The practical application of psychology in differentiating types of mental disorders, necessitates an acquaintance with the whole syndrome. Alienists have long since emphasized the necessity for study of the entire course of the disease, and not merely the isolated symptoms of a given period.

Similar clinical pictures are duplicated in a great variety of mental disorders; hence any diagnosis based upon individual symptoms without regard for the whole, is at best presumption. We should give at least as much attention to mental symptoms, their evolution and source, as we bestow in analyzing and tracing the signs of other disorders, to the parts responsible for their existence.

To name a case dementia because the person refuses to talk, take food of his own accord, or even respond to simple questions, is no less puerile than a diagnosis of measles because of an existing pyrexia and cough. In the syndrome of mental acts by an insane person, certain of the symptoms give body and tone to the whole clinical picture.

Studying the syndrome of many cases, we see groups of patients that represent types of abnormal mentality. Thus by an analytic and synthetic process, studied along avenues for definite observation, we discover one large group of patients representing a special type of mental disorder. Their mental pathology is characterized by introspection, retrospection and self accusation. Pessimism and psychomotor inactivity bounds their mental horizon. Worry, with depression and mental pain. is marked. They fail of reaction to stimuli received by contact with others, even under the most optimistic environment. They believe they alone, are the creators of their present misery. That mental disorder is melancholia. In this group the delusions are legion.

The content of the delusion is as varied as the personality and education of the patient. Psychomotor inactivity is characteristic of melancholia but sometimes the mental anguish impels these victims to bitterly reproach themselves for their want of moral integrity, and they will inflict on themselves bodily punishment as a penance for their alleged unpardonable sins.

The normal power of their mind is long maintained, but it is abnormal in action. They are justly regarded as suicidal. They are apt to refuse food and medication, alleging that their condition is hopeless and that they want to die.

From the same analysis we have another group of patients less numerous than the melancholiacs, whose dominant symp

toms are characterized by psychomotor activity, optimism, and a feeling of mental and physical well being. They are apt to refuse any care or medication offered, and repudiate the suggestion that they are sick or nervous. Like the melancholiacs, their normal strength of mind is long maintained but abnormal in action. Their mental alertness is often more acute than is their normal. Especially is this true of their hearing. Their delusions are numerous and of varying content.

Confident of their superior mental and physical strength they embark on many business projects that are grotesquely absurd. Unlike the melancholiac, they show an excess of mental and motor activity. This group of patients is a distinct clinical type that measured by the whole course of their mental disorder, clearly differentiates them from melancholia, and justifies the name mania.

Their self-confidence and optimism submerge their judgment of civic privileges toward other people. Impelled by strong delusions of persecution, they openly, knowingly and without remorse, defend their beliefs by homicidal acts.

The melancholiac is pre-eminently pessimistic, introspective and honestly believes he is ethically responsible for effecting his present and eternal damnation. To avoid that calamity his weakened judgment impels him to attempt self destruction. The maniac in optimistic self-defense, attempts the destruction of persecutors.

There is a third group of patients who present symptoms common to both preceding groups. They in many cases show brilliant intellectual attainments, but possess a mental twist. Sane on all subjects save one, which is their hobby. It is not true that every person who has a hobby is insane. So long as they provide support for themselves and their dependent ones, and do not project their personally entertained belief to the dentriment of the moral and civic rights of their fellowmen, they are not insane.

When adherance to a single concept impels its possessor to neglect the rational and necessary duties of life, and which duties would have been performed but for the all absorbing interests of that one idea, that person is insane.

The clinical picture evolving the evidence essential to a diagnosis of this third type of mental disorders, covers especially the second and third decades of life. It is characterized by the gradual development of a systematized delusion crystalized out of many and varied, but erroneous interpretations of words and acts innocently expressed or done by their associates.

The content of the fixed delusion is detailed with accuracy of logic, because mental weakness is not present for many years. As we analyze the mental symptoms of this group, evidence accumulates to the establishment of one fixed and controlling delusion.

New and varied delusions come into view and are interpreted by the patients, as harbingers of evil to the fruition of their one dominating idea. They seek new locations and thereby lose many of their old delusions of persecution, but each new environment brings other and equally annoying conceptions of plots for their downfall. Each new set of false beliefs has the effect of exalting the abiding delusion to the position of a north star, in the life of the person in whom it exists.

On all other subjects these patients converse sensibly and reason logically. Their bodily condition is usually indicative of good nutrition. The abiding delusion makes them a monomaniac, or if we accept our modern nomenclature, a paranoiac. They are not suicidal, and are more apt to be homicidal, than the maniac with many delusions.

A fourth group of cases larger than the monomaniac group, more numerous than the maniac group, and almost if not equaling in number the melancholiac group, offers a rich field for the medical psychologist.

In the type this group represents, the syndrome begins with early childhood, and matures with the period of adolescence.

Mental deterioration of varying grades is the tendency from the beginning. Their ability to perceive things said or done by others, is but little disturbed. They properly orient themselves, consciousness is clear, but the power of voluntary attention is noticeably impaired. This latter symptom is fundamental in this type of mental disorder.

Certain features designated as indifference, negativism, posing, imitating the actions and repeating the words of physician or nurse, and staring vacantly into space, are especially characteristic of this group. Memory is poor, and especially so for recent events.

The fact that this symptom is present in youth when memory is at its best, is a strong point toward differentiating this type from all other forms of mental disorder.

The train of thought is incoherent, aimless, and often suddenly without completing a sentence, they change to a new subject. They seem to harbor a mass of ideas without ability to carry any one to its goal. Their judgment is always defective,

hence becomes a basis for delusions. New delusions rapidly displace the old, or add new meaning to those longer retained.

Disturbance in the emotional life is very often an early symptom of this type. An absence of the natural affection in youth, for parents or associates, is a common symptom. Laxness of the moral standard as set by the average for the family of the patient, tells us of a progressive mental deterioration. These, with the absence of sympathy, and want of appreciation for kindly acts by relatives and friends, are a few salient characteristics that give background and tone to the type forming this group which has long been designated primary dementia, but now called dementia precox.

The monomaniac patients (paranoiac) are sane on all subjects save one. They show good bodily nutrition and persistently strive but never attain, to the accomplishment of their cherished idea. They are not demented till late in the course of their disorder. In primary dementia patients (dementia precox) all the mental faculties are below par from early life. They are peculiar in speech and actions. They make senseless remarks, repeat meaningless words, and commit foolish and impulsive acts. Periods of depression and excitement dot their course toward further mental deterioration. The psychoanalysis of the syndrome designated primary dementia (dementia precox), leads unerringly to some congenital cerebral defect. It is preeminently a mental disorder of the development period of life.

In the monomaniac (paranoiac) just one department of the mental machinery has lost its balance and is out of alignment with the rest of their mental make up.

Psychoanalysis of the groups designated melancholia and mania, leads to the conclusion that they were born with a cerebral stability normal to the average of their immediate ancestors, but under the stress and strain of social and business exactions, acquired some cerebral instability which caused their mental disorder.

Dyspepsia Due to Myasthenia Gastrica.

*By ALFRED O. Peterson, A. M., M. D., Omaha.

Myasthenia gastric is a perversion of the normal digestive function which constiutes the most frequent cause of dyspepsia in this country and totals 86 per cent of the gastric cases met in practice. It is the most common of all digestive diseases.

*Read before the Nebraska State Medical Association, Omaha, May 2, 3 and 4, 1911.

There is, in this disease, a diminution in the elasticity and strength of the muscular coat of the stomach whereby this organ is rendered unduly distensible and does not empty its contents in normal time. Also the innervation of the nerve centers regulating peristalsis is disordered. We have to deal with what is most frequently described as a weak stomach.

In this disease the chemical signs are frequently of no assistance whatsoever in making the diagnosis and physicians who, believing that gastric analysis consists simply in determining the free and total acidity of the stomach contents, are lead into the error of thinking that the trouble is largely imaginary and hence no sustained or adequate treatment is instituted.

In myasthenia gastrica or, atony, as it is more commonly designated, the estimation of the motor power of the stomach is of highest importance; without it no rational diagnosis nor proper treatment can be instituted. And it shall be the purpose of this paper in discussing the subject of dyspepsia due to myasthenia to more particularly call attention to the methods which shall readily and with fair exactness give the motor power of the stomach.

In this disease, as is the case in many other disorders of the digestive ordagns, a considerable period may elapse between the establishment of the morbid condition and the occurrence of subjective symptoms, and many patients may exhibit the physical signs of atony months or years before they themselves become conscious of its existence.

Women are more liable to the disease than men and tall, thin people are particularly susceptible. It is important to observe that there is a diminution in the intra-abdominal tension in these cases, which fact is particularly pertinent when considering the treatment.

Atony of the stomach is frequently hereditary and is more common in women than men. It is frequently the cause of dyspepsia in children.

Etiologically two types of atony are recognized, viz.: primary and secondary. Overeating and the excessive ingestion of fluids is largely responsible for the primary type. Lack of exercise and fresh air or living in a hot climate may lead to the disease. Various drugs and poisons may also cause atony of the stomach. In short, any condition which induces relaxation of the abdominal musculature with consequent production of lowered intra-abdominal tension may lead to gastric atony.

Secondary myasthenia is very frequent and its causes are