with that lion for seven hours over in Paris-I tore his mouth open and ripped him up-You see, I fight with a clear conscience." When asked about his crime, said, "It was burglary; that's a cowardly crime, but I was hungry and needed the money." His handwriting showed tremor. He wrote his name as, "Henry Rinaldiny; prison name, F. G., No. 28,407" (correct). Up in the corner of the paper he drew a peculiar diagram, which he said was a secret emblem of his family. ? Twenty days

BD

after admission he no longer misnamed objects, but continued restless, incoherent, and to assert that he was a full-blooded gorilla; he frequently smeared the walls of his room with feces; picked pieces out of the flooring of his room, and had an unprovoked fight with another patient. His tubercular lesion advanced rapidly, he lost in weight and developed a considerable pyrexia, his temperature never falling below 100°, and varying between this and 103°. Seven months after admission, his term of sentence having expired, he was recommitted as insane, but three weeks after this was taken home by his sister, presumably to die. Nothing has since been heard of the case.

Henneberg, in 1904, claimed that the condition described by Ganser was very rare, not entitled to a distinctive classification, and goes on to observe that the symptom of "Danebenreden " may be found in normal persons when perplexed, and also when they intentionally give foolish answers to foolish questions. With this position Dr. Ruggles seems to agree, partially, at least, as the following quotation would show: "It seems fair to say that in many cases too much importance has been attached to 'Danebenreden,' and that further analysis would show that it was not a necessarily significant symptom, but a matter of suggestion, perversity, obstinacy, or carelessness. At least, for the dementia præcox patient, these conclusions probably hold good.

"It is possible that the symptom may have another meaning with hystericals, but this seems improbable when we consider the notorious perversity of these patients.

"The desire to answer incorrectly, combined with the wish to answer with the greatest possible ease, would seem to form a sufficient explanation for the larger part of the cases."

This is the conclusion of Dr. Ruggles' article, and may be true of cases which present the Ganser symptom alone, and are not in the confusional state. I have not, however, observed the symptom or the peculiar confusion before in the four State hospitals where my experience has been gained, and do not feel justified in drawing positive conclusions as to the distinction between the symptom and the symptom-complex.

In none of these five cases was a complete anamnesis obtainable, and the history of the onset particularly was incomplete. They were all felons and ranged in age from 18 to 28. The cause of insanity was not assigned in any case, but in Case I, with a diagnosis of manic-depressive insanity, mixed type, it was, at least, partly due to a recent circumcision and vaccination; Case II, diagnosis, manic-depressive insanity, manic type, had been punished very frequently in prison; Case III, diagnosis, manic-depressive insanity, manic type, made a false claim of malingering; Case IV, diagnosis, excitement not sufficiently distinguished, had a depression in the frontal bone from a fall II years previously, or at the age of 9 or 10; Case V, diagnosis, excitement not sufficiently distinguished, had advanced pulmonary tuberculosis. Four of the patients had been alcoholics, but over 72 per cent of the admissions of the Dannemora State Hospital are intemperate.

The two who were discharged recovered, the one who was discharged improved, and the one remaining in the hospital improved, did not have complete amnesia for the attack, but recalled, although not clearly, their answers which manifested "Danebenreden," and the cases were otherwise typical. No satisfactory explanation of this fact has occurred to me, but they were very closely questioned regarding their memory of the confused period. In all, the symptom was of short duration and sudden cessation. The fifth case showed the typical symptom for 20 days, but continued to give silly answers, and the confused state persisted until his discharge after seven months.

All appeared to be constitutionally inferior, and two had previously served terms for felonies. Constitutional inferiority is the rule among criminals, and explains why a frank case of manicdepressive insanity among the psychoses with which they are afflicted is a rarity, the great majority having a marked and somewhat similar paranoid trend.

With perverse and silly answers to the examiner's questions, in various widely differing psychoses, we must all be familiar; but the peculiar confusion and misnaming of objects seen in these cases and in the case reported by Dr. Frost seems to present a definite picture, and to merit the retention of the distinctive term in honor of the original observer, and to deserve the interest of further study.

BIBLIOGRAPHY.

1. R. Henneberg: Ueber das Ganser'sche Symptom. Allgemeine Zeitschrift für Psychologie, 1904, p. 621.

2. A. H. Ruggles: Observations on Ganser's Symptom. American Journal of Insanity, October, 1905, p. 307 (with a very complete index of references).

3. H. P. Frost: Hysterical Insanity: Report of a case presenting Ganser's symptom-complex. American Journal of Insanity, January, 1907.

p. 301.

AN ANATOMICAL ANALYSIS OF SEVENTY CASES OF

SENILE DEMENTIA.*

By C. G. McGAFFIN, M. D., TAUNTON, MASS.

The following analysis of the Taunton State Hospital autopsies on cases of senile dementia or cases so diagnosed by members of the staff of that hospital, was conducted independently of Dr. Southard's analysis of the Danvers State Hospital material, and subsequent to it, to discover whether the Taunton material, diagnosed by a different staff, would contain a similar grouping of conditions.

Clinics have been held similarly to the Danvers method, already described, but not all of these cases here considered have been passed upon by the whole or a majority of the staff, but by the superintendent and one assistant physician. Many, however, were presented at the staff meetings, and all the data that could be secured from that source have been used.

From the opening of the Taunton laboratory in May, 1898, to the first of January, 1909, 328 autopsies have been made. On 75 of these a diagnosis of senile dementia was made, or 23 per cent.

This high percentage is not unusual, and a similar one is to be found in the records of nearly every insane hospital and asylum in the country.

In five of these cases the head was not opened, leaving 70 cases as the basis for this report.

For many years it has been thought by psychiatrists that senile dementia was rather a "dumping ground" into which to cast many heterogeneous cases arising after the sixtieth year of life and showing symptoms, one or some of which might fall into the group of symptoms usually characterizing this psychosis. Too little attention was paid to arteriosclerosis of the brain as an entity, and it was held that such atheromatous change and senile dementia were identical and the one affecting the brain necessarily entailed a diagnosis of the other; also organic brain disease was too often overlooked.

* Read at the sixty-fifth annual meeting of the American Medico-Psychological Association, Atlantic City, N. J., June 1-4, 1909.