13. In paresis the blood pressure is generally a little high in the beginning and during the first period, but shows a tendency to become lower as the psychosis develops and the organic changes are more marked, so that in the terminal, marasmic stage it may be lower than the physiologic normal.

14. During the intercurrent states of excitement of paresis the pressure shows a tendency to be lower than that previously found in the same individual.

15. In senile dementia the pressure is always considerably higher than the physiologic maximum. W. R. D.

Il tempo di reazione semplice agli stimoli tattili ed acustici negli stadi iniziali della demenza precoce. Ricerche psicometriche. Del Dr. I. BERGAMASCO. Giornale di Psichiatria Clinica e Tecnica Manicomiale, Anno XXXV, p. 287.

The subjects of this research were four sound men between 24 and 30 years of age, and eight patients suffering from dementia præcox. The author concludes that:

I. In states of advanced dementia, there is a slowing in the reaction time, as great as the dementia is severe, and this is established for dementing forms in general.

2. In the early forms, or those which are not severe, on the contrary, the reaction times are not very different from those obtained in sane individuais of similar age, social condition, and culture.

3. In the patients, as in the sane, the reaction to tactile stimuli is slower than that to auditory stimuli.

4. The influence of practice is shown in general, but only in certain cases will there be a progressive diminution of the successive results. Sometimes we see the time diminishing to the end of the third series, but rising suddenly in the fourth. Sometimes the order is more or less inverted; that is, the first series has not the lower value, and is higher than the succeeding. In general, therefore, not even in the same is there much regularity.

From the above it may be deduced that the necessary conditions for a personal reaction to a stimulus, which must be, in several cases of dementia præcox are not changed, in contrast with the appearance and strange acts of the subjects.

As a corollary it may be said that examinations of this kind in cases of dementia præcox have little diagnostic value. W. R. D.

Epilepsie et ponction lombaire. Par F. TISSOT. Le Progrès Médical, An. 37, p. 226, 9 Mai, 1908.

Six epileptic men were subjected to lumbar punctures with the object of determining if such procedure had any curative or ameliorative value by causing a diminution of the cerebro-spinal pressure. The results were negative.

W. R. D.

Book Reviews.

THE AUTOPATHOGRAPHY OF C. W. BEERS.'

BY CLARENCE B. FARRAR, M. D.,

Assistant Physician and Director of the Laboratory, Sheppard and Enoch Pratt Hospital; Associate in Psychiatry, Johns Hopkins Medical School; Visiting Physician, Bay View Asylum.

It is, or should be the object of every alienist to study his cases first and foremost from their individual subjective points of view. The habit of passing through a mental ward and forming opinion of patients from brief and routine interviews; setting down extraordinary ideas as delusions, without more ado, easing the psychiatric conscience, perhaps, by defining them as delusions of grandeur, persecution, or the like; meting out at once summary and violent treatment to meet violent emergencies, without deliberate consideration of the pathogenesis of the emergency-these are some of the fruits of that nonchalant collective objectivity which still too often stigmatises the treatment of patients in hospitals for mental disease. In dealing with these patients there is undeniably requisite a greater degree of judicious tact based on skilled insight, than is called for in the general handling of other classes of cases. It is lamentable that this condition is so commonly left unsatisfied, and the fact is the fault of inadequate medical education and medical legislation.

One of the richest and most valuable sources of information at the alienist's disposal, is the "confession" of the convalescent or recovered patient. Sometimes, it is true, such a confession is difficult to obtain. The subject is too painful; the recollection of their extravagances of conduct is humiliating to many sensitive minds. And yet in a free and straightforward conference between doctor

"A Mind that Found Itself." By Clifford Whittingham Beers. New York and London: Longmans, Green & Co., 1908. 362 pp.

and patient, under the terms of friendly interest and sympathy, as the latter recounts his season of fear, of doubt and suspicion, of misunderstanding and uncertainty, of impulse and untamable activity, it may not be he alone who is visited with regret and shame for inconsiderate acts or words. Even the most kindly-intending physician may have to reproach himself with overhasty conclusions, ill-timed jests, ill-considered replies, if not with methods of treatment unnecessarily severe, amounting even to unkindness or cruelty.

The autobiography of Clifford Whittingham Beers, “A Mind that Found Itself," which appeared early this year, embodies the confessions of a protracted and recurrent mental illness, and the exposure of alleged inhumanity of treatment. Such a book must. inevitably be "sensational," and it acquires a somewhat exaggerated importance by being given over to lay-reading, this importance being still further exaggerated by the introductory note. of William James.

From this note one easily gets the impression that the case is an extraordinary one, that such transformations as that through which the author passed (from a depressive-suspicious state to one of elation) are rare, and finally that the book presents a perfectly fair statement of conditions from the view-point of a sane man, inasmuch as the author recovered from his malady. A perusal of the book does not substantiate any of the above-named impressions. This fact does not, however, detract from the interest and value of the work.

Clinically the case of Mr. Beers, while not particularly unusual, is a very instructive one. In the first place it is significant to note a characteristic temperament underlying the psychosis, which constantly asserts itself, intensified by the morbid process, and especially in evidence in the period immediately after recovery. It is expressed in an observation from the author's student days. He was particularly interested in tennis. "Its quick give-and-take suited my temperament, and so fond was I of it that during one summer I played not fewer than four thousand games." It is this sort of supercharged devotion which leads to excellence, when coupled with long-suffering persistence in serious undertakings. Otherwise it characterizes the tempestuous zeal of superficial characters who propose much and perform little.

The author enjoyed good health up to November, 1895, during his second year at Yale College, when he was perhaps nineteen years old. About a year and a half previously his brother had been stricken with a severe brain disease which gave rise to epileptiform convulsions, and terminated fatally in 1900. From the first of his brother's illness, he was harassed with the obsessional fear that he too might become a victim of epilepsy. The crisis. came in November, 1905, with the sensation that his "nerves had snapped, like so many minute bands of rubber stretched beyond their elastic limit." This is a not uncommon early symptom in depressive cases. After a prodromal period of varying length patients frequently describe the definite feeling of something snapping" or "giving way" in their head. And from this event they often date their disordered state. This sensation, which is experienced as if it were a physical fact, may be nothing else than a parasensory interpretation of the consciousness of loss of mental independence and of the feeling of self-control. The prodromal period represents the struggle to maintain this independence and control, the patient feels his grip slipping, and when the break comes, it is as if the brain had snapped, and self-sufficiency and certainty pass away.

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In the present instance the patient was henceforth possessed with an overwhelming "dread" of recitations, which in spite of conscientious labor often prompted him to report himself as "not prepared." Following graduation in 1897, the old dread followed him through three years of business activity-five years in all, which represent the neurasthenoid introduction to the final crash. which came in June, 1900, during the exhaustion following a severe attack of grippe.

The inhibition which, at the beginning of their psychosis, depressive cases so painfully feel blocking their thought and action, now became dominant and was accompanied by an intensified dread of impending epileptic attacks. Mr. Beers had concluded with himself that he would rather die than live the life of a confirmed epileptic, and when the dread had become metamorphosed into a delusion and he believed himself actually a victim of the disease, an attempt at self-destruction followed. The patient threw himself from a fourth-story window, thereby breaking both ankles

and generally bruising himself, but not losing consciousness. With the shock of the fall the fear of epilepsy vanished permanently and left no rack behind.

A depressive phase, in no wise unusual, supervened. It was characterised by suspicional and self-accusatory delusions, the outgrowth of the suicidal attempt, and by proportionate sensory misinterpretations. The suspicional attitude culminated in the likewise extremely common symptom of doubting the identity of relatives. The patient's brother was no longer his brother, but the latter's double, acting as a detective. "For more than two years I was without relatives or friends." All sensory impressions became translated into hostile attacks and the depression reached a fairly marked degree of illusional clouding of consciousness, with refusal of food and mutism.

The period of depression was succeeded by one of elation. The phase of transition, always the most interesting in circular psychoses, is charmingly described by the author; it has in it, however, nothing symptomatically unique, except in so far as the symptoms of every patient are individual, and therefore unique. The process of transformation such as occurred in his case is one of common observation.

The depression, or more correctly speaking, the period which elapsed between the onset of the psychosis proper and the definite appearance of the maniac phase, extended over twenty-six months. During the second half of this period the symptoms appear to have been less pure, and transition elements were frequently visible. The feeling of utter unworthiness and degradation gradually lost its edge, and in June, 1901, on entering a private sanatarium (the second in which he had been confined since the beginning of his illness), "a feeling of superiority easily asserted itself, for many of my associates were, to my mind, vastly inferior to myself." Although still overshadowed with "the cloud of death," he nevertheless experienced a "new feeling of comparative contentment." With diminishing inhibition the patient began to busy himself more actively again with suicidal ideas and plans. This too is a common observation.

The transition, plainly, was gradually being accomplished. In July, 1902, Mr. Beers was surprising himself and his fellow