years will see a radical uprooting of many of our crude theories of brain disease and be the means of establishing less empiricism in its treatment.

There has been a tendency of late years to multiply the kinds of medicine in use. Chemists and druggists are now having their innings in the multitude and variety of their manafactured medicine especially for nervous diseases. Synthetical chemistry has added its hundreds of new remedies to the pharmacopoeia and, as usual, all are lauded by some medical men as being, if not specifics, at least invaluable in the treatment of all "the ills which flesh is heir to." Laudatory pamphlets in the best form of the printer's art are thrust forth broadcast all over Christendom. As the result thousands upon thousands of so-called remedies are now swallowed in faith more than by works. This influx of poly-pharmacy is now at flood-tide but the ebb is sure to come as the age of credulity passes away. All medicines are of secondary importance in any disease and in the near future the tendency will be to trust to sanitation, hygiene and proper pabulum rather than to drugs. The master-builder asks for material and the vital entity needs, primarily, food to build up and also proper excretion to carry off the dead. So food, cleanliness and fresh air are paramount requirements. These are fulcrum agencies, as without them all the medicines that were ever discovered or invented would avail little. The trend of medical opinion is already in this direction and in that good time coming these essentials will hold a more prominent place. As a result, legal and illegal quackery will fade and fail in a corresponding degree.

There is nothing more disheartening in the practice of our profession than the receptivity of medical absurdities by weak-minded members. The personal equation is seen of each person, as readily as degrees are in a thermometer, by the eagerness of many to accept new-fangled theories and practice on first presentation. These credulous mortals, who are always seeking after the marvelous and are never satisfied with waiting for the slow but sure progress of scientific truth, swarm in every community. They would accept voodooism or fetichism did it come through professional channels, because medical ultraism with a spice of mysticism suits some minds. Some of the older members will remember how they were treated to a treatise not many years ago, on the benefits of the administration of raisins as a sedative for acute mania. The more the excite

ment intensified the larger the quantity given, until-as was suggested by me-the consequent dyspepsia put to flight, the maniacal ogre. We all remember how blue glass was extolled to quiet the maniac. Some even went so far as to erect buildings with blue glass in them, and told us wonders as to its quieting effects. It would have been thought that the blue sky had enough of that color in it to satisfy the most fastidious. There would have been some semblance of fitness in it, had the brilliant intellect which had dis. covered this remedy made it a therapeutic agent to cure "the blues" of melancholia.

We all know of an alienist who became afflicted with senile decay, and in this mental deterioration thought he had discovered the "Elixir of Life." This was the secret which philosophers had been seeking for throughout the ages, and herein was to be found eternal youth. There was the other day placed over his tomb "Sacred to the memory." Strange to say he has to-day a number of deluded followers, who laud with many adjectives the fluid extracts of cerebrine, testine, cardine, ad infinitum. These ingredients go through the mechanical process of extraction, to be followed by the chemical and vital changes in the system and yet maintain a peculiar aptitude to raise dead issues, and revivify moribund tissues. This pristine nastiness catches the vulgar imagination and I see that in a capitol city it is used to ensnare the weak and unwary. The arch-quack finds thousands of dollars in it because of multitudes who swallow the glittering bait. This catch-penny method is not new for the Romans gave the raw lungs of foxes to consumptives to strengthen their lungs, and fed the brains of deer to racers to increase their running power, and fed liver to cure melancholia (black bile).

This retrospective glance is given to emphasize my prophecy that in the near future, common-sense methods will prevail where not only will such nostrums be relegated to limbo, but mere medication will take a secondary place where it virtually belongs. In this way legal and illegal questions will be subordinate to intelligent methods and far removed from the disgraceful ways of the "cure-alls" of to-day. When it is shown that we rely for cure primarily upon the "Gospel of fatness" and the powers which belong to physiological righteousness, then will therapeutic quackery be largely disarmed of its malign influence in the community.

In the future the question of personal and chemical restraint of the insane will no longer be debated, as it is to-day.

After ten years of non-restraint treatment in the Toronto Hospital for Insane, and after a longer or shorter period of non-restraint in a large number of other institutions of a kindred nature, it is evident that personal liberty of the most liberal kind will be the method for the future. The days of mitts, camisoles, straps and crib-beds will be consigned to the past, unless exceptional circumstances should arise.

In some countries it has been the custom to appoint chief officers of public institutions, not because of fitness, but because of political bias. The man who has the correct party ear-mark, or who shouts the proper shibboleth of political sectaries is sure to be one of the elect. He may be qualified for the position, or he may not; that is of secondary importance if only he has been an orator for his party, and has faithfully turned the crank of the votingmachine. I knew of one of this kind, who was not very long ago appointed to a splendid institution after a brilliant administrator had been superceded, who had given efficient service for fourteen years, but was ostracized because of former allegiance to a party.

The new incumbent was so ignorant that he knew nothing about spelling, or the use of capitals. In writing, periods, commas, semicolons and all such punctuations were ignored and even the word God was written with a small "g". These were not lapsus-pennae but rather the result of mental vacuity. The battle-cry of "To the victors belong the spoils" should stop short at charitable institutions where the highest talent and best executive ability are needed. It is proper to say that such untoward things belong only to the untutored savages of Soudan and Uganda, and will be remedied with the march of civilization. In the next fifty years a Jubilate will be sung over the extinction of such a selfish and disastrous policy.

Some heroic and outspoken member of the Association will in the near future classify and describe in faithful portraiture a large class of persons of neurotic and hereditary tendency, who have relatives in the various hospitals for insane. Chief officers come in daily contact with them, and much of the trouble with such is the innate tendency there is to be exacting, suspicious and complaining. This is not so much their fault as their misfortune. They have a certain amount of mental instability which leads them to have vivid imaginations which conjure up the worst phases of life and conduct, and which leads them to believe in all the supposed horrors of asylums.

The lack of ordinary judgment, the feeble discretion and the credulous nature deprive such of the possession of the normal modicum of common sense, which is so necessary to have in all well behaved persons. Of course, there are many exceptions to this statement but the class exists, and it is from among such the asylums, however well conducted, are libelled, often with honesty of purpose, but with circumscribed mental vision. When the intellectual and moral standards are raised in the near future these persons will disappear and with them one of the plagues of asylum official life.

The writer might thus wander on into the hypothetical without end. Let him say, however, that there is great advancement in all branches of psychiatry and greater promise for the future along the lines of experimental and clinical exploration. The best minds in our profession are working to this end and have justly discarded mere metaphysical speculation for the entities of vital phenomena in all their multifarious manifestations. As a result new continents of the hitherto unseen have been discovered and there are yet more worlds to conquer. For the sake of our common humanity, we are glad that in our noble profession so much solid ground has been found and cultivated by many of those seeking after the truth. We have great faith in the discoveries of the near future, as eager and honest workers are everywhere seeking to solve life's enigmas. It may be said, however:

"There is a good time coming, We may not live to see the day, Yet, earth shall glisten in the ray

Of the good time coming."

M

THE PREVENTION OF TUBERCULOSIS IN HOSPITALS

FOR THE INSANE.

BY J. W. BABCOCK, M. D.,

Physician and Superintendent, South Carolina Lunatic Asylum, Columbia, S. C.

In large asylums, reformatories, and prisons, the prevalence of phthisis is a matter of common observation. While statistics prove that tuberculosis causes one-seventh of the deaths among the whole population of the world, the figures collected by Hagen1 in 1850 from the reports of many asylums showed that among the insane more than one-fourth of the mortality was due to this fatal disease. In 1892 Clouston, who has studied this subject more than thirty years, concludes that "The fact that, under the most favorable conditions of life and treatment that we can at present devise for the insane in the best asylums, three of them die of pulmonary phthisis to one person in the general population at the same age, is one full of interest and significance." Ireland3 says fully twothirds of all the idiots die of phthisis. So great is the liability to tuberculosis in certain prisons that commitment to them is almost equivalent to a death sentence. Cornet found that during a period of fifteen years the mortality from phthisis among males in Prussian Prisons was 45.82 per cent of all deaths; in females 49.33 per cent. In the prisons of Austria the mortality from this disease reached 61 per cent during four years, while in the penal institutions of Bavaria it was only 38.2 during eight years. Among the 1,400 convicts of the Illinois State Prison at Joliet fully onethird have consumption, and nearly all the deaths in that penitentiary are due to this single cause.

5

The frequent association of mental disease with pulmonary consumption and scrofula has, for over half a century, attracted the attention of alienists. Well-sustained evidence ascribing this relationship to heredity, habit, or diathesis is to be found in the standard works on insanity. A special form of mental disease called phthisical insanity is also recognized by some authors."

In commenting upon this association Buckmill makes an abstract from his annual report of the Devon County Asylum for 1861: "The number of patients who die of phthisis is always a source of peculiar anxiety, inasmuch as the development of this disease may be regarded as a test of the sanitary conditions of an