. u I ■! "Quantam eijo quldem vldeo motus morbosi fere omnes a motlbus in systemate nervorum ita pendent ut morbi fere omnes quodammodo Nervosi dici quejnt."—Cullkn'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 NBURIATRY. Intended Especially to Subserve the Wants of the General Practitioner of Medicine. VOLUME XXV. CHARLES H. HUGHES, M. D., Editor. MARC RAY HUGHES, M. D., Associate Editor. HENRY L. HUGHES, Manager and Publisher. 3857 Olive Street, ST. LOUIS, MO. 10O4. CONTRIBUTORS AND COLLABORATORS. TO VOLUME XXV. J. G. KIERNAN, Chicago. JAMES H. MCBKIDE, Los Angeles. C. WERNICKE, C. H. HUGHES, Breslau. St. Louis. F. W. LANGDON, J. W. WHERRY, Cincinnati. Clarinda, la. T. D. CROTHERS, MARTIN W. BARR, Hartford. Elwyn, Pa. INDEX TO VOLUME XXV. ORIGINAL CONTRIBUTIONS. A Psychological Incident in the Court Room 351 Forensic Aspect of Double Suicide ...273 Heredity: Its Influence for Good or Evil 509 Insane Suicide, Insane Homicide, or Murder, Which? 421 Limiting the Term "Insanity." 147 Medical Science, the Medical Profes- sion, the State and the People 36 Mixoscopic Adolescent Survivals in Art, Literature and Pseudo- Ethics 1 Mixoscopic Adolescent Survivals in Art, Literature and Pseudo- Ethies 219 Mixoscopic Adolescent Survivals in Art, Literature and Pseudo- Ethics _ 335 Mixoscopic Adolescent Survivals in Art, Literature and Pseudo- Ethics 473 Morbid Exhibitionism 348 Multiple Neuritis: A Clinical Lecture 137 Outlines of Psychiatry in Clinical Lectures 26 Outlines of Psychiatry in Clinical Lectures 199 Outlines of Psychiatry in Clinical Lectures 292 Outlines of Psychiatry in Clinical Lectures 437 The Erratic Erotic Princess Chimay: A Psychological Analysis 359 The Gentleman Degenerate 62 The Life and Health of Our Girls in Reiation to Their Future 8 The Louisiana Purchase Exposition, the Neurasthenic and the Brain- Tired 490 The Quarter and Semi-Decade Treat- ment and Curability of Epilepsia..326 i 2^4K: Index. EDITORIALS. A Blushing Scalp; or, a Cerebral Vaso-Motor Reflex in a Game of Cards 87 A Great and Unexpected Lossof Life. 82 A Neurologist for the Russian Tsar ...229 A Physician in the Cabinet 368 A School of Forensic Medicine in France 377 A Surgeon of Oophorectomic Fame 381 A Texas Mother of Quintuplets 239 Addressing a Doctor as "Dec." 522 An American International Congress on Tuberculosis 238 An Apoplectic Engineer 3/9 An Attack of Chorea 240 An Interesting Discussion on Epi- lepsy 235 An Important Move 81 Anti-Tuberculosis Awakening 81 Alum 237 Asylum Promotions 523 At Last the Rush Monument 374 Bequests of a Reverend Paretic 524 Bioplasm as a Tissue Builder 91 Brain-Strain or Eye-Strain, Which? 378 Correspondence 242 Crowded Insane Asylum 521 Crystal Springs 90 Death of Dr. E. C. Runge 128 Death of Dr. John B. Murphy 230 Death of Dr. McCorn 238 Died on the Field of Dishonor 373 Director Stcnson 385 Doctor Neils Finsen 88 Dr. A. B. Arnold 381 Dr. A. E. MacDonald 530 Dr. Charles D. Chaddock's Address 385 Dr. Eduardo Maragliauo 384 Dr. Edward Cowlcs 241 Dr. E. C. Runge 91 Dr. Frederick Peterson 241 Dr. George F. Butler 529 Dr. George F. Shrady Has Resigned 529 Dr. Hughes' Book'and His Friends 230 Dr. William W.Graves 529 Dr. William W. Ireiand 92 Erotopathy and Morbid Egoism 85 Especially Deserving: 385 "Few Men." 92 Further Gifts to the Harvard Medical School 73 Harmful Drugs in Proprietary Medi- cines 75 Heinrich Heine's Homeopathic Jokc.535 Herbert Spencer 90 How the Hair Turns White 73 "How to Live." 231 Inebriate Bankruptcy 533 Injunction Against Dlugasch and . Finkelstein 240 Insanity Among Negroes 231 Immacuiate Conception in the xvi. Century, and the Wiles of the Matrons Thereof 74 Japan's Physicians -535 Macdonald Recovers $20,000 383 Medical Centenarians 71 Medical Conventions at the World's Fair 91 Medical Press Exhibit at St. Louis... 89 Medico-Legal ...535 Missouri State Medical Association....241 Old News About the Hypnotic Power of Electricity 236 "Oral Hygiene in Public Institu- tions." 74 Parke, Davis and Company's New Manager 92 Pathological Exhibit at the St. Louis Fair 385 Penal Fountains of Disease and Vice..526 Politics and Public Health 232 Progress in Understanding of Alco- holics 234 Remarriages of Wives by Female Sex- ual Inverts 524 Index. iii Saunders' American Year Book 91 Savary Pierce is dead 3°7 Senator Coe 53° "Short Cuts to Cemeteries." 510 Some of Our Judges 381 Suicides in the United States 380 Suicide from Insanity Due to Acci- dent 525' Tabloid and Soloid 385. Tapeworm in the Brain .,. . 80 To Prevent Tuberculosis 372 Toxins of Insanity 5-2 Tulane Gets a Million 377 Two Valuable Papers by St. Louis Men 372 The Abiogenesis Controversy 526 The Acq ittal of General Leonard Wood 234 The American. Electro-Therapeutic Association 239 The American Cartoonist 92 The American Neurological Associa- tion 241 The American Medical Society for the Study of Alcohol and Other Nar- cotics 5J0 The American Medico-Psychological Association . ._ 241 The American Public Health Associ- ation ..: ~ '. 536 The Appointment of Prof. Wm. Osier..528 The Birth of Liberty 239 The Censor of This City 376 The Century Magazine 240 The Crime of Coerced Insomnia 532 The Daily Medical 128 The Dangerous Perambuiating Para- noiac •-•- 84 The Eye-Strain Theory of the In- ebriety Cure 352 The Fifteenth International Congress of Medicine, Lisbon 531 The Forensic Aspect of Double Sui- cide 240 The Fourth Pan-American Congress. 536 The Gates are Open and the World is Coming 239 The Humiliation of Regular Medicine by Government Laws 534 The International Congress of Arts and Science 369 The Legal View of Insanity 370 The Name of Mount Tabor Sanita- rium 530 The Newer Views of the Pathology of Locomotor Ataxia 368 The New McLean Hospital 76 The Noise Limit of Cities on the Part nf Police 376 The Meeting of the American Medi- cal Association 240 The Medical Profession and General' v Wood !87 The Passing of Listerine and the Coming of Thymol 376 The Physician in French Politics 520 The Plea of Mysophobia and Other Morbid Fears 228 The Practice of Medicine. A Penn- sylvania Decision on What It Is..522 The Press Particeps Criminis in Pat- ent Medicine Fraud 383 The Pressure for Room at the City Insane Asylum 535 The Psychic Sequence of Non-Public Restraint of Children 229 The Psychology of the Decollette Dress '87 The Pullman Palace Car Company .... 377 The Pyromaniac, the Pyrophobiac and the Pyrophile. 83 The Return of Kratz 85 The School of Matrimony 229 The Thanks 373 The Thirtieth Annual Meeting 88 The Trained Nurse 92 The Weight of George Francis Train's Brain 92 The World's Fair at St. Louis 372 The World's Fair at St. Louis 382 Two New Sanitariums 86 William Matthew Warren 90 Young's Hotel, Atlantic City 240 IV Index. SELECTIONS. Clinical Neurologv. A Fatal Ending of a So-Called Acute Circumscribed Edema (Quincke's Disease.) 246 A Micrococcus the Cause of Idiopathic Epilepsy 116 A Separate Center for Writing 94 Abiotrophy 94 Adrenalen in the treatment of the Cardiac Toxemia of Pneumonia... 95 An Extreme Case of Bradycardia 102 Anxiety Neuroses 97 Amyotrophic Lateral Sclerosis 398 Arteriosclerosis—Angiosclerosis 244 Auto Agglutination of the Erythro- cites 386 Cavities in the Spinal Cord— 250 Cerebral Wound Rivaling the Phineas P. Gage Case 99 Concerning Porencephaly 103 Convulsive Tic with Coprolalia 98 Cyto-Diagnosis ill Degeneracy 550 Epilepsy 248 Exophthalmic Goiter 247 Facts About Cancer 394 Fracture of the Base of the Skull 555 Hemorrhagic Encephalitis with Es- pecial Reference to Its Tubercu- lar Form 118 Hereditary Aphasia 104 Lucicn Lofton's Don'ts in Modern Gynecology 388 Note on an Adductor Retlex of the Foot 244 Nycturia in Cardio-Vascuiar Affec- tions 99 Metabolism in Pregnancy 393 Mosquitos and Maiaria ,-556 Organic Disease of the Brain Follow- ing Traumata 117 Pathology of Inebriety 247 Peculiar Disturbance of the Apprecia- tion of Time in a Case of General Paralysis ..119 "Physiological Economy in Nutri- tion.'' 400 Postural Albuminuria 392 Prognosis and Curability of EpiIepsy..ioo Psychiatry and the Side-Chain The- ory _ _ 245 Recent Advances in Neuropsychi- atry _ 113 Relation of Neurotic Cases to Abdom- inal Surgery 556 Resistance to Variations in Temper- ature and Taking Cold 117 Rise of Blood Pressure in Later Life.. 93 Stokes-Adams Disease 96 Suit of an Opera Singer Against a Physician 555 Sugar Formation in Liver Tissue Pre- served in Alcohol 393 The Action of Arsenic on the Bone- Marrow of Man and Animals 119 The Cause of Epileptic Convulsions ..395 The Cure of Diabetes 399 The Early Diagnosis of Arterio- sclerosis _ ...- 396 The Genesis of Epilepsy 112 The Heart and the Vasomoter Sys- tem 387 The Musical Equivalent of Epileptic Seizures > 548 The "Psychology" of Jane Cake- bread 552 The Pathology of General Paralysis ...248 The Relation of Fat to Nervous Dis- ease 107 The Remote Effects of Head Injury..39o The Sudden Atrophic Influence of Craniospinal Nerves 107 Traction on the Jaw in Whooping Cough 112 Traumatic Locomotor Ataxia 106 Traumatic Neuroses _ 245 Index. Clinical Psychiatry. An Extraordinary Memory.: 415 On the Relation Between Mental States and the Circulation and Respiration 121 The Psychology of Occupation 264 Neuropathology. Are Disease Germs Normally Harm- less? 561 Case of Pneumococcal Meningitis and Some Records of the Value of the Cytological Examination in Cases of Meningitis 263 Post-Mortem Findings in Landry's Paralysis 401 Report of a Case of Brain Tumor In- volving the Right Lateral Ven- tricle 263 The Brain and Spinal Cord in Hered- itary Ataxia 403 The Etiolgy of Sleeping Sickness 261 Neurophysiology. Does Body Make Brain? 559 Nerve Regeneration 251 Ramon y Cajal's Morphologic Units Reaffirmed 560 Subcortical Expressive Reflexes 561 The Ethics of Eating 251 The Influence of Milking Upon the Quantity and Quality of Milk 557 Neurosurgery. Anastomosis of the Facial and Acces- sory Nerves '. 127 Glycosuria and Diseases of the Ear...405 Precaution in Operation for Tris Facial Neuralgia 562 Resection of the Cervical Sympa- thetic 261 Trigeminal Neuralgia Treated by In- traneural Injections of Osmic Acid 404 Neurotherapy. A Comparison Between the Medical Uses of the X-Rays and the Rays from the Salts of Radium 253 Adrenalin in General Surgery and Neurology 124 Alcohol in Surgery 408 Analysis of Gluten Flours 253 Best Methods of Counteracting Psy- choses Due to School Strain 125 Cordite Chewing. A New Vice Among Soldiers 126 Dessicated Thyroid in Paralysis Agi- tans 542 Dormiol as a Hypnotic in Mental Diseases 123 Exclusion of Mentally Defective Im- migrants 254 Fatal Iodism ". 539 Human Improvement and Race Con- servation 411 Hydrochloric Acid in Excess 413 Hypodermic Medication in Italy 548 Insomnia 541 London Sewage 411 Lumbar Puncture in Uremia 406 M. Curie's Experiments with Radium Emanations 540 Metal Diseases 407 Nerve Suture and Nerve Regenera- tion 407 New Elixir of Life 257 New Hospitals for the Insane 413 Phosphorus in Psychasthenia 542 Preparatory Course for Nurses' Train- ing Schools 408 Quinin and the Malarial Parasite 255 Radiotherapy Dosage 256 Recreation Piers in New York 410 Successful Treatment of Tetanus 254 The Dietetic Treatment of Diabetes..537 The Etiology and Pathology of Arte- riosclerosis 258 The Intensity of Cholera Amboceptor Formation After Alcoholic In- toxication and Mixed Infections. 259 VI Index. The Thenelles "Sleeper." 414 The Treatment of Serious Effusions..259 The Washing-Out Plan -543 Tinnitis-Aurium 540 Venesection in Opium Poisoning 252 . Psychotherapy. Sin and Dropsy 264 REVIEWS. Saunders' American Year-Book of Medicine and Surgery for 1904 ...266 Subjective Sensations of Sight and Sound 267 Surgery of the Prostate, Pancreas, Diaphragm, Spleen and Hydro- cephalus .....' 569 Surgical Anatomy of the Head and Neck 567 The American Journal of Psychology..132 The American Year-Book of Medi- cine and Surgery for 1904 416 The Doctor's Recreation Series 564 The Journal of Mental Science 418 The Man Who Pleases and the Woman Who Charms 265 The Medical Book News 568 The Perverts 129 The Physician's Visiting List 134 "The Story of New Zealand." 132 The Surgical Treatment of Bright's Disease 565 The Tenth Annual Report 134 The Worth of Words 265 Transactions of the Congress of Amer- ican Physicians and Surgeons .... 133 A Compend of the Practice of Haema- therapy 134 Are VVc to Have a United Medical Profession? 135 Battle and Company's Bacteriological Chart > .133 Clouston on Mental Diseases 568 Contributors to "The Medical Brief"..268 Electro-Diagnosis 133 Epilepsy and Its Treatment 417 How to Attract and Hold an Audi- ence 129 How to Attract and Hold an Audi- ence 268 Iodine and Phosphorus 134 Les Psychoneuroses et Leur Traile- ment Moral 418 Medical Books 569 Pearce on Nervous Diseases 265 Pocket Reference Book 569 Progressive Medicine 131 Progressive Medicine, Vol. I, March, 1904 ...'. 4'8 Radiotherapy and Phototherapy: Ra- dium and High Frequency Cur- rents 566 ^OO*^' THE Alienist and Neurologist. VOL. XXV. ST. LOUIS, FEBRUARY, 1904. No. 1. MIXOSCOPIC ADOLESCENT SURVIVALS IN ART, LITERATURE AND PSEUDO-ETHICS.* By JAS. G. KIERNAN, M. D., CHICAGO. Fellow of the Chicago Academy of Medicine; Honorary Member Chicago Neurological Society; Foreign Associate Member of the French Medico-Psychological Association; Professor of Neurology, Chicago Post-Graduate Medical School. ROUSSEAU early exhibited what he called short-sight- edness, and was treated for this by glasses. His dis- torted study of medicine led him to give it a sexual excess explanation. While there is very little doubt but condi- tions mimicking myopia may be produced in this fashion, it is a very open question whether Rousseau's eye condi- tions were not an expression of his general defect. Exces- sive masturbation, according to Knies.t very often leads to functional disorders of the eye and hyperaemic states of the conjunctiva. The same is true of sexual excess. Con- junctival hyperaemia, weakness of accommodation, weakness • Continued from the Alienist and Neurologist. Vol. xxlv. No. 4. t The Eye in General Diseases. 1 2 Jas. G. Kiernan. of the interni and the common slight narrowing of the field of vision are very frequent symptoms, while tangible ana- tomic changes are hardly ever present. The eye obeys, according to Talbot,* the general law that degeneracy may show itself in the minute change, resulting in disturbance of function or In that producing disease, or finally, in atavism. The defects of the eyes requiring glasses are ex- ceedingly frequent in degenerates and often aggravate their morbidity. Certain of the headaches, Rousseau pictures, were clearly of eye-strain origin. This eye-strain, how- ever, does not in any degree support the wild claims made for its aetiologic influence in paretic dementia and in condi- tions occurring in the hereditarily defective. "Reflex" doc- trinaries have shown exceedingly charlatanish tendencies, and in these few have surpassed the eye-strain magnifiers of their office. A Philadelphia ophthalmologist, a self-con- stituted censor of the profession, has, according to the Med- ical News, lately made a "desperate attempt to attract at- tention to an over-ridden theory by affecting to show that Darwin, Huxley, Carlyle, Wagner and some other celebri- tiest were the victims all their lives to their having ne- glected to correct an alleged eye-strain. Judging from these Biographic Clinics all physiologists, neurologists and clinicians have been in error in considering man anything but an appendix to his eyes." Even aesthetic and scientific deficiencies, according to this ophthalmologist, are due to eye-strain. Carlyle's interest, Garnett! remarks, "in science as in poetry, was solely ethical. If he could connect a scien- tific discovery or hypothesis with what he deemed a truth in religion or morals, he was delighted; if like the Darwin- ian theory, it came in company with an unwelcome con- clusion he was disgusted, but he admits his indifference to even such a hero of research as Faraday, if his discoveries had no visible influence on human conduct or welfare. It was the same with art: cathedral architecture impressed •Degeneracy: lis Signs, Causes aid Effects. t Biographic Clinics. 1 Great Writers: Cariyle. Mixoscopic Adolescent Survivals. 3 him as the incarnation of religious feeling, but his taste in painting was that of any Annandale peasant." This opin- ion, as to the origin of Carlyle deficiencies from his en- vironment and race characteristics (which as I showed over half a decade ago* was exceedingly probable), is scouted by the ophthalmologist, who charges it up to the account of Froude's crimes as a biographer. This error casts a sig- nificant light on the value of "Biographic Clinics" from the standpoint of bibliography. Rousseau early exhibited the mentality of the bour- geois revolutionist who desires to level to his own place, but no further. In this particular the political economy and sociology of Rousseau bear a very close resemblance to those of the modern plutocracy, shop-keeping popula- tion and rural middle class. While Rousseau shows unde- niable traces of the influence of Locke and Hobbes, he con- tinually repudiates his indebtedness. The French revolu- tionists were much deeper students of the literature of the English Puritan revolutionists of 1640 than is usually sus- pected. Just after the deposition of Louis XVI, there ap- peared a French translation of the trial of Charles I. It was unfortunate, however, that Rousseau accepted the con- ception of state domination from the Roman law, rather than the doctrine of individual right, which is a dominant part of the English common law. His "Social Contract" is essentially the conception of Hobbes' Leviathan. While Rousseau, in his Social Contract, is at the outset an evo- lutionist, he becomes a revolutionist, who has no definite knowledge of the rights of the individual. The main positions of Rousseau are, according to Mor- ley.t these: In the state of nature each man lived in entire isolation, and therefore physical inequality was as if it did not exist. After many centuries, accident, in the shape of difference of climate and external natural condi- tions, enforcing for the sake of subsistence some degree of joint labor, led to an increase of communication among men, to a slight development of the reasoning and reflective fac- • Alienist and Neurologist, 1895, t John Moriey: Rousseau. 4 las. G. Kiernan. ulties, and to a rude and simple sense of mutual obligation as a means of greater comfort in the long run. The first state was good and pure, but the second state was truly perfect. It was destroyed by a fresh succession of chances such as the discovery of the arts of metal working and tillage, which led first to the institution of property and second to the prominence of the natural or physical inequalities, which now begin to tell with deadly effectiveness. These inequalities gradually become summed up in the great distinction between rich and poor; and this distinction was finally embodied in the constitution of a civil society, expressly adapted to consecrate the usurpa- tion of the rich and to make the inequality of condition be- tween them and the poor eternal. It has been remarked that the constitution of the United States and the Declaration of Independence owe their origin to the Social Contract of Rousseau. This asser- tion betrays a curious ignorance of the relationships be- tween the American doctrines and those of the Whigs of England, to whom Rousseau owed his inspiration. Locke, remarks Graham, "seems to have influenced most of all the Genevese philosopher. The calm views of the Treatise on Government find their bold, if not logical conclusions, in the impassioned reasoning of the Social Contract. His opinion that there exists a pact between the prince and the people, the breach of which engage- ment on the part of the prince justifies rebellion, became the orthodox Whig creed, and was formally accepted by Parliament when it declared that James II had tried to subvert the constitution by breaking the original contract. The doctrine of passive obedience in England was shaken by the Revolution which deposed a king. The doctrine of 'divine right' was shaken by the Hanoverian succession, which changed a dynasty, while the staunch supporters of non-resistance were only found amongst High Churchmen like Bishops Kettlewell and Kenn, who called it devoutly the doctrine of the Cross. But in France no events had yet occurred to destroy the old faith; the same dynasty continued associated with all that was greatest in the Mixoscopic Adolescent Survivals. 5 country's history and the faults and vices of the kings no more affected it in the minds of many, than the vices of the popes affected the infallibility of the Papacy. The Gallican Church was keenly monarchical, and the clergy were still in harmony with the opinion of Bossuet, who preached that kings were sacred things, and that even if the rulers were as wolves, the Christians should be as sheep. It remained for Rousseau to change the sedate ar- guments of publicists into a revolutionary explosive and to apply doctrines which had been innocuous in England to deadly effect in France. It is remarkable that the opin- ions which proved most destructive across the Channel were imported from this country, where they were harm- less. The free-thinking of Chubb, Toland and Tindall, which only met with hot argument from the clergy and cool indifference from the laity, when adopted by men like Voltaire, helped to sap the faith of society and the institu- tions of the French people. The political opinions of Locke and Sydney, which had only served quietly to de- pose a king when adopted by men like Rousseau, went to overturn ruthlessly the whole constitution of France." As has been pointed out by Macaulay, however, revo- lutions in the English speaking countries are preservative, rather than destructive, since despite all retrogressive in- fluences the revolution has proceeded along the lines of the English common law, recognizing that the rights of one in- dividual extend as far as the right of another begins, and no further. Had Charles 1 and James 11 succeeded, the revolutions in England would have been as radical as those of France. As already pointed out, however, Rous- seau fell in with the general current of thought sweeping over France. Here, as elsewhere, his genius, was a result- ant rather than a determining force. The germ of the "Social Contract" was an essay written in response to the prize topic offered in 1749, by the Acad- emy of Dijon: Has the progress of the arts and sciences helped to corrupt or purify morals? Rousseau's description of how this topic affected him illustrates that bourgeois type of mind which aligns the bourgeois with the atavis- 6 Jas. G. Kiernan. tic minds found in the criminal lunatic and savage. In all these, the senile tendency to believe in human degeneracy is marked. "All at once," remarks Rousseau, "I saw another world and became another man. In an instance I felt my head dazzled by a thousand lights, crowds of new ideas presented themselves at once with a force and con- fusion which threw me into inexpressible agitation. I felt my head seized with a giddiness like intoxication, a violent palpitation oppressed me. Unable to breathe walking, I lay down under one of the trees in the avenue and passed half an hour in such agitation that on rising, I saw all the front of my waistcoat moist with my tears, which I had unconsciously shed upon it." The excitement thus pro- duced by a trite topic, fitting in with the ideas of Adamic innocence which Rousseau had imbibed from both his Cal- vinistic and his Catholic training, illustrates how great was the emotional instability existent in him at an early period. The controversy between Rousseau and Diderot, as to which originated Rousseau's method of treating the topic, seems futile when this is remembered. It is very probable, how- ever, that Diderot's suggestion of a paradox gave Rous- seau's style more verve than it would originally have had. Rousseau, however, was guided by the same bourgeois trend of mind in his treatment of the topic, as he was in so many other directions. Moreover, as his Confessions show, he en- tertained a spite against the Paris Academy of Science for the treatment of his essay on music, to which reference has already been made. In an egocentric mind like that of Rousseau, this would tend to depreciate science and to show that it was degenerating. Like all mixoscopists, Rousseau declined to see the evil in the past in order to enjoy from a fancied contrast, the peculiar coarseness of the present. Graham supposes with considerable plausibility that both stories as to the origin of the essay were one- sided, and that both friends were of opinion that to argue the paradoxical theory was the best course—Rousseau from sentiment, Diderot from ingenuity. Rousseau here found an outlet for his pent up social animosities; an obscure writer, he could speak bitterly of those whose names were Mixoscopic Adolescent Survivals. 7 on every lip; an unscientific man, he could scorn those whose systems of philosophy were filling the world with interest and whose theories gave occasion for endless debate; poor, he scoffed at wealth and its luxury; unpolished, he mocked at the insincerity and affectation of fashionable life; inex- pert and slow of wit, he rebuked the pertness and nimble talk of refined society. He has measured the literary value of his essay when he says that, though full of heat and force, it is devoid of logic and order, and that of all writ- ings, it is the feeblest in reason and poorest in harmony, "for the art of writing is not learnt at once." Indeed, the side it adopts is that which a clever youth in a debating society would take to show his ingenuity, and then vote against in order to show his good sense. But what invests the Discourse with interest is the fact that it contains the germ of the doctrine of all his after writings, and reveals the whole character of the man with all his violence against hereditary customs and social distinctions and restraints. The essay illustrates how much the platitude sways the bourgeois mind, even in an revolutionary. (To be continued.) THE LIFE AND HEALTH OF OUR GIRLS IN RELATION TO THEIR FUTURE.* By JAMES H. MCBRIDE, M. D., LOS ANGELES, CAL. THE first need of life is a good physique. Whether one's work is in the field, or the college, or the home, health, vigor, and endurance determine the amount and quality of it. Whatever a few sickly geniuses may have accom- plished, the average man or woman needs the physical capital of a sound body. Though the world's work is increasingly mental work, the tests of efficiency being more and more mental tests, there was never a time when physical robustness counted for more than at the present day. The mind has had exclusive attention in systems of education. They have dwelt with nothing but the intel- lect. We are now beginning to recognize the importance of the body in the intellectual scheme, and of the brain in re- lation to the body, and of the mind as the supreme func- tion of the body. Life is a conflict, and its vigor, harmony and achieve- ment come of this. Agencies within the body and without are working against survival and tend to lessen life or de- stroy it. If the defenses of the body against disease were abandoned for a day, we should die. Our destruction would also be certain, though slower, if the higher contests of life were abated. Conflict is the price of existence. Life of the right sort consists in doing things, in overcom- •Read before the Amercan Academy of Medicine. Washington. D. C., May 11.1903. 8 The Life and Health of Our Girls. 9 ing. This requires robust qualities of mind and body, and these express the energy that days and years have devel- oped and compacted into structure. From childhood to ma- turity we are determining the quality of health and char- acter. At every stage of life we are what our past has made us. The brain is the organ of thought, but the entire body is concerned in the mental functions. This is so because at every step in the evolution of the organism from lower life, with every addition to the nervous mechanism, there were corresponding new connections of brain and body in ever increasing complexity. All ages of life have gone to this. All relations, all experiences, all conflicts, tragedies, triumphs, and failures, all survivals of individuals and of function went to the making of these relations that life ex- hibits. The inter-dependence of brain and body is a primary fact of life, and a common-place of physiological psychology. The solidarity of the organism is shown in the relation be- tween the size of the heart and brain. It is not probable that any part of the body functionates without influencing the brain. If a limb is amputated in early life, the nerve cells of the center controlling it will not develop well. If the muscles of one arm are developed by exercise, the other arm grows stronger. If one hand gains in skill by special exercise, the other gains in a regular and measurable proportion. Mosso has shown that during mental effort blood leaves the extremities and flows toward the brain. We seem to think to our finger ends. The one thing more than any other that has dominated man's life and made him what he is, is action. The re- sults of action were woven into the fabric of man's brain by the experiences of countless generations of ancestors. In the primitive man, thought always expressed action; it was out of the necessities of action that thought came into existence. Our thinking has in it a muscular or motor ele- ment. It recapitulates those primitive motor co-ordinations that were in the making of it. It is not difficult to see that the athlete's actions are /■ 10 James H. McBride. the expressions of his thoughts. The connection is famil- iar. It is a like truth and a larger one that all thinking, even the reasoning of the philosopher, has in it a sub- conscious rehearsal of old motor associations, through which thought came into existence; ancestors laid the foundation in their motor thinking for all the fine reasoning of their wise and spectacled descendant. In the primitive man the motor relationships of thought were simpler; in the more highly developed, height upon height has been reared for more complex reasoning, and yet the motor element is still there, though it is veiled and takes place in invisible physiologic pantomime. Stanley Hull says, "We think in terms of muscular action." With all mental processes there is this motor filiation, and as thought succeeds thought a thousand actions of the body are gone through with in physiologic short-hand. An educational system should have two main objects: First, to make a sound and healthy body; second, the formation of character through mental and moral discipline. As all character comes of moral experiment, so the efficient body comes of experiment in doing things, in all possible discipline that gives the body strength, symmetry, poise. The Greeks were wiser than we. They saw that the proper foundation for mental training was training of the body. In our system of education we have heretofore worked at the top and neglected the foundation. In our strenuous preoccupation with the mind we have forgotten the body. Dr. D. A. Sargent, of Harvard, says concerning the ne- glect of physical training in our public schools: "There is not a single exercise in the school curriculum that requires them to lift their hands above their heads, or to use their hands and fingers, except to turn a page or thumb a piece of chalk." Again he says: "Under such conditions, with no attempt made at classification according to physical needs, with everyone doing the same thing, without any moral enthusiasm on the part of the teacher, without hope of approval or reward on the part of the pupil, without even the inspiring strains of music to relieve the monotony, The Life and Health of Our Girls. 11 our public-school children are put through what some per- sons call educational gymnastics.*" There are evidences of an awakening interest in this country in the physical side of child life. Gymnasiums are now in use in the public schools in a number of our cities, though relatively the number is small. It is a most gratifying sign also that our colleges and universities have gymnasiums with skilled directors, and, in the colleges for young women, special attention is now directed to the physical development of the students. The proportion of young people who go to colleges and universities is, however, a mere fraction. The vast major- ity of our young people never even go to a high school, nor is anything whatever done with a view to physical de- velopment. We leave their bodies to the caprices of natural activity and the chances of occupation. Much of those old constructive forces that belonged to the virile life of primitive man, forces that were packed into every fibre by ages of harsh experience, that were majestic in their power and still potential in every child as a splendid physical capital, are not utilized by our methods. In regard to the life of young women, we are liable to be misled into thinking that more of them have an inter- est in outdoor life and sports than is the case. The young women who play golf and tennis are relatively conspicuous, and when we see them we congratulate ourselves and are inclined to brag a little because of the growing fondness of young women for out-door life. We forget their obscure sisters, the great majority of girls and young women who rarely or never play tennis or basket-ball or golf. Those who engage in these or any out-door sports are a mere fraction of the total number. Unfortunately these latter, in common with the others, almost universally wear the con- ventional style of dress, that is, they compress their bodies with unyielding garments, and they will, of course, have the usual proportion of weak muscles and displaced organs. Physicians alone know how much misery is caused by the unhygienic dress of women. That all protests have in •American Physical Educational Review, March 1900. 12 James H. McBride. the past been fruitless might easily have been foreseen. It took epidemics that killed their thousands, not sermons on hygiene, to make men establish quarantine. Health regu- lations have rarely been adopted because of instruction in hygiene,—they have been enforced by the necessity of self-protection. The promise of better health for women from proper dress is quite vague. The classes who illus- trate the advantages of it are not models of form and gracefulness, while the appeal of fashion and the desire to conform and please come of a normal and wholesome in- stinct. It is not probable that women will be greatly in- fluenced in their dress by any appeals made on the ground of health or comfort. Hygienic dress for women will come as they discover that in their new competition with men, just now beginning, they will fall short of the best possible success to the degree that they lack the staying qualities that men have. They will then adopt hygienic dress from necessity. The worst feature of women's dress is the corset. The following is a hint of what it means in the life of women: In an Eastern college* for young women there were 35 in the graduating class. Of these, 19 dressed after hygienic models and wore no corsets; 16 dressed in the usual style. Eighteen of the class took honors, of these 13 wore no corsets. Of the seven who were chosen for Commencement parts, six wore no corsets. Of those who carried off prizes for essays during the year, none wore corsets. Of five chosen for class day orators, four wore no corsets. Query: If the wearing of a single style of dress will make this difference in the lives of young women, and that, too, in their most vigorous and resistive period, how much difference will a score of unhealthy habits make, if persisted in for a lifetime? The vital capital of a generation depends primarily up- on what the parents transmit. A sound constitution may be wrecked by abuse and the offspring be thereby affect- ed unfavorably. The bodily vigor of the parent, which is largely under individual control, influences offspring quite •Dr. Lucy M. Halt. in Outlook. Tlie Life and Health of Our Girls. 13 as much as the inborn parental qualities that are inherit- able. The first demand of parenthood is health. A strong and robust body may battle successfully against a bad heredity. If men and women would live as they ought to live for a few generations, half the morbid heredity would be eliminated. This is a capital fact in the possible im- provement of the race. The effort of society should be to make men and women of this day physically sound, and ultimately make the race so. Heredity, which is the most important single-factor of life, would then always work toward racial betterment. As it is now, if all disease and crime were swept away, mankind is living so badly that the crop of the diseased and criminal would soon be large again. The inheritance of both health and disease has generally had obscure beginnings and far-off relationships. The insanity of today is in its genesis largely an affair of the previous generation and others farther back. Influ- ences that weakened the vital resistances of ancestors sent into the world unstable brains that were unequal to the adverse conditions of life. The heredity of each one is complex and infinite. Ages upon ages of human expe- rience, with their strength and their weakness, are packed into our bodies. They act and think and speak in us. We are children of thousands of ancestors whose multiplied lives reach back across the centuries. In the deeper, physiological sense the race inheritance is the larger. The common impression that play develops the body sufficiently is an error. Play is the natural language of the growing body, and is vitally important to children. It has the advantage of furnishing the greatest amount of ex- ercise witii the least expenditure of mental effort. It ap- peals especially to the automatisms, and so while it exer- cises, it diverts and rests. Play, however, does not sup- ply all the training that is demanded. Neither does work. Work is excellent, not alone because it does in some measure promote development, but because it has in it a moral discipline. It cannot supply alone a certain kind of discipline that is needed. The gymnasium of the garden and field has helped to give robustness to generations, but 14 James H. McBride. it develops the body unequally. Neither does it supply the finer and more accurate muscular adjustments, with the associated mental drill that special training supplies. Life demands this special training more and more as social or- ganization increases in complexity, both in its intellectual and industrial relations. There is no more profitable drill than that which is obtained in this way. Attention, alert- ness, interest, courage, quickness of decision, the larger forces of character are here being made in the individual as by a ruder training they were made in the race. Awkwardness, lack of skill in doing things is waste. Accuracy, ease, gracefulness are economies. Special train- ing of the body brings the power of self-control in action— an important matter in character making. To do things speedily and accurately, to do them in one way and that the best, this is self-control of a high order. Self-control does not consist in keeping still. It consists in that wise self-direction that men of action show, and that makes their lives significant. No girl should be allowed to grow up without special physical training. This should be supplied when the body is growing and the physiological habits are being establish- ed. If the body is not made strong and is not well de- veloped before 20, it will not be after that time. The size of the muscles is determined during the growing period, as is the skill in using them. Special exercise, in later life may develop temporarily neglected muscles, but as soon as the exercises are abandoned they will return to their former size. If they are well developed during the grow- ing period, the larger size is a permanency, and the vigor that goes with this means not only physical capital, but a mental resource. There is no more important fact relative to the life work than that all activities of the body tend to develop the brain and the mental power as well. Child play and games, the romp and frolic of boys and girls, and all games of skill involve those primary coordinations that are racial in origin, and that are a preparation for the higher and more complex coordinations of later life. Every game well The Life and Health of Our Girls. 15 learned, every kind of work involving skill that is well mastered, means new brain structure brought into activity that serves as a foundation for mental acquisition later. Every game that a boy learns makes a smarter boy of him if he utilizes the skill for the best purposes. Girls need not play all the games that boys do, but there is no reason why they should not be as robust as boys, and no reason why they should not have the physical training that makes strong bodies. I am now directing the physical training of a little girl of 12. She is most active and has never been seriously ill. Her tastes are for out-door life, and they have been encouraged. She climbs trees, runs over the hills, hunts flowers and insects, studies birds and loves nature. She is thoroughly healthy in mind and body. When I examined her at 11 years of age, 1 found that her trunk and arm muscles were mere bands. They were certainly a poor re- port of her activities. She is now taking systematic train- ing. She does not inherit large muscles, and there will be no attempt to make an athlete of her. To do this would be to rob other parts of the body. What she needs is com- pactness and solidity with moderate size and a certain skill- fulness. Her life history will be practically determined by what is done with her body during the next five years. One could easily write a prescription for early invalidism in this child, and have it filled in thousands of homes of the land. Have her wear the conventional dress, crowd her in school and college and neglect her physical develop- ment, and at twenty we have the tragedy. The physical development of girls is not so simple a matter as that of boys, for the girl's body is more complex and the development period has more risk in it. An in- active life is quite as bad for the girl as for the boy, and over-study or stress of any kind is more serious in its con- sequences for the growing girl. Girls learn quite as fast as boys, or even faster, and the effects of over-study are often not apparent until after they have left school. The phrase "over-study" is often mis-used. If adults and children work under proper conditions they rarely are injured by 16 James H. McBride. any amount of mental labor. If men who work with their brains and students who apply their minds intensely would take proper rest, food and exercise, there would be no danger of over-working. When people thus engaged break down in health they should charge their failure to a neglect of the essentials of healthy living. Many young women injure their health in school not because they study too hard, but because they fail to observe a few simple laws of health that could be summarized in a page. A girl of twelve coming under my observation studied hard at school and became morbidly anxious about her studies. She slept little, had almost constant headache, no appetite, was bloodless, emaciated and poorly developed. She was ordered from school for three months, and was required to play out-door games and take much exercise. When school was resumed, her exercise and general hy- giene were carefully directed. In six months she was strong and without an ailment, and now, four years afterwards, she is in perfect health, though she has not missed a day from school. The result showed that she had not studied too hard, but that her physical development had been neglected. The student girl should take active out-door exercise every day, under proper conditions of dress. Girls are liable to over-do at out-door exercise and at gymnastics. This is especially liable to be the case with those who need exercise most. Intelligent direction is necessary for most of them. Mothers who are fearful their daughters will break down from over-study need have no fears if the young women care for their physical life. Systematic and per- sistent exercise out doors will usually insure good health for girls and young women who are studying. A few weeks or months of out-door life or of active training is not suffi- cient. This would be a parody on what should be a life habit, as much as eating and sleeping. Plato provided that two years out of the three from seventeen to twenty— certainly, the best years for study—should be entirely de- voted to the gymnasium. Plato had limitations in his experience, for he had never The Life and Health of Our Girls. 17 ridden on a fast train, nor talked from New York to San Francisco, nor searched for God's stars through modern smoke, but he knew the secret of health and the real source of man's power. He looked to the triumph of life, not to the petty victory of examination day. We often hear it said that woman's organization is more delicate than man's, but this delicacy is partly if not wholly the work of civilization. Centuries of repression and hin- drance, of hobbling and swaddling have gone to the making of her physical frailty, what there is of it. We admire the frail type of beauty with its appealing suggestions of dependence. The Amazonian mother whose hardy prog- eny will be the captains of the next generation draws no eye. Considering that civilization tends to refine away feminine vigor, and that there are yet many women who are physically strong, shows what miracles nature can work, and it certainly is a prophesy for racial betterment. In the wild state woman shows no serious physical frailty. She carries the burdens of the tribe, and her fiber is as tough as that of man. We need have no fear of the fate of the race if the living are kept healthy. Here as elsewhere, quality is more important than quantity. Through the law of the survival of the fittest, there comes ultimately the survival of the best. In nature's large economy, it is surely true that the race that becomes extinct deserves its fate. The building of a strong body with the establishment of good health means to achieve that which runs through all normal life, good physiological habit. All life is in last analysis, habit; there are not only habits of mind, but habits of body, over which we have but indirect control. The functional life of any organ tends to repeat itself, and this repetition is habit. If by a wise way of living one has established the best possible functional life in the organs, this becomes the standard for the body and the energies are on a level with the physiologic habits that have thus been formed. Doctors know how easy it is to set up morbid, grumbling habits in some organ or organs, that may continue for years or even a lifetime. Every part of the body has a 18 James H. McBride. certain capacity to resist disease or unfavorable conditions, and if this resistance is once broken down by some neglect or disorder of any particular organ, the vital capacity of that part is ever after of an imperfect kind. Half our work as doctors is in treating disorders that are the result of some part of the system having been injured by sickness or neglect, and which ever after is an invalid organ, drawing a heavy pension from the system for its disability. The systematic physical activity and the good personal hygiene in early life that go to make one strong have also the advantage that these practices become life habits that cannot be broken without discomfort. The desire for healthy exercise becomes a kind of hunger of the body that must be satisfied. There are very many people who from lack of good phys- ical development live always on a lower plane than would otherwise have been the case. They are not sick,—they are simply less alive than they ought to be. Their physical development was never properly completed, and the func- tions of the body have never realized their full capacity. All the achievement of men and women is based largely upon capacity for sustained exertion. To be capable of this, one needs a body that from proper drill in the formative period of life has the habit of energetic and swift response to demands. A poorly developed body means less work and an inferior quality of work, less courage, less persist- ence. It means in some cases, to put among the common places a career that with robust health might have risen to great achievement. Boys are better developed than girls because they lead more active lives than girls. There is no reason why a boy should be physically more active than a girl. There is no reason why the man should be better developed physically than the woman. Our methods should produce the best possible development of both. The animal enjoyment a boy finds after a day in school in wild, rough play puts fresh life into him and new thoughts into his head; while the girl, early impressed with a sense of the importance of decorum and with the ghost The Life and Health of Our Girls. 19 of propriety ever before her, goes home quietly, and the studies of the day still recurring in the tired brain like an echo, her mind is occupied by them in spite of herself. Study pursued under such circumstances may be ruinously harmful, when the same amount might do little or no harm, if done with proper regard to the necessity for exercise and diversion. There is very much in the life of young women of the present time that tends to arrest the development and re- sult in the lowering of the life capacity. They get through girlhood successfully, but the stress of married life or in- dependent employment is too much for their frail bodies and they become invalids or semi-invalids, capable of en- during little, doing little or enjoying little, and spend their lives on the border land of the physically necessitous. The girls of the present day, who are brought up under more comfortable conditions than their grandmothers, have gained much, no doubt, in the change of conditions; but they have lost something, in that in many homes there is less of healthy exercise, less of that kind of work that de- veloped the body and also developed simple and healthy tastes. There is, as a result of this, poorer physical de- velopment, less feeling of responsibility in the home on the part of the young ladies, and not so great a sense of duty. When every member of the family had every-day, specific duties, work to do that had to be done, work that exer- cised the body as well as the moral sense in discharging a duty, such life, dreary and harsh as it sometimes was, and often barren of most of those things that we regard as common comforts, had at least the great advantage of pro- viding work that furnished physical exercise, and that was also done under the sense of obligation. There is a moral and physical healthfulness in such a life that goes to the making of strong and simple characters and that puts purity of blood and vigor of constitution into descendants. Many women, in my experience, break down because, or partly because, they have not a certain kind of training fitting them for the responsibilities of life. No young woman should grow up to a marriageable age without hav- 20 James H. McBride. ing been initiated gradually into the work and responsibili- ties that belong to a wife and the keeper of a home. A lack of this kind of training is the cause of much nervous invalidism. One who has grown up without proper train- ing in these matters is more liable to have a distaste for such duties than if she had been taught from girlhood to consider them as a matter of course. New and untried du- ties are always hard, and they are doubly hard if one dis- likes them, for a distaste for work involves ruinous friction. The number of young women who soon after marriage break down from the unexpected strain of new duties is very large. The mother of a young woman who had be- come a nervous invalid within two years after marriage said to me there was no apparent cause for her daughter's illness, as she had been shielded from everything from childhood. This was apparently not because the young lady was delicate, but because an indulgent and unoccupied mother chose to keep her daughter in the condition of a child. The real cause of her trouble was plain enough; she had never known what work or care or responsibility was and the little stress of caring for home made an inva- lid of her. One may well ask why any healthy girl should be shielded. What she needs is not shielding but intelligent and sympathetic direction in work that tends to develop a sense of duty and an exercise of judgment. What is a home for to a young woman, if it is not a school that in some measure anticipates by preparation the later and larger dis- cipline which should come to all, a school from which she is graduated into the sober and exigent realities of woman- hood? Why, indeed, should any one be shielded? Were Maria Mitchell and Lucretia Mott shielded? Were our grandmothers, who lived simple and toilsome lives prepared therefor by being shielded? Was it ever the case any- where that a person who had been shielded grew to be a forceful character or proved a success in presence of the swift and onerous demands of life? Every girl should at least be prepared for the event* The Life and Health of Our Girls. 21 ualities of married life. Not all women marry, but no woman is a loser who has the training that prepares her for all possible responsibilities of womanhood. Whatever tends to develop in woman all the characteristics of woman- hood is an advantage to her. We cannot ignore the fact that there lies in the basis of woman's nature the eternal law of womanhood, and that whatever she may do, what- ever station she may fill, she is none the worse but infi- nitely the better for being a thorough woman. It is worth remarking that happiness depends more largely upon health than people know. Whatever the causes of unhappiness may be in general, 1 believe that im- perfect health, not that which puts one to bed, but that of low vitality and sluggish function which makes endurance unreliable and the performance of tomorrow uncertain, this kind of imperfect health is chargeable with much of the unhappiness that there is in the world. With a desire to get the views of educators and phy- sicians on the subject of the life and health of American girls, 1 recently addressed the following question to 20 phy- sicians, school principals and teachers. "Do you believe that American girls of this generation will be physically stronger than their mothers?" I have only space to quote the reply of Prof. H. E. Kratz, Superintendent of the Schools of Calumet, Michigan. Professor Kratz is an educator of national reputation, one of those who had the insight to recognize early the pri- mary importance of the physical side of the life of school children. He has made careful investigations on this sub- ject and has written articles of permanent value in regard to child growth and health. He says: "Your question is one that cannot be an- swered off-hand, and even then not definitely or positively. There are some things that would indicate that the girls of to-day are not as strong, physically, as their mothers were at their age. 1 believe there is a growing tendency on the part of parents in this country to shield their girls from the hard- ships and severe experiences to which they were exposed. 22 James H. McBride. A mistaken kindness seeks to protect them from all adverse influences. Of course, strong character and strong bodies are not as readily developed under such conditions. I be- lieve there is also an attitude on the part of the boys and girls to demand more from their parents, taking it as their right to escape these severer experiences of life which go to make up strong men and women. There is, therefore, a tendency to hot-house growth, and this will of course neither develop strong bodies or strong minds. On the other hand, we are waking up more to the need of physical training in the public schools, particularly in the cities. The matter is in its infancy, but the time I believe is not far distant when our high schools and at least upper grade schools will all have well-equipped gymnasiums and more careful attention will be paid to the physical devel- opment. Quite a number of the best equipped high schools are already well equipped along these lines, but the great mass of the boys and girls are not yet provided with such physical training as they need. "As the city population is so rapidly increasing in pro- portion to the rural, the necessity is growing greater for better provision in the line of physical training, as in the cities the opportunities for physical training and the limi- ted number of duties which can be imposed upon the chil- dren are a great handicap. "The universities, as you rather intimate, are making, as a rule, excellent provision for physical training, but of course the number of girls in universities is small as com- pared with the large number elsewhere. "On the whole, 1 am rather inclined to the opinion that the girls of today are not as strong physically as their mothers."* •Dr. Mary E. B. Rltter in a paper read before the California State Medical Society in 1903. (rave the results of the examination of 660 freshmen ciriis at the University of the State of California, at Berkeley. Of this number: 176 or 26J4 per cent, are subject to headaches; 193 or 295i per cent, are habltuallyconstlpated; 86 or 13 percent, are subject to indigestion: 3 or V, per cent, had defined tuberculosis; 7 or 9/10 percent, had goitre; 57 or 9 per cent, were markedly anemic: 105 or 16 per cent, had abnormal heart sounds; 62 or 9K per cent, had rapld or Irreguiar puise; 193or295£ were subject to backaches; 443 or 67 per cent, were subject to menstrual disorders; 10 or 1K per cent, gave histories of having broken down in grammar or high school, two from "nervous prostration." in contrast to these figures, 149 or 22 6/10 per cent, reported themselves as free from all aches or pains or functional disturbances. The Life and Health of Our Girls. 23 The overwrought and intense manner of many Ameri- can women is partly due, I suppose, to the contageousness of custom; but it is also due to jerky and imperfect co-or- dination of undeveloped muscles and over-sensitive nerve centers. Well-developed and vigorous nerve centers com- mand the muscles to orderly, smooth and graceful move- ment, whereas those not so developed leave the muscles to ill-regulated and haphazard action. This is made worse when one falls into the too common American habit of fictitious animation, stilted attitudes of mind and body, and artificial and fussy manners that arouse tense, cramp-like muscular states that are wastefully exhausting, so that gripped hands, scowling features, anxious eyes, irregular movements leak away the energy as fast as it accumulates. Many women seem to think that interest calls for a display of intensity, eagerness and affectation of excitement. They are vastly mistaken. Healthy interest is quiet mannered; it is low voiced; it demands no fuss; it involves no strain. Our intense and hurried American life which indicates mental tension and unhealthy excitement can be cured by cultivating composure and stopping our high-pressure methods of doing things. The greatest need for healthy human lives is plain, simple, and homely interests. Those who do not have them lack an essential condition of sound character. The interests of American women are too often mere excitements, and these are always unhealthy. They are unfavorable to quiet . and systematic living and lead to selfishness and discontent. I believe much of the poor health of women is due to their habits of excitement. They lose thereby the nack of taking things with composure and self-restraint; the most ordinary occurrences stir up an in- tensity of feeling and a certain amount of mental tension that are uncalled for and are unhealthy. The woman who is thoroughly healthy lives a frictionless and a fuller life; she is cheerful, she is satisfied with those simple and homely things upon which the most of happiness and the healthier happiness depends. She is more charitable, she has more faith in life and more confidence in human 24 James H. McBride. nature. She does not "endlessly question whether she has done just the right thing." She does not make her con- sciousness a reception hospital for wounded feelings, and in seeing things in just proportion she distinguishes be- tween the occurrences of moment and the trival incidents of life. We Americans, both men and women, have too much self-consciousness; we are over-anxious about appearances and effects; our dash and intensity and eagerness are arti- ficial and wasteful. Healthy mindedness is outwardminded- ness; it is forgetful of self in a quiet interest in things to be quietly done. It means that calmness, not excitement, indicates strength; that force of character is not shown by haste, but rather by deliberateness; not how speedy, but how carefully; not how much, but how well. There is too much eagerness and fussy restlessness in our life. Expression is entirely out of proportion to im- pression. Though the greater part of life consists in doing something, it does not follow that we should be forever on the run. The work of life is not wholly in action. Self- restraint, calmness, a certain repose have a large share in the enterprise. In all physiologic processes, there is a certain amount of energy put by as a reserve. If this were not so, every action or every thought would leave us bankrupt of vitality. If we are to have proper self-direction and concentra- tion of effort, there must be structures and centers that are resting, having reserves of unused energy. Through this comes self-direction and restraint of tendencies and im- pulses. In the healthy and well developed body, uncon- scious restraints are always being applied in order that irregular action and waste be prevented. Those who fail here wear too much expression in their faces, and are rest- less and anxious-minded. They scatter their energies in useless muscular tensions and in ill-regulation of thought and action. One often sees in plain country folk a calm- ness of expression and a quiet manner that is in beautiful and restful contrast to the knit brows and eager manner of the city resident. The Life and Health of Our Girls. 25 To insist upon the completest womanhood is not to demand that every woman should marry. The idea that woman's only function was that of reproduction was prim- itive; it was a belated survival of the period of the tent- and the war club. There are other things for many women besides marriage and maternity. There is no danger of race extinction; Nature has taken out insurance against that. The problem is not to get more people—it is rather to improve those we have, and leave room also for those who come after us to live better and ampler lives. The cry for more people and dense populations is animal and material. Is not the strug- gle already hard enough and bitter enough? Do we want more of the necessitous; more mothers weary and worn with grinding toil, more stunted children, more fathers heart-sick and hopeless with the fight of poverty? It will, however, always remain true that the one, best work for most women will be in the home, wheie as wives and mothers they will have the making of men and the shap- ing of men's destiny. Though there are other worthy aspirations that woman may have, there are none higher than this. No oratory that she can pronounce, no pictures that she can paint, and no books that she can write, ex- ceed in worth to the world a life like this. By leaving her impress upon her children, she lives again in them and in their descendants, and in them too she carries forward the ideals and perpetuates the great traditions of the race. OUTLINES OF PSYCHIATRY IN CLINICAL LECTURES.* BY DR. C. WERNICKE, Professor in Bresiau.t LECTURE TWENTY-SEVEN. Chronic and protracted alcoholic delirium. The polyneuritic psychoses. Presbyophrenia. A case of acute asymbollc allopsychosis. THAT after awaking from the critical sleep of alcoholic delirium, a paranoiac stage of short duration is often ob- served, 1 have already stated. It rarely lasts longer than a few hours, or two days at the most, and is amply char- acterized by the persistence of the defective orientation and falsification of consciousness, the belief in the reality of the dream-like experiences passed through. Still exceptionally after the sleep a condition corresponding essentially to this paranoiac stage may persist for weeks and months and even longer, cases which have been termed chronic alco- holic delirium.X Chronic alcoholic delirium is either de- veloped from acute delirium tremens in the way described, or the latter has not occurred in pronounced form, but only repeatedly abortive attacks of the corresponding condition, which are limited to shorter intervals, a few hours and even less. But an initial stage of decidedly longer dura- ation, to which more or less numerous traces of acute de- lirium are combined, seems never to be wholly wanting in •Continued from Alienist and Nturologist, Vol. xxlv. No. 4. tEngiiih by Dr. W.Alfred McCorn. Supt. Elizabeth General Hospltal. Elizabeth. N.J. JA few examples from my Clinic have been reported by E. Klefer, Diss, laaug. Bres- iau. 18*0. 26 Outlines of Psychiatry in Clinical Lectures. 27 the cases of chronic alcoholic delirium. Besides, the chronic state of these cases presents certain additions, which are to be charged to the alcoholic degeneration. These are the very marked loss of the ability to attend with relatively well retained memory pictures, a thus induced disorienta- tion in respect to the relations of time and the occurrence of confabulations, either that these are communicated spon- taneously, or that they seem to be wholly invented by the patient for the completion of noticeable memory defects with respect to the immediate past. That the acute symp- toms of false sensations and the motor restlessness and insomnia thus arising are wanting in this chronic delirium, has already been emphasized. Termination of chronic alcoholic delirium in recovery is possible, if the patient's general condition can be improved, and, by continued abstinence, the other signs of cachexia and degeneration. If this favorable result is not attained, then a dementia with progressive impairment of memory and gradual loss of initiative occurs. Protracted delirium tremens, curable in itself, where the acute symptoms of combined false sensations and the mo- tor restlessness may often continue many weeks, is to be differentiated from chronic delirium. Usually some debil- itating factor, as e. g. chronic suppuration, tuberculous processes in the bones, chronic pulmonary tuberculosis or cirrhosis of the liver may be ascertained to be the cause of such a protracted course. The other termination of this protracted delirium is often death, as seen from these examples, in consequence of the fundamental exhausting disease. Protracted delirium may form transitions to inani- tion delirium so-called, but is still to be differentiated from it usually. Acquaintance with chronic delirium tremens puts us in position to know two other well characterized disease types, without my presenting examples of them. It will be suffi- cient to remind you of previous demonstrations. You re- member Mrs. S., a tailor's wife, 41 years old, I presented some time ago as an example of polyneuritic psychosis, who had to be brought in on a bed, because she was unable to 28 C. Wernicke. walk owing to an atrophic paralysis of the legs of a poly- neuritic nature. Her physical condition was easily ascer- tained, because she appeared perfectly natural and attentive, and her attention by determination of the range of sensation revealed a normal condition. A combination of the four psychotic symptoms familiar to us was then the more conspicuous. The first was the allopsychical dis- orientation: the patient had no idea where she was, she believed she was with a former employer in the country as a make-shift, on looking out of the window to recognize the spires of the neighboring city of R., mistook me for the family physician, the accompanying fellow patient for the chambermaid, the assistant physician for the son of her employer; she regarded the present occasion a legal pro- ceeding in which she would be sworn, she fancied she recognized court officials from R., in the audience and a number of her youthful acquaintances. Still she at once correctly recognized all other concrete things and objects. The second symptom was an extremely conspicuous impair- ment of the ability to attend. The patient at once forgot what she had just said; a number of three units, a foreign sounding word, which she should retain, she had forgotten after the interjection of a short question, and if still further time was let elapse, she had forgotten that such a state- ment had been made. An ophthalmoscope—an instrument unfamiliar to her—she considered after a short time with the same interest as at first and claimed never to have seen it before. Accordingly she did not know how she had reached the auditorium, that she had been carried up two floors, and she did not know the time of day or whether she had eaten her dinner or not. But she considered it very possible that she had, for she was not hungry. When I asked her what she had done yesterday, she said she would have to think, but then told with all definiteness and detail of an excursion with her employer's family to a brewery and park in a neighboring village. She also told of various events of the preceding days. She definitely remembered of having put the children to bed the evening before. She had been sixteen years with this employer Outlines of Psychiatry in Clinical Lectures. 29 and gone away occasionally because the gentleman had been dissatisfied with her personnel and she had not been able to help her husband when unoccupied. We here find the third conspicuous symptom, that of confabulation or additive false memory. You remember 1 referred to the connection of this symptom with memory defects. But the extent of this memory defect was surprising, for it extended far beyond the time of the acute disease and back years. Hence, there was no possible doubt that such an absolute defect existed, and this was the most strikingly shown, when 1 called the patient's attention to the paralysis of her legs and the contradiction that she claimed to have taken a long walk yesterday. The origin of this paralysis was a complete enigma to her. As you will remember, 1 called attention to the fact that such a loss of memory for the time of the disease, i. e., for the duration of the inability to attend, seems readily comprehensible*, but that a so-called retroactive amnesiat was demonstrable in our case. The patient be- lieved she lived in R., as before, while she had moved to Breslau with her husband some years ago. She well re- membered her marriage and the friendly relations with her former employer, which she had kept up from R. She also correctly gave all other data of her earlier life. It was easily proven that she had retained as much of her school knowledge as could be expected of people of her station and age. She was incapable of all mental arithmetic, for, in spite of her possession of the multiplication table she always forgot the number, but on paper she could correctly solve examples with numbers of several units. With respect to the history of the origin of the case, we had learned that the woman appearing ill and almost waxy pale at the time of the presentation, had had fre- quent uterine hemorrhages for six months. An especially severe hemorrhage four weeks ago had preceded the acute onset or her disease. Previously, a weakness of the legs had gradually appeared, with pains and paresthesia. Of •See Alienist and Neurologist. Vol. XX, p. 542. tSee Alienist end Neurologist. Vol. XX, p. 380. 30 C. Wernicke. the mental disorder beginning very acutely we have only an imperfect report, according to which paroxysmal delirious conditions, especially at night, also paroxysmal frenzy may have existed. With us, the patient only the first day had an intense motor restlessness (with simultaneous mutism). Then the condition developed, which 1 could show you and continued almost unchanged for months, but still had grad- ually resulted in a passable resolution, for the patient could be discharged improved after six months. With respect to the etiology of the case, we had placed the chief weight on the patient's repeated hemorrhages. Not only the anamnesis and the patient's appearance indi- cated this, but the blood examination, for we could only find 55% of haemoglobin (by Gowers' method). But we have later learned from the patient's own statements, that during the last two years she had drank a great deal of Bavarian beer, and recently brandy and whiskey in large amounts. As you see it is here a matter of form of disease to which certain defect symptoms are added in spite of its acute origin. I mean the loss of the ability to attend and the retroactive amnesia, the severe impairment of memory. Still actual dementia cannot well be spoken of, unless vio- lence is done to this concept. The animated face, the at- tentive manner, the well retained attention are evidences in this respect. Nevertheless, the existing defect well explains why no trace or perplexity was present, in evident opposi- tion to the marked allopsychical disorientation. Only a paroxysm of anxiety readily comprehensible on the occasion of the clinical presentation may be disclosed by miscon- ception of the situation, as a court room. Likewise, the wholly affectless, apathetic and disinterested conduct of the patient on the ward indicates a certain mental defect. It only remains to say a few words as to the acute on- set of the disease. In our case sufficient data are wanting, and if we judge from our own observations, the typical disease type of a hyperkinetic motility psychoses had pre- ceded. But it seems", according to other experiences with analogous cases, as if very often a sort of dazed condition Outlines of Psychiatry in Clinical Lectures. 31 with motor restlessness and hallucinations, which most re- semble delirium tremens, but without having its typical course, then a delirious stage in the acute disease is pres- ent, followed by the more chronic state described of very much longer duration. This always declines gradually. In my opinion, this latter stage in its specific composition is characteristic and decisive for the diagnosis from the defi- nitely comprehensible symptoms described. With respect to the polyneuritic symptoms of the disease, in our case they were very pronounced and had caused a total inabil- ity to stand and walk. The paralysis was flaccid, the re- flexes absent, the muscles everywhere very sensitive to pressure, the quadriceps and peroneus muscles were espec- ially affected on both sides. In most of the muscles affected reaction of degeneration existed and a marked blunting of the faradic excitability universal. The sensi- bility was very distinctly affected in the terminal members and the sense of position especially implicated. On dis- charge, restitution was so far advanced that the patient could stand and walk without support. The picture of polyneuritis is not always so pronounced as in our case, it is very common that only a diffuse wasting of the muscles, a slight blunting of the faradic excitability and tendon reflexes, a slight sensitiveness to pressure of the muscles and a tendency to spasm exist. Indeed, in other cases the polyneuritis, from whence the name is de- rived, is wholly wanting in the existing psychosis, a point to which 1 will return. If for the present we adhere to the disease concept of the polyneuritic psychosis, its prog- nosis, in case the etiological factor is removed may be said in general to be favorable. The large majority of cases terminate in resolution, if very slowly. Still a part of the cases end fatally in a few weeks. Without doubt this course depends on the kind of etiological factor, and in this respect alcohol seems to take a relatively favorable position. It here seems to behave similarly as in polyneuritis itself, which is the basis of the extremely frequent deleterious disease type of acute ascending or Landry's paralysis. Strange it is that 1 have never seen these severe cases of 32 C. Wernicke. polyneuritis accompanied by polyneuritic psychosis. Besides in the number of cases alcohol takes the first place, then the metallic poisons, lead and arsenic particularly.* 1 have repeatedly called attention to the fact that in psychiatry a connection between the clinical type and the etiology is to be recognized only in so far as definite clin- ical pictures generally follow certain injurious factors, while an exclusive connection of the sort is contradicted by daily experience. So it is with the purely empirical statement given of the disease type of the polyneuritic psychosis. Under this name is comprehended that very diverse per- nicious factors are to be considered etiologically, as is known in polyneuritis. But an eclectic proof of the correct- ness of our position in this question we will leave to per- ceive in the fact, that exactly the same disease type with- out polyneuritis is met with, as I have recently stated. This is particularly true of the delirious form. 1 remember a case of the sort in the wife of a physician, whose child while traveling had fallen out of the car door owing to its being imperfectly fastened, who in her anxiety knew of nothing better to do than jump after it. She sustained a severe head injury and presented after regaining con- sciousness, the typical picture of the delirious form of the polyneuritic psychosis. It was shown by examination that the four symptoms peculiar to the chronic stage were present at the same time. An analogous case, which I still have under treatment, followed a severe surgical opera- tion, a gastro-enterostomy, which of itself was favorable in its course and is now in the convalescent stage. As in these two cases a combination of psychical influences and somatic interferences caused the outbreak of the disease, a part of the cases differentiated as so-called symptomatic or inanition psychosis present the same clinical picture as the polyneuritic psychosis. But the best evidence for our stand- point is the clinical picture of presbyophrenia almost iden- tical with the polyneuritic psychosis. Presbyophrenia is the specific mental disease of senility •Case* of polyneuritic psychoses are Case 17. Heft 1 and Case 9 Heft 2 of the "Krankenvorstelluneen." Outlines of Psychiatry in Clinical Lectures. 33 in the meaning and with the limitation by which we recog- nize an etiological classification of mental disease, i. e. it is met with exclusively in the aged, if it is differentiated from the polyneuritic psychosis, and in many cases no other etiology can be ascertained. Still it represents only an essential portion of the psychoses due to senility. It occurs in two forms like the polyneuritic psychosis, an acute de- lirious and a chronic. The latter may be regarded incur- able after existing for a long time and is composed of the same constituents as the polyneuritic psychosis in the chronic stage above described. You meet with the same symptoms of allopsychical disorientation with perplexity wanting, loss of ability to attend with retained attention, confabulation and retroactive amnesia. But pathological changes in the mental state and especially of two varieties, in that first an euphoria not corresponding to the conditions of the reality, then a choleric mood is added. You remem- ber the two examples I have presented. One was Mrs. H. of 78, who manifested her good health by a certain com- fortable loquacity and, because she considered herself a young girl, presented fits of bashfulness which are very comical at her age. The other, Mrs. K. of 84 you will re- member as a great reviler, who used the most obscene language and accused those about of the worst abuses. It was evidently a matter of confabulated memories on the basis of misinterpreted events and hypochondriacal sensations that both patients had in common, the facial expression, gestures and utterances which must by their energy strengthen the suspicion of senile dementia. The acute or delirious form of presbyophrenia has essentially the same character- istics as the chronic, perhaps with the exception of retro- active amnesia. But besides a moderate degree of motor restlessness, insomnia and periodical hallucinations, visual especially, exist. On the whole it presents the picture of an essentially mild delirium tremens correspondingly pro- longed. I remember a case of the kind in a woman of 76, until then active, in whom the disease terminated so fa- vorably that the patient was able to carry on a very ex- tensive business for many years. The duration of the dis- 34 C. Wernicke. ease in the cases which recover, which often happens, is from four to eight weeks. In other cases it passes im- perceptibly into the chronic form or simple senile demen- tia, which is always the terminal stage of the chronic form. The cases of disease you have become acquainted with have the common characteristic of allopsychical disorienta- tion and therefore deserve the name of acute allopsychosis. Among these acute hallucinosis is rendered prominent by the fact that it is the result of irritation by hallucinations, which in time leads to disorientation, so that the paranoiac stage lets the disorientation stand forth clearly. Whereas, delirium tremens, polyneuritic psychosis and presbyophrenia present allopsychical disorientation from the first as a symptom of defect. With respect to delirium tremens, I re- fer to my previous remarks. With regard to the polyneu- ritic psychosis and presbyophrenia, it might be attempted to ascribe to the two diseases, general loss of ability to attend for explanation of the allopsychical disorientation. That this is not permissible is shown, e. g., by a case of postepileptic allopsychosis*) with well retained ability to attend. Besides, it occasionally occurs that the allopsychi- cal disorientation seemed increased to asymbolia. Thus, I could recently present a second time as asymbolia, a pa- tient who had previously shown the ordinary picture of polyneuritic psychosis.* But an independent asymbolic form of acute allopsychosis occurs, if very rarely, as the following case proves. It is the matter of a teacher, N., of 43, who was admitted to the Clinic February 10th, 1887, and discharged recovered after seven weeks (March 29th). The onset of the disease was very acute, following solici- tous nursing of a patient, and then the death of his wife affected the patient greatly. He was then wholly disor- ientated for a few days and, with vivid hallucinations, wandered about the neighboring villages and was brought to the Clinic by his fellow citizens, bound hand and foot. At the Clinic he was somewhat reticent, gave little and un- •Case 7, of the Krankenvorttellun£en der Psychiater. Kllnik iu Bresiiau. Heft 2. •Case 9, Ibld. Outlines of Psychiatry in Clinical Lectures. 35 willing information and evidently mistook the persons and surroundings. This could not only be inferred from his meagre answers, but chiefly from his conduct. While he could evidently see and hear sufficiently, presented no brain symptoms, had perfect control of his movements, the use of the most common objects seemed wholly unknown to him. He put his head into the bowl, tried to put his pants on like a shirt, did not know how to use knife, fork and spoon. He later learned to recognize the bowl and grasp it with his hands. The affect, in which he was constantly, was that of allopyschical perplexity, and continued of moderate intensity, yet it rendered the thorough examination of his mental condition difficult, for it usually caused the patient to be reticent. Still this much may be claimed with cer- tainty, that traces of aphasia have never been observed in him. From his sporadic answers tt might be considered that the patient retained comprehension of speech for sim- ple questions. With respect to the motor conduct, the con- dition corresponded to a moderate degree of motor restless- ness, but without the addition of real motor symptoms, at most corresponding to the definition of aimless motor im- pulses. Patient tumbled about his bed, assumed the strangest positions, constructed a sort of cage from pieces of his mattress, clung to his shirt, stripped it off, twisted the covers together, etc. It was difficult to get him to leave the bed, probably because this place had gradually become familiar to him. A marked, anxious affect was ob- served only when a change in his position was effected, otherwise only a moderate confused affect or an apathetic mood existed constantly. The patient must be taken up to attend to his bodily requirements, otherwise he soiled him- self, evidently from disorientation. Hallucinations could not be wholly excluded, but certainly were not numerous and in no way the cause of his intermittent motor restlessness. On decline of the symptoms described, the patient became convalescent. ( To be continued.) MEDICAL SCIENCE, THE MEDICAL PROFES- SION, THE STATE AND THE PEOPLE. DR. WILLIAM E. ROGERS MEMORIAL ADDRESS BEFORE THE FACULTY AND ALUMNI OF MEMPHIS HOSPITAL MEDICAL COLLEGE, DELIVERED NOVEMBER 18, 1903. By CHARLES H. HUGHES, M. D., ST. LOUIS. Dean of the Faculty and Professor of Neurology and Psychiatry, Barnes Medical College, St. Louis. GENTLEMEN OF THE FACULTY, MEMBERS OF THE CLASS, LADIES AND GENTLEMEN: I ESTEEM it an exalted pleasure and honor that 1 have been selected to deliver the first of the Memorial Lectures in commemoration of the distinguished and es- teemed Dr. William E. Rogers, whose name and labors in the line of his profession were so long and worthily iden- tified with the welfare of this good portion of the country. He was also known throughout the South, and his name and fame extended further in his day—as far north as the great lakes, south to the southern gulf and to the eastern and western ocean shores and even beyond the Atlantic. In medical annals and in the popular heart his virtues will be cherished, with the memories of the Paul Eves, Henry Campbells, Joseph Jones, Crawford-Longs, Marion-Sims, Claudius Mastins, Hutson Fords, the Stones, the Cart- wrights, the Yandells, the McPheeters, the Dudleys and the McDowells of the Southland; and with the Drakes, the 36 Medical Science, Medical Profession, Etc. 37 Popes,* the Comegys, the Mathews, McMurtrys, Lintons, Hodgens, Frenchs and Stones, not far away from your borders, and Saunders, Erskine, Henning, Simmons, Smythes, Sinclair, Maury, and their colleagues among the older men of this worthy faculty, and with the Mitchells, Thorntons and others of this city. The great edifice of medicine whose outer portals you have passed and within whose area you have entered and are walking onward, is an unwalled and roofless structure of many apartments and all devoted to science. It is open to the heavens of science, to let in the sunlight and reveal the stars of progress in their courses. It is dedicated to the making of men, high-minded men, patriotic, capable men in one of man's greatest of vocations; such men as should constitute the State in these perilous times of venal public service. We walk therein, not so much as our fathers did, in the bewildering twilight and shadow of great truths yet to dawn upon the Medical World, but in the full sunlight of many discoveries which have brought us so near, in the light of Nature's revealing mysteries, that we almost walk in science, as the patriarchs did of old, in spirit, with the Great Jehovah. While, as of old, the Heavens declare the glory and the firmament showeth the hand-work of God, now the once mysterious earth and its atoms, its ions and atmosphere reveal astounding omniscience and omnipotence. Once-hidden things of worth in living and inanimate nature are now brought to light by research of the sciences tributary to our art, have placed us in closer communication and give us clearer perceptions and comprehension of the Great Designer of Cosmos, in relation to the organism and wel- fare of man. Though we look now from Nature up to Nature's God not so far off as our ancestors did, for the sciences which were but nebulous or non-existent in their day, have made the once umbrageous fields of vision full of light in many places, we no longer see as through a glass darkly as they did. We look from Nature's laws and • Dr. Charies A. Pope, founder of the St. Louis Medical College, was born in Aia- bama, and M. L. Linton, of the same school, in Kentucky. 38 Charles H. Hughes. later revelations at this wondrous complicated mechanism of man, and see with an illuminated vision that exalts our wonder, gratitude and powers and increases our responsi- bilities and duty for better, higher, nobler work for the welfare of our fellows. Gentlemen, you have selected no common calling for your life work. Chemistry disintegrates matter till its ultimate com- bining qualities are discovered. These smallest parts of matter which can take part in a chemical change, it has named atoms. The atom is the combining organizing unit of chemistry. The smallest combination of atoms that will form a given compound constitutes the molecule. The smallest particle of matter that can exist separately and yet retain its composition and properties is called, in physics, also, a molecule. The molecule as distinguished from the atom of chemistry is the structural unit of physics. The sensible changes of matter, as evaporation of water into steam or its solidification into ice, or the liquification of air, all bodily contractions by cold or expansions by heat, wherein the chemical composition is not changed but which, under changed conditions of heat or cold, as in the return of steam by the cold condensation to water or ice, or the change of ice by heat expansion into water again, are molecular arrangement changes, but when water is evolved into its component atomic elements, that is, into one ele- ment of oxygen and two of hydrogen gas, the change is atomic. It has been the belief of chemists, for some time, "that most molecules are possessed of a structure. That they are not single, simple, indivisible, minute, insensible masses but consist, themselves, of aggregations of still smaller particles, held together by the operation of some other force." These particles are the atoms already referred to and the force which holds them together into molecules and compounds is called chemical affinity and chemical attraction. To the mind of the chemist such molecules are little systems which are attracted to each other by this particular force; in the ordinary movements of the molecules, the sys- Medical Science, Medical Profession, Etc. 39 tern moves about as a whole. In this respect it bears some analogy, in an infinitely minute scale, to a solar system. The atoms of a molecule are regarded as in a state of motion as respects one another, possibly revolving about one another, while the entire system or molecule, at the same time performs its independent movements, just as in the solar system the various members perform various movements toward each other while, at the same time, the whole system travels upon its prescribed orbit (Newth). But since your best text-books were written chemistry carries us still farther into the arcana of Nature and the ion or electron, a component radical of an atom or mole- cule, a product of electrolitic decomposition, has been added to the nomenclature of those basic sciences of your art, chemistry, biochemistry and electricity, which go along with anatomy, physiology, etc. The anion is the electro negative component of an electrically disintergraded product, brought out at the anodal or positive pole; the kation show- ing at the negative or cathodal pole in electrolysis. The discovery of the ion in connection with the dis- covery of radium has modified the theory of atoms as in- dividual particles of matter, but not as combining elements. Leucippus and Dalton and Avogrado must now step aside while a woman, Madam Curie of France, enters and engages our attention for a moment, along with her hus- band, whom she leads. "Though she bends him, she obeys him; though she draws him, yet she follows." The recent wonderful discovery of radium, the tenth part of a grain of which will illumine a room and color its glass windows violet, greater in size than the cubic space of this platform, if enclosed, for an incomputable time, and an ounce of which has been rather extravagantly estimated to possess the thermal motor force of the world's horse power, has made a woman's name immortal and with the generosity of her sex toward man, she takes her chemist husband, Monsieur Curie, to share in her immortal fame. By this discovery of the Curies, elaborated by Professor Oliver Lodge, and others, the ions or electrons are shown to be related to atoms, as our planet earth and its moon 40 Charles H. Hughes. and their neighboring planets and their moons bear relation to the sun and other planetary systems to our sun. Very curious! is it not? This revolutionary discovery for chemistry and phy- sics is found in pitchblende. And all this has come about through the discovery of one woman in a chemist's laboratory. Of course Madam Curie could not keep it to herself. She told her husband, her husband told the sexton and the sexton tolled the bell which has tolled the knell of the atomic and molecular con- ceptions of matter as we have too narrowly regarded them, as representing ultimate divisions of matter. M. Curie recently showed before the Royal Institute of London that radium spontaneously and continuously disen- gaged heat in such a rapid stream, the ions rotating so rap- idly and violently as to give off a violet light, affecting photo- graphic plates through opaque substances and giving white glass a violet color. This radium radiance and intense ac- tivity has revealed chemistry as the anatomy of the infini- tesimal. The revelation has changed our conception of gravity and the atomic theory. Radio-active energy is a new form of energy brought to our notice through its won- derful action on water and metals. Dr. Brokaw of St. Louis, after eighteen hours exposure to radium produced perfect photographs, equal to the best X-ray pictures. These ions or electrons compose and give to atoms their properties, preside over and determine chemical attrac- tion or affinities and the cohesion and aggregation of atoms into molecules and sensibly perceived masses of matter. The secret of chemical affinity is revealed through our knowledge of the ions. It is computed by these wise men that the ions or electrons hold the fluids and gases together and in their distinctive forms, preside over gravitation and guide the planets in their courses and keep them in their orbits; give earth and sun heat, the sun light, the moon its reflecting light, regulate vegetation and animal life and growth, give the human mind perception, emotion, thought and power, and regulate all intelligence. The mad philosopher of Ben Jonson's Rasselas, who believed he regulated the Medical Science, Medical Profession, Etc. 41 planets and the seasons, never conceived so much in his wildest morbid fancies. Seven hundred ions are computed to make an atom of hydrogen, eleven thousand ions an atom of oxygen, but radium is divisible into thousands and hundreds of thous- ands of ions, life giving, death dealing, heat and light en- gendering, almost beyond our computation and comprehen- sion. Radium rays, like X-rays, are germicidal.* If an atom be so small, as chemistry proves, that no microscopic lens is powerful enough to discern it, what must we think of these infinitesimal ions, so minute that one hundred thousand of them or more make up each of the invisible atoms, that make up the molecules, that make up the neurones or cells and axones and dendrites of the organs of the wondrous organism whose wonderful move- ments, normally regulated and balanced in health, and ab- normally moved and unbalanced in disease, is to be the ob- • Besldes the heat and light rays of radium, it gives out invisible rays of three kinds that have a simiiar velocity and force. Professor Crookes has gravely stated that one gram of these emanations could more than lift the British navy out of the sea. Becquerel knew of the lesser radiant energy of uranium and thorium in 1896. Pitchblende is mostly oxlde of uranium. Six years after, 1902, Madam Currfe extracted a pure radium chlorlde from It. It might appropriately have been called Curium, since not oniy a woman, but a very curious woman, found It, and It promises to be some- thing of a cure-all especially, if the quacks can afford to use it and pay their advertising bilis besldes. I have seen Professor Rutherford, of McGlll University, Impress the electric current by it. 1 have seen him condense Its luminous radiations with liquld air so as to give a beau- tiful emerald hue to a foreign substance, and I have seen, by means of the Crookes splnthariscope, three-fourths of a gram of radium reflected on and from a sulphlde of zinc screen in a dark room, send out radiations, flying like meteors and shooting stars. Radium will make the aqueous and vitreous humor of the eye self-luminous, even though the llds are closed and thick paper covers them. It will Illumine through the lens and retina and reveal cataract or other disease. But the exposure must be very brief, as otherwise blindness may follow, for radium is a destructive agent, destroying to kill or cure, according to the skill with which It is used, like the surgeon's knife or the weapon of the unskilled or reckless quack. It may Improve or destroy animal life, arrest or advance or- ganic development. It has been conjectured that not oniy radium but that uranium and thorium are in the sun. It has aiso been conjectured that thorium and wllltamlte ara products of radium disintegration. The force of gravity and magnetism are afferent, that of radium is efferent. It has recently been discovered in the ores of Utah which furnish Carnotite, containing an oxlde of uranium, vanadium and other oxldes. This will likely cheapen the product so as to give It universal therapeutic use. Thorium, which has sufficient radioactivity to be of therapeutic value simiiar to radium. is found in Nerway, Sweden, Brazil and North Carolina, is marketable at about the price of silver, that is, it is oniy worth Its weight in siiver, while pure radium is worth Its weight in diamonds of the first water. 42 Charles H. Hughes. ject of your life study. As the skilled engineer and mechan- ician regulates, repairs and builds the grosser machin- ery of man's wonderful but less perfect contrivances, you are to regulate and control this wonderful mechanism of man which the great Architect and Builder has designed and fashioned in his image. The light and life of all life and light and heat and color combinations is in these ions, so infinitesimal in size that a hundred thousand of them are computed as necessary to make an invisible atom. This newly discovered force* has given us the new term ionic disintegration. By its means MacKenzie Davidson of London, Gussenbauer of Vienna, have cured epitheliomata. Cancer and blindness have been favorably impressed by it. It has cured lupus and Professor Rutherford, from its re- sult in cutaneous tuberculosis, thinks it ought to destroy pulmonary diseases and eradicate the great white plague from the land. tThe light from one tenth of a grain and four expos- ures were sufficient to disintegrate and destroy these mor- bid growths. Under this brief treatment the skin would slough as from a powerful X-ray. Like musk, valerianate of ammonia, the scent of flowers and other odorous sub- stances, radium loses no appreciable weight during these violent luminous radiations. The germicidal therapeutics of strong white light have entered a new phase since the coming of the Roentgen, the Finsen and the radium ray, and you will utilize them in your practice. Radium is now harnessed to the flying chariot of medical progress and like the X-ray, the N-ray and the • The newly discovered element, radium, according to Dr. Davld T. Day of the De- partment of Mines and Metallurgy at the St. Louis Worid's Fair, will be exhibited as one of the treasures of his department. A small plece of the costly metal, less than a Grain, has been secured from Doctor Curie of Paris, Its discoverer, and will be brought there next year. The exhibit will be made by a private exhibitor, who secured the specimen at a great cost especially for the Worid's Fair. Dr. A. V. L. Brokaw, of St. Louis, and one of your own citizens have aiso working samples. t Radium is destined to take a prominent part in the great awakening for the ex- termination of phthisis pulmonalisi which has now extended beyond the limits of the medical profession, out among the people, who are now organizing for its eradication, as. in the Visiting Nurses' Association, of Chicago, projected open-air municipally pianned sanitaria and the St. Louis Worid's Fair movement for a worid's medico-legal and popu- iar congress on the subject. Medical Science, Medical Profession, Etc. 43 Finsen light, it is henceforth to be at your service, with the other great agencies of our therapy, for the ameliora- tion and eradication of disease and the hygienic welfare of man. You are to include them in your studies and to learn if you can to what extent they may be capable of changing vicious constitutional states and altering neurone activities and effecting blood changes for good or ill to the afflicted. Strange and marvelous is it not that this wondrous agent with its marvellous power and properties should be obtained from uranite or pitchblende or oxide of uranium? It is for you to determine whether this newly dis- covered, marvellous energy of radium is an emanation or a reflection from some other source in Nature. Edison has hinted at the latter. He thinks this wondrous force is "rendered fluorescent from some hitherto unnoticed ether vibration, just as the Roentgen ray and the Herzian wave remained undreamed of for centuries after the phenomena of sound and light and heat were well understood, so it is not only possible but extremely probable," he thinks, "that there are other rays in the immense gamut from sound to ultra violet, not yet discovered." In his experi- ments he says that he has found that "the ordinary elec- tric arc, when raised to an extremely high temperature, gives off a ray which renders the oxalate of lithium highly fluorescent. In the same way the Roentgen ray renders platinum-baryum-cyanide, tungstate of calcium and cupro- cyanide of potassium highly fluorescent." The X-ray develops in these substances a condition of activity which results in the emission of actinic rays with a little heat. He says: "The actinic rays, as you will find from your study of physics, are those rays of the spectrum that are most potent in producing chemic changes, viz: the blue, violet and ultra violet. But radiant energy may effect its chemical changes without light, as radiating heat and the X-ray."* •Sajou's Cyclopedia thus abstracts E. S. London's article on this interesting sub- ject in Klin. Woch.. June 3. 1903. If a plece of sealing wax is actively rubbed with fiannel, it will, as is well known, attract to Itself from a short distance small pleces of paper. If. now. after the sealing wax 44 Charles H. Hughes. We see the effect of radiant energy every day about us in the fading of fabrics, as carpets in parlors, which our mothers, wives and sisters so unwisely, because unhealth- ily, darken, and in the tanning and freckling of the skin, for which they more prudently wear gloves and veils. Edison's conception of radio-activity is that "the rays which radium and other new elements emit are rendered fluorescent by some form of all pervading ether vibration which has not yet been insulated or measured," but the radium discovery appears to have singled it out as similar to, if not identical with electricity, and the term electron would seem an appropriate synonym for ion. The phenomenon of wireless telegraphy would seem to add strength to this view, for what are Marconigrams but the regulated liberations of these electrons or radiating units controlled and sent on their lightning way through ethereal space and recorded by marvellous mechanisms of human invention. We have reached an age when we marvel at nothing. When a grain of musk, after months of exposure perfumes a whole boudoir, yet loses none of its weight, and when the human voice may be conducted thousands of miles on a tiny wire; when a revolving cylinder of wax may catch and record and reproduce that voice and the words it utters, when a stream of invisible force generated by a dynamo and sent along a wire may propel machinery and send us swiftly over rail and space; when atmosphere and gases that enliven or kill and burn and explode, may be evolved has been rubbed with the fiannel, it is passed over the box containing the radium. Its power to attract pleces of paper Is lost. Mammais are killed by exposing them to the radium from a distance. Mice were used, and were piaced in giiasses which were covered with a gauze sheet of zinc. The radium lncl• sed in a box of gutta percha and metal was piaced upon the cover. Such animais died within four or five days, under symptoms of paralysis of the nerve centers, while mice simiiariy confined, but not exposed to the radium, lived and were in healthy condition. Upon the human skin radium thus used exerts an Irritating influence and produces a dermatitis. Arterial blood is darkened in color under the influence of ra- dium rays. The blind who are siightly susceptible to light have this susceptibility much in- creased when radium is brought near to the eves. The blind who have no susceptibility to light do not react to the action of the radium. The blind who can detect indistinct shadows of objects upon a light background, under the action of the radium are enabled much more sharply to outline the objects. Persons with sound eyes, if the same are closed and tightly bandaged, perceive the Il2ht when the radium is brought within ten or fifteen centimeters of their forehead. Microscoplcal examinations may be made in a dark room by means of the radium rays. Medical Science, Medical Profession, Etc. 45 from inert minerals and from the water we drink and the air we breathe; when fulminates that rend forests and shatter cities, may be instantly transformed from quiescent substance and instantaneous destruction immediately follow peace and apparent security. This is the era in which you are entering the greatest of professions. Great forces of nature for good or ill are at your command. Yours is not to destroy, but to repair. That chemistry which can provide so much destruction, gives you also instrumentalities of reconstruction. It gives oxygen, ar»on and ozone and congeals the atmosphere to re- store vitality and the vitalizing iron, phosphorus and lithecenes and other reconstructive products of organic chemistry and the enzymes and peptones to aid, supplant and reconstruct the tired machinery of digestion and assimilation, strychnia and electricity and predigested foods to support, while na- ture works to your hand. It gives you local and general anaesthesia, chloroform, ether, cocaine, codia, morphia, atrophia and the coal tar derivatives to assuage pain; and it gives you chloral, sulphonal, urethan, hyoscine, hyoscia- min, the valerianates, bromides, lacucaria and other agen- cies to tranquilize and promote sleep, that sweet restorer of tired nature which we must often invoke for the ill, the brain-broken, the nerve and soul-weary and the neuroti- cally heavily laden in this strenuous life of brain and heart and mind and nerve-strain. These agencies and a thousand others are your re- sources, to be added to that dernier and potent resource, the knife, when wielded by skilled hand and enlightened diagnostic and other therapeutic skill, are your aids in min- istering to the welfare of your fellows who shall fall physi- cally or mentally maimed in the battle of life and look to you for help. The past decade has given us in neuro-cytology the neurone conception of Ramon y Cajal with its newer and clearer views of the nervous system; with its motor, psy- cho-motor, psychic, sensory, heat, inhibitory, metabolic and other centers. These discoveries give us better views of brains and bodies of life organisms, of the blood's circula- 46 Charles H. Hughes. tion, the air we breathe, the fluids we drink, the foods we eat and all the vital movements of our system and our en- vironment and the conditions of our being. Life is health, and disease is coming, each day by the aid of these reve- lations, to have a broader and deeper significance. We are daily learning more and teaching better, both ourselves and the world, of normal physiological or healthy and of abnormal or unhealthy or pathological life. Dr. Benjamin Rush drafted the principles of the Decla- ration of Independence before Thomas Jefferson embodied them in that immortal document of human rights. Rush went into the first American Congress, taking the place of a more timid gentleman who resigned because there was to be a declaration of independence and war, and Rush signed that declaration, which before Jefferson, he had been instrumental in designing. And after the war was on he found in the American May-apple, out of which our podophyllin is made, that efficient substitute for the mercurials and other coll- ogues, which during the war of the Revolution were not allowed to come into our country. The genius of Rush was equal to the demands of that trying hour, and like Leonard Wood, his medical knowledge enhanced his ability in the other directions where the army's welfare was concerned. And there is William Beaumont, what place had he before the people? Yet see what he did. Neither William Beau- mont, who gave the world exact knowledge of the physiol- ogy and chemistry of digestion, nor Ephriam McDowell, who first showed the world after the Caesarian section how to successfully enter the human abdomen and save life, nor Marion-Sims, who saved the health and lives of thousands of women by perineoraphy and suture, nor G. E. Brown- Sequard, who taught the world a higher neurophysiology, taught the vicarious functions of the cerebral hemispheres and made epilepsy a tractable malady, nor that brilliant surgeon, Paul Eve, of your own state, nor Samuel Gross of Kentucky, nor the accomplished Stone and Cartright of New Orleans, the latter a preceptor of my early days of medical study, nor Crawford-Long, who gave us anaes- thesia, all sons of our sunny southland, and they have Medical Science, Medical Profession, Etc. 47 never received merited popular recognition in monumental memory among the people's immortals. And there are Wells and Morton, both also closely iden- tified with the discovery of anaesthesia and its practical ap- plication to the alleviation of human misery, and Dorothy Dix, the philanthropist, who caused to be built eighteen state hospitals for the insane. I might continue to name scores and hundreds of unrecognized and unhonored men of med- icine at home and in other lands, who are unrecognized as they should be by the public. We of the profession re- member them with gratitute and honor. But why have not the peaple honored them as they ought and as they deserved? Their benefactions on the race have "Fallen like the gentle rain upon the place beneath" and blessed both giver and recipient, but like the hidden providences of the all-provident Provider, the silent bless- ing of our ministration, in hygiene and prophylactic sug- gestion, and in potent sanitary reform and provision for man's welfare, have been accepted thanklessly and often unconsciously by the people. Why is this so? It is not, as you see, because we have not done much for the world. It is because we have not enforced a just recognition of our service to mankind. We have worked and waited and gone unrewarded because we have been silent before the people and let others who have less claims on popular gratitude and reward usurp the place in public esteem that belongs in much larger degree than it has been bestowed, upon the votaries of the true Aesculapean art. The quacks, with a modicum of knowledge and a moiety of brains, who are often only drug clerks or insig- nificant men without conscience and with little or no knowledge, proclaim from the pseudo-scientific side and from the housetops and through the press who are not so cau- tious as they should be, of the harm they do the great- ness of medicine to cure, in manner that ultimately works harm by its failures. The patent medicine and systems of quackery of a decade or two ago are now seldom heard of —newer quack remedies have taken their places. 48 Charles H. Hughes. We are not appreciated as we should because we do not take part enough with the people. We do not talk enough of legitimate medicine and its resources in public places, but let the quacks mislead the people. We retire too much from public contact and from politics and do not seek and fill all the places before the people where medical knowledge and skill and counsel are needed. My advice, therefore, is for you to become thorough physicians by intimate association with each other and then take your proper place among the people. Be fond of your work and study, but be not too exclusive with the people. Encourage the best men among you to become public men and hold office, for the good of the profession and the people and to raise the plane of politics to the high plane of your great and noble profession, whose aim is and has ever been, from the earliest time, the highest welfare of mankind. A public man like a physician who lives in accordance with the oath which the father of medicine administered to his disciples, lives by the decalogue and the Golden Rule.* Hyppocrates was a heathen physician or perhaps an agnostic heathen; he did not believe in the miracles attri- buted to the goddess of health any more than we do in the faith of the faith healers and faddists of our day. But he had a code of moral duty and enjoined it by an oath upon his disciples. Let me enjoin your obedience to it. It is the golden rule of medical ethics and true fellow- ship. While sordid commercialism, now threatening our de- •The Hippocritlc oath was as fallows: "I swear that I will keep this oath and this stipuiation; that I will follow that system of retime which, according to my ability and judgment, I conslder for the benefit of my patients, and abstain from whatever is deleterious and mischievous. "I will five no deadly medicine or suggest any such counsel. "With purity and holiness I will pass my life and practice my art. "Into whatever houses 1 enter will I go for the benefit of the sick, and will abstals from every voluntary act of mischief and corruptions. "Whatever is connected with my professional practice, or not in connection with It. that I see or hear in the lives of men which ought not to be spoken of abroad 1 will ■ot divulge, as reckoning all such should be kept secret. "While I continue to keep this oath invioiate, may It be granted me to enjoy life and the practice of the art respected by all men of all times. But should I trespass and vioiate this oath may the reverse be my lot" Medical Science, Medical Profession, Etc. 49 struction, serves the world "for what there is in it" for the commercialist, forming combines and syndicates and misus- ing and perverting the tariffs for the financial betterment of themselves and the worsting of their fellows, our motto is the welfare of mankind and incidentally our maintenance along with the good of our fellows. Our mission is to up- build and strengthen for the happiness and good of the world. It is a great profession, is it not, with which to cast one's lot in life? It has given the world certain safety from many once devouring diseases. Its beneficence begins with man's life before he goes into the cradle and follows him to the grave. It has secured his safety from smallpox. It has driven the yellow fever almost completely from the land and it is now pointing the way of safety from that great white plague, consumption, and from the Eastern bubonic plague, and from our own scourge, malaria. It has sequestered, and in some instances, cured the leper and found its fatal bacillus. It has taken the fangs out of those serpent diseases, in this audience, unnamable. It has rescued, and is rescuing thousands of victims from death by timely operations upon and within the head and abdomen, nerves and arteries. By antisepsis and anaesthesia it has saved thousands upon thousands. It has mitigated the terrors of typhus, typhoid and phthisis, by showing their causes and avoidance. It has mastered many diseases and caused milder morbid conditions to take the place of others. It stands guard at Castle Garden and other seaports and turns back the diseases of European crime, pauperism, neglect and degeneracy and guards our shores against other pestilences of the old world. It has in a thousand ways made modern life an enduring possibility under the other- wise adverse influence of our too strenuous conditions of existence and other exhausting influences of a too intense, exclusive and morbid commercialism, that have made the mighty dollar the chief aim of living. It has founded or been the inspiration in founding hos- pitals, sanitaria schools and homes for the foundling, the infirm, the aged, the sick, the insane and the feeble- 50 Charles H. Hughes. minded, and devised gymnasia and rest cure resorts for the well that they may not become sick. It has rescued the lunatic from bonds and freed him from his chains and treated him as a sick man and saved him. it has likewise shown inebriety to be a disease and now cures its victims. It has diffused and scattered its blessings so unostenta- tiously, gently and so lavishly among the people and its benefits have been bestowed in so many ways in dispen- saries and charities and hospitals innumerable, wherever the maimed in the battle of life are to be found, that its great beneficence has not been appreciated as it ought, and its power for the welfare of the people not understood and felt as it should. If this is not so why has not a place been made by a grateful people for a medical man in the cabinet of the President of the United States and why has not the statue and face of Benjamin Rush, Surgeon General of the Army of the American Revolution been placed in Helen Gould's Pantheon of great men? Why was not Rush given a place in Washington's cabinet? Washington honored Rush, though Rush did not agree with him politically. Why has not the Surgeon General of the Army and Navy been given a place in the cabinet as well as the Secretary of War, etc.? It has discovered how alcohol, through beverages that contain it, damages the nutrition and integrity of the brain's arteries, distends them by vaso-motor paralysis, thus changing the blood supply and damaging the brains, neu- rones and membranes, as well as harming the liver and stomach, kidneys, etc., and from your teaching and exam- ple the people may learn lessons of caution and temper- ance with regard to the drink that destroys heads and hearts and households and bankrupts lives and minds and shatters commercial and professional credit and destroys manhood and personal honor. It stands, 1 repeat, between the people and the pesti- lences that destroy them and through its patient, pains- taking, courageous endeavors, these plagues are stayed. It walks and works in the wake of devastating armies and Medical Science, Medical Profession, Etc. 51 helps to repair, by enlightened medical and surgical re- source, the ravages of war and to avert them. It watches over camps, where death with its microbic millions revels in human destruction and destroys the messengers of the grim monster, unseen by human eyes, without the lens. It makes the warrior strong on the battlefield and gives him hope in the consciousness that the help of a great and resourceful profession will come to his aid should he fall in battle or by microbic sting, deadlier than the enemy's missive. Wherever danger of disease is, there is the doctor to help and sustain and lift up mankind. 1 do not subscribe to Ella Wheeler Wilcox's vicious poem: "Laugh and the world laughs with you; Weep and you weep alone." etc. This poem is a sarcastic and cynical description of a class. It does not correctly portray our kindly humanity as a whole. Our noble profession in its daily round of clinical duty and in its work of mercy refute it; this in- stitution with its hospital attachment, its worthy faculty and nurses refute it; all the great world's charity and phi- lanthropy, clerical and secular, refute the coldblooded sen- timent, too. The graves of the volunteers in yonder cem- etery who came to help succor the victims of the yellow plague and fell, themselves a prey, refute it, though some of their graves are yet unentombed. A sentiment too coldblooded and cynical to rightly come from the lips of woman, save in cynical sarcasm of a despicable minority in the heartless class only, of the world's many people. Were I to sing an answer, 1 would say: Smile and the world smiles with you; Weep and you weep not alone. For this heart hurt world has other hearts That beat In feeling with your own. Cultivate the amenities of life. Be good and true to yourselves and to each other. Practice the habit of showing kindness; it will react reflexly upon your nature and en- large it and help you to help those who fall in your way 52 Charles H. Hughes. for your skillful ministrations. Kindliness and cheerfulness and honest hopefulness, based on study and knowledge, will add to your skill and success at the bedside, in office, and with the world in general. Be true in all the exalted relations of your profession to patients and people and you will find this a really pleasant world to live in, despite the intercurring illnesses and misfortunes of life and its people, kind and good and true as a rule, if you are kind and good and true to them. You will find them out reflexly. For, heart to heart is a wondrous reflex of smiles and tears, of hopes, woes and joys, of sorrows and tears. Get close to them and treat them well and they will, as a rule, return your charity, your generosity in kind. Not always, for there are ingrates and sore-heads and sour-tempered kickers and misanthropes, misconceived and mismated abortions and squint-eyed brains and strabismic hearts, owned by people who live wrong side up and wrong side out and wronj; end foremost and inside out and outside in, in this motly show of life. But get close even to them, with a warm heart and kindly conduct, and even they are not always so bad as they look. They are prettier than they are painted sometimes, but it takes more of the paint of charity to gloss them over into presentable appearance than you can sometimes afford to waste on the job. But be kind to them, if you can, anyway, and charitable, for some of them are built that way by a bad heredity and can't help being cross-grained, ill-natured and sour, sordid, sore, suspicious, hoggish and cynical and cussed, so easily as some who have come into the world better endowed and lived in a more sunshiny atmosphere of environment. In this country, whose government derives its powers from the consent of the governed, with occasional ex- ceptions caused by the corrupt boodler, grafter or that other political Judas, the "legislative agent," who generally calls himself a lawyer, the state is a composite political pic- ture of the people and it is the duty of the medical pro- fession to aid the people in the development of sound brains in sound bodies, to eradicate the degenerate and the Medical Science, Medical Profession, Etc. 53 decadent who are unfit for citizenship. "Mens sana in corpore sano" should be the shibboleth for the franchise and it should extend to the immigrants at Gastle Garden and the voters our courts make of foreign citizens, and to the native born, without distinction. As physicians, we should demand physiological qualification for the franchise. The decadent in organism, as of mind and morals, should be dropped from the voting list. The greatest duty before the medical profession of our time is to seek to learn and then to advise the people and the state how to sustain the over-strenuous life of our day among so many of the aspiring and ambitious, so that they may not, so often and so many, fall prematurely broken in endurance and wounded unto early death because of cease- less overstrained activities and striving for success and sometimes for existence, even among their fellows. Action, always action and the motto of Napoleon's dazzling success and premature ruin to himself and people. Audacity! always audacity! is putting our Nation and our people on such a strain, especially among the Napol- eons of finance and the admirals and generals of gigantic business and commercial strategy, that the strain of organ- ism that brings premature exhaustion, brain-break and vi- tal ruin to this and other nerve centers of our men of action, so often long before their natural time of failure, must be met and mastered by research, resource and hy- gienic admonition and remedy. Our masters and past grand masters in the business world should hear from us incessantly as they live in ac- tion, the doctrine of rest and regulation of their anatomies, and be warned by us of the dangers of over-action and over-stimulation, especially alcoholic stimulation and over- time night-strain. There never was a time when great and capable medi- cal men were so much needed as now. Mediocrity and grasping avarice rule in our legislative halls and states- men are few. There are not too many physicians of the right sort. There are not enough and there never will be enough physicians among us, if the strenuous life 54 Charles H. Hughes. of our day goes on as now. Without medical support and popular medical enlightenment on the conservation and repair of brain power, the collapse of their vital power will come to the people of the United States and this over- stimulated, proud and powerful Nation will take her feeble and insignificant place among the weak Nations of the earth undergoing extinction; when another Byron shall ask, as was asked of Greece, Rome and Carthage; shall ask of the Great United States of America, that continent of powers: Where are they? And the historian shall answer: They perished of unguarded over-strenuosity and over- stimulation while they were yet young. The Sun of the Great Western World Republic (for the whole vast conti- nent is our destiny) perished while it was young. The sun of its glory set while it was yet day. When the epitaph of this great people shall have been written by the historians of decadent nations, it will be re- corded of us: "They were a great people but they rested not; they stimulated when they should have slept. They drank alcoholics and like stimulants when they were tired. In their inordinant ambition they turned day into night and night into day and slept not as they ought. They gave much thought to business and professional glory and syn- dicate achievement and the vices and the indulgences that prodded them to the degree of self-destructive over-action, but little, too little consideration gave they to the repair of the machinery of mental action. They wore out their psychic neurones and the great nerve center organs of their once wondrous power. They passed into a morbid giantism and then into pigmies and then they perished. Over- strenuosity, vicious stimulation and unrest destroyed them." The machinery of imperilled minds now on the rack of present strenuous conditions of business and life itself in every form, in our large cities especially, will need your considerate attention and best resources. It is the duty of the profession to avert the impending calamity of race degeneracy and extinction by helping the people to keep their organisms in repair and guard against Medical Science, Medical Profession, Etc. 55 wrong marriages and wrong habits that lead to degeneracy, the depravity of the blood and poison of nerve centers that come of over-action, over-stimulation and insufficient rest and repair. Your chemistry, your physiology, your wonderful new therapy will be needed to sustain the strenuous life of to- day, and it has just come to you timely. How our good and worthy fathers in medicine would have rejoiced to see this day of wonderful therapeutic advance. They who had to take away toxic blood and make it anew by the slow process as of vital reconstruction of their time, as compared with ours, and relieve congestion by venesection and purging alone, because they were without our additional agencies to constrict the caliber of distended vessels, causing disease in vital organs. They who had neither our antisepsis nor anasthesia, our hypnotics nor analgesics. The average business man, while he has been on his feet, has hitherto despised the doctor, but he is learning better now. Too many of his comrades are falling suddenly about him, of so-called heart-failure, which is the sequel of over-strained brain and vagus nerve innervation failure as well. Too many are dying prematurely of other causes, beginning in neurasthenia, cerebrasthenia, hyperaemia and vasomotor and visceral over-strain. They will consult you in the oncoming days, as they now do their lawyers, and not wait till they cannot read the ticker or figure profit and loss, before calling on you for aid. The coming doctor will not be called to see people chiefly in bed, as now, and conduct patients through long sieges of perilous illness, wearily watch- ing and waiting on assaulted nature. The wise citizen will call the doctor a iittle before he thinks he may be on the road to the cemetery. As things are going now, there are not, and will not be, too many doctors for the needs of the people. Indeed, there are not medical men enough to protect the people from the consequences of the strenuous life; not enough to save them from their sins against the physiology and anatomy of their own organisms, under the strain of over-effort, over-stimulation, over-indulgence in follies of deed and thought and fake and fad medication. 56 Charles H. Hughes. The over-strained and unstable psychic neurones are breeding today foolish religious creeds, popular heresies and propensities to evil and crime, which can only be cor- rected through a better knowledge of how to live and maintain the integrity of that substratum of all good judg- ment and sound, steady mind, a well sustained and rested brain. The time is upon us and before us, when the people must learn what the medical profession knows, and is yet to further know, about the conservation of vital energy and neurone force and put the knowledge in force and practice in correct living, if they would save themselves and the state from destruction. New demands for brain power make necessary further knowledge and provision for con- serving and imparting brain strength. This knowledge of the profession must become the practically applied knowledge of the people and the state. The state is what the qualities and powers of the people make it and the people are what we make them by our counsels. Legislation should be aimed against the diseases and morbid influences that degenerate and immoralize the race. Then will disease and infirmity of body and mind and pauperism of body and spirit begin to disappear from the face of the earth, and those institutions for the care of the imbecile and the insane, the hospitals for the psychically ill and the reformatories and penitentiaries will cease to be so much needed as now, because the causes of morbid crime and criminal disease of mind and body will have been reached and remedied by medical science applied to legis- lation and to the lives of the people. The services of the doctor, as a minister to disease, will be in less demand and the occupation of the lawyer will likewise be gone, because a strong-brained, level-headed and healthy-bodied race will avoid litigation, as we now shun the "pestilences that walk in darkness and the destruction that wasteth at noon-day." My advice is to stand with your tribe,* as your ances- • When as a youth, before the iate unpleasantness, Fred. Nichois, the Old Man of the Avaianche, was dining at my father's house, 1 asked him what he would do if war broke out Medical Science, Medical Profession, Etc. 57 tors north and south did, before the late unpleasantness between the states. Stand for your profession, join a good local and National Medical Society and insist before all the world on proper professional recognition in public places. Insist that a place be made in the cabinet for a doctor, that the pay and place and rank of medical men in public service be commensurate with their merit, from cab- inet officer down through the army, navy and marine ser- vice to local health officers, coroners and, even oil inspect- ors, who should be either doctors or chemists. Let your efforts be for medical places, for medical men everywhere, in public service and for the rights, interests and just rec- ognition of medical men everywhere where they should be. On Bedloe's Island, in the harbor of New York, stands the statue of Liberty Enlightening the World. Under it have passed landward, in days agone, the mental cripples and cranks and bodily diseased of Europe. Many of these under our influence are now sent back and more are to follow, but still they come, in thousands monthly, the political cranks and criminals, moral imbeciles and political degenerates, born, not of liberty, but of conditions that dwarf and distort the brain and unfit them to live rightly in the atmosphere of freedom. It will be your duty to show how men, high-minded men, with neurones well nourished on the invigorating soil and in the atmosphere of law-restraining freedom, can make men fit for the Freeman's franchise in these American States. Men are much as their brains and minds are builded. It will be your duty to show the people by example and precept and by instruction derived from the fountain sources of anthropological science, how right brains and minds are built and how states that are strong can only build on sound neurone material. between the North and South, he sald: "I guess we will all have to eo like the Indian, with our tribe." And that is about the way it went. The heart is stronger than the head. A luaatlc at Fulton. Mo., on learning that all the patients were to be sent to their respective counties, sald the whole country had gone craiy and there was no use in us few lunatics staying housed up any longer. 58 Charles H. Hughes. The time is coming when we must have statesmen again; when the JackSons and Websters, Clays, Calhouns, the Jeffersons and Hamiltons, Bentons and Bells, the Wash- ingtons and Henrys will come again to the political surface to brighten our country's skies and study and labor for the people; when the pothouse politician, the boodler, the grafter, the legislative agent, the lobyist and promoter, who do the people for themselves, will give place to men who do for the people's welfare. Among the latter, the doctor- statesman will be there, as our Benjamin Rush and other physicians were in evidence in the days that tried the souls of men and the hearts of women, at the birth of the Republic. Among them there should most appropriately be some of you, for the trend of a medical man's training is in the direction of the peoples' welfare. In the future president's cabinet, as sanitary counsellor to the chief ex- ecutive and the advisor for the country's welfare on mat- ters of public health, some one of you should find a fitting place. Aim for the presidency if you will, so that you may hope to fall among the cabinet. The more medical men the people get in the public service, the better it will be for the people. When the om- nipresent lawyer and his ready gift of gab and multitudi- dous precedents, telling how things were done "before the war" and Magna Charta, and should be repeated now and forever more, shall make way occasionally in public life in the better time coming, for the man of sanitary science, the man of bacteriologic and biochemic knowledge, familiar with Nature and her resources in relation to man's welfare, it will be better for mankind. When you go out into active practice, syndicate your efforts; get together; join yourselves into companies and found community hospitals with all the modern aids to re- search, and appliances for relief and cure, beyond the re- sources of a single man, especially in surgery. Look well after the perfect exploration of the body and its toxines, its microbes and the diseases which cause, accompany or in- vite them. Have among you all the instrumentalities of research — test-tubes, reagents, microscopes, electricity, Medical Science, Medical Profession, Etc. 59 X-ray machines, radium and Finsen ray appliances, surface and clinical thermometers, endoscopes, ophthalmoscopes, cystoscopes, laryngoscopes, stethoscopes, etc. Explore the dark places and secret recesses of the organism; bring to light the vicious processes in the kidneys, the lungs, brain and other viscera that threaten destruction and life. No one man can do all this, so you must syndicate your research if not your business; agree among your- selves who shall be especially equipped for this or that re- search work — one with the reagents of urinalysis, another with endoscopic research, ophthalmoscopic and auroscopic, uteroscopic, vaginoscopic examinations if you have not among you the highest type of fully competent exclusive specialists in these departments. You should get together in this way, harmonize in your work, charge the people better prices for better service than for imperfect and incomplete work, and when you shall have then gotten together and shown the people what true medical science and its wonderful resources are, select a good medical man, by preference over all others, for state and national office and stand by hun in all he may do for the good of the people, especially for their sanitary welfare. There is much yet to be done in the direction of enlightened sanitary legislation besides good, pure water, perfect sewage systems, garbage incinatories, clean streets, sidewalks and public places free from disease germ sputa. Those who expectorate on the floor of their own or another's dwelling, on a hot stove, a hot air or water or steam coil, or register, should not expect to rate as a gentleman in a sanitarian's estimation. There is also the ice man who gets his ice from a con- taminated bayou, pond, river or lake, or who makes it antiseptically and yet sends it uncovered through our streets and drags it from wagon to door over the microbe- contaminated sidewalk. There is also the beef man, who may slaughter cleanly enough but sends his dressed beef or other meat unprotected to the butcher, from the shoulders covered by clothing that may not have been innocent of microbic colonization since the death of the little tailor that 60 Charles H. Hughes. the devil got with the cabbage and the broad cloth under his arm. And the baker follows the butcher with bread ex- posed to contamination to be delivered to the people. Then there is the diligent and frugal dago who sleeps with the fruit of California, Italy or Spain, wipes his fruit with his own mouchoir, wet with his own spittle and makes it shine like his kid brother does your shoes. Then there are also the thousand and one other com- modities that come from questionable places through sources of contamination to our tables — the water, the beer and ale on draught, the whiskey drank at bars, the glasses washed over again in the same tub, and the dust-laden candies and jams that tickle the people's palates and fill the pockets of the undertaker after the doctor has signed a death certificate of tuberculosis or toxhemia. Finally, gentlemen, make your good influence felt, not only on the profession but on the people. The ethics of your profession enjoin this. You are not to advertise like the quack your wondrous skill to cure particular diseases, but to enlighten them about themselves and to interest them against disease and its causes, which are all about us. Gentlemen, foster in yourselves an indomitable spirit of achievement for your own good, the good of the pro- fession and the people. Do something worthy. Return an account of your talents to your Alma Mater who has hopefully entrusted their better keeping to you, neither rusted nor damaged by age nor neglect, nor folded in the napkin of disuse and indifference. Return them ten, twenty and an one hundred fold, if you can, and you will have consciences void of offence toward yourself, your fellow men and God, so that you may lie on a bed of peace and dwell in a house of plenty in the latter days of your life. Your contemplations will give you happiness and satisfaction. Your retrospective reveries of the part you shall have played in the world will be pleasing, and your dreams of the future beyond all mortal ken shall be hopeful and bright. The specter of misspent time will not rise up to make you unhappy, and there shall not come to you from "be- Medical Science, Medical Profession, Etc. 61 neath the shades of funeral cypress planted thick behind" "reproachful whispers on the wind from your loved dead" or from the loved dead of any whose lives may have been entrusted to your sacred care. Despite your best intention, weak and sinful as we mortals are, you may fall short sometimes on duty and cast a sad and half-reproachful look over some of the "pages of your memories past." But if you have, as you may in your career, * * * "lent strength to the weak, or In the hour ot need, Mindless of his home or creed, over the suffering form have bent," and ministered mercifully with such skill and knowledge as unneglected opportunity shall have given you chance to acquire, you shall not have lived in vain. You will look backward "with thankful heart, and with hope be- fore," assured that from the good works of your life you shall nevermore part. ADDENDUM NOTE. Insidious changes are taking place in this government our fathers of the Republic founded by and for the people. The links of the chain of popular golden rule fraternity have weakened much since our worthy ancestors combined and pledged their lives, their fortunes and their sacred honors to overthrow monarchical and special class tyranny, and new tyrannies have sprung up instead — tyrannies no less baneful than those our sires overthrew. These tyran- nies of combinations for public plunder in legislation, in office, in business, and of late even in some of the labor unions and employers' combines, will require your attention as citizens. Then there is also the negro, which you are always to have with you. You will come in contact with him in his home and will have a chance to help him by good hygienic counsel to right manner of living and to a higher civilization. He has lost something, as well as gained something, by being free from the white man's paternal restraint and advice, as those of us who know him best do know. THE GENTLEMAN DEGENERATE. A HOMOSEXUALIST'S SELF-DESCRIP- TION AND SELF-APPLIED TITLE. Pudlc Nerve Section Falls Therapeutically. HOW often is there delivered from the womb of some noble and grand woman—some little soul, scarred in such manner that stigmatizes its after life and brings a stain so deeply colored as to stamp it in the eyes of the world a 'social outcast and criminal.' How thoroughly ignorant was one good mother of the burden of sorrow which was fast developing in a boy upon whom she was counting to be an exemplary character in the eyes of his fellow man and as she often expressed it, in the eyes of God—for there was no more queenly type of the true Christian spirit than that which seemed to complete and envelop this good woman. Thanks be to a God whom they say does everything for the best—this darling woman went to her grave knowing nothing of a terrible affliction which had virtually possessed this son from the date of his birth, and whose absence from her dying bedside sug- gested a picture of neglect. Where was he? In a little room in the wilds of a distant part of the country, bowed in grief, realizing that he could never kneel at that bed- side claiming to be the offspring of such a God-like woman, irrespective of the fact that no responsibility rested upon him and with the full knowledge that, had anyone blamed her, the son would have become a raving maniac. "The few lines which are written above are simply the preface of a statement which is intended for such who feel that they can gain anything from it in dealing with cases 62 The Gentleman Degenerate. 63 of a like character. We are well aware there is ever a possibility of some good man being thrown into a dungeon for things which are a part of his being, but who is honest, upright, gentlemanly in his manner to others, and who would gladly take flight from a social evil known as sexual perversion, were his brain or mentality so constructed as to enable him to do so. "The animals in jail for theft and murder and other like fiendish crimes would, even in their absolute indifference to everything going to make up a good man, regard the condition above referred to as honorable. Society has to be protected, of course, yet should scientific mien not exert themselves to do all in their power to save the well- meaning from degradation and ostracism which naturally follows such affection? Take our most charitable citizens who are ever ready to rescue the unfortunate from the slough of despond. Is it not in their own nature to shrink from those so cursed, but whom they know in other respects to be their equals in point of birth and general intelligence, and a desire to be clean? "Thirty-nine years ago there was born to a couple in one of the far eastern cities a son—the subject of this discussion. The father was a gentleman of decidedly liberal education, being born in Ireland and graduating from one of the old world's best colleges. Being an Irish patriot he naturally figured in the rebellion of '48, which meant death to him, unless through intrigue he could escape. Such version as the son was given, of the flight, need not be mentioned here beyond the fact that my old Irish nurse assisted him to the seaport, where he was enabled to jump on board and claim protection of the Stars and Stripes—falling upon his knees at the time, looking upward, thanking God that he was a free man and enjoy- ing the benefits of the emblem of liberty—the American Flag. Upon reaching the United States he became inter- ested with several other Irish patriots—whose names are watchwords with the Irish as well as the Americans familiar with Irish history—and established or edited a paper known as the . Owing to the excited condition 64 A Homosexualist's Self-Description. of Irish affairs these patriots separated; my father going into another city and state and being immediately taken up by an Irish gentleman and placed in business. It was not long before his attainments became known, and he was recognized as one of the leading intellectual lights of the city, which claimed the distinction of possessing a highly cultured class. "In the course of time, it being vouched for that my father filled all the requirements of a true gentleman, he became interested in and married a woman who was almost his equal from a literary standpoint—it being almost a puzzle when any question of philosophy or any other studies amongst the older children arose, which to ask— father or mother. However, that love for mother asserted itself and we wanted our father to think that our mother was the brighter and in nine cases out of ten her solutions of problems were correct and our father had nothing to do but admit it. (The object of the writer in mentioning these points will no doubt be understood by those under whose observation this statement may come.) The marriage was granted under dispensation of the Pope—yet as in most cases of mixed marriages unhappiness was ever conspicuous, every child, however, always sided with the mother, and her religion was courted although she herself never inter- fered. Aside from this my father was associated with pol- itics, and like most of those who are ranked reasonably high in the same, the liquor habit made its appearance, also epilepsy. This entailed great hardships upon a proud family and it is needless to say many were the trials and tribulations in that family. If I am correct it was more of the Jacksonian epilepsy than the idiopathic. There was always a peculiar noise preceding the worst of these spells, and the whole family were greatly alarmed. As young as I was at the time I knew nothing of the cause, but regarded it as due to drink. Irrespective of the family clashes over religion, he was at times very kind to his children, and many times when he saw the ship sinking, many times did he call his children to him with tears in his eyes, realizing that he had been the cause of much The Gentleman Degenerate. 65 unhappiness and it was still lurking within reach of his children, to develop to the point of sorrow (in one) that of a social outcast in the eyes of the world, however, but not in the eyes of One whose ways are most mysterious. This father passed away after a lingering illness due either to epilepsy or apoplexy. The priest was there to perform the last rites of the church—yet as he had not been a Catholic in good standing his remains had to be placed in Protestant burial ground. His pallbearers were men of the highest standing in the community. It was at least certain that with the last flicker of life his mind was on his dear old home in Ireland and the woman upon whom was devolved the correct rearing of the children he left behind. Was her task easy? No. Many sacrifices were made by her and so far as the daughters were concerned there was nothing to worry about—of the sons, upon two came sor- rows for which they were irresponsible, the third still remains close to his sisters and the absent one hopes this boy may be spared to give them that protection which a brother should, for the mother is no more. With the flight of that soul some fifteen years ago went the whispered words, 'Why does my boy remain so long at the market place?' It is needless to state that when the announce- ment of this death was communicated to him—that his hand went up in supplication to the Almighty to give him that manliness and character that his mother wished, in order that he could be a companion for his sisters, one to whom they could look up to and take pride in. "Was this son regretful at his father's death? At that time, no; for he felt that he must have been aware of his physical condition at the time he married a grand and beautiful woman. "THE SON "a regular 'girl boy' as he was called, always afraid to tell a fib—never using bad language, never smoking nor chewing, thoroughly honest, shunning the girls and always having some boy friend he fancied for his good looks and endeavor- ing to show him some kindness in the way of making him 66 A Homosexualist's Self-Description. presents—never cared for an ugly boy—in fact did not know why he particularly cared for any, always studious, receiv- ing high honors at school for thoroughness in his studies and exemplary deportment. The child mind not under- standing the features of certain matters recalls his desire to bunk with any gentleman who might be the guest of his father, and to them, no doubt revelations were made, but naturally ascribed to childish innocence. I felt myself growing stronger in this way. In other words showing a preference for such society and ignoring girls—yet being timid in the presence of both male and female—was frequently twitted about it. "This of course became an annoyance to me. 1 would never associate with girls and always felt slighted when some boy schoolmate whom I liked would run off with a crowd of boys — was never physically or morally coura- geous, but always terribly hurt when anyone doubted me. This was done to worry me as they all knew I was quite an honest lad. My method of resentment would usually be to run up and give the hand of the aggressor a good bite. This melancholy condition continued to grow upon me* and it was fast dawning upon me that it would be something to disgrace me in the eyes of those whom 1 had known all my life, and the shadow would naturally fall upon those nearest and dearest to me on earth. I recall two gentlemen — one especially handsome — whom I knew who had gone west to go into business, and seeing the danger pursuing me, I wrote to them for a position. Mark this peculiar phase of the case. I felt in some way I could enter into some peculiar relationship with the good looking man. But upon reaching my destination 1 found the party in question prospering, yet so changed that the impression first made become a mere nothing. The writer was at this time about nineteen or twenty, had never touched a drop of liquor, never smoked, chewed, used coarse language or gambled, associated himself with the church (because his mother wished it) and led for a while a good life but was terribly homesick. Going back to the trip, there were just a few little incidents which I recall that made an impres- The Gentleman Degenerate. 67 sion upon my mind. I ran out of money, with the excep- tion of twenty-five cents, when 1 was half through the trip. I made up my mind not to borrow, so when 1 reached territory adjacent to that of our own country, the engine having stopped for water, I ran across the line, so 1 could say that I had been on foreign soil and bought a little bologna sausage and bread and was badly scared when some Texan said that there was smallpox over there. But 1 was very hungry and ate the bread and sausage all the same. 1 did however have to borrow a dollar before reach- ing , yet the party who obliged me, 1 did not care for, as it occurred to me I was in the clutches of a desperado or 'con' man. 1 returned the amountim mediately upon reach- ing my employer's headquarters, and gave him a polite farewell with thanks for his kindness. Incidentally here I was considered by the people on the train as a young man actor or priest. "It appeared from the start that I was well liked in my new position and for some reason it occurred to me that I would make a success socially. I carried letters to some of the best families and soon discovered that for one so young and being a little extravagant I was doing well. In a non-professional way I became identified with theatrical, lyric and dramatic people and soon found myself in the social whirl—yet withal, the eye was for the man instead of the woman, that is handsome appearing men. Liquor was soon with me one of the necessities. A handsome man meant the tinkling of glasses. I will leave to those who are interested in the case from a physiological stand- point what at times would follow, in addition to frequent chastisement. Haunting the parks, seaside resorts and other localities, a lonely man afflicted, no hope of cure as intimated by physicians and neurologists, this being repeated to me in all localities, large cities and small towns. This man who has found rest for a time on the tops of mountains with nothing but God's shelter for him, this man who has sat in the woods with only the beasts of the forest for company, this man who has been on the seashore, with not a soul or house in sight, watching the terrible dark 68 A Homosexualist's Self-Description. breakers splashing and dashing with but a flickering light here and there to startle him from the great burden under which he was placed. Why has he handled the pick beside the common foreigner, why has he exhausted himself in pulling heavy timbers over rollers in the large mills on the coasts, at night? Why has he picked the hops in the field of the Northwest and, to escape eiror, crossed the continent again and again to pick apples in an orchard in the absence of other work? Why all this? Because he wished to save his family and the name of the good mother who bore him. "Twenty-five years of this misery is a long time for such torture, yet the struggle goes on. If the wishes of this lonely man were realized, and he trusts it may not be long before he may find the surroundings illumined and he be enabled to step into the sunlight—a clean and wholesome man—or in the absence of such bliss—his mother's arm be extended down from the region beyond into which he may be embraced and find that rest which may be emblemized as eternal." These autobiographic reflections of a sexual pervert, with reverse sexual instinct feelings and impulses, are given place here, as contributing to complete the portraiture of the homosexual form of hereditary perversion and also to call attention to the often revealed psychic accompaniment of morbid egoism and craving for sympathy. Such of this class who have come under my observa- tion and care as patients, have been inclined to write up their cases, without suggestion to that effect and without urging. The morbid egoism to disclose the self-feeling is like that of Claud Hartland, another patient of the editor's, whose book was excluded from the mails. This narrative does not give details, but were similar to those described by many of Kraft-Ebing's patients troubled by homosexuality. In this case an operation was performed on the filaments of the pudic nerve supplying the testes, but the morbid inclination still persists, notwith- standing the operation and a course of chologogues, anti- septic intestinal treatment and full bromism. This man is a competent accountant and a cultured The Gentleman Degenerate. 69 gentleman, much distressed still by his persisting malady and has asked to be castrated and talks earnestly of suicide as a not far distant resort in the event of failing of relief. This case appears to be in the head and not in the genitals. Having endeavored after this operation to convince this unfortunate man that the trouble was now in his brain and mind alone and that he should do as other men have to do and do do, keep his passionate impulses in abeyance to the higher purposes of his nature and the nobler ambitions of life, he answered as follows: "What you claim can be accomplished through efforts on my part is impossible—of course you will dispute this. Were our positions reversed for a month, you could under- stand. If the difficulty is with the head, all 1 have to say is that it has centered there with such vigor and tenacity that it would appear to me that the elimination of the trouble in one center has been doubly concentrated in another. The head of my firm has heard about my weak- ness and certain insinuations have been spread broadcast, resulting in my displacement from my position. I will be upon the streets next week—to go where—the Lord only knows. "I can not change this unfortunate condition—for if I could it would be an awful stigma upon me if I did not. You are certainly a grand man—in your profession—yet there must be something about my brain construction that even is beyond you. Let me ask you—would extreme methods (you know my meaning) amount to anything? If so 1 will go into a charity hospital and have it done. Do something, 1 must. 1 have told you the truth. It means that or worse. "You are the only man who can help me. Would what I have suggested accomplish anything? You may think this idle talk, but no one knows better than myself that it is not. "Save my family I must; they do not know my where- abouts." The sufferings of this unfortunate are real. The train- ing of the inhibitory centers of the cortex over the lower centers of the brain and cord have evidently been sadly 70 A Homosexualist's Self-Description. neglected in this man's youth. The full sway of any of the passions tend to moral and physical habitual dominance of the passions in the hereditarily unstable neuropaths, with vicious and perverted passionate entailment from father to son, as appears in this unfortunate victim of congenital fate. The medico-legal aspects of these cases of homo- sexuality and of some other cases of perverted as well as natural, but abhorrant sexual violence, obtrude here, but we will not now discuss them. In a letter six months subsequent to the operation he writes as follows: "1 am if anything, worse than before, as 1 now follow in the street those who attract me." On the last of January of the present year this un- fortunate neuropath wrote the following despairing letter: "I am now convinced that from an experience in St. Louis during my last visit (an experience without consum- mation) that there is absolutely no avenue of escape from my trouble but to be placed under restraint, and if I can get back to St. Louis it is my intention to place myself in the hands of the authorities irrespective of the consequences, as I am certain to get into trouble, and 1 can not stand this thing longer. I know just what Dr. and yourself would suggest, yet from the statement of other physicians — the trouble is of the head and there would be no cer- tainty that the operation in question (castration) would be successful. You well know the debilitating experiences through which 1 passed after the first surgical work. I jumped on a train in St. Louis last night and followed a party clean through to South McAIester. 1 was expected back at the hospital that night. I spent all my money. I do not know for certain that I have a position here, as the company is in a bad way and none of the officials are in town. "I came very near getting in serious trouble on the trip. If I am compelled to pass through another surgical operation it will have to be at the city hospital. My trunk and satchel are at the Hospital. I feel terribly over this, as 1 promised Dr. 1 would conduct myself with decorum. If the remedy he suggested is a sure cure, then I will have to accept it." THE ALIENIST AND NEUROLOGIST. VOL. XXV. ST. LOUIS, FEBRUARY, 1904. No. 1. Subscription $5.00 per Annum in Advance. $1.25 Singie Copy CHAS. H. HUGHES. M. D.. Editor. HENRY L. HUGHES, Manager and Publisher. Editorial Rooms, 3857 Olive Street. Business Office. 3857 Olive Street. 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. EDITORIAL. [All Unsigned Editorials are written bf the Editor.] MEDICAL CENTENARIANS.—The Journal Am. Med. Ass'n. has translated and abstracted Picard's interesting historical sketch of this subject from the Gazette Mid. de Paris for April 4 and 11, reviewing also the life insurance and other statistics in regard to "when and how physi- cians die," quoting extensively from The Journal. Hippoc- rates, he states, is said to have lived 104 years, and 140 is ascribed to Galen by one enthusiastic historian, but not by others. Three Arab physicians are cited as centenarians, and Picard has found records in France of four before PatenStre, who died in 1709, aged 103. Poncy, who died at Paris in 1724, was born in 1623 and practiced to 100. Politiman is another French physician who lived into his second century—his biographer states to 140—and was in the habit of getting tipsy every evening, as also Dr. Espa- 71 72 Editorial. nago, who died at 112. A portrait of a Dr. P. Defournelle, inscribed 1690 to 1810, is preserved at Paris, but the first official record of a medical centenarian in France is Dr. A. Chaule, born 1741, who lived to be 103, followed by Dr. Fau, also 103. Dr. Zalewski's death notice recorded at Bordeaux credits him with 111 years, and states that he was born in 1780, but no official record of his birth has been found, Dr. Bossy, who died at Havre in 1897 at the age of 104, was in such good health to the last that he made a trip to London three years before. His grand- father was 99 at the time of his death, and his father 108. The latter died at London in 1848 and had always enjoyed good health. Dr. Jean David of Montpellier celebrated his 102d birthday, February 10, 1903. He retired from active practice at 98. Picard has found four medical centenarians among English members of the profession of the last cen- tury and five in this country. The latter are Dr. D. D. Smith, Cairo, 11l., and New York, who is said to have mar- ried at 123; Dr. D. Burk, Washington; Dr. H. Courtnay of Hancock; Dr. W. B. Sprague, and Dr. O. S. Taylor of Auburn, N. Y., concluding with Dr. C. Graham, whose cen- tennial was celebrated by a banquet mentioned in The Journal in 1884, p. 549. Dr. Marvogenis was a Greek physician, who attained the age or 100 in 1898, and a Swedish physician, Dr. Ivervex, who is said to have in- vented an elixir which enabled him to live to 104. Only two Italian medical centenarians are mentioned and both died in the eighteenth century. A Dr. O. Kowansky in Russia is said to have served in the Napoleon wars and died in 1887, aged 109. He was paralyzed for sixteen years before his death, but continued his practice to the last. It is said that he dictated a prescription a quarter of an hour before he died. In Spain Dr. F. Verdugo lived to be 105, practicing at Salamanca for eighty years, until his death in 1867. Another Spanish colleague was mentioned in 1875 as 105 years old, living in good health with a wife of 103. Dr. David, above mentioned, seems to be at present the dean of the profession the world around. Picard hopes to hear from others in regard to medical centenarians, Editorial. 73 as he would be glad to render his compilation as complete and accurate as possible. Communications addressed to him, M. L. Picard, care Gazette Mid. de Paris, 93 Boule- vard St. Germain, VI, Paris, will be thankfully received. He cites his authorities in detail, with extracts. HOW THE HAIR TURNS WHITE.—Metchnikoff's ob- servations (New York Medical Journal) appear to show that the atrophic process, whereby canites ensues, is due to the intervention of uninuclear phagocytes. These cells are situated primarily in the medullary portion of the hair shaft, but make their way onward to the cortical layer, where they absorb the pigment granules and remove them from the hair. A great number of these phagocytes may be found in the roots of hair which has only partly turned white. The occasional phenomenon of the hair turning gray in a single night is to be explained by the phago- cytes being endowed with greatly heightened activity.— Denver Medical Times. FURTHER GIFTS TO THE HARVARD MEDICAL SCHOOL.—In his speech at the commencement exercises of Harvard University, President Eliot said: "This year our treasurer reports that the cash addition to the property of the college is $1,300,000. Of that sum #500,000 consists of contributions to the great undertaking of the medical school. And that leads me to speak of this particular di- rection of the beneficence of the friends of the university— for medicine. More than $2,000,000 have been attracted to the medical school undertaking. The money comes easier there than anywhere else. What is the reason? It is di- rected in this way by the profound sense of gratitude of many men and many women for the service which medi- cine has rendered to them, to their children, to those dear to them. It is directed in this way by the conviction that many more discoveries and unimagined blessings are com- ing out of medical study into the service of the world. This very day there have been added to the funds provided for the medical school undertaking $285,000. And both 74 Editorial. gifts—there are two—come charged with the most sacred purpose to do good in this world."—St. Louis Medical and Surgical Journal. IMMACULATE CONCEPTION IN THE XVI CENTURY, AND THE WILES OF THE MATRONS THEREOF.— The Ga- zette hebdomadair des Sciences medicates de Bordeaux recalls a matter of interesting conjugal history in the following decree of the Parliament of Grenoble, February 13, 1537. "Considering the evidence showing that it is more than four years since the said Lord of Aiguemere has car- nally known the said Lady of Auvermont; considering the defense of the said lady, declaring that, although she has not carnally known her husband, yet having imagined in a dream the person and contact of the said Lord of Aigue- mere, she experienced the same sensations of conception and pregnancy that she might have received in his presence, and affirming that, since the absence of her husband, for four years, she has never had an intercourse with any man, and that she has nevertheless conceived and born the said Emmanuel, which she believes to have come about by the force of her imagination; considering the deposition of the Ladies of Albriche, or Pontrinel, of Orgeval, etc., affirming that such an accident may happen to women; that such things have happened to themselves and that they have conceived children of which they have been happily deliv- ered, which resulted from certain imaginary intercourse with their absent husbands, and not from copulation; con- sidering the attestation of the midwives and of the phy- sicians; the court decrees that the said Emmanuel is and shall be declared the legitimate and true heir of the afore- said Lord of Aiguemere, and charges the appellant to hold the said Lady or Auvermont as his wife in estate and honor." "ORAL HYGIENE IN PUBLIC INSTITUTIONS" has been recommended by the "National Dental Association," at the recent meeting held at Asheviile, N. C. We cor- dially endorse the recommendation, as we do the teaching Editorial. 75 of hygiene generally in all schools, beginning with the kin- dergarten. When oral, mental and physical hygiene shall be generally inculcated in the minds of children we shall develop a better people, strong in all of the essentials of a strong and just and great government. HARMFUL DRUGS IN PROPRIETARY MEDICINES.— That many widely advertised and generally used medicines depend largely for their action on morphin and similar drugs is charged by Dr. J. B. JWattison, of Brooklyn, N. Y., in Tfie Medical News (April 4). Dr. Mattison warns us against what he asserts is "the danger involved in the lawless sale—lawless because not safeguarded by law—of the many nostrums in which morphin and cocain play the largest part for harm." He goes on to say: "As a nation largely neurotic—both ancestral and ac- quired—we offer an inviting field to venders of such wares, who ply their trade with a vigor worthy a better cause, and the result of which we must make note if we would conserve the best interest of many whose well-being is given to our care. It goes without saying that the larger, by far, number of the many nostrums—nervines, anti- neuralgic pills, powders, tablets, and liquids- so much her- alded and lauded for relief of pain and nervous unrest, have morphin as their active part. And this 'part' in some is not small. In one, largely advertised, there is one-eighth grain in each teaspoonful. The risk of morphinism, in cer- tain persons, from that amount is large; in fact, a smaller, in ;i highly nervous patient, on whom it acts kindly, will create the disease. A ten-years' case of morphinism, un- der my care, seven years ago, had its rise in a one- sixteenth grain daily dose. "Even larger risk of inebriety obtains in using the various nostrums containing cocain, so much lauded for the relief of coryza and other nasal ills. In the form of ca- tarrh snuffs and solutions, its power for harm is far greater than when taken by mouth; in fact it ranks almost—or quite—with its subdermic effect, by virtue of the highly absorptive nasal mucous membrane, and its nearness to the 76 Editorial. brain, making its seductive power and ill effect on mental health specially prompt and pernicious. One of these nostrums contains l#s per cent, cocain—two per cent, is the strength often used for anesthesia—and any 'cure' having that amount is dangerous. Insanity is certain, if its use be continued." Dr. Mattison tells us that the abuse of cocain arising from its use in colds or catarrh is very common, and that many wrecks are the result. He concludes: "Such the situation. What the need? This. "An act making it illegal to sell morphin or cocain ex- cept per prescription, and the prescription not to be refilled, save by order of the attending physician. "A law compelling the maker of every nostrum to print the formula on wrapper, and those containing morphin or cocain, the amount of the drug in each dose. America is behind the times as to what could and should be done to avert this ill. The American Association for the Cure of Inebriety can, and it is to be hoped will, make earnest effort along this line, and so effectively safeguard one phase of the public weal." Another and better remedy is a law with heavy pen- alties making the magazines and newspapers that adver- tise these pernicious drugs particeps criminis with the con- scienceless advertisers and fully responsible for damages to health and life accruing from the pernicious conspiracy to filch and fell confiding, unsuspecting, suffering, gullible hu- manity that goes to the newspapers for medical aid. THE NEW MCLEAN HOSPITAL.—The American Journal of Insanity makes some pat and pertinent remarks on this excellent institution and its work which we desire to forcefully present to our readers, as representing the ad- vances in psychiatric study and management which charac- terizes this foremost,typical American hospital for the insane. One great underlying principle, marking the contrast from earlier periods, is seen to assume prominence. This is the recognition of the paramount rights of the patient. The laws and administration which preceded the so-called Editorial. 77 modern reform, were for the protection of the community, and, if necessary, the annihilation of the patient * * * "Each year witnesses some advance in the interest of the insane person, for his comfort or treatment, and all engaged in this department of medicine now strive to obtain the most liberal interpretation of problems presented for their consideration." "In reviewing what has been accomplished and in what direction energy is to be expended in the future, Dr. Cowles (McLean Hospital) reveals the inspiration of a great progress. We do not assert that Dr. Cowles has been alone in pointing the way, but the successful development of the McLean Hospital, under his guidance, has repre- sented the tendency of thought, and has justified the lib- eral policy of the present day. The new McLean is the most complete departure from the monastery plan of insti- tutions. Its separated houses were intended to appeal to the patient as a system the least removed from home life." * * * "The community from which the hospital derives its support has responded, and each year the income and de- mand for accommodation increase without curtailing the ad- mission of indigent people, who are regarded by an en- dowed hospital as proper recipients of its ministrations." "Dr. Cowles has cultivated the admission of patients at their own request, and upon their own volition, and each year has seen an increase in the number thus seeking treatment, which now includes more than half of the ad- missions." The feature of the report this year lies, in its treat- ment of the scientific aspect of psychiatry. "In his earlier work upon fatigue, neurasthenia and the genesis of insan- ity, Dr. Cowles gave instructions in practical psychology which theorists in this department would do well to imi- tate. He accomplished a greater result in delimiting mental symptoms in a way to call for an investigation into their causes. This investigation is now under way. It is proposed to study technically the nutrition in health and disease, tissue metabolism, the blood and the excretions. 78 Editorial. A laboratory of chemical physiology has been organized at the McLean, and is now in active operation. Of its work, under an expert in this line, Dr. Cowles writes as follows:" * * * "During the past year this laboratory has been com- ing into the close relations with the clinical services long ago prescribed for it as likely to open a fruitful field in the study of bodily conditions associated with mental dis- orders." * * * "The problem to be dealt with here is very largely that of nutrition. The nutrition question is funda- mentally a chemical one. It means not only observation and research in the physiology of digestion and its disor- ders, but investigations of the processes by which the tis- sues and cells exercise their power to feed themselves from the nutritive elements conveyed to them in the blood,—the processes by which the body makes over food materials into itself, uses them in work, and excretes the waste products. It is the disorders of these processes of metabolism that have a large part in the derangements of nutrition and the dependent functions of the nervous sys- tem; and it is to such derangements that disorders of the mental functions may be due in many cases. The meth- ods of study involve the application of the latest results in the remarkable progress that is being made in physiologi- cal and pathological chemistry, and the precise chemical es- timation of the food ingested and the excreta." Dr. Folin has made a clear statement concerning his work in the following abstract: "The most important work in this department during the year has consisted of metabolism experiments. Pre- liminary to this work, and going hand in hand with it, cer- tain analytical operations, upon which depend the value of all metabolism investigations, have been tested as to their accuracy, and some new methods have been devised. One of these was Dr. Folin's "New Method for Determining Ammonia in Urine and other Bodily Fluids," which is now in constant use in the laboratory, and the paper has been published (Hoppe-Seyler's Zeitschrift, 1902). Mr. Shaffer, the assistant in the laboratory, has made careful historical Editorial. 79 study of former methods for this purpose, and they were all found to be quite unsuitable for metabolism work; he has also devised a new modification of the "vacuum distilla- tion method" which greatly reduces the time of the opera- tion and yields accurate results. His paper is a well- written contribution "On the Quantitative Determination of Ammonia in Urine," and has been published (American Journal of Physiology, 1902). The method for determining urea, published from the laboratory last year by Dr. Folin, has been further perfected, and the objections raised against it disproved (Hoppe-Seyler's Zeitschrijt, 1902); also the "Method for Determining Etherel and Total Sulphates in Urine" has been improved (American Journal of Physiology, 1902). A method has also been worked out by means of which the excess of mineral acidity and alkalinity in urine can be determined with comparative ease. The factor is of considerable importance in certain abnormal metabolic con- ditions; the method is not yet published. This analytical work is necessary, as was mentioned in last year's report, because of the imperfections that still render most analyti- cal methods of clinical chemistry too inaccurate to permit the detection of even marked metabolic changes and pathologi- cal conditions, as indicated by variations in the excretions." * * * "Extended metabolism experiments were begun, and accurate analytical data are now being collected, which, it is hoped, will contribute to the question as to what classes of mental disease are, and what are not, due to disorders of metabolism. These experiments have consisted in keep- ing patients, for a short time, on a uniform, but acceptable diet of known nitrogen value, and carefully determining, quantitatively the forms in which this nitrogen is elimina- ted in the urine; the purpose is to learn whether any unusually large fraction of the nitrogen so eliminated ap- pears in forms or in quantities, unknown to the normal ni- trogen metabolism. The analytical investigations already made have helped very much to make this metabolism work more effective." "The report is concluded with the remark that the 80 Editorial. equipment of the chemical department is practically very complete; and chemical investigations can now be carried on in the McLean Hospital under unusually advantageous con- ditions. The only material want that is not fully met in this department is that of files of certain periodicals; some complete sets of these are yet needed for the frequent con- sultation that is required of the work of many other in- vestigators in physiology and chemistry, whose progressive activity was never greater than at the present time, making convenient references to the newer and older literature of the subject, an important aid to present inquiry." As the journal from which we abstract says: A field of great promise lies here, to compensate the disappoint- ment on the results of years of section-cutting upon which too much energy has been lost, and we hope the institu- tion may not lack for ample financial aid to prosecute so praiseworthy and profitable a work for science and the wel- fare of science and philanthropy. TAPEWORM IN THE BRAIN.—A most curious case was recently made public in the course of an inquest on the body of a man who died in Pentonville Prison while un- dergoing a sentence of two months' hard labor. Dr. Syme, assistant medical officer, said that the deceased man was in good health when admitted, and was put on oakum picking. On his first serious symptom of illness he was removed to the prison infirmary and died suddenly on the following day. The case was a most unusual one. On examination, his brain was found to be studded with larvae of the tape- worm. There were over fifty of these parasites, and they had worn away the skull. The tapeworm must have been generating for years. The eggs, which the deceased must have swallowed, were of canine extraction and were be- lieved to have come from the dog. Death was caused by the larvae of tapeworm, of which specimens were shown to the jury.—British Jour, of Nursing. We should like to know how authentic the source of this remarkable statement is and how well verified it can be. Editorial. 81 ANTI-TUBERCULOSIS AWAKENING.—The present year witnesses many organizations for the arrest and suppression of tuberculosis, all growing out of the assiduous work of the medical profession for the past several decades, in throwing light on the nature and perils of this insidious messenger of death and in pointing out ways to combat it. There are to be two tuberculosis exhibitions this year, one at Baltimore and the other at St. Louis. The Baltimore exhibit was lately made under the auspices of the Maryland Tuberculosis Commission, the state board of health and the Public Health Association. Such an exhibit and organization should exist in every state. This Maryland organization is conducted by 250 prom- inent medical and lay citizens. Charts, lectures, photo- graphs, pathological specimens and lectures relating to the nature of consumption and its management by sanitaria and other hygienic measures characterized the recent work at Baltimore. Another tuberculosis exhibition will be at the World's Fair in connection with the subsection Hygiene. This will show what can be gleaned in this country and abroad on the subject, especially the exhibits of the International Bureau for the prevention of Tuberculosis at Berlin. Active work is being done by the visiting Nurse's Association of Chicago, a strong and efficient organization, well supported by medical and lay influences, male and female. AN IMPORTANT MOVE in the direction of the suppres- sion of Tuberculosis is the International Congress of Tuber- culosis fostered by the World's Fair officers and the United States Government, to meet at St. Louis Oct. 3-4-5. This congress is especially important because it is to be a medico-legal and popular congress, the first of its kind ever fostered by a Universal Exposition, in which the work of the medical profession is to be utilized and practicalized, it is to be hoped, in fruitful legislative and popular meas- ures for the public welfare, in stamping out the great and subtile menace of the human race of tuberculosis. 82 Editorial. Dr. E. J. Barrick, of Toronto, is President of this Congress and Mr. Clark Bell, an attorney of New York, is chairman of the committee on organization. Another important American Congress is to follow in April, 1905, and an exceedingly important foreign congress will follow in September and October, 1905. Dr. Henry D. Holton of Brattleboro, Vt., is president of the Congress of 1905, and the president of the Paris congress is Professor Brouardel. Thus are the people and the profession becoming alive to the danger and duty of the hour. It has been objected that the brightest lights in tuber- culosis work are not shining conspicuously, but they have shown so long and so brilliantly in other days and in other places that the world is full of light and the pathway of public duty for medical man and layman is now clear enough for efficient work, so the average medical man and the layman and laywoman know what ought to be done in the premises. It now only remains for the profession and people to get together and strike the final finishing blow to this insidious demon of destruction. A GREAT AND UNEXPECTED LOSS OF LIFE such as that of the late theatre fire at Chicago or the fatalities of a battlefield, attract public attention, arousing inquiry as to cause and prevention. But the remediable causes that are always killing, like the water and dust carried causes of death, are much more insidious but quite as certainly fatal. The bacilli infected dust of our city streets, for example, ex- cites little concern and less comment. City legislators might atone for their own shortcomings and make vicarious amend for the boodle sins of their predecessors by keeping down the city dust, providing for better street sprinkling, washing and making a surety of clean dairies, pure milk, pure water and clean public houses, as well as safe exits from burning theatres and other places of public assemblage. More people contract disease in the all-day closed and darkened theatres in one year, and slowly die, than would equal an annual holocaust lil •" — Tn a 2 e s S o u TABLE I. 0) ul 8 Vi c ss > o 3 8" u3 >1 C (0 perverts ibles ioral deli o a. ■a u c o o to m o c 3 Is J3 E c a a a (J X **S O.UJ Sexu Incor Othe a> o "^ X >. o o o X o flj -l-» ha o 3 OJ 1- < 0> M S •a c 2 c o i £ n c S£ £•8 >-8 o < c have placed among the conditions resulting from degenerative changes in the brain for reasons which will appear later. General paralysis is universally regarded as a disease of the brain, and there can be no possible reason for classify- 152 J. W. Wherry. ing it as a form of insanity. True, it is almost always accompanied by insanity, but the general paralysis, with its motor complications, is purely and wholly organic, and does not bear the remotest relation to the insanity with which it is so frequently associated. The degenerative changes which occur in the brain in general paralysis seem to strip that organ of its powers of resistance and to render it peculiarly susceptible to the invasion of delusive ideas. So long as delusions are present the general paralytic is insane, but the insanity is caused by the delusions, and not by the trembling hand, or "thick tongue," or the occa- sional attacks of apoplexy. The paralysis is the condition from which the patient dies, and the thing upon which the eye should be fixed; the insanity is only incidental. Instead of it being called general paralysis of the insane, it should more properly be named, the insanity of general paralysis; that is if insanity exists, for I can conceive of the possibility of a man passing through all the physical stages of general paralysis without presenting any evidences of insanity, though this, probably, seldom occurs. Insanity and moral degeneracy 1 have classified as the two divisions of derangement of mind, and following these the usual forms of insanity, except that I group them as toxic, and autotoxic, though the reasons for so doing cannot be given here. The classification as given in this table may not be above criticism, but I offer it for the consider- ation of alienists with the hope that it may prove to be of some service even though imperfections may exist. As an introduction to what I may say on the subject 1 give the following reasons why dementia should be differ- entiated from insanity, the details of which will be worked out in subsequent pages. 1. Insanity, based on delusions, and dementia, have not a sufficient number of elements in common to allow both to be included in the same definition. 2. Insanity is a derangement of reason; while dementia results from obstruction to reason. 3. Insanity is characterized by false conclusions; de- Limiting the Term "Insanity." 153 mentia is characterized by imperfect, or inadequate, con- clusions, but not necessarily false. 4. The false conclusions of insanity are the logical results of false premises; the inadequate conclusions of dementia are the illogical results of true premises. 5. In insanity the judgment is diverted, by delusive influences, from following a true course; in dementia it is weakened, and impaired, and unable to hold to any course. 6. In insanity the will is strong and unduly prominent, either to do, or not to do; in dementia it is weak and, in many cases, practically obliterated. 7. Insanity is an unequivocal condition, either positive, or negative; dementia is neither, but is indifferent, apathetic and unconcerned. 8. Insanity sails with a new chart, and a new com- pass, straight for a new port; while dementia has lost both chart and compass, and sails for no place in particular, but drifts into any harbor that lies in its way. 9. In insanity the cause of the disorder is located in the mind itself; in dementia the cause is located in the brain. 10. Insanity is psychical in its origin; dementia, physical. WHAT IS INSANITY? The consideration of the subject in hand, however, can- not stop with the enunciation of general principles; we must go into details. If imbecility, and the various de- mentias can be eliminated as forms of insanity, and the lat- ter so restricted as to include only those forms of mental disorder having their basis in delusion, 1 believe that a great deal of confusion now existing can be avoided. Let us see if the plan outlined is feasable. In the first place, then, who are insane? By what means do we detect men- tal alienation, and how are we enabled to say this is, and this is not insanity? Can we speak definitely in the mat- ter, or do we only voice an opinion? Must we draw our conclusions solely from the actions of the individual, even while realizing that actions are more frequently vicious 154 J. IV. Wherry. than they are insane? Sir John Nicholl says: "I look upon delusion and insanity to be almost, if not altogether, convertible terms. In the absence of anything in the na- ture of a delusion, the supposed lunatic is in my judgment not properly or essentially insane." This is a legal dic- tum but I heartily concur in it for, looking at the matter as 1 may, from a legal as well as a medical point of view, I cannot see how there can possibly be real insanity ex- cept as it has in its basis a delusion. 1 say real in- sanity advisedly. The condition known as insanity sus- tains such complex relations with the world at large that it, unlike physical diseases, must be viewed from various standpoints. A condition of mind which would warrant commitment to a hospital for insane, for medical treatment, or would justify incarceration in. the same institution to pre- vent injury to others, would not necessarily be sufficient to establish insanity when pleaded as a defense to crime. A man may be so disagreeable as to make life a burden to his friends and associates, without being insane. He may be an object of general ridicule, and his peculiar actions may incite either the laughter or scorn of the observer, without being insane. He may be engaged in all sorts of street fights and saloon brawls, and even stain his hands with the blood of his fellowman, without being insane. He may desert, or mistreat his wife, starve his children, or filch the pennies from a dead man's eyes, without being insane. He may do anything and everything without be- ing insane. His actions are no evidence of insanity. More than this, his mental condition may be such as to excuse all his actions, short of actual crime, and yet not be insane. Consequently, while there are cases of mental aberra- tion which call for incarceration because of their vicious- ness; and others who, by virtue of mental incapacity, are unable to cope with the world and thus require, and de- serve, to be cared for in hospitals, it follows that the laws relating to the commitment of individuals to these institu- tions must be broad in their conception of insanity, and ex- tended far beyond the limits of the scientific or technical idea. Indeed, the law itself views with very different feel- Limiting the Term "Insanity." 155 ings the insanity which is committed to a hospital, and the insanity which claims irresponsibility for murder. There are many patients confined in state hospitals who are not scientifically or technically insane. If they were there would be more recoveries. They are degener- ates, and never did, and never will, arise to the dignity of insanity. Imbecility is not insanity. Mental weakness of any kind is not insanity. Sheer mental weakness from disuse or non-use of the mind is no more insanity, than muscular weakness arising from a like cause, is physical illness. There are all grades of mental weakness in men just as there are all grades of muscular strength. That one man has been endowed with, or has developed, ten-fold more muscular strength than another, is no evidence that the latter is ill. That one man has been cheated by na- ture of his mental qualifications; or has been unable or un- willing to make the most of the trifling gift she did bestow; or, indeed, by vicious practices or unseemly habits has quenched untimely the fire once kindled, until he can no longer retain his position in the battle for existence, but must be cared for by friends, or in a state hospital, is no evidence in itself of insanity. Blandford says: "We cannot describe or define under the one word "insanity" the whole mass of disorder to be seen within the walls of a lunatic asylum for, among these inmates, we find congenital idiots and imbeciles varying greatly in mental capacity, persons suffering from organic disease of the brain, from the results of epilepsy or syph- ilis, and besides these a number whose minds are disordered and subject to delusions and hallucinations." During the past year there were admitted to this hos- pital, 256 patients, and of these, 171 could be technically called insane, while 85 were made up of imbeciles, epilep- tics, and uncomplicated cases of dementia. Not one of these 85 entertained a delusion, and few of them possessed sufficient intelligence to formulate a false belief. Many of the 171 classed as insane were imbeciles, epileptics and de- ments, but these gave evidence of insanity in addition to their brain impairment, while the 85 presented no features 156 J. W. Wherry. differing in any way from ordinary imbeciles, epileptics and dements except in the extent of their affliction and the presence of an element of viciousness, which made it im- possible for them to be cared for outside the hospital. These 85 patients were divided as follows: Hysteria _ _. _._ 2. Imbecility 30. Epilepsy 14. Senility _ __.. 8. Organic dementia _. 8. Primary '' 14. Secondary" 9. Total 85. Cases of dementia and imbecility, and insanity, resem- ble each other only in this, that they are all out of har- mony with their environments, and are taken care of in hospitals because they are incapable of taking care of themselves and cannot be cared for by friends. DEMENTIA NOT INSANITY. Is insanity, then, to be defined simply as a condition which requires care on the part of the state? Or as a con- dition of mental enfeeblement, or of disordered mind, or of no mind at all? Must it be made to cover all the mentally halt and lame and blind found in state hospitals? If the mentally halt are insane, must the mentally blind be nec- essarily insane as well? Does the oculist make no dis- tinction between defect in vision and absence of sight? Are myopia and blindness convertible terms? Is the knowledge of the oculist founded on a more scientific basis than that of the alienist? If so, let us hasten to correct the error. Let us endeavor to arrive at a more definite, and conse- quently scientific, idea of insanity. Let us no longer call dementia, insanity. Until we include blindness in the clas- sification of diseases of the eye let us avoid giving demen- tia, either primary, secondary, organic, or senile, as a form of insanity. Partial, or complete loss of sight may come from any of the diseases of the eye, or from disease of the Limiting the Term "Insanity." 157 brain, but the loss of sight is the condition following the disease, not the disease itself. And so a partial, or com- plete loss of mind may come from any of the forms of in- sanity, or from disease of the brain, but the loss of mind, whether complete or partial, is the condition following the insanity and not the insanity itself. At the same time a disease of the eye may accompany a partial loss of vision, or even be associated with blind- ness, without there being any difficulty experienced in dis- tinguishing between the disease and the loss of vision. And insanity may be associated with dementia without the identity of either being changed or lost. Dementia, in any and all its forms, proclaims a disease of the brain—not of the mind. The mind may become disordered, or deranged, but never obliterated, or weakened, while the brain remains intact. In the idiot the paths of mental conduction have never been opened; in the dement they have been closed. One is non-developmental, the other degenerative. That is the only difference. One never opened its gates; the other has long since closed its doors. Disease has dark- ened every window of the brain and barred every avenue of entrance or exit. The mind, by virtue of this process of obstruction, may be deaf, dumb and blind to the world at large, but not insane. M. Sacase, in American Journal of Insanity, Vol. 10 page 277, refers to this matter thus: "The term imbecility and dementia are frequently used as merely translations of each other, but although they agree in some respects, they differ essentially in their origin—the one being acquired and the other original. Thev are also distinguished from mania and monomania, since in these there is a vicious and ab- normal connection of ideas, whilst in the other, ideas have never been associated or have ceased to be so. In one case there is perversion, in the other, inability." That dementia follows insanity comes only from the degenerative changes produced in the brain by reason of the insanity. It is not the fag end of insanity, nor do they bear any relation to each other, except that of a cause and an effect, through the intermediary influence of the brain. 158 /. W. Wherry. In other words, insanity is the cause of degenerative changes in the brain, dementia the effect. Few cases of dementia, however, result from previous insanity. It comes from the use of alcohol, from syphilis, and from the nat- ural processes of brain degeneration incident to old age. The number of cases of secondary dementia, or dementia re- sulting from the ravages of insanity, are very, very few in my opinion. I know that a large per cent of the dements in hospitals for insane are classed as cases of secondary dementia, but I question the diagnosis. I can much more readily believe that they are cases of primary dementia of long standing, whose original condition of dementia was not differentiated from the insanity which accompanied it. But in later years, when the insane condition had disappeared, the truth not having yet been recognized, the dementia be- came prominent and was assigned a name to indicate that it was a sequel to the insanity. The dementia was not secondary in time so much as secondary in consideration; nor so much a result of the insanity as of a careless ex- amination of the patient, coupled with the practice which then existed and still exists, namely: calling dementia, in- sanity. WHEREIN PRIMARY DEMENTIA DIFFERS FROM INSANITY. Primary dementia, as I understand it, is a condition of premature mental decay caused by a cessation of brain de- velopment, and which may or may not be accompanied by insanity. It occurs generally at the period of pubescence and frequently follows a precocious childhood. Up to the time of puberty all the dynamic forces of the body seem to be centered in the brain, but at this eventful period a change occurs in the vital currents and the developmental forces of life, which hitherto seemed to expend all their energy upon the brain, now forsake it, and their rich stores, which were lavished so abundantly upon the mind, are now, by some trick of nature, poured with equal profusion into the physical structure, so long neglected. New sluice gates have been opened and the vital currents have been de- flected into other fields. The body grows stronger; mus- Limiting the Term "Insanity." 159 cles develop; the chest expands; the physical structure is now to be matured for purposes of procreation. The ordi- nary brain can endure with equanimity this act of dynamic desertion, but in the cases we are considering, by virtue of instability of structure, to be abandoned is to be lost. All that occurs at this time is scarcely known, but the brain has apparently rounded out its career and the day of its glory has departed. It develops no more, and the mind, groping about to discover new opportunities for mental ex- pansion, finds itself hemmed in on all sides by the un- yielding walls of brain obstruction. Further growth is im- possible, by reason of its changed environment, and the mind can only struggle as best it can to adjust itself to the change in its fortunes, and to console itself with the thought of "what might have been" had it chosen a bet- ter and more enduring habitation. Except to fashion itself to its restricted space and conform its activities to its limited opportunities, it has changed little or none. It may have little to say to the outside world and may say it very poorly, but what can be expected of a mind that has been denied all opportunities for development? How can it reason without further knowledge and how secure further knowledge walled up in a brain such as this? The brain has been stricken with palsy and the mind can only accept the situation, which is nothing to its discredit. The men- tality of a Webster, placed in such a receptacle, could do no more. Can this condition, uncomplicated and in itself, be called insanity? The changes in thinking, feeling and act- ing are those only which come from a decrease in func- tional power; but is this the change which is the keynote of insanity? Is the gradual decrease of mental power in primary dementia any more of a change than- the gradual increase which comes with the usual and natural mental development of the individual in health? Is the prolonged departure from the usual way of thinking, feeling and act- ing that distinguishes the adult from the infant, insanity? Well, then, is the prolonged departure from the usual way of thinking, feeling and acting which makes the character- 160 /. W. Wherry. istic mental difference between manhood and old age in itself insanity? I think not. The one is as much to be expected, and follows as naturally and consistently as the other. The presence of a delusion in either case would constitute a good and sufficient basis for insanity, but the insanity would be a condition in itself, separate and apart from the dementia with which it is associated. Would it not be better to distinguish between insanity, and simple and uncomplicated dementia, whether primary or secondary? Would it not give us a more intelligible foun- dation upon which to base a scientific study of insanity than the ground we now occupy, which is so uncertain in its stability, and so unsteady and variable, in its continual shifting to meet the new exigencies forced upon it by vir- tue of the extensive field we seek to cover with a single word? I cannot help believing that not only idiocy and imbecility should be differentiated from real insanity, but primary dementia as well. To my mind the changes occurring in the latter have nothing whatever in common with the mental changes which occur at the inception of acute mania, or acute melancholia, or any other form of real insanity. Primary dementia is based on degenerative changes in the brain, and the condition is practically incurable. Insanity is based on a delusion, a false conception, and its continuance, or cur- ability, depends upon the continuance or disappearance of the delusion. If primary dementia is permanently cured it is scarcely primary dementia. It is more than likely a case of mistaken identity. Mentality never regains its pristine purity when the brain is once stricken with the blight of primary dementia. There may be improvement, and some- times, an apparent recovery, but this is usually only tem- porary and seldom, if ever, does the patient remain away from the hospital permanently. The brain cell may retain some of its integrity, and this may appear to good advan- tage when observed under the most favorable circumstances, but it never recovers its original functional activity. These people may, and do, recover from the accompanying insanity, but the brain remains impaired, inviting new attacks, and Limiting the Term "Insanity." 161 the mind never repossesses its former strength and activity. Periods of stupor, occurring in primary dementia, are more than likely the result of a delusion, rather than a part of the dementia itself, for the stupor is more apparent than real, as evidenced by the accuracy with which the stuporous individual can relate, subsequently, everything that occurred during the attack. However deep the stupor in which he is wrapped may seem to be, he is much wider awake to his surroundings than is usually believed, and, however prolonged the stupor may be, or how remarkable the various aspects it may present, a close observance of the individual will reveal a considerable amount of "method in his madness" after all. When these cases tell you, after recovery, that they heard everything that was said during the attack, and fully comprehended the situation; that they wanted to reply to questions asked, and to do what was requested, but something prevented, does it require any great stretch of the imagination to conclude that this "something" had its basis in a delusion? In my own mind I am convinced that the stupor in these cases is an evidence of insanity, rather than an indication of dementia. Indeed, many cases of so- called primary dementia may not be dementia at all, but a condition of apparent stupor, having its basis in a delusion, and which disappears with the disappearance of the delusive idea. Are these the recoverable cases of primary dementia? All cases of primary dementia are not insane, just as all imbeciles are not insane. Cases of primary dementia admitted to hospitals are in nearly every instance attended with insanity, but this insanity stands out more or less prominently and can easily be separated from the dementia with which it is associated. There is a vital and essential difference between an individual who believes that his right leg is made of glass, and one who, by virtue of early brain degeneration, is incapable of believing anything with any degree of certainty. There is the same degree of difference between the insane idea that grass is red, white and blue in color, and no idea at all, as there is between no idea at all, and the sane idea that the color of grass is green. In other words, there is the same distinction existing between 162 J. W. Wherty. insanity and complete dementia that exists between complete dementia and sanity. Primary dementia can scarcely be held to be a form of insanity for there are many, many cases of early mental failure occurring at, or about, the time of puberty, which are never committed to the hospital, and there is no necessity for doing so. The primary dementia is present, but there is no insanity. They are the precocious children who later prove to be the dullards in the school. They develop into the people who never do well and who are a constant and perennial disappointment to themselves and to their friends. They are the individuals whose moral lapses give rise to much and frequent litigation and in whose prolific fields wild oats spring up again and again in a never-ending succession of crops. Sometimes they develop insanity later, in fact their condition of mental unsoundness invites insanity, but even then the insanity and dementia, it seems to me, appear as two conditions, not as one. To avoid confusion, primary dementia, as well as secondary, organic and senile dementia, must be considered as having their basis in degenerative changes occurring within the brain, and not in any derange- ment of the mind. THE BASIS OF INSANITY. Insanity can never be extended to cover every abnormal and unusual mental condition as alienists are now attempting to do, and so long as we insist on doing so nothing but confusion and uncertainty need be expected. Nor is it suffi- cient to simply eliminate imbecility, and primary, secondary and senile dementia. We must do more. We must clarify the atmosphere surrounding insanity itself. Whenever we try to establish a form of insanity called intellectual insanity, which is based on a man's manner of thinking; and another form called emotional insanity, based on the way he feels; and still another form called violent, or homicidal insanity, based on the way he acts, we are only laying traps for our own feet and pitfalls for our neighbor. There can be but one basis for insanity, indeed there needs to be but one, no matter into how many divisions the evidences of Limiting the Term "Insanity." 163 insanity may be formed. The one basis of insanity is what a man feels; not the light and evanescent feeling or emotion ordinarily experienced, but a feeling so intense as to become an absolute conviction, an innate sense of assurance, which needs no argument to establish its position. Ordinary emotions are founded upon, and have their existence in, a sense of pleasure or of pain. This is the source and origin of their being. An emotion, according to Webster, is "an excitement of the feelings, whether pleasing or painful; disturbance or agitation of mind caused by a specific exciting cause and manifested by some sensible effect on the body." This feeling which lies at the threshold of insanity is not a simple emotion. It is more than this; so much more that there should be a different word to express it. It lies deeper; it is more intense, and it has no specific exciting cause. It may carry with it either the sensation of pleasure or of pain, but these are its creatures rather than its cause, and are only incidental. Indeed, the threads of pleasure and of pain sometimes become so interwoven and entangled that their identity is lost, or so obscured as to become unrecognizable, and pain becomes pleasure and pleasure, pain. Who can look upon the excessive demonstrations of unbridled grief without wondering whether or not the accompanying sensation is not more of pleasure than of pain? Who can contemplate the hypochondriac without feeling that he finds great pleasure in the discovery of some new discomfort or some new disease? Who can listen to some melancholiacs without believing that they derive a morbid pleasure from the maledictions they heap so abun- dantly upon their own devoted heads, or from the sackcloth and ashes they voluntarily assume to endure? This deeper feeling is not a definite sensation, but a fundamental tone. It is the prevailing tone of feeling of sanity swollen to gigantic proportions, and it dominates all intellection, all acts and all emotions; and until it does dominate mentality no man can be safely called insane. Its first act of aggression is to bind the intellect. There is no other method by which it may gain absolute control. No man will voluntarily act in opposition to the dictates of his own 164 J. W. Wherry. judgment. Warp the judgment to fit the act and its con- summation is assured. Men are but puppets; the idea is the force which shapes and molds their lives. Whether it is an idea instilled at a mother's knee; or driven home by the ferrule in the hands of the master of the village school; or one that was sown in the soil of bitter experience and watered by the tears of repentance; or an eternal verity planted by the hand of the Almighty; or a delusion raised into consciousness by an unseen hand; these are the living and potential forces which fashion a man's existence. Let the idea be but evolved—let the delusion be but born, and the change in the thoughts, acts and emotions will follow in logical sequence. In this tendency to dominate mentality lies the danger of an exaggerated fundamental tone of feeling. When it once implicates the judgment its mission is complete. It spends no further force upon the emotions or the will; it simply supports and controls the idea which the judgment has sanctioned; and this idea, created by virtue of a neces- sity, is amply sufficient for all subsequent needs. The idea fegulates the processes of reasoning; it governs the future deliberations of judgment; it guides the actions; it con- trols the emotions. But deep down beneath it is an all- compelling force which commands the situation. The acts and the emotions are but the slaves of a mightier power, making no distinction between the false and the true, only more ready, perhaps, to obey the commands of a tyrant, than the milder requests of a considerate and more reason- able master. Insanity, then, may be said to be the expression, by means of the acts and the emotions, of what a man thinks, as determined by the quality of the fundamental tone of feeling, instead of by the dictates of a normal and unbiased judgment. Tomlinson says, in a paper read before the 59th. Annual Meeting of the American Medico-Psychological Association, "When we take into consideration that insanity is the man- ifestation of alteration, not destruction of function, we can appreciate that the activities involved are the same in amount and kind, in both normal and abnormal cerebral functioning. Limiting the Term "Insanity." 165 In the one case they represent the response to external stimuli, the effect of which is habitual; while in the other they are excited by centrifugally generated stimuli, more or less out of accord with external relations. There is no abstract difference (he says) between the conduct of the sane and the insane! The difference lies in the nature of the experience which gives rise to the conduct." What, then, is insanity? The word itself means, not sane, or not sound; that is, a mind that is unsound. It is important, however, to make a distinction between sound- ness of mind, and the sum total of knowledge. A man may be wise beyond his years, or a congenital idiot, with no suspicion of insanity in either case. The aggregate of knowledge is not a test for insanity. A man may be ignorant, nay, hs may even be illogical and unreasonable without being insane. Many voting precincts would be emptied if all ignorant, illogical and unreasonable men were committed to hospitals for insane. Many business failures are the result of illogical reasoning. Either false premises were accepted as true, or wrong conclusions were drawn from imperfect reasoning or from imperfect knowledge. These men may be regarded as incompetent or incapable, but not one could be rightly called insane from these facts alone. And yet, insanity is illogical and i nreasonable, and adopts false premises, or draws false conclusions from premises that are true. How can these two conditions be so similar and yet so widely apart? What is the distinguishing feature which marks a man as insane? What is the peculiar quality permeating insanity which can be relied upon as differen- tiating this mental condition from all others? Not the amount of knowledge; not illogical reasoning alone; not viciousness; but simply this: In sanity the judgment is guided and con- trolled by the intellect, and its conclusions, whether good, bad or indifferent, must be regarded as sane. In insanity the judgment, as well as the intellect, is dominated by a fundamental tone of feeling, and the whole mental life par- takes of the peculiar quality of this basic sense. CAN THERE BE INSANITY WITHOUT DELUSION? 1 believe that insanity is a mental attitude based upon 166 J. W. Wherry. an exaggerated fundamental tone of feeling, which gives birth to a delusion; that this delusion is the source from which this mental attitude derives its general characteristics, as well as its local color, and that without a delusion, either expressed or concealed, there can be no real insanity. It is true there are occasional cases of insanity in which no delusion can be discovered, and there are some, who stoutly contend that the undiscoverability of a delusion is proof positive of its absence. 1 do not believe, however, that this opinion is held by those who have had long years of experi- ence in dealing with the insane. But there are other cases where conclusions regarding the presence or absence of a delusion can not be drawn with certainty; where no delusion finds expression and there exists no evidences of its conceal- ment. No statement to the effect that insanity is always associated with a delusion can stand, if there are known to be cases of insanity in which no delusion exists. The establishment of the latter proposition would nullify the former, in a measure at least. But let us see upon what ground the statement is made that there have been cases of insanity without delusions. It may be possible that the assertion rests upon no firmer foundation than the one it seeks to qualify. In the first place, was the examination conducted by a man of experience? All men do not determine the pres- ence of the physical symptoms of disease with equal facil- ity nor with equal success; and mental symptoms, likewise, do not respond to all inquirers alike. Was there no possi- bility of the delusion being concealed? Was there nothing to indicate that the patient's manner of thinking, feeling and acting had its basis in something abnormal? Was there any possibility that the patient was unable, by reason of the confusion attending a recent mental upheaval, to formulate a statement of the true condition of affairs? Would not the replies of the patient, when he says that he cannot describe his condition, that he does not know what causes it, and that he has made every effort to break away from the feeling, but cannot do so, indicate that the condition is not spontaneous, but must have a cause? If he Limiting the Term "Insanity." 167 feels that he is submerged in an emotional sea, or com- pelled to a certain course of action, or led to doubt where he once believed; what is it that submerges, and compels, and leads? Is it nothing because the patient has not yet recognized it, or, having recognized it, is unable to put his knowledge into words? Or, in the absence of all positive knowledge, is there any greater reason for saying the pa- tient has no delusion, than for saying he has? Under these circumstances would one statement carry any greater weight of authority than the other? McFarland, in a paper read before the American Asso- ciation of Superintendents of Institutions for Insane some years ago, refers to the probable existence of delusions in all cases of real insanity, in these words: "Everyone real- izes how few of the delusions of the insane mind are ever revealed, and how readily they are revealed under one set of circumstances and concealed under others. All insane asylums abound in cases of unquestionable mental disease, where its palpable manifestations are so obscure that the unskilled observer would doubt its existence. A certain suspicious reserve, a mysterious shyness of manner, some haughtiness of bearing, or something marked and singular in the tone of voice and manner of utterance, some strange attachment to some particular position or seat, or special stress applied to the doing of some act, may be all that distinguishes the individual from other men. Yet one, guided by experience, has no hesitation in declaring such cases to be instances of a latent delusion, and is prepared for the sudden exhibition of extreme or violent acts, of which any of these almost unobserved antecedent peculiari- ties furnishes the explanatory key. In such cases the ex- tent of the disease is not at all measured by what appears on the surface, and those who treat the insane are con- stantly surprised by the revelations of recovered patients as to the multitude and singularity of the delusions which possessed them while in a state which seemed, for all dis- coverable sign, so little removed from full enjoyment of reason." As an illustration of the mistake frequently made of 168 J. W. Wherry. ignoring the possibility of a delusion being present, simply because it does not challenge attention, and, moreover, making no effort to discover one because the case had been diagnosed as insanity without delusions, Dr. McFarland continues, referring to a case under his care: "She was not discharged at the time. She proposed subsequently that she be allowed to continue to write her book. 1 gave my consent, and when she got fairly into the work, the whole delusion, which had lain concealed in her case for eighteen years, became fully developed, and it showed that all this perversity of conduct arose out of one single delusion; and the delusion was, that in the Trinity distinctions of sex had to exist, and that she was the Holy Ghost. That there was a God the Father, Jesus Christ the Son, and she was the female Holy Ghost. It appeared, moreover, unmistak- ably in her writings that this delusion had possessed her for eighteen years, growing and increasing upon her, and giving origin to all this perversity of conduct, clearly and connectedly as 1 now see it, making out a case perfectly consistent with the idea of an original intellectual delusion underlying and producing all the so-called phenomena of moral insanity." DEFINITIONS OF INSANITY. But, admitting that there is no delusion present, there still remains another horn to the dilemma, namely: Is the individual insane? Who can say? The determination of in- sanity today is not a positive conclusion, but a matter of opinion. There is no rule by which it can be meas- ured. There is no standard to which it can be fixed. One expert, grown gray in the work, and with long years of ex- perience to his credit, will testify that the prisoner is in- sane; while another expert, grown equally gray in service, and with similar advantages in the way of experience, will testify with corresponding certainty that he is not. Here is the supreme test of all definitions of insanity, for a defini- tion that will not stand in law is no definition at all; it is only a makeshift, which serves all purposes with celerity, but none with fidelity. Limiting the Term "Insanity." 169 A prolonged departure from a man's usual method of thinking, feeling and acting is said to constitute insanity. But this is not enough. A man, steeped in iniquity and a brother to vice; a reviler of Christ and an enemy to all that is virtuous and good, enters a house dedicated to the worship of God. The service, in some mysterious manner, strikes a cord which haply responds, and for the first time he thrills with the touch of the divine. He comes again and again, and at last the hand o: a saving grace is laid upon his head; his heart is attuned to a new song, and he experiences the sweet peace which comes at such times to the troubled soul. He is a changed man. He is born again. He thinks no more as he used to think, nor does he feel or act as before. There is a prolonged departure, it is hoped, from his former method of thinking, feeling and acting. But this is not insanity; there is no delusion here. Men are permitted to change their opinions, and their feelings, and their actions; to make this departure as prolonged as they desire, and to freely adopt any views or any ideas they may choose, without any implication of insanity, unless the change of opinions, or adoption of ideas has been at the instance of a delusion. Many alienists prefer the following definition, and some believe in its accuracy: Insanity is a prolonged departure from a man's usual method of thinking, feeling and acting, not due to external causes. "Not due to external causes" is added as the saving clause. In other words, any mental condition due to external causes is not insanity. This would be an easy solution of the problem if true, but what about disappointment, or grief, or traumatic injury of the brain? Do these ever cause insanity? Are they not due to external causes? Another definition much in favor is as follows: A pro- longed departure from a man's usual method of thinking, feeling and acting, without adequate external cause. Here "without adequate external cause" has been formulated to avoid the criticism evoked by the former definition. It was recognized that if a man was overcome with grief, by reason of the death of a relative, his unusual conduct would not 170 J. W. Wherry. be insanity because there existed, in the death in the family, a good and sufficient cause for his condition. According to this last definition no mental condition can be called insanity so long as there is an adequate external cause to account for it. This definition is better than the other, but is it all that can be desired? Is alcohol an external cause? Is it adequate to account for the condition? Is alcoholic insanity a myth? There is still another definition, similar in every way to the one just considered, except that the words, "due to disease of the brain," are added. This means that insanity is the prolonged departure, as above, that it must not be due to an adequate external cause, and that it is the result of disease of the brain. Here one must give up in despair, for this definition, the best by far of all, has completely eluded its pursuers by running into a hole out of sight. The statement that insanity is due to disease of the brain is all right when propounded as a theory, but it is all wrong when offered as a definition. Some believe this as a theory, while many do not. Those who believe it have been unable to demonstrate it, and, finding, even, gross pathological changes in the brains of a thousand insane patients would be no positive evidence of disease of the brain in the par- ticular individual before you. Defining insanity by the assumption of a condition which is not universally believed, and whfch cannot be demonstrated, can only be regarded as an opinion, entitled to all the respect and consideration due to a personal opinion, but not to the authority of a definition. Tomlinson says: "it is a great misfortune that the brain is not so carefully studied in those dying from typhoid fever, pneumonia and general sepsis, as it is in the insane. We are too apt to take for granted that a certain condition found postmortem in the brain of a person dying insane is the cause of the insanity; losing sight of the fact that we do not yet know that the changes we find do not also exist in the brains of the sane who die under similar physical conditions. Indeed, our observation of the microscopic changes in the brain and its coverings, among the insane, Limiting the Term "Insanity." 171 and our study of the histology of the cortex, would tend to confirm this doubt; so far as any changes are apparent, aside from those present in dementia (note the distinction made pathologically between insanity and dementia) and even these changes can often be found in advanced or pre- mature senility, where no mental disturbance has existed. It is the belief of the writer (he continues) that the time will come when we will recognize the histological changes, found in the brains of the acutely insane who die, as the result of the physical conditions which preceded and were associated with the insanity, and not as the cause of the mental disturbance." But what of the man without the delusion? Is he insane? It is useless to rely upon the definitions of insanity. If one says he is not insane and another says he is, who shall decide? How shall they decide? If, in order to save my case, I pronounce him sane, who shall say me nay? This much 1 grant: If the examiner will demonstrate the absence of a delusion to a reasonable degree of certainty and, at the same time, furnish evidence that the man is insane, why, it will be useless for me to go further, for a careful statement from him as to the methods employed in securing this satisfactory evidence of insanity would render any further definition of this condition unnecessary. The definition of insanity which I have given as my own is not above criticism. It is only one more added with the hope that it may prove to be better than any now in use. It establishes insanity by the presence of a delusion and, while the discovery of the delusion is not always a simple process, it is not, 1 believe, attended with any greater difficulty than is met by every physician in deter- mining the presence of many of the symptoms of physical diseases. It yields, of course, most readily to experience and it is a delusion scarcely worth the name that can long succeed in successfully escaping detection at the hands of an expert. This definition is surely clear and definite, if that is any merit, and its acceptance can be refused only on the grounds that the foregoing pages have not fulfilled their mission. Those who still continue to regard imbecility 172 J. W. Wherty. and dementia as forms of insanity cannot accept this defi- nition, but if, after all has been said, the reader will dwell upon the thought a little longer, I believe that he, too, will conclude, that without a delusion, either expressed or con- cealed, there can be no real insanity. In the case of Elizabeth Heggie, charged with the murder of her daughter, which is so ably and extensively reviewed in the American Journal of Insanity, Vol. 25, Dr. Cook, physician of the asylum at Canandaigua, N. Y., testified as follows: "He was of the opinion that the defendant was of unsound mind. He was unable to say that in his opinion, positively and without qualification, using the term 'insanity' in its ordinarily received acceptation, she was then insane; he used the words 'unsoundness of mind,' not 'insanity,' making in this case some distinction—not using them as precisely convertible terms. He entertained a doubt about there being a delusion, and it was partly on that account that he hesitated to pronounce positively upon the insanity." Dr. Cook recognized that there could be conditions of unsoundness of mind which were sufficient to relieve an individual, committing a crime, from all responsibility, without there being any evidence of insanity. He also recognized that real insanity could not exist without the presence of a delusion. Could he have satisfied himself that the delusion was there, even though it might never have been formulated into words, he would have unhesitatingly pronounced her insane. Entertaining a doubt regarding the presence of a delusion he must necessarily entertain a doubt of her insanity. In the same trial Dr. Butteo, Superintendent of the Hartford Asylum, in his testimony, "was not convinced that the defendant was insane; but the evidence showed him that there was a state of mental unsoundness and debility which created in his mind a strong doubt of her sanity." When the Doctor says that she was not sane, nor was she insane, it would seem at first glance that he had used con- tradictory terms; and the terms are contradictory according to their usually accepted definitions. "Insane," to be sure, would mean anyone not sane, if we rely simply upon the dictionary, but every physician of experience realizes that Limiting the Term "Insanity." 173 there are many men who are neither sane nor insane. Idiots, imbeciles and dements are all of unsound mind, and are neither sane nor insane. Justice Mason, in charging the jury in the same case, said: "* * * When you come down to the question of what is destined to be the real point in this case to estab- lish insanity, and that is, the delusion, it is said to be upon the question of her relations to her daughter, etc." The editor of the Journal of Insanity in reviewing the case says further: "As the Court put it to the jury, on the main issue, it was wholly a question of delusion or no delusion in the legal sense, and that sense is well and authoritatively defined by Justice Mason." Dr. Forbes Winslow, in his "Diseases of the Brain and Disorders of the Mind," says: "There are other affec- tions of the nervous system that resemble in many of their features mental alienation. In such cases there is often great emotional exaltation, perversion of the instincts, con- fusion of thought, exaggeration closely bordering on aber- ration of ideas, as well as great eccentricities of conduct. Such symptoms may exist independently of insanity, as a distinct type of nervous disorder. It is only when the mind exhibits signs of positive alienation, manifested by the pres- ence of a delusion, that we can satisfactorily affirm that insanity, in the right acceptation of the term, has clearly and unmistakably exhibited itself." Dr. John E. Tyler, in a paper entitled, "Tests of Insanity," gives additional testimony on this point, and, although he does not employ the exact word, it is evident that he refers only to delusions. He says: "It has seemed to me that there is a peculiarity in the state and manner of action of the insane mind which is always present and almost always so characteristic of insanity, as to be worthy of notice, and able to give us often decided aid in coming to a just conclusion in doubtful cases of alleged disorder. We all know that with the insane, self becomes the central point of interest—the important consideration and the authority. * * * Upon any subject within the circle of his disease, facts and external circumstances have little or 174 /. W. Wherrf. no influence with him. His convictions come from his own personal laboratory. They are original. Sometimes they are strictly intellectual results; often they grow from a morbid emotion. But they are coined by him, and not received from another. And they are ultimate authority to him. No sane man is ever half so sure of any most palpable truth as an insane person is of the infallibility of his own convic- tions." This belief in his own convictions, however, is not due simply to egotism, as Dr. Tyler infers, but to the exist- ence of a delusion, which stamps its impress upon these convictions, and by virtue of which they occupy a position in consciousness denied to the convictions of sanity. A case in point is that of Ann Barry, charged with infanticide, and in which Dr. John P. Gray, at that time Superintendent of the Utica, N. Y. State Hospital, testified as follows: "Have heard pretty much all the evidence given on this trial; have conversed with the defendant. From my examination of her I discovered no evid'ence of insanity. Insanity is a disease of the brain in which there is a change in the way of thinking and acting of the individual, and that involves a delusion, a supposition of facts that do not exist. Her confession of committing the infanticide does not show a delusion, and 1 do not think that she was insane at the time of committing the alleged crime." In a Treatise on Mental Diseases, by W. Griesinger, the following occurs, the words in brackets being my own. "Profound modification in the sphere of the character and feelings, [moral degeneracy] morbid mental tendencies and emotions, [as in imbecility] general or partial diminution of the intellectual forces, [as in dementia] may exist in various diseased conditions of mind, either acute or chronic, without the presence of actual delusions. But experience teaches, nevertheless, that in a great majority of cases a different state of things exists; that insane ideas, properly so-called, make their appearance, and with the appearance of these insane ideas, which can no longer be resisted, constituting actual delusions, the mental disorder, which at first only reached the feelings, has now extended its influence and become insanity of the intellect." In other words the Limiting the Term "Insrnity." 175 presence of delusions is prima facie evidence of, as well as essential to, insanity of the intellect; the only condition in fact which merits the distinction of insanity. Dr. Thomas S. Kirkbride, while president of the Asso- ciation of Medical Superintendents of Institutions for Insane, made the following statement in his able discussion of Dr. Chipley's paper on the Legal Responsibility of Inebriates. He was considering the subject of moral insanity when he said: "in almost every case delusion can be detected. At the same time 1 am willing to acknowledge that there are cases in which, while 1 believe delusion exists, it is extremely difficult to detect, but I have never seen a case which would be called insanity in which I did not believe real delusion existed." A DELUSION IS NOT A BELIEF. A delusion, however, is not simply a belief; nor is it merely a false belief. Any number of false beliefs may be entertained without producing a condition of insanity. In fact, many of the beliefs we now hold may be false. Are we not almost daily called upon to give up some long cherished belief? Do we not constantly find that the con- clusions of yesterday must be modified and changed before they can satisfy the requirements of to-day? Are not all beliefs the product of imperfect knowledge? Perfect knowledge leads to truth—not to a belief. No one believes that he is hungry or thirsty. He knows it. He knows it because his information is gleaned from sources so absolutely unquestionable as to leave no room for doubt. When an element of doubt exists, or the source of the information is such as to render its presence more or less probable, or even possible, we no longer know. Under these circumstances we can do no more than believe, and the volume and strength of our belief is in due proportion to the possibility of error. A belief, then, is always question- able, for so soon as our information becomes a positive truth, then belief blossoms into absolute knowledge. A delusion, whatever else it may be, is not a belief. Its possessor can conceive of no possibility of error in its composition. There 176 J. W. Wherty. is no probability, nor even possibility of doubt regarding the primitive elements of which it is constructed. It is not simply an idea that can be fostered to-day and abandoned to-morrow, with little or no concern, but a living truth whose roots strike deep into the very soul. It is not a mere opinion, poising lightly in consciousness, clothed with but brief authority, but a perfect whirlwind of absolute convic- tion, that comes to reign and rule, and flings defiance at all beliefs and opinions; at the counsel of friends; at the customs of society; at the frown of judges and the threats of the law. Nay, verily, a delusion is not a belief. It is more than this. To say that a delusion is a false belief is no better. All beliefs possess an element of falsity, else they would not be beliefs. We possess but few truths. Most of our mental property consists in beliefs and they are valued, ac- cordingly, as such. If anyone doubts them, why, very well, it is a matter of no concern to us. We give them to the world, indifferent to their reception and careless as to their existence; but a delusion seems to be wrenched from the very Ego itself. It must be accepted by others. It is ab- solute, unqualified, unquestionable truth. It is so myster- ious in its origin, so instantaneous in its conception and so overwhelmingly all-powerful in the manner of its conviction, that it appears to be stamped with the seal of positive ac- curacy, and to bear the very impress of the Almighty. It is unlike any other mental conception. It is -not a belief, nor a creed, nor an opinion, nor a trust, nor a faith. Men hold these more or less lightly, but a delusion is burned into the very core and center of his being. It is a thing for which men will hate their friends; desert their families; defy the law; assassinate the one they love the best and die, if need be, in its defense. Can any mere belief, whether true or false, claim allegiance such as this? Can any belief so torture a man that he will strike, without other cause, at the source of his own existence? Can any mere belief so nerve the arm and steel the heart that a man can strangle his sleeping babe, the while he calmly smiles with the assurance of a duty nobly done? Can any possible Limiting the Term "Insanity." 177 mental conception, except a delusion, transform a beggar into a king, seated upon his throne amidst the glitter and glamor of his royal court; or a king into a miserable in- grate, flying from the imaginary wrath to come; or into a snake, or a flying archangel, or a glass tube or into any and every other conceivable thing, whether above the earth, or on the earth or in the waters under the earth? Beliefs are the result of knowledge; delusions have no such origin. A belief has its birth in the laws of associa- tion; is built up logically and consistently from the mater- ials at hand; demands no defense at the hands of its originator and differs little from the beliefs of others. A delusion, on the contrary, is an idea born in subconscious cerebration; it is projected into consciousness during a period of mental stress; it is strenuously defended by the originator, and no one else believes it to be true. A de- lusion is even more than an idea; it is an idea that Gan be felt. A belief is the product of conscious effort, but a delusion comes unheralded and unannounced, bursting into the field of consciousness and filling the whole mental horizon with the glory and glow of its own significance. Ideas, which had hitherto been the guiding stars of a man's life, pale and fade in the radiance of this newly arisen sun. Motives, which heretofore had formed the very main- springs of his existence, lose their force and meaning in the readjustment following this intellectual upheaval, and new and alien motives are introduced to fit the new con- ditions. The faiths and beliefs of a lifetime are forgotten or deserted. The whole mentality is filled with the per- sonality of the new idea, and every faculty is made sub- servient to its despotism. The judgment, the emotions, the will, are all molded and shaped in conformity therewith. Is it a delusion of persecution? Then Fear arises in his re- sistless might and crushes out joy and gladness. Grim Terror stajks through all his thoughts, and Malice points her long and bony finger at the fancied author of his woes, and goads him to avenge the wrongs he has so long and so patiently suffered. Has he committed the unpardonable sin? Then the deadly miasma of Doubt is evolved. Grief 178 /. W. Wherrv. smites the rock of pride and a fountain of tears gushes forth. Suspicion withers with its baleful breath everything good and true, and all hope is swallowed up in misgiving and disbelief. Is it a delusion of grand-eur? Then Joy is dominant and unconfined. Laughter greets the ear. Life is sweet. The glittering generalities of pomp and power are his, and every emotion and every act are in harmony with the delusion he entertains. In insanity, every alien act and every alien emotion has its origin in a delusion. No matter what the man may have thought, and felt and done before. There is now a new order of things. Old things have passed away or have been temporarily dominated by the new. An alien idea has been crowned king, and every mental faculty has been sold into bondage. With an alien idea upon the throne there must come alien emotions and alien acts. At first we ob- serve these alien acts, but are not sure they are not vic- ious in their nature. We go further. We observe the alien emotions, but are not sure that they are sincere, or that they are not the ebullitions of vacuity, or the accumu- lated froth on the surface of a weak mentality. We go still further. We probe the mental depths to find an alien king upon the throne, and from this alien triumvirate of act, and emotion and delusion, we form the mental atti- tude, and this we call insanity. But, if in our investiga- tions we had found that the alien king had absconded or, indeed, had never gained a foothold, then no amount of alien acts, or alien emotions could have constituted real in- sanity. In other words, in the absence of a delusion, no amount of elation, or hilarity, or torrents of tears, or gnash- ing of teeth, or exacerbations of temper, or queerness, or peculiarities, or crankiness, or viciousness, or any other thing, would constitute insanity. The mental life of the insane is not necessarily hap- hazard and without system or method. In the earlier stages at least it holds pretty consistently to the faith that is within and, however unreasonable it may seem to those who draw conclusions from a different premise, there is usually a pretty definite harmony existing between the de- Limiting the Term "Insanity." 179 lusion and the emotions, and its outward expression in the form of concrete acts. The fleeting fancies, so common in dementia, cannot be called delusions. They are but the fitful and grotesque gambolings of a mind freed from all restraint. They have neither the inherent power, nor the dynamic force, of a de- lusion. They come and go. The mind has again become a child, playfully sporting in the evergreen fields of imagina- tion. They have no more significance than the same ideas in the minds of children, who play at keeping house, or riding in a coach and four, or holding a dignified and solemn consultation over the pain-racked body of a suffer- ing doll. That they have been regarded as delusions in many instances is evident from the history records in hos- pitals for insane, but that they lack all the essential qual- ities of a delusion is a fact not difficult to recognize. RELATION OF HALLUCINATIONS TO DELUSIONS. Hallucinations are of no slight importance in the consideration of insanity, for, when present, they form one of the most distressing symptoms of this disorder; but hal- lucinations, in themselves, are harmless. It is only when they become crystallized in the form of a false conception, that they are found to be dangerous. Many sane people have hallucinations of sight or hearing, but they are able to detect the fallacy, and correct the erroneous impression. So long as they are recognized as hallucinations, and exist merely as vagaries of sight or hearing, no serious results ensue; but when they become sufficiently dominant to give rise to false ideas or beliefs, then untoward consequences may result. A man may hear unusual sounds, which he rightly ascribes to inflammatory processes in the middle ear. He may, indeed, hear sounds, which seem to be spoken words, but he knows this to be impossible in the absence of anyone to utter them. There comes a time, though, when the spoken words become more persistent and more significant; when the usual explanation of their origin is no longer satisfactory, and then the delusion is born. 180 J. [V. Wherry. A man who can listen to these voices with a feeling of unconcern, knowing that they have no basis in fact, is harmless and is not insane; but, if, when these words are again heard, something tells him, without any possibility of error, that they were spoken by his companion at his el- bow, with the intention of insulting him, then he is not only dangerous but no longer sane. Hence, hallucinations as a symptom of insanity, have their basis also in a de- lusion. They cannot, indeed, be considered as evidences of insanity unless, by reason of their delusional implication, they lose their real significance and give rise to erroneous conclusions. It is seldom, however, that hallucinations of themselves give rise to a delusion. On the contrary, they are almost always thrust into prominence by reason of the facility with which they fit into the dominant idea. The halluci- nations of the sane differ very widely, in all probability, from the hallucinations of the insane. In one case, they arise merely from some defect in the organ of sense, or in the process of brain registration, with which anomaly the individual soon becomes familiar, and corrects with no greater difficulty than attends the correction of double vis- ion. In the other case, the disorder may or may not arise from the defects in the organ of sense. Probably not. They are a part and parcel of the fabric of insanity itself. Hallucinatory threads, when present in insanity, are closely and intimately associated with the very warp and woof of the disease, and their ultimate ends are twisted and enmeshed in the roots of a fundamental delusion. They are born of a false conception, and rocked in the cradle of a false be- lief. Their origin, frequently, is in the very necessity of the situation. They become absolutely essential by virtue of an all-compelling emergency, and the sufferer sees the thing for which he so longingly looks, and hears the voice for which he so patiently listens. A man, feeling a sense of unusual, sudden and myster- ious power, believes that he has been divinely called to an important mission, the details of which are supplied by the fervidness of his imagination. He feels the thrill and Limiting the Term "Insanity." 181 throb of conscious power pulsing in every vein. He is stirred to the deepest depths of his nature by the possibili- ties attending this divine connection. The outcome of the mission is to be so important and far reaching in its re- sults, that it would be beyond accomplishment by any human means alone, but under His guidance and His di- rection, nothing can withstand the asssault. He already feels the assurance of His aid and the benediction of His presence, and he listens intently for the voice of the Mas- ter. Every faculty is strained to catch the first glad word. All other sounds are lost, or forgotten. His ear is tuned alone to the accents of the Almighty. Why does He not speak? He is in an agony of despair. The situation grows desperate. Wrapped in oblivion to all earthly sounds he listens on. The strain begins to tell; the words must come. And just then, miraculously, it seems to him, there comes tinkling down through the immensity of space, "a still, small voice," and the delusion is rounded into activity. Hallucinations, to be effective, must be grounded in a delusion. 1 can see no reason why the insane should not have the same harmless hallucinations, founded on some trick of the organs of sense, that the sane have, and which, having no foundation in a delusion, are corrected in the same manner. All the quips, quirks, and peculiarities of the insane are not necessarily evidences of insanity, any more than the same features are evidences of insanity in those unafflicted with mental disease. They are just what they are, no more, no less, and stand for the same value wherever found. The insane may have hallucina- tions, and all other peculiarities possessed by the sane, without their being implicated in their mental alienation in any manner. So long as these hallucinations are corrected by the patient, the attention of the observer is seldom- called to them, and it is only when they become a part and parcel of the delusion itself, that they are thrust into prominence. Consequently, it is safe to conclude, that all uncorrected hallucinations have their roots in a delusion, whether the individual has been adjudged insane, or other- wise. 182 J. W. Wherry. STABILITY OF DELUSIONS. A delusion, when once installed, does not vanish in a day. It departs, if it goes at all, only with the removal of the cause which gave it birth. Its term of residence may be permanent, or temporary, but while it remains it is not sub- ject to very great variability in the manner of its manifesta- tions. If there is any change at all, it will be found in its vol- ume rather than in the inherent quality of its original ele- ments. It grows weaker by reason of the ravages of time, in common with other products of the mind, though the fact that it remains active and vigorous long after every other in- telligent concept has fled, is striking evidence of the tenac- ity and endurance of the fundamental elements which underlie it. While it may vary slightly from time to time, it does not possess the variability of the "evanescent de- lusion" of the text-books. The basic principles of the de- lusion remain practically the same, the change occurring only in the form of its manifestations; and the fact that this variation in the form of its expression has been taken as a modification of the delusion itself, has been the cause of all the confusion regarding the stability of delusions. To illustrate. A transcript of the history of the delusion of one, M. F., a patient in the hospital, reads thus: "January 6th. Has the delusion that she is to be kidnapped by masked men, who will inflict upon her the most inhuman torture, for the purpose of extorting a ran- som from her friends. "March 8th. Delusion has changed. She now be- lieves that a conspiracy has been formed whereby armed men will appear on the ward, at a given signal, and mur- der her in her sleep. "April 11th. Patient has still another delusion. She now believes that she is to be put out of the way by means of poison introduced into her food. As a result of this she insists upon buying her food outside and having it shipped in original packages, to be handled by no one but herself after its arrival." Evidently here is a patient, who has had three sepa- rate and distinct delusions within a period of three months, Limiting the Term "Insanity." 183 or, at least, so it would appear; but this is an error, and is the result of recording conclusions derived from merely a surface view of the situation. The truth is there, but it lies deeper. The fact is, the delusion has never faltered or varied in any particular since the date of its inception. The basic principle of her delusion was that she was to be sub- jected to great bodily torture and mutilation, which could end only in death, and this deep and abiding conviction was beyond all possibility of error, for reasons which she felt, rather than thought, and could not put into words. That she originally believed that the content of her delusion was to be accomplished by means of kidnapping her; that later the means to be employed took the form of a conspiracy to commit cold-blooded murder, and that still later the end was to be attained by introducing poison into her food, is no evidence of any change in the fundamental principle of the delusion, but a variation only in the means by which the end was to be accomplished. The first solution of the problem was suggested by reading the newspaper accounts of the Cudahy kidnapping sensation. The delusion was doubtless already present, and she consequently read everything pertaining to the affair with avidity. The seed of suggestion fell upon fruitful soil. It was a proof print, a first impression, and so accurately did it fit into the delusion, that no later impression, no matter how stoutly maintained, has ever been able to com- pletely efface it. After being brought to the hospital, the lessened possibility of being kidnapped obtruded forcibly on consciousness, and then through some form of suggestion, the delusion was expressed in the terms of cold-blooded murder. The same concrete facts, namely: the barred windows and locked doors, which would prevent kidnap- ping, would likewise prevent the entrance of armed men, and, after further consideration, or as the result of some- thing she read, or remarks made by other patients, she fin- 'ally adopted the poison theory, as offering the most reason- able solution (to her) of the problem. But the kidnapping idea had made such an ineffaceable and lasting impression, that even while she felt sure that she would be murdered 184 J. W. Wherry. or poisoned, this original idea hovered always in the back- ground. The ideas, then, that she would be successfully kid- napped, murdered, and poisoned, were not delusions, but mere beliefs, and subject to all the change and mutability thereunto belonging. The unchanging and unquenchable idea that she was to suffer a violent death, was the delus- ion which filled her waking hours with dread, and haunted her when asleep. The various means by which she be- lieved it was to be accomplished, and to which she gave expression from time to time, were evidences of a delusion, but not the thing itself. Indeed, 1 am forced to believe, that the majority of delusions recorded in histories of cases are not delusions at all, but merely the surface indications of a basic idea, which is one and unchangeable, while it exists at all, and which, like the partnt lode, remains con- cealed from the superficial investigator. THE BASIC PRINCIPLES OF DELUSIONS. A conception of a delusion, formed exclusively from ob- servations confined to the surface indications alone, is sure to lead to error. By recording, as veritable delusions, all the means and methods which the patient suggests as his theory of the manner in'which the fundamental design is to be worked out, or has been accomplished, is to leave the impression that delusions are as numerous as the sands upon the seashore; whereas, 1 verily believe, that all the real, actual, fundamental delusions possible, can be counted on ten fingers, and then have fingers to spare. The same basic delusion may exist in the minds of a dozen men, and it may find expression in a dozen widely different beliefs, but these beliefs are not the delusion, by any means. A careful analysis of 638 cases, where delusions ex- isted, has been made and, although no two individuals gave expression to the faith that was in them in exactly the same terms, the number of real, fundamental delusions was very small. In other words, these 638 people had 638 be- liefs, but they had very few delusions, the same delusion sufficing for many. For instance, one single delusion, Limiting the Term "Insanity." 185 namely: the fear of injury, was entertained by 414, but the means and method by which this injury was to be ef- fected, were as varied and numerous as the people them- selves. There is no personal element in the delusion. It appears whenever, by reason of stress and storm, the men- tal soil is properly prepared in the presence of poisoned and impoverished blood. The fear of injury takes posses- sion of the coward and the man of courage with equal fa- cility, when it appears in the form of a delusion, though the channel through which the injury is to come, and the means adopted to prevent it, may differ widely in each in- dividual. The delusion is thrust into consciousness with- out the recipient's cooperation, and without his consent; the means of its accomplishment, however, is determined by the personality of the man, and his general knowledge and environment, while the measures adopted for its prevention are voluntary, whether criminal or otherwise, and usually differ in no way from the methods that would have been adopted, had the danger been real instead of imaginary. Consequently, owing to the fact that no two men are alike; that no two men will possess the same general knowledge, or experience the same identical environment, and that no two will evolve the same beliefs from the same basic idea, it is plain to be seen that a very few de- lusions would be sufficient for all the uses of mankind. An analysis of the 638 cases, mentioned above as hav- ing delusions, resulted in the following classification, which shows in a graphic manner how all these false beliefs are resolved into a sense of power, and a sense of fear, as the basic principles of all delusions, except that of altered identity, and this has its origin exclusively in illusions or hallucinations of sensation. In the great majority of cases the delusion of altered identity arises solely from illusions; that is, the idea of a change in identity is based upon some pain, or unusual sensation, or loss of sensation, in some portion of the body, which the patient misinterprets into a false belief, and this takes root in the form of a de- lusion. Where there is no pain or unusual sensation pres- ent, and the idea has no such basis, then it has its 186 /. W. Wherry. foundation in an hallucination of sensation, rather than an illusion. In either event the delusion of altered identity differs very materially from the delusion of power, or the delusion of fear, both in its origin and in its process of development. The delusion of altered identity develops slowly, and in most cases it rests upon a tangible, though misinter- preted foundation. The delusion of a sense of power, or a sense of fear has its primordial origin in an hereditary proclivity of temperament, which is encouraged by an envi- ronment favorable to its development, and is precipitated into activity by mental stress and strain associated with contaminated blood. The delusion of identity, on the other hand, is not a product of heredity, even in the re- motest degree. It arises from a disposition to "want to ac- count for things" and a tendency to do so, by reason of erroneous teaching, in a mystical or supernatural manner. It occurs, when it exists alone, in persons of little or no education who believe in ghosts and other preternatural manifestations; in conditions of mental enfeeblement where the capability of proper discrimination is lost, or in abey- ance, and in hysteria and similar mental states. When it exists in conjunction with a delusion of power, or a delus- ion of fear, it is not so much a condition of altered iden- tity as a supernatural explanation of the delusion already present, and this distinction is not only important, but can always be made. The delusion of altered identity exists alone in only a small per cent of cases. The classification of delusions follows: Out of a Sense of Power spring three delusions, namely: Grandeur, Super- iority and Sexual assurance; and out of a Sense of Fear, three more: Injury, Self-abasement and Sexual anxiety. From these there follows a host of beliefs, limited only by the capabilities of the imagination. Limiting the Term "Insanity. 187 TABLES OF DELUSIONS. TABLE I. Grandeur Definite Of person Physical strength Mental strength Official importance .Executive ability, etc. _. . f Personal possession Of property |Rea,ty i Sense of power r„f „„„„ f Exaltation fOf person j Sense of well-being [indefinite-j I _. . I Vague possessions I Of property j Va*lous%molument f Spiritual Superiority • i emoluments Sanctified Immortal To be offered as a sacrifice Divine mission to perform, etc. {Position Beauty Accomplishments, etc. C Offspring immortal Sexual assurance -j Sexual relations only with God (.Dominion over opposite sex, etc. TABLE II. Sense of fear Injury- Definite ("To body r To person \ To soul I To reputation To property •( f Destruction Robbery LIndefinte f To person -j Impending calamity I To property-! Future loss Self-abasement - {Committed the unpardonable sin Neglected opportunities Divine displeasure, etc. f Disgraced Social \" (Defiled, etc. f Infidelity Sexual anxiety \ Forcible intercourse (."Lost manhood," etc. 188 J. W. Wherrv. f Direct Altered identity Personal Material TABLE III. {Lost head, arms, etc. Has head, arms,etc.,of another {Is another person Is of opposite sex Is a ghost, etc. 'Is made of giass Is made of wood Is made of gold . Is made of stone, etc. Animal Is a snake Is a dog Is a lion Is a cat, etc. . Reverse -j I Demons Possessed by -J Devils (imps, etc. I Occupied by •( (Animais Fiames of fire, etc. These tables represent only 638 cases, but a close analysis of any number of so-called delusions will reveal the somewhat startling fact, that, with the exception of the one delusion, altered identity, all the others may be reduced to two fundamental principles, namely: An exaggerated sense of power, and an exaggerated sense of fear. But this discovery is not so startling after all, when we consider that this sense of power, and this sense of fear, are, in all the world, the two most potent forces. Every individual possesses a sense of power, which would lead to rapacity, robbery and violence, unless tempered and held in check by a sense of fear. Every individual is endowed with a sense of fear that would make skulking cowards of us all, unless upheld and strengthened by a sense of conscious power. A conscious power to do, and to dare, and to brook- no restraint, is ever held in equilibrium by a conscious fear of the law, of the anathemas of society, of our own con- Limiting the Term "insanity." 189 science, and of the threatened hereafter. Between these two forces our course is held straight. Between these two forces civilization expands and grows. By virtue of a per- fect balance of these two forces we know all that is best, and noblest, and sweetest in life. And by the domination of either of these to the exclusion of the other, we have that state of disorder and disarrangement of natural con- ditions, which belongs exclusively to insanity. This, then, is the duality of our lives. To do, and to fear. And this is the singleness of insanity: To thrill with unlimited power, or shudder with absolute fear. Is it a matter of surprise that the mental operations of the insane follow a single channel, and no longer experience the elas- ticity and variation that comes from opposing forces, which check and support each other? Hence we find that actual delusions are very scarce indeed, while the number of false beliefs to which they may give rise is limited only by the number of individuals. These 638 false beliefs were divided as follows: f Feelings of grandeur 72 Sense of power-j Feelings of superiority 52 (.Sexual assurance 2 r Injury 414 Sense of fear-j Self-abasement 44 (.Sexual anxiety 46 Altered identity 8 This shows the remarkable preponderance of "fear of injury" as a delusion. Sixty-one per cent of the total of all false beliefs center around this one dominant idea. Included in these were all sorts of beliefs, as to the form in which this injury would come; by poison, by shooting, by electricity, by hypnotism, by devils in hell, and by con- spiracies innumerable; while many were simply overwhelmed by an exaggerated feeling of impending calamity, but could give no definite expression to the means or methods by which this calamity would come, and could, consequently, make no preparations for defense, except to hide in out-of-the-way corners, bewailing their fate, or trembling with fearful appre- 190 J. W. Wherry. hension. From the fear of injury, feelings of self-abasement, and sexual anxiety, arise 79 per cent of all false beliefs. MANIAC-DEPRESSIVE INSANITY. So far I have spoken only of those forms of insanity, in which the delusion remains unchanged and without varia- tion in its basic principle, so Jong as it exists. 1 now wish to call attention to manic-depressive insanity, a condition in which the two fundamental delusional principles, namely; a sense of power, and a sense of fear, follow each other in more or less regular succession, like the ebbing and flowing of the tide. While, in some forms of insanity the delusion never varies from the time of its inception, the form now under consideration is characterized by a marked delusional interchange, at more or less regular periods. An exaggerated sense of power, is followed by a reactionary sense of equally exaggerated fear, and the patient is plunged from the heights of self-complacency into the depths of dark despair. In this delusional reaction, however, it is noticed that a perfect equation is maintained between these two forces. The higher the patient rises in the scale of power, the lower he falls in the scale of fear, when the reaction comes. At one time strong and defiant; at another, tremb- ling with weakness and cringing with fear. If there is but slight exaggeration of the sense of power, then there follows but slight exaggeration of the sense of fear. So equally proportioned are these two forces, indeed, and so close and intimate are the relations they bear to each other in this reactionary cycle, that one cannot forbear wondering some- times whether, after all, they may not have their origin in a common source, and that instead of being two separate delusions, are really but varieties of a single, ultimate, fundamental delusion. This delusional reaction is not an anomaly, however. On the contrary it is the thing most to be expected. A delusion cannot possibly be entirely foreign to the general content of a man's psychic life. A man cannot possibly experience, in the form of a delusion, something he has never previously felt even in the remotest degree. The delusional Limiting the Term "Insrnity." 191 life differs from the normal in its intensity rather than in its primitive elements. Give a man's simple opinions the value of absolute convictions; give his ordinary beliefs the weight of unquestioned authority; give his normal sense of power and of fear free, unlimited and unrestricted range; in other words, exaggerate the natural mental processes to a sufficient degree; tincture them with the ethereal essence of a divine revelation; paint them with the never-fading colors of the eternal verities; fire them with the zeal of fanaticism; or chill them with the damp, unwholesome atmosphere of gloom and despair; convert the fundamental principles of normal mentality, in short, into delusions, and you have insanity. The adequate and equal opposition of the sense of power and the sense of fear is the normal condition of the mind, and the one usually experienced by those most sane. Who has not felt the equanimity and sense of perfect poise, which comes from a well-sustained equilibrium of these opposing forces! And, on the other hand, who has not felt, at times, some slight shifting of the point of contact? Who has not some morning arisen from his bed with a sense of mental expansion; with a willingness, nay a desire, to grapple with all the problems of existence; with that ill-defined, but well-recognized, sense of well-being, in whose radiant light all obstacles fade and vanish as the mists retire before the morning sun? And who has not arisen from that self-same bed on another morning with an ill- defined feeling of impending calamity, with a sense of mental suffocation in the midst of vague but threatening difficulties; with courage sinking down, down, down, into depths apparently unfathomable, while the mind gropes in the midst of thi < increasing and oppressive gloom for the tangible basis on which this apprehension rests? Are these not common experiences, in a mild degree of course, and varying in intensity with the temperament and personality of the individual? Do not all vital currents ebb and flow with more or less rhythmical precision? Are happy people always happy or serious people always sad, even in the presence of a continuous and unchanging environ- 192 J. W. Wherty. ment? Does not night follow day? Is there not a never- ending procession of the seasons? Does not material exist- ence demand the sunshine and the cloud; the storms of winter and the heat and effulgence of summer; the showers of April and the mantle of snow, before it can attain its perfection? Does not religion swing by a single thread between fanaticism and licentiousness? Does reform not succeed indifference, and indifference again follow the active period of reformation? Action and reaction. This seems to be the perfecting process, and it is no less true of the mental, than of the material life. Why this is so we know not. Does the soil, whose surface has been flooded with the impregnating rays of a summer sun, still require the winter's storm to estab- lish its fructification? Does the ship, that occasionally buffets the waves of a tempestuous sea, more clearly fulfill the requirements of its necessities than the one which sails the seas of eternal calm? This much we know. The psychical pendulum swings ever between varying degrees of'hope and despair; between a sense of power, and a sense of fear. Morbidity succeeds elation, just as night succeeds the day. The degree of intensity of each determines the mental status. The sanest of people have experienced, at times, and without a conscious cause, an exuberance of spirits, which must be forcibly suppressed in the interests of a proper sense of dignity and decorum; a welling up of hilarious impulses, which require a firm and steady mental grip to hold them in due subjection. At another time the same individuals will feel the temporary blight of an impending doom, which requires an active mental struggle to prevent their being entirely engulfed by the waves of morbid fear; a sense of impenetrable gloom, which threatens to overwhelm with an ill-defined dread of coming evil, and from which relief is obtained only by complete submergence in the daily affairs of life. These experiences, however, are temporary in their nature, and a way of escape remains open. Magnify, enlarge, expand, intensify these feelings; close all avenues of escape; shift the scene at more or less Limiting the Term "Insanity." 19 3 regular intervals, and you have manic-depressive insanity. The delusion, then, 1 consider to be the essence of insanity; and by delusion 1 do not mean a "queer idea" or a peculiar belief, which men may possess, and do possess, without any change in their mental lives, but an idea that is palpitating with life and throbbing with all the energy of a divine revelation; that takes hold of a man with the absorbing and all-compelling power of an irrefutable con- viction, and that shapes and molds his mental life in conformity therewith. Without the advent of some such force, there could not occur that radical change in a man's method of thinking which insanity necessitates. DO THE INSANE REASON? The "change in thinking" of the insane consists, not so much in a warping of the reasoning faculties, as in the quality of the conclusions. The insane are not deprived of the power of reasoning. Reasoning means the capability of thinking; not the quality of the thought. In practically all cases of insanity, uncomplicated with idiocy, imbecility, or dementia, the power to reason is still intact. To say that a patient is "unreasonable" does not imply that he is unreasoning, or incapable of reasoning, but that his con- clusions are at variance with those deduced by an average mind. When everything is taken into consideration how- ever, the change in feelings and relations, by reason of a delusion which tinges the whole mental sky with its baleful light, and implicates every function of the mind in the furtherance of its design, I am not so sure that the con- clusions reached by the insane, differ very materially from those which would be deduced by any other mind from similar materials. He has neither lost the power nor for- gotten the art of reasoning; he is only measuring motives with another yardstick, and though many and woeful are the blunders he makes, still, can a man doubt his own mind? Take 50 patients on a ward, who are suffering, not from mental enfeeblement, but from insanity. Ask any one of them his opinion of the mental condition of his companions, and he will tell you, confidentially, that, while he is all - 194 -J. W. Wherry. right, everyone of the others is crazy. Ask another, and another, until all have been approached, and you will be surprised at the similarity of the replies. The contention of each that he is "all right" may be an indication of insanity, but the unanimous opinion regarding the others is very good evidence that they possess, not only the power of reasoning, but pretty fair judgment, as well, with refer- ence to matters outside themselves. It is due to this very fact that the insane do reason, and not only reason them- selves, but are able to detect the false note in the reasoning of their associates, that the hospitals are not forcibly emptied of every patient inside of 24 hours. It is only by reason of this fact that two or three attendants are able to control 40 or 50 patients. Did patients not recognize the insanity of each oth literature, art, industry and science. "After the opening of Congress on Monday afternoon, September 19, will follow, on Tuesday forenoon, addresses on main divisions of science and its applications, the general theme being the unification of each of the fields treated. These will be followed by two addresses on each of the twenty-four great departments of knowledge. The theme of one address in each case will be the Fundamental Con- ceptions and Methods, while the other will set forth the progress during the last century. The preceding addresses will be delivered by Americans, making the work of the first two days the contribution of American scholars. "On the third day, with the opening of the sections, the international work will begin. About 128 sectional meetings will be held on the four remaining days of the Congress, at each of which two papers will be read, the theme of one being suggested by the Relations of the special branch treated to other branches; the other by its Present Problems. Three hours will be devoted to each sectional meeting." Related subjects will be arranged on the program for different hours. Addresses limited to fifty- five minutes. The director is Howard J. Rogers. The administrative board consists of Butler, Harper, Jesse, Pritchett, Putnam and Skiff. The president is Simon Newcomb; Vice-presi- dents, Muensterberg and Small. The sub-divided sections are likewise presided over by eminent men, distinguished in the several departments of this work. THE LEGAL VIEW OF INSANITY.—The vagaries of judges in dealing with the difficult subject of criminal responsibility are notorious, says our London correspondent. A man may be acquitted before one judge on the ground that he was insane when he committed a criminal act, whereas he would have been convicted before another. Editorial. 371 Medical evidence they often treat with scant respect, preferring to decide the question by their own lights. The following case is an example: A retired clergyman, aged 62, of Oxfordshire, England, committed no less than seven indecent assaults on girls aged from 11 to 13 within a period of six months. Previously he had had a hard-working and apparently blameless career. The medical evidence showed that there were hardening and thickening of the arteries, especially those of the head, and that he suffered from time to time from dizziness, attended with general mental con- fusion. There was also defective memory for recent events. He knew right from wrong in the abstract, but did not appreciate the moral significance of his acts in relation to the individuals concerned. The condition was regarded as progressive, and it was stated that the law or moral restraint had no effect on him. He did not understand that he was doing harm to the girls. Dr. Mercier, the eminent alienist, confirmed this evidence, holding that the prisoner was suffering from premature senile decay and both physical and mental deterioration, and that the case was certifiable. The judge pointed out to the jury that the prisoner had filled respon- sible offices, and had before the trial been regarded as sane. As to the "senile decay" described by the medical witnesses he repudiated the idea that mere decay of the faculties was evidence of insanity or irresponsibility. It lay for the defense to show that the prisoner did not understand that he was doing harm to the children. In conclusion he asked the jury as men of the world to exercise their "common sense." This intimation had the effect evidently desired. After a few minutes consultation they convicted the prisoner, who was sentenced to six months' imprisonment with hard labor. The "common sense" exercised by the judge and jury in this case was, as it often is, only "common ignorance." Common sense is a strong point, and a valuable one in the character of the ordinary English juror. His weak point is want of subtlety, and on an intricate or scientific question he requires the guidance of superior minds, instead of being told to exercise his "common sense." In the celebrated case of Mrs. Maybrick, who was convicted of poisoning her 372 Editorial. husband with arsenic, "common sense" had much to do with the verdict. An array of scientific evidence, if anything, stronger than that of the prosecution, was produced to show that Mr. Maybrick had not died from arsenical poisoning at all. Instead of telling the jury that the prisoner was entitled to the benefit of the doubt on this point, the decision of which in the affirmative was a necessary preliminary to the verdict of guilty, the judge told them not to pay too much attention to the medical evidence, but to decide the case by the other circumstances, thus reducing an essential point to a merely collateral one. The jury exercised their "common sense," to which the fact that the prisoner had a lover strongly appealed, and convicted her.—Journal A. M. A. TO PREVENT TUBERCULOSIS.—The Alienist and Nedrologist is gratified at the efforts making in this city to stamp out this scourge. It is by diffusion of intelligence of hygienic resources against the plague among all that success can be secured. For this reason we applaud the move of Health Commissioner Simon and President Eaton and his colleagues of the St. Louis Society for the Prevention of Tuberculosis, also the Baltimore Congress, on this subject and the coming joint congress of medical, legal and lay workers which is to meet at the Worlds Fair next October. Let everybody now be enlisted in this projected war of extermination of the great White Plague. The medical profession has investigated to the bottom of the matter and warned the people, for many decades past, with "line upon line and precept upon precept;" so there is no longer excuse for popular ignorance and apathy regarding the fatal ravages of tuberculosis and the means and necessity of stamping out the fatal disease. TWO VALUABLE PAPERS BY ST. LOUIS MEN appeared in the May Medical Fortnightly. One by Dr. Heber Robarts on Radium; the other by Frank Fry on Chorea and Graves' Disease. THE WORLD'S FAIR AT ST. LOUIS is bigger than any little editorial can portray it. It grows and grows on repeated Editorial. 373 inspection. It might be seen every day from inception to close and the sight seer would not see all. To see it thoroughly is better than the ordinary trip around the world. After seeing all the Universal Expositions since the Cen- tennial in 1876 at Philadelphia it appears to us to be the greatest of all. And after the exhibits are all scanned and the buildings inspected in the day time, a trip around the lagoons, on the intramural and up on the observation wheel and the electric tower reveals an indelibly impressed, resplendent dream of transcendent illuminated beauty that must remain in the mind forever after. The Alhambra by Moonlight, so graphically portrayed by Irving is not so entrancingly beautiful. THE THANKS of the profession and the people of this city are due to the Pure Milk movement lately inaugurated by Dr. Murrell and others and to Mr. Strauss of New York for his generous and humane initiative in the movement. This move will help to conquer tuberculosis and ward off anaemia and neurasthenia and other ills among infants and children. DIED ON THE FIELD OF DISHONOR is not permissible, by the proprieties, on medical certificates. If it were, what a role of dishonor and shame, degradation, disgrace and misfortune, would appear in the death certificate of diseases remotely or ordinarily due to alcohol and its toxic compounds and derivatives, from the wine that giveth its color in the cup, to the mocking seductive cocktail and the persuasive mint julep, the whiskey straight, the champagne that paineth only after the night has been spent, in its exhilarating embraces and the malted beverages which, if daily taken in any considerable quantities, delusively bear us to our biers, when otherwise resistible disease assails. "De Mortuis Nil Nisi Bonum" is the injunction ever present with the charitable physician when certifying the fatal pathologic sequellae of alcohol in any of its myriad enticing forms of illusive destruction. If the public might know the precise facts charitably 374 Editorial. concealed in burial certificates, as to the real ravages of this still-worm chaperone of death, this destroying spirit of the still, it might in time, turn appalled from that autotoxic pathway which leads to destruction, the daily voluntary alcoholic beverage. And for the sake of the real facts boards of health might have private non-public records of the direct, remote and immediately contributing causes of disease, in which alcoholic causes might candidly appear, to be used as the basis of warning, sanitary statistics, without undue publicity and disgrace of individuals. AT LAST THE RUSH MONUMENT.—The bronze statue of Dr. Benjamin Rush, presented to the United States Government by the American Medical Association, was formally unveiled June 11, on the grounds of the Naval Medical Museum and accepted by 'President Roosevelt. Many members of the Association, members of the Cabinet, and other officials were present. Dr. J. C. Wilson of Philadelphia, on behalf of the association, delivered a tribute to Dr. Rush. In his speech of acceptance President Roosevelt said that he accepted on behalf of the nation, "the gift so befittingly bestowed by one of the great professions—this statue of a man who was eminent not only in that profes- sion, but eminent in his service to the nation as a whole." He would improve the occasion, he said, to deliver a short sermon to the eminent specialists before him on the duty of citizenship. "Today," he continued, "no specialist in a democratic country like ours can afford to be so exclusively a specialist as to forget that one part of his duty is his duty to the general public and to the State. Where govern- ment is the duty of all, it of course means that it is the duty of each, and the minute that the average man gets to thinking that government is the duty of somebody else, that minute the Republic will begin to go down. It is a fortunate thing for our country that we should have before us the lives of men like Rush, who could take a part in our public life as distinguished as is implied by his having been a signer of the Declaration of Independence, and yet Editorial. 375 to do it without a particle of neglect of the man's own proper duties." The Presidents' reproof and warning to the medical profession to not lapse in duties of citizenship is good and timely. We have delayed long in this duty to the memory of Doctor Rush and would have waited longer had the pro- fession left this memorial remembrance to the people or their representatives in Congress. Reputable medical service and the public service of reputable medical men do not get their deserts at the hands of the peoples' representatives in these days when quacks and 'fake' doctors are heard in halls of legislation and the voices of the regulars and the reputables are silent. Too many good medical men of means, leisure and ability in this country eschew politics, too literally accepting the insulting reproof of that English judge who advised a medical man who justly spoke as an expert in a just cause, to go home to his patients. If medical men continue silent in the synagogue, the political Sanhedrin will continue to ignore medical interests. Matters will be different when doctors of fame and independence take their proper places in public affairs, secure a medical man in the Presidents' cabinet who will be at least the peer there of the agriculturist and the com- mercialist. Sanitation and sanitary interests are as impor- tant as soil tilling or financiering, and physicians should be as significant in the Governments' and the peoples' esteem as lawyers and soldiers. Right sanitation of body and brain, that keeps a nation strong and great, in mind and brawn, and saves it from decay, is more than armies, to win the fray, in this our strenuous day of world com- petition and struggle for supreme existence. In this country of popular government it is the duty of every aggregated interest, whether in or out of a political party, to voice its opinion, on matters of public morals and policy. The medical, or the clerical professions should not be exceptions. It is only thus that official executives of the people may rightly know the popular will among all classes. Partisan papers are apt to give but partial and partisan news, trimmed to suit the exigencies of party, as 376 Editorial. the platforms do. Popular sentiment should be enforced from all sources upon platform makers and the safest sources are from the non-partisan interests. There the pulses of the people may best be felt. From their radial arteries radiate the whole truth and nothing but the truth as to how the people feel. THE CENSOR OF THIS CITY is entitled to thanks for its efforts at eradicating the patent medicine and fake newspaper medicine and medical appliance evils. Just now the people are being ground between the upper and nether millstones of trust combine, oppression and patent medicine fraud, the latter being directly assisted by the newspapers in their advertising pages and the former being tacitly helped by the silence of the press. Partisan newspapers are all too politic to speak the entire forceful truth concerning these twin evils and some other periodicals are too venal to speak out in the people's in- terest, while other papers are indifferent. THE NOISE LIMIT OF CITIES ON THE PART OF THE POLICE.—We note with pleasure the efforts in the inter- est of human life and limb and vital organs to keep the automobilists and bicyclists within the lawful limits of speed, but why not include the street cars? If a poor cabman, backed by no syndicate of wealth and numbers had violated the law as the 'auto' and 'bike' sprinters have, they would all have been driven from the streets with revoked licenses. Now while the enthusiasm for public welfare is on with the police, would it not be well to have an ear to the noise limit of street cars, motor cycles and autos, so that people may have a chance to sleep and conserve their vital- ity for sustaining the strain of living in these strenuous days, when everybody pleases himself, and no one seems to care, law or no law, for the comfort of the other fellow. THE PASSING OF LlSTERINE AND THE < OM1NG OF THYMOL.—The wild thyme has added a fragrance and a therapeutic availability in many ways to the antiseptics Editorial. 277 since and before Lambert put his attractively named Lis- terine on the medical market. Among those was an ele- gant preparation put up in this city many years ago, but not extensively advertised to the medical profession by Alexander, and called Thymolen, I believe. Later came a similar compound called Pasteurine, but the best and most perfect of them all for antiseptic purposes, both internal and external, is that elegant preparation offered to the pro- fessions of medicine, surgery, dentistry and for cosmetic and antiseptic toilet purposes—Euthymol, whose composition and therapeutic availability will at once attract the attention and win the approval, if carefully noted, of every intelli- gent doctor who may read and try it. And this medicine is not found among our ads, though Parke, Davis & Co., those well known and useful caterers to the therapeutic wants of the profession are. TULANE GETS A MILLION.—The Louisiana State Supreme Court has rendered a gratifying decision giving the bulk of the estate of the late A. C. Hutchinson, amounting to approximately one million dollars, to the Tu- lane Medical College. A SCHOOL OF FORENSIC MEDICINE IN FRANCE.— The French Minister of Public Instruction has issued a de- cree for the establishment of an institute of Forensic Med- icine and Psychiatry in Paris. The institute, which is in- tended to provide special training and to grant a special diploma to those who wish to practice as expert medical witnesses in the law courts, will be under the direction of the dean of the medical faculty and the professors of fo- rensic medicine and of psychological medicine. It is to be hoped the time is not far distant. THE PULLMAN PALACE CAR COMPANY is about to introduce a sleeper which, from a sanitary standpoint, will be a considerable improvement over" that hitherto used on the railroads of the country. The new standard is severely plain and is devoid of all scroll and grill work. The up- holstery of the car has been reduced materially and all the 378 Editorial. angles possible have been taken from the car. Imported mohair has been adopted as a standard curtain and the en- tire design of the decoration and furnishing is planned with a view to minimizing the work of cleaning the car and pre- venting the lodgment of germs. ^ BRAIN-STRAIN OR EYE-STRAIN! WHICH? The Medical Times notes that five among the most eminent scientists, essayists and poets of the early Victorian era—all of them afflicted with chronic and inveterate ill-health, varying in form, but claimed to have arisen, in every case, from one and the same cause, eye-strain—are the subjects of Dr. G. M. Gould's latest contribution to medical literature. He contends that simply fitting these illustrious invalids with spectacles would have removed the primary mal- adjustment, thereby at once restoring them to the full command and enjoyable use of their great faculties and enabling them to surpass even the measure of what they actually achieved for the benefit of mankind. It is noticeable that all of them—Carlyle, Darwin, Huxley, De Quincey and Brown- ing—managed to reach a good old age, while their mental productiveness lasted as long as is usual with the higher class of brain-workers. In this respect, indeed, they com- pared favorably with Scott, Southey, and others of their earlier compeers, who were never suspected of heterophoria. Prima facie, therefore, the instances our author relies on are not perhaps very strongly conformatory of his hypoth- esis. But his argument is both so ingenious in itself and so plausibly presented—fortified as it is by a thorough mastery of the scientific principles and biographic details in- volved—as to seem almost impossible of refutation by any ordinary disputant. In our opinion, what it chiefly needs is that kind of clinical evidence which alone is finally con- vincing, the evidence of living contemporaries. Surely, among existing leaders in the respective domains of science, art and letters, there must be (if Dr. Gould's pathologic view of the matter be correct) quite a number of sufferers from the remote effects of eye-strain, whose symptoms run parallel, or nearly so, with those of the men Editorial. 379 he has chosen as examples. Let these, or some of them, be sought out, and induced to place themselves under the most skillful and up-to-date ophthalmologic treatment. It may be presumed that, whatever the result, no objection would be raised to its publication. Directly authenticated testimony such as this would go much further toward es- tablishing or disproving Dr. Gould's theory than any amount of reasoning based upon vague descriptions and complaints in the memoirs of dead-and-gone celebrities. What we require are first-hand statements of their con- dition "before" and "after," from distinguished individuals still in their intellectual prime. Brain, eye, nerve and other center strain might equally as well account for the ill health of the aforenamed literary and scientific gentlemen. Gould is a clever reasoner from his visual standpoint, but where are Stevens and Ranney with their eye-strain epilepsy, cephalalgia, etc., and where does the brain itself come into the consideration of brain- strain troubles in the brain-workers and brain-overworkers of this, as well as preceding ages? AN APOPLECTIC ENGINEER stricken at his post in the engine room permits the ferryboat America, of the Grand Street Line, New York to crash into the pier. A patient of mine, a railroad engineer, was found to have epileptoid seiz- ures, though none had ever been known to have occurred while he held the lever. He was advised to work in the shops only, and those above him having disposition of his services were advised to never give him control of an engine. Railroad men filling responsible posts like engineers, dispatchers, brakemen, switchmen, etc., should be subject to frequent neurological inspection as to their freedom from certain nervous affections involving the head. This is quite as important as examinations for sight defects. Brains liable to give out suddenly with attacks of epi- lepsy or vertigo, vertiginous epilepsy, amnesia or sudden paralysis or spasm are out of place in responsible positions on railroads, as much so as men who are liable to become disabled by an inopportune recurrence of dipsomania. 380 Editorial. Railroad company managements are beginning to un" derstand the risks and dangers to the service and the pub- lic of men who drink. They should likewise have a care concerning other nerve diseases among men whose heads have to be relied on for steady, safe service. SUICIDES IN THE UNITED STATES.—The St. Louis Republic notes that "George P. Upton, formerly associate editor of the Chicago Tribune, in an article in the New York Independent shows that in thirteen years there have been 77,617 suicides in the United States, of which 57,317 were men and 20,400 were women. Of the professions, 535 physicians destroyed themselves, against 98 clergymen and 61 lawyers. The increase in the number of children who are self-destructionists is a matter of comment. "Life insurance statistics for 1902 show 2,500 cases of suicide in fifty cities. St. Louis leading Hoboken, Chicago, Oakland, New York, Milwaukee, Cincinnati, Newark, Brooklyn, Boston, Indianapolis and New Orleans. It will prove a surprise to many that St. Louis should lead. "Mr. Upton does not attempt to solve the problem beyond suggesting that the home exercise more authority "in regu- lating appetites, passions and habits." He adds that "there might be more hope for the decrease of crime of all kinds if so many homes were not sending out so many boys and girls unwarned, undisciplined, uninstructed and unprotected." "We are living in an age," comments the Republic further, "when it is a constant battle in business and social circles and when every man and woman is under a more or less severe mental strain. We do not seek healthy, outdoor amusements as we should. Life is a severe struggle for the majority of people and we are inclined to take life too seriously. In every class we are looking beyond. We are not, in other words, satisfied with environment and condition, but are struggling to reach a position beyond us. The natural result is that nervous systems become weakened. Suicide comes with abnormal nerve states. There is not a man or a woman but who at some time has said: 'What's the use?' If the nerve balance is destroyed at such a time Editorial. 381 a sudden impulse to suicide may overcome the normal will to live." A SURGEON OF OOPHORECTOMY FAME, a really skillful laparotomist, was seen appoaching a coterie of our lady friends, when one of this smart set said, "hold on to your ovaries, ladies, Doctor is coming and he will get you if you don't watch out!" The gold mine, industrial stock, gold brick and all sorts of scheme fakirs, not excepting some of the proprietary men, now reaching out and "going for" "tenderfoot" doctors, who have a rating with Bradstreet's or Dun's, suggest a similar caution. Hold on to your pocket books, gentle con- fiding doctors or these fakirs will get you. It is the business of these fakirs to plead plausibly for their schemes and take in doctors, if they are not wise as the serpents that are after them. The medical man on "Easy Street," who has by hard and long work earned the right to be there, is often bunkoed by these business bargain baiters when he least suspects it. The vocation of a doctor of medicine does not tend to the cultivation of business cunning against the bunko steerer. He is a stranger to their ways and they take him in. DR. A. B. ARNOLD, aged 84, emeritus professor of nervous diseases in the College of Physicians and Surgeons, Baltimore, died at the home of his son in San Francisco March 28th last. SOME OF OUR JUDGES.—"The decision of the Missouri Court in the Butler case is too unfortunate to pass unnoticed. Butler was the chief in the war of Mr. Folk against the St. Louis boodlers. The Circuit-Attorney secured a convic- tion for bribery. The Supreme Court now upsets that conviction. The opinion was written by Judge Fox, who has been mentioned as one of the beneficiaries of Butler's favors. Of the two judges who concurred one was a candidate for the Governorship. The ground of the decision is that, as an ordinance giving the Board of Health the right to let a garbage contract was unconstitutional, Butler was not 382 Editoial. guilty of bribery when he paid the Board $2,500 to award the contract to him. These contracts have been awarded by the Board of Health for thirty years. The right of that Board to award them has been repeatedly upheld. Even if the Board did not have the right, we have apparently the decision that an official may take money to perform official acts and then set up as a defence, for instance, that Missouri was not legally admitted into the Union, and hence there can be no official act in Missouri, and therefore, as a member of the bench declared last summer, there is "no boodling in Missouri." The seeming determination to free Butler at any cost has so outraged public feeling and common-sense that the result may in the end be good, by increasing the chances of electing a Governor who will do away with the whole system by which a man is able to buy contracts for himself and secure judgeships for his friends. Meanwhile, the Supreme Court of Missouri cuts a sorry figure in the eye of all the world. Possibly legal strictness required the decision, although we doubt it, and the public will certainly not believe it. The contempt with which the decision has been received, and the implications that have been freely made against the court's integrity, are a sufficient sermon on the evil of a system which does not allow the judiciary to rest above suspicion." THE WORLD'S FAIR AT ST. LOUIS is an instructive object lesson in its state buildings, the state exhibits in other buildings, and in the annex exhibits of the Philippines, the Boer War and North Pole voyage shows, etc.; of the rise and progress of the United States, and especially of the fourteen states comprising the vast and memorable epoch-making Louisiana purchase, which this exposition commemorates. The World's people may here see a tableaux vivant, giving an impressive, life-like portrayal of the world's wonderful progress, hitherto unequalled by any other exhi- bition of its kind. In former similar exhibitions one city and one state have been mainly interested. In this, four- teen states, moulded out of the empire ceded by Napoleon, Editorial. 383 are especially concerned and shown, and the whole North American Continent is likewise on exhibition. The Louisiana Purchase Exposition, besides showing what the world has done and is doing today in all the es- sentials of a great exposition, reveals, in fuller proportions and grander outline, the stature of our Republic, standing as a giant before the Nations, prosperous in resources, limit- less in possibility for the welfare of mankind and invinci- ble for defense of its great humanity-advancing and world- uplifting purposes. The finishing touches of this remarkable picture of the living world as it is today, may be found, without immoral blemish, on the Pike and at its annex exhibits, save and except, perhaps, the Jerusalem show, where recreation, pleasure and instruction are offered the visitor in many varied forms. Numerous restaurants are also there to re- plenish the body and brain-weary sight-seer, and the prices of all are moderate for what is given. 1WACDONALD RECOVERS £20,000.—A jury in the Supreme Court before Justice Dickey, has rendered a ver- dict for £20,000 in the libel suit of Arthur MacDonald against the New York Sun. The issue was whether MacDonald was an honest scientist and pursuing his work in the Board of Education at Washington in good faith and with pure motives, or whether, as asserted by the Sun, he was a counterfeit scientist, using his work as a cover for ulterior objects. We are glad to know justice has been done Doctor Mac Donald. He is an honest, conscientious investigator and deserves well of the people. The New York Sun was a victim of somebody's envy and malice probably. THE PRESS PART1CEPS CR1MINIS IN PATENT MEDI- CINE FRAUD.—Below is one of the many scare head advertisements one may see in the daily papers and often in the religious and literary papers and magazines. "IF IN DOUBT, TEST YOUR URINE." "Let a bottle of morning urine stand still, twenty-four hours. If it becomes cloudy, or contains floating particles, 384 Editorial. or if a sediment forms, your kidneys have been diseased for months, and your only hope of life and health is to at once take Greenback Ketchum's Safe Sure Cure." The constitutional guarantee of freedom of speech and press does not hold men who publish newspapers guiltless of aiding and abetting the crime of killing by false repre- sentation and delayed relief through patent medicine fraud, and laws should be framed accordingly. The man who holds you up on the highway and robs you of your money and the man and his confederate who frighten you into taking a patent medicine or keeps you from real relief, through deceiving you into taking, are alike criminal. The average patent medicine vendor is a blatant fraud and a seductive silent criminal and the newspaper is his 'pal.' The way of the patent medicine advertisement leads to destruction. Its pathway is watered with mourners' tears and filled with funeral processions. The chief beneficiaries of these confederated criminals are the makers of coffins, hearses, funeral palls, diggers of graves and writers of epitaphs over dead men's bones. They are banded bunko steerers to confiding frail mortal gullibility leading on to hopeless invalidism and the tomb. The thief who steals your purse, the devil who lures the innocent from virtue, the black brute who robs woman of honor's garland, the destroyer of life or virtue or health in any other guise or form, excite abhorrence and move the right feeling heart to sympathy, protest and vengeance, but who condemns the crime of the false hope-inspiring, disease-prolonging, life-destroying patent medicine fakir and his willing friend and joint confederate in destructiveness and gain, the daily secular, and alas, too often the religious press? DR. EDUARDO MARAGLIANO, whose excellent contri- butions to neurology have often appeared in this periodi- cal, of Genoa, head of the University of Italy, in a com- munication to an assemblage of Philadelphia physicians, announces his belief that he has discovered a certain Editorial. 385 prophylactic treatment against tuberculosis, and one that will prove of great benefit in the early stages of the mal- ady. He has produced what he holds to be a specific therapy for tuberculosis and bases his conclusions on clinical laboratory work covering a period of thirty-four years. ESPECIALLY DESERVING of medical patronage are the Ladies' Home Journal and Everybody's Magazine, for the right stand they have taken against the advertisement of fake patent medicines, against lending their pages, as Everybody's Magazine expresses it, "to help swindle the public," to help unscrupulous men to frighten the credu- lous into believing that all sorts of diseases and ailments possess them in order to sell a lot of cheap stuff at high prices, much of it positively harmful." And other maga- zine publishers are following their lead. DIRECTOR STENSON of the Pomological Department of the Louisiana Purchase Exposition commends apples as a cure for evil habits. Similia similibus curantur! As the apple began all our trouble, the sons of Adam may now yet Even on the primitive transgression with Ozark Moun- tain red apples, and that section of Missouri raises enough to supply a sinful world with the pomological antidote. TABLOID AND SOLOID have been sustained by Brit- ish courts as proper protected trade marks of Burroughs, Wellcome & Co., and these words stand for good goods and elegant and accurately made pharmacals for ready dis- pensing. PATHOLOGICAL EXHIBIT AT THE ST. LOUIS FAIR.— Under the general direction of the American Medical Asso- ciation there will be a pathological exhibit at the St. Louis Fair, showing pathology and bacteriology especially. DR. CHAS. G. CHADDOCK'S ADDRESS before the Medico-Psychological Society was a masterly presentation of the progress of modern Psychiatry. SELECTIONS. CLINICAL NEUROLOGY. AUTO-AGGLUTINATION OF THE ERYTHROCYTES.— There are many peculiar phenomena among the so- called immunity reactions. One of the most peculiar is the ability of an individual's serum to agglutinate his own cor- puscles under certain conditions. I his phenomenon has been observed in Hanot's hypertrophic cirrhosis of the liver by several observers (Klein, Hayem, Reitmann and Obermayer.) It will be remembered also thai Flex- ner considers auto-agglutination of the red cells to be re- sponsible for the thrombi which often form in typhoid fever, pneumonia, etc., the bacterial toxins possibly causing the agglutination. Eisenberg has observed auto-agglutina- tion in a case of generalized pyocyaneus infection, arising from a severe wound of the leg. It has been noticed dur- ing the course of the infection that when blood was with- drawn for examination it did not clot in the ordinary man- ner, but the corpuscles gathered in chimps and sank to the bottom of the pipette, leaving clear plasma above. This is the phenomenon of auto-agglutination. The serum from such blood was also isoagglutinating to some extent, that is, it would agglutinate the red cells of another individual. "At the autopsy the blood in all vessels, especially the cerebral vessels, appeared as a colorless fluid, in which heaps of coherent corpuscles were suspended in the form of red points." Blood obtained from the heart separated into a layer of agglutinated corpuscles at the bottom, while the serum collected at the top of the tube. Singularly, however, the serum had lost the isoagglutinating properties 3S6 Selections. 387 which it had during the patient's life. Eisenberg explains this by supposing that after death all the agglutinating substances had been absorbed by the patient's own cor- puscles during their agglutination. This accords with the well-known fact that cells can absorb more agglutinin than is necessary to accomplish their agglutination. This obser- vation raises a fundamental question. The patient's blood contained something which was capable of agglutinating his own corpuscles, yet this agglutination would occur only when the blood was withdrawn from the body or after the patient's death. This suggests in the first place the view of Metchnikoff, that the "immune bodies" exist for the most part intracellular in the body, i. e., in the leucocytes, and are liberated only when these cells disintegrate after blood is drawn or after the animal's death. It suggests also how vastly different processes in the test-tube may be from those in the living body. From observations of this nature, of which there are other examples, it is evident that there is much which is yet dark as to the modus operandi of the immunizing substances.—Journal A.M. A. THE HEART AND VASOMOTOR SYSTEM. L. F. Bishop, New York City (American Medicine). The fre- quent discrepancies between the heart-sounds as heard by the stethoscope and the pulse as determined by palpita- tion must have impressed all observers. It has been a matter of surprise that hearts, which, by their sounds, seemed to be doing good work, were often accompanied by a pulse giving a poor impression, and on the other hand, cases showing irregularities of the heart-sounds have been associated with a pulse showing a fair degree of regularity. When it is remembered that, in the light of evolution, the heart is constructed of the same elements as the bloodvessels and is only a differentiation of the circulatory tube, and when it is appreciated that not only the blood of the heart but the blood of the whole circulation is sur- rounded by a muscular envelope that maintains its pres- 388 Selections. sure, it can easily be seen that in palpating any portion of this blood-containing system, the variations in pressure will be a complex of the whole envelope and not merely of its strongest portion. The vasomotor system is much more liable to disorder than the heart and the heart is able to compensate for a good deal of misbehavior on the part of the vessels, but in compensating, it often appears to be misbehaving itself. Thus, one may fall into the error of predicating disease of the heart-muscle when the trouble really is a functional derangement of the bloodvessels. In many of the cases that are strikingly benefited by the Nauheim treatment the results are undoubtedly obtained by a restoration of the peripheral circulation and the relief of the heart from a struggle to compensate for it. Not only clinical but pathologic study confirms the fact that diseases of this class, including myocarditis and ne- phritis, have their origin most often in degeneration of the bloodvessels, at first functional and then organic. The coronary arteries of the heart become Involved and then the heart-muscle suffers. The vasovasorum of the blood- vessels suffer and then the larger vessels, so even in the early stages of circulatory symptoms, the relationships should be appreciated and the hygiene of the peripheral circulation becomes a matter of serious supervision. LUCIEN LOFTON'S DON'TS IN MODERN GYNECOL- OGY.—These valuable "don'ts" are as good as if an alienist and neurologist had prescribed them. They are equally as good in the practice of neuriatry and psychiatry. Don't tell a patient with merely an eroded os that an operation will be necessary. Treat the condition always first. Don't make digital or macroscopic examination too lengthy. Don't attempt to mix private matters with the sacred science of gynecology. The two are incompatible. Don't even criticise a woman who is unclean. Remem- ber ignorance plays no uncertain roll in the life of every- one, hygienically speaking. Selections. 389 Don't ever display anger while making any explora- tion. Gentleness, politeness and kindness are the cheapest and most effectual weapons one may possess in all vocations. Don't depend on a female patient to carry out your initial instructions, but show her yourself. Results come then. Don't make a hurried digital examination because you may have to make many. Once well done relieves con- stant and unwarranted dread upon the patient's part. Don't criticise a lacerated perineum. No woman likes to be reminded that her much-loved accoucheur did her wrong, when she wasn't looking. Don't remove an ovary if you can remove the pain. A sexless woman is a slab-stone upon the waning popu- larity of the excessive debauchery of abused women. Don't pronounce every abdominal pain of ovarian origin. Women are surely susceptible to appendicitis and mostly every other ache to which the stern sex is liable. Don't call upon the surgical world to note your match- less method of doing a hysterectomy, but rather call upon all the science and skill that within you lies to save every poor sufferer the humiliation of such a formidable under- taking. Don't forget that narcosis has removed many enor- mous cystic (?) tumors in time. Don't attempt the specialty of gynecology without cause, a wagon load of "horse sense" and years of experi- ence. There are men in business who have been in harness for several decades, who are still staying very near the bank, and who will not approach deep water, save under high pressure. Don't thrust upon a neurotic the appalling news that her condition is always due to an abnormal position of her womb. Don't tell a candidate she has "falling of the womb." Thousands go around every day expecting this shamelessly censured organ to fall between their knees any moment. Don't delude a woman into believing her uterus is 390 Selections. pinned to her spinal column, or that it is twisted upon its axis, or that it is bent upon itself, so that only the re- cumbent position will cure her. Tell her little. Do for her much and your name will receive a divine blessing at her hand. Don't stuff a vagina too tightly with your gauzes, your wool or your cotton. There is nothing more disagree- able than an unnatural foreign body hereabouts. Don't treat all female comers for some disorder pertain- ing to your branch, remembering that they might occasion- ally be afflicted with something else the other fellow can do. Don't be narrow in your conclusions. It requires two halves to malrbid fears of the brain-fagged victims. A little daily diverting mental activity is better than autocratically en- joined repression of thought and emotion, which cannot be accomplished. A little exercise of those neurone aggrega- tions (which we call centers), which have not felt the brain fag of the daily grind, if followed by ample sleep and nu- tritional reconstruction will prove salutary if we skillfully regulate, by judicious chemico-therapy the involved psychic neurones, and this, the present day neurology is now cer- tainly resourceful enough to do with the aid of properly adapted environing influences, even in psychasthenia, about the cure of which so many are yet incredible. A stroll or ride from the Inside Inn on Commonwealth Avenue, past the Utah, Indian Territory, Arizona, Missis- sippi, New Jersey, Iowa, Minnesota, Kansas, Massachusetts, New York, Ohio, Missouri and Wisconsin buildings of a balmy August, September or October early morning or evening, turning west down the valley roadway, between the New York and Kansas buildings, skirted with trees and flowers, with the gigantic bird cage, showing the birds of the Smithsonian National Zoological park, with the Okla- homa, Colorado, West Virginia, Montana, Vermont and New Hampshire buildings on the north, with the Michigan and South Dakota close by them, will instruct and interest in a restful way anyone whose brain neurones are not too much exhausted for even slight mental movement. Birds of many climes and forms are'there, large and small, squat and tall, and shapely and ^shapeless, graceful, graceless and gross. And their habits, all or nearly all, of seeking rest and sleep at the close of each''day, will set an object lesson example from the feathered I tribe worth 506 Charles H. Hughes. emulating by many World's Fair visitors. About this ex- hibit are seats for the weary and at the west are music and meals. From a seat here one may contemplate the ingeniously constructed, conical-shaped Washington State building, the United States Fisheries Commission building, the Portland Cement Exhibit building, the Potteries of Ohio, the Colorado burros and, near by, is the Mining Gulch, Third-rail railroad, the Metal pavilion of the Colo- rado School of Mines, the Kentucky building and the Gov- ernment building and the Mines and Metallurgy palace. The South Dakota Corn palace in this vicinity is a specially pleasing, ingenious and artistic feature, where one may rest any morning in rapt contemplation of its beauty and skill- fully artistic construction. The Kentucky, Texas, Hoo Hoo and German buildings are all in walking distance, in which one may rest and enjoy himself. My dear brain-tired brother doctor, if "It seems to you, you'd like to go Where bells don't ring nor whistles blow, And clocks don't strike, and gongs don't sound, Where you'd have stillness all around. Not real stillness, but just the trees' Low whisperings, or the hum of bees, Or the brook's faint babbling over stones In strangely, softly tangled tones. Or maybe a cricket or katydid, Or the songs of the birds in the hedges hid, The bullfrog's sturdy note, Or other 'such sweet sounds as these To fill a tired heart with ease.'" You may even find these restful features, strange as it may seem, in connection with some parts of the great Ex- position if you would avoid there the Machinery buildings, the Pike and the other noisy places, and seek the many tranquil spots skirted and reached by the Intramural rail- road, the autos and Roller chair or on foot. They are the woody glens, like those leading to the great bird cage, the Philippine villages, the bridge over Arrow Head lake and the old Spanish fort that stands by it, in the early morn or shady eve, the Sunken and Machinery gardens, the great Plazas, where only the bands disturb, and the smoothly The Exposition, and the Neurasthenic. 507 gliding gondolas and launches of the Lagoons, or the seats of the colonade of States overlooking the rippling Cascades and the quietly passing boats below, or on the bridges (remote from the crowds) across the Lagoons, or the many restful places about the various eminences where restful, home-like State buildings are, like those of Bouvoir, Monticello, Fort Clatsop, Maine, New Jersey, Maryland, along Colonial Avenue, near the Inside Inn, where In- diana, Rhode Island, Nevada, Connecticut, Pennsylvania and Arkansas are, on the same street opposite, and other buildings having no bands playing. In addition to this you seek one of the many quiet sleeping places at night on the high ground environing the Exposition, in hotel, in tent city or in private house. On some part of the porticos of most of the State buildings, and most of the other buildings, one may find shady and restful chairs and enjoy a tranquil and inspirit- ing view and verdure of trees and in "these thick and rich- hazed sumptuous autumn nights" common to Missouri now, when "the moon grows like a white flower in the sky" and "stars are dim," and "tired Nature rests content among her sheaves, as a fond mother rests among her children," the tired brain may recoup itself upon a tranquil feast of smiling delights, of soothing scenes, in a thousand places about the Exposition and away from the music-stimulated Plazas, where the masses most are seen. After having visited nearly every World's Exposition since 1876, and having been over one hundred times in this, though without yet having seen it all, 1 make this record of my experience, that it transcends them all in grandeur and beauty of architectural and sesthetic feature, as well as commercial and politico-economic comprehensiveness. At the Louisiana Purchase Exposition, the strong and vigorous who runs through it may read the lesson of the great modern world's great progress, and the brain-weary may, if prudent, view it with leisurely pleasure, if he take but time enough, for unlike its predecessors, beauty and amplitude of landscape as well as architectural design show everywhere, and within its ample grounds may be 508 Charles H. Hughes. found a hundred restful views refreshing to look upon for body and brain. Notwithstanding the immensity of this great Exposition, where the healthy, hearty seeker after world's sights may satiate his mind with a full mental meal in two or three weeks, the specially brain-fagged, with mind strained in one line of business or professional thought, may make of it a recreative, diverting, restful, sight-seeing tour of the world within from forty to sixty days. Here he may go and visit within thirty- six hours, without mental or bodily fatigue, Ireland and Jerusalem, and on another two days and a night he may see Austria, Germany, Holland, Sweden, the Tyrolean Alps, Charlottenberg Castle, Das Deutsche Haus, sleeping each intervening night on terra firma. He may go to the Philippines on another day and be but an hour or two in transit, if he stops at a near-by hotel by means of the Street and Intramural railways or the Automobile transit. He may, in the same manner, go to Mysterious Asia, to Morocco, New York and the North Pole, Over and Under the Sea, to and from Paris, to the Battlefields of the Civil War and Mexico, to Santiago, to Cuba, to the Galveston Flood, to China at the Pavilion, to the British Pavilion and the Cottage of Burns, near the banks of the Doon, to the Bra- zilian, Japanese, Belgian and other foreign buildings, to Alaska and its totem poles, to Oregon and to Washing-ton, States of tall timber fame, to the Mining regions of Mis- souri, Colorado and the Great West and down into the mines, whence comes in life-like representation the mineral wealth of these United States. In like manner may the natural resources and manufacturing products of all countries and' all sections of this great country be seen. So we may see the aborigines of America, the Indian school and huts, the African dwarfs, the buildings of all the States, and the extensive water, forest, and plateau views of this blended and unequaled picture of landscape and architectural beauty and commercial and educational utility, such as the world has never before seen in one assemblage, and whose like perhaps we shall never see again. HEREDITY: ITS INFLUENCE FOR GOOD OR EVIL.* By MARTIN W. BARR, M. D. Chief Physician, Pennsylvania Training School, Elwyn, Deiaware Co., Pa. FROM the most ancient times it has been accepted with- out question that heredity is law—a law verified by accumulated evidence gathered in every department of science that treats of organic life. A review of the observations, experiments and conclusions, thus reached, is necessarily an interesting study to earnest thinkers in many fields, as is proven by your including the study in to-day's program; and this invitation to accompany you through some by-paths of research is, 1 assure you, most highly appreciated. It is by this interdependence and interchange of views and results attained that a knowledge of the inexorableness of this law has been attained and demonstrated, and only by a continuance of such interchange, may we still further elucidate the justice of its penalties and the mercifulness of its awards. The aim and crown of such labors is the perfecting of life all along the line; the flowers of the garden, the far-stretching fields of waving grain, the over-shadowing orchards, domestic animals—both bird and beast—the flocks and herds, shall each feel the touch of energizing power in the elimination of ill and infusion of good; and the family to which all these contribute, shall realize the prophetic vision that its sons may grow up as the young plants, and its daughters appear as the polished corners of the temple. It is time to awaken to this call for the strenuous feverishness of the day has ushered in such a reckless dis- •Read at the Annual Meeting of the G. B. Association, Phiiadelphia, Jan. 25, 1904. 509 510 Martin W. Ban. regard of life, that man fails to recognize accountability either for his own life or his neighbor's. It would be well to go back to the contemplative age and to realize that in both the giving and the taking of it, the most sacred thing about life, is life itself. To such an end do our labors point, and in this are the florist and the farmer agents in large measure. The cross fertilization of flowers, the intermixture of grains, the grafting of orchards, the cross-breeding of animals, are fruitful sources of information as to the fit propagation of species, and guides therefore in that study of mankind—the proper study of all men. The law of physiological heredity is based upon the tendency observable in each and every organism to repeat itself in its descendants. This would, in the higher organisms, include largely the transmission of those psychic qualities which, in large measure, depend upon physiologic conditions. Darwin's celebrated hypothesis of pangenesis, "which implies that each of the atoms or units constituting an organism reproduces itself" is perhaps the strongest basis, for this reasoning. Here we are led to "consider each living being as a microcosm, made up of a multitude of organisms" each possessing the fundamental properties of life—nutrition, evolution and reproduction. "Alongside of this mode of multiplication, I suppose that the cells, prior to their con- version into formed and perfectly passive material, emit minute grains or atoms which freely circulate through the entire system, and when they find sufficient nutrition after- wards develop into cells like those from which they came. These atoms we will call gemmules. We assume that they are transmitted by parents to their descendants, and that usually they develop in the generation immediately following, though for several generations they may be transmitted in the dormant state and develop at a later period. It is sup- posed that gemmules are emitted by each cell or unit, not only during its adult state, but during all its states of development. Finally, we assume that the gemmules have a mutual attraction for one another, and hence their aggre- gation into germs and sexual elements. Thus strictly speaking, it is not either the reproductive elements or the germs that Heredity: Its Influence for Good or Evil. 511 produce new organisms, but rather the cells themselves, or units constituting the whole body."* According to Ribot: "This hypothesis enables Darwin to explain a great number of phenomena, very different in appearance, which, however, physiology regards as essen- tially identical. Among these we may name gemmiparity, or reproduction from buds, fissiparity, where reproduction is effected by spontaneous or artificial division, sexual gener- ation, parthenogenesis, alternate generation, the development of the embryo, repair of the tissues, growth of new members in place of those which are lost (as occurs in the case of the lobster, the salamander and the snail)—in short, all modes of reproduction whatsoever, and all the modes and all the varieties of heredity." "The cause of heredity," says Hackel, "is the partial identity of the materials which constitute the organism of the parent and child, and the division of this substance at the time of reproduction. Heredity, in fact, is to be con- sidered only as a kind of growth, like the spontaneous division of a unicellular plant of the simplest organization." Indeed 1 suppose one of the clearest expositions of this power of reproduction is found in the process commonly known among florists as "layering," or the propagating of many plants from one by laying a leaf in the ground under suitable conditions; here the original cell on leaving the mother plant, not only receives but multiplies and distributes this power without diminution of energy. Yet this appar- ently simple mechanism in the lower forms finds such resist- ance in the extreme complexity of the higher organisms, as to produce and constitute many variations in heredity. Only a few of these may be considered in the limits of a brief paper, but 1 will strive as far as possible to touch the several broad divisions, under which these may be more closely studied—heredity direct, reversional and collateral. In the first named, DIRECT HEREDITY, the offspring may receive physical and psychic characteristics from both parents in equal degree, or it may resemble one more than the other; again there may be an agreement or a difference (Note.)—Darwin: Variation, etc., vol. II. chap. xvll. 512 Martin IV. Ban. according to sex—the son receiving the paternal, the daughter, the maternal characteristics; or the cross transmission where the son resembles the mother and the daughter the father. Cross heredity is sustained by many great physiologists who give numerous examples. "Every son takes after his mother" says Michelet—"Catherine and Marie de Medicis, gave us true Italians, and Louis the sixteenth, was a real Saxon King, more German than the Germans themselves." Buffon claimed to derive all his gifts from his mother and Mirabeau says of his son, "He possesses ail the low qualities of the maternal stock." Nero, the Gracchi, Henry fourth, and James first, are notable examples of maternal trans- mission; Hypatia, Julia (Pompey's wife,) Lucretia Borgia, Anne de Beaujeu, and Madame de Stael of paternal. Cross breeding in the lower animals gives similar tes- timony. The Arabs seek always the genealogy of the female for their horses. With the French it has passed into a proverb "Chien de chienne et chienne de chien." The transfer of moral qualities is thus noted by Buffon: A she-wolf crossed by a dog, dropped two cubs of which the male was wild and savage, the female gentle, familiar and even affectionate. In direct sex-heredity we have also numerous examples; Hannibal, Tasso, Charlemagne, Rafael, Bellini, Pitt, and D'lsraeli, are however, instances of exces- sive talent, force or genius, and therefore a greatly prepon- derating influence. With many of these there were also the added influences of environment, and the association of strong personality. A singular case coming to my knowledge is that of a man of wealth and education, whose grandfather was a moral imbecile, and he himself notorious for his extreme cruelty to animals. On one occasion, in a violent fit of temper, he deliberately stabbed and killed a favorite horse of great value. Similar traits were noted in his son who, rich, handsome, cultured, of esthetic tastes, a graduate of one of the most prominent colleges in America, made a pronounced hit in his chosen profession. Enjoying for some years phenomenal success, wine and women proved his bane, and he sank lower and lower. His excesses no longer tol- Heredity: Its Influence for Good or Evil. 513 erated at home, he drifted from capital to capital in Europe, and finally established himself in Japan with a harem. With an appetite still unsatisfied, he exhibited new phases of moral degeneration, causing his body to be tattooed with wonderful skill, every picture a work of art. Thus his back bore a huge dragon, the shading of each scale showing perfection of detail; this, on revisiting America, with the utmost vanity he shamelessly exposed. Returning to Japan, he bought a performing bear and wandered from place to place clad in the garb of a hinin, exhibiting himself, his bear and his harem, and distributing photographs of each and all in endless variety. This past-master in vice, shocking both Europe and America, and astounding even Japan, next hired a squad of Japanese boys, who, attired in full uniform, are trained in military exercises. To these are opposed an equal number of monkeys dressed as Chinese soldiers, and the war of China and Japan is constantly renewed for the entertainment of himself and his harem, who watch in ecstacy of delight the sufferings of the poor brutes. Rewards are offered, and the more bloody the contest and the greater the atrocities, the more intense is his gratification. Yet another case is that of a man also of high social position, who was closely related to one of the famous presidential families; his wife one of three sisters all noted beauties. With every advantage of education and culture, a gifted artist, excelling in miniature painting, in which he gained a reputation for exquisite delicacy of coloring and attention to detail, he was nevertheless a moral imbecile, brutal in his treatment of his children and of the wife with whom he lived for over forty years in a silence unbroken by the interchange of a single word. Of five children— three sons and two daughters—two sons inheriting all their father's brilliancy and artistic tastes, were moral imbeciles; one a thief, a liar, a profligate and a fugitive from justice; the other a minister of religion admired for his talents, but untruthful, dishonest and unreliable, losing the esteem of all good people as rapidly as he gained it. He had a son, also a pronounced moral imbecile. Of the three normal children, a daughter inheriting her 514 Martin IV. Ban. mother's beauty had three sons all mentally defective. This latter case shows the second variety to which we have alluded, and which we will now discuss. REVERSIONAL HEREDITY or ATAVISM, is the form which of all others attests the certainty of hereditary trans- mission. Here the offspring may resemble neither parent, yet may develop physical traits, idiosyncrasies, habits, tal- ents or vices, traceable to a grandparent or to some far away ancestor. "Is it not marvelous" says Montaigne, "that this drop of seed from which we are produced should bear the impression, not only of the bodily form, but even of the thoughts and the inclinations of our fathers? Where does this drop of water keep this infinite number of forms, and how does it bear these likenesses through a progress so hap-hazard and so irregular that the great-grandson shall resemble the great-grandfather, the nephew the uncle?" This form recognized by the ancients, is recorded by Aristotle, Galen and Pliny. Plutarch tells of a Greek woman who having given birth to a negro child, was brought to trial for adultery, when it was discovered that she was the fourth descent from an Ethiopian. An analogous case transpired in this very city: A young couple happily married were on the verge of separation, the wife having born a negro child, when the young man's father revealed to him the skeleton in the family closet. His great-grandfather was a negro. In this reversion to original type, the prepotency of type frequently asserts itself, either in hastening degeneracy or in an effort of nature to redeem the race. Thus, in a family in which through five generations of neurotic inter-marriage, I have traced the taint from one insane progenitor appearing in the various forms of insanity, imbecility, epilepsy and consumption; where there was admixture with unconiaminated stock the children were normal, although the taint reappeared in later generations. In the advance from savagery, both with man and beast, this reversion to original type is liable to occur under any strain or change of environment. How often may the wolf be traced in the dog—the tiger in the cat? The negro brought from the wilds of Africa to America was rescued from can- Heredity: Its Influence for Good or Evil. 515 nibalism—transferred from barbarism to civilization. Slavery was for him a period of evolution in which impelled to advance he was also in that advance, guarded from a lapse into former conditions and shielded from the responsibilities and cares of existence which at that stage his very childish- ness forbade his assuming. Crimes against wome'n were almost unknown in the whole Southland. As soon as the strong hand was lifted the tiger leaped, and we have now daily instances of reversion to original type. INDIRECT or COLLATERAL HEREDITY—i. e., the appear- ance in a later generation of qualities or characteristics of uncles, aunts or cousins, is in reality only an evidence of atavism traceable to some neuroses in a common ancestor which, tenaceous and prepotent, reveals itself in many descendants in lieu of one, showing a stability amounting to a dynamic force. This stability is also noted in what is known as "use heredity" where the repetition of habit or occupation leads to its becoming a part, as it were, of the family or the race, and therefore transmissible by generation. The same theory accounts for the gradual loss of certain powers or even of organs upon which the animal or the individual is no longer necessarily dependent. As is well- known in the case of prostitutes, nature safeguards the race eventually by means of sterility, disease or death. But for this what might not have been the further increase of numbers? In spite of it what disasters have not been accomplished? This law of use and disuse—kinetogenesis—together with the law of inheritance of acquired character was clearly stated as far back as 1809 by the French philosopher Lamark, thus: "The development of organs and their force or power of action are in direct relation to the employment of these organs." This is an open sesame to the study of the various heredities of the emotions, of the intellect, of the will, of talents, of skill, as also of disease, of parasitism and of crime. Two notable examples showing these in marked contrast resulting, the one in progression, the other in degeneration, is first: the Bach family whose history covering a period of two-hundred years, shows fifty eminent musicians. 516 Martin IV. Barr. The average birth-rank of progenitors during that period being thirty-six years, their descendants were therefore conceived during the highest period of development and therefore of procreative power. The second, a family known as the Tribe of Ishmael, is supposed to have its root in the old convict stock transported to America in the seventeenth century. Oscar McCullogh has followed its history through" six generations, beginning with three individuals and increasing in less than a century, to five thousand, flooding the North- west with a continuous stream of pauperism, imbecility, insanity, and crime. Here we find life in a turbid stream taking the line of least resistance—a gutter existence gathering filth at every crossing. Degenerating as the sexual impulses become exag- gerated, puberty is reached and reproduction effected in the very age of childhood, before the physical being is otherwise developed. This is the race suicide most to be dreaded; it is the quality more than the quantity of numbers that needs to be maintained. Not only do degenerates multiply more rapidly owing to this precocity and exaggeration of sexual desire, but the many phases of moral imbecility present often an intellectual precocity and cunning that would deceive even the very elect, so that the normal are con- stantly seduced and impregnated by the abnormal and thus is being produced a constantly increasing body of defect. Of all heredities there is none that so clings with the per- meating, penetrating, disintegrating power, as an heredity of imbecility; and you may perhaps realize that in this 1 am able to speak with some authority when in an absolutely unbiassed study of the family histories of 3,050 mental defectives, I have found various heredities a potent cause in 65 per cent, of cases, and one-half of these due to direct heredity of insanity and imbecility. Truly, according to this, there is more care exercised in the breeding of animals than in the procreation of children! 1 never realized this fact so entirely until, a few years ago, when engaged in the trial here in Philadelphia of Samuel Henderson, an imbecile, aged 15, the son and grandson of imbeciles, for the murder of Percy Lockyer aged 5. Heredity: Its Influence for Good or Evil. 517 The boy Henderson, like so many of his class, is a series of contradictions: He is tender and cruel, ingenious and crafty, phlegmatic and nervous, unfeeling yet affectionate; he is open, frank, artless, secretive, shy, deceitful, truthful in many ways, but also an accomplished liar. Atavism and environment combine to form a moral imbecile, in whom the moral sense is obstructed or altogether absent. One of his chief characteristics was fondness for animals, babies and young children, and it was remarked on the afternoon of the tragedy how carefully he carried the little Percy on his shoulder across the muddy fields to the playground in the wood from which later he returned alone. When search was made for the missing child he denied, when first inter- rogated, at\y knowledge of him or his whereabouts, but afterward, revealing the imbecile peculiarity in his suscep- tibility to suggestion, he was finally led to a confession of the deed and to a narration of the circumstances leading to it. How that playing "Wild West Show"—his parents had travelled with Buffalo Bill—the child ran against his knife and, as he expressed it, "just stretched, and said nothink." Then in sudden terror he stabbed him again and again, dragged the body into the stream, concealed it under rocks and ran home, where he took up his evening duties with the same indifference which he displayed later in the court room when a prisoner at the bar. It is this childishness, instability, irresponsibility—which reveals more than all else the force of the law of disuse in heredity. Children, we call the victims of such and children they are, be they six or sixty. It is the assurance of this gained in a life experience of companionship with these children, that has led me to see how that the great mystery of life and responsibility of race continuity is too often committed to children; and to arrive at the conviction that no man or woman with a pronounced heredity of ill—physical or psychical—has a right to risk its transmission. Studies in heredity tend to emphasize the wisdom of those ancient peoples who taught that the healthful develop- ment of the individual and the elimination of the weakling was the truest patriotism—springing from an abiding sense 518 Martin W. Barr. of the fulfillment of a duty to the state. The surest rescue of a race from imbecile childishness, is a prolongation of normal childhood full of healthful exercise and free from mental precocity, which delays the period of puberty; then if marriage be deferred until maturity in full vigor be attained, the period of reproduction will be proportionally advanced, and the quality of the race will be preserved without dimi- nution of numbers. THE ALIENIST AND NEUROLOGIST. VOL. XXV. ST. LOUIS, NOVEMBER, 1904. No. 4. Subscription $5.00 per Annum in Advance. $1.25 Single Copy. CHAS. H. HUGHES, M. D., Editor. HENRY L. HUGHES, Manager and Publisher. Editorial Rooms. 3857 Olive Street. Business Office, 3857 Olive Street. 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. EDITORIAL. . [All Unsigned Editorials are written by the Editor.] "SHORT CUTS TO CEMETERIES." —The following sanitary salvage views are sound. If the daily press were always as sound on the deleterious influence of quack adver- tisements as on overstrain of brain at political conventions, it would be better approved by the medical profession. This editorial is from the St. Louis Star: "Short Cuts to Cemeteries.—The death of Reporter 'Jim' Galvin at the Republican State Convention at St. Joseph brings up the devastating influence of conventions on the health of those who have had to make them a study. "Although Mr. Galvin's death could not be charged to the St. Joe Convention, because it was comparatively mild in its demands on strength and vitality, the same has not been true of other nominating bodies recently. "News comes this morning that Gov. Pattison of Penn- 519 520 Editorial. sylvania is dying, largely because of the strain incurred in nominating Parker in St. Louis. "The National Democratic Convention was a test of endurance through which no man should be required to go. "Sanitariums and rest shops of the country are full of politicians and newspaper men who have not recovered from it yet. Dave Hill and many members of the New York dele- gation and other State delegations are still under the weather. "Beginning with the session of the Committee on Cre- dentials, which lasted over thirty hours, the St. Louis con- vention followed with two all-night sessions, full of the most riotous debate and the most nerve-wrecking contentions. "The Democratic State Convention which nominated Folk at Jefferson City was nearly as bad. "AH night sessions of the Committee on Credentials and the Committee on Resolutions preceded all night sessions of the convention. "Folk was nominated at sunrise one morning, and after an adjournment for four hours the convention continued its work all day. "The same reckless disregard of the rules of health and living are conspicuous at such gatherings all over the country. "It is not possible that the safest and sanest delibera- tions should be attained under such unsanitary surroundings and circumstances, and for this reason, if no other, these . convention methods should be abolished. "There is grave necessity that an eight-hour law be passed for all such bodies, with a penalty clause severe enough to prevent any violation of its provisions." How can men expect deliberate and sound logic to show in platforms evolved from fagged and fuddled brains after a night of vigilance. It is not strange that a delib- erate rested brain had to revise the platform of the St. Louis National Democratic Convention. THE PHYSICIAN IN FRENCH POLITICS.—"Twenty- three physicians were chosen as candidates for the mayor- alty in as many French cities at the recent elections, and Editorial. 521 of these only two were defeated." This is a pointer for America. Medical men should seek to gain and hold legiti- mate political influence for the good of the profession and the welfare of the people. When medical men claim and secure their due share of political influence quacks and quackery will go from the foreground to the background and their political promoters will have more regard than now for true professional inter- ests and the real sanitary welfare of the populace. CROWDED INSANE ASYLUM.—The Board of Health has discovered again that the insane asylum is over-crowded. This discovery is made about once every six months. There are 720 patients in the asylum, 199 of them being compelled to sleep in the hallways and general as- sembly rooms. The building is crowded with 500 patients. Not more than 400 can be safely and comfortably cared for. This condition is the scandal of more than a decade. The asylum has been crowded for years, many of the pa- tients being cared for in the Poor House. In the new St. Louis now beginning to grow, a leading feature of municipal policy should be an intelligent up-to- date system of public institutions. St. Louis is poorly equipped with the instruments of humanity and humane purpose. To lift the city to the highest level in this re- spect should be the aim of every public spirited citizen and a fixed item in the program of the municipal government. —Post-Dispatch. We are glad to see the public press taking an interest in our eleemosinary institutions and especially in those peculiarly unfortunate who fall mentally maimed in the strenuous battle of life or who fall as brain bruised vic- tims of ignorance and vicious heredity. While the Mayor is asking for the purchase and reten- tion of the lagoons in Forest Park for the pleasure of the people and the beautifying of the most beautiful and exten- sive Forest Park in the world after the Worlds' Fair, let him not forget these unfortunate wards of a philanthropic people who can not speak out their needs. 522 Editorial. Philanthropy is the true measure of civilization and well endorsed and equipped eleemosynary institutions are the true indices of philanthropic measurement. The divine injunction "with what measure ye meet it shall be measured unto you again," has a scientific as well as divine injunction aspect. The mentally maimed rightly and timely cared for may be restored to the usefulness of rational life, to bless again the state and the family, oftentimes in self-support and remunerating labor for the good of all. The insane asylum proper was constructed to accom- modate 250 patients. The poor house addition had also to be later utilized, but it is not suitably constructed and is not safe from fire, when crowded wiih insane. THE PRACTICE OF MEDICINE—A PENNSYLVANIA DECISION ON WHAT IT IS.—A Chambersburg Pennsyl- vania Judge lately assessed a fine of two hundred dollars on an itinerant so-called 'doctor' Thomas E. Eldridge. Following is the dictum of the judicial decision, "the practice of medicine consists in the offering of services as a physi- cian, and treating diseases, deformities and injuries by any means whatsoever." The assumption of the vocation of doctor of medicine without the legal qualification caused the sentence. ADDRESSING A DOCTOR AS "DOC" has been very properly interdicted by the Health Commissioner of St. Louis. It is not even the proper thing for horses. TOXINS OF INSANITY.—There are others like those of phthisis, syphilis and typhoid, but James Wright Putnam is quoted in the Buffalo Medical Journal as naming Bright's disease and diabetes mellitus prominent among the diseases, the toxins of which may produce insanity. Auto-intoxication from a disordered alimentary canal which produces disturbances varying between headache and irritability, and confusional insanity, are familiar to all of us. Berkley is quoted in several instances showing the oc- "V Editorial. 523 currence of confusional mania from constipation, from dia- betes, from hypersecretion of the thyroid; also Gowers in the mental disturbances incident to exophthalmic goiter. Williams, Hobbs, Macdonald, Clouston, Charcot and others are mentioned as supporting the theory that many cases of insanity are produced by toxins. The author concludes with the statement "that its close connection with many general diseases makes it of special interest to the general practitioner and specialist alike." To these may be added epilepsy and its probable toxine, tetanus, etc. ASYLUM PROMOTIONS.—The Dominion Medical Monthly says truly in accord with all real psychiatric ex- perience: We are in perfect accord with sentiments of a member of the Opposition when he states that the Gov- ernment ought to make promotion in the asylum service a reward for faithful services. Nor do we see the need of passing by a faithful and competent assistant when a super- intendent is required, as is too often done. The medical serv- ice in our various asylums should not be a means of awarding doctors who have d ne a little stumping and a little caucussing for party; and it is to the credit of no government to use the offices as bait for party angling. Our insane asylums should be hospitals, medical appoint- ments to which should be made irrespective of party, and preferment given to those with experience, who have de- voted their lives as internes since graduation. The doctor with political ambitions given the quietus, whether in gen- eral practice or a specialty, should not be foisted upon the wards of the government. THE EYE-STRAIN THEORY OF THE INEBRIETY CURE, as seen by the laity, is well portrayed in the fol- lowing from The Mirror: A new disease added to the long list of those asserted by the talented author of "Bio- graphic Clinics" to be due to eye-strain is alcohol addiction. At a meeting of opticians at Milwaukee en Wednesday of 524 Editorial. last week, a Chicago refractionist reported a case of chronic alcoholism cured by eyeglasses. The speaker took the ob- vious ground that the craving for alcoholic stimulation was a nervous affection, and he had found, he said, in a long series of ocular examinations, that inebriates often suffer from anomalies of refraction and other producers of eye- strain. Such being the case, the natural corollary follows that spectacles will cure inebriety. The reasoning is as profound and as sound as a good deal of that used by many of the extreme advocates of the eye-strain theory, and no doubt we shall soon have the inebriate looking through other glasses than those he must tip up to make transparent. REMARRIAGES OF WIVES BY FEMALE SEXUAL IN- VERTS.—The Alienist and Neurologist of November, 1902, called attention to the marriage of two female sexual in- verts in Canandaigua, New York, and the subsequent death of the "husband." The widow, "Mrs." Edith Dyer Howard, was married to George Richmond, a Pennsylvanian, at Shortsville, New York. Mrs. Howard has been a "widow" since March, 1902. Her first husband" was known as William G. Howard, but, after death it was found the sup- posed man was a woman, whose real name was Alice. Alice Howard was legally married to Edith Dyer twelve years ago. The "husband" was then 20 years old and came of a family well known and respected in this section. Since childhood male attire had always been worn by the supposed William. At intervals three children appeared in their home, two of whom are claimed as their own and one said to have been adopted. There has been a change in the characteristics of the "widow" since what is regarded as the approach of the menop iuse. Formerly, she showed no special desire for male society, but since the death of her "husband" there have been gradual changes in this par- ticular, which led to the re-marriage. BEQUESTS OF A REVEREND PARETIC—The Asso- ciated Press notes the death on September 13th of Rever- Editorial. 525 end James, of Natootna, Kansas, who created a great sensation and much trouble by his paretically magnificent endowment of Kansas colleges and other public institutions of that state. He believed and declared himself to be one of the heirs to a fabulous estate in England to $20,000,000, and made bequests accordingly. He was pastor of the M. E. church at' Oakley, at a salary of $500 per year. Among the bequests made was $1,000,000 to the Kansas Wes- leyan at Salina. This money, he stated, would be paid as soon as he could go to England and get it. Salina became excited, and real estate went booming. By the assistance of the school and a local banking house, both of which be- lieved in the story, Rev. James secured the means to go to England. After sailing he was lost to his friends for sev- eral months. He suddenly appeared in McPherson, Kan. His mind was a blank as to what he had done in England, except that he saw his brother, who told him that their father had died, but had willed his fortune to his stepchil- dren. Rev. James believed in the story so implicitly that Judge Osborne was sent to England to investigate. Upon his return he reported that there was no foundation for the story. Paresis makes much trouble in the world other than monetary, and it ought to be better understood on the stock exchange. . The high pressure brain-strain life of our "captains of industry" and "Napoleons of finance," is developing and has developed many disastrous paretic movements in the financial, as well as in religious and political fields of men- tal action. It is well to steer clear of the sphere of in- fluence of the paretic and the paranoiac in church and state, on change or on the hustings. The morbidly deluded often mislead the sane but over-confiding into that "way which seemeth right unto a man," though the way leadeth to dis- comfiture or misfortune. SUICIDE FROM INSANITY DUE TO ACCIDENT is held by the Mass. Supreme Court in Daniels vs. N. Y. N. H. 526 Editorial. & H. Ry. Co. (62 L. R. A.) to be such a new and inde- pendent agency as does not come within and complete a line of causation from the accident to the death so as to render the one guilty of the negligence responsible for the insanity when the suicide is voluntary and wilful. It is obvious this decision would hold only in states where the knowledge of right and wrong is a test of insanity. K. PENAL FOUNTAINS OF DISEASE AND VICE are our city jails. The innocent as well as th°; guilty are put in them and detained for trial or as witnesses. No innocent man should be subjected to the indignity and degradation of a dirty jail, and a man is lawfully pre- sumed innocent till proven guilty. No man, innocent or guilty, should be exposed to tuberculosis, syphilis or the moral contagion of criminal as- sociation, unless the law ordains it as a merited punish- ment for crime. The light of an accused or suspected man or one de- tained as an important witness to cleanly and safe custody demands separate restraint, free from exposure to either physical or moral pestilence, pending the determination of his guilt or innocence. The average modern jail, with its dirty, disease-infected cells, is a crime against humanity and a stain upon the humanitarian pretensions of our time. Many a man is unjustly murdered under the guise of the law by unjust exposure in disease-infected cells, or ruined in morals by unwilling, undeserved communication with the stinging vipers of evil communication. The Fort Wayne Journal-Magazine has taken up this subject none too soon for the welfare and rights of bclh in- nocent and guilty among people who have the misfortune to gat in jail. These bree.lers of disease and immorality, as well as the state penitentiaries and reformatories, need more enlightened oversight and management on lines of both physical and moral hygiene. THE ABIOGENESIS CONTROVERSY.—Despite the seemingly crushing defeat inflicted on Bastian and the ad- Editorial. 527 vocates of spontaneous generation by Pasteur and Tyndall, the result of which was the germ doctrine as now system- atized after more than three centuries of existence, the doc- trine of abiogenesis has been revived of late years. It is unfortunate that the most blatant advocates of this doc- trine know so little of biology as to ignore need of control experiments and disregard entirely, evolution as seen in em- bryogeny. This is the case with an Indiana experimenter, who knows nothing of culture mediums and confounds mi- crobes with comparatively high types of life, like insects. The first step has been taken in abiogenesis by chemists who have formed organic products from purely mineral substances which have never passed through life as have coal and coral limestone. The crude abiogenesis of the 70s was accompanied with an equally crude hetero- morphosis. Concerning a recent contribution to this ancient, rather chaotic philosophy, the eminent Ameri- can embryologist, C. S. Minot, remarks in a recent review of Studies in Heteromorphosis, by H. Charlton Bastian, that (Boston Med. and Surg. Journ.,July 14, 1904.): "The author is unfortunate in making the ambitious at- tempt to overthrow the fundamental conceptions of biology, as to species, heredity, the genetic relations of forms, etc., by maintaining that by heteromorphosis one form of low life may give rise to another entirely different, as bacilli and eggs of rotifers to protozoans! He lacks the very most rudi- mentary conception of scientific proof, and the elementary ideas as to experimentation which we might expect of a schoolboy. It is only necessary to say that his typical experiment is to put stagnant water with vegetable matter in an open flower pot. Finding, at first, one species plen- tiful and days or weeks later another species plentiful, he has proved that the first has changed into the second. It is hardly necessary to add that the book is in no sense a scientific publication, and should be forgotten as speedily as possible." That the criticism so far as style, method, judicial tone and logic are concerned, is fully justified, no candid reader of the work criticised will deny. It is written rather from the standpoint of the medical special pleader than from the viewpoint of the scientific investigator. This is 528 Editorial. particularly unfortunate, since the principle which Bastian sought to maintain is supported in a much less crude sense by morphologic studies of microbes. The gap, however, be- tween the protoza and the microbe is too wide to be bridged by a jump like that portrayed by Bastian. The microbes are a kingdom of their own, distinct from vege- table and animal, but shading into each. The bisexual vegetables are higher in many particulars than the mi- crobes most allied to the animal type. The sudden jumps from microbe to animal can only appear possible to micro- bophobists who designate bacteria as bugs. This is, how- ever, a sophomoric pedantic twist to Minot's criticisms when he hopes that Bastian's work will be forgotten. It is only by discussion that advance is made and the quick- est way to destroy an authoritative tone in science, is to discuss it from a purely logical standpoint and admit facts when proven without seeking to overwhelm them with rid- icule, even though ridiculing pedantic displays of ignorance. Pasteur and his followers through this very pedantry have caused more waste of medical intellect than has hitherto obtained in any department of science. Koch, in his re- versals of his original position as to tuberculosis, aptly il- lustrates this. He and his followers ridiculed any student of comparative medicine who, ten years ago, pointed out differences between human and animal tuberculosis. These differences were regarded as differences produced by soil, rather than by different germs. Koch now claims that the difference is of kind, not degree. A similar reversal is probable when abiogenesis and heteromorphosis are pre- sented by better trained advocates and in a less crude form, which recognizes actual teachings of biology. THE APPOINTMENT OF PROF. WILLIAM OSLER of the Johns Hopkins Medical School, Baltimore, as Regius Professor of Medicine at Oxford University, in succession to Sir John Burdon Sanderson, has been approved by King Edward. Prof. Osier, who has been Professor of Medicine and physician to the hospital of the Johns Hopkins Medical Editorial. 529 School since 1889, is a Canadian by birth and is fifty-five years old. After being graduated from McGill University, at Montreal, he studied in Europe. From 1874 to 1884 he was a professor at McGill University, and then for five years was Professor of Clinical Medicine at the University of Pennsylvania. Dr. Osier will continue to hold his position at Johns Hopkins University until 1905, thus completing the coming term at that institution. DR. GEORGE F. BUTLER has severed his connection with the Alma Springs Sanitarium, at Alma, Michigan, where for nearly five years he has been Medical Superin- tendent, and has returned to Chicago where he will hence- forth limit his practice strictly to Internal Medicine. He will fill the chairs of Professor of Therapeutics in the College of Physicians & Surgeons, and Professor of Medicine in the Dearborn Medical College; he has also been appointed as one of the attending physicians in the Samaritan Hospital. Dr. Butler will continue to edit and publish his maga- zine "How to Live," and it is understood that he has under way another medical work for a Philadelphia medical book publisher. Dr. Butler is one of the tried and true in social and vocation life. Alma will miss him; the many patients over the land who have felt his kindly, skillful hand, will miss him. Chicago and the two Colleges to which Dr. Butler has gone will be doubly blessed. DR. WILLIAM W. GRAVES informs his professional friends that he has returned to the city and that he will limit his practice to nervous and mental diseases. DR. GEORGE F. SHRADY HAS RESIGNED the editor- ship of the Medical Record after nearly forty years of con- tinuous service beginning with its foundation. The Medical Record owes the high position it holds to-day in American medical journalism to Dr. Shrady. The journal was founded by him thirty-eight years ago. His name has been on it 530 Editorial. ever since. This record of continuous editorial management, says his successor Dr. Thos. L. Stedman, has been exceeded only by that of Wakeley's and the Lancet. The beginning of the Medical Record was small and Dr. Shrady was its first typo as well as editor. Beginning as a semi-monthly in 1866 it has grown to a weekly of two thousand pages annually. THE NAME OF MOUNT TABOR SANITARIUM, at Port- land, Oregon, has been changed to Crystal Springs Sani- tarium. The medical directors are Dr. Robert L. Gillespie, President, formerly staff physician, Murray & Gillespie Hospital, Butte; St. Vincent Hospital, Portland Hospital and N. P. Sanitarium, Portland; Dr. Walter T. Williamson, Secretary, late first assistant physician, Oregon State Insane Hospital, Prof, nervous and mental diseases, Willamette University; Dr. Henry Waldo Coe, Treasurer, founder of Crystal Springs; Dr. William House, Resident Physician, late Erie County Hospital, Manhattan State Hospital, and Lecturer University of Buffalo, New York. Dr. Coe, it will be noted, still retains his efficient con- nection with this well-known sanitarium for the nervous of the Pacific states. SENATOR COE.—Dr. Henry Waldo Coe, editor of the Medical Sentinel and distinguished neurologist, has been nominated for State Senator at his home in Portland, Oregon. DR. A. E. MACDONALD retired from the superintend- ency of the Manhattan State Hospital, East, Ward's Island, New York City, October 1st, 1904, after which date and until further notice, all communication relating to the Hos- pital should be addressed to Dr. J. T. W. Rowe, acting superintendent. Dr. Macdonald's personal address will be Columbia Court, 431 Riverside Avenue, corner of 115th street, New York City. THE AMERICAN MEDICAL SOCIETY FOR THE STUDY OF ALCOHOL AND OTHER NARCOTICS was organized Editorial. 531 June 8, 1904, by the union of the American Association for the Study of Inebriety and the Medical Temperance Asso- ciation. The object of the union of the two societies is to create greater interest among physicians in the study of one of the greatest evils of modern times, promote more ex- act scientific study of the nature and effects of alcohol in health and disease, particularly of its etiological, physio- logical and therapeutic relations, and to secure more accu- rate investigations of the diseases associated with or result- ing from the use of alcohol and narcotics. THE FIFTEENTH INTERNATIONAL CONGRESS OF MEDICINE-LISBON, APRIL, 1906.—We have received the first number of the Journal of the Fifteenth International Congress of Medicine, that will take place in Lisbon on the 19th-26th of April, 1906. This number contains the statute of the Congress, the organization of the sections and of the national committees of the different nations. This congress will admit besides only scientific men presented by the Na- tional or Portuguese committees. 25 francs, 20 marks, one pound sterling or five dollars is the admission fee. The work of the Congress is divided into 17 sections: 1, Anatomy (Descriptive and compared anatomy, anthropol- ogy, embyology, histology;) 2, Physiology; 3, General path- ology, bacteriology and pathological anatomy; 4, Therapy and pharmacology; 5, Medicine; 6 Pediatry; 7, Neurology, psychiatry and criminal anthropology; 8, Dermatology and syphiligraphy; 9, Surgery; 10, Medicine and surgery of the urinary organs; IT, Opthalmology; 12, Laryngology, rhinol- ogy and stomatology; 13, Obstetrics and gynecology; 14, Hygiene and epidemiology; 15, Military medicine; 16, Legal medicine; 17, Colonial and naval medicine. The executive committee of the Congress intends print- ing before the reunion, all the official reports; it is neces- sary that they shall be given before the 30th of September, 1905, to the general secretary. For the free communications it is necessary that they should be given before the 31st of December, 1905, if the authors want that the conclusions should be printed before the opening of the Congress. Editorial. 533 maimings. But the railroad superintendents and directors and the bond holders sleep the tranquil refreshing sleep of brain that daily gets the quantum of refreshing rebuilding sleep. A more just regard for the powers of physiological endurance of brain and consequent mental capacity for steady unremitting work, of railway skilled employees would conduce even to the interests of corporate greed for divi- dends, as well as to the conservation of public life, and peace of mind and salvation of body and limb. We plead for similar concern and care for the steady and sure brain working power of railway operatives, to that bestowed on machinery and equipment, assuring the railroad manage- ment that such rational concern make for dividends and against casualty damages and for the public welfare and happiness. Railroad corporations should have neurological as well as legal advice. It is better to prevent casualties by taking just care of the brain powers of railroad men than to pay surgeons for correcting and plaintiffs for consequences of accidents. It would be well if railroad managers should heed the rest counsel derived from experience and a spell of nervous prostration from overstrain, by Sir William White, late naval constructor and President of the British Institute of Civil Engineers. At the recent Engineers (St. Louis) Congress Sir Wil- liam proclaimed his experience and his feelings against overwork, though for many years, and until he fell pros- trate under the strain, he was proclaimed "the leader of the strenuous life" in his line of thought and work. This great ship builder, prime mover and greatest in the reconstruction of the modern British navy, the reputed builder of more battle ships, cruisers, torpedo boats, torpedo boat destroyers than any man in his day, concludes that it does not pay to ruin health in overwork, at the expense of-rest recreation of brain. INEBRIATE BANKRUPTCY.—A financially well circum- stanced saw mill owner in Arkansas is reported, while in a 534 Editorial. state of mental depression following a protracted spree, to have filed a voluntary petition in bankruptcy. He listed his assets at #18,000 and his liabilities at §4,000 and a lawyer, who had been on the spree with him, drew up the petition. Four days after, he and his lawyer sought to revoke the petition on the ground that the petition was an ineb- riate hallucination and the judge has taken the case under advisement. This man's bankruptcy was only in his brain. He had taken better care of his financial, than of his neurone resources. If men who drink to profound intoxication all realized and acted wisely upon the fact that a profoundly alcoholized brain is not ordinarily normally reliable, for one or several days after drinking has ceased, there would be fewer suicides, homicides, financial and other miscarriages and misfortunes due to alcohol, on the calendar of casualty, calamity and crime. THE HUMILIATION OF REGULAR MEDICINE BY GOVERNMENT LAWS.—An act regulating the practice of medicine in the Indian Territory, after providing that "no person shall practice medicine and surgery or either as a profession without first being registered as a physician and surgeon" etc. and exacting certain very good qualifications, and declaring that any person who shall prescribe or administer medicine for or who shall in any manner treat disease, wounds, fracture or other bodily injury for pay shall be deemed physicians and surgeons under this act and concludes with the final and further humiliating pro- vision "that osteopath, massage, Christian Science and herbal treatment shall not be affected by this act." If medicine qualified can have no more influence upon legislation than to prescribe rigid laws for its own prac- titioners and only on condition that no restrictions be put upon quackery outside the ranks of regular medicine, the profession had better cease its efforts to protect the people from quackery and 'fake' systems of medicine. With a united harmonious medical profession and a medical man Editorial. 535 in the President's Cabinet to advise on medical measures and sanitary laws we may hope for better things for legit- imate medicine. Then the great medical profession will be an interest quite as strong as the 'isms' and 'pathies' and fads of the day to be placated by political legislators and the press. THE PRESSURE FOR ROOM AT THE CITY INSANE ASYLUM forces the superintendent to make premature dis- charges of patients and as the result of such pressure an homicidally inclined inmate apparently recovered was recently discharged, only to relapse and meet his death while attempting to smother a sleeping lady in a house which he had entefed without leave. Thus does overcrowding of insane hospitals not only endanger the safety, comfort and chances of cure of inmates but of people outside. JAPAN'S PHYSICIANS.—Japan is said to have the largest number of physicians from the fewest schools of any nation on earth, and we also learn that they are the best equipped medical men in the world.—K. C. Med. Rec. St. Louis lately had a welcome visit from President Kitasato of Imperial University of Tokio. MEDICO-LEGAL.—During the coming year we will pre- sent four articles from the fluent, forceful and accurate pen of Dr. Jas. G. Kiernan where the issues in each record have been passed upon by the courts. They will be equally as interesting as those previously published to the medical men and members of the bar who so generally read the Alienist and Neurologist. HE1NRICH HEINE'S HOMEOPATHIC JOKE.—The Med- ical Record acquaints us from Ughette's work, "Physicians and Clients" with the following: Heine while travelling in the south of France, having been entrusted by a mutual friend in Lyons, with the con- veyance of a large sausage to a homeopathic physician and 536 Editorial. being very hungry on the way consumed, with his wife's assistance, a large part of the sausage. On arriving home Heine sent his homeopathic friend the following note: "Dear Doctor:—From your scientific investigations, we learn that the millionth part of a certain substance brings about the greatest results. 1 beg, therefore, your kind acceptance of the accompanying millionth part of a Lyons sausage, which our friend gave me to deliver to you. If homeopathy is a truth, then this little piece will have the same effect on you as the whole sausage. Your HE1NRICH HEINE." THE FOURTH PAN-AMERICAN MEDICAL CONGRESS will be held at Panama from the 2nd to 6th of January, 1905. Titles of papers to the section on Nervous and Mental Diseases should be at,once sent to the Secretary of this section, Chas. H. Hughes, M. D., 3857 Olive St., St. Louis, Mo. » THE AMERICAN PUBLIC HEALTH ASSOCIATION meets at Havana, Cuba, January 9 to 13, 1905. Secretary, Chas. D. Probst, Columbus, Ohio. SELECTIONS. NEUROTHERAPY. THE DIETETIC TREATMENT OF DIABETES.—In se- vere cases if a test diet has shown that the patient excretes more carbohydrate than he takes in, we must pro- ceed cautiously. The next step in such a case is to ex- amine the urine carefully for oxybutyric acid and its allies. The easiest way of doing so is by the "perchloride of iron" test. 1. If the addition of a few drops of solution of per- chloride of iron causes the urine to assume a dark, port- wine color, any change of diet should be made very grad- ually, for such a patient is always in danger of coma, and the coma may apparently be precipitated by any sudden change in dietetic habits. The carbohydrates in the diet should therefore be reduced very slowly, and bicarbonate of soda should be administered at the same time in quantities of from one-half to one ounce daily. Proceeding thus one can often get the patient gradually on to the diet of pure proteid and fat described below. Not infrequently, how- ever, one meets with difficulty. The sugar excretion may remain high, and the patient's weight and general condition may deteriorate, or coma may threaten. If things shape thus, it is best to abandon all attempts at a rigid diet, and to allow a definite quantity of carbohydrate in the form of bread and milk. For it must never be forgotten that in some of these severe or, as Dr. Pavy calls them, "compo- site" cases proteid is as harmful in the direction of increas- ing the amount of sugar in the blood as carbohydrates. Even when everything is going well it is not advisable, when one is dealing with this type of the disease, to give 537 538 Selections. more than 500 grammes of cooked meat a day, or its equiv- alent in other forms of nitrogenous food. In many such cases one must reluctantly abandon all attempts to keep the blood sugar-free, and be satisfied if the output of sugar does not rise above 100 grammes per day. 2. If the perchloride reaction is negative, one can pro- ceed to a strict diet without much anxiety. Whether this should be done suddenly or gradually is a matter of choice. Provided the patient can spare the time it would seem bet- ter to proceed gradually. One should begin by eliminating from the diet sugar and all the grosser forms of carbohy- drate, then the farinaceous foods, then bread, and finally even milk, each of these articles being replaced as it is withdrawn by a carbohydrate-free substitute. The final strict diet would be something as follows: Breakfast: Bacon or buttered eggs or both, or some cold ham; casoid-meal bread with plenty of butter; coffee made with sugar-free milk and sweetened with saccharin. About 11 a. m.: A glass of sugar-free milk and a dia- betic biscuit or rusk. Luncheon: Soup; any animal food, e. g., a little cold meat or game or some fish; cheese; salad with plenty of oil; some starch-free bread; as a beverage, any natural wine or a little spirit and aerated water. Afternoon: Tea with plenty of thick cream and a dia- betic rusk or two, or biscuit, with plenty of butter. Dinner: Any clear soup with the addition of some grated cheese; fish; any meat; green vegetables with melted butter; baked custard made of sugar-free milk and eggs; beverage as at luncheon. At bedtime: A glass of sugar-free milk and a diabetic rusk or biscuit. If such a diet suits the patient—and of course it ad- mits of variation to meet individual tastes—and if the sugar excretion disappears, he should adhere to it as long as possible. After a few weeks one may test his powers of consuming carbohydrates cautiously by allowing a weighed quantity of bread, and it will often be found that a certain degree of assimilative power has returned. In 540 Selections. lirium and death in less than three weeks. The prescript- ion called for 2 gm. potassium iodid in 200 gm. distilled water and 20 gm. syrup. She took only four spoonfuls, but the character of the eruption, its abrupt commencement, the general syndrome, the fever and the negative bacteriologic findings all confirmed the diagnosis of an idiosyncrasy to the iodid superposed on a kidney affection. TINNITUS-AURIUM.—Can it be relieved? A. Schloss. M. D., in /our. A. M. A., Sept. 12, answers this question in the affirmative. He uses a Hopkins' Electric heater, al- lows the air to reach a temperature of from 200 to 300 de- grees F., depending on the case, and uses it at a pressure of 5 or 6 lbs., for as long a time as the patient can stand it, not exceeding five minutes. The diameter of the open- ing of the ear piece is three-sixteenths inch, and the stream of air is directed as nearly as possible against the tympanum. Three treatments a week for eight weeks, no failures. M. CURIE'S EXPERIMENTS WITH RADIUM EMANA- TIONS.—In a paper recently read before the Academie des Sciences, M. Curie brings out some of the physiological ef- fects of radium. The emanation given off by radium causes the death of the smaller animals, when breathed by them. He used an apparatus in which the animal is placed in a confined space and is made to breathe air which is charged with the emanation. A large jar is filled to one-third with pumice stone soaked with potash. Above this is a support which confines the animal (a guinea-pig) in the upper part of the jar. Oxygen is introduced into the jar to keep up the animal's respiration, while the car- bon dioxide which he gives off is absorbed by the potash. The radium emanation is sent into the jar by another tube at the beginning of the experiment. At the end of a cer- tain time, varying from one hour to several hours, the res- piration of the animal becomes short and abrupt; he rolls himself up in a ball with his hair standing on end. Then he falls into a profound torpor and his body becomes cold. 542 Selections. not be surmounted, and so the matter drags along until a point is reached where something must be done, and sacri- fices are made which could have been avoided had the sit- uation been controlled by a firm hand from the outset. The warm bath given just before retiring, followed im- mediately by a hot drink, is of great value. In the admin- istration of the bath, the patient's face should be bathed with cold water, and the head above the eyes enveloped in a towel wrung out of cold water. This is an important and necessary point in technique which is usually neglected. It prevents cerebral congestion, and the sensation of vertigo which often follows the prolonged warm bath if given with- out the cold head compress. The patient should lie in the bath quietly from fifteen to twenty-five minutes, and the water should be kept at a temperature of 98°. After emerging from the bath, the patient must not be rubbed dry, for this has an exciting effect. The excess of water should be wiped away quickly, and the patient at once put into bed and given a glass of hot milk and the hypnotic selected. The milk or hot drink must be so hot that it can only be sipped.—Modern Medicine. PHOSPHORUS IN PSYCHASTHENIC.—A Martinet (la Presse Medicale, No. 93, p. 805, 1903) says that phosphorus is valuable in all forms of mental depression, not only those which are due to accidental and evanescent conditions, but those which are of long standing. The phosphorus is given in the form of a mixture composed of phosphoric acid 10 parts, acid sodium phosphate 20 parts, and distilled water 200 parts. Of this mixture the patient takes thirty drops well diluted, preferably after meals, the dose being gradually increased until 100 drops are reached, providing it causes no disturbance of the stomach. The persistent use of this medication is almost invariably followed by im- provement. Medicine. DESS1CATED THYROID IN PARALYSIS AGITANS.—J. C. Castalvi, in the Revista de Medicina y Cirujica Practicas, calls attention to the resemblance which paralysis agitans 544 Selections. stance in which in a morning hour the excretion of urine was only 53 cc. per hour, and then a dose of opium taken without fluid ran it up in the next hour to 234 cc. Here there was obviously plenty of water in the blood, but it was unable to get out till the opium cleared the blood of uric acid, so freeing the renal capillaries and allowing the water to pass. Obviously then, the uric acid in the blood controlled and kept back the water; the water in the blood did not control the uric acid. If a pint of water had been administered that morning before the opium would it have increased the excretion of water? Probably hardly at all, there was a large amount of uric acid in the blood and it was obviously blocking the renal capillaries and keeping all the water in, and the water was scanty before the opium, not from want of fluid in the body and blood, but from blocking of capillaries by uric acid. But there is one way in which excess of water may in- crease the excretion of uric acid, and that is by producing dyspepsia; for dyspepsia diminishes the digestion and absorption of food, and so diminishes the formation of urea and of acid products, and this produces increased alkalinity of the blood and so increased solution of uric acid, and, for a time, increased excretion of uric acid. Probably, at least, one portion of the dyspepsia, produced by the excess of water, is due to its diluting all the digestive fluids and rendering them less active solvents of the food substances submitted to their action. Thus, we may say, to complete this part of the subject that the uric acid in the blood con- trols the excretion of water, and that the addition of water to the blood does not control or increase the excretion of uric acid, but that to a certain extent, by diluting the di- gestive fluids and producing dyspepsia, the continued ad- ministration of excess of water does, to a small extent, in- crease the excretion of uric acid. It is now, however, quite unnecessary to give excess of water at all, for all uric acid disease is prevented by stopping the introduction of uric acid. A person who forms 10 grains of uric acid a day and swallows other 10 grains in his food, will have 20 grains of uric acid to deal with each day, and may suffer Selections. 545 more or less severely from uric acid disease; but, if he will take the trouble to shut out the unnecessary 10 grains which he swallows with his food, he will gradually draw clear from excessive uric acid; he will hive to deal each day only with 10 grains of the substance, and he will cease to suffer from the severe diseases which its excess in the blood and tissues produces. But the practice of washing out with excess of fluids, which is due to an antiquated physiology, is still carried on, and it is therefore necessary to show up the harm which it only too often does. In arthritis, due to uric acid, it produces dyspepsia; dyspepsia increases the sol- vent powers of the blood for uric acid, and so the uric acid is dissolved out of the joints, and collemia, anemia and de- bility may take the place of the arthritis. The patient is cured of one form of uric acid disease only to suffer, and perhaps, to suffer very severely, indeed, from another form which is, perhaps, worse than the original. That he may get clear of his gout, is true, but this may be replaced by anemia, high blood pressure, with all its intracranial results, with mental depression and other troubles, and the danger of cerebral hemorrhage, or, before long, he may find him- self suffering also from Bright's disease, dilated heart and dropsy. But the worst effect of this washing-out plan is seen in the far more numerous diseases which uric acid produces, through its effects on the circulation, those dis- eases which 1 have called the collemic group, of which ;: right's disease is the worst type. The worst possible thing to happen in all collemic diseases and that which makes the prognosis in Bright's disease almost absolutely hopeless, is heart failure, for Bright's disease may be de- fined as collemia producing defective circulation, the defect- ive circulation being doubled, trebled and quadrupled by subsequent failure of the heart. Collemia itself means de- fective combustion, but that defective combustion is far more than doubled if the heart fails as well. Now, when the heart is fighting against capillaries obstructed by uric acid, when it has as much as it can do to k. ep up the cir- culation from day to day against these obstructed capillaries, 546 Selections. it is obvious that a comparatively small matter may turn the scale against it and lead to its dilatation and complete failure. Now, this is exactly what excess of fluid does—it produces, as we have seen, dyspepsia, and dyspepsia pro- duces defective nutrition, defective nutrition not only through- out the body, but of the most important muscle of all, that of the heart; and then we must not forget that a pint of fluid weighs a pound and a quarter, and that each pint of fluid more in the blood is \% pounds more for the heart to drive. In this way excess of fluid does infinite harm—it dilates the stomach and causes incurable dyspepsia, dyspep- sia causes debility, and the fluid does also increase, to a very large extent, the work the heart has to do. No won- der the heart fails and dilates; no wonder it ultimately be- comes like the bulged outer casting of a bicycle tire, abso- lutely beyond repair. Now, in recent years, 1 have seen quite a number of cases, of which I could give notes, did space permit, who have gone through this treatment of washing out and have survived by accident as mere helpless wrecks, with hearts which have been stretched beyond endurance and which will never again be fit for good work, lives which are crip- pled and which must live, if they live at all, on mere suf- ferance and as invalids. Some of these cases have told me that they were forced to drink pint after pint of water in spite of an absolute distaste and loathing for fluid, (see Uric Acid, ed. vi., p. 30), for in this case Nature says "no" with all the force at her command. They do not want water, as there is already excess of water in the blood and tissue fluids, but the patients are forced to drink and man- age to get down several pints a day in spite of Nature's protests and in excess of her requirements. Gradually, be- tween dyspepsia on the one hand, and excess of fluid to drive and excessive obstruction of the capillaries on the other, the heart fails, and dilates, and gives up the strug- gle, and one day the patient takes to fainting severely, or becomes more or less dropsical, and the worst that can possibly be done for these patients has been accomplished. Perhaps in the great and extensive employment of Selections. 547 water, in the present day of treatments for dilatation and failure of the heart, quite a large number of these cases are probably due to the absolutely unphysiological idea that uric acid can be washed out. It is nearer the truth to say that the patient can be washed out, and is not unfre- quently washed out, but the uric acid remains, and, more insane of all, those people who go in for washing out do also introduce each day in the food quite as many grains of uric acid as they could hope to wash out, if the process did act as it is supposed to, by those who have trusted to their imagination and not looked to see what the physiol- ogy of the body really does. If the pericardium is very strong and refuses to give way, then the excess of fluid produces very high blood pressure with headache, mental depression, epistaxis, per- haps cerebral hemorrhage, but in any case the treatment is both painful and dangerous and 1 have shown that it is useless and unnecessary. The opposite side of the picture is, I think, to be seen in the enormous amount of good which can be accomplished in many cases of collemia and Bright's disease by cutting off all fluids, by putting the patient on a pint, or even half a pint of fluid in the twenty-four hours, or even an abso- lutely dry diet of bread and fruit, and small amount of fluid in the fresh fruit being all that is taken for days together. The way in which the heart will sometimes recover under these conditions, when not hopelessly damaged, and with the recovery of the heart the way in which the defective combustion which we call Bright's disease will gradually pass away, is an object lesson which many today should witness to show them how extremely silly and unphysio- logical is the opposite plan of treatment, the attempt to wash out the uric acid from the body in excess of fluid, when the uric acid, as a matter of fact, controls absolutely all output of fluid from the body, and the absolutely insane attempt to cure uric acid disease by sweeping it out with one hand, while pouring it in with the other. In this and all cases of uric acid disease there is no necessity to run such terrible risks, for the uric acid excretion can, in most 548 Selections. cases, be reduced to at least one half by cutting off intro- duction, and if this is done it may be unnecessary to do anything at all to increase its excretion. A somewhat low and dry diet of bread and fruit with, or without, a little alkali, will do easily and safely all that is required.—Alex- ander Haig, M. A., M. D.. Oxon, F. R. C. P., London, Physi- cian to the Metropolitan Hospital and to the Royal Hospital for Children and Women, in the Canada Lancet. HYPODERMIC MEDICATION IN ITALY.—C. A. L. Reed, in the Cincinnati Lancet-Clinic of February 20, 1904, records that the hypodermic medication is used in Italy with great freedom and more success than in any other country. CLINICAL NEUROLOGY. THE MUSICAL EQUIVALENT OF EPILEPTIC SEIZ- URES.—In an editorial article in the New York and Phil. Medical lour, for April 9, 1904, the writer considers that the phenomena of epilepsy present one of the most fasci- nating fields of clinical study on account of their variety, complexity, and often unexpected deviations from the typ- ical, "classic" epileptic attack. A number of authors have commented upon the unusual types of epileptic seizures, including phenomena so com- pletely dissociated from the ordinary manifestations of epilepsy that they have been styled "the equivalents of an epileptic seizure." In a recent article Montagnini (Gaz- tetta degli ospedali e delle cliniche, Dec. 27, 1903) dis- cusses the "musical equivalent of the epileptic fit,'' taking as illustration a case which he observed in the Insane Asylum for Women in Venice. The musical equivalent was first observed in 1897, by De Sanctis (Riv. quindic. di psichiatria, 1897,) who found that an "attack of singing" could completely take the place of the typical seizure or could accompany the usual motor phenomena of the typical fit. In the same year Cristiani, of Lucca (ibid., 1897,) reported an observation which tal- Selections. 549 lied with those of De Sanctis. In the case recently reported by Montagnini, a married woman aged forty-eight years, who was bedridden with epileptic insanity, would suddenly begin to sing. Her song was a succession of musical tones succeeding one another slowly and forming always the same melody, with occasional slight variations. The song ended suddenly, sometimes by a low murmuring or a series of low soft notes, and usually lasted about five or ten minutes. During the "attack," sensibility to pain was considerably diminished, and painful stimuli did not arrest the singing, unless they were very intense, when the song was taken up as soon as the stimulus was removed. No convulsive movements were noted during the attacks, but at times the patient was observed to grow pale, and once a general tremor accompanied the singing. Neither the temperature nor the pulse was affected. The attacks came on suddenly, were not induced by external stimuli or by excitement, and occurred almost always at the same hours of the day (usually in the morn- ing, occasionally in the evening,) and almost always when the typical attacks from which the patient had been suffer- ing before were due. After the attacks, the woman did not show any excitement, but relapsed into her customary tac- iturn and apathetic state. Montagnini considers this case as analogous to those reported by De Sanctis and by Cristiani; that is, he re- gards the singing as the musical equivalent of the epileptic fit, and the case as one in which epilepsy took the shape of attacks of singing. In support of this view he adduces the constant periodic recurrence, the unaltered form, the sudden beginning and ending of the song, the partial loss of consciousness of the patient during the singing, the al- tered sensibility to pain, and the general tremor sometimes accompanying the singing. This case certainly presents unusual and interesting features, but it will take more than a few cases to decide whether singing occurring in attacks as described is an equivalent of epilepsy, or is merely the caprice of an insane person. There is no doubt, however, that our knowledge 550 Selections. of the phenomena of epilepsy is constantly extending, and that the Italian school (Lombroso, Jonnini, etc.,) to whom belongs the credit of establishing the principle as to Xiae psychical or substituted motor equivalents of epilepsy, is gradually strengthening its position.—Modern Medicine. DEGENERACY, according to Dr. D. R. Brower, (Illinois Medical Journal) evinces itself in the co-existence of ear, jaw, teeth and other marked bodily defects with grave mental and moral twists and effects. The ear being one of the unstable factors in evolution, was, as had been early pointed out by Morel, most markedly stigmatized by degen- eracy. Paranoia, epilepsy, recurrent and periodic psychoses, moral and mental imbecilities, idiocy and allied states were among the most marked mental expressions of degeneracy. Degeneracy often appeared in congenital lack of balance, exhibited in more or less serious and permanent mental abortions or in erratic break-downs occurring from time to time. Hysteria was often an expression of degeneracy, characterized by the nerve instability of the other types. In the discussion by the Chicago Academy of Medicine, of Dr. Brower's remarks, Dr. A. E. Baldwin, expressed the opinion that most definitions of degeneracy were by no means clear and that standards were needed for comparison. Dr. E. S. Talbot, claimed that degeneracy was a biologic process of disintegration, the reverse of integration. The scope of degeneracy was often limited to certain signs which were its sole expression. These signs (stigmata as they were early called) might be the only expression of degen- eracy. Their significance had to be determined by a care- ful examination of the organism in which they were found since stigmata might be merely defects produced by degen- eracy or might indicate how deeply such degeneracy had penetrated. In proportion to the depths of degeneracy in the organism would the stigmata affect the earlier simpler or later complicated acquisitions. Of necessity when the organism was affected by degeneracy the abnormal element would take the line of least resistance as determined by the depth of degeneracy as well as the variability of the Selections. 551 structure concerned. The face had become a variable struc- ture since its contest for existence with the brain has caused the jaws and face to assume what (for food and defense purposes) was a lower type although as regards to existing functions and the higher standpoint of environment, this type was the higher. As the face and jaws were contin- ually being sacrificed for the benefit of the brain, this sac- rifice must be considered as a degeneracy of a part for the benefit of a complex whole. This condition occurred under the law of economy of growth long ago pointed out by Aristotle and cleared from obscurity by Goethe. Dr. A. C. Cotton was particularly interested in the subject from the standpoint of paediatric prognosis. He would like to know how that biology of the degenerate under five compared with that of the normal individual. Like Dr. Baldwin he had felt the necessity for clearer definitions than those usually given. Dr. W. G. Stearns stated that norms, as his researches had shown, could be established only by comparison of individuals of the same race. Some later opponents of the doctrine of degeneracy were guilty of assuming that degen- eracy of the morbid type necessarily implied a mental or moral twist. This was not the case. It very frequently implied merely a predisposition to morbid action either in the lower or higher nerve centers or in the functions or structure of some organs. Dr. C. S. Hallberg called attention to the fact that degenerates with a mental twist often passed examinations, only revealing their twist when this was irritated by a seeming insult to their imagined dignity. According to Dr. J. G. Kiernan degeneracy was a nec- essary and often salutary phase of embryonic evolution. Structures which appeared during embryonic life, useless to the future being, were swept away by degeneracy, for the benefit of the embryo as a whole. When through arrested development, the influence of degeneracy on the lower structures was checked, it attacked the higher structures. Degeneracy might equally be shown in a defective liver or kidney as in a defective brain. It did not as Morel pointed 552 Selections. out half a century ago, necessarily imply defective men- tality and morality. Moreau had shown that degeneracy expressed itself in: First, absence of conception; second, retardation of conception; third, imperfect conception; fourth, incomplete products (monstrosities;) fifth, products whose mental, moral and physical constitution is imperfect; sixth, products specially exposed to nervous disorders; seventh, lymphatic products; eighth, products which die in infancy in a greater proportion than sound infants under like con- ditions; ninth, products which although they escape the stress of infancy are less adapted than others to resist dis- ease and death. Dr. G. F. Butler was of opinion that too much stress had been laid on the criminal side of degeneracy to the neglect of its physical side. Environment at the plastic periods of childhood and puberty might favorably influence the mental and moral aspects. As a rule, degeneracy ex- pressed itself in a way to balance rather than in actual deficiency. THE "PSYCHOLOGY" OF JANE CAKEBREAD — (Rob- ert Jones, M. D., Medical Superintendent, Claybury Asylum.) Dr. Riggs of St. Paul abstracts from the Journal of Mental Science the following apt illustration of the psychic decad- ence of and perversion of the higher neurones of the cortex due to alcoholic indulgence. It points a psychiatric moral and depicts a tale of pathologic woe, worthy of the heed- ing by all physicians. It is not an uncommon clinical pic- ture of the sequence of drink. The author discusses at length the history of the famous Jane Cakebread, an inebriate who obtained a remarkable notoriety in London during the last years of the reign of Victoria because of her peculiar character and her 280 con- victions in the police courts. The Inebriates Act of 1898 was directly due to her case, and the later revision, the Inebriates Act of 1902, has made impossible the recurrence of such a pitiful career, for by it such unfortunates may be committed to reformatories, where they can receive proper care. Incidentally, the author notes with interest that of Selections. 553 the 428 persons so far provided for under this act 25% have been found mentally deficient and others definitely insane. Her parents were of the small farmer class. The large family of children, with the exception of Jane, all seemed to be normal and respectable. With very little schooling, she became what she called a "single-handed parlor maid." While in service she was left a legacy of 100 pounds, and from that time her downward career began. Admitted to Claybury Asylum in 1896, Jane, while nominally a servant, was in reality a vagrant who had not been self-supporting for at least 30 years. Examination showed her language to be vague and disconnected. She possessed delusions of grandeur, believing herself to be a "lady of high character," entitled to a fortune, a portion of which had been stolen from her. Her general appear- ance was striking, her physiognomy denoting in many ways character and will power and her manner was at times gracious and condescending. In spite of her irregular life she was in good physical condition save for incipient cata- ract. She was, however, extremely changeable, becoming at a moment's notice noisy, violent and threatening. While promising to behave, she possessed very little self-control, was abusive to the nurses and officials, and extremely dif- ficult to manage. As time went by she became more noisy, more fla- grantly untruthful, less and less amenable to discipline, and more inordinately fond of notice. At the end of three years there was a total collapse, and she died of heart failure and dropsy, with cirrhosis of the liver and kidneys. Post mortem showed the brain well convoluted, of good size and weight, with some wasting of the central convo- lutions. There were adhesions at the apex of the right lung and marked atheroma of the aortic arch. Heart, fatty, with hypertrophy of the left ventricle. The liver was dis- tinctly "hob nailed," the substance being fatty and indu- rated. The same condition extended to the kidneys and spleen, and the abdomen and lower limbs were markedly dropsical. In discussing the psychology of this woman's condition, 554 Selections. Dr. Jones refers to the manifestation of what he calls the "collective interests of the individual,"—vanity, self-com- placency, self-esteem. Without pride, she desired admira- tion and approbation, and her exalted ideas of her own importance accorded well with her love of power. The happiness she derived from hearing her name called in the police court amply compensated for a night spent in a cell, and one of her greatest joys consisted in reading clippings or extracts about herself from the police news. The writer looks upon her susceptibility to the opposite sex as a sort of esthetic interest springing mainly from vanity. She would put up her hair in curl-papers, decorate herself with bits of ribbon, lace, etc., to impress the doctors on their rounds. Like a child, her greatest pleasure was to "show off," this desire for prominence amounting to a disease, but she was wholly indifferent and indiscriminating as to the personality of her audience. It was accompanied by jealousy, distrust of the nurses, who she thought injured her, and by violent outbursts of anger when the praise for which she longed was not forthcoming. Believing herself a grand lady, she constituted herself a supervisor of the patients in the hospital, a conceit in which she was humored by the attendants. Despite her high opinion of herself, Jane had no self- confidence. She depended almost entirely upon the opinions of others, and this was the cause of her lack of self-con- trol, her fickleness and vacillation. She was considered by many eminently religious, yet she lacked high ideals, honor, reverence and admiration for the good. Psychologically, Dr. Jones believes that this apparent religious sentiment was but the natural product of her egotism, coupled as this often is with intolerance and a spirit brooking no contradiction. With no moral standard, there was never even the least suspicion of sexual perver- sion, and no allusion to immoral conduct was ever heard from her. She was absolutely untruthful, but this was due to defective memory, a pathological condition induced by alcohol. While lack of inhibition and mendacity are common in Selections. 555 alcoholics, Dr. Jones believes that her vanity, love of dis- play and notoriety were characteristics deepened into abnor- malities by her constant recourse to alcohol. In other words, characters of such predisposition as hers, once the taste for alcohol is acquired, become easy prey to inebriety and insanity. Jane Cakebread was no drunkard in the common acceptance of the term, but was a tpyical inebriate of the "periodic drinker" type, her desire for alcohol occurring intermittently. She drank then only in small quantities, but that little was poison to her. Inebriety depends not only upon inherited tendency, but upon personal idiosyn- crasy, and Dr. Jones concludes, therefore, that the only safety for this class of persons lies in total abstinence. FRACTURE OF THE BASE OF THE SKULL.-E. Fos- sataro finds that the diagnosis of these fractures is difficult, owing to the frequent absence of symptoms and pathogno- monic signs. Protrusion of brain substance occurs only in the gravest cases. To state that there is a fracture of the base requires a careful study of the whole group of symp- toms present. Traumatism of the temporal or parietal region, followed by abundant and prolonged hemorrhage from the ear of the same side, with preservation of hearing and sometimes accompanied by facial paralysis, will justify a supposition of a longitudinal fracture of the petrous portion of the temporal bone. A blow on the occipital region, fol- lowed by otorrhagia consisting of an abundant serous dis- charge and exceptionally of brain substance through the auditory canal, accompanied by deafness and paralysis of the facial nerve, should lead to the diagnosis of a perpen- dicular or oblique fracture of the petrous portion of the temporal. Armali di Medicina Navale in Kansas City Med- ical Record. SUIT OF AN OPERA SINGER AGAINST A PHYSICIAN. —It is reported that a well-known opera prima donna of Munich, Mme. Milka Terniua; has brought suit for 50,(00 marks against her physician. She suffeied severely from trigeminal neuralgia anc', while mu'er treatment for the Mime, 556 Selections. became partialis paralyzed in the left side of the face. She was led to believe that the remedies employed for the neuralgia brought on the paralysis. Who can and will enlighten us as to the probable medication causing so dire a result? RELATION OF NEUROTIC CASES TO ABDOMINAL SURGERY.—McMurtry of Louisville speaks only truisms in the following, concluding an excellent paper read before the St. Louis Dedical Society in June, on secondary abdom- inal operation. In this connection it may be well to mention that class of patients familiar to all doing extensive work in abdom- inal surgery, which may be designated the neurotic class. With persistent pelvic pain and dysmenorrhea they are usually introduced to surgical treatment with cervical dila- tion and uterine curettage. Again, they seek surgical treat- ment, and are pleased to have the appendages removed. Later they are apt to have hysterectomy. Always improved for a time by an operation, but never cured, they go their way. To operate in this class of neurotic patients, without demonstrable lesions, is a misapplication of surgery, and should not be done even for the so-called moral effect which, at best, is rarely more than a temporary impression. MOSQUITOES AND MALARIA.—Dr. William S. Dodd, writing from Talas, Asia Minor, says that ten years ago that town, which is four thousand feet above the level of the sea, was entirely free from malaria. To-day that trouble is exceedingly common, although there are no most quitoes, neither has there been any upturning of the earth, even on a small scale. The soil forms only a thin covering over the rocks, except where there is no covering at all. The climate is painfully dry, and there are no trees exctpf in irrigated gardens. He has made no examination for Plas- modium, but the symptoms are typical, and the effect of quinine and arsenic on the disease leaves no doubt as to the correctness of the diagnosis. Selections. 557 NEUROPHYSIOLOGY. THE INFLUENCE OF MILKING UPON THE QUANTITY AND QUALITY OF MILK.—M. Lepoutre, agricultural engi- neer and assistant to M. Roquet, professor of zootechny and animal physiology at the Agricultural Institute of Belgium, has just made a series of interesting and careful experiments at the laboratory of zootechny and hygiene of the said institute for the purpose of determining the influence exerted by milking upon the quantity of milk, upon its composition, and particularly upon the proportion of its fatty materials. Although our knowledge as to the influence exerted by the nervous system upon the physiological tissues is very meager, the experimenter started from the innervation (ner- vous stimulation) of the glands in general (to the greater or less excitation of which corresponds a more or less abun- dant secretion,) in order to try to bring about an artificia excitation of the mammary innervation for the purpose of improving the lacteal secretion. Broadly considered, the operation of milking is a rational massage that has the effect of drawing from the udder a quantity of milk much greater than that which is contained at the outset. It is admitted that the udder of a good cow may, before the operation, contain 3 quarts of milk already formed, while, if the animal is well treated, the udder may yield from 10 to 15 quarts. It follows, besides, from the experiments of M. Lepoutre, that milking exerts a great influence upon the proportion of the fatty materials contained in the fluid. This influence is due, according to the experi- menter, to the peripheric excitation of the nerves of secretion, which in their turn, by reflex action, bring about a greater excitation of the glandular cells. If we consider the general case of milking from two teats at once, as usual, we find that the effect produced is not the same during the entire period of the milking. The milk extracted from the first two teats is generally richer in fat than that of the two milked in the last place, and this richness will be greater if we simultaneously milk the two teats of one side, than if we simultaneously milk one teat of one side and one of the other 558 Selections. and then the two remaining ones—in other words, if we da the milking diagonally instead of laterally. The phenomenon is singular, if not obscure. It seems, however, explainable by the fact that in diagonal milking the excitation extends to all of the nerves of the gland, while in lateral milking it extends only to the side on which the operation is per- formed, and is consequently stronger. At all events, the influence of milking upon the proportion of fat is shown by the following experiment of M. Lepoutre. The same cow was milked several times and simultaneously by two different persons, who at each operation changed sides. The milk of each side was collected separately. One of the persons per- formed the operation by exerting a simple alternating pressure upon the teat, while the other performed a downward massage at the same time. The milk collected by the latter person was always markedly richer in fatty matter than that collected by the former. The difference was considerable, since in the first case there was 55 per cent of the total yield, and in the second 45 per cent. The method of milking has there- fore a great influence upon the quality of the milk, and this influence is not explainable unless we grant that it bears some relation to the excitation produced. On the other hand, the milk obtained at the beginning of the operation is not so rich as that obtained at the end. Up to the present, this fact has been explained by the state- ment that a prolonged operation ends by detaching from the lactiferous vessels the particles of butter adhering to the walls. M. Lepoutre is not of this opinion, and remarks that the operation is performed more vigorously at the end than at the beginning. The excitation must therefore be stronger, and the reflex action be greater upon the mammalary tissues, thus causing a lactiferous secretion richer in fat. The experiments of Prof. Roquet's assistant tend to con- demn all milking machines, especially those based upon the use of a centrifugal pump. Up to the present it has been thought that the superiority of hand milking is shown only by the quantity of milk obtained; but now it is necessary to add the superiority from the viewpoint of richness in fatty matters. Selections. 559 Although these facts would show machines to be useless which, it was thought, would some day solve the problem of mechanical milking, it is probable that more highly im- proved ones will eventually take their place. The principles upon which these new apparatus will be based will be those of the mechanical and intensive production of nervous excita- tion at present effected, unconsciously as it were, by manual treatment. It is not unlikely even, and it is the logical conse- quence of what has just been said, that the milking machine of the future, based upon such principles, will be able to perform the operation of milking better and obtain a greater quantity of milk, richer in fatty matters, in a more uniform and more scientific manner.—Scientific American. DOES BODY MAKE BRAIN?—In a recent number of the Contemporary Review appears a forcible and suggestive paper on "Play as an Education," by Woods Hutchinson. His chief contention is that the progress of investigation in the field of psycho-physics continues more and more decidedly to indicate that the organization of the brain is bound up so closely with muscular activities that no educational scheme can be rightly based on a plan which does not take full cognizance of this fact. In the hydra the nervous organiza- tion consists simply of fibers which assist in securing food; there is no brain. In the starfish, the brain, if brain it can be called, is only a double ring of nerves about the mouth. As we ascend the scale of animal life we find similar rings about the nose and eye. The locus of these rings deter- mines the capital of the body-state, and all the rest of the territory included in the area of the animal hastens to get a representation there. Such is the genesis of the brain. If these observations be sound, it may be inferred that the more complex and delicate the muscular life, the more com- plex and delicate will be the structure of the brain and the greater its intellectual power. This conclusion is supported by a study of the play of animals. The simplest organisms have no period of play. The frog has no play time. Birds have little. In this respect dogs and cats are their superiors in a degree commensurate with their superior intelligence. 560 Selections. While the child plays he is organizing his brain; it is growing; he is gaining the power which in after years will enable him successfully to cope with situations demanding a well- trained mind. The lesson which lurks in this conclusion for teachers and school authorities may be condensed into a phrase: Shorter hours of study, and public school play- grounds everywhere. The latter should be under school super- vision and should be recognized as an integral factor in education, not merely tolerated as a necessary evil or regarded as a side-issue. Athletics should likewise be cordially recog- nized as an essential part and force in the curriculum. RAMON Y CAJAL'S MORPHOLOGIC UNITS REAF- FIRMED.—Lewellys F. Barker writes from Berlin to the Journal A. M. A. as follows: "in view of the attacks made on the neurone doctrine by Nissl and Bethe in Germany, it was interesting to find that Ramdn y Cajal not only holds firmly to the doctrine of morphologic units in the nervous system, but is as yet by no means prepared to admit the existence of organio continuity among these units; in other words, he supports the neurone doctrine as strongly as ever, and in addition, still believes in the "contact theory" which he originally suggested. His newer preparations lead him to assert more vigorously than ever the transference of impulses through a contact relation of the end feet of axones and collaterals to the cell bodies and dendrites of other neurones. And he has shown that the pericellular reticulum which Bethe described as a terminal nervous reticulum and declared to be so important as negativing the conceptions of the neu- ronists, is not a reticulum of nerve fibers at all. It would seem almost the irony of fate that Bethe, who was asked some years ago to write an epitome of the newer neural conceptions and postponed doing so in order to avoid being premature, should have published his book on the neuro- fibrils on the eve of Ram6n y Cajal's new discoveries. But Bethe may console himself with the fact that every new book dealing with fields in which research is active is now out of date when it is published, and besides Bethe, Selections. 561 by waiting and experimenting, has been able to present us with a wealth of new observations, for which every neu- rologist must be deeply thankful. Whatever may be the fate of the theories of the great Spanish investigator, this much is certain, that to him belongs the lion's share of positive contributions to morphologic knowledge of the nervous system in the closing decades of the nineteenth century." SUBCORTICAL EXPRESSIVE REFLEXES.—Woodworth reports some experiments to demonstrate the fact that physical expressions denoting what are known to be the result of mental processes can also be the result of mechan- ical and chemical stimuli to centers outside the brain. This was observed in the decerebrated cat, where such expressions as those depicting pain or anger were pro- duced. The "ether-cry" was manifest in the decerebrated animals which shows quite clearly that such expressions as these do not require an organ of consciousness for their production, but are, after all, most often primarily sub- cortical reflexes. [NOTE.—We have many examples of subcortical re- flexes about us, but have grown accustomed to the vague term "subjective consciousness," which has not yet been wiped out, but the above data will furnish a much longed for limitation for the worn out term.]—St. Louis Courier of Medicine. NEUROPATHOLOGY. ARE DISEASE GERMS NORMALLY HARMLESS?—It is well known that many creatures or organisms that are dangerous or even fatal to man are harmless to him in their natural state, their carnivorous or parasitic mode of life being an abnormal one. The mosquito, for instance, lives upon vegetable juices in the absence of animals on whose blood it may feed. Birds whose normal food is grain may be made to like flesh food, and this liking might con- 562 Selections. ceivably lead them to a predatory existence. That some- thing of this kind is true of the disease-producing bacteria is suggested by the hypothesis, according to which these arc all non-parasitic in their origin and may exist harm- lessly outside of animal tissues. This thesis, which appears to have originated with Pasteur, is upheld by Prof. E. Bodin, holder of the chair of bacteriology in the University of Kennes, France, who has just published a work on "The General Biology of Bacteria" (Paris, 1904.) Says M. H. Pieron, a reviewer, in the Revue Scientifique: "This means that a virulent bacterium, producing a definite disease in the organisms infected by it, may live outside of these organisms on inert products and abandon its virulent parasitism; and that, inversely, an inoffensive species—that is to say, one' that can not live in complex organisms—may be capable, out of contact with any living being, to acquire, by a series of successive transformations, an injurious character that would correspond to the appear- ance of a new disease. "Thus disease would be really an accident, because the pathogenic power of bacteria would itself be an acci- dent. We might conceive of a human life, up to its nat- ural extinction, side by side with bacteria such as those of tetanus, septicemia, tuberculosis, and typhoid fever—bac- teria at that time inoffensive, that is to say, saprophytes. "Here we have certainly a dream, but the conception that regards all bacteria as ferments or agents of chemical transformation, useful at bottom, may have, rash as it is, some considerable measure of truth. In any case, it is seductive."—Translation made for the Literary Digest. NEUROSURGERY. PRECAUTION IN OPERATION FOR TRI-FACIAL NEU- RALGIA.—Robt. Abbe, of New York, advocates the inter- position of a sheet of rubber tissue as a permanent barrier to the reunion of an intracranial nerve, divided in front of the Gasserian ganglion, and holds that it would in many Selections. 563 cases make unnecessary such severe operations as renrova) of the ganglion. He thinks operations on the ganglion have been overdone, and that resection of one-fourth to one-half inch Qf nerve anterior to the ganglion and within the cra- nium, and interposition of rubber tissue can be relied upon for a perfect cure up to six years at least. The probability of permanency he claims to be as great as in any other method. It is a simple, speedy and safe method, and there- fore fulfills the highest aims of the best surgery. He reports a case of six years' standing with good results thus far. See full account in "Annals of Surgery." REVIEWS, BOOK NOTICES, REPRINTS, ETC. THE DOCTOR'S RECREATION SERIES. By Chas. Wells Moulton, general editor, arranged by Porter Davis, M. D., and issued by the Saalfield Publishing Co. of Akron, Ohio, Chicago and New York. The two volumes lefore us viz: The "Doctor's Leisure Hour" and the "Doctor's Red Lamp" are entertaining^ restful reading. They will entertain both doctors of medi- cine and dentists and men of other professions, and laymen of none will find some fun in these pages at the expense of the doctors. The illustrations are unique, pleasing and good and the books are well published and on good paper. To the doctor of literary taste seeking a collection of the floating non-technical wit and wisdom concerning the practice of medicine, doctors' and dentists' lives, will find, we think, in this series a long felt and hitherto unmet want. As stated by the general editor, many of the selections are old favorites. All relate some episode in the doctor's life in a manner both striking and original. Many of them are by well-known and standard authors. We believe this is the first volume of its kind ever offered to the public. Volume number one contains 352 pages of pleasing recreation reading from such authors as S. Weir Mitchell, John Kendrick Bangs, Opie Reid, Jerome K. Jerome. Four illustrations. Volume number two has an excellent list.of stories by Conan Doyle, Joseph Kirkland, Ian Maclaren, Margaret Oliphant and others. The one which particularly interested us was "Doctor Santos," by Gustave Morales, in that the 564 Reviews, Book Notices, Reprints, Etc. 565 doctor is placed in a very unusual position for a doctor, being given, on the death bed of a patient, a large sum of money to use as his conscience might dictate. The story is too long for the space at our disposal but it alone is worth the price of the book. The volumes are entirely independent of each other, are finished in silk cloth, gilt edge top, and retail at #2.50 per volume. THE SURGICAL TREATMENT OF BRIGHT'S DISEASE. By Geo. M. Edebohls, A. M., M. D., LL. D., Pro- fessor of the Diseases of Women in the New York Post Graduate Medical School and Hospital, Etc., New York. Frank F. Lisiecki, Publisher, 9-15 Murray St., New York, N. Y. The essential of the Edebohls operation of renal decap- sulation for Nephritis consists in invariably removing the kidney capsules, whether normal or pathological, loose or tight. "Edebohls, April 22, 1899, details six cases of opera- tion upon kidneys, the seat of chronic nephritis, in one of which, performed January 10, 1898, the operation was de- liberately undertaken with a view to bringing about a cure of chronic nephritis diagnosticated as such before the oper- ation." Having established his claim to priority in this pro- . cedure, the author discribes the indications for its perform- ance, and gives a detailed history of seventy-two operations with the results and a conclusion in its favor, as "the main if not the only hope of sufferers from a hitherto incurable malady." The author does not discuss that all important factor, the silent psychic suggestion of a surgical procedure sug- gestively undertaken and hopefully acquiesced in by the pa- tient. Months and even years may be added to lives by timely and rightly suggested and performed surgery and es- cape from the after misdirected hopeless sort of treatment and management of these cases, especially in those recur- 566 Reviews, Book Notices, Reprints, Etc. rent forms dependent upon profound neuropathic depression, of which surgery may make inadequate estimate. The psychopathic and neuropathic factor need more consideration than are given them in surgical therapy or by the author. we think. With this view before us let us examine this statement in the author's conclusion: "Of the entire number of seventy-two patients, thirteen received no benefit from operation, while fifty-nine experi- enced amelioration varying from slight or temporary improve- ment to complete cure. In nine cases the operation rescueJ the patient from immediately impending death." Operations of this character, as a last resort after a full trial of the resources of. neurotherapy, psychotherapy and general constitutional management, are well enough, but it is well not to expect too much of the operation alone, that is, independently of the exalting psychic im- pression, hopeful expectation and confident suggestion. As to the precise surgically remedial value of this decapsulat- ing the kidney for chronic Bright's Disease we must, of course, withhold positive opinion and await the maturer conviction of larger observation and deductions from clinical experience. RADIOTHERAPY AND PHOTOTHERAPY: RADIUM AND HIGH FREQUENCY CURRENTS. By Charles Warrene Allen, M. D., Professor of Dermatology, etc., Post Graduate Medical School, New York, etc., etc., and assisted by Milton Franklin, M. D., and Samuel Stern, M. D., illustrated with 131 engravings and 27 plates and published by Lea Brothers and Co., Philadelphia, 1904. The author in his preface truly says "the new therapy, based upon recent discoveries in the domain of radiant energy, has already achieved such positive results in some hitherto intractable maladies as to warrant us in consid- ering it a powerful addition to our armamentarium. Nat- urally this has stimulated an immense amount of investigation and experiment, so that the reduction of this mass of knowledge to as usable form and the elimination of faulty observation have required the review of a vast quantity of ' Reviews, Book Notices, Reprints, Etc. 567 literature coming from all the quarters of the civilized globe." "In order to secure adequate data on which to base a judg- ment of the actual merits and relative values of the various methods of treatment by light and rays, the author and those aiding him have endeavored to ascertain the truth so far as possible, by actual work, before committing any state- ment to print." This book is therefore, as an examination of its con- tents from cover to cover will confirm, a timely and valuable contribution to the practicable therapeutic reference books of the up-to-date practitioner of medicine, both neurological and surgical and should be on the ready reference shelf or table of every advanced physician who does things for the best welfare of his patients. It compasses well the subjects embraced in its comprehensive title. SURGICAL ANATOMY OF THE HEAD AND NECK. By John B. Deaver, M. D., published by P. Blakistons Son and Co., 1012 Walnut St., Philadelphia, Pa. This book is made up from those sections of Dr. Deaver's complete work on surgical anatomy which treat espec- ially of the regions which are of greatest interest to those practitioners who confine their work to diseases of the ear, eye, nose, mouth, throat and nervous system and provides this class of specialists with an absolutely unique book, useful, practical, new. The illustrations, which were prepared to exemplify the text, have been drawn directly from dissections made for the purpose. They are accurate, artistic, realistic and are reproduced in accordance with the highest standards of typography. The text is clear, succinct and systematically arranged. It sets forth the principles of anatomy as applied to medicine and surgery and describes with thoroughness the anatomic conditions fundamental to the various surgical op- erations. The illustrations of brain sections are especially satis- factory for ready and accurate reference by the busy writer on cerebral pathology or surgery. 568 Reviews, Book Notices, Reprints, Etc. Dr. Deaver has done a good work and the publishers with their accustomed anticipations of the needs of the profession, have wisely placed this excellent book on the market at a moderate price. The brain and skull plates are especially valuable for ready reference by the alienist and neurologist and for surgery of this region. THE MEDICAL BOOK NEWS. Beginning with the July, 1904, number, Blakiston's Son & Co., extended the sphere and influence of The Medical Book News, taking its place among the regular magazines as the mouth- piece of the medical profession in so far as the literature of that profession is concerned. While retaining all its distinctive features, the journal will be published monthly, instead of bi-monthly, as here- tofore. A number of new departments are contemplated. Two of these—"Faculty Notes" and "Foreign Books"—com- mence in the July number. Contributed articles of decided medico-literary interest and merit will appear regularly from the pens of writers of repute. CLOUSTON ON. MENTAL DISEASES. New (6th) Edition. Clinical Lectures on Mental Diseases By Thomas S. Clouston, M. D., Lecturer on Mental Diseases in the University of Edinburgh. Thoroughly revised. Crown 8vo, 738 pages, with 29 full-page plates. Cloth, $4 50 net. Lea Brothers & Co., Publishers, Philadelphia and New York. 1904. We have pleasure in calling the attention of the many appreciative readers of the Alienist and Neurologist to the new (6tn) edition of Clouston on Mental Diseases, etc. Concerning this valuable book on Psychiatry written on the field of practical clinical observations, the author justly ob- serves: The scientific views regarding mental diseases have recently undergone great changes in regard to etiology, classification and pathology. Toxic and bacteriological causes of origin are in the air, and are put forward with Reviews, Book Notices, Reprints, Etc. 569 great force and confidence by some of the keenest workers among our younger men. The Italian school of brain pa- thology questions many things which we had before accounted settled generalizations. The tendency of the best of this modern work is to throw Psychiatry into closer relationship with General Pathology, and with the medical sciences as a whole, in their scientific aspects. There is a spirit of optimism now prevalent in regard to the possibilities of cure by direct means of such "incura- ble" diseases as General Paralysis and Epilepsy, which is new and most stimulating to us all. Such new views and new facts I [the author] have endeavored to notice in this edition, and the entire book I have largely re-illustrated by new Pathological plates. As in regard to previous edi- tions, we cordially commend this revised and advanced edition. SURGERY OF THE PROSTATE, PANCREAS, DIAPHRAGM, SPLEEN AND HYDROCEPHALUS. An historical re- view. By Benjamin Merrill Ricketts, Ph. B., M. D., Cincinnati. Is an exceedingly valuable epitome of ref- erence and review to the practicing surgeon from a meri- torious source of practical working experience, the author being well known to us as worthy of the position he holds in surgical practice and thought. MEDICAL BOOKS, General Catalogue, P. Blakiston's Sons & Co., Philadelphia. Price 25 cents. This is a hand reference manual of the latest and best medical publications. POCKET REFERENCE BOOK and Perpetual Visiting List, including information in emergencies, from standard authors, is published by the Dios Chemical Company, St. Louis, Mo. Upon the Management of Suppurative Cases of Appen- dicitis; Goiter—Diagnosis and Treatment; Peritonitis. By Charles C. Allison, M. D., Professor of Principles and 570 Reviews, Book Notices, Reprints, btc. . Practice of Surgery and Clinical Surgery, Creighton Medi- cal College; Surgeon to St. Joseph's, the Wise Memorial and Douglas County Hospitals, Omaha, Neb. Brain Injuries. By Walter T. Williamson, M. D.f Portland, Oregon. Medical Director Crystal Springs, Mt. Tabor, Ore. (formerly Mt. Tabor Nervous Sanitarium); Pro- fessor of Nervous arid Mental Diseases at Willamette Uni- versity. The Despoilers. By Edmund Mitchell, author of "The Templeof Death," "Towards the Eternal Snows," "Plotters of Paris," "The Lone Star Rush," "Only a Nigger," "The Belforts of Culben," "Chickabiddy Stories.." Treatment of Chorea. By Henry Waldo Coe, M. D.t Portland, Oregon. Ex-President North Dakota State Medi- cal Society; President Oregon State Medical Society; Med- ical Director Mt. Tabor Nervous Sanitarium, Etc. Nicholas Steno. By Frank J. Lutz, M. D., Professor of Surgery in the Medical Department of the St. Louis University, St. Louis, Mo. Reprinted from Medical Library and Historical Journal, July, 1904. Radium, Radioactive Substances and Aluminum, with Experimental Research of the Same. By Myron Metzen- baum, B. S., M. D., Cleveland, O. The Physiological Areas and Centres of the Cerebral Cortex of Man, with New Diagrammatic Schemes. By Charles K. Mills, M. D. The Danger of the Use of Opium in Infancy. By T. D. Crothers, M. D., Superintendent Walnut Lodge Hos- pital, Hartford, Conn. Radium. By Heber Robarts, M. D., M. E., St. Louis. Founder and formerly Editor American X-Ray Journal; Reviews, Book Notices, Reprints, Etc. 571 First President Roentgen Ray Society of America; Mem- ber Roentgen Ray Society of London; Late Surgeon to the Northern Pacific Railway, Etc. Preliminary Treatment in Minor Gynecological Surgery. By William B. Small, M. D., Philadelphia.Chief Surgeon, Gynecological Dispensary, University of Pennsylvania. A Foreign Body in the Meatus Acusticus Externus, Aggravating an Acute Tympano-Mastoiditis. By Emil Am- berg, M. D., Detroit, Michigan. Treatment of the Morphine Habit. By Robert L. Gil- lespie, M. D., Medical Director Mt. Tabor Nervous Sani- tarium, Etc., Portland, Oregon. Apoplectic Motation. A Method of Distinguishing Pro- gressive Cerebral Hemorrhage. By William Browning, M. D., Brooklyn, N. Y. Specimen of Pseudarthosis or False Joint of the Ulna. By Myron Metzenbaum, B. S., M. D., Cleveland. Table Wines. Are their Uses to be Encouraged? By Henry O. Marcy, A. M., M. D., LL. D., Boston. Is the Journal of the American Medical Association a Partisan Organ? By G. Frank Lydston. Hereditary Resemblances in the Brains of Three Brothers. By Edward Anthony Spitzka. The Technic of Vaccination. By Myron Metzenbaum, B. S., M. D., of Cleveland, Ohio. A New Retractor for Mastoid Operation. By Emil Amberg, M. D.r Detroit, Mich. Suprapubic Enucleation of the Prostate. By H. O. Walker, M. D., Detroit, Mich. JUN 14 \W> Vol. XXV. NOVEMBER, 1904. No. 4 V A JOURNAL OF AND 3MHnBMmmn FOR THE NEUROLOGIST, GENERAL PRACTITIONER AND SAVANT. •P THE INTRODUCTION OF LECITHIN INTO MEDICINE j based upon extensive laboratory physiological investigation of willed lecithin itself. Physicians desiring to use clinically this new agent will find in ild's LECITHIN SOLUTION a reliable, accurate preparation of Ik- pure isolated substance. tes on Lecithin will be gladly sent upon application. F \ I k1- n i i & Fosi Ace Does Not Always Imply Honesty. Old Planks Are Often Very Rotten So Are Some Old Firms Who Use Age To Cover Rascality. //IffSENAURO.CAROID, SeveralFirmsareSellin&Spurious ZKiKi lTHIAUON;TONGAUNEr Counterfeiting Everything Worth Counterfeiting. EVERY GENUINE BOTTLE OFARSENAURO HAS OUR SEAL ON THE NECK LOOK OUT COUNTERFEIT HAS NOT. C/MS KOOIM PhRM\.lZ»,*J»*ai St. NJf. TO Written Endorsements From More Than 8000 Physicians. VIN MARIANI INTRODUCED NEARLY HALF A CENTURY AGO: "The Preparation which made Coca known as a remedy!" Priority, Facilities and Processes of Manufacture MAINTAIN MARIANI COCA PREPARATIONS INIMITABLE. AVOID "COCA WINES" Extemporaneously made with Cheap Wine and Cocaine Substitutes harm Patient and Physician and betray confidence in the unique properties of Coca VIN MARIANI Represents TRUE COCA with a Sound Nutritious FRENCH WI N E; An Adjuvant to all other Remedies in Convalescence — Wasting Diseases — Neurasthenia And Allied Conditions from any cause. Inquiries from Physicians Receive Ethical Consideration MARIANI & CO., 52 West 15th Street, New MONTREAL. The Coca Leaf A PERIODICAL ADVOCATING THE RATIONAL USES OF COCA MAILED FREE TO PHYSICIANS ON REQUEST. P'JUS, LONDON, BERLIN, ^It 1 *s The Ideal Emulsion £ WKy? Because its formula is physiologically correct Because it's not medicated,—just easily digested fat Because if s pancreatized,—Nature's way of emulsifying fats. Because its menstruum prevents coalescence of globules in stomach. Because it produces no disagreeable after-effects. Because it contains no oxidized fatty acids to irritate stomach. Because patients like it—it's palatable. Because it's economical—its fat content is high. Because it's ethical,—advertised to the profession only. Because it always contains the purest Lofoten Cod-Liver OiL Because the verdict of the profession is that it can be absorbed and assimilated when plain oils and ordinary emulsions are rejected. Such are some of the chief reasons, briefly stated, why Hydro- leine is the ideal emulsion. Sold by druggists. Write for literature. THE CHARLES N. CRITTENTON CO., Sole Agents, 115-117 FULTON STREET, NEW YORK IN THE TREATMENT OF ANJEMIA, NEURASTHENIA, BRONCHITIS, INFLUENZA, PULMONARY TUBERCULOSIS, AND WASTING DISEASES OP CHILDHOOD, AND DURING CONVALESCENCE FROM EXHAUSTING DISEASES, THE PHYSICIAN OF MANY YEARS' EXPERIENCE KNOWS THAT, TO OBTAIN IMMEDIATE RESULTS, THERE IS NO REMEDY THAT POSSESSES THE POWEH TO ALTER DISORDERED FUNCTIONS, LIKE 7Aws'%»p MANY A TEXT-BOOK ON RESPIRATORY DISEASES SPECIFICALLY MENTIONS THIS PREPARATION AS BEING OF STERLING WORTH. TRY IT, AND PROVE THESE FACTS. SPECIAL NOTE._Fellows' Syrup is never sold In bulk, but Is dispensed In bottles containing 16 oz. MEDICAL LETTERS HAT BE ADDRESSED TO MR. FELLOWS, 26 Christopher street, new york. i.- %'%.'%'%. %%-'V'%. «.'%%.'*-%.'%%.'* %r-%.l Please Remember that, in addition to its bene- ficial action upon the appetite, digestion and assimilation, GRAY'S—TONIC stimulates nutrition, enriches the blood, restores vitality. It is the remedy of choice in debility and malnutrition i THE PURDUE FREDERICK CO., 298 Broadway, New York, 10 GREASE in COD LIVER. OILj Deranges the stomach and hinders digestion. That's the reason Hagee's Cordial of Cod Liver Oil with Hypophosphites of Lime and Soda is so much better than plain cod liver oil or emulsions. The grease has been eliminated—the active principles only being retained. You get all the good without the bad. The stomach assimilates it- the blood absorbs it—the tissues feed on it. It contains all the alterative, nutritive, reconstructive and vitalizing properties of cod liver oil without the grease, or the taste, or the odor that have done so much to injure the reputation of cod liver oil. HAGEE'S CORDIAL stimulates nutrition and assimilation. Useful in phthisis, scrofula and all chronic pectoral complaints, coughs, colds, brain exhaustion, nervous debility, palsy, chronic cuta- 'neous eruptions and impaired digestion. Diminishes the toxicity of leu- comaines and favors their oxidation. Prescribe CORD. OL. MORRHUAE COMP. (H&gee) and your patients will take it. Put up in 16 oz. bottles only, ON EVEI ST. LOUIS.MO. Vol. XXV. CONTENTS. No. 4. ORIGINAL CONTRIBUTIONS. INSANE SUICIDE, INSANE HOMICIDE, OR MURDER, WHICH? By Jas. G Kiernan, Chicago _ •. 421 OUTLINES OF PSYCHIATRY IN CLINICAL LECTURES. By Dr. C. Wernicke, Profes- sor in Bresiau 437 MIXOSCOPIC ADOLESCENT SURVIVALS IN ART, LITERATURE AND PSEUDO-ETHICS. By Jas. G. Kiernan, Chicago - 473 THE LOUISIANA PURCHASE EXPOSITION, THE NEURASTHENIC AND THE BRAIN- TIRED. By Charles H. Hughes, St. Louis 490 HEREDITY: ITS INFLUENCE FOR GOOD OR EVIL. By Martin W. Barr, Elwyn, Pa. 509 EDITORIALS. 'Short Cuts to Cemeteries" The Physician in French Politics Crowded In- 519 sane Asylum The Practice of Medicine—A Pennsylvania Decision on What It Is—Addressing a Doctor as "Doc" Toxins of Insanity Asylum Pro- motions The Eye-Strain Theory of the Inebriety Cure Remarriages of Wives by Female Sexual Inverts Bequests of a Reverend Paretic Suicide from Insanity Due to Accident Penal Fountains of Disease and Vice The Abiogenesis Controversy The Appointment of Prof. William Osier Dr. X George F. Butler Dr. William W. Graves Dr. George F. Shrady Has Resigned The Name of Mount Tabor Sanitarium Senator Coe Dr. A. E. MacDonald The American Medical Society for the Study of Alcohol and Other Narcotics The Fifteenth International Congress of Medicine, Lisbon The Crime of Coerced Insomnia Inebriate Bankruptcy The Humilia- 4 CRYSTAL SPRINGS (Formerly Bit. Tabor Nervous Sanitarium) HENRY WALDO COE ) ROBT. L. GILLISPIE > MEDICAL DIRECTORS WALTER T. WILLIAMSON ) SANITARIUM AND COTTAGE HOMES. FOR NERVOUS, MENTAL AND DRUG CASES. SEPARATE QUARTERS FOR DIFFERENT CLASSES OF CASES. The humid, temperate, equable climate of Portland is often of great service in the treatment of nervous conditions, notably of insomnia. Office, " THE MARQUAM." — Portland, Oregon. Dr. Barnes Sanitarium STAMFORD, CONN. (Fifty Minutes From New York City.) FOR MILD MENTAL AND NERVOUS DISEASES Also Cases of Neurasthenia and Nervous Prostration. With a separate detached department for ALCOHOLIC and DRUG HABITS. Under management of competent alienists. Splendid location overlooking Long Isiand Sound ani City. Rates reasonable for excellent accommodations. Both voluntary and committed cases received. For terms and information apply to F. H. BARNES, M. D., Stamford, Conn. Lonf Distance Telephone 9, Stamford: WALNUT - LODGE - HOSPITAL, HARTRORD. CONN. Organized In 1880 for the Special Medical Treatment of ALCOHOL AND OPIUM INEBRIATES. Elegantly situated in the suburbs of the city, with every appointment and appliance for the treatment of this ciass of cases, including Turkish, Roman, Saline and Medicated Baths. Each case comes under the direct personal care of the physician. Experience shows that a iarge proportion of these cases are curable, and all are benefited from the application of exact hygienic and scientific measures. This institution is founded on the well-recognized fact that Inebriety is a disease and curable and all these cases require rest,change of thought and living, with every means known to science and experience to bring about this result. Applications and all inquiries should be addressed T. D. CROTHERS, M. D., Sup't Walnut Lodge, HARTFORD. CONN. CONTENTS.—Continued. tion of Reguiar Medicine by Government Laws The Pressure (or Room at the City Insane Asylum Japan's Physicians Medico-Legal Heinrich Heine's Homeopathic Joke The Fourth Pan-American Medical Congress The American Public Health Association. SELECTIONS. EUROTHERAPY _ 537 The Dietetic Treatment of Diabetes Fatal lodism Tinnitus-Aurium M. Curie's Experiments with Radium Emanations Insomnia Phosphorus In Psychasthenia Desslcated Thyroid in Paralysis Agitans The Washing- Out Pian Hypodermic Medication in Italy. XINICAL NEUROLOGY.. 548 The Musical Equivalent of Epileptic Seizures Degeneracy The "Psychol- ogy" of Jane Cakebread Fracture of the Base of the Skull Suit of an Opera Singer Against a Physician: Reiation of Neurotic Cases to Abdominal Surgery Mosquitos and Maiaria. 4EUROPHYSIOLOGY — J57 The Influence of Milking upon the Quantity and Quality of Milk Does Body Make Brain? Ramon y Cajal's Morphologic Units Reaffirmed Subcorti- cal Expressive Reflexes. NEUROPATHOLOGY 561 Are Disease Germs Normally Harmless? 6 BARNES flEDICAL COLLEGE, City of St. Lnui-. 1 BOARD OF TRUSTEES. JOHN D. VINCIL. D. D., Presldent. Grand Secretary Masonic Grand Lode* Missouri. JOHN C. WILKINSON. Vice-President. Hargadine-McKittrtck Dry Goods Co. GEO. A. BAKER. Presldent Continental National BartJ: A. M. CARPENTER, M. D.. Vice-Presldent of the FacuIty. A. R. KIEFFER. M. D.. Assistant Secretar.. WM. T.ANDERSON, Treasurer. Presldent Merchants Exchange and Dir*r St. Louis National Bank. J. B. LEGG Presldent Legg Architecture C C. H. HUGHES, M.D.. President of the Fx.• JOHN H. MARMADUKE. Cashier Meaic a S* ings Bank. HON. JNO. M. WOOD. ex-Atty.. Genl. .¥.. PINCKNEY FRENCH, M. D.. Secretary. FACULTY. Prof. C. H. Hughes, M. D.. Pres. Prof. A. M. Carpenter, Vice-Pres. Prof. C. M. Riley. M. D. Chas. R. Oatman, M. D. W. C. Day. M D. Jno. H. Duncan, M. D. Edwin R. Meng. M. D. M. D. Jones. M. D. J. T. Jelks, M. D. S. C. Martin. M. D. W. L. Dickerson, M. D. G. M. Phillips. M. D. F. L. Henderson, M. D. A. R. Kelffer. M. D. J. H. Tanquary. M. D. Jno. W. Vaughan, M. D. A. W. Fleming, M. D. R. C. Biackraer M. D. C. H. Powell, M. D. M. Dwight Jennings. M. D. J. Leiand Boogher. M. D. Plnckney French, M.D.. Secr»:i ^-A FOUR-YEARS' GRADED COURSE OF INSTRUCTION.-m. Season of 1899-1900 commences September 11th. and continues seven months. Instruction, practical: new and spacious building, located in the heart of the city and within five blocks of the new sa-: modern In all appointments; ample clinical and iaboratory facilities; course of study conforms to the n&r' ments of all health boards: tuition moderate: ho plta! and dispensary privileges free. Special terms to ?>c--. brothers of physicians, sons of the clergy and graduates of pharmacy and dentistry. For announ - information, address BARNES MEDICAL COLLEGE. ST. LOUIS. NO 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. Wm. B. Fletcher, or Dr. M. A. Spink, Phone, 381. No. 1140 East Market St., Indianapolis, Ind 7 CONTENTS.—Concluded. IEUROSURGERY _ 562 Precaution in Operation for Tri-Facial Neuralgia. REVIEWS. REVIEWS, BOOK NOTICES, REPRINTS, ETC 564 The Doctor's Recreation Series The Surgical Treatment of Bright's Disease Radiotherapy and Phototherapy; Radium and High Frequency Currents Surgical Anatomy of the Head and Neck The Medical Book News Clous- ton on Mental Diseases Surgery of the Prostate, Pancreas, Diaphragm, Spleen and Hydrocephalus Medical Books Pocket Reference Book. PUBLISHER'S DEPARTMENT. PUBLISHER'S DEPARTMENT (Adv. Page) 13 The Magic Transformations of Modern Surgery A Corrector of lodism Hagee's Cordial of Cod Liver Oil Compound The Officers Elected Dr. C. L. Stevens Scientific Work on Coca Reaping Ptomaines Battle & Co. Celerina and Aletris Cordial Rio When the Menses are Suppressed from Exposure The Christmas Delineator. VACCINE POINTS UR modern, scientific methods of »»• cine manufacture insure Precise results. Immunity from accident or untoward effect. The physician who uses our vaccine * tains the highest percentage of succtssft vaccinations and is spared the aonoyio«° violent reaction and troublesome sore ir«* TUBES AND POINTS. Capillary GiM T»bii, lwnneti.ally «»W, box* of 10 And 3. /Wj fU»lt, eAch iu A Ua'a brwUble «1 *«■•' boici of 10. [VERY PARCEL BACTEPtOLOatCALLY ABO PHYSIOLOGICALLY TESTED. We are the world's largest producers of Diphtheria Antitoxin and Vaccine Virus. During all the years ofotf work as manufacturing biologists not a-singlc untoward resuIt ever followed the use of our Serum or V« PARKE, DAVIS A COMPANY i: rMn.lt. Mich., U.S.A.; Wa.km.llt, Onl; Hounalow, En*. w York, Clilcaifo, St. Louis, ltnston, Baltimore, New Or-Uani, Kansas City, .odisnanotls, MlnnespoW. - - London, En*.; Montreal, Que.; Sydney, N.S.W.; St. Petersburg, Ko»U; Simla, India; Tokio, Japan. Sent Free to Physi- cians. This is an illustrated, cloth bound book of 68 pages, printed in two colors on fine coated paper. It contains short chapters on The Feeding of Infants. Quantity of Food and Fre- quency of Feeding. Formulas for Infants of different Ages. The Nursing-bottle. Cow's MilK. Position when Feeding. Sleeping. Exercise. Bathing. Clothing. Nursing Mothers. Care of Mouth and Teeth, and other Chapters on subjects re- lating to Infants and the Nursery. Doctor, you will find it a very useful book to present to your patients. We supply it free of charge and would enjoy sending you a copy. MELL.INS FOOD COMPANY. BOSTON, MASS. 10 OS H en O m 00 WE SUPPLIED ALL THE CITY INSTITUTIONS WITH DRY 600DS LAST YEAR... CO. WM. BARR oSS>s Keep the Largest Stock of Goods suitable for HOSPITAL PURPOSES TO BE FOUND IN ST. LOUIS, And Special Terms will be made with all Institutions ordering from them. BEDDING MATERIALS OF ALL KINDS, UNDERCLOTHING, IN SILK, WOOL AND COTTON, LADIES' AND CHILDRENS' READY-MADE CLOTHING, FLANNELS AND UPHOLSTERY, TABLE AND BED ROOM LINENS, SOAPS, NOTIONS AND PERFUMERIES, ARE ALL SPECIALTIES AT THE; WM. BARR c&Sds GO'S NEW BUILDING, SIXTH, OLIVE AND LOCUST, « - - ST. LOUIS. P. S. Write and find out our special terms to Hospltais. HALL-BROOKE A Licensed Private Hos- pital for Mental and Nervous Diseases. CASES OF ALCOHOLISM AND DRUG HABIT. THE NATIONAL MEOICAL EXCHANGE— Phrsiclans', Dentists'. 1 »d Druggists' Locations and Property bought, sold, rented and exchanged. Partnerships arranged. Assistants and substitutes provided. Business strictly confldential. Medical, pharmaceutical and scientific books supplied at lowest rates. Send ten cents tor Monthly Bulletin containing terms, locations, and list of books. All inquiries promptly answered. Address. H. A. MUMAW. M. D. Elkhart, lnd. THE NATIONAL Surgical and Dental Chair Exchange. •pEAUTIFULLY situated on Long *-* Island Sound one hour from New York. The Grounds consisting of over ioo acres laid out in walks and drives are inviting and retired. The houses are equipped with every Modern Appli- ance for the treatment and comfort o(, their guests. Patients received from any location. Terms Moderate. DR. D. W. McFARLAND, GREEN'S FARMS, CONN. Telephone 67-5, Westport. Conn. All kinds of new and second-hand Chairs, Bought, Sold and Exchanged. 0&-SEND FOR OUR BARGAIN LIST^&aH Address with stamp. Dr. II. A. MUMAW, Elkhart, lnd. LARGE DIVIDENDS Are assured stockholders of the SIERRA- PACIFIC SMELTING CO., Sonora, Old Mexico. , Easy Payments. Agents Wanted. Write for terms. Address, HENRY MUMAW, Elkhart, lnd. 12 PUBLISHER'S DEPARTMENT. THE MAGIC TRANSFORMATIONS OF MODERN SURGERY. (As Diagnosed by a Woman.) Miss Mary Ann Smith had gold galore, But aias, to her grief and shame, In feature and form she was such a fright No lovers a wooing came! She studied the matter pro and con, Then sought, with a purpose grim, Those medico-surgice-science chaps, And they went to work with vim. They rolled and thumped and vapored and steamed, Massaged her early and iate, From five foot two they stretched her out Till she measured five foot eight. They modeled her nose from a beak to a Greek, Her ears carved shapely and thin; They shaved the prominence off her cheek, And molded it into a chin. They curled her iashes and arched her brows, And gave her of dimples a few; They pared down her heeis and toes until She could easily wear number two. To auburn her fiery locks they turned; Her freckles all disappeared; Complexion and teeth of pearl they gave, And plucked out a promising beard. They cut and they siashed, they spliced and they stitched. In one continuous whirl, Presented the bilis, and sent her away An up-to-date Gibsonized girl. And when she'd settled with them she found Of her wealth was left but a tithe; But society sings the praises now Of "beautiful Marian Smythe!" Laura Alton Payne. 13 STIMULATION WITHOUT IRRITATION 0 Means New Life to the Scalp. Q • • • The EVANS VACUUM CAP gives the Scalp a thorough massage and encourages a free and healthful circulation without rub- bing and without the use of drugs or irritants. It will Stop Hair From Falling Out and restore a normal growth where live follicles exist. The Cap is used about ten minutes twice a day and its effects are pleasant from the very beginning. We will refund your money in full if results are not satisfactory after a 30 days' use. Note—To those who find it convenient to call at our offices, we will give a sufficient number of demonstrations free to satisfy them as to the merit of this appliance. £ A CALL ON OR ADDRESS, A A EVANS VACUUM CAP COMPANY, ST. LOUIS OFFICE, Fullerton Bldg. # NEW YORK OFFICE, 1300 Broadway. Impotency Cases t matters not how hopeless; cured or relieved by our combination. Helantha Compound. ielianthus annuus [sunflower.] Fr. root. bark.H. Australian. Piain or with diuretic. Lis a powerful action upon the blood and entire organism. is in- iicated in all cases complicated with Malaria, Scrofula, im- >overiished Blood, Anaemia, etc.. etc.,in conjunction with Pil Orient- ilis (ThomDson), will control the most obstinate cases of Impo- tency. "Drink Cure" cases, saturated with Strychnine, "Weak Vlen" cases, who tried all the advertised "cures" for impotency, md were poisoned with Phosphorus compounds, readily yield to his treatment. Pll Orientalis (Thompson) contains the Extract \mbrosii a 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 alt countries where the Isiiam has pianted 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 formuias and medical testimoniais) to physicians who are not acquainted with their merits. r> , • I Heiantha Compound, $1.85 per oz. Powder or Capsules. rnces. \ p|| Orientalis(Thompson)$1.00 per box. THE IMMUNE TABLET COMPANY, AGENTS: Meyer Bros. Drug Co., St. Louis. Lord, Owen & Co., Chicago. Evans-Smith Drug Co., Kansas City. Redlngton A Co., San Francisco. J. L. Lyons & Co., New Orleans. WASHINGTON, D. C. ENGRAVING CO. MEANS-THAT YOU CAN GET HIGH GRADE CUTS FOR ANY KIND OF LETTER PRESS PRINTING AT 8 4 MASON ST. MILWA UKEE HALFTONES ON ZINC OR COPPER WOOD ENGRAVING ^oVF^-V-a ORIGINAL DESIGNERS a ARTISTS 14 Publisher's Department. A CORRECTOR OF IODISM — Dr. W. H. Morris re- ports (Southern Clinic for May) success in the use of bromidia, which he says has proved corrigental of iodia. Discussing his results he says: Vomiting is so frequent and troublesome a symptom, in many diseases besides irritation and inflammation of the stomach, as to demand much prac- tical attention from the physician. So, although the causes are so various, and although we are actually treating a symptom for this symptom, bromidia is remarkably effectual. We have all employed the remedy for colic and hysteria, two disorders where nausea and vomiting are as pronounced as they are persistent, and almost the first evidence of relief is shown by the disappearance of these disagreeable symp- toms. It is quite as efficacious for the nausea and vom- iting from ulcer or cancer of the stomach. There is noth- ing that will more quickly check the vomiting, and the hypnotic effect is quite in order. HAGEE'S CORDIAL OF COD LIVER OIL COMPOUND is one of the most popular cod liver oil preparations on the market. All the nutritive properties of the oil are retained and the disgusting and nauseating elements are eliminated. Combined with hypophosphites of lime and soda it offers to the profession a reconstructive of great value.—St. Louis Medical Review. THE OFFICERS ELECTED at the 30th Annual Meet- ing of the Mississippi Valley Medical Association, held at Cincinnati, O., October 11-13, are as follows: President, Bransford Lewis, M. D., St. Louis; First Vice-President, Frank Parsons Norbury, M. D., Jacksonville, 11l. ; Second Vice-President, J. H. Carstens, M. D., Detroit, Mich. ; Sec- retary, Henry Enos Tuley, M. D., Louisville, Ky. ; Assist- ant Secretary, Jolm F. Barnhill, M. D., Indianapolis, Ind.; Treasurer, S. C. Stanton, M. D., Chicago, 11l. Next place of meeting, Indianapolis, Ind., October, 1905. DR. C. L. STEVENS, of Athens, has been elected edi- tor and publisher of the Pennsylvania Medical Journal. SCIENTIFIC WORK ON~COCA.—Mariani products have . not been merely pushed upon the market commercially, 15 Publisher's Department. without any regard to scientific details. In the laboratories at Neuilly, France, the Coca plant is studied botanically and chemically to determine how best to develop its prop- erties. From there thousands of plants have been sent to the principal botanical gardens throughout the world, and every effort is constantly made to study this substance, and to afford others an opportunity for its scientific inves- tigation. This is related not as a matter for mere praise, but to impress the fact that here is the largest manufactory of exclusive Coca preparations in the world. This could not have been so extensive, nor so successfully maintained through all these years, if it was not founded upon merit and conducted upon those liberal principles which unite all that is possible scientifically with mere commercial interest. Thus it will be seen, that whatever has been done toward advancing the popular use of this restorative substance, has been the outgrowth from the original conception of preseiving the true qualities of recent Coca in a nutritive wine. Vin Mariani was nearly fifty years ago introduced to the medical profession. It has been endorsed by physicians everywhere, and whatever success has been achieved through it is due to those physicians who, having recognized its worth, have since continued to employ it.— The Coca Leaf. REAPING PTOMAINES.—A great many people seem to think that it matters little what kind of material goes into the building of the human structure! They feed on thorns and expect to pick roses! Later, they find they have sown indigestion and are reaping ptomaines. It's a wonderful laboratory, this human body. But it can't prevent the formation of deadly poisons within its very being. Indeed, the alimentary tract may be regarded as one great laboratory for the manufacture of dangerous substances. "Biliousness" is a forcible illustration of the formation and the absorption of poisons, due largely to an excessive proteid diet. The nervous symptoms of the dyspeptic are often but the physiological demonstrations of putrefactive alkaloids. Appreciating the importance of the command, "Keep the Bowels Open," particularly in the colds, so easily taken 17 Publisher's Department. at this time of the year, coryza, influenza and allied con- ditions, Dr. L. P. Hammond of Rome, Ga., recommends "Laxative Antikamnia and Quinine Tablets," the laxative dose of which is two tablets, every two or three hours, as indicated. When a cathartic is desired, administer the tablets as directed and follow with a saline draught the next morn- ing, before breakfast. This will hasten peristaltic action and assist in removing, at once, the accumulated fecal matter. BATTLE & CO. have just issued the third of the series of twelve illustrations, of the Intestinal Parasites, and will send them free, to physicians on application. CELER1NA AND ALETRIS CORDIAL RIO, equal parts, teaspoonful every four hours, is a most efficient remedy for amenorrhea. WHEN THE MENSES ARE SUPPRESSED FROM EXPOS- URE, or from colds, wet feet, the result of emotional excitement, or febrile conditions, if not complicated with organic change, but by a more passive congestion, Aletris Cordial Rio is a very reliable remedy. It is an emmena- gogue, not abortifacient. THE CHRISTMAS DELINEATOR.—The December De- lineator, with its message of good cheer and helpfulness, will be welcomed in every home. The fashion pages are unusually attractive, illustrating and describing the very latest modes in a way to make their construction during the busy festive season a pleasure instead of a task, and the literary and pictorial features are of rare excellence. A se- lection of Love Songs from the Wagner Operas, rendered into English by Richard Le Gallienne and beautifully illustrated in colors by Leydendecker, occupies a prominent place, and a chapter in the Composers' Series, relating the Romance of Wagner and' Cosima, is an interesting supplement to the lyrics. A very clever paper entitled "The Court Circles of the Republic," describes some unique phases of Washington social life. There are short stories by F. Hopkinson Smith, Robert Grant, Alice Brown, Mary Stewart Cutting and Elmore Elliott Peake. Many Christmas suggestions in needlework, cookery, etc., and many special articles. 19 •————————t—» EUGENE! G'«en Free FIELD'S POEMS* A $7.00 BOOK J to each person interested In aubscriblnf; to the Eugene Field Monument Souvenir Fund. Subscribe any amount desired. Subscriptions aa low utl.00 will entitie donor to bis daintily artistic volume jhaeayj jaA t * FIELD FLOWERS" C^ fill ♦ fcIoth ^und, 8x11). ai a M l-llll j certificate of tubaeriptioD to ^r ■ ■^er*JeT £ fund. Book eontaini a selec- tion of Field's beit and most representative works and is retdy for delivery. But for the noble contri- bution of the worid's greatest' artists this book could not have been manufactured for leas than $7.00. The Fund created Is dl- Tided equally between the family of the late Eugene Field \ and the Fund for the building; of a monument to the mem- ory of the beloved poet of childhood. Address EDGENB FIELD MONUMENT SOUVENIR FOND, (Alio at Book Stores) 194 Clinton St., Chtcaf If yvti alto wish to send postage, enclose 10 cte. THE Book of the century Handsomely Illus- trated by thirty- two of the Worid's Greatest Artiits. Pfll K'S MEDICAL REGISTER I ULI\ O AND DIRECTORY MAS ESTABLISHED IN 1888. Do Not Be Deceived By Imitators. See that the name B. L.. POLK & CO. IS ON THE ORDER BEFORE YOU SIGN IT. POIiK'S is the only complete Medical Directory. I'OI.K'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. R.L POLK & CO., Publishers, SUBSCRIBE NOW. Greenmont-on-the-Hudson. For NERVOUS and MENTAL DISEASES. RALPH LYMANS PARSONS, M.D. RALPH WAIT PARSONS, MX). City Office, 21 East 44th St., Mondays and Fridays, 3:30 to 4:30,p.m. SING SING, P. O., N. Y. Long Distance Tel., Hart, 140A, Sing Sing, N.Y CREST VIEW SANITARIUM, GREENWICH, CONN. A quiet refined home for the treatment of Chronic and Nervous Diseases, In the midst of beautiful scenery, 28 miles from New York. H.'M. HITCHCOCK, M. D. The MILWAUKEE SANITARIUM Wauwatosa, Wis. FOR NBRVOUS 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. This is the Best Medium for — Sanitaria— -' 20 LIVE VIGOROUS BLO • § will save many desperate cases. If your patient is Anaemic, Consumptive, Dyspep- tic, he needs good, live, healthy blood for his salvation. - But how shall he get it? If the alimentary process has failed to keep up the nourishing and supporting contents of the blood, there is but one thing to do, and ten thousand fold experience has proved that that one thing is this—where nature fails to produce good and sufficient Blood, We Can Introduce It from the arteries of the sturdy bullock by the medium of BOYININE BoviIstine is the living blood conserve, and to every properly equipped physician who will test its properties microscopically, phys- ically, or therapeutically, it will speak for itself. Send for our scientific treatise on topical and internal administration and re- ports of hundreds of cases. THE BOVININE CO., 75 West Houston St., New York. LEEMING MILES & CO., MONTREAL Sole Agents for the Dominion of Canada- ADRENALIN ASTRINGENT AND HEMOSTATIC OF MARVELOUS POTENCY. WIDELY USEFUL IN SURGERY OF THE EYE, EAR, NOSE, THROAT, VAGINA AND URETHRA, AND IN Practically Every Form of Hemorrhage encountered by physician and surgeon. Its remarkable potency, broad usefulness, prompt action, and freedom from untoward results, stamp Adrenalin as one of the most notable agents in the materia medica. Supplied lo solution (ready for we), 1 part Adrenalin Chlorlde, 1000 parte normal ealt solution— In ounce glen-stoppered rials. LITERATURE ON BEQUEST. 1 OUNCE ACETOZONE (C.H.CO.O.O.COCH.) ANTISEPTIC ■H-M ha* prt»#xJ T»T7 Wt»fVWT Midwwi »,. U.t ii lsOiprctfrd that ftacawl if<|.&aM M lot Inaliraiai of ■ •rraaic triiauta. y» ■ U dVaw, ate., bm » Dclcawd litmure. mm» >• vory raadlly dicemfemi, u4 •*•■■. •a owal bo n«'i-1m-J no proiral Jilinmaa ftare la Tidaiiy of • at can ••■i, rtJat» ■ ■Ma abw-t. If haalnl lo »™i»-, aaw a* • iiflntlna any mrull. At.«U mean. ia) ■fi«et»b»n dhpaaaKL la ii*iiH •*•*■ asi>M, alcOao). clynHo AM Ma* goat ■1 asoold ool M •u.tjLojr.l. PARKE, DAVIS & CO. DETROIT, MICH. U.I.L POWERFUL GERMICIDE AND INTESTINAL ANTISEPTIC. OK MASKED VALUE IN TYPHOID FEVER CHOLERA DIARRHEA TONSILLITIS DYSENTERY GONORRHEA PUERPERAL FEVER MALIGNANT EDEMA and other diseases of like origin in which the source of infection can be reached by the solution. In the opinion of many physicians Ace/ozone is tht most remarkable antiseptic ever brought to the attention of the profession. Supplied in ounce, half-ounce and nuarter-ounce botties; also to vials of 11 grains each, 6 rials in a bos. Write for booklet with Clinical resorts. PARKE, DAVIS & CO. laboratories: Detroit, mich., U.S.A.; walkerville. out.; hounslow, eng. SRANCHCS: NEW YORK, CHICAGO, ST. LOUIS, BOSTON, BALTIMORE. NEW ORLEANS, kANSAS CITY, MINNEAPOLIS, INDIANAPOLIS, MEMPHIS; LONDON. ENG,; MONTREAL, QUE.; SYDNEY, N.S.W.; ST. PETERSBURG, RUSSIA; SIMLA, INDIA; TOKIO JAPAN. 52,396 PRESCRIPTIONS IN THIRTY-TWO MONTHS I 1 s I 1 Shows the confidence the Physicians and Public have In WHITCOMB'S. Certified Prescription Work. My force of six prescription men allows every prescription to receive the thought and necessary time required for its proper compounding. Your prescription is checked and certified to by two prescription men before it leaves the dispensing room, thereby rendering mistakes impossible. Twenty-five years' experience as pharmacist and chemist. Thirteen years chief clerk for the late M. W. Alexander. Positively no counter prescriptions. Fred'k E. Whitcomb, Ph. 0., Graduate New York College of Pharmacy, Garrison and Washington Aves., Mail orders solicited. St. Louis. i®^®^^58g®®®g®®g®gg®g8ag®S 25 Too Much Business Not Enough Health... :"'•-• That's what's the matter with ma- of your patients, Doctor. YOU KNOW it Is almost Impossible to cure the» at home. Send them to Alma Springs Sanitarium And let us demonstrate what can be done for them here. THINK A MOMENT. We have the most remarkable mineral waters I the United States, ALMA BROMO AND ALMARIAN. The best equipped and most scientifically conducted Sanitarium. First-class Physicians. Delightful climate. Write for full Information ALMA SANITARIUM COMPANY, Alma, Mich. GEORGE P BUTLER, M. D., Medical Superintendent. Medical Batteries AT WHOLESALE PRICES ELEGANT WALL CABINET for Direct, Alternating Current or Cell*, Gires Galianle, Faradlo and Sinusoidal Current, Cautery and Lluht. VI ItltO MASSAGE MACHINES, with Electric Batterj. Best In the world. MARBLE GALVANIC and FARADIC WAIL PLATE, on I v $18.00. FARADIC BATTERIES from (13.75 up. GALVANIC and CAUTERY BATTERIES from 88.00 np. ■nil ros our WHOLESALE PRICE LIST or Static Machine* Surgical Instruments X Ray Machines Electrodes Operating Chains Trusses Nebulizers Supporters MONEY BACK IF VOU ARE NOT SATISFIED Western Surgical Instrument House Salesroom 69-71 Dearborn St. j~lj■/»a.s»/*h ll ■ Factory S9th and Wallace 8ts. BHIurBB, ILL. WHMWLL'gBfflHg THE SANATORIA! HUDSON, WIS. EIGHTEEN MILES EAST OF ST PALI FOUNOKD ST ROBCRT A. OIVEM, M.O.. IN I SS9. Extensive and beautiful grounds. Perfect privacy. Located a few miles west of Phiiadelphia. Refers by permission to Drs. R. A. F. Penrose, James Tyson, Charies K. Milis. Wharton Slnkler, William Osier, James Hendrie Lloyd, Thomas G. Morton, Barton Cooke Hirst, John H. Musser, Alfred Stengel, John A. Ochter- lony, John B. Deaver, W. W. Lassiter. B. L. GIVEN, Proprietor. NATHAN S. YAWGER, M. D.. Superintendent. HERBERT C. STANTON. M. D., Ass<. Physician. For full information, address, BURN BRAE, Telephone connection CLIFT01 HEIGHTS. KLAWAHE CO., PA. An Institution fully equipped with evr appliance and convenience for the care = treatment of the Invalid and Sick, Electric Apparatus, every kind of Bss Massage, Swedish Movement, etc. Contagious diseases and the violent •" disagreeable insane not received. Beautiful' surroundings and in a bealttr locality. For information address SAM C. JOHNSON, M.D., Manage For FORTV YEARS The remarkable prestige among scientific Therapeutists of Wheeler's Tissue Phosphates in Tuberculosis, Convalescence, Gestation, Lactation, Nervous Impair- ment and all conditions where Nature needs a lift, has been due to the fact that it determines the perfect digestion and assimilation of food, besides assuring the complete absorption of its contained Iron and othei Phosphates. "As reliable in Dyspepsia as Quinine in Ague." T. B. WHEELER, Montreal, Canada. To avoid substitution, in pound bottles only at one dollar Send for interesting pamphlet on the Phosphates in Therapy. Free samples no longer furnished. N 29 : "IT IS A PLEASURE TRIP AT ANY TIME OF THE YEAR." $21.00 St. Louis TO New York VIA BIG FOUR ROUTE AND Chesapeake and Ohio Ry. STOPOVER as long as you like at Virginia. Hot Springs, not exceeding 10 days at Washington, Baltimore and Phiiadelphia. Leave St. Louis, Arrive Washington, Arrive Baltimore, Arrive Phiiadelphia. Arrive New York, The Grandest Scenery East of the Rocky Moun- tains. Elegant Coaches, Sleepers and Dining Cars. E. B. POPE, Western Passenger Agent. Big Four Ticket Office. Corner Broadway and Chestnut Streets. 12:00 Noon. 3:39 p. m. 4:54 p. m. 7:04 p.m. 9:08 p. m. Lectures on Neurology By CHAS. H.HUGHES, M.D., St. Louis. Extensively & Expensively ILLUSTRATED. Containing outlines of PROF. HUGHES' Lectures on Nervous Disease and simplifying Neurology for the Student and General Practitioner. Price, $3.00. Remit promptly to H. L. HUGHES, 38S7 Olive Street, St. Louis. Most of the First Edition has already been taken and those desiring copies of same send their orders in early, before the edition is exhausted. St. Louis Baptist Hospital, JWm« | m *w IMI V lUL h LhJi C :BlfifJl 'W * i '--Mf ^t^^^y" I fc I "* *aK ■t£!»i DR. C. C. MORRIS, Supt. N. E. COR. GARRISON & FRANKLIN AYES., St. Louis, Mo. This hospital is open to the medical pro- fession generally, and physicians who bring their patients here are guaranteed every courtesy and the exclusive control of their patients. It has a well equipped Bacteriolog- ical and Pathological Laboratory under the supervision of a physician well trained in these branches. Surgical casts are given special attention Address all communications to .DR. C. C. MORRIS, Supt. 30 ^Chestnut has a flu rr p Opiuma Habit AIN has relief in. rivE-GKAiNiflatiKarnnialSblets WHICH DO NOT DEPRESS THE HEART DO NOT PRODUCE HABIT ARE ACCURATE-SAFE_SURE" MADE SOLELY BY The«Rr iKarruriia C^an^icai Company ST. LOUIS/MO. U.S„A. SAMPLES AND LITERATURE ON APPLICATION *P KENSE NORWALK, CONN. For the treatment of Insanity and Nervous diseases, Alcoholic and Narcotic Habitues. Wednesdays 2:30 to 4:15 P. Al., 12 East 47th Street. NEW YORK CITY. ADDRESS: EDWIN EVERETT SMITH, SOUTH WILTON, CONS THE Its piace in the talking machine art is at the Wj 'iop. Evtry other machine Is successful only to the ex- tent that it Imitates or infringes the GMfMnVt The only practical processes for recording and re- producing sound are covered by Graphopbonc ptr& A comparison shows that no other talking mach|r!! approaches the perfection reached by the 6r<* pliant in recording and reproducing music, sow speech or any sound. No one should be de- ceived by piausible representations to the cor- trary, but decide for himself by nuking a faircomptf* Thi> fir inhrmhnno la without a rival for home entertainment. i lie urdpiiopiione For tne nome |8 sold from $5.0o up. TIip fir ihhnhhnne fir inrl The crowninfr wonder of the art. reproduces with foj IIIC Uld^llUpilUIIC UldllU, volume and marvelous periection of tone. Can be he** as far and farther than the j,troiine:»t vo>«-e will carry bound. £ff\« Columbia Phonograph Co., "^"StTiSSS&iio. 31 IF YOU ARE if if if AN ADVANCED PHYSICIAN or PROGRESSIVE LAWYER, <** YOU CANNOT DO WITHOUT THE ALIENI5T in NEUROLOQIST, CHAS. H. HUGHES. M. D., Editor. T HE ablest men in Neurology and Legal Medicine subscribe and write for it. The morbid movements of the mind, brain and nervous system are mirrored in its pages by master minds in medicine It constantly gains and seldom loses subscribers. address Hm L# HUGHES, MANAGER AND PUBLISHER, 3857 Olive Street, ST. LOUIS, Mo. $5.00 Per Annum. s 32 mem MoiWTArw route FROM ST.LOUIS TO rfOTSFRfMCS^RK,SAW ANTONIO AND POINTS IN MEXICO ANPCAUFORWfA FOR FURTHER INFORMATION ADDRESS COMPANY'S AGENTS OR BROOKLYN HOME FOR NARCOTIC IN- EBRIATES, OPIUM' CHLORAL. COCAIN 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, PROFESSION^ attention, based on 30 years' experience in the study and treatment of this disease. WE CAN COLLECT Your old bilis. We are turning worthless ac- counts into ready cash for scores of physicians NO COLLECTIONS, NO PAY. fctfJrSSi exclusive Physicians Collecting Agency in the United States. Write for terms Physicians Protecllre Ann., Kansas t'ltj, Mo. IP 33 L FRISCO SYSTEM tfl£ Chicago & Eastern Illinois R. R. Double Daily Trains BETWEEN St. Louis and Chicago MORNING AND EVENING Morning or evening connection at both termini with lines diverging, Equipment entirely new and modern throughout. A DOUBLE TRACK RAILWAY. Equipped with practical and approved safety appliances. Substantially constructed. 34 SANITARIA. These are the largest, most reliable and most completely equir:< institutions for the care of the invalid, in all parts of the country, il ranged according to States. For description see advertising pages. STATE. CITY IN CHARGE. Arkansas Hot Springs J. T. Jelks Connecticut Greenwich H. M. Hitchcock T. D. Crothers Hartford Norwalk E. E. Smith Greens Farm D. W. McFarland Westport F. D. Ruland F. H. Barnes 11 Stamford Illinois Godfrey W. H. C. Smith Indiana Indianapolis W. B. Fletcher Maryland Catonsville R. F. Gundry Massachusetts Milton J. S. Perry Michigan Alma Flint Geo. F. Butler C. B. Burr Missouri 11 St. Louis C. C. Morris Fanny A. Compton • * New York Astoria, L. I. J. Jos. Kindred W. S. Watson F. W. Seward R. L. Parsons Fish-Kill-on-Hudson II Goshen 1 I II Sing Sing P. O. Astoria, L. 1. J. J. Kindred > > New York City Martin W. Curran Oregon Portiand Henry Waldo Coe Pennsylvania • i Clifton Heights Easton C. Spencer Kinney Tennessee Memphis G. E. Pettey. Wisconsin • > Wauwatosa Hudson Lake Geneva Kenosha, Richard Dewey S. C. Johnson W. G. Stearns G. F. Adams 35 Keep Your Name Before the Trade IT PAYS.= It can be done easily and with little expense with THE ADDRESSOGRAPH. It prints 3,000 different addresses per hour, 3 cts. per 1,000. +*•♦♦+♦++++++*++♦+♦♦++++++♦+♦+♦**■ + + ♦ + + + + + + + + + + + ♦ + + + + + + + + + + + + + + + + 4 + + + + + * + + + + *♦♦♦♦♦+♦♦♦♦♦♦+♦♦♦♦♦♦♦++♦♦♦♦♦♦♦♦♦ On Envelopes Fac-Simile Letters Order Blanks Monthly Statements Booklets Pamphlets Wrappers Postals Pay Sheets Pay Envelopes Time Tickets Time Cards Shipping Tags Fac_Simile of Typewriter Neat and Business-like No Errors No Omissions No Duplicates No Wasted Postage Additions and Changes Easily Made List Always Perfect 11,000 Shrewd Advertisers Use it Write for Catalogue The Addressograph, 173 South Canal Street, CHICAGO, ILL. 38 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. 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, 3857 Olive Street, ST. LOUIS, MO. 39 BIND THE ALIENIST AND NEUROLOGIST OUR 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 Toois iasts 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 90 CENTS for 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 Uixe, 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, 3857 Olive St., ST. LOUIS, MO. YOUNG'S HOTEL, ON THE BOARD WALK ATLANTIC CITY, N. J. JAMES R. KEENAIN, Proprietor. European Plan, Absolutely Fireproof. Directly opposite Young's Pier, where Convention is to be held. 40 BROMIDIA EVERY FLUID DRACHM CONTAINS FIF- TEEN GRAINS EACH OF PURE CH LOR- AL HYDRATE AND PURIFIED BROM. POT.; AND ONE-EIGHTH GRAIN EACH OF GEN. imp. EX. CANNABIS IND. AND HYOSCYAM.-IS THE ONLY HYPNOT- IC THAT HAS STOOD THE TEST, AS A HYPNOTIC, FOR THIRTY YEARS IN EVERY COUNTRY IN THE WORLD. ECTHOL IODIA PAPINE BATTLE & CO., coSS, St. Louis, Mo., II. S. A.