The means used in the conducting of revivals are, it will be clearly seen, such as will excite the emotions alone in the greater majority of cases; and while these generally do no harm, still in many instances they undoubtedly do mischief. "For it is a known fact, that intense or longcontinued emotional disturbance is one of the chief factors in the causation of insanity." Persons without much education of course depend on their emotions to a greater extent than those whose intellects are better developed, and, as a consequence, their thoughts and actions are generally as unstable and fleeting as the emotions themselves. But cases occur in which an emotion not only becomes intensified in power, but assumes a permanency altogether inconsistent with a normal condition, such condition being embraced under the definition of emotional insanity; and when the aberration of mind is chiefly exhibited by the disturbance of some one emotion it is called emotional monomania. And many persons are in this condition, I am convinced, through the means used in conducting revivals. In fact, the statistics of Ohio for 1882 show that in the twenty-eight years which the Asylum for the Insane at Cleveland has been in operation, religious excitement came fourth in the list of the causes of insanity, being exceeded only by masturbation, intemperance and domestic difficulty, and these were only slightly in advance. Also, that of the two hundred and ninety patients admitted to the Asylum at Columbus, during that year, twenty were insane from religious excitement, out-numbering any other one known cause. They further show that since 1855, two hundred and eight persons have been admitted at the Dayton Asylum, insane from this cause, being exceeded by only two other ones, namely, masturbation and domestic trouble; masturbation being the cause in three hundred cases and domestic trouble in two hundred and ninety. It will be seen from these statements that the position occupied by religious excitement in the list of the causation of insanity, is about on a par with any other known one. In emotional monomania there is not necessarily either delusion or error of judgment, but it generally happens that the intellect, sooner or later, becomes involved. This condition often evinces itself in religious services in very curious ways; for instance, in the community where I live, there are a number of people who have banded themselves together under the name of "Second Work" People. They believe in, and profess to have received, a second blessing from the Lord, and claim that it is impossible for them to sin-a delusion under which, I may remark, people who trade with them do not labor. They also imagine that they are persecuted by the regular Church, so they hold

cures.

presence

meetings in halls and private houses, where most extravagant proceedings are indulged in. I am personally aware of two cases of insanity which have been caused by emotional excitement generated at these meetings. There is now in the city of Boston a sect who imagine that the of disease in the body is caused by the absence of the spirit of God, so they cure disease by placing the back of the person afflicted against that of one whom they imagine to be without sin, and claim to effect many It will be clearly seen by the medical mind that cases of hysteria and like troubles are the only ones cured by such proceedings as these. After a view of some of the evils arising from the modes of conducting revivals and the failure to attain the end that is desired, it will be seen that we cannot always approve of the methods of conducting them. But it will be well to remember that much good has undoubtedly been done, and that as the molecular structure of no two brains is alike, so no two persons think exactly alike. Therefore, we should live under that beautiful rule laid down by the martyred Lincoln, "With malice toward none and charity for all, doing the right as God gives us to see the right." And lastly, in considering the truth of these matters, it will be well to remember that when Pontius Pilate asked Jesus himself the direct question, "What is Truth ?" he received no reply. Has that question been answered to this day?

SCIATICA WITH FALSE ANCHYLOSIS OF HIP-JOINTS.

BY W. E. ALDERSON, M. D., RUSSELLVILLE, KY.

The following case, which I beg leave to submit, may possibly be of some interest, because of its persistence, notwithstanding the most active and scientific treatment by the best talent from the first twinge of pain, fourteen years ago; the character and intensity of the pain; the effect upon the muscles; fixation of the hip-joints, and the apparent recovery from all this since November last.

Having treated with success a case similar in origin and initial symptoms, the same plan was determined upon with this patient when coming under my care, but, I confess, with many misgivings and apprehensions of decided failure, in view of the very superior advantages of treatment which he had before possessed.

ALDERSON-Sciatica With False Anchylosis of Hip-Joints.

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Mr. J. R. B, aged 38, married, prior to this disease had been a stout, robust young man, and always enjoyed good health. In July, 1869, had an attack of malarial remittent fever, continuing four weeks. Convalescence was slow and as a sequel came the first symptoms of that which was to torture him so long, manifesting itself by sharp and lancinating pains at base of spine, radiating to hip-joint and down the right thigh; great muscular weakness supervened, so that in attempting to rise from a sitting posture or to bend the body when erect, would cause a fall forward. Temporary relief was obtained by external applications, the paroxysms becoming periodical and of varying intensity until the following July (1870), when the disease again became very severe, but yielding some under treatment as before. From vicissitudes in temperature he then suffered more or less until the same month in 1872. At this time more serious symptoms begun to develop, the pain being constantly aggravated in region of spinal cord, and his locomotion was so much affected that he was compelled to resort to canes for support in walking. His condition remained very much the same until 1881. During the time, however, from a previous diagnosis of rheumatism, he visited Hot Springs, Ark., and for two months, March and April, 1879, was treated with electricity and baths, but without benefit. In the Spring of 1881, he was confined to his bed, the puncta dolorosa now being manifested, the most severe point being half way between the trochanter major and the tuber ischii and another at popliteal space. These "held their own" pretty well from this on until his final improvement. By hypodermics of morphia excruciating pain was, in a measure, relieved. Upon getting up he was now forced to use one crutch, his gait becoming more unsteady.

About this time the great efficacy of the waters at Eureka Springs, Ark., was being extensively advertised, and the patient tried their healing power conjoined with mechanical treatment for the space of two months, the former failing and the latter giving relief for a little while after each application. This was effected by some kind of pneumatic apparatus which being fitted air-tight to the limb and the enclosed air exhausted, thus relieved the pressure from the nerve at the sciatic foramen.

The following year again found him at Hot Springs from September to the middle of December when, in addition to the baths, he had internal medication and the application of the actual cautery to both hips, the pain now being bilateral. When applied in the evening there was relief for six or eight hours, but when left off his nights were passed in cease

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less vigilance. He returned home heart-broken and discouraged, giving up, after all his forbearance, as a helpless and hopeless invalid, confined to his bed suffering excruciatingly from starting pains, involuntary muscular contraction, and unable to bend or move his limbs. Morphia, being his only relief, was now used constantly for several months, two full doses per day being given hypodermically.

return.

In April, 1883, he was taken to Cincinnati and placed in the City Hospital, under the care of Dr. C. G. Comegys, who continued his medical adviser after his return home until my charge, and to whom I am indebted for many valuable suggestions. In the hospital measures for the relief of the agonizing and exhausting pain of the sciatica were first instituted before attempting any treatment for the anchylosis. These consisted of hypodermics, deep into the tissues of each buttock, of pure sulphuric ether. This was done once or twice every day. The relief was almost instantaneous and lasted several hours, but there was always a Similar injections were also given afterwards by his family physician and with the same result. Having under this anodyne obtained rest and consequent increase of vital energy, attempts were made, under full anesthesia, to break up the adhesions about the joints. This operation was performed once and the resulting inflammation combated by counter-irritation, subsided in a few days. Passive motion of joints was now kept up from day to day and the patient was soon able to take exercise upon his crutches. With this improvement, after a stay of three weeks, he returned home with the strict injunction to keep up the passive motion and daily voluntary exercise. Shortly after his return, however, the pain set up with renewed intensity and the joints became as rigid as Worn out with discouragement and great nervous prostration, there was developed such extreme hyperesthesia and morbid fear of pain that there was an almost absolute loss of will-power. So very sensitive and highly wrought was his nervous system that the slightest pull upon the bed-clothes, or jar to the bed, would call forth a scream of agony. The touch of the finger upon either thigh would elicit involuntary muscular contractions and terrible pain in and around hip-joints. His nights were passed in restless and sleepless anxiety, unless he was heavily dosed with morphia. He remained in this condition until August when, the morphia having been withdrawn, and that too without any of its terrible sequels, he was put upon the use of the specific tinct. of pulsatilla, ten (10) drops four times a day, the last dose at bed time. The result by the first of October. was truly marvelous. There was comparative freedom

ever.

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ALDERSON-Sciatica With False Anchylosis of Hip-Joints.

15

from pain when still, cessation of the nightly starting-pains, and consequently sweet, refreshing sleep. He was, however, unable to move his lower extremities or to be turned in bed, being perfectly rigid, fixed upon his back. Any attempt to move his limbs would bring on firm contracture of muscles and tendons around hip joints, so that they were held as in a vice. There was shortening of right limb, apparent lengthening of the left, and marked atrophy of thighs. The sarcolemma had become absorbed, so that muscles presented to the touch only tense fibrous bands. The trunk and upper extremities were muscular and well-nourished. His appetite was good, bowels and kidneys acting normally. Some trophic changes gave cause for considerable apprehension. Severe herpes appeared upon feet and toes, accompanied by ulceration around nails. This yielded to internal use of organic acids and application of astringents after some desquamation and the loss of several nails. Excessive sweating of the feet occurred and had quite an acid odor. The hair changed color to a considerable extent, becoming gray and brittle; no changes in vision. A cursory view of some of the symptoms manifested in this case might lead to a diagnosis of hysterical joints, but while, satisfied that the long suffering and great depression of mind had added a strong hysterical element, yet, upon a careful differential diagnosis, such an inference was excluded. Under ether, I found that there were no well-marked organic lesions. There was evidently thickening of the perisynovial structures from inflammation, and the constant contraction of the tense, atrophied muscular bands increased the sensitiveness and produced the anchylosis. Owing to this combination of elements my treatment was both moral and physical, if I may so express it. The patient, being a gentleman of education and refinement, could comprehend the theory. of his trouble, after explaining carefully my conception of the condition of his joints, their ligaments and the muscles surrounding them, impressing it more forcibly by diagrams. The plans and rules of treatment were then detailed, and it was understood that they would be gently but rigidly enforced. He readily promised me his co-operation by strong efforts at will-power and endurance. His sufferings were most intense, but the fortitude displayed was wonderful and one of the prime elements of success.

Galvanic and faradic currents, massage, kneading of muscles and passive motion of joints was the treatment, each being performed by the medical attendant himself. Electricity was applied, at first, four times a week, in the following manner: A zinc plate attached to positive pole was placed upon a foot and a sponge on negative pole rubbed well over