beneath, as well as interference with motion by their stiffness, and by pressure and retaining of icberous discharges, produce pain, etc. These pathological products are best removed with soap-suds-gauging the amount of alkali by the acuteness of the disorder. Recent research has shown that sensitive nerves do not all end in the papillary layer of the skin, but that in the mucous layer of the epidermis are found terminations of nerves, and they are seen to enter the epidermal cells, and are in position to be readily acted upon, either by pathological products or medicines, and by removal of the comeous layer of the epidermis are easily reached by the latter. It is a cardinal principle in the treatment of eczema, that all effete products must be removed. Hebra's method of the application of soap in the squamous eczema has not been improved upon. In these cases the vesicles are imprisoned by the dried scales, and their contents are soaking the nerve endings. This is overcome by the friction liberating the vesicle contents, and relieving the nerves of the irritation of the ichorous discharge surrounding them, and allowing the diseased parts to come in direct contact with the application, which must be made at least twice daily. After using the soap, each time, the diseased surface should have a water dressing, or when this cannot be used, the part should be covered over thickly with one of the bland oils or fats. This soap treatment requires patience and thoroughness in order to be of value. The concentrated liquid potassa may be used over the dense infiltration occurring when the palms of the hands are alone affected, but the vast majority of cases will yield to the alkali in the form of soap, which has the advantage of reaching only the parts desired and with less pain than when liquid potassa is used. Spirit of soap made by dissolving two parts of soap in four of alcohol in selected cases may also be used.

TAR.

In the squamous variaties where there is little infiltration the tars are useful. It must be used tentatively at first, only apply the preparation to a small portion of the diseased surface and watching its effect; if beneficial, then the whole surface may be brought under its influence. The derivatives from this product have no advantage over the article itself except it be in elegance of preparation. Carbolic acid, pure, used as a caustic or blisters when surface is small are useful. Carbolic acid to relieve intense pruritus in small patches, in the strength of one part of acid to ten or twelve of water is one of the best of remedies.

MERCURIALS.

In the later stages of the disease, cellular or fibrous infiltration will be found the field for the application of some form of mercury. Its first action probably being destructive to the new formed tissues, while its further action would be to stimulate the parts rendering absorption more rapid.

Purposely I have avoided the mention of the newer preparations useful in different forms of the disease, because some are too lately before us to be positive of their beneficial action, while others are no more rapid in the eradication of the disease than the old and time tried remedies, and those that we are all familiar with in their chemical or therapeutic actions. My purpose has been only to call attention to the principles of treatment necessary to be followed in order to render eczema, as it is, a perfectly curable disorder.

LECTURES.

HALLUCINATION IN ITS CONNECTION WITH THE FUNCTION OF SPEECH; PSYCHO-MOTOR HALLUCINATIONS.

BY J. SEGLAS,

Médicin-Suppléant of the Salpétriere.

TRANSLATED from the FRENCH BY F. W. MANN, M. D., DETROIT, MICHIGAN.

Hallucination is one of those psychical phenomena which has long attracted the attention of alienists and psychologists. Prolonged investigation does not, however, altogether enable us to realize its nature, seat, or etiology. Avoiding recapitulation of the innumerable theories formulated in connection with this subject, we may practically regard them as reducible to four: the peripheral or sensory, the psychical, the psycho-sensory theory, and that theory which attributes hallucination to the perceptive centers of the cortex.

This last theory, relying as it does upon the most recent acquisitions to cerebral anatomy, physiology and pathology, is the one which in our opinion provides the best interpretation of the general symptoms of hallucination; and in permitting the investigation of this curious phenomenon, appears to throw light upon sundry obscure points in morbid psychology. It is one of those obscure points still little investigated that we propose to examine to-day-hallucination in connection with the junction of speech.

This question, which at first sight, would simply appear to

be that of auditory hallucination, only approximates that aspect of the question from a single stand-point, as we shall presently see. Before, however, considering this subject, its study will be facilitated by briefly recalling the mechanism of speech. Let us first remember that the word is only the auxiliary of the idea, which can exist independently of the word, and is formed in advance of it. This idea is but the association of memory images, resulting from sensory impressions, which can be localized in the common centers of perception, as the auditory, the visual, and so forth, each being capable of mutually reviving the other.

Like the idea the word is simply an aggregate formed by the association of four kinds of images, which are subsequently specialized, but are incapable of reviving the idea of any object unless associated by a higher cerebral act with the different sensory images of this object. The associated images forming the word are of four kinds, auditory, visual, articulo-motor and grapho-motor. It is these images which serve to give substance to our thought during reflection by more or less vivid presentations dependent on personal aptitudes, so that consequent upon the predominance of such and such a group, we become hearers, observers, or actors. There exists but one difference between operations of this kind and those which enable us to communicate with our fellows; the former are internal phenomena, while the latter presuppose an external excitation or real act. In . both cases the same centers are energized. In our ordinary condition the internal speech images are feeble, and require a certain amount of attention, but in other conditions as in those which form the subject of our present inquiry, their intensity can be so augmented that it attains that of external speech, thus giving rise to a genuine hallucination.

This stated, we can proceed to the study of these hallucinations. "It is by the ear," says Gueneau de Mussy, "that we receive our most important and numerous impressions." This statement so true in physiological conditions offers a simple explanation of many pathological conditions, as for instance the frequency of auditory hallucinations in the insane. But every case does not exhibit the same characteristics from the clinical as from the physiological stand-point, and it behooves us to discriminate carefully, some being simple, others complex.

The simplest hallucinations are those consisting in confused noises which the patient interprets by onomatopoesis or by the more definite sounds pertaining to some object, as the sound of

a bell, the noise of a cannon, the whiz of bullets, etc. In more complicated cases genuine voices seem to be heard. But these are phenomena of a different nature, if the views expressed on a previous occasion be accepted. In the first mentioned case the hallucination in reality deals with but one idea, in affecting one or several of its constituent images. We take for instance the hallucination of the sound of a bell. The idea of a bell is formed after the following manner. A bell has tolled in our hearing. The relations transmitted by the sensory nerves to that portion of the cerebral cortex destined for the reception of sounds, that is to say, the common auditory center, store themselves in the cells of this center, which are from that moment functionally differentiated. But coincidently with this auditory image which alone could furnish only the sensation or recollection of a sound, in order to complete the idea of a bell, other images, visual, tactile, etc., are essential. All these images having been once associated possess the power of reciprocally reproducing the ever-dormant idea of a bell.

Consequently, if instead of an external excitation, we have to deal with some intimate functional disturbance, producing the hallucination, what will ensue? Then (speaking only of auditory hallucinations) the pathological disturbance can only affect cells specifically differentiated for an auditory image, but this image not having been associated with other sensory images, and unable, therefore, to awaken an idea, we shall by the projection of this image have to deal with very simple elementary hallucinations reproducing noises more or less distinct, which the patient can only reproduce by imitation, and to which he does not attach any objective idea, or even estimate, except by comparison.

If on the other hand, these images of sounds or noises have been primitively associated with other sensory images in forming an idea, under the influence of the hallucinatory process, which affects but one of these images, this idea reappears anew, and it is in this way that the awakening of certain auditory images in an hallucinated individual can by association give him the idea he is hearing the tolling of a bell.

But in both these cases, the functional disturbance only involves the cells of the common auditory center, purposed for sound perception, the images they afford as they are or are not associated with other images can or cannot awaken an idea, but a single idea only. We will designate these hallucinations, simple auditory hallucinations. By investigating more complex

hallucinations, those in which the patient hears voices, we shall perceive that another element intervenes, and that these connections are established between the hallucination and the speechfunction. We will consider these hallucinations in their simplest form, that in which they are limited to a single word, the mechanism being in all respects identical when an entire phrase is concerned.

We have seen that the word was formed of four images localized in certain special centers. When one of these centers becomes the seat of a functional disturbance, producing an hallucination, the image which is stored there becomes sufficiently vivid to project itself, and is then perceived under the same conditions as if it had been produced by an external excitation. In the case we are specially considering the auditory center for words comes into play, and will give the patient the auditory hallucination of some word. This is termed verbal auditory hallucination.

But this is not all. At the outset we might think it is by the ear alone an hallucinated individual can perceive words and sentences. This undoubtedly is most frequently so; but we must not forget that internal language comprises four constituent images of the word, under which it can be represented to us. The auditory image is most frequent, the majority of us being naturally listeners; and it is probably the same with the insane, among whom auditory hallucinations, especially verbal ones, are the most frequent. Furthermore, we must not forget that if we are not listeners, we can become such by practice, the insane affording confirmation of this. Because, in chronic forms of insanity, where auditory hallucinations predominate, as in the delirium of being followed, the patient after a certain period becomes so much a listener that he cannot think without hearing his own thought plainly formulated in his ear. This constitutes the phenomenon of thought-echo. The auditory images, in these cases, have become sufficiently vivid to project themselves under forms of hallucination reproducing the essential thought of the patient.

We

Although a less frequent occurrence other word-images, may, like the auditory ones, be projected as hallucinations. therefore leave the domain of auditory hallucinations and consider those of sight. We can practically repeat all we have said regarding hallucinations of hearing and primarily recognize simple visual hallucinations of lights, colors, and objects, caused by the projection of images stored in the common visual center,