5. Doubts and indecisions are evidence of fatigue of the higher centers which preside over formative and newly synthetized associations. The final judgment is thus rendered difficult or impossible and the victim finds himself in a state of vacillation and with a tendency to revert to the lower and simpler associations long formed. Weakened cerebral inhibition also plays its part.

6. Obsessions and impulsions are the emotional result of the above factors and show themselves principally as a failure to inhibit the feelingtone of ideas automatically repeated, yet the all-pervading asthenia checks the impulses short of accomplishment.

7. Psychasthenia should be differentiated from hysteria, epilepsy, dementia præcox, manic-depressive insanity, and paresis.

8. The treatment is largely prophylactic and educational.

W. R. D. Considérations thérapeutiques sur les troubles mentaux d'origine toxique. La médication iodée. Par HENRI DAMAYE. L'Echo Médical, Annee 12, p. 381, 9 aout, 1908.

The author, briefly discussing the subject of intoxications, refers to his treatment of confused and stuporous cases with iodide of potassium. He believes that iodine has a specific action upon ganglion cells and explains the remissions in paresis by what he believes is a temporary cessation of the intoxication. He suggests that the group of confused cases have an acute or a subacute period of confusion which he terms the therapeutic period and is of the opinion that in this proper treatment may prevent the case from becoming a chronic one. Abstracts of ten cases are given, six of which were cured, two improved, and two unchanged. Details of the method employed follow. From the abstracts the impression is derived that the general treatment by rest, diet, etc., may perhaps have had quite as much to do with bringing about the recoveries as the iodine medication. References are made to several papers on the same subject. The author believes that the iodine medication is at last an adjuvant to more general measures, and that by its use we may shorten the course of the mental trouble. W. R. D.

Considerazioni statistico-nosologiche sulla demenza precoce. Pel ALBERTO ZIVERI. Il Manicomio, Anno XXIV, p. 87, 1908.

This study was made on the patients at the hospital at Brescia, Italy, which has a total population of 568, or 278 men and 290 women, the cases of dementia præcox forming 25, 28, and 22 per cent, respectively, of the above numbers. In the majority of cases the onset was between the ages of 20 and 25. All of the cases are placed in the hebephreno-catatonic and paranoid groups, which seems a somewhat meager clinical classification, 80 per cent of the men and 87.5 per cent of the women belonging in the former, and 20 per cent of the men and 12.5 per cent of the women in the latter. These are the principal statistics which are shown in the tables given. Comparisons are made with the results of other writers, which

are numerous. The author then discusses etiology at considerable length and gives several case abstracts. He concludes:

1. That dementia præcox is always a constitutional disease (in a broad sense, that is to say it may be so regarded as much on account of the changed metabolism as by a deviation from the normal mental) and as such may sometimes be developed (though more slowly) without any apparent external etiological factor, but also frequently brought about and accelerated in its course and termination by many accidental factors (emotions, ill usage in a broad sense, trauma, intoxications and infections.)

2. A dementia præcox from an accidental cause as of post-infective or post-toxic origin does not exist, but we may have a pseudo-dementia syndrome which is post-infective or post-toxic, occuring in few cases in which an amentia instead of terminating in recovery has an unfortunate end and is succeeded by a demential state which may have some analogous characteristics with dementia præcox, and from which it is difficult to establish the differential characteristics with certainty. This form does not appear to attain to the unity of dementia præcox, and it would seem that there are various diseases or syndromes included in the latter. It is important to keep the syndrome of dementia præcox as formulated by Kræpelin intact. W. R. D.

De la soidisant "paranoia." Par DR. SERGE SOUKHANOFF. Journal de Neurologie, 14 Annee, p. 241, 5 Juillet, 1909.

In this paper Dr. Soukhanoff discusses the work of Kræpelin and other modernists who have done much to formulate the present views regarding paranoia, and compares the teachings of the present day with those of the past. He satisfactorily sums up his paper with the following conclusions: 1. Chronic paranoia with hallucinations is a form of dementia præcox. 2. That form formerly known as reasoning paranoia belongs to the order of reasoning psychoses, that is, one of the constitutional psychopathies. 3. Acute paranoia should be counted as a maniacal-depressive psychosis. 4. The paranoid symptoms observed in the chronic intoxications should be entered under the corresponding title of the so-called psychoses of intoxication.

5. Of the complex group of the former paranoia there does not remain any symptomatic complex which may actually be considered as an autonomous disease.

W. R. D.

Half-Yearly Summary.

CALIFORNIA-On June 10, 1909, the State Commission in Lunacy decided upon an increase in salaries of the medical officers of the State hospitals, those of superintendents, which are now $3000, being $3600, and those of the assistant physicians being increased proportionately.

-Southern California State Hospital, Patton.-There are now under construction the following buildings: A receiving cottage, which is really a group of three, consisting of two wings, one for male and one for female patients, which will hold 30 patients each, and connected by a two-story building, the first floor of which will be used for hydrotherapeutic purposes, and the second floor to be occupied by nurses. There will be an extra large corps of nurses on duty in this building, and the ratio will be one nurse to six patients. There is also building a cottage for the first assistant physician. Contracts have been made for the following buildings: One large two-story cottage for 80 female patients and to cost $40,000; another cottage of cheaper construction for 75 patients, which will cost $20,000. In addition to the above work the erection of a second story of the building, known as the Congregate Dining Hall, will soon be begun. This second story will be divided into small wards and occupied by 100 male patients. It is to be an open ward and patients confined here will be employed about the farms, grounds and orchards. The cost of these buildings are covered by special appropriations passed by the last legislature.

In addition to the foregoing, contracts have been let for the erection of two small cottages at a cost of $7000, which will hold 30 patients each. These two cottages are especially designed and adapted for tubercular cases, and these will complete a group of four cottages, the four having a capacity about 100 beds.

COLORADO.-The legislature recently made an appropriation to establish an institution for the care of the feeble-minded, to be located on farm land near Denver.

-Colorado State Insane Asylum, Pueblo.-The Board of Lunacy Commissioners awarded contracts August 10, 1909, for the erection of three new cottages, for 100 patients each, at a total cost of $150,000.

DISTRICT OF COLUMBIA.-Government Hospital for the Insane, Washington.—The Training School held its graduation exercises recently and 12 nurses, 10 women and two men received diplomas. Seventeen attendants

successfully passed the examination of the junior year and are eligible for membership in the senior class. With the appointment of a chief of the Training School, which has been recently effected, it is proposed to outline a course of even more practical instruction than heretofore, and it is the intention to have a complete canvass made with the object of inducing as many attendants as possible to enter the school. This hospital is frequently called upon to furnish to the community in which it is located employes trained as mental nurses in order that their services may be made use of in private work, and it is hoped to train in the future a much larger number, so that, as the community may wish from time to time to be supplied, the institution will be in a position to meet the demands upon it in this particular.

As a result of a series of staff meetings, which have been attended by the members of the medical fraternity in Washington generally, a bulletin containing the papers presented at these gatherings has been issued. This publication has been put forth as an effort toward fulfillment of what is conceived to be the true position of a hospital for the insane, viz., that it should not only be a center for psychiatric information, but a center for the distribution of that information. The bulletin contains the following papers: 1, The Relation of the Hospital for the Insane to the Medical Profession and to the Community, by Wm. A. White, M. D.; 2, The Present Status of Psychiatry in America, by Henry W. Miller, M. D.; 3, The Morbid Anatomy of Mental Disease, by I. W. Blackburn, M. D.; 4, The Functional View of the Insanities, by Shepherd Ivory Franz, Ph. D.; 5, The Standpoint of Histopathology in the Study of Mental Disease, by Nicolas Achucarro, M. D.; 6, The Use of Association Tests in Determining Mental Contents, by Shepherd Ivory Franz, Ph. D., and Wm. A. White, M. D.; 7, A Case of Unilateral Hallucinosis (Alcoholic), by Wm. A. White, M. D.; 8, A Case of Delirium Produced by Bromides, by Mary O'Malley, M. D., and Shepherd Ivory Franz, Ph. D.; 9, The Cytological Examination of the Cerebro-Spinal Fluid, by William H. Hough, M. D.

The Amusement Hall has been practically completed, the contractor's work having been nearly finished, while contracts have been let for the furnishing of the building. It will seat approximately 1200 people, provision being made for the accommodation of more than 800 downstairs and over 300 upstairs. The building is a modern one in every respect; it has been built of brick with white terra-cotta trimmings, to harmonize in appearance with the buildings of the hospital extension, contiguous to which it is located, and is admirably adapted in every detail for the purpose for which it was designed.

A new boiler house is being erected and will contain four 300-horsepower boilers. When it is completed it will be coupled up with an existing boiler house and from this source there will be supplied all of the power and heat for the entire plant.

With a view of adding profitable stock to its herd of cows, the hospital has had erected on its farm at Godding Croft, Md., a modern barn to pro

vide for the housing of 60 calves. It is the intention to supply the cows for the hospital herd hereafter through the medium of the retention and the raising of calves on this farm and fifty are already being cared for at this place, to which have been removed also the poultry yards maintained by the institution.

The plumbing in the home and the relief buildings has been completed and Oaks A Building has been remodeled, so that the tubercular ward has been made materially less, and the remainder of the second floor has been given over to white female patients, with physicians' quarters in the front. The capacity of the building has been increased by approximately 15 beds.

With the opening of a number of additional wards in the hospital during recent months, all the space available for patients has been practically taken up. As all the wards are now occupied, and as the population of the hospital is rapidly increasing, the time seems not far distant when they will be crowded.

Meters have been ordered for the wells, kitchens, pumping station and power house and when they are installed it is expected to be able to keep account in a more systematic manner as to the cost and the use of hot and cold water.

In the laundry a female assistant to the foreman has been appointed to have direct charge of the women employes and to act as the housekeeper for this class of employes.

A work of importance is about to engage the attention of the electrical division of the institution in the re-wiring of the old buildings of the hospital and the laying of conduits throughout the grounds for the proposed change in the electrical plant from a direct to an alternating current.

ILLINOIS.-On July 1, 1909, the State hospitals changed names: that at Bartonville, which has been known as the Illinois General Hospital for Insane, will hereafter be called the Peoria State Hospital, and the others will be known as Jacksonville State Hospital, Elgin State Hospital, Kankakee State Hospital, Watertown State Hospital and Anna State Hospital. These were considered more convenient than the old titles.

At the last session of the legislature an appropriation of $803,000 was asked by the State Board of Charities to establish colonies of epileptics at Kankakee, Anna, and for feeble-minded epileptics at Lincoln.

-Anna State Hospital, Anna.-On April 16, 1909, a new psychopathic hospital was opened here with appropriate ceremonies, addresses being made by Dr. William L. Athon, the superintendent, by Governor Deneen, by Dr. Frank Billings, president of the State Board of Charities, and by Judge Monroe C. Crawford, county judge of Union County. The cost of this hospital was $50,000 and it is modern in every respect. A similar hospital was recently opened in connection with the Watertown State Hospital, which cost $100,000, and two, one for men and one for women,