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Entered according to the Act of Congress in the year 1891 hy

LEA BROTHERS & CO., In the Office of the Librarian of Congress at Washington. All rights reserved.

PHILADELPHIA:

DORNAN, PRINTER,
No. 100 N. Seventh Street.

CONTRIBUTORS

TO

VOLUME FIFTY-NINE.

A. C. ABBOTT, M.D., of Philadelphia.

John L. DICKEY, M.D., of Wheeling, W. Va. Lewis H. ADLER, JR., M.D., of Philadelphia. JOSEPH EASTMAN, M.D., of Indianapolis. HARRISON ALLEN, M.D., of Philadelphia.

Jos. EICHBERG, M.D., of Cincinnati. OSCAR H. ALLIS, M.D., of Philadelphia.

E. C. ELLETT, M.D., of Philadelphia. HERMAN B. ALLYN, M.D., of Philadelphia.

FRANK R. ENGLAND, M.D., of Montreal. JAMES M. ANDERS, M.D., of Philadelphia.

AUGUSTUS A. ESHNER, M.D., of Philadelphia. ALBERT S. ASHMEAD, M.D., of New York.

J. T. ESKRIDGE, M.D., of Denver, Col. SAMUEL AYRES, M.D., of Pittsburg.

CHARLES PERRY FISHER, of Philadelphia. L. Bolton Bangs, M.D., of New York.

EDWARD D. FISHER, M.D., of New York. WM. S. BARKER, M.D., of St. Louis, Mo.

F. FORCHEIMER, M.D., of Cincinnati.
ROBERTS BARTHOLOW, M.D., of Philadelphia. William H. FORD, M.D., of Philadelphia.
SAMUEL BELL, M.D., of Detroit.

A. H. FRASER, M.D., of Harper, Kansas.
E. OLIVER BELT, M.D., of Washington, D. C. CARL FRESE, M.D., of Philadelphia.
D. BENJAMIN, M.D., of Camden, N. H.

HENRY D. FRY, M.D., of Washington, D. C. HERMANN M. Biggs, M.D., of New York.

V. P. Gibney, M.D., of New York. John S. Billings, M.D., Surgeon U. S. Army. ARTHUR J. GILLETTE, M.D., of St. Paul, Minn. BERNARD E. BRODHURST, F.R.C.S., of Manchester, William GOODELL, M.D., of Philadelphia. Eng.

GEORGE M. GOULD, M.D., of Philadelphia. Mrs. CHARLOTTE B. BROWN, M.D., of San Fran. Edwin E. GRAHAM, M.D., of Philadelphia. cisco, Cal.

N. F. GRAHAM, M.D., of Washington, D. C. Paul R. BROWN, U. S. Army.

W. M. GREENLEE, A.M., M.D., of Lebanon, Ohio. CHARLES H. BURNETT, M.D., of Philadelphia. J. P. CROZER GRIFFITH, M.D., of Philadelphia. CHARLES W. BURR, M.D., of Philadelphia.

B. E. HADRA, M.D., of Chicago, Ill. HERBERT L. BURRELL, M.D., of Boston, Mass. C. A. HAMAN, M.D., of Philadelphia. J. S. CAIN, M.D., of Nashville, Tenn.

WILLIAM D. HAMILTON, A.M., M.D., of Columbus, J. ABBOTT CANTRELL, M.D., of Philadelphia.

Ohio. JAMES STRATTON CARPENTER, M.D., of Pottsville, WILLIAM A. HAMMOND, M.D., of Washington, D.C. Pa.

T. A. HARRIS, M.D., of Parkersburg, W. Va. R. J. CHRISTIE, SR., M.D., of Quincy, Ill.

F. C. HEATH, A.M., M.D., of Lafayette, Ind. T. M. L. CHRYSTIE, M.D., of New York.

FREDERICK P. HENRY, M.D., of Philadelphia. R. CLEARY, A.M., M.D., of Rio Janeiro, Brazil. E. P. HERSHEY, M.D., of Denver, Col. J. Solis-COHEN, M.D., of Philadelphia.

BARTON Cooke HIRST, M.D., of Philadelphia. SOLOMON SOLIS-COHEN, M.D., of Philadelphia. F. HORTON, M.D., of New Castle, Wyoming. W. M. L. COPLIN, M.D., of Philadelphia.

DR. HOVENT, of Brussels. ANDREW F. CURRIER, M.D., of New York.

L. HUFFAKER, M.D., of Daisy, Tenn. S. G. DABNEY, M.D., of Louisville, Ky.

E. P. HURD, M.D., of Newburyport, Mass. ALEXANDER DALLAS, M.D., of New York.

Woods HUTCHINSON, M.D., of Des Moines, Iowa. J. HERBERT DAREY, A.M., M.D., of Granger, Minn. H. ILLOWAY, M.D., of Cincinnati. EDWARD P. DAVIS, M.D., of Philadelphia.

HENRY D. INGRAHAM, M.D., of Buffalo, N. Y. John B. DEAVER, M.D., of Philadelphia.

A. B. ISHAM, M.D., of Cincinnati. H. C. DEMBITZ, M.D., of Louisville, Ky.

EDWARD JACKSON, M.D., of Philadelphia.

E. G. JANEWAY, M.D., of New York.

William ClInTON SHEEHY, M.D., of New Bedford, H. L. JENCKES, M.D., of Hazel Green, Wis.

Mass. Robert W. JOHNSON, M.D., of Baltimore.

GEORGE ERETY SHOEMAKER, M.D., of Philadelphia. ALLEN A. JONES, M.D., of Buffalo, N. Y.

MANNING SIMONS, M.D., of South Carolina. W. D. JONES, M.D., of Rising City, Neb.

WHARTON SINKLER, M.D., of Philadelphia. E. KELL, M.D., of New York.

HENRY SKINNER, M.D., of Philadelphia. G. W. KEMPER, M.D., of Muncy, Ind.

R. M. SLAUGHTER, M.D., of Virginia. S. Rush KETCHAM, M.D., of Philadelphia.

RICHARD SLEE, M.D., of Brooklyn, N. Y. EDWARD L. KEYES, M.D., of New York.

STEPHEN SMITH, M.D., of New York. GRGRGE NOBLE KREIDER, A.B., M.D., of Spring. i W. A. DEWOLF Smith, M.D., of New Westminster, field, III.

B. C. H. A. LAFLEUR, M.D., of Baltimore.

J. W. SNOWBALL, M.D., of Plainfield, N J. ERNEST LAPLACE, M.D., of Philadelphia.

A. O. SQUIER, M.D., of Springfield, Mass. JOSEPH LEIDY, M.D., of Philadelphia.

ALFRED STENGEL, M.D., of Philadelphia. JAMES J. LEVICK, M.D., of Philadelphia.

C. S. STEWART, MD, of Amite City, Louisiana. A. A. LEVINGS, of Appleton, Wis.

DAVID D. STEWART, M.D., of Philadelphia. WILLIAM M. Lewis, M.D., of Greensburg, Ky. JOHN S. STEWART, M.D., of Philadelphia. ALFRED L. LOOMIS, M.D., of New York.

Louis A. STIMSON, M.D., of New York. G. FRANK LYDSTON, M.D, of Chicago, Ill.

CHARLES G. STOCKTON, M.D., of Buffalo, N. Y. M. MAGELSON, M.D., of Fergus Falls, Minn. GEORGE A. STUART, M.D., of Wahu, China. G. BETTON Massey, M.D., of Philadelphia.

J. E. SUMMERS, JR., M.D., of Omaha, Neb. PETER McCarey, M.D., of Philadelphia.

CHARLES SZADEK, M.D., of Kieff, Russia. D. J. Milton Miller, M.D., of Philadelphia. HENRY LING TAYLOR, M.D., of New York. Morris B. Miller, M.D., of Philadelphia.

J. MADISON Taylor, M.D., of Philadelphia. W. H. F. MILLER, M.D., of Clifton Forge, Va. ROBERT W. Taylor, M.D., of New York. JAS. MITCHELL, M.D., of Madison, W. Va.

W. H. THOMSON, M.D., of New York, Robert B. Morison, M.D., of Baltimore.

Paul THORNDIKE, M.D., of Boston. CHARLES P. NOBLE, M.D., of Philadelphia.

H. TOULMIN, M.D., of Baltimore. FRANK P. NORBURY, M.D., of Jacksonville, Ill. F. J. Tower, M.D., of Milwaukee. ROSWELL PARK, A.M., M.D., of Buffalo, N. Y. W. R. TOWNSEND, A.M., M.D., of New York. W. THORNTON PARKER, M.D., of Salem, Mass. LAURENCE TURNBULL, M.D., Ph.G., of Philadelphia. BRUCE PEDEN, M.D., of Bloomfield, Ark.

JAMES A. TURNER, M.D., of Little's Mills, N. C. WILLIAM PEPPER, M.D., of Philadelphia.

J. HILGARD TYNDALE, M.D., of New York. A. M. PHELPS, M.D., of New York.

JAMES Tyson, M.D., of Philadelphia. C. R. Pontius, M.D., of Fremont, O.

FRANCIS UBER, M.D., of New York. Miles J. PORTER, M.D., of Fort Wayne, Ind. WELLER VANHOOK, A.B., M.D., of Chicago. WILLIAM HENRY PORTER, M.D., of New York. EUGENE WASDIN, M.D., of Charleston, S. C. D. W. PRENTISS, M.D., of Washington, D.C. W. H. WASHBURN, M.D., of Milwaukee, Wis. JOSEPH Price. M.D., of Philadelphia.

T. H WEAGLY, M.D., of Marion, Pa. W. B. PRITCHARD, M.D., of New York.

EDWARD A. WELCH, M.D., of Pottstown, Pa. AMAND N. RAVOLD, M.D., of St. Louis.

William H. WELCH, M.D., of Baltimore. THADDEUS E. REAMY, M.D., of Cincinnati, O. MARIE B. WERNER, M.D., of Philadelphia. John Ridlon. M.D., of New York.

GEORGE D. WESTON, M.D., of Fort Payne, Ala. L. T RIESMEYER, M.D., of St. Louis, Mo.

ROYAL WHITMAN, M.D, of New York. HENRY A. Riley, Esq., of New York.

W. J. WILBERT, Ph.G., of Philadelphia. John B. ROBERTS, M.D., of Philadelphia,

BURT G. WilDER, M.D., of Ithaca, N. Y. JOHN RODMAN, M.D., of Abilene, Texas.

DEFOREST WILLARD, M.D., Ph.D., of Philadelphia. GEORGE G. Ross, M D., of Philadelphia.

J. W. WILLIAMS, A.M., M.D., of Paterson, N. J. Julius L. SALINGER, M D., of Philadelphia. A. W. WILMARTH, M.D., of Elwyn, Pa. AMOS SAWYER, M.D., of Hillsboro, Ill.

W'm. E. WIRT, M.D., of Cleveland, Ohio. REGINALD H. SAYRE, M.D., of New York.

G. A. WRIGHT, B.A., M.B. Oxon., F.R.C.S., of G. E. DE SCHWEINEZ, M.D., of Philadelphia,

Manchester, Eng. HENRY SEWELL, M.D., Ph.D., of Denver, Col. H. V. WURDEMANN, M.D, of Milwaukee, Wis. CASPER W. SHARPLES, M.D., of Seattle, Wash. JAMES K. YOUNG, M.D., of Philadelphia. Edwin B Shaw, V.D., of (age City, Kansis.

A WEEKLY JOURNAL OF MEDICAL SCIENCE.

Vol. LIX.

SATURDAY, JULY 4, 1891.

No. 1.

PROFESSOR OF NERVOUS AND MENTAL DISEASES IN THE WESTERN

ship. This association is so quaintly described by ORIGINAL ARTICLES.

that inimitable writer, Sydney Smith, that I shall GASTRO-INTESTINALAND HEPATIC DISORDERS, crave your indulgence for a few moments while I ESPECIALLY CHRONIC GASTRO-INTESTINAL

include a short quotation. He says: CATARRH, IN RELATION TO THE ETIOLOGY OF SOME CASES OF INSANITY."

“Happiness is not impossible without health, but it is

of very difficult attainment. I do not mean by health BY SAMUEL AYRES, M.D.,

merely an absence of dangerous complaints, but that

the body should be in perfect tune, full of vigor and PENNSYLVANIA MEDICAL COLLEGE, PITTSBURG, PA,

alacrity. The longer I live the more I am convinced

that the apothecary is of more importance than Seneca, I think it is generally admitted by those who and that half the unhappiness in the world proceeds from have given the subject much thought that in many ing in the wrong place, from a vexed duodenum, or an

little stoppages, from a duct choked up, from food presscases the usually assigned causes of insanity are un

agitated pylorus. The deception as practised upon satisfactory and insufficient. Relatives or friends human creatures is curious and entertaining: My friend are generally ready with an explanation, particularly sups late, he eats some strong soup, then a lobster, then when this fits in with some preconceived idea of their

some tart, and he dilutes these esculent varieties with

wine. The next day I call upon him. He is going to own, as, for example, those much-abused causes- sell his house in London and retire into the country. religious excitement, disappointment and overwork; He is alarmed for his oldest daughter's health. His exbut to the student of psychology these are two often

penses are hourly increasing, and nothing but a timely

retreat can save him from ruin. All this is the lobster, inapplicable, if not incorrect. He feels that much

and when over-excited nature has had time to manage is wanting to account for the phenomena witnessed, this testaceous encumbrance, the daughter recovers, the and that many links in the chain of etiology are finances are in good order, and every rural idea effectmissing; but it is not always easy to find these miss- ually excluded from the mind. In the same manner old

friendships are destroyed by toasted cheese, and hard ing links; indeed, the subject is one beset with diffi- salted meat has led to suicide. Unpleasant feelings of culties. On this matter of exact etiology, both the the body produce corresponding sensations in the mind, text-books and asylum reports leave much unsup

and a great scene of wretchedness is sketched out by

a morsel of indigestible and misguided food. Of such plied. The list of causes is long enough, but we infinite consequence to happiness is it to study the cannot help feeling that they are too general, and body." do not meet the requirements of scientific precision.

Of course, this is known to everybody, but a more In connection with the obscure causes of some

striking picture could not be presented of the effects cases of insanity, it is the purpose of this paper to

of disordered states of the digestive organs on the examine briefly into certain morbid states of the

mind. gastro-intestinal tract, of the liver, and of deficient

To make the subject before us better understood, excretion, which seem in the writer's judgment not

let us divide it into three parts. In the first, we uncommon but perhaps often unrecognized causes

shall consider the morbid states of the gastroof mental derangement, and especially of melan

enteric canal and the liver and also other condicholia.

tions favoring the accumulation and generation of In a general way, disturbances of the nervous system arising from derangement of the digestive nent cause of the mental disturbance in question.

those toxic agents which we believe to be a promiorgans have been recognized from remotest an

In the second, the absorption of these toxines and tiquity. It would be superfluous to more than refer

their effect on the brain and nervous system generto the well-founded connection between dyspepsia ally will claim our attention ; and in the third we and despondency; between so called biliousness and shall consider the partial retention or retarded elini“the blues," or between prolonged constipation and nation of various poisons from the economy and mental dulness, drowsiness or headache. The de- their further cumulative effect upon the brain and rivation of the words melancholia and hypochon- excretory organs. driasis sufficiently indicates that the old Grecians were acute observers and believed in such relation- opinion that chronic gastric and intestinal catarrh,

Addressing ourselves to the first part, it is our 1 Being the Address in Mental Disorders delivered at the with chronic indigestion in the stomach and intesannual meeting of the Pennsylvania State Medical Society at Reading, Pa., June, 1891.

Quoted from Brunton : Disorders of Digestion, p. 45.

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