be due to the general anaesthetic action of the drug, he points out the fact that cocaine absorbed into the blood does not produce a general analgesic effect, as is produced in the case, for example, of morphia. On the contrary, in small doses it acts as a stimulant. The fact that pain ceases only when the genital zones are cocainized and that it may be permanently dissipated by area, does away, he thinks, with the subsidence of the pains is a part of the euphoria produced by the drug. The fact alluded to above, that in cocainization of certain parts of the genital zones only individual pains disappear from the symptom complex, militates against the supposition of a simple, general narcotic effect.

cauterization of this assumption that the

I cannot vouch for or deny the accuracy of the above statements, as Fliess's monograph has just come into my possession and I have had neither time nor opportunity to put them to the test. Curiously enough, the genital zones of Fleiss correspond exactly with the most sensitive portions of the sensitive reflex area mapped out by me in 1883.*

*On Nasal Cough and the Existence of a Sensitive Reflex Area in the Nose. America, Journal of the Medical Sciences, July, 1883, The results of these experiments were first brought before the Baltimore Medical Association in the early part of 1883, and subsequently before the Medico-Chirurgical Faculty of Maryland (April, 1883, vide Transactions) and the American Laryngological Association (May, 1883 vide Transactions). The conclusions reached from these investigations were as follows:

"(1) That in the nose there exists a definite, well-defined sensitive area, whose stimulation, either through a local pathological process, or through the action of an irritant introduced from without, is capable of producing an excitation which finds its expression in a reflex act or in a series of reflected phenomena.

(2) That this sensitive area corresponds in all probability with that portion of the nasal mucous membrane which covers the turbinated corpora cavernosa.

(3) That reflex cough is produced only by stimulation of this area, and is only exceptionally evoked when the irritant is applied to other portions of the nasal mucous membrane. (4) That all the parts are not equally capable of generating the reflex act, the most sensitive spot being probably represented by that portion of the membrane which clothes the posterior extremity of the inferior turbinated body and that of the septum immediately opposite.

(5) That the tendency to reflex action varies in different individuals, and is probably dependent upon the varying degree of excitability of the erectile tissue. In some the slightest touch is sufficient to excite it; in others, chronic hyperæmia or hypertrophy of the cavernous bodies seems to evoke it by constant irritation of the reflex centers, as occurs in similar conditions of other erectile organs, as for example the clitoris.

(6) That this exaggerated or disordered functional activity of the area may possibly throw some light on the physiological destiny of the erectile bodies. Among other properties which they possess, may they not act as sentinels to guard the lower air passages and pharynx against the entrance of foreign bodies, noxious exhalations and other injurious agents to which they might otherwise be exposed?

Apart from their physiological interest, the practical importance of the above facts from a diagnostic and therapeutic point of view is sufficiently obvious. Therein lies the explana

I have, on innumerable occasions,* shown that phenomena widely different in character and anatomical sphere of operations may be produced at will by artificial stimulation of this area, and that they may be dissipated by local applications to, or removal of, the membrane covering the diseased surface. It is therefore not difficult to conceive that the phenomena referable to the uterus and ovaries during menstruation may be influenced in a similar manner. The specific relations of the two zones and the crossed action of the reflex, if such it be, are much more difficult of explanation. If such a condition of affairs exists, it is certainly a remarkable phenomenon.

These observations, therefore, encourage the belief, if they do not establish the fact, that the natural stimulation of the reproductive apparatus, as in coitus, menstruation, etc., when carried beyond its normal physiological limits, or

tion of many obscure cases of cough which heretofore have received no satisfactory solution, and their recognition is the key to their successful treatment."

In calling attention to this area as containing the spots most sensitive to reflex-producing impressions, I did not, nor do I now (as has been wrongly inferred), desire to maintain that pathological reflexes may not originate from other portions of the nasal mucous membrane. Indeed, wherever there is a terminal nervous filament it may be possible to provoke sneezing, lachrymation and other reflex movements. My contention is simply this, that the area indicated in my original paper represents by far the most sensitive portion of the nasal cavities, and that pathological reflex phenomena are in the large majority of cases related to diseased conditions of some portion of this sensitive area. That all pathological nasal reflexes arise from irritation of this particular area is a proposition which I do not, and never have maintained. The determination of these sensitive areas is of special importance and interest in the solution of the pathology of the so-called nasal reflex neuroses. Whether a special sensitiveness in certain portions of the nasal mucous membrane exists or not, the agitation of the question has led to more rational methods of procedure in the treatment of a large class of nasal affections, and to more conservative methods in intra-nasal surgery Before the location of the sensitive area or areas, the nasal tissues were destroyed with an almost ruthless recklessness that bade fair to bring intra-nasal surgery into the worst repute. (For an elaborate discussion of this whole subject see article by the author in Wood's Reference Handbook of the Medical Sciences, edited by Buck, Wm. Wood & Co., N. Y., 1887, vol. v, pp. 222-242.)

*My books upon this subject may be found in the following publications: A contribution to the study of coryza vaso-motoria periodica or so-called "hay fever," N. Y. Med Record, July 19, 1884. Coryza vaso-motoria periodica in the negro, with remarks on the etiology of the disease, N. Y. Med. Record, Oct. 18, 1884. Rhinitis sympathetica, essay read before Clin. Soc. of Md.; see brief abstract in Md. Med. Journal, April 11th, 1885, and in Internationales Centralblatt f. Laryngologie, etc., Sept., 1885. Observations on the origin and cure of coryza vaso-motoria periodica, Trans. Medico-Chir. Faculty of Maryland, 1885. Review of Morell Mackenzie's essay on hay fever, etc., The American Journal of the Med. Sciences, Oct, 1885, p-p. 511-528. See also discussion of the subject before the American Laryngological Association (May 14th, 1884, vide Transactions, p, 113 et. seq) See also cases of reflex cough due to nasal polypi, Trans. of the Medico-Chirurgical Faculty of Md., 1884, and articles in Wood's Handbook already referred to.

pathological states of the sexual apparatus, as in certain diseased conditions, or as the result of their over-stimulation from venereal excess, masturbation, etc., are often the predisposing, and occasionally the exciting causes of nasal congestion and inflammation and perversion of the sense of olfaction. Whether this occur through reflex action, pure and simple, or as a sequel of an excitation in which several or all of the erectile structures of the body participate, the starting point of the nasal disease is, in all probability, the repeated stimulation and congestion of the turbinated erectile tissue of the nose. It is highly probable that this erectile area, or organ, so sensitive to reflex-producing impressions, is the correlative of certain vascular areas in the reproductive tract, and that the phenomena observed may therefore be explained by the doctrine of what we may call, for want of a better name, reflex, correlated action. In these remarks I have attempted no thoroughgoing exposition of the subject, but simply laid before you the results of my personal labors. These no longer represent,

I am glad to say, the result of solitary observation and isolated experience. I have not attempted, as Fliess has done, to touch upon the biological side of the question.

The study of the relations between the nose and the sexual apparatus opens up a new field of research, of pleasing landscape and almost boundless horizon, which bids to its exploration not only the physiologist and pathologist, but also the biologist. Above all it brings us face to face with a serious problem of life, an interesting enigma, whose significance it will be the task of the future to divine.

ALCOHOLIC EPILEPSY.

A Wrong Theory Misapplied to the Case of Arthur Deustrow.

IN

By DR. C. H. HUGHES, St. Louis.

N the Quarterly Journal of Inebriety (Vol. xx, No. 3) appears an article* in which psychologic truth and error are blindly mingled and the author seems much mentally mixed in his psychiatry, too much confused concerning the true data of practical alienism to be the Corypheus he assumes to be on the subject of alcoholic automatism or indeed upon the subject of epilepsia in any form, to say nothing of its psychical equivalent or substitutive states, the most difficult and abstruse subject in psychological medicine; one which the novice in psychiatry and the veteran in neurology alike hesitate to tackle. But there are times and places in morbid mental science, as in the realm of theological disquisition, when and where "fools rush in where angels fear to tread."

The author, apparently under the dominant delusion that he is one of the distinguished denizens of the Houseboat on the Styx, calls up the ghost of a medico-legal casus celebre and discusses the ignoble hero of that trial, Arthur Deustrow, in a new light, a light in which he never appeared when he walked the earth as fiendish and unprincipled a murderer as ever justly "felt the halter draw," with vicious fiend's "opinion of the law."

In this remarkable post mortem production the Duestrow case is considered "a good example of epileptic insanity." "The case shows," the author says, "the powerful influence, environment and heredity exert in certain cases."

*By Dr. William Lee Howard.

The influence of heredity is all right enough when invoked to establish insanity. But when a man assuming to be an alienist capable of solving grave and obscure problems of mental alienation, invokes environment to prove his case, he gives himself away logically and psychologically speaking. The insane man is the man, of all others, who is out of harmony with his environment and acts counter to them. A statement like this is the lapsus of a novice in psychologic science.

"Duestrow's mother," this record goes on to state, "was the daughter of a saloon-keeper," but not a drunkard saloonkeeper or an insane saloonkeeper, which this record does not state. "This daughter," continues the record, "was in the habit of drinking (beer omitted by the record) at her father's place (home omitted in the record). His (Deustrow's) father was also an habitual user of alcoholic drinks (beer omitted)." In short, they were beer drinking Germans -as most Germans are. As Bismarck is and von Moltke was. And as some gentlemen of die Vaderland among my acquaintance are, who could give this young man, Howard, sounder views, in spite of their beer-embarrassed brains, than was ever held by the clearest head of "all the Howards." But this dreadful record continues. "The alcoholic (beer beverage) habit continued throughout the lives of both parents, and the son, Arthur Deustrow, was given beer to drink when an infant," and his mother was probably given beer to drink when she was carrying Arthur. This was horrible? though the record omits it. But if every boy who while a babe got a little beer or ale, or suckled breasts from mothers who were given beer or ale to make milk in the breasts, must have alcoholic epilepsy, what is to become of the German and English nations? Shade of Kaiser Wilhelm der Gross, what is to become of Deutschland und Bavaria? where an average of fifty gallons of beer per capita. is drunk.

"When Duestrow was 13 his father became suddenly wealthy" and Arthur "commenced a series of dissipations which continued up to the time he committed his repulsive crime." This is not strictly correct. Duestrow's series of