and his lectures were regarded as models of conciseness and clearness. His resignation to give fuller attention to his hospital duties, was much regretted by the faculty and the school.

Doctor Stack was an example of those quiet and unobtrusive men who live but to do their duty, seeking neither fame nor advancement, their reward being the consciousness of work well done. His devotion to his profession was tireless, his comprehension of medicine in its widest sense was deep and practical, but though fitted by ability and education for a higher position than he ever sought, he chose rather the accomplishment of good, and the relief of suffering, than self-advancement.

He is survived by an aged mother and two brothers, Mr. Geo. F. Stack, of the U. S. Post Office Department, and Jos. C. Stack, Esq., of Washington, D. C. Upon the family falls the heaviest bereavement, and they deserve sincerest sympathy. The medical profession has lost an honorable member; the patients and their friends, a friend as well as a physician; his colleagues will long miss his companionship and wise guidance; and the hospital authorities have lost a faithful and loyal assistant. May we not say of him in the quoted words of a life-long friend:

"Thou art not idle; in thy higher sphere

Thy spirit bends itself to loving tasks,

And strength to perfect what it dreamed of here

Is all the crown and glory that it asks."

I. W. BLACKBURN, M. D.

Book Reviews.

State of New York. State Commission in Lunacy. Twentieth Annual Report. October 1, 19c7, to September 30, 1908. ALBERT WARREN FERRIS, SHELDON T. VIELE, WILLIAM L. PARKHURST, Commissioners; T. E. MCGARR, Secretary. (Albany: J. B. Lyon Company, State Printers, 1909.)

This bulky volume of 1700 pages presents a very adequate résumé of the work of New York in the care of her indigent insane during the year 1908. There has evidently been no lowering of the standard of physical care and as surely a higher standard of professional care as shown by the reports of those institutions which have appointed directors of clinical psychiatry to supervise the medical work. The fullest report of this character is presented by the Manhattan State Hospital in an account of the work of Dr. George H. Kirby, the newly appointed director of clinical psychiatry. Here we have a careful psychological analysis of 1463 cases admitted in 1908 and a critical review of the significance of their mental symptoms. If the plans of the commission to extend a similar study through the appointment of directors to all the hospitals of the State are fully carried out they will greatly benefit the scientific study of mental diseases. The report as a whole confirms the conviction which we expressed upon reading the report of 1907 that the care of the insane of New York is becoming year by year increasingly better.

Tenth Annual Report of the State Board of Insanity of the Commonwealth of Massachusetts for the Year Ending November 30, 1908. (Boston: Wright & Potter Printing Co., 1909.)

This report is presented in its usual form, being well printed and bound, but it is not alone in mechanical details that it is up to its stand ard, as besides the usual statistical matters which it contains there is much more of special interest. Chief of these may be mentioned the very full reports of two conferences held by the State Board of Insanity with the trustees and medical officers of the various hospitals under its supervision on the question: How may the medical and scientific spirit be best promoted in our institutions? Here such men as Tuttle, Page, Drew, Packard, Channing, Quimby, Stedman and others give their views and, as Dr. Copp, the secretary, expresses it, "are seeking the same end, towards which we are willing to work together." This part is well worth reading by trustees and medical officers of hospitals who have the best interests of their patients at heart, as they will surely find stimulus and encouragement. There is

also much that will interest those concerned in the administrative problems of the care of the insane in the report made to the legislature by the board in May, 1908, and which fills 22 pages of the volume. Here are outlined the plans for taking over Boston's insane and putting them under State care, a movement which we understand is well under way at the present time. The necessity for every institution having a psychopathic hospital or wards is emphasized here as well as in the conference reports. The cause of many failures to secure better care for the insane in the past is due to lack of the above and the attending special care which acute cases need. The subject of family care of the insane is not dwelt upon so much as in former reports and from the fact that there was a decrease of 31 during the year 1908, and a decrease of 10 the previous year, it would seem that it is not proving so successful as was first anticipated.

The whole number of insane under care October 1, 1908, was 11,544, an increase of 776 persons, or one insane person to every 277 of the estimated population of the State. This does not include 538 unrecovered insane temporarily absent from institutions and a considerable number of others who had previously been discharged or had never appeared in institutions for the insane. W. R. D.

Index-Catalogue of the Library of the Surgeon-General's Office, United States Army. Authors and Subjects. Second Series, Vol. XIV. I-RZEHAK. (Washington: Government Printing Office, 1909.)

This volume contains 10,019 author titles, representing 5,281 volumes and 8158 pamphlets. It also contains 4065 subject-titles of separate books and pamphlets and 31,370 titles of articles in periodicals. Of special interest to those engaged in caring for mental cases are those pages on which are found such subjects as Psychalgia, Psychasthenia, Psychiatry, Psychical, Psychology, Psychotherapy, etc., but it is not limited to these as Reflexes contains many references of value. We have previously dwelt upon the value of this work to the medical world and can only reiterate it here. W. R. D.

"Der angeborene Schwachsinn in seinen Beziehung zum Militärdienst." VON THEOPHIL BECKER, Stabs- und Battaillonsarzt. Bd. XXVI, Bibliothek v. Coler. (Berlin, 1910, August Hirschwald.)

Germany, Austria, Russia and France have led in the study of military psychiatry. The first three began about 1870, while France, in the past ten years, has made rapid progress under the leadership of Granjux, Régis, Rayneau and others.

Although Soukanoff's idea of a distinct military depressive psychosis has not been accepted, still all have agreed that military life does produce a depressive coloring of the psychosis, and that recovery is found in a larger percentage of military cases than of civil cases.

Dr. Theophil Becker has given a very complete study of "Congenital Feeblemindedness in its Relation to Military Service."

In the introduction he gives some interesting tables showing that the number of cases of mental disease has gradually increased in the German Army. Thus there were 0.39 per 1000 strength in 1873, and 1.1% in 1906. Practically the same rate of increase has been noted in other armies. He gives as especial causes for increase in the armies the following facts:

1. Soldiers are required to possess much special information and to adapt themselves to new and strange surroundings.

2. There is increased knowledge of abnormal psychic conditions in the army.

On October 1, 1905, the German authorities began differentiating in their records between mental diseases and feeblemindedness. Further, Becker found, in going over the records, that previous years had always shown an increase in admission for mental diseases during the fall months-the time when the new recruits are incorporated. This is shown in the following table of average admissions:

Oct.-Nov.-Dec. Jan.-Feb.-Mch. Apr.-May-June July-Aug.-Sept.

The number of cases of mental diseases and feeblemindedness for the year 1905-06 was equal, i. e., 305 or 0.57%. But among the fall recruits the feebleminded were earlier detected and, of course, presented the evidences of feeblemindedness at the time of their being drafted. Further, he points out that some of the feebleminded were discharged in a period of excitement (the result of the strange life), and hence were counted among the mental diseases. For these reasons the author has taken up the study of the feebleminded in their relation to military service. He does not mean that this is a clinical entity, but that it includes the defect psychoses, both those that are endogenous, and those that are acquired in childhood. Naturally, the lesions in many cases are too gross, especially in the motor sphere, to pass the mustering surgeon. Although the "Burgermeister" should report all such conditions; and although they have the reports of teachers and ministers at their disposal, still some cases will pass the Board only to be subsequently discovered in the troops. Besides, there is a popular error that military service may be beneficial to these persons; and in addition, many times the questions addressed to the recruits or their families are not really understood.

In the second chapter he describes the various forms in which feeblemindedness is manifest, i. e., their heredity, their previous life, the bodily and intellectual defects, as well as those of memory and attention. He discusses their knowledge of school matters and experiences of life, and gives several examples of their slovenly attempts at writing.

In the third chapter he discusses those borderland cases that seem capable of some service.

In the fourth chapter he discusses the complications with nervous and mental disturbances, i. e., multiple sclerosis, hysteria, epilepsy, obsessions, acute confused conditions, degenerative psychosis and hebephrenia.

In the fifth chapter he discusses their relation to military law. The depression which leads to absence without leave, and desertion, deserves especial attention. Epilepsy or psychical epilepsy are often present. He draws attention to the fact that complete amnesia is not always found in these epileptic states. "Erinnerungslücken" and "Errinnerungsinseln" are both characteristic. Pathological reaction to alcohol is notoriously common in these cases, when the actions are entirely impulsive and compulsive. Pathological anger is characteristic with its removal of a controlling will. In cases of doubt he insists that the doctor should state the facts and let the authorities judge.

Chapter six has to do with the differential diagnosis. In this he lays great stress on a knowledge of their previous life, with its many defects in measuring up to the usual standards. Defects in development, especially cranial defects-stigmata of degeneration—when present in sufficient number, are very important. Usually these are noted in even a brief examination. As to the intellectual condition he has found Sommer's tables of questions most helpful. He has modified this to include more facts of everyday life. For further testing of higher intellectual qualities he follows very largely Zichen's work.

In conclusion he presents the following points:

Ist. These cases not only can not adapt themselves to military life, but they also come in conflict with military law, hence should be eliminated as soon as possible.

2d. If retained they are liable to periods of mental excitement, which, arising after enlistment, make them pensionable, and the army is obligated to care for them the balance of their lives.

3d. While the surgeons all now receive psychiatric instruction, still it is very desirable that they should spend a period at psychiatric clinics at intervals, so as to be fully informed as to the latest developments in this subject.

4th. One or more especially equipped men should be assigned to each army corps to have charge of mental and nervous cases sent to them for observation.

5th. The army in general needs to be better informed so that they may aid in speedy elimination of this unfit material.

6th. The military legal cases should be examined and reported upon, especially where there seems to be a lack of motive or something unusual about the case.

Throughout this whole book one finds completely reported and discussed cases covering the different points mentioned.