side of the narrow lath and destruction follows. Fear Las now paralyzed confidence in our power, and we no longer are able to do these feats. Now, let us analyze physiologically the somnambulist. He sees clearly what is to be done, but the organs which should warn him of danger are locked in sleep; he is, therefore, fearless and executes sucessfully whatever his corporeal activity will permit him to undertake. Awaken him, and at that instance he sees his danger, and is lost.

We may observe the difference between somnambulism and dreams thus: Dreams consist merely of sentiments and internal ideas; while in somnambulism, one or more senses becomes susceptible of external impressions, and one or more instruments of voluntary motion are thrown into action. A somnambulist is forever in danger of meeting an untimely death by accident, and should not therefore, sleep in an upstairs room with open doors and windows for fear of walking out at same. I have known of a few such incidents in my time. There is no cure discovered for this mental and physical malady, but fortunately, its tendencies grow less after the subject reaches the age of 45. Why this is so I do not know, unless it be due to retarded cerebration after reaching this period in life. I have never read anything in text-books pertaining to this phase of the subject, and my knowledge is based upon observation alone. It has been my privilege to study several somnambulists during my medical career, and I have discovered that there are different degrees cf this phenomenon ranging from a mild somniloquy, a mere muttering of words with perhaps slight muscular movements to that of extreme excitement with hallucinations and profound delirium. This form belongs chiefly to children, and is called by mothers and the old women, nervousness or worms. The profession call it night terrors with children, and nightmare with adults. The somnambulistic state is reached when the brain cells governing locomotion acts in conjunction with mental cells, thereby producing co-operation of mental and physical powers. Ambu lism does not seize the mind at all times of somniotic individuals, thus the force may be spent in somniloquism, or in silent somnium. Why one person lies in a state of tranquillized sleep while dreaming, when another endeavors to put into action all thoughts relative to physical functions is a matter belonging wholly to the idioorasy of the dreaming individual. This peculiar feature of the dreamer leads to somnambulism, a mental perversion from natural sources and not the result of secret powers handed down from the celestial courts.

Closely allied to somnambulism is hypnotism, in fact somnambulism is but a form of self-induced hypnotism brought on through the vivid suggestions of a dreaming mind. Hypnotism is that branch of mental science which deals with the phenomenon of hypnosis, and the method for its induction. This science is but little understood by the laity, and I may say the medical profession is not very familiar with its influences. Perhaps some present are somewhat skeptical on this subject, and believe it belongs to the "black arts," or to the magician in giving his mystic exhibitions. But it has proven beyond a doubt worthy of a place in the history of science. To study closely this natural pscyhological phenomena furnishes one of the richest feasts the mind ever indulged in. Facts, theories, notions, superstitions and terminology are unfortunately thrown

together in a state of great confusion in the field of hypnotism, as everything that pertains to psychology. We should discard all prejudice and superstition, and study it from a scientific standpoint for a few moments. We know there is an external invisible agent, or an unknown natural force transmitted from one individual to that of another, producing certain physiological conditions of the nervous system, whereby one person may have complete control over another. This we call magnetism, but I believe this a poor term, but for a better one we are pleased to call it thus. To distinguish it from ordinary sleep, with which this condition presents great similarity, it may be called hypnosis. The term hypnotism may be applied to the entirety of the phenomena associated with conscious and unconscious suggestion. Hypnosis best defines the changed condition of the mind of hypnotized individuals in suggestive sleep. The term suggestion is applied to the production of adynamic change of the nervous system in an individual by another, by means of conveying the conviction, conscious or unconcsious, that this change occurs, or has occurred, or will occur. The series of facts consists in the mode of production of this strange condition, and here false interpretations have given rise to the most erroneous conceptions. It has been proven that the power of hypnosis resides, not in that of the operator, but in the subject alone, therefore every individual hypnotized does it by utilizing his own powers of mind concentration. This fact was discovered in try. ing to hypnotize idiots. It was found that extreme cases of insanity would not yield to hypnotism or hypnotic influences, owing to their brains being so intensified from the morbid condition existing therein.

. Much good might result from a legitimate and scientific application of this agent in the cure of certain nervous ailments through the power of suggestion, but it will never merit favor as a general agent in the cure of diseases, for it has long since been thoroughly tested in the primitive period of medicine, and all that was found good was retained and much was discarded as too uncertain for reliability. It is the fragments of this science that really furnishes the foundation for all new patents now in vogue for the cure of the sick without drugs, and I must say that it is much abused by this class of pretenders. For the past decade this buried science is being exhumed and an effort to put new life into it is meeting with poor success by those who have been Rip Vanwinkling for these many years, and believe that they have made a new discovery in this thing called "magnetic healing," "christian science, vital science," and many other pseudo-sciences of like character, all having misleading terms, and hypnotism as a working basis. Suggestive therapeutics is an element of hypnotism that is extensively used by all legitimate practitioners of medicine which is eminently essential, and tends to stimulate an underlying principle or vital force that establishes and maintains hope, which is of itself a nerve stimulation, that carries many despondent patients over a critical period in their condition to a safe return to health,

Much could be said along the line of hypnotism, in fact a series of articles could be written on the subject, and we have only arrived at the outskirts of a vast field for scientific investigation, therefore, I shall not undertake to go into the minutia of this intricate phenomenon, but

leave you to study at your leisure the most fundamental elements of greatest interest to yourself and the profession.

Realizing that medical knowledge is frequently sought regarding many fads and fallacies aloof in the world today, I believe it important as a matter of professional information and general education, to investigate the things that so mysteriously confronts the public and give to it the true facts as found by those who reason from cause to effect. Many take for granted that things are true because so many believe it, but thanks to the medical profession for its timely liberation and its selfthinking qualifications in all matters pertaining to scientific knowledge and knotty problems.

I shall in conclusion, touch upon a matter that is supposed to deal only with the departed spirits of our fellowman. I can scarcely have the audacity to write upon a subject I have never seen in medical books, and one so ridiculously lame as to hobble pass unnoticed by thinking men of the profession, but such foolishness finds lodgment in the minds of some people, and it should be "downed" by the cudgel of common sense in the hands of our ministerial brethren, but as they appear too reticent to undertake a reformation along this score, and seemingly very willingly allow any one to fight their battle, I shall deal a few light blows in discrediting such belief as run rife with those superstitiously inclined. This old theory has long ago gone to seed, but some do not know it. It does not take long to convince a rational mind that there is nothing in it, that it is a farce from first to last. From a scriptural point of view there is nothing to prove that a departed spirit ever returns to earth to hold communication with living subjects. This is too absurd to be interesting, or even smack with intelligence, but in so much as such belief lingers in the minds of some we assume the privilege to express our opinions.

If one spirit can be induced by enchantment to return to earth and converse with, what is called a medium, then all the dead of the past ages could be induced to do the same until we would be living in the midst of a gabbling throng of sojourning spirits. Another strong proof against this nonsenical idea is that all spiritualists or mediums, as they prefer to be called, choose the cover of darkness in giving their exhibition. They must have darkness to aid them in sucessfully mystifying their subjects. If it was a reality that an individual had the power to do these miracles it would stand the test of daylight investigation, and the medium would be only too glad to proclaim to the world the great truths found in spiritualism. This the chief of all superstition should be relegated to the "black arts," and made to take its place alongside with other sleight-of-hand tricks played on the stage for the amusement of spectators and not shoved into the ranks of true science, thereby degrading the cardinal virtues of same. We should constantly bear in mind that miracles cannot be performed by human hands, and that God of the universe only is capable of juggling with the spirits of the dead, and that it is always done in His own majestic manner, according to divine laws revealed in his proclamations to the world.

I believed the medical profession should become interested more on matters pertaining to public falsehoods and superstition, as it will aid us materially in enlightening those in need of such knowledge. People look

to their family physicians for information on all scientific and psychologic topics, rather than their spiritual advisor, therefore I trust you will pardon me for parading this threadbare subject before you, but I hoped to stimulate a desire in the profession to discountenance all such theories as our better judgment tell us is false, and establish a fort for the protection of true science against such pseudoisms as find favoritism in the minds of many.

marks.

PULMONARY HEMORRHAGE.*

Clarence A. Good, M. D., St. Joseph, Mo.

HEN we speak of pulmonary hemorrhage, one thinks immediately of pulmonary tuberculosis, for this, in the vast majority of cases, is the cause of hemorrhage from the lungs one meets in practice. And this is the condition to which I desire to confine my re

We now know that hemorrhage from the lungs is not a cause of phthisis, but a result of a pre-existing phthisis, recognized or unrecog nized. Hemorrhage occurs some time during the course of the disease in a majority of the cases, variously estimated at from 60 to 80 per cent. It may be the first indication of the disease or may occur any time during the course of the disease.

Hemorrhage from the lungs may occur in one of two well recognized forms: The bleeding may come on suddenly, without premonition and be free; the amount brought up varying from a couple of drachms to a pint or more; or, the blood may be small in amount, just enough to color the sputum and the bleeding extend over a more prolonged period of time. It is the first variety that I wish to discuss.

The diagnosis of a free hemorrhage from the lungs is easily made, in fact, the patient usually knows the condition himself." Occasionally it is somewhat difficult to distinguish if the blood is coughed up or vomited. If one can see the blood within a reasonable length of time after the hemorrhage occurs diagnosis can usually be certainly made, for blood from the lungs, in the class of cases under discussion is bright in color, more or less frothy from admired air, and if carefully examined will usually show particles of mucus and muco-pus.

Having arrived at the conclusion that the blood is from the lungs, all further examination directed to locating the bleeding part should be avoided. I mention only to condemn the practice of physical examination of the chest to determine the seat of the lesion, and this applies to the most delicate methods of physical examination. It makes no particular difference from what part of the lungs the patient is bleeding, the indications are the same. Percussion of the thorax and turning of the patient in order to listen to different parts of the chest shortly after or during bleeding, is certainly pernicious. Granted that the patient is

* Read before the St. Joseph-Buchanan County Medical Society, June 12th, 1907.

bleeding from the lungs, or has lately bled from the lungs, the next thing to consider is the treatment and care of the patient, and it is upon this that I wish to dwell.

During the last few years it has been my privilege to attend several cases of pulmonary hemorrhage. In many of the cases I have been associated with other physicians and the methods of treatment carried out and recommended have been a surprise to me. I know of no other acute conditions in which the treatment used and advised has seemed so erroneous to me. We seem to lose sight of the fact that we have bleeding from an artery situated in pathological tissue, and delude ourselves with methods of treatment that scientific men have long ago proved fallacious.

case of

What are the conditions and indications for treatment in a pulmonary hemorrhage? To mo there has always been but two, measures directed toward stopping the hemorrhage, and reassuring the patient.

Let us consider the latter first. Can we conscientiously give reassurance to the sufferer. I think we most certainly can.. I never saw a fatal case of pulmonary hemorrhage in phthisis. I know they do occur and so do you, and I also know that the fatal cases are mighty few, and so do you. I have seen several patients die as a result of the hemorrhage, but never one from the hemorrhage.

When one begins to cough up blood from some of his internal organs the condition is admirably conducted to cause alarm. And I think this is usually the first indication in treatment, to reassure the patient. One don't have to sit down and enter into a long discussion in order to do this, but one can do it while doing other things; but, even if one did do this I am certain in my own mind that the time would not be lost, nay, it would even be time much better spent than hustling for the bypodermic syringe and adrenal bottle. What other than the kind words of hope and encouragement have we to allay mental alarm? We have that sovereign remedy-morphine, which should be used hypodermically. I doubt if there is one present who wouldn't advise its use. Use it at once and in sufficient doses to quiet the patient. Is this mental assurance and quiet we are striving to give only that hope and comfort we wish always to give to a fellow sufferer? By no means. It is sound therapeusis. All one has to do is to watch the heart beat and the blood pressure to be convinced of this. What next should be done? Well, if one has not been too rapid in performing the above tasks, if he has taken some little time to do them well, he will ofttimes be gratified by the fact that nothing more need be done. The bleeding will have stopped, thanks to aided na

ture.

Perhaps at this point I may digress a little and spend some little time on what I consider erroneous methods of treatment. Adrenalin is I believe the greatest sinner. Pulmonary hemorrhage is usually over in short time, and most of the ordinary things used in its treatment take hours to act, therefore they do no harm. But thanks to the enterprise of the advertising agent of the packers, we are reminded daily of adrenalin. And we are sampled freely enough so that most of us always have some of it on hand, either in tablet form or solution. Were this a harmless agent things would not be so bad, but, verily, I believe it to be an agent of great harm in pulmonary hemorrhage.