Seniors" of the American Institute, and invest them with like powers and authority, said board of seniors to be composed of members who have paid dues for twenty-five consecutive years.

The legitimate work of this society is changing from year to year so that the needs of to-day are quite different from those of twenty or thirty years ago.

This society is the homoeopathic society of the state, and it is the representative of homoeopathy in this commonwealth.

In these meetings are gathered the best minds and brightest thoughts of the profession, and through your concerted action as a society, is exerted all the influence which the profession can bring to bear for the advancement of science. Each year the number and importance of the matters coming before this society are increasing, and more time is needed for their proper consideration and discussion, for here if anywhere must be decided all matters which have to do with the best interests of medicine in general, and homœopathy in particular.

Our time for business meetings is so limited that matters are rushed through without proper knowledge or discussion, and if they are called up again for reconsideration, they are dealt with in the same hasty and unsatisfactory manner.

We now have other societies, such as the Surgical and Gynecological Society, the Boston Society and various other local societies which furnish ample opportunity for the consideration of scientific subjects.

It would seem to me wise for this society to devote at least one-half day or evening each year to the consideration of matters which have to do especially with the interests of homoeopathy, such as reports of hospitals and institutions where homoopathy has partial or entire representation, to the end that we may better understand the needs as well as the influence of our school in this state. How many of us are there who are sufficiently familiar with this subject to give information, or discuss it intelligently? I am aware that this proposition will be met with the reply that we already have too little time for the scientific papers and a proper discussion of them.

The bureaus of Surgery and Gynecology might be abolished, as we have a separate society for the consideration of these two branches, and the time that has been occupied by these bureaus devoted to business purposes; or if the concensus of opinion is opposed to doing away with any part of the present arrangement of bureaus, then have the semi-annual meeting adjourned to an afternoon or evening meeting midway between the semi-annual and annual meeting.

By this means we would become better informed, better organized, and better prepared for concerted action when legislative matters, or any others, affecting the interests of homoeopathy, come before us.

While the physician of to-day has lost much of the prestige which his brethren of forty years ago enjoyed, more is required. of him in service, education, and scientific attainments than before, and while medical education has vastly increased, the physician has in inverse ratio descended from the lofty position which he once occupied, almost to the level of a tradesman. The secular press so teems with quasi medical articles, written by quasi professors, with long names and few brains. The legion of cure-alls are advertised not only in print but on trees, fences, and house-tops, so that many a man, as well as woman feels that he knows as much, or a little more than his physician; and what home is there in which you will not find the head-ache pills, stomach tablets, soothing syrup and celery compound, and how seldom it is that we are called till one or all of these have been tried.

The subject of germs and microbes has been cussed and discussed in the daily press until their various names have become household words and in some instances household gods to be feared if not worshipped.

How then shall we meet this spirit of commercialism which is abroad in the land, and which would degrade the noblest profession on the face of the whole earth to the level of a mere occupation, whose chief reason for an existence is to enable us to extract sheckels from the pockets of our patients? It would be ideal if we were all sufficiently endowed with this world's goods, so that we could do away with book-keeping, and devote our entire time and energies to the advancement of science and the well being of our fellow men, but some of us are not thus fortunate and must needs consider financial requirements.

While in the flesh and surrounded by material wants these things must be provided for. The physician has his obligation to his family, to himself, and to the community in which he lives, and if he has proper self respect he desires to bear his art of the various charities which abound in every community. He shall also provide (should he be so fortunate as to reach it) for a comfortable old age. All this requires money, and usually his income depends entirely upon his profession so that the monetary consideration is one of no mean importance.

It is not enough to be able to maintain an existence and support a family in the most economical manner, for if any person earns the pittance which he receives, it is the physician who sacrifices everything for his profession.

I am not at all in symapthy with the idea that the physician should pursue his calling, guided only by the love of science and a philanthropic desire, neither do I believe that money should be the only or even the chief object to be obtained. There are services rendered by every physician which money hath not purchasing power enough to pay. The few dollars which we re

ceive are naught, compared with the satisfaction of having successfully combated disease, and saved a precious life to loving friends.

Important as are the things that pass with the using, they are small in comparison with truth verified, conscience enlightened, and a multitude of helpful ideas set in motion which will go on down the future ages, shedding their light and bearing their fruit long after the face and form of the personality which set them in motion, shall have been forgotten.

That physician, be he man or woman, who works for a price only, usually gets it, but that is all they do get. The higher mental satisfaction which comes to the ideal physician from the consciousness of having rendered valuable service to suffering humanity, and of having added somewhat to the common stock of knowledge, does not bring any sense of satisfaction or compensation to them. It has not entered into their consideration and for them has neither meaning nor value.

The physician who is a physician merely from his love of science, and makes slight account of the personality of the patient, no matter how thorough his education, or profound his knowledge, will be only a little more successful than his avaricious brother.

The ideal physician is the one who combines with a thorough education and love of scientific study, the idea of the fatherhood of God and the brotherhood of man, and who allows this idea to so permeate his own personality, that it touches the needs of his patients at every point and enables him to see himself in his patient, under like conditions, trusting his ideals and holding them before him as a torch in his hand, to lighten his pathway, and if only he keeps this light burning brightly will he carry healing and happiness and enable all to realize the truth that the physician's task is the holiest one by Heaven decreed, an errand all divine, the burden of our mortal needs to render less is thine.

To you, the younger members of this society who are just entering on your professional life, I wish to bring my most. sincere congratulations, that it is given to you to live in this new century, surrounded with all its magnificent opportunities, with its avenues of research and investigation extending on every hand, with the well equipped colleges and large hospitals, the field is limitless, and to you we look for great achievements. Personally, I can but regret that I was born so early, or that these opportunities were born so late.

As grateful children let us remember with thanksgiving the labors of the fathers which made possible the opportunities of the present, and extend to them, all that respect and reverence which their faithful toil has so well merited.

To you who are in the heat of the battle, as well as to those

who are in the afternoon of life, and realize that a large part of their life's work is behind them, I say, "Be not discouraged but rather rejoice in what you have been able to accomplish and with renewed courage and ever increasing faith in our grand old law of similars, press onward, and to you I would say in the words of Browning,

'My friends grow old along with me,

The best is yet to be

The last of life, for which the first was made.

All things are in His hands, who said,

A whole I planned, youth sees but half.

See all, trust God, nor be afraid.""

THE NEW KRÆPLIN CLASSIFICATION IN DIAGNOSING AND TREATING THE INSANE.*

BY GEORGE S. ADAMS, M. D. SUPERINTENDENT WESTBORO INSANE HOSPITAL

From the institution standpoint of the care of the insane, that classification is valuable, which permits a ready diagnosis of the form of disease, which enables a fairly accurate prognosis, to be given, and is flexible enough to permit from time to time the introduction of new forms or the modification of existing ones, thus keeping the physician interested in the study and treatment of his patients.

This classification should also, when taught in medical schools, enable the student to acquire a working knowledge of mental diseases, so that in general practice he can detect them in the early stages when it is evident that treatment is the most successful; for it is probable that there is no greater proportion of unstable or degenerate persons in the community than there were fifty years ago, but the conditions of our modern life act more powerfully to bring about insanity in the unstable than did those of the middle of the nineteenth century.

The classification of Kraeplin, which has been adopted in the Insane Hospitals of Massachusetts, and also in many progressive hospitals of other states, meets more fully the needs of insane hospitals than any other, and, though far from perfection, and unfortunate in some of its terminology, one of its best features is that it readily permits changes and modifications as does no other classification known to the writer.

Dr. Emil Kraeplin published the first edition of his "Handbuch der Psychiatrie" in 1883, and it has gone through seven editions. The eminent author has modified and enlarged his work and his mind is still open to further improvement. Indeed, one merit of his classification is its adaptability to changes.

*Read before Mass. Surgical and Gyna cological Society, June 13, 1906.

on

Although no English edition of his work has yet appeared, Defendorf's "Clinical Psychiatry," Kraeplin's "Lectures Clinical Psychiatry," and articles in psychiatric literature have supplied, in a great degree, this deficiency to those who do not read German.

I will now briefly call attention to some of the forms presented by Kraeplin, dwelling with greater length upon those of most importance, not only to the alienist, but to the physician in general practice.

Infection Psychoses: These include fever delirium, usually resulting in recovery, though occasionally severe, and familiar to every physician; and infection delirium, believed to be due to the specific toxine of typhoid fever, small-pox, hydrophobia, and malaria, as it appears without relation to the temperature. Here the prognosis must be very guarded, as not more than fifty per cent recover. In hydrophobia nearly all the cases die. The Post Febrile period presents a number of psychoses believed to be due to infection, some of mild and others of a severe character, and the prognosis is usually good. Naturally most of these cases are seen by the general practitioner, as but a few come to hospital care.

Another group of cases, not large, usually come to the hospital for care and are called Exhaustion Psychoses. The first of these is collapse delirium. This arises from exhaustive causes, such as childbirth, loss of blood; and to acute diseases-as pneumonia, grippe, erysipelas, etc. Here, while the exhaustion is extreme, there is much motor excitement, with hallucinations, delusions, clouding of consciousness and the disorientation and incoherence of speech are extreme. The indications are to superfeed the patient and reduce the excitement. This result. can best be secured by the prolonged neutral bath with the indicated remedy, and if treatment is instituted early, the prognosis is good.

Acute confusional insanity differs from the foregoing in that the confusion is greater, but the prognosis and treatment are similar.

Intoxication psychoses include the insanities due to toxic. substances taken by the patient. They include alcohol, opium, cocaine, hemp, lead poison, etc. They may be acute and chronic. Recovery can only remain permanent by abstinence from the offending toxin. Often it is impossible to the individual by reason of impaired will power.

We now come to a group of cases, the study and treatment of which are very important-called by Kraeplin, Dementio Praecox. This term, first applied by Pick to cases of "hebephrenia," is extended by Kraeplin to cover three general forms having certain common characteristics but differing in other symptoms. I regret that to these cases a title meaning "pre