terial whether the symptoms are produced by one form of intoxication or another unless we can diagnosticate the kind of intoxication and it be of a type which is remediable. If it be an intoxication from the bowel and we can remove the source of the poison, the prognosis is favorable. If it be a case of intoxication of the so-called rheumatic type and we can get the materies morbi through the kidneys the prognosis is fair. If we have an intoxication from some general infection in the blood which we cannot eradicate, the prognosis is grave irrespective of the lesions in the meninges. The prognosis then of meningitis is entirely clinical. The second case which I recorded may have been tubercular meningitis. I did not look into tho question because it brought up a very much disputed point as to whether cases of tubercular meningitis ever recover or not. I do not think we have any right to say that the case was or was not one of tubercular meningitis. We must simply say that the means of correct diagnosis is absent. We have at our disposal means of diagnosis during life by which we may be able to state with some degree of certainty that a certain case was tubercular meningitis and if it recovers we can say with some degree of certainty that the case has recovered. I refer to diagnosis by lumbar puncture. Lumbar puncture has been resorted to a number of times by introducing the hypodermic needle between the second, third and fourth lumbar vertebrae with the child lying on one side and withdrawing some fluid or permitting it to run, determining the degree of pressure by the manometer and then examining the fluid for the micro-organisms which it contains. In that way in some cases tubercule bacilli may be found in the fluid thus obtained. If tubercule bacilli are found we have excellent evidence that the disease is of a tubercular character. Until we have found the cause of tubercular meningitis by such means of finding the tubercular bacilli in the fluid as I have mentioned we have no right to say that a case of tubercular meningitis can recover. At the same time we have no right to say that a case of tubercular meningitis cannot recover. The question is beyond our knowledge to settle because of the absence of reliable data. I have had five deaths from meningitis within the past two weeks and of these two had pneumonia and two bowel trouble. One was a case of osteomyelitis of the femur which may or may not have had meningitis." Dr. Patrick: "How many autopsies?" Dr. Christopher: "Two. There seems need of some determining factor to justify a diagnosis of meningitis. It is, after all, a question of terms. I think we are all agreed that the occurrence of the lymph exudate upon the meninges is not enough to make out a disease which has the fatal prognosis that meningitis has. If meningitis is an anatomical condition we must admit that we cannot diagnosticate it during life with absolute certainty because the symptoms do not justify the exact anatomical condition present. We do find a certain number of things clinically which have an extremely bad prognosis and it is desirable to use the term meningitis to cover them. You may relegate the term meningitis to anatomical conditions that are found but if you do you must use a different word to describe the clinical conditions which are found. As remarked by Dr. Favill we must admit that there has been a general collapse of the anatomical condition which constitutes meningitis. We no longer need to have pus or lymph, we may get along even with simply the changes which occur in the arteries or vessels themselves, and still have meningitis. The farther we get from the old gross lesion of meningitis the farther we are from the causative symptoms observed. THE CASE OF STURGEON YOUNG.* A Question of Hypnotic Injury and Death. Reported by CLARK BELL, Esq. Abstracted from Advance Sheets, Medico-Legal Journal, by C. H. Hughes. THE HE Coroner of Chautauqua County, A. H. Bowen, M. D., Health Officer at Jamestown, New York, held an inquest as to the cause of death of Sturgeon Young, a colored lad, who recently died there in January, 1897, under circumstances that led the authorities to regard it proper to investigate the cause of death, and how far it was traceable to his condition, as affected by the repeated placing of the lad in hypnotic state, by hypnotizers who were not skilled in the matter, and from which, it was thought, he had sustained physical injuries which might have incited the disease of which he died. I was called upon by the Coroner to aid him in this investigation, and I requested him to have a careful and complete autopsy made by competent medical men, and the inquest was adjourned to enable me to furnish him with * Read before the Psychological Section of the Medico-Legal Society Feb. 10, 1897. Read before the Medico-Legal Society, Feb. 20, 1897. expert and opinion evidence bearing upon the questions he regarded as important to the inquiry he was conducting. He furnished me with such of the facts as had transpired, a resume of which is given in my letter enclosed and with a Hypothetical question, which is subjoined. I sent a letter, of which the following is a copy, and the Hypothetical question to some of the more prominent experts who are members of the Psychological Section of the Medico-Legal Society: Dear Sir:- Will you please reply to the following hypothetical question? In case of a youth seventeen years of age, of good physical development and medical history, well nourished, weighing about 125 pounds, upon autopsy with no observable lesion, beyond slight cerebral softening, and trace of kidney deterioration, vital organs normal with cause of disease diagnosed as diabetes mellitus; and it appearing upon conceded evidence that the deceased had for approximately over six months been a chronic "sensitive subject" of extreme susceptibility to hypnotic or "mesmeric influence;" having been protractedly and repeatedly hypnotized many times by amateurs and irresponsible and reckless youthful operators and dabblers in hypnotism; and while under the influence or in a state of statuvolence having been sat or stood on, by men of average or heavy weight, while in a cataleptic state, with head and feet supported, so that he formed a bridge between such supports; and having been thrown into and left in hypnotic or trancoidal states with instructions to emerge therefrom at a given time, and upon emerging apparently from such trancoidal state complaining of nervous chill, physical prostration and malaise; in your view and opinion, according to the best of your professional knowledge and belief, according to the best authorities and latest research wherewith you are familiar, in physiology, pathology and psychology—would physical injury or organic impairment particularly of the renal function, or symptoms of glycosuria, directly or indirectly, follow from the psychic or emotional disturbance or derangement of nerve function, involved in or due to, the morbid innervation incident to such hypnotic practice or experimentation in "mesmerism" or alleged animal magnetism? Medico-Legal Society, No. 39 Broadway, NEW YORK, Feb. 1st, 1897. My Dear Sir and Colleague:-1 have received from the Coroner of Chautauqua County, a hypothetical question of which I enclose you a copy, to which he desires a reply from some of our medical experts familiar with the subject of hypnotic suggestion. Briefly, the case, aside from the statement made in the hypothetical question, is; that this Coroner is now conducting an inquest at Jamestown, N. Y., upon the body of a young negro named Spurgeon Young, which excites great public interest. Dr. C. J. Phillips and Dr. Wm. M. Bemus made the autopsy and subsequently testified substantially that, the treatment to which the deceased had been subjected while under hypnotic influence, had in their opinion, caused the disease, diabetes mellitus which had caused death. The hypothetical question gives substantially the results of the autopsy, except that Dr. Phillips testified that he found no external bruises or internal lesions sufficient to cause death except as stated in the hypothetical question; that sugar was found in the urine, which he stated was the indication of diabetes, but that the tissues of the kidneys were not broken down. He further testified that diabetes was a kidney or nervous disease that may be caused by strong nervous excitement or non-assimilation; and that he believed that the tax upon the nervous system had a tendency to cause diabetes, and that acute and chronic diseases of the brain of a depressing character, such as might be caused by hypnotism might produce the disease. He further testifled that hypnotism is sometimes used with beneficial effects in cases of hysteria and paralysis, but as it was commonly practiced it was extremely dangerous, and that it was a severe strain upon the subject's nervous system. He also testified that the first stage of hypnotism might be refreshing, but that the further stages might be dangerous. He was cross-examined as to whether a subject could be made to commit suicide or crime under suggestion, upon cases read from medical Journals; and answered that the cases were unusual, but that he had no doubt of their truth and was positive that hypnotism was a dangerous agency. It was claimed before the Coroner's jury by the District Attorney that hypnotism as practiced by amateurs was dangerous alike to morals and lives of the subjects in certain cases. I have been appealed to by this public official to aid him as a public officer in the investigation of the subject by the opinion of scientific experts connected with this body in aid of the due administration of justice. The inquest is adjourned to to-morrow evening and will be further adjourned to hear my reply. I therefore ask that you forward to me at once your answer to the enclosed hypothetical question, taking into consideration also, as the basis of your decision, and opinion such facts as are contained herein, so that I may forward your reply to the Coroner. Yours hastily, CLARK BELL. |