13, I guess." He cannot multiply 2 x 4. Says, "I can't remember-such a long time ago I learned only about radium and arc lights at school."

Being urged to name the months he finally says, "Monday.' He does not attempt to name the days; says they get all mixed up." He cannot name any of the principal stores or hotels of the city, and when the names are suggested by examiner he says he never heard of them. He gives a wrong location for the railroad station.

He calls a watch "a round thing "-its use? "to look pretty, I guess." A knife and a pencil are called "sticks "; a button is a "butter." Colors are miscalled or not named at all. A newspaper is a "contract all mixed up." Letters and figures are miscalled, and letters are called figures, etc.

The patient was removed after two days from the observation dormitory to a single room and the attendants were instructed not to question him as above nor encourage him to talk further about radium and arc lights. He was ordered a brief cold shower bath daily, followed by friction, and was given strychnine sulphate, gr. 1/30 t. i. d. He quickly gained strength, ate, and slept normally; sat up in bed and looked at the pictures in magazines, still proclaiming himself unable to read; wanted to dress and return to the big room "to see the men and watch the cars go by." He continued in the same mental condition, but brighter and more active, until the twelfth night after admission, when he awoke from a sound sleep at 2 a. m., came out of his room and asked the night nurse where he was and how he came to be there in a strange place which seemed to be a hospital. He said that he had gone to sleep about nine o'clock the evening before in his cell at the jail and that, upon awaking a few minutes before, he noticed that the window was different; and when he looked about the room he could not find his clothes which he had laid on a stool, out of reach of the rats. When told that he had been in his present surroundings nearly two weeks he was incredulous, and asked for a newspaper to show the date, which he remembered was February 3d when he had gone to sleep. He showed a little excitement and was eager to discuss the matter at length but was induced to return to bed. He did not sleep again, however.

When I saw him the next morning he did not recognize mesaid he had never seen me before. He was sitting up in bed, reading. His expression was lively, he smiled freely and talked with much more animation and freedom than before. He was entirely clear concerning all of his past, with the exception of the fortnight just elapsed, which was a blank to him, not pierced by even the slightest dreamlike remembrance. He had no recollection of having entertained the ideas about radium, etc.

He gave a clear and connected account of himself, prefacing it with the remark, delivered with an embarrassed, apologetic air, that what he had to tell was so strange he feared no one would believe it, and for that reason he had not previously given to any one the real explanation of his many erratic acts during the past seven months. He then told of a fall from his motor cycle in August, 1905, in which he struck on his head and was knocked unconscious for half an hour. He had a terrific headache for two days and kept to his bed. After this he had queer spells, difficult to describe, in which he seemed only semiconscious or as if in a dream, with no conception of time and with no control over his actions, though he knew to a certain extent what he was doing. He thinks that he must have looked and acted naturally though, as no one noticed anything wrong with him. In these spells he went under assumed names, forged checks, and committed thefts of which he had no knowledge until he found the articles in his possession afterward. Twice during August he found in his basement in the morning bicycles which he had appropriated the day before. He was gradually and with difficulty able to remember where he had gotten them and on these two occasions he returned the wheels to the stands from which he had obtained them. One of them he had taken from in front of the City Hall, probably leaving his own there in exchange. Not finding his wheel when he returned the other, he had made inquiries for it in the building and then reported his loss at the police station, giving his correct name and address (this I was able to verify from the station-house blotter). The remainder of this account includes statements from the anamnesis. The third time he took a wheel he carried it at once to a pawn shop and was there arrested, giving an assumed name. His father obtained his discharge without sentence. A week later he was

again arrested, this time for attempting to cash a forged check. He was now examined by two physicians and committed to a private hospital for the insane, his father not believing him actually insane but not knowing what to do with him except to take this advice. After two weeks, during which he made himself useful about the place, he ran away-in one of his spells, he says. He came to himself perched on a trolley pole, engaged in stripping the insulation from the wire with the purpose of electrocuting himself. He then stole a ride to New York, where he lodged at a first-class hotel and lived well for several days until he was arrested for his board-bill. He spent some time in the Tombs but was finally released through the intervention of friends, after which he obtained, on the strength of his good appearance and businesslike manner, the agency for a patent arc light and returned to Buffalo to prosecute this business. He borrowed some money on his expectations, rented an office, engaged assistants, and went actively to work; but had little success, so that in a few weeks he was in financial straits. Then followed the theft of suit-cases from street-cars, four or five in all, on January 29, 30, and 31, resulting in his arrest on the last-mentioned date, his transfer to the jail on February 2, and his lapse, on the following day, into the peculiar state in which he was committed to the hospital and came under our observation.

Following his sudden emergence from this condition, which has been described, he underwent rapid convalescence, showing, however, much instability and childishness for some time. He had several attacks of depression in which he moped and cried, would scarcely speak, complained that he was "down and out," that his friends had all deserted him. Then he would quickly recover his spirits and show a keen interest in the life of the ward, working industriously, playing games, etc. He was inclined to tease for small privileges and often cried like a baby when refused. These symptoms disappeared with the return of physical vigor, and the patient was discharged on June 1, apparently recovered, but after reaching home he cried, said he felt downhearted and nervous and was not willing to stay there. At his own request he was returned to the hospital where he again seems very well, and speaks confidently of his ability to get along outside at the next trial. The analgesia disappeared at the time

of his awakening and since then no physicial signs of hysteria have been present. The visual fields for form and color were found normal after his recovery-they were not tested earlier.*

I am aware that the circumstances in this case, and the symptoms as well, are such as to give rise to a strong suspicion of malingering; and this possibility has been kept in mind throughout. I believe, however, that the facts as stated, justify the diagnosis of hysteria, the result of trauma, acting upon a highly sensitive, unstable, and immature organism already taxed by precocious family and business cares. The assumption is that the acute psychosis which I have described was induced by the mental strain and excitement consequent upon his arrest and imprisonment, and this may be regarded as merely an episode in the course of the essential disorder.

The patient went home in September last. When seen a month later he was quite well and is so reported now-December, 1906.

CLINICAL AND PATHOLOGICAL REPORT OF A CASE OF ADDISON'S DISEASE WITH TERMINAL

MENTAL SYMPTOMS.1

BY HARRY W. MILLER, M. B. (Tor.),

Pathologist and Assistant Physician, Taunton Insane Hospital, Taunton,

Mass.

The following case of Addison's Disease with a psychosis which appears to have more than a casual relationship to the somatic disorder is not without interest from a clinical and pathological standpoint in view of the infrequency with which such combinations are observed:

Summary of clinical history.-Female; forty-seven years of age on admission to Taunton Insane Hospital June 30, 1902. No psychopathic taint in the family. Three sisters died of pulmonary tuberculosis. Cotton weaver by occupation; no school education. Is said to have always been robust and vigorous; normal weight 150 to 160 pounds. Twice married, but had no children and no miscarriages. No venereal disorders. A moderate beer drinker.

. . I am so tired

In the spring of 1900 she began to complain of weakness, exhaustion, and shortness of breath on exertion. "I feel as if I had been working for a year and had no rest. and worn-out all the time." Two months later patches of yellow appeared on her face and neck, which were spoken of at the time as "yellow jaundice." The discoloration next appeared on back of the hands, forearms, and the chest. In the fall of 1900 this pigmentation was noticeable, according to the husband, over the greater part of the body. While at first yellowish it later took on a brownish hue, and reached its maximum intensity one year before admission and after that paled somewhat. She was compelled to give up her mill work and engage in a lighter occupation in the summer of 1900. She lost weight, feeling of exhaustion

Read at the sixty-second annual meeting of the American MedicoPsychological Association, Boston, June 12-15, 1906.