ical symptoms are cured. The danger of a relapse is thus very materially lessened. Is this way the children are kept from the usual injurious influences of their home as long as possible and are strengthened psychically by assosiation with many children who are not nervous. The children are also to be invigorated physically by continuing the hydropathic treatment, exercise out of doors, turning, etc. The administration of iron and the best food possible is indicated if chlorosis is present, as it usually is. Other trifling physical troubles may of course receive therapeutical attention at this time. If all these measures are carried out we will have the pleasure of seeing these children escape a relapse and be permanently free from hysterical manifestations.

MELANCHOLIA OF LEPROSY.

By ALBERT S. ASHMEAD, M. D., New York.

DR. HANSEN

believes that there is no such thing as melancholia of leprosy, and that this is a disease invented by me. *It appears by this affirmation that Dr. Hansen knows little about leprosy, but what he has seen of it in Norway. For in other countries, melancholia of leprosy has been found. He gives a reason for his belief. He is persuaded that the brain is never affected in leprosy.

I find in Dr. Havelburg's (of Rio Janeiro) last report that, of thirty-six autopsies of maculo-anesthetic form, there were two cases of simple meningitis, one tubercular meningitis, one of nodular tuberculosis of the cerebellum, two of hydrocephalus, two of degeneration of the posterior columns of the spinal cord, one of atrophy of the spinal cord, one of thickening and hyperæmia of the lumbar portion of the spinal cord. In this list there are only six brain diseases. Here is a list where all but one are brain diseases: Dr. Beaven Rake found among the chief intercurrent diseases during 1889, in the Trinidad Leper Asylum, two cases of epilepsy, one of mania, one of sunstroke, one of cerebral hemorrhage, one of cerebral thrombosis. Chief intercurrent diseases during 1892, in the same asylum were; one epilepsy, one mania, three dementia, one hemicrania.

This proves certainly that the brain may be affected,

* "I will not take up Dr. Ashmead's discussion of the Leper conference of Berlin I will only say that, I still never have seen an instance of Melancholia of Leprosy. This affection is á discovery of Dr. Ashmead, but I regret to say that neither I nor any one else in Norway has any idea of the exsistance of such an affection. never affected in leprosy, etc."-G. A. Hansen M. D. 1898,

+Hospital dos Lazaros, Rio Janeiro, 1897.

the reason is that the brain is Jour. of Amer. Med. Asso. Feb. 26,

and consequently that there may be a melancholia of the leper.

The following will show Dr. Hansen that such a condition really exists, and that there are things connected with leprosy, which can be better learned in America than in Norway:

"The initial phenomenon of leprosy," according to Dr. Garcès, of Colombia, "is a vaso-motor paralysis, a shock to the peripheric nervous system, which prepares it for receiving the microphyte encountered in leprosy, but which alone does not constitute the disease. The latter may exist in the anesthetic form without microbes, and perhaps likewise in the initial stage of the other forms; in all, the nervous lesion and the local circulatory disturbance precede, and these exist, the microbe establishes itself as a swarm of bees alight in the hollow tree which can contain them."

I will only observe here, that if the vasomotor paralysis is the initial lesion in nervous leprosy, there must be mental depression independent of psychologic causes. Our American author says again:

"In short leprosy is a microbian disease, but whose primordial symptoms and lesions are localized in the nervous system, and independent of the microbe sometimes through life. It is possible to carry the bacillus of Hansen, without being a leper, and vice versa there are lepers without bacilli.” I quote these lines with a hope to astonish Dr. Hansen, as he astonished me by saying that there is no such thing as melancholia of leprosy.

I think that Dr. Hansen has never been in Japan, as little as I have been in Norway, and I suppose that his curiosity has not has not been much occupied by that far-off country. I hope therefore to tell him something new, by informing him that in Japan suicides of lepers from melancholia are not by any means uncommon. If Dr. Hansen will only consider that there are among the forty-five million Japanese, at least one hundred thousand lepers (registered and unregistered), that in Colombia, where, as Dr. Garcès told me, lepers committed suicide by causing themselves to be bitten by snakes, there are thirty thousand

lepers; he will perhaps come to the conclusion that there are things about leprosy, not invented by me, which, to use his own expression, he has never seen.

That Dr. Hansen has had no opportunity in Norway, to observe facts of this kind may be explained by the following passages which I extract from Dr. Wolff's (of Strasburg) pamphlet, Leprosy Reminiscences from Norway.

He quotes Hansen himself:

"The conditions of life, which contribute to the expansion of a contagious disease, are extremely favorable in this country. In the first place, the consumption of water for cleaning purposes is very scanty, the cleanliness of the persons and the dwellings exceedingly defective. Hence the formerly enormous spread of scabies; fifteen years ago there never came a leper to our institutions who was not scabious. To the uncleanliness, as an element favoring the propagation of a contagious disease, is superadded another one, which might be called psychological and which is connected with education. Our peasants are all fatalists; if they are sick, it is because it was written; it never occurs to them that they might become leprous in consequence of their own carelessness, and if this fate has overtaken one of them, his surroundings would deem it sinful to put the slightest restraint on their intercourse with the sufferer. The consequence is that lepers are as intimately frequented as healthy people, which means a great deal with our peasantry. They live not only in the same house with the leper, but in the same room, they eat at the same table, from the same dish, with the same spoon, nay, they sleep in the same bed.-Hansen." (What an admirable institution the mixed isolation law of Norway must be, where two-thirds of the lepers are isolated in these homes.Ashmead.)

"Finally," says Wolff, "we have a few words to say in regard to the psychological condition of the lepers in Norway.

"The patients feel comparatively happy, probably because they belong the most part, to the lowest classes, and therefore find themselves more comfortable in the lazarettoes than at home. In spite of the horrible and contin

ual pains they have to endure at certain periods of the disease, there never occurred a case of suicide of a leper in the asylum."

It appears then, that the physical and psychical condition of the Norwegian leper is an exceptional one. He passes from filth and poverty to a comfortable dwelling, which must be a palace to his mind. His conviction, held fast in his pachydermatous brain, is that there is a destiny to which a true Norwegian ought to pay a manly submission; his unemotional nature, ruled, controlled by this belief, puts him beyond the reach of a melancholic influence, and allows him to be, as Dr. Hansen cheerfully observes, "of the same mental disposition as other people," and "remarkably seldom we see a depression of their good humor in spite of the disease." But, great God! what must be the mental disposition of these other people, and how low their habitual good humor must be, if not even leprosy can depress it!

Prof. Meschedes (Königsberg), Section of Neurology, International Medical Congress, Moscow, August 19 to 26th, 1897 (Dr. Schlessinger, of Vienna, reporter), speaks as follows: "I consider that leprosy exerts a direct influence on the development of dementia, the cerebral phenomena resulting possibly from some irritating lesions of the nervous system, brought on either by Hansen's baccilli or by their toxines.

"I base this theory on a case of psychosis with which I have recently met in a leper.

"The patient, a man of 28, showed the first symptoms of leprosy in 1891. In December, 1896, without any obvi. ous cause, he was suddenly attacked with symptoms of acute dementia, which necessitated his admission into my wards. He was discharged in 42 months, having recovered from his mental affection, and was transferred to the medical wards, to receive treatment for the leprosy itself.

"After a short initial period of melancholia, during which the patient refused to take food, hallucinations of all organs suddenly developed, with excitement, oppression, intense motor discharges and delirious ideas of a