ing the hair to fall, it has been suggested to test this method in all parasitic affections of the hair follicles in which the elimination is an essential element in healing, for example, trichophytosis, favus, sycosis, et cetera. In a case of sycosis of the beard, which had existed for five months, and in which there was deep infiltration and induration about the follicles, the hair began to fall after the seventh sitting, and after two more treatments by the x-rays the pustules had dried and most of them disappeared. The infiltration gradually yielded, and the skin became soft. After thirteen applications the patient was completely cured.

The r-rays were tried in the case of a man of forty with trichophytosis ectothrix of the beard and neck. The hairs began to fall after the second sitting, and after the fifth sitting the face was perfectly clean.

In two other cases of children with ring-worm of the scalp the hair began to fall after the seventh sitting, followed by some desquamation and hyperpigmentation, and complete cure after seventeen sittings.

A case, which included nearly the whole scalp, and had resisted various attempts and methods of treatment for over twenty years, showed a loss of hair after the eighth sitting. The treatment was continued for four months in successive different areas, destroying the parasite in parts actively treated, the scalp becoming normal and the hair growing in new in many parts, but leaving evidence that the disease was not wholly eradicated.

From these observations the experimenters believe that the fall of hair begins after six or seven sittings, and that in the method employed by them no danger need result. They think that the special action of the ray is directed to the pillar itself. It is admitted that it has not been shown as yet that permanent epilation can be secured, though in a case treated by Oudin no recurrence of hair had appeared after more than seven months.

PSYCHIATRY.

BY WILLIAM MILAN EDWARDS, M. D., KALAMAZOO, MICHIGAN.

MEDICAL SUPERINTENDENT OF THE MICHIGAN ASYLUM FOR THE INSANE.

HOSPITALS FOR THE ACUTE INSANE.

FREDERICK PETERSON, President of the New York State Lunacy Commission, in a letter to the Buffalo Medical Journal for November, 1902, as reported in the American Journal of Insanity, calls attention to the need of reception hospitals for acute cases and those alleged or suspected to be insane. He assumes that all will agree that the sooner a case of insanity, especially an acute one, is put under the best treatment and safest superstition the better. With this idea in view a sort of emergency hospital known as the psychopathic hospital has been constructed in a large number of the chief towns in Germany. In many cities in this country and Europe, provision has been made for these emergency cases in connection with general hospitals. Such has been

the case in Berlin, Vienna, Paris, Philadelphia and at the Bellevue Hospital in New York. Doctor Peterson says that in cities near a state asylum the need of a psychopathic hospital is not so apparent as in places more remote, but at the same time owing to the rather slow methods of commitment that even in cities like Buffalo, where there is a state hospital, patients are not infrequently kept in station houses awaiting necessary legal examination and commitment. Thus many cases of insanity in which treatment should be begun at once have, pending their examination and commitment by legal process, been kept in jails or almshouses some days without treatment. It is a fact that patients are sometimes sent to hospitals for the insane who are not really insane but suffering from various forms of delirium due to typhoid fever, pneumonia or other diseases.

Doctor Peterson says that Albany has already established a reception pavilion in connection with the Albany general hospital, where all these emergency cases of insanity and cases of apparent insanity are now received. This has proved very successful. He thinks if there were such a pavilion in connection with general hospitals in large cities that these cases could be received and treated immediately pending their examination and commitment, and in cases which are doubtful their insanity could be verified before resorting to legal process. He calls attention to the statistics of the pavilion for the insane at Bellevue Hospital for the five months ending June 30, 1902. There were admitted 986 patients. Of these 652 were sent to the Manhattan State Hospital; 21 to private asylums for the insane; 33 to other institutions; 79 were sent into Bellevue Hospital as not insane, but suffering from other ailments; 182 were sent back to their friends without commitment; 27 died; 24 remained in the pavilion. He especially calls attention to the remarkable fact that out of this total number of 986 admitted, 79 were sent into the Bellevue Hospital as not insane, and 182 were sent back to their friends; 27 were so ill that they died in the reception hospital. In their classification of diseases received at the pavilion for the insane for three months ending June 30, 1902, there were 584 cases. Among these were 118 cases of epilepsy, hysteria, chorea, alcoholism, morphinism, and the like, and 28 cases marked as not insane. These statistics afford something of a commentary upon the usefulness of such a reception hospital.

Doctor T. S. Clouston, of the Royal Edinburgh Asylum, in a paper read before the British Medico-Psychological Association and abstracted in the American Journal of Insanity for January, 1903, makes a strong plea for attempting to treat cases of acute insanity in general hospitals. He argues that in a general hospital a patient can often be treated without the loss of social prestige or business standing. If this attempt is successful mental disease is put on the same footing as other bodily diseases, and the public mind becomes educated to regard insanity in the same light as other severe and prolonged bodily affections. To treat these cases in general hospitals is simply to extend the specialization in medicine which has already done so much for the growth of medical

science. They should be treated separately from cases of ordinary disease, and only those who are in an acute and curable stage of insanity should be admitted. Patients should be admitted precisely like other hospital cases and without any tedious legal formality. A special staff of physicians and nurses should be provided in wards especially built to meet the needs of the patients. He concludes with an outline of what he considers an ideal provision for the treatment of the dependent insane. This would consist of:

(a) Wards in connection with general hospitals for the reception of incipient, transient and proper cases of acute disease.

(b) Reception hospitals for patients requiring legal commitment. (c) Ordinary hospitals for patients whose insanity continues from month to month.

(d) A boarding-out system for quiet, industrious and manageable

cases.

THERAPEUTICS,

BY DELOS LEONARD PARKER, PH. B., M. D., DETROIT, MICHIGAN.

LECTURER ON MATERIA MEDICA IN THE DETROIT COLLEGE OF MEDICINE.

VISCERAL GOUT CURED BY THE INGESTION OF
GRAPES.

GOLDSCHMIDT, of Strasburg (Journal de Médicine et de Chirurgie Pratiques, December 22, 1902), reports in detail a case of visceral gout, occurring in his own practice, which was cured by the free ingestion of grapes.

The patient, a man aged sixty-four, had been, in his younger days, a well nourished and healthy man. In adult life, however, he was attacked with rheumatic gout, and for some years previous to 1880 had two and sometimes three attacks of this disease each year. These attacks were always severe and confined him for weeks to his house or bed.

In addition to the rheumatism this man suffered also from a disturbed condition of his nervous system that at times amounted to true hysteria. His sleep at all times was disturbed and accompanied by spoken words and muscular movements.

During the attacks themselves fever was present to a high degree, and also frequently hallucinations. At the end of an attack there was usually a series of convulsions with a marked tendency to heart weakness and pallor of the face and interrupted respiration. The only remedy found to be of value in treating these attacks was morphin sulphate. Under the influence of this drug sleep came on. The remedy was palliative, however, rather than curative. Earlier in the disease. colchicum had seemed to be of value, but later this had to be given up on account of disturbances of disgestion it came to produce.

In 1880 he suffered from an attack of pleurisy, and this was fol

lowed by an irritability of the stomach that was so pronounced and so persistent that cancer was suspected.

In this condition he was kept alive for a long time by means of nutritive enemeta. Finally, however, he became so wasted and so weak that his death was anticipated. At this time Doctor Goldschmidt had been able to eliminate the possibility of cancer being the cause of the gastric irritation and to substitute in its place visceral gout.

While the patient was lying in the condition above described the season of grapes arrived, and with it there came to the patient an intense longing to eat some of this fruit. In response to his pleadings a small quantity was given to him. These he ate with no bad effects. Then the quantity was increased and still no bad effects followed. The result was that in a short time he was allowed to eat all the grapes he wished. From this time on he practically lived on this fruit and ate whole basketfuls without stopping, and from this time on also he began to get well. Soon after starting on this diet he found he could retain other kinds of food, and gradually he took advantage of this power.

In closing his paper the writer says that the restored health of the patient, dating from 1880 and suffering no interruptions since that time, must in great part be attributed to the grapes he ate through the dictates of an irresistible impulse.

PATHOLOGY.

BY ALDRED SCOTT WARTHIN, PH. D., M. D., ANN ARBOR, MICHIGAN.

JUNIOR PROfessor of pATHOLOGY IN THE UNIVERSITY OF MICHIGAN.

THE HEMOLYMPH NODES.

THE year just closed has seen an unusual amount of scientific energy directed toward the investigation of the problems concerning the blood and the blood-forming organs. Of the researches into fields previously unknown or but recently studied, the recent work, which has raised a group of glands, practically unrecognized before, into a position of importance, both in so far as their anatomic and pathologic features are concerned, has attracted much attention; and during the year a number of workers have made important contributions to this subject. These studies have in many ways shown that the present views concerning the lymphoid tissues are very imperfect and inadequate and that we must assign to such tissue a more important rôle, both in health and in disease, than it was formerly supposed to possess. That the regional lymph-glands differ in structure and function appears to be the case; and in particular do those retroperitoneal glands having a red or brown. color appear to possess especial functions of hemolysis which assign to them an anatomic and pathologic position more nearly related to that of the spleen and bone-marrow than of ordinary lymphatic glands.

A hemolymph node is a lymphoid organ containing blood-sinuses. Lymph-sinuses may or may not be present. Those containing only

blood-sinuses may be designated hemal glands, while those containing both blood- and lymph-sinuses may be termed hemolymph glands. In some glands the blood-vessels appear to communicate directly with the lymph-sinuses, and such glands may not inappropriately be termed hemal lymphatic. Inasmuch as the chief function of these organs appears to be one of hemolysis, all of the forms may be included under the comprehensive designation of hemolytic glands. In man the hemal lymphatic variety is most common, the majority of the prevertebral retroperitoneal glands appearing to be of this type. In the deep cervical region a small number of hemal glands are always present. Numerous mention is made throughout the literature of the last fifty years of red, pink or brown glands occurring in the human body, but it was not until 1884 that the suggestion was made (H. Gibbes) that these structures were of independent nature and function; and not until 1901 was this suggestion proved and the importance of the organs demonstrated, both in so far as their anatomic and also their pathologic relations are concerned. In this year investigators working independently in Italy, Germany and America made important contributions to this subject, as a result of which the attention of a number of workers was during 1902 directed to these organs.

Retterer (Comptes Rendus de la Sociétié de Biologie, January 17, 1902) reported the results of observations on the lymph glands in animals under the conditions of starvation and hemorrhage, and ligation of the lymphatic trunks. As a result of his experiments he concludes that the red glands (hemolymph glands) have the same structure as the gray glands (ordinary lymphatic glands); and that all lymphatic nodes possess the same structure and function; they are all hemolymph glands and produce both lymph and red blood cells. He holds further that the color of a lymph gland (redness or paleness) depends entirely upon whether the red cells are retained in the sinuses or quickly removed into the general circulation. Local or general conditions may so affect the lymph current that there is either a stasis of red cells in the lymph glands or these cells are more quickly swept into the lymph vessels. Changes of pressure in the lymphatic circulation are sufficient to convert the same glands into pale glands or into hemolymph glands of red color.

Lewis (Journal of Physiology, March 27, 1902) gives a preliminary communication of his studies concerning the histology and physiology of these glands. He divides the hemolymph nodes into three classes: hemal, containing blood-sinuses only; hemal lymphatic with sinuses containing a mixture of blood and lymph; and a third class containing ordinary lymphatic glands in which the sinuses for the greater part contain lymph. All possible intermediate forms exist. The functions. of the hemolymph nodes are presumably the formation of leucocytes, destruction of red cells, the formation of phagocytes, and the destruction of leukocytes. The spleen may be termed a hemal gland.

Warthin (meeting of American Pathologists and Bacteriologists, Cleveland, March, 1902; Journal of Medical Research, May, 1902)