PUBLIC SERVICE.

UNITED STATES ARMY.

Week ending September 30, 1895. Major Washington Matthews, Surgeon, having been found incapacitated for active service by an Army retiring board, on account of disability incident to the service, is by direction of the President retired from active service, this date, September 26, 1895.

Leave of absence for four months, to take effect about November 5, 1895, is granted Captain Thomas U. Raymond, Ássistant Surgeon.

Leave of absence for one month, to take effect when his services can be spared, with permission to apply for an extension of one month, is granted Captain Eugene L. Swift, Assistant Surgeon, Fort Yates, N. D.

A board of medical officers to consist of Colonel Charles H. Alden, Assistant Surgeon General, Lieutenant Colonel William H. Forwood, Deputy Surgeon General, Lieutenant Colonel David L. Huntington, Deputy Surgeon General, Major Charles Smart, Surgeon, Major Walter Reed, Surgeon, is constituted to meet at the Army Medical Museum Building in this city, on Tuesday, October 1, 1895, at 10 o'clock A. M., for the examination of candidates for admission to the Medical Corps of the Army.

Major Henry Lippincott, Surgeon, is relieved from duty at Fort Adams, R. I., and ordered to Fort Sheridan, Ill., for duty, relieving Major Alfred C. Girard, Surgeon. Major Girard, on being thus relieved, is ordered to Fort Douglas, Utah, for duty, relieving Major Charles L. Heizmann, Surgeon. Major Heizmann, on being thus relieved, is ordered to Fort Adams, R. I., for duty.

Captain Richard W. Johnson, Assistant Surgeon, will be relieved from duty at Fort Huachuca, Ariz., upon the arrival there of Captain William J. Wakeman, Assistant Surgeon, and ordered to Fort Logan, Colo., for duty.

Leave of absence for one month, to take effect about the 5th proximo, is granted Major Joseph B. Girard, Surgeon, Presidio of San Francisco, Cal.

Major James C. Worthington, Surgeon, is granted leave of absence for three months, on surgeon's certificate of disability.

UNITED STATES NAVY.

For Two Weeks ending September 28, 1895.

Surgeon D. Dickinson detached from the Minneapolis " and ordered to examination for promotion.

Surgeon D. N. Bertolette detached from the "Atlanta" to duty on the "Minneapolis." Assistant Surgeon M. S. Guest detached from the "Minnesota" and ordered to the "Vermont."

Surgeon R. C. Persons detached from the "Minnesota,' "ordered home and placed on waiting orders.

BOOK REVIEWS.

THE SCIENCE AND ART OF OBSTETRICS. By Theophilus Parvin, A. M., M. D., LL.D. Third Edition. Philadelphia: Lea Bros. & Co., 1895.

The Third Edition of this excellent work by one of the leading obstetrical teachers of America comes to us much improved and revised up to date. The changes consist of alterations in the order in which the subjects are discussed, which is made to conform to the author's oral instruction. Nearly onethird of the book has been rewritten, additional illustrations have been introduced and the endeavor has been "to make it a faithful reflex of obsteric science and art at the present hour." It is dedicated to the author's class of 1894-5 at Jefferson Medical College, of which he says: "I testify the strength and happiness your industry, fidelity and loyalty have given me."

Parvin's Obstetrics is one of the concise and therefore cheapest works on this subject. The author's excellent judgment is shown throughout; so his conservatism, as for instance in speaking of the use of the forceps (p. 604), which he estimates to be called for in not more 5 or 6 per cent. of cases; many times, he asserts, the perineum is torn or other injury inflicted on the puerpera by its unnecessary use.

Where conciseness is so imperative but little opportunity is given for the graces of composition of which the author is master, but he has furnished a work remarkable for clearness and simplicity and his notes embody a large amount of useful and curious information. There is no safer book for the student than this.

REPRINTS, ETC., RECEIVED.

Report of the Abdominal Sections in the Gynecological Department of Mercy Hospital from July 1 to October 1, 1894. Reprinted from Pittsburgh Medical Review, December, 1894.

Strabismus as a Symptom; Its Causes and its Practical Management. By Leartus Connor, M. D., Detroit, Michigan. Reprinted from the Journal of the American Medical Association, June 29, 1895.

CURRENT EDITORIAL COMMENT.

NEW REMEDIES.
College and Clinical Record.

ONE is surprised to find how many years elapse, in many instances, between first authoritative mention of the therapeutic value of a drug and its introduction as an official component part of a national pharmacopeia. PRESENCE OF MIND. British Medical Journal.

If we were asked what single quality more than any other conduces to success in medical practice, we should be disposed to say presence of mind. The doctor must be master of himself, not only "though china fall," but though he discovers that he has been studying the pathological changes in a glass eye, or feeling his own pulse like the intoxicated physician of the legend. Swift, in his "Diary to Stella," speaks of the frequency with which people "reason wrongly at first thinking." Medical men are no more exempt from this infirmity than the rest of mankind; but the carefully-cultivated presence of mind, which is the first law of professional self-preservation, generally makes them more successful in concealing it. The young practitioner often gives himself away by offering the first muddy stirrings of his thoughts as an opinion instead of waiting for it to settle.

"AN OVERCROWDED PROFESSION.” Canada Lancet.

THERE can be no doubt that the profession of medicine has become terribly overcrowded, notwithstanding the raising of the standard of matriculation. Each successive effort made to discourage candidates for the degree succeeds only in filling the halls of the medical colleges with an increased number of school teachers and farmers' sons, who imagine that the profession must have a "good thing" that they are trying to keep others away from. Viewed from every standpoint the future of medicine as a means of making a living is a black one indeed, and there can be no doubt that every man enters medicine with that end in view, apart from any view of a philanthrophic nature, for every man must live, and in a new country, such as ours, there are very few who have had the good luck to have a large enough fortune to enable them to use medicine as a means to an end in furthering scientific research.

PUBLISHERS' DEPARTMENT.

All letters containing business communications, or referring to the publication, subscription, or advertising department of this Journal, should be addressed as undersigned.

The safest mode of remittance is by bank check or postal money order, drawn to the order of the Maryland Medical Journal; or by Registered letter. The receipt of all money is immediately acknowledged.

Advertisements from reputable firms are respectfully solicited. Advertisements also received from all the leading advertising agents. Copy, to ensure insertion the same week, should be received at this office not later than Monday.

Physicians when communicating with advertisers concerning their articles will confer a favor by mentioning this Journal. Address:

MARYLAND MEDICAL JOURNAL,
209 Park Avenue, Baltimore, Md.

THE legal tests of responsibility of the insane as applied under the laws of the United States have given rise to grave discussion in the ranks of the medical profession. This must arouse every thoughtful mind. Such discussions are intensified by reports of cases all over the country, and especially so in our city by that of George Ducovic. That a knowledge of the nature of the homicidal deed committed by an insane person, and of its being a violation of the law, is neither safe nor reliable as a test of the responsibility of the accused is the undivided opinion of our profession. The conclusion to this is, not whether the accused knew the legal consequences, but could he resist the morbid desire which so engulfed his reason?

The legal profession has been trained to accept legal decisions, precedents, and the settled authorities in a long line of cases, and to inquire what the law really is, rather than to investigate its justice, its foundation, its reasons, and the principles upon which it is based. The inquiry of that profession and especially of the Judiciary is what is the lex scripta? They seem to be bound by it, and are determined at all hazards to enforce its provisions according to precedents and decisions, established in time reaching back almost to the dark ages.

As to the true tests of legal responsi

bility in the insane, law is (in the opinion of the medical profession at least) very short of what the science of medicine demands. The unprejudiced mind should investigate this subject in the light which science has brought to its solution. Our law-making power should examine our statutes to see if they are founded upon sound principles.

The medical profession, yea, all professions, the public even, know that a knowledge of right and wrong, and of the penalties of the law, are not the proper tests in such cases. The men

best qualified to judge tell us that the insane not only know right from wrong and often fully understand the nature and penalties of the law, but as a rule they can discriminate between right and wrong in their wrong doings committed under the force of insane delusions which they cannot resist, and I insist that these truths must be considered in determining criminal responsibility.

The legal profession, especially the thinking members, must acknowledge this. They must also acknowledge that our law as interpreted by our courts, in many cases, is misleading; and that a careful revision by our legislators would be a speedy relief. The case of George Ducovic, who was tried and convicted at the April term of Criminal Court, Allegheny County, of murder in the first degree, shows fully the state of the present

law, and the need of different legal proceedings in such cases. That Ducovic was insane cannot be doubted, as was found since his conviction. He was admitted to Dixmont, May 13, 1894, a very insane man, suffering from delusions of suspicion and persecution. He believed he was persecuted in many ways, the most serious of which was to take his life. Such is the testimony of the superintendent and staff of the hospital. On August 29, 1894, two months or more before the time set for his execution, I was called to the jail to examine him as to his mental condition, but owing to some irregularity in obtaining the order from court I was not allowed to see him.

On Saturday, September 6, I was again called, at which time I asked the assistance of Dr. Samuel Ayres. Soon after the examination was commenced, and we elicited the following facts:

First That in his native country he had been very much depressed at one time, and had sought death while blasting in a stone quarry by refusing to get out of harm's way during the explosion.

Second: That when discharged from Dixmont he believed that he was only sent to court and remained in the P. F. W. C. R. R. station, Allegheny, until night, waiting for some one to escort him to the courthouse, after which he went to the home of a friend in Etna Borough, where he exhibited the same delusions as before he was sent to the insane asylum. He insisted that they must help him to bring his supposed enemy, Dobrozdravic, to justice; that he and eleven others were conspiring against his life and welfare.

After various unfruitful attempts to have Dobrozdravic brought into the courts, he went to work in the coal mines, where he acted strangely, working, stopping suddenly, crying, praying, and when at home wanted to be alone in his room.

Suddenly he gave up his work without assignable cause and came to the town to seek justice.

It was his idea that Dobrozdravic was to have killed him on a certain Wednesday, on which day he would have killed Dobrozdravic had he had an opportu

nity. He first threatened him, thinking that he would get into the court by so doing and obtain justice.

Failing in all other attempts at justice he killed him for the following reasons: First To save his own life.

Second: To get before the courts, believing that he would be justified, and that it would be publicly proclaimed that he had done a great and moral act.

Third That he owed it to society to rid the community of such a character. Also, he often talked to a friend of a daughter of a member of the firm for which he worked who was greatly enamored of him, and whom he could have married had not Dobrozdravic placed such a stigma upon him. He often decorated his head with flowers and wreaths simulating a woman, at which time he was solicitous in taking part in marriage ceremonies.

On the evening of the killing he went to the house of a friend again to seek aid in obtaining justice, at which time he became very excited and cried bitterly, but was finally quieted. Then he said, "You have ceased to be my friend and I will have to seek justice alone," and in a few minutes he committed the act for which he was sentenced.

The deed done, he talked to friends and officers apparently unagitated and made no effort to escape. At this writing the jail physician, Dr. Cheesrown, informs me that prisoner thinks a woman of small stature appears nightly at the foot of his bed in a white robe, which he believes to be a good omen.

He thinks Dobrozdravic was found guilty and that he is unjustly detained by mistake; that no judge can punish him for the act, thinks it strange that he is detained at all.

To recapitulate :

He thinks that Dobrozdravic was seeking his life, position and money; that he was aided in the conspiracy by eleven others; that he was compelled to kill Dobrozdravic to save his own life; that Dobrozdravic was found guilty; that a daughter of the firm was enamored of him; that he will not be punished; that it will be publicly proclaimed that he is innocent; that he

thought it was the general talk that Dobrozdravic was to kill him.

These delusions he had before he went to Dixmont, after his release from there, and when examined by us.

From the examination with the history of the man and the crime and all facts deduced therefrom we unqualifiedly stated that he was insane.

He was so incoherent at times during our examinations it was with difficulty the interpreter could make out any meaning. Prisoner had insane delusions of fear and suspicion, but we could find no excuse for such delusions. The parties were not conspiring against him at all but wished him well and were sorry for his condition. His notions were without credence, a positive evidence that he was insane.

These cases do not attribute their annoyance to unnatural or unseen things, or impossible means, but to the malevolence of real persons who plot against them, have evil designs on them, who poison their food, etc. His was a typical case in that these persons reason correctly from false premises; their statements are coherent and rarely confused. With a fixed delusion such a one may go on for years making a living and possibly accumulating something; but, as a rule, he is lacking in effort in one direction and apt to be meddlesome. He is thought to be harmless. A jury would likely see only eccentricity, "just a little off," and the populace go on unconscious of danger until something desperate is done to avenge an imaginary wrong. He thinks he shall be a public benefactor if he rids the world of this culpable individual. Encouraged by the hope of notoriety, he expects to gain the highest pinnacle of publicity and be hailed as a great deliverer. Does he know that he is wrong? Could he resist the insane desire to act? Unquestionably no.

Some are of a suspicious temperament, others are made so by real experience or ill-health. The weak are always suspicious throughout the animal kingdom, and the human brain is not different in instinct. They think they are looked at, watched, followed, conspired against,

which is possibly a mental evidence of an illy-nourished or anemic brain. Their career is instinctive. In this condition of morbid suspicion they attach delusional importance to very simple acts. There may be morbid feeling of fear connected with the suspicion. In the case of Ducovic the fear was the more marked. With monomania of suspicion, patients may conceal their thoughts except to their intimate friends, and may even deny believing them if accused, some even appearing sane only while locked up, the delusions cropping out again as soon as at liberty.

The facts are plain. This young man, well behaved, industrious, seized by the delusion above stated, kills his imagined. foe. The act was an insane one. There is a feeling abroad that a man, if insane and irresponsible, is always so, whereas most insane often are collected enough during most of their lives. Prisoner did his work, which was mechanical, well, but he had no power of persuasion that it was wrong. I have no doubt that if he had failed in his attempt or had been let run at large he soon would have had to have been locked up again.

That the prisoner knew he was killing a man and that he knew the penalty, does not exclude insanity, for I have had under my care the worst kind of insane who knew the penalty of murder, yet they were mad. In any other case than murder, an irrational act is taken as ground at least for suspicion that the mind of the perpetrator is disordered, but in murder no account is taken of the unreasonable act.

The medical profession may be said to agree substantially as a body that in the homicides by the insane a knowledge of the character of the act committed, and of its being a violation. of law, is not a safe and reliable test of responsibility. We have investigated this question with courage, without prejudice, and in the light which science has brought to the solution. There is too much belief in the common sense of a jury, to be the best judge of insanity. One great fault is partly due to the law requiring definitions from medical wit

nesses.