140. Mott-59 years.

Epileptic and absinthic. Father

died at 81. Mother senile dementia.

141. Hers-17 years. Pronounced imbecility. Father, excessive alcoholic and venereal, grandfather the same. Grandmother epileptic and insane. Uncle inebriate, aunt epileptic. Cousin-german epileptic.

PREVENTION OF INSANITY. THE DUTY OF PSYCHIATRY AND THE STATE.-The German publicist, Dr. William Hirsch, has observed: "It becomes the task of modern Psychiatry not only to treat individual patients but also to observe society, and especially to guard against that phenomenon which ought to be termed Secular Hysteria, the peculiarity of which is that it attacks not isolated individuals but epidemically entire communities, and in that way influences the development and metaphysical conceptions of whole nations."

Is there not a corresponding duty on the part of the State to deliberately mould its policy so as to render the community less and less susceptible to such attacks, an obligation which, when once recognized, would be fulfilled from considerations of public economy? Such policy of prevention would extend to isolated cases. In our last Annual Report we ventured to refer to the importance of restrictions. upon parentage. When congratulated upon the birth of his son, it is related that the father of Nero bitterly exclaimed: "The offspring of me and of Aggrippina can only be a monster who will scourge the world." It is a startling thought that society is still content to breed under the laws of Roman degeneracy.

According to the modern doctrine of heredity it does not appear that it is a disease which is inherited, "but a diathesis, a predisposition, a want of resistance to all baleful influences of the direct, exciting causes of disease." This lack of resistance must be overcome by education. We have heretofore urged the extension of free instruction to the adult population by means of the school, the library, the lecture, the training in manual arts. It has been a theory of public instruction that the natural bent or inclination of the pupil should be watched for and developed.

Is it not evident that the theory is erroneous? We respectfully invite the attention of your Honorable Board to the suggestion that the mental point of least resistance is the point of danger, and that our system of public instruction should be so directed as to bring up the laggard faculties of the pupil and set them into harmonious co-operation.— From Trustees Report, Pennsylvania Hospital for Insane.

PSYCHOTHERAPY.

DANGER OF HOME ATTENTION OF THE INSANE.In my report of 1894, I urged upon the citizens of Delaware the necessity of familiarizing themselves with the methods in vogue in caring for the insane and stated that a goodly number of cases were detained at their homes until they became dangerous to themselves and others, and then and then only they consented to allow them to be removed to a hospital. I cannot do better to instil this into the minds of the citizens of this State than to quote from the admirable work of M. Règis on Mental Medicine: "The fundamental principles of the treatment of the insane is isolation. This consists in separating the patient from his habitual surroundings from contact with persons and things familiar to him, amongst whom he lives, and where its disorder had its birth and development. Nothing is worse than the detention of the patient in his own dwelling, and the continuation of his stay amidst his family. There is, in such cases, the influences of the family on the one hand, an influence that is injurious and prevents or delays the cure; and on the other hand the influence of the patient upon his family, which is not less hurtful, and sometimes, where there are children, actually dangerous. Moreover we must take into account the danger from an insane person, either to himself or to society, against which his situation with. his family affords only very insufficient guarantees. Isolation is, therefore, a measure of security and a powerful therapeutic agency"-Dr. Wm. H. Hancker, Med. Supt., Delaware State Hospital for Insane.

CLINICAL NEUROLOGY.

HYSTERIA.-A

FAVORABLE PROGNOSIS NOT ALWAYS SAFE. That a favorable prognosis is not always safe in hysteria, has been shown by Fournier and Sollier (Jour. de Med.). In some cases expectant treatment will not answer. Death may occur from spasm of the glottis. Fournier had a case with severe asphyxia in a young woman of twenty that was saved by faradism, but who afterwards had another attack, in which she died. Where there are laryngeal manifestations in hysteria it is not safe to leave the patient to herself. Potain had a case of hysterical angina pectoris that died, and the post-mortem revealed nothing to account for the fatal result. In hysterical anorexia, death also has been known to occur, even where artificial feeding has been resorted to. The system in such cases seems to have no power of absorption. Vaginal hysterectomy is particularly dangerous in such cases.-Periscope, Medical and Surgical Reporter, February 6, 1897.

KEROSENE IN ALCOHOLISM.-The most recent remedy for alcoholism in Russia is petroleum or paraffin oil, to which the notice of the St. Petersburg medical authorities was called by accident. It appears that a laboring man who had been drinking heavily for four days and nights entered, in a complete state of intoxication, a grocer's shop. Unnoticed by the shop keeper, he staggered up to an open cask of petroleum and began drinking from it. It is related that the petroleum cured him of all the effects of overdrinking; the nausea, unsteadiness of gait and headache disappeared as if by magic.-N. Y. Med. Times.

NEURIATRY.

THE TRAUMATIC NEUROSES IN THEIR MEDICOLEGAL RELATIONS.-Dr. A. L. Hall, in a paper on this subject, concludes as follows:

1. The surgeon should be an equal authority with the neurologist in determining the sequences of trauma upon the nervous system.

2. Neurasthenia is the usual form under which traumatic neurosis expresses itself, and its symptoms are indistinguishable from neurasthenia arising from other than traumatic influences.

3. The actual condition of the patient previous to the accident must be known in order to reach a correct estimate of the damage from injury sustained by the nervous system. 4. The type of symptoms manifested by the neurosis, whether neurasthenical or hysterical, is oftentimes a question of vital importance in the adjudication of a claim for damages. 5. Traumatic neurosis occurs oftenest at the centres of population, but it is by no means a rare affection in the country districts.

6. It is probable that traumatic neurosis is dependent upon some definite-yet unknown-change in the arrangement and structure of the cellular elements of the nervous system, which gives rise to stable rather than unstable symptoms.

7. A stable, well-organized symptom complex indicates damage to the nervous structures; while instability of symptoms and want of orderly arrangement denote trivial injury, -and, if long continued, simulation is rendered probable.

8. The so-called "objective symptoms" depend upon the psychical rather than the physical state of the subject, and are unreliable guides to diagnosis.

9. A correct diagnosis is best obtained from a reliable account of the accident, the history of the previous state of the patient, the presence of surgical troubles, and the existence of a stable, well-defined, organized symptom complex.

10. The term "traumatic neurosis" is an expression for an indefinite condition, and a simplification of the subject is desirable from a clinical stand-point.--Medical Record.

THE PUPIL IN PARESIS.-Simerling (Berl. klin. Woch.) refers to the Argyll-Robertson phenomenon in the insane. In 3,000 cases of general paralysis (various observers) reaction to light was lost or diminished in 65 per cent. The symptom is an early one and of importance in the diagnosis of general paralysis. Referring to the Argyll-Robertson phenomenon along with the lost knee jerks, he remarks: "the

more advanced the disease the more these symptoms are found together. Permanent one-sided loss of light reflex is rare. The irregularity in the pupil in general paralysis is well recognized. Diminished reaction to light first occurs, then total loss, then paralysis to accommodation". In a few cases of general paralysis without tabes, Simerling has noted the phenomenon recorded by Gowers, namely, the pupil first of all reacts to light, then dilates and ceases to respond. The inequality of the pupils shows considerable variability of the pupils on different days. The pupils are usually stable in general paralysis. The phenomenon was also observed in 19 cases of senile dementia and even in old people of sound body and mind. It was present in 9 cases of syphilis of the central nervous system, but was rare in chronic alcoholism. The loss of this reflex is an extremely important symptom, and even when it does not cause serious misgivings as to the presence of general paralysis, etc., it points to a disturbance in the central nervous system. General paralysis may supervene many years after the loss of the light reflex. The loss of this reflex undoubtedly constitutes one of the chief distinguishing features between epilepsia and hysteria. If the reaction is sometimes present in epilepsia, then, in the author's opinion, there is. hystero-epilepsy.

NERVOUS FUNCTIONS OF THE SUPRARENAL CAPSULES. -Dominicis has already published various studies of the functions of the suprarenal capsules, and a recent article. by him in the Gazetta d.Osp. e d Clin. of November 22, 1896, throws new light upon their connection with the nervous system. The experiments he describes on dogs and rabbits consisted in the transplantation of one capsule, after ligating its pedicle, to the internal and anterior surface of the kidney, leaving its point of attachment intact. The animal remained in the same health as before. Ten to fourteen days later, he removed the other capsule, and in every case the animal died in three hours with the same symptoms as when both capsules are removed at once. The transplanted capsule showed no traces of degeneration, anatomically nor histologically, and seemed to be perfectly normal. Its func