THE investigation concerning the management of the Cook County Insane Asylum which was pending in the County Court at the time our last issue appeared, has been completed and the decision from the bench follows the exact lines which have been maintained by the MEDICAL STANDARD concerning the proper care of the insane in this county. There have been innumerable "investigations" of this asylum, but never before was there anything which approached completeness; witnesses were not compelled to testify, no oaths were ever administered, and the whole power of a corrupt board of county commissioners was in every instance used to defeat anything like a fair inquiry. If under such circumstances charges of maltreatment were substantiated, and the asylum gained the reputation of being a disgrace to the State, it is no wonder that in the present instance, with a judge upon the bench who could not be influenced by the unscrupulous if not criminal operations of members of the county board, who withstood the bitter denunciation of a bankrupt blackmailing sheet, and with great firmness compelled not only the attendance of witnesses, but even made the county board particeps criminis, it is no wonder we say that the revelations made were of such character as to give the Cook County Insane Asylum, up until the advent of the present administration, the undesirable notoriety of being the worst managed institution in the United States, if not in the world.

The findings of the court are but the judicial expression of opinions which have long been held by the medical profession as the result of careful, non-judicial investigation.

The system of management has been, is now. and always will be radically wrong so long as it remains in the hands of fifteen incompetent men, who know as much from personal experience about insanity as an Icelander does about sunstroke. The present board of managers is probably no worse than its predecessors, and yet with the exception of Dr. Gilmore who as a physician has from the beginning of his official term inveighed against the "boodle" influence of the Blair's Cools, Kimballs, Sennes, Hodgkins, et al, there is not a single individual on the board who is competent even to manage a hospital for sick cats, and yet these are the men who control the public charities of Cook county, interestsdemanding the broadest intelligence, the deepest sympathy and the highest integrity, entrusted

to the care of men gathered from the dregs of politics. Is it any wonder that judicial "roastings" are necessary?

The deliberate attempt to make the medical superintendent the scapegoat of the county commissioners failed most miserably. Dr. Kiernan's vindication has been complete. The county board is responsible for the abuses which have so long existed. But will the county board now do anything? Most assuredly it will do nothing except bluster and create newspaper talk. It will protest that its dignity has been assailed, but it will do nothing more. With one or two noteworthy exceptions the county board does not contain an individual who has the moral or mental integrity which will enable him to sink his greed for gold and his "party obligations" and do what he believes to be honest and for the best interests of those entrusted to his care.

THE decision of Judge Prendergast that the Cook County Insane Asylum is no longer a fit place for the reception of patients, is a sad commentary on the management of charitable institutions in this county.

The reform measures proposed by the Judge are such as cannot be easily arried out at present. The time was when the State would have assumed charge of the fire trap at Dunning, but the difficulties now in the way of such a transfer are almost insurmountable. A boodle county board will not willingly release its grasp on an institution which provides so many fat places for relatives and friends. They would not willingly pay for the support of the insane if they had not a hand in the distribution of patronage. The probabilities are therefore that the present overcrowded condition of the asylum will continue, the commissioners will stand up for contractors who deliver "green" meat and the spasm of virtue which has lately been so characteristic a trait of the county commissioners will relapse into innocuous desuetude and the "good old times" of passing bills for stone contracts, etc., will reign in the county building. Verily, the public is easily satisfied.

DR. BURDRAGHI has recently ("Med. Abstract") discussed the question of murder by the insane. Only two of these cases were transitory frenzy, the great majority having been cases of delusions of persecution. Eighteen per cent.

were associated with epilepsy, and one was anthropophagous. In fifty-eight per cent. the murdered persons were relatives, and in forty-two per cent. strangers. The youngest murderer was only four years old, a girl who threw into the fire an infant she was left to mind; the oldest was seventy years of age; the majority (thirty) between thirty and forty years.

As to sex seventy-five were men and twenty five women; seventeen were quite illiterate, and sixty-one very imperfectly educated. Religious delusions were present in twelve and in five of these were the immediate motive of the crime; twenty-five labored under hallucinations, and fourteen had been previously insane. Fifteen were instances of plural homicides, one individual having perpetrated no fewer than eleven. In nineteen no motive could be assigned.

That even excessive joy may subvert the reason is proved by the case of a man who, having unexpectedly come in for a fortune of $10,000,000, killed his wife and children. In fourteen, a surprisingly small proportion, was the act premeditated, and in these, as in fifteen per cent. of the whole, considerable ingenuity was shown in its execution. Twenty-seven sought concealment in flight, but all sooner or later returned. Three only attempted to prove an alibi. Twenty-three prevaricated,

but of these twelve had lost all recollection of thelr acts, sixty-seven remembered them, but in fourteen cases they were committed under the influence of hallucinations; fourteen others, though cognizant of what they had done, were of very weak intellect, and one was a case of transitory frenzy. Fifty-four exhibited more or less remorse, but of these forty-six failed to realize the heinousness of their crimes; seven gloried in them; twenty-three attempted to exculpate themselves; thirteen undoubtedly of weak intellect, simulated insanity; eleven of these were subsequently transferred from the asylum to the jail, and six in all succeeded in escaping from asylums.

Seventy-eight of the hundred homicides were acquitted of responsibliity on the grounds of insanity, fifteen were pronounced to be partially accountable for their acts (a verdict recognized by German law), and sentenced according to various terms of imprisonment, while eight were found guilty of murder. These statistics demonstrate that the usual legal tests of responsibility of the insane are erron

eous.

"THE British Medical Journal" continues to iscuss the subject of the "Physician in Fic

tion" mooted by the MEDICAL STANDARD Some years ago. It says:

From the beginning of the present century to about the time of the Crimean war, a very different type of practitioner was introduced into current fiction. In his student days he was wild and full of animal spirits and practical jokes, being neither very studious nor very sober. He is represented in this stage of his career by Mr. Bob Sawyer, Mr. Ben Allen and Mr. Jack Johnson. When duly qualified he developed into a kind hearted, whist playing, middle class, family surgeon, somewhat of a time server and a humbug, but honorable withal, and nearly always found on the side of virtue. This was the practitioner of Miss Austen, of Thackeray, of Dickens, and of the hundred and one novelists who came between them. Here the apothecary was never taken as a hero, by any chance, and was often only introduced on the scene to certify to the heroine's dangerous condition, for the harrowing of the faithless lover, or at best was set in the chimney corner to amuse the inconvenient father while the hero and heroine enjoyed the sweets of uninterrupted intercourse. In Miss Austen's delightful novel, "Pride and Prejudice," the medical man is introduced to attend on Jane's throat with as little notice or approbation as the butcher might receive who supplied her with mutton chops.

Mr. Harris, in "Sense and Sensibility" is only valued for his daily bulletin and unfavorable prognosis which is not verified by the event. The surgeon in "Persuasion" attends Miss Musgrave after her accident in a satisfactory manner, but is else a shadow. In "Emma" however, we get a full length portrait of this class of practitioner. Mr. Perry was a country surgeon in large practice. His admiring patient, Mr. Woodhouse, says of him, "Poor Perry is bilious, and he has not time to take care of himself, which is very sad, but he is always wanted all round the country. I suppose there is not a man in such practice anywhere. But then there is not so clever a man anywhere." He does not confuse his patients by variety of climatic recommendations. “Perry" continues Mr. Woodhouse, "was a week at Cromer once, and he holds it to be the best of all sea-bathing places. A fine open sea, he says, and very fine air, and by what I can understand from him, you can get lodgings there quite away from the sea, a quarter of a mile off, very comfortable." He was very attentive to his better patients. "Poor little Emma," says her father, "you were very bad with the measles, that is, you would have been bad but for Perry's great attention. He came four times a day for

a week.

He said from the first it was a very good sort, which was one great comfort, but the measles are a dreadful complaint. I hope whenever Isabella's little ones have the measles she will send for Perry." Timid Mr. Chillip, in David Copperfield, and that worthy practitioner who attended little Nell at the village inn, belong to the same class. We all remember how the latter felt the child's pulse, “and as he did so, eyed the half empty wine glass as though in profeund abstraction. 'I should give her,' he said at length, a teaspoonful every now and then of hot brandy and water.' 'Why, that's exactly what we have done, sir,' said the delighted landlady. 'I should also,' observed the doctor, who had passed the footbath on the stairs, 'I should also,' said the doctor in the voice of an oracle, put her feet in hot water and wrap them up in flannel. I should likewise,' said the doctor with increased solemnity, 'give her something light for supper, the wing of a roast fowl now.' 'Why goodness gracious me sir, it's cooking at the kitchen fire this instant,' cried the landlady, and so indeed it was, for the schoolmaster had ordered it to be put down, and it was getting on so well that the doctor might have smelt it if he had tried; perhaps he did."

Thackeray has drawn in Pendennis the elder an excellent picture of the same type. 'Helen Thistlewood had one day hoped for a different lot than to marry a little gentleman who rapped his teeth and smiled artificially, who was laboriously polite to the butler as he slid upstairs in the drawing room, and profusely civil to the lady's maid who waited at the bedroom door, for whom his old patroness used to ring as for a servant, and who came with even more eagerness. Perhaps she would have chosen a different man, but she knew on the other hand, how worthy Pendennis was, how prudent, how honorable, how good he had been to his mother, how constant in his care of her, and so she married him.

In the Huxters, father and son, Thackeray has made a much less engaging sketch of men who were simply vulgar and commonplace, and in his fashionable physician, Dr. Brand Firmin, we see a mere humbug and hypocrite, but as if in compensation, Thackeray rises to a higher level than any of his predecessors in his Dr. Goodenough, a type of medical man, which in its essentials of knowledge, honor and benevolence, was as we shall see, to monopolize the fiction of the following generation.

The next definite representative of this type is perhaps Tom Thurnell, whose character Charles Kingsley drew in his novel "Two Years

13

Ago" published about 1857. He wages an unpopular and unsuccessful war against sanitary defects in the little Devonshire coast town where he practices and when in spite of the efforts and in consequence of the sanitary shortcomings of the place, cholera breaks out, he and his two friends fight with the disease to the bitter end, visiting the sick, warning the healthy, and in all ways attacking the causes of the disease. He is an intelligent, kind hearted, gallant, straightforward man.

The modern novels whose heroes or subsidiary characters are medical men formed on such a model, are legion. In "The Ladies of Beaver Hollow" we have George Mildmay, the young surgeon, found cheerfully walking miles in the night time to the help of a pauper. Mrs. Henry Wood's medical practitioners of this stamp are many, but she had lived in Worcester and took men dear to the British Medical Asso

ciation for her originals. Miss Yonge, too, Charles Reade, James Macdonald, George Eliot, "Pen Oliver," among others, have given us characters of this kind which will not die. And so the popular conception of the men of our profession has grown. From charlatans and buffoons they have become in the eyes of their neighbors examples of the very highest and noblest type of humanity.

THE MEDICAL STANDARD called attention some time ago to the growth of the naphtha habit among the female employes of rubber factories. The inhalation of naphtha fumes, produces a peculiarly agreeable inebriation. Naphtha is used to clean rubbers and is kept in large boilers to the valve of which the female employes obtain access and breathe the fumes. The habit was introduced from Germany, and is chiefly found in the New England States.

THE strictures which have been passed upon medical men who visit Europe, by our foreign confreres, would seem to be in a measure merited. We do not believe that the great mass of the profession in this country are bores; indeed we think that taken as a whole the medical profession of America stands as high as any in the world for scientific attainment, politeness and general gentlemanly conduct. The time has come when a person can secure as thorough an education if he will on this side as on the other. But there is a certain class of men who by hook or by crook gain entrance to the profession and being moderately well supplied with money imagine that by spending a few months abroad their return will be heralded throughout the land, and patients will flock to them as the foun

tain head of all knowledge, even though that head be hydrocephalic to the last degree. Is it strange then that foreign medical men of high scientific education should refuse to allow these medical bores, “globe trotters," as they are, to pry into private clinics and hospitals and make common property of private patients, for the sole purpose of self aggrandizement and laudation upon their return to American soil? We think that the manifest tendency to check this encroachment upon the rights of private individuals, whether at home or abroad, by a class of ignorant, unscientific, and careless medical men deserves the approbation of that large class of studious members of the profession to whom a single well studied case is of more actual scientific value than a host of "impressions from foreign clinics" by professional sight seers.

ON the evidence of an imbecile whose mental state, moral perversion and tendency to make sensational charges are so notorious that almost every judge in the county refuses to receive his evidence in the sensational cases where he so frequently attempts to testify for pay, Dr. J. L. Gray of Chicago, was indicted by a packed grand jury for malfeasance when assistant county physician. There is very little doubt that this indictment was secured by a political intrigue, using this imbecile hired assassin of character as a tool. The vindication of Dr. Gray from the charges is certain, but the annoyance caused is so great that Dr. Gray, in justice to the profession against whom this imbecile directs his attacks in consequence of certain delusions of persecution due to previous commitment to an insane hospital, in which Dr. Gray took part, should see that he is placed where he can do least harm.

THE recent attempt to enforce the resignation of Drs. McLean and Frothingham from the University of Michigan faculty cannot but prove disastrous to that institution. The chief crime of these gentlemen seems to have been a praiseworthy desire to remove the clinical department of the university to Detroit, where it could be best conducted. The unfitness of Ann Arbor for clinical instruction has always been obvious to every impartial observer. The local clique, however, appear desirous of running the institution in their own interests, and hence this attack on those imbued with broader views. It is to be regretted that so great an anxiety for the local interests of a country town should imperil the welfare of a great State university as this feud is certain to do.

THE recent investigation concerning the death of the "mind reader" Bishop has resulted, as every intelligent person supposed it would, in the discharge of the physicians who were accused of performing an autopsy on a living person. That any intelligent physician could make the mistake of "posting" a cataleptic is beyond credence.

The assertions, however, of a paranoiac mother and hysterical wife have caused the physicians an extraordinary amount of inconvenience, and had the effect of opening up the vast mine of wonderful stories concerning the burial of live people which a credulous public has feasted on to the point of satiety. It is about time that some society or body, if such a one can be found, in which the public have confidence, promulgates the fact that burial alive is an absolute impossibility, a bugaboo which but serves the sensational ends of sensation-seeking newspapers and hysterical women. It is time that the dear public should know that it can have complete enthenasia without the disadvantage of shocking a mourning cortege by turning over in the coffin.

THE recent meeting of the American Medical Association demonstrated the fact that in holding its sessions on the border lines of the country the association does not pursue a wise policy.

The American Medical Association should in fact as well as in name represent the profession of the whole country. To ask delegates and members to traverse the entire breadth of the continent, and at the same time provide no reduced rates for transportation, is equivalent to inviting the members to stay at home.

The MEDICAL STANDARD believes that the National Association should represent the best element and the best thought of the profession in every part of the country; that it should speak with authority upon every subject relating to the welfare of medicine in its broadest sense; that its sessions should be devoted to the consideration of those topics which are of vital importance not only to the profession, but to the community at large; that it should have the iutelligent and hearty support of every reputable member of the profession in the United States.

With such an association American medicine would stand the peer of any profession in any country.

But the fact cannot be overlooked that in the past the American Medical Association has been anything but an ideal national association.

While the MEDICAL STANDARD yields to no