nasal hemianopsis which vanished the following day. Mitchell and de Schweinitz reported the case of a patient with normal central vision who showed marked contraction of fields and irregular binasal hemianopsia. Pierre Janet cites two cases; one of right hemianopsia of several days duration in a patient manifesting other marked stigmata of hysteria, the other of homonomous hemianopsia of both eyes, which followed a unilateral amaurosis of ten years' standing, the fields later becoming normal. He suggested that, when recovering from a hysterical amaurosis, the visual field might in many cases, take an hemianopic form. Wilfred Harris reported a case of left hemianopia with contraction of the remainder of the field, in which total amblyopia was induced by suggestion. The condition cleared up after a month's treatment. Harris concluded "that hemianopsia, rarely binasal, more commonly lateral and left-sided, with accompanying constriction of the remaining half fields, may occur as a temporary phenomenon in hysteria." This conclusion, however, is not universally accepted, and is denied by many authorities, as Gowers, Parinaud, Charcot, Giles de la Tourette and Freund.

The author's case was a boy twelve years of age, with a history of progressive failure of vision of four weeks' duration. He had sustained several trivial accidents sometime before, was subject to fainting spells, cried on the slightest provocation, and said and did "queer" things at times.

Examination showed vision: Oculus dextra, nil; oculus sinistra, hand movements. Pupil equal and active. Fields showed a bitemporal hemianopsia. No recognition of either red or green. Conjunctivæ more or less anesthetic. Fundi normal.

Under treatment with syrup of iodid of iron and blister to left. temple, the vision gradually improved and in four months the fields had returned to normal.

LARYNGOLOGY.

WILLIS SIDNEY ANDERSON, M. D.

LARYNGOLOGIST TO HARPER HOSPITAL, DETROIT, MICHIGAN.

ACUTE TONSILLITIS.

WOOD (Annals of Otology, Rhinology and Laryngology, March, 1909) discusses briefly the pathology of acute tonsillitis. He says: "Investigations as to the bacteriology of this condition have shown that it is not a specific inflammation, in that it may be due to several varieties of pyogenic organisms. In the more severe forms the streptococcus pyogenes is generally found, while those accompained with a large amount of exudate are generally due to the staphylococcus pyogenes aureus or albus. The penumococcus is found in about five per cent of the cases and occasionally the bacillus coli communis. Mixed infections are more common than are infections with one variety of organism."

The author's summary is as follows: From a pathologic standpoint we

can recognize three types of acute tonsillitis:-A proliferative form with increase in nearly all of the cellular elements of the tonsil; a lucunar form, in which the cryptal epithelium shows the most severe lesions; and a suppurative form in which abscesses develop within the germinating follicles. These different forms are generally associated together in a given case, but anyone of them may be the predominating lesion. Certainly in all cases we have a proliferation of the cellular elements, and very early in the process there is associated some diapedesis of multinuclear leukocytes through the cryptal epithelium and possibly some necrosis of the epithelial cells. If necrosis of the cells is great enough to cause a break in the epithelieum, the parenchyma of the organ is open to attack, and the bacteria gaining access to the tonsillar tissue probably find lodgment in the follicles and there cause intrafollicular abscesses.

In closing it may be well to say a word concerning the forms of tonsillitis as they can be recognized clinically. We certainly can differentiate between a simple proliferative tonsillitis in which the tonsils are swollen and reddened, and a suppurative form in which the swollen reddened tonsil shows the presence of exudate, either purulent or membranous, coming from the crypts. It is not possible clinically to differentiate between follicular abscesses discharging into the crypt and necrosis of the epithelium associated with diapedesis of large number of neutrophiles. It is better, therefore, to class these two types under the single heading of suppurative tonsillitis.

THE IMPORTANCE OF TONSILLAR AND PHARYNGEAL INFECTIONS IN THE PATHOLOGY OF INFANTS. BROLET (Gaz. Med. de Nantes, Number IV, 1909) calls attention to certain complications aside from the familiar effect upon the voice and respiration. He mentions conditions often not observed, such as transient fever, prolonged subfebrile state, or fever due to the involvement of the lymphatic glands. He urges more frequent examinations of the rhinopharynx in children. He considers the surgical and the medical treatment in these conditions, and recommends the arsenical waters of Bourboule.

DERMATOLOGY.

WILLIAM FLEMING BREAKEY, M. D.

CLINICAL PROFESSOR OF DERMATOLOGY AND SYPHILOLOGY IN THE UNIVERSITY OF MICHIGAN,

JAMES FLEMING BREAKEY, M. D.

ASSISTANT IN DERMATOLOGY IN THE UNIVERSITY OF MICHIGAN.

MULTIPLE DACTYLITIS SYPHILITICA (PHALANGITIS

HEREDOSYPHILITICA-HOCHSINGER.)

KLOTZ reports a case of this condition in an infant. The patient was ten months old. The parents presented no symptoms of syphillis or tuberculosis, nor gave any history of such infection or inheritance. The patient was a first child and born at full term: at birth the nose was slightly

sunken and snuffles were observed, neither of which, however, were sufficient to call for treatment or to leave permanent marks. There were no signs of disease during the first eight months, when several fingers and one toe showed swelling. The child was then taken to a physician, who gave it internally one-sixth of a grain of calomel with saccharated ferrous carbonate four times a day without apparent improvement. At ten months of age the first phalanx of both fingers, thumb and middle fingers of the left hand were thickened without cutaneous changes. The second toe of the right foot was similarly affected, and over this the skin was red and scaly. On the left side of the thorax over the free ribs was a small fluctuating tumor. It was at this time that the child was brought to Doctor Klotz. He injected a suspension of one-fourth grain of calomel into the gluteal muscles. Improvement was noticeable within four days. A second injection of one-third instead of one-fourth grain was given, followed by general improvement. Calomel inunctions were now substituted as a line of treatment, and continued for about two months, during which time there was almost complete subsidence of the swelling in the toes and fingers, and the child cut two teeth.

For the following six months inunctions of iothion were used daily, and then the calomel ointment was resumed during the succeeding spring. From this time on normal development occurred. The patient was well nourished, eating, sleeping, walking, running as would any healthy child of the same age.

Doctor Klotz points out the failure of the mercurial therapeutic test as given in insufficient doses, and emphasizes the intense action of an intramuscular injection of the same drug. In this case the absence of any satisfactory history suggests the possibility of atavistic heredity.

J. F. B.

PSYCHIATRY.

ALBERT MOORE BARRETT, A. B., M. D.

PROFESSOR OF PSYCHIATRY IN THE UNIVERSITY OF MICHIGAN AND DIRECTOR OF THE
STATE PSYCHOPATHIC HOSPITAL.

CHARLES WELLMAN HITCHCOCK, A. M., M. D.

ADJUNCT PROFESSOR OF NERVOUS DISEASES AND CLINICAL PROFESSOR OF NEUROLOGY IN
THE DETROIT COLLEGE OF MEDICINE.

CHOREIC SYNDROME WITH MENTAL PHASES IN A FEEBLE ALCOHOLIC.

SEPTICEMIA;

HISTOLOGIC REPORT.

CLAUDE and HERMITTE have reported to the Paris Society of Psychiatry (Revue Neurologique, February, 1909) an interesting case, citing that the appearance of troubles relating to the psychic sphere have been noted in the course of chorea by all authors much given to its study. A young girl presenting a marked alcoholic heredity and having neurotic antecedents, herself of mental inferiority, exhibited under the influ

ence of alcohol vague delusions poorly systematized which did not prevent her from following her usual occupation. In February, 1907, she developed some ideas of negation, and shortly after presented a progressive choreic syndrome which compelled her to give up her work. A bit later, the mental difficulty increased taking the form of maniacal excitement with hallucinations and mental confusion. The choreic movements persisted for some days, then lessened and disappeared when the condition of septicemia was marked. A double suppurative parotitis ensued and death occurred in coma.

The motor agitation possibly attendant upon alcoholic delirium differs so entirely from that presented in this case that only the choreic diagnosis was here possible. The chain of events is thus built up: In a subject predisposed by alcoholic heredity, feeble and degenerate to start with, alcoholism determined her vague delusions. Finally, under the influence of an infection, as a point of further departure, at once appeared the choreic difficulty and mental phases of the acute maniacal type. Both the motor and psychic phenomena developed for a time synchronously; then the infection became localized in the parotids, the septicemia manifesting cutaneous localization; the profound involvement was favored by malnutrition, insomnia, incessant agitation so that the bad functioning of organs, particularly of the liver, determined the fatal issue. All of this is confirmed by the histologic report which shows evident hepatic changes as well as encephalic lesions which perhaps explain the choreic and psychic phases.

Whatever ideas may be held relative to the origin of choreic troubles, it is nevertheless interesting to be able to affirm in the light of this case that the same infective process, which was manifest at the end of the illness, in giving place to parotid and cutaneous suppuration, has very probably, by lesions meningo-cortical and of optic-striate centres given rise at the same time to the choreic disturbance and the acute delirium, both developed in a soil the predisposition of which was only too evident.

A CASE OF COLLECTIVE INSANITY.

C. W. H.

DUPRE reported to the Paris Society of Psychiatry (Revue Neurologique, February, 1909) an observation of hallucinatory insanity (of persecutive type) communicated by a woman to her husband and children.

The woman had for a long time, about two years, exhibited rather clearly systematized delusions of persecution. An old landlady, she believed, pursued her in different dwellings, with the connivance of neighbors. They wished to injure her, to electrify her, kill her, et cetera. Alcohol developed visual hallucinations and thorough examination revealed besides, some ideas of jealousy, and at intervals periods of "gaiety" with erotic proposals.

The husband, rather feeble, the subject of convulsions in infancy, shared the delusions of his wife. He believed in all the conspiracies which her

deluded mind had concocted and exhibited auditory illusions and disorders of general sensation.

At night, the two, feeling that they were being charged with electricity were violently disturbed thereby, and in the end fell to assaulting each other. He could recognize the folly of his wife's visual hallucinations. and agreed that anyone would pronounce her insane, but in his own ideas could see only confirmatory evidence of the wickedness of neighbors in plotting against them.

The children, aged four and six and one-half, had absorbed the delusions of the parents and one had opened the window and cried "Murder," that they were killing her mother; et cetera. The eldest had even, under the influence of suggestions, told her father that a neighbor had endeavored. to induce her to kill her mother with a revolver which she (the neighbor) had shown her. This entirely imaginary scene had its entire origin in the hallucinations of the mother, to which she had given expression in the presence of the child.

This is a classic example of insanity imposed by a deluded and active adult upon a feeble and passive partner and its communication to the children by contagion of fear, the only morbid element by which children so young could communicate with their parents in the building up of this family insanity.

The scattering of the family will break up its further contagion and in the further evolution of the psychosis in the mother (the more active. factor) will show what prognostic gravity it will eventually merit.

NEUROLOGY.

DAVID INGLIS, M. D.

C. W. H.

PROFESSOR OF MENTAL AND NERVOUS DISEASES IN THE DETROIT COLLEGE OF MEDICINE.

CARL DUDLEY CAMP, M. D.

CLINICAL PROFESSOR OF NEUROLOGY IN THE UNIVERSITY OF MICHIGAN.

REFLEX NEUROSES ARISING FROM OCULAR

CONDITIONS.

ZEIGLER (New York Medical Journal, November 7, 1908) states that various reflex neuroses arise from ocular conditions, such as: Ciliary spasm or strain from uncorrected ametropia; accommodation effort whether in youth or old age; muscular unbalance; and, painful ciliary scar or shrunken eyeball, in neurotic subjects; phlegmatic individuals would probably not be affected. The symptoms arising from nasal condition may exactly duplicate those from ocular abnormalities. The most active etiologic factors are: Pressure contact, between the turbinates and the septum; hyperesthetic areas in the nose, especially located on the tubercle of the septum; and nasal obstruction. Among the nervous conditions mentioned as reflex are: Headache, migraine, muscle spasms, chorea, epilepsy, gastric neuroses, and neurasthenia.