The prevalence of fashion in medical thought is illustrated by the fact that the Irish seventeenth century theory of the contagiousness of phthisis still prevailed at that time at Rome and the room in which Keats died was treated as if an infected person had died therein.

Taking into account all the circumstances of Keats' career: His lack of fixity of purpose, which even Shelley found evident in "Endymion", his suspicional tendencies described by himself and others, the emotional mobility noted by Lord Houghton and others and clearly evident in the jocose satire on George IV, his irascibility and pugnacity as well as his heredity, the influence of phthisis on Keats' mental state is clearly manifest.

If he had confined himself to the regular routine life of the medical practitioner, his life might have been preserved, since the emotional alternations of the life of the man of letters were certainly productive of vasomotor changes stimulating the mental and other symptoms of phthisis, and thus producing exhaustion.

The influence of phthisis on the mental state of Emily Bronte is equally demonstrable. Her keenest biographer, Miss Robinson, says: "Insanity and genius stand on either side; consumption has worse and better angles. Let none call it impious or absurd to rank the greatest gift to mankind as the occasional result of an inherited tendency to tubercular disease. There are of course very many determining causes. Yet it is certain that inherited scofrula or phthisis may come out, not only in the diseases, but in alternation for better or worse condition of the mind. Out of evil may come good or worse evil."

The father, Rev. P. Bronte, could not be called a pleasant easy-going husband and father. He rivaled Carlyle in being "illgey to live with". "How I pity his delicate wife who sat lonely and neglected as he was studying or when he did not come, bore with patience his stern peremptory manner. He was a passionate brute, cutting her favorite silk dress into shreds because he, her lord and master, chose that she should not accept a gift. He threw the children's pretty shoes in the fire because forsooth he

did not fancy the color. Occasionally he would vent his beast-like rage by firing pistol shots out of doors. A union of this semi-insane temperament and consumptive constitution of his wife certainly produced genius tinged with sadness".

The history of the two Bronte sisters certainly affords abundant evidence of the mental symptom associated with phthisis observable in Keats.

One lesson stands out prominent from these facts, the mental symptoms of phthisis are caused by and cause physical unrest. The interaction of these two factors tends to accelerate the progress of the disease and, by increasing. the physical exhaustion of which they are the expression, to decrease the chances of recovery. The mental condition of phthisis therefore needs as much attention as the physical. To calm the restlessness of the phthisical is therefore to add one factor toward recovery. Antipyrin in small doses has been found by Clevenger to be of value in this direction. I have found acetanilid contraindicated but have noted that phenacetin exerts a beneficial influence. Loomis is of the opinion that these drugs owe their influence in fever less to their antipyretic power than to their influence on the excitability of the nervous system. This excitability is present in all mental conditions attended by suspicion. The moral treatment of phthisis is no less likely to be of value than medical treatment. The fact should also be remembered that the precocity of these phthisical and scrofulous children, is a symptom of disease likely to result in mental and physical break-down ere the period of puberty be past.

(To be Continued.)

IMPERATIVE CONCEPTIONS.

THE

A Note by C. H. HUGHES, M. D.

HE insane display with their delusions many morbid states besides, some of which are clearly comprehended by the general practitioner and some are not, and even the mind of the skilled psychiatric clinician and experienced student of medico-legal alienism, is not always clear upon. all of these states. Among the data of Alienism the morbid impulsions of the homicidal, suicidal, pyromaniacal, kleptomaniacal and the perverse inclinations and acts of the reasoning or affective insane are well enough known to psychiaters. These, as well as singular aversions and freaks of speech, feeling and conduct, are recorded in the literature of insanity. But the imperative conceptions of the insane independent of delusions as evidence of mental unbalance were questioned in the Guiteau trial and are still doubted by some eminent authorities.

The following auto-description sent me by a patient whom I have had under treatment will settle this question. Impulsions to suicide and extreme melancholia atonita have coexisted in the history of this patient who is now much improved as to these mental states, and it may be premised that she descended from an irreproachable and upright ancestry, being the daughter of a distinguished English-speaking divine noted for his probity and piety, and she herself is a christian church member, hitherto noted for her religious. fervor and zeal and indefatigable church work.

Here is the record so far as I may give it without disclosing too much of the personnel of the patient.

M.-A.

Dr. Hughes:-I write to know if you thought it would do me any good to take medicine at home, that is, if you can send me some without me going to see you. I am not well by any means, and yet I am not sick. You said for me to quit swearing. I can't, would that I could. I go about my work crying and talking. I will say, "well I just will not do that any more," and it will not be five minutes until I will be at it again. It seems to me I have done awful deeds and they follow me, or that I am possessed of evil spirits and can't get rid of them. I think and say such awful things. I never did so before, and do not believe I want to now. It is not convenient for me to go to St. Louis so often, and I do hate giving up being cured. If you will oblige me, write and tell me what you think. Direct to M. M. A.

When such imperative conceptions pass the boundary line of normal restraint into the uninhibitable realm of mental aberrations and become resistless expressions and acts violative of the proprieties and normal restraint of environment and have a recognizable disease for their basis, we class them as evidences of insanity. The mental state is that of insanity, and the condition is only a question of degree, for here is ill health affecting the brain and a change of natural character out of harmony with natural self and environment as a consequence, and this is true mental aberration.

One of my office patients while engaged in business came to me expressly to be relieved of a conception and impulse to kill a certain person in his employ. He had insomnia, cerebrasthenia and apepsia nervosa. When relieved of these nervous conditions, he recovered. Some years subsequently he actually attempted to kill one of his men, for which he was arraigned and taken into court. He was not under treatment at the time.

Recurring morbid conceptions and frequent impulsions to suicide are often observed in every neurologist's practice, certainly they are very frequent in mine.

Enough significance is not attached by the general practitioner to the imperative conceptions and morbid impulsions of cerebrasthenic dyspepsia. They are not so frequent as the phobias, but they do exist in some patients and will be revealed to us if we inquire closely of the psychopathic cases. A volume might be written in illustration of the many forms of imperative conceptions and impulsions of the actively neuropathic, but to enumerate them is not the intent of this article, but simply to illustrate the nature of the imperious conception which so often precedes the recognized outbreak and overt act of insanity.

Wigan, author of "Duality of the Mind", who was an acute observer, as well as an ingenious theorist, called these cases "madness of volition", "a state of mind so common", he says, "that no person at all conversant with the management of the insane but must have met with many instances". He could enumerate many examples of it, "the most remarkable of which", he gives the following, which by the way is a case of true folie circulaire of the French, the cyclothemia of Kohlbaum:

"I was once visiting at a very respectable establishment for persons of deranged intellects of the upper class, when the house was suddenly disturbed in the middle of the night by the violent noises and language of a young gentleman who had been long an inmate, and whose disease assumed a character of periodicity. There was a kind of cycle, beginning with intense despondency, passing on to composure, to cheerfulness, hilarity, boisterous gaiety, violent and convulsive mirth, extravagant volubility and wit, gross and monstrous obscenity, incoherence, and thence into the most furious mania, requiring coercion. This gradually subsided into melancholy, left him two or three weeks in a state of tranquility, and then went again. its miserable round. On the present occasion the patient insisted on seeing the head of the establishment, but as he was manacled by both wrists to the bed, it was not thought necessary to comply with his demand. The violence of the efforts he made and his furious screams, at last alarmed the attendants lest he should break a blood-vessel, and the