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and dependent, upon their associations for being competent to formulate or produce an idea; and secondly these more complex ones affecting the function of speech by disturbing the visual center for words. It sometimes occurs, that certain hallucinated individuals see legible words appear before their eyes. A lady whom I attended during an attach of religious melancholid, was so affected seeing such words as “Damned" "Accursed.” A patient I saw at Bicêtre, saw in the air words written in letters of fire. Another frequently observed black letters on a firy background. Le Mané, Thecel, and Pharés at the feast of Baltazr afforded examples of this kind of visual hallucination. What occurs in these cases? The visual center for words is the seat of an hallucinatory process which gives the images such intensity that they project themselves under the same conditions as if the patient actually read words written by external agent. We can therefore say that if there are auditory verbal hullucinations, there are also visual verbal hallucinations.

But there yet remain two word-images of a very different nature— the motor images. Can that part of the junction of speech be affected by halluncination? It is this point we wish to examine. Before doing so, however, a short digression is necessary.

There are patients who claim a voice speaks to them, but nevertheless do not perceive any sound. They hear the thought -the language of thought-it is an entirely internal conversation. This phenomenon, of which numerous examples are found in theological works has long since been confounded with hallucinations of hearing. M. Baillager has definitely distinguished the differences existing between these phenomena and ordinary hallucinations, making of them a separate class—psychical hallucinations. If this denomination be accepted, its application is ambiguous so far as regards the nature of this phenomenon; the majority of people apparently agreeing with M. Baillager, others not admitting this to be any hallucination, others only discerning in it a variety of auditory hallucination psycho-sensory as the other example. Finally some authors explain these facts by the intervention of another factor, the speech function. M. E. Fournier regards these phenomena as hallucinations of the speech function, and M. Max Simon considers them impulses of the same function. We believe an explanation of psychical hallucinations will be discovered in these views; although our opinion differs somewhat from those of the physicians just cited. We think that the psychical hallucination is in effect a genuine hallucination having the same claim to that title as psychosensory hallucinations. But it differs from these in its essential character — it is especially a psycho-motor hallucination, effecting the speech-function in its motor-element. This is the point we shall try to demonstrate.

Among the constituent images of internal language, figure, mental representations of articulatory movements. While with most people, these are frequently effaced, at the expense of the vesical and auditory images, with others on the contrary they acquire preponderance, and such people during reflection, then mentally speak their thought instead of hearing or seeing it. If the mental representation is especially vivid, it follows that in place of an interior word, the thought may be articulated in a more or less loud voice. It may even happen that thought may be formulated in a loud tone, as with people who speak to themselves. The motor image of articulation can therefore become sufficiently vivid to provoke verbal articulation, passing thus from internal to external language.






DR. A. E. CARRIER read a paper on eczema. See page 481.

DISCUSSION. DR. J. H. CARSTENS said the paper was so thorough and complete that it left little to be said, and as he had not spoken on dermatological subjects for some time, he felt a little rusty. He had been struck with the force of Dr. Carrier's remarks upon arsenic. He thought that in debilitated subjects the disease would often disappear more speedily under the administration of arsenic than any other drug. For the relief of the pruritus he preferred a very mild solution of bichloride of mercury (about one grain to eight ounces of water). Some cases he thought were advantageously treated by berberis aquifolium.

Dr. Eliz. DEUEL said that some time ago she had had an attack of acute eczema, and had obtained no relief until she had


applied a poultice of grated carrots, and then anointed the surfaces with mutton tallow. In the troublesome form of eczema affecting the auditory canal she had excellent results by a strong application of sulphide of zinc and boracic acid.

DR. SPRAGUE had not had very extensive experience with eczema, and had usually had success with the old remedies, oxide of zinc ointment and alkalines. In children he thought boro-glyceride a useful topical application for the relief of the pruritus.

DR. MILLS considered the views expressed in the paper to be in accord with scientific opinion on this matter. There are two kinds of patients, the one class plethoric and the other anæmic, and constitutional treatment must be based on these differences. As a preventative measure he was in the habit of smearing the irritable surface with a thick unguent of paraffin, white wax and lard. This effectively excluded the air and kept the skin moist. For the relief of the pruritus he had found no remedy equal to carbolic acid.

Dr. R. C. Hutton, said he had had a little experience with some new remedies which he did not consider satisfactory. Flexible collodion with ecthyol, and collodion and iodoform. It forms an impervious, coating, but does not in his experience modify the disease.

DR. CARRIER 'remarked that every remedy was essentially tentative. It is especially needful to remember the stage of the disease in the application of remedies. The treatment of a vesicular eruption must be different from a pustular one-the latter must not be confined by any impervious application. Adjourned.

Signed, F. W. MANN, M. D., Secretary.



Reports to the State Board of Health, Lansing, by observers in different parts of the State, show the diseases which caused most sickness in Michigan during the month of September (four weeks ending September 29), 1888, as follows, the diseases being arranged in the order of greatest prevalence:

Diarrhoea, rheumatism, neuralgia, dysentery, intermittent fever, bronchitis, remittent fever, consumption of lungs, cholera morbus, cholera infantum, influenza, typho-malarial fever, tonsilitis, erysipelas, typhoid fever (enteric), pneumonia, inflammation of kidney, inflammation of bowels, pleuritis, inflammation of brain, whooping-cough, diphtheria, puerperal fever, scarlet fever, cerebro-spinal meningitis, measles, membranous croup.

For the month of September, 1888, compared with the preceding month, the reports indicate that remittent fever, bronchitis and influenza increased, and that neuralgia, cholera morbus, cholera infantum, consumption of lungs and erysipelas, decreased in prevalence.

Compared with the preceding month the temperature in the month of September, 1888, was much lower, the absolute humidity and the day and night ozone were less, and the relative humidity was slightly more.

Compared with the average for the month of August in the nine years, 1879 to 1887, intermittent fever, typho-malarial fever, consumption of lungs, tonsilitis, whooping-cough, diphtheria, neuralgia and cholera infantum, were less prevalent in September, 1888.

For the month of September, 1888, compared with the average of corresponding months in the nine years, 1879 to 1887, the temperature was lower, the absolute and relative humidity and the day ozone were less, and the night ozone was much less.

Including reports by regular observers and others, diphtheria was reported present in Michigan in the month of September, 1888, at twenty places; scarlet fever at twenty-four places, typhoid fever at thirty-five places, and measles at seven places.

Reports from all sources show diphtheria reported at seven places less, scarlet fever at one place less, typhoid fever at seven places more, and measles at the same number of places in the month of September, 1888, than in the preceding month.

HENRY B. BAKER, M. D., Secretary. LANSING, October 4, 1888.


EDITOR OF THE PHYSICIAN AND SURGEON: I have not the least doubt that the editor of this journal intends to be just as faithful to his alma mater as I can possibly be. In advocating, as I understand he does, the removal of the clinical department to Detroit, he doubtless advocates what he honestly believes would, if accomplished, benefit the medical department. Now, when I grant all this the editor may be willing to admit that I rejoice as sincerely as he does in everything that tends to increase the prosperity of the medical department of the University.

I have always supposed that it is a very great honor to graduate from the medical department of the University, and I have been fortunate enough to meet with quite a number of the laity who believe that a physician who has the seal of the great University of Michigan on his diploma is entitled to the coufidence of the people as one well qualified to treat their ailments. I am therefore surprised and grieved to find graduates of our honored alma mater who endeavor to prove that those of us who graduated at Ann Arbor had not much of any clinical instruction, and inasmuch as clinical instruction is necessary to made a good physician, therefore

I protest against such statements. They cannot surely be received with approval by the thousands of physicians whose only credentials for public confidence may be their hard earned diplomas from the University of Michigan. Moreover, to contend that the clinical material from the clinic of the medical department came or comes from Ann Arbor alone is hardly fair. The well earned reputations of Palmer, Frothingham, Maclean and Dunster, brought patients from all parts of our country. I remember seeing patients at Maclean’s, Frothingham's and Palmer's clinic from California, New York and Canada, and indeed from almost every State in the Union. The patients from Ann Arbor were only about ten per cent. of all those that were treated in the clinics. The last issue of THE PHYSICIAN AND SURGEON proves that the same condition obtains now, for I find there cases reported as treated in the clinic that came from places quite remote from Ann Arbor. It can be easily shown from the records, that from eight to nive hundred cases are treated in the clinics at the medical department every year. I appeal to my classmates and I ask them, if the length of clinical instruction was not often so great as to weary them. I have seen clinical work done at the University at which there were often no students but the professor's assistants, because the time of the students was otherwise taken up, and the wealth of clinical material was so great that the professor could not dispose of it in the time alloted to him. No clinical instruction indeed!

There are a few more points connected with this subject which I cannot dwell on now, but with your kind permision, I may urge them on a future occasion. Respectfully,


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