R3 9015 00222 192 0 University of Michigan - BUHR 610.5 A 4 WA 18371 VILUWAILAUUUUUUUUN 12 பயபயபபாது IIIIIIIIIIIII ARTES SCIENTIA LİBRARY VERITAS OF THE OF MICHIGAN UNIVERSE TCEBOR| IS PENINSULA பயயாயாயாயாயாயாயாயாயாபபாயாயாயாயாயாயாயாம் TRCUMSPICE TOANகம்பாபாபாபாபாபா வாயாடYA "Quantam ego quidem video motus morbosi fere omnes a motibus in systemate nervorum ita pendent ut morbi fere omnes quodammodo Nervosi dici queant."-CULLEN'S NOSOLOGY: BOOK II. P, 181-EDINBURG ED., 1780. THE Alienist and Neurologist A JOURNAL OF Scientific, Clinical and Forensic NEUROLOGY AND PSYCHOLOGY, PSYCHIATRY AND NEURIATRY. Intended Especially to Subserve the Wants of the General Practitioner of Medicine. VOLUME XXX. CHARLES H. HUGHES, M. D., Editor. MARC RAY HUGHES, M. D., Associate Editor. HENRY L. HUGHES, Manager and Publisher. 3858 West Pine St., ST. LOUIS, MO. 1909. CONTRIBUTORS AND COLLABORATORS. TO VOLUME XXX. TOM A. WILLIAMS, Washington, D. C. JAS. G. KIERNAN, Chicago. C. F. BUCKLEY, San Francisco, Cal. L. J. J. MUSKENS, Amsterdam. FORBES WINSLOW, London. C. H. HUGHES, · St. Louis. T. TURTREGESILO AND H. GOTUZZO, Brazil. ALBERT S. ASHMEAD, New York. AMOS SAWYER, Hillsboro, I11. CHARLES F. NEU, Indianapolis, Ind. P. M. ST. CLAIR AND J. ALLEN JACKSON, Indianapolis, Ind. BURNSIDE FOSTER, St. Paul, Minn ERNEST JONES, Toronto. HARRIET C. B. ALEXANDER, Chicago. ALADAR ANJESZKY, Budapest. MARTIN W. BARR, Elwyn, Pa. Index. INDEX. ORIGINAL CONTRIBUTIONS. ......... 63 eases... A Few Important Points in Regard Normal Senility and Dementia to Nervous and Mental Dis- Senilis. . .... ...... 421 Pagan Science (Faith Cure) and A New Phase of the Unwritten the Human Mind. .......... 28 Law...................... 608 Psychological Notes and Queries .. 32 Recollections of Joseph Fodor.... 600 “A Suggestion Concerning the In- creased Longevity of Life In- Report of a Case of Meningeal surance Policy-Holders.".... 148 Hemorrhage. ............... 130 The Confession of a Mysophobiac. . 622 Barefoot Phobia in a Psychasthenic 18 The Criminal Irresponsible ...... 611 Cerebellar Connections. .......... 295 The Difference Between Suggestion Clinical and Forensic Aspects of and Persuasion—The Impor- Transitory Frenzy........... 589 ! tance of the Distinction...... 158 Dementia, Amentia, Destrumentia The Emmanuel Movement and Its (or Destruomentia.).......... 275 Affinities ................... 280 Is Genius a Sport, a Neurosis, or a The Error of Medical Emmanuelism Child Potentiality Developed ? 169 in Psychiatry ............... 123 Is Genius a Sport, A Neurosis, or a | The Neuraxis and Pelvic Strain of Child Potentiality Developed ? 262 Present Day Transportation Is Genius a Sport, a Neurosis, or a Methods. A Neurologic Note Child Potentiality Developed ? 567 of Warning.................. 291 The Pathology of General Paralysis. 577 Lecherous Degeneracy and Asex- The Psychological Vocation of the ualization or Sequestration... 166 Physician. ................ 1 Mental Advance in Women and The Therapeutic Staying of Age Race Suicide. .............. 594 and the Recuperability of the Mental Disorders in Ankylostomia- Senile and the Senile Dement. 137 sis. ...... ....... 21 Thoughts on Suicide ............ 253 Not Responsible................. 177 | War: An Incurable Mental Disease. 128 Index. 90 EDITORIALS. “An Apothecary to the Holy Do Not Overlook Psychiatry in Ghost". .. .. 626 Your Therapeutics. ........... 315 An Aunt of the Murderer.......... 89 Dr. Darlington's Report of the An International League Against Health. ...................... 314 Epilepsy. ................. 634 Dr. Douglas Argyll Robertson.... 91 A May Day for Inauguration Day. 190 Dr. Edward Holmes Van Deusen.. 638 American Medico-Psychological As- Dr. Frederic Brush................ 94 sociation. ................. 196 Dr. George F. Jelly's Life was American Medico-Psychological As- Threatened. ............... sociation Next Meeting...... 88 Dr Harvey W. Wiley........... 92 A “No Tip" First-Class Hotel..... 628 Dr. J. Edward Turner ........... 630 Announcement of the Archives of Dr. Robert C. Eccles' Letters in the Internal Medicine........... 318 Medical Fortnightly.......... 88 A Penal Institution Hospital for Eighteenth Century Conception of the Insane. . . .............. 299 Tuberculosis in Venice...... 193 A Professional Rebuke from Hip- Emotional Erotopathy in a Grand pocrates. . ................. 191 Jury......................... 313 A St. Louis Physician in High Polit- Eroto-Emotional Murder Passion ical Position........... ....... 190 Mania Again and the Usual "Babinski on Hysteria”......... 194 Verdict....................... 301 Body and Mind and Mind and Body Ex-President Roosevelt. . ........ 197 -A Sensible Clerical View... 183 Fake Cure (?) of Insanity........ 189 Bootham Park, York. ........... General Stoessel an Apoplectic.... 633 Brain Fag and Pessimism ........ 637 Honored Washington's Statue in Canal Zone Sanitation........... 311 Budapest. . . ............... 634 Can Opsonic Estimates be Relied Ier Congres International de Psy- Upon in Practice?.......... 192 chiatrie, de Neurologie, de Psy- Charges of Cruelty at the St. Joseph chologie et de l'Assistance des Mo., Insane Hospital. ....... 317 Alienes, Amsterdam. ....... 188 Cheerful Congenial Work.......... 180 ſ Indians Die When Their Occupation Child Labor..................... Is Gone-Plague May. Exter- minate. ... ......... 636 Continuous Counsel and Treatment of the Life Insured. ......... 187 Individual Non-Roller Towels.... 191 In Re Harriman. David Walsh, M. D............. 635 .... 632 Disease Engendering and Suggest- J. M. Baldwin.................. ive Confession Police Sweating Johns Hopkins Hospital Psychiatric Methods. ... ... ... ... ... ... 625 Clinic. . ................... 187 Does the Delirium of Tonsilitis Katatonia in Relation to Dementia More Likely Show Tragic Ten- Præcox-Mickle.............. 181 dencies than Other Forms of Delirium?......... .... 91 | Lateral Knee Jerk.............. 196 636 309 ... 88 Index. ....... 302 Let the Public Know from Us About Alcohol. . . ........... 81 Lombroso. . .................... 637 Mania Transitoria, Mania Impul- sira, Temporary Insanity.... 314 Medical Expert Testimony ....... 300 Memorial to Dr. Benj. F. Stephen- son. ............... Mind and Brain Therapeutics..... Mind Cure Fallacies............. Mrs. Mary A. Hunt. ............ 305 Murderous Jealousy at Eighty-Four 91 Neurological Scepticism as to Elec- trotherapy. ................ 84 Not Responsible.................. 319 Only Single Doses.............. 310 Patients in the St. Louis City Hos- pital. ..................... 88 Physicians Appreciated of Old and the Moral................... 186 President Taft for a Health Bureau 195 Psychohygeia for Jurors .......... 312 Psychopathically Curious Court Visitors......................... 188 Public Press Appreciation of the Medical Profession...... .. 77 Questions as to Alcohol in the Hu- man System. ............... 184 “Quis Custodit Custodes”........ 635 Reduce A. M. A. Dues ........ ... 196 Referring to the “Half Miraculous”. 313 Responsibilty in Mental Diseases.. 300 Rush, the Pioneer, In Recognizing Inebriety as a Disease....... 94 Sanitation Politics. ............ 90 Screen Hospital Windows the Year Round ........................ 312 Separate the A. M. A. Treasurership. 196 "Since the Immortal Rush Rested.” 192 Sir Walter Scott's Amnesia and the Bride of Lammermoor....... 182 Sixteenth International Congress. 627 Social Psychotherapy.............. 631 Some Sanitary Prophylactic Pro- gress. ..................... 633 Suicide Race Salvage.............. 304 Supposed Favorite Days for Suicide in Prussia. . . . ............. 634 Switzerland..................... 91 Syndicate Your Practice, Doctors of Medicine................ 631 The American Society of Alcohol and Other Narcotics. ....... 303 The American Society for the Study of Alcohol and Other Drug Narcotics................... 181 The American Medical Editors' Association.................... 310 The Anti-Alcoholic Museum ..... 634 The Biograph and the Panorama as Aids in Psychotherapy.... 91 The Central American Chigre..... 186 The Cuts for Illustrations ......... The Death of Moebus............ 638 The Eroto-Psychopathic Degener- ate. ....................... 298 The Fellow Who was H-11 on Fits. 628 “The Fetich of Work and Its Sani- tation."................... 178 The Funny Page Folly............ They Have Passed Away......... The Homes Commission Work.... 186 The Mann Bill. The Medical Colleges of Missouri.. 185 The Medical Era's Gastro-Intestinal Editions. . . . ............... 634 The Medical Profession's Duty to Civic Public Instruction ..... 86 187 79 310 Index. .....629 The Mississippi Valley Medical As- The Street Car Motorman's, ..... 92 sociation ......... The Unfeeling Routine Method of The New Surgeon General. ....... 181 Medical Practice............. 181 The Offspring of Divorce Incom- patibles .................... 184 The Wreckage of Worry......... 82 The Personal Factor in Medication. 85 The XVI. International Medical The Physician in Politics ........ 85 Congress. .................. 89 The Practitioners' Sundays. ...... 629 Tobacco Amblyopia .............. 312 The President of the American Traumatic Recovery from Insanity. 624 Gynecological Society. ...... 630 Voluntary Unilateral Nystagmus. 87 The Proposed New Hospital for Mental Disease in Boston. ... 307 W. E. Lewis.................... 316 The Question of Acromania ...... 309 When the Lawyers Get Familiar The Ratio of Psychopathic Heredi- with the Fact.............. 92 ty............................ 5 XVIth International Medical Con- The Right of the Delirious to Hos- gress. . . .............. ...... 196 pital Security................ 87 1 500 Lunatics in Fire............. 311 CORRESPONDENCE. Environmental Psychotherapy. ... 320 I thenic Mysophobiac......... 198 Legal Psychology and Psychiatry. 199 The Following Letter............ 95 Letter of a Convalescing Psychas- IN MEMORIAM. Dr. Joseph Spiegelhalter ........ ..... 324 SELECTIONS. CEREBRO-SURGERY. Dysbasia Angiosclerotica ........ 205 Surgical Puncture of the Brain. ... 101 “Microsphygmy".................. 96 CLINICAL NEUROLOGY. Personal Experience in the Study A Lantern Demonstration of Le- of Disease. . . ................ 204 sions of Spinal and Cranial Raynaud's Disease and Uric Acid. 206 Nerves Experimentally Pro- The Clarification of Our Concepts duced by Toxins............ 329 Concerning Hysteria........ 327 Amyotrophy in Syringomyelia.... 97 · The Cortical Lesion for Motor Babonneix. . . . ................. 325 Aphasia. .................. 33+ Berkeley on Alcohol and the Ner- The Mechanism of Gastric Secre- vous System and Vascular Tis- tion. . . . ................... 326 sues. ..................... 325 The Pathogenesis of Tabes Dorsalis 202 Congenital Syphilis and Progressive The Psychic and Adaptive in Diges- Paralysis........ ...... 96 tion. ... ....... ............ 200 Index CLINICAL PsychiATRY. Acute Maniacal Excitement in a Patient Eighty-Two Years of Age; With Possible Relation of Blood Pressure to the Con- dition....................... 100 Alcohol and Psychic Disease in the Army. . . . ................. 207 A Case of Motor Apraxy......... 645 A Case of Impaired Sense of Per- spective. ................. 645 Case of Cysticercus in the Brain ... 646 Chronic Alcoholic Psychoses...... 338 Conservation of Life............. 340 Dementia Præcox and the Syrian After the Strain of Modern Civilization. ............... 211 Early and Mild Cases of Mental Dis- order. ..................... 213 Epilepsia and Epileptoid......... 337 Functional Corectopia in Epileptics 641 Investigations Regarding Insane Patients with Hereditary Dia- theses..................... 643 June and December, the Suicide Months. . . . ................ 207 On Heredity in Dementia Præcox. 642 Psycho-pathology of Everyday Life 641 Resistances and Retardation in Brain-work (Wiederstande und Bremsungen in den Hirn..... 217 The Mongolian Type of Imbecile.. 99 The Nickelodeon............... 209 The Psychology of Dementia Præ- cox (Uber die Psychologie der Dementia Præcox.) ......... 218 The Serum Diagnosis of Diseases of Syphilitic Origin in the Nerve Centres. ................... 6391 The So-called Korsakoff Psychosis. 640 Timidity as a Factor in Psycho- Neurotic Conditions (Le Role de la Timidite dans la Patho- genie des Psycho-Neuroses).. 215 Forensic Psychiatry. Las Nuevas Teorias de la Criminali- dad. . . . .................... 220 Medical Expert Testimony. ...... 341 Hemo-NeuroDIAGNOSIS. Blood Examination for Parasites. . 102 HEMO-NEUROPHYSIOLOGY. In Too Obscure a Corner ......... 647 JURISPRUDENCE. The Legal Protection of the Child in the Struggle Against Alco- holism. ................... 648 NEUROANATOMY. With Reference to Charcot's Artery of Cerebral Hemorrhage and Duret's and Carvill's ........ 344 NEUROLOGY. Paralysis of the Laryngeal Recur- rent Nerve. ................ 652 The Relation of the Tuberculin Re- action to the Nervous System. 651 NEUROTHERAPY. Calcium Hypophosphite in the Treatment of Epilepsy...... 652 Opsonins and Therapeutic Vaccines in Paresis ................... 103 Serum Treatment of Meningitis... 345 The Ancient Greeks Used Sterilized Water. ................... 102 The Influence of Alcohol Upon the Public Health .............. 103 NEUROPATHOLOGY. Concerning the Function of the Pituitary Body.. .......... 346 Experimental Myocarditis ....... 227 viii Index. PROPHYLACTIC Psychiatry. Compulsory Race Suicide for Crimi- nals and Imbeciles ........... 384 Myristic Toxicity................ 228 On the Morphology and Biology of the Granular Cells.......... 346 Medico-Legal Psychiatry. Insanity as a Defence in the Crimi- nal Courts—III............. 225 M’Naghten, Like Hadfield and Bell- ingham, was a Delusional Lunatic. ................... 222 NEUROPHYSIOLOGY. The Internal Secretion of the Ovary 653 Psycho-NEUROTHERAPY. Should Alcohol be Administered to Patients Suffering from Delir- ium Tremens................ 654 PSYCHIATRY. A Clinical Study of Optic Neuritis in Its Relationship to Intra- cranial Tumors. . ............ 657 An Idealistic Analysis ............ 228 Cerebral Influenza............... 106 Improvement in Hospitals for the Insane.. ..... 228 Psychasthenia. .... ..... 656 Psycho-PhysioLOGY. Das Gedachtnis. ....... L ..... 350 ......... 356 REVIEWS. A Case of Double Monstrosity Bibliography of the Contributions (Thoracopagusteras Anacata- of Geo. M. Gould, M. D...... 660 didymum). ... Bibliotheque de Psychologie Ex- A Literary Banquo's Ghost....... 233 perimentale et de Metapsychie 110 Alcoholic Psychoses in Hospitals Bier's Hyperemic Treatment..... 352 for the Insane. ............. 357 Compte Rendu des Travaux...... 237 A Manual of Psychiatry. ........ 663 Congenital Elevation of the Scap- Anthropological Papers of the ula; Sprengel's Deformity. ... 233 American Museum of Natural Description of Apparatus Devised. 356 History. ................... 112 Diseases of the Nervous System. . 231 Apostle of Higher Medical Educa- Dr. Adam Hammer, Surgeon and tion. ..................... 659 Apostle of Higher Medical A Review of “Lila Sari," A Ro- Education................. 659 mance of the Southern Pacific. 235 Economic Loss to the People of the A Study of the Urinary Acidity and United States Through Insects Its Relations.............. 354 that Carry Disease. ......... 235 A Study of the Respiratory Signs of General Practitioners and Simple Chorea Minor. ............. 664 Refraction. ........ ..... 356 Index. ........ 376 Hagee's Cordial of the Extract of Cod Liver Oil Compound..... 664 Handbook for Attendants on the Insane..................... 231 History, Effect and Condition of the Massachusetts Milk Stand- ard Revised Laws.......... 353 Hospital Reports. . . ............ 307 How Simmons, “Our Peerless Lead- er," Became a Regular...... 664 How Simmons, “Our Peerless Lead- er” Became a Regular........ 233 Hysteria E Syndromo Hysteroide. 354 Illinois Southern Hospital. ....... 664 In an Interesting Paper. ......... 664 Insomnia and Verve Strain...... 108 “In Mr. Havelock Ellis's “The Soul of Spain'"................ 236 · La Simulation de la Folie. ........ 110 Layman Occupancy of Large Patches in the field of Medical Practice. . . . ............... 353 Les Progres de L'Assistance des Alienes en Hongrie .......... 663 Little Journeys to the Homes of Great Business Men......... 2:32 Medical Guide to the Hot Baths of Bath.......................... 659 Medico-Psychological Association. . 107 Nervous and Mental Diseases..... 107 Vervous and Mental Disease, Mono- graph Series No. 2. Studies in Paranoia. . . ............. 109 New York State Commission in Lunacy.. ... .............. 664 On Herpetic Inflammations of the Geniculate Ganglion. A New Syndrome and Its Complica- tions. · Outlines of Psychiatry. .......... 660 Parke, Davis & Company......... 662 Practical Dietetics .............. 233 Practical Radium: The Causation of Cancer and Its Curability with Radium.................... 662 Psychotherapy: Its Scope and Limitations. . ............ 110 Religion and Medicine ........... 110 Starr's Organic and Functional Ver- vous Diseases.............. 661 Syndromos Pluriglandulares En- docrinicos. ................ 3.57 The Aix-Les Bains Thermal Treat- ment. ..................... 2:31 The Canadian Surse............ 23:3 The Care of Imbeciles in Hospitals for the Insane and Elsewhere. 357 The Cerebral Centers for Taste and Smell and the Uncinate Group of Fits. . .................. 109 The Far East........ ........ 107 The Influence of Morbid Dreaming on the Development of Insan- ity. ....................... 108 The Journal of Experimental Zool- 111 ........... The Lengthening Cycle of Life .... III The Liver of Dyspeptics and Par- ticularly the Cirrhosis ....... 353 The Seed of Popular Lectures on Insanity. ................... 112 The Pacific Monthly ............ 2:32 Index. The Secret of Sex............... 663 | The Worth of Words............. ........ 112 The Significance of the Conference Travel Magazine. ................. of Criminal Law and Criminol- 356 ogy. . ......... 356 : Type Mongol De L'idiotie. ....... 354 The Theory of the "Complex".... 355 ;. Wellcome's Photographic Expos- The Treatment and Cure of a Case . of Mental and Moral Deficiency 109 ure Record and Diary ....... 112 į aren PUBLISHER'S DEPARTMENT. A Doctor's Symphony. ........... 251 One of the Grossest Drug Frauds .. 365 An English-Chinese Lexicon of Papine. . . ..................... 116 Medical Terms. . . .......... 116 American Medico-Pharmaceutical Pension for Dr. Wm. B. Atkinson. 252 Prayer Against Skin Diseases and League. ................. 246 Insanity. .................. 246 A Story to Remember............ 121 Precautionary Measures. ........ 669 Battle & Co. ................... 669 President Taft on a National De- Battle & Co., Chemical Corporation 366 jartment of Health ......... 219 Battle and Co.'s Dislocation Chart. 252 Senator Beveridge on the Physi- Battle & Co. ................... 121 cian. ..................... 117 Chronology of the Recognition of Takes His Own Medicine........ 116 Inebriety as a Disease....... 118 Tie Curse of the Chimney ....... Cod-Liver Oil in Convalescence 250 from Acute Lung Diseases ... 119 The Gastric Neuroses............ 36.5 Dr. Moreau Wolf.. ............ 668 There Exist. .................... 669 Ecthol ......................... The Fossil Man of Chappelle-aux- Saints. . . . ................. 247 Golden Opportune Moments .... 248 The Modern Treatment of Hav Good Results in Stubborn Cases. Fever. .................... 362 Girl, Asleep, Shoots Self. ....... The Negro and the Hookworm.... 673 Honors to Dr. John F. Hill...... 368 Ice. . . ....................... 364 The President and National Sani- In Chronic Affections of the Liver. 247 tation. . . ................... 117 I Have Been Taking Cactina Pillets 247 The Poison Label in Russia ...... 246 It Is Strange. ................... 668 The Pacific Monthly. . ........... Medical Examination for Men.... 671 The Purdue Frederick Co........ 365 Medical Men. .................. The Therapeutic Action of Pru- Mellin's Food for the Aged ....... 247 noids . .................... 363 More Ground, Less Noise, Asked for Treatment of Acne. ............ 252 City Hospital. ............. 671 Topics of Public Interest........ 669 Nervous Excitement ............. 363 l Wearing Out the President....... 07:2 248 364 247 668 THE ALIENIST AND NEUROLOGIST. VOL. XXX. ST. LOUIS, FEBRUARY, 1909. No. 1. THE PSYCHOLOGICAL VOCATION OF THE PHYSICIAN.* By Forbes WINSLOW, M. D., D. C. L. LONDON. IN these days of revived mesmerism under the name of 1 hypnotism, suggestion, Emmanuelism, Christian Science, mind healing, faith cure, osteopathy and other one idead sub- stitutes for rational medical treatment, those "no less than seven marvelous cults alike in despising each other," as Weir Mitchell has characterized them, it is well to note the rational appreciation of the right relations and value of psychic in- fluence in therapeutics, as recognized by the distinguished President of the Medical Society of London more than half a century ago, an abstract from whose Lettsomian lectures in 1854, we here present. -Ed. : I have undertaken, in my first lecture, to illustrate the special psychological attributes of the physician—to claim for the cultivators of medical science higher and more exalted functions than those usually assigned to them—to consider the physician in his spiritual character, as having at his com- mand, and under his control, a medicina mentis as well as a medicinu cor poris-agents of great power and magnitude- which have not been sufficiently recognized or appreciated. *The First of the Lettsomian Lectures. Forbes Winslow. It will be my object to establish the close connection between the Science of Mind, and the ScienCE AND PRACTICE op Medicine, and to illustrate the true philosophic character of the professors of the healing art. Δει μεταγειν την σοφιαν εις την ιατρικην, και την ιατρικης εις την σοφιαν ιατρος γαρ φιλοσοφος loobcos."'* . We form but a low and grovelling estimate of our high destination of the duties of our dignified vocation—if we conceive that our operations are limited to a successful applica- tion of mere Physical Agents. God forbid that we should thus vilify ourselves, and degrade our noble science! “A physician whose horizon is bounded by an historical knowl- edge of the human machine, and who can only distinguish terminologically and locally the coarser wheels of this piece of intellectual clockwork, may be, perhaps, idolized by the mob; but he will never raise the Hippocratic art above the narrow sphere of a mere bread-earning craft.”+ The physi- cian is daily called upon, in the exercise of his profession, to witness the powerful effect of mental emotion upon the mate- rial fabric. He recognizes the fact, although he may be un- able to explain its rationale. He perceives that moral causes induce disease, destroy life, retard recovery, and often inter- fere with the successful operation of the most potent remedial means exhibited for the alleviation and cure of bodily disease and suffering. Although such influences are admitted to play an important part, either for good or for evil, I do not con- ceive that, as physicians, we have sufficient appreciation of their great importance. “If a patient dies,” says M. Reveille-Parise, “we open his body, rummage among the viscera, and scrutinize most narrowly all the organs and tissues, in the hope of discovering lesions of some one sort or another; there is not a small vessel, membrane, cavity, or follicle, which is not attentively exam- ined; the color, the weight, the thickness, the volume, the alteration-nothing escapes the eye of the studious anatomist. He handles, touches, smells, and looks at everything; then he draws his conclusions one way or another. One thing only *Hippocrates, tSchiller. The Psychological Vocation of the Physician. escapes his attention; that is, he is looking at merely organic effects, forgetting all the while that he must mount higher up to discover their causes. These organic alterations are ob- served, perhaps, in the body of a person who has suffered deeply from mental distress and anxiety; these have been the energetic cause of his decay, but they cannot be discovered in the laboratory or the amphitheatre. Many physicians of extensive experience are destitute of the ability of searching out and understanding the moral causes of disease; they can not read the book of the heart, and yet it is in this book that are inscribed, day by day, and hour by hour, all the griefs, and all the miseries, and all the vanities, and all the fears, and all the joys, and all the hopes of Man, and in which will be found the most active and incessant principle of that frightful series of organic changes which constitute pathology. This is quite true—whenever the equilibrium of our moral nature is long or very seriously disturbed, we may rest assured that our animal functions will suffer. Many a disease is the contre- coup, so to speak, of a strong moral emotion; the mischief may not be apparent at the time, but its germ will be never- theless inevitably laid."* In proportion as we recognize our psychological character and position, and estimate the effect of these spiritual agents, shall we be successful at the bedside, elevate ourselves in the social scale, and not only deserve, but command, the respect of the public, and place the science of medicine upon the highest vantage-ground of which it is susceptible. How is it possible for us to influence the minds, of others if we have no accurate knowledge of the constitution and operation of our own understandings? As well might the physician adminis- ter, for the relief of an acute malady, a material agent of whose properties and modus operandi he is vowedly ignorant. “He that would govern others, first should be The master of himself, richly endued With depth of understanding, height of knowledge." MASSINGER. Referring generally to the present aspect of that branch of philosophy whose claims I am now advocating, I would, in **On Moral Therapeutics." Paris. Forbes Winslow. limine, observe, that the advancement of mental science has of late years been greatly retarded by the prejudices which have prevailed in reference to all abstract metaphysical in- vestigations. An impression has existed, that this inquiry unfitted the mind for the contemplation of subjects more im- mediately associated with the useful and practical affairs of every-day life; that the researches of metaphysicians served only to darken, bewilder, and dazzle the understanding, and to teach the use of pedantic jargon, and of obscure and tran- scendental phraseology. Hence arose the sarcasm, that to recommend a person to engage in the study of metaphysics was a delicate and indirect mode of suggesting the propriety of subjecting him to the restraint of an asylum. “I am the person you wish to see,” said the illustrious Plato to his foreign guests, who desired an introduction to the grave philosopher, under the impression that they were to see a man exhibiting qualities very different from those possessed by ordinary mor- tals. Does, I would ask, the mind grow severe in proportion to its enlightenment? Why should a knowledge of the most exalted department of philosophy unfit us for the active pur- suits of life, or for the society of mankind? Need we be sur- prised at the attempts which have been made, in the present utilitarian age, to depreciate the study of metaphysical philosophy, when we take a retrospective glance at its his- tory. The modern meta-physician is engaged in more useful and loftier speculations than that of considering whether the essence of mind be distinct from its existence, and what are the qualities inherent in it as a nonentity? Whether angels passed from one point of space to another without passing through the intermediate points? Whether they can visually discern objects in the dark? Whether more than one angel can exist at the same moment in the same physical point? Whether they can exist in a perfect vacuum, with any rela- tion to the absolute incorporeal void? Whether, if an angel were in vacuo, the void could still be termed perfect? These, and similarly abstruse and absurd speculations, seriously occupied the patient attention of a few of the learned school- men and theologians of former times, and gave rise to the idea of the science of metaphysics being the art of talking grave - --- The Psychological Vocation of the Physician. nonsense upon subjects beyond the limits of the human under- standing. We are not justified, however, in any wholesale condemnation of these apparently profitless and Quixotic speculations. May we not use the language of the founder of the Inductive Philosophy, and say of the ancient schoolmen, that, “in seeking for brilliant impossibilities, they sometimes discovered useful realities.” Bacon, when referring to the researches of the alchemists, for the philosopher's stone, says, that they performed the office of the husbandman, who, in seeking for a hidden treasure, turned up the soil, and pulverized the earth, thereby rendering it better fitted for the purposes of vegetation. Although the schoolmen were baffled in their attempts to discover the es- sence of the soul, and to ascertain, with any degree of satis- faction to their own minds, the precise number of angelic spirits who could pirouette at the same instant upon the point of a needle, they nevertheless opened a path for the philosopher amidst the dreary forest which he had to traverse, and pointed out to him the dangerous portions of his journey, in which they themselves had stumbled and fallen. Modern Metaphysics, and its sister science, Theology, hold the same relations to the rhapsodies of the schoolmen as modern chemistry does to the speculations of the alchemist. No right-thinking men would repudiate the study of modern chemistry on account of the obscure and apparently profitless researches of the alchemists: by parity of reasoning, are we justified in denouncing the serious and patient study of mental philosophy, on account of the scholastic jargon, nonentities, unmeaning generalities, and inanities, of some of the ancient metaphysicians? In forming an estimate of the value of any branch of philosophical inquiry, we must be cautious how we apply the interrogatory, cui bono?-neither must we adopt as our model of imitation the mathematician who, refusing to admit that any advantage could result from the study of a science not directly related to his own favorite study, exclaimed, when recommended to read Milton's “Paradise Lost," “What does it prove?” Are the lofty emotions, the glorious imagery, the sublime speculations, the melodies that have charmed our ear, Forbes Winslow. elevated our thoughts, improved our hearts, ennobled our nature, purified our manners, and thrown rays of sunshine over the dreary and thorny path of life, to be dismissed from our contemplation because they have no obvious and direct relationship to the practical business of life? Let us not en- courage the vulgar prejudice against those exalted inquiries that have no apparent or intimate association with the science of medicine, which constitute the charm and poetry of life, and exercise a powerful influence upon the intellectual progress of nations, the civilization of the world, and the character, happiness, and destiny of man! "- Desolator! who shall say Of what thy rashness may have reft mankind? Take the sweet poetry of life away, And what remains behind?” Goethe, when referring to the healthful influences of imaginative literature upon the heart and intellect, eloquently observes,—“When the man of the world is devoting his day to wasting melancholy for some deep disappointment, or in the ebullience of joy is going out to meet his happy destiny, the lightly-moved and all-conceiving spirit of the poet steps forth to be the sun from night to day, and, with soft transi- tions, tunes his harp to joy or woe. From his heart, its native soil, springs up the lovely flower of wisdom; and if others, while waking, dream, and are pained with fantastic delusions from their every sense, he passes the dream of life like one awake, and the strangest incidents are to him a part of both of the past and of the future. And thus the poet is at once a teacher, a prophet, and a friend of gods and men. At the courts of kings, at the tables of the great, beneath the win- dows of the fair, the sound of the poet was heard, when the ear and soul were shut to all beside; and men felt as we do when delight comes over us, and we pause with rapture, if, among dingles we are crossing, the voice of the nightingale starts out touching and strong. The poets found a home in every habitation of the world, and the lowliness of their posi- tion exalted them the more. The hero listened to their songs, and the conqueror of the earth did reverence to the poet, for The Psychological Vocation of the Physician. he felt that without poets his own wild and vast existence would pass away and be forgotten forever."* Would that I could, in equally lofty, fervid, and touching eloquence, impress upon others the conception which I myself have formed of the value—the practical importance-to the physician, of a more general acquaintance with those branches of polite literature which serve to chasten the taste, discipline the mind, develop holy aspirations after truth, invigorate the understanding, improve the heart, and keep in abeyance those corroding emotions which often embitter our existence, en- gender disease, and shorten the duration of human life. The science of mind has been truly designated “the science of our- selves,” of all that surrounds us, “of everything which we en- joy and suffer, or hope and fear; so truly the science of our very being, that it would be impossible for us to look back on the feelings of a single hour without constantly retracing phenom- ena that have been there, to a certain extent, the subject of our analysis and arrangement. The thoughts and faculties of our intellectual frame, and all which we admire as wonder- ful in the genius of others; the moral obligation which, as obeyed or violated, is ever felt by us with delight or with re- morse; the virtues of which we think as often as we think of those whom we love, and the vices we ever view with abhor- rence or with pity; the traces of divine goodness, which never can be absent from our view, because there is no object in nature which does not exhibit them; the feeling of our depen- dence upon the gracious Power that formed us; and the antici- pation of the state of existence more lasting than that which is measured by the few beatings of our feeble pulse,-these, in their perpetual recurrence, impress upon us the vast import- ance of a knowledge of the philosophy of the human mind.”+ When referring to the influence of such studies upon the mind, Burke, with great eloquence and truth, observes, that “whatever progress may be made towards the discovery of truth in this matter, we shall not repent the pains we have taken in it. The use of such inquiries may be very consider- able. Whatever turns the soul inward on itself, tends to concentre its forces and to fit it for greater and stronger fights *** Wilhelm Meister." Browne. Forbes Winslow. of science. By looking into physical causes, our minds are opened and enlarged, and in this pursuit, whether we take, or whether we lose our game, the chase is certainly of service. Cicero, true as he was to the academic philosophy, and conse- quently led to reject the certainty of physical as of every other kind of knowledge, yet truly confesses its great importance to the human understanding: 'Est animorum ingeniorumque nostrorum naturale quoddam quasi pabulum consideratio con- templatioque naturæ.' If we can direct the light we derive from such exalted speculations upon the humbler field of the imagination, whilst we investigate the springs and trace the courses of our passions, we may not only communicate to the taste a sort of philosophical dignity, but we may reflect back on the severer sciences some of the graces and elegances of taste, without which, the greatest proficiency in those sciences will always have the appearance of something illiberal." This science, apart altogether from its direct utility, has other great and obvious advantages, which, in the absence of more conclusive recommendations in its favor,ought to demon- strate to us the importance and value of a knowledge of our own mental constitution. The discipline—the training-the expansion-which the mind undergoes in the study of its own operations, are of themselves benefits not lightly to be appre- ciated. The cultivation of habits of accurate observation and reflection, of patient attention, of rigid induction, of logical ratiocination, qualifies the mind for the more ready pursuit of those branches of knowledge that are considered to be more closely connected with the practical and active busi- ness of life. The mental gymnasium to which I refer is admir- ably fitted for the development, regulation, and cultivation of those faculties of the mind upon the right exercise of which depends our intellectual advancement and happiness. It is not my wish, in advocating the claims of mental philosophy, to undervalue those sections of knowledge which have an almost exclusive reference to the physical sciences. I am quite disposed, however, to admit that it is an unfortunate effect of mere physical inquiry, when exclusively directed to the properties of external things, to render the mind in our imagination subordinate to the objects to which it is directed; The Psychological Vocation of the Physician. the faculties are nothing, the objects are everything. The very nature of such inquiry leads us perpetually without to observe and arrange, and nothing brings us back to the ob- server and arranger within; or if we do occasionally cast an inquisitive glance on the phenomena of our thought, we bring back with us what Bacon, in his nervous language, calls the “smoke and tarnish of the furnace.” The mind seems to be broken down to the littleness of the objects which it has been habitually contemplating; and we regard the faculties that measure earth and heaven, and that add infinity to infinity, with a curiosity of no greater interest than that with which we investigate the angles of a crystal, or the fructification of a moss. Such are represented, by a philosopher* of high stand- ing, as the inevitable consequences of a too exclusive devo- tion to the study of mere physical phenomena. But I would advance a step further, and maintain that a knowledge of the philosophy of the human mind is indispensable to the success- ful prosecution of physical science; that without a knowledge of mental phenomena, a high degree of perfection and accuracy could not be attained in any of the collateral branches of knowledge. I cannot dismiss this division of my subject without directing your attention to another branch of study intimately associated with the science of medicine and mental philosophy and one most essential to the education of the psychological physician. I allude to logic, or the art of reasoning. Need I advance an argument, to establish the importance of a more general knowledge of that science which analyzes the opera- tions of the human understanding in the pursuit of truth. Mr. Stuart Mill places this science upon its right basis when he argues that logic is not (as some maintain) the science of belief, but of proof or evidence. Its object is not to teach the physician what the symptoms are which indicate disease: these, he must acquire from his own experience and observa- tion, or from that of others. But logic, as he maintains, sits in judgment on the sufficiency of that observation and experi- ence to justify his rules, and on the sufficiency of his rules to justify his conduct. It does not give him proofs, but teaches *Browne. 10 Forbes Winslow. him what makes them proofs, and how he is to judge of them. Logic can never show that the fact A proves the fact B, but it can point out to what conditions all facts must conform, in order that they may prove other facts. “It is,” says Mr. Mill, "to use the words of Bacon, the ars artium, the science of science itself. All science consists of data and of conclusions from these data, of proofs and what they prove. Now, logic points out what relations must subsist between data and what- ever can be concluded from them; between proof and anything which it can prove." It is not sufficient to establish that a knowledge, a technical knowledge, of the process of reasoning, an apt appreciation of the use and application of recognized logical formulæ, is not actually necessary to enable a person to reason rightly, in order to prove that an acquaintance with the science is not indispensable to the physician. It is true, as Dr. Gregory observes, that a sailor may navigate a ship, who is ignorant of the principles of navigation, and a person may construct a dial, who knows nothing of the principles of astronomy, spherical trigonometry, or the projection of the sphere. Extensive experience, a natural quickness of appre- hension, an intuitive perception of the relationship between phenomena, a capability of ready generalization, often make a man a good practical logician who has no knowledge of a syllogism, or of the elements of logical science. Among the higher order of practical intellects there have been many of whom it was remarked, “how admirably they suit their means to an end, without being able to give any sufficient reason for what they do, and apply, or seem to apply, recondite principles which they are wholly unable to state.” But, as medical philosophers, we must not be satisfied with this natural aptitude or intuitive perception of the princi- ples of logic. The science of medicine is especially amenable to the rules of logical and inductive reasoning. Having to unravel the mysterious phenomena of life, the investigation and treatment of those deviations from its normal state, termed disease, peculiarly expose us to many sources of error and fallacy, unless we cautiously keep in view the great truths The Psychological Vocation of the Physician. inculcated by the Baconian philosophy, and are guided by the unerring principles taught by its illustrious founder- "The great deliverer, he who from the gloom Of cloistered monks, and jargon-teaching schools, Led forth the true philosophy." There are but few gifted men in our profession or in any other walk of modern science, of whom we could, in justice, say that they were able to dispense with the patient study of facts, or with the recognized formule of logical and inductive science. It was remarked of the immortal Newton, that he appeared to arrive per saltum at a knowledge of principles and conclusions that ordinary mathematicians only reached by a succession of steps, and after the result of much labor, long- continued and profound meditation. It is only by strictly applying the principles of the inductive process of reasoning -by which we conclude that what is true of certain individ- uals of a class is true of the whole class; or that which is true at certain times, will be true under similar circumstances at all times—that medicine will take rank with the exact sciences and its cultivators have a right to claim a foremost position among the distinguished philosophers of the day. In the study of medicine, perhaps more than in any other science, we are peculiarly exposed to the danger of adopting false facts, of being seduced by specious and hasty generalizations, and led into error by deducing general principles from the con- sideration of a few particulars—the bane of all right and sound reasoning—the foundation of all bad philosophy. It is on this account that logic should form a part of the curriculum of our medical schools. In analyzing the passions, it is our duty to ascertain, if possible, the nature of the mysterious union existing between particular organic tissues and certain emotions of the mind. Why, for example, should the passion of fear specially affect the heart, and, if of long continuance, induce actual physical changes in the centre of the circulation? How can it be ex- plained that in certain diseases of the heart the patient often manifests a morbid apprehension of some approaching calamity? Again, it is for the medical psychologist to ascertain the inodus operandi of the passion of anger upon the hepatic secretion 12 Forbes Winslow. and the re-action of disease of the liver upon the irascible tem- perament. How does fear cause diarrhoea, and predispose the system to the action of contagion? Again, may it not be possible to elucidate the action of terror in suddenly arresting hæmorrhage; and explain why the apprehension of threatened disgrace checks attacks of convulsive disease arising from a morbid principle of imitation, and arrests the progress of epidemic suicide? The emotion of hope is known specifically to influence the respiratory functions, and in the last stages of pulmonary disease the patient is often buoyed up with the certain expectation of recovery, whilst the angel of Death is hovering about him. “How frequently have I seen the deli- cate female, in the last stage of pulmonary consumption, lighted up and everything assume a bright and cheerful aspect about her. New schemes of happiness have been contem- plated, new dresses prepared, and everything was brilliant in her prospects, whilst her parents lived under the greatest apprehension and solicitude, the physician seeing nothing but inevitable fate for the poor victim whose distemper has de- luded her."'* In endeavoring to solve these and other subtle points in psychology, we must be prepared to encounter the ridicule and opposition of those who taboo all such speculations as futile and presumptuous. In our patient and persevering study of abstract philosophical truth, we must not be discouraged by such indifference and opposition. It may be legitimately within the compass of the medico-psychologist, aided by dis- coveries in physiological and other collateral sciences, to un- ravel the nature of that mysterious union existing between mind and matter; and to trace the origin and source of the emotions, and the mode in which spirit and matter reciprocally act upon each other. The man devoted to the discovery of these great truths may be compelled to resign himself to the neglect and contumely of his contemporaries. Such, alas! has too often been the fate of those great and noble spirits who have shed undying lustre on the land which gave them birth, and the record of whose deeds forms the brightest spot in our country's annals. It is the recollection of the history of such *Sir H. Halford. The Psychological Vocation of the Physician. martyrs to science as Harvey and Jenner, which induces us to exclaim with Coleridge, “Monsters and madmen are canonized, whilst Galileo is buried in a dungeon!" A Brahmin crushed with a stone the microscope that first developed to his vision living things among the vegetables of his daily food. Professor Sedgwick, when referring to this fact, observes, “The spirit of the Brahmin lives in Christendom. The bad principles of our nature are not bounded by caste or climate, and men are still to be found, who, if not restrained by the wise and hu- mane laws of their country, would try to stifle by personal violence, and crush by brutal force, any truth not hatched by their own conceit, and confined within the narrow fences of their own ignorance." In analyzing the nature of the passions, ascertaining the connection with each other, mode of action upon the system, and special relationship to certain organic structures, it is necessary to recollect that they are planted in us for wise, beneficent, and noble purposes; and it is only when they are abused, and not subjected to a healthy discipline, that they induce disease, and affect the duration of life. While the impressions made upon the nervous system are moderate, and restrained within due bounds—when there is a natural gratification of the passions, guided and ennobled by reason, the effect produced upon the system is rather of a beneficial than of a pernicious nature. The “passions are, in morals," says Sydney Smith,“what motion is in physics: they create, preserve, and animate; and without them, all would be silence and death. Avarice guides men across the deserts of the ocean; Pride covers the earth with trophies, mausoleums, and pyramids; Love turns men from their savage rudeness; Am- bition shakes the very foundation of kingdoms. By the love of glory, weak nations swell into magnitude and strength. Whatever there is of terrible, whatever there is of beautiful in human events, all that shakes the soul to and fro, and is remem- bered while thought and flesh cling together,-all these have their origin in the passions. As it is only in storms, and when their coming waters are driven up into the air, that we catch'a glimpse of the depths of the ocean; so it is only in the season of perturbation that we have a glimpse of the real internal 14 Forbes Winslow. nature of man. It is then only that the might of these erup- tions, shaking his frame, dissipate all the feeble coverings of opinion, and rend in pieces that cobweb veil with which fash- ion hides the feelings of the heart. It is then only that Na- ture speaks her genuine feelings; and as at the last night of Troy, when Venus illumined the darkness, and Æneas saw the gods themselves at work, so may we, when the blaze of passion is flung upon man's nature, mark in him the signs of a celestial origin, and tremble at the invisible agent of God." "Who that would ask a heart to dullness wed, The waveless calm, the slumber of the dead?” CAMPBELL. Having, I trust, established the necessity of a more general acquaintance with mental philosophy, it is now my province to demonstrate its practical application as a therapeutic agent in the hands of the physician. From the annals of empiricism the psychological physician may glean many useful lessons. “Fas est et ab hoste doceri,” is a maxim as applicable to medical as it is to moral and political science. May not the success that sometimes follows the ad- ministration of an extravagantly eulogized nostrum often depend upon the moral confidence inspired in its much-vaunted efficacy? Medicine often has a curative efficacy because the patient is told and believes that it will cure—is unerring in its effects—infallible in its results. Let us learn a lesson from this fact, and remember the observation of Cole- ridge, that“he is the best physician who is the most ingenious inspirer of hope.” How often has a disease which has baffled the skill of the scientific, practical man, vanished before the spell of a village witch? A patient afflicted with a malady which refused to yield to the demands of legitimate medicine, surrendered himself into the hands of a notorious quack. A friend endeavored to rescue him from the grasp of the charla- tan. He saw the daily fee accompanying the daily deceit, and expostulated; when the patient exclaimed, “For God's sake, destroy not the hopes that man holds out to me: upon them I live! without them I die!" In acute attacks of disease, the patient who has the least fear of dying has, cæteris paribus, the fairest prospect of re- The Psychological Vocation of the Physician. 15 covery. The tonic and often stimulating influence of HOPE not only arrests the progress of organic mischief, but invigor- ates the system, thus warding off the approach of disease. Aretæus, appreciating the importance of rousing and sup- porting, by means of moral agents, the nervous system, when in a state of depression and debility, expressly counsels the patient to be of good heart, and advises the physician to en- tertain him with agreeable conversation, and to do his utmost to encourage hope and confidence. With a view of abstract- ing the mind of the patient from a contemplation of his own sufferings, he directs that his mind should be diverted with the sight of plants in full bloom, and agreeable paintings; and suggests that the bed of the patient should be placed near a window commanding a beautiful prospect. The chamber, he says, should be strewed with flowers; amusing books should be read, and the soothing influences of music should be brought to bear upon the moral treatment of the case. The mind of the patient should not be permitted to dwell upon his plıysical malady and he should be constantly buoyed up with the hope of recovery. When speaking of the plague of Athens, Thucydides says that “the most affecting circumstance connected with the epidemic was the great and fearful mental dejection which accompanied the attack. The mind appeared at once to sink into despair, and the patient often gave himself up without a struggle." We all fully appreciate the potency of mental depression among the predisposing causes of contagious disease. During the prevalence of epidemic diseases, it may be a matter worthy of consideration whether there are not some powerful MORAL REMEDIES, by means of which they may be shorn of much of their virulence. It is a question entitled to serious discussion, what are the best means within our reach to effect so desirable an object? Many may smile at the idea of attempting, by any mental measures, to create a revulsion in the public mind, and thus to destroy, if possible, all fear and apprehension. When Rome was threatened with pestilence, the public authorities marched in solemn procession to the national temple, and means were adopted for appeasing the anger of the gods. The psychological effect of this, to our minds, superstitious pro- 16. Forbes Winslow. ceeding, was to allay public apprehension, and to excite hope and confidence. May not we adopt measures somewhat analogous to arrive at similar results? Have we not within our power effectual means of acting upon the public mind en masse, for creating, during the existence of those fearful panics which so often accompany the prevalence of pesti- lential diseases, a new turn to the current of thought, and of dispelling unnecessary fears and morbid apprehensions? God has so intimately associated the spiritual with the material portion of our organization, that He will not consider that we are slighting His dispensations, or making light of His awful providence, if, in obedience to His will, and in conformity to the recognized laws influencing the mysterious union of mind and matter, we adopt moral or mental means for curing or preventing disease. Such being a view of the question sanctioned by Religion and Science, it behooves us to consider whether some measures might not be adopted for the purpose of abstracting the public mind from its own depressing apprehensions, thus rendering the system less liable to be acted upon by those physical agents alleged to give origin to the disease. This is only suggest- ive; it may be entirely impracticable; but whether it be so or no, I have not the slightest doubt of the unsoundness of the principle, and of the importance of adopting every legitimate means of allaying any panic that may occur, and of looking beyond the mere physical means at our disposal, for the pre- vention and cure of disease. It is our duty, during these painful epochs, to dismiss from the mind the contemplation of subjects calculated to awaken gloomy apprehensions, to depress the feelings, and exhaust the nervous energy. Every reasonable mode of in- ducing cheerfulness and serenity should be encouraged. Con- stant and agreeable occupation will do much good. An effort should be made to excite emotions of a pleasurable character. The exercise of charitable feelings, the determination to keep in abeyance all the corroding passions—such as anger, jealousy, revenge, covetousness—and the effort to cultivate “love, peace, and good-will toward men,” will be found of positive The Psychological Vocation of the Physician. 17 advantage in invigorating the physique, and thus rendering innocuous the poison of contagion. We should never forget that those whose vital powers are debilitated are the most susceptible to epidemic maladies, —that the depressing emotions induce this predisposition more certainly than any other cause. A humble reliance on the will of God, a well-sustained piety and cheerfulness, are the safest and most legitimate means (apart from the use of physical agents) of preventing the spread of epidemic mal- adies. During the prevalence of any such visitation, it is our duty individually, as well as nationally, to fortify and strength- en the system, by resolutely determining not to yield to use- less fears and childish apprehensions; and, so far as it is in our power, to inspire ourselves and our neighbors with energy and courage, and as a powerful prophylactic agent, to cultivate "Sweet, unanxious quiet for the mind.” They are the happiest, healthiest and the longest lived, who systematically cultivate ease of mind. BAREFOOT PHOBIA IN A PSYCHASTHENIC. A CLINICAL NOTE. By C. H. Hughes, M. D., St. Louis. A CHEROPHOBIAC paresthetic psychasthenic is now A under my observation, in the person of a Russo-Ameri- can, aged twenty-six, resident of the United States about six- teen years, who possesses, among the numerous paresthetic sensations and the several neurasthenic phobias and hypo- chondriac apprehensions of which he complains, this peculiar fear, observed by myself for the first time in a long life of neuropathologic study and not of record in the literature of psychiatry. This young man is of medium stature and good propor- tionate weight and generally good physique, 5 feet, 8 inches, high and 150 lbs. avoirdupois. · He has been debilitated and hypochondriacal for several years and under medical treatment by different physicians for two years. He has tardy gastric digestion-fermentative gas generating dyspepsia in stomach bowels and insomnia and makes daily notes of his symptoms “lest he might forget," before reaching the office of his medical consultant. Torpidity of the vital functions, generally incomplete hepatic action, constipation, microsphygmy and patholesia are pathog- nomic features in his case. His numerous paresthesias are distressing as are likewise his apprehensive pathophobias. He has a mother who is melancholically insane and a path- olesic melancholia tinctures most of his morbid fears. -18– Barefoot Phobia in a Psychasthenic. 19 The following expressions, of this psychasthenic path- ophobiac, will serve as a revelation of the inner man, made known by his peculiar verbiage, as we often elicit it from better educated persons “to the manor born” and trained in better manner of speech. “When I think bad," he says, “it goes to my feet and stomach, I get ereated irritated) and weak and there is a moving in my head. If some one-says a mean word to me I feel discouraged.” “I have flashes and pains and have often no patience.” “My back draws, I am weak in the side. Get mean feelings and hot and sore and mad, some- times bowels move too much. Where would be a good place for me to go?” Sudden transient sweatings, also other morbid sensations, short of positive pain are described by him. He uses neither tobacco nor alcoholics often and both have been forbidden. His eyes are not defective, but he has ambliopia, more at some times than at others, mostly after attempting customary business, especially in after part of the day, which attempt he must soon discontinue because it makes him so extremely incapable. He “tries to do some- thing and in half an hour must quit." He feels so (indefin. ably) bad. He has heat and cold flashes and perspirations under emotion like a woman at the menopause. This man admits an old gonorrhoea, denies other venereal disease, shows tardy and diminished knee jerk, ex- tremely sensitive about the patellae to the rubber percussion hammer. He fears impotency and complains of feeble erec- tions, impaired sexual appetite, delayed ejaculation and aspermatism. He fears he is all gone in the sexual sphere and says his fiancee has abandoned him because of his sick- ness. He speaks of himself further:“When I draw my breath a strange weak feeling comes up from bowels. If I talk to any- body I fear it is not right or that I will say something I ought not to say." He is exceedingly timid at times. In short he has much of the self introvertive inquisitive- ness of hypochondriasis and morbid egoism that may presage insanity-possibly folie du donte. C. H. Hughes. An enlarged and somewhat thickened great toe gives him much solicitude and makes himsick to look at it,” he says. I gave him a little memorandum book in which to record his observations of himself and get them off his mind by bring- ing them to me each visit, from which I take the leaves as he brings them, read and destroy them. Psychoneurasthenia less marked than this, has often in my own personal observation, when neglected of right and unremitting psychiatric management and treatment, passed into grave insanity. Psychoneurasthenia is a much more common precursor of marked forms of insanity than we find recorded in the literature of neuropsychopathology. He is dark complexioned, with dark hair, skin and eyes. Though no history evidences syphilis, he improved under hydrargyri iodidi, salol and peptonated bromide of lithia in quantities and dosage sufficient to correct uric acid diathesis and promote proclivity to a greater amount of sleep and keep a clean prima via. Regular neurone entoning and oxydiza- tion promoting electrizations (static) are also employed. From the tout ensemble of this young man's symptoms and their persistence, he appears to be in the incubative stage of an oncoming grave mental aberration. Neglected of per- sistent skillful treatment he might pass into melancholia agitata or to dementia praecox. Dementia praecox as well as melancholia are ordinarily the culminating sequences of inadequately managed or neglected psychasthenia profundis plus an inherent or acquired diathesis psychopathica. This man can not tolerate the sight of a naked person male or female, mature or infantile. This gymnophobe has a special horror at the sight of an infant's bare foot, an inexpressible dread, he says, when compelled to see this part of a babe's anatomy. MENTAL DISORDERS IN ANKYLOSTOMIASIS.* By T. TurtregeSilo and H. Gotuzzo. Alienists to the National Insane Asylum, Brazil. It has been observed for a long time that intestinal worms I are the cause of mental disorders in individuals who are infected with them. In most all of the works on mental diseases issued in last century, beginning with Esquirol, it is stated that certain worms occupy a very prominent place among the causes of disease of the brain. It would take too much space to cite all the numerous cases in which the various psychical dis- orders are attributed to the presence of worms in the intes- tines. Much more discreet is Krafft-Ebing, when in his report “On the Acute Cases of Excitation," resulting from this cause, he arrives at the following conclusion: Trychosis caused by helminths is rare and only observed in juveniles of weak con- stitution. It seems to me that the conclusion of this great physician is quite true. A great number of previous writers arrived at an exaggerated result in consequence of a wrong interpreta- tion, as they consider as a constant occurrence what occurs in a few cases. In this case a likeness is conspicuous between that which may happen in psychiatry and that which is con- firmed in pediatrics. Worms are in the etiology of children's diseases of primordial importance; quite a number of the morbid conditions are due to the presence of worms in the *Translated from Archives Brazilairos. -21— 22 T. Turtregesilo and H. Gotuzzo. intestines of children. In this age, on the contrary, a hel- minthiasis has been in a great majority of cases on account of a trivial coincidence, without any pathological importance, and those who attribute serious consequences to the helminths did so without foundation. But notwithstanding their lessened importance there is a reason why we do not entirely omit them in the etiology of mental diseases. Tape worms, arse worms and intestinal parasites, affecting individuals who are strongly psychopathi- cally predisposed can determine mental disorders of greater or lesser gravity. The thing is rare, but exists. What nevertheless up to the present time has not been exactly de- scribed in mental pathology are the great psychic alterations which can be observed in the course of the ankylostomiasis. We will not refer to the slight alterations of character so frequent in many other morbid conditions, neither to the many well known disorders of taste and appetite, which if they are perverse can, in the uncinariasis lead to the greatest imaginable extravagances. Indeed the voracity of the ankylostomiasis—an appetite for what is unfit for food, etc.- already many times described, is rightly considered as a direct expression of the pain in the gastro-intestinal tube, the seat of the uncinarias. As Professor Azlvedo Sodre stated at the meeting of the National Academy of Medicine, when one of us related in his discourse before this association what we had observed, that what we now have to do is to remove such an interpretation and consider veracity as one manifestation of the changed mental condition. But we repeat that the alteration of the character and appetite are mental shortcomings, already described in the symptomatology of ankylostomiasis. That what, up to to- day has so far not been agreed upon the annoying uncinariasis is the appearing of the great mental. In the year 1906 we had opportunity to observe in the National Insane Asylum, three cases of uncinariasis accom- panied by great psychic changes in which we could establish a relation between cause and effect. We now describe these cases. Mental Disorders in Ankylostomiasis 23 1. Observation, ankylostomiasis, degeneration, delirious periods (hypochondriac and persecuting ideas.) A. J. S., a Brazilian, 26 years old, colored, can read and write, entered the hospital on October 14th, 1906. The mother was hysterical; absence of syphilis and alcoholism. During the first few days in the hospital he was partly violent, partly melancholic and mistrustful. But after a few days he began to complain of intense and continuous pains in his stomach and in his head, which, when questioned, he said he had been suffering from for some months; moreover he felt the need of fresh air and soon he gained a little more courage. All these complaints he attributes to poison, which has been supplied by the persons with whom he lived before. He had taken it occasionally and it sometimes had ill effects. Thus criminal action cannot be consequently justified or ex- plained. We were impressed by the marked anemia of the patient, accompanied by systolic contractions with a maximum of 4° interval, above the point; in addition to it a light swelling of the lower limbs and face, especially of the eyes and the tongue. He suffers from constipation and we made an examination of the feces. A great quantity of the eggs of the “uncinarians” were disclosed. At the same time a specific globular infection indicates pronounced eosinophilia. Thereupon an anti-helminthic treatment was immediate- ly begun (purgative, six capsules of thymol of 1 gr., each taken within quarter of an hour of the other alternately,) and this therapeutical treatment was repeated thrice in 45 days. The patient showed some improvement in his general aspect; the pains and want of breath ceased, the delirium, a mixture of hypochondriasis and persecution gradually lessened, till they completely disappeared about the end of November. This is one month and a half since he was received into the hospital. This continued till December 15th, when he was released without worms or delirium. 2. Observation. Ankylostomiasis, inferior degenera- tion, dysmimia, incoherent delirium. P. T., a native of the state of Sao Paulo, white, 19 years 24 T. Turtregesilo and H. Gotuzzo. old, single, could read and write, employed in commerce and mining. He came to the hospital October 16th, 1906, show- ing a great cutaneous and slimy paleness, the white of the eyes bluish, light swelling of the eyelids, anemic and endo-appen- dicitis. Hematological examination: great decrease of the number of the hematins and of the percentage of the hemo- globins, light hyperleukocytosis, remarkable eosinophilia (18 per cent.) Examination of the feces: found a great quantity of the eggs of the uncinarias. He showed many physical stig- mas of degeneration; onanism, absence of syphilis and alcohol- ism. Showing pronounced alterations of memory; especially in regard to recent facts. He has delirious with religious ideas and a puerile dignity. He is very incoherent and without any system. As in the previous case, the different afflictions, thanks to the treatment of thymol, decreased and also gradually his mental disorder. The patient left the hospital in much better health De- ccember 14th. 3. Observation. Ankylostomiasis, inferior degenera- tion, mental disorder. M. A. O., colored, Brazilian, juvenile, (exact age not known), entered the hospital March 12th, 1906, presenting a clinical case of ankylostomiasis, confirmed by microscopical examination of the feces. Hematological examination: hemoglobin 35; density 1,060, congelation 1'10" hematins 4.100.000, white globules, small lymphocytes 11 per cent., large lymphocytes 12 per cent., mononuclear neutrophils 6 per cent., polynuclear neutro- phils 52 per cent., polynuclear eosinophilias 16 per cent., transition 3 per cent. The patient, who had various physical stigmas of degen- eration and onanism, had lost, when entering the hospital, completely the notion of time or place. The mental disorders are very pronounced. When, after some time, the same diminished, there existed a curious psychical condition, in consequence of which the patient, in an ironical and sarcastic way, ridiculed all persons and things, in which condition he resembles the description given by Oppenheim under the Mental Disorders in Ankylostomiasis 25 denomination of “Mania of Sarcasm" in cases of tumors of frontal lobes. Here the same progress is made as in the previous cases; improvement of the mental disorders and the annoying unci- nariasis at the same time. Finally cured as were the others. In these three clinical cases, which we have just described, what kind of relation exists between the ankylostomiasis and the mental disorders? Is there a simple coincidence of the annoying uncinariasis with the marked psychical alterations, or have we to deal with a relation of cause and result between these two groups of morbid manifestations? It seems to us that the question must be determined by the last alternative: an ankylostomiasis was a decisive cause of the mental disorders. Let us prove in the first place the evolution of the sickness; at the same time that we lessened the symptoms and ordinary indications of the sickness, we extinguished the psychical alterations. The parallelism was so plain, so evident, that it is hardly necessary to emphasize it. • In the second place we have to demonstrate the character of the delirium as related in our first observation; common symptoms of uncinariasis, much pain in the stomach and in the head, want of breath, etc., have been explained by the patient as manifestations of a poisoning, practiced by reso- lute persons; in other words, the patient explained his disease being conscious of his hypochondriac and persecuting deliriums. On the other hand, we must in no manner be surprised of the fact, that uncinariasis can cause in certain individuals mental disorders in such considerable number. We know from Lussana that ankylostoma conceals the diverse toxic substances, which introduced in circulation, diffuses itself in liquid atmosphere, in which live all our anat- omical (physiological?) elements and which constitutes half of our make-up. To toxic substances hidden by parasites it is necessary to combine with other poisons, which result in actions of these substances upon all of the tissues, and which actions have been especially studied in the elements of our blood. Consequent- ly brought into contact with the psychical cerebral cells, they necessarily become metabolic. Such cells by inheritance or 26 T. Turtregesilo and H. Gotuzzo. acquisition are miopratic, that is, in a brain of an individual, predisposed or degenerated, the changes of the metabolism can have as consequence mental disorders and delirium. These facts seem to prove that intestinal parasites can effect great mental changes, but an observation is not yet a proof, simple reasoning will be sufficient to examine before- hand their existence. But at a closer examination a critical mind will not oppose us, by placing positively the toxical substances, concealed in duodenal uncinariasis amongst the numerous poisons of vegetable, animal or mineral origin, which can provoke insanity, more or less intense, more or less lasting. The description of them occupies a large chapter in the works on psychiatry. An objection may be raised against our arguments; an objection based on the inconsiderable number of cases of in- sanity compared with the considerable diffusion of uncin- ariasis in our rural districts. We only beg to say: 1. Only lately* has been called the attention of the psychiatrists to this point, and it has been hoped that an exact observation may discover new cases followed by a close examination, unfortunately omitted in previous cases. 2. It is a fact that in ankylostomiasis the great mental syndromes are not frequent, and it is not less true, that the little psychical alterations (changes of character, taste and appetite) are the most frequent ones, yes, are even the rule. Nevertheless the differences existing between the two groups of deviation in psychiatry, are differences of small importance, of quantity and not of quality. Finally we beg to state that malaria, notwithstanding its endemic character in many parts of our country, is seldom observed as a direct cause of mental disorders in patients of our hospitals; on the other hand, nobody can deny that impaludism is one of the marked causes of dysphrenia. Already the Professors Juliano Moreira and Afranio Peioto in their admirable paper before the Congress of Lisbon, *When this article was already in the hands of the printer, we found in the “Revista Medica" of 1876, an article by H. Luiz de Mello Brandao, in which the author calls attention to sundry cases of insanity caused by ankylostomiasis, which even culminated in suicide by strangulation. Mental Disorders in Ankylostomiasis 1906, on “Mental Diseases in Tropical Climates,” stated that an uncinariasis is the cause of a mental defect, observed so many times in descendants of people having suffered of ankylostomiasis. “The descendants of these people are fre- quently imbecile or mentally feeble without any other cause." While the poor nutrition raised in these countries reflects so sadly on the new generation, still we consider ankylosto- miasis as the decisive cause of insanity of the various clinical forms. RESUME. Ankylostomiasis must be considered as a decisive cause of dysphrenia. The mental disorders determined by ankylostomiasis are two-fold; one type, already observed for a long time, although differently interpreted, is very fre- quent and ordinarily not intense; i. e., alterations of character, appetite and taste, these are mentioned by all the authors. The second type, not yet described up to the present time, is much less frequent, but more intense and presents the forms of the great mental syndromes. The apparitions of these disorders are occasioned 1st, by a predisposed cause—degeneration. 2nd, by a determined cause ankylostomiasis. Intoxication and exhaustion of ankylostomiasis explains the pathogenesis. The anti-parasitic treatment causes the disappearance of the mental disorders. PAGAN SCIENCE (Faith Cure) AND THE HUMAN MIND. By ALBERT S. AshmEAD, M. D. New YORK. IN the Buddhist religion of Japan, besides the Kami (gods) worshipped, such as Shichimen-seven headed serpent; Kishi Mojin, the mother of child demons; Kotohira, or fire god (a metallic protector of the multitude; Yebisu (leech); Dai-Koku- ten, great black heaven; Kangiten, Heavenly Joy, etc., etc., there also are divinities in human form, mostly canonized apostles and disciples. Amida Niorai or Dai-Butzu of Kioto and Kamakura is the premier human divinity of the Buddhist faith,usually represented seated on a lotus flower. Idols of Amida may be seen at six temples in Tokio. Yakshi Niorai is the divinity of medicinal herbs. Sick people petition this deity for restoration to health. He is a canonized doctor, as Dai Butza is a canonized priest, called Buddha. The founder of the religion of Buddha in Japan is Sho Tokutaishi, who was a pupil of Nichira, the head of the Budd- hist church. The divinity of the six things: earth, water, fire, wind, air and mind is called Dai-Nichi Niorai and is the same to the Buddhists as Tenshoko (goddess of the sun) is to the Shintooists. This two-headed god is amalgamated in the two religions of Japan, as the great Sun Divinity. Medicine therefore was religion in Japan. Shaka Niorai, the founder of Buddhism in India, died 457 B. C. Idols may be seen in all temples, Buddhist and Shinto, or Buddhist-Shinto amalgamated, well worn by de- votees rubbing the figure and then the corresponding portions of their own bodies; these are called Binzura Sonja and repre- sent the servant of the disciples of Shaka, noted for his energy -28- Pagan Science and the Human Mind. 29 and untiring perseverance in attending to his duties. This "transfer by friction” is an ancient idea which our own pro- fessors of animal magnetism have studied with profit, just as the priests of Japan have done. At the time of appeals to Binzura Sonja for relief from pain or disease, the applicant must throw into the huge crated cash box, always found near the idol, some money wrapped in a piece of handkerchief paper which they take from the pocket of their own sleeve. We do the same to the organ grinders from the flat windows or on the streets. Each day the wily Japanese priests from the basement of their temples, crawl into the secret vaulted depths of these money receptacles and collect the offerings found deposited there by the sick ones who have been patients of the God that day. This revenue for the priesthood is immense. When the old wooden god becomes rubbed almost entirely away or so that his features or members can no longer be recognized, he is reluctantly re- placed by a brand new idol. The older he looks the more powerful, however. As a system of faith cure, this is very ancient in Japan. It must be borne in mind that Buddhism is pure atheism, while Judaism and Christianity and Mohammedism are the- isms. The greatest of the theisms is, however, Hinduism, and Buddhism originated in India. There is no such thing as a Buddhist god as we know him, a personality or a word of God or a Saviour. They worship only essence-like spirituals of “capacity” or “ability” or “joy of joys,” etc. All their rights are based on the natural constitution of the world and of physical life, and the laws and forces reigning therein. Buddhism demands of its adherents not blind faith, but a conviction gained and confirmed by one's own investigations and by earnest reflection. Buddha him- self, by incessantly working at his own heart and brain, at- tained Buddha-hood—the highest wisdom. Atheism of our own Ingersoll is almost the same as the atheism of the greatest Gautama (Buddha.) No essential difference exists between worship of Binzura Sonja and Christian Science; these two systems of attempt at cure or alleviation of ills by working the will, or by contemplation 30 Albert S. Ashmead. along certain lines, “in such cases made and provided," of Binzura Sonja and of Mother Eddy are parallel, the one with the other, and in this respect“ nothing new under the sun," so far as the presence of a visible form is an aid to the eye of the mind by means of the eye physical. Pagan science has the advantage, is superior for the easily led, the superstitious. That the west misunderstands the east, I fully believe. I do not look upon immolation and sacrifice before idols as other than an attempt by the idola-- trous to propitiate or conciliate a particular spirit quality of nature to which they recognize their subjection. The crucifix with the affixed human form, the insignia of the altar, the vestments of the priests, are visibilities more elaborate, of the western civilization and serve the purpose (as is the intention) of keeping the mind upon the theme by reason of the enduring effect upon the memory. Carlyle's Sartor Resartus shows the value of distinctive clothing, for enhancing the embodiments of authority, of social distinction, and Binzura Sonja remains visible to the memory, with all the accessories of his station. That his form becomes dis- colored or wasted by the attrition of pleading hands, gives no occasion for the thought of waning power. The spirit is there. A new or a rejuvenated form will impress the memory nevertheless more strongly. All forms of attempted communication with the unseen, unknown, exist, and are panoplied by reason of the wish of the devout. The marble magnificences of Mother Eddy are beyond the hope or dream of poverty-stricken Binzura Sonja. So long as the world has superstition, priests will exist to feed it—and be by it fed— for the distressed of the earth need their aid; need rest for the mind and peace for the soul, and such refuge is a natural selection. Here let us indulge the hope, the belief, that the day of human sacrifice is gone forever, yet the Chris- tian Church teaches: “When you take the sacrament, you must believe that you eat the actual body and drink the actual blood of Christ.” Mandatory! Again we see extremes meet, for as I have read: “The belief of the American Indian (the highlands near Patagonia) is that if one eats the heart of an enemy whom he has killed Pagan Science and the Human Mind. 31 in combat he has thereby added to his own heart the courage that was possessed by his fallen foe. I do not know upon what the Christian mandate is based, if not upon the words attributed to Christ at the Last Supper: “Eat and drink in remembrance of me.” The struggle for existence is in the church as in the world outside of it: non-conformance, con-consonance, are apt to be fatal, certainly serious, to the delinquent. Thus are the olden forms of expression retained a long time after they cease to bear import other than that of ambiguity. I have digressed from Pagan and Christian Science. Last night I read of the death of a young person while under Christian Science treatment. The name of the disease was not stated. People go too far and too fast. Designing per- sons take advantage of the credulity of others, as we all know. Without doubt such is Binzura Sonja; but we see to-day, in this land, the same thing in Christian Science. 50 West 106th Street. PSYCHOLOGICAL NOTES AND QUERIES. From the Life Observation and Reflection of a Past Septua- genarian Physician. By Amos SAWYER, M. D. IX/EBSTER defines hallucination as a diseased imagina- tion. If the brain is diseased,yes, if not, no. “Dreams, those wild magicians that do play such pranks when reason slumbers,” are not caused by a diseased imagination, but are healthy mental hallucinations acting while its physical machinery is at rest, making impressions on the minds spirit- tual retina in the same manner that material objects do that of the physical one we are familiar with, or we would not, as we do, see our childhood homes with all their stored treasures, as bright and as beautiful as their reflection in our youthful days, and as we rove through the streets of our native town, we see them as they were and not as they are. In one case, the picture formed on the physical retina is the reflection of a material object from without; in the other it is the shadow of an immaterial object originating within, as well from brutish bodies as in man, as witnessed when the sleeping dog moves his legs and yelps as he chases in hallucination the rabbit, as well as the cat, when catching the imaginary mouse. The hen when she lays an egg during the night, does so because she is setting on an hallucinated nest. A man and his wife, returning at night from a neighbor- hood entertainment, saw three ghosts, two of them standing at one side and the other directly in the road; the frightened team ran for home, but as they passed, the one in the road sprang at the wheel, and with its long bony fingers caught hold of the spokes and held on for a long distance, and with -32— Psychological Notes and Queries. 33 every revolution of the wheel, it would look at them with its fiery red eyes and a ghoulish grin. Arriving at home they waked the two hired men and told them what they had seen. They persuaded their employer to go with them to the place where the ghost at the wheel let go its hold; when they reached the spot they found a piece of newspaper, and where the other two were seen, were two more papers tied to stakes, a farmer had used for guides while straightening his fence along the road, and this spoiled a very thrilling ghost story. In this case, the hallucination did not result from a diseased imagina- tion, because their brains were not diseased. The brain is composed of matter, and matter is inert, and can act only as it is acted on, by something not matter, call it by any name you please. It was not due to a natural picture formed on the physical retina, for that would have taken the shape of a piece of newspaper, but the shadow was so indistinctly formed that it gave rise to a feeling of doubt and fear in the man (not the tenement he lived in) and the picture they saw was one filling all the requirements their fancy had so frequently drawn of a ghost-like form and this was reflected from their spiritual retina to the material one. One night after returning from a long, tiresome ride, I found that a fire had broken out in the woods along the public highway and a long line of fence around my farm was in dan- ger; the neighbors were fighting the fire. I rode to the end of a lane where I could pass into the woods, when I met three men living on my farm and was greeted with the welcome cry, "Fire out.” I asked them to remain halfway up the lane until I could ride along the line on the burnt district to be certain that some smouldering piece of punk or bunch of dry leaves had not started the fire afresh. I found everything safe and as I came out on the public highway, I fell in with a stranger riding my way, and after passing the evening greet- ing, to which he made no response, I mentioned the recent fire, but taking no notice of this he quickened his horse's pace to a trot. I spurred my horse and kept beside him when even in a gallop; suddenly he disappeared going ahead of me. I asked the men waiting in the road who it was that passed them; they replied, “No one has passed since you left.” I then re- 34 Amos Sawyer. lated my adventure with the stranger and this was met with an incredulous laugh, and “it must have been your shadow you saw." But how could this be, unless (which it was not) the moon was shining, and even so, I was riding a black pony and wore a slouched hat. How could my shadow be transformed into a large bay horse with a heavy black mane and tail, and the rider wearing a cap? There was a high fence on each side of the lane, which was 40 feet wide. It occurred to me then that I did not hear the horse's footsteps as they hit the ground. It must have been a subjective cerebral impression induced by an unconscious momentary somnam- bulism, although to me it seemed a reality. A lady told me that at a spiritual seance that she not only saw her dead husband, but shook hands with him. That she believes this, there can be no doubt, as she makes occasional visits to the medium for this purpose. The seances are held in a dark room, with hands clasped to those of the others forming the “circle." The fixed gaze in the direction where the spectral form is to appear, together with their willing subjective minds, make them fit subjects for mesmerism, and when under this influence they see and hear only what the medium exercising this power, wills that they shall see. That some persons possess this mysterious power there can be no dispute, as their subjects will catch imaginary fish, eat potatoes, after being told that they are apples, oranges, etc. So, and for the same reason, the subject sees such objects as the mesmerizer desires, or do as he directs. That the attention must be passively fixed on some object before this influence can be gained is a necessity, and this condition exists in the believer when he attends a spiritual seance. That the fakirs of India possess this power to a marked degree there can be no doubt. Josephus, univer- sally admitted to be a good man and truthful historian, tells us that during the siege of Jerusalem, the immense gates which required the strength of 20 men to open, and were bolted to immense stones, unfastened the bolts and opened themselves. This may be true, and no doubt is accepted by spiritualists as confirming their assertions that the spirits of the departed loved ones do return to this world and give Psychological Notes and Queries. evidence of their presence in various ways. Continuing, he tells us that when a young heifer was being led up to the altar to be offered as a sacrifice she gave birth to a lamb. The most charitable view to take of this statement is, that unbeknown to him he had been hypnotized; otherwise, he was a historical prevaricator, as well as a pathological liar, and the gate open- ing story rests on one of these two things. I am aware that these remarks will call down upon my head the denunciation of so-called spiritualists, but until they can do what science justly demands, they have no right to complain when the uncertainty of doubt (first stage of knowledge) causes us to deny that the things done by this, as yet, unknown power, is the work of spirits. Science says: “Place a pendulum on a solid granite pedestal, under a glass globe, and with the medium at a distance, by this power cause it to oscillate, or an instrument which measures the one thousandth part of an inch and move the index one notch; or place a hermetical- ly sealed tube filled with pure water, and a portion of arsenic beside it and put the one thousandth of a grain of arsenic in the water in the tube; do one of these things and we will believe that it is done by spirits of the departed. It is a problem that may be solved by exclusion, and science seems to have succeeded in doing this with the spirit part of it. On the afternoon of September 5th, 1859, my mother came to me very much excited and said: “Some member of the family will be killed before night, do pray be careful what you do and stay in the house until I return.” This warning was given to my father and sister, then at home; she then ordered her carriage that she might warn a married daughter living in the town a mile distant. I felt inclined to make · light of her fears, but refrained when I saw that she felt cer- tain that her predictions would come true. Shortly after she left, my father, contrary to the promise he had laughingly made my mother, saddled his horse and started for town. About an hour thereafter my mother, in a high state of ex- citement, returned and exclaimed: “Where's your father?” “He has gone to town." "Then he has been killed at the rail- road crossing, just as I started for home.” I jumped into the carriage with her and started to town still feeling that 36 Amos Sawyer. her convictions would prove false, but half way there we met a messenger who informed us that father had been run down by two drunken men and that both he and his horse had been instantly killed. Now what was it produced this impression so suddenly? She said, that in the sense the word is general- ly used, she had no warning; just an impression, with great agitation which under the circumstance would naturally follow. It did not point to any particular member of the family, only that some one beside herself would be killed. The late General Jesse J. Phillips, said that late at night, before the battle which would begin in the morning, seeing a light in General Lyttle's tent, he entered for a friendly chat, but found the occupant busy writing, and in answer to an inquiry, said: “A few hours ago a feeling came over me, and I continue to feel impressed, that I will be killed in to-mor- row's battle, so I have been arranging my business in case that this impression proves true, and am now just finishing a piece of music ('I am dying Egypt, dying.') I began some time ago.” He said that the General seemed so solemnly in earnest about the warning he had received, that he did not have the heart to, as he felt inclined to, make light of it, but bade him good-night and retired to his quarters, expecting to enjoy a hearty laugh at Lyttle's expense after the next day's engagement, but this was not to be, for as the General was leading his brigade, true to his warning, he was killed. Some years ago a lady living a few miles north of this place, suddenly became impressed with the belief that her son that day would be drowned, and when, after dinner he announced his intention of going to town, she mentioned the impression, and after, against her protest, he determined to go, she exacted the promise that under any circumstance he would not go near the water. When crossing the creek near town, he was hailed by some boys and invited to go in swim- ming with them; at first he declined, giving his reason, but when told to keep in the water where he could wade, he finally yielded to their solicitations. At length, being an excellent swimmer, he decided to swim the length of the hole and thus convince his mother that her fears were groundless, but be- fore half the distance was reached he was taken with cramps Psychological Notes and Queries. 37 and drowned. Now what was it that caused these sudden impressions? It could not have been due to any material thing, for there was no sight, no sound in the tenement their spiritual body occupied. It was a psychological picture of death, something originating within the spirit form, but what it is remains an unsolved problem. One peculiar thing is, its fatal predictions always come true, when they come, not as dreams, but when the recipient is in full possession of all his faculties, with the normal inhibitions of the waking state active and the nervousness resulting, is the natural effect which a death warrant for some dear one would produce. There must at all times be an inward spiritual speech of which we are not conscious except upon special occasions; that same something that warns us as we walk, and rebukes us when we stray. Something that has a knowledge of coming events. A mental wireless telegraphy. Another mysterious power is the so-called clairvoyance or the power to project an intelli- gent portion of one's self beyond the tenement in which it dwells, to some distant locality and see what is going on there. I have not any faith in the advertising fakirs who make their living telling fortunes, nor did I believe that such a power existed in any human being; but some years ago the first stage of knowledge (the uncertainty of doubt and ignorance) was passed in the following manner: A patient's husband claimed to possess this power and sent a message for me to call, as his wife was seriously ill. When I answered it, about 9 P. M., I was greeted with: “Where in thunder was you when the message was delivered? I went to your house, office and the drug store, and only caught up with you a short distance from my house." I replied I was not conscious that he was following me or when he passed me; he replied, “I fol- lowed you with my mind." This caused me to laugh heartily, when he answered: “By to-morrow I will tell you what your patient, with cancer of the face, is doing, and will, as I frequently do, put him to sleep.” After a while we went out in the yard where it was quiet, when he said: “There are two men in the room, one rocking in a chair hard, and talking fast; the other man is in a straight back chair. They get between me and John. Now I have him and he knows it. : 38 Amos Sawyer. They have gone and the bedroom door has been closed. Now I will give you another proof. Recently I was returning from Colorado, when I noticed a gentleman in the car who seemed greatly agitated; at last I could not refrain from asking him what was the matter, when he told me: I live in Ohio, but went to Colorado on business, and just received a telegram, stating that my wife was dangerously ill and to come imme- diately home.' I said, 'Tell me where you live and I can tell you how she is and what she is doing at this moment.' I put my- self in condition and then told him that there had been a change for the better, that his wife was quietly sleeping and that there was a small child asleep beside her. There was a trained nurse in the room on watch. I said, 'As I am a stranger to you, you will confer a favor if you will let me know how you may find your wife as well as what she was doing when I had the vision'. He wrote: 'I found everything was just as you stated even to the child in bed with her'. The postal he wrote I read. The next morning I called to see my patient, and asked him how he rested during the night. “Bully. Alf was with me and put me to sleep." "How do you know when he is with you?” “I can feel his hand moving over me and the soothing feeling that comes with it is unlike any- thing else.” “What time last night did you feel he was with you, and was there anyone here beside the members of your family?” “It was about 9 o'clock and two of my neighbors were here; one of them was in the rocking chair and talking so fast that I could not get a word in edgewise. When I felt Alf was here, I asked them to move so my bedroom door could be closed as I wanted to go to sleep, and I expect I made them mad.” So this was additional proof of the power possessed by this gentleman, to, as it were, project part of himself be- yond the tenement in which he lived. In reply to the ques- tion, how do you do this, he answered, “I do not know, only I shut off my brain, except that back of my ears.” This power to see objects not present to the physical vision is not, as commonly believed, the power of one mind to read the thoughts of another, for in the cases cited the mind of the ob- ject was not read, being entirely eliminated. It must be this same mysterious power which enables some persons to follow, Psychological Notes and Queries. 39 blindfolded, the track of one who a short time previous had hidden a pin in a piece of furniture for him to find. Mr. S. said that when using this power he shut off as it were all the brain except that back of the ears. But a young girl I saw give an exhibition at the Mercantile Library Hall in St. Louis, Mo., over 50 years ago, when being blindfolded asked for just a finger breadths of her forehead below the line of hair be left exposed or she could not read the writing on the pieces of folded paper handed to her to test if it was due to reading the mind. But as these slips were mixed with others the contents were unknown until after she read them, when in every case her answers were found to be correct. She told the contents of my pocketbook, the number of a bill which I did not know before. In reading the writing on folded paper, she pressed it against the uncovered portion of her forehead. In this case the cerebrum was used for this purpose; in the other the cere- bellum. This power, at the present time, is an unsolved secret which one day will be discovered. Certainly there is a psychological wireless photography about it, and some people are endowed with enough of this subtle substance to mentally do what will be done instrumentally in the near future. Physicians should be physianthropists, and it would be better for them if they could be physiognomists. This pecu- liar psychological wireless telegraphy which enables the opera- tor to read the character and thoughts of another is a gift possessed by very few. Stephen Gore, a wholesale grocer, living in St. Louis, Mo., 65 years ago, seldom had to charge the balance of a custoirer's account to profit and loss, and when he did so, it was on account of some misfortune which befell the merchant. He always made use of this power be- fore granting credit to a new customer. After he retired and turned his business over to his son and partner, Helfenstein, Gore & Co., whenever a new customer wanted credit on part of his bill, invariably sent for the senior Gore, and his decision decided the question. They claimed never to have lost an account when a favorable report was given by this new style of reference. On one occasion, while attending court, a lawyer from an adjoining town, came in and took a seat beside me; after care- 40 Amos Sawyer. fully looking at the jury trying a case, said:“ I'll bet ten dollars how this case will be decided, though I have not heard a word of the testimony." Just then another lawyer came over where we were and remarked:“ I've just come in on the train, but I can tell how the jury will decide this case." He did not know that a guess had already been made, but the conclusions were both the same, and sure enough the verdict was as pre- dicted. In reply to the question, how do you do this, they answered, “we read in the expression of the faces the mental impression produced by the evidence and rarely make a mis- take.” A very popular auctioneer, who for years followed the business, at a recent sale remarked: “If you gentlemen will line up before me I will point out the man that will bid on the harrow that I am now going to put up." In answer to my inquiry, he said: “I have been in this business so many years that in most cases I can read a man's intentions by looking at his face." No doubt this peculiar power is cultivated and used by fake fortune tellers. Another psychological condition has been térmed the hallucination of the dying. As Webster defines a hallucina- tion to be a diseased imagination, therefore, the question arises, what is imagination? Webster defines it as a “faculty of the mind;” and this again suggests the inquiry, can the mind become diseased? I emphatically answer, no! For instance, when looking at a number of telephone wires, often they seem to be twisted, but upon a closer observation we discover our mistake. This was an optical and consequently an endosmotic mental delusion; but did we see the wires and poles where there were not any; that would be a mental, exos- motic hallucination, caused by an abnormal cerebral condi- tion, which formed a false picture from within, on the retina. Now, as to some extent, this condition must always be pres- ent in the dying, it could be used as an argument against the supposed communion at that time of the departing spirit with those who had gone before, was it not that there is biblical and other evidence to the contrary. The night my father died, my brother's oldest child was born; six years after the boy died, and when dying, he asked his father to carry him to another room, and as they were the boy dig, and when dying, he asked Psychological Notes and Queries. passing across a dark hall he looked intently at one end and exclaimed:“Who is that father?" "I don't see anyone”. “Oh, yes, there is father; its grandfather Sawyer, he's holding out his hands, don't let him take me!" The boy then threw his arms about his father's neck and died. I believe that he saw and recognized his grandfather's spirit-form, for he had not for years heard his name mentioned, and of course had not seen him, therefore, the recognition must have been spiritual. Can anyone say what communion there may be between the spirit of the dying, as the soul is about ready to spring home- ward from its long or short sojourn on earth, and that of its Maker, or its dear ones who have gone before? A gentleman living at Jamaica Plains, near Boston, Mass., told me that he lost two children with scarlet fever; his son died and his remains were kept in the house, as his sister was expected to die in a few hours, and then both could be buried in the same grave. When dying, his sister asked: “Where is George, father?' "Downstairs shall I call him?” “You have told me a story, father, George is dead; he has just come now and is waiting for me to go to heaven with him. Good- bye father, good-bye 'mother, good-bye everybody," and she died. In such cases it seems that they must have seen a spiritual being rather than it resulted from a hallucination, which in an adult, under like conditions, might be supposed to exist as the result of a diseased brain. Any opinion founded upon such evidence could consistently be called blind belief, and science says "belief is no good, we must know;" but as we believe upon evidence, are convinced by reasoning, but know only through consciousness; therefore, we know very little. All our actions are speculative, being founded on belief; if not, name an example. Belief in the success of a project is what prompts us to undertake it, and if the result proves it to have been the blindest kind of belief, still we are forced to continue its use; there is no other alterna- tive. To the question, "What shall I do to be saved," the Divine response was “Believe in Jesus Christ". These notes founded on facts, not fancies, were stored in memory, with the queries during a life's journey of three score and eleven years. Hillsboro, Ill., November, 1908. A FEW IMPORTANT POINTS IN REGARD TO NERV- OYS AND MENTAL DISEASES. By CHARLES F. Neu, M. D., Indianapolis, Ind. WHILE the principles of medicine in general are making noticeable advancement and progress, particularly in regard to the prevention of disease, and in the attempts being made to determine and devise means by which to en- able Nature to combat and overcome pathological conditions, there is one branch that does not seem to be keeping apace, viz.: that part dealing with diseases of the nervous system, inclusive of the mental condition. In other departments of medicine it will be found that various measures which have for their object the elimination of those factors acting as causative agents in the production of diseased conditions are being continuously instituted and carried out. As a result we find that the ravages of many of the more virulent dis- eases are not only being lessened, but are becoming to some extent eliminated, viz., smallpox, yellow fever, malaria, tuberculosis, etc. It is unnecessary to go into detail to point out wherein the ravages of these diseases have lessened, and to a certain degree been eliminated, or to indicate the various means and methods utilized to bring about such results. Attention need only be directed to the interest that is being taken in one of them, namely, tuberculosis, to show what is being done. It is a condition engaging the vital attention not only of the patients affected, of the physician in charge, and of the immediate family, but also that of the surround- ing community, of the local authorities, and of those in charge of federal and even international affairs. It is diffi- cult to form even a relative estimate of the time, energy and money that is being spent in the endeavor to lessen and stamp out the ravages of just this one disease, so 1424 Nervous and Mental Diseases 43 appropriately designated “the great white plague." Suffice to say it is occupying the time and brains of some of the best men of the world of to-day. MORTALITY AND FREQUENCY. If a disease carrying off annually on an average between 65,000 and 70,000 individuals in the United States alone de- mands so much attention, and will demand more and more so long as its ravages continue, should not another condition which carries off almost as great a number also demand a corresponding attention? The report of the United States government of the Bureau of the Census for 1904 gives the number of deaths annually from tuberculosis as averaging over 65,000 for the five years preceding, and the deaths from diseases of the nervous system as averaging over 60,000. It must also be taken into consideration that for a disease which blots out the lives of this number annually, there must be some ratio in regard to the average number afflicted who are either partially or wholly incapacitated from earning either their own livelihood, or providing for those who are dependent upon them, and as a consequence must be taken care of and thus become a burden. The same government report gives the enormous number of 199,773 as suffering from diseases of the nervous system and who are in institutions devoted to their care and treatment. In addition, there must also be taken into consideration those who, because of inherited mental deficiencies or of acquired mental weaknesses, are burdened with a constitution which renders them incapable of taking part in the struggle for existence from the first, and thus, also must be taken care of. According to the same re- port, there are of this number 17,000 given as being in and re- quiring institutional care and support. The cost of this care and maintenance amounts to about $25,000,000 an- nually. While there is this large number directly under institutional management and control, it must be remem- bered that this is by no means all that are thus afflicted, since it can be readily ascertained that there is just as large a number who are being taken care of either by private re- sources or eke out a parasitic existence as tramps, vagabonds, charlatans, criminals, etc. 44 Charles F. Neu IMPORTANCE OF SUBJECT INDICATED. Recognizing these facts, it becomes at once evident that this is a question which deserves more attention than is being given it, and that it is not receiving the close study that its seriousness demands. The solution of the problem is un- fortunately a most difficult one, more so probably than in any other branch of medicine, as there are so many different factors that come into consideration as causative agents. It is only too true that in such a disease as tuberculosis the active causative agent is vastly different from those in the subject under consideration, for in the one we have the invasion of the living body by a living organism, while in the other it depends more upon the action of outside agencies acting upon a constitution whose power of resistance is limited, or which possesses a susceptibility to those influences. But just as there are means being devised, measures being instituted and methods carried out which have for their object, and, as a matter of fact, succeed in lessening the ravages of tuberculosis and many other diseases of a kindred nature, so, also, can the lessening of the horrors of this condition be accomplished by the institution and adoption of proper measures. In order to indicate the probable and possible factors that will have to be taken into consider- ation in bringing about a solution of this problem, it will scarcely be necessary to go into details, but reference will be made to only a few of the more inportant ones. Heredity AS A Factor. It can hardly be denied that of all the factors which take part in the development of this condition heredity is the most important, not in that it directly transmits the pathological conditions manifested, although even that can be shown to be true in some cases, but in that it transmits an endowment, taint or predisposition which renders the individual particu- larly susceptible to outside deleterious influences or agencies. Here, perhaps, more than in any other class of patients, one is able to perceive the enormity of the sentence imposed upon mankind when it was decreed that the sins of the parents should be visited upon the children even unto the third and fourth generations. Nervovs and Mental Diseases. 45 It is unfortunately impossible to give an accurate es- timate of the frequency with which a direct hereditary con- nection can be established, for as yet no reliable methods have been generally adopted to place it upon a statistical basis, but its importance must be paramount when it is recog- nized that all authorities maintain it to be a predominant predisposing factor. Another condition that makes it diffi- cult to ascertain the frequency of hereditary connection is the fact that only too often when inquiry is being made to obtain the hereditary history of a patient, instead of giving what information can be given, an attempt is made, not only by the patients themselves, but also by those in a position to furnish such, to refute any possibility of it, under the mis- taken idea that a more favorable aspect of the case will be presented, or from some other motive unknown to the ex- aminer. Broadly speaking, it may safely be said that from 60 to 65 per cent. possess such hereditary transmission. DRUG ADDICTION AS A FACTOR. Probably the second most important factor taking part in the generation and production of nervous and mental dis- turbances is drug addiction, the most prominent of which are alcohol, opium and cocain. Of all the exciting causes it seems probable that the in- judicious and excessive use of alcohol takes the lead. But one must not lose sight of the fact that it is not always possi- ble to determine definitely whether this drug addiction is to be regarded as a causative factor or as a partial manifesation of the disturbance, for it has been definitely proved that in many patients the latter is the condition existing. It is a well-established fact that the nervous system appears to be especially sensitive to the influence of alcohol, and in many cases suffers to a much greater degree than the other tissues from the effects of habitual and prolonged use. But even here heredity must be taken into consideration, for the ten- dency to drink is often inherited. Its relation to occupation, social status and personal surroundings is only too manifest to require any detailed discussion. It is impossible to give any reliable estimate as regards the frequency of its existence in this class of diseases, for it is a notorious fact that the 46 Charles F. Neu. statements of those addicted to its use are, as a rule, wholly unreliable, and also because of the fact that some of those so addicted are able to conceal it from their surroundings for years, and it only becomes evident from some casual incident. But the seriousness of the effects of the prolonged or habitual addiction to drugs, particularly alcohol, does not limit itself to the individuals themselves nor indirectly to their sur- roundings, but is also manifested in the offspring, for such has been shown to be, if not the most prominent, at least one of the most prominent factors in the production of de- fective children, and in the transmission of a neuropathic or psychopathic condition. VENEREAL DISEASES AS A FACTOR. Another prominent factor taking part in the production of the diseases under consideration is one that hitherto has not received the attention that the seriousness of its effects demands, and one for which the medical profession in general is to be highly criticized and censured because of its appar- ent indifference and apathy in regard to it. The action and effects of venereal diseases are so far reaching and in some cases so disastrous that it makes one shudder at the thought of the suffering it entails. It is a well-recognized fact that gonorrhea is one of the most potent factors in the causation of diseases of women. It is a prominent factor in morbidly modifying the sexual life and functions of both sexes, to a degree as yet too little recognized and understood, and with too little attention given to it along that line. Morbid appe- tites and desires leading to morbid actions and habits. To what extent syphilis is to be regarded as a causative agent it is difficult to say. So far as general paresis and tabes are concerned, we know that the great majority of cases are the result of syphilitic infection, and the frequency of these two conditions alone is sufficient to stamp it with the brand of the strongest condemnation and to demand the consideration of methods leading to its extinction. But its action does not stop at this. While at certain stages its toxins seem to have a special predilection for nervous struc- tures, yet throughout its whole course there is no organ or tissue of the body that is immune to its action, and its action Nervous and Mental Diseases. 47 is not confined to the individual infected, but is also mani- fested in the offspring. Its importance in this direction is at once evident when it is taken into consideration that at least 10 per cent. with certainty, and 15 or 20 per cent. probably, of imbeciles are the result of syphilitic infection in the parents. FAULTY TRAINING AND EDUCATION OF CHILDREN. In the faulty training and education of children is also found a most important factor in the production of an un- stable nervous and mental constitution. When we take into consideration the impressionability of the nervous sys- tem of children and their susceptibility both physically and mentally to external impressions and influences, it is not surprising that the effects resulting therefrom are instru- mental in shaping and moulding more or less definitely and permanently their physical and psychical make-up. The most powerful and most lasting impressions are, as a rule, those coming from the ones in direct control and care, par- ticularly when parental. Unfortunately, only too often there is present in these parents a nature but ill-adapted to educate and train their offspring, due, on the one hand, to inefficiency and inadequacy and, on the other hand, to over- solicitousness and over-anxiety. Unconscious of their own weaknesses and defects, they all too readily instill the seed of an imperfect judgment into the organism which they are rearing and moulding. But this faulty education and train- ing is found not only in the home or in the guardian, but also in the school. How frequently do we hear of certain children being stigmatized not only because they are in part out of harmony with their surroundings, but also because the teach- er and fellow-pupils fail to understand their character and constitution? It is difficult to determine definitely to what extent such faulty education and training are instrumental in the production of an unstable nervous or mental constitu- tion, but the frequency of such disturbances at this time of life attributable to such causes is such as to indicate the neces- sity for a serious consideration of the question. I Class OF IMMIGRANTS AS A FACTOR. Another condition which is regarded as a factor in this relationship is the class of immigrants that are being con- Charles F. Neu. tinuously dumped upon our shores. Just what is the relative proportion of such disturbances manifested as between those native born and those of foreign extraction is difficult to say, but Burgess, of Montreal, has shown that for Canada, at least, the proportion is decidedly higher in the foreign born, and it can be safely assumed that what is true of that country also holds true for the United States. And, further- more, it is only too evident that the physical, as well as the mental status of so many of the class of immigrants that are being poured into the country is decidedly below the average. The STRUGGLE FOR EXISTENCE AS A FACTOR. Still another factor, because of its prominence, deserves serious consideration, namely, the influence of the high pres- sure of so-called civilization, the overwhelming desire to ac- quire an imaginary sufficiency of this world's supplies, the inclination and tendency to live beyond the means at com- mand, the impetuous ambitions to occupy the topmost heights in the social world, exert an influence which neces- sarily taxes to the utmost the mental and physical conditions of those engaging in the struggle. The struggle for existence is more strenuous and vigorous at present probably than at any other stage of this world's history, and in the struggle as between one with better endowments than the other, there is no question as to which will come off the victor. There are many other factors which play a role either as predisposing or exciting causes in the production of this class of disturbances, such as prolonged illness, prolonged emotional strain, disturbed domestic relations, injuries, etc., but these come into consideration more in the domain of general medicine and are there dealt with: suffice to say that they only bring about the final breakdown. CURATIVE AND PREVENTIVE CONSIDERATIONS. In the consideration of the question as to how existing conditions can be remedied, or the agencies bringing about those conditions combated, it may be approached from two view points, the one a curative, the other a preventive one. Nervous and Mental Diseases. CURATIVE CONSIDERATIONS. So far as curative measures are concerned, one must consider those applied before admission into institutional care and those administered afterward. In regard to the latter not much can be expected beyond what is being done at the present time. In this, as in every other form of illness, the best results are obtained the earlier curative measures are adopted, and in the great majority of cases they have passed beyond this early stage before the question of admission is considered. Part PLAYED BY GENERAL PRACTITIONER, Upon the family physician falls the opportunity of ap- plying those measures or administering those remedies at the time when the best results are to be expected. Few per- sons seem to realize the responsibility that devolves upon the general practitioner. While this seems to be an age of specialism and of specialists, they may all yield the position of honor to the general practitioner. He is the one who is called upon to face and meet first all the diseases and ail- ments in their incipiency to which human flesh is heir. He is the one called upon to give first aid, and, as a rule, only when he fails to give relief do the patients resort to those engaged in a specialty, and that these frequently fail also is indicated by the numerous methods adopted by so many who, without any or very little preparation beforehand, endeavor to remove, and in some cases do, that which the physician. fails- in. These methods are not always such as appeal to what appears to be just and honest, and some to be anything but reasonable, but there are some patients who will yield to such measures when more rational ones fail to make an impression. Great public prominence is often given to such cases, but we rarely hear much comment concerning the scores who receive no benefit or are even made worse. The injury in these questionable methods is in that they are carried to an extreme, are applied to conditions where they do positive harm and can not pos- sibly accomplish any good. Amongst the foremost of these is Christian Science and allied principles. That it does good in individual and properly chosen cases is unquestionable, 50 Charles F. Neu. but that it can nullify the action and effects of a tubercular infection, of a diphtheric infection, of a syphilitic infection, or, broadly speaking, of any disease in which there is a struc- tural organic basis, is a condition beyond comprehension, and the danger attending the assumption that such is possible, and the treatment carried out accordingly, is fraught with such direful results that those guilty of such indiscriminate methods of treatment should be made to suffer the conse- quence. PREVENTIVE MEASURES FROM AN EDUCATIONAL STANDPOINT. To the realm of preventive medicine must we look, how- ever, for the greatest beneficial results in lessening the fre- quency of those disturbances. From this standpoint, edu- cation must be the fountain head of our measures to combat these conditions. Just as education has been, and is, one of the predominant means utilized to inculculate the principles and conditions which, when put into action, have lessened the ravages of all infectious and contagious diseases, so well illustrated in the crusade being carried on against tubercu- losis, so also must reliance be placed upon education of the masses, of the conditions tending to produce abnormal ner- vous constitutions, or abnormal functioning of an apparently normal one, and upon education in the measures to be carried out which will tend to lessen and limit the existence of those conditions, and when a proper conception of the gravity of existing conditions has been inculcated and appreciated more stringent measures can be readily instituted. The question of a more thorough education of those choosing the profes- sion of medicine as a life work comes first into consideration along this line. Considering the frequency and seriousness of this class of diseases, on the one hand, and the limited time and attention devoted to their study in the educational insti- tutions in which such fundamental knowledge is acquired, on the other, it is at once evident that one of the first steps to be taken is in that direction. The scientific study of psychol- ogy has not kept pace with that of other branches of medi- cine. Too little attention has been given to it, and as a con- sequence we know very little in regard to the normal mechan- Nervous and Mental Diseases. ism of the psychological processes; how can it, then, be expected that pathological processes will be any better under- stood, much less intelligently and scientifically treated? It is time that the institutions for medical education awaken to that fact and act accordingly. There are encouraging indications that some of these educational institutions are giving more time and attention to the study of psychology and psychological processes, both in the normal and abnor- mal, but still more is required. As has already been stated, upon the family physician falls the responsibility of applying measures during the earli- est stages of the disturbances, and to him must we also look for the diffusion of that education which must play an impor- tant role in the realm of prevention. He unconsciously becomes the family mentor. His knowledge of the physical and mental weaknesses and de- fects makes it possible for him to advise where another neither could nor dared. In his relation of confidential intercourse with the family he exercises an influence which but few, if any other, could reach. Consequently the necessity of being prepared to detect the danger signals, to advise and adminis- ter the proper preventive measures, is so evident as to need no further discussion. TREATMENT OF HEREDITARY INFLUENCES. In regard to the question of heredity, a close study of the situation reveals the fact that it is a most difficult problem to solve. It may seem harsh, unjust and even inhuman to resort to measures which will involve personal rights and liberties, but when it comes to a question that not only en- tails the welfare of the individual and of the community at large, but also the welfare of future generations, there should not be an over-consideration of those personal rights. While leniency can, and should be, shown to those unfortunates who possess constitutions that render them susceptible to such disturbances, for much can be done to prevent their development, to lessen their intensity, and to ameliorate their conditions, yet when it becomes evident that the propa- gation of the species means the propagation of beings whose physical or mental constitutions possess endowments and UNCES. 52 Charles F. Neu. stigmata which must render them incapable of competing in the struggle for existence, and consequently make them a burden not only to themselves, but also to their environment, the question of sacrificing those rights should be seriously considered. Viewing this question from an impartial standpoint, or as nearly impartial as it is possible so to do, does it not seem more just and humane to all con- cerned to limit the suffering and sorrow to the individual rather than permit it to be transmitted to those who unfor- tunately must bear the curse of their inheritance whether or not? To those who may feel justified in thinking otherwise, let them consider the hordes of tramps, vagabonds, criminals, etc., scattered broadcast over the land; let them visit the halls and corridors of our charitable institutions, of our in- stitutions of correction and of penal punishment, and let them remember that at least 60 per cent. of this class have inherited a constitution which is responsible in a great meas- ure for such a condition of affairs; then, perhaps, they will take a different view of the situation and be willing to admit that, at any rate, something should be done to lessen and abolish such human sorrow and affliction. There is no state in the Union but has some form of law to regulate the mar- riage act, rude though they be in some of them, but more stringent measures are necessary. Too many are permitted to enter the marriage state whose propagation can not fail to produce anything but creatures who are a burden to them- selves and a curse to the community. Some states have es- tablished institutions for the custodial care of the feeble- minded, and these unquestionably are a great blessing to humanity, and, on the whole, a source of public economy, but their number is far below what is required, and their in- fluence is far too restricted. This custodial care and the question of the propagation of the species should not only include the feeble-minded and defective, but should also ex- tend to those who have acquired a constitution or condition that must inevitably transmit its baneful influences to the offspring Nervous and Mental Diseases. 53 PREVENTIVE TREATMENT OF DRUG ADDICTION. What has been said of heredity applies almost equally to the question of drug addiction. Alcoholism, the most prom- inent and extensive of these, is receiving probably more atten- tion than any other condition active in the production of nervous and mental disturbances, but not for this reason. An active propaganda is being carried on in various chan- nels, having for its object the lessening and abolition of its use. Various methods are being utilized in an attempt to disseminate a conception of the baneful influences and dire results following excessive or prolonged consumption. Va- rious legislative measures are being enacted, tending to lessen and prohibit its distribution, but more stringent measures still are necessary. When it becomes evident that an in- dividual has so far lost the personal respect to his environment, when morbid appetites and desires have grown beyond con- trol, it is only humane and just that they, too, should be placed under custodial care, which would exercise a super- vision which can not be procured otherwise. This neces- sity is still further warranted in that too many are unable to control their ungovernable appetites even in spite of the personal remorse, in spite of the heartaches and suffering that they cause to others, and in spite of the imposition of fines and even imprisonment temporarily. But there is another point to consider in this connection. It can not be doubted but that to the offspring of individuals whose bodies are continuously saturated with and bathed in alcoholic beverages, or other drugs, whose minds are dulled and stupefied, rendering them incapable of recognizing and realizing the curse they are not only to themselves, but also to their procreation, is transmitted a constitution which is far below the average, and which so frequently manifests itself in the form of some neuropathic or psychopathic de- rangement, or even imperfect development. Bourneville has shown that in 1,000 cases of imbecility, alcoholism was present in the parents in at least 621. No comment is neces- sary in regard to the conclusion to be drawn, or the preven- tive measures that are indicated. It is sufficient to ask the question, Whether or not such creatures, for the mere 'grati- 54 Charles F. Neu. fication of their passions, should be allowed to propagate their species, which must inevitably bear the consequences and suffer the penalty of such an inheritance? TREATMENT OF VENEREAL DISEASES. The relation of venereal diseases in regard to causation has already been pointed out, and so far as treatment is con- cerned, but little can be expected, more than is being done at the present time. There should, however, be more active steps taken, more energetic measures instituted leading to the prevention of its dissemination and to its abolition. It is time that the members of the medical profession were aroused from their apparent indifference and apathy, and goaded to the education of the laity as regards the injurious actions and horrible consequences resulting from this evil. Its very insidiousness and privacy endow it with a relative degree of danger. Why should this class of cases be exempt from publicity or quarantine any more than tubercu- losis, smallpox, diphtheria, etc., for it is just as infectious, and, although the immediate effects are not, perhaps, so directly dangerous to life, yet its ultimate effects are many fold more productive of constitutional disturbances, and these, in turn, must involve the neuropsychical. It is time that the mantle of this false sense of modesty and secrecy be thrown aside and the condition placed upon its proper basis. RELATION OF ILLEGITIMACY. Closely allied to this class of cases is another group of unfortunates who, while victims of the results of the gratifica- tion of their own passions, yet, on the whole, are deserving of more leniency and generosity than is, as a rule, meted out to them. It is a condition which involves not only the young and ignorant just entering upon that stage of life wherein they are brought to a realization of a special element in their nature but it also involves those of maturer years, who, because of their knowledge and experience, should have exercised better judgment. It is a condition that will exist so long as there are individuals of the two sexes. It is a condition which is not to be countenanced, but condemned from every stand- point, and yet it is a condition which, when it does arise, is deserving of at least some consideration. The poor unfor- Nervous and Mental Diseases. 55 tunate who, in response to one of the most powerful forces in her nature, steps beyond the threshold of virtue and moral- ity, becomes disgraced and shunned by all society, except, perhaps, a few vultures who hover about her only to feast upon her misfortune or intensify her misery, is called upon not only to suffer the pangs of hell herself, but also to pro- pagate a being who throughout life must bear the stigma of illegitimacy. Is it to be wondered at that this is also a source of many admissions to our charitable institutions, or the source of many a degenerate, physically, mentally or morally? Here likewise education fails to accomplish what is desired. In spite of the fact that the principles of morality and vir- tue are inculcated into their minds from earliest childhood, in spite of the fact that the evil consequences which are almost inevitable should the step be made beyond the thresh- old of those principles, are observed day after day, month after month and year after year, yet its existence and fre- quency have not lessened; consequently it is a problem which must be taken into consideration in the measures instituted for the lessening of the disturbances under consideration. Defective IMMIGRANTS. So far as the question of defective immigrants is con- cerned, it is gratifying to note that the requirements for ad- mission into the country are being raised higher year after year, and it is only a question of time until a standard is reached which will place them upon a basis equal to that of the native born. Social CONDITIONS. In the various causative factors that have hitherto been considered, the conditions have been such that remedial measures were not only possible, but quite probable, for soon- er or later public opinion will become alive to the necessity of exercising more energetic and stringent means to lessen such a source of sorrow and suffering to humanity. But there is another condition, so complex and so far reaching, involving so many different elements, that it is most difficult to determine which of those elements are the most dominant, or how they are to be regulated. It is the condition of affairs participating in the struggle for existence. Among the more 56 Charles F. Neu. prominent of these elements may be mentioned the con- tinued high tension, physically and mentally, of those en- gaged in the struggle to keep abreast of, or to supersede their fellow, the increasing participation of the female sex in voca- tions and occupations which formerly were limited to mem- bers of the opposite sex, the high nervous and emotional tension due to the increasing demands of the social whirl, the baneful influences resulting from the conditions leading up to and terminating in divorces, and many other closely allied conditions. Of these there is one class particularly which deserves the severest criticism and censure. This is a class that is unwilling to exercise the care and attention that the fulfillment of the marriage vow entails, who resort to every means conceivable to prevent or interrupt the pro- cess of conception even at the risk of their own lives, a fatal termination of which is only too frequent. No one but the medical profession knows how many otherwise healthful lives are sacrificed annually, either directly or indirectly, from this cause, upon this altar of imaginary self-protection. Failing in the attempt to prevent, they chafe under its con- tinuance, they shrink from the duty and care that it will necessitate, and too often they nurture an unkindly feeling toward the offspring, and too often place it into the hands of an entire stranger to nurture, at a time when nothing is so essential to its healthful development as its natural nourish- ment and protection. Is it any wonder that under such circumstances there is brought into existence a being possess- ing a constitution but poorly supplied with the forces capa- ble of withstanding the influences against which it must struggle? These are only some of the more important factors in- strumental in the production of nervous and mental dis- turbances, which, as yet, do not receive the attention from this standpoint that their importance demands, and the consideration of which must concern the question of the lessen- ing of this scourge of human health and happiness. Nervous and Mental Diseases. Discussion. Dr. G. W. McCaskey, of Fort Wayne: I will not take up any time in criticism, but will limit myself to the discussion of two or three points that will bear emphasis. One of the questions which the Doctor has emphasized very particular- ly is that of heredity. We all of us understand the influence of bad heredity on children and the different disease per se which is usually transmitted, but the hereditary tendency, some condition embryonic in its origin, some condition of the nervous system or other organs which makes that in- dividual more susceptible to disease. More particularly is this true of nervous diseases, and that is what we are now considering, and we would like to impress the position which the medical profession should feel and exercise toward the unfortunate class of society, because we know if we could control these conditions during the development, during the prenatal period, much could be accomplished. Oliver Wen- dell Holmes said: “Our education begins a century before we are born.” It certainly begins several months before, and the early months and years are certainly important in the development of the nervous diseases and venereal dis- eases and a large class of other diseases, and I want to empha- size our obligation. We should feel our obligation on this question and do our part to educate the public and make them understand the importance of the prevention of these diseases. The question of drug addiction is an old and time- worn one. We do not understand the phenomena of it. We understand its far-reaching importance and we are perhaps doing what we can. It is true with drug addicts and with those suffering from venereal diseases we meet with the pro- geny suffering from disordered nerves. We may feel the de- sire for gratification of those tastes and passions implanted in us by Nature; however, I believe it is our duty to press along these lines and educate the public up to the point of a reasonable degree of control being extended over society in these things which are undoubtedly a menace and which are producing disastrous results upon the body. The Doctor mentions the responsibility of the general practitioner in the early recognition and treatment of ner- 58 Charles F. Neu. vous diseases. I would like to emphasize this point, also. As the Doctor has said, practically every case of nervous disease first falls into the hands of the general practitioner, and it is often true that it goes on perhaps because the phy- sician fails to recognize the disease in its incipiency. It is true of the heart, lungs, etc. as well as of the nerves and men- tal diseases. After the case has developed into insanity the problem is a very different one, and it is astonishing how many cases of severe insanity could be successfully treated by timely measures. Those slight deviations from the nor- mal mental state of the individual should have more impor-- tance attached to them by the family physician than has be- fore been done, and the family physician should see that they do not go on to pronounced cases of insanity. I agree with the Doctor in a general way that the in- tegrity of the social body is more important than the in- dividual. It is a fundamental principle of our government, “the greatest good to the greatest number.” We must re- strain individual liberties in order to get best results for the general public, so I believe there is a limited class in which this is profitable. I think it is a little premature, perhaps, to press this, other than to attempt to educate up to the point where they will recognize its importance and take the measures to effect their control. The same is true of venereal diseases. The whole problem is of a difficult character and I fear it will be several generations before the profession can be anything like a unit, and still longer before the public can be made to see the necessity of the public dealing in this way. The whole subject of nervous and mental diseases is extremely interesting, is the necessary result of the extremely strenuous life we are living, and we see it on every hand; nervous systems breaking down and people suffering from overstrain because of the strenuousness of modern life, and while we see things that ought to be done we have got to move slowly. This means almost a revolution, so we must move slowly, educate the profession first and the public at the same time, if possible, because they need it. Dr. Albert E. Sterne, Indianapolis: I want to corro- borate the propositions which the essayist has set forth, but Nervous and Mental Diseases. 59 I want to emphasize in particular two things. The first of these deals with the popular idea that mental diseases par- ticularly arise from natural causes. That is especially true in the beginning of mental diseases. When a mental dis- ease arises it has a basis. It makes no difference whether or not there is in that disease an organized pathology; there is a physical basis from which this case arises, and it is our duty to recognize that, and it is a delusion that mental diseases are heaven-sent or hell-sent, as the case may be. Another ques- tion of extreme importance I want to speak of. There is no doubt at all that heredity and hereditary influences play a considerable role in the manifestation of disease. At the same time we should recognize that there can be no doubt of the fact that by preaching this doctrine of heredity, pure and simple, we as a profession, are doing a great deal of harm. We should recognize heredity, but we should be very careful of impressing too strongly upon the progeny that he or she will suffer by a disease because the parents suffered from that disease. I am thoroughly convinced that many a man and woman has committed suicide because the idea was engraved on their minds that because some ancestor has committed suicide that he must have that tendency. And, gentlemen, we must understand that diseases are not actually hereditary. No disease is hereditary. That is, if we understand the proper derivation of the word “hereditary,” namely, that such a disease exists from the prenatal conception. We have a tendency, but no disease is hereditary as such, not even syphilis. When syphilis exists in the ovum it is acquired syphilis, and there is a vast difference between congenital diseases and inherited diseases. I want to emphasize these things particularly, because we can do a great deal of damage in putting too much stress on heredity. We must educate the people, but we can accomplish a great deal of harm by the tactless use of our knowledge about the true aspect of this question. Dr. F. B. Wynn, of Indianapolis: The great thing in medicine at the present day is prevention. We are prone to think of prevention as applied to such diseases as are of known germ rrigin-diphtheria, tuberculosis and such dis- 60 Charles F. Neu. eases—and the sanitarians are certainly accomplishing a great work in this line. Now it appeals to me that there are other fields in which prevention is just as possible, and I should place preventive medication under three heads: First, the prevention of communicable diseases; second, the prevention of social conditions—improvement of social conditions, edu- cational development and the like, and, third, I should make it apply particularly to those diseases from the use of various insanitary articles which are used either as drugs or medi- cines. That is a good thing, and all concede that the future of medicine is along the line of prevention, and the doctor of fifty years in the future will be a very different man, because he will be paid really for preventing disease rather than to cure it. I just want to refer to the third thing, namely, the question of drug addiction. I came near missing this meeting, because just before I started I was visited by a lawyer who requested that I should go and talk to a man who was a sub- ject of the cocain habit, having acquired the habit by the use of an atomizer or something of that sort. I am afraid he is a ruined man. I believe as practitioners we should take that home with us, because we are prescribing cocain and morphin and be- cause in one way or another we have been in part responsible. I know that it is true that these habits are acquired through the use of patent medicine, but how often do we prescribe remedies for cough in which there is opium, and our patients get the prescription refilled again and again, and so without our knowledge these habits are being formed. I never p re- scribe morphine without I give it myself. I believe you ought to prescribe these things yourself and not write pre- scriptions for people to have filled over and over again, and so with cocain. Dr. F. F. Hutchins, of Indianapolis: There is another feature in the mental and nervous diseases that it does not seem to me has been touched upon. It is true there is a physical basis, but I do not believe that physical basis is a diseased one. The patient may be a man of genius perhaps; it may be that he began wrong, was badly trained. If that is it, this trouble lies in the hands of our educational frater- Nervous and Mental Diseases. nity, the early educators in the schools, but that ought to be combined with the physician's influence, because in this environment lies the situation at the present time. If there is one thing we need in these cases of neurasthenia it is the old-styled faculty of common sense—it is good common horse sense. We have these cases coming to us with dis- torted ideas and opinions which seem to us ridiculous. What is the thing at fault? It is simply the inability to see them- selves as they are. If, instead of trying the various forms of hypnotism, sending them off on trips—if we would simply take these patients and on the idea that “a little knowledge is a dangerous thing,” work the thing out on a sensible basis, and say to them if you have this idea you must give a reason for it. Have them reason out these ideas and see that these reasons bear the light of investigation. If they can not do that in the conversation, have them keep a book, a ledger, and have them keep an account of every idea and have them present the reasons for and against and then go to some person and sit down and reason it out with them on the ground of common sense. Many of these brains are simply twisted-warped-and if we have heredi- tary strain we can not help that. We can not take that strain off of these people, and we will have to train up these brains to meet it and that can only be done by developing the reasoning faculties. Dr. George T. McCoy, of Columbus: I just want to speak one word. The question of heredity has been brought out very fully but the question of early training has only been hinted at. I believe that the early training of the child has much to do with its history thereafter, and at the risk of be- ing called an old fogy I will say that I am opposed to the kin- dergarten for that reason. You educate the mental, and I would much rather that my children spend their time making mud pies and wading the creek than attending kindergarten. Dr. G. W. H. Kemper, of Muncie: There has been some- thing said in the paper, and very particularly too, in regard to the alcoholic question. And I notice that heredity in this day always hits the boys and not the girls; so I am inclined to think that with the man inclined to the habit, that it is the Charles F. Neu. example he sets for his sons. He takes his boys to the saloon. He does not take his daughters. We talk a great deal about the alcoholic question and I am not a Prohibitionist, never voted the Prohibition ticket—but in the last few years I am wonderfully down on the saloon and I want to see the day come when the saloon is banished. It is one of the vents of hell for the habit of intemperance and for every other vice and crime that has been mentioned in these papers here to- day. God help us to vote it down! Dr. A. C. Kimberlin, Indianapolis: Some one has said that if parents would buy skates for their children instead of books they would have a much happier family. There is a story of a certain king in whose family there was a tendency to insanity. The king had one son. He educated this son separate and independent from any one who was predis- posed to insanity and did everything that medical skill could devise to protect his son. He kept him away until he reached his maturity, when he was suddenly seized with insanity. Certainly we have to stand aside for heredity. Drug addict- ions, etc., become causes. Everything that plays with the povers of reason is most disastrous, but, as Dr. Hutchins has emphasized, the victims are those who have been well trained, of good social standing, and we have to go back to a family evidence of an unbalanced mind, and there is a predisposi- tion that we must take account of. Yet we should be ex- ceedingly careful in making representations to the case. They respect you and they esteem you as their friend, and what you say is not manifest then, but we find the influence of it later. Dr. Charles F. Neu: I have nothing in addition to add to what has been said. As mentioned in the paper, the com- ing thing is prevention, and the first step is the question of education. I quite agree with Dr. Sterne that it would be most injurious to impress upon any individual the influence of heredity. The first point is educating the physicians them- selves. That is where it should begin in order that we may be in position to recognize the progression of these more marked things which are to follow. NORMAL SENILITY AND DEMENTIA SENILIS. THE THERAPEUTIC STAYING OF OLD Age. By C. H. Hughes, M. D., St. Louis. MORE or less marked paresis of the normally active movements of midlife mind and body which character- izes full mental maturity, may come on more or less pro- nouncedly with advanced years after the seventh decade or near thereto and into extreme old age and sooner in less enduringly endowed organisms, with reference to longevity. The time comes to the normally aged in the declining course of nature sometimes after or about the seventh decade or, “if by reason of much strength” after, the eighth or ninth decades when a marked decay line appears in the individual, when the feeble knees smite together, the "right hand, (if he be right handed, if otherwise the left or even both if ambi- dextrous,) forgets its cunning', the voice and memory fail, the teeth and hair are gone, the eyes grow dim, the hearing has failed, the gait is slow and cautious, short and feeble of step, the back bent forward, hand grasp feeble, step un- steady, limbs tremulous, the reminiscent mind mutters or in “idle comment" announces the last scene of the last stage of the final breaking of the brain; all“ foretelling the ending of mortality." Then there are the younger, the prematurely senile, whose brain shows age like aberration before the senility of the normal time of man in general, in the early vigorous de- cades between forty-five and sixty-five and earlier, when healthy men do not normally fall into senility. The demen- tia paralytica, and in the dementia praecox and manic de- pressive periods. These are they in whom the assaults of (63) 64 C. H. Hughes. time have been anticipated or accelerated by disease or morbid vicious indulgences not yet universally recognized as disease, making decadent degenerate inroads upon the integrity of the brain, through toxic and brain strain and other attacks robbing this organ of timely repair and rest. The vessels prematurely altered in texture and lumen, tor- tuous or obstructed, the vaso motor centers and nourish- ing vessels of the gray cortex damaged ahead of the work of time on the vascular system and on the psychic neurones, etc., etc. If the brain is thus or by central traumatism or other cause prematurely aged we may in some cases stay or set back the process of senile decline, lift certain burdens and remove obstructions from the impeded and disturbed machin- ery of the mind, and remedy for a while the overburdened brain and stop extreme and over-rapid mental decline and decay. Conditions leading to emboli, thrombi and vascular abnormal change may by timely remedial resource be changed, or put in abeyance for a while, so that we may better estimate the unembarrassed mental condition of the patient and de- cide his capability for normal mental action if relieved of removable or surpressible diseased states. If we find on careful examination no marked arcus senilis, a fair hearing and seeing capacity, no cataracts or but one cataract, no marked non-remediable tremors or hebetude of mind or if we find remediable febrile delirium only, no medicine-resisting constipation, no cystic or hepatic congestion, or atrophy, or torpidity, etc., beyond remedial resource, no gravely non-reflex responding skin, no fixed pupils nor brain tumor, no choked disc, etc. If we find the least virile reflex to be present and some cremasteric reflex, the blood count not hopeless, nor the arteries too incom- pressible nor their walls too gravely irreparably damaged by sclerosis or atheroma, too greatly reducing the lumen, and the kidneys and liver reasonably intact, etc., etc., we may hope to improve and bring back to the senile dement his normal state of healthy senility in natural correspondence with his age and we should not fail to try to do so. Normal Senility and Dementia Senilis. 65 The inherent neurenogen problem however, as in every case of prognosis, is one to be considered in every question of insanity or sanity with senility and this is a problem of many factors in physiological and pathological psychology and in- herent or acquired direct or crossed organic endowment. We should not give up an old man down with psychas- thenic prostration till we know after persistent and rightly directed therapeutic trial and properly secured brain rest, that his condition is irremediable. I have seen octogenarian dements, feeble, prone, prostrate and tremulous to helpless- ness, recover their normal tone and live on clear of head, though comparatively feebler than in their younger days, but sane and sound of mind as septuagenarians. Riggs* of St. Paul has lately reported a patient aged eighty-two, almost completely relieved of delirium under treatment, such as might have been denied him by others on the mistaken ground of the hopelessness of age. The confusion of mind, the de- lusions, the motor restlessness and intractable insomnia pari passu with the lowering of the cerebral blood pressure from 210 mm. hg. to 130 mm. hg. I have seen graver cases re- stored to normal senility. The feebleness of age demands of us and with equal right as with that of infancy, our therapeutic consideration and help and we should not assume our inability to help more in the one case than in the other, till after we shall have exhausted all the resources of our armamentarium for recuperation. Pure senile dementia, uncomplicated with disease be- yond that of age decadent cerebral atrophy, if this may be called disease, probably does not often occur. And mental capacity sufficient for the immediate personal needs and natural desires and rights of the individual may co-exist with very considerable pure uncomplicated old age atrophy of brain. Capacity may be limited but intact. Uncomplicated cerebrasthenic debility of mind ought never to be called dementia, though it is often mistaken for it in the aged and so-called senile dements who need only judiciously restored brain tone to become themselves again, are feeble but not demented old people. *St. Paul Medical Journal, December, 1908. C. H. Hughes. The decaying psychic neurone is itself so intimately associated with the cerebral arteriole change of age, (arterio sclerosis, atheroma and the like), that one can not say any given case is absolutely one of pure senile dementia, but we say when the age is great and evidences of the usual disease of the brain that make primary and lead to secondary or terminal dementia, are not markedly apparent, that the case is one of senile brain failure rather than otherwise appreciably disease-produced dementia. I am here presuming the predominance of the neurones over the vascular system, especially through the predominant vaso motor influence, as I have elsewhere maintained, * while conceding the great importance of the blood as the life of the organism. In suspected curable senile dementia, as in other forms of insanity, the blood count of the red blood cells espe- cially, might lead in the direction of a more certain prognosis and a more efficient therapy. The blood pressure must like- wise claim our attention and the increased or dimished leuco- cyte count. The remopathology of psychopathy is yet in scientific embryo. In the practice of psychiatry and the study of alienism, as in every other department of medical work, we must con- sider and treat the entire individual to be most successful in judgment and cure. Before we may safely and irrevocably say dementia senilis, we must be assured that the psychic neurone is irre- vocably decadent from advanced age, that the asynapses, whatever it may be, in the brain is not remediable, that the synapsical or inter-neuronic relations are disturbed be- yond repair, for the hypothetical inter-neuronic connecting material or synapse of Foster, Sherrington, McDongal and others, which F. W. Langdon has so cleverly likened to the developer of the photographic plate, is probably an important potentiality in properly producing a completed picture of sanity or insanity. As a neuritis may impair, exaggerate or destroy the con. ductivity of an afferent or efferent nerve and sensation may *Neurological Practice of Medicine. Normal Senility and Dementia Senilis.' 67 cease to be transformed into motion in the spinal cord, by reason of a sclerosis of the posterior or anterior cornua or a complete transverse myelitis, and as function may be re- stored in other instances, say of removable pressure involve- ment of nerves or cord, so may changes in the neurone of the brain or their connections, whether in dendritic or direct (Cajal) contact or environing or internal circulation, give chance of functional recovery to the mental processes. After the age of sixty and often before that age, the average so-called healthy man should go into medical train- ing, as it were, for the remainder of the battle of life, like a pugilist for the coming fight, for there will soon come to him the need for all the reserve power of his system, hemotogenic, neuronogenic, thyrogenic, peptogenic, metabolic, phagocytic, etc. The doctor, as the dock to the ocean voyaging ships, should be often sought for needed repair in order that further voyaging may be safer. When dementia senilis so-called, appears as pure phren- asthenia, showing extreme general weakness or failure of intellectual power without marked delusional perversion and with the psychic failure that is displayed in amnesia and other symptoms of psychic or psychomotor center exhaustion of brain power only and not with marked delusional perver- sion of mind, and even then at times, especially if the timidity and phobias of neurasthenia appear, we may look for recovery to normal senility and sometimes to a quite virile senility with or after right recuperation of the nerve centers through re- stored nutrition and rest to the brain and other ganglia of vital influence over the general organism concerned in the making and movements, mental and physical, of man. This recovery may take place even though cerebrasuria appear and there should exist the psychopathic diathesis or “phrenitic disposition,” as Rush' called it a century ago, understanding it as we do now, to mean the insane hereditary proclivity of brain to take on a psydrocerobrosis inclusive of an aptitude of the blood vessels going to nourish and sustain or disturb 1 Rush: "On the Mind," 1812. 68 C. H. Hughes. the brain, to take on morbid action under morbid provocation such as a toxhemia. He noted the fact, though the neural vaso motor relations to the arterioles and their central in- fluence in the brain had not then been proven by the physiol- ogists and the pathologists had not told us yet of arterio and cerebrosclerosis or proclaimed that a man is as old or young as his arteries, not always true, however. “The brain and the mind when preternaturally irritable communicate more promptly deranged action to the blood vessels of the brain," he said. He seems to have had a right conception of the so-called cerebral hyperemia and blood stasis of Trouseau,? Hammond and others which my friend, Dr. C. F. Buckley, formerly of Haydock Lodge, but now of San Francisco, so plausibly controverts. Nevertheless, though the cranial cavity with reference to its circulation may be a plenum, variations in blood pres- sure there on the neurones through stasis or cardiac vis a tergo and vaso motor paresis are possible, and may modify function. The entire neural organism of the individual should come under review with its omnipresent visceral and sys- temic relations, in estimating the possible outcome and pres- ent mental status in dementia, either primary or secondary, not forgetting that the senile dement may be simply neur- asthenic and feeble of mind from recuperable brain debility as younger people may be. He may have the insane diathesis that would have made him mad in younger days from a poison like alcohol or an autotoxin in the blood and become sane after its elimination. To rightly understand and treat senility and senile de- mentia as with other diseases in which the mind is involved, such as psychasthenic neurasthenia for instance, we should interrogate with neuropsychologic discernment the whole patient. The nervous system in all of its distributions and omnipresent relations to the viscera and the systems of physiological function should be considered, from the ganglion 2 Clinical Medicine. 3 Diseases of the Nervous System. 4 Cerebral Hyperemia. Does it Exist? Normal Senility and Dementia Senilis. 69 of Ribes in the brain, the brain itself, with its cortex, men- inges, great basal ganglion (and Meynert's optic), its related spinal axis down to Auerbach's intestinal plexus, Walter's cocygeal impar ganglion and all intervening knots or net- works of nervous influence over the organic life. The cardiac, renal, suprarenal, hepatic, mesenteric, thoracic, solar, semi- lunar ganglia, the thyroid suprarenal and other ductless glands and their neighboring influenced and influencing or- ganism, should also claim consideration. Gangliopathy, direct or reflex, as in morbid states of the ganglia of Remak and Bid- der in functional cardio gangliopathy or in the ovarian plexus and the vagus and pudic nerve areas of the body and their reciprocal genital, cardiac and pulmonary and cerebral in their morbid as well as normal relations. The upward im- pression of genital and downward influence of mental im- pression, are not to be overlooked, though somewhat modified by age in senile morbid states.? Even the venous pampiniform, the venous and neural ovarian, the venous and neural pudic and pudendal, as well as the prostatic, pyloric, pulmonary plex- uses, etc., may play a part for our consideration in this, as in other maladies of the central nervous system. Dr. J. Leonard Corning, in his book on "Brain exhaustion with preliminary consideration on cerebral dynamics" desig- nates “a group of clinical phenomena” in brain exhaustion of any age, quite as applicable to the senile as to those who are younger, “the chief feature of which is a morbid limita- tion of the ratiocinative capacity of the individual conse- quent upon functional brain disease.” These manifestations of cerebral exhaustion he com- prises chiefly under the following headings which were pre- sented in a paper read before the Medical Society of the 1 The pituitary gland and Sajous' wonderful researches may help to further enlighten us, but want of space and other considerations prevent their consideration 2 The precise influence of the internal secretion of the prostate and the ovary have not yet been defined. bere. 70 C. H. Hughes. County of New York and published in the New York Medi- cal Journal as far back as December, 1883, and they are worthy of consideration to-day. 1 1. Morbid Limitation of the Ratiocinative Processes. 2. Morbid Emotional Phenomena. Psychical 3. Derangements of Memory. Symptoms. 4. Volitional Impairment. 5. Evanescent Mental Confusion. 6. Disorders of Sleep-Morbid Dreams. 7. Lack of Mental Concentrativeness. 8. Ocular Symptoms. Physical Symptoms. 9. Acoustic Symptoms. {10. Vaso-motor Disturbances and Cardiac Derangements. 11. Local Head-Pains. Secondary Insufficiency of Voluntary Muscular Symptoms. Power. Sometimes 13. Morbid Fears. consecutive 14. Lachrymose Condition in the Male, to the pri- mary ex- Wrongly called Hysterical. haustion. | 15. Morbid Sexual Manifestations, Wrongly called Hysterical. When these symptoms appear in the aged, we should seek to remove them as we would in a case of ordinary brain fag cerebrasthenia by all the means which restore the exhausted store, if you please, according to PAuger, of the intermolecular “neurone nourishing oxygen," before deciding that they are the product exclusively of age decadent or other organic disease. There are in the aged intercurrent functional conditions capable of great amelioration or re- moval altogether, with improvement of mental function following. It is a clinical error with experience against it, to say once senile dementia always dementia, before we are sure of the permanent hopeless paralyzing atrophy of the psychic centers. Morbid limitation of the reasoning powers is the charac- Normal Senility and Dementia Senilis. 71 teristic alike of profound psychasthenia and of functional senility and both may be ameliorated and often recovered from in many cases. Hence we should not decide, if once dementia always dementia, either in the senile or in precocious form. Both may be recovered from as manic depressive brain disease and profound encephalonasthemia are, though, per- haps, not so often, yet almost so, according to my own per- sonal experience and Clouston's results. Cases of presenile dementia appearing as pure senile dementia, such as follow excessive epilepsia (or the status), especially of the nocturnal type and are sometimes asso- ciated with day time displays of petit mal paresis and such as may follow judiciously therapeutically suppressed epilepsy as well as from too excessive and too prolonged brain function suppressing bromide of potash treatment, (strontia and lithia bromide being always preferable with a little iodide,) especially. These bromides being less harmful, should be skillfully and recuperatively given with lethisin, etc., to restoring the im- paired tone of the cortex before reaching a fixed conclusion of hopeless senile insanity. The insanity of pathological decadence, arteriosclerosis, atheroma and brain neoplasins are not necessarily old age conditions. Sometimes, also, a state of intellectual hebitude may sup- plement for a time a missed epilepic paroxysm or appear as a part of the exhausting sequence of an epileptic seizure, (noc- turnal perhaps) and abide with the victim for a considerable time just as epileptic and epileptoid automatism does, to de- ceive the non-experienced observer. There may be a stupor- ous dementia, appearing as a psychic equivalent of the epileptic axcess escaped, as there is often a maniacal alternative paroxysm. There is also to be considered in the aged as in those of earlier life, the dementia following sense destruction or “dep- rivation" which is often more apparent than real, requiring the closest differential diagnostic scrutiny when senile demen- tia and mental incapacity are suspected or apparent. In this connection it should be remarked that deafness is a more serious and complicating deprivation than vision loss, 72 C. H. Hughes. to embarrass judgment. Aphasis too and slight bulbar pare- sis may be misleading complications. These and other sense intercurrent failures, as of touch, smell, taste, etc., which come to the aged and the gravely epileptic in their automatic and obtunded states of mind and neuraxis may embarrass conclusions. What Joseph Shaw Bolton has called the “primarily neurotic dementia,” as distinguished from epileptic and other forms of secondary or terminal dementia, must always be looked for and estimated in making up a judgment as to the completeness, permanency, degree and hopelessness of the dementia of degenerative senility, “the last stage of all” in the life and mental function of the brain. We must also bear in mind what Lewis C. Bruce* has more clearly established, perhaps, than any other hematol- ogist, that while the blood serum in health contains phago- cytic agglutinins to “certain strains of staphylococci and streptococci; these protective agglutinins can not be demon- strated, according to Lewis, in the blood serum of over sixty per cent. of maniacal patients.” Here is a hematologic demonstration of the lowered power of resistance to mal hemotoxhemic influences in the insane far more valuable to us than the opsonic index in determining hemic resistance to microbic invasion. These observations further suggest the search for and removal of the insidious auto intoxication or any possible allohemic contamination which may complicate, prolong or cause our senile or other dementias. The lesson of this observation is to endeavor first to lift the toxic burden from the brain before we reach the final con- clusion of hopeless dementia, even though a species of Ford Robertson's micrococcus may be found invading the brain, similar to what he has found in dementia paralytica. In the aged, metabolism should be specially looked after, both the anabolic and reciprocal catabolic changes should be pysiologically adjusted to the best of our ability-assimila- tion and correlative elimination should be adjusted to the - *Symptoms and Etiology of Mania. By Lewis C. Bruce, Medical Superin- tendent. Perth Dist. Asylum, Murthly, Edinburgh Med. Jl.. March. 1908. Normal Senility and Dementia Senilis. 73 rebuilding needs of normal brain and mind movement and the needs of physiological excretion. We should bring up the hemoglobin oxygenizing power of the blood as well as its red corpuscles as near the normal as we can get it and then decide the mental status of the pa- tient under the healthiest conditions possible to him. We do not estimate the permanent physical strength of a feeble patient down with a fever (a typhoid or malarial hema- turic,) neither should we estimate the possible continuing mental condition of a dement until we shall have found out whether the condition of his brain may be brought back to normal by right treatment or not. Dementia senilis should be given a chance to recover of its cerebral anaemia, cax- hemia, cerebrasthenia, etc., before we make a final diagnosis and prognosis. A blood count of minus 3,000,000 red blood cells and minus 50% of hemoglobin that, brought to plus 4,000,000 of the former and plus 60% hemoglobin may give us a basis for hoping for recovery to normal senility of mind without demen- tia or delusion. Leucocytosis and the white cell count may yet claim more consideration than it has yet received in the manage- ment and prognosis of senile and secondary dementia, since Lewis S. Bruce has found “in cases of mania of the confu- sional type, leucocytosis always high, and the higher the leucocytosis the more hopeful the prognosis,” the polymor- phoneuclear leucocytosis being uniformly high even after the recovery in short, sharp, rapidly recovering maniacal at- tacks“ and this hyper leucocytosis persists indefinitely.” In cases of confusional mania that convalesce more slowly the polymorphoneuclear cells are at first greatly in- creased in number, then they subside somewhat only to in- crease again as complete recovery takes place. "In cases of mania of the manic depressive type, the symptoms of hyperleucocytosis are often present and corre- spond to the period of excitement." In a case of mania ending in dementia, the record fell from a range of from about 18,000 to 8,000 in the maniacal 74 C. H. Hughes. stage to a range of from 5,000 to 7,000 to 3,000, being nearer three and four thousand during eleven out of a seventeen days record. Latent microbism and latent infection, especially from the intestinal tract, are important and the indican urine re- action should not be overlooked. These considerations suggest a ferruginous and albu- minous hemotheraphy in which must be included ample opportunity to the patient for an oxygenating aerotherapy. Of course we must look to the kidneys and all other emunctories and correct conditions such as uremia, and the uric acid diathesis as in treating for other disease. The direct oxygenization of the blood through the lungs and electric ozonization and electric vaso motor impression upon the cerebral circulation in certain cases, suggest them- selves to the somatic psychotherapeutist as preliminary to a completed conclusion in these interesting cases. Other means of touching the brain and its neurone centers and springs of thought will also occur to the accomplished alienist as well as other and more purely psychic methods of brain and mind impression and test. Ideogenetic states of brain and mind, inherent or long acquired eccentricities, must also be estimated and either included or excluded according to their weight, in calculating the individual's mental status as to sanity or insanity, amentia or dementia, or both combined, soundness or un- soundness of mind from both. Congenital amentia itself may be a factor in the evolution of ultimate old age dementia. In some cases these considerations are as important as pathopsychosis engendering causes, acquired in later life, such as excessive brain strain, autointoxication, post febrile, venereal, erysipelatous, gonorrheal, infection of the brain, etc. They have all to be considered in the aged and should be removed if possible, or medicinally modified, before passing judgment on the mental conditions as to permanent failure of capacity in the senile. The centers of psychic reception, association and pro- jection and their molecular and cellular movements receive Normal Senility and Dementia Senilis. 75 impressions at birth and prenatal, that contribute to deter- mine in after life the psychic personality either with or with- out exceptional stress of cytonosotic impression. We should well consider them in problems like the one before us as we regard them in considering insanity in general. Right psychotherapeutic help and correct psychologic judgment should be applied while considering the mental state of this condition, not as necessarily regarding him as a hopeless old age, diseased dement, but as possibly having a weakened and strained brain, psychasthenic and cere- brasthenic, capable of feeble, but normal mental action, when put in right brain and body repair, righted up and toned up to the accustomed normal functioning of a sane, though may be psychically or even physically shaky, old man. Simple ideas as well as word and event memories, both recent and remote, pass from the mind in senile dementia and senility as they sometimes do in the brain exhaustion of the non senile. This is not, therefore, necessarily sympto- matic of senile dementia. Before a naval engagement a prudent navy Captain prepares his ship for action. Before inspecting a human mind and passing judgment upon its soundness or sanity, it is always well to therapeutically clear the brain, if possible, that sustains, supports and reveals or displays it through which and by which mind is always manifest to psychological science. In considering the mentality of the extremely aged as to soundness or sanity of mind, time is to be considered, “time that takes on trust our youth, our joys, our all we have, and pays us back with age and dust."* It is possible for a man may be sans eyes, sans teeth and almost sans everything, and yet be sane of mind, though his brain be feeble almost to dementia and further on in the declivity of life, feeble even unto approaching death. The dying old man may utter a last sane word. The entire subject of amnesia in its various forms must be justly weighed in trying to reach the true mental state of the aged and verbal amnesia especially, as the recalling of *From a composition by Sir Walter Raleigh, written the night before his execution. 76 C. H. Hughes. ordinarily familiar names and transient forgetfulness of them is the least significant, while absolute and continuous memory failure of essential matters and amnesia of personal identity of grave significance must be considered in forming a correct judgment, as for example of an old man married three times, forgetting each time of his previous marriage. The automatism of the aged from absent-mindedness and mental absorption with matters not connected with their present environment, their dwelling in the better impressions of their past, by the old man or woman lonely and forsaken, it may be, of family and friends of early life and preoccupied with the sentiment that "all the uses of this world” about them are necessarily "weary, stale, flat and unprofitable,” must also be estimated in passing upon the integrity of an extremely aged brain and mind. "The mossy marble rest O'er the lips that (they) had pressed In their bloom And the names (they) loved to hear Have been carved for many a year On the tomb." and they often mentally dwell with them. This is the sad social penalty incurred by those of good central psychic neurone heredity longevity. But we can not here enter more fully into this interesting feature of even normal senility. (To be CONTINUED.) THE ALIENIST AND NEUROLOGIST. VOL. XXX. ST. LOUIS, FEBRUARY, 1909. NO. 1. Subscription $5.00 per Annum in Advance. $1.25 Slagle Copy. CHAS. H. HUGHES, M. D., Editor. Editorial Rooms, 3858 W. Pine Boul. HENRY L. HUGHES, Manager and Publisher. Business Office, 3858 W. Pine 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 Postoffice in St. Louis as second-class mall matter. EDITORIAL. (All Unsigned Editorials are written by the Editor.) PUBLIC PRESS APPRECIATION OF THE MEDICAL PROFES- sion.—Notwithstanding the countenance it gives to the promotion of impoverishment, crime, disease, prolonged mis- ery and death through the indiscriminate advertisement of conscienceless quackery, the daily press often records its appreciation of the work of true medical science as in the following which we take in this instance from the St. Louis Star-Chronicle. But the other papers of St. Louis, the Post- Dispatch, the Times, the Globe, the Republic, the Anzeiger, the Mirror and Censor have likewise paid tribute, often with merit of good intent, sometimes also automatically and unconscious- ly, to the real good work for humanity of the great medical profession. This excerpt, however, is about the strongest we have seen. It places modern scientific medicine where it belongs, in the front of the world's great benefactions and truly captions -77— 78 Editorial. its editorial referring to medical achievement, as the “Real World Power, The Kind We Want." Read it. A medical writer might have said more, but not better in the same space. “Whether or not we did any good to the Cubans by send- ing our army and navy to expel Spain may be doubted by some; but we met there a foe more powerful than Spain, and conquered it. When this fearful antagonist was routed it helped the whole world and harmed no one. It was a victory of peace in the midst of war. The hero who gave the race the victory died of the pestilence, but the triumph remained a triumph. This was the conquest of yellow fever. “We are putting $300,000,000 into a ditch across Panama. The French failed, but we are succeeding. We are moving dirt so fast that it is a marvel to the engineering world. Mr. Stevens, who was in charge of the work, says it will be of no use when it is done, but we are going on with it, firm in the faith that a short cut that will avoid 15,000 miles of steaming between the two sides of a continent will finally pay. As the big ditch' moves steadily on to completion every American heart swells with pardonable pride in the deed. “But the digging of the ditch is in all probability second- ary to another achievement at Panama, which will be farther reaching than any possible triumph of engineering. We have established an experimental station in decent living in the tropics for which the world has been waiting. “Ever since we began talking of the Isthmian canal its opponents have said that we should lose hundreds of thou- sands of lives in the work. Panama was the home of pesti- lence. Malaria was a part of the everyday life and yellow fever was perennial. Other places had yellow jack at times; Panama was his permanent dwelling place and the national flag of the isthmus should have been the saffron banner of plague. They said this, and they said true. “But we have made a city down there where yellow fever and malaria are unknown. We have found out the causes of these diseases and we have made a healthy town in the old home of the fevers. It is all a matter of taking intelligent pains. Mosquitoes must not be allowed to breed. There Editorial. 79 must be no undrained swamps, no stagnant water. There must be no cesspools and open sewers for typhoid. Water must be sterilized. Flies must be fought. Rats must be exterminated. Every host for a germ must be hunted out and killed. Result: A tropical city as free from disease as those of the north. A good example spreads, even in Spanish America. Our brethren of the disease ridden littorals of South America and Mexico are beginning to see the tremendous importance of the methods of the health department of Panama. They are sending committees to find out how we do it. The good health of the canal zone bids fair to become contagious. The lazar- ettos of South America are likely to be wiped out by a wave of hygiene from our good health breeding station on the Isthmus. "This will be worth more than the canal. A real world power is the one that shows the world how to live. New Zealand and Switzerland are far more important as world powers to-day than is Russia. And if we can show how life in the tropics may be made healthful, we shall open the way for the development of millions of square miles of the world's richest lands, on which the people of the future will live in comfort and plenty. Such plague spots as Bombay and Cal- cutta will learn how to purge themselves of their disease, and we shall have done more of good than the most optimistic ever dreamed of.” The Funny Page Folly of the dailies ought to be a thing of the past, at least as presented in the" foxy grandpa, katzen- jammer kids, Uncle Louie and Aunt Tiny and Buster Brown" series of illustrated torture to old age, showing how disre- spectful and cruelly mischievous a child may be to old kin- dred, robbing age of its need and right of peace of mind and rest and sleep. Daniel Webster in one of his great criminal court pleas reminded the jury that the man murdered in his sleep was an "old man to whom sleep was sweet." Picturing little devils incarnate, making life miserable, robbing the aged of the rest and sleep that maintain age and promote long life, annulling all the moral precepts and the 80 Editorial. teachings of the Golden Rule and kindergarten in respect of age is not a delectable dish of instruction by object lesson to set each Sunday before the children. A sound psychology in the building of a growing brain and mind for substantial after life fairness of character can not approve of such vicious pictorial Sunday newspaper school- ing of American children. Such pictorial lessons in vicious psychic life are ruinous and the Boston Herald has done an opportunely wise act for the welfare of our child mind of America in discontinuing such illustrations of vicious mischief and petty crime in syndicate illustrated “original sin," for some of the illustrations are criminally original. This bad Sunday newspaper kindergarten ought to be discontinued and a more rational and innocent humor sub- stituted, such as might help and not harm the rising genera- tion in its evolution toward the fair play duties to be de- manded of them in a free, fair government in their social life. The themes of some of these Sunday pictorial pages suggest the folly of an insane hospital corridor or a school for idiots. The syndicated Nemo nonsense in Slumberland and Monkey Shines of Waggles in Wonderland, Mars Ellen, the Terrors of the Tiny Tads, Angelic Ange lina, the Stepbrothers, the Kids, Yanitor Yens, etc., are not vicious in their mental influence, but they are not edifying. They are better de- signed to develop and foster foolish imagination and un- reasonable fancies in children than normal level headed men- tal evolution. The Newlyweds and their baby is a witty showing of two fools with but a single thought to humor and spoil their bawl- ing idiot progeny and McManus shows in an instructive man- ner how the problem is being accomplished. Bill's bad dreams have a sanitary and salutary moral in them, but Jack the Sailor with a sweetheart in every port, is silly in its portrayal and suggestive of supreme unedifying folly. Some of these foolish pictures should not find a place in any sensible person's library, in any schoolhouse or in any in- Editorial. 81 stitution for feeble-minded or insane even. The dissemination of pictorial syndicated sin and folly should be beneath the purpose of the modern daily press. Let the Public Know From US ABOUT Alcohol.- We have learned much of alcohol in recent years, says the New York State Medical Journal, but we have not given the public the benefit of our knowledge. “We have steadily diminished the amount of alcohol used in our hospital wards until it has become almost obsolete as an internal remedy; but still the public has continued to judge the medical profession's attitude toward alcohol by the copi- ous prescribing of it in the past and by what it sees of the doctor's habits at his club. So far as the public knows, alco- hol is still approved by the medical profession. It is time to set the public straight in this matter; and if we have not agreed to cast it out entirely, much good would come if the public could know that it is now but comparatively little used as a medicine. The practical layman will understand the meaning of the fact when we tell him that in the last twenty- five years the medicinal use of alcohol has decreased more than seventy-five per cent. A remedy which is being elimin- ated at this rate is approaching its end.” The tide of scientific knowledge is against the use of this poison as a beverage and in too frequent prescription. Time was even “when drunkenness in a doctor was considered a minor fault, old doctor X had more sense when drunk than all the other doctors sober," was a frequent comment, notes the editor of the Maryland Medical Journal. “This is now a thing of the past.”. It is a pathogenic agent and as such is not a fit daily beverage for any one and neither distillery nor brewery logic will ever again reinstate alcoholics as proper for table use or prescription purposes save under the most cautious limita- tion. It must take its place with the poisons to be prescribed with antiseptic precautions as the surgeons say. Medical banquets especially and particularly to graduating classes 82 Editorial. as the Maryland Medical Journal insists should be without alcoholics on the menu. Science has pronounced it, as it was pronounced by the wisest of men centuries ago, a mocker. The doctor looking for nutrition in alcohol, save in most exceptional states of the system, and who does not chaperon it through the vascular system with a superabundance of real reconstructive nutrition and tissue protecting fluid, is not wise. The WRECKAGE OF WORRY.—The popular periodicals are getting hold of the physiopathological view of depression engendering mental states in an intelligent way, as the follow- ing from Harper's Bazaar illustrates, the lifting of worry from the mind is an important therapeutic factor, as neurologists well know, and is about all there is in the faith cure and christopathy et id omne genus mirabale. “Consider for a moment the physiological effect of the worry habit. Regrets, doubts, scrupulosities, fears,anxieties,ap- prehensions—these harpies lay hold of the mind, shake it to its center, and turn existence into a life of death. But then man is not mind alone; he is the unity of mind and body. The physiological psychologists never tire of ringing the changes on the mutual influence of mind and body, on the absolute solidarity of brain and thought. Indeed, some notable think- ers in our time have gone so far as to say that what we call mental and what we call physical are not two separate en- tities, but two aspects of one and the same thing. However this may be, we know that,as Prof. James puts it,' All mental states are followed by activity of some sort. They lead to inconspicuous changes in breathing, circulation, general muscular tension, and glandular or other visceral activity, even if they do not lead to conspicuous movements of the muscles of the voluntary life. Now, what sort of physical activity does worry lead to? Through the medium of the sympathetic and vaso-motor nerves it affects for evil the secretions of the stomach and bowels, retards digestion, dis- turbs the proper elimination of waste products from the sys- tem, and thus sets up a kind of self-poisoning or auto-intoxi- Editorial. 83 cation. Through the same physical machinery it affects the calibre of the blood vessels and thus disturbs the circulation of the blood. Under the pressure of worry these nerves con- tract; with the removal of the worry they relax and the blood flows once more freely. Thus we can see how worry can give rise to dyspepsia and constipation, with all their brood of attendant miseries.” The Alienist and Neurologist has so often spoken in this strain that these words seem like an echo. The Ratio of PsychoPATHIC HereditY.—The problem of heredity discussed in the last August letter box of The Hospital, by A. R. Urquhart, Medical Superintendent of the James Murray Royal Asylum, Perth, is a subject too much overlooked from the family record standpoint, by physicians in general practice and too greatly neglected in Government investigations and by Medical Associations, as Dr. Urquhart complains of Great Britain. We make the same complaint of our National Medical Association and National Govern- ment. Dr. John McPherson is being aided in this direction in Great Britain by the Carnegie Trust. But this is not help enough in so important a matter. Dr. Urquhart insists, as to morbid heredity, that it is absolutely necessary that all persons should be noted-sane or insane. On that principle, all families should be recorded -sane or insane—together with the characters of each person, their individual diseases, and so on. Complete and intimate records, if selected at random, would give informa- tion of the deepest interest, not only in reference to rheuma- tism and phthisis and mental disorders, but would reveal the heredity of all disorders, the rise and fall of families, the facts upon which eugenics must be founded. Writing as a physician and a citizen, he urges this great investigation. He has shown that the worst possible heredity -the insanity of both parents-is not inevitably productive of damaged offspring. The results of twenty-eight families in this unfortunate category were: 33 per cent.. of children alive and sane, 44 per cent. insane, 23 per cent. dead. He 84 Editorial. insists on the regenerative powers of the race, and the bene- ficial effects of appropriate environment and trusts that a fatalistic acceptation of our present evils will never be the rule for the medical profession. We wish that complete en- lightenment in the direetion of this form of research may fully sustain Urquhart's hopes. NEUROLOGICAL SCEPTICISM AS TO ELECTROTHERAPY.- In view of the molecular impression possibilities of electricity, its cataphoric power, its demonstrable vaso motor influence, its proven anodyne and somnificent effects, its ability to hold the most violent neuralgic free from pain, its power over mus- cular contraction and other demonstrable influences over function and molecular movement in the human organism, even to necrotic shock when powerfully enough applied, as in electrocution, accidental or by direction of the law; in view of all of these and its power of moving the atmosphere to man's will as in wireless telegraphy and of carrying a voice over vast telephonic distances and its phonographic reproduc- tion, the neurological agnosticism that denies the power of this potent agency to do more than make psychic impression upon patients is a revelation of inadequate and faithless ex- perience. Electricity, though not yet fully understood in all of its possibilities and potencies in medicine, is certainly a real as well as psychic therapeutic agency, affecting the subliminal as well as the conscious mind centers and impressing itself, if rightly employed, favorably upon the central as it may be clearly seen to do on the peripheral nervous system. No one single agent is superior to it in neurotherapy, even though we concede it to have also pure psychotherapeutic influence. Some neurologists, however, use static machines too im- posing and frightful in size and power for the greatest good of certain timid neuropaths. Here the untoward psychic in- fluence of fright is to be considered. Electrizations should ordinarily be soothing and satis- factory, in neurotherapy, rather than frightful, exciting and Editorial. 85 repellant. We should not commit psychic assault with our batteries and look for cure to follow. The PhysicIAN IN POLItics is the caption of a forceful and timely editorial in the St. Louis Medical Review from which we quote: “We believe the physician should take an active part in legislation, and that he is fitted much better than the average man to carry out the work. There is no logical reason for the old plea that a doctor should not mix up in politics. He is eligible, both mentally and morally; and certainly more emi- nently qualified than dramshop keepers, and just as much so as the average lawyer or business man. We need legislation in matters concerning the public health and in regulations in the practice of medicine. “The great Virchow accomplished as much in the field of medicine as anyone in his time, and yet he found time to take an active part representing his people in the legislature. Even in the earliest days of our government none took more active interest in legislating than Dr. Samuel L. Mitchell, representative in Congress and afterward United States Sena- tor. And yet he acted for twenty years as one of the physi- cians of the New York Hospital and Professor of Chemistry, Natural Science and Agriculture in Columbia College and en- joyed a large and lucrative practice.” President Burrell of the A. M. A., C. A. L. Reed and others have struck the right chord on this subject in harmony with long ago utterances of the Alienist and Neurologist. There is no valid reason why medical men should stand back of ignorant politicians and plead second hand to unwill- ing ears and less informed minds for the sanitary welfare of the people as they now have to do. The PERSONAL FACTOR IN MEDICATION was a pithy and pertinent editorial theme of a recent number of the New England Medical Monthly: “Many of the failures to attain proper results from medi- cation,” says the editor, “have no doubt been due to the fact 86 Editorial that the dosage was improperly understood and the drug administered with undue caution and timidity. So varied is the resistance and susceptibility of the patient that many have arrived at the conclusion that dosage is an unknown quantity and can be expressed in only an approximate way. Hence most every one has his own individual dose which is to be determined only by experimentation. While a few are extremely sensitive and unpleasantly affected by even minute doses of certain drugs, the majority can take more than the average dose of the text-book and may require even more than the maximum amount advocated. This is particularly true of quinine, arsenic, mercury, the iodides together with the opiates and sedatives. In fact, as regards almost any agent the heroic dose is the one which often brings success.” We should say rather the well adapted dose as to nerve center states of impressibility, resistance, time of giving and other favorable circumstances for administration. Take the giving of chloral, trional and other hypnotics at other times than the normal hours for sleep and in the quiet of the bed- chamber, moderate doses are apt to prove abortive and con- tribute to the development of the therapeutic agnostic and nihilist. · The Medical PROFESSION's Duty to Civic PUBLIC IN- STRUCTION.—When a medical society undertakes to act for the public good, it deservedly commands respect and co- operation from public sentiment and esteem. A medical society should not exist for the mere intellectual and social self-interest of its members alone. There is a sphere of use- fulness in impressing its influence on the public mind in various educational ways. The title of the presidential address of the American Medical Association, delivered at the fifty- ninth session:“A New Duty of the Medical Profession: The Education of the Public in Scientific Medicine,” and more recently that of another address by Dr. M. Allen Starr, at the opening of the Medical Department of Columbia University, "The Duties of the Medical Profession to the Public," present convincingly such obligations. Editorial Dr. Burrell, in his address outlines the objects of a medi- cal society as follows: “First. That individually its members may be better able to care for the sick. Second.—That they may collectively be better fitted to prevent disease. Third. That they may know men and their ways and by social inter- course may live broader lives.”—Presidential Abstract from Dr. Tom's address before First District Branch Medicial Society of New York. VOLUNTARY UNILATERAL NystaGMUS.-Dr. Walter L. Pyle read before the ophthalmologic section of the A. M. A., June, 1908, the record of a woman, aged 22, "in excellent physical condition save frontal ‘sick headaches,' catarrhal conjunctivitis of both eyelids and sinistral eyelid oedema.” Cases of voluntary eye-ball oscillation are about as rare as the voluntary ability to move the ears, yet not so rare that the author has not found thirteen cases in the literature, viz.: those reported by Benson, Lawson, J. W. Smith, W. E. Gam- ble, Noyes, Williams, Dodd, A. E. Davis, J. E. Coleburn, Grimsdale, Ernest Clarke and Fuchs. The case of Michael Angelo whose eyes became nystagmic, “so affected by his strained attitude in gazing up at the vaults of the Sistine Chapel, which for many months he was en- gaged in decorating with frescoes, that he lost for some time the power to read, except when he elevated the paper above his head and raised his eyes," and Nieden records a case (1874) of acquired nystagmus“in a plant cutter,” a workman who, in standing under the tree, observes very exactly a line marked for cutting, while keeping his eyes in a strained condi- tion and upward direction." THE RIGHT OF THE DELIRIOUS TO HOSPITAL SECURITY.- Too many patients jump to their death out of general hospital windows or precipitate themselves downstairs not rightly con- structed for safety or over banisters of rotundas not properly wired or otherwise through want of nurse's vigilance. The care of the delirious requires knowledge and watch- fulness. Every hospital should have well screened windows above the ground floor. 88 Editorial. These precautions are not solely for lunatic asylums, but for the safety of any patient liable to be delirious from febrile or other toxhemia or often from surgical shock or fever. A hospital without a goodly number of window guards is not well equipped. PATIENTS IN THE St. Louis City HOSPITAL were given cigars by a nurse as Christmas presents. “Eighty-eight patients in one of the wards of the City Hospital smoked ten cent cigars as they lay in their couches on Christmas morning. The cigars were remembrances from the ward boss-Miss Rydore, the head nurse.” “On her first round Christmas morning she handed a cigar to each patient and in a few moments the two wards were filled with the aroma of the weed. Except on Christmas morning smoking is forbidden in the City Hospital.” Smoking in the hospital of cigars selected by a nurse should not be permitted in any hospital. The distribution of nicotine to the sick, even to be only smoked, is not a suitable performance for hospital nurses and it should be condemned, even if done by man or woman of educated medical judgment. AMERICAN Medico-PSYCHOLOGICAL ASSOCIATION Next Meeting.—The 65th Annual Meeting of the American Medico- Psychological Association will be held in Atlantic City, N. J., on June 1st, 2nd, 3rd and 4th, 1909. The headquarters will be at the Marlborough-Blenheim Hotel. B. D. Evans, Medi- cal Director of the N. J. State Hospital, is Chairman of the Committee of Arrangements. J. M. Baldwin's “The Thought and the Thing," "Das Denken und Die Dinge oder Genetische Logic," has been translated into German by W. F. G. Geifze, likewise Dr. Ramon y Cajal's “Studies in Nerve Regeneration”—“Studien Ueber Nervenregeneration” translated by Dr. Johannes Bresler. Dr. Robert C. Eccles' Letters in the Medical Fort- nightly on “The Lands Where Medical Science Evolved,"is espe- Editorial 89 cially edifying to all interested in the Medicine and Sanitation of classic antiquity. The Maryland Medical Journal, representing the whole State and all shades of opinion therein, will always stand for honest progress, and its pages will always be open to a defense of the right—to a serious, well-founded criticism of anything which is wrong in medical affairs. So say we all of us of the staff of the Alienist and Neurol- ogist. The November number has a fine portrait of Dr. Stokes and Dr. Hill and illustration of Mount Hope Hospital. AN AUNT OF THE MURDERER, Harry Kendall Thaw, died insane September seventeenth, at the Friends Asylum, a suburb of Philadelphia. “The fact that she was an inmate of the asylum for the insane was used in the second trial of Harry Thaw for the murder of Stanford White, when a defense of insanity was advanced in behalf of Thaw. The aged woman had been an inmate of the asylum for several years, but the fact was con- cealed from the public until it was necessary to have it known in order to save the life of the woman's young, unfortunate nephew.” The XVI. INTERNATIONAL Medical Congress to be held at Budapest from the 29th of August to the 4th of Sep- tember, promises to be an interesting, instructive and well attended meeting of the world's best and greatest physicians. The members of the XVth International Medical Con- gress in Lisbon, have labored zealously for the next Congress. His Majesty, the King of Hungary, has granted his patronage to this Congress like all preceding Congresses, which is to exercise a most beneficial influence upon the health and wel- fare of mankind. The Mann Bill intending to prohibit the sale to physi- cians by manufacturers of hyoscine, duboisine, cocaine, scopolomine, etc., is an unwarranted restriction upon the per- sonal liberty of purchase and selection of the physician as 90 Editorial much so as would a prohibition of the purchase for personal use by surgeons of certain surgical instruments. We hope this part of the Mann bill will not pass. It savors of tyranny too much for an American representative in congress of a free people to champion. Dr. George F. Jelly's LIFE WAS THREATENED for cer- tifying to H. B. Mackay's insanity, resulting in Mackay's commitment to the asylum for the insane in June, 1903, from which Mackay escaped in 1904 and lately shot Postmaster Morgan of New York under the delusion that the Post- master was withholding Mackay's mail. The homicidal insane should seldom be freed and then only under heavily bonded expert guardianship without the chance to procure weapons, except only cases of plain toxic delirium or operable traumatism. SANITATION Politics is the duty of the medical press and medical men. No medical journal need apologize for talking out for or against men and measures, promotive or subversive of the public sanitary welfare. The power of the medical profession in the interest of the people should be seen and felt by the politicians. We want a department of health and a wise physician in the cabinet. President Roosevelt and Uncle Joe Cannon and all political autocrats to the contrary notwithstanding, and the people will and must have them. MIND AND BRAIN THERAPEUTICS.-Dr. Allan McLane Hamilton, while discountenancing “domestic medicine," agrees with Dr. Burrell, President of the A. M. A., in his recent address that the public should be enlightened more than it has been heretofore. Instead of the present apathy of our profession we should in some measure arouse ourselves to expose fraud, etc., by tracts or other publications, etc.. See N. Y. Medical Record, November 14, 1908. MIND CURE Fallacies. It is high time the profession was taking more pains to counteract the theological and Editorial. 91 mystical mind cure fallacies of the day with the truth in regard to scientific psychological medicine based on the revelations of science as to the true relation of mind and brain to the remainder of the organism in disease. MURDEROUS JEALOUSY AT Eighty-Four is reported in the associated press from Viroqua, Wisconsin. Elond Olson there killed his wife, one year his junior, and then attempted suicide. The double tragedy took place in their home on a farm near a small village about six miles from Viroqua. The aged husband is not expected to live. SWITZERLAND has banished absinthe. This is probably the beginning of the end in the little republic of the daily use of poisons as a beverage. Dr. Douglas ARGYLL ROBERTSON, the well-known ophthalmic surgeon, whose name has long been a household word in the medical profession, more especially in connection with the pupil phenomenon of tabes, which bears his distin- guished name, is dead. His death occurred last month in India. DOES THE DELIRIUM OF TONSILITIS MORE LIKELY SHOW TRAGIC TENDENCIES THAN OTHER FORMS OF DELIRIUM? We should be pleased to have the many general practitioners who take this periodical give us answer. People have put bullets into their brains while suffering with this malady. One of the editor's patients, an ex-police officer, attempted to shoot an imaginary person in the room, but was prevented by the physician at his bedside and the revolver was removed and the patient recovered. The delirium of tonsilitis is of asthenically active form with violent speech and action, unlike the depressing asthenic toxic form of delirium of which Shakespeare speaks as having the "Life of all his blood touched corruptably And his poor brain doth by the idle comment that it makes Foretell the ending of mortality." THE BIOGRAPH AND THE PANORAMA AS AIDS in Psycho- THERAPY.-The panorama has been a long time in use as a 92 Editorial. valuable psychotherapeutic agent in hospitals for the psycho- pathic. The writer employed this aid to mental medication over a third of a century past. But the moving picture is of far greater value with certain patients, if we select the pa- tients and the pictures and the time of showing them with due regard to psychic ailment and the attention power of endurance. Of course it would not do to show an active battle scene to a battle scarred veteran paranoiac whose delirium shows in morbid conception of how fields are lost and won, nor the passion play in epitome to a religious paranoiac who insanely believes himself to be the Christ or to the manic depressive melancholic who moans or raves of sins unpardoned. But rightly selected the panorama and the moving pic- ture should have their place in helping the mind of the insane as well as those of the sane. Even the song scenes are valuable for both sane and in- sane, though some of them are handicapped by the falsetto voice and false set o' teeth, too often manifest in the cheaper shows. When THE LAWYERS Get FAMILIAR WITH THE Fact that the neuroses as well as tuberculosis and other dis- eases are caused by unsanitary jails, street cars, theatres, etc., there will be much more litigation and plenty for the now-briefless young barristers to do. The Street Car MOTORMAN's jerky halt and sudden start will also get medico legal consideration and recognition before the courts, as a thing to be remedied in behalf of the sanitary welfare of the people. Dr. Harvey W. Wiley, Chief Government Chemist, whose administration of the pure food law has not been satisfactory to many food dealers will probably resign. His condemnation of benzoate of soda as a preservative of foods, the referee board does not sustain. They say that the compound is not injurious to human health and truly so. Manufacturers will be permitted to continue the present practice of preserving their goods with this soda compound, though as heretofore the statement inust appear on the labels Editorial. 93 that the benzoate is used as a preservative. Tne board con- sists of President Remsen of Johns Hopkins University, Prof. A. E. Taylor of the University of California, Professor Russel H. Chittenden of Yale, Professor Christian A. Herter of New York, Professor John A. Long, Northwestern Uni- versity. The board concluded; That the use of sodium benzoate, in either small or large doses, does not injure the nutritive value of food. That in any dose under half gram per day, with food, it is in no wise injurious to health. That in large doses—that is, up to four grams daily- with food, it does not act as a poison or in any way injure health. And why should not benzoate of soda in reasonable quantities be rather approved than condemned? The sodium salts are generally salutary in moderate quantities, while common table salt in excess may kill, and is a producer of scurvy. Even the borate of soda once legally but unjustly condemned in this state as a poison in baking powder is only poisonous in enormous quantities of many drachms. While this particular salt, the benzoate of soda, like most of the sodium salts is healthful as an antiseptic and antilithic. Its condemnation in the necessarily limited quantities for which it is used as a preservative, is no more justifiable than the condemnation of common salt would be. Antiseptic food, rightly regulated in quantity, ought not to be condemned but rather encouraged as proper health preserving. Neither benzoate of soda nor benzoic acid nor any of the medicinal compounds of soda or the benzoates are harmful to the organism. The quantivalence of sodium with hydrogen is not hurtful, but may prove serviceable in full doses in certain hydroptic states of the system and by its possible liberation of oxygen in this and other morbid con- ditions, although it has also an affinity for and is a carrier of oxygen. A robust octagenarian patient told me that he had taken a teaspoonful of the carbonate of soda in a glass of 94 Editorial. water daily since he was twenty years of age. He had been advised in his early life to take it for hyperacid dyspepsia. His radials were at that time still compressable. It was a matter of pride with him to jump up and clap his heels to- gether two and three times before reaching the ground again. He shortly after married a buxom widow for his third wife. About two and a half years afterward he was buried with his fathers. DR. FREDERIC Brush, Of Boston, has been appointed superintendent of the New York Post-Graduate Medical School and Hospital. RUSH, THE PIONEER, IN RECOGNIZING INEBRIETY AS A DISEASE.—Dr. Benjamin Rush, in his “Diseases of the Mind," published in 1812, recommends “The establishment of a hospital in every city and town in the United States for the exclusive reception of hard drinkers" and says "they are as much objects of public humanity and charity as mad people; and religious, moral and physical remedies * * * should be employed * * * for the complete and radical cure of their disease.”—C. H. Hughes, 1894, on Inebriety. CORRESPONDENCE. THE FOLLOWING Letter from Dr. J. W. Babcock, Superintendent of the State Hospital for Insane at Columbia, S. C., is valuable and interesting: London, England, Aug. 22, 1908. C. H. Hughes, M. D., Editor Alienist and Neurologist. St Louis. DEAR DOCTOR HUGHES:—You may be interested to know that I have been studying the pellagra problem in Italy, France and England. From the study of a number of cases near Venice and Milan, I fully satisfied myself that the malady we have in South Carolina is identical with the disease called pellagra in Italy. Since coming to London I have gone over the whole subject with Dr. Sandwith, who discovered pellagra in Egypt in 1891, and has drawings, paintings, photographs, etc., of his former cases. All this evidence has fully confirmed my previous conclusion that we have been having genuine pellagra in South Carolina 'for some time. Remembering your interest in the subject, I take the liberty of writing you about my conclusions. I also enclose clippings from the Times relating to the reports by the commissions on lunacy and the feeble-minded, which I trust will be of interest to you. With assurances of my high appreciation of your letter last winter, I am Very truly yours, J. W. BABCOCK. (95) SELECTIONS. CLINICAL NEUROLOGY. CONGENITAL SYPHILIS AND PROGRESSIVE PARALYSIS.- Müller says that Wassermann's researches have finally proved that without syphilis there can be no progressive paralysis. The fact that some 10 per cent. of paralytics do not give any history of syphilis is explained by the possibility of ignorance of the existence of the disease, which is often the case in women, and the well-recognized untrustworthiness of all venereal patients. Still more important is the fact that paralysis may occur in consequence of inherited syphilis. Müller reports three cases of progressive paralysis in such patients. That they are more frequent than is usually thought is probable, when the extraordinary distribution of syphilitic infection in all classes of people is considered. Often, there- fore, a careful family history and an examination of the patient's parents may clear the mystery of a progressive paralysis in apparent absence of any leuetic infection.—Brit- ish Medical Journal. "MICROSPHYGMY" forms the subject of an interesting article in Le Progres Medical, by Drs. Bournville, Richet and Saint-Girons. The condition was first described by M. Variot in 1898, and he gave the name to a syndrome charac- terized by a triad of symptoms, microsphygmy, idiocy, and ichthyosis. Three types of “microsphygmy," or small pulse, may be distinguished, in which the pulse is either feeble, but perceptible, appearing as a fine undulation; or is altogethes imperceptible (asphygmy); or is only perceptible occasionally and in certain conditions. According to these authors the condition extends to all the peripheral arterial trunks, but is (96) Selections. 97 most easily detected in the brachial. It is not due to an arterial lesion, but rather a physiological defect in the arterial system, possibly a spasm of the muscular tunics dependent upon some change in the sympathetic system. Variations in the degree of microsphygmy under certain conditions—ex- ternal temperature, inhalation of amyl nitrite, etc.—are char- acteristic of the condition. It is found in females only and associated with some condition of idiocy; on the other hand Variot's third symptom of ichthyosis is not always present. Other dystrophies and malformations are frequently asso- ciated with it. Family history generally shows a tuberculous, syphilitic, or alcoholic taint. Such rare and extreme condi- tions are chiefly interesting in suggesting the cause for similar phenomena of a milder type in comparatively normal in- dividuals.—The Hospital. AMYOTROPHY IN SYRINGOMYELIA.—The Hospital com- ments and records as follows: It is a fact that receives less recognition than it should that one of the most prominent symptoms of syringomyelia may be muscular atrophy. The disease may consequently simulate amyotrophic lateral sclerosis or progressive muscular atrophy. That this should be so is not surprising when one remembers that the lesion in the cord consists of overgrowth of the substantia gelatinosa around the central canal, together with more or less over- distension of the latter. If these changes extend as far as the anterior horns of grey matter it is clear that there will be de- struction of anterior cornual cells; the consequence of this destruction will be atrophy of the corresponding muscles, and reaction of degeneration in them. If the over-distension of the central canal destroys anterior cornual cells in the cervical enlargement, progressive muscular atrophy will be simulated; if in the dorsal region the amytrophy may escape detection; if in the lumbar enlargement. peripheral neuritis will be simulated, and so on. It might be thought that the diagnosis would be rendered obvious at once by there being inability to distinguish heat from cold and pain from touch in the parts affected by amyotrophy. This is not necessarily so. The atrophy may be pronounced in the hands and arms, for 98 Selections. example, whilst the phenomena of dissociated sensations are to be made out only in some other part of the body. In every case of obscure amyotrophy, therefore, it is essential to test not only cutaneous sensibility, but also sensibility to heat, cold, and pain, both in the obviously affected regions and in the rest of the body too. The following is an instance in point. The patient was a young man of 22 who exhibited a classical condition of main en griffe. He stated that he was perfectly well up to the age of 20, when he began to notice that his hands were becoming less powerful than they had been, and that they also felt cold and numb. These symptoms had come on apparently without cause and they slowly but steadily ad- vanced. There was no family history of any similar com- plaint. At first sight the condition seemed to be that of pro- gressive muscular atrophy, notwithstanding the unusually early age at which it had set in. In favor of this diagnosis could be urged that there were no cerebral symptoms, no visceral troubles, that there was no demonstrable sensory disturbance in the hands or arms notwithstanding their being the site of subjective sensations of coldness and numbness, that the atrophy was limited to the small muscles of the thenar and hypothenar eminences and of the interosseous spaces, that the humero-scapular and the facial muscles were perfectly normal, and that there was nothing in the patient's family history to suggest a primary muscular dystrophy. On further examination the knee-jerks were found to be exaggerated, and the plantar reflex was extensor upon both sides. This suggested amyotrophic lateral sclerosis; but when a careful investigation of the patient's sensory phenom- ena was made it was discovered that whereas these were per- fectly normal over the greater part of the body, and over both upper and both lower limbs, there was a well-defined and broad band of dissociated anæsthesia varying from 242 to 442 inches in vertical extent and reaching, roughly speaking, round the left side of the body from the spine behind to the umbilicus in front. Here the patient could feel quite well Selections. 99 in the ordinary sense, but was unable to distinguish heat from cold, or pain from touch. The diagnosis could not be confirmed by examination of the spinal cord, but syringomyelia accounts for all the symptoms better than any other diagnosis. The possibility of amyotrophy being due to syringomyelia should always be borne in mind. CLINICAL PSYCHIATRY. THE MONGOLIAN Type Of Imbecile.—Dr. James C. Carson, Superintendent of the Syracuse State Institution for Feeble-Minded Children at Syracuse, N. Y., after thirty years study of these cases makes the following conclusions: The table presented in last year's report of births of the Mongolian type shows that a total of 419 children were born in the 72 families represented or an average of 5 5-6 to a family and, as was then stated, in these 72 families 72 children were feeble-minded or 17 per cent., all Mongolian and not a single one of any other type of feeble-mindedness. Again of the 419 children 144 were first and last born and of the first and last born 56, or 39 per cent., were children of the Mongolian type. 275 children in these families were intermediate and of this number 14, or 5 per cent., were Mongolian imbeciles. In order to make a comparison our application book was opened at random and in the regular order of applications made during the years '86, '87 and '88 in 72 successive fami- lies where the records were complete and in which forms of feeble-mindedness appeared they showed a total of 343 births, or an average of 494 children to a family. Then again, among these 343 children the records show 91 feeble-minded ones, or over 26 per cent. Further, in eleven of these families there were two or more feeble-minded children and in two families of four and five children each, all were feeble- minded. His deduction from these figures is therefore, in short, that Mongolianism is due to some cause other than heredity; that a mother seldom if ever bears more than one feeble-minded child when the type of that one is Mongo- 100 Selections. lian; that the Mongolian feeble-minded are apt to be last-born children, a considerable percentage also being first-born, and that in families of children where the Mongolian type appears the mothers show a more prolific average than the mothers in other forms of feeble-mindedness. ACUTE MANIACAL ExciteMENT IN A PATIENT EIGHTY- two YEARS OF AGE; With PossiBLE RELATION OF BLOOD PRESSURE TO THE CONDITION, by C. Eugene Riggs, M. D., Professor of Nervous and Mental Diseases, University of Minnesota, read before the Minnesota Academy of Medi- cine, November 4, 1908, and reported in the St. Paul Medical Journal for January, reports this record: The patient's blood pressure when first taken was 210 Mm. Hg. Under treatment the arterial tension was reduced to 130 Mm. Hg. The de- lusions, confusion, motor restlessness and retractable in- somnia disappeared pari passu with the lowering of the blood pressure. An aggravation of her symptoms was always asso- ciated with an increased arterial tension. The patient was a woman in her eighty-second year, a widow and an American, with negative family history. The menopause occurred in her fifty-first year. She had never suffered from any serious illness. A year ago she was struck on the head by a cupboard and also lost one finger by the accident. At the time she was not unconscious. Her present illness began about July 1st, 1908. She became depressed and greatly worried over her son's financial affairs; said that her head was dizzy and felt like bursting. She then developed the delusion that the world was on fire and that she and her children were being destroyed. Her delusions later assumed a persecutory and erotic phase. She imagined that her people were kept in the hospital for some evil purpose, and that she was detained simply for punishment; that the nurses and doctors liked to see her suffer and hear her moan. If she heard any noise in the halls she imagined people were talking about her and making fun of her. When she was given a bath she thought she was going to be scalded. She said the male nurses were scoundrels and that they were keeping women in the hospital for immoral purposes. There were hallucinations of sight. Selections. 101 Her agitation and motor restlessness were very extreme; her insomnia was persistent and distressing; she was very noisy. There were severe headache, excessive flatulency, poor diges- tion and constipation. Her hemoglobin was 68%; red blood cells 5,240,000; white cells 17,350; sp. gr. of the urine 1024, acid in reaction, no albumen, no sugar, urea 1.7%, indican in excess. Her weight was 63 pounds. The excess of indican showed the presence of intestinal putrefaction and was certainly one source of the impurities in the blood stream which gave rise to the arterial hypertonus. Two months after her admission to the hospital there was a great improvement in our patient's condition; there was no longer headache, her appetite was fair, her sleep moderate. Her delusions were fleeting and did not seem to distress her, her conversation was rational, and she was able to be out of doors most of the time. Within the last few weeks her old symptoms have again recurred with a mild intensity; they were preceded by an in- crease of blood pressure, the manometer indicating 180 Mm. Hg. The arterial tension is now 130 Mm. Hg., and she is apparently again on the road to improvement. CEREBRO-SURGERY. SURGICAL PUNCTURE OF THE BRAIN.—The Maritime Medical News selects this subject contributed by H. Till- manns, of Leipzig, to the British Medical Journal for October 3. Although puncture of the brain was practiced by Hippoc- rates, the method has been revived in recent times, especially upon the recommendation of Neisser and Polak. The method is valuable both as a diagnostic and as a therapeutic proced- dure. As a diagnostic measure it has been found of value in hæmorrhage, abscesses, cysts, tumours and foreign bodies. For therapeutic purposes it is indicated in hydrocephalus, hæmorrhages, cysts and abscesses. The technic of the opera- tion is simple. Under local anæthesia, a small incision down to the periosteum is made at the site where the puncture is to be made; the cranium is perforated with a round-headed 102 Selections. Dogen or Sudeck drill; in order to avoid puncturing of the dura, a ball pointed Dogen drill is used to perforate the inner table. The aspiration of the brain is then proceeded with. Should the puncture produce no result, the opening may be easily enlarged. If necessary, the puncture may be repeated at a different site. For puncture of the lateral ventricle, for hydrocephalus, the author recommends the method of Kocher, Neisser and Polak. The puncture is made through the frontal bone at a point 2 cm. from the central line and 3 cm. from the precentral fissure. The ventricle is reached at a depth of 5 to 6 cm. HEMO-NEURODIAGNOSIS. Blood EXAMINATION FOR PARASITES.–Stäubli. A new method mixes a drop of blood with about ten to fifteen times the amount of 3 per cent. acetic acid and centrifuging the mixture. Using the usual mixing pipette for counting white blood cells is well adapted for this. The sediment is exam- ined in a fresh state or after being dried and stained. The search of the blood for trichinæ, for malarial crescents, spiro- chetes of syphilis, and other organisms has shown the advan- tage of this method over the dried smear. He uses any of the chromatin stains, Jenner or May-Grünwald. Only the para- sites and the nuclei of white cells take the stain; the red cells are completely dissolved by the acetic acid. NEUROTHERAPY. The ANCIENT GREEKS Used STERILIZED Water.-In the first century of our era Rufus of Ephesus wrote: “The water of all ponds and rivers is bad, except that of the Nile. Stagnant water and the waters of streams which traverse un- healthy lands or pass near public baths are unwholesome. The best water is that which has been boiled in vessels of earthenware, allowed to cool, and heated again before drink- ing.” For armies in the field the following method of purifica- tion is recommended: “A series of pits extending from the Selections. 103 highest to the lowest point of the camp, should be dug and lined with the soft unctuous clay of which pottery is made. The water is caused to flow successively through these pits, which retain all the impurities.” It is remarkable that neither of these methods was deemed necessary in the case of the water of the Nile which, although the microscope shows it to be safe, is apparently the worst of all and looks like very muddy Sauterne.—Scientific American. THE INFLUENCE OF ALCOHOL UPON THE Public Health. -F. Peterson dwells upon the disastrous effects produced on the public health by the present alcoholic excesses, and estimates the economic loss caused thereby. He considers the current notion that alcohol is a food as disastrous, for it is a poisoned food. He notes that the present view is that alcohol is a depressant rather than a stimulant. It perverts digestion, depresses heart action, lessens the capacity for muscular work, diminishes the intellectual functions, brings about slow, far-reaching anatomical changes, such as fatty heart, kidney lesions, disease of the blood vessels, muscular and nerve tissue changes, and weakens the normal defenses of the body against infections, especially tuberculosis. Phy- sicians should be missionaries for reform in the use of alcoholic drinks. The walls of French hospital wards are placarded with wise rules in this respect, and the author has placed on his own prescription blanks the following temperate state- ments: Alcohol is a poison. It is claimed by some that alco- hol is a food. If so, it is a poisoned food. The daily regular use of alcohol, even in moderation, often leads to chronic alcoholism. One is poisoned less rapidly by the use of beer than by drinking wines, gin, whisky and brandy. Alcohol is one of the most common causes oi insanity, epilepsy, paralysis, diseases of the liver and stomach, dropsy, and tuberculosis. A father or mother who drinks poisons the children born to him or her, so that many die in infancy, while others grow up as idiots and epileptics.—New York Medical Journal. OPSONINS AND THERAPEUTIC Vaccines in Paresis, by 104 Selections. John D. O'Brien, M. D., Pathologist and Assistant Physician, Massillon State Hospital, Massillon, Ohio. “THB OPSONIC INDEX IN GENERAL PARALYSIS." For a period of time O'Brien made daily observations of the opsonic index with respect to the B. paralyticans, re- gardless of the duration or stage of the disease, and he found the opsonic content of the serum to fluctuate considerably; even daily fluctuations were observed. One variation of 0.30 to 1.40 was noticed in one case; this fact, in connection with the multiplicity of symptoms and viscera diseased in this infection and its rapid course in some cases, adds con- siderable evidence that the disease is undoubtedly a systemic one. These variations in the opsonic index of the blood- serum are an evidence of the periodic activation and inhibi- tion of the machinery of immunization, that in a progressive infection of this kind there seems to be a gradual unabated multiplication of bacteria in the blood and tissues, bacteria thrown out from the various infective foci in different parts of the body in large doses, and at inappropriate times, their conveyance to different parts of the body and consequent deleterious effects; the immunizing stimuli which are here required for raising the opsonic power and for maintaining it at a high level make default. Each exacerbation of the patient's condition corresponds to a large outpouring of bacteria into the blood-stream, with a diminution in the resistive power of the individual, followed again and again by ill-adjusted doses, and at inappropriate times until finally either one long invasion and a congestive seizure occurs or a series of invasions and death ensue. “THE APPLICATION OF BACTERIAL VACCINES IN THE TREAT- MENT OF Paresis.” The results achieved by Wright and his followers in the treatment of different diseases, more so tuberculosis, by the injection of properly dosed killed cultures of the causative organism, led O'Brien to apply the principles of such to paresis; a vaccine was prepared from B. paralyticans, each injection to be governed by a quantitative measurement of the anti-bacterial power or opsonic index of the patient's Selections. 105 blood-serum as compared with that of a normal person. Without exception there followed the same train of events in each case; upon the inoculation of the vaccine there super- vened a period of intoxication which is characterized by a decline in the anti-bacterial power of the blood called the “Negative Phase.” This negative phase, which usually terminates at about the third day following the inoculation, is usually more or less accentuated or prolonged, according as a larger or smaller dose is used, and discloses itself clini- cally by mental disturbance, patients growing quite depressed and irritable; severe headache, marked degree of discomfort, and a feeling of general malaise. Upon the negative phase there followed the “Positive Phase," whose characteristic feature is an increase in the anti-bacterial power of the blood corresponding to a period of increased resistance. There is associated with this phase a slight rise in temperature, marked leucocytosis, a general pronounced feeling of vigor and well- being; this phase may be prolonged for from 7 to 10 days, and the event of its decline, as estimated by an examination of the opsonic content of the serum, is the signal for rein- oculation. This condition of high positive phase may last for quite a few days. O'Brien found, as a rule, that his cases were ready for inoculation at about 12-14 days. The cases taken were a small number of the ordinary run of general paralytics as admitted to the hospital, each case determining its own dose. He began with a minute dose, but sufficient to evoke a satisfactory response, and then regulated same by the length of the negative phase; in this way he was was able to obtain a satisfactory standard dose. His observations lead him to believe that we can expect great assistance from vaccine therapy, if the same is con- ducted under the guidance of the opsonic index. All the patients in the beginning of the treatment were apparently at their worst during the negative phase; being depressed, irritable, and with but little display of energy, while within a few hours after the establishment of a positive phase the pic- ture was reversed, they appearing bright, active, congenial and obedient. That this improvement corresponds with an 106 Selections. increase in opsonic power, he satisfied himself, by observing the alternate improvement and depression with the rise and fall of the opsonic index of the blood, and that with proper dosage a steady uphill progress was observed--both mentally and physically. PSYCHIATRY. CEREBRAL INFLUENZA.-Cases of this affection are re- ported by T. G. Moorhead, T. W. Clay, and J. Livingston. The symptoms variously observed were general weakness, rise of temperature, inability to stand or walk, vomiting, violent head pains, delirium, coma, paresis, convulsive seiz- ures, etc. Of the four cases reported, three recovered and one died. It was difficult to make a positive diagnosis at the outset, except that it was evident that the patients were suffering from some profound toxemia of the nervous system. No special treatment was employed beyond the meeting of the various symptomatic indications. The general type of the severer cases was not unlike that of cerebrospinal menin- gitis.—Medical Record. REVIEWS, BOOK NOTICES, REPRINTS, ETC. The Far East, volume two, number one, is on our review table for the first time. It is an attractive, well established periodical which no man seeking to be well informed can afford to be without. It is sent out at the moderate price of thirty cents a copy. The issue before us is well illustrated and contains the following views “Snow Clad Fuji,” “Mount Fuji from Tagon- oura,” “Fuji from a Tea Garden," “Dawnbreak on the Fuji,” “Department of Finance,” “Under the Cherry Cloud,” “Our Aryan Kinsmen in Japan, Ainu Subjects of the Mikado,” “Castle of Nijo; Place of the Charter Oath, 1868," “ The Hozu Canon,” “Down the Mozu Rapids,” “Boating up the Rapids," “Where the Hozu Comes out at Arashiyama.” Medico-PsychOLOGICAL Association of Great Britain and Ireland held at London on the 19th of November, under the presidency of Dr. Mercier, was an interesting and profitable meeting. Nervous and Mental DISEASES. The New (6th) Edition. By Archibald Church, M. D., Professor of Nervous and Mental Diseases and Medical Jurisprudence in North- western University Medical School, Chicago; and Freder- ick Peterson, M. D., Professor of Psychiatry, Columbia University. Sixth edition, revised and enlarged. Octavo volume of 944 pages, with 341 illustrations. Philadelphia and London. W. B. Saunders Company, 1908. Cloth, $5.00 net; half morocco, $6.50 net. W. B. Saunders Company, Philadelphia and London. This valuable book is again before us and as of the pre- ceding editions we cordially commend it. It is revised up to (107) 108 Reviews, Book Notices, Reprints, Etc. date in illustrations and context and continues to merit in every way the good opinion we have hereto expressed con- cerning it. It is certainly worthily entitled among Saunders' successful books deserving of a place in every medical library. INSOMNIA AND Nerve Strain, by H. S. Upson, M. D., with skiagraph illustrations is a very entertaining, readable and instructive book by a professor of diseases of the nervous system in the Western Reserve University and attending neurologist to the Lakeside Hospital, Cleveland, Ohio, in which the author plausibly asserts that “mania, melancholia and dementia praecox are the mental scourges that fill our asylums with young people on the threshold of productive activity' and contends by citation of a large number of cases, “that the nerve strain of those cases, almost always associated with insomnia, is not degenerate and is not incurable.” In this connection also the action of the nervous system is described “in vascular control, in inhibition, nutri- tion, and shock; and the specific differences are formulated between vital and non-vital matter, and between nerve cells and lower tissues" based on the author's claimed “discov- ery of the vaso-neural circuit." The well known Putnam's Sons, New York and London, of the Knickerbocker Press, are the publishers. THE INFLUENCE OF MORBID DREAMING ON THE DEVELOPMENT OF INSANITY, by J. Leonard Corning, A. M., M. D., New York. Dr. J. Leonard Corning's monographic contributions to psychiatry, neuriatry and neurology ought to be put in more permanent form for reference by psychiater and neuriater. In 1899 among other valuable monographs he wrote an in- structive one on the influence of morbid dreaming on in- sanity, a valuable companion to Dr. Schlaff U. S. of Franz Fues, of Zubinger and Hammond. Not enough consideration has yet been given to this sub- ject. The morbidly impaired or lost inhibitions of the mind deranged has the counterpart in and are often preceded by the fancies of the sleep states. Normal and morbid pre- Reviews, Book Notices, Reprints, Etc.. 109 cursory dreams of incubative insanity need further observa- tion from alienist and neurologist than they have yet received. Nervous and MENTAL DISEASE, MONOGRAPH Series No. 2. STUDIES IN PARANOIA, by N. Gierlich, M. D., and M. Friedmann, M. D. Translated by Smith Ely Jelliffe, M. D. The chief feature of this interesting and valuable mono- graph is the hopeful aspect it presents as to curability of certain hitherto considered incurable paranoid states and the claim it makes for the true comprehension of morbid condi- tions in mental observation and the basing of treatment and prognosis thereon rather than upon the name. We endeavor, as Jelliffe says, to lay down general princi- ples underlying the clinical pictures, rather than sterile dis- cussions concerning classification. THE CEREBRAL CENTERS POR TASTE AND SMELL AND THE UNCINATE GROUP OP Fits, Based on the Study of a Case of Tumor of the Temporal Lobe with Necropsy. By Charles K. Mills, M. D., Professor of Neurology in the University of Pennsylvania; Neurologist to the Phila- delphia General Hospital. Reprinted from The Journal. This is one of the most advanced of this well known American cerebro-anatomical and physiological investigator's productions. The author is as painstaking, thorough and instructive in this as in his preceding contributions to cere- bral localization in man. Neurologists and alienists will de- rive especial profit and pleasure from this product of an in- defatigable investigator of brain function. THE TREATMENT AND CURE OF A Case of Mental AND MORAL Deficiency. By Lightner Witmer, Ph. D., University of Pennsylvania. Reprinted from The Psychological Clinic. A practical paper from a source of practical experience worthy of consideration. The cure of this case is one of the first fruits of the hospital school in connection with the lab- oratory of psychology of the University of Pennsylvania. 110 Reviews, Book Notices, Reprints, Etc. RELIGION AND MEDICINE. The Moral Control of Nervous Disorders. By Elwood Worcester, B. D., Ph. D., Samuel McComb, M. A., D. D., Emmanuel Church Boston, Isador H. Coriat, M. D. Published by Moffat, Yard and Com- pany, 1908, New York. A book which we regard as destined to be therapeutically hurtful by advocating the proposed combined practice of medicine by medical men and the clergy. PsychoTHERAPY: Its SCOPE AND LIMITATIONS. By Charles K. Mills, M. D., Professor of Neurology, University of Pennsylvania. From the Department of Neurology, University of Pennsylvania. Read at the meeting of the Philadelphia County Medical Society and reprinted from the Monthly Encyclopedia and Medical Bulletin. This is an interesting contribution which might be read with profit in connection with our criticism of Religion and Medicine. BIBLIOTHEQUE DE PSYCHOLOGIE EXPERIMENTALE ET DB MetaPSYCHIE, under the direction of Raymond Meunier, comprises the following: Les Synethesies. By Henry Laures. La Pathologie de l'Attention. By N. Vaschide and Raymond. L'Audition Morbide. By Dr. A. Marie Meunier. Les Prejuges sur la Folie and Preface. By Dr. Jules Voisin. Le Spiritisime dans ses rapports avec La Folie. By Dr. Marcel Viollet. Les Hallucinations Telepathiques. By N. Vaschide. LA SIMULATION DE LA Folie par A. Mairet, Professor de clinique des maladies mentales et nerveuses a l'Univer- site de Montpellier. 1 volume in-8° de 324 pages. This treatise on the simulation of insanity has special features of interest to the medico-legal alienist portrayed by a master in psychology and psychopathology. Masson & Co., are the publishers, 129 Boulevard Saint-Germain, Paris. Reviews, Book Notices, Reprints, Etc. 111 THE JOURNAL OP Experimental Zoology, published by the Wistar Institute of Anatomy and Biology has accepted an article from Dr. A. L. Hagedoorn on “A Case of Observed Origin of Color Varieties in Mice and their In- heritance” and one on “The Experimental Control of Asym- metry at Different Stages in the Development of the Lob- ster," by Victor E. Emmel and the American Journal of Anat- omy has also accepted one on “On Some So-called Anatomical Characteristics in the Brain, Due to Race and Sex, by E. P. Mall, while the Anatomical Record has accepted for publica- tion articles of especial interest to all neurologists on “The Present Position of the Theory of Auto-regeneration of Nerves," by J. G. Wilson and “A Note on the Technique of the Nissl Stain for Nerve Fibers," by V. C. Meyers. The Journal of Comparative Neurology and Psychology has the following among its contents for October, 1908: “A Comparison of the Albino Rat with Man, in Respect to the Growth of the Brain and Spinal Cord, with two plates and one figure," by H. H. Donaldson and “The Morphological Sub- division of the Brain,” by J. C. J. Herrick, and the Journal of Morphology presents one on “The Early Development of the Pigeon's Egg with especial reference to Polyspermy and the origin of the Periblast Nuclei.” All are of special interest to alienists and neurologists, together with Smith's "Educability of the Paramaician," Yerkes' and Dodson's and Ludwig Edinger's “Habit Forma- tion” in the November number. But many more are of interest in these valuable publica- tions devoted to the underlying and side studies of neurology and clinical psychology and psychiatry. The LengthENING CYCLE OF Life. By Captain W. R. Hodges, read before the commandery of the State of Missouri, Military Order of the Loyal Legion, November 7, 1908. A very interesting presentation of the subject by a veteran of the American Civil War. 112 Reviews, Book Notices, Reprints, Etc. THE NEED OF POPULAR LECTURES ON INSANITY. By Henry R. Stedman, M. D., reprinted from the Boston Medical and Surgical Journal. A valuable paper containing information as to the true nature and signs of approaching insanity. ANTHROPOLOGICAL PAPERS OF THE AMERICAN MUSEUM OP Natural History, Volume 1, part 5. The Hard Palate in Normal and Feeble-Minded Individuals. By Walter Channing, M. D. and Clark Wissler, Ph.D. This subject is well handled by competent men and will add to the alienists' and neurologists' knowledge of associate, physical and mental departures from the normal. The WORTH OF WORDS, by Ralcy Husted Bell with an in- troduction by Dr. William Colby Cooper. Third edition Revised and Enlarged. Hinds and Noble, Publishers, 31 West 15th St., New York City. Concerning the worth of words, a correct knowledge of which is so essential to proper and forceful speech and written composition, we have knowledge of no other book so useful in the editorial sanctum as Dr. Ralcy Husted Bell's brochure on the subject indicated by the above terse allitera- tive caption. The third edition has been placed before us on our review table. It will prove to be an invaluable ready refer- ence book to any writer who may test its merits as an aid to correct composition and to any conversationalist or platform speaker who would wield words with logical and grammatical accuracy and force and who speaks or writes would not? WellcoME's PHOTOGRAPHIC EXPOSURE Record and Diary. This photographic pocket-book includes Wellcome's Exposure Calculator, which tells correct exposure in any circumstance by ONE TURN OF ONE SCALE. In addition, the book is full of photographic informa- tion condensed into a small space, with plenty of blank pages for records, notes and diary. Fitted complete with wallet and pencil. Reviews, Book Notices, Reprints, Etc. 113 Opsonins and the Employment of Therapeutic Vaccines in the Treatment of General Paralysis of the Insane, by John D. O'Brien, M. D. Experimental Observations into the Etiology and Treat- ment of Paresis, by Dr. John D. O'Brien, Massillon, Ohio. The Treatment of Syphilis by Arylarsonates, by Colonel F. J. Lambkin, R. A., M. D. Sheffield, Eng. The Therapeutic Action of Iodine and its Compounds and Mercury in Diseases, especially exclusive of Syphilis, by Henry Alfred Robbins, M. D., Washington, D. C. Unusual Positions of the Appendix with Report of Cases and Observations on the Thyroid and Parathyroids, by Dr. Herman Tuholske. The Influence of Morbid Dreaming on the Development of Insanity, by J. Leonard Corning, M. D., New York. Annual Report of the Board of Managers of the New Jersey State Hospital, Trenton. A Primer of Wood Preservation. Ophthalmology for General Practitioners, by Leartus Connor, M. D., Detroit. Cystic Degeneration of the Kidney, by Dr. Clarence M. Nicholson, St. Louis. Perforative Peritonitis, by Dr. John B. Murphy, M. D., Chicago. Transitory Disturbances of Consciousness in Epileptics by S. P. Goodhart, New York. The Meniere Symptom Complex, by Dr. S. P. Goodhart. Work Cure, by Addison S. Thayer, M. D., Portland, Me. The Deterioration and Commercial Preservation of Flesh Foods, by W. D. Richardson and Erwin Scherubel. 114 - Reviews, Book Notices, Reprints, Etc. - - - Correlation of the Physician and the Layman, by William Francis Drewry, M. D., Petersburg, Va. Sigmoiditis, by W. H. Stauffer, M. D., St. Louis. A Cruise to the Orient. By Casey A. Wood, M. D., Chicago. Report of a Case of Abdominal Pregnancy, by C. M. Nicholson, M. D., St. Louis. The Significance of Sudden Severe Pain in the Right Inguinal Region, by Edmund Adam Babler, M. D., St. Louis. Perforative Appendicitis Complicating Pregnancy, by E. A. Babler, M. D., St. Louis. Three Cases of Cerebellar Tumor, by Wharton Sinkler, M. D., Philadelphia. The Etiology of Epidemic Poliomyelitis. Wharton Sinkler, M. D., Philadelphia. A Case of Epilepsy of the Family Type, by Wharton Sinkler, M. D., Philadelphia. Third Biennial Report of the Parsons State Hospital for Epileptics, Parsons, Kansas.. What Medical Journals Can Do to Reform Medico- Legal Inquiries, by R. B. H. Gradwohl, M. D., St. Louis. Annual Report of the New Jersey Training School for Feeble-Minded, Vineland, N. J.. Bacilos del Rino-Escleroma, by Dr. Santiago Letona, San Salvador, Central America. Cirugia de las Vias Urinarias, by Dr. F. Guillermo, Cano, San Salvador. La Prostatectomia en el Hospital Rosales, by Dr. Luis Paredes, San Salvador. . . . . . Contribucion al Estudjo del Balsamo de el Salvador, by Dr. Don Dario Gonzalez, Guatemala. Reviews, Book Notices, Reprints, Etc. 115 Report of the Hospital Rosales, San Salvador, Central America. Algunas Observaciones De Rino-Escleroma, by Dr. Alfonso Quinonez, San Salvador. Communications to the Pan-American Medical Congress assembled at Guatemala, August, 1908. Operative Procedure for Resection and Restoration of the Male Urethra. By Manuel Enrique Araujo. Hematozoario. By Doctor Gustavo S. Baron of the Bacteriological Laboratory, also Hospital Rosales, of San Salvador. New Operative Procedure for the Correction of Pterigion Method of Dr. Manuel Enrique Araujo. Congenital Elevation of the Scapula-Sprengel's Deform- ity. By Alex. Earle Horwitz, A. M. M., D., St. Louis. 111th Annual Report of the Board of Managers, Maryland Hospital for Insane, Catonsville, 1908. On the Diagnosis of Some Functional Diseases. By Dr. Robert T. Edes, Reading, Mass. 56th Annual Report of the Managers Syracuse State Inst. Feeble-Minded Children, N. Y. 57th Annual Report of the Managers Syracuse State Inst. Feeble-Minded Children, N. Y. Incipient Amyotrophic Lateral Sclerosis, with recovery. By Dr. Leo. M. Crafts, Minneapolis. A Fifth Case of Family Periodic Paralysis. By Leo. M. Crafts, M. D. Wear and Care of the Nervous System; The Influence of the Ductless Glands Over Metabolism; Medical Education. By Leo. M. Crafts, B. L., M. D., Minneapolis. g You appreciate the MEDLE LIN'S FOOD importance of using an infant food that can be varied to suit any individual case. Then you should value Mellin's Food. ya OF SCOOP Literature and Samples upon request. Mellin's Food Company, Boston, Mass. I Nitrogeneous mate- rial is one of the most important ele- ments in baby's diet. g Mellin's Food pre- pared with fresh milk, is rich in nitrogeneous mate- rial. Literature and Samples upon request. Mellin's Food Company, Boston, Mass. PUBLISHER'S DEPARTMENT. An English-Chinese LEXICON OP Medical TERMS, prepared by Dr. Philip B. Cousland, has just been published in Shanghai. Though the author is an Englishman by birth, he has based his book largely upon the Medical Dictionary of Dr. George M. Gould, of Philadelphia, a high compliment to American scholarship. Dr. Cousland has recently published a translation of Prof. Halliburton's edition of Kirkes' Physiol- ogy. Papine in the new 16-oz. bottle—as offered from Jan. 1, 1909, by Battle & Co., Chemists Corporation, St. Louis- shows a saving to the profession of $2 per dozen, as against the price of 2 doz. of the 8-oz. size at $8.50 per dozen and in which latter there will be no change, either as to size or price. Takes His Own MedicinE.-In Baluchistan when the physician gives a dose he is expected to partake of a similar one himself as a guarantee of his good faith. Should the patient die under his hands the relatives, though they rarely exercise it, have the right of putting him to death unless a special agreement has been made freeing him from all respon- sibility as to consequences, while if they should decide upon immolating him he is fully expected to yield to his fate like a man. Medical Men have been sadly derelict in bringing to bear the influence on public affairs which should have been exerted by a learned and influential profession. We have tamely relinquished almost all political power and influence until, as a profession, we have almost ceased to be a factor in shaping legislation. We are largely to blame for this our- (116) 117 Publisher's Department. selves, as we have maintained an attitude of cold hostility toward any member of our profession who ventured to seek political preferment, no matter how able and well qualified he might be. In the meantime we have begged favors when we should have been in position to have dispensed them. We should not submit to being relegated to a subordinate posi- tion. We should take a lesson from the legal profession on this subject.—Dr. Geo. T. McWorter. SENATOR BEVERIDGE ON THE PHYSICIAN.-"Have your doctor look you over every six months, no matter how well you feel—or oftener, if he thinks best. Have your regular physician. Pick out a good one, and, especially, a man con- genial to yourself. Make him your friend as well as medical adviser. The true doctor is a marvelous person." “How astonishing the accurate knowledge of the accom- plished physician. How miracle-like the dainty and benefi- cent skill of the modern surgeon. The peculiar ability of a great diagnostician amounts to divination. And he, whom Nature has fitted for this noble profession, is endowed with a sympathy for you and an intuitive understanding of you very much akin to the peculiar sixth sense of women—that strange power by which she ‘knows and understands." “If your machinery is out of order, he will tell you so, and do what is necessary to repair it. He will comfort and reassure you, too, and administer to the mind a medicine as potent as powder or liquid. But you will get no false sym- pathy from him. If you have nothing the matter with you, yet think you have, your doctor will take you by the collar of your coat, stand you on your feet, and bid you be a man. Be a faithful guardian of the treasures Nature gave you." From Senator Beveridge's recent book of advice to young men called “The Young Man of the World,” issued by the D. Appleton Co.—Ind. Med. Jour. The President and National Sanitation.—President Roosevelt has made to Congress the following recommenda- tions in regard to a National Health Bureau: “It is highly advisable that there should be intelligent action on the part WANTEV-A RIDER AGENT IN EACH TOWN - and district to ride and exhibita sample Latest Model “Ranger" bicycle furnished by us. Our agents everywhere are making money fast. Write for full particulars and special offer at once. NO MONEY REQUIRED until you receive and approve of your bicycle. We ship to anyone, anywhere in the U.S. without a cent deposit in advance, prepay freight, and allow TEN DAYS' FREE TRIAL during which time you may ride the bicycle and put it to any test you wish. If you are then not perfectly satisfied or do not wish to keep the bicycle ship it back to us at our expense and you will not be out one cent. We furnish the highest grade bicycles it is possible to make at one small profit above actual factory cost. You save $10 to $25 middlemen's profits by buying direct of us and have the manufacturer's guar- antee behind your bicycle. DO NOT BUY a bicycle or a pair of tires from anyone at any price until you receive our catalogues and learn our unheard of factory prices and remarkable special offers to rider agents. when you receive our beautiful catalogue and study our superb models at the wonderfully low prices we can make you this year. We sell the highest grade bicycles for less money than any other factory. We are satisfied with $1.00 profit above factory cost. BICYCLE DEALERS, you can sell our bicycles under your own name plate at double our prices. Orders filled the day received SECOND HAND BICYCLES. We do not regularly handle second hand bicycles, but usually have a number on hand taken in trade by our Chicago retail stores. These we clear out promptly at prices ranging from $3 to 88 or 810. Descriptive bargain lists mailed free. single wheels, imported roller chains and pedals, parts, repairs and equipment of all kinds at half the usual retail prices. $ 50 HEDGETHORN PUNCTURE-PROOF $480 SELF-HEALING TIRES A SAMPLE PAIR CO A TO INTRODUCE, ONLY The regular retail price of these tires is $8.50 per pair, but to introduce we will sell you a sample pair for $4.80(cash withorder $4.55). HODGETHORN_REGORO NO MORE TROUBLE FROM PUNCTURES PUNCTURE. PROOF NAILS, Taoks or Glass will not lot the SELF HEALING atr out Sixty thousand pairs sold last year. Over two hundred thousand pairs now in use. DESCRIPTION: Made in all sizes. It is lively and easy riding, very durable and lined inside with a special quality of rubber, which never becomes porous and which closes up small punctures without allow Notice the thick rubber tread ing the air to escape. We have hundreds of letters from satis- "A" and puncture strips "B" fied customers stating that their tires haveonly been pumped and “D," also rim strip "H" up once or twice in a whole season. They weigh no more than to prevent rim outting. This an ordinary tire, the puncture resisting qualities being given tiro will outlast any other by several layers of thin, specially prepared fabric on the tread. Theregular price of these tires is $8.50 per pair, but for make-SOFT, ELASTIO and advertising purposes we are making a special factory price to EASY RIDING. the rider of only $4.80 per pair. All orders shipped same day letter is received. We ship C. O. D. on approval. You do not pay a cent until you have examined and found them strictly as represented. cash aisoount of 5 per cent (thereby making the price 84.88 per pair) if you Send FULL CASH WITH ORDER and enclose this advertisement. We will also send one nickel plated brass band pump. Tires to be returned at OUR expense if for any reason they are got satisfactory on examination. We are perfectly reliable and money sent to us is as safe as in a bank. If you order a pair of these tires, you will find that they will ride easier, run faster, wear better, last longer and look finer than any tire you have ever used or seen at any price. We know that you will be so well pleased that when you want a bicycle you will give us your order. We want you to send us a trial order at once, bence this remarkable tire offer. IR VOM nccn TIDco don't buy any kind at any price until you send for a pair of I TUU NEED TIRES Hedgethorn Puncture-Proof tires on approval and trial at the special introductory price quoted above; or write for our big Tire and Sundry Catalogue which describes and quotes all makes and kinds of tires at about half the usual prices. but write us a postal today. DO NOT THINK OF BUYING A bicycle or 1 pair of tires from anyone until you know the new and wonderful offers we are making. It only costs a postal to learn everything. Write it NOW. C D J. L. MEAD CYCLE COMPANY, CHICAGO, ILL. 118 Publisher's Department. of the nation on the question of preserving the health of the country. Through the practical extermination in San Fran- cisco of disease-bearing rodents our country has thus far es- caped the bubonic plague. This is but one of the many achievements of American health officers; and it shows what can be accomplished with a better organization than at pres- ent exists. The dangers to public health from food adultera- tion and from many other sources, such as the menace to the physical, mental, and moral development of children from child labor, should be met and overcome. There are numer- ous diseases, which are now known to be preventable, which are, nevertheless, not prevented. The recent International Congress on Tuberculosis has made us painfully aware of the inadequacy of American public health legislation. This na- tion cannot afford to lag behind in the world-wide battle now being waged by all civilized people with the microscopic foes of mankind, nor ought we longer to ignore the reproach that this Government takes more pains to protect the lives of hogs and of cattle than of human beings. The first legislative step to be taken is that for the concentration of the proper bureaus into one of the existing departments. I therefore urgently recommend the passage of a bill which shall authorize a re- distribution of the bureaus which shall best accomplish this end." He had better have recommended a Department of Pub- lic Health, for to this complexion will it come at last and with a physician in the President's cabinet. He wisely says re- garding hospital ships for the navy: “Two hospital ships should be provided. The actual experience of the hospital ship with the fleet in the Pacific has shown the invaluable work which such a ship does, and has also proved that it is well to have it kept under the command of a medical officer. As was to be expected, all of the anticipations of trouble from such a command have proved completely baseless. It is as absurd to put a hospital ship under a line officer as it would be to put a hospital on shore under such a command. CHRONOLOGY OF THE RECOGNITION OF INEBRIETY AS A Disease.—Inebriety, according to Crothers (1888), has been Publisher's Department. 119. recognized as a disease ever since the second century of the Christian Era, when Vulpian, a Roman jurist, urged the neces- sity of treating inebriates as sick and diseased and with special surroundings and by special means. In 1747, Cadillac, of France, urged that the State provide special hospitals for dipsomaniacs. Since then Dr. Rush, of Philadelphia, in 1790; Dr. Cabanis, of Paris, in 1802; Professor Plateur, of Leipzig, in 1809; Salvator, of Moscow, in 1817; Esquirol, of France, in 1818; Crammer, of Berlin, in 1822, all in their time were active advocates of the treatment of inebriety in suitable inebriate asylums. In 1830 the Connecticut Medical Society appointed a committee to report on the need of an asylum for the medical treatment of inebriates. In the same year, Dr. Woodward, of the Worcester Insane Asylum, Massachu- setts, made a plea for special hospitals for inebriates and that inebriety be treated as a disease. In 1844 the English Lun- acy Commission urged that inebriates be regarded as insane and sent to asylums for special treatment. In 1864 the first inebriate asylum was opened for patients at Binghampton, New York, but from lack of proper public support and polit- ical dissensions a few years later, it was changed into an in- sane asylum. Since then, however, numerous asylums for the treatment of inebriates have been opened in the United States, various countries of Europe, Australia and New Zeal- and are doing important work in the solution of the proper care of this large class of cases.— Dr. G. Alfred Lawrence, Some Medico-Legal Aspects of Inebriety in the Post-Graduate. COD-Liver Oil In Convalescence from Acute LUNG DISEASES.—The unquestioned value possessed by cod-liver oil in all conditions of reduced vitality and particularly in those marked by serious nitrogenous waste, has won for it the most extensive use and firmly established it in the medical profession's favor. Not alone in chronic disorders, attended by mal-nutrition, has its worth been demonstrated, but also as a builder of tissue and a reconstructive in convalescence, especially in that state following acute lung and bronchial inflammations. Two Hundred Thousand Families The intellectual aristocracy of America, have one rule in magazine buying- "The Review of Reviews first, because it is a necessity" THE AMERICAN REVIEW REVIEWS EDITED BY ALBERT SHAW Desca LYNCHUSOANET - 12.1992 28 CM SEND FOR A SAMPLE COPY V THE NECESSARY A MAGAZINE MAGAZINE LIBRARY IN ONE MAGAZINE The Review of Reviews Has attained a larger subscription list than any magazine that deals wholly with serious subjects and is accepted as the best periodical to keep one up with the times. It is non-partisan. 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The Review of Reviews Company, 13 Astor Place, New York Publisher's Department. 120 At the present season, keeping in mind the prevalence of lung and bronchial diseases, cod-liver oil's possibilities as a food and tonic for convalescents from pneumonia and other acute respiratory ailments should not be overlooked. Few diseases leave a patient so utterly broken-down and so sus- ceptible to a still graver disease as do these acute infections of the lungs and bronchi. Judicious care and a properly chosen therapeutic, regimen, during the several weeks immediately following a pneumonia, may determine the difference between complete recovery and the grafting on of a tubercular process. At this important period, the indicated remedy, cod- liver oil, stands out in bold relief against a background of a host of drugs. But care must be taken that a palatable preparation be chosen, for, though a serviceable product be selected, if its use disturbs the stomach and interferes with this important organ's function, its value will be vitiated by the harm done to the gastric apparatus. Hagee's cordial of the extract of cod-liver oil compound is the ideal preparation of this class and daily it demonstrates its efficiency in the hands of thousands of physicians. Ex- temporaneously prepared cod-liver oil combinations cannot receive serious attention when the medical profession has at its command such an elegant, palatable and yet, withal, meri- torious agent, as Hagee's cordial of the extract of cod-liver oil compound. Granting, however, that a product prepared in small quantity and at irregular intervals has some merit, it cannot be so trustworthy as one which is prepared in large quantity and accurately compounded by men who make its preparation a life work. It is this feature that puts Hagee's cordial at the head of the cod-liver oil preparations, insuring for it stability and cer- tainty of composition. The efficiency of this cordial of the extract of cod-liver oil as a reconstructive is largely enhanced by the addition of the hypophosphites of calcium and sodium, which are in themselves tissue foods of the highest order. The routine administration of Hagee's cordial during the period of convalescence from acute lung and bronchial diseases prac- tically insures against such a serious consequence as tuber- The Ralph Sanitarium For the Treatment of Alcoholism and Drug Addictions HE 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. 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-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 529 Highland Kansas City, Mo. 529 Highland Avenue VO CLADK 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 Pil Orient- alis (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 Orientalis (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 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. Helantha Compound, $1.85 per oz. Powder or Capsules. Prices: Pil Orientalis(Thompson)$1.00 per box. ENGRAVING CO. MEANS - THAT YOU CAN GET HIGH GRADE CUTS FOR ANY KIND OF LETTER PRESS PRINTING AT 84 MASON ST. MILWAUKEE HALFTONES ON ZINC OR COPPER WOOD ENGRAVING SOMMESIN & ORIGINAL DESIGNERS & ARTISTS THE IMMUNE TABLET COMPANY, WASHINGTON, D. C. AGENTS: Meyer Bros. Drug Co., St. Louis. Lord, Owen & Co., Chicago. Evans-Smith Drug Co., Kansas City. Redington & Co., San Francisco. J. L. Lyons & Co., New Orleans. Publisher's Department. 121 culosis and reduces to a minimum the possibility of chronicity of the original disease.—Medical Era. BATTLE & Co., St. Louis, Mo., have issued number 8 of Dislocation Chart series. Physicians desiring the above or any back numbers, cen get same upon request. A STORY TO REMEMBER.--National calamities have be- come world calamities. The appeal to sympathy that binds all mankind in one has never been greater than at the present time. The Italian disaster brings back the memory of the terrible San Francisco days when men rose tu heights of almost snperhuman strength and devotions. Recitals of such deeds are always good to read and helpful to remem- ber. A story of unselfish devotion and physical hardihood is told by Charles Frederick Holder in the February Metro- politan Magazine. WHY IS IT? That each month in all the best homes in this country, on the library table, and in every club reading room, you find the METROPOLITAN MAGAZINE It is because it keeps you in touch with those great public and human movements on which the American family depends. It is because its stories are the best published anywhere. It is because its illustrations in color, and black and white, set the standard. It is because its articles are the most vital and interesting. It is because there is something in each copy for every member of every American family. A YEAR’S FEAST 1800 Beautiful Illustrations. 1560 Pages of Reading Matter. 85 Complete Stories. 75 Good Poems. 50 Timely and Important Articles. 1000 Paragraphs presenting the big news of the “World at Large." 120 Humorous Contributions. Wonderful Color Work, presented in frontispieces, inserts and covers. All Yours for One Year's Subscription to THE METROPOLITAN MAGAZINE Price $1.50 per Year or 15 Cents a Copy The Alienist & Neurologist and the above sent for one year for $5.00 OU. A4 OCT 9 2996 UNIV. OF MA CAZ ERARE THE ALIENIST AND NEUROLOGIST ST. LOUIS MO. Vol. XXX. MAY 1909. No. 2. A JOURNAL OF NEUROLOGY AND PSYCHOLOGY PSYCHIATRY AND NEURIATRY. FOR THE NEUROLOGIST, GENERAL PRACTITIONER AND SAVANT. PANOPEPTON Is an absolutely sterile liquid food and cannot ferment; completely peptonised and cannot embarrass any function of the body; wholly assimilable and leaves no residue; agreeably stimulating and holds the patient subjectively to a hopeful outlook. Panopepton is specifically a food for therapeutic use, adequate for nutrition and of peculiar excellence in respect to palatability, wholesomeness, reliability and uniformity. The label gives complete analysis; literature and clinical reports in abundance are at the command of the physician. FAIRCHILD BROS & FOSTER ODLUKREDIT Nitty NEURONHURST DR. WM. B. FLETCHER's Sanatorium for Mental and Nervous Diseases. A new building newly furnished throughout with accommodations for fifty patient For terms address Dr. M. A. Spink, Superintendent. Long Dis. Telephone 381 No. 1140 East Market St., Indianapolis, In St. Louis Baptist Hospital DR. C. C. MORRIS, Supt. N. E. COR. GARRISON & FRANKLIN AVE 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- cal and Pathological Laboratory under the supervision of a physician well trained in th branches. Surgical cases are given special attention Address all communications to DR. C. C. MORRIS, Sup THE ALIENIST AND NEUROLOGIST. VOL. XXX. ST. LOUIS, MAY, 1909. No. 2. THE ERROR OF MEDICAL EMMANUELISM IN PSYCHIATRY. (An Alienist's and Neurologist's Psychotherapeutic Note to a Patient's Spiritual Counsellor.) By C. H. Hughes, M. D. N overzealous minister of the Gospel of the Emmanuel movement proclivity giving spiritual consolation to a religious insanoid psychasthenic, having doubts about her salvation and other symptoms of folie du doute, is advised from a psychotherapeutic standpoint, in order that the woman of little faith and much doubt may be saved, as follows: REVEREND SIR:--This poor girl's brain is not strong enough to stand more mental commotion than already has arisen therein. She is overwrought in mind. Peril to her mental stability impends. “Consider her frame.” “Re- member she is but dust” that can be wafted and driven by the wind of adverse environment to despairing hopelessness and mental destruction. She cannot endure more emotional strain. Be as tender as the Master would be, as you would be or ought to be with your own sore brain, if ever so unfortunate or as you would be with a sprained or broken limb, unfit for use and requiring rest and bandages for restraint of motion. --123— 124 C. H. Hughes. Her brain has been strained and broken and is weak. Do not exhaust it with further emotion. Organs beside the brain are out of order—liver, bowels, wrongly acting heart and other organs. The prayer of Nature in a case like hers is for rest. Let her rest, my dear, well-meaning but mistaken, brother. Let her sleep and rest when she will, "safe in the hands of one dis- posing Power” without the torture of over mental action even under your beatific portrayals of the hope of heaven. There is a balm in Gilead for her, but it is not in “words-words- words.” It is in therapeutic relief of damaged organs and brain-in rest and sleep—“Sleep, the balm of hurt minds." Whatever value there may be in the suggestion that“He is able and willing to save”—“That whosoever cometh he will not cast out" –"That underneath are the Everlasting arms '- “He healeth all diseases,” etc., etc. Whatever may be conceded to the psychiatry of faith and hope, tired nature in brain and mind, as well as in muscle and limb, has its claims as “sore labor” has its bath in sleep. “Sleep that knits up the ravelled sleeve of care" by reconstructing the neurasthenic brain cells, after the retrograde metamorphosis of over action. They de- mand the reintegration for disintegration, the surest restor- ing influences of ample sleep for the melancholia and doubts of restless psychasthenia. Religious argument, ever so con- solatory in form, at this time, robs the gray cortex of the psychic rest this poor brain is dying for and is harmful. The Emmanuelists had their day before the church of Rome separated the priestly healers from the doctors of medi- cine and even in the old pagan temples. They had better remain separate or at least religion as a therapeutic aid to medicine had better keep its present subordinate and accessory place. That Divine Master in psychology-Master of the Mas- ters in effective psychic suggestion and precision once said, “they that are sick need the physician." The domain of the demi fous and paranoiac, religious erotic or otherwise, is not the right sphere for the Emmanuel movement in mental healing. It is as harmful as christop- athy (if I may be allowed the coinage) or Christain Science, so called. The Error of Medical Emmanuelism in Psychiatry. 125 Blind demi fous lead the equally mentally blind and both fall into the ditch of mental overthrow together. Certainly there is enough of abnormal mentality abroad in the land without the aid of preachers and prelates to play further havoc with brain cell instability still out of the asylums for the insane. These should not be hurried on their way there and helped on to destruction by this new psychochristopathic · fad. This letter was addressed to a meddling Divine who in- sisted on presenting “the truth” to a psychasthenic patient whose profound brain tire rendered her brain incapable of sustaining further psychic impression. She recovered through enforced brain rest and restoration of other associated dis- ordered functions and keeping her away from church and the clergy until the mind's vision was clearly restored. Religion has its right place and time in the therapeutics of certain minds and the physician, as well as the clergyman, should seek to understand when and where that time and place is. But the ministry is out of place when it seeks to engage in the practice of medicine even as the physician is when he seeks to regulate the religion or spiritual convictions of his patients when they are under the disease dominion of mel- ancholia, though he need not refrain even then from reminding that, as the scripture saith, “He doeth all things well,” or as suggested above. Every experienced real alienist who has had the medical care and entire control of any considerable number of insane, (who is not a recent political appointee from the ranks of gen- eral medicine without such experience,) knows what a difficult problem it often is to rightly decide, for the welfare of the patient, as to who should or should not go to the chapel and to its religious services and how the skill to rightly decide grew upon him by experience. The religious paranoiac, the erotic, the erotoreligious and the nymphomaniac are problems for the psychiater from the point of view of psychotherapy in relation to attendance at the chapel or ballroom, as much as the suicidal or homi- cidal in dining-room, or sewing room or out upon the daily 126 C. H. Hughes. walk or in the hospital games or in their rooms alone where weapons of destruction may be found or life-destroying suggestions may be excited. As these and the drug addicted and the dipsomaniac are guarded from access to the pharmacy and the wine cellar, so must certain others be guarded from Emmanuel methods and the Christian Scientists. The victims of the “invisible and the voices” are numerous in hospitals for the insane and the votaries of mysticism and the lured of the unseen, are becom- ing too numerous, in too many ways and varieties in our daily life outside of the hospitals. Too many are to-day suffering from paresis of the nor- mal psychic inhibitions for stable rational mental life in many mentally over wrought assemblages of modern cults of the un- seen and unreasonable.* *A neurotic young lady, an enthusiast of the old, but so-called “new thought" cult, took away from the writer a patient whom he had formerly successfully treated for a profound state of brain exhaustion, vertigo and threatened apoplexy, again recurring, though the writer was enabled to stay with the patient till he was again out of danger and after a few days of profound brain rest able to go to a restful watering place under the advice of a sensible clergyman ad- visor of the family before the “new thought” psychic per- verts got him under treatment. There was a precipitating element of acute alcoholism in the recurrence of this case. Psychoneurasthenia less marked than this has often in my own personal observation, when neglected of right and unremitting psychiatric management and treatment, passed into grave insanity. Psychoneurasthenia is a much more common precursor of marked forms of insanity than we find recorded in the literature of neuropsychopathology. The man himself is a sensible logical person with all confidence in his medical advisor, but he was under chemical hypnosis at the time and a bachelor, living with the orphaned daughter of his dead brother for the mistress of his house and she became agitated and senseless through abnormal solici- tude. The Error of Medical Emmanuelism in Psychiatry. 127 The reading of Raymond's Experimental Psychologie and Metaphysical Series, beginning with Vaschides' Tele- pathic Hallucinations continuing Dr. Marcel Violett's Spirit- tism in Connection with Insanity, Marie's Morbid Audition, the first chapter on the Supernatural Origin of Insanity in Lubomirska's “Prejuges Sur la Folie," prefaced by Jules Voisin, Vaschide's and Raymond Meunier's Pathologie de l'Attention and the Synesthesias of Henry Laures, would quite counterbalance and offset the unscientific claims of Elwood Worcester, D. D., Ph. D., Samuel McComb, M. A., D. D. and Isador Coriat, M. D., for the “moral control of nervous disorders” set forth in that psychopathic blending of “Religion and medicine,” lately from the press of Moffat, Yard and Company. it resistivel nas mazilonissima bilsil in asti si!! soloslova'l letnomiqyál 2 bron1798 lo 21491 ST -SIT '29birozsV sisiw ynimiuud 20112 lspievriqboll. puro -ji02 a'tsuloid lootsM 10 minitrogenoitsrioullsH oHD soijibula bidiol. 2'9115l/. .vtists:2011 oliw moito9710) si ceis WAROAN. "INCURABLEMENTAL DISEASE! uils elul id boys1919 9110'I sI w I I" 's detin: sb iyoloslis 'Bx'ALBERT SHASHMEADOM. Dhe6V 12V bilbow ,2916 71019H! W idbaar? s lue purisit io 20islo Onitngioambili 092fto bas isledistro) viisp DROFI GEORGE BURNAM FOSTER of the Uniyersity I lutof Chicago, whose book on The Finality of the Christ tian Religion's produced much discussion when it was pubi lished some time agolt wilhin two weeks,giye to the public an.. other volume, which promises to be even more sensational in its attack upon orthodox theology. The title of the new book is “The Function of Religion in Man's Struggle for Existence.” In a sense it is a companion or rather supplemental volume to his earlier publication. The position which he assumes in his latest work is more radical than that advanced by him two years ago. The book takes the position that religion is entirely utilitarian in its purpose and does not hold its power by reason of any divine sanction or by scientific demonstration. Prof. Foster has no sympathy for religion as a divine sacrament. He declares that man must look upon religion as a necessary creation of human nature "or else be excused from further interest in the problems of God and freedom and morality.” He traces the development of religion from the arrow, worshipped by the savages of Ceylon, to the spiritual God of modern civilization. This new book begins with a discussion of primitive man. He had two evils before him, “the impenetrable darkness of the future and the unconquerable might of hostile powers." It was this need of help which "impelled the soul to create religion, nay, which was religion. Man generated the gods to do for him what he could not do for himself.” Here is notice of a forthcoming sustained avowal that religion is an utility-an inevitable sooner or later application --128- Albert S. Ashmead. 129 of the doctrine of natural selection. Gradual evolution will not bring the wars that have followed an assumed divine revelation. I believe utility is even now the underlying sense much more general and unconsciously than the faithful are aware of or willing to admit-an unconscious evolution as all evolution is. When God and religion cease to be invoked for a divine smile and blessing, upon a projected armed, military enter- prise upon another people a far advance will have been made toward an agreed brotherhood of man and the Hague. Yet contention and disease will never cease to afflict mankind, as it will never cease to afflict the lower orders of life active and still-and-war is a disease mental, an unrest, for which no remedy, may be found. Even unification so far a$: it-may, beiby elimination of race, and color distinction, cannot abrogate the necessity of the struggle for, existence. Motion, motion/is the state ; to the end of the life of this clanet. 211961DD301/ą ani?item! 1996 ?! CH 11/11) -$!; isto us frufjirde IN 1907 998 rue # 1 0 10. 1رر ، دین (زء و1؟) (. إ {{ بینرز (1) / رالي [ !!}}. ا س 4:. H 22914.ole ionis 224323,191ci's boosloo lobisius vit IF 1933 ?)7001 films!! På et') '3-2011 o os seus us .4207 od nogi ITA Clip:/2 ; y c ! ( {": 9:1 - PSH H 7 2:F otell [.) (1 M2'1 1 : : - 71 ,11 بن و، ۲۰۱۶، ب 1، :"( :: ۰۱ : ۰۶ :! )53 زر، 1 ( ز بنز * E PIJE " T ?timttti7-** ;+*+/+674) utifrie 191 Post 292453 m 10 54,75! ; 21 097 PIT?!"). O DISTRIT :1797 1791 "10 kinnis III 37 1738 calin 911 25 17 ini lipe : fi 12 for lub in vs Vuolo b) a101'} i )? 6 ! - hrs :974792 ? ?! !", w 11,2 li? ?*3!1!17! If ,7! ost "21199 poza rin) PP,'11 P eļ9 ir 44:. H . ii i o n poin7 be $ ::101: Sina !! 'v'zibe; ri 2010!!,1!!!!: sra! puc "voit us!; (?: ("! Tsis risi Palines pir irikiistriksjedili proi'? : ÜST! :-) """?!!!! '; b): 52 Frits printszans 2011 Pirita REPORT OF A CASE OF MENINGEAL HEMORRHAGE. By P. M. St. Clair, M. D., Assistant Physician, and J. ALLEN JACKSON, M. D., Pathologist, Central Indiana Hospital for Insane. THE following case is of interest on account of (1) the trivial nature of the fall; (2) the grave and fatal results; (3) the clinical and pathological findings. We are greatly indebted to Dr. J. J. Hoffman, our friend and colleague, Assistant Physician of the Department for Women for the accompanying photographs. CLINICAL History. G. W. K. single, age 33 years, was admitted to this in- stitution August 19th, 1893. At this time he was destructive, homicidal, melancholic, violent, restless and sleepless. He imagined that he had been charmed but would recover from it. Family History.: Has no bearing upon the case. Past Medical History.: Five months before admis- sion the patient suffered a severe sunstroke after which he had been subject to epileptic convulsions. These attacks at first were frequent, occurring as often as three or four times a day, but in later years they did not average more than one a week. Under close observation the attacks did not vary from ordinary epilepsy, but were usually severe, and lasted for quite a long while. History Of Present Illness.: On September the 24th, 1908, the patient was seized with a severe convulsion, falling and striking his head upon the floor. Upon first examination the patient was upon the floor. At this time the examination showed the following con- --130— Report of a Case of Meningeal Hemorrhage. 131 ditions. The patient is in an unconscious condition, complete- ly relaxed, with blood oozing from both ears, mouth and nose. This blood is mixed with a substance simulating cerebro spinal Auid. Respirations are slow and at times simulate Cheyne-Stokes respiration. Pulse slow, regular, fair volume and high tension. Upon examination of the skull a de- pressed fracture of the right temporal bone is observed. Pressure over this fracture causes an attempt at motion of the left arm and leg. Nervous examination: Patient is completely paralyzed, most markedly upon the left side. The right pupil is dilated and fixed. The knee jerks and other reflexes are lost. There is no response to irritation except over both feet and a short distance above the ankle. Diagno- sis of a depressed fracture complicated with a fracture of the base was made. An operation at this time was considered, but it was felt that it offered no hope of recovery. The pa- tient lived three days with no change in his mental or physical condition, except that on the second day the left pupil was dilated and he developed incontinence of urine and feces. AUTOPSY Record. The body is that of a well developed, well preserved, adult male. The musculature is well preserved as well as the subcutaneous fat. Livor mortis is well marked in the dependent portions. Rigor mortis is marked. Small areas of decubitus, superficial in type, are seen over the sacral re- gion. There is a contusion over the right temporal muscle as well as a depressed fracture at the junction of the squamous portion of the temporal bone with the parietal. On dissect- ing back of the scalp the diagnosis was confirmed. The pupils are equal, but the right seems more clear cut and fixed in its dilatation, while the left seems irregularly dilated. There is no evidence of conjunctival hemorrhage or corneal ulcers. The ears are normal, save for a few recent clots which have evidently accumulated between the intervals of cleaning during life. The nose contained a few minute clots of blood. The bones, muscle and joints show no evidence of disease except that described above. CIRCULATING System. The pericardium is adherent to the pleurae. There is a 132 P. M. St. Clair and J. Allen Jackson. Mona small amount of fluid in the pericardial sac. The heart is. smaller than the patient's clinched fist. There is a small amount of epicardial fat. It retains its normal contour. The apex retains its normal position regardless of the chronic adhesions. The cavities are not dilated, but are compara- tively small and contain both dark and chicken fat clot. The tricuspid valves show no evidence of sclerosis or thickening at any point and measure 12.5 c. m. in circumference. The mittal Valves are normal and measure 10-cmisin diri, The pulmonary and 'aortid valves are free from any evidence of disease and measure respectively 8 and 7 c, m. in ćir. "The RADIOTHs on IVE 08tetb 17 DOE 191 litri heart muscle is firm and cuts, with increased resistance Treiz tains lits shape, and is red in colok The heart weighs 280; grams T UTIV031 do 90011 on batoilo ji sul toi?!! sunt 1 fizyty zo leturn fáei LARGER VESSELS!!" 777's Lori :") 2991 Átil the orifide ofi'the coronarylarteries are seen small calcareous plates. The thoradic and abdominal aorta show C807318Y901 moderate arteriosclerosis, b9401519h llaw £ ju jerit ei visas - IBN 25 b979997RBŚPIRATORY System: 951 ;" 03:15 The left pleura is firmly adherent to the thotáx; comis pletely obliterating the left' pleural cavity. It is 'adherent tó the pericardium. It sends protongations down into the lung and is considerably thickened. There is no fluid in the pleural cavity. Fi() Je suitq or's siin on 1!109435 31:11 The i left lungi weighs: 350zgramś ): It is less voluminous than the night!"It is bound down by adhesions and is torn upon its removal from the thoracic cavity. It is darker in color. In the upper lobe crepitation is present, but the lower lobe is firm, çuts with increased, resistance and crepitation is absent..The cut surface shows ired and gray areas and cut sections sink in water! The right pleura shows a few more recent, adhesions upon its posterior and lateral surface and is not thickened-otherwise normal..!! 7-4077!:0 ; 11110:1116, till 13171) 1) FIT!! ) Tili ! ILM") Report of a Case of Meningeal Hemorrhage 133 191.310IZAH' resist - The night, lung is more yoluminous than the left-weighs 960 grams. In the upper and middle lobe crepitation is pres- ent, and the lung.siş resonant a few.emphysematquş, blebs are seen along the anterio-lateral bordes of the lung. The lower lobe stands out: prominentlyricrepitation is ab resonance is gone Fiit cuts with resistance and the cut surface shows, red areas of consolidation. Cut sections sink in water. The trachea, larynx and nares are normalisergaul bonis bustus THE AUMENTARY, System. 9102. The peritoneum ; is, smooth and, glistening and there are nojadhesions. There is no fluid in the peritoneal cavity - The liver weighs (1210 grams, Its margins extend one finger's breadth below the costal margins. The organ is small, and is pale with a grayish tint, here and there. It is firm, cuts with resistance, and the capsule is not thickened! Mufhé cut surface has a pale nutmeg appearance."'The Yobes and lobules are not distinct_the larger vessels are'apparently dilated.' Con gestioh is slight and a few globules of fat'afe seen” upon the knife! The gall bladder 'is distended and contains an excess! of dark colorea'bile!The'bile ducts are patulous. Pancreas and ducts are apparently norimal: " The large and small it? testines hormal. The stomack is large-contaitist'some unb digested' liquid brothy' 1doking substance. It is not blood stained. There is an excess of thin glary mucous upon it's membranous surface. "The pharynx, oesophagus, fauces and mouth are normál?to) B of liude »j to 200 orj (2119S / PTOV antzib) 15502 03 2,97151551) 30T rod 19046103 stal seis 11:12:b (woja RINO GENERATIYE SYSTEM. and buil 170 The left kidney / weighs 150 grams,1. Iş about pormal, in size and consistency. Capsule strips readily, leaving a smooth surfage: '/o Guast sunfece is pale-cortex; and medullary, portion well differentiated. The cortex measures: 5 m. There is an increase of pelvic, fat, 11 The vessels are., normal. The right 134 P. M. St. Clair and J. Allen Jackson. kidney weighs 160 grams and presents a similar picture as the left. The ureters, bladder and generative organs are normal. THE BLOOD AND GLANDULAR SYSTEM. The spleen weighs 110 grams. Is about normal size and shape. The capsule is wrinkled. The cut surface shows a hyperplasia of the connective tissue. The adrenals, thyroid gland and lymphatic glands are normal. Nervous System. The scalp shows a hematoma of the right temporal muscle and is apparently normal in thickness and attachments. The cranial bones are thin and apparently unusually brittle. CRANIOGRAPHY. Upon examining the skull a noticeable contusion is seen over the region of the lower portion of the temporal bone upon the right side. Evidences of a depressed fracture are seen below the contusion. On dissecting back the scalp the hematoma is seen to have diffused throughout the temporal muscle. Dissecting back the muscle the fracture is distinctly observed. It extends upward into the temporal bone for the distance of an inch. Near its center is a depressed, distinctly separated plate of bone extending beneath the level of the quter plate. The lower portion of this fracture is lost in the petrous portion of the temporal bone and extends trans- versely across the base of the skull to a corresonding point on the left temporal bone. The fracture, so to speak, distinctly divides the base of the skull—by this line-into two distinct portions and these are held together only by tissue support. So completely severed is the base that to and fro motions simulating a hinge joint can be made. After removing the calvarium an extradural haemorrhage is distinctly noticed upon the right side corresponding to the site of the depressed Report of a Case of Meningeal Hemorrhage 135 fracture. The membranes are universally adherent through- out to the calvarium. Upon dissecting back the dura the brain substance corresponding to the site of the splintered bone is torn. The vessels of the pia are intensely injected. Upon the left side between the pia and arachnoid scattered here and there over the middle portion of the temporal and parietal lobes are seen numerous clots of blood. The hemor- Clots in the Pia Arachnoid upon the left side. rhage from the right side is from the meningeal—upon the left side the source of hemorrhage was unobtainable. The sinuses were apparently intact and not ruptured. The brain was preserved in toto as a specimen showing extradural clot upon the right side and pia arachnoidal clot upon the left. Extra dural clot upon the right side. 136 P. M. St. Clair and J. Allen Jackson, MicROSCOPICAL EXAMINATION. The heart shows no pathological changes. The lungs: The vesicles are filled with red cells and debris. There is leukocytic infiltration into the vesicles more marked in some areas than in others. There is lymphoid infiltration into the interalveolar tissue more advanced in some areas than in others. The blood vessels are engorged. The bronchi and bronchioles show moderate catarrhal changes. The spleen, stomach, intestines, pancreas are normal. The kidneys, save for slight intertubular congestion in the medullary portion, are normal. The liver: The lobules are distinct. The cells near the periphery of lobule and central vessels show fatty globules containing debris. The nuclei are distinct. There is lymphoid infiltration into the interlobular connective tissue with beginning fibrous tissue formation. There is perivascular lymphoid infiltration as well as around the bile ducts. The ducts and vessels are normal. THE THERAPEUTIC STAYING OF AGE AND THE RE- CUPERABILITY OF THE SENILE AND THE SENILE DEMENT.* By C. H. Hughes, M. D., St. Louis. THE aged are too much neglected, by themselves their normally related friends, advisors, guardians and espe- cially those who hold the relation to them of medical coun- sellors and physicians. The optimistic studies of Elie Metchnikoff on the pro- longation of life, wisely considering the sanitary care of the large intestine, its microbes and ptomaines, are worthy of extensive emulation and extension to the entire man and mind of advanced and declining age. The other extreme of man and all parts of the problem of health conservation and life prolongation, should engage our attention, especially with reference to the prevention of the remedial or removable maladies which complicate and pre- cipitate senility, senile insanity and the general decline of life. Minot's illustration of the aging man with the spinning top bound to run down at a definite time, when the force im- parted from without by the jerked enveloping string shall have spent itself, is a forceful but not a perfectly fair com- parison for, like the blood, which for instance, after a wound of the smaller arteries accomplishes its own hemostatics, the human organism has within itself the means of reproducing to a certain extent, its tissues and to a great degree of accom- plishing its own repair. Its forces and methods, in the light even of our present limited knowledge compared with the *Continuation and conclusion of the subject of Normal Senility and Demential Senilis in February number. (137) 138 C. H. Hughes possibilities of future discoveries,* are marvellous; so re- markable and wonderfully accurate that physicians, surgeons, orthopaedists, ophthalmologists and all other repairers of the human machine could do but little good in their respective lines of work without the vis medicatrix naturæ in its broad modern sense. Innate endowment and inherent power of resistance are important factors in every problem of life prolongation and of the eradication of disease. But it is a mistake to conclude in all cases, or even in a majority of the prematurely old or even in the septogenarian or even in the octogenarian or nonogenarian senile who come under our observation, sometimes, that the end is come and cannot be postponed, until after we shall have tried and proven the efficiency or inefficiency of remedial efforts over the appearing decadence. It may be arrested. Somewhat apropos of the preceding, Thomas L. Stedman, M. D., Editor of the Medical Record, discussing editorially, Insanity in the Sixth and Seventh Decades, says: "Old age has for long shared with malaria, and recently with, autointoxication, the distinction of being a sort of etiological catch-all, any morbid condition occurring in one over sixty, the cause of which is not patent to the laziest diagnostician, being blithely referred to arteriosclerosis or other assumed senile changes. Arteriosclerosis, however, is now known to be a disease of those who live fast, as well as, or rather than, of those who live long, and gradually one disease after another, formerly regarded as of old age is being discovered to be simply in old age. In psychiatry especially, perhaps, the senility theory has been found most convenient and satisfactory, any form of insanity occurring in persons past the meridian of life being often looked upon as due purely to the age of the subject, and therefore, the cause being irremediable, being regarded as itself incurable. “Recently Drs. E. E. Southard and H. W. Mitchell have studied twenty-three cases of mental disease developing in the sixth and seventh decades in order to determine their re- lation to senile phenomena. All those cases came to autopsy *Phagocytic power, neurone assimilation, harmone formation, etc. The Therapeutic Staying of Age 139 and consequently the clinical analysis was supplemented by a study of the anatomical changes. The report of their findings was presented to the American Medico-Psychological Associa- tion at its annual meeting in Cincinnati in May, 1908 (Ameri- can Journal of Insanity, October, 1908). Of those twenty- three cases, three were alcoholic in origin, five were paranoiac, four were cases of delirium, three were maniacal, and nine were cases of depression. In none of these cases was the in- sanity characteristically due to the premature onset of senile atrophy of the brain. Atrophy was found in several of the brains examined, and in all the cases in which it occurred the duration of life beyond the onset of mental disease was much longer than in the case of those subjects whose brains were of normal or over weight. The insanity could not therefore be rightfully referred to the atrophy as a cause. The pigmenta- tion also was not characteristic of old age. Perivascular cell pigmentation was a constant feature, but this is a not in- frequent feature in normal brains of persons in the fifth de- cade. The neuroglia cell pigmentation was also constant, but it varied in degree in the different cases, and the signif- icance of the variations was not at all apparent. More strik- ing variations were shown in the nerve cell pigmentation. In four cases there was hardly any pigmentation, in eight only was the senile yellow pigmentation present in the Betz cells. In one case the satellite cells were highly pigmented, while the adjacent nerve-cells were without pigment. On the whole there was little characteristic in the pigmentation, the variations being interesting but without apparent significance in relation to the age of the subjects. “As a result of their studies, clinical and anatomical, of these cases the authors conclude that“ neither old age changes nor arterial disease have any necessary connection with the development of insanity in the later years of life, at least in the sixth and seventh decades. It seems probable that arteriosclerosis senility, and various forms of insanity are entities which frequently interpenetrate, but are logically and genetically quite separate. Even the degree to which old age and arterial disease serve as complicating factors in insanity has been much overestimated. 140 C. H. Hughes "If Drs. Southard and Mitchell are right in their conclu- sions, and so far as the findings in those cases go there seems to be no reason to doubt them, one more of the opprobia of old age has been removed. The more disease in the aged is studied, the more “normal," if such a term can be applied to disease, is it found to be; that is to say, the more is it found to be subject to the same etiological laws as disease at other periods of life, and the less is it seen to be due to age per se. Doubtless there are degenerative changes coincident with or dependent upon senility, but disease in the aged is by no means always referable to those changes, and the modern investiga- tion of the physiology and pathology of old age is demonstra- ting every day the fatuity of Cicero's assertion that old age is itself a disease. There is a normal old age in which life is as endurable and as enjoyable as it is in the young or the mature, and the reward of patient and rational treatment of disease at this time is as great as at any other period." We may remedy the physical complications of the old age state, especially when they are such as, under peculiar stress, appear in younger persons. It may be truly said of old age that it has its premature disease senility and dementia senilis which may be averted. The time of real senility and senile dementia may be post- poned or prevented altogether. Aged people do not die or become demented so much or so often from old age pure and uncomplicated as from the diseases that specially attack advanced age because of its weakened resistance to disease engendering influences and neglected care, precaution and inadequate appreciation of the disease liabilities of far ad- vanced life. Suggestions in this line of thought and endeavor are the purport of the remainder of this paper, in order that old age (and its senility of mind) should come, as Metchnikoff main- tains it should “in its natural place at the end of the normal cycle of life”-robbed of its terrors, robbed of all needless preventable or mitigatable infirmities and gracefully in its natural place at the end of the normal vital cycle." So common was the blood and circulation found to be a The Therapeutic Staying of Age 141 fault in insanity in general in his day as it is in ours that Benjamin Rush, the great American psychiater of a century ago, regarded the disease as “primarily seated in the arteries,” though ptomaine and microbic toxhaemia was not understood by him as seen in our day, he knew of the “sinning” peccant humors of the blood. He enjoined his readers and those who listened to his clinical lectures on the subject in the Penn- sylvania Hospital at that early day or read them after him to “never lose sight of the blood vessels" in investigating the cause of it and of all diseases. We should not do so now with our improved hematoscopic resources. The significance of this injunction is brought home to us as conveying the importance of an anti-autotoxic and anti- blood stasis therapy even in so-called anaemic conditions of the brain, when we consider that in post mortems of dements, terminal or senile, we seldom find the brain, liver* and kidney free of evidence of congestion and its consequences, to say nothing of the congested and damaged kidneys, the chole- lithiasis, scirrhosis, yellow atrophy, etc., with the brain dam- aged, coarse and microscopic, meningeal, ependymal, adventi- tious, exudatal and morbid ventricular states. The frequency of vascular and organic renal, as well as hepatic, changes found post-mortem, after dementia and dementia senilis and the experimental results of Dr. Haven Emersonf with the vasodilators, show how perilous it was to over dilate and irritate the renal arterioles, whether by toxines, alcohol or psychic brain strain affecting the vaso motor cen- ters and the same is true of the blood supply and the blood states in the brain. The brain is as vulnerable in its circula- tion to arteriole dilating toxine influence as the liver or kidneys. "An almost constant feature of the latter is some grade of circulatory disturbance in the form of venous hyperemia or *Jaundice, displaced liver, diseases of the liver vessels, congestion of the liver, suppuration in and around the liver, cirrhosis of the liver, perihepatitis, syphilis of the liver, malignant disease of the liver, tuberculous, lardaceous, actinomycotic, and bydatid diseases of the liver, acute yellow atrophy, and icterus neonatorum source presented in Hale White's latest book. Nephritis has been caused experimentally by means of various toxic substances, but the resulting lesions are not identical with those so commonly observed in human beings. 142 C. H. Hughes local anemia, or both together, and it has been thought that this may be the sole etiological factor in some instances. With a view to determining the influence of such circulatory changes on the function and structure of the kidneys, Dr. Haven Emerson (Archives of Internal Medicine, June, 1908) under- took an experimental inquiry into the effects of repeated in- halation of general vasodilators, of mechanical injury to the kidney, of injection of alcohol, adrenalin, and physiological salt solution into the substance of the kidney, of increased viscosity of the blood from introduction of gelatin into the circulation, and of intravenous injection of adrenalin and lead acetate. As a result of these observations it would appear that interference with the blood supply of the kidney can be brought about by means of chemical injury to the renal parenchyma, and that the process of repair that ensues may involve such a destruction of secreting tissue as to cause the death of the animal. In consequence of the use of general vasodilators the kidney suffers at least a mild grade of de- generation, which may be due not to the specific renal irrita- tion caused by the drugs employed, but to the defective blood supply resulting from frequently repeated vascular relaxation. “An analysis of the accepted causes of chronic nephritis in man shows that a common factor in many of these is a more or less severe and prolonged stagnation in the renal blood- supply, and although this factor is often associated with the presence of irritants capable of injuring the tissues of the kidney, an insufficient supply of blood alone will cause first an error in the function and later an alteration in the structure of the kidney. Cardiac disease, bacterial toxins, and metab- olic waste-products are probably the causes of the errors in circulation that bring about the changes mentioned. Ac- cordingly, the prophylaxis consists in increasing present efforts to check the spread of infectious disease, and the cor- rection of habits of over-stimulation and overwork so preva- lent in large centers of population.”+ A more complete examination of the senile as to ante- cedent history and ancestral longevity with further personal + Editorial in Medical Record, August 28th, 1908. The Therapeutic Staying of Age 143 inspection and psychic interrogation than we here indicate and the right treatment, physical, psychophysical and chemi- cally and physiologically therapeutic as to brain and other nerve center rest, restoration, blood renovation and toxine elimination and autotoxine prevention and the modification of uric acid and other diatheses will help to either exalt or depress prognostic hope in these aged subjects. And I can- not tell when this point is reached, for I have seen the most pernicious anemic in profound neurasthenia and the greatly glycosuric and albuminuric recover of associated melancholia and dementia. As therapeutics is not specially germane to this article and only incidental to this subject we merely outline a sug- gested method in senile dementia, where the same may be practicable, preparatory to prognosis as to curability thereof. By curability of dementia senilis, we do not mean the restora- tion of the patient to pristine power of mature mentality, but to the natural non-demented state of one in the mental con- dition of normal senility of mind or the normal feebleness of brain and mind peculiar to natural age decadence. In the first place before we decide that a senile dement is hopelessly demented we should treat him with such environ- ment as would give him no irritation of mind, excite no de- lusions, nor keep alive delusions already existing. We should give to the over-wrought brain all possible rest and tran- quility and assimilable nutrition and food for pleasing, divert- ing, tranquilizing, non-fatiguing thought, as well. He should not be visited or interrogated to exhaustion of mind, nor kept awake when he might sleep. He should have at least two · regular daily healthy evacuations from the bowels, such as show a good condition of the liver. The bladder should be looked to daily and it and the prostate in man put in the best possible condition, and the genitalia in both. All subjects that harrass and worry should be kept from his attention. “In the sere and yellow leaf” of life he should be tenderly cared for and not have former responsibility thrust upon him, nor fatiguing, harrassing or painful memories revived. His children and the dependent relatives he may have helped daily, when in better mental estate, should be 144 C.H. Hughes considerate and careful of him, not to wound his sensibilities nor in any way to shock him as he grows old and feeble and after the mental change of senile aberration has occurred to guard against all possible mental tax or tax of over-physical exertion that may deprive him of mental or physical rest or sleep, by every possibly anticipated timely help. I am accustomed to using in all cases of senile dementia in the beginning of my efforts to restore the aberrant mental action to that of normal senility of thought and feeling the following formula for hepatic, intestinal antiseptic effect: Hydrarg protoid, gr. vi.* Pepsin scale, gr. xii. Salol, gr. l. Hypoquinidol, gr. xii. Ferri pyrophos, gr. xii. Glycerin et aq. Menth, pp. q.s ft. Mass. Ft. cap., No. xii. One every morning early before breakfast. If chronic venereal disease is suspected as an existent or precedent possibility, the preceding capsule is repeated after the midday meal daily and Kalium Iodidum given at bed time, pro re rata. A brain tonic anti-melancholic dose of Codia (one-fourth to one-half grain or even a grain) may be added if indicated, to the morning and midday capsule, adding also some ex. col co, or Aloin, etc., Codia, may also be prudently given if bowels move excessively, or for intercurrent maniac depressive states. The stools should be copious, show good liver effect and the bowels be kept antiseptic. Normal salt enemata may be given adjunctively if deemed advisable. Ordinarily with this, to secure a quiet brain at night time, bromide of ammonium or sodium in thirty grains or more and bromide of lithium in ten grain doses or to maximum, are given every night or so often as experienced medical judgment may sug- gest in three drachms of essence of pepsin, preferably Fair- child's. A single dose of chloral hydrate well diluted (say twenty-five grains) might be substituted for or be added to the qromide at night time only for awhile and not oftener than once daily. Aloin in half this quantity should alternately substitute the pertoiouide if ptyalism impends or other considerations suggest the substitution, The Therapeutic Staying of Age 145 Tranquil sleep must be regularly secured to the patient, a free, clean alimentary tract by the above or with other means additional and a good easily assimilated and varied nutrition, largely of milk and cream and butter, eggs and buttermilk with suitable fruits and vegetables and not over much meat. The more buttermilk the better (in accordance with Metchnikoff's idea for eliminating the old age microbe if you please, if any of the buttermilk should reach the lower bowels.) The stomach and kidneys as well as liver, brain and bowels must be rightly cared for. In short our ship in stress of psychopathic storm, should if possible be righted up and put in best possible form for normal resistance and right sailing by evoking all the aid in the direction of the greatest therapeutic skill that may promise to be psychiatric These and other things done, we may then decide how much the vessel is really damaged. Sometimes we find, not- withstanding first appearance conditions of injury, that the apparently impending wreck is not so disastrous after all. Applying this similitude to the old man apparently demented, we may see him sometimes brought into the haven of normal senility or old age sanity. Though in old age resistance, in the battle of life, must ultimately needs fail in the inevitable course of nature, resis- tance against the environing enemy should be marshalled by the medical advisor. We should reinforce wherever we may and aid in postponing the issue of the conflict, even though the fate and final ending be certainly against sanity or life or both. Dementia præcox in the prematurely senile is often tox- hemic or anemic psychasthenia and encephalonesthenia. It is inadequately oxidized and nourished neurone debility of the aged brain, which intensifies and aggravates the effect of the arterioles contracted in their lumen and contributing to premature cerebral atrophy. We should remove what we can of this in the aged and postpone established senility so long as possible and not make our diagnosis of senile dementia until after we shall have tried all proper remedial resource. To pronounce one irrecoverably demented before his time 146 C. H. Hughes in the course of the aged man's march to the grave, before we have attempted to reinvigorate the exhausted brain, might prove to be a serious error to him or her and to others and lead to neglect or grave life error, and damage to the old per- son's welfare and wishes in the distribution of bequests of property post-mortem. It would not harmonize our profes- sion and practice with our rule of conduct in regard to the young, concerning whom our motto ordinarily is “where there is life there is hope"—to neglect attempts at cure of the aged. We should not cease in diligent endeavor in their behalf for restoration of such failing and feeble powers of the organism as may possibly be re-established. Likewise with the subject we are considering, let me repeat, to conclude, that whether organically demented or only sanely senile the old man should have all his vital functions normally supported by a judicious therapy and habit regulation and ample sleep secured to him. His vitality should be saved to him by every means known to the science of life conservation. He should have the same consideration and chance given him and his debilitated con- dition as though he were young, with more prospective years after than before him. The deprementia of autotoxemia, with its impaired mem- ory, mental depression, stupidity, etc., should be considered in every case of senility or suspected dementia senilis, de- mentia præcox and in some cases of possible simulation of Kraepelin's “manic-depressive insanity," before rendering a final irrevocable conclusion. Just as we should look also for and remove, if possible, all evidences of pure neurasthenic psychasthenia, with its associate atonic conditions of the viscera and the bowels, indicanuria, hemotoxines, etc., before giving a final judgment for dementia. We should do this after the manner of the surgeon who, if in doubt, makes an exploratory incision and other procedure, holding in abeyance These illustrations are from Dr. Dupre's article: "The Differential Diagnosis between Paralytic and Other Forms of Acquired Dementia,” in the Transactions of the First International (Amsterdam) Congress of Psychiatry, Neurology, Psychology and the Assistance of the Insane, Sept., 1907. DEFENCE SENILE. EXCITATION, ITATIENCE, ME VETE Vasque metiatt ansieus. La malade, femme anpassant polie et live on tema plaindre relater, thier de l'entrare ..injurfer termes urnes et ole ont le personnel. DEMENCE SÉNILE aser tranquillite, rostentement, euphoriet Waste wlacide et utilit a-Senile Dementia with b—Senile Dementia with Tranquility Excitation, Impatience, Contentment, etc. Facial expression placid Viciousness or Vulgarity, etc. and self-satisfied. All the illustrations in Facial expression anxious and Dr. Dupre's article will appear later. distrustful. The Therapeutic Staying of Age 147 the wielding of the knife until absolutely sure in his diagnosis. The dyscrasias, dysarthria, dysesthesia, dysbasia, dysgraphia, dysphasia, dysbulia and many other of the symptoms ex- pressive of infirmity in the aged are sometimes due, in part at least, to more or less transient vaso-motor conditions, etc., capable of more or less favorable therapeutic modifications, etc., cell tone and to more or less correctable nutritional conditions. We should not neglect attempting, at least, im- provement of these states. * *Therefore though therapeutics may not be considered germane to the scope of this and the preceding discussion, I have deemed this much appropriate as a sugges- tive outline of the therapeutics of old age, too much neglected by the profession, like the too much omitted therapy of the menopause in women, to emphasize the impor- tance and to show my manner, in part, of bringing about in the senile dement conditions as nearly normal to his organism, before deciding upon the grave question of his possible or probable insanity and incapacity. As ptomains and autotoxines may excite delirium or cloud the mind and as other states of the blood, in either quality or quantity may affect it, through influence upon the brain, for the relations of vascular to mental states as proclaimed by Rush and as already shown further back in the history of psychopathology and psychiatry, are recognized, I have always deemed it a duty before forming a final judgment as to the real state of the senile when pronounced demented, to clear the brain through a thor- ough therapeutic relief of the entire system, where that has been practicable, in relation to the brain and allied nervous system. As we have here given but a sug- gestive outline of treatment to illustrate the principle, the reader will add his own further therapeutic reasoning and prescriptions. "A SUGGESTION CONCERNING THE INCREASED LONGEVITY OF LIFE INSURANCE POLICY. HOLDERS."* BY BURNSIDE Foster, M. D., ST. PAUL, MINN. ODERN medicine has, above all, two chief aims, the | prevention of disease and the recognition of its earliest signs in the individual. In both of these aims the business of life insurance has an immense interest, since the nearer we approach to their accomplishment the more we add to human longevity. I was much interested in reading the address of Prof. Irving Fisher, delivered before this body at its meeting in February last, on the Economic Aspect of Lengthening Human Life, and his plea for concerted action on the part of life insurance companies to lend their financial aid to the cause of preventive medicine, is one which meets with my hearty sympathy and approval. I do not know when or where the idea of enlisting the life insurance companies in the cause of preventive medicine originated, but it has been in my own mind for a good many years. In the course of an ad- dress delivered in 1902 before the Minnesota State Sanitary Association and published in American Medicine, vol. V., Nos. 11 and 12, (1903) I alluded to it in the following sentences which I should like to quote at this time, to prove that the idea is not a new one. *Address delivered by Burnside Foster, M. D., of St. Paul, Minn., chiei medical examiner of the New England Mutual Life Insurance Company, for Minnesota, and editor of the St. Paul (Minn.) Medical Journal, to the Association of Life Insurance Presidents, New York City, on the afternoon of Friday, April 2nd, 1909. (148) Increased Longevity of Life Insurance Policy-Holders 149 “The business which more than any other is directly concerned with the health of the people is the life insurance business, and when we consider the enormous amount of capital invested in this business and the enormous numbers of people, including both the insurers and insured, who are interested in it, it would seem that life insurance companies might form a powerful combination which would be capable of accomplishing a vast amount of good in this direction. Fire insurance companies have found the support of salvage corps as adjuncts to the regular municipal fire departments to be a very profitable investment. In an analogous but somewhat different way I believe that life insurance companies would find it profitable to use their money and their influence in supporting the work of municipal boards of health, and also, perhaps, in pursuing and maintaining independent investiga- tions of the many problems concerning sanitation which re- main yet to be solved. “The companies pay out annually millions of dollars for death losses which result from preventable diseases. Would it not be profitable from the business point of view alone to spend some of this money in endeavoring to prevent some of these diseases? Of course life insurance companies would be unable, in case they should pursue any such policy as the one suggested, to know just what lives they were saving, and they would of course assist in saving many lives that were not insured. Fire insurance salvage corps assume that all threat- ened property is insured and endeavor to protect it all. I be- lieve that the life insurance companies could well afford to do the same. “If all the life insurance companies would combine and set aside each year a fund to be devoted to a co-operative investigation of some of the problems of preventive medicine an immense amount of good would be accomplished at an expense which would be trilling to each company, and the direct return to the companies would be very large.” Preventive medicine becomes more nearly an exact science all the time and while its possibilities are far from be- ing realized, this is not because of its own inexactness or short- 150 Burnside Foster comings, but because the people have not yet awakened to the fact that those diseases which cause the greatest number of deaths and the greatest amount of suffering are actually preventable, if money enough is spent to prevent them. The only way to enlist all the people actively in the crusade against preventable disease is to present the subject as an economic one, which it surely is, and one which appeals directly to their pocket-books. I am glad that life insurance companies are beginning to be interested in it from this point of view. Its study will prove profitable to them and will afford a most valuable object lesson to the people. I have another suggestion to make, which I was especially invited to make and which is distinctly germane to the sub- ject of preventive medicine as well as to the economic conduct of the business of life insurance. So far as their policy-holders are concerned, life insur- ance companies have two chief objects in view: First, that every policy-holder shall be physically sound when his policy is issued, and second that he shall live as long and pay as many annual premiums as possible. These two conditions are also of great importance to the policy-holders themselves because a low death rate means a smaller cost of insurance and also because every one wants to live as long as possible. All life insurance companies are careful, some more so than others, to see that their risks are carefully selected, and on the whole I believe that the medical examinations for life insurance in this country are rigorously and honestly made, and that the great majority of accepted applicants are sound at the time their policies are issued. This, of course, is as it should be, but so far as I know no effort is made by any life insurance company to keep in touch with the physical condition of its policy-holders after their policies are issued. Life insurance companies will, of course admit that anything which would add five or ten or more years to the average longevity of their policy-holders, so that they would pay just that many more annual premiums, would be an immensely valuable stroke of business. I believe that this very thing is possible although, of course, I would not go so far as to state anything definite as Increased Longevity of Life Insurance Policy-Holders 151 to the average increased longevity that might be brought about. There is probably not a physician who has not many times in his experience detected, while examining a patient for some other purpose, the early signs of some beginning organic disease, of which the patient had no suspicion. In such cases the early recognition of the first evidences of the disease has enabled the physician to so order the life of his patient as to prevent the further progress of the disease, if it is a curable one, or to retard its progress and to enable the patient to live much longer than he would have lived had the disease not been detected until later. - Many persons die of kidney disease, (of brain and other nerve center diseases.-Ed.) of tuberculosis, of cancer, of diabetes, of heart disease, and of other diseases every year, and many millions of dollars are paid by the life insurance com- panies which have issued policies on the lives of these persons, who were sound when the policies were issued, and who might have lived much longer and paid many more annual premiums if the diseases which caused their deaths had been recognized and properly treated in their earliest stages. To à medical audience it would not be necessary to go into details in regard to this statement and perhaps to this audience it is not appro- priate to do so, but I am sure that you will all understand that diabetes, for instance, begins very insidiously and is often present for many months, perhaps years, without symptoms, and its presence is very apt to be first recognized as the result of an examination of the urine, made for some other purpose. You can also readily understand that if diabetes is detected in its very earliest stages and the patient put upon appropriate treatment at once, he will live much longer than if it is allowed to go on unsuspected until treatment is of little avail. So too, the early diagnosis of tuberculosis, of cancer, of heart disease means a better chance for recovery and a longer life for the individual. These are the very diseases which figure most largely in your mortality tables. My contention is that it is perfectly possible to recognize, in many cases, the early signs of these diseases before the individual suspects that any evidence of disease is present, and that life insurance 152 Burnside Foster companies would save large amounts of money which they now pay in death losses by inaugurating a plan of systematic re-examination of all their policy-holders at regular intervals, say every five years. This, of course, could not be made com- pulsory on all policy-holders, but I believe that the great majority, if the reasons for the examination were explained to them, would be very glad to report to the medical examiner at a specified time and submit to the necessary examination. The expense to the companies would be trivial, and in certain cases where the policy-holder was insured in two or more companies the expense might be easily divided. In- deed, the companies might enter into an agreement for the exchange of information regarding all policy-holders as they now do in regard to rejected or postponed applications, and still further reduce the expense. The details of the plan which I suggest would of course have to be carefully worked out by the companies, but I feel certain that by adopting some such plan as I have in mind, the statistics of life insur- ance companies would in a few years show a greatly reduced mortality with correspondingly increased profits to the busi- ness, and a lessening of the cost of life insurance. The whole tendency of modern medicine is toward the early recognition and the prevention of disease, and the life insurance company which first makes a practical application of this principle to its business will not only bring about a revolution in the busi- ness of life insurance, but will also confer an immense and last- ing benefit to the world. It has been my experience, and other physicians have had the same experience, that there is a constantly increasing number of individuals who are adopting the custom of pre- senting themselves to physicians at stated intervals, not be- cause they think they are sick, but for the purpose of being examined to ascertain if their organs are sound and their functions being properly performed. This would indicate that the importance of the early recognition of evidences of disease is being recognized. I have several times as the re- sult of such an examination had the experience of detecting the beginning of some chronic disease, unsuspected by the Increased Longevity of Life Insurance Policy-Holders 153 and ith apps to lich individual, and I am positive that this discovery followed by appropriate advice has added some years to the life of that individual. Surely, the regular periodic examination of a large percentage of the immense group of individuals repre- sented by the policy-holders of the life insurance companies of this country, would bring to light many instances of in- cipient disease which appropriate treatment would either cure or check and it is equally sure that the average longevity of this group of individuals would be increased. I am also convinced, that, if a carefully worded letter were sent to each policy-holder at stated intervals, say every three or five years, explaining the advantages to them of such an examination and offering it to them without charge, as one of the benefits con- ferred by their policies, a very large majority of them would avail themselves of the privilege. Life insurance, the most beneficent and philanthropic of all businesses, and the profession of medicine have for years worked together in the study of many problems having to do with human life. Aside from the humanitarian point of view, the business of life insurance has an immense financial inter- est in the increase of human longevity; and in spending money to aid in the accomplishment of the aims of preyentive medi- cine, the companies may legitimately charge the amounts thus expended to the regular expense accounts of their busi- ness. Medicine is expected to do much and does much in the name of sentiment, charity and philanthropy. Life insur- ance companies cannot spend the money of their stock-hold- ers or their policy-holders for such purposes, but when senti- ment and philanthropy also spell more premiums from policy holders and hence cheaper insurance, they not only may but must invest in them. I look forward with confidence to the time when preventable diseases will be prevented and when curable diseases will be recognized in the curable stage and will be cured, and I believe the grandest triumphs of civiliza- tion will be the achievements which will result from a realiza- tion of the possibilities of preventive medicine. The coming of this time will also mark a new era in life insurance. As an additional suggestion I append a draft of a letter which, or some modification of which, would, I feel sure, induce a very 154 Burnside Foster large proportion of policy-holders to report for examination at stated intervals. SUGGESTED Letter to Policy-HOLDERS. “My DEAR SIR :-As a policy-holder in this company you are directly interested in the economic conduct of its business, since the amount of your dividends, and hence the cost of your insurance, depends upon the profits earned each year over and above the cost of carrying on the business. You are also, it is presumed, interested in your own individual longevity and would like to live as long as possible. We hope therefore that you will read this letter carefully and that you will be willing to accede to the request contained in it. It is well known to physicians that very many of the diseases of which people ultimately die, have existed a long time before their symptoms have been noticed by the patient, and that when the patient finally consults a physician, it is often too late to do all that might have been done if the disease had been detected earlier. Many diseases may be checked or cured in their early stages. Many individuals are beginning to realize this and the custom of consulting a physician at stated intervals for the purpose of being examined to ascertain the presence or absence of the early signs of disease is growing to be a common one. We have decided to offer our policy-holders, as one of the benefits of their policy, an opportunity to receive such an examina- tion, at stated intervals without charge to them. You have now been a policy-holder in this company for---years and we should be glad to know that you are in the same good physical condition at the present time as you were at the time your policy was issued; if on the other hand you have at the present time any evidence of the beginning of any disease it is for your interest as well as for ours that it should be de- tected, in order that you may put yourself in the way of being cured if possible. We should be very glad if you would pre- sent yourself to our examiner, Dr. -between the -- and the- of this month for exam- ination, taking the enclosed blank with you. Increased Longevity of Life Insurance Policy-Holders 155 “There will be no expense attached to this examination and of course all information in regard to it will be held as confidential between the examiner and the company. There is no obligation on your part to have this examination made, and it has of course no bearing on the status of your policy, but since the interests of all our policy-holders are affected by having as large a number of them periodically examined as possible, we hope that you will accede to our request. “Yours very truly." It occurs to me that the directors of life insurance com- panies in considering, if they do consider, the suggestion I have made to-day, may fairly look at it from another point of view, besides that of adding to the longevity of their policy- holders. The problems concerning the prevention of disease, concerning the prolongation of life and concerning public and private hygiene are being talked about, and thought about and studied by the people, at the present time, more intelli- gently and more earnestly than ever before in the history of the world; this is undoubtedly the case. I believe it is also true, that events of the last few years have shaken to some extent the faith of the people in life insurance, as a business. Life insurance as an institution, as a protection to the family, stands as firmly as ever, but unfavorable public sentiment has been aroused by the publicity which has been given to some of the business methods which have been practiced by some of the life insurance companies. Would it not be a good thing for the business of life insurance, if the public were to learn that the companies, besides offering a protection to the family, after the death of the bread-winner, were earnestly and seriously engaged in a concerted effort to protect the bread-winner during his life? I believe it would, and I believe that if the business of life insurance and the profession of medicine, were to join hands on the platform of preventive medicine, they would both earn the gratitude of humanity. The financial rewards to the life insurance companies would also be great; the people would share largely in the financial benefits, since the cost of their insurance would be lessened, and the medical profession while not profiting financially- 156 Burnside Foster indeed, preventive medicine is directly against the financial interests of the medical profession-would take pride in its share of the added benefits to mankind. When preventive medicine becomes actually preventive, a large number of diseases, notably the communicable diseases, will become practically extinct, just as the bubo plague and cholera are now practically extinct in most highly civilized communities. It will be necessary, however, in order to keep the sanitary defenses of a nation properly manned to have at all times a large standing sanitary army of medical men who will be ser- vants of the state rather than servants of the individual. This is the ideal future of the medical profession. The possibilities of properly directed scientific effort in the control of disease in animals have been amply demon- strated by the United States Government in the work that has been done during the last twenty-five years by the depart- ment of agriculture in protecting hogs, cattle and domestic fowls from the many pests which formerly were so fatal to these animals, and the millions expended by the Government in this work have been returned many times in the form of increased profits to the farmers and stock raisers and have added immensely to our national prosperity. The problems of the control of the diseases of mankind are not very different from the problem of the control of the diseases of beasts. Are not its citizens at least as great an asset to a nation as its hogs? The government undertook the matter of protecting the lives of its hogs and cattle because the people demanded it. When the people demand it, it will also undertake to protect the lives of its citizens. It is as simple a problem to drive typhoid fever out of the United States as it was to banish yellow fever from Havana and from Panama. The medical profession has for years been pleading for governmental aid in their efforts to prevent preventable disease. It has pleaded to deaf ears. Let the immense influence of the life insurance companies be brought to bear upon the Government in this matter and those ears will be deaf no longer. Whether, gentlemen, the directors of the companies represented in this association see any merit in any definite suggestion I have made to you to- day, or not, is a small matter, compared with the immense Increased Longevity of Life Insurance Policy-Holders 157 educational value to the people of witnessing an active effort on the part of the great institutions which you represent, to prevent preventable disease and to add to human longevity. THE DIFFERENCE BETWEEN SUGGESTION AND PERSUASION—THE IMPORTANCE OF THE DISTINCTION. By Tom A. Williams, M. B., C. M. (Edin.) of Washington, D. C. IN the literature of psychotherapy, much is spoken of the " methods of persuasion and suggestion respectively. But no very clear idea seems to have emanated from the ex- perience of the different schools. Déjérine has reached the belief that even the most cogent reasoning only convinces through the hearer's faith in the superiority of the reasoner. In spite of this, he believes himself to be using the method of persuasion in the treatment of the patients in the Salle Pinel of the Salpétrière.2 Bern- heim3 under the name of suggestion has long used a method quite similar, with equal success. The treatment which Dubois4 calls moral is also largely suggestive, although theoretically he lays much stress on re- education. Of course, re-education, like the education of the child, in whom reasoning faculties are in embryo, must be largely a matter of suggestion; but what the psychotherapist usually has to meet is an adult whose psyche has not tran- scended the childlike. Not, however, until his suggestibility has been replaced by reasonableness can re-education be said to have occurred. Of course the patient must feel that his teacher is superior to himself, and in a good many more ways than medically. But this feeling is needed only for the begin- ning, and indeed is connoted by the patient coming to consult. Later, superiority must show itself in clear reason, and not by unspoken “personality," as it is vaguely called, which too often means a merely brutal beating down of opposing ideas. (158) The Difference Between Suggestion and Persuasion 159 The patient will not be cured by a mere negation of his notions, however authoritative: this method does not foster mental growth. A trend of hurtful tendencies must not be violently broken, but must be rebent, often slowly, to what the psycho- therapist's experience tells him is the best direction for the given patient. This is the antithesis of the method of sug- gestion, is truly the method of re-education, and fulfills the indication, which I cannot put better than in the words of Duprat," "to implant the habit of attention and study, to restrict the domain of credulity by developing the critical sense, to give practice to individual and independent reflec-- tion, to fortify the will, to create the habit of comparing dis- interestedly one's motives for judging and believing; in a word to teach a child to doubt and to will, to master himself, and hence to be free.” The failure to accomplish this by the present scholastic education is most striking, as any one may learn by talking with a teacher of the young. It is most important then to clearly distinguish the one method from the other, in order to know which we are apply- ing, as well as to understand the indications for each. So unsatisfactory have been the distinctions proposed that Bab- inski® has recourse to teleology upon which to found the difference between suggestion and persuasion. He is dis- satisfied with the psychologic distinctions, and therefore calls suggestion that which is pejorative, that is to say, which im- poses an unreasonable or evil idea somewhat in the sense of insinuation. By persuasion he means the imposition by any means of an idea which he believes to be reasonable and be- nign. As Babinski's ideas upon hysteria are now becoming accepted so widely, and as so many patients requiring psycho- therapy are hysterical, it is very important that before yield- ing to his despair of finding in psychology a criterion to dis- tinguish suggestion from persuasion, that we should make every effort to demarcate the two processes one from the other, more especially as I hope to show that the distinction of Bab- inski is unsound from the clinical and psychological point of view as well as less practical than the one I venture to pro- pose, which depends not upon the truth, validity, reasonable- 160 Tom A. Williams ness or tendency of the idea presented, but is founded upon the manner in which it is accepted or rejected by the subject. It is in order to incite a discussion which may bring light where confusion now reigns that I venture to offer the following considerations. Truth and validity have no absolute criteria: they have to be judged by consensus. While no one accepts opinions without critique, yet it is a fact that most current fundamen- tal so called truths have been imposed upon us before our critical power had developed. Most of our acts are founded upon beliefs of this kind, and the extinction of such a belief connotes a change of individuality against which the instinc- tive psychic defense reactions are constantly on guard. When such beliefs are at variance with the environmental doctrines (and the patient or friends realize this), a cure is sometimes sought. Thus in the middle ages, when the doctrine of possession by devils made the possessed behave in the man- ner they conceived to be devilish, thaumaturgists flourished. In our own day, spinal commotion has produced psychic paralysis, with its characteristic clinical picture, and has been profitable both to its victim and his medical and legal ad- visers, until it was rudely shaken by more accurate clinico- pathological research. The false belief that he has a weak stomach still produces many a chronic invalid. The want of information of the doctors of the passing generation about the psychic mechanism of these disorders is responsible for the vogue of the Christian Science, Mental Healing, Ecclesias- tical and other cults, and also of many remedies, physical, electrical and pharmaceutical, and even whole schools of therapy, which after a period of notoriety, more or less brief, fall into deserved desuetude, their active agent the psychic factor on the contrary coming more and more into prominence. The difficulty of these cures has two sources, firstly, the tenaciousness of ideas absorbed unreasoningly, and secondly, the doctor's ignorance of their role in the production of dis- ease, and his lack of taste for the kind of study which would teach him their pathogenesis and direct an intelligent treat- ment. The Difference Between Suggestion and Persuasion 161 The psychogenesis of many medical and surgical condi- tions is now being very forcibly and unpleasantly brought home to the medical profession by the Christian Scientist; and this economic argument will strongly aid in terminating medi- cal ignorance. The tenaciousness of such ideas has been well- known by the students of traumatic neurosis, and may be illus- trated by such a case as that of the gastropath who, after being cured by Déjérine, 10 said, “I don't feel myself at all, it is like another person." The convulsive seizures of hystericals are often merely the emotional reactions against the assault of their cherished fixed ideas, as in the case of a hystero-trau- matic patient who, after maintaining a digital contracture for five years, reacted by an attack of nerves when a gentle attempt was made to relax his fingers, Brissaud" pertinently remarking “his contracture is his life.” A psychasthenic of my own declared, in speaking of the obsessions which tormented her, “the thoughts are me; I could not pull them up without everything else in my mind, the machinery stops if—". These are all manifestly unreasonable ideas; but many a person whose ideas conform to general opinion has acquired them in an unreasoning way; and he may, at the instigation of a skillful operator, as readily absorb the most unreasonable ideas. The process by which this is done is suggestion, which no one disputes; so that an idea imposed by suggestion may be either reasonable or the contrary. Hence between sug- gestibility and apparent reasonableness, there is no disaccord. On the other hand, a person of the most painstaking criticality may have a knowledge of facts not generally known or be unaware of an incident well known to his neighbors, which may cause him to profoundly dissent from recognized standards, and to appear utterly unreasonable. His un- reasonable ideas, however, are based upon a capacity for in- dependent judgment, and not upon suggestibility by the environment: it is the process which would be called persuasion did it derive from another person. Hence there is disaccord between unreasonable ideas and susceptibility to persuasion. We must therefore conclude that the distinction between suggestion and persuasion does not depend upon the result. 162 Tom A. Williams For instance, the indisposition of the man who became ill on account of the reiteration of his friends who for a joke plotted against him is an example of pejorative suggestion; but must we not call meliorative the suggestion which induces a child to get up and continue to walk, although he has fallen and hurt himself, because he is made to believe by certain dis- tractions that he is very little hurt. 12 The medical literature teems with cases of psychotherapy by meliorative suggestion similar in principle to the preceding example. Our daily life furnishes numerous examples of meliorative persuasion, even though the majority of men are not rational- ists. For example: When a person resolves to sleep with the windows open after having learned that a consumptive takes less catarrh, suffers less from the cold, and enjoys better health on account of living in the open air, it being taken for granted that he understands the physical properties of the atmos- phere, which make the access of a sufficient quantity of oxygen impossible without a draught more or less severe, it is right to say that he makes his decision because of persuasion. As for pejorative persuasion the best examples are the eccentrics, who for lack of education can not see the defects in the bizarre ideas they have adopted after a long period of reflection upon the facts. Were they suggestible, such eccentric ideas would be substituted with great facility by any new idea; but it is not so. The persons who do change their ideas so easily are merely the imitators of eccentricity; and these are no more truly eccentric than are truly decadent the followers of the cult of decadence. One cannot judge the psychology of a class by a study of its camp followers. If suggestion cannot be distinguished from persuasion by results, it follows that its difference depends upon the process; but before examining this it is necessary to eliminate those properties possessed in common in both suggestion and persuasion. For example: The act of substituting a newly imposed idea for an antecedent belief belongs both to sug- gestion and persuasion; in either, the subject may make an effort to oppose the incoming idea. Here it is possible to make a distinction regarding the criticism used by the sub- The Difference Between Suggestion and Persuasion 163 ject; but any difference depends fundamentally upon the num- ber of facts he valued in order to resist persuasion as against suggestion. In the latter, there is a mere brute resistance against the imposing. When this opposition is overcome by stating that it van- ish, and also when it is overcome by stratagem or by surprise, it is equally so by suggestion. This suggestion is indirect when the opposition of the subject is disposed of through turning its flanks, so to speak, while the subject is occupied with some irrelevant matter. The suggestion is direct when a mere affirmation suffices to destroy an adverse idea. Now, on the contrary, an idea is imposed by persuasion in virtue of the fact that the subject reaches the new conviction while all the time fully aware of the whole process, practically speaking, which takes place in the minds, both of himself and his persuader. An orthodox believer in the cosmogony of the book of Genesis who becomes convinced of the truth of the Darwinian theory of natural selection by reading books of Christian apologetics must have become so by persuasion, contrary suggestion being put aside. The distinction then is one of awareness of the subject. The popular mind has grasped this distinction in the current notion voiced by the saying:“I don't know how I was tempted to do that, the man hypnotized me." From these considerations it follows that there is a funda- mental distinction between suggestion and persuasion, and this consists of the subject's entire unconsciousness, the absence of realization of the manner in which a new idea has been imposed upon him during suggestion. Sometimes he is even ignorant of having received anything new. Persuasion, on the other hand, appeals to the individual's own power of reflection, and this makes him aware of the whole process of reasoning by which he becomes con- vinced. A false conclusion derived from persuasion is false not in virtue of incorrect reasoning, but by error in the premises. The folie raisonnante of the paranoiac furnishes another striking example of autopersuasion. Suggestibility is annihilated by scepticism, the habit of suspension of judgment, doubt. These, however, connote 164 Tom A. Williams persuadability unless carried to the pathological degree of folie de doubte. The victim of this form of psychasthenia may be persuaded but not convinced. The lack of convic- tion, however, is merely one of the manifestations of the diminished feeling for reality which is so prominent a symp- ton of these patients. 13 They are altogether unamenable to suggestion, which is impossible without a feeling of entire certainty, a certainty so great as to impel its victim to acts and beliefs which may be entirely irrational. Suggestibility is diminished and persuadability fostered by rational education, and during the progress of this, the same individual may exhibit both reactions, according to the intellectual habit aroused by the various stimuli employed. The rational psychotherapy of hysteria includes a re-educa- tive procedure of this type. At the conclusion of the course the patient is no longer suggestible, and cannot therefore be termed hysteric. Incomplete and imperfect perhaps as is this analysis, I cannot but feel it is in a more fruitful direction than the teleologico-ethical one to which Babinski has succumbed. I trust, therefore, that the illustrations and arguments offered may, if not convincing, call forth others more so; for this is more than an etymological quid nunc: it voices a need for words to represent differences in essence rather than arbitrary use, and thus give to their use not only precision, but mean- ing, in the already very difficult study of the neuroses and their therapy, now one of the most encouraging branches of medical art, though so long its reproach. 1. In the Discussion seur l'Hysterie. Revue Neurologique, 1908, sum narizeri by the author, N. Y. Med. Jour., Jan, 9, 1909, also Clinical Lecture. 1906, ma conception de l'Hysterie. 2. In Camus et Pagiez, Isolnement et Psychotherapie, Paris, 1905. 3. Hypnotisme Suggestion, Psychotherapie, Paris 1903, (2nd ed.). 4. Les Psychonevroses et leurs traitement morale. Paris, 1903. Trans. by Jellifte and White, 1905, N. Y. The Difference Between Suggestion and Persuasion 165 5. La Morale, Paris. 6. Ma Conception de l'hysterie. Loc de l'Internat. Also Revue Neurologique 1908. 7. Author, recent advances upon Hysteria in relation to traumatic neuroses. Monthly Encyclopedia, Nov. 1908. 8. Author. The most common cause of nervous indigestion. Jour. Abnormal Psychology, Boston, Feb'y, 1909. 9. Author. Le role du Medicine en creant et en maintenant per res suggestions maladroites les maladies produites par l'imagination. Congres de Neurologists Lille, 1906. Trans. Am. Med., July, 1908. 10. Seen by the author in Salle Pinel. 11. Revue Neurologique in discussion sur l'Hysterie, 1901. 12. See also author various articles on hysteria in Internat. clinics, 1908. Bost. Med. Review of Neurology and Psychiatry, Brain (to appear) and Surg. Jour. Mar. 25th. 13. Raymond et Janet. Les Obsessions et la Psychasthenie, Paris, 1903, also author Differential Diagnoses bet. Neurasthenia and affections for which it is often mistaken. Arch of Diag. N. Y. Jan. 1909. LECHEROUS DEGENERACY AND ASEXUALIZATION OR SEQUESTRATION. By C. H. Hughes, M. D. St. Louis. W HILE ex-President Roosevelt rightly laments race suicide in those worthy to have and able to maintain a profusion of progeny and the fearful prognostication 'of mul- tiplied people and minimized provision for them, reckoning as he did, without taking count of modern methods of pre- venting conception, the multiplication of degenerates goes on with the stress and vices of our own civilization and it is fortunate certain means of progeny prevention are known to and practiced by the degenerate and the otherwise unfit for propagation. The pity is that less of the degenerate criminal and libidinous classes are not born and that public enlighten- ment is not such that these fungus growths of civilization are not better understood by people and public authorities and their baleful influences on society are not timely quarantined against. We destroy the deadly stygomia faciata and kill off yel- low fever, why not asexualize the lecherous degenerate and cut off his libidinous and passion-born base brood? The late Ivins Hollister horror of this kind in Chicago demands the speedy death of Ivins, but timely asexualization would have averted both of his recent crimes and a law de- claring judicially sanctioned asexualization the proper remedy, conjoined with penal servitude for men like Ivins and his confederates would save virtuous women, make the wayside safe for them and save society from the pestilent pernicious brood of similar lechers and criminals. -166- Lecherous Degeneracy and Asexualization 167 I think the State of Missouri once had a law making the penalty of rape asexualization among negroes. It was re- pealed on the ground that it was cruel and unusual punish- ment and because it was not a general law applicable to whites and blacks alike. But electrocution is cruel and unusual punishment or was so regarded till we knew better, and so is hanging in the same sense. It would be quite as cruel to break a criminal eroto- path's neck as it would be to emasculate him. The fiery bull or stallion may be made as quiet as a lamb by this process and the danger of the innocent being gored or otherwise harmed is thereby averted. The old man eighty-six years old who lasciviously at- tacked a child in Chicago and got a ninety-nine year sentence, might have had a happier old age if he had been sans testes. Emasculation should even now be the penalty of such men with sequestration added the one as preventive, the other as either penalty or charitable care and restraint as to other morbid impulsion. The other would be homicide, reported at the same time, from Chicago, who shot because of resist- ance should receive the same local treatment. Too intimatə a relation between the genitalia and the head, with the former lasciviously dominating both subliminal and supraliminal con- sciousness and inspiring and impelling to crime is bad for the individual and for the progeny of such people. One of the problems of procuring a normal civilization is to eliminate the bestial elements from the social and political and com- mercial life of our people and it is better to go to the fons et origo of the satyriac criminal and nymphomanic and break the pitcher at the fountain. This would be wise medico-legal therapeutics. The lascivious lunatic (and many of these creatures are insane in their cerebro-spinal sphere) whose libidinous lives are dominated more or less voluntarily, only under the domi- nance of the abdominal brain and pudic nerve areas, should be aided by a sound neuropsychiatry and a neurologically influencing surgery, to commit scientific race suicide-by indirection and skillful emasculation, under kindly anaes- 168 C. H. Hughes. thesia and antiseptic precautions, thus conserving the race from a vicious, civilization destroying kind. Nature in her peculiar way, through sexual impotency, has her own though tardy surgery for the extirpation of the undesirable, as giving us a hint of prompter procedure for the avoidance of racial degeneracy. The breeding in and out of mulattos and of certain inferior animals resulting in incapacity to procreate their species beyond a certain point is a fact of nature germane to our argument. State laws preventing the marriage of cousins do not stop the evil because “love laughs" at laws often as it does “at locksmiths" and it is better for some, as St. Paul enjoins, to marry than to burn. But the morbid degenerate erotopath does not burn and he or she does not always marry and the crop of idiots, imbeciles, insane and other degenerates keeps on multiplying to the peril of our future as a nation yet as- piring in many quarters to be a great, good and strong people. Asexualization applied to many at Castle Garden would be a prophylactic of value against impending American degeneracy. The Sicilian Mafiato and Black Hand and Camarillo are not the greatest menaces to our mental national stability. Other vicious unstables come in at this gate of entry to American Freedom whose progeny will menace our future when they grow up to be American citizens. The greatest menace of all is the psychopathically ill and neuropathically unstable progeny, born almost of the still. It were fortunate for humanity if such were all still bom or their procreation prevented. The veil and the sheath of which Malthus never dreamed have somewhat safeguarded the world from this vicious brood and this is indirect suicide of the unfit. IS GENIUS A SPORT, A NEUROSIS, OR A CHILD PO- TENTIALITY DEVELOPED?* By Jas. G. KIERNAN, M. D., CHICAGO. Pellow Chicago Academy of Medicine, Foreign Associate Member French Medico-Psychological Association; Honorary Member Chicago Neurologic Society, Honorary President Section of Nervous and Mental Disease Pan-American Congress 1893, Chair- man Section on Nervous and Mental Diseases American Medical Association 1893; Professor Neurology Chicago Post-Graduate School 1903; Professor of Nervous and Mental Disease. Milwaukee Medical College 1894-5; Professor of Nervous and Mental Diseases Illinois Medical College 1905; Professor of Forensic Psychiatry Kent-Chicago College of Law. NONCEPTION of a potentiality is difficult for the ordinary half-baked middle class mind to realize. With his Gradgrind adoration of facts he is unable to see the forest for the trees. However concrete a fact may be, it does not exist for him if it be associated with a general principle. This is nowhere better illustrated than in his mental attitude and that of his slavish sycophant, the commercial medical men with a surgical bias. He mentally belittles science by disso- ciating it from art, poetry and music and belittles these by denying them what he calls practicality and making them simple methods of pure emotional intoxication. He re- pudiates as peculiarly offensive Huxley's scientific use of the imagination. Such minds peculiarly lack historical per- *Continued from Alienist and Neurologist, August, 1908. -169- 170 Jas. G. Kiernan. spective. To them Leonardo da Vinci for example is simply a “dago" painter, yet as an English critic wrote as far back as 1721 he “was a man so happy in his genius, so consummate in his profession, so accomplished in the arts, so knowing in the sciences, and withal, so much esteemed by the age wherein he lived, his works so highly applauded by the ages which have succeeded, and his name and memory still preserved with so much veneration by the present age-that, if anything could equal the merit of the man, it must be the success he met with. Moreover, 'tis not in painting alone, but in phil- osophy, too, that Leonardo surpassed all his brethren of the 'Pencil.'” Da Vinci's* latest biographer, Brockwell, remarks “Leon- ardo anticipated many eminent scientists and inventors in the methods of investigation which they adopted to solve the many problems with which their names are coupled. Among these may be cited Copernicus' theory of the earth's move- ment, Lamarck's classification of vertebrate and invertebrate animals, the laws of friction, the laws of combustion and respiration, the elevation of the continents, the laws of gravi- tation, the undulatory theory of light and heat, steam as a motive power in navigation, Aying machines, the invention of the camera obscura, magnetic attraction, the use of the stone saw, the system of canalization, breech loading cannon, the construction of fortifications, the circulation of the blood, the swimming belt, the wheelbarrow, the composition of ex- plosives, the invention of paddle wheels, the smokestack, the mincing machine! It is, therefore, easy to see why he called 'Mechanics the Paradise of the Sciences.'”. This many-sidedness has been elsewhere prominent in art, music and literature. Indeed in literature especially that of the master poets, Shakespeare particularly, this many- sidedness is peculiarly prominent. Indeed since genius is as Herbert Spencer showst a resultant, it must be so. Art, Havelock Ellis forcibly remarks, is no mere passive hyperes- thesia to external impressions, or exclusive absorption in a *Leonardo da Vinci. Principles of Psychology. Is Genius a Sport? 171 single sense, but as a many-sided and active delight in the wholeness of things, is the great restorer of health and rest to the energies distracted by our turbulent modern movements. Thus understood, it has the firmest of scientific foundations; it is but the reasonable satisfaction of the instinctive cravings of the organism, cravings that are not the less real for being often unconscious. Its satisfaction means the presence of joy in our daily life, and joy is the prime tonic of life. It is the grati- fication of the art-instinct that makes the wholesome stimu- lation of labor joyous; it is in the gratification of the art-in- stinct that repose becomes joyous. The fanatical commercial- ism that has filled so much of our century-made art impossi- ble—so impossible that beyond one or two voices, raised to hysterical scream, no one dared to protest against it. The satisfaction of the art-instinct is now one of the most pressing of social needs.* The mental makeup which fails to see such prominent elements from a lack of historic perspective, naturally fails to associate facts in general experience from what it calls com- mon sense, really a mentally decrepit egotism produced by a rut. Man's two great faculties, walking and talking, are potentialities since he is born with neither, but has to learn both. He has greater potentialities to accomplish walking and talking than his ancestors who first learned both, but he still has to repeat their experience with the results which flow from introducing a new factor into an organism which dis- turbs the physiologic balance previously existing. Walking is one of the many"natural" functions which, introduced into the organism, have pathologic results. Pathologic, as Vir- chow points out, means simply a disturbance of physiologic balance previously existing, not nosologic (or disease) results. The physical disadvantages of the upright position markedly affect the reproductive apparatus of both sexes. The female disadvantages are well known, but to the male less attention is paid. Normal descent of the testicles as C. Moullin* points out occurs in the eighth or ninth month of fetal life, the left one first, the right shortly before birth. In *New Spirit. *Clinical Journal, Jan'y 17, 1908. 172 Jas. G. Kiernan. some animals the rule is the same. In highly organized mammalia, the testes never come down at all. In the major- ity they do not come down until the period of sexual maturity is approaching. In many they come down only during the period of sexual activity. For the greater part of the year they remain in the abdomen, and are comparatively insig- nificant in size. With each recurring sexual period they in- crease enormously in bulk and descend into the scrotum for the time. At the end of the period they go back into the abdomen and resume their former size and quiescent state. Here descent of the testes, increase in size and assumption of functional activity are simultaneous events regulated by the same cause. In man the same three events occur as in these animals, but not as a rule simultaneously. The testes de- scend before birth, while still retaining infantile proportions. Increase in size and assumption of functional activity take place later. The origin of this difference is due to the assump- tion of the erect attitude and consequent necessity for early closure of the inguinal canal. Clearly it would not be for the advantage of the race were the tunica vaginalis to remain widely open, leading vertically down from the bottom of the abdominal cavity, until sexual maturity had been attained. A tendency to the same condition occurs among the old world apes. The events are the same, only the time relations are altered. Every now and then an exception occurs. The vast majority of non-descents of the testes in man have nothing to do with any of these mechanical or allied causes. This is a persistence through childhood of a condi- tion, normal at a certain period of fetal life, and normal in certain animals. Development has been arrested, just as occasionally the development of the upper lip or of the palate is arrested, so that hare-lip or cleft palate results. The arrest may be complete. Here these testes retain throughout life infantile character, size and position, and never become functionally active, so far at least as the production of sper- matozoa is concerned. In a very few, development progresses to a certain point and then retrogression ensues. The testis in these cases develops normally and descends at the right Is Genius a Sport? 173 time, and then ascends again into the abdomen and stays there. In others again the arrest, instead of being complete, is only partial. In these the testes descend a variable dis- tance into the inguinal canal and sometimes become function- ally active, sometimes do not. And finally, development may be arrested for a time, and then, at puberty, begin again. Just when it is beginning to assume its adult proportions, in- creasing in size at an enormous rate, the testis in this boy is beginning again to move down towards the scrotum. Within a month it has already come down the whole length of the inguinal canal, and there is no evidence as yet that it has stopped. The testis behaves as it does in many animals, and in the way presumably it would have continued to behave in man, had not assumption of an erect attitude rendered earlier descent advisable for the good of the race. This renewal of descent occurs sufficiently often to deserve to be taken into consideration, and has a very important bearing upon the treatment. Given the case of a boy under 14 years of age with a testis in the inguinal canal, the treatment depends upon whether there is a hernia present or not. If there be a hernia and the child is over one year old the hernia must be dealt with and the testis with it. Such a hernia will not be cured by a truss. If it could not be prevented from coming down while the child was an infant in arms, thoroughly under con- trol, it is not likely to be prevented by the same means when the child is able to run about. Some other plan must be adopted, and the only other plan is operation. But if there be no hernia and there never has been a hernia, the testis should be left and be given the chance of further develop- ment. There are certain risks. The testis, while in the in- guinal canal, is always liable to injury. It may become twisted upon itself and strangulated. And there is always a potential hernial sac. The tunica vaginalis remains open in every case of undescended or partially descended testis. But so far as the testis itself is concerned the risk of injury or torsion is not very great, not sufficient to justify immediate removal, and the liability to hernia, under these conditions, is 174 Jas. G. Kiernan. not much greater. If no hernia came down during the first year of infancy it is not probable that any will come down during childhood. Two things are necessary for the descent of a hernia; one is a patent tunica vaginalis, and the other is a sufficient length of mesentery. At birth the mesentery is so long that the small intestine can reach the bottom of the scrotum, without any dragging. But after birth the length of the child's body increases so much faster than that of the mesentery that in a little while the bowel can scarcely touch the internal ring. The tendency, therefore, for the bowel to enter the inguinal canal steadily diminishes, and, as a matter of fact, strangulated hernia after infancy and before puberty is rare. Therefore, if no hernia has ever been down and the testis remains in the inguinal canal, it is worth while running the risk in the hope that at puberty when the testis begins to develop once more it may once more begin to descend. At puberty, if the testis be still in the inguinal canal and shows no sign of moving onward, something must be done. What this should be depends upon the condition of the testis. If it be well developed and the cord is of sufficient length, or can be made of sufficient length to allow of the testis being transplanted into the scrotum, this may be done with a rea- sonable prospect of success. There is some hope that such a testis will maintain its nutrition, perhaps grow still more and become functionally active. But if the testis still retains its infantile character transplanting it into the scrotum, suppos- ing it can be done, is of no use. The testis has not failed to develop because it is retained in the inguinal canal. It is re- tained in the inguinal canal because it has failed to develop, and it is absurd Moullin claims, to think that moving it on will make it develop. This is, however, too strongly put. The testicle perfect- ly developed may remain in the abdomen or may pass into the canal. Transplantation as A. E. Halstead has shown, may not only stimulate the reproductive function after sixteen years, but may likewise develop the tonic function. Back- ward children are sometimes stimulated in intellectual and physical growth by transplantation of the testicle. If the Is Genius a Sport? 175 testicle be, however, arrested both in structure and potential- ity transplantation is useless. The retained potentiality of tonic power and reproduction which is stimulated by the im- proved nutrition produced by change in place. The erect position while, as here seen, somewhat malign in effect has more than compensating advantages. “The greatest maai- festation of the new spirit that Havelock Ellis* knows of took place long since in the zoologic history of the race when the immediate ancestor of man began to walk on his hind legs, so developing the skillful hands and restless brain that brought sin into the world. That strange and perilous method of locomotion—which carried other diseases and disabilities in its train, more concrete than sin-marked a revolutionary outburst of new life worth contemplating. With these ad- vantages come the stages of uncertainty which threw such a pall of terror and suspicion over man as compared with his immediate precursors and in romantic love with the birds.t This uncertainty which London refers to the authropoid jumpers amid trees actually resulted from the erect position. Psychology in the normal adult attacked by uncertainty deals essentially with disturbances of the co-ordination con- stituting the “ego.” The “ego" oscillates between perfect unity, absolute incoordination, and the intermediate degrees, without line of demarcation between normal and abnormal, health and disease, the one trenching upon the other, or else it ceases to be. The “ego" is the cohesion for a given time of clear states of consciousness, accompanied by others less clear and by physiologic states which, though not entering into consciousness, are even more effective than the conscious states.ft Certain cortical areas exclusively connected with associa- ting tracts have little if any direct connection with the bodily periphery. Such cortical areas and subsidiary associating tracts, bound into the higher unity of the cerebral hemi- spheres, constitute the material substratum of the “ego.” Dis- turbance of the intricate relations involved in this is necessa- *New Spirit, p. XIII Prelace 3rd edition. * Finck, Romantic Love. tt Ribot, Attention. 176 * Jas. G. Kiernan. ** rily accompanied by disturbance of the “ego," or may render an "ego" impossible. On accurate connection of projection areas (passing outward to the periphery) with projection areas, and of these with "abstraction" areas, the faculty of logical corelation depends. Correction of the countless errors made during a lifetime is possible only by inhibitions, exer- cised by the association fasciculi. Correction with approach- ing maturity is delegated to the "abstraction” field, whose functions are ordinarily performed in an automatic manner.* Fatigue and other constitutional disturbances break up the associations constituting automatism. The individual then becomes actively conscious of the necessity of controll- ing conceptions constantly received from sense impressions. The factor assumed to secure balance between associations is termed will or volition. This final act of consciousness re- sults from a complex co-ordination of states, conscious, sub- conscious, or unconscious (purely physiologic), finding ex- pression in action or in inhibition. Volition is an effect, not a cause. Into the subconscious and unconscious factors enter the condition of various organs and the results of training. These last, at first conscious, as in the child's learning to walk, speak, be modest or cleanly, are finally transferred to the sub- conscious spheres and become automatic. The higher the mental state the greater the transference. The conscious mental processt indicates an imperfection of the cerebral organization and the presence of an unusual activity which deranges the equilibrium, the innate or pre- viously acquired automatism, and does not find a well formed mechanism ready to discharge it. It is the transitory phase between an inferior and a superior cerebral organization, ex- pressing novelty, incertitude, hesitation, growing astonish- ment, imperfect association and incomplete organization, slowness and inexactness in transmission, loss of tenure in the phenomena of reaction. The nervous paths are not distinctly enough traced to permit, without destruction in the final effect, reflex movements or reflex ideational sensations. The •Spitzka E. C. Jour. of New and Ment. Dis. 1878. †Herzen, Jour. of Ment. Science, 1887. Is Genius a Sport? 177 degree of the conscious mental process determines the amount of attention. Attention is hence comparatively slight in the ape, hereditarily defective child, and philistine, since the power of new ideas to create states of uncertainty depends on the presence or absence of preformed paths. The balance of the "ego" is disturbed when strains unduly obtrude the un- conscious or subconscious upon consciousness. The potentiality of the child passing through the period of stress constituted by learning to walk must affect his power of mental co-ordination and affect the Weltschmerz,(world weariness) of puberty. (TO BE CONTINUED.) Not RESPONSIBLE for the views of writers for the Alienist and Neurologist is the attitude of this magazine. It will sub- mit to its readers whatever is well and worthily presented. Only painstaking and fairly complete presentation of the author's subject is exacted of writers for its pages. Manuscript not accepted is not necessarily unfit, but un- available at the time. THE ALIENIST AND NEUROLOGIST. VOL. XXX. ST. LOUIS, MAY, 1909. NO. 2. Sudscription $5.00 per Annum in Advance. $1.25 Single Copy CHAS. H. HUGHES, M. D., Editor and Publisher. Editorial Rooms, 3858 W. Pine Boul. Business Office, 3858 W. Pine Boul. HUGHES & Co., Printers and Binders. This Journal is published between the first and fifteenth of February, May, August and November, and subscribers failing 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 mail matter. All remittances should be made to Chas. H. HUGHES. The Alienist and Neurologist is always glad to receive articles or photographs from subscribers or friends and material acceptable for publication. Manuscripts and photographs should be addressed to the Alienist and Neurologist and where their return is desired in case of non-acceptance, should be accompanied with an addressed envelope and sufficient postage. Any Comment, favorable or unfavorable, specifically set forth, is always wel- come from friend or enemy or any “mouth of wisest censure." EDITORIAL. | All Unsigned Editorials are written by the Editor.) “The Fetich op WORK AND ITS SANITATION."-Says Marion Ready of The Mirror, foremost among the literatti of St. Louis, from Reflections by T. K. H., whom we are quoting: “Work should not be a madness. It should be a joy. I have known what happiness is,' says Stevenson, 'for I have done good work.' What fools are men who work to-day and every day and put joy aside, saying they will have their joy later. They never have it. When they are ready to quit -1786 Editorial 179 their work, their work won't quit them. They have lost their capacity for joy. All such work, though, is false, for it is only greed masquerading as work. If a man loves work, he will get joy out of his work. * * * * * * There's nothing that will do the world more good than lots of loafing. Whit- man loafed and invited his soul. Thoreau loafed. Sir Isaac Newton was loafing when the apple fell on his nose. Watts was loafing when the kettle lid danced and gave him the idea of the steam engine. All the poets have been good loafers. I was reading Bolsche's life of Ernst Haeckel the other day. He was a worker but he mixed his work with joy, in his studies of the radiolaria and the medusae, by loafing on the Mediter- ranean. It was adorable—the way he got out of practicing medicine because he was pained by the suffering of the world, yet satisfied his sense of duty to his father's will that he should practice, by making his office hour between 5 and 6 o'clock a. m. Of course, it is wrong usually to shun contact with suffering, but not so much so when a man has in him such big performances as Haeckel's championship of Darwin, his ‘General Morphology,' his 'Riddle of the Universe.' Reading of Haeckel, too, I was struck with the vast futility of the work-madness about us, because it is not combined with imagination. Haeckel had imagination, though he is a Ger- man scientist. Darwin had it, else he had not made that vast sweep of generalization from things that so many men had seen before. Work with pleasure in it, work with imagination to assist, work that has an end and a beginning out of oneself- all these are good, but work for the mere sake of gain is folly and work that produces nothing valuable is a crime. Work has its value as an anodyne. Work is not wholly the curse the Bible says it is. Work is simply the thing for which our youthful play is a preparation, and normally it should give us as much pleasure as adults as the exercise of the play- instinct gives us as children. 'Blessed is the man who has found his work,' said Carlyle anticipatorily quoting Elbert Hubbard. So say we, all of us." There is a blessing in work-a physiological blessing. 180 Editorial CHEERFUL, CONGENIAL WORK converts the primeval curse into a blessing. “I will make his curse a blessing," said the Omnipotent one. Work sustains body and brain. “The curse of labor" becomes a blessing as the law of Nature demands. The human organism works mainly inde- pendently of the will as well as somewhat dependently. The intestines and the viscera, the heart, the lungs, the liver, kidneys, the skin, the lacteals, the internal secreting glands, the chyme and chyle forming organs, organs of secretion and the metabolic movements go on in their congenitally assigned work and when they cease action the machinery of life ceases to move and be. From of old it has been said“ the blood is the life," but action, movement, reconstruction is the life of the blood. When it ceases to move, the heart and vaso motors quit work and the blood stagnates, decomposes, microbic infec- tions get in their deadly work. It dies. Inaction is death to organic functioning. Life inaction would kill the central neurones that preserve their own autonomy by their selective power of reconstruction through assimilation and maintain through their organically or- dained work their existence and relations. But it is action, digestion and appropriation congenial to its natural endowment, that maintains the normal life of the neurones and the neurone centers whether in subliminal ganglion cells of the sympathetic system or spinal cord or in the higher center of the cerebral cortex where volition and thought reside. And here and elsewhere is the organism rightly adjusted normal action and rest, that is, alternate action and rest for repair suited to normal nerve center needs. In the human organism the subtle machinery of mental impression (movement) and expression (action—work) its cor- relative disintegration and physiological integration and re- pair are essential to life continuance. As the blood is helped back to the lungs by muscular move- ment, as the receipt and expulsion of air oxygenizes, decarbon- izes and replenishes the blood and the lacteal fluid poured into it for nourishment and the revivifying of the cells and the re- Editorial 181 building metabolisms, so the work within normal limits of vol- untary and involuntary vital organism gives physiologically agreeable satisfaction and life. Life is the physiological functioning of the cells, and work within physiological limits is salutary and to the higher centers of the brain it is sen- tiently pleasurable and satisfactorily reconstructive. THE AMERICAN SOCIETY FOR THE STUDY OF ALCOHOL AND OTHER DRUG Narcotics held a very successful meeting at Washington, D. C., last March. Many valuable papers from sources of large clinical and laboratory experience with the toxic disease engendering agent were read. It is well that the profession is telling what they know in public on the toxic power, disease and brain and body degenerating effects of alcohol. The power and baneful influence of this chemical criminal against the constitution of humanity should be clear- ly known to all who would consider this poison as a beverage. The New SURGEON GENERAL. Colonel George H. Tor- ney is now Bridadier and Surgeon General, Vice Robert M. O'Reilly, Surgeon General retired. Colonel Torney made an excellent sanitary reform record in San Francisco after the earthquake as Chief Surgeon of the department of California. The country and the army are to be congratulated on the accession of this worthy successor. KATATONIA IN RELATION TO Dementia Praecox, MICKLE is one of the several interesting and instructive articles in the January Journal of Mental Science. The January number is of special interest and value to our readers. Maudsley, Brown, Nolan, Reddington, Robertson, Thomas Johnstone are the other contributors to this number. All good reading. The Unpeeling Routine METHOD OP Medical Practice of some of the physicians we know, as if the patient were a dumb unquestioning manikin automaton, is responsible for some at least of the many converts to the mind cure, faith cure, Christian Science, etc. At a recent ministers' Evangelical Alliance meeting in St. Louis, a St. Louis divine gave his personal knowledge of a 182 Editorial psycho-therapeutic case of a certain man in Kirkwood,"given up to die by his physician," whom this preacher had visited. The minister repeated to him a few comforting passages of Scripture, then went again with other similar words. Again and again he saw the man, until finally he was convalescent. The suggestion was later made that he join the church, which he did. Something was evidently lacking in the medical manage- ment of such a case as this, both in the psychic demeanor and the physio-chemical therapeutics of the physician. This man needed a sustaining and sympathetic psychotherapy com- bined with right medical remedies. The little cold, mechanical, half-informed doctor in medicine has had his day. Psychology, neuro and psycho- therapy must become a part of all doctors' practice, as it has for all time been with the most successful. Sir Walter Scott's Amnesia AND THE Bride or Lam- MERMOOR.—That always interesting periodical, the Albany Medical Annals, organ of the Alumni Association of the Albany Medical College, has reproduced the record from Ballantyne's Narrative of the interesting mental states of the great British writer in connection with this tragic story: "The Bride of Lammermoor” (says James Ballantyne) “was not only written, but published before. Mr. Scott was able to rise from his bed; and he assured me that when it was first put into his hands in a complete shape, he did not recol- lect one single incident, character, or conversation it con- tained. He did not desire me to understand, nor did I under- stand that his illness had erased from his memory the original incidents of the story, with which he had been acquainted from his boyhood. These remained rooted where they had ever been; or, to speak more explicitly, he remembered the general facts of the existence of the father and mother, of the son and daughter, of the rival lovers, of the compulsory mar- riage, and the attack made by the bride upon the hapless bridegroom, with the general catastrophe of the whole. All these things he recollected just as he did before he took to his bed; but he literally recollected nothing else—not a single character woven by the romancer, nor one of the many scenes Editorial 183 and points of humor, nor anything with which he was con- nected as the writer of the work. 'For a long time,' he said, 'I felt myself very uneasy in the course of my reading, lest I should be startled by meeting something altogether glaring and fantastic. However, I recollected that you had been the printer, and I felt sure that you would not have permitted anything of this sort to pass.' 'Well,' I said, upon the whole, how did you like it?'—'Why,' he said, 'as a whole, I felt it monstrous gross and grotesque; but still the worst of it made me laugh, and I trusted the good-natured public would not be less indulgent. I do not think I ever ventured to lead to the discussion of this singular phenomenon again; but you may depend upon it, that what I have now said is as distinctly re- ported as if it had been taken down in short-hand at the moment. I believe you will agree with me in thinking that the history of the human mind contains nothing more wonder- ful.” To many of our readers this record is a familiar story, but to some of the many younger students of clinical alienism this important clinico-historical record of psychic autom- atism and subliminal consciousness will be interesting to remember. Hence we here record it. Records like this should be fresh in the minds of every student of forensic psychopathology. BODY AND MIND AND MIND AND BODY-A Sensible Clerical View.—It is refreshing in these days of "New thought” fallacies, Christian Science philosophy which is neither sound philosophy nor science nor truly Christian, and medical Emmanuelism, which is neither sound biblical preach- ing nor good medical practice, to read the following which we abstract from the editorial pages of the Christian Register. "The greatest advance which has been made in the last half century in the practice of medicine and in the treatment of the mind is in the recognition of the influence of the body over the mind and the way in which through the body, by improving its conditions, one can favorably affect mental operations and the spiritual atmosphere in which one lives. Every physical organ has its direct influence upon the mind. 184 Editorial. Each organ is related to a series of mental operations, senti- ments, emotions, moods, and capacities. The new science treats of these things and also of the part played by disease in any one of the organs, in its effect upon the mind and the astonishing benefits that may be secured by simple operations and the proper treatment of disease in the body. In no par- ticular in the history of medical science has progress been more marked and beneficial.”. THE OFFSPRING OF Divorce INCOMPATIBLES or matri- monial misfits, as the latter have been facetiously called, orphaned by the perpetual divorce mills, grinding not like those of the gods, exceeding small, but large and numerous, need better provision than is yet made for their rearing by the State. It is the custom of the courts to do the best they can under the embarrassing circumstances, by assigning these unfortunates to one or the other of the parents, when often, neither is fit to rightly care for them. When the parents are divorced, some better provision should be made for the ju- dicially orphaned. The State should provide for them some suitable psychical and physical orphanotrophy that would supplement the whilom maternal and paternal influence put asunder with the severing of the conjugal knot. There is too often something too radically wrong in the mental makeup of one or both parties to a divorce proceeding, to justify entrusting the moulding of the growing mind to either. And there are level-headed, stably neuroned widows in the land, and numerous enough, who would know how to love and rightly rear such children and take proper care of these little victims of the divorce evil in such divorced child's home. Such institutions and women might help to overcome inherent transmitted parentally bestowed neuropathic apti- tudes. As the present custom is, the children are not taken much into the count and yet they are the most important of the factors in a divorce proceeding. On them innocently falls most of the evil of parental mismating. QUESTIONS AS TO ALCOHOL IN THE HUMAN System.- In England in a controversy now going on between the Editorial. 185 brewers and scientific experts, this question of the saving relation in the human system of water alcoholization is ad- vertently recognized by the brewery interest through their representative, Mr. Edwyn Barclay, in the following question, “What is the general effect on the human system of a beverage containing a very low percentage of alcohol combined with a large proportion of easily assimilable carbo-hydrates and proteids? What is the specific effect of such very diluted alcohol so blended with neutral matter and in such connec- tion?" These questions, says The Hospital, raise issues of great interest; and clear answers to the questions, apart from all prejudice, are of importance to the whole community. In pursuance of this idea The Hospital has devoted a considerable amount of time and expenditure to its investigations into the subject. Three years ago it published an exhaustive report of its Special Analytical Commission on the History, Manu- facture, and Properties of Whisky and Distillery Spirits; two years ago it dealt with Light Wines in the same way; and it has now in the press, and will shortly publish, the report of its Special Analytical Commission on Beer. The medical profession, the Alienist and Neurologist in- cluded, awaits with deep interest the Commission's report, hoping especially for further light on the micro-neuroscopic, neuropathic and cerebro-psychopathic effects of this nerve center and general tissue poison. Precisely how alco- hol's well known vaso-motor effects are caused, how much through its influence on cerebrospinal fluid abstraction, how much is due to great amounts of alcohol's direct toxic power and precisely how the water in beer and wine modify nerve center damage as compared with the higher proof alco- holic drinks are questions physicians and especially alienists and neurologists are anxious to know. THE MEDICAL COLLEGES OF MISSOURI can be classed as the medical departments of endowed, or state supported, universities and those dependent upon their own financial resources. Three belong to the former class and seven to the latter. The Barnes Medical College belongs to the latter and 186 Editorial. by far outranks all the others belonging to this class, having a percentage of failures but little over one-third of the general average, and coming within three per cent and six per cent respectively, of getting as good results as the two medical de- partments of endowed universities belonging to the former class. The faculty justly expresses themselves as proud of these results. This statement is based on data taken from the re- ports of the different examining boards as found in the Journal of the American Medical Association. The Homes Commission Work and the attempt to sup- press it is the subject of just editorial comment in the Journal A. M. A. March 13th, 1909, the objection being that the report is too broad in dealing with the social evil, the most deadly of all evils save that of liquor excess. This is one of the best of the Government commissions. Its work and remedy ought to be known all over the country in order that the fire of venereal destruction may be extin- guished. Knowledge here is wisdom and safety. The Central American CHIGRE.—Since the question of the significance of rat Alees has come to the Marine Hospital Service in relation to the spread of the Bubonic plague, and the indictment holds good against the pulex pallidus we are prompted to call attention to the Chigre or Jigger of the Cen- tral and South American states (pulex penetrans.) This insect got into our editorial skin at Panama and burying itself deep, gave us much annoyance and discomfort and rodents for many months afterward. The killing of the mosquito and rodents may not be the only thing necessary to prevent the spread of yellow fever or of the Bubonic plague in tropical and semi-tropical countries. Physicians APPRECIATED OF OLD AND THE MORAL.- In the time of Hypocrates, who assailed superstition sug- gested health cures as we are doing to-day, sensible people gave physicians praise and the crown of honor, the right to eat at the king's table, sometimes salaries from the state of as much as $2000 annually in some instances and large fees Editorial, 187 for successful treatment, $100,000 dollars or more in some pri- vate cases. The Southern Practitioner calls attention to this. The moral of this is to cultivate sensible level-headed people of means as well as the worthy poor and do your best to understand and prevent or cure the diseases they may be inclined to or have and try to promote mental stability and the death of medical folly and fads among your community by showing successful safe management of the human machine in a rational scientific manner. Johns Hopkins Hospital PsychiaTRIC CLINIC.—The announcement of the gift of Mr. Henry Phipps of one million dollars for sustaining a psychiatric clinic connected with this institution is a handsome recognition of the growing apprecia- tion of this branch of medicine by intelligent laymen in this country. The CutS POR ILLUSTRATIONS appearing in this issue were made by the Knoxville, Tenn. Engraving Company. The cuts for many previous illustrations were made by the Clark Engraving Co. of Milwaukee, so that our work is done in different sections of the country and the New South has become financially reconstructed and rapidly taking her place in the industrial van with the other American states, as if the set back of civil war had never been. May all sections pros- per alike in the north and south and poverty never come to any section of our country and this land of plenty is the prayer of the Alienist and Neurologist. CONTINUOUS Counsel AND TREATMENT OF THE LIFE IN- SURED.—Dr. Burnside Foster, of St. Paul, in his interesting address as Chief Medical Examiner of the New England Life Insurance Company, which appears in our pages this month entitled “A Suggestion Concerning the Increased Longevity of Life Insurance Policies," has suggested to us the idea contained in the head lines of this editorial, viz.: that it would be a wise thing on the part of the life insured and of the insuring com- panies for the former to be kept more or less continuously under the medical observation and sanitary counsel during the life of the policy with a view to preventing intercurrent 188 Editorial. diseases and securing a chance for longevity directly to the individual assured. Another suggestion we would also make is that certain persons not perfectly well might safely be insured under arrangement for constant medical surveillance and hygienic management. Good risks might be taken under contract for right medical watchfulness of many cases now rejected, as of functional neurotic disorders, diabetes in the aged and over brain strained transient and remittant albumi- nuria in the psychasthenic, etc. Ier CONGRES INTERNATIONAL DE PSYCHIATRIE, DE NEUROLOGIE, DE PSYCHOLOGIE ET DE L'ASSISTANCE DES ALIENES, AMSTERDAM, 2-7 Septembre, 1907. Some extracts from the proceedings of this important congress will appear in this and subsequent numbers of the Alienist and Neurologist. PSYCHOPATHICALLY CURIOUS COURT VISITORS.--The so-called civilized world is made up of the level-headed, stable- brained sane who, like Job, preserve their rational integrity of mind and maintain propriety of conduct under all circum- stances, even the most adverse, the insane who act strangely even under normal environment because disease impels them to bizarre conduct and speech, the insanoids who do and say queer things which we laugh at or censure if we understand them, because though they are not perceptibly insane, that is not so much diseased in brain as the real lunatic, those who know how to diagnose them, know them to be not quite right in their heads. Then there are the born idiots from whom no one expects anything but foolishness of speech or conduct-idiotic con- duct—they are built that way and cannot help it. Then there are people who are neither insane nor idiotic, who act like both to the confounding of psychology. They are neither normally circumspect of speech or of conduct. They use their brains as though they were psychic cripples. Among these are the extremely curious—the rubbernecks of court trials, especially who think nothing in this world should happen and hardly in the next, that they are not permitted to see or hear about and some can not wait on the course of na- Editorial. 189 ture to take them to the undiscovered bourne. This class includes, as in the Lemp case and the late Thaw case, the pruriently inquisitive, the uneasy with lascivious desire to know all the particulars of every matrimonial misfit or conjugal faux pas revealed in divorce trials. They dote on the lasciv- ious details of an unhappy conjugality as others do on the de- tails of horrible murders. They have been neglected of education and self-control training in line of the proprieties of life and conduct. Fake CURB(?) OP INSANITY.—It is well known to experi- enced alienists that the majority of first attacks of insanity self recover under changed environment, rest and so little therapeutics that many insane hospital chiefs administer noth- ing beyond suitable laxatives, the removal of possible sources of psychic irritation and timely hypnotics, leaving to time, with the patient thus environed, to do her perfect work in cure. The newspapers, too often unintentionally favoring quackery, record the recovery of an inmate of a New York County Hos- pital for the insane who had been for months therein being prepared by absence from the environing cause of insanity, through hypnotic treatment. The young man, aged twenty- three, after this preparation for recovery at the asylum had ten hypnotic treatments within as many weeks and recovered. It is not uncommon for patients so managed to recover after a certain time without hypnotic treatment. But the last man who comes in contact with a "mind finding itself" whether that man be an outside regular physi- cian, a faith or mind curist or hypnotist, gets the credit from the public of bringing about the cure which nature accom- plishes, for insanity is often thus self-limited. The real clinical fact about hypnotism and insanity is that the really insane cannot be hypnotized. They are too much self-cen- tered with their delusions. Their thoughts are too introverted. When a hypnotist cures insanity the insanity is already past and nature has brought the patient to a stage in con- valescence when recovery is already begun. An attempt at hypnotism then might not prevent recovery from going on some, while it might and certainly would in some cases arrest 190 Editorial. convalescence or cause relapse in others. The folly of an hyp- notist trying his art of influence and suggestion upon a mys- tically obsessed lunatic or upon a paranoiac, manic depres- sive or maniac is sublimely absurd to one who knows some- thing of the nature of psychopathy as seen in the asylums. But when convalescence has come after the lapse of its ending or psychic remission time then any influence that might attract the attention of the recovering patient, help to draw out his already expanding but lately inverted self-consciousness, may appear to cure though it be only the last incident in the completion of the impending recovery in the “life whereof our nerves are scant” enough in resistance under life's stren- uous exactions. A St. Louis PHYSICIAN in High POLITICAL Position.- It is gratifying to note that Doctor John Fremont Hill, of Augusta, Me., the new appointee to the position of vice chair- man of the Republican National Committee, is the son-in-law of Norman J. Colman, of No. 5499 Delmar Boulevard, St. Louis, a member of Grover Cleveland's Cabinet. Doctor Hill has been a frequent visitor at the Colman home since his marriage to Mr. Colman's daughter, Mrs. Laura C. Liggett, in 1897. Aside from having been Governor of Maine for four years he is a physician and publisher, owning the list of periodicals known as the Vickery and Hill magazines. Doctor Hill's appointment to succeed Frank H. Hitch- cock came as a result of a long personal friendship with Judge Taft. The more good and capable and financially independent physicians seek and hold office the better it will be for the wel- fare of all of the people and for the good of the profession also. Medical men know of popular needs as well as lawyers, finan- ciers, merchants and farmers, and in some respects more than they all. A MAY Day for INAUGURATION Day would be a salutary change and sanitary reasons for the change from March the fourth ought to have great weight. The March days are prolific of malaria, pneumonia, rheumatism, colds and mental Editorial. 191 and nervous depression. The sun does not shine much in early March over the Capitol City. Better change the presi- dential inauguration provision of the American constitution to conform better to the human constitution and select a day in May for the great event. There are some good reasons against the change that were more cogent ones than now when the date was fixed by our forefathers, but the sanitary reason is the paramount one now for abandoning March the fourth for the day of Presiden- tial inauguration. INDIVIDUAL Non-Roller Towels.—A sanitary idea strikes a Legislative Solon in Missouri in a measure to require individual towels for all hotels and rooming houses and the daily airing and washing of these and the sheets, blankets and pillow cases. The outer or upper sheet must be nine feet long. The latter clause is rather long drawn out unless in- tended for a race of giants. A state inspector to see that this law is enforced is provided for in the bill of this sanitary Solon, though it is a good provision against cold feet if a factory can be found that will make sheets and blankets of this exceptional size. Notwithstanding the unique sheet length clause in this bill its other provisions are good. It is worthy of commenda- tion from a sanitary point of view if for no other reason than that it aims to abolish the disease and death breeding and dirt disseminating roller towels. Its provisions ought to apply to the Pullman Palace Car Company whose heavy, almost unwashable and too seldom washed blankets, portiers and window curtains ought to be substituted by more porous and lighter asbestos cloth draperies. This bill has been facetiously called the bed sheet bill. It ought to be termed the hotel germ extinguisher bill. A PROFESSIONAL REBUKE PROM HIPPOCRATEs.--Dr. Abraham Jacobi, in a recent address giving his conception of the Modern Hippocrates (New York State Medical Journal, March, 1909), quotes the elder Hippocrates of Hellas as fol- lows: “Disputes among doctors cause disrespect of the whole art among the people so that they begin to doubt the reality of the medical art." 192 Editorial. The wise admonition of the wise old sage of Cos has not yet been heeded as it ought to be and the doubters are four- ishing with their disbelief in everything. Wonderful “scien- tists” are springing up about us-Christian Scientists—who. though they eat and sleep and clothe themselves by art, seek to persuade themselves and others and for substantial fees, that there is nothing substantial in disease or its cure. Dis- ease and its cure with them differs from hunger and the need of housing and clothing in being merely “a misconception of mortal mind." Can OPSONIC Estimates Be Relied UPON IN Practice? is the question E. C. Hart asks and discusses in the British Medical Journal concerning the Wright School, which he says must be reckoned within clinical medicine, but that it is doubt- ful whether opsonins represent more than a fractional part in the highly complex machinery of immunity production. Granted that they are the important factor in immunization, the question as to their reliability is still open. Technical considerations of standardization of emulsions, cultural diffi- culties, agglutination questions, etc., concern only those ex- perts whose responsibility it is to render such technicalities as free from sources of error as possible. They do not affect the practicing physician, whose only concern is with the pertinent questions of reliability and cost. As regards cost, everyone knows that it is necessarily high. As to reliability, countless observations have been reported in which the estimations have appeared to be of the highest value in diagnosis and determin- ing treatment. But such experience is not universal even when securing the best talent among the exponents of the opsonin theories. There appears to be a growing conviction, says the author, that except possibly in the hands of an ex- tremely small band of experts, the method is not of the general utility with which it has been credited. “Since the IMMORTAL Rush Rested from his labors, vast progress has been made and vaster still is making in the management of the drink habit and in the treatment of the drink disease. Facts which but a few years ago advanced observers, like Morel, Magnan and the few neurologists of Editorial. 193 their time, first took note of, touching the hereditary trans- mission of neuropathic instability and dipsomaniacal ten- dencies through ancestral alcoholic excesses and vice versa have not only passed into the possession of the profession generally as practical knowledge, but have become largely the mental possessions of the people. Crothers and Marcy and Happel and a host beside have added medical testimony yet more convincive.”-From Dr. C. H. Hughes' presidential address before the Section of Diseases of Mind and Nervous System, Pan American Medical Congress at Washington, D. C., Sept. 7th, 1893. Eighteenth Century Conception Of TUBERCULOSIS IN Venice is thus editorially presented by the New York Medical Times incidental to a discussion of Dr. Chas. L. Dana's letter on Medicine in Venice to the New York Medical Journal of last year. “There must in other eras than ours have been among the Venetians some dim intuitions at least, of the nature of tuberculous infection. The Italian anatomists Morgagni and Valsalvi, for example, had some idea of the infectivity of phthisis. And laws were made at the instance of the latter, which no doubt well reflect a good understanding of the sub- ject by the Italian people of that time. And when in 1754 the sanitary magistrate of Florence asked for an expert opinion from the Florence Medical College upon what articles would most likely be infected by a consumptive, and what means were best for their purification, Antonio Cocchi advised, in terms which would seem not at all anachronistic if set forth in an International Congress on Tuberculosis to-day. In 1760 a special hospital for consumptives was erected in Olivuzza, into which were moved such patients from other hospitals, in order that they might not spread the infection. In Naples edicts of like tenor were promulgated, albeit the punishments prescribed would appear to us a trifle drastic, as: "Regarding physicians who do not reveal the nature of the illness (consumption), they shall undergo a fine of 300 ducats. for the first offense, and for the second ten years exile.' That in fectivity was well comprehended in Rome and that phthisi- 194 Editorial. ophobia, however, is not an essentially modern development, is evidenced in a letter to a friend which Chateaubriand wrote from that city, relating the death (from phthisis) of Madame de Beaumont: 'I am in a great difficulty. I had hoped to get 2,000 crowns for my carriage, but, by a law of the time of the Goths, phthisis is declared in Rome a contagious disease; and as Madame de Beaumont rode two or three times in my carriages, nobody is willing to buy them.” “BABINSKI ON Hysteria."--A preceding issue of the Alienist and Neurologist had an interesting translation by Dr. Chaddock, of St. Louis, of Babinski on Hysteria and here is the very pertinent comment of The Hospital on the sub- ject, Jan. 23rd issue. Dr. J. Babinski has contributed an important and highly interesting article to La Semaine Medi- cale on the subject of hysteria. The main theme of this con- tribution is that the traditional use of the term hysteria has led to much confusion in the diagnosis and treatment of neuro- pathic conditions, and he seeks to define clearly what morbid conditions fall properly under this heading, and what should be excluded. He points out in the first place three principal causes which have led to an excessive extension of the term hysteria beyond its proper application. In the first place mistakes have been made in diagnosis by which organic affec- tions have been interpreted as hysterical. This fact is readily recognized by all neurologists, and requires but little com-- ment. Thanks to certain definite signs which have been dis- covered in recent years, and by which neuropathic conditions of organic origin can be detected and differentiated in the initial stages, such mistakes are much less frequent. In the second place hysteria has been confused with fraud and simulation. The author points out the difficulty of distin- guishing these two conditions in many cases because the phenomena simulated may be identical with those produced by the subject of hysteria. The difference lies in the mental attitude, which in the one case is conscious and voluntary, in the other case unconscious or subconscious. So far, the author's arguments conform to usually accepted views and present no point of contention. It is under the third head- Editorial. 195 ing that he strikes out on a somewhat new line of thought. He contends that under hysteria different nervous conditions have been included which ought to be distinguished from one another. He differentiates three kinds of nervous phenomena which have received the appellation “hysterical,” but which, he contends, are separate and distinct, and should not there- fore be brought under one common denomination.-The Hospital. President Taft POR A Health BUREAU.—The efforts of the alienists and neurologists and other influences are likely to meet with the final fruition. Surgeon General Walter Wy- man, of the Public Health and Marine Hospital Service, has been requested by the President to draw up a tentative plan for the consolidation under one bureau of all the agencies exercised by the Federal Government for the preservation of the public health. Upon the suggestion of General Wyman and other promi- nent physicians, the President will base what he has to recom- mend in his message to Congress next fall regarding the matter. Such a reform would touch at least four of the executive departments very closely. These are the Treasury, under which the Bureau of Public Health and Marine Hospital Service now operates; the Department of Commerce and Labor, which has much to do with isolation and other phases of treatment of contagious diseases in connection with im- migration; the War Department, under whose supervision all the sanitation and preventive work has been done in Panama and the Philippines, and the Department of Agriculture, which, through the Bureau of Chemistry and its food in- spection, is a tremendous agency for the general health. This is the most important move of his administration up to date. This is a wise and far reaching move for the welfare of our country. It ought by taking just account of and pro- viding measures for psychical and physical hygiene and sani- tation to contribute to maintain and improve our strength as a nation strong and worthy of perpetuation. - 196 Editorial. LATERAL Knee Jerk is a phase of Westphals”, knee sign observed occasionally by the editor of this Journal on which phenomenon he would ask more light from his confreres in neurology. One case recently of psychasthenia, profound neuras- thenia, symptoms of a neurotic, insomniac with a history of long antecedent but no latent syphilis, suggests the question. Will some one answer. Patient appears recovered except the anomalous patellar reflex phenomenon. XVITH INTERNATIONAL Medical CONGRESS from the 29th of August to the 4th of September, 1909 meets at Budapest under the patronage of His Imperial and Apostolic Royal Majesty. Address: Budapest (Hungary) VIII Ester- hazy-Utcza 7. All present indications point to a scientifically successful and socially enjoyable meeting. We hope to see many read- ers of the Alienist and Neurologist there and look forward with pleasant anticipations for ourselves. The Austro-Hungarian people are hospitable and the medical profession there fill a high place in medical and popular esteem. AMERICAN MEDICO-PSYCHOLOGICAL AssOCIATION.-The Sixty-fifth Annual Meeting will be held in Atlantic City, New Jersey, Tuesday, Wednesday, Thursday and Friday, June 1, 2, 3 and 4, 1909. Headquarters will be at the Marlborough- Blenheim. An interesting program is already assured. Reduce A. M. A. Dues to three dollars and get in more young practitioners. SEPARATE the A. M. A. Treasurership from the Secre- taryship. The work and responsibility of either is enough for one man. Reduce the price of advertising to physicians, sanitariums, health locations etc. Serve the profession first, make money incidental only. Editorial. 197 Ex-PRESIDENT Roosevelt has undertaken a risky sort of relaxation for his time of life, his North American acclimatization and the strenuous mental life he has so lately been subjected to in the Presidential office with his neuro- psychic propensity to over-brain tax and its possible neuras- thenic sequence. A home rest in the seclusion of some of our Northern or Western mountain fastnesses would have promised better for him sanitarily than in the wilds of Africa, to say nothing of the dangers of the ptse fly and of the African malarial mosquito and hematuria. CORRESPONDENCE. LETTER OF A CONVALESCING PSYCHASTHENIC MYSOPHOBIAC. To show the fading out of the phobia of contamination. “Dear Doctor Hughes: I think I have been getting along very well, that is, as well as usual and when I left St. Louis till the last few days I am getting very little sleep and dream most of the time when I do sleep. Twitch and jump after going to bed too. I have worried over trifling foolish things more than usual to-day and have had a pain which starts in the back of my head and extends up and over, my head is very hot and my feet very cold, more so than usual the last few days. I am awfully thin at present, but don't mind that if it is just as well for me. I enjoyed myself in Chicago much more than here, but was on the go so much of the time while there that I guess I over did my nerves as I was so exhausted all the time. No danger of the like happening here as this is a small place and consequently I go but very little. Have not any desire to go and if I do don't.” "P.S. I almost forgot to add that I am very constipated when without medicine for my bowels. A. P.” Extract from a letter from a convalescing mysophobiac. Recovery of these cases is rare. My cases have as a rule abandoned my treatment and progress to more positively recognized forms of insanity or to suicide. It will be observed that this patient makes no reference to her phobia of contamination, but mentions the fact of “trifling annoyance." In treating these cases it is a part of our psychotherapy to never take the initiatory in reference to their special fear or -1984 Correspondence. · 199 "mania” as it is sometimes erroneously called, though we ourself years ago offered the term mania contamination in discussing a case of verdiphobia in a patient who, from a be- ginning fear of paris green on potato vines, came to fear everything green, green carpets, window shades, table covers, wall paper, etc., and finally died insane. These cases usually begin with psycho-neurasthenia, as both of the cases I am here referring to did, engrafted on an inherent neuropsychopathic endowment. I have never seen a person with the filth dread malady who was not at least somewhat insomniac and neurasthenic, though they have revealed neurasthenia less markedly than the ordinarily nervously exhausted who consult or are brought to the alienist and neurologist. C. H. H. LEGAL PsychoLOGY AND PSYCHIATRY second interna- tional course was held at Giessen (Grandduchy of Hesse) Germany, April 13 to 18, 1909. The course was under the direction of Professor Sommer with the co-operation of Pro- fessors Mittermaier and Dannemann of Giessen and Professor Aschaffenburg of Cologne. SELECTIONS. CLINICAL NEUROLOGY. The PsychIC AND ADAPTIVE IN DIGESTION.-The March Colorado Medicine has the following pertinent words to say on this subject: Every subject in medical science moves on apace, and that of digestion is not a laggard in the universal procession. While the historic researches of Beaumont laid the broad foundations of our knowledge of gastric digestion, a good superstructure has been evolved only within recent years by the remarkable work of Pawlow, Cannon and others. No longer can the digestive secretions be studied in vitro alone, but under vital conditions as well. Pure chemistry does not open up all of their secrets, potencies or eccentricities of behavior. There is a vital, a“psychic" element, as Pawlow puts it, which is the dominant note in their activity. As he well says, “the psychology has in many cases displaced the physiology of digestion.' For instance, if a foreign substance like sand be intro- duced into the mouth of a dog, it is followed by the secretion of an unusually large amount of a very watery saliva, to aid in the speedy removal of the sand. A similar effect follows the introduction of acids, salts or bitter substances, and for the same purpose. But if food is placed in the mouth, a thick, mucoid saliva of digestive power is poured out, adapted to aid in mastication, deglutination and digestion. The drier the food is, the greater will be the inpour of saliva-a striking proof that the first of the digestive glands adapts itself to the character of the food. Now by contrast comes in the psychic element–i. e., if we pretend to throw sand into the dog's mouth, a watery -200— Selections. 201 saliva pours in; if food, a slimy saliva. . Thus through the eye or sense of smell—in other words, the mind-the salivary glands are differently influenced in their work, and their out- put in quantity and quality is different. So with the gastric juice, each kind of food calls forth a particular activity of the gastric tubules, with a gastric juice of special properties. Thus the juice poured out on bread has the greatest digestive power; that on meat, less; and that on milk, but half of that for bread. This variation in the percentage of free HCl and pepsin is no less remarkable than that in the quantity of gastric juice and the duration of its secretion. Sham feeding (feeding a dog food which escapes through an artificial esophageal opening) leads to a copious secretion of gastric juice. The amount of this will vary with the agree- ableness of the food and will be equally marked when a hungry dog is even tempted by the sight of food (the psychic juice.) The adaptive power or instinct of the pancreas is even more noticeable, because of the four distinct enzymes the pancreatic juice contains, namely, steapsin, acting on fats; trypsin, acting on proteids; amylopsin, acting on starch, and rennin, curdling milk. Merely tempting a dog with food causes a speedy secretion of this juice. A meal of starchy character increases the per- centage of amylopsin; of proteid, the percent of trypsin; of fat, the steapsin. The bile, according to Pawlow, is only discharged freely into the small intestine by fats and digestive proteids—the food-stuffs only upon which bile normally exerts a digestive effect in connection with the pancreatic juice. The succus entericus seems to be the only one of the digestive juices uninfluenced by psychic stimuli. The adaptive power, outlined above, of the various digestive juices is one of the wonderful and inexplicable phenomena of our bodily workings and is calculated to arouse the wonder and interest of the student of digestion. The state of the brain and mind has much to do with apepsia and dyspepsia in normally as well as abnormally acting stomach. 202 Selections. Long before Pawlow, Amariah Brigham, an American alienist and neurologist, covered this ground and more and presented the brain origin of this disease. The Pathogenesis Of Tabes DORSALIS, By Tom A. Williams, M.B C.M., (Edin), Washington, D.C. (Read by in- vitation before the Philadelphia Neurological Society. Pub- lished in full with illustrations, American Journal of Medical Sciences, Aug., 1908.) Controversy as to the pathogeny of tabes has not ceased since Duchenne surmised its sympathetic origin, and Charcot later supposed it to be a posterior column dystrophy, similar to that of Friederich's ataxia. His great authority prevented due attention to the researches of Obersteiner and his follow- ers until the memoir of Redlich appeared in 1896. The dis- coveries as to the syphilitic etiology of tabes caused greater attention to the work of Nageotte, who in 1894 had indicated the constancy of lesions on the radicular nerve at the point where it receives its meningeal sheaths. These lesions corre- spond to one or other stage of the granulomatous process, varying as they do from simple round cell infiltration, to granuloma, and even breaking down with formation of cavi- ties. They are due to primary chronic meningitis, evidenced by the lympho-cytosis found on spinal puncture during life, and post-mortem when skillfully looked for; although the tendency of the process to resolution and fibrous tissue forma- tion leaves only a slight thickening in the membrane already fibrous by nature. (See illustrations from Nageotte in Am. Jour. Med. Sciences.) The changes in the cord are consecutive to this. That this is so, is proved by similar changes of the posterior column after disease or experimental section of individual roots, and by the change occurring in the mechanical affection of the radicular nerves due to the increased intraspinal pressure caused by the growth of cerebral tumors. The noxa falls upon the root fasciculi very disparately, and this corresponds to the disparate nature of the sensory troubles, which do not preponderate so much as formerly Selections. 203 supposed upon the fibres which subserve the sense of attitudes and of muscular movement; for it is now definitely shown that cutaneous sensations are always involved more or less, though probably later in the disease. The superficial lightning pains described by Gowers and the psychometric analysis of the sensibility of tabetics by Vaschide are an index to this; while the researches of Head enable us to explain the modifications in terms of deep, protopathic and epicritic sensibility. The fibres subserving the life of internal relation may differ morphologically from those subserving external relationship, as contended by Pierre Bonnier with particular reference to the eighth nerve, the principal posterior root, where the cochlear portion, whose function concerns the outside world, is affected only rarely, while the vestibular portion, concerned with intrinsic rela- tionship, is involved very commonly indeed in the tabetic process. However this may be, it is certain that impaired sense of attitudes is always accompanied by impairment of the deep pain sense and of perception of the vibrations of the tuning fork by the bones, and as these functions are conveyed in the same peripheral path, while they are separated within the cord, clinical evidence is in entire harmony with the pathogenetic theory advanced by Nageotte. The data fur- nished by the optic nerve symptoms are similarly best ex- plicable by a meningeal affection, involving in this case not a posterior root, but a homologue of an intra-spinal path. The tabetic symptoms referable to the sympathetic do not differ from those produced by experimental section of the spinal roots, nor from those in syringo-myelia, which, how- ever, attack the cell bodies in the intermedio-lateral column. Charcot's negation of changes in the sympathetic is effectively disproved by the researches of Roux, who found the medul- lated fibres markedly decreased in tabetics. The anterior roots are not unaffected; but the relative absence of serious myopathies early in the disease is accounted for by the rapid regeneration of the fibres. This is shown by the “terminaisons en croissance" exhibited by Nageotte's preparations and by the results of section experiments. The 204 Selections. regeneration of the posterior root fibres extends only to Red- lich's ring, at which they lose the neurilemma sheath. Finally, evanescent lymphocytosis and reflex iridoplegia, the two most characteristic signs of tabes, are found in many cases of syphilis without other tabetic symptoms; indeed, both some- times occur in the secondary stage, the former in as many as forty per cent. The contention of Babinski and Nageotte is, therefore, accepted that a chronic syphilitic meningitis is responsible for what has been called tabes dorsalis, and that it was formerly disregarded on account of the tendency to the occurrence of resolution and fibrosis of the lesions. The practical application of this conclusion is of the greatest importance in the treatment of the disease. Cases taken early may be completely arrested, and in all cases the active manifestations may be resolved if adequately treated before the destruction of the noble elements has occurred, though naturally the residues of former exacerbations cannot be removed. Author's ABSTRACT. 2118 Wyoming Avenue. PERSONAL Experience in THE STUDY OF DISEASE. - Seneca's account of his own sufferings from angina pectoris is classical. He was not a physician, by the way, although, like one or two of the fathers of medicine, something of a physicist. For the best illustrations of the subject under notice one must consult the more recent literature of migraine. This disease is known to affect especially intellectual people, and furthermore the predominance of its symptoms over its physical signs makes the anamnesis peculiarly valuable. In point of fact, a host of medical self-observers have left records. Abernethy remarked humorously (as humour went then) that during hemianopia from this cause he could see no more of his own name than the “knee" (ne) and the “thigh” (thy). Other names are those of Fothergill; Parry, of Bath, perhaps the first discoverer of exophthalmic goitre; Airy, who intro- duced the term teichopsia, and was the son of Sir George Airy, the astronomer, likewise a sufferer from, and writer on, mi- graine; the French pathologist Lebert; and Wollaston. Du Selections. 205 Bois Reymond based upon his own symptoms a study of the pathology of the cervical portion of the sympathetic. From migraine to gout is not a long step, and Sydenham's personal experiences probably inspired not only the graphic description of its acute form, but also his testy remark on the diet appro- priate to it, that “more importance is to be attached to the desires and feelings of the patient ... than to doubtful and fallacious rules of medical art.” Self introspection has had a place, too, in the study of asthma. Separated by an interval of a hundred years, the asthmatics Floyer and Bree ad- vanced two of the principal theories of its causation now cur- rent. Trousseau's asthma used to wake him at three o'clock in the morning; he collected similar instances of periodical recurrence of this affection and others allied to it. When the malady studied happens to be very rare, like the myotonia which Thomsen suffered from, its possessor and observer occupies a position of peculiar authority, as also in such a case as that of Hack, who, having an empyema of his maxillary antrum, and being a rhinologist to boot, obtained a distinct advantage, in one sense, over fellow workers—an advantage which he turned to good account. But even in quite common complaints extreme familiarity has proved of service. The elder Mr. Weller's dictum as to the association of width with wisdom is borne out by Cheyne's aphorisms on obesity, although hardly by the cases of Bennet, Andrew Clark, Gran- cher, and the great Laënnec—all of them authorities on tuberculosis and themselves tuberculous. Self-knowledge in a bodily sense may indeed have been the starting point of research in many a case quite unsuspected. Had not he himself made no secret of the fact in his lectures, no one would have known that a certain distinguished living investigator used to suffer from a low degree of blood-coagulability, and also another abnormality which had an even greater share of influence on his work.—The Hospital. DYSBASIA ANGIOSCLEROTICA (intermittent limp, from induration of the walls of the vessels), caused by excessive smoking.-Erb, in 1904, showed that of 38 men who suffered 206 Selections. from dysbasia angiosclerotica 10 were heavy smokers and 15 were enormously heavy smokers; so that 25 smoked to excess out of a total of 38. In 14 of these cases excessive smoking was the sole etiological factor; all other causes, such as syphilis, alcohol, diabetes, etc., being excluded. Simon records a case of dysbasia angiosclerotica in a man aged 64, who had not had any severe strain, had not been unduly exposed to the weather, had led a quiet life, had not had syphilis nor any serious illness except cecitis eight years previously, but who had smoked thirty strong cigarettes daily since the age of 19; he had inhaled and swallowed the smoke. The patient complained of heaviness and weakness in the legs, headache and cardiac disturbances. The radial arteries were hard, tortuous, and sclerosed, and the pulse was of high tension. The heart was not dilated; the second aortic sound was accentuated; pulsation in both arteries of the left foot was entirely absent, and was absent in the posterior tibial, and only feebly present in the dorsalis pedis of the right foot. Evidence of this nature shows that the excessive use of tobacco excites arterio-sclerosis in the arteries of the legs, and thus causes intermittent limp. It is true that many heavy smokers are not affected in this way, but their escape from arterio-sclerosis does not prove that other heavy smokers will be equally fortunate. Some families display a tendency to arterial sclerosis. If such a tendency exists, it is un- doubtedly developed by the abuse of tobacco.-Canadian Journal of Medicine and Surgery. RAYNAUD's Disease AND Uric Acid as presented by Gilbert in his excellent text book on “Uric Acid and Its Con- geners" in the organism is of sufficient interest and value to justify the following reference abstract which should have been included in our review of this excellent book. This subject is introduced in the chapter on “Some Usually Un- recognized Conditions" which we commend as a whole to our readers, especially to the general practitioner. After dis- cussing Raynaud's discovery and Haig's uric acid theory and Rosewater's case of lithemic gangrene which he details and summarizing Rosewater's case, Gilbert thus concludes: Selections. 207 “The case reported by Rosewater, together with several others cited by Haig, fairly demonstrates the fact that oc- clusion of the capillaries (generally at the venous end) by urates, may prevent the return flow of blood from the poorly vascularized extremities, and give rise to the production of the same series of objective symptoms, as would follow from a ligature of the part. The normal interchange between blood and tissue cell is interrupted; and, if the obstruction is complete and permitted to remain long enough, the cell lan- guishes and dies in the midst of its own excreta-i. e. gan- grene results. But if the obstruction is only partial, we get the usual signs of temporary ischaemia, cyanosis, erythemae. “The fact that other uricacidaemic signs are invariably present; that the ingestion of purin foods and drinks speedily aggravates the local condition; and that withholding further introduction into the system of such foods and drinks, taken in conjunction with the employment of anti-uric-acid treat- ment affords speedy relief, would seem to furnish satisfactory clinical evidence of uratic origin of this affection. Indeed, from a theoretical standpoint as well, the established physio- chemical facts are sufficiently abundant to warrant the classi- fication of Raynaud's disease among some usually unrecog- nized uric acid conditions." CLINICAL PSYCHIATRY. ALCOHOL AND Psychic DISEASE IN THE ARMY.-We transcribe to endorse the following from the Military Surgeon. In an interesting paper in the Deutsche Militararztliche Zeit- schrift, Stier concludes, as the result of extensive investiga- tion, that the danger of alcohol in the production of psychic disease is very grave. Military authorities should absolutely prohibit the use of alcoholic beverages by soldiers, for alcohol enfeebles the body, invites disease and clouds the intellect. JUNE and December, The Suicide MONTHS. Sunshine and Age in relation thereto. There was a marked augmenta- tion in the number of suicides in New York last year, the in- 208 Selections. crease over the five-year average being 151. As the problem of suicide is only another of the questions now relegated to the medical profession, the physician should have some gen- eral idea as to the conditions underlying suicide throughout this country. In McClure's Magazine for June, 1908, Mr. George Kennan has a most interesting article on the“Problems of Suicide,” and as he is always painstaking, it may be as- sumed that his figures are the most reliable now obtainable. "When we consider the fact that more than ten thousand persons take their lives in the United States every year, that more than seventy thousand die annually by their own hands in Europe, and that the suicide rate is constantly and rapidly increasing throughout the greater part of the civilized world, we are free to admit that the subject is one of the utmost gravity. In 1881 the annual suicide rate of the United States was only 12 per million of the population, and our total num- ber of suicides was only 605. Last year our suicide rate had risen to 126 per million, and our suicides numbered 10,782." There are various problems of suicide which call for spe- cial attention. It has been shown by Dr. Oscar Geck, of Strassburg, by Durkheim of Paris, and Gubski of St. Peters- burg, that, contrary to general belief, June is everywhere the suicide month, and December the month where self-destruc- tion is at its minimum. “Spring and summer are the suicide seasons, not only among the closely related nationalities of Europe and the United States, but among the ethnologically alien people of the far east.” Also the clear, dry days show the greatest number of suicides, and the wet, partly cloudy days the least. There is probably a psychologic reason for this in the fact that everybody at these seasons appears to be happy, except the would-be suicide, and there seems to him no hope for a share in that happiness; hence, he ends his life. Another curious feature is, that in times of war or of any great calamity, such as an earthquake, where people are drawn together in friendly sympathy, the suicide rate is always lowered. As one would naturally suppose, there is a steady increase in the suicide rate in all countries, with advancing age. These statistics would seem to support the pessimistic Selections. 209 philosophy of Schopenhauer, and to prove that the longer one lives, the less one wants to live. “The question of what can be done to lessen the suicide tendency and check this great waste of human power and energy, brings me,” says Kennan, “to the only important cause of self-destruction, which seems to me removable, and that is newspaper publicity.” The in- Auence of suggestion, after reading details of a case of suicide, is all potent with many. An epidemic of suicide broke out in the summer of 1901 in Emporia, Kansas. Mayor House issued a proclamation as follows: “I have consulted the Board of Health, and if the Emporia papers do not comply with my request, I shall have the right to stop, and stop summarily, the publication of these suicide details, under the law pro- viding for the suppression of epidemics. I believe the liberty of the press is not to be considered before the public welfare, and that the courts would sustain me in using force to prevent the publication of newspapers containing matter clearly dele- terious to the public health.” The Mayor's position is prob- ably an impregnable one. At any rate, there is no doubt that suggestion, as derived from newspapers or books, is a decisive factor in influencing the despondent to take the final plunge. Sane Suicides are more likely to be committed by the aged in whom the illusions of a once happier life have vanished and to whom life's solitariness, the pain of disappointment and poverty, of progeny dead, ungrateful or neglectful or morally gone wrong have made their sad and mind perverting im- pression and shocked the organism into vital depression. THE Nickelodeon.—The magazines of the country have recently devoted a considerable amount of space to the dis- cussion of the 5 and 10-cent moving picture shows, “nickel- odeons,” and much has been said of the effect they have on the receptive youthful mind. From a medical standpoint the effect of vivid portrayals of fantastic happenings, catastrophies and crimes upon the youthful mind is one of interest. We all know how strongly realistically these subjects are set forth, and what an intense impression they make, sometimes even upon adults. The in- sidious effect upon childish spectators is in many instances 210 Selections. bad. The impressions are more lasting than many think and the ultimate effects not easily perceived. Yet quite often the pictures shown are educational in a high degree and accom- plish much good. We, of course, cannot say how much of actual crime is traceable to the moving picture shows but we believe their influence cannot be entirely bad. Children should not be allowed to indiscriminately patronize this style of entertainment, though we really believe when one comes right down to a common sense view of the subject he will admit that good predominates here as almost everywhere else. A doctor recently dropped into one of these shows and, while seated waiting for the performance to begin, his atten- tion was drawn to a youth who entered and took a seat near him. There was an unmistakable appearance of feeble- mindedness on the youth's countenance, though he wore work- ing apparel and evidently was employed in some occupation that brought him in contact with his fellow-men. The study of that young man's expression as a picture was flashed upon the canvas showing a criminal at work was interesting in the extreme. His eyes bulged, his mouth worked convulsively, at times his nervous restlessness would cause him to half rise from his seat in a very ecstasy of emotion. He was evidently greatly moved by the vivid scenes and with difficulty re- gained his composure. Here the doctor saw a menace that was a real one. The effect upon that immature being was anything but wholesome. Crime might easily follow one of his visits to a show of that kind. We are indeed interested in the effect of these things upon the human mind and cannot too soon point out what evil there may be. But no matter how much we protest against our children and our weak-minded citizens patronizing this form of amusement they will continue to seek their pleasure as they see fit. The only real solution it seems would be by legislative restriction of the character of pictures that may be made. Here some good might be accomplished, and we need not interfere further in a business that affords so much of real pleasure to the masses and at so moderate a cost.- --Abstract from editorial by L. A. C. in the Medical Fort- nightly. Selections. 211 Two St. Louis boys confessed to having robbed a safe under moving picture show suggestion. They said the pic- ture show made it look so easy.—ED. DEMENTIA PRAECOX AND THE SYRIAN AFTER THE STRAIN of Modern CivilizATION.-Dr. H. Thwaites in the Journal of Mental Science writing on Dementia Præcox and Mental Degeneracy in Syria says: “The youth suffering from dementia præcox is one con- genitally deficient, he enters upon his life struggle badly equipped because devoid of, or with diminished, physical feeling, he cannot sustain the life of the brain at his own level of civilization, far less so at the relatively high level which he may have to face, and the flickering flame dies out. The latter fact is well illustrated in returned Syrian emigrants from America. In the past year twenty per centum of the admissions to the Lebanon Hospital belonged to this class, and their form of disease was a precocious dementia. “Is it, then, possible to trace any cause for so serious a lack in the mental condition of the average Syrian? In the individual we may read the history of his race; his mental condition is the accumulated result of past influences brought to bear upon his germ plasm, and it is to these influences which have constituted the environment to which we should turn for the primary and efficient factor in the production of diseased states. “Looked at in perspective, the history of Syria reveals certain influences always at work, which make us infer an underlying connection between cause and effect in the re- sulting mental type now under consideration. “The annals of the country show almost continuous subjection to foreign rule; yet there was a time when Syria was for the Syrian, and we may conclude from the Bible records that at that time the standard of civilization was high, and the prevailing mental type in no way inferior. “The Phænicians, at least their closely related neigh- bors, for many centuries we know were one of the foremost peoples in the world, and particularly in the realm of action; but from the time that the Syrians became servants of the Hebrew King David to the present day, they have been a 212 Selections. dependent race and have been forced to put up with condi- tions imposed upon them by their rulers, with the result that independence of spirit has been stifled, and acquisition checked or suppressed in every department of mental activity. It is true that the Arabs for a time infused new life into the people, but such influence was short-lived and lost itself amid the supineness of the Turkish regime; and now art is almost unknown, science has few ardent followers, philosophy makes no progress, remaining content with past achievements, and religion amongst the Mohammedans is of a non-productive type, and among Christians, in the place of the birth of Chris- tianity, is mostly a system of fetichism without the intelligent application of inner principles. The mental life of the masses is of a hand-to-mouth order consisting mostly of simple sense impressions, and with so little traffic between higher and lower centres that badly formed association tracts are inevit- able, and limited mental capacity with paucity of ideas the rule. But the worst feature is that psychical feeling, or con- sciousness, or the vis a tergo, or whatever you may prefer to call it, is bound to suffer, and in extreme cases ceases to exist. It is inefficiency of environment then which has been the responsible factor in producing the type of brain wanting in a fundamental principle, and the lack persisting has become focused in posterity as endemic degeneracy. Whole neigh- borhoods, villages, and districts suffer rather than individuals here and there, and a vicious circle has become established which time and radical social reforms alone can alter. The individual born with a constitutionally defective brain enters an environment which tends to foster and increase his defect. Without psychical feeling he ceases to be aggressive, the higher attainments are lost, and soon he retrogrades still further, and suffering from encroachments upon consciousness itself he permits himself to be governed by subconscious states, and shows it by his automatic, stereotyped, or negativistic con- duct; he would revert to a purely animal existence were it not that past achievements cannot be completely obliterated. The wreckage of a once conscious organism must perforce in clude the debris of consciousness, and so we find the curious Selections. 213 medley of intelligent and automatic phenomena which go to the make-up of the full clinical picture of dementia præcox." EARLY AND MIld Cases Of Mental DISORDER.--A very good outline of suggestion for the general practitioner who is “numerous” among our readers is the following editorial in The Hospital, London. That the mental state varies with the bodily health and vigor has been noticed from the earliest times. The severity of the variation ranges from the delirium and hallucinations accompanying specific fevers and other acute toxic conditions, to the morbid emotional feelings and wandering attention which accompany sometimes even a mild cold in the head. Bodily fatigue, too, will disturb the mental state. Shortness of breath due to running will so compel the attention to the action of the heart and lungs as to render for the time being serious thought on outside topics difficult, if not impossible. The same effect is seen in severe organic disease of the heart and lungs. Besides physical causes, there are others which are purely mental. Any emotion, even mild- ly felt, may bias our intellectual faculties, and if it be strong enough to break down the inhibition supplied by the intellect, will upset the mental balance. Fatigue of the higher intel- lectual centres from overwork or“worry," although the effects of these are noticed but little or not at all by the patient, may cause profound mental variation. The mental effect pro- duced depends to a large extent on the idiosyncrasies of the individual. One will become delirious with quite a slight fever or intoxication, another not with a severe one: the emo- tion which will drive one to distraction leaves another quite unmoved. To assign causes for an attack of mental disorder is seldom easy, and often impossible, even by one who has known the patient intimately. The earliest symptoms of mental dis- ease are not, as a rule, recognized by the friends; indeed, the attack is often far advanced before it is realized or admitted that anything is wrong. Very frequently, when friends are pressed to give the earliest date that mental symptoms were noticed they name one, and then add, “In the light of after- 214 Selections. events, however, we now see that before this,” etc. Friends, too, are often loth to own that the trouble is mental and in- sist on it being a "nervous breakdown;" questions in these cases as to previous mental history are promptly scorned as displaying ignorance or a bad diagnosis. In a large number of cases all that can be said, .after careful inquiry, is that such and such factors had some bearing on the ætiology. These factors, however, must be carefully sought, as the correction or removal of them will be a most important point in the treatment. When, in practice, mental symptoms are suspected or found in a patient, three main difficulties arise: first, to make certain of the kind and extent of the symptoms; secondly, to gauge their seriousness; thirdly, to judge how best to deal with the case. These difficulties are, as a rule, greater in mild and early cases than in those of a more pronounced character. Amongst the earliest symptoms usually noticed may be mentioned: eccentricities of conduct, change of temperament (depression or excitability), loss of interest in home or business affairs, changes in ideas of economy, impaired power of con- centrating attention, alteration in emotional tendencies (especially religious), insomnia, loss of memory, and altera- tion of feelings towards relatives and friends. Though the appearance of any of these symptoms may not mean an attack of mental trouble, yet when any of them persist a careful examination of the mental state should be made, together with an attempt to discover the cause of the change. It must not be forgotten that the patient will often conceal his true feelings and sensations, control his temperament, and have his attention unduly stimulated whilst talking to a stranger. As a rule, however, if the examination be prolonged, the most prominent symptoms will be elicited. When the symptoms have not far developed, it may be impossible for the medical man to say for certain that the mental state is altered from the normal unless he has intimately known the patient previous- ly; evidence of others is then essential to the correct judgment of the case. In gauging the seriousness of the symptoms special atten- tion should be paid to several points. Are there any signs of Selections. 215 impulsiveness? If so, do they occur frequently, and in what form? Impulse may be mild, childish, and easy of control; or may be serious—even homicidal—and controllable by no effort on the patient's part. Suicidal tendency, however mildly displayed, demands special note. Changes in the more elementary habits/e. g. personal cleanliness—are of impor- tance, showing changes in early developed centres. Refusal of food may be a serious symptom requiring special attention. Any tendency which, if not corrected, may conduce to the moral or physical harm of the patient, or those around him, must be looked on as serious. • Here is where the advice and treatment of a clinically experienced psychiatrist is needed. Casualties come from prodromal insanity and chronic mental aberration, if these cases are not wisely managed. How best to deal with an early case depends to a large extent on financial circumstances. When these permit and the symptoms are mild and harmless in character, complete change of air and scene, and removal from business, home, or other circumstances which have been present during the commencement of the attack, with a congenial companion who has good influence and control over the patient, may be all that is necessary. Quietness is usually best. Rushing round sight-seeing, travelling from place to place, and “cheerful society," are rarely to be recommended. Fresh air and occu- pation of body and mind is the ideal. Should the symptoms be at all serious, more supervision may be necessary. A capable mental nurse (who has been trained for mental cases) should be obtained, and the question of certification will have to be kept in view. When means are limited, the problem of early treatment is a difficult one; but it should be remem- bered that if the case hangs fire for long or gets worse, early certification and removal is better than late. TIMIDITY AS A Factor in Psycho-NEUROTIC CONDITIONS (Le ROLE DE LA TIMIDITE DANS LA PATHOGENIE DES Psycho- NEUROSES). (Rev. de l'Hypnotisme, January, 1907.) Beril- LON, DAMOGLOU, ETC. Havelock Ellis also gives the follow- ing interesting analysis of this author and subject. 216 Selections. Berillon considers it an astonishing fact that few recog- nize how often timidity is at the basis of all psycho-neuroses. He regards the intimidated person as in a state psychological- ly analogous to that of a hypnotized person. Blushing or pallor are the vaso-motor signs of a real shock which cannot fail, if often repeated, to have an overbalancing or depressing influence on the central nervous system. Berillon's inquiries among a very large number of patients for some years past led him to believe that nearly all the subjects of hysterical and neurasthenic troubles are affected by timidity before their disorders begin, apart from the fact that in a considerable proportion of cases the appearance of a neuropathic affection is directly connected with some act of intimidation of which the patient has been the victim. In such cases the affection resembles the traumatic neuroses in prognosis and duration as well as in symptoms. Education and social environment are the chief factors in the development of timidity. In countries like America and Switzerland, where there is much social equality, timidity is comparatively infrequent. It is very frequent in France, where there is a marked social hierarchy. For the same reason it is extremely common in England (as well as among Ameri- cans of English origin), and no country produces so many cases of the phobia of blushing as England. Damoglou, who occupies the same standpoint as Berillon, follows with a paper on “Timidity in the East.” Here the social conditions are very favorable for the production of timidity, which has become a kind of hereditary and endemic disease. Inferiors are in a perpetual and exaggerated state of timidity before superiors, and the young in the presence of the old. Damoglou considers that this has had a disastrous result in paralyzing the will and asphyxiating the social life of the peoples of Turkey and Egypt. Many years have past since the editor of this journal maintained that psychic timidity was a chief essential of neurasthenia and a prelude to and accompaniment of the phobias of psychasthenia.-Ed. Selections. 217 RESISTANCES AND RETARDATION IN BRAIN-WORK (Wieder- STANDE UND BREMSUNGEN IN DEM Hirn). (Arbeit Psy- chiat. Klinik zu Wurzburg, H. 2, 1908.) Reiger, C. Dr. Rieger has made some careful experiments to meas- ure the relative time in which mental processes can be per- formed. Using the ordinary divisions of minutes and seconds, he divided the last into sixty parts, which he calls tertians. He used a watch graduated with twelve tertians, five in the second. He arranges his letters, words, and sentences into staccato and legato i. e. single and connected. A letter looked at alone takes longer time to write than as the component of a written or printed word. He observes that it is astonishing how little the particulars which go to- gether to make up a view of a landscape, or the letters of a page are noted. Unconnected words take longer time than when they flow in an intelligible sentence. Sixty letters can be read in legato in a second if the sentence is easy; longer words take more time than shorter words unless the latter are uncouth, and from ten to eleven are read in the second. Copy- ing the alphabet in the usual sequence is quicker work than from “z” to “a,” also copying or reading a sentence when the meaning is easy. The sense should be grammatical but need not be logical. Twelve words can be counted in the same time as a hundred words are read; some letters take double the time to write than others; this gives an advantage to the typewriter, who can do each letter with one tap. One can write two letters staccato and four legato in the same time. To write a word in the usual way can be done in half the time than if the letters are written wide apart. The general result was that intentional separation of the natural flow of letters, words, or sentences takes longer time as it costs more effort. Rieger pursues the same kind of inquiry into the appre- hension and naming of outer objects and with the same re- sults. The mind habitually classifies and arranges what is seen, throws the objects into groups, passes over some par- ticulars and rests upon others. What interrupts or disjoints this process costs more effort and more time. 218 Selections. It would be curious to measure the utterances in the flow of staccato words which we often have in maniacal delirium in which the usual association of thought is so utterly broken.-William W. Ireland, Jl. Mental Science. The PsycholOGY OF DEMENTIA PRAECOX (Uber die Psychologie der Dementia Praecox. By C. G. Jung. Halle: Carl Marhold, 1907. Bernard Hart thus discusses this author and subject in the July Journal of Mental Science: This book is the result of an attempt to apply the psy- chological principles worked out by Freud for hysteria and the obsession-neuroses to the sphere of dementia præcox. The investigation is carried considerably deeper than the purely clinical work of Kraepelin, and deeper even than the method which Janet has applied to hysteria and psychasthenia. The latter really attempts little more than to determine the mode of reaction, what we may call the “form" of the mentality, whereas Jung seeks to explain the actual content of the hallucinations, speech, actions, etc. The keynote of the work is its strenuous opposition to Neisser's view that the laws of normal thought have no appli- cation in the mind of the patient suffering from dementia præcox. The author endeavors to show that the psychologi- cal mechanisms at work in these two cases differ only in de- gree. There can be no question that the realization of the truth of this point of view, together with recognition of the fact that chance plays no part in the words and actions of a lunatic, is of enormous importance for the future of psychia- try. Jung's main thesis is that the symptoms of dementia præcox are due to the existence of “complexes” or systems of ideas possessing a strong emotional tone. It will be seen that this corresponds precisely to Freud's conception of the nature of hysteria, and a chapter of the present book is in fact de- voted to a consideration of the numerous points of resem- blance between hysteria and dementia præcox. But whereas the former is mobile and removable the latter tends to be fixed and progressive. The differences between the two diseases Selections. 219 may be summed up as follows: In hysteria the complex leads an independent existence and lessens the amount of mental energy at the disposal of the personality, but sufficient re- mains to enable the individual to adapt himself to the needs of his environment. In dementia præcox, on the other hand, the complexes ultimately dominate and distort the personal- ity, so that the individual and his environment finally become altogether incongruous. In the third and fourth chapters the effect of the com- plexes on the personality is worked out in detail, and the origin of neologisms, stereotypes, negativism, etc., is thereby explained. Considerable use is made of association experi- ments, which are already familiar to English readers through Jung's papers in Brain and the Journal of Abnormal Psy- chology. The final chapter contains the detailed analysis of a case of paranoid dementia præcox, as an illustration of the method of research employed. The whole work is extraordinarily illuminating. It is difficult to predict to what extent Jung's avowedly tentative conclusions will ultimately be substantiated, but that they point to an extremely fruitful line of research cannot be doubted. They have been subjected to considerable criticism on account of their dependence upon certain of Freud's doc- trines, which have not been generally accepted. But the author has carefully defined his precise relation to Freud, and points out that he has only adopted well-grounded psy- chological principles. In any case the validity of Jung's work is by no means entirely dependent upon that of Freud. It may be confidently asserted that the book constitutes one of the most considerable contributions to the progress of psychia- try which has been made of recent years. 220 Selections. FORENSIC PSYCHIATRY Las Nuevas TEORIAS DE LA CRIMINALIDAD. By C. Bernaldo de Quiros. Madrid: Hijos de Reus, 1908. Pp. 258, 8vo. Havelock Ellis makes the following interesting transla- tion and comments in the Journal of Mental Science. Follow- ing up his excellent little book on the special features of Spanish criminality, the author now puts forward a treatise on the wider aspects of criminology with reference to the most recent theories. It is based on an earlier and slighter work published ten years ago. Dr. Näcke writes an introduction in which he remarks that Senor Bernaldo de Quiros has here produced a book which is a complete summary and an im- partial criticism of the new theories of criminality, worthy to be translated into all the chief languages of Europe. Näcke is so energetic an antagonist of Lombroso that his approval is at all events proof that the book is not too partial to the famous Turin professor. It is, however, interesting to see that Näcke here admits that Lombroso has at least performed two services: he has taught us to occupy ourselves with the personality of the criminal and not merely with his criminal act, and in the second place he has made admirable sugges- tions alike for the prophylaxis of crime and the treatment of the criminal. These surely are no mean services. Bernaldo de Quiros divides his work into three long chap- ters: the first on criminology, the second on penal law and penal science, the third on scientific police methods, the chap- ters being divided and sub-divided in a clear and methodical manner. In the first chapter, after tracing the history of criminology, he deals with the three great innovators, Lom- broso, Ferri, and Garofolo, and discusses the main criminol- ogical theories, anthropological (i. e. atavistic, degenerative, and pathological) and sociological. The second chapter, after setting forth the three main channels of influence in penal matters, the traditional current, the movement for re- form (Liszt, Hamel, etc.), and the radical movement for the abolition of punishment except in so far as it is necessary for the treatment of the criminal and the protection of society, Selections. 221 discusses in detail the various questions involved in the treat- ment of the criminal. The third chapter, which is much the shortest, is concerned with the methods of identification, etc. The author concludes that the new movement for the study of the criminal unquestionably represents a real con- quest of the scientific spirit; its simultaneous and independent appearance thirty years ago in three different countries (as represented by Lombroso, Benedikt and Maudsley) sufficed to show that it was a natural and spontaneous movement, and it is now becoming definitely accepted. Lombroso's name is properly associated with this movement, as Beccaria's name was with the earlier criminological movement, not on account of any special value in Lombroso writings, but because of "the fertility of thought in this field which he has produced throughout the civilized world;" it is owing to Lombroso's initiative that the vast army of workers now in the field, even those most opposed to his special ideas, have been set to work. In regard to the treatment of the criminal, the author believes that the day of quantitative punishments is nearly over, and that in the future qualitative measures will prevail; this is the outcome of a movement which began with Beccaria. Society must exercise a public guardianship over criminals in which punishment, as such, has no place. The question of respon- sibility will gradually cease to have any significance; whether a criminal's action was due to free will or determination makes not the slightest difference in the need for controlling and treating him, any more than it does in the case of a diseased person. Bernaldo de Quiros writes with a wide knowledge of the literature of his subject and in a calm and impartial spirit. He naturally devotes special attention to conditions in his own country, and he shows that, just as Spaniards were the pioneers in the rational treatment of the insane six centuries ago, so they have also to-day been pioneers in advocating the rational treatment of criminals. Dorado, whose name is still almost unknown in England, deserves special mention in this connection. 222 Selections. MEDICO-LEGAL PSYCHIATRY M’NAGHTEN, LIKE Hadfield and Bellingham, was a delu- sional lunatic. His delusions were of the persecutory type; he believed that he was harrassed by enemies, and, including Mr. Drummond, the private secretary of Sir Robert Peel, among these enemies, he had shot and killed him in the street. He was successfully defended, and was acquitted on the ground of insanity; but the verdict was unpopular, and the House of Lords, responsive to popular criticism, addressed a request to the judges for an authoritative statement of the law on the subject of insanity as a defense for crime. The prisoner was tried in 1843 (10 C1. and F. 200). The evidence was that M’Naghten was suffering with “morbid delusions,” and that persons so suffering "might have a moral perception of right and wrong, but that, in the case of the prisoner, it was a de- lusion which carried him away beyond the power of his own control, and left him no such perception; and that he was not capable of exercising any control over acts which had con- nection with his delusion; that it was of the nature of the disease with which the prisoner was affected to go on gradual- ly until it had reached a climax, when it burst forth with irresistible intensity; that a man might go on for years quietly, though at the same time under its influences, but would all at once break out into the most extravagant and violent paroxysms." The above is the statement of M'Naghten's case, as sub- mitted to the House of Lords. It is to be noted that it is a clear statement of a case of delusional insanity; only in skele- ton outlines, to be sure, but still giving the essential points in such a case. It meets the question of right and wrong, and disposes of it. It also claims that such lunatics have no con- trol over their delusions. This is practically true; but it is not equally true in all cases. Lunatics vary in this respect, but in a criminal act by a delusional lunatic the inference is that he was controlled by his delusion. In M'Naghten's case this was the vital scientific point-i.e. the fact that he was con- trolled by his delusions; not the question whether he had the Selections. 223 ability to distinguish between right and wrong in the abstract, or even in the concrete. With reference to his particular act, however, his moral perceptions were doubtless obscured by his delusion. Lord Chief Justice Tindal, in his charge to the jury, had said: “The question to be determined is whether, at the time the act in question was committed, the prisoner had or had not the use of his understanding as to know that he was doing a wrong or wicked act. If the jurors should be of opinion that the prisoner was not sensible at the time he committed it that he was violating the laws both of God and man, then he would be entitled to a verdict in his favour; but if, on the contrary, they were of opinion that when he committed the act he was in a sound state of mind, then their verdict must be against him." M'Naghten had been found“not guilty, on the ground of insanity”—a righteous verdict, legally and scientifically worded. But the case was brought up for discussion in the House of Lords, and on June 19, 1843, a series of questions were propounded to the judges, as follows: “Ist. What is the law respecting alleged crimes com- mitted by persons afflicted with insane delusion in respect of one or more particular subjects or persons, as, for instance, when, at the time of the commission of the alleged crime, the accused knew he was acting contrary to law, but did the act complained of with a view, under the influence of insane de- lusion, of redressing or revenging some supposed grievance or injury, or of producing some supposed public benefit?" “2nd. What are the proper questions to be submitted to the jury when a person alleged to be affected with insane delusion respecting one or more particular subjects or persons is charged with the commission of a crime (murder, for exam- ple) and insanity is set up as a defense ?" "3rd. In what terms ought the question to be left to the jury as to the prisoner's state of mind when the act was committed ?" “4th. If a person under an insane delusion as to existing facts commits an offense in consequence thereof, is he thereby excused?" 224 Selections. “5th. Can a medical man, conversant with the disease of insanity, who never saw the prisoner previously to the trial, but who was present during the whole trial and the examination of all the witnesses, be asked his opinion as to the state of the prisoner's mind at the time of the coinmission of the alleged crime, or his opinion whether the prisoner was conscious, at the time of doing the act, that he was acting contrary to law, or whether he was laboring under any, and what, delusion at the time?" Stripped of redundancy these questions mean simply this: 1st. What is the law respecting the alleged crimes of delusional lunatics? 2nd. What is the question at issue when a delusional lunatic commits an alleged crime? The third question practically repeats the second. The fourth question practically repeats the first. The second question also very nearly repeats the first. There probably never was a series of questions embodying one simple point of inquiry clothed in such redundancy and reiteration. The point at issue simply was—What was the English law, in 1843, con- cerning delusional lunatics who committed crimes under the influence of their delusions? This was the point of inquiry, and this point of inquiry, one would suppose, was the proper and only one to be submitted to the jury with reference to the case on trial. But in striving after refinements of definition, this simple inquiry was obscured in a crowd of involved in- terrogations, which, when analyzed, can mean only one thing namely, What is the English law respecting delusional lunatics who commit crimes? The fifth question was entirely apart from the main inquiry, and referred merely to the privilege of an expert giving his opinion on the evidence at the trial. 14 The answers given by the judges to these questions sug- gest the suspicion that both the questions and the answers were devised by the same mind or minds. They are written in the same redundant and involved style, and the same pre- conceived opinions are apparent in them. The answers of the judges, delivered by Lord Chief Justice Tindal, who had presided at the trial of M'Naghten, embodied the following opinion. A delusional lunatic is responsible if he knew"that Selections. 225 he was acting contrary to law. ... That to establish a de- fense on the ground of insanity, it must be clearly proved that, at the time of the committing of the act, the party accused was laboring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing, or if he did know it, that he did not know he was doing what was wrong." And this knowledge was further qualified as pertaining, not to the abstract, but to “the very act with which he is charged;" and then certain refinements were made as to the prisoner's knowledge of the “law of the land," which the law presumes all men to have. A delusional lunatic“must be considered in the same situation as to responsibility as if the facts with respect to which the delusion exists were real." That is, if the lunatic kills another man in supposed self-de- fense, even though acting under a delusion, he is exempt; but if his delusion is that the other man has simply done injury to his character and fortune, he is liable to punishment.-The Hospital. INSANITY AS A DEFENCE IN THE CRIMINAL Courts—III. - In the case of Rex v. Offord (5 C. and P. 168) in 1831, Lord Lyndhurst charged the jury that they must be satisfied that the accused “did not know, when he committed the act, what the effect of it, if fatal, would be with reference to the crime of murder. The question was, did he know that he was committing an offence against the laws of God and Na- ture? He then referred to Bellingham's case, and agreed with Lord Mansfield's opinion. Offord had delusional in- sanity of a most confirmed type, believing that the inhabi- tants of Hadleigh were in league against his life. Under the influence of these delusions he would abuse strangers in the streets; and he carried a list of about fifty names, entitled “List of Hadleigh conspirators against my life." He shot and killed a man named Chisnall, whose name was on this list. He was acquitted “on the ground of insanity." The two cases of Bellingham and Offord present a striking example of the inconsistency of the law. Both these men were delusional lunatics of exactly the same type; for they 226 Selections. both suffered from delusions of persecution, which render such lunatics the most dangerous of all the insane. The jury in each case was charged in practically the same language, and yet Bellingham was hanged and Offord was acquitted. In the next case of importance, however—that of Reg v. Oxford (9 c. and p. 525)—a distinct advance came about by a proper scientific statement of criminal insanity. Lord Chief Justice Denman charged the jury: “If some controlling dis- ease was, in truth, the acting power within him, which he could not resist, then he will not be responsible." This was an unexceptionable statement from a scientific standpoint, and it is unfortunate that it was not allowed to stand without further elucidation. It would have constituted an exemplary definition for all future ages, and would have been to the ever- lasting credit of the distinguished judge who uttered it. But Lord Denman, with that tendency to refine and elaborate which is so characteristic of the legal mind, did not seem satis- fied that it exhausted the law of the subject, for he continued : The question is whether the prisoner was labouring under that species of insanity which satisfies you that he was quite unaware of the nature, character, and conseqences of the act he was committing: or, in other words, whether he was under the influence of a diseased mind, and was really unconscious, at the time he was committing the act, that it was a crime." He also used the expression whether "he was insane at the time when the act was done; whether the evidence given proves a disease of the mind, as of a person quite incapable of distinguishing right from wrong." It is evident all through this charge that Lord Denman's mind grasped the central idea—the essential issue in all such cases—and grasped it much more clearly than any of his pre- decessors had done. He reverts again and again to the simple question whether the prisoner was "insane.” It was only when he attempted to qualify that question with the consideration of the“knowledge of right and wrong" and of the “knowledge of the nature of the act” that he spoiled a good definition, and lost a great opportunity. That the jury saw the point, however, is evident from the fact that they found Oxford “not guilty, on the ground of insanity." They did Selections. 227 not find that the prisoner did not know the difference between right and wrong, or that he did not know that it was a crime to shoot at the Queen, for their common sense must have told them that he probably knew both these things. But they took Lord Denman at his word, and found merely that Oxford had a “disease of the mind." NEUROPATHOLOGY. EXPERIMENTAL MYOCARDITIS.-Fleisher and Loeb (Archiv: Int. Med., Feb. 15, '09), after reviewing the various experi- ments calculated to produce myocarditis, such as injection of pathogenic germs or their toxins (particularly diphtheria toxins), give the result of their experiments, which were large- ly with adrenalin chlorid either alone or in certain combina- tions. They found that when spartein sulphate or sodium benzoate were injected, alone or together, no changes in the arteries or myocardium were produced. If they followed it with adrenalin the animal (rabbit) showed myocardial de- generation in from 10 to 14 days in almost every instance, and in a less number of cases showed also changes in the aorta and arteries. The myocardial change seemed to be the essential lesion and consisted in general of the following: Hypertrophy of the muscle fibers, with increase in the number of muscle nuclei and indistinctness of cross striations; increase in the connectivə tissue with apparent edema between the muscle fibers, and degenerative changes affecting the muscle fibers, especially. later. The typical seat of the lesion, in the left ventricle near the auricular ventricular groove, tends to confirm the sug- gestion that the excessive strain of the heart muscle is at least one of the factors in producing the changes. Such hearts were shown to be functionally inferior to normal hearts. The authors think that this easy and certain method of producing myocarditis experimentally may prove of value in determin- ing the correlation between the activity of the heart and the function of certain other organs under pathologic conditions. --O. M. G. in Colorado Medicine. 228 Selections. Myristic Toxicity.-Cushing in the British Medical Journal reports on Wallace's cases of nutmeg poisoning in America from crude nutmeg or mace that it does not appear to have an abortifacient action. Lobelius relates the case of a woman that was rendered delirious by nutmeg. The symp- toms are drowsiness, stupor, diplopia and delirium and some- times ushered in by burning pain in the stomach, precordial anxiety and giddiness. One boy died after eating two nut- megs. The symptoms resembled those caused by cannabis indica. The poison is contained in the oil of nutmeg, chief of. which is myristicin. He concludes that the symptoms were due when shown in depression, excitation to action on the central nervous system. The oil also had a marked local irritant action, whether given by the mouth or hypodermical- ly. The stomach wall was red and injected; the urine often fibrinous. PSYCHIATRY. IMPROVEMENT IN HOSPITALS FOR THE INSANE.—Dr. E. E. Southard discussing the possibilities of public institutions in the Boston Medical and Surgical Journal notes that many of these hospitals have shown a most gratifying activity within the past few years, to the manifest advantage, not only of their special object of study, but to that of medicine at large. A recent step has been taken in this state of much significance to the cause of progress in the appointment of Dr. E. E. Southard, of the Harvard Medical School, and of the Danvers Hospital staff, to the position of pathologist to the state hos- pitals for the insane. Dr. Southard's admirable equipment for this work, together with his recognized capacity for organ- ization, is assurance of the benefit which is to result from the establishment of this position. More important even than this is the promise such an appointment gives of the completer utilization for medical study of the opportunities which we already have in this and other similar institutions of the U. S. AN IDEALISTIC ANALYSIS.-Paul Mantagazza under the caption Idiogamy (Zeitschrift f. Sexualwissenschaft, Vol. Selections. 229 1, 19:18, No. 4) attempts a psychical analysis of this subject which Dr. Brill gives in an abstract translation in the Journal of Nervous and Mental Disease. The author appears as ideal- istic and self introverted in this analysis as an old time mental philosopher, but nevertheless has reasoned out many interesting features of the psycho-erotic life of man. "By idiogamy the author understands a complete or almost complete sexual impotence with all women except with one's wife or with some definite women. A strong young man of no matter what race when in a condition of plethora spermatica is able to have sexual congress with almost any woman, be she pretty or ugly, young or old, though there may not be the slightest sympathy between them. The relations of hus- band and wife are subject to many psychical elements, espe- cially of an esthetic nature, which are liable to disturb or hinder sexual union. The more automatic and animal-like the act, the more its resemblance to an outburst, the better and healthier is the union. It might be more human than animal, but it will mostly be at the cost of love and posterity. In some, the predilection for beauty is so enormous that it dominates their strongest desires. Such aristocrats of love are powerless in the presence of not pretty women. They can only have relations with pretty or with the prettiest of women because they must at the same time satisfy their esthetic tastes. The ideal of a perfect love would be, to be in position to choose one woman out of thousands who should correspond more than any other to our esthetic tastes, to possess her only and never evince any desire for any other. This ideal is not at all impossible; it is more often realized than we imagine. But it is not always due to a refined esthetic or a highly developed morale of the one who strives to bring it about; it is mostly due to the fact that we are unable to have anything to do with women who deviate much from our ideal. Idiogamy therefore often originates through esthetic, less often through moral reasons. Among esthetic idiogamies can be cited those who can choose only fat or thin women, blond or brown women. In the broadest sense we would call idiogamists those white men who marry Hottentots or ne- 230 Selections. groes. Clinically, therefore, we have real idiogamy when, due to esthetic or moral reasons, coitus is impossible in spite of the firm will and challenging caresses of the woman. As an example of moral idiogamy are those originating through ethical convictions. The most usual form is that found among those who are impotent when confronted with prostitutes,, whereas they are quite potent with other women. The author then cites a few interesting cases illustrating his views." REVIEWS, BOOK NOTICES, REPRINTS, ETC. DISEASES OF THE Nervous System. By Alfred Gordon, A. M., M. D. (Paris), Associate in Nervous and Mental Diseases, Jefferson Medical College, etc., Philadelphia, Pa. This is a valuable, well presented work of four hundred and eighty-seven pages, well illustrated and written by a com- petent observer and published by the well known and long established firm of Blakiston's Son and Company, 1012 Wal- nut St., Philadelphia. Price in cloth, $2.50. The illustrations to the number of 136 are judiciously made and include the essentials in the line of neurological classification with some additions not found in all recent text books. Achondroplasia after Apert being one of them and bilateral arthropathy of the knee in tabes after Glorieux and Van Gehuchten being another, notwithstanding the master delineations of Charcot and others. The original microscopic illustrations of a spinal ganglion affected with rabies, of lead multiple neurites involving the posterior columns, of plagues, of sclerosis in pyramids and Gowers and direct cerebellar tracts and of cell degeneration of anterior cornua in poliomyelitis with context will interest any neurological clinician. The book ought to be in the library of every reader of the Alienist and Neurologist. THE Aix-Les-Bains THERMAL TREATMENT. By H. Forestier, M. D., and published in London at 7, Great Marlborough St., by J. and A. Churchill, 1908. HANDBOOK FOR ATTENDANTS ON THE INSANE, Fifth Edition revised and enlarged, published by the authority of the Medico-Psychological Association. W. T. Keener and -231- 232 Reviews, Book Notices, Reprints, Etc. Co., 90 Wabash Ave., Chicago, are the publishers and its moderate price for its worth is one dollar. This is a valuable book for the purposes designed and for all interested in the care and welfare of the insane. There are brochures of wisdom in its several chapters for the young physician as well as the nurse who would rightly understand and manage the insane. It is a little monument of the humane solicitude for the welfare of the insane by its author and revisers and by the great Medico-Psychological Association of Great Britain and Ireland that conceived and brought it into existence. It is also a facile teacher for any medical student wishing to get an outline knowledge of psy- chiatry easily and readily. LITTLE JOURNEYS TO THE HOMES OF GREAT BUSINESS Men. By Elbert Hubbard. Done into a book by the Roycrofters at their shop, Erie County, New York, is before us, also a picture of the cabin on the Roycroft farm where the journeys are written and a copy of the face of the chief Roycrofter himself with his handsome intelli- gent, kindly, beaming face and long hair. The hair ought to be cut to conform to our day and generation. But you can never cut the acquaintance of the Roycrofter himself once you have known him by his works. Go with him on his little journeys and you will never wish to part from him. You may travel with him a whole year for just one dollar and the Fra Magazine for another dol- lar if you take them now. This man wrote the message to Garcia reprinted over twenty-five million times. The Pacific Monthly, besides other interesting articles and some splendid illustrations of Oregon, Washington and California and Yaqui Land outdoor life, has an inter- esting article by Chin Chan Wang on the coming struggle in the far east and a theory of organic life, left and right handedness, by John Rhoderick Kendall. This meritorious occidental periodical makes a splendid showing among the literary magazines even of our American orient. Reviews, Book Notices, Reprints, Etc. 233 The CANADIAN Nurse is before us with a table of contents interesting, instructive and soul-sustaining to nurses. The James Acton Publishing Co., 59 John Street, Toronto. Practical Dietetics is a book that has been adopted by many teachers and recommended by all the state boards of examiners of nurses where nurses have been appointed for state hospitals. It is edited and published by Alida F. Pattee, Mount Vernon, N.Y. It has been adopted by the United States and Canadian Governments for use in the Medical Department of the army and been added to the authorized text book list of the Boston and New York public schools, in the leading training schools, medical colleges and hospitals. The price is $1.00. How SIMMONS,“Our Peerless LEADER” Became A REGULAR. By Frank Lydston, of Chicago. The above with some prescriptions and death certificates is amusing reading and will be read with interest whether you agree with the author or not. Lydston is nothing iffinot amusing A LITERARY Banquo's Ghost with comments reprinted from the Southern Practitioner and News; The Man in the Glass House reprinted from the Pacific Medical Journal and The Medical Frankenstein reprinted from the Texas Medical Journal all by G. Frank Lydston, M. D. Professor of Geni- to-urinary surgery, Medical Department of the State Univer- sity of Illinois, Chicago. CONGENITAL ELEVATION OF THE SCAPULA-SPRENGEL's De- PORMITY. By Alexander Earle Horwitz, A. M., M. D., St. Louis, for the Division of Surgery of the Medical School of Harvard University. An interesting and exhaustive contribution. The painstaking author gives the following excellent epitome of the history of the deformity as follows: “Attention was first directed to this deformity,” he says, “by Eulenberg, in Germany, in 1863. He reported three 234 Reviews, Book Notices, Reprints, Etc. cases of -hochgradige Dislocation der Scapula', one of the left and two of the right shoulder. Dorsal scoliosis with convex- ity away from the deformity existed in one. There was no rotation of the scapulae. “In 1880 Willet and Walsham, in England, described a case of congenital elevation of the shoulder which came to autopsy. The left scapula was connected by a broad osseous band with the spinous process of the sixth cervical vertebra, and differed in shape and size from its fellow. Four and a half vertebrae, five right and four left ribs were absent. Rota- tion of the scapula with a sharp left dorsal curve existed. A second case with similar symptoms was reported by the same authors in 1883. “In 1888 McBurney and Sands, in America, each pre- sented a case of 'Congenital Deformity Due to Malposition of the Scapula.' They ascribed the malposition to the curving of the superior border of the scapula. Sands resected the curved portion and succeeded in bringing the scapula down. “In 1891, Sprengel, in Germany, again drew attention to this deformity by describing four cases of 'Angeborene Ver- schiebung des Schulterblattes nach oben. Upward dis- placement of the scapula without rotation existed in each case. He advocated a plausible theory for the existence of this deformity, and 'Sprengel's Deformity' has become a synonym for this condition. Other writers rapidly followed, and Zesas has in 1904 collected 100 cases from literature. "In 1899 Honsell, in Germany, reported the first case of bilateral elevation and was followed by Milo Hirsch and others. Fourteen cases have been reported to date." This contribution is well illustrated patho-anatomically and the clinical context will interest every student of the anomalies of the human organism. The radiographs by the author and Dr. P. W. George are splendidly executed. The references are voluminous. The division of surgeons of Harvard Medical School, in having this work prepared for them, is fortunate. Reviews, Book Notices, Reprints, Etc. 235 Economic Loss TO THE PEOPLE OF THE UNITED States THROUGH INSECTS THAT CARRY Disease. By L. O. Howard, Entomologist and Chief of Bureau, Mar. 18, 1909. I: is gratifying to see all departments of the Government interesting themselves in disease prevention problems and measures. To save the people from disease and death is to save money and power to the country. Some day the great psychic significance of saving the people from decadent im- migration at the ballot box will force itself upon the public consideration and then we will begin to rebuild the brain of imported future Americans on the old ideas of brain vigor and right conceptions of Republican Government. The sanitation of a nation which includes the care and quality of the minds of the people is more than armies to its weal. This nation had better have a care for the kind of im- migrants who are going to make up its composite picture of power or weakness among its futurc citizens. It needs to look to Castle Garden and beyond, better than it now does. A Review op “Lila Sari:" A ROMANCE OF THE SOUTHERN Pacific. By William Lee Howard, from “The Smart Set for January, 1909. Once upon a time a French critic named Georges Polti wrote a book entitled “Les Trente-six Situations Dramati- ques," in which he essayed to prove that there were but thirty- six possible dramatic situations. A multitude of other critics straightway fell upon this Polti and wrote him down an ass, which has been his rank and appellation ever since. But even had his fellows sprung not so enthusiastically to his walloping, the world would have found proof of his fatuity, after many years in a zymotic romance called “Lila Sari," by William Lee Howard. The hero in this startling and unprecedented story is a young American who cherishes a virtuous passion for the daughter of a millionaire. The millionaire charters a yacht for a cruise in the South Pacific and takes daughter and lover with him. As diligent students of fiction are well aware, all yachts that sail the South Pacific are eventually wrecked upon 236 Reviews, Book Notices, Reprints, Etc. desert isles, and this one, of course, is no exception. An off- shore earthquake gobbles it and every soul goes to the sharks, save the daughter, her sister, and her lover. These three fall into the hands of a polyandrous queen of a cannibal island who becomes enamored of the man and takes him to her harem. You must read this marvelous piece of south sea fiction to know the rest. Then begins a voyage in a small boat, with the lover as navigator and protector. The book is unparalleled, incom- parable, magnificent, unique—a literary nonesuch. . . . Not a groan came from the falling pirate...His body gurgled (Gott im Himmel!) as it rolled. ..." Incidental paragraphs, explaining the doings of the villains on pathologi- cal grounds, give the suspicion that the author may be identical with Dr. William Lee Howard, the physician, whose marvelous articles occasionally adorn the popular magazines. For sale by all booksellers or the publisher. $1.50 postpaid Richard G. Badger, Publisher, The Gorham Press, Boston. “IN MR. HAVELOCK Ellis's 'The Soul of Spain,' we have a new interpretation of a much misunderstood country. That preconceptions in regard to a people, whose eth- nologic and anthropologic characteristics differ from ours, are a mistake, has been shown before in authorita- tive books descriptive of certain foreign countries which do not happen to lie in the beaten path of travel. But of all countries that have suffered most on account of a limited knowledge founded on hearsay or superficially-conceived magazine articles, Spain easily takes first rank. ThatMr. Ellis would approach a subject of such psychological impor- tance as the correct reading of Spanish character in his own individualistic way, his former books so expressive of mental vigor in getting at truths, are a preparation that mean much to the intelligent reader. But even without knowledge of them, and though the lengths to which he carries psychology may not be to our way of thinking, we can not but applaud him for sweeping away the foolish ideas of Spanish character which have come to us from Merimée's erotic novel and Bizet's colorful opera. Here we have for the first time the mind of Reviews, Book Notices, Reprints, Etc. 237 . Spain discussed in all seriousness, so that the reader soon grasps the moment of its purport; moreover, though tem- perament and customs have affected it in making it racy of the soil, its intellectuality does not suffer. To those who are interested in anthropology and psychology, as modern agents in arriving at a just estimate of nationality and character, no better illustration need be cited than Mr. Ellis's new work."-- H., in Jour. Ment. Science. COMPTE RENDU des TRAVAUX du ler Congres International de Psychiatrie, de Neurologie, de Psychologie et de l'As- sistance des alienes tenu à Amsterdam du 2 à 7 Septem- bre, 1907. Redige par le Dr. G. A. M. Van Wayenburg, Secrétaire Général du Congrés. J. H. de Bussy, Amster- dam, 1908. Address to the Graduating Class of Nurses at the Ortho- pædic Hospital and Infirmary for Nervous Diseases. By Wharton Sinkler, M. D., November 14th, 1907. State of New York Eighteenth Annual Report of the Rochester State Hospital to the State Commission in Lunacy for the Year Ending September 30, 1908. The Sufficiency of the Official Drugs and Preparations in the Medicinal Treatment of Disease. By Oliver T. Osborne, M. A., M. D., Professor of Materia Medica, Thera- peutics and Clinical Medicine, at Yale, New Haven, Conn. Reprinted from The Journal of the American Medical Asso- ciation. The French Clinics in Neurology and Psychiatry. By Tom A. Williams, M. B., C. M. (Edin.) Washington, D. C. (Reprint from American Medicine, October, 1908.) Among other things well said and interesting we abstract the following tribute to our French friends, in our common field of endeavor. In France, neurological teaching proper is not conducted systematically as a whole, as is sometimes the case in Ger- many, but is divided among the departments of anatomy, physiology, pathology, internal and clinical medicine, in addi- tion to the course of the professor of “maladies du systeme nerveux” and that of the professor of psychiatry. 238 Reviews, Book Notices, Reprints, Etc. . Many of the clinicians cited pay some attention to nervous diseases in their teaching; but the distinction that French neurology has attained is mainly due to the clinical teachers now to be spoken of. At the Salpetriere, Professor Raymond continues the famous Tuesday clinic inaugurated by Charcot. It is here that the stranger is astonished by the multiplicity and bizar- rèrie of the manifestations of psychoneurotic patients. Char- cot's love of the spectacular, however, no longer permeates the clinic; and accordingly, lay visitors are less numerous than in his day. To the neurologist, however, the clinic is all the more interesting on this account; for Professor Raymond's clear diction and constant reference to the patient before the clinic much diminishes the difficulty of following in a foreign language the often highly complicated discussions in morbid psychology so often entered into before the class. It must be remembered that a large number of distin- guished collaborators assist the professor in conducting the clinics. The psychological ideas of Raymond are largely founded upon the researches of Pierre Janet, who conducts what is known as the psychological laboratory of the clinic. It is here that Janet makes the observations which have brought him so much fame. Access, however, is only obtained through a personal introduction; for as is readily understood, an audi- ence is not conducive to successful psycho-analysis. Janet, however, exposes his ideas annually in a course of lectures at the College of France, where he is professor. These are un- fortunately only too open to the public, and the hall, not very large nor adequately ventilated, is anything but pleasant, especially as many of the audience seem to be actuated rather by prying curiosity than scientific interest. Raymond's chief of the clinic is Claude, one of the two editors of L'Encephale, well known for his work on general pathology, and now much interested in the relations of psycho- neuroses to chemical modifications of the body. He often gives the clinics, and does so with great ability. The very important selection of che patients from among the 10 or 50 who daily attend is performed by the assistant Reviews, Book Notices, Reprints, Etc. 239 ehief, a position formerly held by Guillain and Lejonne and now held by Felix Rose, who talks both English and German. Besides the preceding, its teachers include Alquier, who has charge of the pathological laboratory of the clinic, and whose work on “ Pott's Disease without Deformity" has excited so much attention. State Hospital No. 2, St. Joseph, Mo., 1907-1908. Use of Alcohol. By J. H. Landis, M. D., Cincinnati. Delaware State Hospital, Farnhurst, Delaware, 1907- 1908. State Asylum for Chronic Insane of Pa. South Mountain, Wernersville Post Office. Fifteenth Annual Report for Year Ending September 30, 1908. Twenty-Seventh Annual Report of the State Hospital for the Insane at Warren, Pennsylvania. For the Year End- ing November 30th, 1908. Reports of the Trustees and Superintendent of the Butler Hospital, presented to the Corporation at its Sixty-fifth An- nual Meeting. January 27, 1909, Providence, R. I. Sixty-sixth Annual Report of the Utica State Hospital at Utica, N. Y., to the State Commission in Lunacy. For the Year Ending September 30, 1908. Twenty-Ninth Annual Report State Hospital for the In- sane, Norristown, Pa., 1908. Luke, The Physician, (Harnack) With Remarks on the Literary, Dramatic and Medical Quality of the Third Gospel, and the Acts. By George Homan, M. D., St. Louis, Mo. A well written brochure by one of St. Louis' best practitioners, the perusal of which will interest any physician. Reprinted from The Aesculapian December, 1908. Brooklyn. 240 Reviews, Book Notices, Reprints, Etc. Delirium Tremens. By Robt. S. Carroll, M. D., Ashe- ville, N. C. (Read before the Tri-State Medical Association at Charlotte, N. C., Feb. 18, 1908.) The Influence of Flesh-Eating on Endurance. By Irving Fisher, Ph. D., Professor of Political Economy at Yale University. This is an interesting but not conclusive con- tribution. The author concludes as follows: The question of the extent to which flesh foods may be used advantageously is still open, but there can now be little question, in view of the facts which have come to light during the last few years, that the ordinary consumption of those foods is excessive. The Importance of Modification of the Sensibility in the Diagnosis of Disease in the Light of Recent Neurological Research. (Abstract.) By Tom A. Williams, M. B., C. M. (Edin.), Washington, D. C. Reprinted from Washington Medical Annals, Vol. VII, No. 3. Read before the Medical Society, April 8, 1908. The article in full will appear in the Am. Jour. Med. Sci.. April, 1909. The Aesculapian, A'Quarterly Journal of Medical History literature and Art. Edited by Albert Tracy Huntington. subscription Price, $2.00 per year. 1313 Bedford Avenue, Brooklyn, N. Y. The Intra-Abdominal Administration of Oxygen. A Further Contribution, With Reports of Additional Cases. By William Seaman Bainbridge, M. D., of New York City. Re- printed from Annals of Surgery for March, 1909. Fifty-Fifth Annual Report of the Trustees of the Taunton Insane Hospital, for the Year Ending November 30, 1908. Abraham Lincoln Elements of His Leadership. Paper Read by Stuart Carkener at Annual Meeting of the Missouri Commandery of the Military Order of the Loyal Legion of the United States, June 6th, 1908. Reviews, Book Notices, Reprints, Etc. 241 A New Field of Practice in Spirit and Drug Neurosis. By T. D. Crothers, M. D., Hartford, Conn. Reprinted from The Lancet-Clinic, February 27, 1907. Informen V Congreso Medico Pan-Americano. Informe Del Doc- tor Jose Azurdia, Secretario de la Comision Ejecutiva Nacional Del Congreso, Leido en la Sesion Inaugural Celebrada el dia 6 De Agosto de 1908. This address and preliminary informa- tion gives a good idea of the Fifth Pan-American Congress. This Congress was a success, especially for the time of year at which it was held. Del Congreso. La secretario de la cocano. Ninety-Fifth Annual Report of the Trustees of the Massachusetts General Hospital including the General Hos- pital in Boston, the McLean Hospital at Waverly and the Convalescent Home, 1908. Eleventh Biennial Report of the State Hospital number 3 at Nevada, Mo., to the Governor, Herbert S. Hadley, for the years 1907-8. Normal Performance of the Tapping Test. By Frederic Lyman Wells, Ph. D. Further Observations on the Roentgen-Ray. Examina- tion of the Accessory Nasal Sinuses. By E. W. Caldwell, M. D., New York. Eleventh Annual Report of the Managers of the New Jersey State Village for Epileptics, Skillman. Doing a good work. Present number of inmates 266. Hypertrophy of the Prostate Not Causing Urinary Ob- struction. By J. L. Boogher, M. D. This author understands his subject practically from the requisite amount of clinical experience. His theme may, therefore, be read with profit by anyone interested in his subject. 242 Reviews, Book Notices, Reprints, Etc. The Anatomical Basis for Successful Repair of the Female Pelvic Outlet. By Irving S. Haynes, M. D., New York. Thirteenth Annual Report of the Managers of the Bing- hampton State Hospital, New York, for the year ending Sept. 30, 1908. The Roentgen Ray Treatment of the Digestive Tract and the Nauheim Treatment of Disturbances of the Circulation. By Dr. Theo. Groedel, Bad-Nauheim. The Borderline of Laryngology, Rhinology and Otology. By Hanau W. Loeb, M. D. This is a very interesting paper. The lines over the border are Neurology and Psychiatry. Address to the Graduating Class of Nurses at the Ortho- pædic Hospital and Infirmary for Nervous Diseases. By Wharton Sinkler, M. D., contains valuable advice and inter- esting information for nurses, their employers and directors. Economic Aspect of Lengthening Human Life. By Professor Irving Fisher of Yale University, delivered before the Association of Life Insurance Presidents. A valuable, forceful paper worthy of perusal by everybody. The present lights on longevity and its possible attainment by many who now die prematurely are instructive to those who will be re- ceptive to them. Thirty-Eighth Annual Report of the Managers of the Middletown State Homeopathic Hospital, New York, for the Year Ending September, 1908. Insanity. By G. Wilse Robinson, M. D., Supt. State Hospital No. 3, Nevada, Mo. Sonderabdruck aus der Deutschen Zeitschrift fur Nerven- heilkunde. Uber den Werk von Schadelkapazitatsbestim- mungen und vergleichenden Hirngewichtsfeststellungen fur vergleden Wer Deutsche Reviews, Book Notices, Reprints, Etc. 243 innere Medizin un die Neurologie. Apelt in Glotterbad bie Freiburg i Br. Arteriosclerosis of the Nervous System. By Hugh T. Patrick, M. D., Chicago. Three Cases of Facial Spasm Treated by Injections of Alcohol. By Hugh T. Patrick, Chicago. Semi-Annual Bulletin of the Kansas State Charitable Institutions Under the Board of Control, Nov., 1908. Recent Advances Regarding Hysteria in Relation to Traumatic Neurosis. By T. A. Williams, M. B., C. M., Edin- burgh. Sur un Cas de Simulation de la Folie. Essai de Psycho- logie Criminelle par Clement Charpentier, Paris. The Present Status of Hysteria. By Tom A. Williams, M. B., Washington. Collection of Reprints of the St. Louis Medical Society. Reminiscences. By O. LeGrand Suggett, M. D., St. Louis. Syphilis of the Mouth. By O. L. Suggett, St. Louis. A Plea for the Specialist. By 0. L. Suggett, M. D., St. Louis. Address to the Graduating Class of Nurses. By Wharton Sinkler, M. D. Fourth Biennial Report of State Hospital Number 4, Farmington, Mo., for the years 1907-8. The Treatment and Cure of a Case of Mental and Moral Deficiency. By Lightner Witmer, Ph.D., Penn. 244 Reviews, Book Notices, Reprints, Etc. Dietetic Studies. By R. J. E. Scott, M. D., New York. Report of State Hospital Number 2, St. Joseph, Mo., for the years 1907-8. A Study of 400 Cases of Epithelioma in Private Practice. By L. D. Bulkley, M. D., and Henry H. Janeway, M. D., New York. Eighth Annual Report of the New York State Hospital for the Cure of Crippled and Deformed Children at West Haverstraw, N. Y. Doing a good work which every state should be doing. Report of the Trustees of the Eastern Michigan Asylum at Pontiac for the Biennial Period ending June 30th, 1908. Fourth Biennial Report of the Superintendent of the Cherokee State Hospital to the Board of Control for the period ending June 30th, 1908. Forty-Ninth Annual Report of the Matteawan State Hospital, New York, for the Year Ending Sept. 30th, 1908. Reports of the Trustees and Superintendent of the Butler Hospital at Providence, R. I., January 27th, 1909. Bismuth Paste in the Treatment of Suppuration of the Ear, Nose and Throat. By Joseph C. Beck, M. D., Chicago. Toxic Effects from Bismuth Subnitrate. By E. G. Beck, Chicago. Studies in Retardation. By F. L. Wells, Ph.D., Waver- ly, Mass. Weig-Wickenthal's “Zur Klinik der Dementia Præcox," By Frederick L. Wells, Waverly, Mass. Reviews, Book Notices, Reprints, Etc. 245 The Differential Diagnosis of Functional from Organic Palsies: Hemiplegia, Paralysis Agitans, Occupation and Habit Cramps and Spasms. By Tom A. Williams, Washington. The Treatment of a Case of Hysteria and the So-called Gastric Neuroses. By Tom A. Williams, Washington. Third Annual Report of the St. Louis Skin and Cancer Hospital, 1908. Thirty-third Annual Report of the Managers and Officers of the New Jersey State Hospital at Morris Plains for the year ending October 31, 1908. A healthy rollicking baby demands fresh air, fresh water and fresh food. Fresh food means mother's milk or uncooked cow's milk. When your little patient cannot be nursed, prescribe for him fresh milk, modified to exactly suit his needs with Mellin's Food We have a pocket size booklet “For- mulas for Infant Feeding” for you, if you are not now provided, and also a package of Samples of Mellin's Food. They are both gratis. Mellin's Food Company, Boston, Mass. MELLIN'S FOOD COMPANY, M9 Boston, Mass. Kindly send me the booklet, "Formulas for Infant Feeding", with Samples of Mellin's Food free of charge. PUBLISHER'S DEPARTMENT. PRAYER AGAINST SKIx DISEASES AND INSANITY.--The · American Journal of Dermatology gives us the following: “A prayer against ring worm has been discovered by a physician abroad who gives the following origin: As Paul was seated on - a marble stone apparently in a contemplative mood, Our Lord, passing that way, said to him, “Paul, why dost thou tarry there?' 'I am here to cure the disease of my head.' * Paul arise and go and find St. Anne to give you some oil; with it thou shalt lightly grease thy head once a day for a year and a day. He who does this will have neither lupus nor itch, nor ringworm nor madness.'” AMERICAN Medico-PHARMACEUTICAL LEAGUE.-Twelfth annual meeting, Monday, May 24, 1909, at Hotel Astor, New York City. All reputable physicians, pharmacists and den- tists are eligible. Eugenie R. Eliscu, M. D., Secretary and Treasurer, New York City. The Poison Label in RusSIA.-Since the Russian Gov- ernment enacted the law requiring the poison label to be attached to all containers of vodka (a strong alcoholic bever- age), numerous cases of accidental poisoning have been re- ported from various parts of the Empire. There is a large population of illiterates in Russia, and with them the poison label appearing on vodka bottles has come to stand for vodka. As a result many bottles of really poisonous mix- tures are being drunk by these people under the impression that any bottle bearing the poison label contains vodka. This emphasizes the danger of making the poison label too common, for while we have few illiterate adults, we have many children, and to them the poison label now means a sign -246- WANTED--A RIDER AGENT AN T IN EACH TOWN and district to ride and exhibit a ample Latest Model “Ranger” bicycle furnished by us. Our agents everywhere are making money fast. Write for full particulars and special effor at once. NO MONEY REQUIRED until you receive and approve of your bicycle. We ship to anyone, anywhere in the U.S. without a cont depasit in advance, prepay freight, and allow TEN DAYS' FREE TRIAL during which time you may ride the bicycle and put it to any test you wish. If you are then not perfectly satisfied or do not wish to keep the bicycle ship it back to us at our expense and you will not be out one cent, e We furnish the highest grade bicycles it is possible to make 0 at one small profit above actual factory cost. You save $10 to $25 middlemen's profits by buying direct of us and have the manufacturer's guar. antee behind your bícycle. DO NOT BOY a bicycle or a pair of tires from anyone at any price until you receive our catalogues and learn our unheard of factory NNNN prices and remarkable special offers to ridor agents. n when you receive our beautiful catalogue and study our superb models at the tonderfully low prices we can make you this year. We sell the highest grade bicycles for less money than any other factory. We are satisfied with $1.00 profit above factory cost. BICYCLE DEALERS, you can sell our bicycles under your own name plate at double our prices. Orders filled the day received. SECOND HAND BICYCLES. We do not regularly handle second hand bicycles, but usually have a number on hand taken in trade by our Chicago retail stores. These we clear out promptly at prices ranging from $3 to 88 or $10. Descriptive bargain lists mailed free. w e single wheels, imported roller chains and pedals, parts, repairs and COASTER-BRAKES, equipment of all kinds at half the usual retail prices. $ 50 HEDGETHORN PUNCTURE-PROOF $A 80 SELF-HEALING TIRES A. SAMPLE PAR HICAGO A SAMPLE PAIR ULLT UCALINO HILO TO INTRODUCE, ONLY The regular retail price of these lires i's $8.50 per pair, but to introduce we will seii you a sample pair for $4.80(cash withorder $4.55). YHEDGETHORN RECORDS NO MORE TROUBLE FROM PUNCTURES PUNCTURE T!RECO PROOF NAILS, Tacks or Glass will not let the $6. 5 air out. 'Sixty thousand pairs sold last year. Over two hundred thousand pairs now in use. DESCRIPTION: Made in all sizes. It is lively and easy riding, very durableand lined inside with a special quality of rubber, which never becomes porous and which closes up small punctures without allow Notice the thick rubber tread ing the air to escape. We have hundreds of letters from satis- fied customers stating that their tires haveonly been pumped "A" and puncture strips "B" and “D," also rim strip “H" up once or twice in a whole season. They weigh no more than to prevent rim cutting. This an ordinary tire, the puncture resisting qualities being given tire will outlast any other by several layers of thin, specially prepared fabric on the make-SOFT, ELASTIC and tread. The regular price of these tires is $8.50 per pair, but for EASY RIDING. advertising purposes weare making a special factory price to the rider of only $4.80 per pair. All orders shipped same day letter is received. We shio C. O. D. on approval. You do not pay a cent until you have examined and found them strictly as represented. 'We will allow a cash alscount of 5 per cent (thereby making the price 84.66 per pair) if you send FULL CASH WITH ORDER and enclose this advertisement. We will also send one nickel plated brass hand pump. Tires to be returned at OUR expense if for any reason they are pot satisfactory on examination. We are perfectly reliable and money sent to us is as safe as in a bank. If you order a pair of these tires, you will find that they will ride easier, run faster, wear better, last longer and look finer than any tire you have ever used or seen at any price. We know that you will be so well pleased that when you want a bicycle you will give us your order. We want you to send us a trial order at once, hence this remarkable tire offer. s don't buy any kind at any price until you send for a pair of IF YOU NEED TIRES Hedgethorn Puncture-Proof tires on approval and trial at the special introductory price quoted above; or write for our big Tire and Sundry Catalogue which describes and quotes all makes and kinds of tires at about half the usual prices. but write us a postal today. DO NOT THINK OF BUYING a bicycle or a pair of tires from anyone until you know the new and wonderful offers we are making. It only costs a postal to learn everything. Write it NOW. J. L. MEAD CYCLE COMPANY, CHICAGO, ILL. Publisher's Department. 247 of real danger. The attempt to impose the poison label upon drugs, medicines and household remedies, which have been freely and harmlessly taken for years, cannot be too severely condemned. When the poison label appears too often, and on nearly everything, children as well as adults will become careless of poison labels.—The New England Druggist. “I HAVE BEEN TAKING Cactina Pillets for my weak heart, occasioned by a continued illness of three months, and have been much benefited by it. I am now able to get along better, since my heart has become stronger and more regular, and I cheerfully allow you to use my endorsement as to it. unquestionable value in functional heart troubles.”—Joss Adolphus, M. D., Atlanta, Ga. IN CHRONIC AFFECTIONS OF THE LiveR, Chionia is a “jewel.” No matter in what type, say in bile insufficiency, congestion and even in cirrhosis, I have obtained most happy results through its use.—J. M. McLaughlin, M. D., Mansfield, Ohio. The Fossil MAN OF CHAPPELLE-AUX-Saints.The Semaine Medicale of Paris, Dec. 23, 1908, describes the re- cently discovered fossil skeleton in a cave near Correze re- sembling more the anthropoid apes than the human being. Girl, Asleep, Shoots Self.—New York, Feb. 19, Eliza- beth Brown, is suffering from a bullet wound, believed to have been self-inflicted while she was walking in her sleep. She was a habitual somnambulist, and as there was no motive for the shooting, it is believed that she fired the shot while in a sound sleep. Mellin's Food FOR THE AGED.—This excellent digestive and digestible food thus offered by the well known and reliable company is an excellent food for the extremely aged. It is par excellence, the best ingredient you can put into the menu of the senile, so says our medical chief. KITCHEN SCULINY SUPUES SUUDULLER YANG Mx DISING ROOM SERVEIC BOM SEVINC XH COSSON DORMITORY AROLIN SPECIAL DIDCROSS PIAL EPEATMENT OMA GET DAY XINS BOOM CORRIDOR ARAIS CORRIDOR We should be glad to receive plans of special features of other institutions for publica- hospital construction from tion as well as notes of psychiatric value. ul OPERATING ROOM valg CURRIDOR T[I-CIII) CORRIDOR SURGICAL WARD FOR WOMEN CRITION SURGICAL AND TOR MER CORRIDOR LT FIRST FLOOR PLAN DESIGNED BY GEORGE T EDENMARTEL AD SUPERINTENDEN ADOLI SCHERPIR ARCHITECT PUTION CANS HOSPITAL POR SICK INSANE CENTRAL INDIANA HOSPITAL FOR: INSANE MAL. CEDAU ITUT NIIT Publisher's Department. 248 Ecthol.-In Ecthol we have a preparation of vegetable origin, which possesses strong antipurulent properties, proper- ties which may be described as specific. Ecthol is nontoxic, so that it may safely be employed by the unskilled, who are thus armed against septic complications. It contains the active principles of two remarkable plants, viz.: Echinacea angustifolia and thuja occidentalis, two American shrubs that have long rejoiced in an extensive reputation as a dressing for wounds. The action of Ecthol is not limited to wounds and suppurating lesions of the integrent. Its anti- purulent action is equally manifest when given internally in the acute specific fevers, in erysipelas, and generally in all cachetic states with a tendency to pus formation. It con- stitutes an excellent dressing for fresh wounds, which are thus protected against septic invasion, but its inhibitory and de-“ structive action on pyogenetic organisms renders it invaluable as a local application to boils and carbuncles, insect stings and bites, ulcers, and for the irrigation of abscess cavities.- American Medicine. Golden OPPORTUNE MOMENTS.-A patient is writhing in pain. To alleviate his suffering, the physician must act with prompt precision. Dependence, in such a crisis, is usually upon a single little hypodermatic tablet. And that tablet—will it justify the faith? Is it medicinally active? Is it of full strength? Is it soluble? Too much stress cannot be laid upon solubility. And let it be remembered that flying to pieces in water is not the requirement. Many tablets do that-fine, undissolved par- ticles settling to the bottom. This is mere disintegration, not solution; and such a tablet cannot be depended upon to yield the results that the practitioner desires and expects. Obviously, the physician should exercise care in choosing his hypodermatic tablets. Let his source of supplies be a house with a reputation for making tablets that are stable, active and of uniform strength; tablets that dissolve promptly and completely. Let him search out a brand of hypodermatic COURT VENTILATI VAATAMATIES VENTILATINO APARATUS COURT DESIONED DY GLORCE T EDEN HARTER MD Surnoon ADULY SCHERPER ARCHITECT BASEMENT - BLACK LINES INDICATE NA AND DSAIMACE SYSTEN KOTK THE ARSLAG OF ALL CONNECTIONS TO UNDER DE TIENTS WONS HOSPITAL FOR SICK INSANEL CENTRAL INDIANA HOSPITAL POR INSANE. MALE on MOS MOAU MU Publisher's Department. 249 tablets that meets all of the requirements above set forth, and let him specify that brand! The largest manufacturers of hypodermatic tablets in the world are Parke, Davis & Co. The hypodermatic tablets of this house are true to label. They are soluble. The materials entering into them are rigidly tested for purity and activity. Specify Parke, Davis & Co.'s hypodermatic tablet. They are thoroughly trustworthy. PRESIDENT TAFT ON A NATIONAL DEPARTMENT OF Health.—“The effect which imperfect drainage, bad water, impure food, ill-ventilated houses and a failure to isolate con- tagion, have in killing people has become more and more apparent with the study which great sanitary authorities have given to the matter and has imposed much more dis- tinctly and unequivocally the burden upon municipal, state and federal government of looking after the public health. The expansion of our government into the tropics, the neces- sity of maintaining our armies and navies there and support- ing a great force of workmen in the construction of such an en- terprise as that of the Panama Canal, have greatly exalted the importance of the discoveries of the medical profession in respect to the prevention and cure of human disease and of diseases of domestic animals." “The triumph which has been reached in the name of the medical profession in the discovery as to the real cause of yellow fever and malaria and the suppression of those dis- eases by killing or preventing the propagation of, or the in- fection of the mosquito, is one of the wonders of human prog- ress. It has made the construction of the Panama Canal possible. It has rendered life in the tropics for immigrants from the temperate zone consistent with health and reasonable length of life, and it has opened possibilities in the improve- ment of the health and strength of tropical races themselves under governmental teaching, assistance and supervision that were unthought of two decades ago." “It is becoming more and more clear that the extending of governmental duties into a territory covered by the profession of medicine is bringing physicians more and more into political The Associated Periodical Press OFFERS FOR INVESTMENT, SUBJECT TO PRIOR SALE AND CHANGE IN PRICE $75,000 FIRST MORTGAGE SEVEN PER CENT SINKING FUND GOLD BONDS Due May 1st, 1928 COUPONS PAYABLE MAY 1st AND NOVEMBER 18t AT THE LIBERTY TRUST COMPANY, BOSTON Principal and Interest payable in Gold Coin of the United States Redeemable at 110 and accrued interest at any interest date after May 1st, 1910, on 60 days' notice. Coupon bonds (with privilege of registration) in denominations of $10, $50, and $100 Capital Stock Authorized and Issued - $500,000.00 First Mortgage Bonds - - 75,000.00 (Closed Mortgage-no more can be issued) DIRECTORS FRANK O. White, President DR. WILLIAM LEE HOWARD, Vice-President RICHARD G. BADGER, Treasurer George C. CROWLEY Ralph Adams CRAM IMPORTANT POINTS 1. The Company's magazines are all well established, all are profitable, all are edited by the recognized authorities in their different fields, and are already earning more than enough to pay all charges. 2. The company has no debts except these bonds, and the entire prooeeds from the sale of these bonds will be used in developing the business. No commissions will be paid brokers or other outside interests. 8. The bonds bear coupons (payable May 1 and November 1 of each year), which can be deposited in your bank for collection exactly the same as the coupons of any government bond. If you prefer registered bonds, certified checks for the interest will be mailed you on these dates. 4. The bonds are payable in gold. 5. With every ten-dollar subscription will be given one share of stock giving each bondholder an active voice in the management of the company and an interest in the profits of the business over and above the good return guaranteed on the investment. For example, a subscription for $100 in bonds would receive a bonus of 10 shares of stock, or $1,000 in bonds would receive 100 shares. 6. Subscriptions received at once will receive as an additional bonus the accrued inter- est on the investment from date of issue. 7. These bonds are a first mortgage on the entire property of the company (now held or hereafter acquired). No other mortgage affecting the validity of the security can ever be issued. 8. The bonds are issued in the low denominations of $10, $50, and $100, for the purpose of giving the small investor an opportunity to secure the same high-grade investment that hitherto could be had only in bonds of $1,000 and upwards. The rapidity with which the issue is being taken up shows the marked appreciation of this innovation, 9. As the issue is small, is widely offered, and has many unusually attractive features as an absolutely sound yet particularly profitable investment, an early application is sug- gested. $24,000 of the bonds have already been allotted. THE ASSOCIATED PERIODICAL PRESS Bond Department . 194'Boylston St., Boston, Mass. Publisher's Department. 250 and governmental relation, and we may expect that in the next decade they will play a far greater part than they have heretofore; and it is proper that they should.” (Extract from President Taft's speech at the University of Pennsylvania, February 22, 1909.) It is significant in that his predecessor favored a bureau rather than a department.) This magazine and its editor, when President of the A. M. E. A., was the first to suggest this department. THE CURSE OF THE CHIMNEY.—Under this caption an editorial in a London medical magazine of decided merit sounds like it might have been written against the smoke nuisance and smoke peril of St. Louis. “Every winter, with its inevitable fogs and phalanx of catarrhal complaints, draws strong attention to the necessity that exists in English cities for enforcement of the laws which have been enacted to stem, though in a trivial and small de- gree merely, the evil of our gigantic smoke nuisance. On more than one occasion we have commented on the laxity with which these laws and regulations-admittedly excellent if carried out in the strict letter as well as spirit-are enforced. Every winter compels us to return to the subject, and to sup- port, as much as it lies in the power of a professional paper, the efforts of the Anti-Smoke Society to mitigate the evil. “The medical profession, as a collective body, has been singularly apathetic in moulding public opinion on this sub- ject of city smoke and its bad consequences. Yet we, as medical men, are thoroughly well aware of the danger to health that exists in the continuance of fogs and a soot and smoke impregnated atmosphere." The editor here speaking associates London fog with London smoke, arraigning the latter and the former together. After paying a compliment to the better control of this evil in New York as compared with St. Louis our London confrere editorially proceeds and concludes: “It is unbelievable that the public will go on year after year, tolerating a state of things which it is good economy to prevent, and bad policy, from a hygienic point of view, to per- mit. Meanwhile it rests as seriously with the medical pro- fession as with members of especialized societies to impress Two Hundred Thousand Families The intellectual aristocracy of America, have one rule in magazine buying- "The Review of Reviews first, because it is a necessity" 2222/EX DITED BY ALBERT SHAW THE AMERICAN REVIEW REVIEWS AZN THE NECESSARY) 1 MAGAZINE SEND FOR A SAMPLE COPY - 1907 - AL 25 CMT MAGAZINE LIBRARY IN ONB MAGAZINE The Review of Reviews Has attained a larger subscription list than any magazine that deals wholly with serious subjects and is accepted as the best periodical to keep one up with the times. It is non-partisan. NEITHER MUCK-RAKES NOR HIDES FACTS With Dr. Albert Shaw's monthly "Progress of the World," with the cartoon history of the month, with the timely contributed articles on just the questions you are interested in, with the best things picked out of all the other magazines of the world for you, with the charac- ter sketches of the notable people of the moment--you can keep intelli. gently up with the times at a minimum cost of time, effort and money YOU MUST SEE OUR BOOK OF MAGAZINE BARGAINS Before ordering for next year. It contains forty pages of special offers, including all the leading magazines and periodicals. It will show you how to save money on your Christmas buying. This interesting and money-saving catalogue is FREE, The Review of Reviews Company, 13 Astor Place, New York Publisher's Department. 251 upon the community the desirability of exerting themselves in this matter as soon as possible.” “So long as the laws against the smoke nuisance are allowed to remain dead letters it is useless to debate the feasi- bility of expensive and problematical measures such as the electrical dissipation of fog, or the yet more problematical remedy of fog dispersal by means of artificially created air currents." This sounds like a familiar St. Louis press editorial. A Doctor's SYMPHONY. By Geo. F. Butler, M. D., Wil- mette, Ill. With this New Year resolve to live without anger, avarice, envy and littleness. Resolve to be generous, liberal and kind; to recognize the extreme value of health and human life and to strive by every means to roll back the tide of dis- ease and death; to give something to shape the million-handed labor to an end and outcome that will leave more sunshine and more flowers to human kind. Let your labor be so ordered that in future times the loved ones may dwell longer with those who love them; open your minds; exalt your souls; widen the sympathies of your hearts; face the things that are now as you will face the reality of death-fearless and alone. Remember that the battle of life cannot be fought by proxy; be your own helper. Go thou alone Let not thy courage fail, Nor weight of pain avail To stay thy onward feet. What e'er betide thee sink not E’en in thy anguish think not Under God's generous sun So much of sorrow lives save good- ness to complete. Go thou alone- Though friends and fortune pass Beyond thee, and alas Love's visions fade away, Look to the stars and ponder How poor thou art, and wonder How the vast undertone Of thy creative thoughts could blossom in a day. 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 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. 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 529 Highland Kansas City, Mo. 529 Highland HALL-BROOKE A Licensed Private Hos. pital for Mental and Nervous Diseases. THE NATIONAL MEDICAL EXCHANGE - Physicians'. Den tists and Druggists' Locations and Property bought, sold rented and exchanged. Partnerships arranged. Assistants and substitutes provided. Business strictly confidentlal. Medical, pharmaceutical and scientific books supplied at lowest rates. Send ten cents for Monthly Bulletin containing terms, locations, and list of books. All inquiries promptly answered. Address, · H, A. MUMAW, M. D. Elkhart, Ind. CASES OF ALCOHOLISM AND DRUG HABIT. REAUTIFULLY situated on Long D Island Sound one hour from New York. The Grounds consisting of over 100 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. THE NATIONAL Surgical and Dental Chair Exchange. All kinds of new and second-hand Chairs, Bought, Sold and Exchanged. la SEND FOR OUR BARGAIN LISTE Address with stamp. Dr. H. A. MUMAW, Elkhart, Ind. DR. D. W. McFARLAND, GREEN'S FARMS, CONN. 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, lod. relephone 67-5 Westport Conn. Publisher's Department 252 Go thou alone The breathing atom in thee Shall one day rise divinely From this its cradled hour, Be wise and brave and loving From lowliest essence moving, In circlets one by one Up to thy perfect shape, the highest earthly power. Pension for Dr. Wm. B. ATKINSON.—In a recent issue of the Medical Standard it is stated that this good man is now living at an advanced age (77 years old) and in com- parative poverty, and the suggestion is made that the Asso- ciation grant him a pension of one hundred dollars a month. He served the Association faithfully and to the best of his ability, giving to it a great part of many of his best years, receiving an insignificant salary. We agree with the propo- sition most heartily. We are in favor of old age pensions for life long service to the Association as a correct principle. We think Dr. Simmons should have a pension and that the secretaryship and treasuryship should be separated. Battle AND COMPANY's Dislocation Chart (in colors) number 9, is now ready for physicians on application to the home office, St. Louis, Mo. TREATMENT OF ACNE.-As acne is a chronic disease, and as cod liver oil in the shape of Cord. Ext. Ol. Morrhuae Comp. (Hagee) exerts its best influence in chronic diseases of the skin, by its alterative and stimulating effects on the functional activity of organs, properly administered, it is one of the most reliable remedies in the internal treatment of acne. In anemic cases; it exerts its greatest power.--Amer- ican Journal of Dermatology. WHY IS IT? That each month in all the best homes in this country, on the library table, and in every club reading room, you find the METROPOLITAN MAGAZINE It is because it keeps you in touch with those great public and human movements on which the American family depends. It is because its stories are the best published anywhere. It is because its illustrations in color, and black and white, set the standard. It is because its articles are the most vital and interesting. It is because there is something in each copy for every member of every American family. A YEAR'S FEAST 1800 Beautiful Illustrations. 1560 Pages of Reading Matter. 85 Complete Stories. 75 Good Poems. 50 Timely and Important Articles. 1000 Paragraphs presenting the big news of the “World at Large." 120 Humorous Contributions. Wonderful Color Work, presented in frontispieces, inserts and covers. All Yours for One Year's Subscription to THE METROPOLITAN MAGAZINE Price $1.50 per Year or 15 Cents a Copy The Alienist & Neurologist and the above sent for one year for $5.00 DENVER ACADEMY OF MEDICI IV. OF MICHIGAN, THE IN ALIENIST AND NEUROLOGIST ST. LOUIS MO. Vol. XXX. AUGUST 1909. No. 3. A JOURNAL OF NEUROLOGY AND PSYCHIOLOGY PSYCHIATRY AND NEURIATRY. FOR THE NEUROLOGIST GENERAL PRACTITIONER AND SAVANT. PAN OPEPTON Is an absolutely sterile liquid food and cannot ferment; completely peptonised and cannot embarrass any function of the body; wholly assimilable and leaves no residues agreeably stimulating and holds the patient subjectively to a hopeful outlook. Panopepton is specifically a food for therapeutic use, adequate for nutrition and of peculiar excellence in respect to palatability, wholesomeness, reliability and uniformity. The label gives complete analysis; literature and clinical reports in abundance are at the command of the physician. FAIRCHILD BROS. & FOSTER NEW YORK SA NEURON HURST Dr. Wm. B. FLETCHER'S Sanatorium for Mental and Nervous Diseases. A new building newly furnished throughout with accommodations for fifty patients. For terms address Dr. M. A. Spink, Superintendent. Long Dis. Telephone 381 No. 1140 East Market St., Indianapolis, Ind. 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- cal 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. THE ALIENIST AND NEUROLOGIST. VOL. XXX. ST. LOUIS, AUGUST, 1909. No. 3. e. THOUGHTS ON SUICIDE. By FREDRIC Griffith, M. D., Fellow of the Academy of Medicine. New York City. I NUSUAL it may be, but not useless, is the task of him who sets himself the study of the balancing of human emotions which may so deflect natural equilibrium of the in- dividual as to cause active desire for or an actual consumma- tion in destruction of physical existence. Every philosophi- cal writer in the past has left somewhere in his work account of personal impressions regarding suicide. Forcible voluntary rejection of life by the body of an individual to medical men must be considered in the light of pathological process, for as the physician deals with death and as the present subject has a high mortality rate, its consideration must prove worthy the attention of scientific minds. As authors know the simplest way for them to free their consciousness of dominating thoughts is by writing some readers contemplating askance may accuse the present writer of being merely under the pall of abnormal morbidity of thought. For the reason that he has found no personal accounts in medical literature dealing with the subject, the writer would rather be considered as the experimenter with the new drug who sets himself carefully to detail sensations, acts and thoughts while under reaction of the [253] 254 Fredric Griffith. physiological dose of the medicine he is examining. For ten years the writer has studied the subject and finds, whether it be acknowledged or not, that the consideration of suicide is a universal topic for personal consideration in all classes of society. An unverified press report estimates that there are one hundred and twenty-five suicides taking place daily in the United States. Continued thought on the matter convinces one that suicide is a disease pure and simple, having its victims succumbing, some in the first acute attack, others after chronic relapsing periods. Type of mind is no criterion for or against an attack of this disease, but the higher the mental develop- ment in general the more likely is it to be considered. A child of six will suicide after a scolding, as city coroner's records show. Von Pettenkopher, octogenarian, scientist, having the highest type of a calculating mind, forcibly breaks the thread of his mortal existence. In a western penitentiary the writer knows three “lifers” serving for murder. One a boy of good family and education, whose mother is a physician; the second an Indian in middle life; the third a dentist, thirty-eight or forty years of age. All have been in prison a year or more. The Indian is placid, used to greatest freedom he bears present confinement with- out a murmur, nor has he ever given cause for reprimand from his keepers. His outlook is probable death from consump- tion—the red man's scourge*—within the next five years. The boy after a period of gradually increasing loss of control, a year ago attempted suicide by throwing himself from the top cell gallery of the prison to a flagstone pavement thirty feet below. The sum of his injuries was a fractured elbow. The benefit was an apparent rapid and permanent readjust- ment of his whole mental organism in relation to his surround- ings gaining that prison drowse—a stupefaction or dulling of the sensibilities, commonly encountered in old convicts, caus- ing them to grow oblivious to the miserableness of their con- dition and to the passing of time. The dentist has the bear- ing, physical and mental characteristics of the aristocrat. *And the average American prison's scourge which might by right sanita- tion be eliminated from prison life as well. -Ed. Thoughts on Suicide. 255 Hypersensitive by nature, every waking moment of his servi- tude is visible torture, yet the unbroken pride and spirit of the man apparent in every movement he makes seem to forever preclude suspicion of suicidal intent upon his part to gain that relief from the mental anguish he is perpetually steeped in. A deep sense of shame, as of open acknowledgment of moral cowardice upon the part of the individual concerned, seems to pervade the average mind when the subject under consideration is broached. In general, it is only aiter such a person's confidence has been won will he agreə to discuss suicide at all. Fear of revealing character tendencies regarding the deepest personal issues of life acts likewise as a deterrent. The greatest original thinker known to the writer is aged eighty-eight. The man can neither read nor write; by the villagers he is considered heathen. To the writer he is a book whose pages may be turned at will revealing American poli- tical, social and individual history of events over a period of three score years. Not the gravest happening, but the show- iest for present purposes in this man's life was that at“Cold Harbor" during the civil war, where part of his face was shot away and a ball embedded in his skull. Asked concerning his thought of forcing his death prematurely he said, had he known what his life was to be, the thoughts of it alone would have been enough to kill him. His theory for his continuance to live was that Deity had placed in him in common with every man the inherent desire to continue the present physical state called life. This man's expression of countenance beams continuously the expectancy of childhood. With no thought of receiving a sensible reply to his ques- tion, the writer engaged a young miss of eighteen with the subject. Her answer came prompt, firm and serious, it ap- pearing as though some individual's first approach to in- dependent thought and consideration of religious belief is through contemplation of self-destruction. A little Jewish girl of thirteen, a patient of the writer's, whom anyone must acknowledge, coming in contact with, to be physically and mentally normal besides having a full meas- ure of grace of thoughtfulness, confided that a number of times she had considered the advisability of taking her life 256 Fredric Griffith. and this for no apparent reason. This being the child's most secret thought, for while the girl's mother has her confidence to a degree, but not in the matter just spoken of. Regarding the relationship she stated, referring to the writer, that “he understands me when I talk crazy things.” The child speaks of her“ other self” as talking through her at times. This case may be passed by some readers as merest rubbish in a morbid- ly inclined pubescent girl. The writer includes it in a class of individuals where beginning at almost any age from the awakening of consciousness there is a turbulency of body, feeling and mind emotion, as waves dash and struggle against pilings—opposing the course of life itself being direct cause of desire for suicide. Seeking to reach an equilibrium the con- sciousness of such an one ever and anon essays the door of death to enter through as if to prove the easiness of that way to quietude. It has been said that a description of the agony attending childbirth has never been written by a woman; one mother told the writer that the sensations feel the same as to have one's arm torn away at the shoulder. The writer would match the mind suffering experienced by the suicidal at the climax of its cerebral storm of (false pains) or in (stillbirth) of the vic- tim, to the body pain of the parturiating woman. As showing the fact that suicidal tendencies in others may be reached and treated successfully the following cita- tion will instance: S— is a German, aged about forty- three; married. The man is and has been in normal physical health. For many years this individual has been manager of a downtown restaurant; besides being secretary of a beneficial organization. From daily contact with highest types of com- mercial minds in the street this person aspires to a position which owing to the limitation of his education and cerebral power exhibited he could never approach. By mannerisms and affectations of speech the man looks upon himself to be the embryo mercantile magnate. Imagine the sensitiveness of such an one when approaching the writer with all the dis- guises of the exquisite high-class pervert drawing near to a prospective victim. The man after a year of professional relationship imparted the greatest desire of his life, namely, Thoughts on Suicide. 257 that he be given a sufficient amount of some sure poison, that he might always carry it about his person for use when- ever anything unbearable should occur. He being thus assured of having an easy way to overcome difficulty thus ever at hand. The writer opposed the request, making a care- ful statement that there would never arise anything in his career of such magnitude as to require the sacrifice of his life by his own hand. The man seemed greatly relieved. He had never discussed the matter so close to his consciousness before with any living being. Eight years have passed and this individual continues to undisturbedly follow the course of his life. The writer from knowledge of human nature, assumes the right to say that the man would have taken early means to supply the cause for excuse for taking the poison, had it been supplied to him. Belief in a Deity and a hereafter, acts only as a preventive against suicide, in so far as it begets calm in the individual affected. Upon the other hand, the ordinary materialistic mind in the writer's estimation, has less chance of preserving the balance of his mind faculties. For the reason that the religionist always has the awe of a mystery to serve as check, whereas the materialist explaining his state of existence to its finality with satisfaction destroys himself with least com- punction and less restraint. An individual contemplating suicide weighs the secret canker upon slightest provocation. Every incident occurring in the daily life of such an one where a possible accident could result in personal injury at once brings up the situation. Thus a person on a tower or looking down from a roof, or contemplating Niagara at the brink thinks of the ease of accomplishment of his desire. There is an innate human power in all of us that goes for de- struction the same as there is a genius for creation. The destroyers are many, creators few comparatively, therefore the world hails the great artist, fame crowns a Phidias. Of the annual countless gazers upon the Mona Lisa masterpiece of Leonardo in Paris more than one has a thought“It's not wonderful for how easy to destroy it.” The same influence in the individual taunts its very being as giving proof of power. Alcoholics and drug takers by lowering of the physical 258 Fredric Griffith. stamina prove ready victims for suicide concept when by sug- gestion or recurring to the thought during the remorseful stage after the debauch. The writer has as friend a Sioux Indian chieftain who has watched the vicissitudes of his people for half a century and who now like those confederates who went to Mexico to avoid being “reconstructed" lives aloof. His present, almost constant, wish is that he might die to avoid the further con- templations of the sorrows of his race. Asked why he did not kill himself, his answer," that he was a man forbids it.” This individual is physically sound, being the father of a child at advanced age. The writer has as patient a cultured woman of affairs. Quick to heed the slightest calls of those dependent upon her, she is at times overcome with apathy. This woman's brother committed suicide in a foreign country. She has acknowl- edged the presence of inclination to take her own life. A promise made to the writer that she would communicate with him when she wished to accomplish the act has for a year served to supply this patient with necessary surplus balance insuring against self-violence in the see-saw of her emotional storms. A boy of fourteen, known to the writer, placed in an en- vironment foreign to his state of previous gentility, became the butt of his fellows. He met petty annoyances by logical argument. Failing to gain the suffrance he considered his due the lad killed himself by taking laudanum. There were no, outward signs of mental distress, yet the little fellow's physical economy strained to snapping point. This case demonstrates the writer's thought regarding the fact of there being a pre- vious state where chance may act to safeguard or destroy de- pending upon as we call it individual strength of character. A young husband once ran into the writer's office, bear- ing a bottle containing a couple of ounces of carbolic acid, with the story that his wife had directed his attention towards its presence in the cupboard, she having placed it there for her personal use in self-destruction. Believing that it was a case of merest fancifulness upon the part of an overwrought female becoming adjusted to the marital state, no attempt Thoughts on Suicide. 259 . was made to see the girl, but replacing the acid with water, the young benedict was ordered to return the bottle to its place without comment or further expression of concern, with a result that suicide has never been attempted. The writer's first personal suicidal impress occurred at the age of nineteen. At this period having returned from a trip abroad he engaged as a “loom boss” in a tape mill. Be- fore the end of the first week of employment a mishap oc- curred in attempting to disengage a four hundred pound case of "filling"-raw material consisting of unglazed cotton thread wound upon large spools-suspended in a rope sling by means of a power hoist which he controlled with one hand at the third floor of the factory building. Owing to slipperi- ness of the flooring, the case toppled through the open door- way crashing to the ground. Following an instinctive cry of warning to mill-people passing along the passageway below, the first thought on seeing the box disappear over the ledge was to follow after it. Without causing any physical reaction in response the concept appeared as a unique exhibit upon the mental horizon, but remained long enough to mark the memory. No blame whatsoever was attached to the writer for the accident by his employers. A year later he found himself a freshman in medical school. Neither mental strain nor any difficulty whatsoever had been experienced in meta- morphosing from head “fixer" of ruptured “shot-cords,” “cams" and" heddles” to the consideration of normal histology and stethoscopes. As though following a simple path all laid out the freshness of a first year college man developed. It was customary for the writer to walk three miles to medical school. Returning homeward after an ordinary day at dusk in the early winter, while passing alone over a bridge without any conscious premonition, the thought suddenly loomed for him to throw himself into the river. Pausing in mental action with personality seemingly appalled, as it were, by the termity of the impulse, though he heard no voice nor saw anything unnatural, yet he was made perfectly conscious of an inde- finable presence gravely directing him not to be overcome by such chaotic thought. As though loosed from a bond the writer felt freed. At once in cynicism as though to test him- 260 Fredric Griffith. self he reverted as he passed homeward to the subject which had just occupied his mind. Thinking lightly if he had gone over the bridge rail into the darkness and the river flowing thirty or forty feet below, being a swimmer nothing worse than a drenching and an awakening to the watery reality would have occurred. But as though to answer the inner consciousness revealed itself again to evidence calmly to him that he would have sunk borne down in leaden casing of the rampant morbid thought. Sixteen years have passed, but the proven consciousness of existence of that“other” deeper self as aptly termed by the little girl already mentioned and which may not lightly be called up or be disturbed, has pre- vented all subsequent trifling with the destined flowing of the stream of his life. Treatment. The establishment in New York City by a charitable organization of a Suicide Bureau where persons contemplating ways and means for suddenly ending life, are invited to call at first thought, seems a bid for sensationalism and active stimulation for exhibitions of the emotionally and hysterically inclined portion of the community's population rather than what must be considered a remedial agent for a definite social ill as well as being a most considerate philan- thropy. Not alone by active service to the individual case, but by every influence from open recognition of the presence of a morbid state of mind which seeks an overthrow in death. Accidental at first the concept if fostered becomes a hidden dominant for fell action upon occasion with or without a logical acquiescence of the will of the individual at the mo- ment of accomplishment. Physicians should ever be upon the lookout to aid by tactful signal interest those individuals who by word or sign indicate the presence of what may be called the suicide con- cept. To preserve life and to make known its intents in so far as in him lies inculcating the philosophy that events are mere incidents in a life which are to be overcome; accom- plished best often by will development to continue to live through them. To vegetate as it were through the periods of demoralizing mental delirium when calm reason seems un- hinging and life hangs balancing like a juggler's sphere in air. Thoughts on Suicide. 261 To lightly meet one of these appeals when detected in a patient insidiously mind sick, which early is but as a symptom- atic malady, aids to fasten what may become an ingrained purpose, organic affection held in abeyance for the time and place to proffer for exaction. In times past the suicide had for his contemplation a burial at the crossroads with a stake through his corpse. After death by suicide one may but con- template with tongue in cheek the morbid anatomy of melan- choly. The writer is fully conscious of his limitations regard- ing the subject he has opened up, but trusts the profession will awaken to the necessity for considering suicide. Attention aroused, the alert and observing physician can many times meet cases in the incipiency and while the victim of the dis- order may not know the benefit afforded him will neverthe- less restrain the individual from a rude confusing stumble into death. IS GENIUS A SPORT, A NEUROSIS, OR A CHILD PO- TENTIALITY DEVELOPED?* By Jas. G. KIERNAN, M. D., Chicago. Fellow Chicago Academy of Medicine, Foreign Associate Member French Medico-Psychological Association; Honorary Member Chicago Neurologic Society, Honorary President Section of Nervous and Mental Disease Pan-American Congress 1893, Chair- man Section on Nervous and Mental Diseases American Medical Asscciation 1893; Professor Neurology Chicago Post-Graduate School 1903; Professor of Nervous and Mental Diseases Milwaukee Medical College 1894-5; Professor of Nervous and Mental Diseases Illinois Medical College 1905; Professor of Forensic Psychiatry Kent-Chicago College of Law. W ELTSCHMERZ is a product of the strain of puberty and adolescence or in precocities set in earlier, when night terrors of persistent type occur. It is practically normal in adolescence tending to disappear when the stress of the period is over. It often develops a pessimism which per- sists in after life. During puberty and adolescence there is normally a struggle for existence between the cerebral and the reproductive system which tends to obtrude subconscious states upon consciousness. From this struggle results a fear of the unknown which produces suspicional tendencies and pessimism. Suspicional tendencies and pessimism, with which they are so often asso- ciated, arise from states of anxiety resultant on instability of association, dependent on lack or non-use of association fibers. Pessimism, as Magalhaest has shown, is a state of nervous in- stability with alternations of irritability and prostration. The subject is supersensitive, impressions called forth are in- * Continued from Alienist and Neurologist, May. 1909. † American Psychological Journal, 1893. (2621 Is Genius a Sport? 263 tense, and, causing prolonged reactions, are followed by ex- haustion. The state is characterized by a general hyper- esthesia, which naturally results in an excess of suffering. From instability and hyperesthesia result discord between feelings themselves, between the feelings and the intelligence, between the feelings, the ideas, and volitions. Discord be- tween the feelings shows itself in a great variety of paradoxes, contradictions, and inconsistencies. To the pessimist, posses- sion of a desired object does not atone for former privation. Pain or unsatisfied desire is replaced by the pain of ennui. With inability to enjoy what he has are coupled extravagant expectations regarding that which he does not have. He is extremely susceptible both to kindness and contempt. He passes suddenly from irritability to languor, from self-con- fidence and vanity to extreme self-abasement. This intense sensitiveness results in intellectual instability, since it involves a great vivacity of the intuitive imagination, which favors the setting up of extravagant ideals lacking in solid representa- tive elements. Hence a gap opens between his ideal and the actual. He can never realize the ideal he pursues, and so his feelings are of a somber hue. From this excessive realism results a state of doubt, a certain distrust of all rational ob- jective knowledge, expressed in occult fears and belief. It assumes another form in extreme subjectivism. The pessi- mist is haunted by images of the tiniest religious scruples, suspicions, fears and anxieties resultant in alienation from friends, seclusion, misanthropy. He has an incapacity for prolonged attention, a refractory attention, and a feeble will. These result in inaction, quietism, reverie, self-abnegation, abolition of the personality, annihilation of the will, amount- ing sometimes even to poetic or religious ecstacy. Pessimism is frequently associated with a morbid fear of death (thanato- phobia). This state tinges mental puberty and adolescence with undue egotism, whence the unpleasant obtrusiveness. This is generally the morbid survival of the adolescent mental state after adolescence. Hebephrenia may result, with its intense vanity, extreme selfishness, religiosity and perverted ethics, aural and visual hallucinations, shallow emotionalism, and violent but controllable impulses. 264 Jas. G. Kiernan. Lust of the algophiliac type, which seeks satisfaction in pain, mental or physical, (whether in cruelty toward others or in self-mutilation), often occurs prematurely between six and twelve or during adolescence. This may arise from con- genital deficiency of power to acquire the secondary “ego,” or from its decay. While the “psychologist" generally ignores the delicate, physical co-ordinations which constitute the material sub- stratum of mind, his intellectual limitations added to his mental indolence are due to the bias of that retrospective men- tality which evolves the universe from its internal con- sciousness. The great nineteenth century apostle of adolescent pes- simism is Schopenhauer. The scenes of our life, he remarks, are like “pictures in rough mosaic, which have no effect at close quarters, but must be looked at from a distance in order to discern their beauty. So that to obtain something we have desired is to find out that it is worthless; we are always living in expectation of better things, while at the same time we often repent and long for things that belong to the past. We accept the present as something that is only temporary and regard it only as a means to accomplish our aim. So that most people will find if they look back when their life is at an end, that they have lived their life-long ad interim, and they will be surprised to find that something they allowed to pass unnoticed and unenjoyed was just their life—that is to say, it was the very thing in the expectation of which they lived. And so it may be said of man in general, that befooled by hope, he dances into the arms of death. “That human life must be a kind of mistake is sufficiently clear from the fact that man is a compound of needs which are difficult to satisfy; moreover, if they are satisfied, all he is granted is a state of painlessness in which he can only give himself up to boredom. This is a precise proof that existence in itself has no value since boredom is merely the feeling of the emptiness of life. If, for instance, life, the longing for which constitutes our very being, had in itself any positive and real value, boredom could not exist; mere existence in itself would supply us with everything, and therefore satisfy Is Genius a Sport? 265 us. But our existence would not be a joyous thing unless we were striving after something; distance and obstacles to be overcome then represent our aim as something that would satisfy us—an illusion which vanishes when our aim has been attained, or when we are engaged in something that is of a purely intellectual nature; when, in reality, we have retired from the world, so that we may observe it from the outside, like spectators at a theater. “Even sensual pleasure itself is nothing but a continual striving, which ceases directly its aim is attained. As soon as we are not engaged in one of these two ways, but thrown back on existence itself, we are convinced of the emptiness and worthlessness of it, and this is what we call boredom. That innate and eradicable craving for what is out of the common proves how glad we are to have the natural and tedious course of things interrupted. Even the pomp and splendor of the rich in their stately castles is at the bottom nothing but a futile attempt to escape the very essence of existence-misery. “And how different the beginning of our life is to the end! The former is made up of deluded hopes, sensual enjoyment, while the latter is pursued by bodily decay and the odor of death. "The road dividing the two, as far as our well-being and enjoyment of life is concerned is down hill; the dream- iness of childhood, the joyousness of youth, the troubles of middle age, the infirmity and frequent misery of old age, the agonies of our last illness, and finally the struggle with death-do all these not make one feel that existence is nothing but a mistake, the consequences of which are be- coming gradually more and more obvious?” The pessimistic phase appears strongly in Schopenhauer's views of women.“One need only,” Schopenhauer says,“look at woman's shape to discover that she is not intended for too much mental or too much physical work. She pays the debt of nature,” he goes on, “not by what she does, but by what she suffers—by the pains of child-bearing, care for the child, and by subjection to man, to whom she should be a patient and cheerful companion. 266 Jas. G. Kiernan. “Women are directly adapted to act as the nurses and educators of our early childhood, for the simple reason that they themselves are childish, foolish and short-sighted-in a word, are big children all their lives, something interme- diate between the child and the man who is a man in the strict sense of the word. Consider how a young girl will toy day after day with a child, dance with it and sing to it, and then consider what a man, with the very best in- tentions in the world, could do in her place. “With girls nature has had in view what is called in a dramatic sense a 'striking effect,' for she endows them for a few years with a richness of beauty and a fullness of charm at the expense of the rest of their lives, so that they may during these years ensnare the fantasy of a man to such a degree as to make him rush into taking the honorable care of them in some kind of form for a lifetime—a step which would not seem sufficiently justified if he only considered the matter. Accordingly nature has furnished woman, as she has the rest of her creatures, with the weapons and implements necessary for the protection of her existence and for just the length of time that they will be of service to her, so that nature has proceeded here with her usual economy. Just as the female ant after coition loses her wings, which then become superfluous: nay, dangerous for breeding purposes, so for the most part does a woman lose her beauty after giving birth to one or two children, and probably for the same reasons. “Then again we find that young girls in their hearts re- gard their domestic or other affairs as secondary things, if not as a mere jest. Love conquests, and all that these include, such as dressing, dancing, and so on, they give their serious attention. “The nobler and more perfect a thing is the later and slower it is in reaching maturity. Man reaches the maturity of his reasoning and mental faculties scarcely before he is 28; woman when she is 18, but her's is reason of very narrow limitations. This is why women remain children all their lives, for they always see only what is near at hand, cling to the present, take the appearance of a thing Is Genius a Sport? 267 for a reality, and prefer trilling matters to the most impor- tant. It is by virtue of man's reasoning powers that he does not live in the present only, like the brute, but ob- serves and ponders over the past and future, and from this spring discretion, care, and that anxiety which we so fre- quently notice in people. The advantages, as well as the disadvantages that this entails makes woman, in consequence of her weaker reasoning powers, less of a partaker in them. Moreover, she is intellectually short-sighted, for although her intuitive understanding quickly perceives what is near to her, on the other hand her circle of vision is limited and does not embrace anything that is remote; hence everything that is absent or past, or in the future affects women in a less degree than men. This is why they have greater in- clination for extravagance, which sometimes borders on mad- ness. Women in their hearts think that men are intended to earn money so that they may spend it, if possible, dur- ing their husband's lifetime, but at any rate after his death." Reviewing Wallace's* life of Schopenhauer, T. P. O'Con- nor remarks that the paternal grandmother of the pessimist recalls that terrible great-grandmother who figures in Zola's pages as the origin of all the evil passion, the sensuality, the madness, the final decay which befell the Rougon Moc- quart family. Schopenhauer's paternal grandmother, after the death of her husband was judicially declared to be in- sane, and was deprived of the management of her own af- fairs. She had three sons. Two of them were undoubtedly of weak intellect. The third, the father of the philosopher, was certainly very peculiar. He was a man of plenty of intelligence, of a strong but somewhat perverse character for a German, as he was at once a good business man and a lover of culture; he was familiar both with the literature of France and of England. He was something of a rolling stone because of the intensity with which he felt things. Dantzic ceased to be a free city. Instead of accepting this state of affairs with the tranquility of most of its citizens, Heinrich Schopenhauer emigrated to Hamburg. He loved England so much that he proposed that his son should be *Great Writers' Series. 268 Jas. G. Kiernan. born there, and with that object he took his wife to Eng- land. But he counted without that lady, who was a per- sonage whom one could not safely ignore. She got homesick for Germany. Back to Germany they had to go. Thus Schopenhauer was born in Dantzic, and on German instead of English soil. Later on Heinrich Schopenhauer took his son to France and again to England. He always had some new idea better than any which went before for bringing the education of his son to perfection. He was a dreamer and a projector of the type that makes a mess of his own life and of the lives of those dependent on him. He died rich, and therefore, though there were fluctua- tions in his business, Heinrich Schopenhauer was not a man face to face with adversity. But he became moody, terri- bly irritable, and finally was found in the canal. He had either fallen or thrown himself from one of his granaries into the water. There was strong presumptive evidence of sui- cide.. Arthur Schopenhauer, the son, was more like his mother than his father. He loved the father but never really cared for his mother. A dedication of one of his works to his father, written years after the parent's tragic death, is a touching proof of the depth of the affection of the child to the parent. Frau Schopenhauer did not love her husband; she mar- ried him for position; she probably did not love anybody much but herself. She was a woman of some attainments and of considerable pretensions. “Mme. Schopenhauer," writes a German misogynist, “is a rich widow; makes profession of erudition; authoress. Prattles much and well intelligently; without heart or soul; self-complacent, eager after approbation, and constantly smil- ing to herself. God preserve us from women whose mind has shot up into mere intellect.” Frau Schopenhauer had literary gifts. For a consider- able time Arthur Schopenhauer was known more as her son than by anything he himself had done. She wrote novels, books of travel, and her fortune-considerable for Germany -enabled her to entertain largely. She lived at Weimar, Is Genius a Sport? 269 which, with Goethe there, was then the literary metropolis of Germany. The house of Frau Schopenhauer was the rendez- vous of the literateurs. Though wealth is able to attract people everywhere, and especially literary men, Frau Scho- penhauer must have been something of a personal attraction to have retained her hold over many distinguished and cul- tured people. She and her son had various conflicts. A 'final rupture came over a matter of business. The conduct of Schopenhauer after this shows an intense selfishness. For eleven years he never wrote either to his mother or his sister; for twenty-four years he never saw his mother. She died away from him, and Schopenhauer remained a misogynist all his life. At one time he thought of marrying; fortunately he did not carry out this resolve, for he was not a man to make any woman happy. His own definition of marriage is sufficient to show how unfitted he was for that state. Mar- riage was a debt contracted in youth and paid off in old age. Then he pointed out that the great philosophers- Descartes, Leibnitz, Malebranche, Spinoza and Kant-had been celibates. He was absorbed in his philosophy, which brought him little comfort. Years after he had published the first edition of his greatest book his publisher told him that a consider- able number of copies had to be sold as waste paper. When he tried lecturing on philosophy in Berlin his class-room was deserted, while that of Hegel, whom he detested and despised with all the virulence which belongs to the serene philosopher, was crowded, and this further embittered him. And all the time he was full of the importance of his work -never for an hour lost faith in himself, and never con- cealed the loftiness of his self-estimate. He displayed much petty irritability. Some woman irritated him very much by chattering outside his door-he was peculiarly sensitive to noise, and especially to the noise of a woman's tongue. He tried remonstrance with his tormentor. This was in vain. Then he lost his not very long temper and turned the woman by force from his door. How much force he employed was tried out in several law courts. The end was that he had to pay the woman an annual income until her death. 270 Jas. G. Kiernan. His life was lonely. He lived in rooms, and as was the custom, dined and conversed in a restaurant. A French writer as he saw him in his favorite inn in Frankfort, where after many wanderings he finally settled down, described him as a very neatly dressed old gentleman, almost like a nobleman of the period of Louis XV., with a beautiful lace ruffle around his neck, a white tie and elegant clothes. He was also an intense lover of neatness and personal cleanli- ness, not altogether a popular or universal virtue at that period of German life in which he lived. He insisted on taking his cold bath every morning, even up to the day of his death, and when he was not well. His face was also striking, even in old age, which was the time when the French observer saw him. The eyes of a vivid and trans- parent blue, his lips thin and with a slightly ironical smile, his broad forehead, with a few curls of beautiful white hair on the side—all gave an air of great distinction to his face. His conversation was brilliant and inexhaustible-rich in observation, in originality, in apt quotation, in fearless anal- ysis, and he could hold admirers for hours—until midnight -listening with undiminished interest. He spoke with equal facility German, French, English and Italian, and Spanish fairly well. Schopenhauer died on September 20, 1860, in his 73d year, peacefully alone, as he had lived, but not without warning. One day in April, taking his usual brisk walk after dinner, he suffered from palpitation of the heart—he could scarcely breathe. These symptoms developed during the next few months. Dr. Gwinner advised him to discon- tinue his cold baths and to breakfast in bed, but Schopen- hauer, with the iatrophobia recurring from plutocratic adol- escence, was little inclined to follow medical advice. To Dr. Gwinner, on the evening of the 18th of September, when he expressed a hope that he might be able to go to Italy, he said that it would be a pity if he died now, as he wished to make several important additions to his“Pararga.” He spoke about his works and of the warm recognition with which they had been welcomed in the most remote places. Dr. Gwinner had never before found him so eager and Is Genius a Sport? 271 gentle, and left him reluctantly, without however, the least premonition that he had seen him for the last time. On the second morning after this interview Schopenhauer got up as usual, and had his cold bath and breakfast. His ser- vant had opened the window to let in the morning air and had then left him. A little later Dr. Gwinner found him reclining in a corner of the sofa; his face wore its custom- ary expression; there was no sign of there having been any struggle with death. There had been no struggle with death, he had died as he had hoped he would die-painlessly, easily. In Schopenhauer is evident the gloom of the hereditary defect aided by parentally made environment so fertile in producing the arrests of evolution evident in the various expressions of adolescent pessimism. His views are pecu- liarly congenial to that oriental contempt for women which dominates German thought since the onset of the present era of militarism. The Schopenhauer philosophy, the middle class business man is peculiarly apt to imbibe and urge since it justifies ethical lapses on the pessimistic ground of “doing others lest they do you.” This last, a survival of the suspicion of primi- tive man, is peculiarly aided by a ' practical" tone given schools in the pedagogic worship of success. The career of literature, art, so-called psychology and “practical" science is dominated by factors which foster adolescent pessimism mak- ing it aim at revolution rather than evolution. This is pecu- liarly true of literature. In active life, as Froude remarks,* man works at the side of others. He has to consider them as well as himself. He has to check his impatience and to listen to objections even when he knows that he is right. He must be content to give and take, to be indifferent to trifles, to know and feel at all times that he is but one among many who all have their humors. Every day, every hour, teaches him the necessity of self-restraint. The man of letters has no such wholesome check upon himself. He lives alone, thinks alone, works alone. He must listen to his own mind for no other mind can help him. He requires correction as others do, but he must be his own schoolmaster. His peculiarities *Life of Carlyle. 272 Jas. G. Kiernan. are part of his originality and may not be eradicated. The friends among whom he lives are not the partners of his em- ployment; they share in it, if they share at all, only as in- struments or dependents. Thus he is an autocrat in his own circle, and exposed to all the temptations which beset auto- cracy. He is subject to no will, no law, no authority outside himself; and the finest natures suffer something from such unbounded independence. Pedagogic infallibility has the same fostering environment. Professors of “science” in uni- versities subsidized by plutocracy utter dicta contradictory of general principles; evolved from an inner consciousness dominated by adolescent pessimism of the type described by Magalhaes. To this type clearly belonged the poet, John David- son, who lately committed suicide. He came of neuro- pathic stock, suffered much from Weltschmerz during adoles- cence and imbibed thereby the morbid tendency of imposing his mental morbidities on the world as standards. He was dominated by Schopenhauer as to women and the future. Naturally he made a failure since his literary art did not atone for the intellectual and moral defects in his literary output. Despite his receipt of a civil service pension from the British government for his services to literature, he found lack of popular appreciation so trying that he committed suicide. This led to some animated discussions as to popular respon- sibility for it. The Literary Digest in discussing this asks: Does the World Owe the Poet a Living? When poets in their misery die, shall their country be charged with blood-guilti- ness? William Watson charges the English nation with re- sponsibility for the death of John Davidson. England is in- different to his death, Watson asserts, and just so she lets her other poets die if they choose, for“ it is as possible as it was in the early days of Samuel Johnson for a genius capable of conferring luster on any age or country to live in obscurity and cruel neglect and to die at last of the accumulated fury of a life- time.” A good deal of comment on the general economic ques- tion of supporting poets has been evoked both in England and also in this country by Watson's letter. To his virtual prop- osition that support should be given in some form by the State, the London Spectator replies that such support might Is Genius a Sport? 273 remove the poet's incentive to work—a reply that rouses the wrath of Mr. Chesterton.-Illustrated London News, May 5, 1909: “When The Spectator answers Mr. Watson by saying that most probably if poets got pensions they would be lazy and not write, I venture, in the case of a society like ours and a paper like The Spectator, to call the remark 'cheek. The society in which we live and of which The Spectator is so solid and placid a prop, may be said, without exaggeration, to be based on the idea that men with much money can be trusted to work well. That is the whole defense, and the only defense, of our oligarchy, of the vast salaries and the vast estates. We are warned that if one miserable poet gets three hundred a year he will cease singing. In that case the governors who get thousands a year ought to cease governing. The orators ought to cease orating; the financiers ought to cease financing; the great bankers must be thinking only of dividends and never of economics; the great landlords must be thinking only of the rent and never of the land. This theory of the soporific power of money, true or false, is utterly subversive of the whole system of England; that venerable object, the stake in the country, becomes a deadly and even derisive object, like the stake driven through a suicide. This revolutionary spirit in The Spectator alarms me. I can not promise to go all lengths with so explosive an organ of opinion, if it really pro- poses, without warning or compensation, upon the pure prin- ciple that money is a dangerous drug, to strip all young aristo- crats of their allowances or all dukes of their private parks." Mr. Chesterton concedes the tenability of the “implied obligation in a people to sustain, in no illiberal spirit, the poets who express the people.” But that implies an obliga- tion upon poets to express the people. “The contract is rightly kept vague and elastic; we will not dictate the poetry, nor should the poet dictate the pen- sion. But the contract, the unwritten, is fundamental. Be- cause I can not express my feelings when I am in love with a woman, I owe gratitude and help to Robert Burns, who can express them for me. But because I pay Burns for expressing his love for a woman (which I feel, but can not express), it 274 Jas. G. Kiernan. does not follow that I need pay him if he expresses his love for a she-rhinoceros, a sentiment which I do not feel, and do not even wish to feel. I admire the sky spangled with stars, but I can not praise it; Shelley can do it for me. But if Shelley takes to praising the skin spotted with smallpox, then I have to tell him, gently but firmly, that I not only can not praise, but do not admire. The breach between the people and the poets has been bad for both; the people have gone without in- spiration and the poets without applause. But the error was in the poets as well as the people, and certainly it was not absent from John Davidson. He chose, in his last stages, to praise inhuman and monstrous things, tyranny and chaos, which the heart of mankind hates forever-things in the high- est and most serious sense incredible. It is partly that which chokes the channel between man and the modern poets. The real poet is the man who says what men can not say—but not what men can not believe.'' (TO BE CONTINUED.) DEMENTIA, AMENTIA, DESTRUMENTIA, (OR DESTRUOMENTIA.) By C. H. HUGHES, M. D. St. Louis, Mo. THE term “dementia” has been vaguely used and indefinite- 1 ly applied to different and varying conditions of mind damage and derangement. Thus dementia paralytica is often applied to paresis menti in its mildest forms when but little of the mentality appears lost, i. e. in its incipient pro- dromal stage when we can make only a probable diagnosis because of the scarcely appreciable paralysis, either in psychi- cal or physical expression.* In other words the mind has not been destroyed, and yet the condition has been designated as dementia and the labial paralysis is not greater than we often discover in pure and simple psychasthenia, often not so much, and yet this slightest of paretic conditions is called paralysis in the com- pound term dementia paralytica. While dementia in its most liberal possible sense may be permissible, with a mental reservation, as it is popularly used, because something is gone out of or taken from the normal mentality power in all forms or degrees of mental derange- ment, yet for purposes of differentiation alienists have long used the term, to distinguish from maniac melancholia and the hypochondriacal and the affective forms of mental disorder including the hysterical hypochondriacal displays, etc. *Incipient paresis is often only the prodomal psychasthenia and cerebrasthenia plus an inherent psychopathic predisposition, (275[ 276 C. H. Hughes Dementia means to most writers on alienism a total or nearly complete loss of the normal powers. And this dementia is so termed because, by disease in- volving the brain or the decadence of age, the mental powers have been destroyed. Dementia in its psychopathological meaning is a disease engendered brain involvement destroying the mind. Even when extreme old age brings about the tech- nical dementia senilis of psychiatry a condition of disease exists if old age true dementia comes on, otherwise the con- dition is one of mere normal senility or extreme debility of mind or psychasthenia from inadequate brain nutrition and atrophy of the psychic neurones. Psychasthenia may simulate true dementia in its symptoms, as it often does, (as we have already shown) in the aged, causing them to appear more demented than they really are and from which they may re- cover, revealing only the amnesia, marked mental slowness of function and extreme debility of thought, such as are re- vealed in the mental processes of some extremely aged but not abnormally minded of great age, (centenarians and the more aged). Amentia has been commonly accepted by alienists as applicable, in contradistinction rom dementia, to those who never had mind, namely, the hereditarily idiotic, the extremely imbecile. Such a term as destrumentia, as implying destruc- tion, or encephaloid destrumentia would be more appropriate as showing that the brain and mind are destroyed or that the mind is non-existant through brain destruction. But we need better terms than any we have now, in the literature of psycihatry to designate certain states of ante- natal amentia, not only such as have already been mentioned, but other conditions such as Mr. H. Clay Shaw includes under his term. There are states of congenital eccentricity of cerebro psychic propensity and peculiarity where something has prenatally been denied the brain of a certainty, for which we have no single word of description save the word congenital eccentricity. The term “mania" too has been extended in its use from its original meaning (madness) and that signifying a violent form for which a term like destromania or destruomania would Dementia, Amentia, Destrumentia. 277 seem necessary to distinguish from other mental states, such as mania a potu, which is too often used as a synonym for delirium tremens, which may appear far different from mad- ness in its mild manifestations of feeble delirious fears of insects, reptiles, etc., as compared with true maniacal delu- sion. This term, as the appellation of mania without delirium as sometimes used to apply to insanity without delirium or reasoning insanity, is misleading to the novice, but when by common agreement among alienists if the application is understood, no harm is done. The French 'erm folie raisonante is better, as applied to right reasoning from a delusive premise form of mental derangement than paranoia. That very expression manic depressive insanity applied as a more com- prehensive term to designate mental states manifest in certain phases of extreme melancholia (as we term it.) In it we have depression and delusive impulses to suicide and violence, whereas in simple melancholia we have mainly emotional depression and self suggested impulses dependent on depression of feeling and “blue' conceptions to suicide- “to be or not to be" is the suicide's question and self suggestion. Whether, as it was to Hamlet, "nobler in the mind" to suffer this or that, or debasing to one's sense of honor and duty to or not to, etc. With the noble Dane it was “whether' tis nobler in the mind to suffer the slings and arrows of outrageous fortune or to take up arms gainst a sea of troubles and by opposing end them”—with his dagger. To him the suggestion of his mind in meditative soliloquy, death was sleep “and in that sleep of death what dreams might come to him.” It was also the question who would overwhelming burdens bear (fardels) when they might thus so speedily and effectively end them in eternal sleep. This was not mania nor was it maniac depression. It was reasoning from depression and the possibilities of relief from an almost killing burden, and almost overmastering sor- row that dominated his life. His mother has been murdered by his stepfather, the King, and the insomniac excited appari- tion of that terrible deed, like the ghost of Macbeth, would not down. 278 C. H. Hughes This was not mania. It was the emotion morbid at a time of "a mind o'er wrought.” It was not depressive mania, though he was depressed by his great grief, much loss of sleep to insanity, or madness, if we may use the term, ac- cording to the custom of his day. The philologic poverty of our language too much impels the use of single words with varied meaning. The ancient Greeks used our specific term for that peculiar life character form of insanity which we term paranoia for all mental disease, yet we have restricted (our German colleagues especially) to that form of mental derangement which our French brethren designate as folie raisonante and we as "reasoning insanity,” such as Hamlet had and yet did not have technically, for he had melancholia with it and at times normal minded simula- tion, simulation for a purpose in connection with the detection of the King's horrible crime. It is not strange that under the psychic strain upon him that Hamlet should have had at times acute psychasthenia sufficient to develop a morbidly mani- festing mentality from which, with return of strength of brain and mind after adequate repose, that the circumstances about him in his peculiar environment should suggest to him the value of feigning insanity at such times as he was in saner moods of mind. But Hamlet's case could not, in any reason- able classification, be classed as one of mania. Yet should you read a German writer and find a person like Hamlet spoken of as having manic depressive insanity, you would know that Hamlet had moods to murder as well as to kill himself, without classing him in your mind as a maniac, for you know he was not, though he had impulses to homicidə as well as suicide and was wont to “put a maniac disposition on,” at times, using the term mania only in the usual sense of ordinary insanity. Thus in the study of psychiatry as in the use and meaning of psychiatry itself the terms mania, dementia, etc., have their principal and their shades of meaning so greatly variant owing to the paucity of our language that even psychiatry to which in strictest and definite meaning pertains the healing of mental disease, has come to have a much more extended signification than formerly, being now used to signify anything and every- Dementia, Amentia, Destrumentia. 279 thing pertaining to the understanding of cerebro mental disease, including cerebropathology, cerebropsychology, cerebroanat- omy with reference to the sane as compared to insane and unsound brain states, the construction and management of hospitals for the insane and psychotherapy or the means, manner and methods of cure for mental diseases.* The more one knows clinically of the vast subject or sub- jects of insanity, the more difficult does it appear to form ab- solutely definite and flawless definitions of all of the many phases of insanity. Apropos to this discussion Dr. E. Dupré, Professeur Agrégé a la Faculté de Médecine, Paris, in a valuable report to the Amsterdam Psychiatric Congress, September, 1907, on the differential diagnosis between paralytic dementia and other forms of acquired dementiať uses the term dementia as synonymous with amentia, which it really is, only the latter begins with the beginning of life endowment- congenital-there never having existed any mind in the in- dividual; while the former is mind once existing, but now destroyed-mind taken away by disease of brain. True dementia, we might say with E. Dupré and others from this writer back to Esquirol and beyond, is the final ex- pression of the ruin of the intellectual edifice, known always to have an anatomo-pathologic substratum, characterized by diffuse destruction, degenerative or inflammatory, of the cortical cells and by finer microscopic lesions. He is speaking here, of course, on the theme of his paper “Acquired Demen- tia' and all real dementias, as he says, are organic. It would be interesting to continue this subject, taking up dementia præcox as presented by Dr. Thomas Johnstone and discussed by those English Coryphænses who followed Savage, Clouston, Bevan Lewis, Jones, Yellowlees etc. But most who read this have also the Journal of Mental Science on their tables. *This, and most of the preceding remarks are such in substance as the author has been accustomed to address to his senior plains the attempt at simplification of a subject not always so simple even to psychiatric experts. *Diagnose differentielle entre la demence paralytique et les autres formes de demence acquise. THE EMMANUEL MOVEMENT AND ITS AFFINITIES. By C. F. Buckley, B. A., M. D. San Francisco, Cal. THIS latest medical fledgling yclept, “The Emmanuel Movement,” however improperly named, bids fair to attract wide-spread attention in consequence of its being the offspring of the Episcopal Church; and hence should receive more than mere transitory interest from the great profession of medicine. As I understand its scope, it is to supplement the efforts of the legitimate practitioners of medicine, by the judicious and pious suggestions toward the higher life. As- suredly nothing of a faulty nature can lurk in this domain, and it essentially differs from the so-called“Christian Science," which not only ignores, but scorns the aid of legitimate medi- cine, with the results so frequently observed in the daily press. Shakespeare tells us “ 'Tis too much proved that by de- votion's visage and pious actions, we do sugar o'er the devil himself,” and while ignorant of the power of his Satanic majesty, it is by no means illogical, to claim that many dis- eases might be rendered innocuous by the elevation of the spirit and pious action. Some very sad slanders are already appearing against the Emmanuelists, their enemies going so far as to say, that their motives, and raison d'etre, are no higher than those of the eighth Henry, when he confiscated to his own use, the cleri- cal and monastic properties, of his domain. The assertion is openly made that the blandishments of Mrs. Eddy and her ingenious cohorts, have so depleted the pews and benches, of the Boston churches, that it became (280) C. F. Buckley. 281 necessary to resort to some means to control the outflow, and restore the prestige, and prosperity of the threatened edifice. That Mrs. Eddy's incoherent blend of mystic and biblical literature, should capture the intellect of any sane person, is beyond the ken and culture of the writer, and only goes to prove what Herbert Spencer long since asserted, that “Man is not a reasonable being." While lending no manner of credence to those accusations against the promoters of this new cult, if such it may be called, the reformer ever has been the victim of slander and vitupera- tion, it is certainly not very creditable to the great Episcopal Church at this time, and for the first time, to claim as original, a practice as old as history, and more especially among the early Christian establishments in all their ramifications. Mrs. Eddy's remarkable treatise, “Science and Health, with Key to the Scriptures,” which she claims is a direct inspiration from the Deity, is, to say the least of it, not very complimen- tary to the Supreme Intelligence, but on the contrary savors rather strongly of an emanation from a ward for mental aberration. Henry Maudsley in one of his public utterances laid marked stress on the fact that if the value of bromides were half as well known in the time of Mohammed, as at the present time, the Koran would have never been written. With the history of the Eddy movement, the medical profession has little to do, but with the arrogance of the sect, in claiming a monopoly of the Deity's power and benevolence, it has much to do, and daily observations show the fatuity of this preposterous assumption. Medical men of a judicial temperament and of profound scientific attainments, cannot fairly impute to any reasonable innovation, improper motives on the part of its author, be- cause the whole domain of medical science, at best, is a never ending kaleidoscope of restless energy and change. The truth of Hamlet's reproach to his friend,“ There are more things in Heaven and on earth than are dreamt of in our philosophy Horatio,'' no person can realize more thoroughly than the medical man. But yesterday Lord Paramount Microbe held the stage, and to-day his pedestal is threatened 282 The Emmanuel Movement and its Affinities. and tottering, and as the days advance his insignificance seems to be more and more apparent. Only a very short time since Lord Lister was elevated to the peerage for advocating and advancing-only a very little—the work that Pasteur really inaugurated, and he is now being lashed to fragments by the new “progressives," who claim that his theories and practice have been abundant- ly deleterious, whilst of very little benefit to the human family. King Koch for whom the great Kaiser built a million dollar hospital, has had a very short reign, as we know; and these and similar examples, limitless in number, only go to emphasize the fact that we must not at the outset seek to quench the rising flame of the Emmanuel movement, but calmly settle down to investigate its merits and lend our heartiest co-operation if deserving. Some ten years ago in a semi-public address to the grad- uating class of the “Physicians' and Surgeons' College” of this city, I took occasion to say that the man who relied on his “pills and potions” alone, never did make, and never could make, a successful practitioner of medicine; that whilst it is our duty to avail of every form and source of material information, we must not forget that we had to deal with a complex human being, composed of mind and body, the one unceasingly acting and reacting on the other. I also informed them that only under the most pressing necessity did I care to do even a trifling operation on a pa- tient, whose mental condition was bordering on melancholia, my observation having been that such patients succumb very frequently to operations commonly without risk. Since the dawn of history at least, if not further back, there has always been a conflict between the materialist and the spiritualist, the conflict is still with us, and I presume no thoughtful person has failed to detect this very conflict in his own personality. Berkeley was probably the most pronounced spiritualist of modern history, and so Byron wrote of him, “When Bishop Berkeley says there is no matter, it matters very little what he says." His fellow countryman, Tyndall, may be put down as the leader of the opposing camp in recent times. In C. F. Buckley. 283 his insolent scoffing at matters spiritual, he was the author of what was known as the “Prayer Gauge" and after having made some beautiful experiments with chemicals, in his well known Manchester address, he said, “I see in matter the promise and potency of every form of life.” Owing to a one sided education, medical men for the most part are in Tyndall's camp, and of course church men for the same cause are necessarily drawn to the other side. Magazine writers whose sonornus phrases pass current for careful medical observation,-although they may not have studied a serious case of disease in their lives,-become advo- cates according to their fancies, but in nowise advance the general subject one iota. Something over a century ago Mesmer “disturbed the peace of Europe," claiming that he had discovered an occult fluid, with which he was able to remedy all the diseases that fesh is heir to. The press agents were not as active then as they are now, and yet in an incredibly short time, his fame and efforts be- came the table talk of all the courts and salons of Europe. One of his pupils who had paid quite liberally for his tuition, had the wit to perceive that the “fluid” was simply the effort of a commanding will-power, and following up this clue, made experiments chat have produced inestimable blessings to afflicted humanity. The efforts and experiments of Charcot, improperly called “Hypnotic Suggestions,” of late years, were following the same lines as Mesmer, and amongst the class of patients thus treated by him the results attained were much more satisfactory than those obtained by drugs and all previous treatments. The amazing feature of the Emmanuel Move- ment, as I have previously hinted, is its claim to any original- ity, for at the present time and long prior to the existence of Dr. Wooster's efforts, a society of physicians in London, known as the “Guild of St. Luke,” have followed precisely the same methods. Many of them are well known members of the profession, and some of their names are known throughout the world. Their habit has been to meet annually at St. Paul's for divine 284 The Emmanuel Movement and its Affinities. worship, and confessedly seek spiritual aid and enlightenment, in behalf of their patients. In a very remarkable controversy between Dr. Storer, of Boston, and Sir James Simpson, the latter pointed out by a quotation from the “Venerable Bede" that the subject of anesthesia which we all claim is so modern, was known and practiced by the early Christian monks, without the aid of chloroform or ether. That some individuals possess a remarkable therapeutic power, has been over and over again asserted by competent observers, and we who belong to the regular medical pro- fession, cannot ignore these observations, no matter how much we may desire to do so. The fact is, in common daily life one person inspires others with courage or cowardice, according to his bent, and people do or dare great deeds, or succumb to trifles, according to the inspiration infused into them. Nothing better illustrates this than the authenticated observations in relation to victorious or vanquished armies. Under equal strain and efforts the one enjoys the usual modi- cum of health, while the other suffers from physical diseases commonly ascribed to material things. This same observa- tion must apply to a large portion of all our diseases; there is beyond question in us a conscious, and unconscious, or sub- conscious life, and certain conditions of health or disease evoke the efforts of one or the other in a greater or less de- gree. Take for instance the familiar example of the somnam- bulist. I presume no materialist will deny that a person in this condition can perform feats away beyond the capacity of that same individual in the normal and conscious state; take again the subject of Hysteria or Pathelesia* as I have named it, what can they not do with their bodies? Medical men of the “microbe school” will scarcely believe that“ tuber- culosis of the kidney,” carefully investigated and diagnosed, surrounded by all the panopoly of microscope and cultures, proved after all to be nothing other than the development of *Pathelesia means a "morbid will" and should be the term used instead of hysteria, which has no meaning, because by the force of will, those patients can do with their bodies things utterly beyond the reach of persons not afflicted in this way. C. F. Buckley. 285 this hydra-headed monster Pathelesia.* The sufferer of a decade ago supposed then to have before her only a short span of a few months at most, now occupies a position of some prominence in the theatrical world. Our works are full of the most extraordinary instances, illustrating the control that people in this condition possess, over what is usually regarded by physiologists as the involun- tary functions of the body, and over which the will in the normal condition has no control whatever. Take for in- stance the well authenticated case of a person who has the capacity to pour out blood from any portion of the body he desired, or was directed to do. Now if persons have this capacity—which cannot be denied-of affecting the in- voluntary systems of their bodies, by some distortion-for want of a better name,-of their normal will, how can it be properly denied that some can influence the wills of others, and so produce changes in their systems that may lead to health or disease? Is it not reasonable to suppose that by some uncon- scious power or well directed suggestion, they may stimulate and arouse in the patient that effort of nature: that vis medicatrix nature which is the aim of all our efforts, whether we prescribe a pill to stimulate the liver, or apply a splint to a broken limb. The marvels, as some people regard them, of Mrs. Eddy and the Christian Scientists, seem to excite the indignation, rather than the studious faculties of the cohorts of Material- ism, and so they are buckling on their armor in all directions to oppose the inroads of this new cult, and hence the maga- zines already commence to bristle with spears drawn to squelch the advance. The facile pen of Woods Hutchinson whose imagination is not always impeded by scientific information, is now en- listed on this side, and presumably before the end of the pres- ent discussion we shall have regular camps of Berkeleyites and Tyndalites. *This lady was a physician's wife, and several prominent men are cognizant of the facts. 286 The Emmanuel Movement and its Affinities. Dr. Hutchinson deserves some special consideration be- cause whilst evidently seeking to oppose all mental operations in the aggravation or production of disease, or improvement of health, and whilst indulging in hair-splitting logic as to what is physical and what is psychical, ascribing all things to the potency of the body alone, proves the very contrary from his own mouth. Having referred to the panic created in the body by some unpleasant intelligence or sudden shock, he says, “The relief of the latter by the confident assurance of an expert, and trusted physician, that the chances are ten to one that the disease will run its course in a few days and the patient com- pletely recover, especially if coupled with some drug, which relieves the pain or diminishes congestion in the affected organs, will often do much toward restoring balance and putting the patient in a condition where the natural recupera- tive powers of the system can begin their work." His experiment of standing up and assuming attitudes of various forms are on the same plane, and he seems to utterly forget that the first part of his experiment is the act of volition to move the muscles in the different directions. When he asserts that what are mental impressions are commonly bodily impressions he ignores the fact that every element of our bodies, every constituent of our physical system, must be changed, at the farthest, every three months, and yet the mentality of the individual remains usually the same, and the most extraordinary fact connected with it is that the memory of more remote events are clearer than the memory of the more recent: hence we have the wonderful thing of memory fresh through a century, while every particle of our bodies has changed at least five hundred times. Some twenty years ago a very learned and devout Catho- lic priest consulted me regarding a cancerous ulcer of the face, which greatly afflicted him. Before entering the church he served with the British Army in India, and having a large private fortune, he always enjoyed travel for information and observation. Before coming to see me he had a con- versation with a very pious Bishop under whose jurisdiction he then served. Touching this facial ulcer, the latter told C. F. Buckley. 287 him to try some religious specific claimed at that time to produce miraculous results. His reply to this was, “I do not think that I am so important in life nor so deserving that I could ask the Almighty to come down from Heaven to per- form a special service for one so unworthy as myself. I pre- fer the natural means, not because of any disbelief, in the omnipotence and immanence of the Creator, but because of my own unworthiness to be the recipient of special favor." This seems to me to typify the highest ideals of our human relations with the Deity, and if more generally applied, would prove of incalculable benefit. It is a little different from the Israelite who commanded the sun to stand still to subserve his own end, and also from the Mohammedan who ordered the sun back to a certain point because he had forgotten his evening prayers, which should have been uttered at a certain time, when the sun reached a certain point. To us commonplace observers it is impossible to con- ceive mind without body, and knowing that we possess both, we must, with the judicial temperament that befits us, seek to draw from all sources such materials—so to speak—as may conduce to the uplifting of both. If any man denies that the mind affects the body or the body the mental condition, he has paid very little attention to surrounding conditions, and he certainly has not studied with much care the varying situations at the bedside of the afflicted. The old, old aim of the Pagan philosopher, the “mens sana in corpore sano,” should ever be borne in mind by the man who has made the alleviation of human suffering his life work. The reproach of Macbeth, “Thou can'st not minister to a mind diseased, etc.,” holds no place in medicine and never did. Even the crude and often cruel experiments of physiologists on the lower animals, prove that the mental attitude, so to speak, of these creatures will affect all their bodily functions. In the whole range of medicine there is nothing more certain than the fact that moral shock will produce physical pain, and even death; and that physical suffering will produce 288 The Emmanuel Movement and its Affinities. profound and complete change in the morale of individuals. It seems to me if these few every day observations were carefully borne in mind by its members, the profession of medicine need not bow the knee to the innovators of “nothing new," nor divide themselves into opposing camps. Our human history is full of tales of the marvelous and of influences ouiside the natural channel, producing results beyond our ken. Instead of scoffing at these tales, and treating them with de- rision, better results may be obtained by a more serious con- sideration of them, and this study should be largely directed, in ascertaining to what degree, and how far the mind influences the body. Perhaps the Materialists can explain—I cannot—the few following facts which came under my own notice. While acting as an asylum superintendent in the north of England, a lady of wealth and prominence came under my care. She had been insane a great many years. Her family desired to make some important changes in her surroundings, involving her removal from the asylum, to a private home of her own. Her sister residing in the country, near Man- chester, some fifty miles off, asked me to visit her. During my visit she asked me if it were possible for her afflicted sister to get any knowledge of our correspondence; I assured her that this was impossible, and explained to her why it was so. She then said, “That is most extraordinary, she must have what is called 'second sight,' because she knows clearly that we are corresponding, and what the nature of this corre- spondence is, and not only that, but when she was first taken ill, she told things as happening in our family that were im- possible to conceive, but have since turned out perfectly true.” I tested the accuracy of the correspondence statement and found it to be perfectly correct and, without possibility of a doubt, there was no physical means at her disposal, by which this information could be acquired. A prominent and wealthy man of San Francisco, pretty well know in New York, becomes the victim of neurasthenia. He is not much beloved in the community because of many questionable transactions to increase “his store." C. F. Buckley. 289 He lives about two miles from my office and on the occa- sion of one of my visits he startled me by requesting me not to pay any attention to “those scoundrels who come to your office inquiring about my health, etc., because while they try to make you believe they are friends of mine, they are the very worst enemies I have.” This man was confined closely to his house, no person allowed to see him but his faithful, honorable nurse. In vain I tried to assure him that no person of any kind came to my office to make any inquiries about him. He flatly contra- dicted me and accused me of concealing the facts. I was so struck by his positive assertion, as against my absolute knowl- edge, as I thought of the contrary, that on returning to my office that afternoon, I made particular inquiries of my as- sistant about the matter. Very much to my amazement he told me that during my absence every day for weeks, several people called to make the inquiries stated, and of which I was completely and blissfully ignorant. I instructed the assistant to order them—there were several of them—to keep away from the office, as no information touching any patient was permitted outside his own home. To the patient I affected complete ignorance, of any in- quiry and made no further allusion to the subject, but a few days after he startled me by thanking me for getting rid of “those touts." A well known lady in San Francisco, who has been mar- ried some ten years, but never became a mother, is confined to her room and bed for two years. She has been constantly attended by three nurses and has had at least twenty differ- ent doctors during this period. At noon every day she is seized with the most peculiar and violent pains, and writhes in agony to all appearance. After a few days study, her demeanor at this time to me, seemed to resemble an effort at parturition and I acted accordingly. I excluded sympathiz- ing friends and dismissed all the nurses but one, who seemed the most intelligent. I instructed her to keep away from the patient's room at this particular time of the day and allow no one else there. A few days after, without her knowledge, I ordered a carriage to her home, a little before the hour of 290 The Emmanuel Movement and its Affinities. pain. I then told the nurse to dress her simply, as I intended to take her for a little airing, so that she could better endure the pain. She was kept out long enough to pass the usual time but she commenced her “agony” in the carriage, at which the nurse and I laughed rather heartily. After awhile she herself joined in the laugh and the spell was broken. From that day on this woman became perfectly normal and shortly after enjoyed with her husband a year's travel in Europe. A distinguished Episcopalian clergyman suddenly be- came insane by the shock of seeing his daughter drown before his eyes in a swollen stream, into which she had slipped. For months he was an inmate of the asylum, without change, though under the best known medical care and efforts. One day he addressed me thus: “Do you not think that in order to regain mental health, one must have mental exer- cise?” I said, “Certainly,” at the same time pointing out the various means at our disposal for many forms of mental exer- cise. “Yes," he replied, “but the only thing that exercises my mind properly is preaching." This patient had to be fed by a stomach pump at this time, and I shall never forget the consternation of the chaplain when I proposed to him that the patient should be allowed to preach. To be brief, I arranged matters so that he could preach at the next afternoon's service, with the caution only, that as we had many sects, he must offend none. Accordingly he preached on “The Existence of God,” and with his profound knowledge of Sanscrit, Hebrew, Greek and Latin, he delivered the most masterly discourse on the subject, that I have ever had the happiness of listening to. This effort seemed to give the desired impetus toward a speedy recovery. Probably some ingenious Materialist can explain this by claiming that the movement of the muscles of the jaw and tongue, rushed the blood to the brain, in such quantities as to restore its normal function! 2614 Pacific Ave. THE NEURAXIS AND PELVIC STRAIN OF PRESENT DAY TRANSPORTATION METHODS. A NEUROLOGIC NOTE OF WARNING. By C. H. Hughes, M. D. St. Louis. W ITHOUT awaiting time, which in the press of pro- fession demand, may not come for a finished in- vestigation before making communication on the subject, the harm of the present-day methods of human beings, trans- portation has so impressed itself upon the writer from among his patients that he feels impelled to make this note that others may be led to look into the subject and give to the profession the benefit of more extended observation. Notwithstanding the admirable adaptability of the anatomical arrangement of the cerebro-spinal axis and splanch- nic cavities with reference to the withstanding of a limited amount of sudden movement and jolting the mechanical ar- rangements of modern travel methods, and vehicles impose altogether too much strain upon the pelvis, the spinal cord, the brain, abdomen and thorax and their contents for the sanitary welfare of the viscera there located. So much more cerebral, spinal, cardiac, renal and other visceral irritability and floating kidney trouble, have come to our attention of late years, since urban trolley transportation has become so universal and interurban travel so much more common than heretofore and everybody having forsaken in a great degree the muscle-toning and system-sustaining and invigorating walking and taken to using the cars for even the shortest distances, that we conclude that this must be one of (291) 292 C. H. Hughes. the potent causes to be added to the count of the harm to humanity of the appurtenances of the strenuous life. Steel railed roads, steel wheels, swaying strong inade- quately spring supplied coaches for passengers and a momen- tum of from twenty to thirty, even to fifty miles an hour, some of the time, and the sudden inconsiderate stops and starts of the underpaid motorman who is not required to have an engineer's knowledge of movements and machinery, have a tendency to disturb the harmonious adjustment of the best adapted human mechanism to jolts and physical and psychic shocks. And when the passenger alights after a sudden in- complete stop with the impress of a twenty or thirty or even as is sometimes the case a forty or fifty mile an hour forward movement still upon him, he does not get out of the cars to terra firma deliberately and free from more or less of violence, especially if he alights upon his heels or flat upon his feet, if he is fortunate enough to reach the ground feet forward, not- withstanding the wonderful adaptability of the vertebral column and spinal cord to moderate violences, with its cush- ioned intervertebral and lateral yielding ligaments and the water cushion protective adjustment of the cord and its water bed within the spinal canal. And when resistance is diminished by disease the harm is greater. One notes this in the irritating effect on certain office patients living long distances from the office and be- fore getting an insight into the cause one would be at a loss to know why certain remedial measures seemed less effectual than formerly. This street railway strain is added to by the jerky starting movements of rapid ascent and sudden stops of elevators in the tall buildings. When the writer had an office in the Commercial Build- ing, and now in the Metropolitan, certain patients could not and cannot be successfully treated in them, especially neuras- thenic height fear patients (acrophobiacs). These had to and yet have to be treated at the residence ground level office. Several medico legal cases of street car cerebro-spinal shock have come under the writer's observation and care. Then there is acroesthesia, that peculiar morbid sensa- tion felt by some (if this term be accepted in this extended Strain of Present Day Transportation Methods. 293 sense as descriptive) on going rapidly up or down from or to a great height. There is also the jolt to the spine and brain of stepping down unawares to the elevator floor, which careless elevator boys so often subject us to, and are still retained in service by their employers. From a neuro cerebral sanitation point of view escalateurs in tall buildings are much to be preferred to lifts or elevators, even when the latter are less violently handled by the lift boy than they are in many. Architectural objections as to space should here give way to sanitary demand in this regard as is every thing else in house arrangement and construction for live occupants. Elevators would not be specially objection- able for morgues, as the nervous systems of the dead are most- ly beyond receiving shocks, in this world at least. But we should really have a care for the living neurotic as they come to and go from our offices. Fortunately we have always maintained a quiet ground floor residence region office, where such patients are treated and when the harm of the elevator first impressed itself upon us as detrimental to certain neurasthenics, we decided not to abandon our ground floor office as at first contemplated, and for this reason we continue to maintain it.* A logically sound neuro and psycho neurotherapy de- mands of the neuriater and psychiater more consideration of the detrimental and destroying influences of modern methods of city, as well as suburban and over country railway travel upon his patients. These are new factors to be taken into account in estimating not only causes of neuropathic and other and more visceral states, but as contributing to the delay of recoveries or prevention of recoveries altogether. *Though another good reason for this conclusion has presented itself in the aversion certain business men, of large affairs, have to going to a very public office and having it known to others that they are neurotically or cerebrasthenically invalided to such an extent as to require treatment. These men come more readily to the quiet retired office at an assigned hour when other patients are not likely to meet them. Some neurasthenics likewise having a morbid dread of meeting strange faces (anthropophobiacs, gynephobiacs) are best treated by this arrangement; the alienist and neurologist who would cure as well as merely treat neurasthenics, can not dispense with the private retired office in a quiet part of a great city with its violent noises of vendors bells, whistles and outcries, tall skyscraper buildings rivaling in height the abode of the cliff dwellers, dusty streets and confusion of fast moving vehicles, besides the perilous auto and rapid transit cars. 294 C. H. Hughes. My own patients (hyperesthetic and neurasthenic, cere- brasthenic and more gravely organically neuropathic) are disposed of in the city with a view to preventing the cerebro- spinal and visceral irritation and wear upon the organism caused by our present violent methods of getting about. The rush and roar and run of life as it now is, are bad enough, without rough riding over rapid street cars. These considerations suggest for the neuriatrist and the psychopathist and they should suggest to all physicians for the good of their patients, to have quietly located ground floor suburban offices and to advise the use of easy going carriages or electric auto cars for their patients in preference to the present violently unsteady trainway coaches going on iron or steel wheels and over iron or steel tracks on inade- quately elastic trucks, jolting mercilessly on the nerves of the neuropathic and the aged, over uneven street crossings and otherwise obstructed tracks, as when the abutting streets are granite paved with every now and then a projecting stone struck by the flange of the street car wheels, sending the car bouncing and bumping along, and making sensitive occupants and night time dwellers along the streets miserable. CEREBELLAR CONNECTIONS. By Dr. L. J. J. MUSKENS.* Accompanied with Lantern Demonstration and presented to the Amsterdam International Medical Congress. I. The flocculus cerebelli (more exactly called lobulus petrosus cerebelli) of the rabbit contains cerebellar cortical matter, but also a part of the nucleus dentatus. II. After clean removal of this entire lobus and staining after Marchi no degeneration is found in the corpus restiforme and spinal cord (3 experiments), which is in accordance with the results of Ferrier and TURNER and R. Russell. For this part of the rabbit's cerebellum at least we can exclude not only the existence of cortico-spinal fibres, but also that of fibres running from this part of the dentate nucleus down the cord; but III. There is coarse degeneration of the middle third part of the superior crus cerebelli; so that this peduncle appears to be not a homogeneous bundle, but is composed by strands of fibres, which allow a further differentiation on the crossection, something like it is the case with the internal capsule.f. IV. The ventral cerebello-thalamic bundle of Probst or the bundle of descending collaterals of the superior crus after Pellizzi, Caval, THOMAS and van Gehuchten, is in all cases degenerated on the other side. V. In the squirrel the focculus (lobus petrosus cerebelli) contains only cerebellar cortical and white matter, no part of the dentate nucleus. After extirpation of the flocculus the degeneration stops short in the adjacent part of the dentate nucleus. No degeneration in the superior peduncle nor in *Abstract. Degenerations in the central nervous system after removal of the flocculus cerebelli. First communication. Koninkl. Akademie v. Wetenschappen. Novem- ber 23, 1904. (295) 296 L. J. J. Muskens. the cord. Comparing this result with that obtained in rab- bits,* we therefore arrive independently from Clarke and Horsley, by comparative physiological means to the same conclusion as these observers, and in accordance with the suppositions of Edinger, Probst and van Gehuchten, admit that for every connection of the nerve fibres, forthcoming from the Purkinje-cells, at least for this part of the cerebellum the basal nuclei are interposed. VI. Further examination of cats' brainst, after lesion of various parts of the cerebellar cortex, with adjacent basal nuclei, proved equally the absence of directly degenerating fibres into the inferior crus or into the spinal cord. Regularly the superior crus cerebelli was found partially degenerated. Also a good number of internuncial fibres towards the other cerebellar hemisphere were degenerated. It also tends to show, that the ventral cerebello-thalamic bundle has more connections with the contralateral floccular part of the cere- bellum than with other parts. That the cerebellar cortex can- not be regarded as the origin of this ventral bundle, is clearly shown by the fact, that in one cat an extensive corrosion was effected of the cortex of the formatio vermicularis .cerebelli; in this animal only the direct connections between the in- jured cortex and the adjacent part of the dentate nucleus was degenerated. VII. Probst supposed that the ventral bundle is formed by fibres, which cross the raphe near the nucleus reticularis after having left the cerebellum by the deep and superficial layers of the middle peduncle. Whereas there is no positive proof supporting Cayal's and van Gehuchten's opinion, that these fibres are descending collaterals of the superior crus, the following result tends to prove the partial correctness of the first view: VIII. In two cats, after crossection of the superior peduncle, in front of its decussation exactly caudally from the red nucleus, no degeneration was found, in the regio of the nucleus reticularis and the predorsal region. *Anatomical research about cerebellar connections. Second communication. Koninkl. Akademie v. Wetenschappen te Amsterdam. Report of January 25, 1906. † Third communication. Report of April 26, 1997. Cerebellar Connections. 297 On the other hand I found in one cat, after lesion of the tegmentum, the instrument passing through the middle ped- uncle, some transversal fibres degenerated, taking their course through the substantia reticularis of the side of the lesion, then sweeping dorsally across the raphe and ascending to- wards the red nucleus of the side, opposed to the lesion. X. In a cat the superior crus cerebelli was partially cut and at the same time the crus cerebelli ad pontem was hurt. In this animal the predorsal region was distally from the lesion, free from degeneration. The ventral cerebello-thalamic bundle was only degenerated on the oral side of the lesion. Downward there was only degeneration of Monakow's bundle. XI. So that I am led to believe, that the majority of the fibres of the ventral cerebello-thalamic bundle may be consid- ered as a part of the decussation of the superior crus; the only difference is, that they cross the raphe far more distally in the pons. In the rabbit at least a number of these fibres appear to run in the crus cerebelli ad pontem. THE ALIENIST AND NEUROLOGIST. VOL. XXX. ST. LOUIS. AUGUST. 1909. NO. 3 Subscription $5.00 per Annum In Advance. $1.25 Single Copy CHAS. H. HUGHES, M. D., Editor and Publisher. Editorial Rooms, 3858 W. Pine Boul. Business Office, 3858 W. Pine Boul, HUGHES & Co,, Printers and Binders. This Journal is published between the first and fifteenth of February, May, August and November, and subscribers failing 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 mail matter. All remittances should be made to Chas. H. HUGHES. The Alienist and Neurologist is always glad to receive articles or photographs from subscribers or friends and material acceptable for publication. Manuscripts and photographs should be addressed to the Alienist and Neurologist and where their return is desired in case of non-acceptance, should be accompanied with an addressed envelope and sufficient postage. Any Comment, favorable or unfavorable, specifically set forth, is always wel- come from friend or enemy or any "mouth of wisest censure." EDITORIAL. (All Unsigned Editorials are written by the Editor.) The EROTO-PSYCHOPATHIC DEGENERATE and the unstable neuropaths on their way there, in the Chinese Missions, is a sub- ject evidently not duly considered, if at all thought of by Chinese Christian Home Mission managers and by the benev- olent clergymen who countenance and sustain the latter. Yet that stratum of the Chinese element who attend the Sunday-School missions is certainly not altogether free from that psychic degradation not uncommon even to the non- Asiatic mind in certain circles of our conglomerate social circle where the scum of the slums and the cream of the higher life of (298) Editorial. 299 civilization are permitted to too freely and unrestrainedly mingle under benevolent impulsion and Christian endeavor. The psychic impulse raison d'etre and motif of the heathen Chinese whose ways are often darker and more pecu- liar than the innocent mission girls can understand, suggest more reserve and circumspection in our home missionary methods and efforts than such methods as resulted in the Elsie Sigel and Leon Ling murder horror. “For ways that are dark," etc., the heathen Chinese are peculiar and should be met with a psychology of conduct in all charitable endeavor peculiar to this peculiar oriental. A PENAL INSTITUTION HOSPITAL FOR THE Insane is a pressing necessity of this and every other state where such establishments do not exist, for such religious paranoiacs as “Adam God,” whose normal name is James Sharpe. Sharpe and his wife were lately given ticket of leave from a Western State and in the present instance was convicted by jury of murder in the second degree in Kansas City last May. Only three of the jurors could see the insanity in this paranoiac. Their views secured a compromise verdict. The man should have been declared insane. When the verdict was read, Sharpe heard it without a show of emotion. “That's all right,” he said, “It's the will of God.” Sharpe's wife, Melissa, is yet to be tried. The murder resulted from police interference with Adam God's meeting and attempted arrest for disturbing the peace- a thing to which certain policemen are all too prone when sentiments uttered are not all to their liking. Missouri needs a Matteawan, not only for real paranoiacs like this unfortunate paranoiac, but for the higher law passion- ate erotic emotionals who think love diverted from or not bestowed on them, according to their wishes, should be shot out of existence. The certainty of a lunatic asylum life sen- tence for brains that run to murder under slight erotic provo- cation would prove a great preventive stroke in this direction. Such a law would be psychically hygienic, mentally antiseptic, as it were, of murderous love passion. 300 Editorial. Medical EXPERT TESTIMONY.—The mere assumption of expert ability, though courts admit the ipsi dixit of doctors as sufficient expert qualifications, will not make right im- pressions on juries or public for the honor of medicine without well established facts and well grounded clinical analysis thereof from the stand point of alienistic experience in matters psychiatric. On this subject a newspaper makes the following, not always unmerited, comment: "It is on matters of mere opinion that public sentiment has discredited the expert witness. The authorities record the emphatic declaration of one of them, made in very early times, to the effect that certain persons had been bewitched. While our alienists would smile broadly at such puerile non- sense, it is easy to conjure up the solemnity with which the utterance was originally made. Will readers of the Hains and Thaw cases four centuries from now be any less cynical about our own experts than we are about the doctor who testified with so much certainty about witchcraft?". Peculiar, bizarre, extreme passionate expression, whether displayed in murder, arson or folly is not necessarily insanity. It is only brain disease impulse or perverted reason caused by disease that makes a case of insanity and unless the expert can closely connect the two he had better say he does not know, than give a positive opinion. There is no need if one always acts in court with fidelity to psychopathic science, of subjecting honest psychological expert testimony to question as to its sincerity, truth and value. The really insane are entitled to it and of their guardian's or attorney's choosing and not by commission only. The public should have the benefit of true expert testimony in every trial of crime or civil cause when insanity is a suspected or feigned possibility. RESPONSIBILITY IN MENTAL DISEASES.—The temptation to appear learned in a court of law has brought many a man into difficulty. It is best to manfully admit ignorance. But the assumption of knowledge may have even a more serious import than merely the exposing of ourselves to humiliation. Editorial. 301 It may bring conviction to a poor innocent mortal against whom circumstantial evidence is strong. In speaking of “Responsibility in Mental Disease,” Lowder (Indian State Journal, April) thus advises a most acceptable course to every fair-minded man called upon to testify in such a case: “Shall we swear away the life of an individual whose normal mental state is destroyed by disease of the brain; or, by our evidence, foist upon society the criminal who seeks to gain his freedom by the insane dodge? Let us be sure we stand by the truth. Let us hew to the line, no matter where the chips fall. Let us refuse to testify in these cases unless we feel certain that we are competent. If we are taken into court contrary to our will, let us refuse to answer questions that we do not understand. A display of honest ignorance is more commendable than an attempt to wade in water of unknown depth.” EROTO-EMOTIONAL MURDER PASSION MANIA AGAIN AND The Usual Verdict.-William Strothman, tried in Judge Fisher's court, St. Louis, on a charge of first degree murder for shooting to death his wife, in their home last September, was acquitted on the plea of emotional insanity, claimed to have been caused by his wife's attentions to an Italian fruit peddler. The jury returned the verdict freeing Strothman after deliberating only one hour. This was Strothman's second trial on the murder charge. The first was a mistrial. The jury found him insane at the time of the tragedy, but fully recovered since. Sirothman attempted suicide after the shooting by firing a bullet into his head and slashing his wrists with a razor. Emotional love maniacs whose cerebro-vaso-motor ner- vous systems are so unstable that their brains fulminate homicide under disturbed love emotion, should, when they suffer themselves to commit murder under jealous emotion, have the benefit of a lengthened vacation from the love life excitement that proves so disturbing to their mental tran- quility that it can only be appeased by murder and that vacation from an erotically distracting world should be within the tranquilizing walls and ground of an hospital for the in- 302 Editorial. sane. A life long vacation in such an institution would benefit both murderous erotopath and the community. Freedom to erotopaths with a love murder history is a peril and a menace to society which ought not to be endured. All unwritten love law acquittals should entitle love inspired homicides to prompt and free insane asylum residence. Murderous erotopaths at large are becoming too numer- ous for the welfare of the world in this part of the globe. MEMORIAL TO DR. BENJ. F. STEPHENSON, the founder of the Grand Army of the Republic. One of the greatest events in the history of the Grand Army of the Republic occurred when the statue of Dr. Ben- jamin F. Stephenson, founder of the organization was un- veiled in Washington, July 3rd. There was a parade of all available United States military and naval forces and the District Militia. President Taft delivered an address followed by repre- sentative J. Hampton Moore, of Pennsylvania, orator of the day. The triangular shaft is of granite, about forty feet high. On each side is a group of bronze, the three representing the cardinal principles of the G. A. R.–fraternity, charity and loyalty. On the western side is a bronze idealized medallion of Dr. Stephenson in the uniform of an officer of the civil war. While the shaft will be a memorial to Dr. Stephenson, it also is intended to be a memorial to the G. A. R. itself. It has been erected at a cost of forty thousand dollars of which the government contributed ten thousand. At the unveiling United States Senator William Warner, of Missouri, past commander in chief presided. It is a gratification to see medical men memorialized even if only occasionally for public patriotic service. If medical men mingled more as they should and could and can in public affairs, especially in politics and legislatures they would be better appreciated. Their real works for humanity would be better understood and the omnipresent self-assertive, ob- trusive lawyer would not as now, be continually ahead of the Editorial. 303 physician in public affairs and appreciation. The record of the attorney at law is in no way paramount in public service to that of the physician and yet the lawyer is always in evi- dence, while the doctor sits silent in the back row. The law- yer beats the doctor at a gabfest, but in the biological labora- tory and at the bedside of stricken humanity he is silent and helpless. Cultivate Auency of speech more and unmerited reticence less, gentlemen Aesculapeans, and take the places that belong to you before the public beside the followers of Blackstone and you will not need lawyers to plead your cause in public affairs. THE AMERICAN SOCIETY OF ALCOHOL AND OTHER NAR- cotics held an interesting meeting at Atlantic City, N. J., June 7th to 9th. A temperance luncheon followed. This Society was the first medical association in the world to take up the study of alcohol and the diseases which follow from a medical and scientific standpoint. It is com- posed entirely of members of the medical profession and its purpose is to study the various conclusions from laboratory and clinical experience concerning the alcoholic problem and its medical and hygienic relations. The Journal of Inebriety is the organ of this Association and is edited by Dr. T. D. Crothers, of Hartford, Conn. The papers treated in the manner of true scientific in- quiry without attempt at legislation or popular proganda of the disease and therapeutic aspects of the alcohol problem, the authors hewing to the line of strict scientific inquiry, letting the chips of science fall where they might to be picked up for burning by philanthropists in the fire of charity for the mistaken drinker, moderate or drunkard. “Alcohol in the Light of Recent Research" was the first paper on the interesting program followed by a plea for scientific publicity; then by a paper on “Alcohol a Deceptive Poison" and that by papers on "Auto-Toxins from Beer and Spirits,” “What Shall We Do With the Inebriate?” “Emitine as a Practical Drug in the Treatment of Inebriety,” “The Rational Basis of the Treatment of Inebriety," "Moral De- 304 Editorial. generacy Following from the Use of Alcohol," "The Influence of Alcohol on School Children," "The Popular Use of Alcohol for the Relief of Stomach and Intestinal Disorders,” “Poisons Due and Arising from Alcohol,” “Fruit, Grain and Nut Diet as Remedies in the Treatment of Inebriety," "The Value of Physiological Methods in the Treatment of Narcotic Drug Addictions,” “Narcotic Drug Addictions,” “The Use of Alco- hol in Cold Climates,” “Psycho-Anästhesia in Inebriety," “Fraudulent Drugs and Proprietary Nostrums,"“ Alcohol and Longevity," "Instruments of Precision in the Study of the Effects of Alcohol,” “The Scientific Solution of the Alcohol Problem,” “Relations Between Inebriety and Tuberculosis," and other contributions. The entire program being one of enlightenment for those of the profession who are beginning to suspect, if not already convinced, that we have gone quite far enough, if not too far, in liberal countenance of alcohol for prescription or for bever- age purposes. Suicide Race Salvage.—The average citizen laments when for slight remediable causes the unstably and readily overwrought neuroned destroy themselves and fly, perhaps, “to evils they know not of, rather than endure the ills they have" and the nearly related mourn the sudden self-destruc- tion of these rashly importunate suicides. But the remaining world owes them for their so-called “untimely taking off,” a debt of gratitude for what they save the race through averting from possible posterity, thus fortuitously prevented, a like inability to courageously endure life. While suicide pacts are foolish from the standpoint of the real good of the in- dividual, they are wise provisions by biological law implanted in unstable brains really unfit to survive in the battle of life. They diminish the ratio of the unstably brained to the stable, and the world needs just now a preponderance of level brained and steady minded moral fardel bearers. The neurotics and the psychopathics are over-working the sensation columns of the daily press with suicide pacts and other unique and startling idiopathic morbid mental perversion displays. What a volume of perverted unstable mind manifestation, Editorial. 305 yet outside of the lunatic asylum might be written on this theme by an observing alienist. Mrs. MARY A. Hunt who was known as the Superintend- ent of the Scientific Temperance Department of the W. C. T. U. was really one of the most wonderful women, in what she accomplished, of modern times. With but very little as- sistance, and by force of energy and persistent effort she se- cured the passage of laws, not only in Congress, but in every state in the Union, making it compulsory to teach the dan- gers of alcohol in connection with physiology in the public and national schools. These laws have been to a very large extent carried out in most of the states and particularly in the National Govern- ment. Mrs. Hunt had a true scientific inspiration of the character of the work, and in addition to securing an enact- ment of the laws, gave great attention to the writing and publication of accurate school books. She became very familiar with the literature on the alco- holic problem in all countries, and accumulated a great vari- ety of facts and statistics, and at the time of her death, knew more about the progress of the alcoholic problem and its scientific solution than any other person. Her genius and skill not only as an organizer, but a leader in enthusing teachers and philanthropists to make this work practical in common schools was phenomenal. With it all she had detractors and critics who at her death sought to be- little results of her work and break up the library which she had accumulated and put it into other hands. For years she had published a school journal, giving facts on the alcoholic question and had begun a bureau for the accumulation and dissemination of facts, which had been growing rapidly. It was thought best at her death to or- ganize a company to continue the work under the name of The Scientific Temperance Federation Bureau. This was incorporated under the state laws of Massachusetts with power to control $1,000,000 as capital. Mrs. Hunt's collection of books, pamphlets, papers and reports on every phase of the alcoholic problem amounted to 306 Editorial. over 10,000 copies, and is probably the most complete col- lection ever made. To this has been added principally by gifts and some purchases several thousand copies every year. This Bureau is a stock company, managed by a secretary and two assistants, an executive board and a list of directors, the central purpose of which is to afford a library for the col- lection of books and facts on the alcoholic problem, and for the purpose of making them accessible to students and writers who wish to know something of the subject. This Bureau is affiliated with an International Bureau located at Lausanne, Switzerland, and in close touch with all the libraries of Europe and this country, who act as agents in procuring all printed matter pertaining to the subject. The great problem is to support such a bureau. At present this is done by membership fees and small donations. A prominent Boston man has offered to build a library suit- able for the work of this Bureau, and other offers have been made, which have not yet materialized. Appeals are made to scientific and philanthropic persons everywhere to contribute funds for the permanent growth and development of this great work. Its practical value will be apparent to every one who is interested in the alcoholic problem, and who would wish to become familiar with the rapidly accumulating facts. The Bureau is practical in its capacity to furnish data and facts on all phases of the alcoholic problem. Every writer and student of the alcoholic problem should become a member of this Bureau and take part in the matter of collect- ing data and receiving its reports and getting accurate facts. This Bureau furnishes charts for teachers and lecturers and lantern slides and speakers within a certain limited area. All the scientific works on the alcoholic problem can be obtained through this Bureau, also a School Physiological Journal. The great purpose is to teach the public accurate facts concerning the scientific problem in all its many phases, and to furnish accurate material for presentation. For further information address The Scientific Federation Bureau, 23 Trull Street, Boston, Mass. I. D. C. Editorial. 307 THE PROPOSED New HOSPITAL POR MENTAL DISEASE IN Boston.—We have previously commented in these columns on the efforts of the Massachusetts State Board of Insanity to provide a much-needed hospital in this city for the first care and observation of mental patients, and a branch thereof for voluntary patients with mental disease. At the first hearing before a legislative committee early this year violent opposi- tion to certain locations developed on the part of interested persons and even, we regret to say, on the part of certain physicians. This opposition so far prevailed that the sites provisionally selected cannot be used, but the main point of this early hearing was attained in that, after some delay, the Committee on Public Charities has reported unanimously to the legislature a bill calling for $600,000 for the land and con- struction, furnishing and equipping, of a hospital in the city of Boston for the first care and observation of mental patients and the treatment of acute and curable mental diseases. The text of this report to the legislature is as follows: Section 1. The trustees of the Boston State Hospital are hereby authorized, with the approval of the Governor and Council and of the State Board of Insanity, to acquire by purchase or otherwise, in the name and behalf of the Com- monwealth, lands and rights in land. * * * Said trustees shall erect on land so acquired, and furnish and equip, buildings sufficient to accommodate one hundred patients and the necessary officers, nurses and employees and to provide for general administration, an out-patient depart- ment, treatment rooms and laboratories for scientific research as to the nature, causes and results of insanity. Any land or rights in land acquired under authority of this act shall be under the control of the trustees of the Boston State Hospital, and any buildings erected thereon shall be a part of said hospital. Sect. 2. To provide funds to carry out the provisions of section one of this act, the treasurer and receiver-general is hereby authorized, with the approval of the Governor and Council, to issue scrip or certificates of indebtedness to an amount not exceeding six hundred thousand dollars, for a term not exceeding thirty years. 308 Editorial. The foregoing bill has been reported favorably by unani- mous vote by the Ways and Means Committee of the House, and it is to be hoped will finally gain the approval of the Legislature. The State Board of Insanity has published a special report to the Massachusetts General Court as to this hospital, dated April 15, 1909. In this report an admirable statement is made of the need and possibilities of such a hos- pital as that proposed. We quote from it in part: Such a hospital should provide adequate facilities for (1) First care and examination of mental patients from Boston and vicinity. Probably 1,500 to 2,000 such patients would come under observation during the year. Ac- cessibility, therefore, is important to prevent recourse to city prison and house of detention for temporary care pending commitment, as now necessary in many cases. (2) Short treatment of acute and curable patients who might recover in a few weeks or months without transfer to other institutions. The average length of treatment in such a hospital would be three to four weeks, rarely, if ever ex- ceeding three months. (3) Out-patient service for those in the early stage of mental disease, who live at home and might avoid commit- ment through medical advice and direction thus afforded. (4) Laboratories for medical and scientific investi- gation and research, contributing to fuller knowledge of in- sanity and betterment of methods of treatment. (5) Instruction to medical students in order that they may, as future general practitioners, be competent to rec- ognize the early symptoms of mental disorder, and by advice and treatment sometimes prevent the development of in- sanity. These requirements necessitate the location of such a hospital in the city, near other hospitals and laboratories. The time of scientific men and medical students is crowded by demands which do not permit waste in going far out of their immediate fields of work. Nothing could be more significant of the changing attitude toward the problems of psychiatry than this liberal statement to a legislative body of the needs of the insane. Editorial. 309 Child Labor in mines, closed factories and with long hours, ought to be abolished, but there are circumstances under which child labor, if under right surveillance had better be encouraged. Moderate labor for many children, especially of the vicious type, is the best form of psychotherapy for the incorrigible and the evil minded. The psychic effect of self-sustenance secured through moderate self help and the salutary effect on poor children and on all children in fact, of doing something for self and mother or father is good in the development of child life, is one of mental and moral sanitation. But child labor should not be excessive as now in mines and factories or at the expense of a few hours a day for in- struction. Child labor should be limited rather than abolished, especially for waifs and those not under right parental con- trol. A child had better be compelled to labor than to loaf and grow up in idleness and mischief. Some children who have had to work have made better men and women than they would have, had they not been so compelled. THE QUESTION OF ACROMANIA comes up frequently in the mind of psychologists and psychopathologists through the not infrequent acts of persons precipitating themselves from great heights, as from modern "sky scrapers," tall cliffs, into Niagara Falls or from our great sea leviathians, etc., are not all either voluntary or accidental happenings. Acroaesthetic impulsion-a disposition to jump—is a peculiar feeling and impulse with many people, mostly neur- asthenics. This peculiar feeling and impulse is so strong with some that they dare not trust themselves near the edge of a high precipice, or top of a high wall, and some not realizing the perilous situation go over to their death below. How much of this is insane impulse and what causes the peculiar mania that seizes some to thus precipitate themselves to death without intent of suicide, is a brain state not yet fully understood. But the acrosuicide suggestion has its victims as well as other forms of suggestion to morbid impulse, the dagger, the pistol, one in certain frame of mind sees before him, for instance, and their suggestion as the former suggested Hamlet's classic soliloquy. 310 Editorial. ONLY Single Doses or a safely limited number of doses of poisonous medicines, should be entrusted to nurses and poisonous disinfectants should be kept off the wards when not needed there for immediate use. This is the safe method of the best regulated hospitals for the insane and is a good plan for all hospitals. Under such a regulation such an accident as at the City Hospital, April 9th, in the giving of a solution of formaldehyde for one of Epsom salts could not happen. Agencies kill or cure according as they may be used. The American Medical Editors' Association, Fortieth Annual Meeting, 1909, at Atlantic City, N. J., June 5 and 7, was a profitable and successful meeting. The papers were apropos to the welfare of the association, the membership were cordial and the banquet was a success. They Have PASSED AWAY.-Drs. W. W. Ireland, Alex- ander Joffroy, Argyll Robertson and Daniel R. Brower. Joffroy, November 24th, 1908, Robertson, January 2nd, 1909, Brower, March 1st, 1909. Ireland died at his home in Victoria Terrace, Musselburgh, Scotland, May 17th, 1909. Dr. Ireland was well known to medical men in psychiatry at home and abroad. He made the human brain his life work. He contributed articles on a variety of topics to current litera- ture and published a work on the “Siege of Delhi.” Dr. Ire- land was well known all over Midlothian and esteemed and respected by all who knew him, especially in his native city of Edinburgh and in Musselburgh. He was a collaborator for this magazine and for the Journal of Mental Science. His best books for the profession are “Through the Ivory Gate' and “The Blot Upon the Brain.” Ireland combined in his character cordiality with literary and professional ability. As a literary man he was ver- satile in French, German, Italian, Hindoostani. The fame of Sir Harry Vane, his latest literary historical work, has spread wherever the English speaking race is found, but especially in America. The medical profession and his friends have lost much in his demise, but his bereaved family more. Dr. Joffroy's name is far famed and familiar in French and cosmopolitan neurology. His name is intimately asso- Editorial. 311 ciated with alcohol and other forms of toxicity in nervous diseases and with the general paralysis of the insane and juvenile paresis. He did not accede to the too general belief that paresis meant neuropathic syphilis and we believe him to have been correct. Our friend Brower should have been known as we knew him to be fully appreciated. We knew him as a young, fellow asylum superintendent, when he was at Williamsburg, Va., and ourself at Fulton. He was a man of earnest ability and productive zeal in psychiatry. His book on insanity published with the collab- oration of Dr. Bannister is a plain, practical treatise reflecting his clinical experience. We did not think on our joint visit to Panama with him and the talented and genial Senn that they would both so soon pass beyond “the great divide." Dr. Argyll Robertson made many valuable contributions to the literature of medicine, the best one of which was on "Eye Symptoms in Spinal Disease” in which he identified what is now known as the Argyll Robertson pupil with posterior spinal sclerosis. These good men gone and we left to mourn them. Pro- fessional and personal regret is now our record, and sympathy for those nearer who must feel more keenly than we the great loss that has come to us all. CANAL ZONE SANITATION.—The Isthmus is now free from yellow fever and almost free from the fatal black water fever that from time immemorial have decimated and destroyed life. Land drainage and free oiling have done this salutary work for the canal zone. Colonels Gorgas and Carter have done their work well, reflecting credit on modern medicine and suggesting the value of a Health Bureau and a medical man in the Cabinet. 500 LUNATICS in Fire.-Oklahoma State Insane Asylum Buildings at Fort Supply near Woodward, Okla. were dam- aged by fire April fourth. Good management by firemen and attendants prevented loss of life. Damage $75,000. 312 Editorial. The fire broke out in the laundry building shortly after the noon meal and the inmates had been returned to their quarters. A panic was narrowly averted. The fire spread from the laundry to the pharmacy supply building and threatened the asylum proper. Another object lesson on absolutely fire-proof construc- tion and equipment for the insane hospital buildings. SCREEN HOSPITAL WINDOWS THE YEAR Round and pre- vent post operative deliriacs, the febrile and other delirious patients, from jumping or falling out. Too many casualties from this neglect in hospital care of patients occur in our hos- pitals. With this precaution Hunicke would not probably have made his mad leap to the ground after the surgical operation at St. Andrews Hospital last April 9th. The same day of the fatality with formaldehyde at the City Hospital. For lack of this sensible precaution nearly every hospital in the city has had one or more similar fatalities. “A stitch in time” is an often overlooked'adage in hospital care and medi- cal treatment. PsychoHYGEIA POR JURORS.-It has not yet apparently dawned upon the judicial mind that sound verdicts are to be expected only from soundly rested and daily invigorated brains, if we may judge from the way jurors are too often treated as to good restful quarters and comfortable and com- plete sleep while determining the merits or demerits of a cause or passing upon the right of life and liberty of the accused, if innocent in certain cases. Jurors who sit up all night or two or more nights in suc- cession, as is sometimes the case, ought not to be expected to render just verdicts in the final morning after such brain ex- hausting ordeals and such psychasthenic ordeals ought to be made good grounds for appeal in many cases. Both forced insomnia and voluntary alcoholism should be ruled out of jury trials. The mens sana in cerebro sano, and the mens sana in corpore sano rules should apply to all jury deliberations. Brain fatigued and mind crippled conclusions ought not to be valid. Editorial. 313 ReFERRING TO THE “HALF MIRACULOUS” effects of serum treatment of pneumonia tetanus and spinal meningitis a non- medical daily thus rebukes the ingratitude of the people toward the medical profession. “The Battle Against Disease.”—We still accord greater favor to the man who can increase the power of a battleship than to the patient delver in the laboratory who labors for the means to preserve life, not to take it. The plaudits of a people freed from monarchical injustice by brave warriors, to become themselves, may be, in turn oppressors, ascend to heaven and grace pages of fulsome his- tory, but only whispered commendation and meager record, if not oblivion, attest the appreciation of the life saving work of medical heroes and philanthropists. Anti-vaccination fools to-day are trying to undo the saving work of Jenner and his followers while even Colonel Gorgas, Colonel Carter or even Findlay, whose life went out in sacrifice before them in demonstrating a far reaching life- saving fact, are not deep in the hearts or high writ in the tem- ples of fame as they should be. Findlay is not in Helen Gould's Hall of Fame nor is Robert Morris the financier, who saved the American Revolu- tion and got a two years' debtor's prison sentence in recom- pense for his patriotic sacrifice from his grateful (?) country. Tobacco AMBLYOPIA.—Dr. W. S. Franklin's (San Fran- cisco) case in California State Journal of Medicine, of a woman who smoked six to eight cigars for two years, but drank no alcoholics, so that alcohol played no part in this case as has been asserted of others, is referred to in The Hospital, London, “The disc showed pale, but no other ocular abnormality. In six months vision was restored to 8 with a correcting cylinder of one dioptre, and to 9 without it. Vision was re- duced to finger-counting at five feet in both eyes, that an absolute central scotoma for red and green existed, and a relative scotoma for form.” EMOTIONAL EROTOPATHY IN A GRAND JURY.-Jackson- ville, Fla., May 6.—Two sensational killing episodes were 314 Editorial. ended here to-day when the Grand Jury ordered the release of Miss Jessie Brown and R. A. Humphries. Miss Brown shot and killed Earl P. Adams, following the announcement of Adams's engagement to another young woman. Humphries shot and killed both his 16-year-old wife and Thomas McManus when he found the two together in his home. The mother of Mrs. Humphries subsequently committed suicide. Dr. Darlington's REPORT OF THE HEALTH of New York City, states that heart disease among school children is greatly on the increase, 3,500 had heart disease in some form. Dur- ing the past two years 234 children have died of heart disease and only 131 of these were under five years of age. With the beginning of school life the rate increased from 28 at the age of 4 years to 286 at the age of 15 years. Better more indirect race suicide by omitted conception. Better less strained oppressive education than defective and degenerate grown up mothers and fathers made so by forced over time study and health broken children, the child being father or mother of the man or woman. But better than all would be better and wiser hygienic conditions of body and mind for school children. More and better nutrition, recrea- tion, air, vacation and rest, more congenial teaching of suit- able things for the child's mind, less cramming and time for mental as well as gastric digestion. More time and better conditions for proper assimilation and development in tone and power for the receptive centers of the gray cortex. The right building of the evolving brain should be deemed of more importance than the mere cramming of it with mere knowl- edge, to the greatest possible extent and in the shortest possi- ble time. Moral and logical brain, physical and intellectual power and endurance and capacity are above precepts, and raw material and undigested facts alone to the child. Education that does not develop strong men and women is abortive. MANIA TRANSITORIA, Mania IMPULSIRA, TEMPORARY IN- · SANITY.—The London Hospital reports that Dr. F. J. Waldo Editorial. 315 at a Southwark inquest objected to the word “temporarily'' in a verdict of suicide while insane. He said he could not record the word, and the jury eliminated it. The Coroner said he knew the word was used, but he considered it wrongly used. A Judge in the Appeal Court had declared thać“tem- porary insanity" was unknown to English law. Dr. Waldo said that the medical term was“ impulsive insanity.” Nevertheless temporary insanity is a clinical fact just as recurrent insanity is, which mania transitory is. It is as much a fact as the epilepsia with which it is usually associated, to which it is a common alternative equivalent. A psychic epileptic substitution, equivalent of the major spasmodic seiz- ure may appear as a transitory or temporary mania—such is the clinical fact well known to alienism, whether recognized by English law or not. Do Not OVERLOOR PSYCHIATRY IN YOUR THERAPEUTICS. The likes and dislikes, the aversions and desires, the mental peculiarities, tastes, habits and character traits, and cherished possessions and appetites are too often not enough regarded in treatment. In short, the mind satisfying influences both within and about the patient are too much disregarded in general practice for the good of the patient, like the following which occurred in our City Hospital. Grief over the loss of his flowing beard, which was shaved off when he entered the City Hospital, Tuesday, to receive treatment for a blood disorder, is believed to have hastened the death of Frederick Mundt, 73 years old, a faith healer. Mundt died early yesterday morning, asserting to the last that mental treatment was superior to medicine. Mundt, who lived at 1006 Chouteau Avenue, declared when he entered the hospital that he had practiced faith heal- ing in St. Louis for twelve years, and that he had a large clientele. He would tell nothing of his affairs, and protested when the physicians told him that his beard would have to be removed. He became moody after his beard was cut, and complained that his strength was gone. A sound therapy would enjoin that this deluded old man's notions about himself should have been tenderly considered. 316 Editorial. Unless he had a scalp disease absolutely requiring the removal of his beard he had a right to keep his beard and to his ideas concerning its strength sustaining powers his mind would have done him good like a medicine. If for sanitary reasons it were better to remove his beard, under the cir- cumstances of his feelings it were better to have given his beard antiseptic care and let it remain to soothe and sustain him in his declining days. Rude violence of this kind, done to cherished feelings of the mind, is seldom sound therapeutics. More of that true psychotherapy, such as belongs to normal medicine both in hospital and outside general practice, with a more considerate regard for the feelings and psychic weak- nesses of charity patients at poor out-patient clinics than is sometimes shown by young doctors clothed with a little brief authority, would give better curative results. This old man's beard, more to him than the “glory of a woman,” was a treasure and a fetich too valuable and too dear to him to be ruthlessly taken away. The psychic shock of its rude removal may not have caused his death, but to rudely cut it off in defiance of the old man's strong protest and convictions of the life sustaining value to him, was not sound therapeutics. Methods of treatment like this do not redound to the glory of regular legitimate normal medicine. We had better in these days of excessive and perverted mind cure fadism put more genuine potent psychiatry in our practice and dis- arm the cranks that desire to sell out true scientific medicine. 'W. E. Lewis, in the Cincinnati Lancet Clinic, within the past year thus comes to the delence of the small college. The Association of American Medical Colleges has sug- gested a curriculum for adoption which meets the approval of most state boards and is offered by most colleges, and in many respects given better by the small college than by those housed in palaces of marble. “From whence came the pioneers and giants of American medicine and surgery? Not from the leading universities, but from the small colleges of which you speak deridingly. From whence came Bartholow, Gross, Blackman, Whittaker Editorial. 317 and Dawson, of whom you speak in glowing terms? They were products of humble medical colleges. “In this connection I would like to ask the writer to tell his readers how many of the Council of Medical Education are products of higher medical education? How many members of the various State boards have enjoyed special medical edu- cation and training? How many of them have degrees in arts or science? I am not attempting to belittle advanced medi- cal education, but I do protest against such uncalled-for and misleading statements as set forth by the writer. How hold- ing examinations in Columbus only and not also at Cleveland and Cincinnati tends to advance medical education, is rather ambiguous and far-fetched. Medical education, like all things else, is subject to evolution, not to revolution. The science and art of medicine can be taught here, as well as anywhere. Then let us boost and quit knocking, bearing in mind that re- sults depend upon the man behind the gun. “In conclusion, I quote again from the article: 'It was said that students would rather hear Mark Hopkins in a tog house than some other teacher in the best college in the land.'” CHARGES OF CRUELTY AT THE ST. JOSEPH, Mo., INSANE Hospital.— He that would lay his hand upon a (lunatic) save in kindness is a wretch whom it were base flattery to call a coward." The following unsustainable charges of cruelty to patients at State Hospital No. 2, preferred against Dr. W. F. Kuhn, superintendent, by Dr. Thomas E. Graham, formerly a staff physician at the asylum, have been made. Dr. Graham found Thomas Yocum pouring cold water on David Labouf. Reported. Yocum removed to laundry department. Frank Athorst found with his legs tied. Dragged across the floor seventy-five feet. Attendant reported. This man was a dangerous delusioned kicker. Attendants found beating Benjamin Hickey. Hickey was in a straight-jacket. Blood was coming from his ears and nose. An attendant said: “If you don't mind, I will kill you." Reported. This nurse ought to be prosecuted. Fisher, a patient, was hit with the buckle of a strap, and blood flowed. The patient had refused 318 Editorial. to be shaved. This attendant ought to be himself flagellated. Harry Barrish, an epileptic, had a fractured jaw. Barrish said a ward attendant did it. This may be a delusion. Pa- tient may have fractured his own jaw. An attendant was seen striking Samuel McLane over the head with a towel roller. Should have been prosecuted under the law. Dr. Graham saw an attendant throw Charles Morris to the floor. The patient was kicked. The attendant was discharged. Should have been prosecuted. Jacob Rosenfield, a pawnbroker, told of cruelties to his wife, who was a patient until her death, several months ago. He may have repeated wife's delusional impressions. ANNOUNCEMENT OF THE ARchives of Internal Medi- CINE comes to us under cover of the American Medical Asso- ciation Journal envelope which carries notice to us of dues. Ordinarily it is all right to kill two birds with one stone and this is also business, but it is not all right for the American Medical Association management to foster any other than the Association's own journal. It is not fair play to the inde- pendent medical journal's interests to publish this rival jour- nal nor is it fair to club at reduced rate with the A. M. A. Journal, unless all other journals are offered the same privilege. The A. M. A. and its journal is for the A. M. A. only and the good of the regular medical profession as a whole. We hardly know at this writing whether to wish the Archives of Internal Medicine the support its able editorial board ought to win for it or not. With such names as are on this board editorial, it ought to be a success, but whether success at the expense of competition and failures of other worthy medical publications should be encouraged is a ques- tion. The right sort of independent medical magazine is a necessity to the American medical profession. It is needed to modify and regulate the growth of too great concentration to keep the profession free from exclusive clan government. Freedom has its tyrannies no less hurtful than the oppres- sions of autocracy in government. Let us guard against oligarchy in the governing of our professions and in our coun- Editorial. 319 · try's rule. Let the A. M. A. be governed for the welfare of all of the profession and by the profession. Those who accept its delegated power should beware of any measures that promise oppression to the right interests of any one. Let us have a free fair-play government of the A. M. A. No semblance of tyranny. Not RESPONSIBLE for the views of writers for the Alienist and Neurologist is the attitude of this magazine. It will sub- mit to its readers whatever is well and worthily presented. Only painstaking and fairly complete presentation of the author's subject is exacted of writers for its pages. Manuscript not accepted is not necessarily unfit, but un- available at the time. CORRESPONDENCE. ENVIRONMENTAL PSYCHOTHERAPY.-A Letter to Physi- cians on Location Features of Treatment for Prodromal and Recent Insanity and for Some Chronic and Apparently In- curable Cases. More practical knowledge in regard to the management of affections of the nervous system involving the mind in dis- order should obtain in general practice. The brain broken and prostrate with psychic perversion should be promptly placed under proper management and treatment in the incipient stages when the best rescue work can be done, when the psychiatric fire is smouldering before the outbreak into destroying flame. The advice and service of the alienist and neurologist or the medical man who has added the special knowledge of alienism and neuriatry to his general knowledge are needed in the prodromal more than in the confirmed stages of insanity. The wise physician in any disease will seek first to learn and remove the cause or ward off its influence as far as may be practicable. It is the highest wisdom to so treat neuropathic symptoms that point in the direction of mental failure. Insanity, like hysteria, is ordinarily the product of both a vicious heritage and adverse environment. The heritage cannot be controlled by the physician, but the environment often can, either by the prompt removal of the patient there- from or by change in the elements that constitute the environ- ment. The sooner and more effectually this is done, the better generally for the victim of the cerebro-psychic disease. The physical and psychical surroundings of the patient should, in most cases, be promptly changed. An alienist of real clinical experience will see things wrong in the environment of a pa- tient afflicted with the symptoms of mental aberration, initial (320) Correspondence. 321 or advanced, when the general practitioner or neurologist without alienistic clinical experience will not so readily notice them. Return to mental integrity may be delayed or advanced in proportion to the possession of this sort of clinical experi- ence and the fate for weal or woe of the stricken one may de- pend upon it. As an exchange among physicians of different and some- what distant localities promote the recovery of hysterics by surrounding them with strange faces and nursing and giving them a treatment they have no part in dictating, so the men- tally alienated are benefited by such change. A new mental impression is made, new psychic neurons are called into activ- ity and diversion from old channels of mental action is begun. Sanitarium and hospital treatment for the brain weary and brain broken, the cerebrasthenic and the insane is predicated largely upon the principle of neuro-psychic diversion and rest of the overwrought central nervous system. Patients go from their homes brain broken, mind bruised, brooding and delusioned under burdens piled upon them at home, to the distant psychiatric and neuriatric practitioner who, assisted by a new environment, lifts the weight and re- moves the morbid impressions from the oppressed and dis- turbed and distorted gray matter centers of perception, emo- tion or ideation and they are dispersed quicker and do not return, as they would if treated amid the adverse surround- ings of the patients' homes. It is not so much the superior skill as the better chance of the distant physician. Away from the daily returning cause or the daily recurring memory of the cause of his mental discomfiture, the patient responds better and more perman- ently to the doctor's treatment. Removed from psychic flames the mental burns may be more easily healed and the fire more readily extinguished in the changed surroundings. The new environment is itself a new medicine the home physi- cian cannot administer without changing the patient's abode. The distant medical man who ministers to minds dis- eased, may raze out the written troublc of the soul of his pa- 322 Correspondence. tient afflicted with melancholia, for example, if the case be recent, through almost the same resources as might fail at home. His chance is better at least because the new environ- ment is better adapted to the recovery than it was at home. The golden opportunity for the patient is during the first three months of his malady. The chance from change is good even during the first year of a functional brain disease with psychic alterations, but chances of recovery under home treatment diminish with each month that passes and when a year shall have gone by the unfortunate victim has reached that stage which all experienced psychiatrists designate as chronic and when this stage is reached, hopelessness for the majority is not far off. Yet in this malady of the very recent cases, where the treatment under changed environment and good clinical psychiatric skill is promptly instituted, an almost in- credible percentage of recoveries may take place, under good psychiatric treatment as high, in cases where such treat- ment is not deferred over a month or two, as ninety per cent. The reason that so many cases of sudden acute mania with great violence recover is because these cases can not be tempo- rized and experimented with by inexperience. They cannot be kept too long at home. It would be the same with melan- cholia and other forms of mental alienation, especially the hysterical, if they received prompter distant treatment. For obvious reasons the puerperal forms can not be sent from home quite as soon as others without psychical peril to the pa- tient and it is a mistake to hurry off the puerperal insanities to an asylum before a reasonable degree of strength is regained. The puerperal state is one of more or less irritability and hyperaesthesia, psychical as well as neural, resulting from the shock of labor, psychic and other causes which should be allowed a few weeks to recover from, before subjecting the patient to the additional strain and shock and possible ex- posure of removal from home. The mutual exchange of patients requiring the benefit of a new environment was often recognized by the older mem- bers of the Medico-psychological Association, then the asso- ciation of superintendents of American hospitals for the in- sane. The original thirteen used to secure the exchange Correspondence. 323 transference of patients to other similar establishments in the state whose progress towards recovery came to a stand- still, by reason of monotony or delusion perpetuation of their asylum abiding place. These transfers often effected re- markable recoveries. I had a similar remarkable experience many years ago when one hundred and twenty-eight chronic patients were transferred from the Missouri State Hospital at Fulton, of which I was superintendent, to the new St. Louis institution. The trip by carriage, ferry boat and rail one hundred and twenty-five miles by daylight and moonlight in fair weather, the novel sight of the new building and the new occupation given some of the patients caused the cure of these chronic cases which I and my predecessor regarded as hope- less. They had passed apparently beyond the medication stage and were taking no medicine either from myself or my successor, Dr. Charles W. Stevens. The building new, archi- tecturally attractive, the laundry, ironing room and culinary departments were then dreams of modern comfort and con- venience and attractiveness and their diverting influences combined with the diversion of the trip to make the long- needed therapeutic change of environment to effect the case. Long dormant normal psycho-neural forces were called into curative and inhibitory activity and psychic miracle was wrought on the principle of psycho-physiological diversion and new normal cerebral action in harmony with the new environment. Mind rightly impressed sometimes moves the molecular activities towards cure in a way yet mysterious to us, but not therefore to be ignored. C. H. Hughes. IN MEMORIAM. Dr. Joseph Spiegelhalter, Surgeon 12th Missouri In fantry, died at St. Louis, Mo., June 7, 1909. Member of the Military Order of the Loyal Legion of the United States, Com- mandery of the State of Missouri. A man of merit in medicine and an old time companion in arms and friend. (324) SELECTIONS. CLINICAL NEUROLOGY. BABONNEIX and Bernard contribute an interesting study of the Ocular Manifestations of Chorea to the Gazette des Hobitaux. Iritis has only once been recorded. Conjunctival anæsthesia is, however, fairly common; but, as Babinski has shown, this must be attributed to involuntary suggestion on the part of the medical attendant. Pupillary symptoms are familiar to modern observers. Cadet has since recorded a striking case of choreiform movements of the iris, and Cruchet has called attention to the alternations of mydriasis and myosis often seen in chorea. The present authors, however, regard this symptom as inconstant and of no importance in the differential diagnosis between chorea and the various tics. Optic neuritis has been noted on several occasions, more espe- cially by Bouchut, who attributes it to hyperæmia; but the suggestion has been advanced that the associated optic neuritis and choreic symptoms are both due to a meningitis. It has often been stated that the paralyses sometimes seen in chorea invariably spare the ocular muscles, and the authors cannot find a single instance of ocular paralysis in the literature of this subject.---The Hospital. BERKLEY ON ALCOHOL AND THE Nervous System AND VASCULAR TIssues, Johns Hopkins Hospital Bulletin. Berk- ley's studies on rabbits and human beings show that in acute alcoholic poisoning the stress of the action of the drug falls upon the walls of the blood-vessels rather than upon the nervous elements of the brain. The involvement of the latter is more gradual than that of the mesoblastic tissues, and is (325) 326 Selections. only traceable after the lymphatic channels have become blocked with the detritus of white corpuscles and other cellular elements. Nevertheless the action of ethyl alcohol, in more moderate but more prolonged dosage, is to deteriorate the nerve cells, as evidenced by nuclear and dendritic changes. In its action on nervous tissues alcohol resembles strongly the toxalbumins and ricin, and its effect is proportionate to the quantity administered, and to the duration of its poisonous action before death ensues. The MECHANISM OF Gastric Secretion, Deutsche Medi- zinische Wochenschrift. Bickel says that the parenchymatous cells of the stomach are stimulated to activity by substances which circulate in the blood and which are of various origin. This function of the stomach is under control of the extra- gastric nervous system impulses from which regulate the secretion by stimulating it or inhibiting it. This explanation of gastric secretion was corroborated by the author in experi- menting with pouches isolated from the stomachs of dogs, these pouches being connected with the body only by several blood vessels. Such nerveless stomachs secreted gastric juice after subcutaneous injections of foodstuffs or after food was introduced into the main stomach cavity. The substances which stimulated the nerveless stomach to secretion must have been contained in the foodstuffs or produced in them after their digestion in the large organ. These facts applied to clinical phenomena compel us to assume that there are two kinds of disturbances of gastric secretion, a gastrogeneous and a neurogeneous one. Disturbances of neurogeneous origin may produce a hypersecretion or a hyposecretion of gastric juice, depending upon what set of nerve fibers, stimulating or inhibitory, have been excited by the cause of the disturbance. Experimentally, Bickel has produced hypersecretion by cut- ting all extragastric nerves in a dog. These facts show the modus operandi in the development of gastric disturbances, depending mostly upon general condition of the body or of the nervous system. They suggest too that psychic suggestive therapy has a very important place in the treatment of func- tional diseases of the stomach. On the other hand, the ex- Selections. 327 perimental evidence obtained with the nerveless stomach shows that dietetic treatment is the mainstay in handling gastric disturbances depending upon local changes.-Med. Rec. THE CLARIFICATION OF OUR CONCEPTS CONCERNING HYSTERIA, by Tom A. Williams, M. B. C. M. Edin., Washing- ton, D. C.—The suggestions at the root of the symptoms of hysteria formerly believed to be autochthonous and durable, and termed stigmata, are generally, though not always, of medical origin. It is very significant that Bernheim for fifteen and Babinski for ten years have never seen hemianaesthesia, contracted visual fields, dyscromatopsia or monocular polio- pia, except in patients previously examined medically. The mode of genesis of these symptoms was first indicated by Bernheim; and the writer has recently presented the theme in a translation of his communication before the Congress of French neurologists at Lille, 1906. (American Medicine, Aug., 1908.) It must be remembered that hemiplegia of or- ganic origin is a familiar sight, and that to the lay mind palsy connotes insensibility. Hence, it is not astonishing that a man who believes a limb incapacitated, believes it also in- sensitive; this, however, is a suggestion. Many so-called hystericals are in reality merely mysti- fiers, more or less conscious of their deviation from straight- forward action, as is shown by the following case: It is that of a man in hospital who confessed to concealing a hypo- dermic syringe in his rectum; and who in a moment of exas- peration an evacuation revealed two. The Trend of the Clinician's Concept of Hysteria, (Am. Ass. of Advance of Science, Psych. Bull. Bost. Med. Jour., 1909.) Such cases have largely contributed to the confusion of our concept of hysteria. They must be eliminated from a discussion of its nature. So also must be excluded abnormali- ties of the tendon, skin, and pupil reflexes which are not modi- fiable by suggestion. Urticaria, dermatographia, eruptions, oedema, hemor- rhages, ulcers, gangrene, and other circulatory or trophic perturbations arise from chemical or structural abnormali- 328 Selections. ties, whether the individual is susceptible to suggestion or not, and have nothing to do with hysteria; nor is the temperature modifiable by suggestion; and the urinary, sudoriferous and salivary secretions are so only slightly, and in so far as the emotional attitude may be perturbed by a suggestion. It must not be forgotten that many intoxicated states which paralyze the neurones which govern the reflexes also necessarily interfere with the psyche, and give rise among other symptoms to many of hysterical type. This by no means means the modification of reflexes by the hysterical symptoms; both are effects of a common cause, either may occur independently in accordance with the preponderance of the intoxication upon one or other parts of the nervous sys- tem. The victims of what has variously been called cerebral neurasthenia, ideo-obsessive psychosis, maladie de doubte, delire de toucher, latterly psychasthenia are the antitheses of the hysterical, though many of their symptoms may be imitated by suggestion, and so removed. The essential psychasthenic characters, however, do not accompany a symp- tom simulated in this way. Dif. Diag. Neurasthenia (Tri-State Med. Ass., Charleston, S. C., Arch. of Diag., N. Y. Jan., 1909.) From hysteria must be eliminated cases of trickery, sim- ulation and mythomania, (2) to the syndrome of hysteria do not belong modification of reflectivity, (3) the vaso-motor and trophic neuroses have nothing to do with hysteria and the other psycho-neurotic states such as psychasthenia, neur- asthenia, cenesthopathia, mental debility and confusion, the early phases of dementia precox, dreamlike states and emo- tional perversions must not be confounded with hysteria. Having eliminated these negative characters, there re- main the very definite conclusions: 1. That all symptoms which may legitimately be in- cluded under hysteria are imposed by suggestion. (2) That the state of suggestibility derives from:-(a) Faulty education, tending to perpetuate and fortify the natural sug- gestibility of the child. (b) Cerebral modifications due to Selections. 329 organic causes, the action of which necessarily varies among individuals in accordance with the hereditary constitution. -International Clinics, 1908. Autumn. A clear conception of the psychological mechanism of hysteria will add enormously to the power of the medical men in controlling the psychoneurotic element present in so many diseased conditions. The hit-or-miss psychotherapy-of-encouragement in many cases does more harm than good. It is as dangerous thera- peutically as digitalis or the knife in hands ignorant of path- ology. The delicate judgments upon which the treatment depends certainly cannot be entrusted to the untrained. However supple-witted may be a pedagogue, priest, or mental healer, he lacks the broad training in the fundamentals of clinical medicine, in which unfortunately some men who spe- cialize too early in their career are also deficient. According- ly, the therapy of hysteria as well as of the other psycho- neuroses can be intrusted with safety only to the physician, and he in turn must rise to the occasion by studying the pathogenesis of these as he now does that of arterio-sclerosis or glandular insufficiency. In the meanwhile, he must have recourse for advice, and sometimes for direction, to the few men who have already devoted themselves to this study. -Mo. Encyclop. and Med. Bull., Mar., 1909. Author's Abstract. A LANTERN DEMONSTRATION OF LESIONS OF SPINAL AND CRANIAL NERVES EXPERIMENTALLY PRODUCED BY TOXINS was one of the specially interesting features of the late Amster- dam International Congress, by David Orr, M. D., Pathologist and Assistant Medical Officer, County Asylum, Prestwich, Manchester, and R. G. Rows, M. D., Pathologist and Assistant Medical Officer, County Asylum, Lancaster, and we take pleas- ure in here reproducing it giving it more than customary space for abstract and omitting for brevity of space, the references. In a previous paper we described the lesions in the poster- ior columns of the spinal cord in cases of general paralysis, and pointed out their similarity with those in early tabes. We showed that the degeneration always commenced at or 330 Selections. close to the point where the posterior roots enter the cord. It is here that the sensory fibres become part of the central ner- vous system and lose their neurilemma sheath; and in all cases we found that precisely at this point degeneration began. While studying these lesions we had indications that it would be advisable to inquire into what was known of the lymphatic system of the posterior roots and columns, and we found evidence of a very convincing nature that there was a continuous flow of lymph upwards along the nerves to the cord; it is believed that the main lymph current lies at the periphery of the nerve bundles immediately under the fibrous sheath. We have in three previous publications referred to the data on which these assertions are based, and in this would put forward several additional arguments of importance. It is well known that tetanus and rabies spread to the cord by the nerve paths, and in this connection we might mention the experiments of MARIE and MORAX, who, after cutting the nerve to the fore-limb of an animal, and later in- jecting a lethal dose of the toxin into its paw, found that no convulsions followed. Homen and LAITINEN after injection of streptococci into the sciatic nerve traced the organisms up- wards into the meninges of the cord; while PIRRONE, experi- menting with the pneumococcus, found changes in the cord, but limited to that side on which the nerve was injected. But in addition to oganisms, chemical and inert substances have been used with like results, for example, Guillain injected ferric chloride into the sciatic nerve, subsequently introducing potassium ferrocyanide into the general circulation, and then found prussian blue in the posterior roots. Then Sicard and BAUER, using China ink, found after injection into the nerve that the granules ascended along the nerves towards the cord. It was evident that if these views were correct we ought to find in the cord cases in which some septic focus existed, lesions of the posterior columns occasioned by the presence of toxins ascending in the lymph stream. On examining cases of brachial neuritis (infective), bedsores, suppurating knee- joint, and septic psoas abscess, we found in the cord of all the lesions expected. We then submitted our theories to ex- Selections. 331 perimental test, and have been successful in inducing posterior column lesions in rabbits exactly similar to those already found in man. The method which we adopted-at the suggestion of Professor LORRAIN Smith, and in whose laboratory the ex- periments were carried out-consisted in filling a celloidin capsule with a broth culture of a certain organism. The sciatic nerve being exposed, the sealed capsule was placed in apposition with it, after which the gluteal muscles were stitched in their original position and the wound closed. As toxins are known to diffuse through the wall of these capsules, we assumed they would find their way into the ascending lymph stream of the nerve and so to the cord, where their presence would be demonstrated by : he ensuing degeneration. The organisms we first employed were Staphylococcus pyogenes aureus. Bacillus pyocyaneus, GAERTNER's bacillus, and the Bacillus coli; later we used the organisms taken from cases of acute colitis. We commenced our experiments at the beginning of 1905, and at first used organisms whose virulence had not been raised in any way. We found, however, that, in order to obtain definite lesions it was necessary to do so; and, further, that it was advantageous to renew the capsule from time to time in order to maintain the supply of toxin. We purposely at this stage ignored the question as to the predilection of cer- tain organisms for the nervous system, and kept strictly to our original purpose of testing our own views and those of others on the direction of the lymph stream in the spinal roots and the possibility of cord infection by this channel. The lesions of the posterior columns in the rabbit's cord were very definite. The degeneration commenced at the point where the sensory fibres lost their neurilemma sheath, and spread inwards to the root entry zone. The collaterals springing from this area and passing into the grey matter were also affected. The degeneration, studied by the osmic acid method, was, in its distribution, quite indistinguishable from the early system lesions already described by us-name- ly, the exogenous zones were much more affected than the endogenous ones. The appearance of the affected fibres in 332 Selections. both transverse and longitudinal sections shows that the de- generation in its early phase is essentially a primary one of the myelin sheath alone. In a more advanced phase we have observed in longitudinal sections of the posterior columns long rows of black globules showing the typical arrangement met with in Wallerian degeneration. In no case did the posterior spinal roots outside the cord or the sciatic nerves show any change when treated with osmic acid. Turning our attention next to the pons and medulla, we found that lesions of the cranial nerves in general paralysis commenced exactly at a corresponding point to those of the spinal nerves; the degeneration affected not only sensory but also motor nerves, and by the experimental method described we have been able to induce similar cranial nerve lesions in rabbits by implanting a bacteria-laden capsule under the skin of the cheek. This, the latter portion of our research, from our recognition of the importance of using organisms of ade- quate virulence and of maintaining the supply of toxins, has yielded more constant results and thrown more light on the initial changes affecting nerves in their intramedullary course where they are devoid of neurilemma. Up to the present we have only completed the serial examination of the pons and medulla taken from two experiments. In the first experiment the fifth and sixth nerves alone showed definite degeneration; in the other nerves the degree of affection was very slight. In the second experiment the degeneration was much more marked and more widely spread, affecting the third, fourth, fifth, sixth, seventh and eighth, and the twelfth to a very slight extent. No appreciable change could be observed in the other-ninth, tenth, eleventh -nerves. The degeneration affected only the intramedullary part of the nerve, and in the case of the motor nerves could be traced as far inwards as the nuclei of origin, especially in the third and sixth, which readily lent themselves to examination. The changes in these two, as revealed by the osmic-acid meth- od, consisted in an acute necrosis of the myelin sheath, which assumed various morbid forms—for example, long and short oval masses, elongated threads of varying thickness, mostly slender, on which were moniliform swellings. The degenera- Selections. 333 tive products stained intensely black, and in the motor nerves the myelin affection was a little less marked towards the nucleus of origin. In one of the degenerated fifth nerves there was Wallerian degeneration in the descending root as far as the lower end of the medulla. All the degenerations were sharply defined from the surrounding tissues, into which obviously no appreciable diffusion of toxins had taken place from the nerve paths. In both cases the extramedullary por- tion of the nerves showed no reaction to osmic acid. Conclusions: 1. Toxins readily spread up spinal and cranial nerves to the central nervous system. 2. In their extramedullary portion these nerves are protected from the influence of the toxins by the vital action of the neurilemma sheath; but on losing this in their intra- medullary part they at once undergo degeneration. 3. The first change is a primary degeneration of the myelin; the axis-cylinders and nerve cells are evidently affected later. We consider the above described lesions to be direct result of the action of the toxins upon the nerves without the par- ticipation of any inflammation as a factor in the process. And here we are at variance with NageoTTE who ascribes the lesions found in the posterior columns of tabes to a peri- and endoneuritis affecting that portion of the posterior roots termed by him the radicular portion, i. e. immediately inside the dura mater. The inflammatory changes there, he argues, cause a dystrophy of the sensory protoneurons, which com- mencing at the terminals spreads backwards along the fibres to the cord margin; the posterior root between the cord and the neuritic focus never shows any degenerative change. NA- GEOTTE has described a similar though less marked neuritis in the radicular part of the motor nerves. We do not intend in the present instance to discuss the many debatable points in NAGEOTTE's argument, but will only put forward what seems to us to constitute two grave objections to the acceptance of his view. We have seen cases of acute degeneration in the posterior 334 Selections. columns without any accompanying inflammation or other morbid change at any point in the extramedullary course of the posterior roots. But what seems to us the strongest argument against Nageotte's neuritic theory is the degenera- tion of the intramedullary portion of the anterior roots which so often accompanies that affecting the sensory fibres; we find it almost a constant concomitant in general paralysis of the insane and in other toxic affections, and have studied its distribution and character chiefly in the motor cranial nerves. Here it is often present to a very marked degree, and as we have pointed out, it commences where the neurilemma sheath is lost and diminishes in degree the nearer one approaches the nucleus of origin. It is the degeneration of the motor nerves in their intramedullary course which so strongly supports the theory of direct toxic action, and demonstrates that the pres- ence of a neuritic process in any portion of the extramedullary path of the sensory and motor nerves is not a preliminary essential. THE CORTICAL LESION FOR MOTOR APHASIA.—The Hos- pital contains the following sensible editorial on this recently mooted yet early settled subject in so far as the chief center of motor aphasia is concerned, that there are other acces- sory or contributory locicerebri, afferent or efferent in relation there is no doubt. But Broca's fame as the dis- coverer of the chief locus morbia of aphasia is secure. The posterior aspect of the third left frontal convolution is the chief center of motor aphasia, every other spot concerned with this speech center appears to be only accessory. Until a few years ago it seemed firmly established that the cortical motor area for speech in the human brain is in Broca's area in the operculum triangularis of the third left frontal convolution. Then Marie declared that this is all wrong, and that motor aphasia is due not to a lesion in Broca's area, but to affections of other parts of the brain. It will be a relief to those who do not like old-established ideas to be sud- denly uprooted to hear of a case in which motor aphasia was caused by softening exactly localized to the foot of the third left frontal convolution. Selections. 335 It is clear that whether one destroys the root of a tree or cuts through the trunk close to the root the effect upon the branches will be the same; similarly, motor aphasia may be caused just as well by a lesion which destroys the fibres com- ing from Broca's area as by one which destroys Broca's area itself. The fact that a patient suffering from motor aphasia may die and exhibit a perfectly normal Broca's area is no proof that this is not the motor center for speech in the cere- bral cortex, for there may be a lesion in the white matter immediately beneath it, causing the same result as if the grey matter were itself destroyed. The patient in question, as recorded by Chauffard and Rathery, was a woman, 61 years old when admitted to hos- pital. Two days previously she had hardly returned home from doing a little shopping when she suddenly felt ill and sat down in a chair. From that moment, without any apoplectic attack and without any loss of consciousness, she had been entirely unable to speak, though up to then her speech had been perfectly normal. When seen in hospital it was obvious that there was facial paralysis below the eyelids on the right side, and a very slight diminution in power in the right arm and hand. Sensi- bility and all the ordinary reflexes were natural. There was neither albumin nor sugar in the urine. When she was spoken to it became clear that she was quite unable to reply. She made visible efforts to do so, but only succeeded in producing sounds that were unintelligible. She understood everything that was said to her perfectly, and at once performed any of the simple movements that she was asked to. The diagnosis of motor aphasia seemed clear and beyond doubt. Further investigations were, however, impossible, for the malady progressed so rapidly that the patient quickly sank and died eight days later. There was a post-mortem examination, which entirely confirmed the older views as to speech localization in Broca's area. On the surface of the left hemisphere, at the level of the opercula, particularly in that portion of the latter which is situated in front of the fissure of Rolando and at the base of the third frontal con- 336 Selections. volution, there was a red area well demarcated from the nor- mal color of the rest of the brain; the meninges at this spot were slightly raised by excess of blood-stained serous exudate beneath the pia mater; the brain tissue beneath was distinctly bulged and on section it was found to be softened and red- dened—the softening being sharply restricted to the region mentioned. Sections of the hemispheres at various levels showed that there was no lesion in the internal capsules, corpora striata, optic thalami, or white matter of the third frontal convolutions. At the level of the anterior convolution of the island of Reil there was a small focus of softening the size of a pea, and beneath the opercula in direct relation with the anterior convolution of the island of Reil there was another small focus of necrosis of similar size. Finally, close to the beginning of the second left frontal convolution there was a patch of red softening, of the area of a threepenny piece, similar in appearance to that in the third left frontal convolu- tion, but less in extent. The main mass of softening, indeed, was confined to Broca's area. When the left Sylvian fissure was opened up so as to expose the Sylvian artery, an ante-mortem thrombus was discovered at a bifurcation of the latter. Careful dissection showed that the branch that was blocked was precisely that which supplies the third left frontal convolution. Trans- verse sections showed that the clot was undoubtedly adherent to the vessel wall. Further examination showed that the original cause of the cerebral lesion was embolism from malig- nant endocarditis, the mitral valve being covered with exuber- ant vegetations. There were infarcts in the spleen and in the lungs. The interest of the case lies mainly in the occurrence of motor aphasia from a lesion almost confined to Broca's area, notwithstanding recent expressions of opinion that Broca's area is not really the motor center for intelligent speech.— The Hospital. Selections. 337 CLINICAL PSYCHIATRY. EPILEPSIA AND EPILEPTOID.—Dr. Seymour Taylor, in a lecture on Epilepsy printed in the West London Medical Jour- nal, emphasizes the instability of cortical centres other than the motor in this disease. Not only may the chief lesion be in the psychical or sense areas of the cortex, it may even be in the cerebellum, the optic thalamus, the medulla, or the spinal cord. Moreover, wherever the principal lesion is, the effects of its “hyperphysiological discharge” spread rapidly to other centres which, in the case of true epilepsy, are similarly but less severely affected. On this hypothesis the “aura," be it gustatory, visional, auditory, psychical, or what not, is the beginning of the fit; and petit mal is epilepsy of some psychical centre or centres which passes off without extending to che motor cortex. On this hypothesis also Jacksonian epilepsy is explained, for this is due to local irritation of the motor cortex by growth, blood clot, depressed bone, or other gross lesion, which can so far upset the stability of the cells affected as to provoke discharge there, but is powerless to cause it to spread to the neighboring healthy cells not irritated. Dr. Taylor de- scribes cases which he has diagnosed as epilepsy of the psychi- cal centres alone, in some of which the ordinary manifesta- tions have subsequenily appeared. One patient was subject without warning to long trains of peculiar thoughts which were unconnected with each other and with her occupation at the moment; she was during these attacks unable to proceed with reading or anything else she might be doing, and was in fact only semi-conscious. Other patients have roaring in the ears, distressing taste sensations, or other "auræ,” without the slightest mental confusion; these patients are benefited by bromides. Nocturnal enuresis has long been recognized as occasionally due to unsuspected epilepsy, and Dr. Taylor thinks that some instances of tumultuous and irregular cardiac action without discoverable cause have also a similar founda- tion.—The Hospital. All students of epilepsy know these facts, but reference 338 Selections. to the roaring in ears and distressing taste sensation should be qualified to sudden accessions that as suddenly go.—ED. CHRONIC Alcoholic Psychoses, by Dr. F. W. Mott, London, Pathologist to the London County Asylums, Physi- cian to Charing Hospital. This paper was presented at the Amsterdam International Congress and attracted much at- tention as did his experimental and histological examination of the cortex of the Lemur's brain and a comparison with that of the Primates in relation to the functional and structural evolution of the convolutional pattern. (1) The effects of alcohol upon the mind depend not only upon the quantity, quality and period of time alcohol has been taken but even more upon the personality of the in- dividual, his temperament and organic constitution. This is shown by a comparative experience in the wards and post mortem rooms of London Hospitals and Asylums. Comparison of statistic results of 1200 autopsies in hospital practice with 1200 in asylum practice. (2) Comparative statistics of alcohol as a cause of in- sanity in the London County Asylums for the last 13 years show an amount of variability of percentages, in the same asylums, for different years and in different asylums for the same year, that can only be explained by a difference of opinion by medical officers as to what constitutes alcoholic excess. (3) Coincidence and cause are often confused; for a lapse from moderation into intemperance may be the first recognizable sign of the mental breakdown. (4) The existence of chronic alcoholic psychoses very frequently connotes either a previous mental infirmity, reveals an unbalanced mind or an insane temperament. (5) The failure to discriminate between what is heredi- tary and what is the result of the alcohol has been the cause of much confusion respecting the effects of alcohol in the pro- duction of insanity. Chronic Alcoholic Psychoses may be divided into 3 groups: I. Mental affections which are the result of the direct or indirect action of alcohol upon a previously healthy brain. Selections. 339 Delirium Tremens. Polyneuritic Psychosis. II. Mental affections resulting from chronic alcoholism occurring in an individual either potentially insane or possess- ing a morbid temperament in which suspicion, selfishness, moroseness, jealousy or other morbid traits are predominant in the character. (1) Alcoholic Paranoia. (2) Alcoholic hallucinatory insanity. III. Cases in which the mental symptoms of I and II groups are more or less combined. While cases belonging to all these groups are met with in the London Asylums only those belonging to group I are met with in the hospitals. To determine how far alcohol is the efficient cause or a coefficient in the production of the psychosis it is necessary to consider the quantity of alcohol taken, the length of time it has been taken, the period of life (climacteric in women), and the motives which led to the habit whether occasioned by occupation, disease or mental distress. Certain signs and symptoms point to alcohol being an efficient cause, viz.. The existence of physical signs and symptoms pointing to visceral disease or polyneuritis. A diminished state of consciousness, loss of attention, mental confusion and the characteristic amnesia. Besides there are certain mental symptoms, which afford strong presumptive evidence that alcohol is an efficient cause and not merely a co- efficient, viz.: morbid jealousy and suspicion: delusions relat- ing to the sexual function and reproductive organs: marital relations and maternal instincts: threatening or terrifying visual and auditory hallucinations accompanied by delusions of being followed by policemen and detectives: delusions of organic sensibility and especially delusions connected with deranged cutaneous and kinesthetic sensibility caused by neuritis. A variability of mood alternating between depression with fear, anxiety and tendency to suicide and exaltation with gaiety and mirth. In most cases of chronic alcoholic psycho- sis morbid states of depression predominate and persist 340 Selections. throughout; in some cases there is persistent exaltation and even grandiose delusions giving rise to a pseudo-general paralysis. The morbid changes in the brain are however essentially different to those of general paralysis. Are the symptoms of chronic alcoholic psychosis ex- plicable by the macroscopic and microscopic changes met with- in the tissues of the body? Is the alcohol a direct or only an indirect cause of the mental symptoms? Even in KORSAKOPF's disease it is doubt- ful whether the alcohol is alone the cause of the symptoms. There is usually associated with chronic alcoholism either a source of microbial toxæmia or autotoxæmia due to deranged metabolism. The poisons in the blood might of themselves produce mental symptoms, but their effects are much more potent upon a nervous system nutritionally deranged and functionally altered by the alcoholic habit.' CONSERVATION OF LIFE.—The New England Medical Monthly writes editorially as follows on this subject: While the care and preservation of our national resources have lately become a popular as well as vital issue, little attention has been given to the still more important aspects embracing the conservation of human life. It has devolved upon Prof. Fisher of Yale to bring this matter to the attention of the com- mission by a most interesting and instructive article which will no doubt result in more definite and systematic work by boards and organizations which have a special interest in such matters. If, as claimed, the average duration of life may be increased fifteen years by the adoption of certain regulations which are well known and feasible, then this economic fact will be recognized by the various insurance companies and conservative measures instituted. This principle has long since been accepted and utilized by the fire and liability de- partments who have earnestly endeavored to lessen all risks of this character—and with great success. In comment upon this subject, the Boston Herald states: “One life insurance company pays out annually $800,000 on account of deaths from tuberculosis. But experts agree that tuberculosis is 75 per cent. preventable. Pneumonia is Selections. 341 considered 45 per cent. preventable, typhoid fever 85 per cent. preventable, and diphtheria 70 per cent. Improvement in general hygienic conditions is lengthening life in Europe at the rate of seventeen years in a century. In Prussia a maxi- mum increase of 27 years has been shown. In Massachusetts the increase is but fourteen years. Prof. Fisher estimates that by the general guarantee of pure air, pure water and pure milk, eight years could be added to the average length of life. If preventable accidents were avoided nine-tenths of a year would be added to the average length of human life. “The appeal to the life insurance interests is not more pertinent than would be the presentation of the economic aspect of hygiene to the public interest. Human life is the greatest of the nation's resources. But the American people, as a whole, hold it cheaply. The waste of life by unnecessary disease and accident is enormous. The supply seems inex- haustible. Consequently waste continues largely unchecked. Philanthropic effort in health improvement has accomplished much for American cities. But sometimes philanthropy lags. Consideration of the economic value of health to a community is worth while. If the annual destruction of productive power can be reduced one-third each year, there is a material saving for the commonwealth. If the average period of productivity in human life can be lengthened one-third, there is a development of natural resources which cannot be equalled in any other field of conservatism.” FORENSIC PSYCHIATRY. Medical Expert Testimony.—Much has been said and written on the subject of the medical expert in court, especially from the standpoint of the physician, but the lay and judicial opinions have not as a rule been based on facts and first- hand knowledge. It is, therefore, with great gratification that one reads in the Juna North American Review a concise statement of the matter from the pen of Supreme Court Justice Clearwater, Chairman of the Committee of the New York State Bar Association appointed to consider the regulation 342 Selections. and introduction of medical expert testimony. Judge Clear- water's high standing as a jurist gives to his words the full weight of authority, while his responsible position as chair- man of the committee above mentioned certainly puts him in immediate command of the facts. All efforts to remedy the present unsatisfactory status of the medical expert have failed, up to the time of the appointment of the commission, because many, both lawyers and physicians, have fought against any change. One of the existing evils, and the first one named in Judge Clearwater's paper, is the lack of standard as to expertness. This was well exemplified in a recent notorious trial in which one of the medical witnesses proved his incompetence by foolish and ignorant answers to the simplest questions. Still he went on the stand as an expert. Other evils of the present system as named in the Judge's essay are the giving of partisan evidence; contradictory testimony from physicians in equally good standing; unprincipled self-styled experts; trial Judges who are incompetent to pass on the ability of experts or the validity of their opinions; payment of witnesses by the liti- gant, and consequenlty the employment of the best experts by the litigant with the longest purse: the contemptuous treatment some experts have received at the hands of rude and unscrupulous lawyers; and most of all trial judges who have sought to draw attention to themselves by their manner of admitting evidence of bad quality. In order that the ends of justice and truth may prevail, “the expert witness should be free from embarrassment, should have no clients to save and no partisan opinions or interests." He should speak judicially as an exponent of the science of medicine, with full knowledge of the highest authorities and of the most recent investigations dealing with his subject. Cross-examination plays havoc with the expert because of his personal embarrass- ment when he is called as one high in authority, and because of unfair attempts of the opposing lawyer to “rattle” him. Says Judge Clearwater:“Scientific opinion to be of controlling value can be given only under conditions of mental repose,” which is seldom possible, we may add, in the witness box. Some newspaper writers have promulgated false views of Selections. 343 the expert's position because of their unacquaintance with judicial proceedings, and first of these is the erroneous state- ment that the calling of expert witnesses is of recent origin. As far back as 1532 Charles V of England in his published Code gave power to appoint expert physicians and surgeons for the examination of injured patients before the court. And this is probably not the first instance. Then too the ordinary witness and his function is mistaken for that of the expert. “The ordinary witness testifies to facts; the expert witness to opinions." The expert should not form his judgment from the evidence of witnesses, and should not draw inferences from their statements. “The only legal method is to frame a question upon assumption that certain facts are true, and then to ask the witness, assuming they are true, his opinions concerning them. While the hypothetical question seems involved, the method pursued is scientific and calculated to eliminate the element of error so far as it is possible to do so." Direct examination of the accused and the passing up by the expert of an opinion in writing is not either desirable or tenable. The sixth amendment to the Federal Constitution granting to the accused the right to be confronted by the witnesses against him makes any such provision unconstitu- tional and would lead to a mistrial. Every party has a right to call witnesses desired and to cross-examine them as seems necessary. In civil actions the deposition of a witness whose attendance in court is impossible may be taken by commission, and on application of the accused may be so taken in criminal actions, but the right to cross-examine remains. The hope is expressed in conclusion that the present efforts of the com- mittee appointed by the Bar Association may prove fruitful. “Medical expert testimony long has been a necessary and always will be an important factor in the administration of justice. It will require time and effort to restore its sullied luster, but the aim justifies the struggle.” We commend the reading of Judge Clearwater's paper by all physicians who are interested in the problems of medical jurisprudence. Tee ought to be no difficulty and no harm either to client or truth, if the expert is really expert in knowledge of his subject and power of expression, if he sticks strictly to the truth. Real 344 Selections. experts have reputations to sustain and are not biased. Adroit questions by lawyers may show only apparent not real disharmony as to matters of fact in psychological science.- Med. Rec. NEUROANATOMY. With ReferENCE TO CHARCOT's ARTERY OF CEREBRAL HEMORRHAGE AND DURET'S AND CARVILL's conclusions the Boston Medical and Surgical Journal remarks as follows on the basis of Aitken's and Ayer's later studies in the Mas- sachusetts General Hospital. “Duret, in 1874, under Charcot's direction, stated certain facts, as the results of his investigations, which have been generally accepted from that time to this, particularly with relation to the blood supply of the basal ganglia. For up- wards of a quarter of a century the lenticulo-striate artery has become fixed in the minds of succeeding classes of medical students as the main source of cerebral hemorrhage. We are glad to call attention to a recent study on this subject from the Massachusetts General Hospital, by Mr. H. F. Aitken and Dr. James B. Ayer, published as a supple- ment to this Journal for the issue of May 6. On the basis of forty-five examinations and painstaking dissections, these in- vestigators found no case of a lenticulo-optic artery, and ar- rived at certain conclusions at variance with accepted opinion regarding the general blood supply of the basal ganglia. Most important is the conclusion that the middle cerebral artery does not play a predominant part in this supply. The dis- sections show that this artery supplies a limited part of the caudate nucleus, the middle of the lenticular nucleus, no part of the optic thalamus and the middle part merely of the in- ternal capsule. This is in striking contrast to the earlier teaching, which maintained that the middle cerebral artery supplies most of the caudate nucleus, all of the lenticular nucleus, the entire internal capsule and a portion of the optic thalamus. Hardly less striking than this is the statement Selections. 345 that the anterior cerebral artery, contrary to the usual opin- ion, supplies vessels of equal caliber to those of the middle cerebral artery and takes an important part in the supply of the lenticular nucleus and the anterior part of the internal capsule. There is less difference of opinion regarding the function of the posterior cerebral artery. A further inter- esting finding is that the choroid artery from the internal carotid supplies a part of the lenticular nucleus and a part of the internal capsule. To demonstrate these points Mr. Aitken has made a series of detailed drawings of individual dissections which cannot fail to be of great value to the stu- dent of this subject, not only as examples of workmanship, but also, which is more important, as a demonstration of the correctness of the observations made. The labor connected with this work is hardly to be overestimated and serves as an admirable example of the painstaking methods which alone are capable of bringing results in this difficult field of anatomi- cal research. Dr. J. B. Ayer has fostered this investigation for many years in his endeavor to arrive at more definite knowledge of the clinical phenomena associated with the anatomical changes of old age.” NEUROTHERAPY. SERUM TREATMENT OF MENINGITIS.-A study of the in- vestigations of Flexner leads one to conclude that acute cere- bro-spinal meningitis, a disease above all others rebellious to treatment, may soon succumb to an anti-serum. Experiments conducted upon animals show that this agent differs from an antitoxin in the fact that it does not neutralize the poison generated by the specific germ but ren- ders it vulnerable to the attacks of the phagocytes. Ad- ministered to the human subject by lumbar puncture, the results are in many instances prompt and gratifying. While by no means a specific the results thus far attained in fifteen or twenty cases show that a large proportion recover and that the usual sequelæ of the disease were generally absent. Abstract from New England Medical Monthly. 346 Selections. NEUROPATHOLOGY. ON THE MORPHOLOGY AND BIOLOGY OF THE GRANULAR Cells, Uber Morphologie und Biologie der Körnchenzellen. (Allg. Zeits. f. Psychiat., Bd. 64, Heft. 2.) Merzbacher. Dr. Merzbacher, of Tubingen, made a demonstration of these structures ai the German Association for Psychiatry, held at Frankfort on April 26th, 1907. What he calls “Abräumzellen" are assumed to take an active part in the decomposition of nervous elements. They present a great variety of forms. The cells of the walls of the vessels, the fibro-blasts, the blood cells, and especially the cells of the neuroglia go to produce the abräum-cells. They are found in acute processes and in dissolution of the nervous tissues, and play a great part in the processes of repair. In the embryo, the appearance of granular cells has been considered to be an indication of encephalitis neonatorum. After a prolonged study of these corpuscles in the embryos of many animals, Merzbacher has arrived at the conclusion that they are no the accompaniments of a pathological process, but serve in the building up of the nervous tissues.-William W. Ireland, in Jour. Med. Science. CONCERNING THE FUNCTION OF THE PITUITARY BODY.- The Cleveland Medical Journal for June, referring to recent work on this important little vital center of brain and sym- pathetic and internal secretory systems notes that since Marie published his first paper on acromegaly in 1889, the chief clinical interest in regard to the pituitary body has centered around the relation of tumors of the anterior lobe to this disease. Another symptom-complex, associated with en- largement of the pituitary body, that has attracted attention is Frolich's disease-a condition characterized by sexual in- fantilism and an increase of panniculus. Recently Herring (Quarterly Journal of Experimental Physiology, Vol. 1, pg. 121) on the basis of painstaking histological studies has advanced the theory that the epithelial portion of the pituitary fur- nishes a secretion which passes through certain stages of Selections. 347 formation and that its production is merely completed by the neuroectodermic part, in which tissue the full activity of the secretion is acquired. He further claims that there is his- tological evidence of the passage of this secretion into the third ventricle to mix with the cerebrospinal fluid. Cramer, in the same publication as Herring (Vol. 1, pg. 189) has shown that strong extracts of the posterior lobe produce, within one or two hours, dilatation of the pupil of the enucleated frog's eye. To check the progressive blindness and to relieve the ex- cessive headache in acromegaly, attempts have recently been made in several cases in London and Vienna to remove the enlarged hypophysis with some measure of success. Red- ford and Cushing (Johns Hopkins Hospital Bulletin, Vol. 20, pg. 105), realizing that it was somewhat premature to attempt such an operation without having some definite knowledge of the effect on the body of total hypophysectomy, undertook the study of this phase of the question by experiments on dogs. Of 20 operations on dogs for the removal of the hypophysis 15 were successful. These animals regained consciousness and behaved in a natural way until towards the end of the second day, when they became very lethargic. In some cases this state of lethargy set in earlier, in four instances it was postponed for four days and once as long as a week. From this lethargic condition they soon passed into coma with a striking incurvation of the spine, a slow respiration with a long drawn inspiratory act, a feeble pulse, a perfectly limp musculature, and often a subnormal temperature. The transition from this deep coma to death was almost imper- ceptible and unattended by a struggle of any kind. The subcutaneous administration of an infusion of a newly re- moved canine hypophysis had no appreciable effect on the condition of the animal. Post-mortem examinations were made in all cases, but revealed no adequate cause of death. These results sustain Paulesco's contention that a total hypophysectomy is incompatible with life. Redford and Cushing conclude from these experimental observations that the surgery of the hypophysis must be limited either to the removal of tumors which may implicate the pituitary gland, or in case of hypertrophy, to a partial hypophysectomy. . 348 Selections. PROPHYLACTIC PSYCHIATRY. COMPULSORY Race SUICIDE FOR CRIMINALS AND IM- beciles.—Memphis Medical Monthly has the following inter- esting editorial on a subject upon which the Alienist and Neurologist has been preaching for the past thirty years. The first law of nature is the first law of nations. Society, finding its present methods of protection against crime inadequate, is searching for some measure which will effectively restrict the procreation of its mentally defective and its criminals. Forbidding the marriage of the mentally defective will not check the breeding of these irresponsibles, a majority of whom are born out of wedlock—they must be rendered physically incapable of procreation. They have no right to beget feeble-minded or degenerate offspring, yet the increase of defectives cared for by the State has amounted to more than 300 per cent in thirty years. Even the statistics-ignoring antivivisectionist, the “anti-this,” the “anti-that” and others of the ultra-sentimental class cannot but agree that the greatest kindness that can be shown the unbegotten offspring of the degenerate is to help them remain unbegotten, and thus save them from a life of crime and mis- ery and uselessness. The nation's future depends upon its children, and we cannot remain survivals if no restrictions are placed upon the propagation of the unfit. Of 709 descendants of the famous "Jukes” family, 280 were public paupers, 140 were criminals and a large number were depraved, diseased or insane. It is estimated that in 75 years this one family of degenerates cost society $1,308,000. The idea of arresting the breeding of criminals and of irresponsibles is old, for it has long been known that heredity plays the greatest role in the production of criminals, but it is only in the past few years that a simple, easy, unobjectionable method of accomplishing this result has been devised. This is the operation of vasectomy—a harmless, painless operation, which does not impair the sexual health or power and which has been proven successful and rational by at least two States in the Union, Indiana and Oregon. Selections. 349 Over two years ago Indiana passed a law authorizing the sterilization of “confirmed criminals, idiots, imbeciles and rap- ists” in its institutions. Over 800 convicts have been steril- ized, 200 of these at their own request. In February of the present year the Oregon legislature passed a similar bill, defin- ing“confirmed criminals” as those serving a third term in any penitentiary or penal institution upon conviction of felony. A similar bill is now before the Illinois senate committee and the Chicago Society of Social Hygiene has taken up the matter, declaring it to be the most important of reforms before the people of Illinois to-day. In an article by Dr. Wm. T. Belfield, published under the auspices of this society, intelli- gent people everywhere are invited to consider the following statements: “(1) That the mentally defective classes-natural crimi- nals, imbeciles, insane, epileptics—have multiplied in the last thirty years more than twice as fast as has the total population; (2) that only a few States have made the slightest effort to restrict procreation by these irresponsible parasites on society; (3) that males can be sterilized by a trifling operation, vasec- tomy,' without pain, danger or impairment of sexuality; un- like castration, vasectomy does not unsex a man; (4) that the Indiana legislature legalized this method two years ago, and that over 800 confirmed criminals have been thus sterilized in that State. Oregon has recently enacted a duplicate law, and similar bills have been introduced in at least two other State legislatures; (5) that the financial, moral and social health of every community would be obviously improved by the general adoption of this measure, which imposes no cruelty or hardship upon these defectives; (6) that true philanthropy demands this measure as a kindness to the as yet unbegotten offspring of the defective classes." The sterilization of our criminals and irresponsibles by vasectomy can be indorsed by those who consider castration and other mutilating operations as barbarous, for all realize the necessity for some measure that will limit the output of criminal and defective classes if the state is to protect herself and her citizenry. 350 Selections. PSYCHO-PHYSIOLOGY Das GedachtNIS (Memory)—By Von Th. Ziehen. Berlin, 1908. Pp. 50, 8vo. Price 1 mk. At the opening of the Kaiser Wilhelm's Academy for the training of military surgeons Dr. Th. Ziehen delivered an address upon Memory, a subject which has attracted the attention of thoughtful men from the earliest times. With characteristic thoroughness the German professor goes over the history of speculation from Empedocles to Munk; his learned notes, which fill sixteen pages, form an interesting part of the pamphlet. Indications of memory have been discerned in insects, such as bees. In vertebrate animals memory plainly appears in fishes, in which there is a rudi- mentary pallium with nerve-cells. When the ventricles of the brain were discovered the Greek and Arabian physicians fancied that these cavities might serve for storing mnemonic images. Hume 'hought that reminiscences were faint revivals of objective impressions, and we do not see how Dr. Ziehen refutes this by comparing the vividness of the remembrance of the impressions of different kinds, such as dull or very bright colours. He observes that in ordinary conditions un- pleasant impressions pass away from the memory more quickly than agreeable ones, though in melancholia the power of reproduction of pleasant memories is cut off. Dr. Ziehen rejects what has been called "unconscious cerebration" and sometimes "sublimal consciousness.” It is only, he says, “a play with words-wooden iron-for if we take from psychical operations their only criterion, their conscious character, nothing remains but a contradiction." He claims that physiological research has now shown that mnemonic images are localised in a different part of the brain from perceptions. In a somewhat critical spirit he goes over mind-blindness and word-deafness. It is only when he comes to sensory aphasia that he feels firm ground. As he ex- presses it: “Word-blindness or alexia is nothing else than a special kind of mind-blindness, and word-deafness, or sensory aphasia, is but a special kind of mind-deafness." Selections. 351 Dr. Ziehen gives many interesting speculations, for which we must send the reader to the pamphlet itself. In con- clusion it may be said that although he brings to this interest- ing subject all that physiology and pathology teach us, the author is constrained to acknowledge that the difficulty of explaining mental processes by physical changes is not yet got over. Plato, he tells us, compared memory to a cage full of birds; the bird we hold in hand is the thing we re- member at the time; the others we can get at some way. Gassendi likened memory to a cloth which had been folded and which readily takes again the same folds. But then, with Plato's illustration, we have the person who sees and holds the birds, and the cloth does not recognise its own folds. Memory may be accompanied by changes in the brain, but we have to explain how these changes recognise themselves or are recognized. William W. IRELAND. [Note.-We give an unusual number of selections by Wm. W. Ireland, as they have appeared in Mental Science in memoriam of our deceased friend.-ED.) REVIEWS, BOOK NOTICES, REPRINTS, ETC. Bier's HYPEREMIC TREATMENT, including Bier's Hyperemic Treatment in Surgery, Medicine and all the Specialties: A Manual of its Practical Application. By Willy Meyer, M. D., Professor of Surgery at the New York Post- Graduate Medical School and Hospital; and Professor Doctor Victor Schnieden, Assistant to Professor Bier at Berlin University, Germany. Second Revised Edition, 1909. Octavo of 280 pages, illustrated. W. B. Saunders Company, Philadelphia and London. Cloth, $3.00 net. This work contains a clear and concise expose of the recently evolved method of applying scientifically hyperemia to the treatment of disease. It not only contains the basic principles, but gives specific instruction for its application to the various condi- tions for which it is considered applicable. He who would safely and successfully apply this treatment, certainly needs the instructions and advice contained in this volume, for it is a “two edged sword,” as the author himself says: “If the rules laid down in this book are not closely followed: if, in cases of acute and chronic inflammations, a correct diagnosis, even as to details, does not underlie the treatment, the trouble will get worse, instead of better, under hyperemic treatment." The methods used to induce hyperemia include the elastic bandage or band, cupping glasses and hot air, the therapeutic range of which is surprisingly broad, including Chorea, Epilepsy, Spinal Meningitis and Locomotor Ataxia, though the author is commendably modest regarding their value in diseases of the nervous system. The physiological and pathological principles (one of (352) Reviews, Book Notices, Reprints, Etc. 353 which is that inflammation is really a physiological process, i. e., “it is a phenomenon indicating the body's attempt to resist a deleterious invasion") underlying Bier's hyperemic treatment appear sound and conclusions logical, so that favor- able results may be expected from its judicious use and proper application. D. S. B. HISTORY, Effect AND CONDITION OF THE MASSACHUSETTS MILK STANDARD REVISED Laws. Evidence, Expert Opinions, “General Court" Extracts of Report of Hear- ings, Letters Published and Arguments of Counsel. Prefaced and published by Charles W. Wood, Worcester, Mass., April, 1909. Interesting reading. Every medical officer and steward and every attendant upon the insane and trained hospital nurses should read it. Milk should be free from impurities or adulteration and priced accordingly, just as foods are and so labeled. LAYMAN OCCUPANCY OF LARGE PATCHES IN THE FIELD OF MEDICAL PRACTICE, by Leartus Connor, M. D., Detroit, Mich. Dr. Connor connotes an evil which should be remedied. The profession and people are much harmed by lay practice of medicine, including drug clerks prescribing behind the coun- ter and even soda fountain boys, both of whom become pro- prietary medicine compounders and proprietors and advisors of physicians, telling them glibly in print how to practice medicine with their special proprietaries. The profession needs light, but can dispense with some of the false therapeutic light of certain of the proprietaries offered them. The Liver OP DYSPEPTICS AND PARTICULARLY THE CIRRHOSIS produced by auto-intoxication of gastro-intestinal origin, by Dr. Emile Boix Hospicaux de Paris. Authorized translation from the latest French edition by Paul Rich- 354 Reviews, Book Notices, Reprints, Etc. ard Brown, M. D., Surgeon and Major U. S. A.-G. P. Putnam's Sons, New York. This is an excellent translation of an excellent book on a subject clinically close to the needs of the practitioner of medicine. As the liver and stomach cannot be ignored in the successful management and understanding of disease in any part of the body in general, so the perusal of this valuable book cannot wisely be dispensed with in clinical, biological and therapeutic medical thought. TYPE Mongol De L'Idiotie. Par le professeur P. Kovalesky. Like all other produccions of this accurate observer and distinguished author this is entertaining and instruc‘ive read- ing. The author here portrays an interesting and somewhat unique type of idiocy to European, English and American minds. HYSTERIA E SYNDROMO HYSTEROIDE (Communicacao á Sociedade de Psychiatria E Neurologia—Agosto de 1908.) Pelo Dr. A. Austregesilo Medico do Hospicio Nacional e do Hospital de Misericordia. Membro da Academia Nacional de Medicina. Rio de Janeiro. Typ. e Enc. do Hospicio Nacional de Alienados. 1909. An interesting and instructive communication on an always interesting subject and from the right source of ex- perience to see and discuss hysteria in its exaggerated and bizarre forms, especially in its catatonic, cataleptic and epilep- toid displays, of which the author gave clinical illustration. A STUDY OF THE URINARY ACIDITY AND ITS RELATIONS, by Henry R. Harrower, M. D., Chicago. The author here says: The estimation of the urinary acidity has in the past been considered a more or less useless procedure, the simple test with litmus paper sufficing for all purposes. The study of this subject does not seem to have received nearly the attention that it deserves, and it is to be hoped that this paper will serve to emphasize the fact that che quantitative examination of the urine for acidity is a most important procedure and a part of the urine examination which should always be carried out. Reviews, Book Notices, Reprints, Etc. 355 In a series of over 250 analyses the average urinary acid- ity was 60°, the lowest being 10° and the highest 274º. (These specimens were examined in routine laboratory work.) Many of these individuals were passing urine with an acidity from 300 to 500 per cent. of the normal and with an acid-unit-index of from 100,000 to 200,000 per day (the minimum in this series being 8,030 and the maximum 358,050), very much above the normal amount. The other findings show that in 35 per cent. of these cases casts and traces of albumin were found; and in 83 per cent. of these cases indican was present to a greater or less extent, usually in large amounts. Eighteen of this series evidenced glycosuria with a sugar content varying from 0.3 to 13 per cent. In these cases the average acidity was 770, with an average acid unit elimination of 132,130-an increase of 330 per cent., and in only one of these was there a positive test for acetone or diacetic acid. From these findings the author thinks (1) that there is a distinct association between highly acid urine and autoin- toxication due to putrefaction of the intestinal contents shown by the relation between indicanuria and high acidity; (2) that in diabetes an excess of acid (not necessarily diacetic or oxybutyric) is the rule, and in addition (3) that this con- dition of high acidity is very frequently associated with albumin and casts in the urine. After referring to Dr. Eugene S. Talbot's good work in this line the author concludes: The study of the urinary acidity and its relation to dis- ease is yet in its infancy, and it is to be hoped that in the fu- ture more time and effort may be expended on the investiga- tion of this important subject. The Theory of the “Complex.” By William A. White, M. D., of Washington, D. C. Reprint from the Interstate Medical Journal, Vol. XVI., No. 4. An interesting subject, interestingly treated. It would be profitable to the general practitioner if more of this sort of 356 Reviews, Book Notices, Reprints, Etc. matter from sources of competent observation appeared in the pages of the general medical magazines. General PracTITIONERS AND SIMPLE REFRACTION, by Leartus Connor, M. D., Detroit. A timely paper of sound advice and profitable service to the general practitioners enjoining the acquisition and practice of knowledge of simple refraction by the family physician so as to keep in the hands of the practicing physician a practice now claimed by the commercial optician. DescriptION OF APPARATUS Devised, by H. R. Allen, M. D., Indianapolis, Ind. To reduce fractures and maintain the loose fragments in constant normal position. By its use and by regarding the principles upon which it should be used the inventor claims that fracture of the long bones heals without shortening. A CASE OF DOUBLE MONSTROSITY (THORACOPAGUSTERAS ANACATADIDYMUM), by J. F. Menestrina, M. D., St. Louis. A very interesting contribution to the subject of mon- strosity and well described and illustrated macrographically and with X-ray showing temporary teeth and points of union of these twins. Travel MAGAZINE is indispensably interesting to our readers who are mostly all travellers. The tercentenary souvenir number gave unique features of North American colonial time history, especially connected with Ticonderoga and the Lake Champlain district and discovery and the great pageants of the third century celebration no where else so lucidly described. The SIGNIFICANCE of the ConferENCE OF CRIMINAL LAW AND CRIMINOLOGY recently held in Chicago, can not well be overestimated by friends of medico-legal progress and humanitarians in general, a concise report of which appears in the Survey. The knowledge common to readers of the Alienist and Neurologist of the close inter-relation of all the various lines Reviews, Book Notices, Reprints, Etc. 357 • of effort for the common welfare will enable our readers to an appreciation of the valuable services being rendered by this one strong national journal of social progress. Alcoholic PsychOSES IN HOSPITALS FOR THE INSANE, by James M. Keniston, M. D., Middletown, Conn. A timely and forceful showing of the psychic evils of strong drink and a good plea for separate institutions for inebriates committed by courts for hospital treatment. The Care Of IMBECILES IN HOSPITALS FOR THE INSANE AND ELSEWHERE, by J. M. Keniston, M. D., Middletown, Conn., Assistant Physician, Connecticut Hospital for In- sane. A forceful plea for the segregation of idiots and imbeciles, and separate from the insane and against permitting mar- riage among those at large. SYNDROMOS PLURIGLANDULARES ENDOCRINicos. Pelo Dr. A. Austregesilo, Medico de Hospicio Nacional e do Hospital de Misericordia. Membro da Academia Nacion- al de Medicina. Rio De Janeiro, Typ. e Enc. do Hos- picio Nacional de Alienados, 1909. ON HERPETIC INFLAMMATIONS OF THE GENICULATE GANG- LION. A New SYNDROME AND ITS COMPLICATIONS (Mo. papers A. N. A.), by J. Ramsay Huni, M. D., of New York, Chief of he Neurological Clinic and Instructor in Nervous Diseases in the Cornell University Medical Col- lege. (From the Pathological Laboratory of the Cornell University Medical College.) Under the general heading of herpecic inflammations of the geniculate ganglion of the facial nerve, the author has brought together for the first time chree separate groups of cases; each group presenting distinct and clearly defined characteristics, but showing various combinations and transi- tion forms. Their union he believes constitutes a new and distinct clinical entity. The pathology of this affection is identical with that of herpes zoster, of which it forms a part, the distinguishing 358 Reviews, Book Notices, Reprints, Etc. features of the clinical picture depending entirely upon the. ganglion involved and the nature of the structures surround- ing it. Heretofore the only recognized seat of an herpetic inflammation on a cranial nerve was that of the Gasserian ganglion of the trifacial. Herpes zoster in the distribution of one or more of its branches was the result. The author believes, however, that the geniculate ganglion situated in the depths of the internal auditory canal at the entrance to the Fallopian aqueduct may be the seat of this specific inflamma- tion. Also Occupation Neurosis of the deep Palman branch of the ulnar nerve by same author. Questions Relative to Drug Addiction. Dr. J. T. Searcy's Views on the Subject as Given in a Letter to Dr. Wiley. Some Aspects of Memory in the Insane, by Florence Berenice Barnes. Report of Experiments Performed in the Psychopathic Ward of the University of Michigan. Three Important Time-Saving Urinary Tests is the sub- ject of a little brochure by Henry R. Harrower, M. D., of 2608 N. Paulina St., Chicago, which will be appreciated by those who use them. Le Crime et la Societe, Par J. Maxwell, Docteur in Medi- cine, Substitution du Procureur General Pres La Cour D'Appel de Paris. 1909. The Educational Treatment of Neurasthenia and Cer- tain Hysterical States, by Morton Prince, M. D., Physician for Diseases of the Nervous System, Boston City Hospital. The Desirability of Instruction in Psychopathology in Our Medical Schools and its Introduction at Tufts, by Morton Prince, M. D., Professor of Diseases of the Nervous System, Tufts College Medical School. The Pupil in Extra-Ocular Disease, by Herbert C. De V. Cornwell, M. D., New York City. Reviews, Book Notices, Reprints, Etc. 359 O Press Bulletins Nos. 21, 22 and 23 of Committee of One Hundred on National Health, 1909. Good reading matter and a good book. Reports on the Legislative Investigation of The Alabama Insane Hospitals, in 1907. Hospital Print, 1909. Alcohol Injections in Neuralgias, Especially in Tic Dou- loureux, by 0. Kiliani, M. D., New York. Reprinted from the Medical Record, June 5, 1909. William Wood & Company, New York. Posterior Column Degenerations Following Injury to the Posterior Roots of the Severith Cervical Nerves, by H. W. Mitchell, M. D., and A. M. Barrett, M. D. Reprinted from The Journal of Nervous and Mental Disease, Vol. 35, No. 9, September, 1908. A Study of Emotional Expression in Dementia Præcox, by J. W. De Bruyn. From the Michigan State Psychopathic Hospital, Ann Arbor, Mich. Reprinted from The Journal of Abnormal Psychology, February March, 1909. Treatment of Varicose Ulcers by Leggings, by J. B. Murphy, M. D., Chicago. Reprinted from The Journal of the American Medical Association, March 27, 1909, Vol. LII., pp. 1033 and 1034. Proctoclysis in the Treatment of Peritonitis, by J. B. Murphy, M. D., Chicago. Reprinted from The Journal of the American Medical Association, April 17, 1909, Vol. LII., pp. 1248-1250. Science vs. Spiritualism, What the Psychical Research Society Has Done with their Opposing Claims, by Dr. James H. Hyslop, Secretary of the American Society for Psychical Research. Reprinted by permission of the New York Times, from its issue of January 17, 1909, by the American Society for Psychical Research, Dr. James H. Hyslop, Secretary, Tribune Building, New York City. A Review of a Repori of Experiments by Sir Oliver Lodge of the English Society for Psychical Research, by Gustavus. 360 Reviews, Book Notices, Reprints, Etc. Myers. Reprinted by permission of the New York Times, from its issue of January 10, 1909, by the American Society for Psychical Research, Dr. James H. Hyslop, Secretary, Tribune Building, New York City. Donnemora State Hospital for Insane Convicts. Ninth Annual Report of the Medical Superintendent, 1908. The Doctor in Court, F. W. Langdon, is an interesting, instructing and amusing address. Some Observations on Renal Diagnosis, by Chas. N. Chitwood, M. D., is beautifully illustrated in colors and an excellent paper. Conditions Under Which the Striae of Incipient Senile Cataract Appear and Disappear, by Leartus Connor, M. D., Detroit. 35th Annual Report of the Medical Director of the Cin- cinnati Sanitarium for year ending Nov. 30th, 1908. 19th Annual Report Eastern Indiana Hospital for the Insane, year ending Sept. 30, 1908. On the Use of the Wax Tipped Catheters for Diagnosis of Kindey Stone in the Male, by Winfred Ayers, M. D., New York. HOSPITAL REPORTS. The following hospital reports are received: Official Reports of the Trustees and Officers State Hos- pital Insane, Danville, Pa., Oct., 1906 to Sept. 30th, 1908. Eleventh Biennial Report of the Supt. of the Clarinda, Iowa, State Hospital. Central Indiana Hospital for Insane, 1908, Report to the Governor. Thirty-eighth Annual Report of the Buffalo State Hos- pital to the State Commission in Lunacy. Seventeenth Annual Report of the Trustees of the Fox- borough State Hospital. Twenty-second Annual Report of the Board of Managers Reviews, Book Notices, Reprints, Etc. 561 of St. Lawrence State Hospital, Ogdensburg, N. Y., to the State Commission in Lunacy. First Biennial Report of the Board of Trustees of the State Psychopathic Hospital at the University of Michigan. Ninety-second Annual Report of the Friends Asylum for the Insane, Frankfort, Pa. Thirteenth Annual Report of the King's Park State Hospital, New York, to the State Commission in Lunacy. 16th Annual Report Massillon State Hospital, Massillon, Ohio. Good Reasons for using Mellin's Food with your baby patients. 1st. Mellin's Food is used with Fresh Milk. Thereby an antiscorbutic diet is assured. 2nd. Mellin's Food perfectly breaks up the tough curd of the milk, rendering it easy of digestion. 3rd. Mellin's Food supplies the proper elements that cow's milk lacks to make it a perfect food for a baby. 4th. Mellin's Food does not contain unconverted starch. Doctor, if you will send us your name and ad- dress, we will gladly send you samples of Mellin's Food, with our booklet “Formulas for Infant Feeding." The coupon is printed here for your con- venience. BOSS.. . .D. . ... ..... ......GOLOSSSSSSSSSS Mellin's Food Company, Boston, Mass. MELLIN'S FOOD COMPANY, M9 Boston, Mass. Kindly send me the booklet, "Formulas for Infant Feeding", with Samples of Mellin's Food free of charge. M. D, PUBLISHER'S DEPARTMENT. The Modern TREATMENT OF Hay Fever.—Whatever be the accepted views as to the pathology and etiology of hay fever, there is little difference of opinion concerning its im- portance and the severity of its symptoms. An agent that is capable of controlling the catarrhal inflammation, allaying the violent paroxysms of sneezing and the abundant lacrima- tion, cutting short the asthmatic attack when it becomes a part of the clinical ensemble, and, finally, sustaining the heart and thus preventing the great depression that usually accom- panies or follows the attack-in short, an agent that is capable of meeting the principal indications—must prove invaluable in the treatment of this by no means tractable disease. In the opinion of many physicians, the most serviceable agent is Adrenalin. While not a specific in the strict meaning of the word, Adrenalin meets the condition very effectually and secures for the patient a positive degree of comfort. It controls catarrhal inflammations as perhaps no other astrin- gent can. It allays violent paroxysms of sneezing and pro- fuse lacrimation by blanching the turbinal tissues and sooth- ing the irritation of the nasal mucosa which gives rise to those symptoms. It reduces the severity of the asthmatic seizure; in many instances affording complete and lasting relief. There are four forms in which Adrenalin is very success- fully used in the treatment of hay fever: Solution Adrenalin Chloride, Adrenalin Inhalent, Adrenalin Ointment, and Adrenalin and Chloretone Ointment. The solution, first mentioned, should be diluted with four to ten times its volume of physiological salt solution and sprayed into the nares and pharynx. The inhalent is used in the same manner, except that it requires no dilution. The ointments are supplied in collapsible tubes with elongated nozzles, which render ad- ministration very simple and easy. (362) 363 Publisher's Department. It is perhaps pertinent to mention in this connection that Messrs. Parke, Davis & Co. have issued a very useful booklet on the subject of hay fever, containing practical chapters on the disease, indications for treatment, preventive measures, etc. Physicians will do well to write for this pamphlet, ad- dressing the company at its home offices in Detroit or any of its numerous branches. THE THERAPEUTIC ACTION OF PRUNOIDS.—Prunoids produce their excellent therapeutic results by stimulating secretions, increasing the fluid content of the feces and only gently increasing peristalsis. They are extremely palatable, easily taken by even young children, and when brought in contact with the secretions rapidly disintegrate and produce their specific medicinal effect. Probably one of the most gratifying features of Prunoids is what for lack of a better term may be called their remote effect. While prompt and decided catharsis follows their administration in six or eight hours, a mild and salutary laxative influence is observed for several days after the final dose of Prunoids. Other cathartic measures act just the reverse, and after their use the bowels invariably show greater lethargy and sluggishness. Nervous ExcITEMENT.—In these strenuous times, when the mental functions are frequently taxed far beyond their powers of endurance, insomnia is only too common. Under these circumstances, Peacock's Bromides will often prove the logical remedy. They do not compel sleep, like hypnotics; but, by allaying the existing nervous excitement, whether due to mental strain, worry or anxiety, they promote sleep in a normal manner. The patient awakens refreshed with a clear head, and does not suffer from unpleasant sequelae during the following day. The over-stimulation of the cerebral functions from alco- hol yields promptly to the soothing action of this preparation, which will often prove to be a standby in cases of delirium tremens. In these patients in whom the commercial bro- mides should not be exhibited on account of their usual irritat- ing action on the stomach already seriously affected, Peacock's Bromides will fully meet the requirements. Publisher's Department. 364 Ice.—Lippincott's says among other things that ice is · used as a handy medium for conveying microbes from the in- terior into large cities, where the inhabitants can indulge in them freely. It is also used to scour pavements with between the ice wagon and restaurant. It is sometimes useful also in scouring steps and floors taking the place of sapolio, etc. One advantage in using ice this way between the ice wagon and cooler, is, that one does not have to stoop to get over the floor with it. The ice hooks take the place of a mop- handle. Ice chunks handled in this way are supposed to wash and kill microbes, especially tuberculotic, by the great weight of the ice. At least this seems to be the germicide philosophy of the ice man and his intelligent patrons. The ice man does not charge extra for this great sanitary service. Good Results in STUBBORN Cases. 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 com- bination 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 usefulness seems to be enhanced by combining it with antikamnia. The rheumatoid conditions so often seen in various manifestations are wonderfully relieved by the use of this combination, and the painful stiffness of the joints which remains after a rheu- matic attack are also relieved by “Antikamnia and Salol Tablets" containing 292 grs., each of Antikamnia and of salol and the dose of which is one or two every two or three hours. Salol neutralizes the uric acid and clears up the urine. The pain and burning of cystitis is relieved to a marked degree by the administration of these tablets. This remedy is also reliable in the treatment of diarrhoea, entero colitis, dysentery, etc. In dysentery where there are bloody, slimy discharges, with tormina and tenesmus, a good dose of sulphate of mag- nesia, followed by two antikamnia and salol tablets every three hours will give results that are gratifying. Two Hundred Thousand Families The intellectual aristocracy of America, have one rule in magazine buying- "The Review of Reviews first, because it is a necessity" THE AMERICAN REVIEW REVIEWS EDITED BY ALBERT SHAW DUCWYBOREK - 300 - AZF 5 CM THE VON SEND FOR A SAMPLE COPY NECESSARY MAGAZINE MAGAZINE LIBRARY IN ONB MAGAZINE The Review of Reviews Has attained a larger subscription list than any magazine that deals wholly with serious subjects and is accepted as the best periodical to keep one up with the times. It is non-partisan. NEITHER MUCK-RAKES NOR HIDES PACTS With Dr. Albert Shaw's monthly "Progress of the World," with the cartoon history of the month, with the timely contributed articles on just the questions you are interested in, with the best things picked out of all the other magazines of the world for you, with the charac- ter sketches of the notable people of the moment--you can keep intelli- gently up with the times at a minimum cost of time, effort and money YOU MUST SEE OUR BOOK OF MAGAZINE BARGAINS Before ordering for next year. It contains forty pages of special offers, including all the leading magazines and periodicals. It will show you how to save money on your Christmas buying. This interesting and money-saving catalogue is FREE. The Review of Reviews Company, 13 Astor Place, New York Publisher's Department. 365 ONE OF THE GROsseST DRUG FRAUDS of modern times has recently been unearthed in Russia, according to a report in the London Lancet of Nov. 28, 1908. Operating over a large part of Russia, an Odessa manu- factory was found by the police to be turning out quantities of pseudo-German preparations under exact imitation labels and in like bottles to those of the bona fide German makers. The amount of business done by the Odessa plant alone was estimated at $1,000,000. Further investigation revealed the fact that over 58 per cent. of pharmaceutical stores were sell- ing false wares. Some of the insults offered were xeroform, made from bricks, sirolin from water, sugar and color, and thiocol, tannalbin, and somatose from mixtures of soap, lime and dyes. Table salt and other equally inexpensive articles had been substituted for quinin, phenacetin and pyramidon. -Ind. S. M. A. Jour., Jan. 15, 1909. HONORS to Dr. John F. Hill.-Doctor John Fremont Hill, of Augusta, Me., the new appointee to the position of vice chairman of the Republican National Committee, is the son-in-law of Norman J. Colman, of No. 5499 Delmar boule- vard, a member of Grover Cleveland's Cabinet. Doctor Hill has been a frequent visitor at the Colman home since his marriage to Mr. Colman's daughter, Mrs. Laura C. Liggett in 1897. Aside from having been Governor of Maine for four years he is a physician and publisher, owning the list of periodicals known as the Vickery and Hill maga- zines. Doctor Hill's appointment to succeed Frank H. Hitch- cock came as a result of a long personal friendship with Judge Taft. THE PURDUE FREDERICK Co. supply the profession with a tonic compound which contains the exact ingredients of a physician whom we knew in his life and the ingredients of which we knew and knew well. It is excellent to give routinely to the insane. The Gastric NEUROSES.-In all functional derangements of the nervous mechanism of the stomach, Gray's Glycerine The Ralph Sanitarium For the Treatment of Alcoholism and Drug Addictions THE method of treatment is 1 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 se 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-therapeutic advantages are unexcelled. Trained nurses, hot water heat, eleetric lights. Special rates to physicians. For reprints from Medical Journals and full details of treatment, address DR. B. B. RALPH 529 Highland Kansas City, Mo. 529 Highland Avenue HALL-BROOKE A Licensed Private Hos. pital for Mental and Nervous Diseases. THE NATIONAL MEDICAL EXCHANGE -Physicians', Dentists 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. MUMAW, M. D. Elkhart, Ind. CASES OF ALCOHOLISM AND DRUG HABIT. THE NATIONAL Surgical and Dental Chair Exchange. All kinds of new and second-hand Chairs, Bought, Sold and Exchanged. SEND FOR OUR BARGAIN LISTS Address with stamp, Dr. H. A. MUMAW, Elkhart, Ind. REAUTIFULLY situated on Long D Island Sound one hour from New York. The Grounds consisting of over 100 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, LARGE DIVIDENDS Are assured stockholders of the SIERRA- PACIFIC SMELTING CO., S Mexico. Easy Payments. Agents Wanted. Write for terms. Address, HENRY MUMAW, Elkhart, lod. relephone 67-5 Westport Conn. Publisher's Department. 366 Tonic Comp. will be found of extraordinary therapeutic value. Its action is manifold, manifested by an immediate influence on the gastric tissues and a substantial promotion of the gen- eral nutrition. As the secretory and motor functions are im- proved, the patient's whole condition is correspondingly bene- fited. BATTLE & Co., Chemists' CORPORATION 2001 Locust Street, St. Louis, have just issued Number 9 of their series of Dislocation Charts, which will be sent free to physicians on request. WHY IS IT? he That each month in all the best homes in this country, library table, and in every club reading room, you find the METROPOLITAN MAGAZINE It is because it keeps you in touch with those great public and human movements on which the American family depends. It is because its stories are the best published anywhere. It is because its illustrations in color, and black and white, set the standard. It is because its articles are the most vital and interesting. It is because there is something in each copy for every member of every American family. A YEAR'S FEAST 1800 Beautiful Illustrations. 1560 Pages of Reading Matter. 85 Complete Stories. 75 Good Poems. 50 Timely and Important Articles. 1000 Paragraphs presenting the big news of the “World at Large." 120 Humorous Contributions. Wonderful Color Work, presented in frontispieces, inserts and covers. All Yours for One Year's Subscription to THE METROPOLITAN MAGAZINE Price $1.50 per Year or 15 Cents a Copy e Alienist & Neurologist and the above sent for one year for $5.0 Ben 1979 6703 A4 UNIV. OF THE ALIENIST AND NEUROLOGIST ST. LOUIS MO. Vol. XXX. NOVEMBER 1909. No. 4. A JOURNAL OF NEUROLOGY AND PSYCHOLOGY PSYCHIATRY AND NEURIATRY. FOR THE NEUROLOGIST, GENERAL PRACTITIONER AND SAVANT. ΡΑΝ Ο Ρ ΕΡΤ Ο Ν Is an absolutely sterile liquid food and cannot ferment; completely peptonised i cannot embarrass any function of the body; wholly assimilable and leaves no residue; feeably stimulating and holds the patient subjectively to a hopeful outlook. Panopepton is specifically a food for therapeutic use, adequate for nutrition of peculiar excellence in respect to palatability, wholesomeness, reliability and formity. The avel gives complete analysis; literature and clinical reports in abundance at the command of the physician. ADOTTTTTTT NEURON HURST Dr. Wm. B. FLETCHER's Sanatorium for Mental and Nervous Diseases. A new building newly furnished throughout with accommodations for fifty patients For terms address Dr. M. A. Spink, Superintendent. Long Dis. Telephone 381 No. 1140 East Market St., Indianapolis, Ind. 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- cal and Pathological Laboratory under the supervision of a physician well trained in the branches. Surgical cases are given special attention Address all communicati Oto DR. C. C. MORRIS, Supt THE ALIENIST AND NEUROLOGIST. VOL. XXX. ST. LOUIS, NOVEMBER, 1909. No. 4. IS GENIUS A SPORT, A NEUROSIS, OR A CHILD PO- TENTIALITY DEVELOPED?* By Jas. G. KIERNAN, M. D., CHICAGQ. Fellow Chicago Academy of Medicine, Foreign Associate Member French Medico-Psychological Association; Honorary Member Chicago Neurologic Society, Honorary President Section of Nervous and Mental Disease Pan-American Congress 1893, Chair- man Section on Nervous and Mental Diseases American Medical Asscciation 1894; Professor Neurology Chicago Post-Graduate School 1903; Professor of Nervous and Mental Diseases Milwaukee Medical College 1894-5; Professor of Nervous and Mental Diseases Illinois Medical College 1905; Professor of Forensic Psychiatry Kent-Chicago College of Law. THE balance constituting the “ego” is very slowly and very early built up. Kussmaul (as Meynert remarks) | shrewdly indicated certain perceptions and movements, com- mon to the fetus in utero, which feeds itself, as it were, by swallowing amniotic fluid. He indicates likewise that there may be special motives, such as the more stimulating taste of the fluid after occasional depletion, into it of the allantois, which induce swallowing. Here then there are two alterna- tives. The fetus swallows, or does not swallow. Fetal con- sciousness is already presupposed, which would exist, how- *Continued from Alienist and Neurologist, August, 1909. + Psychiatry, Sach's Edition. --567- 568 Jas. G. Kiernan. ever, under circumstances that give but little opportunity for perception. The new-born infant at once discovers signs by which it distinguishes between one set of perceptions and an- other. One set of perceptions helps it to define the circum- ference of its own body, another set belongs to the world be- yond it. However obtuse this perception may be, though the child may at first not be able to discriminate between the various impressions of space, still it is certain that the child' perception of its own body circumference is established very early. Among other means by which it learns to distinguish between impressions received from its own body and the outer world are these: Contact of a strange finger with its own skin excites but one tactile sensation; contact between two parts of its own body excites two tactile sensations; one from the touching, the other from the touched part. Furthermore a number of strange auditory sensations strike the ear of a child, but only the sound of its own voice is accompanied with muscular sensations, and so the attendant muscular sensa- tions help the children to discriminate between movements of its own body and any other movement it may see. There is no order of movements, which, under the cover of instinct can be pushed in between conscious and reflex movements. The first instinct of a child would be the instinct for food, but the origin of that has been discussed. There is absolutely nothing in the sensation of hunger, which would acquaint the child with the means of remedying this pain. It attains naught but the concept of pain. In the general restlessness it displays and in the convulsions ultimately resulting from anemia there is nothing which could be likened to an instinct for food. If the child has not to depend on its own resources, but has a nipple put into its mouth, then the sensation thus excited starts the reflex mechanism of sucking. The child has thus acquired the concept that the sensation of satiation is connected with the act of sucking, and these two sensory memories are associated with the innervation-sensations aroused by sucking, and probably, by the scent of the mother's breast. That a child should suck at every finger may be attributable to a reflex mechanism, but the sucking of the child in dreams proves that the act of sucking has produced Is Genius a Sport? 569 images which have been registered in the cortex. The fac- tors of this primary abstract ego are not definitely defined. ... The nature of the ego does not depend upon any definite order of memories, but is determined simply by the most firmly fixed memories. ... As soon as movements of aggression have taught the child to take hold of things it is evidently under the impression that it is living in a world of sweets; it takes everything to the mouth and licks it. A later aggressive movement-kissing like the first sucking movements, is probably based upon the act of bringing an attractive object to the mouth. This latter movement is clearly dependent upon a powerful secondary presentation aroused by its impressions, just as the sucking movements during sleep denote secondary presentations excited in the course of dreams. . . . . Space vision in the child excites movements of aggression, which aim at the possession of the thing it sees, but as it lacks the power of locomotion it has no conception of distance. These aggressive reflexes of the upper extremities are no more co-ordinated in space than the movements of the eyes are before the child has learned to see, and through irradiation these movements become general, leading to a tossing of the whole body, to kicking with all-fours and to cutting of grimaces. These movements, though ex- travagant, are not spasmodic, but must be regarded as results of cortical impulses interfered with by cortical irradiation. ... The acoustic nerve also takes part in reflex im- pulses; the child that hears others speak or perceives other sounds and noises has the desire to bring forth the same sounds and noises. As its cortical functions improve, it develops the secondary idea that the sounds which it brings forth are similar to those of ordinary speech. Wundt correctly re- marks, that “the speech of animals consists of so-called sen- sory sounds, and this is true of children before they have acquired the faculty of imitating syllables.... In all aggressive movements the child over-estimates the possibili- ties of its powers. Experience and an improvement of the power of imitation correct these false conclusions." As soon as the child has reached the age when all cortical fibers ac- quire their white substance, purely reflex movements, and 570 Jas. G. Kiernan. those due to irradiation, diminish in number. :: In the child the expression of emotion may vary much. Under the influence of the apnoetic effect of functional hyperemia at- tendant upon pleasurable emotions there will be movements of aggression bespeaking the force of the child's own personal- ity, or there will be spasmodic movements of repulsion (due to irradiation), such as screaming and crying. All these ex- pression movements, whether due to irradiation or not, dis- patch sensations of innervation to the cortex, which sensa- tions are there turned into “special memories" and serve later on as impulses starting the entire groups of movements, which are involved in expression. Consequently these move- ments of expression result primarily from stimulation of sub- cortical centers, just as simple forms of reflex movements serve as the foundation upon which the structure of more com- plex conscious movements is raised. As soon, however, as these irradiatory impulses, which excite the mechanism of expression, are put under control of an organ of motor co- ordination, they acquire secondarily a higher value as psychi- cal factors of expression. In the child pleasurable emotions result in general movements of the entire body. Even in the adult who dances for joy or performs other extravagant move- ments, occurs a repetition of these primitive mimical move- ments of the child. . . . . . A state of excessive, pleasurable emotion may pass into a condition of maniacal excitement as a result of dilatation of the arterial network of the brain, or a state of pleasurable confusion may end in a transitory swoon. ... The doctrine that ideas are in- herited, and are not the result of perception and association —that movements, even mimical ones, are the result of innate motives and have nothing to do with imitation and early reflexes, can hardly be applied to man. Anger appears early in children. In the first two months the child shows by move- ments of its eyelids and hands strong anger when the attempt is made to bathe it or take something from it. According to Fenelon, jealousy is much more violent in childhood than is usually suspected. Bourdin in claiming that all children are liars, ignores the fact pointed out by Meynert, that the weak inhibitions of the child prevent it from distinguishing clearly Is Genius a Sport? 571 between the subjective and objective-between its wishes and its facts. Cruelty, as might be expected, is frequent in the child, not from any cruelty per se, as claimed by La Fontaine and Montaigne, but simply because, as pointed out by Mey- nert, the feeble secondary “ego” does not as yet so dominate the primary “ego” as to enable it to recognize the feelings of other beings. The child therefore gradually acquires a series of checks on its explosive tendencies, and the egotism shown in the over-estimate of the possibilities of its powers. These ele- ments underlie the mental state of childhood, which, accord- ing to Moreau de Tours,* is characterized by an absence of reflection and self-control, by spontaneous and capricious actions, by dominance of immediate sensory impressions and absence of regard for the future, by desire for power and tyrannical use of it. The imperfectt co-ordination of the slowly acquired in- hibitions is readily upset, whence it occurs that states of uncertainty and resultant terror—“night terrors”—are the earliest morbid mental phenomena noticed in children. The emotion of fear, as Meynert has shown, characterized by greater excitement and attention is probably disturbance of a subcortical center (of the medulla) which defies cortical inhibition. Movements of flight may therefore be started by allied associations in the absence of real danger and even against the will. Fear of the unknown in children, seemingly a reversion to the fear of the unknown of savages, tends like it to produce occult belief. This has been pointed out by Emerson in Margaret Fuller. Despite the German rational- ism of George Eliot such fear found utterance in her“ Beyond the Veil;" a mystically occult contrast with her novels and with the positivism which was her religion. The philosophy of George Eliot should theoretically have effaced such mysti- cism, yet, as a survival of “night terrors,” it came to the sur- face. Dickens portrays with singular felicity this acquired predisposition, when he says about the teacher of the model *De la Folie chez les Enfants. tHarriet C. B. Alexander: Alienist and Neurologist, July, 1893. 572 Jas. G. Kiernan. school,* “Ah, rather overdone, McChoakumchild! If he had only learned a little how infinitely better he might have taught much more. He went to work in this preparatory lesson, not unlike Morgiana in the ‘Forty Thieves,' not looking into all the vessels before him one after another, to see what they contained. Say, McChoakumchild, when from the boiling stove thou shalt fill each jar brim-full by-and-by, dost thou think thou wilt always kill the robber Fancy lurking within, or only maim and distort him?" The balance so slowly and carefully created is readily upset. The support of genius thus raises the broader issue whether an admitted claim on public does not tend to in- crease the primary ego at the expense of the secondary, and hence to decrease expression of genius by diminishing its power of association. That state socialism of the kind urged by the Literary Digest has a degenerative effect was long ago pointed out by Hawthornet in his depiction of the deadening influence of the communal atmosphere of Brook Farm. State support of genius tends to create bureaucracy. Bu- reaucracy means the dead level of conventionalism seen in the Art of Egypt and Assyria. This deadening effect is well depicted by Macaulay :f “In the first place, the principles of literary criticism, though equally fixed with those on which the chemist and the surgeon proceed, are by no means equally recognized. Men are rarely able to assign a reason for their approbation or dislike on questions of taste; and therefore they willingly submit to any guide who boldly asserts his claim to superior discernment. It is more difficult to ascer- tain and establish the merits of a poem than the powers of a machine or the benefits of a new remedy. Hence it is in literature, that quackery is most easily puffed, and excellence most easily decried. In some degree this argument applies to academies of the fine arts; and it is fully confirmed by all that I have ever heard of that institution which annually disfigures the walls of Somerset House with an acre of spoiled canvas. But a *Hard Times. Blithedale Romance. tRoyal Society of Literaturo. Is Genius a Sport? 573 literary tribunal is incomparably more dangerous. Other societies, at least, have no tendency to call forth any opinions on those subjects which most agitate and inflame the minds of men. The skeptic and the zealot, the revolutionist and placeman, meet on common ground in a gallery of paintings or a laboratory of science. They can praise or censure with- out reference to the differences which exist between them. In a literary body this can never be the case. Literature is, and always must be, inseparably blended with politics and theology; it is the great engine which moves the feelings of a people on the most momentous questions. It is, therefore, impossible that any society can be formed so impartial as to consider the literary character of an individual abstracted from the opinions which his writings inculcate. It is not to be hoped, perhaps it is not to be wished, that the feelings of the man should be so completely forgotten in the duties of the academician. The consequences are evident. The honors and censures of this Star Chamber of the Muses will be awarded according to the prejudices of the particular sect or faction which may at the time predominate. Whigs would canvass against a Southey, Tories against a Byron. Those who might at first protest against such conduct as unjust would soon adopt it on the plea of retaliation; and the general good of literature, for which the society was professedly instituted, would be forgotten in the stronger claims of political and re- ligious partiality. Yet even this is not the worst. Should the institution ever acquire any influence, it will afford most pernicious facilities to every malignant coward who may desire to blast a reputation which he envies. It will furnish a secure ambus- cade, behind which the Maroons of literature may take a cer- tain and deadly aim. The editorial "we" has often been fatal to rising genius; though all the world knows that it is only a form of speech, very often employed by a single needy block- head. The academic “we” would have a far greater and more ruinous influence. Numbers, while they increased the effect, would diminish the shame, of injustice. The advantages of an open and those of an anonymous attack would be com- bined; and the authority of avowal would be united to the 574 Jas. G. Kiernan. security of concealment. The serpents in Virgil, after they had destroyed Laocoon, found an asylum from the vengeance of the enraged people behind the shield of the statue of Min- erva. And in the same manner, everything that is grovelling and venomous, everything that can hiss, and everything that can sting, would take sanctuary in the recesses of this new temple of wisdom. The French Academy was, of all such associations, the most widely and the most justly celebrated. It was founded by the greatest of ministers; it was patronized by successive kings; it numbered in its lists most of the eminent French writers. Yet what benefit has literature derived from its labors? What is its history but an uninterrupted record of servile compliances-of paltry artifices—of deadly quarrels - of perfidious friendships? Whether governed by the Court, by the Sorbonne, or by the Philosophers, it was always equally powerful for evil, and equally impotent for good. Yet, granting that the prizes were always awarded to the best composition, that composition will always be bad. A prize poem is like a prize sheep. The object of the competitor for the agricultural premium is to produce an animal fit, not to be eaten, but to be weighed. Accordingly he pampers his victim into morbid and unnatural fatness; and, when it is in such a state that it would be sent away in disgust from any table, he offers it to the judges. The object of the poetical candidate, in like manner, is to produce, not a good poem, but a poem of that exact degree of frigidity or bombast which may appear to his censors to be correct or sublime. Com- positions thus constructed will always be worthless. The few excellences which they may contain will have an exotic aspect and flavor. In general, prize sheep are good for noth- ing but to make tallow candles, and prize poems are good for nothing but to light them. The evil effects of such state socialism are further pointed out by Macaulay* .“ Toulouse had a venerable institution, called the academy of Floral Games. This body held every year a grand meeting, which was a subject of intense interest *Barére: Critical and Historical Essayı. Is Genius a Sport? 575 to the whole city, and at which fowers of gold and silver were given as prizes for odes, for idyls, and for something that was called eloquence. These bounties produced of course, the ordinary effect of bounties, and turned people who might have been thriving attorneys and useful apothecaries into small wits and bad poets." These degenerating effects of what is called "practical" training that is rule of thumb in- tellect acquired in, by and through a rut, are vividly illus- trated by Macaulay* in his discussion of university training. “The bad effects of a university system may be traced to the very last, in many eminent and respectable men. They have acquired great skill in business, they have laid up great stores of information. But something is still wanting. The super- structure is vast and splendid; but the foundations are un- sound. It is evident that their knowledge is not systemat- ized; that, however well they may argue on particular points, they have not that amplitude and intrepidity of intellect which it is the first object of education to produce. They hate abstract reasoning. The very name of theory is terrible to them. They seem to think that the use of experience is not to lead men to the knowledge of general principles, but to prevent them from ever thinking about general principles at all. They may play at bo-peep with truth; but they never get a full view of it in all its proportions. The cause is, that they have passed those years during which the mind frequent- ly acquires the character which it ever after retains, in studies, which, when exclusively pursued, have no tendency to strengthen or expand it.” In a famous couplet Schiller pointed out the same effects in Germany: No one will a cobbler be, Everyone doth himself an author see. The cardinal error in the belief that the world owes the genius a living is that it tends to pauperize him into the pluto- crat, whose many crimes, for centuries, apparent in fore- stallers in Roman times, monopolists in the days of the Stuarts, farmers general in the days of Louis XV. and XVI., *Essays, London University. 576 Jas. G. Kiernan. and trust magnates to-day, have often brought down condign punishment. I. The sense of responsibility for high gifts domi- nant in the Golden Rule (so neglected by dogmatic Christian- ity which, like the old Pharisees “makes long prayers and devours widows' houses”) is absent from all state socialistic creations whether corporations, sculptors, artists, authors, physicians, scientists or mechanicians. Under state socialism the individual withers and the world is more and more. Ideals vanish and the ambition to become a member of Boodle's patriot band Fat from the leanness of the plundered land, rots, art, science and literature, particularly journalism. Of the rotting effect on the last, Balzac* has given a peculiarly vivid picture as true in America everywhere now as then in France. *Lost Illusions. (TO BE CONTINUED.) THE PATHOLOGY OF GENERAL PARALYSIS. An Address delivered before the London (Ont.) Medical Society, June 7, 1909. By Ernest JONES, M. D., M. R. C. P.(Lond.) Demonstrator of Medicine and of Psychiatry, University of Toronto. Pathologist to the Toronto Hospital for the Insane. OUT of the vast subject of the pathology of general paraly- sis I propose to bring before your notice this evening a few of the points that are of most general interest to the clinician and that aid him both in clarifying his conception of the disease and in making an early and exact diagnosis of it. From the point of view of pathology the disease is in several respects one of peculiar interest, to the psychiatrist, to the practitioner and to the State. Of all mental diseases it is at the same time the most preventable and the least cura- ble. Its occurrence could, if thought desirable, be avoided either by the individual or by the State. On the other hand, having once occurred it is absolutely refractory to treatment and leads to a fatal issue more rapidly and surely than almost any other form of insanity. This latter fact renders the early diagnosis of it a matter of high importance not only for the reputation of the physician in attendance, but also for the welfare of the patient's relatives and friends. Again, there are few nervous diseases and no mental diseases the pathology of which is better understood than that of general paralysis. The very fact that it has a specific anatomical substratum is in itself of great theoretic interest, and lends a striking and unfortunate support to the erroneous dogma that insanity is always due to disease of the brain. This dogma happens to be true in the particular affection of general paralysis, but in my opinion it would be most misleading to generalize it by applying it to all other forms of mental disorder. The exist- -577- 578 Ernest Jones. ence of an anatomical substratum is important in two other respects. Through it general paralysis constitutes the main bridge connecting the realm of psychiatry to that of general medicine, and to it we largely owe the renewed earnestness with which the study of psychiatry has been undertaken in the past quarter of a century. Further, the existence of a sharply defined anatomical picture has enabled us to check our clinical diagnoses of the disease in a way that was pre- viously impossible. This has been of the utmost value not only in clearly differentiating general paralysis from the various forms of so-called pseudo-paralysis, but in its educat- ing effect clinically. There is no more salutary exercise for the clinician than to compare a series of his clinical diagnoses of general paralysis with the results of the microscopic exam- ination of the same cases after death; whoever has not made this experiment would be surprised did he do so at the chas- tening effect it would have on his opinion of his clinical capaci- ties. As the anatomical findings are thus even foi clinical pur- poses alone of great importance I will begin by giving a brief account of some of their most salient features. Outside the nervous system one finds, apart from definitely syphilitic lesions, atheroma of the aorta and atrophy of the heart, liver and kidney in a third of the cases. Little need be said of the changes in the nervous system except those in the cerebral cortex. In the peripheral nerves may be seen evidences of parenchymatous degeneration with some overgrowth of con- nective tissue, and, in the case of the optic nerve, of glia tissue. Neuro-retinitis is frequent, the retinal changes being of the same nature as the cortical ones. In nearly a half of the cases the membranes of the spinal cord are thickened and adherent, and there is visible shrinking of the posterior and lateral colunus. In nearly every case there is microscopic evidence of degeneration in the cord tracts, usually in both the pyramidal tract and the posterior ascending tracts; the latter changes are the more frequent of the two and are similar in nature, though not in degree, to those present in tabes dor- salis. The Pathology of General Paralysis. 579 The macroscopic changes found on opening the cranial cavity are thickening and adherence of the dura mater, espe- cially along the middle line and anteriorly, the well known “false membrane" between the dura and pia, with sometimes a haematoma in it, a tough, thick and adherent pia, which tears the cortex when an attempt is made to stiip it, and an excess of turbid cerebro-spinal Auid, both on the surface and in the ventricles. The brain is atrophied, especially in the frontal region, where also the pia changes are most pronounced. The cortex is thin, opaque, hard and injected. The white matter is irregularly injected, and may show patches of soften- ing The microscopic changes may be divided into those that can be studied under the low power magnification and those that need a high one. They are all most marked in the frontal and Rolandic regions. Under the low power the most striking feature is the remarkable disorderly arrangement of the corti- cal nerve cells. The normal division into different layers is here disturbed to a degree found in no other disease. The atrophy and disappearance of considerable numbers of nerve cells, sometimes of whole layers, also at once attracts the attention. An extraordinary number of blood-vessels are noticed, there being evidently present a great proliferation of them. With appropriate methods of staining can also be made out the disappearance of myelin-sheaths, which pro- ceeds to a higher degree and in a more widespread manner than in any other disease, the secondary degeneration of nerve fibres, and the extensive overgrowth of glia tissue. The glia increase takes place especially in the superficial layers of the cortex and along the vessel sheaths. The pial changes will be presently indicated. Under the high power these processes can be studied in greater detail. The thickening of the pia is seen to be due, not to hyperplastic changes, as in alcoholic, senile and arterio- sclerotic conditions, but to an enormous cellular infiltration. This infiltration differs from that which occurs in tertiary syphilitic lesions in being very diffuse and not distributed in foci or following the lines of the nerves and blood vessels, and in being exceedingly heterogeneous. Whereas in tertiary 580 Ernest Jones. lues it is made up almost entirely of lymphocytes, in general paralysis it comprises all kinds of cells. Plasma cells of all ages may be seen, mast cells, lymphocytes, etc. The pial changes in lues are primary to the cerebral ones and the two can be closely correlated: this is not the case in general paral- ysis. The changes in the nerve cells are very pronounced, but are not peculiar to this disease. Almost all kinds of degenera- tion may be seen, such as fuscous changes, vacuolation, tigrolysis, sclerosis, chromatolysis, as well as complete atrophy. In tertiary lues many swollen cells may be seen, but they do not disappear as a result of atrophy in the way they do in general paralysis. The degeneration of the nerve fibres has already been mentioned. It is greatest in the association tangential fibres of the cortex, but is also marked in the effer- ent projection fibres. In the senile psychoses degeneration of the myelin sheath occurs, but there is no secondary de- generation of the axis cylinders, as in general paralysis. The glia overgrowth is very diffuse. Characteristic is the presence of giant spider cells, and a rich formation of thick fibres which are attached in bundles to the blood-ves- sels. One never sees the plaques of fine unicellular fibres so characteristic of the senile psychoses. The changes in the blood-vessels are of the greatest im- portance in making a differential diagnosis. The extensive new formation of vessels, which was previously referred to, takes place mainly by a process of budding from the walls of, the old ones. It is found also in tertiary lues, and to a less extent in arterio-sclerosis, though in the latter case not apart from focal lesions, such as haemorrhages. There is a great overgrowth of the intima, with proliferation of the endothelial cells, the thickened intima later becomes canalized, so that it may be impossible to determine which was the original lumen. The elastic tissue fibres are thickened and increased in num- ber, changes that occur also in tertiary lues. The adventitial cells proliferate but do not reach the large size often seen in cases of lues. The adventitial lymph-spaces are enormously dilated, and are distended by a rich cellular infiltration. The chief constituents of this infiltration are plasma cells, lympho- The Pathology of General Paralysis. 581 cytes and mast cells. Degenerative changes, which are main- ly hyaline, are slight. They are found mostly in the small vessels near the surface, and chiefly occur towards the end of the disease. This contrasts with the advanced retrogressive changes found in arterio-sclerosis and to a less extent in the alcoholic and senile psychoses. Retrogressive changes are also more pronounced in luetic arteritis than in general paral- ysis, and in that condition the artery often reverts to the embryonal state so that the three coats can no longer be dis- tinguished. Further, the wall of the vessel in luetic endar- teritis is not infiltrated with cells as it is in general paralysis, and in luetic meningo-encephalitis the infiltration of the ves- sel is only secondary to that of the pia. A few words may be added concerning the cells that are most characteristic of the disease. The plasma cell, which is probably derived from the lymphocyte, is a fairly large cell with a thick nuclear membrane and metachromatic proto- plasm, which gets lighter as the cell ages. Around the nucleus the protoplasm is lighter than at the periphery and is often tinted yellow. The cell frequently shows degeneration and vacuolation. Mitosis is rarely seen except in the pia. The cell is usually confined to the adventitial lymph space, and extends beyond this only in parts near an adherent pia or where there is intense infiltration. The same remark applies to the distribution of lymphocytes, but this differs in occurring more frequently in the wall of the large vessels, not, as plasma cells do, in that of the small ones. The mast cells are spherical or ovoid cells with coarse, basophile granules and a large oval eccentrically situate nucleus, which is badly marked off from the surrounding protoplasm. They always occur dis- cretely. Very characteristic are the rod-shaped or “Stäbschen" cells, which probably take their origin from the connective tissue cells of the adventitia. These are long cells with branching protoplasm, which frequently contains fat and pigment. The nucleus is often broken and shrunken. They lie attached to the outer surface of the adventitial wall of new blood vessels. They are occasionally seen in other diseases, particularly tertiary syphilis, when there is much new formation of vessels, but only in focal lesions. Even 582 Ernest Jones. then they are short and atypical. In general paralysis they are exceedingly frequent and the distinguishing characteris- tics of the cell are evident to a degree never found in any other disease. The anatomical picture the outline of which I have here sketched is perfectly distinctive of general paralysis, and by means of the post-mortem examination alone, a trained ob- server can without hesitation decide whether a given patient had or had not suffered from this disease. The obvious im- portance of this fact both to theory and to practice need not be further insisted on. We may next consider some of the pathological observa- tions that may be made during the life of the patient. These are of great interest not only as throwing much light on the pathogenesis of the disease, but also in that they enable us to make a certain diagnosis of its presence even in the earliest stages. Many of them, such as the haemic leucocytosis which is so common, particularly after the seizures, are of no great diagnostic value, and I shall confine my remarks to the subject of the cerebro-spinal fluid. The technique of lumbar puncture is so well known that I will only offer a word or two concerning a few personal preferences which a con- siderable experience has dictated. The interval between the fourth and fifth lumbar spines is the most convenient one. The sitting posture is the most advisable, but one must see to it that the patient lies down immediately after the operation and for the rest of the day. The amount of fluid withdrawn should never exceed ten c. c. at the most. The operation should never be performed if there is reason to sus- pect the presence of a tumour of the brain. A great number of physical and chemical properties of the fluid may be investigated, but in routine practice it is only necessary to study three features, the pressure, the pro- teid content and the cells present. The pressure is almost. constantly raised in cases of general paralysis, frequently to four times the normal. The proteid content is always increased. The simplest way of determining this is by means of the ordinary Heller nitric acid test, applied as in urine testing. The extent of the increase can be fairly well gauged by the The Pathology of General Paralysis. 583 density of the ring formed at the junction of the two liquids, or by the time necessary for the formation of it when the fluid is diluted. The fact that this increase in the proteid content of the cerebro-spinal fluid is a constant feature in general paralysis was first demonstrated by Babcock of New York in 1896, though it was not until the publications of several French workers in 1903 that general attention was called to it. The proteid in normal cerebro-spinal fluid is probably globulin only, and it does not exceed half a gramme per litre. In general paralysis the amount is fre- quently four times this, and the proteid consists of both globulin and albumin, rather more of the former than of the latter. A matter of special theoretic interest is that the globulin is of a special kind, one of the varieties of euglobulin, and it has recently been shown that it is this euglobulin which carries the peculiar Wassermann anti-body of which we shall speak in a moment. Many methods have been employed for demonstrating this increase in euglobulin, but I will men- tion only the two which in my opinion are of the most service for this purpose. These were first described a few months ago, one by Noguchi of New York and the other by G. W. Ross of Toronto and myself.* The former consists in adding half a c. c. of a 10% solution of butyric acid in normal salt solution to a fifth of a c. c. of the cerebro-spinal fluid, raising the mixture to boiling point, further adding a fifth of a c. c. of a 4% sodium hydrate solution, and again heating. Within a few minutes, if the reaction is positive, a coarse flocculent precipitate forms. The second test consists in gently pour- ing a little of the cerebro-spinal fluid on to a saturated solu- tion of normal ammonium sulphate. When the reaction is positive a fine greyish-white ring appears at the junction of the two liquids. In the normal cerebro-spinal fluid only three or four cells are found in a cubic millimetre and these are exclusively lymphocytes. In general paralysis on the other hand there are commonly present forty or fifty cells to the cubic milli- metre, and it is not rare to find several hundred. This cell *See Brit. Med. Journ., May 8, 1909. 584 Ernest Jones. increase occurs at the very outset of the disease, a fact of obvious importance for diagnostic purposes. Although the majority of the cells are lymphocytes, usually about two- thirds, still a great variety of other cells are also found, par- ticularly endothelial cells, plasma cells, phagocytes and polymorphonuclear leucocytes. The increase is most marked in cases that run an acute course, and is greater, especially as regards the polymorphonuclear leucocytes, during the seizures that occur in the disease. The three features just mentioned, the increase in pres- sure, in the globulin content and in number of lymphocytes present, are simple observations which can be made by any physician and which in the majority of cases enable us to make a positive diagnosis of the disease. I have now to speak of a far more complicated test, which has of late aroused wide spread interest, the well known Wassermann sero-diagnostic reaction. The credit for the laborious work done on this subject belongs as exclusively to the German school of psychiatry as that done on the simpler observations above mentioned belongs to the French school. The amount of research that has been carried out on the Wassermann reaction may be indicated by the fact that within the past couple of years nearly three hundred papers, many of which are of the highest excellence, have appeared, incorporating conclusions drawn from the exam- ination of several thousand cases.* The essential point of Wassermann's discovery was that the serum of a syphilitic when mixed with an infusion made from syphilitic material, has the power of binding the complement” present in normal blood serum. Complement is the substance which acts on various foreign substances, called “antigens," when in the presence of the corresponding “anti-bodies.” For instance, normal complement-containing blood-serum will dissolve the red blood cells of another animal provided that an anti- body corresponding to those red blood cells is present. This *Those who wish to pursue the subject may be referred to a detailed review of it I have recently published in the American Journal of Insanity, April, 1909. A paper on the Proteid Content of the Cerebrospinal Fluid in General Paralysis, published in the Review of Neurology and Psychiatry, June, 1909, may also be men- tioned. The Pathology of General Paralysis. 585 anti-body has to be obtained by previously injecting the red blood cells of the second animal into the circulation of the first, this animal responding to the injection by pouring out anti-body into its blood stream. It is important to remem- ber that the complement is a non-specific substance which can therefore act on a very large number of different foreign substances, or antigens, while the anti-body is a specific sub- stance which can enable the complement to act only on the corresponding antigen in response to which it was formed. We can thus test whether the complement of a blood serum is bound or not by ascertaining whether it is or is not free to take part in a subsequent reaction. In the test in question, for instance, if the mixture of syphilitic material, which in this case constitutes the antigen, and the blood serum have bound the complement, then this is no longer free to dissolve any red blood corpuscles subsequently added, in spite of the presence of the specific anti-body for these corpuscles. The test is carried out as follows: An emulsion of the syphilitic liver of a foetus is made and a fifth of a c. c. is added to an equal quantity of the fluid to be tested, together with a tenth of a c. c. of the complement-containing blood-serum of a normal guinea pig. The mixture is incubated for an hour or two, and is then added to a c. c. of a 5% saline emulsion of sheep's red blood corpuscles and to twice the amount of anti-body necessary to dissolve these 'corpuscles; this anti- body is obtained by taking the serum of a rabbit which has some time previously been twice injected with sheep's cor- puscles. If the reaction is negative then the guinea pig complement, not being bound, is free to dissolve the red corpuscles; if the reaction is positive it cannot. A positive reaction therefore indicates that some substance, which we may provisionally term a syphilitic anti-body, was present in the fluid that was being tested, and bound the complement to the syphilitic antigen. Each of the five constituents of the reaction has independently to be tested by control reactions, and there are a large number of possible fallacies that I need not here enumerate. It will at once be evident that only a highly skilled expert can per- form the test with any hope of securing adequate accuracy 586 Ernest Jones. of results, and although several simplifications have recently been suggested it is very doubtful whether any modification of the original technique is satisfactory. The clinical results are very striking and have been so widely confirmed as to be no longer open to doubt. They may summarily be stated in a sentence. The reaction is in- variably positive with the blood-serum of patients suffering from general paralysis, and almost always with the cerebro- spinal fluid; it is commonly positive with the blood-serum of patients suffering from syphilis only, but only rarely with the cerebro-spinal fluid, even if the nervous system is im- plicated in the disease. Wassermann's interpretation of the reaction has of late been discredited. It was simply that these peculiar sub- stances found in the serum and fluid were specific syphilitic anti-bodies. It has been shown however that the reaction can be obtained, though not so surely, if the syphiliticemul- sion used in it is replaced by any one of a large number of other substances. The essential constituent in this antigen is of a lipoid nature and is closely allied to lecithin. The substance in the serum or fluid, the so-called anti-body, is contained, as was mentioned above, in the euglobulin. It is present in small quantities in the normal, but is greatly increased in amount in syphilis and meta-syphilis. A great number of facts have been established concerning its physi- cal and chemical properties, but nothing is definitely known of the origin or essential significance of it. Our present knowledge concerning the pathology of the reaction may be summed up as follows. Various antigens of a lipoid nature, which are present in especially large quantities in syphilitic organs, interact, probably as a colloid precipitation phe- nomenon, with some substance which is contained in euglob- ulin, the combination has the power of combining with com- plement, and thus of inhibiting haemolysis. If we now withdraw from these confusing details and with a broader perspective attempt to review them in their relation to the classical conceptions of general paralysis, we must at once be struck by the remarkable confirmation two The Pathology of General Paralysis. 587 of the most important of these conceptions thus receive. I refer to the specificity of the disease, and to the close depend- ence of it on syphilis. General paralysis is in every sense of the word a specific disease. Even on the purely clinical side this has long been suspected. A disease which produces such an extraordinarily delicate lesion as that underlying the Argyll-Robertson pupil, a lesion so fine as to have escaped detection by the most exact methods of investigation, we must suppose to be due to some one constant agent, such as a complex toxin. This surmise reaches almost certainty when we recall the highly peculiar histological picture I have above sketched, and further the exceedingly characteristic changes in the cerebro-spinal fluid. It is unthinkable that such an elaborate and peculiar clinico-pathological picture should be produced by banal causes, such as sunstroke, trauma, woriy, alcohol, etc., as is still frequently alleged. And when we search for the specific morbid agent that must be the source of this elaborate picture our efforts are singularly. rewarded. All the evidence, drawn from the most diverse sources, con- verges with fatal convincingness towards the one and only specific factor in the production of general paralysis, namely syphilis. The amazing corresponding between the distribu- tion of syphilis and that of general paralysis, in different countries, in different towns, in the different social classes and occupations, and between the age and sex incidence of the two diseases; the study of the inherited and conjugal cases; the incidence of syphilis in paralytics, as revealed not only by the history but by the physical signs, post-mortem evidences, difficulty of inoculating the patients with syphilis, and the constant presence of the Wassermann syphilitic substances; the frequency with which patients with syphilis later develop general paralysis: all these considerations are 588 Ernest Jones. in the fullest harmony with the pathological evidences I have above detailed which demonstrate the essential relationship of general paralysis to syphilis. The subject therefore once more affords an illustration of the immediate practical value for clinical and preventive medicine of researches which, when viewed in too one-sided a way, appear to be abstract, dry and fruitless, and the results thus obtained should serve as an active stimulus to further and more profound inves- tigations in these and allied realms of study. 407 Brunswick Ave. CLINICAL AND FORENSIC ASPECTS OF TRANSITORY FRENZY.* By Harriet C. B. Alexander, A. B., M. D. CHICAGO. TRANSITORY frenzy, mania transitoria, folie transitoire, furore transitoria, transitorische Tobsucht, is an acute frenzy which, developing suddenly and rapidly soon reaches a climax with ungovernable, spontaneous motor impulses and seemingly violent anger with complete absence of conscious- ness. The paroxysm does not change in intensity, but after a comparatively short time, rarely more than twelve hours, it subsides, usually after a profound sleep without leaving any recollection of events during the paroxysm, or without patho- logic cerebral change or mental defect. These features were illustrated in three cases wheie the psychosis was offered as a defense for murder and assaults with intent to kill. The accused in the first case was the wife of a saloon- keeper. The victim had an equity in the building where the saloon was. The accused had a neuropathic constitution evinced by the survival of night terror from childhood. These night terrors were accompanied at times by casual hallucina- tions of sight and hearing. This psychic disturbance was accentuated with the onset of menstruation and was particu- larly marked thereafter around the menstrual period. Her early marital life was very happy. She had one child who had reached the age of ten at the time of the homicide. A short time before the homicide the husband formed a liaison with its victim. Shortly before the homicide the accused learned that the husband was to make a trip to the Paris Exposition of 1900 with the slain woman at the latter's ex- *Transactions XVI International Medical Congress, Budapest, 1909, Abstract. -589- 590 Harriet C. B. Alexander. pense. She had saved a few hundred dollars and putting this money in her stocking she went to her husband's saloon in the evening preceding the homicide and asked him to take a walk with her. She asked her husband about the Paris trip who told her that the slain woman wanted him to go and would put up plenty of money to have a good time. She then took the money out of her stocking and offering it to him asked him to stay home. He asked her how much it was. When she told him the amount he laughed at her and said it would be enough to take him to Paris, but not enough to bring him back. He then stated that the slain woman was willing to spend thousands where she had but hundreds. She then returned home alone and had no sleep that night. She was seen at all hours at her window as she had been for many nights before by the policeman on duty. The next morning she purchased a revolver intending, as she said, to end it all by killing herself. She then went to the saloon to beg the woman to give her husband up. The negro porter went to the foot of a stairway leading into a room behind the saloon and told the victim that the accused husband wished to see her. The victim came down the stairs partially clothed. The accused told her who she was and her errand. From this time the accused remembers nothing save a laugh by the slain woman and her scared expression. The victim was then slain by a pistol shot and the accused taken into custody by a policeman who noticed her dazed appearance. She did not regain perfect consciousness for some hours after the occurrence. She had no conception why she was imprisoned. In spite of much public prejudice against the plea of insanity the jury acquitted the accused, finding that while she was insane at the time of the homicide, she was now sane. In the second case, a man of fifty-five, who had led a wandering life, quite common with mechanicians in both English and German-speaking countries, had lived for a time in a somewhat unsettled Pacific Coast region. Here con- troversies were settled by the revolver. The man who could draw first had the advantage. On one occasion the accused ejected a rowdy from a ladies' dining room. The rowdy shot through his trousers pocket at the accused. This seems to Clinical and Forensic Aspects of Transitory Frenzy. 591 have made a permanent impression. The accused patented several petty labor-saving devices. For the better manu- facture of these he removed to Chicago where he committed the manufacture of his devices to mechanicians for whom he' purchased machinery and advanced money with the under- standing that the machines were to be made by a certain time. This time was greatly exceeded when he found the people removing their place of business without notice under sus- picious circumstances. He demanded the return of machines bought and money. These demands were evaded whereupon he called in a lawyer. This lawyer made an appointment for him and the lawyer of the other people as well as the latter's clients. They met in an office of the debtor's lawyer. The accused went with a rovolver (which he had always carried) to this meeting. Here an active controversy ensued; during this the accused believed he saw his debtor put his hand in his hip pocket. He then attempted to draw his revolver. From this time he remembers nothing for twelve hours after- ward until he awoke in the police station. Immediately after attempting to draw his revolver he was struck at by a chair. The revolver went off striking the debtor and inflicting, what was thought at first, to be a fatal wound. The accused then fired the revolver aimlessly. A policeman, called in, con- ducted him to the station. According to this policeman, his lawyer and the ante-mortem statement, as it was believed, of the man shot, the accused was in a state of hallucinatory con- fusion without consciousness. The man shot recovered and then prosecuted the accused very venomously. The jury under the charge of the judge, taking the scientific ground that it was the State's duty under the circumstances to prove sanity beyond a reasonable doubt, promptly acquitted the accused. In a third case, the accused had been in business with a brother. His maternal uncle was an instability. A younger brother had been an inmate of an insane hospital between 15 and 25. The victim of the attempt at homicide was a very tricky individual given to threats enforced by a revolver. The accused lent money to the firm without proper security. This the elder brother repeatedly refused to account for. 592 Harriet C. B. Alexander. Later he agreed to pay back the money in weekly payments. At this time the accused suffered from helmet sensations, ringing in the ears, dizziness and confusion. The accused accepted notes for the weekly payments endorsed by a mutual business friend. This friend suggested that the firm be in- corporated so that all rights be cleanly defined. At this time the accused was sleepless and the helmet sensation, ringing in the ears, dizziness and confusion came more often and lasted longer. The friend suggested that the accused go to a watering place and recuperate. While there the firm was incorporated, but the accused did not appear among the in- corporators. The officers were later elected. The elder brother was made President and Treasurer, his wife Secretary and the accused Vice-President. At the end of the fiscal year the accused asked that the corporation declare a dividend justified by its financial success. This the president refused to do whereupon the accused threatened to have a receiver appointed. Thereupon 'the president threatened to have the accused voted out of the corporation. From this time the cerebral symptoms of the accused increased. He was unable to sleep and walked the street day and night in a dazed state. He would find himself in different parts of the country where he had gone in these periods of mental con- fusion, not knowing how he got there. About this period the elder brother threatened the accused with a revolver which he took from the left hand drawer of his desk. A meeting of the corporation was called to which the accused took a revolver to protect himself. The details of the meeting are imper- fectly remembered by the accused. The elder brother read some paper and when it was finished started to open the drawer in which was the revolver. From this time the accused remembers nothing until he found himself in a patrol wagon an hour after with a policeman.. The accused knocked the elder brother off his chair with his revolver soon after the latter opened the drawer. The elder brother rushed at the accused who was attacked from behind by the former's wife. The elder brother twisted the revolver in the accused's hands discharging it several times. A younger brother smashed the door with a chair and rushed in between the combatants. Clinical and Forensic Aspects of Transitory Frenzy. 593 A policeman was then called and the accused placed under arrest. The accused, after repeated delays by the prosecu- tion, was at length on his own demand brought to trial and acquitted on a technicality as to time of trial. The forensic status of this psychosis must be determined by the clinical evidence in the individual case so far as brevity, explosive- ness, unconsciousness and violence is concerned, it does not stand alone as has repeatedly been claimed by those who employ special pleading in science. To call it cerebral hypere- mia, when its occurrence cannot be denied, is a mere dodge recognition of the transitory furor whch is the essential characteristic of the alleged cerebral hyperemia. To say it must be an expression of larrated epilepsy, when the most minute examination fails to discover any epilepsy, is likewise special pleading equally unworthy of a scientist. MENTAL ADVANCE IN WOMEN AND RACE SUICIDE. BY JAMES G. Kiernan, M. D., CHICAGO. A Canadian chemist, Professor Armstrong, in a recent A address augurs badly for the future, because the men- tal advance of women is, under a biologic law laid down by Herbert Spencer, fatal to race increase. As Professor Arm- strong is a chemist, the bias which makes the chemist's posi- tivism fatal to a judicial temper in biologic and sociologic problems must be taken into account before rendering judg- ment on his augury.. Chemists are like mathematicians, peculiarly liable to a dogmatic cast of mind, which precludes them from seeing the forest for the trees; the association of facts because of some over apparent detail. While both sciences claim infallibility, both are based on working hy- potheses; chemistry on the atom; mathematics on the point. Mathematicians and chemists fail, therefore, when applying unanalyzed statistic methods to biology, physiology and sociology, nothing lies like unanalyzed statistics or chemical reactions. Here is peculiarly apparent the great law that every truth is overshadowed by a sophism more like truth than truth itself, or as Dryden puts it: “Errors like straw upon the surface flow, Who'd seek for pearls and truth must dive below." Not only does the mathematical and chemical bias pro- duce a tendency to sophisms, but it fosters that state of primi- tive suspicional uncertainty, which creates the psychologic law, pointed out by Macaulay, by which“ society constantly moving forward with eager speed is as constantly looking backward with tender regret. These two propensities spring -594 Mental Advance in Women and Race Suicide. 595 from impatience with the existing state. The people are under a deception similar to that which misleads the traveler in the Arabian desert. Beneath the caravan all is dry and bare, but far in advance and far in the rear is the semblance of refreshing waters. The pilgrims hasten forward and find nothing but sand where an hour before they had seen a lake. They turn their eyes and see a lake where an hour before they were toiling through sand. A similar illusion seems to haunt nations through every stage of the long progress from poverty and barbarism to the highest degree of opulence and civiliza- tion." This element of pessimism has to be taken into account in all sociologic jeremiads. From the tree-forest mental squint it engenders, clear mental vision of aught but pessi- mistic data, becomes impossible. This is peculiarly evident in Armstrong's conception of Spencer's law. Herbert Spencer in his Principles of Biology thus lays down the law appealed to by Professor Armstrong: “Every vertebrate is an aggre- gate whose internal actions are adapted to counterbalance its external actions; hence the preservation of its movable equili- brium depends upon its development and the proper num- ber of these actions; the movable equilibrium may be ruined when one of these actions is too great or too small, and through deficiency or need of some organic or inorganic cause in its surroundings. Every individual can adapt itself to these changeable influences in two ways, either directly or by pio- ducing new individuals who will take the place of those whom the equilibrium has destroyed. Therefore there exist forces preservative and destructive of the race. As it is impossible that these two kinds of force should counterbalance each other, it is necessary that the equilibrium should re-establish itself in an orderly way. Since there are two preservative forces of every animal group—the impulse of every individual to self-preservation and the impulse to the production of other individuals—these faculties must vary in an inverse ratio; the former must diminish when the second augments. Degeneration constitutes a process of disintegration, the reverse of integration. Hence, if the term individuation be applied to all the processes which complete and sustain the 596 James G. Kiernan. life of the individual, and that of generation to those which aid the formation and development of new individuals, in- dividuation and generation are necessarily antagonistic." This law has the reverse significance to that given it by Professor Armstrong. It destroys the pessimistic belief voiced by Tennyson in“In Memoriam.” “That Nature lends such evil dreams? So careful of the type she seems; So careless of the single life; That I, considering everywhere Her secret meaning in her deeds, And finding that of fifty seeds She often brings but one to bear." The individual does not wither in development, but be- comes more and more. Prenatally phylogeny (race develop- ment) is continually sacrificed to ontogeny (individual development.) This is in accordance with that law of prog- ress by which life proceeds upward from the inuddled up undivided unity to the clear specialized complexity with a loss of explosive force. The loss results from accumulation of checks on explosive actions; mentally in man's acquire- ment of a secondary ego which, taking into account the rights of others to their own happiness, is an efficient moral agent. The tendency of individuation is therefore to advance. Fer- tility is not, as Professor Armstrong claims, a test of ad- vances. Fecundity is a feature of immature marriages and marriages among degenerates. Quantity interferes with quality; as animals rise in evolution, progeny are fewer, since longer periods of development are needed. Woman has not only developed her individuality with race advance, but has been the social factor. For centuries, while man was the hunter and warrior, woman was the farmer, toolmaker, carpenter, tanner, tailor, shoemaker and decora- tive artist. Every art of civilization originated with woman. When hunting and war ceased to be the chief male occupa- tions man intruded on arts created by woman. “Let us,” vividly remarks Professor Otis T. Mason, of the Department of Ethnology, Smithsonian Institution, "follow the savage woman through her daily cares in order that we may comprehend the significance of her part in the Mental Advance in Women and Race Suicide. 597 play. The slain deer lying before her cave or brush-shelter or wigwam shall be the point of departure in the inquiry. She strikes off a sharp fake of flint for a knife. By that act she becomes the first cutler, the real founder of Sheffield. With this knife she carefully removes the skin, little dream- ing that she is thereby making herself the patron saint of all subsequent butchers. She rolls up the hide, dresses it with brains, smokes it, curries it, breaks it with implements of stone and bone with much toil and sweat until she makes her reputation as the first currier and tanner. With fingers weary and worn, with needle of bone and thread of sinew and scissors of Aint, she cuts and makes the clothing for her lord and her family; no sign is over the door but within dwell the first tailor and dressmaker. From leather especially prepared, she cuts and makes mocassins for her husband. Out of little scraps of fur and feathers supplemented with bits of colored shell or stone or seed, she dresses dolls for her children, makes head-dresses and toggery for the coming dance, adorns the walls of her squalid dwelling, creating at a single pass a dozen modern industries—at once toy-maker, milliner, modiste, hatter, upholsterer and wall decker. She was at first and is now the universal cook, preserving food from decomposition and doubling the longevity of man. Of the bones, she fabricates her needle and charms. From the grasses around her cabin she constructs the floor mat, the mattress, the screen, the wallet, and sail. She is the mother of all spinners, weavers, upholsterers, sail makers. Counting and varying stitches and adding bits of black, blue, red and yellow on her textures, she becomes the first decorative artist, she invents the chevrons, herring bones, frets and scrolls of all future art. To the field she goes with basket or wallet strapped across her forehead. By the sweat of her face she earns her bread and becomes the first pack animal that ever bent under a burden in the world. Home she comes with her load of acorns, roots, seeds, etc., and proceeds to crush them in a mortar or to roll them on a stone slab. Here she appeais clearly as the primitive miller. Or perchance she lays her seeds in a flat tray and by help of wind or a hot stone removes the chaff. Here begins her first lesson in 598 James G. Kiernan. . threshing. Perhaps with a stick hardened and pointed in the fire, she digs the roots from earth or tears away trouble- some weeds from useful plants or digs a hole and drops the seed of pumpkin, gourds or maize therein. While we watch her working, we are looking at the first gardener, farmer and nurseryman. It may be that on some lonely plain or alluvial liver bank there is no cave to shelter her and her babes. How long will it take this aforetime basket maker and leather worker to devise a shelter of grass or skin and thus become the architect primeval? The primeval woman was not a potter. It was not until near the polished stone age that she became the pristine plastic artist. This is true, however, that every form, decoration and function of pottery were in- vented by woman. In the struggle for existence which takes place among many occupations as among individuals and species, militancy no longer demands all man's waking move- ments. The arts devised by woman are in the ascendancy and the man militant has glorified them by his co-operation. Her very ancient digging stick is now a plough, her rude carrying-strap over her aching forehead is now the railroad train; her woman's boat the ocean steamer; her stone hand mill, the costly roller mill; her simple scraper for softening hides the great tanneries and shoe factories; her distaff and weft stick the power loom; her clay and smooth pebble, the potter's wheel; her sharpened stick and bundle of hairs are all the apparatus of the plastic and pictorial arts. In the early history of art, language, social life and religion, women were the industrial elaborative conservative half of society. All the peaceful arts of to-day were once woman's peculiar province. Along the lines of industrialism she was pioneer, inventor, author, originator." Every period of advance has been marked by wo- man's appearance in the intellectual field. The rise of universities created women professors of law, medicine, literature and even theology, in the twelfth century. Fortunately for the intellect of the race, the "new woman" is an old phenomenon. So far as the race is con- cerned, the creation of this secondary ego is most important in woman. Checks will not be created when woman is secure Mental Advance in Women and Race Suicide. 599 in the “home,” gynaecum, or“harem," from evil. Such se- clusion destroys individuality, the source of all advance. This was excellently illustrated in his marriage by Goethe, who, herein, was here as singularly illogical an evolutionist as Darwin. He recognized his mental debt to his mother who was the favorite of poets, princes, statesmen and scien- tists, and the delight of children. She had a strong instinct of self preservation, a dislike of emotionalism and caustic satire. Her mental combination hence was essentially that of the “new woman.” Goethe, dominated by German cant, married his cook, a woman of inferior intellect (which natural- ly prevented any “new woman" tendencies) on the "home" principle. The cook's son by Goethe was of such narrow mind that Wieland used to call him the“ scullion's son.” The mental“rut” into which views like these of Professor Armstrong would force woman, fosters primary egotism, thereby destroying the secondary ego, the great check on explosive actions. This check is all that keeps the race from degenerating mentally and physically. In the highest sense of the term it prevents race suicide. 1644 Pratt Avenue. RECOLLECTIONS OF JOSEPH FODOR.* Upon the occasion of the unveiling of the Statue to his mem- ory. August 29th, 1909. BY DR. ALADAR AUJESZKY, Budapest, Professor of Bacteriology at the Veterinary High School. OR JOZSEF AFODOR THE occasion of the unveiling of the statue to the memory of Joseph Fodor, our great hygienist, is one which generates in our bosoms twofold satisfaction. On the one hand it is a very pleasant circumstance that we are enabled to contemplate, in its finished state, the speaking memorial which is destined to perpetuate his excellent qualities; on the other hand we, who with feelings of veneration pay our trib- *This just tribute to the memory and contributions of the great pioneer hygienist of Hungary and of the World was one of the most interesting and worthy of the many good and valuable features of this great and successful medical congress. The memory of Fodor will abide forever in the hearts and minds of all who seek the highest welfare of humanity and it will live more imperishably than the beautiful stone which commemorates him. -600- Recollections of Joseph Fodor. 601 ute of homage, do so in the presence of our honored colleagues, doctors who have foregathered from all the civilized States of the world, upon the occasion of the XVI. International Medical Congress. Their presence serves to augment our feelings of veneration and lends pomp and brilliance to what would otherwise be a modest function. Our guests will, moreover, be able to assure themselves that Hungary, the fatherland of Semmelweis of glorious memory, knows how to honor fittingly the giants of science and does not forget those eminent sons who have been the first and most eminent apostles of her Public Health. When the Committee of the National Hygienic Union acceded to the expressed desire that, upon the occasion of the unveiling of this Statue to Fodor I should, on behalf of our Journal “Egeszseg," write some recollections of our great scientist I unhesitatingly undertook to fulfill the task, filled as I was with feelings of the deepest gratitude for my some- time master. Yet it is no easy office within the limits of a short article, so to write of Fodor and of his great labors as to be able to present, as a pendant to the chief data of his biography, even in slight measure, a comprehensive picture of his great scientific merits, of his interesting activities as Pro- fessor, of his unwearying labors in the interests of the improve- ment of the Public Health in Hungary, or, finally, of his magnificent literary works. In making the attempt the excuse for all shortcomings must be the unchanging love and gratitude which I bear towards my onetime master. The warmth of those sentiments shall substitute and cause to be forgotten the frailty of my pen and the weakness of the effort. Joseph Fodor was born at Lakocsa in the County of Somogy on the 16th of July, 1843. He finished his studies in the Secondary School at Pecs, entered upon the first year of his Medical Course at Vienna, and continued the Course to a successful conclusion at the University of Budapest. He had attained only his twenty-second year when, in 1865, he was awarded his Diploma in Medicine. He supplemented this, in the year following, by the addition of the Surgical, Oculist's and Accoucheur's Diplomas. At the beginning of 1866 the then Professor of Forensic Medicine, Rupp, took as 602 Aladar Aujeszky. his Assistant Professor the diligent youth who had been already selected by the Capital authorities to fill the office of City Coroner. The same body installed him as Chief Dis- secting Doctor in the St. Rokus Hospital in 1869. The same year saw him appointed as Professor of official Medical Pro- cedure by the University of Budapest, an office which pro- vided him with scope for the exercise of great literary activity in the domains of forensic medicine and Public Health. At this period there was no Chair of Hygiene at the Uni- versity. When the news arrived that Pettenkofer had began to lecture on the subject of Hygiene, at the University of Munich, in 1865, treating this as an independent subject, en- thusiastic men, amongst whom Markusovsky of imperishable memory, recognized the extraordinary importance of this new branch of medical science and began to urge the claims of Hygiene to a special Chair. Casting about for a suitable occupant of the post he created, the choice of the authorities fell most happily upon Fodor. Thus we find him in 1870 in Munich in the enjoyment of a State allowance studying the new science with great interest in Pettenkofer's Institute. But beyond this he added to his store of knowl- edge in the laboratory of Liebig. Pursuing, for some time, his studies under the guidance of Rechlinghausen and Hilger he successfully passed a scientific examination at Wurzburg, whilst, in order to acquire some familiarity with the hygienic measures of the larger foreign cities, he penetrated into Aus- tria, Germany, Holland, Belgium, France and England. He returned home in 1872 enriched by wide experience. After lecturing, for some time, as Professor of Forensic Medi- cine and Public Health at the University of Kolozsvar, which had been established meanwhile, he was called upon to fill the Chair of Hygiene at the University of Budapest in 1874. This chair, which it is a source of satisfaction to remember, was the first on the Continent to copy the example of Munich, at last opened a field to Fodor which lay contiguous to that of the cultivation of the general science of Hygiene. He was now in a position to commence that great work whose final aim was the improvement of Hungarian Hygiene as ex- pressed in his own motto—the promotion of the cause and Recollections of Joseph Fodor. 603 condition of the Magyar Nation, strong in body and strong in soul. It is true that the Institute assigned to the young Pro- fessor was small and lacking in equipment but his infinite in- dustry and love of knowledge triumphed over unfavorable conditions which could not stem his desire for work: rather did they serve to increase his endeavors. He worked with an assiduity worthy of all admiration. He buried himself in his laboratory and gave science an impetus; he discharged his duties as Professor with model precision; he developed great activity in the interests of the practical application of hygienic knowledge and not only wrote scientific works, but also strove to spread scientific knowledge amongst the lay public by means of his brilliant pen. In addition to all this he found time to travel continually for the sake of studying newer hygienic arrangements abroad and took part in Con- gresses at which he rendered account of his own investiga- tions. The value of his work had already been recognized and appreciated both at home and abroad. I cannot enumerate in this place all the distinctions which Fodor received from native and foreign institutions: I can merely mention that he was elected corresponding member of the Hungarian Academy in 1883, and, two years later, ordinary member, whilst he became honorary corresponding member of the Belgian, Spanish, Finnish, Italian and British Academies. The Uni- versity of Cambridge conferred upon him the Degree of Doctor honoris causa in 1891. From this ancient and celebrated University he received the purple gown as, in the words of the Public Orator, “Cultor bacterologiae acerrimus.” This was an honor which Fodor highly esteemed in witness whereof he never failed to wear his gown on special occasions. Death, alas, put an early end to his labors, to the great grief of those who reverenced him and to the immeasurable loss of science and Hungarian hygienic affairs. In February, 1901 he had bemoaned the loss of his one time master Petten- kofer, in a beautiful necrology. The latter had committed suicide at the age of 81. It was as though Fodor had written of himself. “He sought eternal truth. He had found his 604 Aladar Aujeszky. line, had followed its direction and had led science along it. But before attaining the goal he became exhausted on the difficult and tiring roads." Fodor also became exhausted by restless work. At no long interval he followed Petten- kofer to his rest, the cause being thrombosis which had ren- dered necessary amputation of the left leg. The careful en- deavors of his colleagues, the self-sacrificing nursing of those who loved him, the anxious hopes of those who reverenced him could not avail to save him. His strength rapidly de- creased till, at length, with the dawn of March 20th, 1901, that noble heart ceased to beat. Following this biographical sketch let us take a cursory glance at the scientific works of Fodor and recall the land- marks in a career devoted to the public weal. Some books and about 150 treatises and studies, long and short, testify to the labors of the scientist. The greater part of his works have been translated into foreign tongues. Here I can scarcely make detailed mention of those works, yet it would be out of place to forego the mention of the more cele- brated. He wrote his first great book immediately upon arriving home from his study tour in England. The title was“Hygiene in England with Respect to Home Relations." The value of this work extending to 30 printed sheets cannot be better proved than by citing the fact that the Hungarian Academy of Science immediately awarded its author a premium of 200 ducats. The treatise appearing in 1874 in the “Doctors' Weekly" and in a German Hygienic magazine, under the title “The Hygienic Chair and Central Observation" should be mentioned since the ideas therein ventilated are, for the greater part, identical with those in whose spirit the Hygienic Department of the Empire was founded in Berlin, ideas which, by reason of untoward circumstances, could not be translated into action in his own Fatherland. Fodor's investigations of the soil, air and water are of special value: the results accruing were first embodied in many small reports and later pub- lished by the Academy in a work which extended to more than 30 printed sheets. He wrote his latter works in German Recollections of Joseph Fodor. 605 that they might be accessible to foreign experts and for these he obtained widespread recognition. Fodor's celebrity was greatly increased by his investiga- tions of carbon-oxide undertaken upon a new system based upon the formation of carbon-oxide hæmoglobin, rendering possible the discovery of the smallest quantities of carbonic oxide. Fodor's name is rendered imperishable by reason of the results of his experiments to elucidate the essence of immun- ity against disease caused by pollution of the blood. Begin- ning in 1885 and extending over a number of years these in- vestigations traced the course of bacteria in the blood. Fodor was the first to call attention to the effect of blood upon bacteria and to the part played by the varying lixiviation of the blood. To discuss the fame which he acquired in this field would be superflous in view of the full recognition ac- corded his work. His name will be always associated with our fundamental conceptions of immunity and the value of the serum treatment. Of his greater works mention should be made of the wide- ly known and magnificent monograph, the “Handbuch der Hygiene” which appeared in the Weyl collection in 1893. This dealt with the hygiene of the soil. The model text book “Egeszsegtan” (Health) which he compiled for the upper classes of the secondary schools in 1886, a work which has passed through another edition, ought also to be mentioned. Despite his scientific labors and the calls of his chair Fodor always found time to promote in an effective manner the hygienic conditions of the fatherland. What he pro- claimed with no common eloquence from his chair was always upon a high scientific level, though always expressed in lan- guage easy to be understood. Whenever opportunity offered he strove to attain this ideal and he was ever ready to give advice for the common good from the treasure house of his rich experience and knowledge. This, however did not con- tent him: he did not consider it sufficient that he should, whenever necessary, hurry to the assistance of the official guardians of our hygienic affairs. His motto was that hygienic knowledge must be spread amongst the widest circles: public 606 Aladar Aujeszky. and people must be educated in the principles of preserving the health. To this end he enlisted on his side two powerful agencies, the school and the press. In 1885, with the assistance of the then minister for Public Instruction, Augustus Trefoit, a man who could sym- pathize with his ideas, and of Louis Markusovsky, Fodor founded the Middle School Medical and Hygienic Professors' Institute which compelled the recognition and imitation of foreign countries. He was, further, successful in an endeavor to procure for Hygiene a place in pharmaceutical, legal and polytechnic instruction. That he might the better be en- abled to attract the lay public he turned to account an ex- cellent capacity for organization, and again calling for the assistance of Louis Markusovsky and other enthusiastic be- lievers in his principles, formed the “National Hygienic Union" and, in 1887 founded the “Health" magazine ("'Egeszseg.") This latter at first appeared once in two months, but later became a monthly. Fodor educated and gathered together an enthusiastic literary group with whose help, by means of carefully chosen popular articles, he made known the rules of hygiene and proclaimed all that he deemed it necessary to impart. The Master himself was the soul of the new magazine. He showed often enough by his attractive articles, which occasionally verged upon the poetic, that he could appeal not only to scientists but also to the lay public. He gave proofs of this in the “National History Review” of whose staff he was a tried worker and, for seven years, Éditor of the Journal. I have now arrived at the end of my short recollections. Though I have been able to exhibit only the faint outline of the picture of the great scientist, his life and wide activity, yet those who were unacquainted with the labors of Fodor from the inner circle will be able to convince themselves from this resume that that activity was many sided, and of great value, and was sustained through many years with untiring energy for the good of his race and country. His name will always stand out as the greatest and most worthy of rever- ence in the history of Hygiene in Hungary. Sculpture en relief de l'Hygiea sur le monument de Fodor. Relief net paica am JFour-Denimal. Relief of Hygiea on the Fodor statue. Hygiea Fodor szobrán. Mental Advance in Women and Race Suicide. 599 in the "home,” gynaecum, or “harem," from evil. Such se- clusion destroys individuality, the source of all advance. This was excellently illustrated in his marriage by Goethe, who, herein, was here as singularly illogical an evolutionist as Darwin. He recognized his mental debt to his mother who was the favorite of poets, princes, statesmen and scien- tists, and the delight of children. She had a strong instinct of self preservation, a dislike of emotionalism and caustic satire. Her mental combination hence was essentially that of the “new woman." Goethe, dominated by German cant, married his cook, a woman of inferior intellect (which natural- ly prevented any new woman” tendencies) on the “home” principle. The cook's son by Goethe was of such narrow mind that Wieland used to call him the“ scullion's son." The mental“rut” into which views like these of Professor Armstrong would force woman, fosters primary egotism, thereby destroying the secondary ego, the great check on explosive actions. This check is all that keeps the race from degenerating mentally and physically. In the highest sense of the term it prevents race suicide. 1644 Pratt Avenue. 606 Aladar Aujeszky. and people must be educated in the principles of preserving the health. To this end he enlisted on his side two powerful agencies, the school and the press. In 1885, with the assistance of the then minister for Public Instruction, Augustus Trefoit, a man who could sym- pathize with his ideas, and of Louis Markusovsky, Fodor founded the Middle School Medical and Hygienic Professors' Institute which compelled the recognition and imitation of foreign countries. He was, further, successful in an endeavor to procure for Hygiene a place in pharmaceutical, legal and polytechnic instruction. That he might the better be en- abled to attract the lay public he turned to account an ex- cellent capacity for organization, and again calling for the assistance of Louis Markusovsky and other enthusiastic be- lievers in his principles, formed the “National Hygienic Union” and, in 1887 founded the “Health" magazine ("Egeszseg.") This latter at first appeared once in two months, but later became a monthly. Fodor educated and gathered together an enthusiastic literary group with whose help, by means of carefully chosen popular articles, he made known the rules of hygiene and proclaimed all that he deemed it necessary to impart. The Master himself was the soul of the new magazine. He showed often enough by his attractive articles, which occasionally verged upon the poetic, that he could appeal not only to scientists but also to the lay public. He gave proofs of this in the “National History Review" of whose staff he was a tried worker and, for seven years, Editor of the Journal. I have now arrived at the end of my short recollections. Though I have been able to exhibit only the faint outline of the picture of the great scientist, his life and wide activity, yet those who were unacquainted with the labors of Fodor from the inner circle will be able to convince themselves from this resume that that activity was many sided, and of great value, and was sustained through many years with untiring energy for the good of his race and country. His name will always stand out as the greatest and most worthy of rever- ence in the history of Hygiene in Hungary. Recollections of Joseph Fodor. 607 We, his one-time pupils, disciples and friends whose for- tune it was to be nourished at the inexhaustible fount of his knowledge, who were immediately made to feel the warmth of his heart, whom he taught to love all that is beautiful, noble and good, have long ago raised, in our hearts, an im- perishable monument to him. But there are others who knew him only from afar. To such this, his statue, will pro- claim his excellences; it will move the rising generations to diligent labors in the cause that Fodor served so well, a knowl- edge of hygiene and, springing from this, the general well- being of Humanity. A NEW PHASE OF THE UNWRITTEN LAW. By C. H. Hughes, M. D., St. Louis. THE jury acquittal of Edmond Baudin for the murder, by I her request, of his wife, Sept. 28th, presents a new phase of this subject in court. In this remarkable case the husband did for his wife what Baron Larrey, Napoleon's great Chief Surgeon, declined doing at the command of the great Emperor. This case was not tried by an emotional jury in the United States, but in Paris, France. The jury appeared to have condoned this uxoricide, on the supposed, not proven ground of uxorial endearment and importunate resistless suggestion. The woman in the height of a painful suffocating asthmatic paroxysm impulsively asked her husband to kill her and put her out of her misery. He immediately shot her to death, pleading in behalf of his proxy suicide, that he could not help doing the deed. "He loved her so.” This may have been murder under overmastering sug- gestion or murder of motive that was not all sympathetic homicidal impulse. At all events, from a psychological stand- point, the unqualified acquittal of such a murderer is not sound public policy nor has it the basis of sound psychological judgment in justification. A prison sentence and a longer observation of and meditation on and by the murderer might have given Justice and the law more light on this anomalous killing against divine and human law. —608— A New Phase of the Unwritten Law. 609 The following is the record: "Paris, Sept. 28.-Edmond Baudin was acquitted of the murder of his wife in the Court of Assizes to-day, the jury deciding that the act was justified by the fact that Mme. Baudin had begged her husband to end her sufferings from asthma. "Baudin told a dramatic story, during the recital of which, tears streamed down the face of the prisoner, while Judge, jury and spectators wept aloud. Many of those in the court- room were women and they became hysterical and several of them had to be removed. "Among other things, Baudin, who is a mechanic, about 40 years old, said that his wife, whom he loved dearly, had suffered untold torture from asthma, which was gradually choking her. He said she had implored him to end her agony by killing her, and she even begged him on her knees in prayer, to put her out of misery. “On the night of the murder, he said, her medicine was exhausted and he volunteered to get it replenished. She again beseeched him to prove his love for her by ending her sufferings. “He declared dramatically that the sight of his wife in such distress maddened him and he seized a revolver and shot her through the head, killing her instantly. “He then said he intended to kill himself, but the thought of leaving behind a sister, who was dependent upon him, un- nerved him, and he went to her. She advised him to sur- render to the authorities and make a full confession. "Baudin's discharge was received with great satisfaction by those in court and the crowd outside gave him a rousing reception as he emerged from the courtroom.” This murder was done to relieve an otherwise relievable case. Morphia could have been given with Hoffman's anodyne in doses adequate to bring complete relief, without death. Other good therapeutic methods likewise. It might have been given in fatally lethal doses and such euthanasia would have been far less brutal and violent than a pistol shot. But neither opium euthanasia nor pistol shot 610 C. H. Hughes. wound murder are more justifiable than this unwise and impolitic verdict. If men are with impunity to be permitted under the law to kill suffering wives when asked, in a spasm of pain to do so, and of otherwise relievable conditions what is to become of social order and freedom from inexcusable murder in other cases of request acquiescent homicide or so-called ? THE CRIMINAL IRRESPONSIBLE. By Martin W. BARR, M. D., Chief Physician Pennsylvania Training School for Feeble- Minded Children. Elwyn, Pa. AMID the many complex problems engaging the attention of scientists of to-day, there remains one compara- tively unfathomed, indeed apparently unapproached by the general public, viz., degeneracy in its various gradations, with its unfailing accompaniment of irresponsibility. This same irresponsibility apparent among idiots, and the various grades of defective mentality is not so easily dis- covered in the criminal type where a defect, or frequently the total absence of the moral nature, is sometimes cloaked by an astute intelligence invariably perverted and directed toward purposes of ill. Unaware of this, it is not surprising that many—both jurists and physicians—unfamiliar with the type, should fail to recognize it. Thus very often-for unfortunately the cases are growing in frequency—a frightful crime is committed, provoking endless discussion, as experts on either side affirm the perpetrator to be sane or insane; and the ball of opinion rolls to and fro until, as a certain great alienist observed to me at a celebrated murder trial, “The public must feel that Medicine is indeed a very uncertain Science." The trouble is they are viewing a question of dis- ease, not of defect. Of course it is possible that there may be present both disease and defect. Still, they do not realize that there is a class who, not insane, are yet quite as irre- sponsible. Derelicts on the sea of life, rudderless, drifting hither and thither, they become a prey to vaccillating, shift- ing impulse, or else dominated by the will of others, as either -611- 612 Martin W. Barr. victims, or tools, they become a menace, alike to society and to themselves. With the animal impulses exaggerated, often obsessed by a single idea, these, with no sense of gratitude, no idea of relative values, will bite the hand that protects; are absolutely without the moral sense, not immoral, but unmoral-ammoral—they are therefore as irrespon- sible as are young children in whom, as the law recog- nizes, the moral sense has not been developed. These un- fortunates, for the most part victims of a neurotic heredity, too often the offspring of exaggerated lust, are of that neurotic temperament which presents a degeneracy that may by a wise protection be ameliorated, possibly arrested, but never eradicated. Defect, unlike disease, knows no cure. From a personal study of some thousands of cases, typical ones have on various occasions been presented for scientific ends. These, however, are by no means isolated nor excep- tional. Each has been culled from many of its class differing from its fellows mainly in exhibiting variety of combination. Some of these have had their “Aing" in the world, and found its knocks rather excessive. Others have gladly returned even from their homes, saying: “Somehow they don't under- stand me.” Others again have drifted off into the great army of the misunderstood, in haunts of vice or to prison cells, where alas, many of their brothers yet within sheltering arms, are foredoomed to follow. Among all, I have yet to see one, to whom the restraining, compelling, and social atmosphere of the life of a community adjusted to his needs, was not a neces- sity. Experience has demonstrated that the type assumes the character of that form of degeneracy in which it is developed, which is indeed but natural. Thus the degenerate of lowest mentality, betrays the brutish type delighting in filth, even to the handling and eating of excrement and garbage, and abuse of self and of his fellows; himself insensible to pain, he finds his chief pleasure in torturing animals and even human beings. Such is the actual condition of some who fall under the sentnce of “ Judge Lynch." A short time since a terrible crime resulted in the torture by fire, and the lynching of the perpetrator, a negro, who, had The Criminal Irresponsible. 613 there been time for expert examination, would undoubtedly have been proven, as the opinion of a physician declared him, one of this class. Waylaying and attacking a young giil in a lonely place he, after outraging her, cut off her ears and breasts, and after cutting the throat and tearing and chewing her flesh, made fiendish attempts to gouge out womb and bowels. Another case, a low-grade imbecile, the son of somewhat "peculiar" parents, delighted in killing flies and bees, and torturing animals. On one occasion he tied a pet donkey in its stall, and after tearing open the mouth and eneucleating the eyes, he literally hacked it to pieces with a sickle, rib by rib and leg by leg. And yet another, is the son of an extremely nervous woman and a neurotic man, who gave up an excellent posi- tion and abandoned his family to join a peculiar religious sect. The boy has a fair amount of intelligence, but music excites him to a frenzy-screaming and crying--and given to filth, he delights in eating garbage and even excrement. Moral imbeciles of middle-grade capacity-many being incapable of learning to read and write-find their chief, often their only means of mental development, through the hand, manual training leading them into the trades or industrial occupations, the only safe-guard from the indolence which is their bane. Naturally the criminal of this grade turns his acquirement at once toward some evil purpose, and even in early childhood betrays a proclivity toward expert thieving, so truly marvellous, that if demonstrated before a jury of men ignorant of his condition, naturally he is condemned as “too smart to be feeble-minded.” “Smart” enough he is indeed to distract attention, and purloin articles in the very presence of the owner, or to pick a lock with pin or nail. But the absence of moral principle, or of will-power, will make him the fitting tool as well as the victim of some astute crim- inal. For such, many Fagins are in waiting, eager to clutch. A singular example of early development of criminal in- stinct, is that of a boy who at six years of age, was a recog- nized thief, liar, and sexual pervert, and made an unsuccessful attempt to kill his infant sister. He speedily became such a 614 Martin W. Barr. nuisance to the community, stealing mail, papers, milk and bread, that the neighbors requested that he be removed. A pyromaniac, he set fire to his father's house thrice in one week, and was about to perpetrate the same at the large hospital where he was finally sent, when he was detected just before applying the match to a pile of papers he had concealed under a bed. At the age of sixteen, after committing a brutal rape upon a young girl, he was brought to trial and sent to an institution, after the jury was with some difficulty brought to see that he was a mental, as well as a moral defective, and therefore utterly irresponsible. A typical case is that of a waif and stray, who with no family history, was early consigned to a school for the feeble- minded. There unable to master the three "R's” with any degree of facility, he yet, responding to favorable environ- ment and refined association, gave excellent proof of the development of the brain through the hand. He was quite an adept in drawing, modelling and wood-carving; became a fair tailor, an excellent cook; waiter and valet. With winning manners, erect, well set up in response to military training, he excelled in athletics, and was an exceedingly graceful dancer. But he was also an adroit thief, a most accom- plished liar and a sexual pervert. His cunning, together with his excessive egotism and vanity, was evidenced on one occasion, when at an educational exhibit his work being classed as that of middle-grade, he managed to substitute the word high for middle. Later upon finding that this had been rectified, he bribed a boy to steal the ticket. Going out into the world he gave excellent service-first as a valet to a pa- tient in an insane hospital; later as attendant in charge of groups of boys in two institutions for defectives, and he might probably have found a life of happiness and occupation, could he have withstood the thieving propensity which in each in- stance overpowered him, and finally turned him again adrift. He seduced and deserted a girl, and then became a habitue of the tenderloin district, consorting with the lowest of the low of his own sex. Once, when passing a crowd of toughs in one of the most disreputable streets of Philadelphia, I was much amazed to The Criminal Irresponsible. 615 find myself saluted, most respectfully, by one of them, and turning, recognized this boy. Another case is that of a lad of eighteen, who, cruel to smaller children, had a genius for lying and thieving. En- tering the service of a farmer, after deceiving him for months, he in a moment of passion, set fire to a barn, causing a loss of not less than $5,000. Shortly after this, a number of exceed- ingly clever burglaries were committed which baffled the detectives, until it was noticed that the perpetrator invariably used a lavender-colored candle. By this clue it was finally proven to be this very boy, and over fifty burglaries were finally traced to him. In ascending proportion as the intelligence of the high- grade degenerate approaches normal he becomes more dan- gerous to society and to himself. Not only is he less recog- nizable, but it is an argument perfectly logical that the greater the intelligence unhindered by conscientious scruple, the greater the driving force of the engine of ill-the more ambi- tious the work attempted and accomplished. Very artists are they in criminal lines, and undetected in their schemes of evil, thefts and forgeries, may be projected and carried forward, in some instances through years, causing misery to countless numbers. A pertinent, although youthful, example of this type is found in a case I was called to examine for a juvenile court. A handsome Hebrew boy of fourteen, over-developed physically, precocious in every respect, bombastic and lo- quacious, was detained on a charge of swindling which might have been credited to an expert. With ingratiating manners he greeted me on my entrance to his cell with all the aplomb of a society man. “Good morning, Doctor, I presume I am the young man you are looking for, F D - ? I never thought I should be brought to this, viz. to have a specialist decide upon my mental condition. Be seated. I am sorry I have no better quarters to offer you.” Immediately seating himself and crossing his leg he began to entertain me most verbosely, telling me of his likes and dislikes; how he cared nothing for athletics but was devoted to reading, especially the classics, The Criminal Irresponsible. 617 8. Beg first showing that second alternative still re- mains intact. 9. Lex Judiciorum. 1st appearance before Court. Judges usually admit home on probation. 10. Father willing. To be watched by him and Miss zn* 11. Sum up urging. 1st not without talent. Will put talent to use. Beg No. 5. If Miss 2 - remains indifferent it will all rest with the decision of the presiding Judge. It is very doubtful whether I will be permitted to go to the House of Refuge on account of my bad mind. “Miss 2- says that the Judge permitting me to return home on probation is out of the question and he may send me to the higher courts for trial. Rather serious, eh?” What jury would believe all this, the unaided work of a boy of fourteen, or that if so proven, the perpetrator was wholly irresponsible? And yet this same boy had failed to keep up with his classes in school. The physical examina- tion revealed stigmata of degeneration in an assymetrical head, ears with adherent lobules and irregular spinal lines. Mental deficiency, due largely to the indolence peculiar to his kind, had precluded advance along any lines where there was demand upon the thinking or higher reasoning powers, apart from the emotions, yet on occasion, he could with all the skill of a finished actor, summon that emotion which would intensify the character he would simulate. Thus he laughs and weeps at will, and great tears literally drop from his eyes. He is simply a genius in the art of deception, and while fully conscious of wrong doing, and acknowledging it, says he“ just cannot resist the impulse." Although a dullard, yet his loquacity and verbosity were almost unequalled, and he exhibited the phenomenal memory peculiar to the degenerate. Family history shows no taint of neurotic heredity, but meningitis and convulsions had marked his infancy, and kid- ney trouble his approach to puberty. *Note.---The probation officer, 618 Martin W. Barr. Several years ago, a series of exceedingly clever burglaries baffled the police of one of our large cities. Things most mis- cellaneous in character were stolen-women's clothing, old newspapers, busts, vases, and handsome bric-a-brac, but what seemed most extraordinary, no jewelry was taken, nor was silverware disturbed. In many cases there was not the slightest trace of the entrance of the thief-the things simply disappeared. Finally a boy aged fifteen and a half years confessed that he was the head of an organized gang of juvenile robbers. A manly attractive lad, with a bright face often clouded by a lowering expression, giving evidence of nerve strain, he made a full confession of the many ingenious ways their pilferings were accomplished. He told how he would go to a house on an assumed errand, or when delivering goods from the store where he was employed, would manage to get hold of keys, and keeping them, would hastily burn an impression in a piece of soft wood that he constantly carried in his pocket. Later, filling this with melted lead he would manage to duplicate the keys. Learning to pick locks with facility, he would enter va- cant houses in a block, and running along the roofs would climb down into the windows of occupied houses. Sent to market, he would spend the money, reporting on his return that it was lost. On the other hand he would sometimes appear laden with beautiful fruit and vegetables which he had stolen, but which he said had been given him. Being something of a mechanical genius and fond of books and engineering instruments, he had managed to enroll on one of the school ships, from which naturally he was promptly dropped. He related his escapades in the most unblushing way, say- ing: “I cannot help it. Why don't they put me where I can't do things?” When asked if he would like to go to jail or house of detention, his invariable reply was an assent. With absolutely no acquisitiveness he was evidently actuated by a love of adventure, and the excitement of carrying for- ward to successful accomplishment his nefarious schemes and plots. The Criminal Irresponsible. 619 This is a noticeable characteristic of the moral imbecile with whom it is always: “I told you I knew I could do it," rather than the “I got it all right,” that marks the ordinary thief. With him the thing acquired was a negligeable quantity disposed of often in most careless fashion, as was a case of butter stolen by him and buried in the snow, and left there until after the snow had melted. On another occasion he ran off with an automobile and after distancing all pursuit, abandoned it by the road-side, miles away from its owners. Family history showed the maternal grandfather de- cidedly unbalanced, addicted to drink and "slippery in busi- ness," with a brother confined in prison for thieving; the mother a woman of strong will—who dominated the father, a gentle, quiet man—was a spiritualist and interested in all sorts of "isms." At ten years of age, the boy falling from a tree had punc- tured his skull, and there was a depression, half an inch in diameter still to be seen in the right temporal region. Here is a case for which there is absolutely no law. Ac- cording to the principle that all men are born free and equal he pursues the uneven tenor of his way, unshielded from temptation, as is society from his depredations. Another example proves him only one of many, for similarly houses were mysteriously entered, furniture mutil- ated, paper torn from walls, pantries invaded, and pickles and preserves literally smeared over everything. The mischief finally traced to a handsome young fellow, a commission appointed to examine into his mental condition, pronounced him a moral imbecile of high grade. Placed by friends in a quiet country home, in charge of an old couple, he managed by apparent good behavior, to win their confidence until he gained greater liberty, when, as in the previous case the neighbors began to suffer, things mysteriously disappearing and malicious acts being perpetrated as before. Frequently going for the mail and allowed the freedom of the post office, he robbed it systematically for months, before he was detected. 620 Martin W. Barr. At the age of nineteen he developed an inordinate fond- ness for cigarettes, and later became a gasoline fiend,” hang- ing around garages, and absorbing gasoline as opportunity offered. Family history shows the maternal grandmother with recurrent religious mania; the father with a round bullet head, looking a characteristic degenerate, was profane, vulgar and addicted to drink as was also his brother. The records of the coming census will probably emphasize the startling increase of degenerates in our midst, and con- firm what has hitherto been reported only by custodians of the race. That this may lead to a study of abnormal life being required of every student of medicine and law before a diploma is conferred, is a consummation devoutly to be wished. Acquaintance with the defective becoming thus common, and his recognition feasible, we might in time hope for some law, written or unwritten, looking toward a double protection for himself from the world, and the world from him. Such an one might not then pursue persistently through years, a course offensive to the community in which he lives, without being marked as a derelict, and the liberty which has lapsed into license being curtailed. Could such a consumma- tion have been reached some years ago the world might have been spared the horrible details of a tragedy that shocked two continents, and its participants preserved from death, odium and imprisonment, be now enjoying life under a beneficent protection. All these so-called “sinners” would doubtless have been proven degenerates, victims of exaggerated sexual impulse; the intelligence devoted solely toward the dis- quisition and gratification of the animal to the exclusion of the higher psychic sense; ammoral, hence powerless to resist and therefore in the strongest sense of the word, irresponsi- ble. And yet these “Children of a Day,” for, with no memory and no hope, they know only the life of the present (to which they form a perpetual menace) these far from guileless children, scattered by thousands throughout the world, enslaved by lust and unrecognized, are actually unprotected by common law which even insanity knows. The Criminal Irresponsible. 621 To awaken the attention of the public mind to this anomaly should be the aim of every honest citizen. Eventual- ly such awakening may lead to provision for colony seques- tration, by both state and national governments, where all irresponsibles well cared for in homes adapted to various needs, might in the simple life find happiness, as well as the much needed protection. There, work as attendants, assistants, caretakers, might be provided for the restless criminal class we have been considering, or else the various industries of forestry, grazing and agriculture in the free life of the open, best suited to relieve nervous conditions, shielded and apart from the temptations of the great world without, these unfortunates may be brought to be an aid rather than a prey upon the life of the nation. The world is doing much in these latter times for the un- regenerate masses, and results of missions cannot be too highly estimated, but civilized society would do well to start afresh at home and provide there protection for its degenerate class- es. THE CONFESSION OF A MYSOPHOBIAC. REPORTED BY DR. C. H. Hughes. St. Louis. N unmarried lady patient writes from a neighboring state the following painful personal experience with this peculiar psycho-neuropathy. “Am not any better.” “I am perfectly miserable mentally and because of those unnatural notions I live in dread and fear all the time. I can't get them out of my mind or lose sight of them not even for a minute. Life seems a burden and I often feel as if I would rather die than to have to live this way. I think I would be as happy as the average person if it were not for this trouble, but because of it everything before me looks dark. I am so disappointed because I am no better. • I do try to look on the bright side of things, but think I have almost lost hopes of being any different and yet I am so anxious and concerned about my condition that I have never gotten to the point of giving up to it altogether. “I am sleeping very well at present. Am sick at my stomach quite often when worried. My monthly periods are more regular now than they were while I was in St. Louis, but I have the backache and a sort of an ache or dragging feeling in or around the uterus so much of the time. Can any little trouble like that kind be connected with the nervous condi- tion? I was troubled the same way while in St. Louis last winter, but it was nothing unusual for me and never told you -622- The Confession of a Mysophobiac. 623 , about it because I thought it had nothing to do with the nervous trouble, but since coming home thought perhaps I ought to have told you about it.” This patient was not long with us and she makes a sug- gestion as to local trouble requiring attention as a matter of course, for every source of irritation painfully impressing the mind and depriving of rest and sleep should be remedied in these cases. More of the reporters similar cases, in fact all of them, with one exception, have been males, without genital trouble of any kind and no confessed history of pre- vious or manifest present venereal disease. Immediate family neuropathic element is not markedly apparent. Mother and father are living and in fairly good health. No record of hysteria in mother. Neither have been under treatment for neuropathic or psychopathic disease. Some atavic psycho- pathia is here apparent from remoter family history. THE ALIENIST AND NEUROLOGIST. VOL. XXX. ST. LOUIS, NOVEMBER, 1909. NO. 4 Subscription $5.00 per Annum in Advance. $1.25 Single Copy This Journal is published between the first and fifteenth of February, May, August and November, and subscribers failing 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 mail matter. All remittances should be made to CHAS. H. HUGHES. The Alienist and Neurologist is always glad to receive articles or photographs from subscribers or friends and material acceptable for publication. Address manuscripts and photographs to the Alienist and Neurologist. For return of non-accepted manuscript addressed envelope and sufficient postage. Any Comment, favorable or unfavorable, specifically set forth, is always wel- come from friend or enemy or any "mouth of wisest censure." CHAS. H. HUGHES, M. D., Editor and Publisher. Editorial and Business Offices, Rooms, 3858 W. Pine Boul. HUGHES & Co., Printers and Binders. EDITORIAL. \All Unsigned Editorials are written by the Editor.) TRAUMATIC Recovery FROM INSANITY does not often occur, but a case of this kind is reported from Pennsylvania where a patient, put in an insane asylum dormitory with an epileptic, who in a nocturnal alternative furor struck his room companion over the head with a shoe. The concussion brought sanity to this lunatic. Though the result was good in this instance the act recalls the therapeutic impropriety of domiciling insane epileptics with anybody unless it be some of the boodling, grafting, law-defying politicians. (624) Editorial. 625 A little moral sanity promoted in this way would prove salutary and our state motto is Salus populi suprema lex esto. In such a case as the latter the end might justify the means in some of our big American cities. DISEASE ENGENDERING AND SUGGESTIVE CONFESSION Police SWEATING Methods.—The newspapers and magazines have of late been commenting upon police cruelty and their personal right violating methods toward suspected criminals in what is called sweating, especially and most justly con- demning the torturing “third degree” procedure, exercising judicial functions and presuming unfortunates falling under police suspicion to be guilty, without proof in open trial. But beside this wrong to the unconvicted, merely sus- pected criminal, is the harm to his health of body and mind. As well club on the head (which no policeman should be allowed to do), as to torture to insomnia, insanity, epilepsy or death under police sweating methods. People go insane from sleep and natural rest deprivation and otherwise suffer damage in their higher nerve centers and all parts of the body that need regular rest. Torture processes that deprive of essential sleep, weaken the brain and mind into instability, wandering and acqui- escence finally to any sort of suggestion. Such procedure is unscientific, unsafe as to truth eliciting and criminally cruel. It is out of harmony with the humanity demands of our age. Sweating a prisoner from forty-eight to seventy-two hours, by relief sweaters who come themselves fresh from sleep to continue the torturing process, where their predeces- sor has left off exhausted, is a cruelty and a crime against nature and humanity which ought not to be tolerated in this twentieth century, presumably so far removed, in regard to other cruelties, from the barbarous past. The tortures of enforced wakefulness against the daily repair needs of nature, physical and mental through sleep, is a crime that should be stopped. The man heartless enough to torture a fellow man out of his need of normal sleep till brain and mind exhaustion yield a suggested self-convicting confession, accomplishes nothing on the side of crime detection, for the sleep robbing 626 Editorial, torturer gets from his tortured victim finally what he suggests and seeks. The weakened brain and mind, under prolonged torturing deprivation of sleep might then admit anything suggested, whether the thus cruelly treated creature be inno- cent or guilty. Police sweating that hurts health and ex- hausts brain and mind is of no certain value for the ends of justice. The theory of the sweater cult, the torturing detective inquisition, that exhaustion will bring the truth, is a psychic fallacy. It may or may not. Under prolonged or profound brain and mind torture to exhaustion, the weakened brain and mind may then assent to anything suggested, if thereby relief from further torture be in mental prospect and a brain and mind thus treated by minds not fatigued, may even as- sent to a belief, as truth, concerning themselves, to what is suggested, but not true. Lessons in humanity, the Golden Rule and the law of per- sonal and constitutional right to be presumed innocent in- stead of guilty, till legally tried, should be given detectives who sleep their regular sleep and yet deprive suspected crimi- nals of three successive nights of rest, as in the case of Creston, against whose cruel treatment a great criminal lawyer and ex-Lieutenant Governor of Missouri lately so forcefully pro- tested. Creston was taken to the hospital at the conclusion of his unlawful seventy-two hours of sleepless criminal tor- ture. There yet be men in our enlightened humane time who "clothed with a little brief authority" are so criminally, heart- lessly cruel in the exercise thereof, that it were “base flattery to call them coward's." There be some rights to health to which even suspected but unproven criminals are entitled before conviction, at least, under the humane intentions of human law and Divine command. The Golden Rule is a good one for detectives as well as criminals. “An APOTHECARY to the Holy Ghost.”—A druggist in Vienna, after informing the public that he is a pharmacists Francaise and an English and American chemist, announces himself as “Apotheke Zum Heiligen Geist.”. This establishment might not suit Mother Eddy, but it Editorial. 627 ought to suit the new Boston Clerical Psychic Healing Society. Should you look further you would find another pharmacy dedicated Zum Salvator and a little further is a hotel dedi- cated to the red hen (Hotel Zum Rot Hahn). These ought to be sufficient to save and satisfy the Christian Scientists, though there does not seem to be any in the former city. Sixteenth INTERNATIONAL CONGRESS, Budapest, 1909. The general sittings of this great congress were especially interesting, presenting much valuable matter for neurologic and psychiatric thought. G. Bacecelli (Rome) presented: Sulla introduzione dei medica menti eroici entre le ve. M. E. F. Bashford (London): “On Cancer” was splendid. M. Gruber (München): Verebung, Auslese und Hygiene. Artificial Pathenogenesis and its Bearing upon the Pathology of the Cell, by M. J. Loeb, of Berkeley, was pains- taking and interesting, if not finally convincing. The program of the sections was mainly of a high charac- ter. Samples from Section one, August 29th, here follow: Waldeyer (Berlin): Uber den heutigen Stand der Neur- onlehre. Levi (Firenze): L'anatomie et l'embryologie des gan- glions cerebro-spinaux. Calleja (Barcelona): Les neuveaux appareils intra- protoplas miques et leur signification physiologique. Communications sur quelques sujets d’hematologie et de la fine structure du systeme nerveux. Ramon y Cajal (Madrid): Communications sur la struc- ture du systeme nerveux. Donnaggio (Bologna): Etudes sur la structure des ele- ments nerveux. Apathy (Kloozvar): Uber einige Falle angeblicher Ner- venendigungen mit Demonstration von mikroskopischen Praparaten. Nussbaum (Bonn): Die Entstehung des Geschlechts. Romiti (Pisa): Natura del sincizio del villo placentare. Gronroos (Helsingfors): Die Hautmuskulatur der Hal- baffen. 628 Editorial. Huntington (New York): Development of the Lymphatic System of Mammalia. Hammar (Upsula): Der gegenwartige Stand der Morphol- ogie und Physiologie der Thymusdruse. Maximow (St. Petersburg :) Uber Embryonale Entwick- lung von Thymus und Knockenmark bei Saugetieren. The Fellow Who was H-LL ON Fits ought to come round and prod our police and health authorities into sanita- tion spasms such as the police of Cincinnati had, just before the last election. The spasms all ceased after the election was over, but this is what they did there pending the last election. Vegetables on the sidewalks were elevated so as to pre- vent dogs reaching them. Hand or push carts with candy and fruits carted through the streets were covered up. Sweepings from stores, business houses and other prem- ises were not swept into the street. Spitting on the sidewalk was prohibited. Garbage or ash barrels were removed from the sidewalks when empty and were not allowed on the streets on Sunday. Persons found sweeping or littering the streets with dirt were arrested. The police were personally held responsible for the cleanli- ness of their districts. Some day the Million Club of St. Louis will pay some attention to the saving of the health and lives of the people already here and diminish the funerals while inviting the balance of the million to come. Some day St. Louis will have some public lavatories such as befit large cities and other conveniences and sanitary comforts, not yet established, for the stranger who does not own his own home here. "A “No Tip' First-Class Hotel.-In September last the editor of this magazine visited the splendid new Strand Palace (no tip) Hotel in London on the Strand, where all of its 470 rooms are the same price, six shillings, which includes bath, light, attendance and full table d'hote breakfast. They are elegantly furnished with marble basins, hot and cold running Editorial. 629 water, and “no tips" enjoined. We could get meals, but no room, for the reason that every room was engaged weeks and months ahead. Not for any personal or pecuniary reason (for this is no ad.) we wish this deserving hostlery perpetual prosperity and that others may follow its good example and contribute to rid American visitors to London and the con- tinent of the abominable tip annoyance. The PRACTITIONERS' SUNDAYS.-In this connection it is interesting to note that certain medical men of Paris have established “Dimanches du practicien," doctors' Sunday, for the purpose of hearing lectures and demonstrations on progress in the Sciences related to medical practice, such as radium radiotherapy, Wm. Matoa and Dominici being already announced to lecture on these subjects. The Mississippi Valley Medical Association held an interesting and well attended meeting in St. Louis, October 12-13-14. The most interesting subject discussed was “Pella- gra in the Southern States." Papers and illustrations were presented by Dr. J. J. Watson of Columbia, S. C., who referred also to Dr. J. W. Babcock's cases in the Columbia, S. C. hos- pital for the insane. Dr. Watson described also the effect of diseased corn on chickens and presented a clinical illustration in a human be- ing. Dr. C. H. Lavinder's paper referred to Dr. E. J. Woods' interesting case illustrating his report to Surgeon General Wyman of the Marine Hospital Service. None of these con- tributions give us anything more definite as to the absolutely certain pathology of pellagra than is already recorded in the literature. A toxic influence connected with decomposed or infected maize and malnutrition affecting psychic, trophic and intestinal centers, appears mainly at fault as causative of this disease. Drs. Green, Bellamy, Wood, Campbell and Babcock of North Carolina, Searcy, McCafferty and Sommerville of Ala- bama, Dyer of New Orleans, Merrill of Texas, Gray of Utica, have all reported this disease. The term Pellagroid has come into use in relation to this 630 Editorial. subject, a term which will undoubtedly include many cases, possibly a few of our own in the earlier days of our career, when the ability to differentially diagnosticate this interesting disease was not what we might have possessed, had the present presentation of this subject been then familiar to the editor. “THE PRESIDENT OF THE AMERICAN GYNECOLOGICAL Society has appointed a committee to report at the next an- nual meeting at Washington, on the “Present Status of Obste- trical Teaching in Europe and America,” and to recommend improvements in the scope and character of the teaching of Obstetrics in America." A good move. Similar action might well be taken with regard to the teaching of other branches, boiling down to practical essential facts upon which all teachers are in accord, so that students may not be overwhelmed with over-much non-essential detail as now, and not paralyzed through cram- ming with matter and individual theoretic conceptions not yet proven. Examining boards, too, might, take a hint in this connection and ask only real practical questions, such as all might concur in. DR. J. EDWARD Turner, of Wilton, Conn., who founded the first inebriate asylum in the world and was the first to take up and materialize the view of Rush outside of a general hospital, was honored at his old home by a monument dedi- cated to his memory, October 27th. at Wilton, Connecticut. Dr. L. D. Mason of Brooklyn, New York, President of the American Medical Society for the Study of Alcohol and other Narcotics, delivered the dedicatory address at the unveiling of the monument in the cemetery. Dr. Henry 0. Marcy of Boston delivered at the same time, an historic address on "Heroes and Martyrs in Medical Science," Dr. T. D. Crothers, of Hartford, Conn., delivered a special memorial address, “Dr. Turner's Life and Work." The occasion was one of general interest and marks an- other epoch in the medical and scientific progress of the study of the brain and mind. Editorial. 631 SYNDICATE YOUR PRACTICE, Doctors Of Medicine!- Brethren of the medical profession, the time is at hand and now is when you must come together in twos and threes or more and join your business, with your own hospitals and even dispensaries if necessary. If you do not, young men of medicine, the medical service companies will get you in their meshes or some of you must go out of business. An editorial in the January St. Paul Medical Journal on the logical outcome of contract medical practices, referring to the Brooklyn “Woerner Medical Service Company” longer than we have space for, will enlighten you further on this subject. Better syndicate your business young doctors of medi- cine and run it jointly, securing a chance, by division of labor for more rest and study opportunity for yourselves and leis- ure to take part in public affairs and work for the welfare of yourselves and the profession before the people, than become servile supporters, for hire, of these contract medical com- panies that boast of their hundreds of thousands of members who pay a meager monthly or annual stipend, while these companies give you but a pittance for your time and skill asa medical servant of a non-medically owned company which makes the dividends while you do the work. Take the doctors and their hospitals of Los Angeles for pattern of the right way and the Woerner Medical Service Company of Brooklyn for example of the wrong way to con- serve your own best personal, pecuniary and professional in- terests. If the laborer is worthy of his hire, the doctor is worthy of his fee and should not be hired as a mere laborer under the mastery of a company of non-medical men in the line of ordinary professional work. Social PsychOTHERAPY.—Dr. Chas. P. Bancroft, in his presidential address before the Medico Psychological Asso- ciation last year at Cincinnati discussed this most important subject under caption of the psychiatric outlook as follows: “While society may not be able to prevent the marriages of the unfit, it can and should prevent the marriages of the feeble-minded. For its own safety the community should, 632 Editorial. through proper officials, locate all such persons and segregate them in special institutions. Careful inspection of jails and prisons should be made and when discovered these individuals, either before commitment or after the expiration of their sentence, should be transferred to the custodial or school department for the feeble-minded. We cannot prevent crime, degeneracy and insanity if this class is allowed to roam at large. And yet how slowly does the public arise to a proper understanding of the necessity of segregating the feeble-minded. Many states are still without proper insti- tutions for this class. In my own state only five years ago the movement to establish a school for feeble-minded met with the greatest opposition and the custodial department was omitted for fear that the entire enterprise would meet with defeat in the legislature. Such short-sighted policy shows the need there is of popular enlightenment. The out- look is not discouraging, for public sentiment is already slowly changing and the feeling exists that the care of the feeble- minded is not merely a humanitarian movement but is of real economic value to the state. Every such case properly cared for may mean diminished pauperism, crime or future insanity for the community.” In Re HARRIMAN.-In the recent death of the Railway King Harriman, the multi-millionaire "clergyman's son,” the “bloodless magician of Wall Street,” the taciturn and dimin- utive and mentally overstrained magnate of railroad promo- tion and finance, the United States has another example of the brain-fagged American, threatened with organic dis- solution and psychasthenia, fruitlessly seeking the regaining of health in the elusive baths of Europe and from physicians who know nothing of the business overworked, brain-fagged American man broken into non-resistance to every external morbid influence by the over-mastering exaction of the strenuous business life of America. It is said that Harriman finally died of cancer. So did Napoleon, so did General U. S. Grant, so did Missouri's great Benton, all after long careers of ceaseless strenuous activity, and disappointment and why not when the gates of resistance are broken and down, in the struggle against morbific invasion Editorial. 633 and environment? When nerve center resistance is lowered, trophic powers fail and the blood count lessens in its foe fight- ing and powers, the enemies of disease make abrasures in the physiologic fortifications and take the citadel of life. This Napoleon and Moltke of “high finance,” this over- worked "wizard of Fortune," exhausted in brain by his own financial magic, had better have betaken himself for repair, with a good American physician for sanitary counsel, to his own three thousand acres in the Ramapo Mountains and there sought the rest and seclusion and silence from telephone or other touch of his vitally destructive life which the world elsewhere could not give. Great American Wellingtons of finance know too much of action, always action, too much of audacity, always audacity, and too little of rest. Napoleon's ceaseless audacity finally destroyed him through his indiscreet move on Moscow and his Waterloo because he was not then his former normal self in brain tone. The sleep he ignored came to him in epileptic vertiginous attacks and the world thought he was sleeping, leaning against trees or on the march on horseback, but it was the somnolence of epileptoid. Some SANITARY PROPHYLACTIC Progress is being made among the people with reference to precautions against the spread of tuberculosis, but progress is yet slow and incom- plete. Public place anti-spitting sentiment has grown to the extent of railway station and public anti-spitting expectora- tion notices and ordinances. But cigar and cigarette stumps are yet permitted to be picked up from the streets and saloons, and meats and vegetables, fruits, candies, etc., are still ex- posed for sale, unprotected from street dust, and broken candies are dipped up with the hands and put into scales. Ice is hauled over dirty pavements, old unrenovated clothes are sold, hotels are carpeted and swept and furniture dusted, that should be wiped or cleaned by suction. The washing of glasses in which drinks are served needs closer inspection and supervision. These precautions would secure a better tone of confident resistance against disease infection among the people as well as the comfort of psychic satisfaction that edible things are clean. 634 Editorial. The advent of the new method of washing drinking glasses by the customer himself with fresh water jets thrown into the overturned glass is a sanitary innovation that prom- ises much for ultimate anti-microbic safety and the psychic satisfaction of drinkers at public places. The new plain soda water venders and many of the cafeterias having this feature, deserve encouragement by the prudently bibulous. In these days of growing psychotherapy public sanitation is good for the mind, the brain and nervous system and re- lated organism. THE Anti-Alcoholic Museum at Budapest attracted some attention, but not so much as it should. AN INTERNATIONAL LEAGUE AGAINST EPILEPSY was formed to combat epilepsy by members of the Sixteenth In- ternational Congress at Budapest. SUPPOSED Favorite DAYS FOR SUICIDE IN PRUSSIA.— Official statistics say May, June and July are “popular" months for committing suicide in Prussia. Men prefer July, while women favor May. The fewest suicides take place in February. Thirty per cent of the male and twenty-eight per cent of the female suicides occur in the spring time and the next most in the summer, autumn, and winter in the order named. Berlin registers an average of twenty suicides week- ly in June. Youthful persons prefer the night time for sui- cide, while adults oftener choose the morning or afternoon. The fewest suicides occur immediately after sunset. Mon- day, Tuesday and Thursday are“ favorite” days. HONORED WASHINGTON'S STATUE IN BUDAPEST.-The American delegation to the Sixteenth International Congress honored the great father of their great country in conjunction with Hungarians by assembling at the Washington “Denk- mal" by the lake at the entrance to the city park. Dr. Mc- Murtry of Louisville made the principal American address. The Medical Era's GASTRO-IntestinAL EDITIONS.- During July and August, The Medical Era of St. Louis, Mo., issued its annual series of issues devoted to gastro-intestinal Editorial. 635 diseases. The July number took up the usual bowel dis- orders of hot weather and the August was devoted entirely to typhoid fever. These issues always attract considerable attention. The editor will forward copies to physicians ap- plying for same. David Walsh, M. D. concludes an interesting article on certain aspects of medical journalism in the Medical Press and Circular for July with the following tribute to American medical as well as English press: "America has built up a systém of medical journals of which the English speaking world may well be proud. What- ever the future may have in store, we may at all events be sure that the medical journals of America, no less than those of the United Kingdom, will worthily uphold the traditions of a great and noble profession.” GENERAL STOESSEL AN APOPLEctic.-General Stoessel, condemned to death for surrendering Port Arthur to the Japanese, which was changed to life imprisonment, was stricken with apoplexy when he learned that his application for a full pardon had been rejected by the Czar last May. He and his companion general of the navy, Admiral Nebogatoff, have since been pardoned. We hope the pardon may prove a mind cure to both. “Quis Custodit Custodes” is the caption of a pertinent criticism in the Irish Times concerning the carelessness on the part of certain physicians as to the sanitary care of the clinical thermometer, the writer complaining of three different phy- sicians—a rather exceptional experience, we should think- “taking their thermometers from their cases, fingering them, inserting them in the customary way, leaving them the neces- sary time, withdrawing and after some further fingering, putting them back in their cases without washing." We never put a thermometer in a patient's mouth with- out first asking the nurse to dip it in water and never return it to its case without doing the same again. This is a good procedure to forestall such criticism as the above, especially 636 Editorial. if the lavement is antiseptic, as it may always be in a hospital and after the first visit in private practice. It is better to avoid the appearance of unsanitary pre- caution, though most physicians are particular in regard to keeping their thermometers sanitarily clean, even though the patient does not always see the cleansing process. INDIANS DIE When THEIR OCCUPATION IS GONE- PLAGUE MAY EXTERMINATE.-News comes from the North that the death rate among the Sioux Indians of South Dakota from the ravages of consumption, threatens to exterminate the race on the Standing Rock and the Cheyenne River reser- vations. On the Cheyenne River reservation the deaths from the white plague exceed those from all other causes combined and threatens annihilation from the disease. Strenuous efforts, it is said, will be adopted to prevent the Indians from getting whiskey, which the Government thinks, accellerates the progress of disease among the Indians. But the chief cause of Indians' destruction is psycho- physical through deprivation of accustomed liberty of the chase and natural methods of living and the semi-servitude inflicted by the Government. Logan is in psychic chains. “Who is there to mourn for Logan-not one." As the hart panteth for the water brook so the poor Indian, etc. Bootham PARK, YORK, are the name and place of an attractive and well appointed hospital and home for the in- sane and for those who, apprehending insanity, may volun- tarily enter for treatment and as boarders. The institution is founded on voluntary subscriptions. It is located upon beautiful and picturesque grounds with ample lawns and shade trees and a beautiful prospect of the charm- ing country about. Through the courtesy of Dr. C. K. Hitchcock, M. A., M.D., Camb., the capable and courteous resident medical superin- tendent, we in company with Dr. T. D. Crothers, of Hartford, were enabled to inspect the inmates and appointments for their care and comfort in July last. It is interesting to note that Dr. Hitchcock has only three Editorial. 637 paid gardeners for the whole place, greenhouses, vineries, three lawn tennis grounds, cricket grounds and all the vege- table and flower gardens and patients' garden courts. Voluntary work by his patients is a strong point with him; even the lady patients do all sorts of domestic work suit- able to them. But this is common to our American hos- pitals, for the mentally damaged, corporate, private and state. Brain FAG AND PESSIMISM.—The overstrenuous life and its sequent psychasthenia develop irresolution, timidity, fears and dreads and pessimism. “We live in an age of self- depreciation. The pessimists are abroad in the land," said Lord Curzon in a recent optimistic address (such as could only come from his vigorous brain), to the boys of St. Paul's School, a few months ago. But it did not occur to him to tell the boys across the water what all boys there and in our own country ought to know, that pessimism is bread of ill health, of the nerve cen- ters especially, and that the pathway of success and glory and goodness and power leads through right conservation of the strength of the human organism through avoidance of all exhausting excesses and erratic expenditure of vital force. Health of brain gives vigorous hopefulness of mind. To the healthful mind "hope springs eternal.” The well entoned brain is strong and of good courage, it has no morbid fears. The mind thereof and therewith dreads not nor is dismayed. LOMBROSO.—The death of Cæsare Lombroso, of Turin ne Venice, has left a wide gap in the ranks of criminal anthropol- ogy and he was but seventy-three, in this day when men of moderate systemic brain endeavor and power and temperate habits may and do live so often longer.. Lombroso was a man of letters, an ex-army surgeon, insane hospital chief, professor of forensic medicine at Turin and author of many books and monographs with which read- ers of the Alienist and Neurologist are quite familiar. He re- garded genius as a neurosis and so wrote his views upon it in a well known book. He elucidated the morbid side of crime in relation to epilepsy, nocturnal, masked, etc. He was an 638 Editorial. apologist for feminine criminality and in many instnces justa- ly so, but he studied crime too exclusively in its pathological aspects. He leaned too much to the morbid and too little to the motive side of crime, and his analysis of the criminal, therefore, was not always correct as shown by his conclusion concerning an analysis of Harry Thaw. Thaw was neither an hereditary epileptic nor an epileptic maniac. He was morbidly, excessively, egoistic, neglected in his rearing, un- habituated from his youth up to manhood of normal inhibita- tion and right self control over impulses, desires or passions and his murder of Stanford White was the logical result of neglected home and self restraint, an unstable, indolent life. and unbridled passion passed to wilful homicidal frenzy under jealous envy and dislike. Lombroso would have eliminated crime from our vocab- ulary in its common significance and substituted disease. Disease of brain is often crime, but crime is not always dis- ease. The motives of theft or arson are not always founded in morbid brain endowment, though disease accounts for many crimes. The Death of Moebus, of Leipzig, and of Hitzig, has brought the two extensive neurological and alienistic libraries of these eminent neurologists and psychiaters into the book market. Gustave Fock, book dealer of Leipzig, has these splendid collections of European neurological literature for sale; cable address, “Buchfock, Leipzig.” Dr. Edward Holmes Van Deusen, who was the first phy- sician to precede Beard in describing neurasthenia and who gave the editor of this magazine his first correct conception of nervous exhaustion as a psychasthenic condition as differentiated from "general debility” of the then existing nosologic tables, is dead at the age of seventy-nine years. SELECTIONS. CLINICAL PSYCHIATRY. The Serum DiagnoSIS OF Diseases OP SYPHILITIC Origin IN THE Nerve Centres. (Die Serodiagnose der Syphilidogenen Erkrankung des Zentralnervensystems.) (Allg. Zeits. f. Psychiat., Bd. 65, H. 3.) Rosenfeld. In the course of his communication to the Psychiatric Association of the Southwest German Alienists held at Heidel- berg in November, 1907, Dr. Rosenberg stated that Plaut had succeeded in obtaining the reaction of the anti-stuffs in the cerebro-spinal fluid of paralytics in well-nigh 100 per cent. of the cases examined. In lues cerebri, and in lues without cerebral affection, the number of cases that presented a posi- tive reaction was small. Thus the presence of anti-stuffs in the spinal fluid would appear to be pathognomonic of general paralysis. The drawback to this test is the extreme difficulty of the preparations. Fernet and Schereschewsky, working at the Bacteriological Institution at Strasburg, have devised a simpler and easier method described in the Munch. Med. Wochenschrift., Nr. 30. Their preparation, called “Lues- prazipitine” and “Luespraziptinogine,” was found to give a reaction when the serum of a syphilitic in whose organism the Spirochæta pallida was found had been mixed with the serum of several paralytics and tabetics. In the majority of cases, there was a specific precipitate, while neither the serum of a syphilitic subject nor that of a paralytic or tabetic gave a like reaction with normal serum. But in several cases of un- doubted paralysis and in one in which there was in addition involvement of the bones in the disease the precipitate failed (639) 640 Selections. to appear. In the following discussion Alzheimer stated that experiments in the Munich Klinik had shown that this method was often untrustworthy, whereas the complement method used by Wassermann gave constant results.-William W. Ireland, in Jour. of Mental Science, July, 1909. The SO-CALLED KORSAKOPf Psychosis [Uber die sogen. Korsakoffsche Psychose], (Gaz. Lekarska, 1907, No. 33u. 34. Ref. Edward Flatu, Neurol., Cbl., Nr. 15, 1908.) Bornstein. The author discusses the modern aspects of this disease, and depicts the case of a man, æt. 55, whose illness he believes to be Korsakoff's. The differential diagnosis of this case (polyneuritis, paralysis progressiva, presbyophrenia, etc.) is afterwards brought up, and the author is of opinion that the condition is probably influenced by a cerebral arterio-sclerotic affection (headaches, sickness, static and kinetic ataxia, exaggeration of the tendon reflexes and derangement of the pupils). With regard to the nosological placing of Korsa- koff's psychosis, the author reaches the following conclusions: (1) The ætiology of the so-called Korsakoff's psychosis may be a varied one. Generally chronic alcoholism is a fac- tor. The same symptom-complex may be met with in general paralysis, lues cerebri, apoplexia cerebri, poisoning, etc. (2) The beginning and course of the disease may also be varied. The view taken by Bonhoeffer and Kraepelin re- garding the characteristic preliminary stages in the form of delirium tremens and stupor alcoholismus has not yet been proved. (3) The psychic disturbances, which are a feature, can be reckoned on as being nearly always present, and independ- ent of the ætiology. The disease is frequently accompanied by polyneuritis. (4) From a psychiatric point of view Korsakoff's psy- chosis should be looked upon only as characteristic symptom- complex and not as a clinical unit, and generally for the reason that, in spite of conformable course and symptoms, the prog- nosis is dependent on the origin of the disease. The symptom- complex could now be termed a "nosological" unit only when it is found in combination with polyneuritis resulting from chronic alcoholism.-Hamilton C. Marr, in Jour. Ment. Science. Selections. 641 Functional CorectoPIA IN EPILEPTICS [Le Corecto pie funzionali negli Epilittici]. (Arch. di Psichiat., vol. xxix, fasc. i-ii, 1908.) Negro. It has been often pointed out that occasionally in normal persons, and much more frequently in epileptics, and also in so-called degenerates, the pupil may be markedly eccentric. As this corectopia persists when the pupil contracts or dilates, it is presumably due to a permanent anatomical peculiarity of the iris, and as such it has been reckoned amongst the stig- mata of degeneracy. Negro has found that a similar appear- ance may be observed as a transitory condition in many epilep- tics when the accommodation is relaxed and the eyes are examined in a dim light. Under these circumstances, when the observation is continued for a short time the degree of corectopia is seen to alter, and this is especially distinct in cases of hippus. When the pupil contracts, whether under the influence of light or in efforts of accommodation, or after the exhibition of a myotic, the eccentricity disappears; and from this the author infers that the condition is due to an irregularity of tonus in the dilator apparatus under the control of the sympathetic. When the peripheral terminations of the sympathetic are stimulated by weak solution of cocaine the ectopia also disappears, suggesting that the functional irregularity which produces this condition has its seat in the nervous centres governing the active dilatation of the pupil. As an index of nervous instability the author thinks that the phenomenon may have a diagnostic value in cases where epilepsy is suspected. He has found it in from 8 to 10 per cent. of his epileptic patients, and only very rarely in non- epileptics.—W.C. Sullivan, in Jour. Ment. Science (Excerpt.) Psycho-PATHOLOGY OF Everyday Life [Psycho-pathol- ogie de la vie quotidienne]. (Arch. de Psychol., Feb., 1908.) Maeder, A. In this paper, the author demonstrates that various un- expected and seemingly accidental modes of reaction in nor- mal people are based upon the psychological mechanism by which unpleasant experiences tend to be suppressed from the personal consciousness either voluntarily or automatically 642 Selections. This suppression may be effected by isolation of the complex -avoidance of all the associations which relate to it or by derivation-active distraction of the subject who turns away from the complex and directs his energy and attention into other channels. In the normal individual these methods of “forgetting" can only apply to events of little importance; those which have produced a strong emotional reaction are difficult to repress. In the hysteric, such events may be truly suppressed, and are then manifested by attacks, somnam- bulisms, etc. Analogous, however, to these hysterical states are many instances of lapsus linguæ, slips of the pen and sud- den emotional outbursts over trivialities, such reactions being frequently the result of the momentary irruption of a com- plex into the personal consciousness. The author gives numerous examples occurring in daily life which scarcely lend themselves to abstracting. The principles laid down are of paramount importance, illustrating as they do the identity of the mechanism which produces slight disturbances of thought and actions in normal people on the one hand, and the more serious disturbances, hysteria, psychasthenia, and insanity, on the other.-H. Devine, in Jour. Ment. Science (Excerpt.) ON HEREDITY IN Dementia PRAECOX. (Allg. Zeitsch., Bd. 64, H. 2). Wolfsohn. Dr. Ryssia Wolfsohn has made special inquiries into the hereditary transmission of this form of insanity. Out of 2,215 insane patients (1,337 male and 878 female), he has found 647 cases of dementia præcox, i. e. 30 per cent. (23 per cent. male and 39 per cent. female). As causal factors in the transmission of insanity through direct and indirect insanities he takes into account insanity and nervous diseases, but only counts drunkenness in the father or mother. Leaving out 97, in whom the history was defective, Dr. Wolfsohn has 550 cases of dementia præcox upon which to study the incidence of heredity. In 56 pa- tients no heredity was found, while it was traced in 494 cases (235 male and 259 female), that is, in 91 per cent. male and 85 per cent. female. She observes that out of her 647 cases 243 (146 male and Selections. 643 97 female) were ranked in the hebephrenic form; 239 (77 male and 162 female) in the katatonic, and 165 (82 males and 83 females) in the paranoidal form of dementia præcox. Wolf- sohn's deductions are supported by a variety of tables which will, at least, convince the reader who glances over them, of the painstaking way in which the article has been composed. She thus sums up her inquiries: (1) A hereditary taint has been found in 90 per cent. of the cases of dementia præcox, male and female. (2) Of the four factors, insanity in the ascendents is the most frequent, being about 64 per cent., after which come ner- vous diseases, then alcoholism, and last, eccentricity of con- duct. (3) In 34 per cent. of all the cases there was a combina- tion of causes, especially insanity with alcoholism and insanity with nervous diseases. (4) Where alcoholism, nervous diseases and abnormal character appear as hereditary causes, no especial direction of the form of the dementia can be made out, while the trans- mission through insane relatives seems in some degree to in- cline to the katatonic and the paranoidal form of the dementia. (5) No connection can be traced between the hereditary taint and the severity of the symptoms of dementia præcox. -William W. Ireland, in Jour. Ment. Path., (Excerpt.) INVESTIGATIONS REGARDING INSANE PATIENTS WITH HEREDITARY DIATHESES, Untersuchungen uber die erblichen belasteten Geisteskrankungen.. (Allg. Zeits. Psychiat., Bd. 64, H. 1.) Tigges. Dr. Tigges fills forty-six pages with his further researches on the hereditary relations of insanity gathered from wide reading and personal observations. The paper is supported with many carefully compiled tables. His statistics confirm the generally received view of the frequency of heredity as a predisposing cause of insanity. Tigges' figures seem to in- dicate that in direct descent the influence of the mother is most powerful in transmitting insanity, especially to daugh- ters. His conclusions agree with those of Baillarger and Jung, but are sometimes at variance with statistics taken from the 644 Selections. Swiss, English and American asylums, in which the influence of the male parents appears greater. The transmission of the neurosis is most marked when both parents are insane.- William W. Ireland. ON HEREDITY IN DemenTIA PRAECOX. (Allg. Zeitsch., Bd. 64, H. 2). Wolfsohn. Dr. Ryssia Wolfsohn has made special inquires into the hereditary transmission of this form of insanity. Out of 2,215 insane patients (1,337 male and 878 females), he has found 647 cases of dementia præcox, i. e. 30 per cent. (23 per cent. male and 39 per cent. female). As causal factors in the transmission of insanity through direct and indirect insanities he takes into account insanity and nervous diseases, but only counts drunkenness in the father or mother. Leaving out 97, in whom the history was defective, Dr. Wolfsohn has 550 cases of dementia præcox upon which to study the incidence of heredity. In 56 pa- tients no heredity was found, while it was traced in 494 cases (235 male and 259 female), that is, in 91 per cent. male and 85 per cent. female. She observes that out of her 647 cases 243 (146 male and 97 female) were ranked in the hebephrenic forni; 239 (77 male and 162 female) in the katatonic, and 165 (82 males and 83 females) in the paranoidal form of dementia præcox. Wolf- sohn's deductions are supported by a variety of tables which will, at least, convince the reader who glances over them, of the painstaking way in which the article has been composed. She thus sums up her inquiries: (1) A hereditary taint has been found in 90 per cent. of the cases of dementia præcox, male and female. (2) Of the four factors, insanity in the ascendents is the most frequent, being about 64 per cent., after which come nervous diseases, then alcoholism, and last, eccentricity of conduct. (3) In 34 per cent. of all the cases there was a combina- tion of causes, especially insanity with alcoholism and insanity with nervous diseases. (4) Where alcoholism, nervous diseases and abnormal Selections. 645 character appear as hereditary causes, no especial direction of the form of the dementia can be made out, while the trans- mission through insane relatives seems in some degree to in- cline to the katatonic and the paranoidal form of the dementia. (5) No connection can be traced between the hereditary taint and the severity of the symptoms of dementia præcox.- William W. Ireland. A Case of Motor Apraxy, Veber einen Fall von Motor- ischen Apraxie.. (Allg. Zeitz. f. Psychiat., Bd. 64, H. 2.) Westphal. T— was a man, æt. 38, who had several slight apoplectic attacks with passing pareses, some delusions, hallucinations, and other symptoms of mental derangement. Both arms could be freely moved; there was no loss of co-ordination, and no traces of the former paresis. Speech was somewhat affected; there was a loss of words or wrong words were used. Some degree of mental blindness was suspected. Both hands were found useless to perform complex actions, while it ap- peared that the apraxy did not implicate the motor cranial nerves. Westphal tells us that in the great majority of in- stances of apraxy the deficiency is confined to the left hand, or the right hand is less affected. It requires some subtle analysis to distinguish between the loss of mental conception and that of the due performance of the designed action. There were several nervous incapacities in this patient; but, accord- ing to Westphal, the motor apraxy ran like a red thread through the whole disease. The patient died after the article was written. The author was able in a note to record the result of the examina- tion. The most important changes found were sclerosis of the arteries and a considerable hydrocephalus internus. The widening was greater in the left ventricle. The corpus callosum to the naked eye did not appear to be affected-Wil- liam W. Ireland. A Case of IMPAIRED Sense of Perspective, Ueber einen Fall von partieller Störung der Tiefenwahrnehmung.. (Allg. Zeits. f. Psychiat., Bd. 64, H. 1.) Kramer. 646 Selections. Dr. Kramer describes a patient who had an apoplectic at tack accompanied by aphasia and asymbolia. These symp- toms soon passed away, leaving only a slight slowness in find- ing the words, and a dullness in writing and reading. The patient was found to be incapable of recognizing the per- spective in drawings. Looking at engravings he recognized the outlines, but the whole image appeared flat. Thus, in stereometrical drawings he only saw the bare lines. He had no difficulty in recognizing letters. Thus the sentiment of depth and space seems to have been, in this case, somewhat deranged. The case was reported to the East German Asso- ciation.-William W. Ireland. CASE OF CYSTICERCUS IN THE BRAIN, Ueber einen Fall von Hirncysticercus. (Allg. Zeits., Bd. 64, H. 2.) Cramer. A woman, æt. 47, previously healthy, was suddenly seized with pains in the head, giddiness, inability to walk and occa- sional vomiting. When admitted into the Klinik for mental and nervous diseases at Göttingen, she was found to be af- fected by loud noises in the head, pain in the left occipital region and thereabout. These pains were altered by position —they were aggravated when she rose up. The head was held to the left. No alteration was noticed in the cranial nerves or in the eyes. There was increased sensibility to pin- pricks on the left side of the body, also tremulous motions of the tongue, and the reflexes in the arms and legs were in- creased. The vomiting became more frequent and with vio- lent headaches. On one occasion, there was noted itching and a pain in the fingers with a stiffness of one of them. At the same time there was inequality of the pupils. These symptoms were followed by spasm of the fingers of both hands. Then suddenly there came relaxed paresis of the right arm without change in the reflexes. Next day there supervened total paralysis of the right arm and leg with weakness of the bladder. After two days, the paralysis of the right leg passed away; that of the arm remained and also seized the left arm. Further symptoms were rapid breathing, aphonia—which did not last long--and then paresis of all the extremities with re- flexes sustained, and normal sensibility. After a general im- 648 Selections. JURISPRUDENCE. The LEGAL PROTECTION OF THE CHILD IN THE STRUGGLE AGAINST ALCOHOLISM, By Dr. Hercod, Lausanne. Our century, which has frequently been called “the Cen- tury of the Child," and sometimes deserves to be so called, has done very little to protect the child against the ill-treat- ment to which it is exposed by alcoholic parents. It needed in England the articles of Mr. Sims, “The Cry of the Children" and “The Black Stain,'' to awaken public attention and pro- voke legislative intervention which has produced the Children's Act of 1908, that“Grand Charter” of the English child. The principle of legislative intervention to protect the child is no longer contested, and many states, besides England, have already interesting enactments on this subject. The research made by the author of this paper relates to legislation in England, Germany, Switzerland, America and Finland. It includes the following points:- 1. Measures taken to protect the child against alcoholic parents. 2. Prohibiting the giving of alcoholic drinks to children. 3. Children and legislation in regard to public-houses. I. Legislation which allows the drunkard to be put under tutelage or into a special asylum (England, Germany, Switzer- land, etc.), provides against the ill-treatment inflicted on a child by an alcoholic parent as a motive for interference. The text indicates less, except in English and American legisla- tion, what is to become of the child whose father has been placed under control or in an asylum. Note the legislative measures taken in Rhode Island, where it is provided that the children of drunkards shall be confided to a special society at the cost of their parents. This provision hinders unworthy parents from making use of the State in order to rid them- selves of their own responsibility in regard to their offspring. Unless they are backed by a strong public opinion, the laws in regard to paternal neglect will remain a dead letter. They must, therefore, be enforced with persistence. Tem- Selections. 649 perance societies, in every locality, ought to act as a Vigilance Committee, and make known to the authorities and the press the ill-treatment inflicted on children by drunken parents. They will also point out to the societies for the protection of children the great part that alcohol plays in regard to the ill- treatment of children. The institution of a central committee of the juvenile temperance societies, such as the Swiss“ Jugend- werkzentrale" (Central Juvenile Work), might be very useful in this direction. II In proportion as the special dangers of alcoholic drinks for children are known, the question will be raised as to how far the law can forbid everybody, even parents, to give such to children under a certain age. If, theoretically, such a law is made, it is very difficult to carry it out, because many people regard it as interfering with the family rights, or, at least, as a sort of hateful inquisition, and it is difficult to prove the infraction of the law. It is doubtless for this reason that most of the American laws prohibit any one, except parents or guardians, to give alcoholic drinks to children. But such an exception appears to deprive the law of its usefulness. The English law in “The Children's Act” has gone to the root of the problem, and even forbidden parents to give alcoholic drink to their children under five years of age, except in ex- treme cases. Only to five years, is very little, but the habits of the people must be borne in mind, especially in such condi- tions as would make it quite impossible to apply the law. The age limit should, therefore, gradually be raised, and in the meantime the parents must be taught the reason why the law has been made. This can be done by the officers of the law, or by doctors distributing cards of instructions at the time when the child is vaccinated, etc. III. All modern legislation seeks to keep children out of the public-house. Sometimes the publican is forbidden to serve drink to children who are not accompanied by a responsible adult (as in most of the Swiss cantons, Hamburg, Wurtem- berg, Mecklemburg-Schwerin, etc.). In other places it is generally forbidden to children unaccompanied to enter a 650 Selections. public-house (as in Bern, Glaris, Argovie, Oldenburg, Baden, Waldeck, and the greater number of the American States). Unfortunately this prohibition is a dead letter in many coun- tries. The fault is due to public opinion which remains in- different, and to the law which provides ridiculous penalties (in Baden 1 to 3 shillings, Appenzell 5 to 10 francs). A heavy fine for the first offence, and taking away the license for a second, would very soon bring the offenders to reason. The law might go further, considering that the public- house is not a place for children, and it could forbid them to enter, even if accompanied by their parents or a responsible person. Here also the English Parliament has made an in- novation, and forbidden children to enter a public-house even when accompanied (Children's Act, par, 120). A similar rule is found in the legislation of Arizona. However legitimate this prohibition may be, it encounters great difficulties. The parents think they are the best judges as to where they shall take their children. Perhaps it would be possible in order not to offend public opinion too much, which at present is not sufficiently enlightened, to limit the prohibition to the even- ing hours, but in any case to forbid any drink being served to children, even when with their parents. In many countries the laws also deal with the employ- ment of children in the public-house, either on account of morality or of health. In Switzerland the age limit is usually fixed at eighteen for girls (in Zurich it is twenty), and at six- teen for boys; but an exception is always made in favor of the publican's family. The German law fixes twelve as the age limit for boys, and thirteen for girls, as far as regards waiting; the children of the publican make no exception except in towns of less than 20,000 inhabitants. The United States have been very energetic in this matter. The State of Wyom- ing forbids the employment of women and young girls under twenty-one. Connecticut, Idaho, Maryland, etc., the same. Other States allow a lower age. It seems to us that if women are allowed to serve in a public-house the age of twenty should be the minimum, at least in regard to waiting. For youths eighteen at least. Selections. 651 Exceptions in favor of children of publicans are not justifiable, at least in regard to serving. CONCLUSIONS. 1. The children of alcoholic parents, being minors, should be taken from them and confided to the care either of chari- table institutions or placed in private families (abstainers if possible). Unworthy parents should be made to contribute to their support if possible. 2. The law should forbid even parents to give their chil- dren alcoholic drinks. In fixing the age the state of public opinion must be taken into account. Measures should be taken to make parents understand the reasons for such pro- hibition. 3. Minors up to the age of eighteen should be forbidden to enter a public-house in order to drink unless accompanied by their parents. An exception may be possible in case of boarders, at meal times. 4. Children under fourteen years of age should not be allowed to enter a public-house after seven in the evening, even if accompanied by their parents. . 5. It should be prohibited to employ young women or girls under twenty, and youths under eighteen as waiters, whether they belong to the publican's family or not. (The figures indicated are approximate.) NEUROLOGY. The ReLATION OF the TUBERCULIN REACTION TO THE Nervous System.-By Dr. Moro (Munchener Med. Woch. No. 39, 1908.) The author's study of the percutaneous reaction to tuber- culin showed the frequent appearance of a typical reaction, at the same time, in a part of the body corresponding to that where the inunction was applied; as for instance, in the sym- metrical segment of the untreated breast, or on the opposite fore-arm. A skin reaction was moreover repeatedly noted at a considerable distance from the site of the inunction, and occasionally there appeared a belt-shaped distribution of the 652 Selections. reaction-zone. On the basis of these various observations, the author arrives at the conclusion that the nervous system is essentially concerned in the production of the reactions, and that the findings above referred to can only be explained in such a way that the stimulus caused by the tuberculin at the point of inunction, reaches the spinal cord and is from here transmitted to remote skin-segments. There are reasons for assuming that the chief part in this mechanism is played by the sympatheic nervous system.-Post-Graduate. PARALYSIS OF THE LARYNGEAL RECURRENT Nerve.-By Drs. Koerner and Sebba (Zeitschrift fur Ohrenheilkunde, Vol. 56. Ref. in Ctrlbltt. f. d. Med. Wissenschft, No. 26, 1909). The left side of the larynx is more frequently paralyzed, in tabetic patients, than the right, probably because the left recurrent nerve is the longer of the two, and the toxic sub- stance circulating in the blood produces a greater sum of re- sistance for the nerve-current in the long left nerve than in the short right nerve. This is further suggested by the greater frequency of the left-sided paralysis in the other toxic neurites, such as diphtheritic or typhoid neuritis, influenza neuritis, etc. Tabetic paralysis of the larynx is almost invariably observed in the stage of exclusive functional disturbance of the cricoary-tenoideus posticus muscle; it remains the sole paralysis for many years, whereas paralysis through traction or pressure of the nerve leads almost always promptly to com- plete paralysis of all the muscles.--Post-Graduate. NEUROTHERAPY. CALCIUM HYPOPHOSPHITE IN THE TREATMENT OF EPI- LEPSY.-By M. Cicarelli. La Clinique, July, 1909, and New York Medical Journal. The author, encouraged by favorable reports on the treat- ment of Epilepsy with lime salts, commenced employing Cal- cium Hypophosphite, hoping to derive some reconstituent effect from the phosphorus. Calcium Hypophosphite was given in doses of from ten to fifteen grains, three times a day. Excellent results are reported from its use in twenty-five cases. Selections. 655 delirium. Of these 84, 75 were men and 9 women; 75 of the cases were uncomplicated, 9 complicated with trauma or with some acute infective disorder-in most cases pneumonia. To none of these patients was alcohol administered in any form whatever. What were the results of treatment? Complete recovery with the exception of three cases, which proved fatal. One of the three died from accident, having succeeded in jumping out of a window; the other two, suffering from acute febrile alcoholic delirium, were in a very .grave condition on ad- mission, and died suddenly during the night. Even if the accidental death be included we get from these statistics the remarkably favorable percentage of recoveries of 96.43. It is noteworthy that the two patients dying directly in con- sequence of delirium tremens were not affected by any com- plication. The nine patients suffering from complications, including all those with pneumonia, recovered, although alcohol was entirely withheld. It is difficult, remarks Régis, to speak definitely regarding the duration of an attack of delirium tremens, since neither the beginning nor the end of the attack is always definite and sudden; but he considers that in the cases under consideration the cure was speedy. Apart from the negative element in the treatment, the withholding of alcohol, the measures employed were as fol- lows: Food was administered at very brief intervals during the acute stage; some of the patients were isolated, others not; frequent purgation; diuretics; abundant fluid per os.; 30 to 45 gr. each of chloral and bromide of potassium per diem. The principle underlying this simple mode of treatment is to favor in every possible way elimination by the liver, the kidneys, and the bowels. In justification of the eliminative treatment Régis refers to the work of Klippel as to the part played by the liver in the production of delirium tremens. He also states that, in con- junction with Galtier, he has himself proved that in all the toxic psychoses, but above all in alcoholic delirium, increase in the violence of the delirium is associated with a diminution in the excretion of urine, and vice-versa. At the height of 656 Selections. the attack as little urine may be passed in a day as 10 ounces; when convalescence begins the discharge of urine becomes very free, and may amount to 100 ounces or more per diem. During the height of the delirium, also, Galtier has found that the urine contains an excess of skatol, indican, urobilin, sugar, and albumen; at the same time there is a retention within the system of urea, chlorides, and phosphates; the cessation of delirium is marked by a very free discharge of the last-named substances. Alcoholic delirium, therefore, in common with other forms of toxic delirium, must be regarded as an auto- toxic psychosis, the immediate cause of which is a failure of elimination. Hence the rationale of the treatment advised. In conclusion Régis criticises his own results. They show, he says, that it is not necessary to give alcohol to pa- tients suffering from delirium tremens, and he elaborates the theoretical reasons against its administration in these cases. But, he goes on to say, it is possible to assert that even the two patients who died might have recovered if they had been given alcohol. He cannot himself speak positively as to the effects of alcohol in such cases, as he has never prescribed it. To settle the question to his own satisfaction he now proposes to make a control experiment by the administration of alcohol in a sufficiently large number of cases of alcoholic delirium. To some he will give medicinal doses of alcohol as the only means of treatment, beyond feeding and ordinary care for the safety of the patient. To the others he will give alcohol as a supplement to the eliminative treatment previous- ly described. He hopes in this way to obtain scientific proof as to whether alcohol is beneficial, harmful, or indifferent in the treatment of delirium tremens. We shall await with interest the report on his second series of cases. PSYCHIATRY. PsychASTHENIA.—A. H. Ring summarizes his paper as follows: (1) Janet, .... intends to include under the term obsessions, manias of doubt, tics, agitations, phobias and the deliria of contact, states of anxiousness, neurasthenias, and bizarre sensations of strangeness and depersonalization. These Selections. 657 he would group together into a grand psychosis similar to hysteria and epilepsy. (2) Psychasthenia is at base a dis- turbance of the feelings, the will, and perception, and may range from mere eccentricities in the superficially normal through mild depression to melancholia and dementia. (3) There are two types: 1, Those in which the disturbance shows itself, principally in motor fatigue, and 2, those in whom the principal affection is in the sensory motor and emotional sphere, the latter offering the less favorable prog- nosis. (4) Phobias result from an unhealthy, prolonged feeling tone of depressing ideas and may be conscious or sub- conscious. (5) Doubts and indecision are evidence of fatigue of the higher centers which preside over formative and newly synthetized associations. The final judgment is thus rendered difficult or impossible, and the victim finds himself in a state of vacillation and with a tendency to revert to the lower and simpler associations long formed. Weakened cerebral in- hibition also plays its part. (6) Obsessions and impulsions are the emotional result of the above factors, and show them- selves principally as a failure to inhibit the feeling-tone of ideas automatically repeated, yet the all-pervading asthenia checks the impulses short of accomplishment. (7) Psy- chasthenia should be differentiated from hysteria, epilepsy, dementia præcox, manic depressive insanity, and paresis. (8) The treatment is largely prophylactic and educational. Phy- sical and hygienic measures should be combined with ex- planation, persuasion, and encouragement. Logic appeals to these patients, but they are not good hypnotic subjects.- N. Y. Med. Record. A CLINICAL STUDY OF Optic Neuritis in Its Relation- SHIP TO INTRA-CRANIAL TUMORS.–From a careful analysis of about 400 cases of cerebral tumor, Leslie Paton is enabled to draw some important conclusions, some of which may be summarized as follows: Primary pressure atrophy of the optic nerves may be caused by the constant pressure of a tumor upon the chiasma, or on the optic nerves, and this atrophy may occur without any premonitary oedema of the discs. 658 Selections. The greater the distance between the tumor and the chiasma, or the cortex, the less apt is optic neuritis to occur. There exists, in about 50% of cases, a difference in the degree of intensity of the neuritis in the two eyes, but this difference possesses no localizing significance. The amblyopia and the ædema of the disc seem to be in- dependent of one another.—Brain, Part, CXXV. Charles D. Fox, M. D., in Hahnemannian Monthly. 660 Reviews, Book Notices, Reprints, Etc. still attracts the Anglo-Saxon and world people for sanitary recuperation. We acknowledge receipt of an attractive and instructive illustrated book on the subject sent out by the Bath Corpora- tion. This book will be sent postage free on application. OUTLINES OF Psychiatry (Second Edition). By William A. White, M. D. Nervous and Mental Disease Monograph Series No. 1, New York, 1909. Two years ago the first edition of this interesting and val- uable work was published. Now a second is before us. “The principal changes in this edition have been in the main by way of elaboration, with the exception of the chapter on paranoia which has been entirely rearranged. The de- scriptions of several of the psychoses have been extended, par- ticularly in such instances as Korsakow's psychosis, which is so rarely recognized by the general practitioner. “While the work has been extended in the way indicated the greatest amount of attention has been paid to the general part. The chapter on the examination of the insane has been elaborated, especially in its neurological section, by the addi- tion of the most important neurological symptoms, from the standpoint of the examination of insane patients. To the chapter on the definition of insanity has been prefixed a short account of the nature of insanity. It is not expected that a single course of lectures nor the perusal of a single work on mental disorders will make a psychiatrist, but it is deemed of the utmost importance that the student shall have an under- standing of the difference between internal medicine and psychiatry and thereby should gain a general idea of the na- ture of the psychiatric problem.”. We cordially repeat the commendations given its pred- ecessor. This is too good a book to be sent out in paper covers. Price two dollars. The Journal of Nervous and Mental Disease Publishing Company, New York. BIBLIOGRAPHY OF THE CONTRIBUTIONS of George M. Gould, M. D., to Ophthalmology, General Medicine, Literature, etc. Andrus and Church, Ithaca, N. Y. Reviews, Book Notices, Reprints, Etc. 661 Will interest every reader of the Alienist and Neurologist. You need not agree with all of Dr. Gould's deductions or en- dorse all his criticisms to enjoy him. He is a voluminous and searching writer and critic, from his ophthalmological standpoint, not always superlatively logical, but always thoughtful and interesting, especially in his long range teloscopic, ophthalmic post mortem biographies of great men. Dr. Gould needs a readjustment of his psychic lenses in some respects. He is something of a presbyope him- self in regard to discernment of causes of certain neuroses, but he is a good writer and a jolly good fellow to those who know him and means no harm by his over-much writing. Starr's ORGANIC AND FUNCTIONAL Nervous Diseases (New Third Edition.) Lea and Febiger, 706-10 Sansom St., Philadelphia, publishers. Always a good text book, this new edition is adapted still more approvingly to the requirements of students and prac- titioners. The work before us is even still more completely arranged in the revision. In the first part he takes up the methods of examination and diagnosis, with the necessary anatomy and physiology, and with this basis laid he proceeds in the second part to cover the great division of organic dis- eases. In the third part the functional diseases are fully pre- sented, the space allotted having been more than doubled. Part four considers diseases of the sympathetic nervous sys- tem. The work, as we have said, of its predecessors is compre- hensive and practical, embodying knowledge of twenty-seven years devoted to this field of observation and experience. It covers both the medical and surgical aspects of neurology. Within its covers is the latest and most authoritative informa- tion, elaborately illustrated, of modern neuro-symptomatol- ogy, pathology and therapeutics. Dr. M. Allen Starr, the author, is Professor of Neurology, College of Physicians and Surgeons, New York, ex-President of the New York Neurological Society. The present edition has 904 pages, 300 engravings and 29 plates in color or mono- . chrome. The price, cloth, $6.00 net; leather,'$7.00 net. Reviews, Book Notices, Reprints, Etc. 663 Dr. Roberts, the author, maintains the curability of can- cer by radium and asserts that successful results in skin dis- eases can be brought about in half the time required by the X-ray. The remarks relative to the resistance of healthy as com- pared with cancer cell tissue will interest the philosopher in physiology, therapeutics and pathology. The book is put out by the Nixon-Jones Printing Com- pany, St. Louis. The Secret of Sex, the discovery of a New Law of Nature: How Sex is Caused. Cochrane Publishing Co., Tribune Building, New York. Price, 50 cents, explains fully, according to the publishers announcement: How the Czar of Russia secured a male heir to the throne, How to fore- cast the sex of the unborn child, How to determine or produce either sex at will. By E. Rumley Dawson, L. R. C. P. Lond., Fellow of the Royal Society of Medicine, late Member of the Council of the Obstetrician Society of London and former Resident Obstetrician to the Westminster Hospital. It is the first publication, of his discovery, on this side of the Atlantic. A MANUAL OF Psychiatry, by De Fursac, translated by Rosanoff and published by John Wiley and Sons, 43-45 East 19th Street, New York, is one of the best of the good ready reference, small text books on this important sub- ject, now eliciting much more than former interest from students of anthropology in its higher phases and physicians of research, thought and success, coming to our attention dur- ing the past year. It can be carried in the overcoat pocket and used for ready reference. LES PROGRES DE L'ASSISTANCE DES ALIENES EN HONGRIE par le Dr. C. Chyzer, Chef de L'Hygiene et de L'Assist- ance Publique au Ministere R. H. De L'Interieur. Ex- trait du Numero du 15 Mars, 1909. De La Revue De Hongrie. This paper makes a good showing for the care of the in- sane in Hungary and being written in the French language, 664 Reviews, Book Notices, Reprints, Etc. will be generally read by superintendents of hospitals for the insane and philanthropic physicians generally. A STUDY OF THE RESPIRATORY SIGNS OF CHOREA MINOR. By William W. Graves, M. D., St. Louis. From The Jour- nal of the American Medical Association, January 30, 1909, Vol. LII., pp. 364-371. An interesting, painstaking, exhaustive and instructive study and paper on an interesting subject to the neurologist and the family physician. New York STATE COMMISSION IN LUNACY, Twentieth Annual Report September 30, 1908, to the Legislature from this Commission. A voluminous and valuable report, as are all preceding reports to date, showing much of interest concerning the in- sane and causes of insanity and mental degeneracy in that state and the relation of its foreign population to insanity. Hagee's CordiaL OF THE EXTRACT OP Cod Liver Oil Com- POUND, put out by the Katharmon Chemical Company of St. Louis, is the title of a monograph showing Dr. G. A. Heinrich's analysis revealing Morrhuine, Morrhuic acid, Aselline and Lecithine, submitted to the favorable con- sideration of the medical profession. How SIMMONS, “Our PEERLESS LEADER,” BECAME A REG- ULAR. By G. Frank Lydston, M. D., Professor of Genito- Urinary Surgery in the Medical Department of the State University of Illinois. Illinois SOUTHERN HOSPITAL, Anna, Illinois, Training School for Nurses. Annual Announcement. 1909-1910. A good work and flourishing school. IN AN INTERESTING PAPER before us the question is asked, Where Is the Spirit of '76? Why in G. Frank Lydston, M. D., to be sure! An Appeal for the Sake of Man and of Medicine, The Role of Visual Function in Animal and Human Evolution, Extracts from Reviews Concerning Lafcadio Hearn, Bibliography Reviews, Book Notices, Reprints, Etc. 665 of the Contribution of Dr. George M. Gould to Ophthalmology, General Medicine, Literature, etc. A Remarkable Case of Epilepsy Caused by Eye Strain, From the Patient's Point of View, Biographic Clinics, Fifty-Seven Varieties of Medical and Ophthalmic Blunders, all by Dı. George M. Gould, of Ithaca, N. Y. Tonsil Removal, Opsonic Index and Immunity. By Bryan D. Sheedy, M. D., New York. Sex Differences in the Tapping Test: An Interpretation. By Frederick Lyman Wells. A Case of Laryngeal Stenosis in the Adult, Successfully Treated by Intubation; Continuous Wearing Tube for Four Years. By William K. Simpson, M. D., New York. A Sarcoma of the Naso-Pharynx. By William K. Simp- son, New York. Experimental Study of the Occular Reactions of the In- sane from Photographic Records. By Allen Ross Diefendorf and Raymond Dodge. Forms of Insanity in Five Years Admissions to and Dis- charges from the Hospitals for the Insane in Massachusetts. By E. Stanley Abbot, M. D., Waverly, Mass. Motor Retardation as a Manic Depressive Symptom. By Frederick Lyman Wells, M. D., Waverly, Mass. The Munich Psychiatric Clinic. By Frederic H. Packard, M. D., Waverly, Mass. A Study of Some Casts of the Infantile Pharynx with Especial Reference to the Eustachian Tube. By William C. Braislin, Brooklyn, New York. The Prevalence of Pellagra in the United States. By Drs. C. H. Lavinder, C. F. Williams and J. W. Babcock. Iron Medication. By Dr. Erich Matzner, Birkfeld. The Indications for the Radical Mastoid Operation, Based upon Pathologic Lesions. By S. J. Kopetzky, M. D., New York. The Clinical Study of a Series of Cases of Insanity. By 666 Reviews, Book Notices, Reprints, Etc. H. A. Tomlinson, M. D. and G. H. Freeman, M. D., St. Peter, Minn. The Rational System of Medical Education will furnish physicians adequate for the entire field of medical practice. By Leartus Connor, A. B., M. D., Detroit, Mich. Simple Refraction for Family Physicians. Its promotion during 1908-9. By Leartus Connor, A. B., M. D., Detroit, Mich. Adenomyoma of the Uterus, Parasitic Uterine Myomata, The Condition of the Uterine Mucosa in Myoma Cases, Vaginal Cysts, A Series of Interesting Gynecologic and Obstetric Cases, Surgery of the Liver, all by Dr. Thomas Cullen, Balti- more, Md. The Sensory System of the Facial Nerve and Its Sympto- matology. By J. Ramsay Hunt, M. D., New York. The Clinical Diagnosis of Tuberculosis of the Tonsils. By Lee M. Hurd, M. D., New York. Medical Expert Testimony. By Samuel P. Goldman, Esq., New York. The Undeterminate Sentence. By Clark Bell, New York. Remarks on Tic and Chorea. By Hugh T. Patrick, M. D., New York. A Report on the Circulation of the Lobar Ganglia. By H. F. Aitken, Boston. The Kinaesthetic Area of the Brain. By H. Charlton Bastian, London. Report of a Case of Dissociated Personality. By Charles D. Fox, M. D., Philadelphia. A Case of Multiple Sclerosis. By C. D. Fox, M. D., Phila- delphia. Some Drugs that May be Used with Benefit to Gynecologi- cal Patients. By H. J. Boldt, M. D., New York. Dr. Adam Hammer, Surgeon and Apostle of Higher Medi- cal Education. By James Moores Ball, M. D., St. Louis. Reviews, Book Notices, Reprints, Etc. 667 Court Testimony of Alienists. By Britton D. Evans, M. D., Morris Plains, N. J. Removal of an Embolus from the Common Iliac Artery, With Re-establishment of Circulation in the Femoral. By John B. Murphy, M. D., Chicago. A New Instrument for Opening the Skull. By James M. Neff, M. D., Chicago. “Am Steinhof” Hospital and Sanitoria in Vienna for Mental and Nervous Patients of Lower Austria. By L. Ver- non Briggs, M. D., Boston. Sacral Suspension of the Uterus-A New Technic. By John Van Doren Young, M. D., New York. Analytical Description of the Eye as an End Organ. By Joseph E. Willetts, M. D., Pittsburg. HOSPITAL REPORTS, ANNOUNCEMENTS, ETC. Northwestern University Bulletin. Tulane University Bulletin. Bulletin of the University of Nebraska College of Medi- cine. Barnes University, College of Medicine, St. Louis. Thirty-first Biennial Report of the Illinois Central Hos- pital for the Insane at Jacksonville. The Eighty-fifth Annual Report of the Officers of the Hartford Retreat at Hartford, Conn. St. Louis Maternity Hospital. PUBLISHER'S DEPARTMENT. It Is STRANGE.--A mother, father and small child were eating supper, when the child, who had been thinking real hard, looked up and said, “Mama, you was born in Maine, papa was born in Idaho and I was born in Chicago; ain't it funny how we all got together?"--The Delineator for August. The Pacific Monthly of Portland, Oregon, is a beauti- fully illustrated monthly magazine. If you are interested in dairying, fruit raising, poultry raising, or want to know about irrigated lands, timber lands, or free government land open to homestead entry, The Pacific Monthly will give you full in- formation. The price is $1.50 a year. If you will send twenty-five cents in stamps, three late issues will be sent you so that you may become acquainted with it. Read the following splendid offers: Offer No. 1—McClure's Magazine, Woman's Home Com- panion and The Pacific Monthly, costing $1.50, will be sent at a special rate of $3.00. Offer No. 2—McClure's Magazine, Review of Reviews and The Pacific Monthly, costing $6.00, will be sent for $3.60. Offer No. 3–- Human Life, Ideal Homes and The Pacific Monthly will be sent for $2.00. Order by number and send your order accompanied by postal money order for the amount to The Pacific Monthly, Portland, Oregon. DR. MOREAU Wolf, Chevalier of the Legion of Honor, Paris, France, says: “I have pleasure in informing you that I have obtained very gratifying and marked effects from the administration of your Syrup of Hypophosphites in cases of impotence in the male, due either to anæmia or of the nervous system without lesion." (668) THE BUCKINGHAM A s ob ST. LOUIS' MOST EXCLUSIVE MODERN FIRE-PROOF HOTEL WILLIAM A. COCHRAN, General Manager Forest Park and King's Highway, St. Louis, U. S. A. DR. E. E. HALL'S (2) ALL - METAL Open Closed Spraying Expanding Douche Point. SIMPLE TO TAKE APART, STERILIZE AND REASSEMBLE. SPECIAL PRICE PRICE $2.00 TO PHYSICIANS, Write for illustrated literature, and sample of Tablets Formula: indicated in TITE T100 TIM I tt ZINC SULPHO- TONSILITIS, DR. E. E. HALL'S CARBOLATE, COMPOUND URETHRITIS, SODA SULPHO- ANTISEPTIC AND HEALING TABLETS VAGINITIS, CARBOLATE, Non-Poisonous, no Odor, no Staining SODA BORAX. and wherever a W FULL DIRECTONG INSIDE healing antiseptic Used two or more to the quart of is required. water. One or two tablets inserted in the vagina and washed out after several hours, prevents and relieves pelvic inflammation, and atony of the genitalia. Being non-poisonous, no odor and do not stain. Patients appreciate them. 1554 ODGEN AVE., CHICAGO, ILL. ES Publisher's Department. 669 BATTLE & Co., have just issued No. 10 of their dislocation chart series, and will send all back numbers free of charge to physicians, on request. Battle & Co., 2001 Locust Street, St. Louis, Mo. THERE Exist a number of cutaneous disorders which, in the main, are due to a general bad state of the tissues. It is in these that a general up-building process must be inaugurated in order to heal and improve the local cutaneous disturbance. It was formerly the custom to order cod liver oil, with good results. To-day, it is equally advantageous to give the cord. ext. ol. morrhuae comp. (Hagee), which acts not only as well, but better, and is devoid of grease. -Am. Jour. Dermatology. PRECAUTIONARY MEASURES.-As every physician has constantly under his care cases of either typhoid, malarial or bilious fever, it is well to remember that precautionary meas- ures are possible, and if taken in time, much of the trouble with these cases is avoided. If it be true that the materies morbi of these diseases belong to the bacillus group, the remedies manifestly are an antiseptic and an antipyretic. As an in- testinal antiseptic we have nothing better than salol. The consensus of opinion is in this direction. When we add the antipyretic and anodyne effect of antikamnia, we have a happy blending of two valuable remedies, and these cannot be given in a better or more convenient form than is offered in Anti- kamnia and Salol Tablets; each tablet containing 272 grains antikamnia and 272 grains salol. The average adult dose is two tablets. Always crush tablets before administering, as it assures more rapid assimilation. As the necessity of intestinal antisepsis in the treatment of this class of diseases is fully recognized, would not the scientific treatment of the condi- tions preceding them be the administration of the same reme- dies? Fortifying the system against attacks is the best pre- ventive of them. Topics of Public INTEREST.-New York Police to Stop Noises. General Bingham Instructs Men on Violation of City Ordinances. Commissioner Bingham has received daily a batch of Dr. Moody's Sanitarium, San Antonio, Tex. For Nervous and Mental Diseases, Drugs and Alcohol Addictions. Four modern buildings and two detached cottages, with ample provison for proper classification, and with equipments and conveniences for genial home environ- ments, comforts and for rational scientific treatment, which is strictly along ethical lines. Location and locality ideal for health, rest and recuperation. Rooms may be had en suite or with private baths. Seven acres of beautiful lawn and shade. Surrounded by several hundred acres of City Parks and by New Government Post Grounds. Address, G. H. MOODY, M. D., 315 Brackenridge Ave. (Formerly Assistant Physician to State Asylums at Austin and San Antonio, Texas.) MISS COPELAND'S SCHOOL For Special Training of Backward Children Reopens 11th Year, September 1st, 1909. ADDRESS: MISS SUSAN ELOISE COPELAND New Phone, 221 A. Seward Street, Saratoga Springs, N. Y. Dr. E. A. PALMER, Physician. RO NOIVA 16 Gauge, Model 16 Repeating Shotgun Gråde 2.8 This is a high grade, guaranteed repeating shotg which weighs but 614 pounds, and yet is as effecti as most 12 gauge guns which weigh 712 and 8 poun The Marlin 16 gauge The working parts of Model 16 repeating shal repeating shotgun is an are made of the finest quality of steel drop forgi exact copy of the Marlin cut down from solid blocks to the nicely fit Model 19 12-gauge and parts of the finished shotgun. contains all the features With one shell in the chamber and five in ich have made Marlin shotguns famous. magazine, Model 16 shotgun can be fired six ti The solid top, side ejection, automatic recoil safety in four seconds. ck and closed-in action are present in Model 16; For grouse, quail, woodcock, prairie chick ch part refined a little to meet the lighter charges charges teal, woodchucks, squirrels, rabbits and all e powder used in a 16 gauge shotgun. smaller game this gun is unsurpassed. The up Grade D has fine Damascus barrel and Grade shooter will readily see the advantage of a re Model 16 Marlin shotgun barrels are made of ing shotgun weighing a pound to two pounds lig Special Smokeless Steel”; all Marlin barrels are than the average 12 gauge and yet having all ired to shoot both black and smokeless powders. effectiveness of the heavier arm. Send three stamps for catalog which fully describes all the Marlin guns, The Marlin Firearms Co., Willow Street, New Haven, Coi Publisher's Department. 670 mail in which citizens complain bitterly of the unnecessary noise made by vehicles, automobiles and boys playing and running through the streets with tin cans tied to strings. He issued July 18, 1908, a general order instructing the police to suppress all unnecessary noise and to arrest noise makers. The general order reads: The police force of this city can put a stop to a large pro- portion of the unnecessary noises which torment the entire population. Not only is it a matter of health and happiness for all concerned that the people of New York should be dis- turbed at night as little as possible, but there are also thou- sands of night workers in the city who must sleep in the day time. It is a part of the duty of the police force on patrol, as the general protectors of the public, to see that unnecessary noise is suppressed. Generally speaking, a public nuisance is an act that annoys, injures or endangers the comfort, re- pose, health or safety of any considerable number of persons. In cases in which the noises are a violation of the laws or ordinances, arrests will be made. The unnecessary use of horns, sirens, whistles or bells on automobiles or motorcycles is a public nuisance and a violation of Section 385 of the Penal Code. Hand organs in the Borough of Manhattan are al- lowed to play from 9 a. m. to 7 p. m. All rails, pillars and columns of iron and steel transported through the streets of the city, causing loud noises, is a violation of the ordinance. No person owning or having animals or birds making un- necessary noise is permitted to keep them. It is unfortunate- ly true that the streets constitute the only play-ground for thousands of children throughout the greater city, but, even so, the exercise of a little common sense will enable the police to distinguish what is purely unnecessary noise. The police are directed to suppress the shouting of street hawkers of all kinds; all unnecessary shouting and yelling; un- necessary blowing of steamboat or factory whistles; roller skating on the streets or sidewalks to the interruption and interference of traffic; whistling peanut roasters; unnecessary blowing of whistles or horns on motorcycles or automobiles; letting the exhaust escape from motorcycles and automobiles without being properly muffled; blowing horns or bugles or oorooooooooooooooooooooooo EMBLEM Motorcycles and Bicycles 1910 Agencies Now Placed ooooooo000000000-00000000000000000000000000000000 Powerful, Strong, Satisfactory The ideal conveyance for business or pleasure. 342 and 4 H. P. Single Cylinder. 7 H. P. Twin 2.GIGG-CATALOGUES FREESIOGGIO EMBLEM MFG. CO. 0000000000000 ANGOLA, ERIE CO., N. Y. f00000-0000-0000-000000000000 Two Hundred Thousand Families The intellectual aristocracy of America, have one rule in magazine buying- "The Review of Reviews first, because it is a necessity" PUWO THE AMERICAN REVIEW REVIEWS EDITED BY ALBERT SHAW DATEJ - 307 - SEND FOR A SAMPLE COPY 7 THE NECESSARY) MAGAZINE MAGAZINE LIBRARY IN ONB MAGAZINE CO 2 The Review of Reviews Has attained a larger subscription list than any magazine that deals wholly with serious subjects and is accepted as the best periodical to keep one up with the times. It is non-partisan. NEITHER MUCK-RAKES NOR HIDES PACTS With Dr. Albert Shaw's monthly "Progress of the World," with the cartoon history of the month, with the timely contributed articles on just the questions you are interested in, with the best things picked out of all the other magazines of the world for you, with the charac- ter sketches of the notable people of the moment--you can keep intelli- gently up with the times at a minimum cost of time, effort and money YOU MUST SEE OUR BOOK OF MAGAZINE BARGAINS Before ordering for next year. It contains forty pages of special offers, including all the leading magazines and periodicals. It will show you how to save money on your Christmas buying. This interesting and money-saving catalogue is FREE. . The Review of Reviews Company, 13 Astor Place, New York Publisher's Department. 672 WEARING OUT THE PRESIDENT.–We copy, to endorse, the following, by E. J. Edwards, from the St. Louis Globe- Democrat: If our much beloved President is not to be carried into the White House annually in a gasping, asthmatic condition, brought on by his effort to be a good fellow and familiarly meet his American countrymen, some new system of “swinging 'round the circle” will have to be devised. Some of the scenes of his present gigantic undertaking, though surrounded by an atmosphere of good humor emanat- ing alike from his own genial nature and the sympathetic kindliness of his fellow citizens, have approached the margin of the pathetic. Almost voiceless, fatigued to the point of collapse by short hours of sleep, beset on every hand by pro- grammes that must be “carried out,” it is wonderful that the president himself has not had to be carried out.” The President's health is worth looking after for ourselves as well as himself. We, perhaps, can not deny ourselves his occasional presence among us; but need he take in 13,000 miles of American citizenry at one fell swoop? Why may he not travel oftener and not so far on each occasion? Shorter trips with greater frequency would do the business without“ doing" him. We like our president very much, but we do not wish to reduce him to such a state that he can only make signs at us. Few of us are familiar with the sign language, having but a limited experience in joining secret societies and some not be- ing “jiners" at all. We think we understand what President Taft means when he rises on the platform and smiles and strokes his throat three times with his left hand. It means that he would like to talk to us, but his epiglottis has struck. On the other hand if he should meet us on the street and make the same sign, we should take it for an invitation to enter a near-by “gilded palace," but we might be mistaken. If our presidents are to be allowed to continue these jolly- fellow excursions half way round the earth, then there is only one means of preserving our rulers to us in good health and voice, and that is to teach the deaf and dumb alphabet in the public schools in order to permit the chief executive to deliver his speeches with his hands when his throat gives out. 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 cure is complete in a few weeks time. The treatment is varied se 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-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 52 Haukuland Kansas City, Mo. 529 Highland Avenue HALL-BROOKE A Licensed Private Hos- pital for Mental and Nervous Diseases. THE NATIONAL MEDICAL EXCHANGE - Physicians', Dentists 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 for Monthly Bulletin containing terms, locations, and list of books. All inquiries promptly answered. Address, H. A. MUMAW, M. D. Elkbart, Ind. CASES OF ALCOHOLISM AND DRUG HABIT. DEAUTIFULLY situated on Long D Island Sound one hour from New York. The Grounds consisting of over 100 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. THE NATIONAL Surgical and Dental Chair Exchange. All kinds of new and second-hand Chairs, Bought, Sold and Exchanged. PFSEND FOR OUR BARGAIN LISTS Address with stamp. Dr. H. A. MUMAW, Elkhart, Ind. DR. D. W. McFARLAND, GREEN'S FARMS, CONN, 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. Telephone 140 Westport Conn. Publisher's Department. 673 The NeGRO AND THE HOOKWORM.-From a hereditary immunity, partial or complete, to the hookworm, the negro is infecting new ground until to-day some persons claim that 2,000,000 persons in the United States have hookworin disease. And he will bring this anemia-producing worm as far north as it will live to bring a new problem in sanitation to the “border states.” This worm is adaptable and it may come to be an inhabitant of places in the latitude of Phila- delphia. —From Editorial in Taylor's Medical Council. Hay Fever SOLUTION ADRENALIN CHLORIDE CARTOOO O TOME C 714 00: 7 HYOLOGHALSTSOL ADRENALIN INHALANT - MARKE.DAVISCO TOITMICO ALCOHOL 1 CELORLTON 12 GRAN - - ORENZ DKE.DAVIS SC DE TOMICS - OTO - SLAVGUMUT OINTMENT ADRENAL AKU DAV For the treatment of Hay Fever the Adrenalin preparations are easily the most efficient agents available. These are especially com- mended: Solution Adrenalin Chloride (1:1000). Adrenalin Chloride, 1 part; Physiological Salt Solu- tion (with 0.5% Chloretone), 1000 parts. Powerful astrin- gent. Dilute with four to five times its volume of physiological salt solution and spray into the nares and pharynx (see Glaseptic Nebulizer adv. below). Ounce bottles. Adrenalin Inhalant. Adrenalin Chloride, 1 part; an aromatized neutral oil base (with 3% Chloretone), 1000 parts. Administer with our Glaseptic Nebu. lizer or other atomizer suited to oily liquids. Ounce bottles. Adrenalin Ointment (1:1000). Effective either alone or as an adjuvant to Solution Adrenalin Chloride. Collapsible tubes with elongated nozzles. Adrenalin and Chloretone Ointment. Each ounce contains: Chloretone, 20 grains (5%); Adrenalin Chloride, 2-5 grain (1:1000). Astringent, antiseptic and mild anesthetic. Collapsible tubes with elongated nozzles. Glaseptic Nebulizer. The most practical atomizer ever offered to the medical profession. Combines asepsis, convenience, efficiency, simplicity. Read- ily sterilizable. All glass except the bulb, tube and metallic base. Produces a fine spray. Affords excellent results with but a few drops of liquid. Price, complete, $1.25. Write for our literature on the Modern Treatment of Hay Fever. PARKE, DAVIS & COMPANY Laboratories: Detroit, Mich., U.S.A.; Walkerville, Ont.; Hounslow, Eng. Branches: New York, Chicago. St. Louis, Boston, Baltimore, New Orleans, Kansas City, Minne- apolis; London, Eng.; Montreal, Que.; Sydney, N.S. W.; St. Petersburg, Russia; Bombay, India; Tokio, Japan; Buenos Aires, Argentina. 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, 5 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, M.D. OSSINING, N. Y. Long Distance Tel., 365 Ossining. 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. H. EUGENE Given Free POLK'S MEDICAL REGISTER POEMS A $7.00 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 bis daintily artistic volume FIELD FLOWERS" (cloth bound, 8x 11), as : certificate ot subscription to fund. Book contains a selec- tion of Field's best and most representativo works and is ready for delivery, But for the noble contri. THE Book of the century bution of the world's greatest Handsomely Illus. artists this book could not trated by thirty. have been manufactured for two of the World's less than $7.00. Greatest Artists. 3 The Fund created is di- $ vided equally between the family of the late Eugene Field and the Fund for the building of monument to the mem. ory of the beloved poet of childhood, Address EUGENE FIELD MONUMENT SOUVENIR FUND (Also at Bcok Stores) 194 Clinton St., Chicago It yuu also wish to send postage, enclose 10 cts. AND DIRECTORY WAS ESTABLISHED IN 1886. Do Not Be Deceived By Imitators. Seo that the namo R. L. POLK & CO. IS ON THE ORDER BEFORE YOU SIGN IT. POLK'S 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 covers the field. BOOK R. L. POLK & CO., Publishers, DETROIT. MICHIGAN. SUBSCRIBE NOW. This is the Best Medium for - Sanitaria- 1910 ANTIKAMNIA TABLET CALENDAR VVERY Physician in the world will receive a copy of this beautiful Calendar on January 1, 1910 and in the meantime we hope he will remember that “Antikamnia Tablets" and "Antikamnia & Codeine Tablets" are giving just the same excellent results that they have given for the past twenty years. ANTIKAMNIA TABLETS FOR ALL PAIN TAC SMILE FOR USEFUL PRESCRIPTIONE SEE OYL BEATRICE FAC-SIMILE-REDUCED THE ANTIKAMNIA CHEMICAL COMPANY-ST.LOUIS. U.S.A. 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 Legal Medicine, etc., of the world and designed for the General Practitioner of Medicine. Subscription, $5.00 Per Annum in Advance. 0 nce A TRIAL SUBSCRIPTION FOR THREE MONTHS WILL BE SENT TO ANY ADDRESS 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, 3858 Pine Street, ST. LOUIS, MO. BIND THE ALIENIST AND NEUROLOGIST UR new ALIENIST AND NEUROLOGIST Simplex Binder perma- nently binds a volume of four numbers. It is the new idea in bookbinding-not a mere holder, but a permanent binder with which you can do your own binding at home in a few minutes, and turn out as fine a piece of work as an expert bookbinder. Tools and Stitching Material cost .... 40 cents (One Set of Tools lasts for years) The ALIENIST AND NEUROLOGIST Binders cost 50 cents per volume. You can bind in each number as soon as it comes in, and your bound book will always be com- plete, whether it contains one number or four. SEND ONLY 900 HALIENIST AND NEUROLOGIST or one of these binders, to hold a year's numbers, and the 40-cent outfit of tools, etc., and we will send all PREPAID. These binders are hand- somely finished in Vellum de Luxe, and make fine books for your library. Can furnish binders for other magazines of similar size at same price. Extra binders 45 cents. H. L. HUGHES, Publisher, 3858 Pine St., ST. LOUIS, MO. - Waukesha Springs Sanitarium For the care and treatment of Nervous and Mental Diseases New, Absolutely fireproof Building. BYRON M. CAPLES, M.D., Superintendent, Waukesha, Wis. THE EASTON SANITARIUM. EASTON, PENN. Physicians, parents, guardians, or friends who desire to place any mental or nervous patients in a quiet well-furnished home where they can receive good care, and Homeopathic treatment, should visit Easton before making arrangements elsewhere. Over twenty years experience in the Middleton (N.Y.) State Hom. Hospital. Phone 1661. For Circulars, address C. SPENCER KINNEY, M, D. A Private Hospital for Men- tal and Nervous Diseases. HUDSON, WIS. EIGHTEEN MILES EAST OF ST PALL FOUNDED BY RC BERT A, GIVEN, M.D., IN 1859. 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 Osler, James Hendrie Lloyd, Thomas G. Morton, Barton Cooke Hirst, John H. Musser, Alfred Stengel, John A. Ochter- lony, John B. Deaver, W. W. Lassiter. e. L. GIVEN, Proprietor. An Institution fully equipped with ever | appliance and convenience for the care a treatment of the Invalid and Sick, 1 Electric Apparatus, every kind of Bath Massage, Swedish Movement, etc. Contagious diseases and the violent disagreeable insane not received. Beautiful surroundings and in a healthy locality. For information address SAM C. JOHNSON, M.D., Manager HERBERT C. STANTON, M. D., Superintendent. For full information, address, BURN BRAE, Telephone connection. CLIFTON HEIGHTS, DELAWARE CO., PA. SSUE PHOSPHATES WHEELERS TISSUE PHOSPHATI – SUSTAINING- DELICIOUS FOR THE IDEAL TONICK ASTHENIA, T.B.WHEELER MD. FASTIDIOUS COMPANY CONVALESCENTS MONTREAL,CANADA, SAMPLES LLITERATURE LABORATORY, ON REQUEST AN ARM OF PRECISION ROUSES POINT, N.Y. ANEMIA, NEURASTHENIA GESTATION, CONVALESCENCE PWANTED--A RIDER AGENTS IV IN EACH TOWN and district to ride and exhibit a sample Latest Model “Ranger" bicycle furnished by us. Our agents everywhere are making money fast. Write for full particulars and special offer at once. NO MONEY REQUIRED until you receive and approve of your bicycle. We ship to anyone, anywhere in the U.S. without a cent deposit in advance, prepay freight, and allow TEN DAYS' FREE TRIAL during which time you may ride the bicycle and put it to any test you wish. If you are then not perfectly satisfied or do not wish to keep the bicycle ship it back to us at our expense and you will not be out one cent. We furnish the highest grade bicycles it is possible to make at one small profit above actual factory cost. You save $10 to $25 middlemen's profits by buying direct ct us and have the manufacturer's guar. antee behind your bicycle. DO NOT BUY a bicycle or a pair of tires from anyone at any price until you receive our catalogues and learn our unheard of factory prices and remarkable special offers to rider agents. when you receive our beautiful catalogue and study our superb models at the wonderfully zu low prices we can make you this year. We sell the highest grade bicycles for less money than any other factory. We are satisfied with $1.00 profit above factory cost, BICYCLE DEALERS, you can sell our bicycles under your own name plate at double our prices. Orders filled the day received. SECOND HAND BICYCLES. We do not regularly handle second hand bicycles, but usually have a number on hand taken in trade by our Chicago retail stores. These we clear out promptly at prices ranging from $3 to 88 or $10. Descriptive bargain lists mailed free. single wheels, imported roller chains and pedals, parts, repairs equipment of all kinds at half the usual retail prices. and $ 50 HEDGETHORN PUNCTURE-PROOF $ SELF-HEALING TIRES A SARODUCE, CALA 180 Un A SAMPLE PAIR TO INTRODUCE, ONLY The regular retail price of these tires is $8.50 per pair, but to introduce we will sell you a sample pair for $4.80(cash withorder $4.55). MCOGETHORNE REGURO NO MORE TROUBLE FROM PUNCTURES PUNCTURE TIRE CO PROOF NAILS, Tacks or Glass will not let the SELE HEALING 92 USA air out. "Sixty thousand pairs sold last year, Over two hundred thousand pairs now in use. DESCRIPTION: Made in all sizes. It is lively and easy riding, very durable and linedinside with a special quality of rubber, which never becomes porous and which closes up small punctures without allow- Notice the thick rubber tread ing the air to escape. We have hundreds of letters from satis- "A" and puncture strips "B" fiedcustomers stating that their tires have only been pumped and “D," also rim strip “H” up once or twice in a whole season. They weigh no more than to prevent rim cutting. This an ordinary tire, the puncture resisting qualities being given by several layers of thin, specially prepared fabric on the tire will outlast any other make-SOFT, ELASTIC and tread. The regular price of these tires is $8.50 per pair, but for EASY RIDING. advertising purposes weare making a special factory price to the rider of only $4.80 per pair. All orders shipped same day letter is received. We ship C. 0. D. on approval. You do not pay a cent until you have examined and found them strictly as represented. We will allow a cash discount of 5 per cent (thereby making the price $4.55 per pair) if you send FULL CASH WITH ORDER and enclose this advertisement. We will also send one nickel plated brass hand pump. Tires to be returned at OUR experse if for any reason they are not satisfactory on examination. We are perfectly reliable and money sent to us is as safe as in a bank. If you order a pair of these tires, you will find that they will ride easier, run faster, wear better, last longer and look finer than any tire you have ever used or seen at any price. We know that you will be so well pleased that when you want a bicycle you will giv cle you will give us your order. We want you to send us a trial order at once, hence this remarkable tire offer. I van VCEO TIDEo don't buy any kind at any price until you send for a pair of Hedgethorn Puncture-Proof tires on approval and trial at the special introductory price quoted above; or write for our big Tire and Sundry Catalogue which describes and quotes all makes and kinds of tires at about half the usual prices. but write us a postal today. DO NOT THINK OF BUYING a bicycle DO NOT WANT or a pair of tires from anyone until you know the new and wonderful offers we are making. It only costs a postal to learn everything. Write it NOW. and pump. Tires and enclose this making the price sactly as represented IF YOU A J. L. MEAD CYCLE COMPANY, CHICAGO, ILL. We should be glad to receive plans of special features of hospital construction from other institutions for publica- tion as well as notes of psychiatric value. SECOND FLOOR PLAN MEDICAL WARD FOR WOMEN HOUR HORN RECLMO RUFE CLOT CORRIDO WIT) (111) WHEN TTII TOR WOMEN PATIEVES ARING BOOT NIOSPITAL FOR SICK INSANE CENTRAL INDIANA HOSPITAL FOR INSA NE. CONDOR MEN YOR. PATIENES AIRINCHO V LITTI SA ANINE FOR PARED TII][III]*-* CORRILOR NON DORMITORY N 471 4G DẠY ADOLF SCHERRE DESIGNED BY GEORGE F EDENHANTED AGITECT SORUNTENDENT MEDICAL WARD FOR MEN TO ADVERTISERS THE ALIENIST AND NEUROLOGIST C. H. HUGHES, M. D., ED. AND PUB. A QUARTERLY JOURNAL OF PSYCHIATRY AND NEUROLOGY. Subscription $5.00 Per Year. GENTLEMEN: Advertisements Have Not Been a Special Feature of “The AlienIST AND Neurologist.” It does not rely on them for its maintenance as many magazines do. It has been established thirty years and well sustained by its subscription list alone. Therefore it is a specially good medium for your advertisement, and we now solicit it, confi- dent that we can serve your interests and those of our many readers by placing it before the latter. We have a cosmopolitan circulation and the Alienist AND Neurologist is not complete without a full list of appro- priate advertisements to lay before its readers, a large number of the latter (many hundreds) filling the most exalted places in the medical profession, most responsible, official and private positions, as medical officers in charge of hospitals, sanita- riums, the army, navy, etc. We have lived and prospered for thirty years without your advertisement; we can still live on without it, but we need you and you need us to be complete before our many readers in the United States, the Territories, the British Prov- inces and elsewhere abroad. Yours very truly, THE ALIENIST AND NEUROLOGIST. 3858 W. Pine B1., St. Louis, Mo. ANNOUNCEMENT. To Our SUBSCRIBERS, present and prospective, we present this, the closing number of the Thirtieth Year of successful publication of the Alienist and Neurologist. We have endeavored, from the initial number, to present to the General Practitioner, the Alienist, Neurologist and Psy- chologist and others interested, clearer conceptions of Neuro- logic, Psychologic, Neuriatric and Psychiatric Medicine and we shall, during the approaching year and those to follow, con- tinue to present the Advances in the Care of the Human Or- ganism through its Paramount Nervous System. Enlight- ened forensic alienism for physician and jurist will be clearly presented as heretofore. With hearty thanks for the generous support, financial and collaboratorial, received from its appreciative readers, contributors and advertisers, it enters its Thirty-first Year, to continue the enlightenment of the Medical Profession on matters Psychiatric and Neurologic. If you would keep to the front in the profession fill out this blank. ALIENIST AND NEUROLOGIST, 3858 West Pine Boul., St. Louis. Please send for one year, to the address below, the Alienist and Neurologist, for which I enclose $5.00. NAME.............. NUMBER AND STREET............. : City.......... STATE.......................................... Fifty cents additional will also bring you any $1.00 journal or magazine published. Send your list and let us bid on your whole list of publications. Low prices. HOTEL Are You Going to St. Louis? METROPOLE T HE SALT LAKE CITY, UTAH Windermere Hotel Is a delightful place in FIW OW OF -2 BEST RESIDENT SECTION All Brand New and Modern. Centrally Located. and away from the noise and smoke, yet within easy access. 125 Rooms with Bath, Palm Garden. Transient Rates, $1.00 to $3.00 Per Day IW Phone in every room. Cuisine Unexcelled. Special Rates by the Week FW Write for Booklet Address, W. P. WILLIAMSON, Mgr. European Plan $1 to $5 Per Day. E. M. BUDGETT, Prop. SEND FOR BOOKLET BROOKLYN HOME BRIATES ODFIUM FOR NARCOTIC IN. EBRIATES, OPIUM, 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. CRYSTAL SPRINGS “MINDSEASE" FORMERLY MT. TABOR NERVOUS SANITARIUM Cases classified and segregated. The mild, equable, humid climate is often of value in the relief of Nervous states, notably of the insomnia in Neurasthenia. R. M. Tuttle, Business Manager Dr. Henry Waldo Coe, ) Medical offico, The Marquam, Dr. Robt. L. Gillespie, ) Directors Portland, Oregon Dr. J. A. Applewhite, Resident Physician SANITARIA. These are the largest, most reliable and most completely equipped institutions for the care of the invalid, in all parts of the country, ar- ranged according to States. For description 'see advertising pages. STATE. CITY IN CHARGE. Connecticut Greenwich Hartford Norwalk Greens Farm Westport H. M. Hitchcock T. D. Crothers E. E. Smith D. W. McFarland F. D. Buland Illinois Godfrey W. H. C. Smith Indiana Indianapolis M. A. Spink Maryland Catonsville R. F. Gundry Michigan Flint C. B. Burr Missouri St. Louis Kansas City C. C. Morris B. B. Ralph John Punton New York Astoria, L. I. W. E. Dold Fish-Kill-on-Hudson James R. Bolton Astoria, L. I., N. Y. City. Wm. E. Dold. Troy Hiram Elliot Ossining R. L. Parsons Oregon Portland Henry Waldo Coe Pennsylvania Clifton Heights N. C. Stanton Wisconsin Wauwatosa Lake Geneva Kenosha, Waukesha Richard Dewey Oscar A. King G. F. Adams B. M. Caples 2009 LOOD DYSCRASIA as a pathological entity is as indefinable as ever. But recent physiological studies have emphasized anew the part played by certain constituents of the blood as protective, restorative and reparative forces. Modern therapeusis, therefore, finds a fundamental utility in the correction of any varia- tion or deficiency of these forces. Herein lies the special value of ECTHOL-an eligible preparation of selected chinacea Angustifolia and Thuja Occidentalis, presenting in pctent form a remedy of uncommon anti-morbific power. When other remedies of the so-called alterative type fail to exert the slightest effect in the various forms of blood dyscrasia, ECTHOL may be depended upon to promptly produce tangible results. BATTLE & COMPANY LONDON ST. LOUIS PARIS -- - - JUN 271917 3 9016 06991 2684 BOUND UNIVERSITY OF MICHIGAN UNIV. OF MICH. UBRARY