Physical examination: weight 133 pounds. Dullness anteriorly and posteriorly in the right apex; broncho-vesicular respiration posteriorly and voice and whispered bronchophony.

What is the diagnosis of these patients, and what the treatment?

WHAT DO WE NEED TO KNOW CLINICALLY ABOUT THE MIND? It is a deplorable fact that detailed observations upon patients suffering from brain lesions with a view to obtaining exact data regarding the mental changes and a checking up of such clinical knowledge with equally exact post-mortem findings, microscopical as well as macroscopical, are almost an unknown quantity in our literature. Yet such recorded observations are of inestimable value and must be gathered in great number before any deductions of positive value can be drawn as to the localization of psychic functions. Of course, such work cannot be done by one man, but more careful studies could be made by the general practitioner, and with a little more persuasion he might secure more autopsies and turn the brain over to the laboratories for the pathological data.

We cannot hope to obtain such a sequence, however, until our medical schools stimulate the necessary interest and give their students such courses as will permit the general practitioner to make the observations, teach him what to look for and how to look for it.

It is not sufficient to say that following apoplexy or other brain disease there was loss of memory. Memory is a diffuse faculty, the retention quality of each neuron association group, perhaps of each neuron. We must know the special memories disturbed: whether those for space, position, color, form, solidity, music (tone), words or figures, each of which probably has its special local centre in the frontal lobes. To learn this one has but to test out these primary senses. Or there may be a general slacking of all memories, as well as interest and attention (also diffuse qualities), in which case the nervous current reacting the fore brain may not be sufficient to actively energize the cells; a lack of bodily tone.

If these primary senses are disturbed they would, of course, furnish fallacious material to the higher centres for reasoning and judgment. It is, therefore, well to learn if the patient reasons correctly from false premises, which often happens even in healthy minds. Inversely does he draw false judgments from correct premises, the primary sensations being intact. If so, the error is probably in his higher synthetic centres of reasoning and judgment which clinico-pathological evidence seems to place in the middle region of the frontal cortex just under the anterior fontenelle. The power to weigh and decide is probably also in this locality.

If the feelings and emotions are disturbed, how? The mere slacking of the amount of vital energy to the fore brain or an inability to use it well because of a disturbance of some of the primary senses will, as we all know, produce a general irritability and bodily restlessness.

It is now pretty generally accepted that there is an intimate relation between the sympathetic nervous system which presides over the animal functions, circulation, respiration, digestion and reproduction, all the

involuntary muscles and functions, and the mid-brain, especially the parietal lobes; that a disturbance of any of these functions brings about distortion of impression in these brain areas of general (somatic and kinæsthetic) sensation, felt by the patient as vague discomforts and spoken of as emotions and moods.

It is probable that much of the current which energizes the forebrain, allowing associative intellect, passes through these areas of general sensation, hence the resultant dullness following a disturbed digestion or circulation.

When the central end is itself the seat of irritation there may result all varieties of depression and capriciousness and even catatonia, as lately shown by Sothard in his studies on the brains of cases of dementia precox. Ideational states may also send back (from the fore-brain) or block the stream of nervous impulses in such a way as to overload, as the electrician would say, the parietal cortex, causing depression, i. e., as when we conceive of the death of a dear one we are depressed and cannot eat, the breath comes faster or in sighs, and the heart pounds. Evidently, then, in disturbed emotional states the first duty of the clinician is to determine if the error lies in the thoracic or abdominal viscera. In this connection the recent studies of Goldthwait, Painter, Osgood, Reynolds, and Lovett on body posture and visceral ptosis are of unusual interest, as are those of Metchnikoff in pointing out the anatomical and bacteriological errors underlying auto-intoxication. This, I believe, will be found to be a much more common source of mental depression and clouding than has been heretofore supposed. May it not be for this reason that we have so constantly failed to find anything pathological in the brains of patients dying of manic depressive insanity and other depression states?

If careful examination fails to reveal any bodily state which might be primary we must then turn to the brain itself to see if any accident may give cause for believing that there is a depression of the inner parietal table of the skull. This should be carefully ruled out in other parts also, and slight falls early in life should not be overlooked, as there is sometimes an interval of years between such accidents and resulting mental symptoms. Other irritating lesions, tumor and syphilis, must also be thought of. The blood pressure should be taken to discover if there be arterio-sclerosis, although as Dr. E. P. Colby has pointed out, arthromatous vessels too small to materially change the pressure reading may yet cause marked mental symptoms.

The temporal lobes seem to preside over hunger, thirst, combativeness (which pathologically results in homicide) slyness, suspicion and the hoarding instinct. Abnormalities of these mental elements should therefore be looked for and recorded. In this connection it is well to examine the ear. There are many authentic records which show that homicidal mania may be secondary to ear disease.

It is believed on good evidence that the occipital lobes preside over the affections and the gregarious instinct. If, however, the patient loses all desire for or interest in the children or those near and dear to him, or if he is possessed by an abnormal desire to be alone, or a fear of being alone, we are justified in assuming that there is something wrong in this region.

The cerebellum in its central part is known to be the seat of voluntary and perhaps involuntary co-ordination. Its lateral lobes are but little understood, but clinical observation has frequently demonstrated that when the cerebellum exceeds its normal ratio of weight to the cerebrum, the sexual activity has been found excessive.

The proportions in which all the different mental attributes will combine to determine the resultant type of individual are as numerous as the number of different personalities. And in order that any satisfactory conclusions may be drawn from an analysis, we should know as much as possible of the patient's congenital type of mind and his heredity. Learn how far he was ordinarily ruled by his intellect (fore-brain) and how far by instinctive impulse (mid and rear-brain) and whether now, under diseased conditions, this relation has been changed. If self control is localizable it is in the fore-brain and is proportionate to the strength and health of the collective higher-intellectual centres presiding over the ethical sentiments.

I am well aware that from the point of view of the psychologist there are many objections to the localizations here advanced; that into a complex function, such as speech, so many centres enter that the function should be rightly spoken of as diffuse, many parts of the brain being contributory at the same time. So elaborate a switch board with its numerous associative links is indeed an awe-inspiring maze, a kaleidoscope moving so rapidly that consciousness is unable to follow the rapidly changing elements and gets only the final resultant image.

Yet practically we must have some simple working basis and the one which I have here endeavored to outline, based on abundant clinicopathological and experimental evidence, may be used as a nucleus upon which to elaborate, according to our individual grasp of, and interest in, the subject.

In the next issue I shall endeavor to point out practical tests for the primary senses.

The Trustees of Massachusetts Hospitals for Consumptives on January 3 passed the following vote:

"Voted, That it will be the policy of the Board of Trustees of Hospitals for Consumptives to employ at the North Reading, Lakeville and Westfield State Sanatoria, on the medical staff, as far as suitable men can be found, at least one graduate of a Homœopathic Medical School."

Boston University Medical Library has recently received several files of the leading medical journals for the past year, through the kindness of Mr. Howard Goodwin of the well-known firm of Mellin's Food Company. This is not the first time the library has been generously remembered by the firm.

AESCULUS HIPPOCASTANUM.-The nasal symptoms likewise are a sensation of dryness, burning or rawness, like a supervening coryza. Sneezing and coryza soon develop.

The inspired air feels cold as after taking peppermint.

Sensitiveness of the nasal passages and the throat to the inspired air is the leading modality. Burning and rawness is the predominant sensation. This last was described by one prover as though the whole throat was excoriated and constricted with burning like fire on swallowing. Stearns.-No. American Journal of Homœopathy.

EDITORIAL.

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WANTED A MASSACHUSETTS STATE TUBERCULOSIS SANATORIUM UNDER HOMEOPATHIC MANAGEMENT.

In 1895, when the Massachusetts State Sanatorium at Rutland was authorized by our Legislature, a clause was introduced into the bill requiring homoeopathic treatment to be given to those who desired it. The board of trustees appointed by the Governor included an able physician of each school of practice, under whose skilful and harmonious advice matters medical were so well planned and carried out that not only was very great success attained in the treatment of the disease, but also for several years perfect justice was done to the minority school represented-the homoopathic. This was particularly gratifying, because our school of practice had often been rebuffed in its attempts to get a foothold in public institutions, notably in the Boston City Hospital. This justice to our side was largely due to the broad and liberal attitude of the old school medical trustee above referred to, who had made a special study of the sanatorium problem abroad, and whose departure from the Board after a too brief service was greatly lamented. That this liberal provision for homeopathic treatment. was not unwise was shown by the great and continued popularity of this department among the patients and friends of the institution, and also by its superior final results, as can easily be shown. by statistical evidence.

Lately, however, three smaller Sanatoria have been added to the equipment of the State, and have now been running for about. a year, more or less. A new board has the management of these three in addition to the original one at Rutland. On this new board of seven members are three regular physicians, but not one of our own school.

Last summer the position of Superintendent at Rutland became vacant, and for it there were two applicants. Both were nice men personally and of about the same age; but one was a homœopathist and the other a so-called regular.

The homoeopathist had graduated with honor at one of the best medical schools in the country, not one of whose graduates failed to pass the State medical examining board of Massachusetts this last year, and its graduates had a higher average (78.8) than those of any other medical school in Boston.

The regular physician who applied graduated at a medical school, more than ten per cent. of whose graduates failed to pass the State Board Examination, and whose graduates averaged 76.2 per cent. At the same examinations almost five per cent. of the graduates of the Harvard Medical School failed to pass, and the Harvard graduates averaged 78.7 per cent.

Previously to his medical course the homoeopathist had obtained the degree of A.B. at a good university, while the other man had no college education.

As to experience in tuberculosis, a very essential requisite for a Superintendent, the homoeopathist had served most acceptably one year in the Cullis Home for Consumptives, and then almost ten years in the Rutland Sanatorium, which has 350 patients. The regular had served a little more than one year in the Rutland Sanatorium and a little more than one year in a small Sanatorium in the country, which had a maximum of only twenty-five patients. The rest of his time since graduation had been spent in treating

the insane.

The homoeopathist was a man of tact, with winning ways, and was a universal favorite, with executive ability, of strong physique, of recognized integrity and of unblemished moral character. He was recommended as the best man for the place by the efficient retiring Superintendent (although of the other school), under whom he had served in the same buildings and in close touch for three and one-half years. He was also recommended by both of the Consulting Physicians to the Sanatorium, one of whom was of the regular school, and by all of the old trustees who were asked to do so.

Nevertheless, he was turned down, although he was the logical candidate and knew the ropes of that particular institution as no one else in the country did. The present trustees do not say that it was because he was a homeopathist, but there can be no possibility of doubt that that was the real reason for his rejection.

Next, the trustees voted to transfer all the women tuberculous patients in the State to the Rutland Sanatorium, and to assign all the men patients to the smaller ones in North Reading, Lakeville and Westfield. This has not yet been done. Without here discussing the wisdom of this separation of the sexes, about which many have grave doubts, certain it is that this action, whether intentional or not, would naturally deprive all the men patients in the State of the homoeopathic treatment which they had enjoyed at Rutland, and which had been guaranteed to them by act of the Leg islature. After a body of homoeopathic physicians had appeared before the trustees and forcibly protested against this discrimina