coldness and numbness of the extremities, etc. In dementia precox hypochondriacal ideas are far less extensive, and usually center about one or two organs, and are quite apt to involve the sexual organs. Furthermore, in neurasthenia, hypochondriasis tends to increase except as the disease abates, while in dementia precox it tends to diminish as the disease progresses. Neurastheniacs are apt to complain of failing mental power, and express the fear that they are losing their minds in the absence of such symptoms, but in dementia precox, evidences of deterioration really exist, which are not recognized by the patient. Finally, in dementia precox, impulsive acts are often present, but rarely encountered in neurasthenia.

HYSTEROID CASES.

The following record represents the cases of dementia precox in which hysterical symptoms are prominent: The patient, a young lady of good family history, was always considered eccentric, unusually bashful, and somewhat seclusive. At the age of eighteen, while in service as a maid, she began to show greater timidity and became seclusive and reticent. Two months later she left her place of employment and returned home unannounced. Here she immediately went to bed and remained, saying that she did not feel well, though she presented no objective signs of illness. She complained of headache, indigestion and palpitation of the heart, but refused medical attendance. Whenever her mother insisted upon her leaving the bed, she regularly developed hysterical attacks with laughing, crying, screaming, and convulsive movements. In the course of four months she gradually improved, and upon the insistence of her mother who found her a place, re-entered service. She, however, worked indifferently and required constant prodding. Hysterical attacks were apt to recur at critical times when her assistance was most needed. Most of her time off duty was spent in her room and she rarely

went home to visit. Following this she frequently changed her places of employment, rarely staying longer than four weeks in any one place. These changes were usually made without warning, and always without excuse. On two occasions during the succeeding eight months she returned home for two weeks at a time and suffered from what her physicians called hysterical attacks. Finally she went home saying that she had a vision, probably an hallucination, in which she claimed to have seen a black woman enter her room and touch her while asleep. . By this time it was noticeable that she had lost interest in her personal appearance, and was paying little attention to her religious duties. times her mother would find her sitting on the floor laughing over her baby books. The tendency to indulge in unrestrained and meaningless laughter became more marked, and she would laugh not only at table, but also on the street. Two months later, about one year after the onset of the disease, the patient was first seen by me, and from this time the disease has presented the char acteristic picture.

The hysterical manifestation early in this case would naturally obscure the diagnosis. In differentiating dementia precox from hysteria the following symptoms should be borne in mind. In hysteria there is always present what is termed the hysterical basis. This condi tion usually makes its appearance during puberty, and is irregularly manifested by various hysterical symptoms. Such a condition occasionally antedates dementia precox, but is by no means essential. The emotional attitude is quite different in the two diseases. In hysteria the patients are entirely under the control of their feelings, and we find them vacillating from one mood to another impelled by the most trifling incidents. At one time they are extremely despondent, at another very angry, and again they are happy and cheerful, or sullen and disgruntled, but always craving sympathy. In dementia

precox the characteristic emotional state is one of emotional indifference and apathy, with an absence of reaction to the environment. Transient despondency or moderate exaltation may be encountered but these states do not vary from hour to hour or day to day. In hysteria hypochondriacal symptoms are extensive and involve more than one organ, while in dementia precox they are limited.

The

Hysterical paroxysms are characterized by both sensory and motor nervous symptoms. In dementia precox the only paroxysms that ever occur are motor and of an epileptoid nature. In hysteria the mental processes of perception and comprehension are unimpaired. patients are even keen in the recognition of their envir onment, especially any defects in it. In dementia precox occasional hallucinations, such as occurred in this last case, are encountered very early in the disease. In hysteria genuine hallucinations and delusions are never present. What may seem to be hallucinations and delusions are found upon close inquiry to result from fabrication and a lively imagination. The store of ideas in hysteria rarely suffers any impoverishment, though voluntary conversation usually centers about the patient's ills, but in dementia precox desultoriness or scattered thought, in which there is a lack of continuity often occurs early. while the progressive impoverishment of ideas regularly accompanies the course of the disease. Finally, hysterical patients are extremely egotistical.

The necessity of an early recognition of dementia precox become all the more apparent when one learns that the disease in the vast majority of cases has been in existence one or more years before the patient comes to the hospital, in which interval some have wandered from home and become lost to the family, others have developed alcoholic habits, or have acquired sexual diseases, conceived and given birth to children, or have committed criminal assaults, all of which might possibly have been

prevented.

The honor of the family, the protection of society and the welfare of the patient demand more careful attention from the practitioner to this common mental disease.

DISCUSSION.

Dr. Keniston: No practitioner expects to get a full history of the patient whatever his specialty may be. So we in practice with the insane. We are compelled to depend upon the family physician for the history. An early history of these cases is very important. Members of the Society should study the history of each case and in many cases this would prevent the untoward occurrences mentioned in the paper. There is no other State where students have such advantages as here. The students of the Yale Medical School have better advantages than can be had anywhere else in the country. There are twelve clinics in the course of the season, held at the Asylum in Middletown.

SUGGESTIVE THERAPEUTICS.

J. M. KENISTON, M.D.,

MIDDLETOWN.

A.

HISTORICAL AND INTRODUCTORY.

The above term, by many considered to be synonymous with hypnotism, or at least suggestion in some form, verbal, written or action, is the active principle of hypnotism. While the phenomena now classified under either of the above names have only been scientifically studied during the last sixty years, we are justified in inferring that they were recognized and utilized by the ancients thousands of years ago. The priests of Egypt were surpassed by Aaron and Moses in their influence upon the minds of the people. The fakirs of India, the magicians of Persia, the oracles of Greece, the seers of Rome; Peter the Hermit; the mystics of the Middle Ages; the ecstatics of the seventeenth century; the Hesychasts of Mount Athos, who remained motionless for days with their gaze steadily directed to the navel; the Tasko-drugites, who maintained statuesque postures for long periods with their fingers applied to the nose; the Dandins of India, who became cataleptoid by twelve thousand repetitions of the sacred word "Om "; the philosopher Socrates, who often stood motionless and mute for hours (once an entire day); all these, and many more whose names could be cited have consciously or otherwise employed sugges tion or hypnotism on others, or on themselves (autohypnotism).

From time immemorial the strong men and women have dominated their weaker brethren-have sent them joyfully to death on the scaffold or to battlefields "where thousands die to lift one hero into fame "-have organ