behavior, and resulting from disease or defect in one or several of the brain areas. In the semiinsane,-monomaniacs, the insanely jealous, the recklessly extravagant, etc., the symptoms are less intense, less tenacious, and more fleeting, the subjects being in a degree rational, but with limited responsibility.

Insane conditions imply a disturbance of the nutritional processes with an accumulation in the system of destructive products. To quote Professor Tanzi: "The brain does not become injured so much by what it sees and hears, by what it suffers or fears-in short, by that which forms the psychical content of emotion and passion— as it does by the reflected action of the visceral disorders, and still more by the chemical action of the auto-toxins that are developed as a consequence of these disorders, and which, when they have once entered into the blood stream, implicate the nervous system and disturb its functions. Whenever there occurs any disease accompanied by a pathological alteration of metabolism, one of the first symptoms is mental lassitude, which may extend to unconsciousness or coma. But the intellectual capacity may be affected by visceral diseases which are so slight as not to disturb objectively the functions of the viscera that are disordered or fatigued, and it is sometimes more injured and weakened by

diseases and overwork of other organs than it is by disease or overwork of the brain itself." Thus insanity may be as Dr. Wm. Hanna Thomson holds, a blood disorder. In any event there is always in it a toxic element that must be reckoned with, and that does not elude the observation of a thoughtful physician. The causes of malnutrition are removable; psychic control of the secretory nerve currents may be established, the insomnia usually present relieved so as to give the fagged and irritated brain a chance to rest, the patient referred to physical occupations in the open air looking to a restoration of the bodily functions, and shielded during treatment from shock and strains and “the buffetings of the world."

A respectable percentage of all cases of insanity arises from preventable causes; so in a generous quota of persons threatened with mental degeneration the symptoms, if early recognized and properly treated, disappear, and what would otherwise have culminated in hopeless mental disease is put to the rout and health of mind assured.

By way of illustration:

After reading the details of the Carman murder case in the newspapers, Mrs. L., a young married woman who had been subjected to nervous strain, became convinced that she had

inadvertently killed somebody herself and hence was a man-slayer. She could not be argued out of the delusion. She came to believe that one person could kill another and not know anything about it, might elude police investigation, and go on repeating the crime unconsciously and ad libitum. Thus, in her imagination, she was the incorporation of a deadly menance to the whole community. She could not reckon how many lives she might have destroyed and adroitly avoided detection. Most ingenious were her explanations of how this could all be and she escape arrest, of how a milk-bottle, for instance, could fall from her window and fracture the skull of some one passing below, without exciting suspicion in her direction. This delusion was becoming insurmountable when Mrs. L. was brought to my office. Suggestion, coupled with appropriate physical treatment, in the course of a few weeks unrubbished her mind. But after the birth of her first child three months ago, owing to the lowered vitality incident upon confinement and lactation, the old obsession partially reasserted itself in a fear that her boy might inherit a tendency to murder in the same indifferent manner; but the lady has been easily suggested out of it by a very imperative assurance to the contrary.

Such a factored belief crystallized equivalents

insanity. The more the mind dwells on it, the more rapid and certain becomes the brain degeneration that conditioned its conception. Such is the reciprocal relation in these unfortunate cases between the physical and the psychical. And the rational treatment of them all combines the psychodynamic removal of the abnormal mental state with an upbuilding of the brain-cells and a checking of all tendency to nervous perturbation by the administration of accepted remedies.

By this treatment the writer has saved from an institutional life, with its restraints for the patient and its reactions on the lives of relatives, not a few cases of mental breakdown. Within a year a most estimable lady has been spared such a fate which was more than impending. In a highly susceptible brain state induced by ten years of tinnitus aurium, toward the close of which the afflicted woman could do little else than sit and listen to the buzzing in her ears, an idea developed and petrified that she, being perfectly innocent, had committed a most dastardly and contemptible act which had been brought to her notice, and had in consequence incurred the displeasure of the Almighty. The act in question was traced to the hand of another person; but the baseless conviction dominated her thoughts and shadowed her whole

life. She became sleepless and melancholy, and had glissaded well down into the borderland. Psychotherapeutic measures were indicated. The tinnitus, which had defied the efforts of a number of aurists, yielded to the suggestions offered, the delusions were unnested as the troubled mind was conducted into the subliminal realm, apprised of its power to dethrone misconception and inspired to apply it, and the joy of living was restored to an apparently crushed life. Delusional interpretations like the above are the legitimate groundwork of unbalance and physical degeneracy; they constitute the pathognostic symptoms of a rudimentary paranoia, and judiciously framed suggestions must be launched to effect their destruction.

Simple melancholia, with its depression, gloomy thoughts and memories, and disconsolate forebodings, is usually curable. The physician would do well to remember that " every melancholic is a potential suicide" and take the necessary precautions, besides removing all tendency to self-destruction by diplomatic suggestions. The subjects of agitated melancholia are commonly women. The following picture limned by Dr. Younger is true to life: "The patient is never still except when asleep. She paces the room wildly, or sits with her face buried in her hands, rocking her body to and