vision, or the ability to see with both eyes at once, is preserved. When this is present the images may be fused, if not done so naturally, by the aid of movable eye pieces or pictures cut in two and moving the halves closer together or farther apart. If provided with an assortment of pictures the child's interest can be so aroused that the treatment can be kept up with very little trouble. The stereoscope is to be used daily, and con tinued till the faculty of binocular single vision is permanently acquired.

Last of all comes the surgical treatment, which, while often brilliant in its immediate results, is less so in its remote ones. A muscle may have to be divided to allow an eye sufficient. play to render the subsequent acquisition of binocular single vision by training with the stereoscope possible, and for this purpose, and not for the alleged cure of the squint, should tenotomy be resorted to in children. In the official report of a discussion on squint before this association two years ago I was made to say that I never operated for squint before the twelfth year. I did not say this, but what I did say, and what I wish to repeat now, is that I operate before that age with great reluctance. And why? Because some cases are selflimited and will get well of themselves without any treatment. A tenotomy for convergent squint on such a case would ultimately result in a divergent squint, and the last end of such a patient is worse than the first. Many more cases under proper medical and optical treatment will get well, and in these a better result is obtained by not operating. So in all cases I would prefer to utilize the time until the twelfth year with the medical and optical treatment as mentioned, and operate only on confirmed old and otherwise incurable cases in older children or adults where the cosmetic result is the only one to be considered, or in other cases where milder measures do not suffice, and the operation is done with the understanding that it is but a step in the treatment and by no means the end of the treatment. Allow me to present as a summary the following points:

1. All cases of squint should be taken in hand as soon as the condition develops, and treated by rest, glasses and optical exercise.

2. The advice to wait until the child is seven or eight years old and then operate, while frequently given, is bad advice, since by this time the case will probably be purely surgical and the result to be obtained a cosmetic one only.

3. We should aim not only to make the eyes straight, but develop in each its best possible vision, and enable the two eyes to see the same thing at the same time. 4. Operation is a last resort. While advisable earlier in some cases, it had usually best be deferred till the twelfth year, the intervening time being allowed for nature and the surgeon to accomplish a cure by other means, if possible.

What has been said will also apply to the more unusual cases of divergent squint, but I do not mean to speak of cases due to paralysis of an ocular muscle, since they are entirely different in cause, symptoms and course from the ordinary so-called concomitant squint and require entirely different treatment.

Since the preceding was written I have seen the following abstract in the Ophthalmic Record for September:

"The treatment of strabismus from the standpoint of the family physician is summed up by Duncan as follows: 1. In a child aged 3 years or over, he would in every case (with the exceptions noted) advise a thorough examination of the eyes, so as to ascertain the refraction. 2. He would advise that this be done as soon as possible, but if some weeks must elapse before this can be done he would use atropin drops once, twice or three times a day in both eyes, ordering that the drops be left off for at least two weeks before the child goes to be examined. 3. If it be reported to him that the child needs to wear glasses, he would exercise his influence with the parents to see that they were worn. 4. In case of any hesitancy on the part of the parents to attend to the matter, he would free himself from all responsibility by pointing out some of the dangers of delay: 1. The child may be permanently cross-eyed. 2. He may be partially blind. 3. An operation may be needed in after years. 4. The operation, although it may straighten the eye, will not cure the blindness." Porter Building.

Physician-in-Charge Shelby County Poor and Insane Asylum.

HAVING had my attention so frequently called lately to crimes committed by people not generally considered insane, and having to discharge so many from the Shelby County Asylum of whose restoration to health I was not convinced, I have thought some discussion of the status of such persons not inopportune.

How far can the mental energy of the brain be affected, but still keep within the physiologic line? A man's power of judging and comparing, his emotional reactiveness, his inhibitory power, may all be so far paralyzed as to be in abeyance for the time, and yet we may count him free from mental disease. When the limits of the physiologic are passed and a man enters a pathologic state of mind, we are often utterly unable to tell the exact line where the one ends and the other begins. As Maudsley says, you might as well attempt to draw the line between light and darkness. The line must be drawn, however; and we must frequently decide between " Dr. Jekyll and Mr. Hyde."

While insanity is indefinable, and while there are no invariable or infallible tests as to insanity, we can at least approximate correctness when we say that it is a prolonged loss of self-control, rendering one incapable of managing himself or his affairs. I shall state a few cases that have been sent to the Shelby County Asylum for treatment.

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One day recently people at Main and Madison streets, Memphis, were startled by a pistol shot; it was fired by Mr. G. at a person whom he had never before seen, and who had in no way offended him. He had for a long time been considered crazy"; had threatened to kill several people who were "watching" him, and was a regular nuisance. He was a morphine fiend in addition to having an unbalanced mind. No one would take the responsibility of reporting him to the authorities. It was only by accident that a tragedy was averted.

*Read before Tri-State Med. Assn. (Miss. Ark. & Tenn.) Memphis, Nov. 15, 1900

H

Ed. J. and his friend murdered a prominent citizen of Memphis in 1896. After a long trial he was adjudged insane and committed to the Asylum July 6, 1898. He was discharged Oct. 3, 1899, apparently cured. Some time after he imagined all the county officials were conspiring to hang him. He made their life a burden by threatening to kill them, until he was recommitted Aug. 8, 1900.

Chas. P. was committed to the Asylum for treatment April 8, 1893. He was discharged May 10. In 1898 he murdered a good friend of his and a suitor for his sister's hand. He was recommitted Jan. 5, 1899.

Miss W. was received March 1, 1898. She was a handsome young woman, highly educated, and the daughter of a prominent official in a neighboring State. Her health seemed perfect, but with her it was "Anybody, good Lord, just so it's a man." She was a moral pervert. She had disgraced her family and was bringing her father in sorrow to his grave. She drank heavily to drown her conscience. She was discharged in four months much improved. A friend with a kind heart and strong will took her in charge. She is now the wife of a prominent man of New York city, an officer in the Spanish-American war.

Minnie B., a beautiful Spanish woman, received Dec. 21, 1897. She was the most troublesome maniac we have ever had. She was discharged apparently well on July 24, 1898. That night she committed suicide.

Mr. C., received April 22, 1898. He was a man of education, wealth and refinement, a graduate of the Lebanon Law School, and a well-known druggist of this city. His is a sad case of the whisky demon. He will probably die here because there is no one to care for him should he be discharged.

It is better for the inebriate, better for his wife, and better for his children yet unborn, that he be regularly treated until such time as he can control himself. If they remain at home the mistaken policy of "nagging" generally makes them worse. By their attempts at "reform" women rouse insane resentment. They cannot understand the irresponsibility, the disease doctrine involved. Feminine abuse but intensifies irritability and furnishes excuse for neglect of home, if not worse retaliation. The drunkard is as certainly and as awfully diseased as the lepers of old. No reliance can be placed upon the statements of the chronic alcoholic; he tends to become a

confirmed liar, often from inability to tell the truth. If opium addiction accompanies the alcoholism the lie is preferred even if truth would serve better. These "street angels and home devils" can no more abstain from drinking than a kleptomaniac can abstain from stealing.

These poor fellows who frequently drink because they are insane receive no sympathy; their cases are not investigated nor treated, but they are permitted to repeat the performance at the earliest opportunity.

I describe the drunkard simply as a type. The morphine fiend, the cocaine fiend, the victim of simple mania with homicidal tendencies, the melancholiac with suicidal tendencies, the moral pervert, and all the mentally unbalanced, are a menace to the public.

The percentage of insane is increasing faster than the sane, and but for the fact that the insane die much faster than the sane and also recover in large numbers, the various institutions for the care and treatment of the insane would have to largely increase their present capacity.

When a person is adjudged insane and committed to a hospital for treatment, the law holds him irresponsible, and any overt act or any irregular business transaction is excused on this ground. It is a fearful responsibility to deprive a man of his citizenship, of his God-given liberty; therefore to restore this man to full citizenship and full responsibility for his actions, implies a complete knowledge of his real condition. It is then incumbent on the general practitioner to devote a fair share of his time to this important subject, so that the risk of a sane man being deprived of his liberty is reduced to a minimum.

Now if the committing of a person to the hospital for the treatment of insanity be of such enormous importance, surely his release is of equal importance. When a person acts strangely the question at once presents itself, is he sane and responsible? If there be a doubt as to his sanity an inquest of lunacy is held, because he is entitled to a hearing before a jury of his peers. Now what does the jury know about insanity? Certainly they would recognize a raving maniac or a paralytic dement, but of the great question of whether such person is