tion, revised and enlarged. Duodecimo volume of 441 pages, fully illustrated. Philadelphia, New York, London: W. B. Saunders & Company. 1904. (Bound in silk, $1.50 net.)

Saunders's Medical Hand-Atlases. Atlas and Epitome of General Pathologic Histology. By Dr. H. Dürck, of Munich. Edited, with additions, by Ludvig Hektoen, M.D., Professor of Pathology, Rush Medical College, Chicago. With 172 colored figures on 77 lithographic plates, 36 text-cuts, many in colors, and 371 pages of text. Philadelphia, New York, London: W. B. Saunders & Company. 1904. (Cloth, $5.00 net.)

Diet in Health and Disease. By Julius Friedenwald, M.D., Clinical Professor of Diseases of the Stomach in the College of Physicians and Surgeons, Baltimore; and John Ruhräh, M.D., Clinical Professor of Diseases of Children in the College of Physicians and Surgeons, Baltimore. Octavo volume of 689 pages. Philadelphia, New York, London: W. B. Saunders & Company. 1904. (Cloth, $4.00 net.)

Gallstones and Their Surgical Treatment. By B. G. A. Moynihan, M.S. (Lond.), F. R. C. S., Senior Assistant Surgeon to Leeds General Infirmary, England. Octavo volume of 386 pages, illustrated with textcuts, some in colors, and nine colored insert plates. Philadelphia, New York, London: W. B. Saunders & Company. 1904. (Cloth, $4.00 net.)

Progressive Medicine, Volume VI., December, 1904. A Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences. Edited by Hobart Amory Hare, M.D., Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia. Octavo, 374 pages, illustrated. Philadelphia and New York: Lea Brothers & Co., Publishers. (Per annum, in four cloth-bound volumes, $9.00; in paper binding, $6.00, carriage paid to any address.)

Transactions of the American Otological Society. Thirty-seventh Annual Meeting held at Atlantic City, N. J., July 11 and 12, 1904. F. L. Jack, M.D., Secretary. Published by the Society.

LITERARY AND JOURNALISTIC NOTES.

THE Annals of Surgery for December, 1904, issues an anniversary number, commemorating the twentieth year of its publication, containing 282 pages, and is copiously illustrated. The contributors are Johannes Orth, J. William White, W. Watson Cheyne, J. Collins Warren, Frank W. Foxworthy, George Emerson Brewer, James H. Nicoll, Roberto Alessandri, Brennan Dybalt, William J. Mayo, James P. Warbasse, Charles L. Scudder, Francis J. Shepherd, Harry H. Germain, Harry Atwood Fowler, Walter B. Odiorne, Channing C. Simmons, and Francis S. Watson. It is edited by Lewis S. Pilcher, J. William White, Sir William Macewen, and W. Watson Cheyne, and is published by J. B. Lippincott Company, Philadelphia. It is the best periodical exponent of general surgery published in the English language.

THE American Journal of Nursing, which is in the fifth year of its publication, announces that it stands at the head of a move

ment for state registration and higher preliminary and technica! education for nurses. It is published by J. B. Lippincott Company, Philadelphia.

MESSRS. LEA BROTHERS & COMPANY, of Philadelphia and New York, publish a general catalogue, with annual revision, of al! medical, surgical, pharmaceutical, dental, and veterinary books in the English language. It is furnished gratis on application to the publishers.

ITEMS.

MESSRS. BATTLE & COMPANY, Saint Louis, announce that they recently issued the fourth number in a series of twelve illustrations of intestinal parasites, which they will send free to physicians on application.

THE Pope Bicycle Daily Calendar for 1905 contains a memorandum leaf for every day in the year, and 365 original sayings in favor of good roads, good health, outdoor exercise, and that great vehicle of health-giving, the modern bicycle, by our most eminent living men of marked accomplishment. The calendar is free at Pope Manufacturing Company's stores or any of our readers can obtain it by sending five 2-cent stamps to Pope Manufacturing Company, Hartford, Conn., or 143 Sigel street, Chicago, Ill.

MESSRS. M. J. BREITENBACH COMPANY'S Physicians' Daily Memorandum, the most convenient and elaborate desk reminder that has been prepared for medical men, is issued for the year 1905. It will be furnished on application and eight cents postage.

MR. CHARLES MARCHAND, president of the Drevet Manufacturing Company, has invented and patented a safety valve stopper which is intended to reduce bottle breakage very materially. He proposes to use flint glass containers for hydrogen peroxide and cork them with Marchand's safety valve stopper. This will reduce the danger of breakage to a minimum-as near the preventable stage as can be attained. This is a commendable improvement and will materially increase the sales of Marchand's hydrogen peroxide.

MELLIN'S FOOD COMPANY has received the Grand Prize for Mellin's Food, which is the highest award of the World's Fair at Saint Louis.

BUFFALO MEDICAL JOURNAL.

VOL. XLIV.-Lx. FEBRUARY, 1905.

ORIGINAL COMMUNICATIONS.

No. 7

T

Paranoia as It Relates to Homicide.'

BY JAMES WRIGHT PUTNAM, M. D.,

Professor of Nervous Diseases, University of Buffalo.

HERE is no form of insanity which is of greater importance in criminal jurisprudence than paranoia. This statement is made because the paranoiac remains so often undiagnosticated until some act of violence, which results in the serious injury or death of his victim, calls the attention of medical men to his condition.

The examination of such criminals requires not only a painstaking study of the prisoner's history as it relates to his victim, but must include inquiry likewise into his heredity, his youth and, indeed, his whole life up to the time of the examination. The diagnosis of other types of insanity is comparatively easy. The recognition of paranoia is frequently extremely difficult; and oftentimes the demonstration of it to the satisfaction of public, judge, and jury is impossible even in well marked cases.

Lest I should be accused of exaggeration, I may refer to the case of Prendergast, the assassin of Carter H. Harrison, Mayor of Chicago, as recorded by H. M. Bannister. Prendergast was born in Ireland, and came to this country as a baby; his father was an inebriate, and several of his parental ancestors were insane. His mother was a strong woman, with no bad heredity that was ascertained. In early childhood he sustained a head injury by falling that made him unconscious for several hours. This was followed by more or less headache. As a boy he showed peculiarities, was very irritable, and did not care for the companionship of other boys. He went to school for a few

1. Read at the Fourth Pan-American Medical Congress, held at Panama, January 2-6, 1905.

years, and made very good progress. He became a newsboy and did quite as well as such boys generally do, but was rarely on good terms with the other boys. As he grew older he delivered daily papers on a somewhat secluded route, and did this work to the satisfaction of all. About the age of 15 he began to develop delusions of persecution; thought the other newsboys were combined against him, that they were making misrepresentations about him, and that his mother and brother were also against him and constantly trying to do him harm.

A little later, there was much agitation in the Chicago papers about the dangers of railroad grade-crossings and the necessity of stopping the loss of life by track elevation. Then Prendergast became possessed of the delusion that he was God's appointed agent to bring about this important work. To do it, he conceived the idea that he must be made the corporation counsel of Chicago. As soon as Mayor Harrison was elected he applied to him. After Hon. A. Krauss had been appointed, he called upon him and several times demanded the office as his, by right of being the Almighty's agent. At the time of the assassination he went in the early evening to the Mayor's residence and made the same demand. Being refused, he shot Mr. Harrison, and immediately thereafter went to the police station and gave himself up. At the station he was regarded as insane, and at first it was determined to send him to the Detention Hospital for the Insane. At the police station Prendergast insisted that he did it; that he was the divinely appointed agent to elevate the railroad tracks, and in order to do it properly he must be corporation counsel. The mayor refused to comply with his request, and the Lord had commanded him to remove him. He seemed sorry enough, but said he must do as the Almighty demanded. In various interviews he always admitted the killing, and always justified it by his delusions; he seemed to be very sorry that it had to be done. Upon other topics he talked as well as could be expected with his limited education, showing a good memory and emotional control. He had numerous stigmata of degeneracy. After two jury trials he was condemned and in due time hanged. No postmortem was permitted.

A definition of paranoia is essential, as it has been frequently misapplied. Paranoia, literally translated meaning "close to understanding," the term first applied by Mendel, is synonymous with the German primare verructheit, the French delire chronique a evolution systematique, and with the English terms monomania and chronic primary delusional insanity.

It is almost unanimously conceded that paranoia is nearly always due to inherited structural weakness of the nervous sys

tem. In fact, so strongly does Berkley of Johns Hopkins believe this that he says, "For my own part I have never seen a paranoiac in whose case a full and complete history could be obtained, that did not have a hereditary history of drunkenness, of family neuroses, or actual insanity."

With this strong position some able observers disagree, notably Mendel and Magnan. They maintain that only paranoia of early development should be considered as one of the hereditary degenerative type; and that those who have reached middle life. before the disease develops should be regarded as non-hereditary. The Italian school of psychiatrists generally maintain that paranoia may be primary in some subjects, and secondary in others; that when it is primary in an individual it succeeds a generalised insanity in his ancestors; when it is secondary the insanity is confined to one individual. (Regis.)

American psychiatrists generally are committed to the view that paranoia is a primary psychosis founded on a hereditary basis. It may first manifest itself in middle life under the influence of various causes. These may be slight and of short duration; serious mental shocks, or simply the long continued wear and tear of life; the battle against poverty and want; the stress of society; the complications of business, domestic infelicity, and the like.

The development of paranoia in one cursed with neuropathic ancestry is gradual from earliest childhood. The future paranoiac is either above or below the average in the early accomplishments of talking, walking, or the use of hands. As the child passes into youth, physical peculiarities, which mark them from their fellows, often become apparent. Mentally, it is noted that they are either unusually seclusive, irritable, dreamy, or introspective. Although they are often studious, they seldom are exact, so that their progress in science and mathematics is less satisfactory than in art, language, and history.

When the duties and responsibilities of manhood and womanhood are assumed, their inability to resist the strain of life's discipline is manifested in various ways. If plans fail, and endeavor does not meet with success, then the suspicions of the individual against others are aroused. Self is never blamed. The patient becomes more and more under this domination, until from suspicion he passes into systematised delusions of persecution and keeps aloof from his friends, from whom he conceals his delusions.

Hallucinations of hearing usually accompany the disease. The history of the paranoiac often includes the story of wandering from place to place to avoid conspirators, and vain attempts