Of the whole population of our country-those of us who have our liberty and are supposed to be sane-a very small minority can be said to have perfect minds. All minds not perfect are necessarily imperfect, or in other words defective. It consequently follows that the great majority of us have defective minds. Then must this great majority be excused from legal responsibility? If so, there will be but few legally responsible. If not, then we have to admit that some defectives are responsible.

Admitting this necessarily admits of gradations of legal responsibility. This admitted, it is plain that we should not have inflexible laws making arbitrary punishment for the same offense against all offenders alike. If one defective must hang for his crime, then it is not wrong to confine securely and indefinitely other criminals who are more defective and to isolate them from the present asylum with all its possibilities for escape and to enjoy. all the associations, special privileges and gentle nursing which our present asylums are so earnestly trying to bestow upon its unfortunate and diseased.

The object of any form of punishment provided for by law is deterrent and not revengeful in contemplation. The conclusions of the greatest minds and the accumulated experiences of centuries accord to punishment for criminal acts the most effective check possible to be placed upon crime. Fear of punishment and hope of reward modify the acts of all sane individuals and of the great majority of insane ones as well. The object and hope of all asylum management is the exclusion of all vestige of punishment, but the very nature of the situation, the fact of the asylum and the disordered state requiring restraint is within itself punishment to the patient. Moving a patient from a nice, quiet ward to a violent one, with closer confinement and fewer privileges, is punishment, as well as is administering apomorphia, even though it is done entirely through necessity, in order that violence to others may be prevented and any degree of order maintained, and not at all with the object or desire of punishment, and in almost every instance it has a marked deterrent effect upon their conduct and in many cases of the most dangerously insane it positively stops all attacks of violent outbreaks and wrong conduct. These facts prove conclusively that those possessed of the criminal and rebellious tendency, even with universally admitted mental aberration, can be held in check through fear of the results of their wrong doings. So, if by isolation it should appear that there is discrimination against one class of the mentally diseased, merely because its course in them takes a criminal tendency, and should create the appearance of some degree

of punishment, it will be only fortunate in that it will surely induce some to hold in check their criminal tendencies.

Then let us adjust our laws and our institutions to the greatest needs of the greatest number, by confining constantly and securely our defective criminals, though some of them be greatly defective and diseased, thereby protecting society against constant dangers of irreparable impositions, and posterity against endless varieties of multiplied pollutions and defects.

For Texas Medical News.

A New Instrument for the Radical Treatment of Chronic Hypertrophic Tonsillitis With Remarks as to

"Causalis Indicatus."

BY E. L. BURTON, M. D., M'KINNEY, TEXAS.

For the past twelve years I have devoted all of my energies and research to these special branches of my profession. While it is not my intention to bring out any specially new points regarding the condition, I have been thinking and studying along some original lines, as regards the technique and treatment of these cases.

My opinion is at variance with some of the best men in the profession as regards the etiology, pathology and treatment of this condition.

Lubinski, as late as 1887, British Medical Journal, states that primary tuberculosis of the tonsil has never been seen in man. Later, Wright, Philadelphia Medical News, 1892, assumes authority for the statement that lupus is a modified form of tuberculosis. Of course, this itself is in contradiction of Lubinski's theory.

But such a theory will not stand the searchlight of more modern investigation. Lupus and tuberculosis can no more be classed as the same disease than could typhoid and malarial fever be characterized in this manner.

Assuming that lupus or tuberculosis is neither a primary affection of the tonsil, would make little difference. It has been proven beyond a doubt that in the great majority of cases of hypertrophy of the tonsil, especially those cases of follicular or succulent glands, are not only the home of bacteria, but of tuberculosis. It matters little whether it be primary or secondary, inasmuch as all laryngologists of experience recognize they have a great many cases of this

Like pneumonia, preceding the specific manifestation of the disease, we have a case of exposure, a sudden chill or chilliness resulting in acute exudation, or serum infiltration into the lymph spaces and parenchyma, thus inviting a suitable soil for the invasion of the diplococcus pneumonia. The question arises, is pneumonia a primary affection? I will say yes, an acute, specific, primary disease. Of course there is room for diverse opinions; but after all, it is the results we are looking for.

Taking the ground that tuberculosis of the tonsil does not occur primarily, what a favored field we have here to exercise preventive medicine or surgery, to prevent the dread malady-tuberculosis.

My own observation leads me to the opinion that many of these cases are of primary origin, just as much so as diphtheria, or a great many specific diseases, the first symptoms being referable to tuberculosis manifestation.

I have especially in mind a family where five of the children were afflicted with tubercular tonsils-this infection being in some unknown way communicated to them, there having never been any previous history of any trouble of the kind in the family, or ancestors on either side. I know this was the first primary symptom in these cases. There might, and I believe there is, generally, a causation or predisposition to take on specific infection more easily in some subjects than others; because the soil is more suitable in one location than another would not hinder or prevent the development of the condition primarily.

It is an undisputed fact that we can inoculate and produce primary tuberculosis. The first three of the cases referred to, afterwards developed general pulmonary tuberculosis. I examined these cases, but did not treat them, as they were being treated for a simple case of catarrhal trouble. I believe they all died with this dreadful malady before the family or physician fully realized the true nature of the condition. The other two cases were taken hold of in time, operated on and treated by me according to my idea of dealing with such conditions, which I will give later on.

I will state, however, before going further, the average duration of life in such cases where there is a developed case of primary tuberculosis of the tonsil is about two years. The two cases mentioned in same family were, as previously stated, successfully treated by me, after first confirming my diagnosis by the microscope. At first I did not intend to go into the details of this subject quite so much, my only apology-if it might be called onewas to bring to the notice of the profession a new instrument for the radical treatment of chronic hypertrophy of the tonsilar glands.

But the subject seemed so important that I could not pass it lightly by.

In the two cases just mentioned, careful examination of the lungs gave negative results, so you see I had a local circumscribed tuberculosis of the tonsil. In treating these cases, I always look carefully after my patient's food, see that they get plenty that is nutritious and most easily assimilated, as well as to their environments, plenty of fresh air, especially in their sleeping apartments, and, when the weather will permit, out-door exercise, but never excessive. As to treatment, both medicinal and operative-both are demanded-I commence with small doses of creosote and guaiacol, and gradually increase to tolerance. It is surprising how well most patients bear this treatment, and the larger doses they are soon enabled to assimilate, much to their advantage. Locally, I always use a nice, mild, alkaline antiseptic, in the form of a spray, giving preference to some of the more hydroscopic in action.

To these preliminary measures should be added, after about a week, the more radical treatment. This is rendered very easy of execution, and much simplified by the use of "Burton's Tonsilar Scoop," which may be seen by reference to the accompanying cut. It is a very plain and simple instrument, originated and designed by the author.

BURTON'S

TONSIL SCOOP.

With this instrument you may scoop the whole organ out in a few seconds, without the slightest danger under ordinary circumstances. A four per cent. solution of cocaine with two drops of phenic acid to the ounce should be applied topically three times to the tonsil to be operated on at intervals of three minutes, and then wait five minutes before removing the gland.

Adrenalin chloride, or like preparation, should never be used

until after the operation has been completed; the reason is obvious. After this follow the preliminary spray as before and apply topically to the gland, tincture iodine, glycerine and alcohol, equal parts. I find this to be the best remedy, as it prevents pain following operation, and causes rapid elimination and absorption.

The advantages claimed for this new instrument are its simplicity of construction and application, enabling the operator to remove with ease and perfect safety the entire tonsil, or that portion he may desire.

I had intended this article to bring out and explain the radical treatment of chronic hypertrophy of the tonsil more especially than to treat of the diseases per se.

Tuberculosis of the tonsils should be considered a primary affection of the gland, from a practical, if not a theoretical, point of view. For instance, a healthy individual might be innoculated with the tubercle bacillus. Is not this sufficient proof that it may exist primarily, or might it not be taken into the system and find lodgment in some weak spot or part where the soil did not so strongly inhibit its influence?

This is only a manifestation favorable for its growth and production. It would still be a primary manifestation. Are not all acute, specific diseases capable of being produced primarily?

For Texas Medical News.

A Plea for More Accuracy in the Diagnosis of Lues in Its Initial Stage.

BY WM. F. BERNART, M. D., HOT SPRINGS, ARK.

To this title may proprietarily be added "before beginning an anti-syphilitic treatment." A disease so prevalent as syphilis, and one that follows, in the majority of cases, a course so typical and well known, ought seldom, if ever, be clouded by a doubtful diagnosis, providing time and care are taken in this procedure.

It is not my intention to handle this subject on the basis of chancre diagnosed wrongly, but on the contrary on the basis of a genital or extragenital sore diagnosed as chancre, in which the patient is placed under anti-syphilitic treatment before the same is fully justified.

I stringently doubt that if among the more common causes, there is any which will cause an intelligent person to seek the advice of a physician quicker than the cognizance of having a genital sore. It