steadily that the child is very frequently handicapped for life before any attention is attracted to the eyes. Even in adults we shall find over and over again that after the use of cycloplegics we can give them perfect vision with lenses one or more dioptres weaker than they may have been wearing for years.

All oculists have seen many cases of children wearing myopic lenses, fitted by opticians, when the true glass should be for hyperopia. This too common error of the optician may and frequently has led to a permanent myopia and the accompanying hardship of being always obliged to wear glasses, and too often to serious loss of vision. Therefore, do not permit the optician to fit glasses to your patients. The great danger in all myopic eyes is the wearing of too strong lenses, therefore the value of cycloplegics to find the weakest possible.

In cases of hyperopia associated with esophoria you will generally give your patient more satisfactory results by finding out under a cycloplegic the total hyperopia, and thus be able to correct with glasses a greater degree than you otherwise could. In hyperopia there is always a higher degree of latent hyperopia when esophoria is present than there is when exophoria exists, and a hyperopia associated with esophoria always requires stronger glasses than when exophoria is present. In cases where the various methods of examination indicate it to be one of simple presbyopia or hyperopia, especially if associated with esophoria, there seems to be no necessity for the use of cycloplegics.

In all cases of squint in young children an examination under a cycloplegic is absolutely necessary for thorough work, as the use of glasses will frequently correct a squint if taken early.

At this point permit me to go outside of my topic to give just a word of caution. Don't give the parent, who brings a child to you for a little cast in the eyes, the advice that there is time enough later and to wait until the child is older. Many of these little ones have paid the price of your mistaken advice in the way of more or less loss of vision. Don't forget that no child is too young to commence the treatment of a squinting eye, for by the use of cycloplegic glasses and orthoptic exercises much can be done to retain binocular vision and sometimes correct the squint without resort to the knife. Don't ignore or make light of the slight blepharitis which is usually indicative of a refractive error. forget that nervousness or frequent headaches, occipital as well as frontal, are often dependent upon the eyes. Finally, don't overlook the fact that sometimes the child who is dull and backward in his classes, or who is delicate or badly nourished, may be suffering from eye strain and that its correction may completely change the life and character of the patient.

Don't

But to return to the subject of cycloplegics, in all refractive work in children, I believe their value cannot be overestimated. In examining children the necessity of much greater care, thoroughness, and watching of the patient is recognized by all observing

oculists. For example, I have frequently seen children reading the letters of the test type readily with the eyes turned in another direction. They had simply been memorized, and unless the oculist is on the watch and changes the test letters his examination is liable to be wrong. This possibility of error is, of course, liable under cycloplegics, but the danger of selecting the wrong axis and strength of glass in astigmatism is not so liable to occur under cycloplegics.

I have seen cases frequently where the oculist has made repeated changes of astigmatic correction, either the strength of the lens or its axis, claiming the astigmatism had changed. I believe the very large majority of these cases to be due to the fact that no cycloplegic had been used and that the correct glass had never been given. I am constantly meeting cases, even in adults, where after cycloplegics, they will accept and wear with comfort and relief of their symptoms glasses widely different from those indicated before its use, generally accepting a more complete correction than they would previous to the cycloplegic. This I believe is largely due to the enforced rest of the accommodation.

In my judgment the complete rest of the accommodation for one week, due to the fact that the patient is unable to use the eyes for near work, is in itself of the utmost value to him. This rest may even relieve the patient in some cases without any change of glasses.

Consider for a moment that the ciliary muscle is practically working every minute of the time the eyes are open, in some cases doing much more strenuous work than others, focusing the eyes first at near vision, then at distant, and that this action has been kept up for perhaps many years, even during sickness, when the entire muscular system is lowered, and you may then realize what this enforced rest of the muscle may mean.

It is in part for this reason that my refractive work, where a cycloplegic is used, is always done under atropin. I find it is as easy to get my patients to submit to the use of atropin as any other cycloplegic after I have carefully explained to them its action and the advantage to them of accurate work and the rest to the eyes as well. Furthermore, under atropin, you are always more sure of getting a complete paralysis than from any other cycloplegic. For these reasons, if you are going to use any cycloplegic, always use one you can bank on every time. Every one admits that atropin can always be depended upon to give the most complete and positive paralysis. Why then are other cycloplegics, which are admittedly less reliable, used? Simply because their action is of a shorter duration, but to me, as already stated, the longer rest of the accommodation is most valuable, and the additional three or four days away from work can, with extremely rare exceptions, be arranged for. In those who absolutely cannot give up the complete use of the eyes during this week it is my custom to loan them a pair of glasses with which they can see for a few minutes' use, such as reading important letters, signing their names, etc.

CRANIAL INJURIES AS PRODUCTIVE FACTORS IN

CRIMINALITY*

BY DEWITT G. WILCOX, M. D., BOSTON, MASS.

Since the time when the prehistoric Aztecs and Peruvians trephined the skull, to allow the demons to escape from the brain, up to the present, there has been an undercurrent of belief that somewhere inside the cranium there was to be found some physical, tangible evidence of an exciting factor, which caused its victims to do criminal acts. Nor has that belief lessened under the illuminating searchlights of histology, pathology, and microscopy as applied to criminology.

Not until the learned work of Lombroso on "The Criminal," published in 1876, did the study of criminal anthropology take definite shape. Italy seems to be taking the lead in this study, but France, Germany and England are close seconds.

Dr. J. B. Ransom, physician to the New York Clinton State Prison at Dannemora, says, in a recent paper: "In the examination of several thousand criminals I have been led to believe that, as a rule, when in the inherent criminal the right side of the cranium, that is, indicating the right hemisphere of the brain in excessive development over the left, especially where there is a marked fulness over the paracentral lobe, the possessor's impulses lead toward homicide. I have repeatedly been able to place my hand upon this part of the head of criminals, and designate their crimes to be either assault or homicide, without any previous knowledge of their history or themselves."

The study of traumatic epilepsy further confirmed the belief that cranial injuries were important factors in producing abnormal mental conditions, and while the operative results in such cases were disappointing in a measure, in so far as acting curatively upon the epilepsy, yet in establishing the evidence of cause and effect, they were invaluable.

It

My only apology for presenting the narrative of an extremely interesting case is because it is, no doubt, typical of a certain class of criminals, and while it is but a single case, yet it goes far to show why the physician should be quite as deeply interested in the problems of criminology as are our jurists and law-makers. further shows how absolutely inadequate are our present methods of punishing criminals, in so far as the punishment acting as a further deterrent to a repetition of the crime. I wish, however, it to be plainly understood that I do not for a moment seek to explain all classes of crime upon the basis of this one case. I do not even class any great proportion of them with this case, but I do believe

*Read before the Massachusetts Homeopathic Medical Society at Springfield. October 13, 1909.

that this represents a considerable number of our so-called incurable or incorrigible criminals.

Thirty-three years ago there was born in Buffalo, N. Y., a boy, whose parents were above the average in intelligence, thrift, honesty, and sobriety. There were no alcoholics, epileptics, imbeciles or insane on either side of the family, for some generations back. He had older sisters and brothers, whose subsequent lives demonstrated their ability to take their places in the world's procession well up toward the front. This boy (Edward Grimmell by name) was possessed of more than common intelligence, was an apt pupil and gave evidence of manly promise. Up to fourteen years of age he had been subject to no severe illness and was of robust build. Although not of a quarrelsome disposition he became involved in a fight with a boy when he was fourteen years old, and the father of the boy, seeing his son was being worsted, picked up a heavy fence picket and struck young Grimmell over the head. The blow rendered the lad unconscious for some hours, the scalp was lacerated, and he was attended by a physician, who sewed up the wound. The injury was regarded in the light of a concussion and nothing more was thought of it.

It becomes interesting to note here that whereas the lad hai been perfectly well heretofore, yet soon following this injury he had frequently spells of nausea, some of which were so severe as to confine him to bed. Also, he had been, prior to this injury, an orderly, well-behaved scholar, attending school regularly; now he began to run away from school. His school teacher, who had charge of him about this period, said that although he was an exceptionally bright pupil, he acted so strangely at times that she frequently wondered if he was at all mentally unbalanced. There was also manifest at this same period some slight indications of epileptiform seizures, but they eventually disappeared and did not again return.

His first crime was committed when about sixteen years of age, and as I was somewhat interested in the property stolen I remember the occurrence particularly because of the laughable side of it. Diagonally across the street from my Buffalo residence was the First Baptist Church, where my family and I attended, and where young Grimmell's father was a trustee of the church. One Sunday morning the children and teachers assembled in the Sunday School room for service, but to their discomfort, they found the room absolutely devoid of chairs and tables. It was a standing Sunday School lesson which they had that day and no chair-ity for anyone. An investigation showed that young Grimmell had gone to a second-hand furniture dealer the day before and had bargained with him for the sale of the Sunday School furniture, saying they were to have the room newly furnished and he (Grimmell) was appointed a committee to sell the furniture; and he sold it at a good bargain, pocketing the proceeds and even assisting the dealer in loading the furniture on the van.

Now here appears first a significant fact, which later cropped out prominently in all his crimes. He was not in need of any money. His father, who was in comfortable circumstances, supplied him with sufficient for a boy of his age. Neither did the boy have extravagant habits; he was not in with a fast set, his companions were not spendthrifts; he neither smoked, drank, nor gambled.

The history which I am giving you thus minutely has been obtained in a very painstaking manner. I knew the subject, himself, from his early boyhood; I knew the family intimately; in some of the transactions I was an interested party, and finally, last spring, I spent an evening with him and his jailor at the Dannemora Prison, where he is now incarcerated and where he recited in the most dramatic manner the chief events of his criminal career. This recital was taken down in shorthand, and it is from those notes I am making this history. I have taken pains to corroborate any of the questionable statements by writing interested parties, who were able to furnish me the desired information. Moreover, I have made due allowance for the prisoner's tendency to be somewhat dramatic, and his inclination to magnify events to his detriment rather than to his credit.

The Sunday School escapade was passed off as a boyish prank and forgotten. Two years later (when eighteen years of age), and while still attending school, he forged a number of checks, went to the bank where his father did business, got them cashed and went to Detroit. He had no motive in going to Detroit; was not in need of money. Here he was soon apprehended and returned to Buffalo for trial. His father settled the affair out of court.

For two years he seemed to have conquered his evil tendencies and had a clean record. He came to me one day and said he had made up his mind to study medicine and had arranged to enter college at Cleveland, O. His father supplied him with sufficient money to pay his tuition and a month's board. Upon his arrival in Cleveland he went to room with a student named Holly. They had scarcely roomed together a week when all of Holly's money disappeared. He did not have enough left to go home on or telegraph for more. In his distress he turned to his roommate, in whom he had perfect confidence, told his predicament and asked what he should do. Without a moment's hesitation Grimmell pulled out a five dollar bill and told Holly to keep it. Now, although Holly was from the country, he was not entirely green. He looked at that five dollar bill, and the longer he looked at it the more familiar it appeared. It was a bank note from the small country bank where he lived, and from which bank Holly had obtained his money a few weeks before. He then went to the college treasurer, to whom he had paid his tuition in similar bills, and asked if the money had yet been deposited in the bank or given out as change. It had not been, but was lying in the college safe just as it was handed in. This fact convinced Holly that it was reasonable to suppose that