TREATMENT.

The treatment of this disease is largely prophylactic and custodial. The child of bad neurotic heredity showing the characteristics of the paranoiac in embryo, that is, abnormal self-consciousness, hypertrophy of the ego, selfopinionated, selfishness, lack of moral sense, etc., should, if possible, be most carefully reared and trained, and these traits corrected as much as possible. During the prodromal stage of depression every kindness should be shown. these unfortunates, in order to prevent, if possible, the development of the persecutory delusions. At times, in patients whose mental caliber is good, rational conversation and calm, logical and dispassionate arguments may help the patient to correct, for a time at least, his newborn delusions. Too vehement arguments, however, or attempted ridicule will only defeat the end you desire and serve to place yourself in the list of one of his persecutors, with its attendant dangers. The only rational treatment for these patients, after the fully developed stage, is custodial, and this means constant and careful watching, and this can best be done in an institution devoted to the care of the insane.

The medico-legal aspect of paranoia is most interesting, and has been the ground for much competent and incompetent expert testimony. Let me beg of you, should you be called in as a medical expert on one of these cases, to first assure yourself that you are competent, and then be perfectly honest. Do not try to qualify as an expert in nervous and mental diseases, and then go on the stand and be unable to tell what is meant by an Argyle-Robertson pupil, or Romberg's sign, as did a so-called expert in a recent famous trial; the same trial also furnishes us an example of an expert who was evidently thoroughly competent, but whose judgment must have been biased, to

have tried to sustain the contention that his client was insane when he committed the act, but was then sane. I refer, of course, to the Thaw case, and Harry Thaw, if insane at all, which I firmly believe he is, is a paranoiac, and, if so, is just as much insane now as when he committed the act. If all experts were competent and honest, expert testimony, especially in insanity cases, would be in better repute.

Briefly summarizing them, we find that paranoia is a chronic, progressive form of insanity, beginning in early adult life, in persons of bad neurotic heredity, and the characteristic symptom is always the systematized and fixed delusion. Recovery practically never occurs; they are all liable to become dangerous; they are the most difficult of all forms to prove insane, and their insanity is frequently not recognized until they have committed some overt act; they having possibly been previously recognized as being eccentric, or cranks. That this form of insanity may be more carefully and intelligently studied to the end that the public may be more safely guarded, is my only motive for bringing this subject to your attention.

DISCUSSION ON DR. ADAMS'S PAPER.

Dr. St. Joseph B. Graham, of Savannah: I have enjoyed Dr. Adams's paper, for the reason that there is much to commend in what he has said on this subject. As long as we have such juries as exist now in the Southern section of our country, and elsewhere, for that matter, the medical expert is non est. As it is now, we have a jury composed of twelve men, one of whom is a good watchmaker, a good man in his trade; another a farmer, the best there is in town; another makes horseshoes, another is a dry-goods merchant, and the others are engaged in similar trades. We have twelve such men, who know

no more about insanity than a turnip knows how to grow into a cherry. The medico-legal expert can talk himself blind, and the jury will sit and listen, and because they think a fellow who is brought before them is sane they will turn him loose.

Gentlemen, it should be put before the Legislature of every State in the country, particularly of this Southern. country, that a jury should be composed of medico-legal experts; they should constitute the jury; men able to sift and to judge of the wisdom and evidence of the man or men who give it. If a juror is a Geneva watchmaker and I tell him about a certain little muscle underneath the eye, and tell him its name, after I have finished he is not able to recall it for three weeks, perhaps never, and does not know anything more about it than before.

Let me mention a case in point from my personal knowledge. It happened in one of the charity institutions in New York. A doctor, not a large man physically, after coming out of his room, encountered one of the inmates, who was scrubbing the floor of a ward. His room was in the rotunda, and in acting as the officer of the day he had to be up early to get down at seven o'clock. As he started to get out of his room a big fellow grabbed him and said, “Now, I have got you; I am going to throw you down-stairs." And it was four stories to the bottom. The doctor never flinched; he never moved a muscle. He said, “Oh, Mike, that's easy, for you are a giant. Let me appeal to your strength. Take me down-stairs and throw me up." Sure enough, Mike took him down-stairs, and by that time the bells began to ring, and he was put in the ward forever. [Appause.]

Dr. Adams (closing the discussion): We all recognize that it is difficult for the ordinary layman to recognize this or any other form of insanity, except the patient has

melancholia or is a raving maniac, then he is able to recognize it. Few juries can recognize paranoia. As a matter of fact, the patient may have a higher mental capacity than the jurors who try him. The paranoiac has too dangerous a form of insanity to be at large, and, as I said in my paper, frequently their disease is never found out until they commit some horrible crime, and then they are stamped as paranoiacs, and in some communities they take a man out, who has committed such a crime, and hang him on short notice. I will only say this, that I believe medical expert testimony is in such bad repute because so many physicians for a few dollars apparently allow their judgment to be biased in favor of their clients. Dr. Evans, superintendent of the Morris Plains Asylum, New Jersey, is undoubtedly a good, capable man, but he knows as well as any of us that if Harry Thaw was insane at the time he killed his victim, he is insane now; yet he testified the opposite on the witness-stand. When people of such standing do things like that, it is mighty easy to think that way when you are going to be rewarded with a big sum of money for so testifying. No one should take that side of the case if he is firmly convinced that he is going to testify as the facts in the case demand.

A FEW PRACTICAL POINTS ON INFANT

FEEDING.

BY SAMUEL A. VISANSKA, M.D., ATLANTA.

Six years ago, when this Association met at Augusta, I read my first paper before it on the subject of infant feeding; my object in continuing this subject now is to tell you whether the results of my experiences have been satisfactory or not, in order that, in this way, we may come to some conclusion as to what method we shall adopt.

Sometimes some of us boil over with enthusiasm on a subject or method, read a paper regarding it, and the members of the Association must ofttimes wonder if the doctor is carrying out his same ideas, or if his practical application of them has caused him to make changes in his original theories.

With so important a subject as infant feeding—a subject which has always baffled our skill, and which must always continue to do so--we can not deal too often, or discuss too freely, to suit me. Experience has taught us that there are but two ways of feeding an infant, namely, either on human milk at the breast of a mother or wet nurse, or upon an artificially prepared milk diet; hence, we have the two corresponding classes of the breast-fed and the bottle-fed baby. It goes without saying, that the breast-fed are, as a rule, a happier, healthier and larger lot than the bottle-fed, and that the mortality of the former is far less than that of the latter. The most careful preparation can not possibly make the milk of another animal chemically identical with that of a woman, or