forming with the latter in architectural style. The outside dimensions are eighty by forty feet. From the main entrance to a large day-room, traversing the center of the builidng, sleeping rooms lie on either side of a corridor. This space provides for one single bedroom 11X15. The day-room, with bow windows at either end, supplies ample cross light and adjoins the service room, thus permitting complete distinction between the day and night habitation. Beyond the service rooms, sixteen feet of the distal end of the buildings are separated by a double brick partition. This gives a distinct section, with entrance and stairway, containing two bedrooms and service rooms for the use of excited persons. The disturbing element is thus removed from the quieter class during the night by half the length of the building, with several intervening doors and walls. The location of the pavilion protects the city from noise, a result which might otherwise be obtained by special disposition of the windows of the extension.

"The scheme (thus outlined) represents the logical development of the modern idea of the demands of the insane. There is no precedent upon which to formulate a prophecy of the ultimate field of usefulness or results. It is anticipated that this pavilion will furnish (1) transient accommodation for insane patients committed to a State institution and, (2) for patients who need observation before the advisability of commitment to a State institution is determined; that it will be available (3) for mild cases of insanity who may recover in general hospitals; (4) for victims of drug addiction: and, lastly, as an emergency resort, will minister to (5) rapidly developing and critical cases of delirium, and (6) to the sudden and often dangerous forms of mental disorder which occur in the course of general disease or after the shock of surgical operations and anæsthesia.

"In this legitimate extension of its work the general hospital in no way conflicts with the institution for the insane, but becomes an adjunct or integral factor. As a clearing house, opportunities are offered for the determination and preparation of patients for the latter which should greatly add to its effectiveness.

"In conclusion it may be said that with the adaptation of the facilities afforded by the general hospital, all claim of the insane may be met, and as conditions may demand treatment may be had: (1) At home.

(2) In private institutions.

(3) In general hospitals.

(a) In out-patient departments.

(b) In specially arranged words or pavilions.

(4) In hospitals for the insane.

(a) In hospital structures for the actual treatment of the acute recoverable cases.

(b) In detached blocks or colonies for the custodial care

of chronic cases."

The history of the system established in the Albany Hospital is that only incurable cases are sent to the State hospitals, and even these cases are placed under observation in the insane department of the general hospital until the physicians believe that treatment there will not result in cure in a short time. Instead of being "railroaded" to a State hospital, patients are quietly removed to the mental department of the general hospital and are there under the care of competent physicians. The same rates are charged in the insane department that are in force in the hospital proper. Perhaps in the course of a month a patient becomes well and he then returns to his home mentally sound; no one is the wiser. Every one is made happier and the patient has a different feeling himself, that he does not have to worry over the idea that he has been taken to an asylum. The financial saving is considerable; for, while the support of the insane is a direct charge upon the State, yet the town, city or county has to pay for the examination and proper clothing of the patient. This in individual casses will range in price from $35 to $50 per patient. In many cases where it is found unnecessary to commit the patient to a State hospital, this amount would be saved and a like amount would not be expended for the care and treatment of that individual patient in the observation hospital.

President Peterson, who is doing so much to improve the medical service of our State hospital system, refers to the future in the following terms:

"The twentieth century system of caring for the insane by psychopathic hospitals in the cities and colonies in the country would be incomplete if special stress were not laid on the scientific features of this system. The twentieth century finds us on the verge of a remarkable development of clinical and laboratory methods of research in the domain of morbid psychology, and the new system demands that each institution, whether reception hospital in the city or colony in the country, shall be provided with all the facilities for scientific investigation, and it is not too much to expect that present research may bear such a scientific harvest during the new century that its discoveries will startle the world; and, in any event, the unfortunate sufferers from insanity will gain immeasurably by better methods of care, treatment and cure to be ascertained in coming years.

"From the chain and dungeon to the psychopathic hospital and colony is a measure of the progress of the nineteenth century in the care of the insane. May we not employ that gauge as a measure of the possibilities of the twentieth century in the same direction?"

In addition to all the State can do, individual general hospitals must do their share by falling into line with the Albany Hospital.

The homoeopathic hospitals must not be behind in this advancement. New York City and Brooklyn may be provided for by the State, but that is no reason why the general hospitals, under our control in these two cities, should not have a mental department and do their share of this twentieth century system of caring for the insane. Buffalo, Rochester, Albany and all other cities where we have homœopathic general hospitals, must prepare for a similar line of work.

After the record made by the Middletown State Homœopathic Hospital for the past twenty-five years, under the administration of the late lamented Dr. Selden Haines Talcott, the Homœopaths of this State, or of the United States, must not lag behind in caring for our insane.

Thirteenth Annual Report State Commission in Lunacy.

Annual Message to Legislature-1903. Hon. B. B. Odell, Jr., Governor State of New York.

Journal of Mental Science.-Oct., 1902.

American Journal of Insanity. Vol. 57, No. 2, 1900.

A STUDY OF THE PRIMARY AND SECONDARY EFFECTS OF PHOSPHORUS.*

BY ELDRIDGE C. PRICE, M.D.

Baltimore, Md.

N the rush of active practice the physician is prone to forget the

IN

law in his search for the means which demonstrate the law. He may know the drug and the definite preparations of the drug that will relieve or cure the given case, but he does not know upon what law the cure depends. In fact, there are some who go so far as to say a knowledge of the laws of cure is of no practical utility, that the physician can cure as well without such knowledge as with it.

While it may be possible to accumulate a sufficient number of isolated facts to give one a fair working knowledge of therapeutics, yet, certainly, a knowledge of the reason for these facts make one both broader and more thorough in his knowledge of the practical application of these facts.

* Read at Maryland Homœopathic State Medical Society.

In very truth it would seem that an avowed denial of the value of a knowledge of therapeutic principles is but a cloak to cover ignorance. And though it is true that we know but little of this great field, yet that is all the more reason why we should add to this little.

The attitude which declares the superfluousness of approximate correct knowledge, defeats the very end which is claimed to be attainable through ignorance; the ability to arrive at a maximum degree of therapeutic effectiveness. It is this unwillingness to undertake the solution of certain discouragingly vast problems that is responsible for the unsystematized records of physiological experiments, found in our works on alleged pharmacodynamics. It is this spirit that ignores the crying need for a standard of physiological drug dosage, and it is this spirit that would turn a deaf ear to the claims of every drug for a recognition of its double action.

In this study of phosphorus an endeavor has been made to discover the primary and secondary effects of the drug, despite the absence of a standard of physiological dosage and a general lack of system in making records.

Before considering some of the more prominent symptomatic details that have been credited to phosphorus, it will be profitable to regard this agent from a more general standpoint.

Phosphorus is "a constituent of most of the important tissues, and is especially abundant in the nerve centres." This fact suggests that phosphorus bears a food relationship to the organism. It is also well known that in large quantities phosphorus will cause changes in the organism such as no food per se will produce, and these changes will sometimes go so far as to cause death. Like some other substances, iron, for example, phosphorus may, therefore, be regarded both as a food and as a drug. If phosphorus be given in proper amount to supply the needs of the organism, when this agent is lacking, it will simply restore the normal health of the individual without causing morbid disturbance of any kind; but if it be given in quantities too large, or continued too long a time, trouble is sure to result.

So far as it is possible to disentangle the effects of phosphorus as a food and phosphorus as a drug, it is found that different amounts of this agent produce different sets of symptoms. Thus, when given to the healthy in what are considered moderate doses, i. e., 1-30th to 1-15th of a grain, it increases appetite, muscle power, stimulates the circulation, facilitates mental processes and ultimately increases the weight. In addition there is sometimes an increase in sexual power.

With this general improvement in health, analy

sis of the blood shows that a favorable influence has been exercised upon the composition of hæmoglobin, the proportion of red corpuscles being increased. This action as a whole may be regarded as "tonic," and probably due to the food relationship of the element to the organism.

It is obvious that the principle involved in the foregoing action of phosphorus is that of dissimilars, whether interpreted as a simple food effect or as drug action.

When phosphorus is given in larger doses, doses short of immediate fatality, debility rapidly results, and such symptoms as denote blood degeneration, independently of local suffering; the condition which develops being exactly opposite to that resulting from the smaller "tonic" dose above noted, or similar to the condition for which the smaller dose is sometimes given.

At one time it was thought that the systemic effects of phosphorus were due to the sulphurous and sulphuric acids into which it was supposed to be decomposed when introduced into the circulation, but more recent investigations lead to the conclusion that it enters the blood in its "elemental form," and doubtless acts in this form.

The destructive changes, including hepatization of lung tissue, fatty degeneration of the liver, heart, kidneys, etc., and osseous involvement, which are reported as following the administration of phosphorus, while they may be due to an excess of this element yet it is more than the mere presence of too much of a certain kind of a food to which such morbid changes are due. Such pathological conditions, together with their indicative symptoms, are without doubt due to that peculiarity which constitutes phosphorus a drug as well as a food.

Having taken a cursory glance at the general action of phosphorus, let us now examine a little more closely the minuter effects of the drug.

In this study the endeavor has been to separate the effects into two groups of details-the primary effects and the secondary effects. To do this it has been necessary to adopt some clear idea of how to identify a primary effect and a secondary effect, respectively.

In the first place, it has been assumed that in the usual material dose, phosphorus may be regarded as stimulant to the general function of the organism, and, consequently, all symptoms resulting from material doses of the drug which are consistent and congruent with stimulation of the organism have been classed as primary, and all symptoms congruent with an opposite or depressed state of the system have been classed as secondary. Adopting as a standard of