the Red River, which is the boundary between North Dakota and Minnesota, the sale of liquor is usually restricted to a suburb lying within the jurisdiction of Minnesota.

I cannot avoid the conclusions personally that the absence of the public places for the sale of liquor and other arrangements which facilitate the obtaining of intoxicants decrease the aggregate of intoxication, divert the expenditures of the citizen into more profitable channels and decrease to that extent a potent source of insanity, viz., intemperance allied with poverty.

Similarly syphilis and other venereal disease, very prolific in the production of cerebral disease in cities, are insignificant etiological factors in my state. It will of course be readily deduced from previous mention of the occupation of the inhabitants, the probable decrease in intoxication from sumptuary laws and the scarcity of specific disease that general paresis would be a form of psychosis decidedly infrequent with us, and in fact out of 1765 admissions since the hospital opened only twelve haye been paretic.

If, as from the present state of public sentiment upon the question it seems but fair to suppose, the law upon the question of the sale of intoxicating beverages remains practically as at present, some light should be thrown upon the etiological influence of alocohol, or at least the public sale of such, within the course of a few years.

Almost as noticeable as the absence of the paretic from the wards at Jamestown, North Dakota, is the prevalence of the primary and secondary dementias occurring in individuals who as far as general muscular development and hygienic condition is concerned are fully up to normal standard. Cases of secondary or terminal dementia and of permanent mental enfeeblement occur repeatedly after a very brief period of transient excitement, often only a mere expansiveness, and do not during the whole period of their hospital life here exhibit any other phase of the disease. The percentage of recovery is about the same as elsewhere.

The women who average about 185 out of 400 patients are, like the men, mainly from rural communities and agricultural occupations. During the last year the completion of gynæcological examinations elicited the facts that only one in ten refused to be examined by the physicians of the hospital, and but

one in every six of those examined women were found to be normal. Out of one hundred and twenty-seven diseased women (I am now speaking as regards the results of gynecological examinations) ninety-eight were found to have retroversion and retroflexion, the percentage of the latter however being very small; sixty-three out of one hundred and twenty-seven had lacerations of the cervix uteri; seventy-one were suffering from perineal laceration and fifty-seven and forty-three from endometritis and endocervicitis respectively. The amount of ovarian disease seems very slight as compared with the statistics of eastern institutions.

This hospital has, I think, until very recently at least, cared for all insane Indians residing in the state of North Dakota. The reservations within the border of the state contain the most important branch of the once powerful Sioux nation and some smaller allied tribes. Nevertheless there have been but three Indians committed here during the past sixteen years, and this fact is an illustration of the infrequency with which insanity occurs in the Indian of the northwest, even when fully exposed to temptation as regards alcohol and venereal disease, for the Indian, it is said, is not so fully protected against the evils as his white brethren in many parts of the state, and his passions are under feebler control when once they assume the mastery of the

man.

North Dakota has a very fair allowance of physicians to the general population, and the great majority of them is in general practice where exposure to the inclement weather, and long continued cold is a prominent feature of the work, yet only two physicians have ever been committed to the hospital among the nearly 1,800 admissions.

Nearly all the insane of the state are unquestionably committed to the asylum for no private institutions exist as yet, and facilities for the care of patients at home are nowhere very great. There is very little of that good-natured tolerance of markedly eccentric characters to be found in some communities and they are usually quickly committed to the hospital soon after their appearance in a neighborhood.

I have during my stay in North Dakota taken occasion to tabulate the results of investigation in 300 cases of insanity in which as far as I could determine, the disease was due to so

called "moral causes" without the element of heredity being appreciable, one-third each of the total number of cases being respectively foreign born, born in this country of foreign parents, and native born. Purely emotional causes seem to preponderate among the women, while disappointment and worry over business and a career constitute the prevailing factor among men. The difference also in the relative importance of certain emotional states as etiological factors among the foreign and native born is perhaps worthy of attention. The native American and even those born in this country of foreign parents would seem to be more open to mental disturbance through financial loss and keenly susceptible to the influence of long continued "worry" over business matters, even when the latter were apparently going on all right from the standpoint of general success. The numbers, while not large enough to warrant generalizations, may yet be of value in future combined with other studies.

EXCITING CAUSES IN THREE HUNDRED CASES, ARISING FROM "MORAL
CAUSES," IN PERSONS EXHIBITING NO HEREDITARY TAInt, as
FAR AS HISTORY COULD BE ASCERTAINED:

STATIC ELECTRICITY IN ALCOHOLIC INSANITY.

By Thomas E. Bamford, M. D.,

First Assistant Physician Hudson River State Hospital,

Poughkeepsie, N. Y.

To determine the value of electricity in certain conditions of the nervous system resulting from continued excessive use of alcohol, a number of patients at the Hudson River State Hospital were selected for treatment. During the past six months a careful selection of subjects has been made and applications of electricity administered at regular intervals.

It would be extremely difficult to formulate any fixed rule as to the mode of application and the proper voltage for the reason that no matter how careful the operator may be, one patient will complain of pain or discomfort with the mildest spark, while another will describe the sensation as pleasant, with comparatively high voltage. Experience in individual cases gives one the necessary information as to the strength of current to use. The appearance of the spark and the sound indicate the current. To estimate the voltage multiply the spark gap in inches by 10,000.

Of thirty patients treated, four had previously resided in socalled gold-cure resorts and had relapsed within one to three months. The best results were obtained where tremor and restlessness were prominent symptoms. In two cases gastritis was an annoying symptom but this disappeared in a measure after a few applications. It is quite likely that washing out the stomach had something to do with the subsidence of the symptoms. In eight cases the symptoms of mental depression were more marked immediately after an application of twenty minutes duration. In the course of two hours, however, cheerfulness took the place of despondency. In the majority of instances the patients expressed themselves as "feeling good"

for several hours after treatment. It was noted that although stimulation was sought in nearly all of the cases that sedation was the result in many, and in a number of cases where restlessness was not controlled by other means the patient would sleep for several hours after an application. The tremor which is present in alcoholic insanity is one of the last symptoms to disappear. One patient stated that although his mind was clear he could not write as formerly. Previous to his admission here he had been a book-keeper and his employer first detected the patient's real condition from his inability to write in a firm hand. He showed incoördination of the muscles also by irregular spacing and unusual size of letters.

In eighteen patients under treatment, a blood count was taken at the beginning and once weekly thereafter. None of these patients took so-called tonics. The results, after six weeks treatment, would tend to show that static electricity is a valuable reconstructive and tonic, the local action on the tissues causing increased circulation in the part, with increased cellular activity. The number of hemocytes at the beginning of the treatment in twelve cases averaged 2,900,000. The percentage of hæmoglobin fifty-eight, leucocytes twelve thousand. A count was taken at the end of the third week which showed a marked increase in six cases in the number of hæmocytes and a diminution of leucocytes. In three of the six remaining cases there was an increase of hæmocytes averaging 5,000,000, while in three there was little change. All of the patients were given a special diet of the highest nutritive value. The results attained in some of the cases are unsatisfactory because of the difficulty in treating the patients. Many of them were annoyed by hallucinations of hearing and at times were more or less agitated. One patient who had heard voices for several months declared after the first application of electricity that the voices had left him, but two days after he said that the symptom had returned.