has a large amount of self-conscious duplicity in it-is, in fact, a mere dramatization.

What then shall be said to this latest cult which discourses to us of "loss of consciousness," "loss of will-power," and "dual states of consciousness" caused by a wave of the conjurer's hand? This pseudo-science asks us to believe things more incredible than the miraculous. The latter, at least, can be explained by the interposition of a superior power, but many so-called hypnotic phenomena (as the card-board mirror, stigmatization, etc.) cannot be explained either by any recognizable laws or by any special providence. It is notable, however, that the claim of a special providence is made by some fanatics to explain certain hysterical and hypnotoid phenomena, as, for instance, by the faith-cure fakirs. To these and kindred psycho-therapeutists should the practice of "hypnotism" be resigned.

RECORDS OF SEVERAL CASES OF GENERAL PARALY

SIS OF THE INSANE.

BY ALLEN J. SMITH, M.D.

THE following abstracts from the case-book of the Insane Department may be of interest, particularly in the light of etiology, as far as the second and third cases are concerned. During the writer's occupancy of the position of resident physician to the males in the Insane Department, during the first nine months of 1887, there were sixty-eight admissions to the department. Of these there were eleven cases of paresis of the insane recognized—a proportion of over 16 per cent. It is probable that these figures are quite too high, and it is altogether likely that their occurrence was in part due to the circumstances of admission to the insane department following the closing of most of the wards after the fatal fire of 1885.

That paresis of the insane is a disease especially prone in the class of population from which the city hospital draws its wards is by no means unlikely, the exposures, the anxieties of securing a livelihood, and the dangers of various temptations all being exceptionally operative among these people. It seems true, too, that the disease is especially well-marked in the same class, the symptoms, as a rule, being clearly cut and defined in these

cases.

CASE I.-Typical case of general paresis of the insane.-J. L. W., æt. 65, male, tin-worker by occupation, was admitted to the institution February 8, 1887. He had been in the German Hospital several weeks before for the treatment of a fractured humerus, due to a railway accident. While there he tried to fire the hospital and was removed to the Philadelphia general hospital at Blockley, and thence sent to the insane department when the fragment had united.

There had been no known insanity in his family, nor was there a history of any family eccentricities or peculiarities. There were no known hereditary diseases. He himself was an only child and had been uniformly healthy and without venereal taint. His children, five in number, were all healthy and intelligent. There was

clear evidence of the long existence of this disease, unnoticed at the time, but recalled by his friends, since his sanity was questioned. For the past six or seven years he had been living apart from his family, occupied in various ways with varying success. Before this estrangement he was a strict church man, penurious to a fault, energetic in business. Since then he had been almost uniformly guilty of one or other excess, alcoholic or venereal. During this period, too, he had learned to use tobacco inordinately.

Within the past six years he had become entirely changed in his business tact and carefulness. He took a fancy for fast horses, but his purchases invariably were attended with miserable failures. He had been incarcerated for wandering away with hired teams and giving them to the first person who cared to accept his gift. An effort to establish an immense bird cage depot in a small town in New Jersey resulted in marked pecuniary loss. Within the past several years he had shown a tendency to uxoriousness by proposing to any woman he might fancy, and lately he proposed to all he saw. Such incidents, scattered over this period at various times, excited not more than a suspicion of his real condition, happening at intervals in a busy career, and aroused only a feeling of indignation among his friends at his evidently growing love of crime. Six weeks before his admission into this asylum he met with an accident on the railway by which his right humerus was fractured, and within a few days later he manifested unmistakable evidences of his mental disease.

In a case such as this it would be unfair to regard the various excesses, alcoholic, venereal, etc., as the causes of his loss of mind. Doubtless the symptoms of a disease already caused, they served to hasten the course of the case and were themselves heightened by the progress of changes they were urging along.

On admission his physical condition was as follows: A small, well built man, light complexion, gray side-beard, bald head, with but a slight monk's fringe of fine gray hair about it, gray eyes, well formed ears. His pupils were small but equal, and of the Argyle-Robertson variety. Pulmonary system in good condition. Aortic diseases, with some arterial tension, indicating a capillary fibrosis. clear, 1021 sp. gr., and containing a trace of albumin. Enormous appetite; bowels evacuated with but little control. Urine passed freely and also uncontrolled; patellar reflex increased; no ankle clonus. Head well shaped.

Urine

There were several enormous bed sores on his buttocks, which healed readily under the influence of copaiba and castor oil dressing. The broken humerus was firmly united on admission, and about the seat of fracture was a large amount of callus. Speech was good except for the class of words and phrases used as tests; utterance explosive; tongue tremulous. Motive power normal, except that his feet were widely spread in walking. Gestures numerous and thoroughly appropriate.

As previously said, up to the time of the accident (six weeks before admission), he was able to attend to his usual duties in life. When asked why he had fired the German Hospital, he nonchalantly replied that he was simply anxious to see how it would look when in a blaze. On admission he was continually tearing his clothes and dressing himself fantastically in the fragments. He would tear his shirt in shreds and wind them about his hands, in order to "make gloves, as he said, and was constantly removing the dressings from his injured arm and from his sores, in order to apply them in a more satisfactory manner. He had most marked delusions of grandeur and wealth, passing much of his time in making out checks for fabulous sums for various charitable purposes He would found

hospitals for orphaned puppies and kittens; was particularly anxious to endow all the maternity hospitals he could think of. He would indict letters of proposals of marriage to all the crowned women he had ever heard of, and was constantly interested in some marriage engagement, in which he invariably figured as one of the contracting parties.

From penuriousness his whole energy was concentrated in proving himself a spendthrift. He would give away anything and everything, even his multitude of wives. He was a millionaire, a friend of Cleveland's, a husband of Queen Victoria, a king, a god, around whose head the Almighty Himself had placed a halo. Always cheerful, the most squalid surroundings were to him magnificent, the most abject poverty enormous wealth. There were no hypnagogic hallucinations or morbid dreams, but his sleep was always short and broken; and he was constantly the earliest out of bed and ready to go to his important duties of the day. He would wake up in the night and call for some magnificent banquet, but a piece of bread was an acceptable substitute. When kept to a line of thought by constant questions his conversation was intelligent, but allowed to go at will he invariably babbled. Added to his other faults was a marked kleptomania. His memory was not markedly impaired, except for very recent events. Imagination grossly exalted. Power of volition lost, except as shown in obstinacy when crossed in one of his desires. There were no hallucinations apparent, except possibly of hearing. He was very emotional, weeping upon a suggestion and within a few moments smiling with gladness. His sensibility seemed to be very little, if at all, affected. In March he developed a hæmatoma of left ear, which, in course of three weeks, had entirely disappeared. The following month he developed a similar tumor on the right ear, which has since also disappeared. During his stay in this asylum he had none of the characteristic fits of general paresis, nor any history of any previous ones, in which particular the case is separated from the type. Late in the case there were attacks of petit mal, which probably replaced the ordinary seizures, and his death resulted suddenly from a collapse, which possibly was of the same nature. His general health gradually failed, and he lost flesh in spite of his voracious appetite. His walk became unsteady, and a tremor developed about the lips. Mentally his condition continued unchanged for about five months, after which time dementia rapidly followed. His death resulted very suddenly, as

above indicated.

The following notes are taken from the post-mortem records :Skull cap very thin, especially anteriorly. Dura mater normal. There was a large amount of subarachnoid fluid. There were marked adhesions between the hemispheres in the longitudinal fissure and between the various convolutions, without, however, special opacity and thickening of the pia mater. Over the right hemisphere, along the upper margin of the Sylvian fissure, was an irregular patch of ecchymosis in the pia mater. In the lateral ventricles was a large quantity of effusion. No gross lesions in any part of the brain. The gyri were generally flattened, however, and on section the gray matter of the cortex was especially thinned.

In this case the absence of the common epileptiform (almost apoplectiform) seizures is found to be associated with an absence of the usual appearances of meningeal changes, in the shape of chronic pachymeningitis of hemorrhagic or non-hemorrhagic type, or of chronic leptomeningitis leading to thickening and opacities of the pia mater. In this case, too, as in many, the epileptiform paroxysms seem to be replaced by symptoms of collapse of more or less passing nature, associated with conditions of marked cardiac nature; and it might, with some propriety, be suggested that the paroxysms above referred to were in reality due to extreme cardiac spasm, producing on the venous side sufficient stasis and engorgement to account for the meningeal appearances, especially after chronicity of the disease and a number of individual seizures had been experienced.

CASE II.--General paralysis of the insane, probably arising from chronic plumbism. -W. S., white, married, printer, æt. 35 years, was admitted to the insane department of Blockley in May, 1887. So far as could be ascertained there was no hereditary taint of any form. About three years prior to his admission he began to work in a paint factory at grinding colors, and after eight months was one morning attacked by an epileptiform convulsion, following which was noted a slight left sided palsy, soon recovered from, however. He continued at the work, however, for some months longer, until compelled to give it up because of double wrist-drop. This persisted four or five months, after which he endeavored to gain employment again, but the epileptiform seizures becoming more frequent prevented his retining any position for any length of time.

About a year before his admission he began to be regarded queer, and his fellow workmen were considerably annoyed by his actions. About this time one of his employees sent him to deliver a bill at a certain house where he had been successfully dispatched the day previous; this time he returned to report that no such family lived in that house or neighborhood. Thus in more than one way he came to be considered unreliable. When at work he could not bear to be instructed how he should perform any part or to be ordered about in any way; he was surly and harsh to his fellows. He had never been a bright man intellectually, but had formerly been extremely kind and lovable, with a jolly disposition and industrious habits. Despite his natural cheerfulness, however, he was easily worried and desponded over trifling reverses. Was temperate in the use of alcoholics, but used tobacco excessively. He was described as a man of excellent general health before working in lead. His manner of speech was quick and clear in utterance, and his movements rapid for a man of heavy build. There were no evidences of specific taint.

Examination at time of admission showed a man of short, heavy stature, dark complexion, with muddy, leather-like skin, black hair, plentifully streaked with white, and with a gray moustache. Hair very coarse. Eyes dark-gray in color, with pupils equal, of Argyle-Robertson variety; was in fair condition of nutrition, but weak. Pulse normal in frequency, full and hard, with considerable tension.