve Disorders. If your patient suffers from THE BLUES (Nerve Exhaustion), Nervous Insomnia, Nervous Headache, Irritability or General Nervousness, give one teaspoonful four times a day. Neurilla is prepared from Scutellaria and Aroma tics, and is absolutely harmless even under prolonged use. Dad Chemical Company, . . New York and Paris. Illustration of Medical Subjects. THE BIOLOGICAL and PHOTOMICROGRAPHIC LABORATORIES of Dr. Carl Theodor Gramm. Microscopic Slides, Photomicrographs, Lantern Slides, Half-Tone Etchings, Artotype Reproductions For Inserts. Half Tones In Colors (fac- simile of microscopic field) Supplied to Authors, Lecturers, Teachers, Students. Laboratories: Offlcei Wtnnetka, III. Suite 901. 103 State St., Chicago. Publisher's Department 555 From the frequency with which they sign testimonials of doubtful things one might infer that incredulity, if not in- sensibility to moral distinctions, make them an easy mark for those who live by plundering the public." This is a journal for Christian physicians to take. PHYSICIAN was a composed man, who performed neither on his own trumpet, nor on the trumpets of other people. Many wonderful things did he see and hear, and much irreconcilable moral contradiction did he pass his life among; yet his equality of compassion was no more dis- turbed than the Divine Master's of all healing was. He went, like the rain, among the just and unjust, doing all the good he could, and neither proclaiming it in the syna- gogues nor at the corners of streets. As no man of large experience of humanity, however quietly carried it may be, can fail to be invested with an interest peculiar to the possession of such knowledge, Physician was an attractive man. Even the daintier gen- tlemen and ladies who had no idea of his secret, and who would have been startled out of more wits than they had, by the monstrous impropriety of his proposing to them "Come and see what 1 see!" confessed his attraction. Where he was, something real was.—Abstract Albany Med- ical Annals. Charles Dickens in Little Dorrit. RAILWAY DEATHS AND DISASTERS.—If the Santa Fe Railroad company, says the Denver Post, does not look to its own public obligations more sharply it will soon be able to replace its mileposts with tombstones. This is true of other roads running into Colorado as well, but it is poignantly true of the Santa Fe. There is not a week passes without its long list of dead increasing sadly; there is is not a day dawns that does not speak the anniversary of the dying of some man. * * * Husbands, brothers, lovers; dear, dead women, whose voices will never lift again. And the people, the silent, patient, enduring peo- ple, bow their necks to the yoke of disaster and accept these dead as inevitable. Year by year the long list goes Publisher's Department 556 on growing until the headlights of our Western trains shine almost everywhere on places where the dead faces lifted silently to the night. FOR THE NEURASTHENIC—Oftentimes the neuras- thenic patient can be promptly started on the road to recovery by a temporary change of scene and the use of a good tonic. Gray's Glycerine Tonic Compound is of especial value in these conditions of nervous exhaustion, and it often supplies just the right support and recon- struction needed. ELONGATION OF THE UVULA.—As a gargle in sore throat or elongation of the uvula, Kennedy's Dark Pinus Canadensis has very general indorsement. Teaspoonful to glass of water. VIN MARIANI NOT A COCAINE PREPARATION.—The Vin Mariani Company notify us and explain as follows: "The American Druggist, August 19th, 1907, in reply to a query, erroneously stated that Vin Mariani is regarded by the Health Department of New York as a cocaine preparation, and can only be sold under restrictions of the anti-cocaine ordinance." Upon our protest that this was a misstatement of fact, injurious to us and to the trade handling Vin Mariani, the publishers in investigating the source of their information submitted the question personally to Dr. Darlington, the Commissioner of Health, who promptly repudiated the state- ment as unauthorized. He further said that "Vin Mariani, under the new label adopted by the manufacturers, is not regarded as a cocaine preparation, and can therefore be sold as freely as any other medicated wine that does not contain cocaine." In a retraction of their misstatement, the Editor of the American Druggist, August 26th, 1907, referring to the status of Vin Mariani under the various state laws, sets forth the opinion of the New York Board, and concludes: "We have no doubt that the Health Departments of other Nervous Exhaustion Celerina by its sedative action on the cerebrospinal centers conserves nervous energy. It eases the strain on a nervous system key. ed to the highest tension and, therefore, is an exceedingly val> liable means of preventing the nervous collapse or breakdown that might otherwise occur. As a result of its tono-sedative action, psychic equilibrium i* established, and the individual with an overwrought nervous system is given new power and new energy. In the treatment of functional nervous diseases, Celerina will be found of the greatest value, —sedative in its action, bat tonic in its results. RIO CHEMICAL CO. LONDON——NEW YORK PARIS ANAnOI ANALGESIC & AnAUUL ANTIPYRETIC. Is useful in .La Grippe, Sciatica, Rheumatism, Neuralgia, Hemicrania and allied affections. It reduces temperature and relieves pain, without the usual disagree- able after-effects. PRICE Per lb., $3.59; 1000 Tabs (5 er.) $4.00. Wheeler Chemical Works, 137 Lake Street, CHICAGO, ILLS. Publisher's Department 557 cities throughout the country will be influenced by the judgment of the New York officials, and the precedent established by them will be followed generally." ONE ARM OF A REAL STRAP-HANGER LONGER THAN THE OTHER.—John C. Scovel, municipal court judge, the other day was measured for a coat. When the coat was delivered he thought that the sleeves did not fit right, and comparing them found one to be an inch longer than the other. Indignant, the judge took the coat back to the tailor without even trying it on. His tailor merely smiled. "Just try it on," he said. Putting on the coat the judge found the sleeves extended to the same place on each hand. "You do a great deal of riding on the street cars, don't you?" said the garment worker. Judge Scovel admitted that each morning and evening he had for years been obliged to make a long, wearisome journey on street cars. "Hanging on to a strap," said the tailor, "has made your right arm somewhat longer than the other. 1 contin- ually have strap-hanging customers, and so have become careful in measuring the arms and making each sleeve according to the length of the arm." Judge Scovel kept the coat. HOME-MADE BUTTERMILK.—It is now within the power of every household to have an abundance of that refreshing and healthful summer (also winter) drink— buttermilk. To the present time no one knew of any source of buttermilk except from the butter-maker; but now-a-days the butter-maker does his work so well that the buttermilk is entirely deprived of the delicious little grains of fat which add so much to its food qualities as well as to taste. True buttermilk, made direct from fresh, rich milk, within a few hours, of the finest flavor and taste, nutritious and more excellent than the article as originally known, can now be prepared in any kitchen. Publisher's Department 558 This is done by taking a quart of fresh, rich milk, adding a pinch of salt and about half a pint of hot water to raise the temperature to body heat, and lastly adding a tablet which contains a pure culture of lactic acid bacteria. Place all in a pitcher, cover with a napkin, and let stand for twenty to twenty-four hours at the ordinary temperature, and there is your perfect buttermilk. The tablets are made by Parke, Davis & Co., the pharmaceutical and chemical manufacturers of Detroit, Michigan, and are called "Lactone" or buttermilk tablets. On the farm in the process of buttermaking the cream is allowed to sour spontaneously and is then churned. The souring is the lactic acid fermentation caused by lactic acid bacteria or ferments. The difference between the new and old process is one of method and not result. In the old, the lactic fermentation is waited for and expected to occur spontaneously, with disappointment sometimes. In the new, the ferment in pure culture is directly planted in the milk; and the desired fermentation is secured without fail. In Bible days, spontaneous fermentation of dough was depended upon to leaven or lighten bread, and failure fre- quently attended the process, the dough putrefying instead of fermenting, and was then lost. Finally man learned to add yeast to the dough and not to depend upon spon- taneous processes, with the result of always securing the right fermentation and making a better and more nutritious bread. This new buttermilk process is a like improve- ment.—Monthly Bulletin Indiana State Board of Health, June, 1907. DR. STEPHEN L. STRICKLER, of Boggstown, Indiana, favorably comments on the action of Cactina Fillets as follows: "I have used Cactina Pillets for ten years and can say they are more to be relied on than most anything in medi- cine that 1 know. They surely must be made of the drug gathered at the most favorable time of the year, because the cactus you buy on the market is not reliable." Cac- tina Pillets have been on the market for twenty years and Lectures on Neurology By CHAS. H. HUGHES, M. D. St. Louis. Extensively & Expensively ILLUSTRATED. Containing outlines of PROF. HUGHES' Lectures on Nervous Disease and simplifying Neurology for the Student and General Practitioner. Price, $3.00. Remit promptly to H. L. HUGHES, 3857 Olive Street, St. Louis. Most of the First Edition has already been taken and those desiring copies of same send their orders in early, before the edition is exhausted. The Medico-Legal Journal. This Journal is devoted to the Science of Medical Jurisprudence—Is edited by CLARK BELL, ESQ., with a corps of able associates, and published quarterly at $3.00 per annum Each volume has a full and complete Index, and when bound forms a valuable addition to the Library of any Lawyer or Medical Man. The Journal is illustrated with portraits of eminent men of Bench, Bar, Alienists,Scientists, and Medical Men—A new feature has been the publication of Sketches of the Supreme Court of the States and Provinces of North America.—Embellished with portraits of the Judiciary- The States of Alabama, Kansas, Oregon, New Jersey, the Province of New Brunswick. Pennsylvania, Delaware and Connecticut have already appeared. Those of Rhode Island, Minnesota, Ohio, Massachusetts, Maine. Michigan and North Carolina will shortly follow and be continued until all the States and Provinces are published. The Sketches, when complete, will be collected in a volume which will be of great interest to the Legal Profession. The Portraits of the Chief and Associate Judges of each State will appear and Portraits Df early members of the Supreme Court of each State. Each number of the JOURNAL will contain hereafter at least one State and contributed sketches of that court and photographs for reproduction. ____ Lawyers and Judges Throughout the Union are Invited to Subscribe. These volumes will contain a historical sketch of the Supreme Court of each State, written by or under the supervision of the Chief Justice of the Court, or some member of the Supreme Bench, or prominent men selected for that purpose. Address MEDICO-LEGAL JOURNAL, NO. 39 BROADWAY. - NEW YORK CITY. Publisher's Department 559 testimony of this kind has been heaped upon it by the medical profession, They are being employed with benefit in functional, cardiac and circulatory disturbances and exhibit no cumulative action. MIXED BROMIDES.—Dr. Robert J. Preston, Brown- Sequard, Hazard and other learned men of the profession have strongly advocated a combination of bromide salts in preference to the use of potassium bromide alone. The salts of the lighter metals, as sodium, ammonium and lithium, seem to have less of the untoward ,action than the potassium salt. In Peacock's Bromides we have a union of these salts that has proven a most available and trustworthy combination. THE PROGRESSIVE HEALTH COMMISSIONER of Penn- sylvania, Dr. Samuel G. Dixon, had published an order forbidding Pullman car porters to brush the clothes of passengers in the aisles of the cars. The endurance of this noxious custom for years is an evidence of long suffering patience of the American travelling public. Apart from its unhygienic features, this scattering of dust through a car and over the already sufficiently dirty and uncomfortable passengers has been long voted an unmitigated nuisance. The practice is worse than useless as a means to cleanli- ness; dusting off and spreading about the germ laden ac- cretions from the garments of men in all conditions of health and disease.—Medical Record. We endorse and add that the dust brush should be abolished on Pullmans for seats and floors as well as suits. The Pullman company charges enough for cramped accom- modations to provide suction cleaners and dusting rooms, individual soaps and many other sanitary things they still omit. They should give the public intelligent, sanitary porters and a porter's room. ST. LOUIS MO. XXVIII. NOVEMBER, 1907. No. 4 A JOURNAL OF AND FOR THE NEUROLOGIST, GENERAL PRACTITIONER AND SAVANT HOLADIN The Entire Pancreas Gland Extract In 3 gr. Capsules HOLADIN is an extract of the entire pancreas gland, presenting all the constituents both of the digestive and the internal secretion. HOLADIN, whilst possessing great tryptic activity, is of especial potency in respect to the amylolytic and lipolytic enzymes; it is rich in the im- portant cell-constituents, lecithin and nuclein, which peculiarly abound in the pancreas. ORIGlNATED AND MANUFACTURED BY Fairchild Bros. 4 Foster, New York NEURONHUR5T Dr. Wm. B. Fletcher's Sanatorium for Mental and Nervous Diseases. A new building newly furnished throughout with accommodations for fifty patie* For terms address Dr. \Vm. B. Fletcher, or Dr. M. A. Spiiik, Phone, 381. No. 1140 East Market St., Indianapolis' ■ MARIANI PREPARATIONS GUARANTE ABSOLUTELY AS REPRESENTED We have filed wiih the Secretary of Afrriculture the following guaranty, which c* absolute protection to THE -UG TRADE, and assures the MEDICAL PROFESS of the reliability and purity of VIN MARIANI and of all other preparations jm** laboratories and distributed under our firm name: To the Hon, Secretary of Agriculture, Washington, D. C Sir: We the undersigned, do hereby guarantee that the articles of Food and Drugs manufactured, packed, distributed and sold by us, such as VIN MARIANI ELIXIR MARIANI THE MARIANI PATE MARIANI TERPINE MARIANI together with all other preparations Issued by our laboratories and bearing our firm name, are not adulterated or misbranded within the meaning of the Food and Drugs Act, June 30, 1906. New York, November 12th, 1906. VIN MARIANI IS A COMPOUND OP FRENCH BORDEAUX WINE WITH A PREPARATION OF ERYTHROXYLON COCA. Prej>arcd from Aromatic varieties of Coca, low in alkaloid; no Cocaine or poisonous drugs have ever w*8 any of the above Mariani preparations. MARIANI AND COMPANY MANUFACTURlNG CHEMlSTS AND PHAJtMACJSTB '* PARIS, FRANCE: 41 Boulevard Haussmann NEW YORK: 5a W«l Palmyra Springs Sanitarium For the Scientific Care md Treatment of Mental and Nervous Diseases of Women v7 ii 1 i» Home-like^ quiet retreat. Beautifully located in our private 40 acre grove. Easily accessible to all points. All of the lateat appliances for the administration of Hydrotherapy, Electricity, Massage, Etc. nspection is most cordially Long Distance Telephones in invited Sanitarium C. HOWARD SEARLE, M. D., Medical Director A Woman Physician on Medical Staff. tor further information Address 'PALMYRA SPRINGS SANITARIUM, Palmyra, Wisconsin. THE PHYSICIAN OF MANY YEARS' EXPERIENCE KNOWS THAT, TO OBTAIN IMMEDIATE RESULTS THERE 13 NO REMEDY LIKE Syr. Hypophos. Co., Fellows. many Medical Journals specifically mention this PREPARATION AS BEING OF STERLING WORTH. TRY IT, AND PROVE THESE FACTS. SPECIAL NOTE.—Fellows' Syrup is never sold in bulk. It can be obtained of chemists and pharmacists everywhere. In the need ior an effective tonic Obstetrical Work both before and after parturition and in the trying period of lactation is often very urgent Gray's Glycerine Tonic Comp not only meets every requirement but it can be administered without a fear as to any untoward effect, on either mother or child. Effective, reliable and safe. THE PURDUE FREDERICK ™eGOODNESSISNT™eGREASE There are Just two things about cod liver oil—goodness and -'used to be thought that you couldn't get the goodness without the gi That's wrong. The goodness Isn't the grease. It Is no more necessary to swallow the nauseous grease of cod liver oil to get the valuable principles, than It Is to eat the shell of an egg to get the meat. Right there you have the whoie secret of the Incalculable value of ^EXTRACT OF CdD LIVER OILCOMP. In extracting the valuable properties from the grease, nothing is lost in the process; you get all that cod liver oil is famed for, joined with the hypophosphites of lime and soda in a pleasant cordial, without a trace of the dreaded taste. No grease—no fishy odor. prescribeCORD.EXT. OL.MORRHUAE COMP. (hageei <0 and Judge of the merits by results. Put up In I6-oz. bottles only. Viaiharxnon Chemical Co. sr. louis rvio. s Vol. XXVIII. CONTENTS. No. 4. ORIGINAL CONTRIBUTIONS. Electrical Sleep. By C. H. Hughes, M. D., St. Louis 443 Some Psychological Studies on Man's Moral Evolution, No. 3. By Albert S. Ashmead, M. D., New York 44g A Mistaken Diagnosis of Dementia Senilis. Reported with Comments by C. H. Hughes, M. D., St. Louis 464 The Growth op Neurology. By Wharton Sinkler, M. D., Philadelphia 484 Homo Sexual Complexion Perverts in St. Louis. Dr. C. H. Hughes, M. D., St. Louis 487 EDITORIALS. The Amsterdam Congress The Twenty-Ninth Year Night Medical School 485 not Satisfactory to State Board An Eastern Rabbi Knepelin's Critic, Dreyfus Depressive Insanity Stuttering Treatment According to Scripture Poliomyelitis Anterior The New Science-Eugenics The Million Mark The Last Almshouse Lunatic Therapeutically Enjoined Self-Denial The Cocaine Fiend Overcrowding in Hos- pital for the Insane Brutal Vivisection by a Brutal Medical Student Dr. Burrell, the President-elect of the A. M. A. A Cruelty Working Law The Health Rights of the Citizen Barnes Medical College Life Sacrifice of a Surgeon and Physician Some Alienist Medical Opinion Recuperation From Cerebro-spina) Meningitis Aged Authors, the Temperate Life and Louis Cornaro Noah Web- ster as a Spelling Reformer The Egoism of the Insane Erotically Inspired or Erotopathically Impelled Virtue and Vice Another Insane Stabber Baffling to Medical Science The Nervous System and Diabetes was Pavy's The Alternating Insane Automatism of Suddenly CRYSTAL SPRINGS "MINDSEASE" FORMERLY MT. TABOR NERVOUS SANITARIUM Cases classified and segregated. The mild, equable, humid climate is often of value ir the relief of Nervous states, notably of the insomnia in Neurasthenia. R. M. Tuttle, Business Manager Dr. Henry Waldo Coe,) Medical office. The M«r«u«m, Dr- Bobt- L- Gillespie, J Directors Portland. Oregon Dr. Wm. House, Resident Physician Dr. Barnes Sanitarium STAMFORD, CONN. (Fifty Minutes From New York Cm FOR MILD MENTAL AND NERVOUS DISEASES Also Cases of Neurasthenia and Nervous Prostration. With a separate detached department for ALCOHOLIC and DRUG HABITS. Undci management of competent alienists. Splendid location overlooking Long Island Sound aat City. Rates reasonable for excellent accommodations. Both voluntary and cases received. For terms and information apply to F. H. BARNES, M. DM Stamford, Conn. Long Distance Telephone 9, Stamford: "BEVERLY FARM" HOME, AND SCHOOL FOR Nervous ™4 Backward Children 22* Adults. A A A A brick schoolhouse and gymnasium built this summer enables acceptance of a few more selected cases: location ideal; I hour from St. Louis, via C. & A. R. R.; in midst of 130 acres. Individual school work and habit training; separate building for boys, girls and child- ren under 10 years of age. Consultations held at Home if de- sired. Undue public- ity avoided. * * A Address All Communications to /> i?U I? V MADISON ft I W. H. C. SMITH, M. D., Supt. UUUrtt&I, coUnty, U«ba EDITORIALS—Continued. Suppressed Epilepsy Lay Appreciation of Physicians Numerical Race Suicide Alexander Smith——Is it an Evidence of Psychic Decadence? The Testimony of a Woman Sajous Says the Source of the Opsonins Two Hoboken Doctors The Force of Mind in Medicine A New Journal Making Steel and Killing Men A Street Car Roadside Illusion and Delusion American Superlatives and Dr. Mendel Lithium is a Degradation From Copper Hedonic Erotopathic Perversion Dr. Edward K. Taylor New Phase of Psychological Expert Testimony Dr. Albert Warren Ferris Men- del, Sansom, Hitzig, Steffani, Foster, Broadbent and Atwater Dr. Julius Grinker. OBITUARY . A. E, Sansom Dr. Frederick V. L. Brokaw 516 SELECTIONS. EUROTHERAPY _ 517 For the Last Few Years Pharmacists and Physicians Spinal Anaes- thesia in Tetanus High Intensity Galvanic Current in Trigeminal Neuralgia Pharmacological Properties of Synthetic Suprarenin (Adre- nalin) On Sedative and Hypnotic Therapy Extensive Lumbar Anesthesia Bier's Congestion Treatment Loaf Sugar in Diabetes. [eurosurgery 523 Surgical Treatment of Paralysis. 'SYCHTATRY 524 Potomania in a Child. Clinical Psychiatry 524 Meeting of N. Y. Hospital Physicians for the Insane Emotional Control of Japanese Women. Clinical Neurology 526 The Tarsophalangeal Reflex Rare Affection of the Pyramidal Tract with Spastic Spinal Paralysis and Bulbar Symptoms Three Cases of Lingual Neuralgia. Neuropathology _ 529 Brain Tumor The Microbe of Poliomyelitis. MEDICAL DEPARTMENT, MISSOURI STATE UNIVERSITY. BARNES flEDICAL COLLEGE, suSSt* BOARD OF TRUSTEES. JOHN D. VINCIL, D. D.. President. Grand Secretary Masonic Grand Missouri. JOHN C. WILKINSON. Vice-Presides'. I i j r i I'ii.' McKitlrick Dry Goods C& GEO. A. BAKER, President Continental National Balk A. M. CARPENTER. M. D.. Vlce-Pre"sldent of the Faculty. A. R. KIEFFER. M. D.. Assistant Seciw WM T. ANDERSON. Treasurer. President Merchants Exchange and Pro St. Louis National Bank. J. Wl HUG President Lege Architecture'N C. H. HUGHES. M.D.. President of the f& JOHN H. MARMADUKE, Cashier Meiict Ings Bank. HON. JNO. M. WOOD. ex-Arty.. Gen't. fc. P1NCKNEY FRENCH. M. D., Secretary. Prof. C. H. Huehes, M. D.. Pres. Chas. R. Oatman. M. D. "W. C. Day, M D. Jno. H. Duncan, M. D. "Edwin R. Meng. M. D. "M. D. Jones. M. D. "J. T. Jelks. M. D. FACULTY. Prof. A. M. Carpenter. Vice-Pres. Prof. C. M. Riley. M. D. S. C. Martin, M. D. W. L. Dickerson. M. D. G. M. Phillips. M. D. F. L. Henderson, M. D. A. R. Kefffer, M. D. J. H. Tanquary, M. D. Jno. W. Vaughan. M. D. A. W. Fleming. M. D. R. C. Blackmer M. D. C. H. Powell. M. D. M. Dwight Jennings. M. D. J. Leland Boogher. M. D. Pinckney French. M.D.. Seen* FOUR-YEARS' GRADED COURSE OF INSTRUCTION.^- Season of 1899-1900 commences September 11th, and continues seven months. Instruction. esptr^ practical: new and spacious building, located in the heart of the city and within five blocks of the new s'j- modern in ail appointments; ample clinical and laboratory facilities; course of study conforms to the fo- ments of all health boards: tuition moderate: ho pital and dispensary privileges free. Special terms to soas ■ brothers of physicians, sons of the clergy and graduates of pharmacy and dentistry. For announcrrat':'- Information, address BARNES MEDICAL COLLEGE, ST. LOUIS, NO MEDICAL DEPARTMENT, MISSOURI STATE UNIVERSITY. REVIEWS. views, Book Notices, Reprints, Etc Dictionaire De Medicine et de Therapeutiquc Medicale et Chirurgicale L'aime et le Systeme Nerveux Internal Secretions and the Prin- ciples of Medicine The Proceedings The Diagnosis of the Nervous System The Asylum News Preliminary Medical Education The Nervous System of Vertebrates The Nature and Treatment of Pterygia Paton Diseases of the Rectum, their Consequences and Non-Sur- gical Treatment International Congress Advancing St. Louis Art Value in Developing a City Public Health State of New York Anatomy of the Brain and Spinal Cord A Brief Sketch The Hos- pital A Plea for the More Energetic Treatment of the Insane Anales Del Cuarto Congreso Medico Pan-Americano The Integrative Action of the Nervous System. PUBLISHbR'S DEPARTMENT. ublisiier's Department (Page) The Old Lunatic Room The Thoughtful Provision The Struggle of the Ages —Danger to Doctors State Regulation Remedy Against Spread of Disease President Roosevelt on Nalional Hcalih Mrs. Maybrick on Unsanitary and Cruel Prisons The Interstate Medic;il Journal A Defect of Popular Education For Nervousness, Sleepless- ness and Sexual Excitement Caught by a Cold—Section of the Amended Penal Code Evidence of the Service Japanese are Legal Practitioners—-The Christian Register and Patent Medicine Ads Phy- sician Railway Deaths and DisasKrs- For the Neurasthenic Elon- gation of the Uvula—-Vin Mariat.i Not a Cocaine Preparation One Arm of a Real Strap-Hanger Longer than the Other Home Made But- termilk Dr. Stephen L. Strickler Mixed Bromides The Progres- sive Health Commissioner. The most meritorious emulsion of cod liver oil in any market—we say this of Egg Emulsion Cod Liver Oil, Improved; we say it with out hesitancy. The purest of Lofoten cod liver oil is used in its prep- aration. The emulsifying agent is fresh eggs. The preservative is brandy. FOOD-EVERY DROP OF IT. Egg Emulsion Cod Liver Oil, Improved, contains no waste material—no mucilage, no Irish moss. Every drop of it is readily digestible. Every drop of it has definite food value. It keeps well. It is agreeable to the taste. It does not disturb the stomach. SPECIFY " P. D Supplied in pint bottlw. & CO." WHEN PRESCRIBING. fM EMULS.M COD LIVER ■ Each pint oj AbilenA contains upward of four hundred graint ofpure sodium sulphate—three times that of other similar waters, AbilenA is unquestionably the best agent of its class in the treatment of constipation (acute or chronic), as well as all hepatic disorders for which the saline group is indicated. NATURAL CATHARTIC WATER JUST AS IT COMES FROM THE WELLS. AbilenA is bottled and goes to the consumer just as it comes from the wells in Kansas. It has more natural salts in perfect solu- tion than any other natural water in the world. No nausea, no irritation of the ali- mentary tract, no griping or straining follows the use of AbilenA. Supplied in two suu—quart tad mulL PARKE, DAVIS & COMPANY laboratories: dctroit, mich.. u.s.a.; wa lk c rvi lle. ont.; hounslow, ino. ■ ranches! new york, chicago. st. louis, boston, baltimore, new orleans. kansas city, indianapolis. minneapolis, memphis: london, eng.; montreal, que.; sydney, n ».w , st. petersburg, russia; bombay, india, tokio, japan: buenos aires, argentina. RIIRN RQAF A Private Hospital for Men- uuixn ui tL. ^1 and Nervous Diseases- THE SANATORIA HUDSON. WIS. EIGHTEEN A1ILES EAST OF ST P*' rOUNOCOBV ROBERT A. GIVEN, M. O . lN I859. Extensive and beautiful grounds. Perfect privacy. Located a few miles west of Philadelphia. Refers by permission to Drs. R. A. F. Penrose, James Tyson, Charles K. Mills, Wharton Sinkler, William Osier. James Hendrle Lloyd, Thomas G. Morton, Barton Cooke Hirst, John H. Musser, Alfred Stengel. John A. Ochter- lony, John B. Deaver, W. W. Lasslter. B. L. GIVEN. Proprietor. NATHAN S. YAWGER. M. D., Superintendent. HERBERT C. STANTON. M.D., Asst. Physician. For full information, address, BURN BRAE. Telephone connection. CLIFTON HEIGHTS. WLMRf CO., PA. An Institution fully equipped with ew appliance and convenience for the care treatment of the Invalid and Sick. Electric Apparatus, every kind of Bit Massage, Swedish Movement, etc. Contagious diseases and the violent disagreeable insane not received. Beautiful surroundings and in a hei: locality. For information address SAM C. JOHNSON, M.D., Man The remarkable prestige among scientific Therapeutists Wheeler's Tissue Phosphates in Tuberculosis, Convalescence, Gestation, Lactation, Nervous Impair ment and all conditions where Nature needs a lift, has been due to th fact that it determines the perfect digestion and assimilation of foe: besides assuring the complete absorption of its contained Iron and otto Phosphates. "As reliable in Dyspepsia as Quinine in Ague." T. B. WHEELER, M. D. (Rd.) Montreal, Canada To avoid substitution, in pound bottles only at one dollar Send for interesting pamphlet on the Phosphates in Therapy. Free samples no longer furnished. DOWN GO THE HIGH PRICES No. 3—Operates equally well on 110 volt direct and alternating cur- rent, any cycles. Price with Applicators, #15.00 UNDSTROM-SMITH PORTABLE VIBRO-MASSAGE MACHINE (Patented; A Complete Mechanical Massage Machine. It gives a long and pound- ing stroke, medium and side stroke, short and rubbing motion. MOTOR WILL NOT STOP This machine is made on such principles that even with the hardest pressure of the handle it is impossible to stop the motor, even when run only on one cell. The vibrator is perfectly oil-proof and made of the very best material and workmanship. An ordinary chair can be made a VIBRATING CHAIR with this vibrator in a minute. Not *50, Not $35, Only 910 to *I" No. 1-Five Dry Cell Ma- chine with applicators, $I0.00 No. 4-Eight Dry Cell Ma- chine with applicators, $15.00 SEND FOB. ILLUSTRATED CATALOGUE LINDSTR0M, SMITH VIBRATOR COMBINATION is a combined Vibrator and Faradic Galvanic outfit. Will give Vibration and both currents at the same time if wanted. Price f25.00. Money Back If Yon Abe Not Satisfied. MANUFACTURED BY LINDSTROM, SMITH CO., 253-261 La Salle Street, CHICAGO, ILL., U. S. A. BROOKLYN HOME 8Bra« 174 St. Mark's Avenue, Near Prospect Park. Dr. J. B. MATTISON, Medical Director. Patients six, select. Treatment modern, HUMANE, effective. PER- FECT PRIVACY and EXCLUSIVE PERSONAL, PROFESSIONAL attention, based on 30 years' experience in the study and treatment of this disease. WE CAN COLLECT Your old bills. We are turning worthless ac- counts into ready cash for scores of physicians NO COLLECTIONS, NO PAY. ft^-ft exclusive Physicians Collecting; Agency in the United States. Write for terms. Physicians Protectee Assn., Kansss City, Mo. CONTINUALLY TELLING ABOUT THE PHYSICIAN'S VIBRAGENITANT and FLUID VIBRATODES has Induced hundreds of physicians to Investigate our claims and they Invariably found them correct. Don't you think It would pay you to In- vestigate this splendid therapeutic vibrator? When writing for our new catalog also ask about our LIGHT THERAPY APPLIANCES, FROM $6.50 to $50.00. ACTINIC RAY GENERATOR, 1500-6000 CANDLE POWER, PROM $50.00 to $75.00. VIBRATING CHAIR AND OSCILLATOR, PROM $75.00 to $150.00. Let us prove to you that we make the best and cheapest electro therapeutic appliances. THE SAM J, GORMAN CO., manufacturers. 161-163 SOUTH CANAL STREET, CHICAGO. EASTERN OFFICE: NEW YORK VIBRATORY AND ELECTRICAL CO. 1931 BROADWAY, NEW YORK KENSE NORWALK, CONN. For the treatment of Insanity and Nervous diseases, Alcoholic Mi Narcotic Habitues. Wednesdays 2:30 to 4:15 P. M., ADDRESS: 12 East 47th Street. EDWIN EVERETT SMITH, NEW YORK CITY. SOUTH WILTON. CONN, A WORD To the Profession: Each copy of the ALIENIST AND NEUROLOGIST contains about two hundred pages of Scientific Matter of value, compiled by the Master Minds in Neurology and Lega) Medicine, etc., of the world and designed for the General Practitioner of Medicine. Subscription, $5.00 Per Annum in Advance. A TRIAL SUBSCRIPTION FOR THREE MONTHS WILL BE SENT TO ANY ADDRfcSS ON RECEIPT OF ONE DOLLAR. To the Advertiser: The ALIENIST AND NEUROLOGIST circulates in every state and territory, the British Provinces and the princi- pal Capitals of Europe; the Advertising Rates will be found herein on another page and a perusal of them will show the prices to be low, considering the class of advertising. Sample Copies will be cheerfully furnished on applica- tion to H. L. HUGHES, Manager and Publisher, 3872 Washington Ave., ST. LOUIS, MO. E PUINTOIN SANITARIUM ASSOCIATION, (INC.) A PRIVATE HOME FOR NERVOUS INVALIDS. A new and elegant Home built ex- pressly tor the accommodation And treat- ment of persons suffering from the vari- ous forms of Nervous and Mental Dis- eases such as Neurasthenia. Hysteria. Melancholia, Chorea, Migraine, Loco- motor Ataxia, Aphasia, Melancholia, the different forms of Paralysis, together with other incipient Nervous and Mental Diseases. The building Is located in the most aristocratic residential portion of Kansas City, Missouri, immediately facing Troost Park with Its magnificent Paseo, and within easy access to electric cars to all parts of the city. It Is a solid Brick and Stone Fire-Proof Building furnished with the latest modern con- veniences and the most approved sci- entific medical, electrical and hydrother- apeutlc appliances for the successful treatment of NERVOUS AND MENTAL DISEASES. References—Any member of the med- ical profession in the Central States! For further particulars apply to JOHN PUNTOIN, M. D„ Kansas City, Mo. NO NO1SY OR VIOLENT PAT1ENTS RECEIVED. RESIDENT PHYSICIAN. Office Rooms, Altman Building, Residence and Sanitarium, Eleventh and Walnut Streets. 3001 Lydla Avenue. Sanitarium Established 18S7 KENOSHA. W1S. On the NortW.l«o R.ilro.d. 0n fc sbor( rf tn ho^^ L.k, Miction A private institution for the scientific treatment of chronic diseases.— Nervous diseases a •pecialty. Combine* in most perfect form the quiet and notation of country life, with the luxuries of high- dan hotels, and the safety of the best medical skill and nursing. For further information and illustrated booklet, address the managers, N. A. Penooyer. M. D. KENOSHA, WISCONSIN G. F. Adams, M. D. Loos Distance TtL 109 Qi OOw, JO Htsta Ptrwt. TuewUfi. 11« 4. TatopttMM C*OWl WJU, WALNUT ~ LODGE - HOSPIT. HARTFORD, CONN. Organized In 1880 for the Special Medical Treatment of ALCOHOL AND OPIUM INEBRIATES. Elegantly situated in the suburbs of the city, with every appointment and appliance H the treatment of this class of cases, including Turkish, Roman, Saline and Medicated Bat' Each case comes under the direct personal care of the physician. Experience shows tna large proportion of these cases are curable, and all are benefited from the application exact hygienic and scientific measures. This institution is founded on the well-rei fact that Inebriety is a disease and curable and all these cases require rest .change of 1I and living, with every means known to science and experience to bring about this resuA Applications and all inquiries should be addressed T. D. CROTHBRS. M. D.. Suo't Walnut Lodge. XaRC OCIlCVa Sanitaria, Lakl Geneva Wis. LAKESIDE for General and Nervous Ols eases-No Mtnul Cases Takm. Two Homes with complete sanitarium equipment. OaK WOOD forMtt- tal Diseases. Acute cases received for diagnosis and treatment. Convalescing cases re-educated. Raw are as low as the most efficient treatment and the hest trained nursing will permit. GO Aries of Oak Woadi. DR. OSCAR A. KING, Superintendent. Chicago Office, 72 Madison St., cor. State. Hours: 10 to 1 Tuesdays and Friiays.