ture, writing, spelling, grammar, arithmetic, including advanced, geography, including physical, U. S. history, rhetoric and physics. In these subjects I would require not less than 70 per cent. in any one study and an average of 80 per cent. in all. I would have the examination compare with the ones given common school teachers in our first-class States. As the weaker States grow stronger I would add to this list in this order, botany, latin, algebra.

Right here I want to say to you from my own personal observation as a teacher, that I have seen students with high school diplomas and first-class college degrees fail and fail again to pass these examinations, so don't sneer too much at the common school education. Remember it is not the number of studies a pupil has gone over, but how many he knows and can use. You can't judge a man's knowledge by the number of books in his library.

In his four years' medical college course the student will also get anatomy, physiology, chemistry, biology, materia medica and all the laboratory courses. These added to the other subjects I have indicated will make no mean education; calamity howlers to the contrary, notwithstanding. All any education, no matter how extensive it may be, can do for a man is to teach him to think, to reason and to act intelligently for himself.

Some of our ultra-educated little fellows are insisting upon the higher education, thinking we owe an apology to the European countries for our ignorance. If these men believe that conditions are on such a high plane over there we can, by a great effort, spare them here. America need make no apologies to any country or people on God's green footstool. Financially, physically, mentally and every other way, our countrymen, as a whole, need not feel abashed anywhere in the world. Understand 'me-I would also criticize the low grade advocates. They should be compelled to raise their standards, as fast as consistent, to a happy medium.

To sum up:

Ist-The only common sense, feasible plan for entrance requirements is to have one uniform list for the whole United States. Any other method leads but to "confusion worse confounded."

2nd-All States and schools of medicine must strive to agree upon this, and New York must remember that she is only a little part of this country and that, while she would like to set the standard high, all other States are not ready for it yet. Each section must allow for the others' peculiarities. When all the States are in line and working in unison, then the requirements can gradually be raised as the weaker States grow up to it.

3rd-Until some method is devised by which a boy's heart and soul can be examined for honesty of purpose, ambition and natural ability, and until some method is discovered of reading his future success, let us not insist that higher education must be an absolute essential for the study of medicine.

CONSTITUTIONAL INFERIORITY.*

FREDERICK C. ROBBINS, GOWANDA, N. Y.

It is a very evident fact that in the examination of large numbers of the insane one finds many stigmata of degeneracy. While it is admitted that everyone is allowed a few tell-tale stigmata, one cannot but be impressed on examining a case with marked physiological defect, that the same was to some extent the basis for the psychosis.

In the imbecile and idiot the signs are markedly evident. but in many cases the signs, while not so conspicuous, are very plain to the trained eye.

There can be no doubt that individuals presenting such stigmata have low resistive forces, are more easily impressed by certain things and have a lower moral tone; in short, very poor stability.

The student cannot but be impressed with the fact that there is some reciprocal relation between the physical degeneracy and the general personality. On examination a new case presenting marked stigmata with many of the symptoms of one of the psychoses, one is often at a loss how to classify such a case. Is it a case of manic depressive, dementia praecox or involution melancholia according to the symptoms, or is it a case of constitutional inferiority? (as we call it in the classification adopted by Dr. Adolph Meyer, of the Pathological Institute of the New York State Hospital service).

If there are no clear-cut symptoms and there has been no apparent pronounced etiological factor outside of the physical degeneracy, the patient being of a rather fair intellectual standard, able to do business, care for himself, but often reacting to what must be a deficient mental make-up, one cannot but feel that it is a case belonging to the constitutional inferiority class.

Where the case presents marked flight of ideas, retardation and depression, why is it not a manic depressive episode on a constitutional inferiority basis?

We find that the range of intelligence is decidedly limited and there seems to be a point in the educational sphere beyond which they are unable to go. Their knowledge of current events is very ordinary and on the whole they are what one might call shallow. The cases I have seen are quite emotional and as children they were those who insisted and did have their own way, being beyond parental control. As regards their moral stamina, to a great extent it is undeveloped; while they will deny, often very angrily, any deviations from social and moral ethics, we find that in many cases there is a complete lack of morality. They are, as Defendorf says, "Moral imbeciles."

If we examine into these cases carefully, we find some

*Read before the New York Homoeopathic Medical Society.

marked hereditary factor such as a bad temper, extreme nervousness, symptoms of neurasthenia, hypochondriasis, undue irritability or some abnormal deviation from the ordinary normal equilibrium.

Everyone who is not equal to or is not superior to his forebears is certainly retrogressing, and there is no doubt that in cases belonging to this group such is the state of affairs.

As we examine very carefully into the family history, one cannot help being impressed with the fact that physiological stigmata must enter to some extent, at least, and in many cases to a considerable degree, into the mental make-up of the individual.

The anatomical signs vary to a great extent in different individuals; there may be a decided abnormal development of the cranium, a lack of proportion, as is often noted in the criminal. The face may show much asymmetry, viz: the eyes being of the mongol type; increased or distorted growth of eyebrows; ears defective in position and size and lobules are apt to be adherent; palate may be high and narrow or low and saddleshaped, sometimes presenting a longitudinal torus; the teeth may be defective, second dentition being incomplete.

In several male patients have been observed enlarged mammary glands, absence of hair on body and soft voices, while in women have been seen increased growth of hair on body and voices approaching the masculine. The cases are often sexual perverts in some form; are inclined to masturbate to a more or less extent and the men have abnormal nightly emissions.

It is often a great question what the normal condition of an individual is or should be. What you or I would call queer or odd, others might call normal. We often have relatives visit. patients and say to us that the patient is as well and acts as he or she always did, while to us they seem far from a normal standard. In such cases we have to discharge them recovered to their normal condition.

The first case I present is that of a young woman who twice attempted suicide on the streets of Buffalo; a case which was a puzzle to the police. She, having no one to care for her and unwilling to be influenced by relatives, was sent to the hospital for treatment. Before she left, she admitted to one of the physicians that for the first time she had learned the meaning of the word discipline. While her hospital experience has benefitted her, she will no doubt return to her former habits, being of a very erotic temperament and one who is controlled by her impulses.

Adm. June 5, 1906: Age 29: Widow: U. S. Skirt

maker.

F. H. Father is of a very nervous temperament. When the patient was a child, he would become very angry at her and would often knock her down on the floor. Mother is also very nervous and rather erratic.

P. H. Patient born in Cherry Creek, N. Y., Nov. 4, 1878: began to attend public school when 6 years of age and attended same until 20 years old. Had the ordinary children's diseasesmeasles, chicken pox, mumps and whooping cough. At 16 years had anaemia, which condition lasted for two years, after which she entered Buffalo Normal School; was there four years, but did not attend regularly and finally decided that she did not care to be a teacher, so went and worked as nurse girl for her sister; became dissatisfied and, as another sister was an actress. decided she would like to be one also and ran away, not telling where she was going. Traveled for two years "starring." During that time she met an actor whom she married, but lived with him only three weeks, as she found he was not true to her. Becoming tired of the stage, she went back to Buffalo and became a skirt maker for a clothing firm.

PSYCHOSIS: When a child, patient had a very vicious temper; when she became angry, would throw herself on the floor, kick and scream, throw things about and at times would bite herself on the arm. Of late years has confined herself to screaming and throwing things about when she was opposed and could not have her own way.

During the Pan-American year had considerable insomnia for which she took chloral, and one day she took an overdose, from which she was quite ill. For the last year patient has been going about with a physician who was engaged to be married to another young lady. Patient admits that he gave her money at various times and made her some indefinite promises of marriage. In February, 1906, having bought some laudanum, she went down to his home, drank the laudanum out on the sidewalk, threw the bottle down, went into the office and said she had come to say "good-by." On being questioned she told what she had done. The bottle corroborated her story, several physicians were called, she was given heroic treatment and made a good recovery with no ill effects from the drug. This matter was hushed up and she became more intimate with the physician, but he would always put off marrying her, although at one time they were going to elope. On the 3rd of June, 1906, she bought some laudanum; had some difficulty in purchasing same, but finally, at one store, in reply to questions, she said she wanted it to put in a poultice and was given two ounces. On the way home telephoned to a physician and asked him to tell the physician with whom she was going that she was about to do some harm to herself, and several hours afterward drank the laudanum and went to bed. In a short time the physician she had telephoned to came in and she told him what she had done. He immediately sent for two other physicians, who lavaged her stomach and sent her to the General Hospital. While there, cried a good deal and was at times very hysterical.

ON ADMISSION: Was crying very loudly. Said that she

was not insane and did not want to stay; was quite resistive on being taken to ward.

Her height was 5 ft. 7 in., weight, 155 lbs. Hb. 80 per cent.; well-developed, heavy features, pudgy in appearance, face small, nose broad, ears large; palate high and broad with marked torus; chin a trifle receding. Cephalic index 78.23; expression of eyes duil dermographia slow in appearing and faint.

Well oriented as to time, place and persons. Memory of recent and past events very good. No delusional or hallucinatory condition. Educational tests very good. Denied attempting suicide; in fact, fabricated about all her past life. Insight good, judgment poor.

June 12th, 1906. For the first week after admission was very resistive; would not conform to hospital rules and would cry and scream when she found she had to obey.

June 17, 1906. Up and dressed. Sits about ward, taking no interest in surroundings, appearing very apathetic, often noticed with eyes fixed, perfectly oblivious to what is going on about her.

June 25, 1906. Discussed past. No intention of committing suicide now; previous attempt being for effect only.

July 4, 1906. Exhibition of temper.

More cheerful. Looking about ward, though

July 10, 1906. reluctantly. Aug. 16, 1906. Very good self-control. Paroled for 30 days, at the end of which time she was discharged, recovered to her normal condition.

The second case is one of manic depressive on a constitutional inferiority basis. This patient, a young man, showed such marked stigmata of degeneracy as to suggest that the mental condition was an episode on a defective basis, there being an utter lack of shame, inability to distinguish between truth and falsehood and success in no occupation. This patient became the despair of his parents on account of his alcoholic excesses and finally was committed as a last resort.

Adm. Oct. 24, 1906: Age 26; Single; U. S.; Clerk in Bottling Works.

F. H. Paternal grandfather died of general paresis. Maternal grandfather died of Bright's disease; a paternal uncle died of spinal meningitis, and a paternal aunt died of a cancer.

P. H. Patient was born in Salamanca, N. Y., May 14, 1880; attended public school from the age of 7 to 15 years, at which age he went to work, remaining only a short time in a place as he would either be discharged for negligence or would leave on account of being "tired" of the place. Of late he has worked for his father in a bottling works as clerk.

PSYCHOSIS: In 1898 patient was in Providence Retreat, Buffalo, for several months; he had been masturbating a great deal previous to admission and had developed delusions of perse