Case No. 10.-Miss H. S., age 19 years, bright, active girl. Of late at home she had been fault-finding, irritable and showed the disagreeableness of not being well, being fretful and easily offended. Even her sweetheart causelessly ceased to interest her and went to the discard with her closely associated home interests. At home she cried, was depressed and blue to the extent of having little temper storms or uncontrollable weeping when scolded for 'imagining things." The hot days made her worse. The doctor said nothing but "'nerves," a spoiled girl" and "hot weather discomfort." He advised her to get out of doors, have company and visit some. Accordingly she went to spend the night with her girl chum. She did brighten up, chatted and seemed more like herself. They dressed for bed and as the lights were ex. tinguished she drew a concealed bottle from her bosom and drank the contents, carbolic acid. June 30th.

Case No. 11.-H. H. J., a professional man, age 52 years. He had been in a depressive state of ill health for two months. His family realized the mental character of his illness, but he was genteel, talked rationally, they said, and at times seemed encouragingly better. As the weather grew hot abruptly he seemed to stand it poorly. He was sleepless, restless and extremely sad and seemed to lose all interests. left the house in the evening to walk it off," he said. The next day they fished .him out of the river. He left $100,000 to those who kept him home to give him good care. June 30th.

He

Case No. 12.-Mrs. L.C..B, age 40 years; had not been well for ten years, though she mothered five children and was a useful housewife. She underwent a major pelvic operation five months ago, removing organs said to have nothing special the matter with them. The operator is quoted as saying the operation would terminate the menstrual function and help her neurotic condition." She became despondent, sad without external cause, confused in mind and had a general misunderstanding and misconstruction of facts. With the sudden coming of the summer heat a mental frenzy was added to her confusion and she wanted to be alone. Though attentively watched, while the husband was eating supper, she looped a stocking about her neck and over a clothes hook in the wardrobe. Thus the relief to the neurotic condition promised to the patient is apparent. June 30th.

Case No. 13.-B. N., age 43 years, al

ways a robust farmer, He complained of not being well but kept at work. His physician told him he was physically well that there was nothing the matter with him; that his nervous whims were imaginary and he could "wear that off by working and not think about himself." But he lost interest in his work and as the days got warmer he fretted and complained, was restless and slept poorly. He asked his wife if she was afraid of him. Said he was afraid of himself; that everything seemed wrong at times and he feared something would happen to him. The family felt it their duty to attend a neighbor's funeral. He would not go; said he could never stand the trip in the hot sun; said the heat was nearly killing him. While the family was at the funeral he called a friend by phone to come quick or something awful would happen. When the friend arrived he had cut his throat and blown the top of his head off with a shotgun. June 30.

Case No. 14.-V. C., a carpenter, age 40 years, working regularly. He had done his work recently with lack of interest. Would stop and study simple work as if he did not know how to put the parts together. The wife said he was depressed and that she found him crying at night. He complained of the heat, left his work and drowned himself, leaving this note: "I am tired. I know it is awful to do this but I can't help it. God be with you." June

30th.

Case No. 15.-R.E., 25 years old, a dairy worker. For a week he had been despondent. Said he was not well and wanted to go home. Said he could not stand the heat and he could not sleep; that he could not think well; that he got confused and thoughts came to him that scared him. He suicided by drinking formaldehyde. July 1st.

Case No. 16.-Mrs. R. L. W., age 32 years. The husband said she had been nervous for a month; that she was whimsical, fretful and the children annoyed her. Some nights she slept poorly. The doctor saw only nervousness aggravated by the heat. While he recognized her mental depression he said, she talked clearly. He prescribed a rest from lactation and house drudgery. The morning of July 2d she went about house duties as usual. When the husband returned from work she lay on the floor where she finally had succumbed to hemorrhage from a razor cut in the neck and one in the wrist.

The prevailing opinion is that heat is a maximum cause of insanity. These 16 suicides all occurring with our initial hot

weather, at the passing from spring to summer, when there must be that physiologic reaction to compensate the change, I thought to determine if the heat change was a factor. To my inquiry, Mr. P. Connor of the Kansas City Weather Bureau, kindly replied:

Dr. S. Grover Burnett,

No. 3100 Euclid Ave., Kansas City, Mo. My dear Doctor: I quote the following meteorological data in compliance with your communication of 24th instant:

June 29, 1913, highest temperature 93 deg, lowest 78 deg.; relative humidity 53 per cent.

June 30, 1913, highest temperature 87 deg., lowest 73 deg.; relative humidity 81 per cent.

July 1, highest temperature 82 deg., lowest 72 deg.; relative humidity 81 per cent. June 30, there was rainfall to the amount of 0.22 inch.

July 1, there was rainfall to the amount of 0.24 inch.

Aside from the fact that an appreciable fall in temperature occurred on June 30th and July 1st, there was nothing noticeable in the line of weather conditions. But the same character of change took place on the 21st, 22d and 23d of June, minus the rainfall, and excepting the three latter dates, the mean temperature was above normal from the 14th to the 30th of June. In looking over the charts for the days you mention I find but little range between cyclonic and anti-cyclonic conditions, and barometric pressure was about neutral at this place.

Very truly, P. Connor.

You will note the temperature was 93 deg. and the humidity 53 per cent June 29th with 5 suicides. The street thermometers registered a higher temperature. There was a little rain, temperature 87 deg., but the humidity was 81 per cent with 7 suicides, June 30th. July 1st, a little more rain, temperature 82 deg., humidity still 81 per cent with but 3 suicides. Leading up to this maximum temperature of the season Mr. Connor tells us that excluding June 21st, 22d and 23d, the mean temperature was above normal from June 14 to that of the 30th," therefore if the heat had been detrimental its effects were accumulative up to the humidity excess when a wave of suicides seemed to be climaxed. It is in accord with the general opinion that high humidity provokes heat collapse. To further compare the admission of patients in each of the 12 months, I have totaled each month of my records for 10 years as follows:

Total admissions for ten years.2877 These figures show relatively a small number of admissions for February, March and April. From 170 admissions in April they jump to 354 in May and 450 in June. July, the hot month, drops its admissions to 240 and August down to 150. Then comes September, the month demanding a physiologic reaction to compensate for the change from summer heat to autumn cooling, between summer and winter, with its astronomical equinox. The admissions here jump from Augusts 150 to 364, more than double, corresponding to the high seasonal change of May and June. From Septembers 364, October drops to 150 and November to 125. Then follows December, a conundrum, with 205 admissions and January, still worse, with 308, a close second to May and September. For a time, as a cause of insanity, I held the extremes of admissions in December and January; but winter responsible for the large number of on excluding acute alcoholics and acute exacerbation of the chronic alcoholics, preholidays celebrators and the post-holiday celebrants, my calculations seemed faulty. Therefore, I consulted the medical head of an institution exclusively for alcoholics, averaging 40 cases per month, and I found that their December and January admissions were two to three times greater than any like period. This is in accord with my final summary, namely, that my admissions of mental cases for December and January are not different from other average months if alcoholism is excluded.

So I would say briefly that my ten years figures do not show that extreme summer or extreme winter is an immediate, direct cause of insanity. They do indicate, however, that the monthly admissions of acute insane, after excluding the alcoholics, are not materially changed throughout the year except at the two distinct time periods named, namely, May and Jnue, the first in importance, and September in close approximation. Astronomically, you will recall, summer, in the northern hemisphere

begins with the summer solstice, that point in the e-clip-tic at which the sun is farthest north from the equator, about June 21st to end with the autumnal equinox September 22d. During cold weather the determination of eliminative functions has been from the body surface largely to the mucous membranes and deep eliminating organs. The great outer protectives fortify the whole being against cold, as a result of the active brain cell chemistry in producing heat and regulating the vascularity of deep and surface organs. As winter subsides and summer dawns there must be a reversal of all these functions in some degree. The greatest of all chemical workshops, the brain and its subsidized complexities, must furnish refrigerating media instead of heat to the tissues. The vaso-dilators and constrictors and the secretory and excretory functions must prepare the great surface evaporator, the body surface, for active reverse function, receiving useful materials and excreting useless, toxic materials. Large quantities of liquid are taken up by the mucosa and poured out cutaneously and the kidney and deep eliminatives generally are rested, a compensatory seasonal rest and activity of these important organs which, as a collective systemic accomplishment,

seems to rejuvenate the individual the individual by

seasonal epochs.

Again, suppose the taxations of winter, or other causes, debilitate the general health and the individuals physiological reactions fail to reverse the essential chemistry of tissue function, a failure to clarify the systemic test tube through April and May, meeting the precipitated summer heat of June 21st with his chemistry still in a poison cloud, unable to perspire, is it a wonder he feels "smothery" in an added 81 per cent humidity and blows up mentally rather suddenly? Suppose he Suppose he does get through this period and through July and August, complainingly and under-toned, has not this non-compensating chemistry and physiological reaction the same good reason for not meeting the September equinoxial reversal of function demanded to gracefully cross the line of demarcation between seasonal heat and cold? This would seem to point to a reasonable cause for the large number of acute insanities in my ten years statistics in their relation to heat.

But all persons do not become insane as a result of heat. Some succumb mentally and physically, suffering delirium or coma, making the alarming and often fatal clinical picture of "sunstroke." Often those recovering have mental or focal brain symptoms, or both, later, showing irreparable

have fairly melted away in the attack on its chemistry. This is best illustrated in first viewing the normal cell. Figure 1 schematically represents a brain cell with its protoplasmic branches, (1), (3) and (4), its gemules or protoplasmic buds, (2) and (5), the Nissl's bodies (6), the intracellul: r network, (9), and the nucleus, (7).

Figure 2 shows a normal cell with elongated and irregular Nissl's bodies. Figure 10 shows a brain cell of a rabbit killed by artificial heat. It shows a dissolution of the Nissl's bodies, a pigmentation of the nucleus and a dissolving of the margins of the cell body.

Figure 9 is an archystichochrome cell and should have the spindle and irregular

RABBIT
KILLEDEHEAT
Fig. 10.

MEDULLARY STICHOCHROME