which she asks her uncle to send for her, and the detailed instructions she gives. As a matter of fact at the time this letter was written, the patient had no clear idea of the illness through which she had been passing, and her assuming that the head nurse could and would at once arrange for her leaving, shows that she was not yet altogether au courant as to her relations in the hospital.

Quite out of keeping with her normal neatness are the numerous words and phrases struck through with the pen. We see here a considerable uncertainty and indecision in expressing a simple and direct idea, representing the aftermath of psychic depression which only a few weeks before had made it almost impossible for her to express any idea at all.

Finally the patient refers to someone whom she had called "Cousin Kitty," showing that earlier in her illness there had been confusion of the identity of persons. Indeed she now tells us that during the first few weeks she quite confounded the individuality of those about her, mistaking doctors and nurses for former relatives, friends, and acquaintances.

I shall show but one more letter, this one written only a fortnight ago. It illustrates a new phase of convalescence, the use of artifice to gain her ends. The letter was directed to her mother and she had attempted to disguise the character of her handwriting, not, however, with complete success. This is the letter:

My dear Mrs.

"SHEPPARD HOSPITAL.

Your daughter is an object of pity and distress. I think her trouble is more homesickness than anything else. Can't you come and take her home? Her father was here to see her some time ago, and she begged so hard to go home with him, but he said he had business in the city and could not bother with her. She says if she ever gets home again she will know how to appreciate it. I am sure she will, too. If she was my daughter and I had a home to take her to I would certainly gratify the wish.

I don't know whether you will thank me for writing this or not. It is my sympathy for her that has prompted me to do it. There is too much noise and confusion here for her.

Truthfully yours,

A PATIENT.

P. S. I thought it best not to sign my name in case it might get the nurses in trouble."

It will be remembered that in the previous patient a hypomaniacal phase succeeded the affect depression and initiated convalescence. In Miss C. affect anomalies played no part in the developing disease picture. With the clearing of consciousness, however, and the returning insight, nostalgia sometimes became pretty insistent. She wore an expression of sadness and yielded not seldom to outbursts of crying. If one spoke to her, though, she was usually responsive and soon exchanged tears for smiles. Thus her sadness was psychologic and did not pass beyond normal bounds. Depressive delusions were never present, and no suicidal tendency ever appeared.

At the present time the patient is nearly well. She is gaining slowly in weight, being now at 110 pounds (100 on admission). Besides laxatives, the only drug she has received is Cannabis Indica, which in 2 or 34 grain doses a half hour before meals. usually has a good effect in stimulating the appetite and sometimes perhaps assists in establishing a normal euphoria.

The menstrual function, which intermitted in October and December, has been regular and normal from January, co-incident with beginning improvement, although at first the patient was usually somewhat more depressed and emotional at the time of her periods.

There is still a sense of fatigue accompanying effort which will gradually wear away, as well as a degree of subjective unsureness, indicating that recovery is not yet complete.

The pupils are equal and all the reactions are normal. The tendon reflexes continue somewhat exaggerated.

In the present case as well as in the last one we have to do with a psychosis of fairly rapid onset, running a course of several months and ending in recovery.

Both are tolerably pure type-cases and their essential difference we find to lie in the fact that here it is primarily the intellectivevolitional side of consciousness which is involved, while in the other case the emotive sphere was chiefly affected. In the latter case, however, psychomotor depression was not absent, and similarly in this patient there have been emotional disturbances and mild manifestations of depressive affect-so that in spite of the apparently wide divergence between the two symptomatologic

pictures, we are led to recognize in them first cousins of disease. We know, moreover, that in the same patient conditions of profound psychomotor depression, culminating in so-called stupor, may alternate with clearly-defined attacks of maniacal excitement or emotive depression. What determines the character of the outbreaks in the same or in different patients we have as yet no means of knowing."

'Miss C. was discharged from the hospital about six weeks after the second demonstration. The fatigue phenomena had practically disappeared and her mental reaction was normal. She had regained her usual weight, 115 pounds. Three months after discharge she reported that she was well and that she now weighed 130 pounds (end of August, 1906).

British Medical Association

Psychological Section

The British Medical Association, for the second time in its history, held its annual meeting in Canada in August of this year. The meeting extended over four days, August 21-25, and over two thousand members and visitors took part in the proceedings. The Psychological Section, presided over by Dr. William Julius Mickle, of London, well known for his studies in paresis, and his book on the disease, was well attended, and its sessions were of particular interest, as they gave opportunity to work out clearly the different trends of thought which characterize the psychiatrists of Great Britain and America. Many of the discussions were of high order, and in spite of the hot weather, which must have been a revelation to the visitors who regarded Canada as a land of snow and ice, at times, became animated and warm.

The social functions, during the meeting were many, and a luncheon given at Toronto Asylum, to the members of the Psychological Section and the visiting members of the American MedicoPsychological Association, by the Ontario Government was a happy event. The Hon. Mr. Hanna, Provincial Secretary of the Province of Ontario; Drs. Mickle and Schofield, London; Drs. Hurd and Brush, of Baltimore, were the chief speakers, and while a vein of humor characterized their remarks, it was quite evident that all thought Ontario should go even further than she has already done, in making provision for the treatment of the insane.

The following is a brief abstract of the proceedings of the Psychological Section:

AUGUST 21, 1906-FIRST SESSION.

"The Etiology of General Paresis." By A. R. Diefendorff, Middletown, Conn. :

Dr. Diefendorff based his observations on a study of one hundred and seventy-two cases of paresis, cared for in the Connecticut Hospital for Insane, from 1898 until 1905.

During this period the percentage of cases of paresis, as com pared with the total admissions, ranged between 7.8 per cent and 5.4 per cent per annum, with a decided upward tendency in the number of females.

In regard to causation he ascribed the greatest importance to syphilis, but believed that alcoholism should not be overlooked as a most important factor in the development of this disease.

The paper was discussed by Drs. Mickle, London; C. K. Clarke, Toronto; T. J. W. Burgess, Montreal, and H. W. Miller, of Taunton, Mass. A discussion on general paralysis was then opened by the president, Dr. W. J. Mickle, who dealt with the delimitations of the disease under the headings: Symptoms. Morbid Anatomy, Predegenerate Relations.

Dr. W. Alden Turner, London, expressed the opinion that in general paralysis and tabes dorsalis syphilis is the great predisposing factor in both disorders.

As far as exciting causes were concerned, they were to be looked for in trauma, alcoholism, nervous stress; or, perhaps, as Forbes Robinson has suggested, in intestinal autotoxis.

Dr. L. Harrison Mettler, Chicago, regarded paresis pathologically as another phase of the tabetic process; in other words, it was a primary cortical neurotic degeneration, and from this point of view the prognosis was practically hopeless.

Dr. J. O'Brien, Massillon, referred to some recent experiments he had made as the result of a study of Dr. Forbes Robertson's investigations. In 95 per cent of cases of paresis he obtained an organization similar to the Klebs-Loeffler, in other types of insanity only 2 per cent.

Animals inoculated with this bacillus developed the physical signs of paresis, and post-mortem examination revealed lesions similar to those seen in early paresis.

At the conclusion of the discussion Dr. A. T. Schofield, London, made a few remarks on some investigations he had made in the new psychology."

WEDNESDAY, AUGUST 22, 1906.

"Cerebral Localization in the Study of Psychiatry." By Dr. Charles K. Mills, Philadelphia:

Dr. Mills began with a brief review of literature and personal