percentage is somewhat higher in melancholia. chronic forms of nephritis are the more

The

common, and

are especially associated with depression and dementia ; but we see also a large number of quite typical cases of acute Bright's disease. It is, I think, shown by many of the above cases that the mental disturbance is a symptom of the bodily weakness; in all cases an an intimate connection is evident; and, almost invariably, improvement in the renal disorder is attended by distinct change for the better in mental condition.

How much more prevalent renal disease is among our insane patients than among the general population of Alabama it is impossible to positively state. There is more Bright's disease in every community than is recognized; and in general hospitals kidney disease is very common, both as a primary lesion and as a complication of other disorders.

In about sixty urinalyses in non-insane patients, however, casts and albumin together have been found in twenty per. cent. only, notwithstanding the fact that the cause of the examination in many of the cases was suspected renal disorder.

It should also not be forgotten that serious Bright's disease almost invariably produces some effect upon the mental character of the patient; all physicians recognize the minor psychic symptoms of uræmia, and it should be borne in mind that, scientifically speaking, this delirium, emotional disorder, hebetude, etc., differs only in degree from a true "insanity." Not all of the nephritic psychoses are committed to insane asylums, by any means.

Edes, Tuttle, Allbutt, Spallitta and others, insist that mental disorder-especially depression and worrycause disease of the kidneys. In a certain sense this may be true, since the influence of mind over body must necessarily be recognized. This influence, however, is very indirect; and while continued mental strain may derange the renal as well as well as other bodily functions, it is not to be held accountable for the frequent co-existence

of nephritis and insanity-it can in too many cases be shown that the kidney lesion preceded the mental disorder. In not a few instances it seems to me proba. ble that the nephritis and the intellectual disturbance are of approximately simultaneous development, and due to a common cause-the poison of an infectious disease, or a poison generated in and absorbed from the intestinal canal, for instance. It is not unlikely that some light will be thrown upon not only the pathology of the mental symptoms of uræmia, but also upon the nature of some forms of the so-called Bright's disease, by the prosecution of the study of the auto-infections, which is just beginning to receive adequate attention. It seems not improbable that many of the so-called "uræmic" symptoms may be in reality the manifestations of ptomaine poisoning, rather than a result of the toxic action of urea or the ammonium salts. The reported effects. upon the animal economy of the ptomaines, muscarine, choline, neurine, etc., strikingly resemble the classic picture of some of the forms of nephritis. Instances of mental disturbance due to acute or chronic ptomaine poisoning have been reported by several recent writers.* Most poisons, including the animal alkaloids referred to, are in great part excreted by the kidneys. If these glands perform their full duty, accumulation of the deleterious matter in quantity sufficient to produce ill effects is prevented; if the poison excites disease in the kidney, or if a previously existent chronic renal lesion renders excretion imperfect, the poison, provided the source of its production remain long active, does accumulate in the circulatory fluids and ultimately makes manifest its toxic effects, mental disorder of some kind and degree being a not infrequent symptom.

Whatever interpretation be placed upon the fact of the frequent association of mental disease with kidney

*A. C. Farquharson, " Ptomaines and Other Animal Alkaloids." John Wright & Company, Bristol, 1892.

Wagner," Physical Basis of Acute Mental Disease " British Medical Journal, November 7th, 1891.

lesions, the practical bearing of the subject upon diagnosis, prognosis and treatment, and its consequent importance to the hospital physician, must be evident. It is to be hoped that continued work along this line in the wards of the numerous hospitals of the insane in our country may be productive of results of some permanent value in the pathology and treatment of insanity.

On Certain Animal Extracts; Their Mode of Preparation and Physiological and Therapeutical Effects.*

*

By WILLIAM A. HAMMOND, M. D., Washington, D. C.,

Surgeon-General U. S. Army (retired), late Professor of Diseases of the Mind and Nervous System.

GE

ENTLEMEN:-I wish I could believe all the pleasant things that my friend, Professor Roosa, has, in the goodness of his heart, just said about me. There are two expressions of his, however, which I know to be true. First, I scarcely need any introduction here, for though I have been away from you for more than four years, I feel that I am, if only for an hour or so, back among my own people, and I experience something of the emotions of the captain who walks the quarter-deck of his ship. Second, I am one of the founders of this school. I shall always regard that fact as the most honorable of all the events of my professional life-the one in which I take the most pride. The excellence of the work done here by the faculty and the phenomenal success that has attended upon their labors are circumstances of which they may well feel a justifiable elation and in which emotion I claim the right to share.

But I am not here to-day to speak of the triumphs of this school. I want to tell you of some of the work upon which I have been engaged since I left you and the story will; I think, interest a body of physicians like yourselves, who come here to learn new facts and thus to keep abreast with the progress of the age. You remember that about three and a half years ago Dr. Brown-Séquard electrified the medical and non-professional world by announcing that the expressed juice of the testicles of the guinea-pig was an agent capable,

* A lecture delivered at the New York Post-Graduate Medical School and Hospital, January 16th, 1893.

when injected into the blood, of arresting to some extent the inroads of old age and of curing certain diseases to which mankind is subject. I at I at once entered upon a series of investigations of the matter, some of the results of which are published in the New York Medical Journal for August 13th, 1889. I became convinced that we had in the juice of the organs in question a means of acting upon the body in a manner and to an extent different from that of the effects of any other substance previously known to medical science.

But, though surprising in its action, I found that there were certain practical difficulties in the way of the fresh testicular juice ever becoming of general use in actual practice.

In the first place it had to be used fresh, for if not, there was great danger of a putrefactive process being set up and blood poisoning produced, and this was the result in several cases in which it was used in this country. In large cities there is almost an impossibility of getting the organs in question immediately on their being removed from the animal.

Secondly, it was extremely difficult to filter the thick juice, even when diluted according to Brown-Séquard's directions. Filtering paper would not do, for the morphological constituents passed through and an abscess was very liable to be produced at the point of injection. A porous stone filter absorbs the juice and none of it came through, as there was never a sufficient quantity to saturate the stone and to pass through it. A large amount could not properly be made at one time, as it would not keep, so that it was necessary at every séance to prepare a fresh quantity.

After a time, therefore, during which I did my best with the fresh juice; using for this purpose the testicles of the ram and creating several abscesses with febrile disturbance, I gave up this method and turned my attention to preparing extracts, not only of the testicles, but of other organs of the body. It would be to some extent