practice of medicine, that they have exercised that skill in the examination of the case in question; and that that which they saw, or the evidence which they obtained in the course of their examination of the patient, independent of anything learned from or told them by others, was sufficient to satisfy them as to the correctness of their diagnosis of insanity, and the justification of certificates to that effect.

The learned Judge makes it clear that infallibility is not expected; at the same time, he is at some pains to point out the grave responsibility involved in making certificates of insanity, and the necessity for the exercise not only of all the diagnostic skill possessed by the examiner, but of a thoughtful consideration of the nature of the act in question, and naturally of the consequences which may follow the making of a certificate of insanity. At the same time the Judge, in his opinion, makes it clear that possessing the qualifications and having complied with all that the law demands of those who practice medicine or surgery in the examination of persons alleged to be insane, physicians cannot be held liable for the consequences which follow the use of certificates they may make and sign under such circumstances.

PELLAGRA AND PELLAGROUS INSANITY IN THE UNITED States. -Shortly after the publication of the report to the South Carolina State Board of Health, upon Pellagra and Pellagrous Insanity in the AMERICAN JOURNAL OF INSANITY for April, 1908, Dr. J. W. Babcock, Medical Superintendent of the State Hospital for the Insane, Columbia, S. C., who was largely responsible for the report, and who has devoted much time and study to the subject, went to Europe to make further investigations and to compare the cases of Pellagra to be seen in Italy and elsewhere in southern Europe and in Egypt with the suspected cases observed in this country.

Dr. Babcock has just returned and in a letter received from him from London just before sailing for home he says: "I have fully satisfied myself as to the identity of Pellagra as it exists. in the Southern States and in Italy and Egypt. I studied many cases near Venice and Milan; and in London, Dr. Sandwith has been especially kind in reviewing the whole subject with me at the London School of Tropical Medicine."

Dr. Babcock is to be congratulated, not only upon the opportunities he has had of following up, in localities where Pellagra is not only well known, but scientifically studied, the observations made in this country, and recorded in the report to which we have referred, but upon the confirmation of the conclusions which he had practically drawn from his studies.

We trust then, as the JOURNAL had the honor of publishing his preliminary studies and the report thereon, it will also be the medium through which the results of his European investigations, as well as those which we understand he is now conducting, will be given to the profession.

EXTRAORDINARY LONGEVITY IN AN INSANE WOMAN.-The death of an aged patient in a hospital for the insane is not usually an event of sufficient importance to call for comment. Samuel Johnson's ideal was

An age that melts in unperciev'd decay
And glides in modest innocence away;

but when there appears to have been a reversal of the Darwinian law and an "unfit" person has survived as a bit of mental wreckage after sixty-five years of residence in a State asylum, the event compels reflection on the significance of longevity so extraordinary.

The New York State Lunatic Asylum at Utica (now Utica State Hospital) was opened on January 16, 1843. Margaret Cahoon, who died on August 24, 1908, at the age of ninety-nine, was admitted to its wards as a patient on August 29, 1843. She had been transferred thither from the Hartford Retreat, Connecticut, where she had been a patient since 1841. She had therefore been under continuous confinement as a helpless and irresponsible person for sixty-seven years. At the time of her admission the patient was described as "demented and unappreciative," without ability to engage in coherent conversation, and she "appeared to have but little realization of what was going on about her." Margaret Cahoon must have been known to many generations of psychiatrists throughout the United States who served their apprenticeship at Utica, as a confirmed dement who was dragging her useless body with infinite slowness to the grave. Had she had the mentality to observe it, her record of what had

been accomplished in the world's work since she entered the Hartford Retreat in 1841 would have formed an interesting and instructive chapter. It is hard to believe, for instance, that when she travelled to Utica from Hartford the New York Central Railroad was not in operation. The journey must have been made largely by water, the last part of it on one of the packets which ran on the Erie Canal. And if one stops to think of the changes which have taken place in the administration of the Utica State Hospital and the care of the insane within that long period, one cannot avoid the pleasing conclusion that great length of days in this instance must have been the result of continuous and progressive humane care. And yet how many newspapers, one wonders, have pointed to this moral in commenting upon the much advertised event? Unfortunately, the sensational press, with its eye and ear at every key-hole, is ever ready to make the most of the exceptional case of ill treatment, while the rule of enlightened and humane care-and we are sure it is the rule in the larger State institutions such as that in which Margaret Cahoon dragged out her hapless existence and never realized in her experience, poor creature, that "life protracted is protracted woe "receives scant if any recognition under a distorted sense of newsvalues. We are the more moved to this comment at this time because only a few weeks ago even so eminently respectable a newspaper as the Evening Post, in discussing the increasing burden of insanity and mentioning as one of its causes the obvious accumulation of the insane, said:

Back in the eighties a man had to fancy himself the North Pole or cleave a neighbor's skull in order to secure a ticket of admission to a padded cell. To-day the absent-mindedness of a paying teller, acute hysteria or the emotional insanity of a drunken paramour suffices.

That paragraph surely was written by a man who must have been born not earlier than "back in the eighties." Has anybody ever seen a padded cell in the United States? Personally we know of no institution in this country in which such an anachronism exists. Indeed, back in the forties in the first annual report of the State Lunatic Asylum at Utica, written during the year of her admission thereto, Dr. Brigham says:

Many of the violent class are brought to us in chains or with their limbs confined by strong cords. These are in all cases immediately removed and

the patient is kindly addressed and assured that he is among friends who will use him well. He is then taken to the apartment which he is to occupy and permitted to have his liberty; but his attendants are directed to watch him carefully and if he is disposed to be violent, to strike, to break windows or the furniture, to put him in his room. We adopt very few methods of restraint even with the most violent patients, never in any case use ropes or chains and dispense entirely with strait jackets. We occasionally have a patient who will exhaust himself by excessive activity, that we fasten in a gentle manner to a chair or a bed for a short time, but none of these methods of restraint are long continued. We much prefer that a patient should occasionally break a pane of glass or tear some of his clothing, than to keep him constantly confined. . . . . For the most part those who are brought here in a very excited state and require the foregoing treatment, when they recover feel grateful for the attention bestowed upon them when in this condition, and are sensible that they were kindly treated, and not only so, but appear to realize that by the course pursued their lives were saved. They also lament the trouble they occasioned those who had the care of them.

Let those of us who are prone to flatter ourselves that all advances in psychiatry have been made within our own generation ponder the foregoing paragraph and realize in estimating the causes which may have contributed to the longevity of the patient under consideration that during all those long years her ears were not unused to "the still, sad music of humanity."

Book Reviews.

Nineteenth Annual
Transmitted to the

State of New York: State Commission in Lunacy.
Report, October 1, 1906, to September 30, 1907.
legislature January 31, 1908. (Albany: J. B. Lyon Company, State
Printers, 1908.)

This volume of more than 1300 pages contains much statistical material, profitable, doubtless, to the members of the legislature, whose duty it is to perfect the necessary legislation for the proper management and maintenance of the institutions controlled by the Lunacy Commission, but of local, rather than general, interest. The formal report of the commission, with accompanying documents, however, contains much which every person engaged in the medical care of the insane may read with profit. We learn that the recovery rate shows a slight increase over that for 1906, that the capacity of institutions for the insane in New York has been increased 621 beds during the year, that through the vigilance of the State Board of Alienists 352 insane aliens have been deported and 170 nonresident patients have been sent to the States where they have a legal residence, that the entire disbursements for the care, oversight, and support of the insane during the year were $5,927,531.37, and that the number of the dependent insane in institutions on October 1, 1907, was 27,162

persons.

In the proceedings of the quarterly medical conferences attended by representatives from the hospitals and members of the Lunacy Commission one is impressed with the development of the present spirit of scientific effort as compared with the administrative zeal which formerly gave tone to them. Instead of discussions upon soap, on the proper roasting of coffee and grinding of pepper, on the size and style of paper and envelopes, on the use of the safety razor, on the vacuum-cleaning of clothing and similar necessary, but unimportant matters for the consideration of expert alienists, we find papers and discussions on the training of nurses and their hours of duty, on the admission of dotards to the hospitals, on the best statistical tables for the annual report, on the occupation and diversion of patients, on open-air treatment in psychiatry, and on the care of the insane prior to commitment. The discussions seem pithy and practical, and display a knowledge of the subjects under consideration and a refreshing habit of viewing all hospital questions from the standpoint of the physician. The discussion which followed the report of the director of the State Pathological Institute is a case in point. It shows plainly a wide sympathy with the aims of the institute and a hearty spirit of co-operation.