Forms of Skin Affections. First Aid to the In- PAGE MEDICAL SOCIETY OF THE COUNTY OF NEW YORK . . 231 RECENT LITERATURE. A System of Human Anatomy, including its Medical NEW NATIONAL PHARMACOPIA CORRESPONDENCE. LETTER FROM BALTIMORE. B. PAGE 235 . 236 237 238 MISCELLANY. TE NEW YORK ACADEMY OF MEDICINE. 229 The Differences in form of the Adult Head. — An THE RELATION OF LABORATORIES TO MEDICAL SCIENCE 233 OFFICERS . 234 BOOKS AND PAMPHLETS RECEIVED 240 240 The Boston Medical and Surgical Journal is published weekly by Houghton, Mifflin & Co., 4 Park St., Boston, where subscriptions are received and single copies of the Journal are always for sale. See Index to Advertisements, page 27. TO THE MEDICAL PROFESSION. LACTOPEPTINE DEMONSTRATED SUPERIORITY OF LACTOPEPTINE AS A DIGESTIVE AGENT. Certificate of Composition and Properties of Lactopeptine by Prof. ATTFIELD, Ph. D., F. R. S., F. I. C., F C. S., Professor of Practical Chemistry to the Pharmaceutical Society of Great Britain. LONDON, May 3, 1882. dered sugar of milk. The acids used at the iactory-lactic and hydrochloric are LACTOPEPTINE having been prescribed for some of my friends during the past five the best to be met with, and are perfectly combined to form a permanent preparation; years-apparently with very satisfactory results - its formula, which is stated on the the milk sugar is absolutely pure; the powder known as " diastase," or starch-digest. boites, and its general characters have become well known to me. But recently the ing (bread-, potato-, and pastry-digesting) material, as well as the "pancreatine," or manufacturer of this article has asked me to witness its preparation on a large scale, fat-digesting ingredients, are as good as any I can prepare while the pepsin is much to take samples of its ingredients from large bulks and examine them, and also mix superior to that ordinarily used in medicine. Indeed, as regards this chief ingredient. them myself, and to prepare LACTOPEPTINE from ingredients made under my own di- pepsin, I have only met with one European or American specimen equal to that made rection, doing all this with the object of certifying that LACTOPEPTINE is what its maker and used by the manufacturer of LACTOPEPTINE. A perfectly parallel series of experi professes it to be, and that its ingredients are in quality the best that can be obtained. ments showed that any given weight of acidified pepsin, alone, at first acts somewhat This I have done, and I now report that the almost inodorous and tasteless pulveru- more rapidly than LACTOPEPTINE containing the same weight of the same pepsin. Sooner lent substance termed LACTOPEPTINE is a mixture of the three chief agents which enor later, however, the action of the LACTOPEPTINE overtakes and outstrips that of pepable ourselves and all animals to digest food. That is to say, LACTOPEPTINE is a skill- sin alone, due, no doubt, to the meat-digesting as well as the fat-digesting power of fully prepared combination of meat-converting, fat-converting, and starch-converting the pancreatine contained in the LACTOPEPTINE. My conclusion is that LACTOPEPTINS materials, acidified with those small proportions of acids that are always present in is a most valuable digesting agent, and superior to pepsin alone. the healthy stomach; all being disseminated in an appropriate vehicle, namely, powJOHN ATTFIELD. LACTOPEPTINE contains all the agents of digestion that act upon food, from mastication to its conversion into chyle, thus combining all the principles required to promote a Healthy Diges tion. One of its chief features (and the one which has gained it a preference over all digestive preparations) is that it precisely represents in composition the natural digestive juices of the stomach, pancreas, and salivary glands, and will therefore readily dissolve all foods necessary to the recuperation of the human organisin. LACTOPEPTINE is sold entirely by Physicians' Prescriptions, and its almost universal adoption by physicians is the strongest guarantee we can give that its therapeutic value has been most thoroughly established. The undersigned, having tested LACTOPEPTINE, recommend it to the Profession. ALFRED L. LOOMIS, M. D., Prof. of Pathology and Practice of Med., University of the City of New York. SAMUEL R. PERCY, M. D., Prof. Materia Medica, New York Medical College. F. LE ROY SATTERLEE, M. D., Ph. D., Prof. Chem., Mat. Med., and Therap. in N. Y. Col. JAS, AITKIN MEIGS, M. D., Philadelphia, Pa., Prof. of the Institutes of Med. and Med. Juris., W. W. DAWSON, M.D., Cincinnati, Ohio, Prof. Prin. and Prac. Surg., Med. Co. of Ohio; PROF. JOHN ATTFIELD, Ph. D., F. R. S., F. I. C., F. C. S., London, Eng., ALFRED F. A. KING, M. D., Washington, D. C., Prof. of Obstetrics, University of Vermont. D. W. YANDELL, M. D., Prof. of the Science and Art of Surg. and Clinical Surg., University of Louisville, Ky. L. P. YANDELL, M. D., Prof. of Clin. Med., Diseases of Children, and Dermatology, Univer- ROBT. BATTEY, M. D., Rome, Ga., Emeritus Prof. of Obstetrics, Atlanta Med. College, Ex. CLAUDE H. MASTIN, M. D., LL. D., Mobile, Ala. PROF. H. C. BARTLETT, Ph. D., F. C. S., London, England, For further particulars concerning Lactopeptine, the attention of the Profession is respectfully directed to our 32-page Pamphlet, which will be sent on application. THE NEW YORK PHARMACAL ASSOCIATION, Nos. 10 and 12 College Place, New York. 2.0. BOX 1574. Entered at the Post Office at Boston as second-class matter. November 23, 1883. CASES OF PATIENTS AT THE MURDOCK Professional Notices. Our First Death and its Cuse. A Letter from the DR. BUCKMINSTER BROWN Physician who Attended Her. BOSTON, Oct. 22, 1883. DEAR SIR: Allow me to acknowledge the great favor Has removed to 39 Marlborough St., Boston. which I received at your hospital, indirectly, through DR. WALTER CHANNING one of my patients. The autopsy enables me to give a better description of her case than I could in any other way. From it we quote: It revealed a left ovarian cyst, which was embedded at the base, and behind, in a cancerous mass of the encephaloid variety and ulcerative stage. Recent and extensive inflammations had rendered the organs of the hypogastric and pelvic regions almost a compact mass, so strong and extensive were the adhesions. This condition accounted for the great suffering and rapid change of the last few days of her life. I am satisfied that fully two months of comparative comfort were added to her life by the use of your Liquid Food. I am using your Food, in a variety of cases, with great satisfaction. Thanking you for all kindness to myself and patient, I am Very respectfully yours, Mrs. S., born in 1841. Married; mother of two children. While carrying the second child she was very ill all the time, and bal a very severe labor, causing laceration of the mouth of the womb, and other injuries incident to such severe deliveries. Since that time she has will receive a few cases of Mental and Nervous Diseases at Brookline. P. O. address, Brookline, Mass. Office in Boston, 146 Boylston St. Office Hours, 12 to 1. From June 1st to October 1st, in Boston by appointment only. DR. NORTON FOLSOM Ilas removed, and will meet these desiring to consult him in cases of Mental Disease at No. 15 Pemberton Square, from 11 to 1 o'clock daily, or elsewhere by appointment. Residence, 19 Berkeley St., Cambridge. Telephone 7014. DR. CHARLES H. MALLETT, Graduate of Harvard Medical School, eight months House Surgeon in Boston Lying-In Hospital, and three suffered more or less from these injuries and other dis- DR. IRA RUSSELL, eases, which in turn have contributed to depress her nervous system, and bring her into a state of great suf fering, which has been long and tedious. To alleviate these suffering opium was administered as the only remedy that would give relief, until the opium habit was contracted In this condition she came to the Murdock Liquid Food fiospital. Not able to walk or stand, weak and restless, passing her nights in pain, vomiting her food almost every meal, often deeply colored with fresh blood. Four weeks' treatment with Liquid Food cured all the vomiting, overcame the opium habit, and now the patient sleeps well, eats well, and retains her food, and has gained some ten pounds in flesh. Miss T., aged 24 years. In health weighed 140 lbs. In December, 1830, was taken sick with pleurisy, which resulted in an effusion of pus into the pleural sac. Several times pus was drawn by aspirating. At one time two quarts were drawn. Finally the sac was opened, and a drainage tube was put in, and the sac has continued to discharge until the present time. She was admitted to Murdock's Free IIospital, May 5, 1883, weighing only 80%1⁄2 lbs., having lost 60 lbs. of flesh, being unable to take and digest food enough to sustain the system under such a drain, and has been badly constipated for three years, being obliged to take medicine weekly for the same. On Liquid Food she gradually began to gain flesh and strength. The discharge from her side diminished %, tube reduced the same per cent, and has been relieved of constipation. Her spirits revived, and she improved and was able to ride and take short walks daily, until in August she received a severe mental shock, which upset her nervous system so that she refused food of all kinds for several weeks. She has finally recovered her mind, and now takes food again, and is gaining daily and able to ride out. Miss V., Oct, 1882, was blind, had both eyes operated on, but without success. Other troubles followed piles, kidney trouble. Casts were found in the urine, the left kidney being badly affected. Peritonitis and cystitis followed. After being in a hospital three months, entered ours Oct. 5th, unable to retain food, vomiting incessantly, and in a helpless condition. Has taken four teaspoonfuls of Food daily. Retains her food, is able to go around some, sitting up and working at what her sightless eyes will allow, gradually improving in health, strength, and spirits. Mrs. O. for four to five months was unable to retain any food except four to five ounces of milk daily, with lime water: her weight reduced in one year fifty-five pounds; suffering from many complaints, she was obliged to take morphine daily in increasing quantities. She has been in the Hospital two months, has taken no morphine, and after the first week able to retain common food, and has gained seven pounds since, gaining one pound per week, and now discharged. Her last physician wrote us that she was incurable, and all the many that treated her gave the same opinion. Mrs. A. was for one year under treatment for uterine hemorrhages and extreme nervous debility, by the best physicians, with no beneficial results. She became completely prostrated by the disease. Her nervous system was so run down that she had no control of her nerves, passing the nights in a wakeful horror of some dreaded misfortune or death. Previous to this illness her weight had been one hundred and sixty pounds, but her sufferings soon brought her weight to one hundred and twenty pounds. She at last concluded to try what could be done for her at Murdock's Free Hospital, as she had taken medicine enough and thought she needed something to build her up. She entered in July, began taking one teaspoonful four times a day, and now, using her owr. words, "is perfectly well both physically and mentally,' and we are of her opinion, as she left us in September and is now in perfect health. Murdock Liquid Food is in general use at MURDOCK LIQUID FOOD CO., Boston. Assisted by his son, DR. F. W. RUSSELL, receives patients into his "Family Home," WINCHENDON, MASS., for the treatment of Nervous and Mental Diseases. DR. GEO. B. TWITCHELL, President of the Board of Trustees, N. H. Asylum F. M. LORING, PHARMACIST, 655 Tremont Street, Boston. MASSACHUSETTS HOSPITAL. EUROPE!! 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Sent by mail, post-paid, on receipt of price by the Publishers, HOUGHTON, MIFFLIN & CO., BOSTON, MASS. Madame La Chapelle's "Health Preserver," And REVERSE CORSET for preventing and overcoming Uterine disease. Preeminently useful during Pregnancy. Especially adapted to treatment of Functional Derangement. It affords immediate satisfaction. Heat and pain in back and pelvis, prolapsed bowels, ovarian weakness, troubles of the Bladder, and attendant reflex troubles of Heart, Brain, Stomach, and Liver, are relieved by its application. Every one made to order, from glove kid and calf. In measuring give exact size (under all clothing) of Waist; Abdomen at Umbilicus; Hips, largest part; Thigh; and length from Waist to Pubes. Retail price, with Leggings, $15, to Physicians, $10; WHITE, WILLIAMS & CO., "No Doctor will fail to recommend or furnish them after knowing their value." Original Articles. GENERAL PARALYSIS OF THE INSANE. BY GEORGE F. JELLY, M. D. I CANNOT hope to add anything to the already existing knowledge of this disease, but its rapid increase in modern times, its insidious beginning in many instances, the importance of its early detection, and its fatal character, make it one of the most interesting of brain diseases, and I shall narrate briefly a few cases which have come under my personal observation at the McLean Asylum and in private practice. The French physicians first described general paralysis as a distinct disease. Esquirol recognized insanity with paralysis as incurable, but looked upon the latter symptom simply as a complication and not as a part of the disease. In 1822 M. Bayle for the first time noted that the mental disturbance and paralysis were synchronous. M. Delaye in 1824 thought it not always accompanied by insanity, and that it was a softening or atrophy of the brain. In 1826 M. Calmeil gave a most complete account of the disease, and has therefore generally been regarded as its discoverer. General paralysis may be defined as a disease of the brain marked by general and progressive loss of coördinating power over the muscles, especially those of speech and locomotion, with greater or less impairment of sensation, always tending to dementia, and characterized by a sense of well being or actual delusions of an exalted character. (1.) Commencement period or period of incubation. (2.) Maniacal period. (3.) Period of chronic mania, lapsing into dementia, with utter prostration of mind and body. These periods often run into each other, and the first may escape the notice of friends and even of physicians unless they are accustomed to observe patients affected with this disease, but sooner or later it presents both motor and mental symptoms, which are characteristic, and if the disease runs its course and no intercurrent disease supervenes no portion of the body escapes. con In the first period the patient may simply be noticed to have changed, to be more irritable, more easily excited, less able to attend to business, more forgetful, less careful of money, and less shrewd in bargains. There is, if I may so express it, a peculiar "damaged dition of mind, which gives the friends anxiety, but of which the patient is entirely unconscious. It is during this early stage that the patient may commit irregularities in business and in his moral conduct, may wreck his own and others' fortunes, and may ruin the reputation and prospects of his entire life. Hence the necessity of the early recognition of the disease, that its victim may be restrained in some way and pro It is essentially a disease of civilization and of mod-tected from himself. There soon develops some diffiern times, is much more common in the cities than in the country, and attacks by preference the robust and vigorous rather than the sick or those whose constitutions are weak congenitally or from the effects of dis ease. More than any other serious mental disease it appears in persons in whom insanity is not an inheritance, chiefly in men who are in the prime of life, from thirty-five to fifty years of age. It is rare in persons under thirty or over sixty. I have seen one case in a man of twenty-six, and within a fortnight have examined a man sixty-four years old who presented all the characteristic symptoms of the disease. Most of the cases coming under my own observation have been in persons between forty and fifty. In women the disease is comparatively rare, but I am unable to give definite statistics in regard to the relative proportion between men and women. It is about one in ten or twelve. culty in articulating certain words, especially those abounding in consonants; there is a tremor of lips and tongue, like that of a person about to weep; and it is observed that he drags one or both feet in walking. He now becomes extravagant and passes into the period of excitement. He considers himself all-powerful, believes that he owns everything, and talks constantly of the most extensive projects a trip to the moon, pumping the Atlantic Ocean dry, and invents wonderful machines. At this time he is often very licentious, and talks much of his sexual powers and his influence over women. He is indifferent to his friends, is untidy in dress, and does not observe the proprieties of life. He may become violent at the slightest provocation, especially if any attempt is made to control or oppose him, and then is very dangerous, his weakened mind being capable of great fury, resembling the excitement following an epileptic seiz ure. While in the excited period he is often taken to an insane hospital. There he soon settles down and becomes contented and happy, and owns the whole There are at the present time at the Taunton Hospital ten male and three female paretics; at the Worcester Hospital there are twelve male and one female paretics; and at the Danvers Hospital there are forty-establishment. one male and fourteen female paretics, making a total of eighteen females in a total of eighty-one cases, which I should think a larger proportion than usual. The whole number of patients in the three hospitals is two thousand and fifty-six nine hundred and eightyfour men, and one thousand and seventy-two women. The most common causes of general paralysis are 1 Read before the Boston Society for Medical Improvement, February 25, 1884. He considers himself well, and his complacency and self satisfaction continue through the whole course of the disease. The delusions change rapidly; there is great incoherence; when questioned he contradicts himself, and when his delusions are proved false he may admit their falsity in one moment and reassert them the next. Hallucinations of sight and hearing are not infrequent. Sometimes epileptic or apoplectic seizures occur among the earliest symptoms, especially those of an epileptic nature, which may be the first warning of the serious nature of the malady. During the progress of the disease they are very common, and may cause death at any time, and if frequent the mental failure is very rapid. In the later stages of the disease the paralysis increases, until he is no longer able to walk at all; the difficulty in articulation becomes worse, and produces a mere unintelligible jargon; the mind becomes incapable of any effort whatever; the sphincters are relaxed, and the patient dies from exhaustion; from choking owing to inability to swallow; suddenly, from convulsions or apoplexy; from serous effusion into the brain, or from some intercurrent disease, as pneumonia, diarrhoea, or septicemia from bedsores. The incipient stage may be one of melancholia instead of exaltation, which, however, is comparatively rare, and is distinguished from ordinary melancholia by the greater mental weakness; there is no method, and there are no connected and good arguments. The writing of a general paralytic is characteristic, and is often one of the first symptoms to attract attention. At first only a certain tremulousness may be noticed; then words are left out and misspelled, and as the disease progresses the tremulousness and indistinctness are more and more marked until the writing is entirely illegible. The diagnosis in well-marked cases of general paralysis is easy, no other disease presenting the same combination of symptoms, excitement, extravagance, loss of memory, tremor of lips and tongue, and impairment of gait. Sometimes in the somewhat rare cases where maniacal excitement is the earliest symptom, and there is no defect in the speech and no trouble in walking, even if delusions are extravagant, it may be difficult to make a positive diagnosis between general paralysis and acute mania. We must then await developments before giving a positive opinion. There are, however, certain impressions of general mental weakness which such cases give which will help very much in forming a decided opinion. Later in the disease there may again be difficulty, unless the physician is furnished with a full history of the case from its commencement. Advanced dementia, with hesitation in speech, may give rise to some doubt, but the absence of the peculiar muscular tremors in lips and tongue, and the optimistic view of things taken by general paralytics, even when very feeble, will help settle the diag nosis. In the epileptic seizures of general paralysis the tongue is seldom bitten, the insensibility following a fit is much more deep, and the impairing effect of each seizure is much more apparent than in true epilepsy. The peculiarities in walking arise from the loss of In the grand mal of epilepsy the outcry which precoördinating power and increasing paralysis. The cedes the convulsion is characteristic, but is not heard gait is stiff, the patient moving with a jerking, uncer- in general paralysis. tain movement, though he may walk fast. He easily trips, and sooner or later shuffles, and as he progresses a peculiar straddling gait is seen, and finally he drags his legs after him in an indefinite, peculiar manner, as if they did not belong to him. Sometimes the gait is high stepping, and the patient walks with erect head. There is always more or less paralysis of sensation, which increases as the disease advances, and the sensibility finally disappears. The condition of the patellar tendon reflex is of some diagnostic value. In certain cases it is exaggerated, in others normal, and in still others below normal. In the majority of cases where there is any change it is supra-normal in the early stages of the disease. Well-marked exaggeration in both legs is strong corroborative evidence of general paralysis; diminution or absence of it is decidedly less so, but has some value. Where patellar reflex is absent disordered gait is among the first symptoms. There is generally inequality of the pupils, in some cases there is dilatation of both pupils, and sometimes the pupils are both abnormally small, mere pin holes, as in a case which I have had under observation for several months. There is often no great change in the temperature of general paralytics. It averages a little above normal, but there is nothing diagnostic in it. There is a noticeable difference between the morning and evening temperature, and the prognosis as to time may be based to a certain extent upon the amount of this variation rather than upon any great or continuous elevation. An ophthalmoscopic examination of the eyes of general paralytics often reveals atrophy of the optic disks, but as this change is frequent in other forms of cerebral disease its existence is corroborative rather than diagnostic. Sometimes locomotor ataxia has been mistaken for general paralysis, but the general history of the case and the absence of mental symptoms would eliminate the latter disease. The prognosis in this disease is always unfavorable. Remissions of active symptoms, which may continue for some months even, are not very unusual, but a relapse and eventual death must be expected. A few cases of recovery have been reported, but they lack the confirming test of time. The average duration of general paralysis is from two to three years, though a few cases have lived five, and, it is said, even ten and twelve years. I have in mind two undoubted cases, perfectly characteristic in every respect, one of which is of eight years' and the other of six years' duration. Much will depend in each case upon the violence or acuteness of the symptoms, the previous history of the individual, and the care which he receives. In one of our public institutions, whose superintendent is a very careful and accurate observer, a patient with general paralysis was considered a case of locomotor ataxia for a year, till the development of disease made the diagnosis plain. A comparison of the symptoms of the two diseases shows the following dif ferences: GENERAL PARALYSIS. Mental symptoms generally though lence. Great sexual excitement. From above down. LOCOMOTOR ATAXIA. Motor symptoms primary, following acute pain in distal part. Mental symptoms secondary, and are failing memory, with gradual impairment, without excitement. No sexual desire and loss of sexual power. May extend over ten or twelve years. From below up. Very little can be said in regard to treatment. It must be mainly palliative, and directed to rendering less rapid the ravages of the disease. Quiet, a carefully regulated life, and the removal from everything which has a tendency to excite are essentials, and when there is much excitement these can rarely be attained outside of an insane hospital. Various emergencies and conditions call for medical treatment, and sedatives, tonics, and in the later stages stimulants may be useful, but nothing curative can be hoped for from any treatment. The pathology of general paralysis is still debatable ground, but is admitted to be a degenerative inflammation of the cortical portion of the brain. Its inflammatory character is denoted by the post-mortem appearances. Those most commonly seen are adhesions of the dura mater, the vessels of which are often distended, and on its inner surface are found layers of hæmorrhagic exudation. The arachnoid is milky and thickened, studded with Pacchionian granules, and united to the dura mater. It is sometimes separated from the pia mater by effusion, and sometimes firmly adherent to it. The pia mater and the cerebral cortex present the most pathognomonic signs of the disease. It adheres to the convolutions so intimately that portions of the latter come away with it, leaving a reddened surface. These appearances are seen chiefly in the frontal, posterior central, and parietal regions. The points of adhesion may be few or numerous, but are confined to the summits of the gyri. When the pia mater is removed the cortical substance is found atrophied in cases of average duration. Not only is there atrophy of the cortex, but also small capillary apoplexies may be seen. If the patient dies early in the disease we do not find the adhesions of the later stages, but only hyperæmia, with some opacity of the arachnoid. The vessels of the brain are often tortuous and varicose, and their walls are thickened; this is especially true of the veins of the pia mater. There may be effusions of serum or blood into the ventricles and sinuses, which fill the place of the atrophied brain. There may be the same changes in the spinal cord and its membranes, but Westphal does not connect these appearances with the diseased conditions found in the brain (which is the true seat of the disease), and thinks them independent of each other. General paralysis is essentially a cerebral disease. 66 Dr. Blandford, in his work on Insanity and its Treatment, says: That the cortex is the seat of this disease can hardly be doubted if we reflect that after all it is an insanity resembling in many respects the ordinary non-fatal insanity which we term mania. The 'pars affecta' is one and the same. The line of demarkation between ordinary insanity and general paralysis is exceedingly fine, and the whole history of the latter points to a difference in degree rather than in kind. That general paralysis is intractable and progressive is the fact that we are certain of. The hyperæmia which accompanies curable mania subsides and the disease vanishes. The hyperæmia of general paralysis becomes a slowly advancing inflammation which destroys the tissue." CASE I. I. G., aged forty-three, single, merchant. Admitted to the McLean Asylum July 22, 1869. No insanity in family. He has been a man of very convivial habits. One year before admission he found himself unable to do his work, and retired from busi In January, 1870, speech more impaired. March 8th, eight months after admission, was semiconscious for an hour and a half, and the next day there was a repetition of the same condition. After these seizures the thickness of speech and dullness of intellect increased. Strange and deluded. Believed that the Lord was in his room. His mother died about this time, but when told of it he was affected only momentarily. April 2d. Very restless, full of wants and schemes. Says that his mother is alive, and wishes to go to her. Is noisy at night and destructive. Losing flesh. After One month afterwards he had an apoplectic seizure, and could not swallow for twenty-four hours. this he rallied, but was very weak and incoherent. June 7th. Could walk with difficulty, and could take only liquid nourishment, but was in the best of spirits; considered his room magnificent, and believed himself quite well and possessed of great physical strength. A month later he became highly excited, noisy, very filthy, and utterly incoherent. This excitement told upon his strength, and after being confined to his bed a week with symptoms of effusion he died, after one year's residence in the asylum, and two years from the commencement of the disease. CASE II. F. A. B., aged thirty, married, innkeeper. Admitted August 31, 1869. For three months had been queer and excited. Much worried by the enforcement of prohibitory liquor law. On admission very much excited; believed himself Napoleon I. Speech thick, lips tremulous, gait enfeebled and shuffling. His condition January 21, 1870, five months after admission, was much the same, except that he had advanced in dementia and feebleness. His delusions continued, and after nine months' residence in the asylum he was transferred to the Boston Lunatic Hospital, where he died within two years from the commencement of the disease. CASE III. W. B., aged forty-five, widower, lawyer, native of New Hampshire. Admitted May 12, 1870. His father was subject to periods of depression. Patient was married ten years since, but his wife lived only six weeks. Her early death gave rise to talk on the part of his acquaintances, and he was blamed though there seems to have been no reason to believe him in fault. He had a lawsuit with his father-in-law about his wife's property, was defeated, became sullen and morose, and has since lived much by himself, and has dwelt upon his treatment by others. Has considerable property in real estate, and has had a very annoying class of tenants. Two years ago became very licentious, and he has been much addicted to masturbation. For months his friends have noticed a change, and think that he has not appeared natural. Three weeks before admission he seemed very dull and stupid, was |