There are cases in which you may get some harm from the use of turpentine; you may set up trouble with the bladder or stomach, either one of which will add a serious complication to the case.

One great trouble in handling typhoid fever is that the physician goes very often to the family with the idea of multiple seven in his head. He gets the family imbued with his idea of the seventh, the fourteenth, or twenty-first day, and with these multiples of seven, if the fever does not break the members of the family become restless. It is wise, as soon as you make a diagnosis of typhoid fever, to tell the family that the patient will be lucky if he gets out of his bed in six weeks; then there will not be constant annoyance between the physician and family.

Dr. James H. Crawford, of Martin: I have listened to these papers on typhoid fever with a great deal of interest, also to the discussion of them with reference to the treatment, and wish to put myself on record as saying, at the present time, that typhoid fever will never be wiped. out, it matters not what prophylactic treatment may be instituted. If it is incurable, how can it be wiped out? I should like for the doctor to answer that question when he closes the discussion.

With reference to the second paper on this subject, in continued fevers, as we have in typhoid, I never use any of the coal-tar preparations-acetanilid, phenacetin, antikamnia, or any of that kind of preparations-because they only weaken the heart; they cause irregularity of the heart's action, and we frequently hear of bad results. from the use of the coal-tar derivatives. But I agree with the venerable gentleman (Dr. Williams) with reference to the cold-water treatment. That is the only remedy I use in reducing the fever from 103 to below that point, which is the dangerous point of the fever.

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Dr. Williams (closing the discussion): I will say, in trying to answer the question that has been asked, that if the same zeal that is used in suppressing an outbreak of smallpox, of yellow fever, or any of the infectious diseases, was applied to typhoid fever, we would think as little of it, and that is not only my opinion, but my answer. (Applause.)

Dr. Scott (closing the discussion): I wish to say, in reply to the remarks of the gentleman, I use acetanilid as a sedative, and not for the purpose of reducing the temperature.

Again, in using water, I never put a patient in a bath at the temperature of the body; that would make the patient hotter; I put them in a bath with the temperature of the water, say, at 90, and then I find I have no trouble.

PARANOIA.

BY W. HERBERT ADAMS, M.D., SAVANNAH.

I desire to present, as briefly as possible, and without any fine-spun theories, some thoughts on a form of mental disease which is a very prevalent one, which is wofully misunderstood, and frequently unrecognized until it has reached the explosive stage, when some particularly bold, hideous, unnatural, and apparently motiveless crime stamps the perpetrator as a victim of this mental defect, paranoia. Paranoia has many synonyms, among which may be mentioned monomania, folieraisonante, diefeructheit, delusional insanity, fixeidee, washnsinn, etc., monomania being possibly the most common and appropriate one.

Paranoia is most comprehensively and classically defined by Spitzka, who says it is a chronic form of insanity, based on an acquired or transmitted neuro-degenerative taint and manifests itself in anomalies of the conceptional sphere, which, while they do not destructively involve the entire mental mechanism, they dominate it. A more simple definition is that it is a chronic progressive mental disorder, characterized by fixed and systematized delusions; generally of a persecutory or grandiose character.

Etiology: Paranoia is almost always based on some hereditary taint. The patient's ancestors need not neces sarily have been insane, but they will generally be found to have been neurotics of some form. Occasionally, the disease may be acquired, but even then, stigmata of de

generation will generally be found, showing the neurotic taint. The disease occur about equally in both sexes and generally develops between the ages of twenty-five and forty.

Pathology: There are no distinctive pathological anatomical conditions in paranoia. At times there seems to be cerebral or facial asymmetry and other stigmata of degeneration, but frequently, nothing pathological can be found, either in the gross or microscopical anatomy of the brain, though it is possible that there are unrecognized changes in the structure or arrangement of certain of the association fibers or their cell endings.

Prognosis: The prognosis in this psychosis is bad, though occasionally in persons of superior mental powers, the delusions may be corrected, especially when they are of a simple, persecutory nature. The prognosis is said to be worse in cases where the delusions are of an erotic or religious character. Upon the whole, however, this form of mental disease presents one of the most unfavorable outlooks of any of the psychosis. The tendency is for the delusion to become more firmly fixed, more systematized, and for the patient to become more and more dominated by them, finally neglecting their ordinary occupations and giving themselves up entirely to the carrying out of their fixed ideas. There is, however, in most cases, very little tendency to dementia, and many of these cases retain many of their intellectual faculties unimpaired to the last. Many of these cases, as their malady progresses, become extremely dangerous and homicidal, on account of their persecutory delusions. It is for this reason, that the general practitioner should be familiar with this type of insanity and be in position to advise the patient's family of the necessity of most careful watching or seclusion of the patient before the storm

of their wrath breaks on the head of the hapless victims of their delusion. These patients are very rarely suicidal, though there are cases of religious paranoia in which the victims mutilate themselves, and have even been known to crucify themselves in conformity with their delusions. This type, however, generally become religious enthusiasts, reformers or ascetics. It was a patient of this type (Peter the Hermit) who started the crusades which kept Europe involved in religious wars for two centuries. Another case of this type was Joan of Arc. Both were victims of visual and auditory hallucinations of a religious nature. The question as to many paranoiacs are medically, but not legally, insane. hospital as soon as the case is positively diagnosed, is a very difficult one to decide offhand; certainly it is that if they were so secluded, many most deplorable occurrences would be avoided, but until the general practitioner and the laity are more enlightened on the nature of paranoia than they are at present, most of them will not be sent to hospitals until they have committed some overt act, and then, they are far more likely to be sent to prison, tried and hung as ordinary criminals, because many paranoiacs are medically, but not legally, insane. Many of them know perfectly well, the difference between right and wrong in the abstract, but not when it applies to their particular case.

Symptoms: The onset of paranoia is gradual and there is nearly always a prodromal period of depression, and during this stage the initial delusions are born. The delusions are nearly always persecutory or grandiose in character, either one may precede the other, or they may exist simultaneously. These patients, as children, show marked eccentricities; are often morbidly self-conscious, and always intensely egotistical. They have an over