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though very interesting as regards the way in which bodily processes and mental phenomena interact, can scarcely be said to have enlightened us on the real question. Some time ago Wundt of Leipzig, in discussing Weber's and Fechner's laws, made the following statement: "Not only have we discovered the law of the dependency of sensation upon stimulus, but we have indicated the method by which the intensity either of sensation or of stimulus can be calculated when the intensity of its correlate is given. The method is simplicity itself, for it pre-supposes no more knowledge than the multiplication-table and no more apparatus than a book of logarithms"-and very much the same may be said of Ebbinghaus' law of memory. But after all this is only another way of regarding the same thing, and it does nothing in the way of showing us the real nature of the mental processes. And yet in the face of some apparent successes it does not seem right to let the mental symptoms follow their own course without some attempt to check or to modify them, after we have definitely concluded that there is no structural defect in the nerve centres and tracts. I come across people who are quite well as far as can be ascertained in their bodily processes, and yet who suffer intensely. At present suggestion, with or without hypnotism, seems to do more good than anything else. I have known a lady cured of insomnia, depression, and headache by the very natural process of having a baby. Was this a physical cure (in a way which certainly cannot be understood) or was it a mental cure, by giving her something to think about in place of the ennui of uneventful married life, thus providing occupation and mental relief?

We know the curative effect of time upon emotional states, how the most poignant grief (and this without any marked structural process) degenerates into an easily portable placidity merely by the action of a moderating influence,

which, whilst leaving intact the idea, robs it of emotional sting. You may say that through the agency of time the idea has lost its intensity through diversion of tracts to some other quarter, but this is not so, because we can prove that the idea remains in all its vividness and can be as fully discussed as ever, but it has lost its tone-it no longer affects-in a word, its accompaniment of Emotion has left it for ever.

I am not without confidence in affirming that notwithstanding the general despair as to success in improving mental symptoms when simply physical treatment seems useless there is yet ground for the belief that we may do good service by a system of mental training; but constant and personal attention is indispensable, and the process is apt to be tedious and is certainly expensive.

Perhaps I may for a moment refer to the very proper insistence made by the Lunacy Commissioners against the too common practice of placing very large numbers of insane persons under limited medical supervision. It is argued, and in my opinion correctly, that persons gradually lapse into a state of dementia because such mental energy as remains is neglected, and that if individual attention could be given the revival of nervous energy would be assured. Of the truth of this I am certain. I have often taken in hand apparently hopeless cases, and by regularly talking to them and trying to arouse dormant mental states I have succeeded in replacing listlessness by energy, apathy by attention, and impulse by deliberate will action.

In dealing with private patients the importance of small homes cannot be exaggerated, and, if possible, change of surroundings should be given, because the patience of an individual becomes weakened by too continuous effort and there is novelty in change. Where, as in public schools, there is a very large number of pupils the indifferent plodders are apt to go to the wall and only

those of brilliant promise are selected for special exhibition, so is it in overcrowded establishments-those of ponderous inactivity are left to their broodings, and recovery is blighted where a timely and continuous stimulus might be of inconceivable value.

It is above all things necessary in treating cases of emotional alteration to place them in new surroundings, away from family influences, to persist in methods calculated to arouse new ideas with their own peculiar emotional tones, so as to let the old ones starve by inanition-not so much to leave the individual to fight his own morbid thoughts (a process which often tends to emphasize the disordered function, because the very fact of trying to overcome it keeps strongly in consciousness the one thing which we are seeking to weaken)—not, I say, to leave the patient alone to struggle with his obsessions, but to take away ourselves the weight from him, to release him of the burden which he vainly tries to shuffle off. It is in this way that Suggestion becomes a powerful agent, not by pooh-poohing certain painful feeling and saying that they do not exist, but by ignoring them and setting up other strong tones, whilst we allow Time to aid us in subduing old influences. The patient must be kept going in new tracks, whilst the old footsteps are gradually made faint, not by his own scattering of oblivious sand, but by a gradual and final desuetude. This is the rationale of Freud's treatment, and it is easy to perceive how long and tedious the cure may be.

If by these means we can set up a change in the emotional tone it is but a step further to obtain success in increasing Inhibition, in strengthening the Will, because as new processes are set up so do the old constituents of the old Will fade and a new Inhibitory power is inducted. We do not call upon the patient to exert a Will which by its essential composition is a part of the same morbid

process as the Emotion, but we try to induce a new Will in harmony with the new emotions which we are seeking to arouse, a new Inhibitory Force which shall so uproot past troubles that their very existence is a lost memory. I have noticed with this emotional change that there is often an irritability of general demeanor, patients become peevish and discontented, a state compounded of despair and anger; they go from one practitioner to another, are told that there is nothing the matter with them and that it is merely a case requiring time. Then, finding that they do not get well, they naturally become hopeless and desperate, unbearable to themselves and others.

It is a mistake to tell these people that there is nothing the matter with them. Is it likely that they delight in spending their money on medical men, in the gloom of separation from amusements and family duties? What they want is disciplined treatment, not the ordinary form of rest-cure, but residence in good hygienic conditions under some one who, whilst having plenty of sympathy, can mix it with firmness and authority, so as to check the ramifications of disordered Feeling and make the patient feel how to help himself.

You will notice that it is chiefly among the better classes that the symptoms of which I have been Speaking occur; the lower classes do not suffer so much in this way; they have occupation all the day long; they have large families and are not dependent on the theaters and the golf-clubs for their diversions; for these Time is all too short, for the others it is too long and tedious. You have only to turn to the law reports to see how responsible are the sudden outbursts of Emotion for crimes of all kindsblind fury, the hasty deed, unconsciousness of all process of thought at the time, then the hasty repentance, and to all this the law is blind as regards mitigation says, in fact, "That is what I am here for-to check."

Suprarenal Extract in Vicarious Hemorrhage

BY JOSEPH W. IRWIN, M. D., Louisville, Ky.,

Formerly Professor of the Principles and Practice of Medicine in the Kentucky School of Medicine.

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From time to time we meet with cases of hemorrhage of the rectum not due to the ordinary causes, such as hemorrhoids, fissures, lacerations, abrasions, etc. We denominate such hemorrhages as vicarious, usually preceding the menstrual period or occurring at that time, taking the place of menstruation.

A young lady, seventeen years of age, consulted me, having had for six or eight months previously troublesome rectal hemorrhages. An investigation was ordered and made by a rectal specialist, who reported that he could find nothing wrong with the rectum beyond a slight hyperaemic condition just above. the internal sphincter ani. I made a subsequent examination and confirmed the specialist's diagnosis. Observing the case for a few weeks subsequently, I found that hemorrhage occurred periodically and usually preceded the menstrual discharge four or five days. The menstrual discharge was scanty, very light colored, and attended with mild dysmenorrhoea.

I concluded to try a more or less recent remedy for the relief of the hemorrhage. I prescribed suprarenal extract, 1-1000 solution, fifteen drops to be taken every three hours until the hemorrhage ceased. The second dose relieved the hemorrhage and no more of the remedy was taken at that time. The following menstruation occurred nor

mally, no rectal hemorrhage attended it. The second month slight rectal hemor rhage occurred again, when two or three doses of the suprarenal extract afforded prompt and complete relief.

I have seen within the past year five or six such cases, not always hemorrhage of the rectum, but hemorrhage. from the inner canthus of the eye, of the nose, etc., and always of a vicarious character, and in every instance I have prescribed the suprarenal extract and secured prompt relief for these patients. I am convinced from the experience I have had with the use of this drug in other hemorrhagic conditions as well, that complete cures will ultimately follow its use from time to time.

REMOVAL OF ADHESIVE PLASTER. Difficulty is often experienced and pain and discomfort to the patient in the removal of adhesive plaster, especially over hairy parts. Oil of wintergreen applied directly to the plaster spreads throughout the adhesive material and causes it to come away readily and painlessly. When extensive areas are to be be removed the application of an ointment of adepislanæ hydrosus, with 10 per cent of oil of wintergreen incorporated, is even more useful than the oil alone.

"He escaped with a sprained ankle, which is remarkable, as the machine struck him between the lamp and the radiator." Sibley (Ia.) Gazette. Reminds you of the man who was shot in the oil regions.

Deafness Caused by Telephones

BY HERBERT LANIER, M. D., Kansas City, Mo.

HE auditory nerve is the most im

Tpressionable of all the nerves of

special sense. It is a well known fact that sounds to which we are not accustomed, such as that caused by the make and break of the current from telephone batteries, frequently due to the operator's carelessness, exert a direct influence on the auditory perceptive mechanism.

Few realize how seriously the hearing may be impaired by the sharp popping noises so frequently heard in telephone receivers. To have normal hearing, a pressure of 15 pounds per square inch must be maintained on both sides of the drumhead. The eustachain tube leading from the pharynx to the tympanic cavity permits ventilation, and the normal air pressure within, and the entrance of air through the ear externally exerts an even pressure on both sides of the drumhead.

These sharp cracking noises so near the ear raise the air pressure sufficiently to force the drumhead inward. Since there is not a corresponding increase of pressure in the tympanic cavity to balance the drumhead, it destroys the normal tension of the drumhead.

Anything which disturbs the normal tension of the drumhead and assicular chain will diminish or abolish the hearing for two or three lower octones, and any disturbance of the perceptive apparatus will diminish the intensity of hearing.

These noises also cause hyperemia and congestion and stimulate secrelion and effusion into the labyrinth, causing abnormal pressure on terminal nerve filaments, resulting in tinitus aurium, neuralgia of ear, vertigo and dizziness.

The noises attendant upon the pursuit of certain occupations destroy the hear

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CURRENT MEDICAL LITERATURE.

CLASSIFICATION OF INEBRIATES.

C

HAS. A. ROSENWASSER, in the Medical Record, recognizes various types of cases, and, while, of course, individual cases present individual features, he thinks there is a certain similarity which permits of their classification into groups. For practical purposes he arranges five such groups. They will be briefly considered.

Group 1. This includes the large number of persons who, while attending to their usual vocations, are daily consuming a small amount of alcohol in some form, and who have the drink habit without knowing it. They do not get drunk in the ordinary sense of the word, they do not stagger or lose control of themselves perceptibly, but they are more or less braced up by alcohol much of the time. They are usually considered to be moderate drinkers, and almost never apply for treatment for the habit. They are of interest, however, as representing the army from which the true inebriates are recruited.

Group 2. This group comprises persons who have gradually developed from what are commonly called moderate drinkers to more or less constant heavy drinkers. The individual may or may not get perceptibly drunk at times, but it is plain that he is drinking too much. He begins to grow neglectful of himself and affairs, does not keep his business appointments, and is prone to forget his obligations to his family and to society in general. It is for the members of this group that office treatment holds out the greatest hope.

Group 3. This group is composed of those inebriates who are subject to periodical sprees, and who between the attacks are usually sober citizens, total abstainers, in fact. During the spree it

is usually necessary to overlook their wishes and deal with them as we would with any patient bereft of his senses. Restraint is often necessary. This can sometimes be accomplished by keeping the patient under the care of an intelligent nurse for a few days, or placing him in a hospital. When the attack is over most of these patients are as well as they ever will be, irrespective of the treatment applied, for periodical dipsomania is usually a manifestation of epilepsy or manic-depressive insanity, and complete recovery is decidedly rare. For many of these patients, office treatment is of value, however, for they can in some instances be taught to live so that the attacks will be less numerous and less severe, and also how to foretell the onset of the attack and to return at once for treatment on the first indication that an attack is imminent. This class of patients will tax one's patience to the extreme, but the condition is by no means hopeless. If we but get the patient to return to us in the hour of trouble and lessen the attacks and shorten their duration we will have accomplished something worth working for.

Group 4. This group is composed of inebriates who have become unable to or less drunk most of the time, they are a menace to themselves and to society. They are the individuals we see drunk upon the streets or in our police courts and jails, if they are poor, or leading wild and riotious lives and spending days and weeks in drunken revelry if they are rich. These are the patients demanding custodial care, for whose For families sanatoria are a blessing. some of the members of this group, detention over a period of years under legal commitment on a compulsory labor farm holds out a faint hope.

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