nation of cases, and the factors which control blood pressure. A number of tables are inserted and the conclusions are as follows:

1. There is no definite relation between pressure and exalted or depressed emotional states, but the very general occurrence of higher pressures with the first few readings on consecutive days in any individual case suggests that there is some nervous condition at work which has the effect of interfering with the pressure.

2. The only condition revealed by collating a number of sphygmomanometer observations which has a constant relation to height of pressure is advancing age.

3. From pressure observations alone only a very rough opinion can be educed as to the structural alterations of the circulatory mechanism.

4. Height of pressure and slow coagulation rate are generally associated, but this is a rule to which there are many exceptions.

5. The high percentage of the smaller blood-vessels, especially renal, which present microscopically structural changes, points to the great importance of vascular lesions in the histogenesis of insanity.

6. Evidence in the form of free gland cells in the blood stream is recorded, which lends support to H. Batty Shaw's view that in some cases heightened blood pressure may be due to the entrance of kidney substance into the circulation.

In view of the fact that vascular changes are so frequently met with in the insane, the author believes that the routine record of the blood pressure in conjunction with histological examination of the blood-vessels is likely to result in a better understanding of the factors which control the circulatory mechanism, and if only for this reason is a measure which fully justifies the time it occupies.

W. R. D.

Psychasthenia. By A. H. Ring. Boston Medical and Surgical Journal,

Vol. CLXI, p. 185, August 5, 1909. This is a very good digest in which the author briefly discusses the history, symptom complex, clinical picture, diagnosis, and treatment of psychasthenia. His conclusions follow:

1. Janet, who coined the word psychasthenia, intends to include under the term, obsessions, manias of doubt, tics, agitations, phobias and the deliria of contact, states of anxiousness, neurasthenias and bizarre sensations of strangeness and depersonalization. These he would group together into a grand psychosis similar to hysteria and epilepsy.

2. Psychasthenia is at base a disturbance of the feelings, the will and perception, and may range from mere eccentricities in the superficially normal through mild depression to melancholia and dementia.

3. Two types: (1) those in which the disturbance shows itself principally in motor fatigue and (2) those in whom the principal affection is in the sensory motor and emotional sphere, the latter offering the less favorable prognosis.

4. Phobias result from an unhealthy, prolonged feeling tone of depressing ideas and may be conscious or subconscious.

a

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-Dearly 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 Aoor 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, 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