of fat by gravity, that is, by setting the milk or by using the céntrifugal machine. We may therefore change the per cent of fat without changing the proportion of proteids which remain constant. Careful analysis of milk set for six hours gives We have, therefore, an excess of proteids as compared with human milk, and by dilution can place it where we wish. The lack of sugar can be maintained by adding milk sugar, not for purposes of sweetening, but because the carbohydrate is needed for nutritive purposes. Lime water neutralizes the acidity of the milk and makes it more digestible for other reasons. When we increase the fat in relation to the proteid, as in the proportions of human milk, we have a softer and more digestible curd. With these facts as data we can make a home modified milk to good advantage. The simplest method with which I am acquainted is that of Dr. C. W. Townsend, published in Boston Medical and Surgical Journal, 1899. He takes the top one fourth of milk set for six hours, which represents fat 10.00, sugar 4.50, proteids 4.00; as sugar must be added, it is just as well to represent it as : FAT. SUGAR. PROTEIDS. 4.00 per cent. 4.00 per cent. A 20 oz. mixture with sterilized water would contain per ounce: FAT. SUGAR. 0.20 per cent. PROTEIDS. 0.20 per cent. We must also remember that an even tablespoonful of sugar contains 313 and each tablespoonful added to a 20% mixture increases the percentage of sugar 2.00 per cent. On the above basis if we write, top milk, 43; water, 153; and lime water, 13; sugar of milk, 2 tablespoonfuls, we have: FAT. SUGAR. PROTEIDS. .80 per cent. 4.80 A good mixture for weak stomachs or slight diarrhoea. Or top milk, 83; water, 113; lime water, 13; sugar of milk, 2 tablespoonfuls:· [Read before the Worcester County Homeopathic Medical Society.] Depression in a greater or less degree is usually observed at some period in almost every form of insanity. Excitement also, may precede or follow a depressed stage, in many cases thereby making diagnosis difficult unless we take into consideration that both are liable to occur in the same case, and that a close relation exists between the two states, inasmuch as both involve the higher centres. Depression when it exists as an insanity seems to depend upon a lowered activity, and consequently an increased resistance of those groups of neurons which form the higher or ideation centres; the increased resistance of the higher centres with which they are in most intimate anatomical relation thereby inhibiting their function. The result of this action is mental pain, slow reaction to stimuli, slow muscular reaction, and diminished general sensibility, all of which can be observed in simple melancholia. There are several well-known agencies that depress and lower the activity of the neuron. among these are exhaustion, physical or mental, depressing emotions, and toxins. We have observed in quite a proportion of our acute cases a greater or less degree of anæmia, which undoubtedly has resulted in lowering the resistance of the nervous system, and exposing it to influences which tend to mental disturbance. Chief Several writers claim that there is an early stage common to a great majority of insanities, which they term the stadium melancholicum, and from which may follow any one of the various types of insanity. When depression is observed in a mental case, either at the beginning or during its course, a diagnosis, and consequently a prognosis, cannot be made upon the depression alone. Melancholia presents many clinical phases, any of which may more or less characterize the depressed stages occurring in other insanities. Terms are used to express these phases, such as suicidal, religious, hypochrondriacal, and lycanthropic melancholia. Melancholia agitata is a type imitated by active delusions expressed through the motor channels (bites her nails). Melancholic frenzy is the counterpart of maniacal furor. Melancholia attonita is marked by extreme concentration upon a few painful delusions, and with greatly impaired attention for surrounding objects. Here the increased resistance of the higher centres is often so great as to so inhibit the association of ideas that stupor follows. A state of depression closely resembling melancholia with stupor has been observed in a circular insanity. We have also seen a marked period of depression precede a maniacal outbreak in epileptic insanity. Patients convalescing from mania acute may frequently pass into a condition of melancholia and occasionally melancholia with stupor. Depression, and with suicidal impulse, may sometimes be seen during the development of paranoia. It generally follows closely upon the development of ideas of persecution, and the patient, seeing no escape, desires and may seek selfdestruction. Suicidal impulse has occurred during the development of delusions of an ecstatic nature in an adolescent insanity under our care. The patient heard herself called of God and the angels to go to them in heaven, and used every means to act upon this hallucination and destroy herself. A case was under treatment last year that presented the most active suicidal impulses that one often witnesses. She talked rapidly and coherently, generally insisting that she was not ill and that she never felt better in her life. Her physical health was good, although she slept but little for several weeks. She always insisted that she wanted to live, yet seized every opportunity to injure herself. According to the old nomenclature, this case would necessarily have been classified either as acute mania or melancholic frenzy. presented symptoms of both mental states, and tended to recovery. This case fairly illustrates the now generally accepted belief that mania and melancholia are not two distinct psychoses, but one disorder, comprising phases either of exhilaration or both. It of Circular insanity may commence with a period of excitement or depression. Either period may be greatly prolonged or of short duration. During the depressed period the patient shows a marked desire for solitude, is disinclined to occupy herself, and loses all natural affection. Delusions a self-accusative nature are infrequent. There is, however, nothing diagnostic about these delusions to differentiate them from simple melancholia. The depressed period generally exceeds the maniacal except in attacks with a very short cycle, in which the durations of the periods are usually If the period of depression forms the first part of the first cycle, during this state one would be quite unable the same. to diagnose the condition. The case might easily be mistaken for simple melancholia, and a favorable prognosis given, whereas, instead of recovery, would follow repeated periods of melancholia, mania, and lucid intervals. The condition of stupor, which is one rarely observed in the depressed period of circular insanity, is like the stupor in melancholia with stupor. The patient is conscious of what goes on around her at the time and relates it, or is able to relate it, afterward. In the stupor of confusional insanity this is not the case. Depression is mentioned by some authors as occurring in confusional insanity; I have not seen it. We may have various phases of depression as well as excitement in the insanity of adolescence. Imbeciles show a tendency to motor restlessness, but seldom appear depressed. Dementia præcox is a comparatively new term, and embraces a class of cases in which no symptom of mental deficiency may have been observed until the approach of adolescence. In fact, the child up to this time may have shown promise of quite exceptional mental ability. During the period of adolescence a vast variety of mental symptoms may appear. Depression and excitement, uncontrollable impulses, persecuting delusions, and immoral conduct are a few of the symptoms which may occur. The cases most difficult of recognition, however, are those where none of these symptoms stand out prominently. The young person who is noticed to be gradually failing in mental application, through no lack of endeavor, also losing the power of concentration and becoming irregular in habits, showing an irritability and waywardness quite out of proportion to his or her former disposition, is in danger of this form of mental alienation known as dementia præcox, or premature dementia. The activity of the symptoms may be arrested at any stage, but there is left behind a degree of mental incapacity which lasts through the patient's life. Oftener in these cases than in any others, perhaps, is a hope held out to the parents of recovery from what seems to be nothing more than an attack of simple melancholia or mania. Last July a male patient came to this hospital, who on the |