ant to share the responsibility in the case of any untoward result. The doctor said he was not prepared to state how much of the convalescence and cure of these women was due to careful nursing. I have been impressed that the reason a considerable percentage of surgical cases recover is because of the careful nursing of the cases after operation. But, to the reminiscence. In 1893 we had a patient in the asylum who had formed the habit of swallowing articles. He was an only child and his parents were neurotic. When there seemed to be some trouble of the stomach in this case we endeavored to obtain consent for operation, but there was some inexplicable horror of operation on the part of the mother that seemed to be shared by the father. Finally there were symptoms of perforation and the patient died. On post mortem examination it was found that a tenpenny nail had been forced through the coats of the stomach. The perforation was on the anterior aspect near the lesser curvature. The edges of the hole made by the nail were well defined. The patient apparently died from the combined effects of shock and peritonitis. In the stomach were seventy-five stones, the largest of which weighed an ounce, the smallest thirty grains, the combined weight being thirteen ounces. There were thirty-eight nails measuring from one-half to five and one-fourth inches in length, some being straight and others crooked. Their combined weight was six ounces. There were fifteen staples, two screws, three buttons, one piece of glass, and numerous small gravel stones. The combined weight of the foreign contents of the stomach was twenty-one ounces, and of the stomach itself fourteen ounces. The coats of the organ were much hypertrophied, especially the mucosa. The ruga were well developed. NORMAL AND ABNORMAL, RATIONAL AND IR RATIONAL, HEALTHY OR UNHEALTHY DELUSION. By Charles H. Hughes, M. D., In the recent contest of the will of Miss Brush, the deceased New York Christian Scientist, this question constituted one of the chief features of that remarkable trial and the court very properly held delusion to be consistent, while some of the medical experts testifying in the case appear to have unpsychologically and unscientifically held delusion to be inconsistent with sanity, whereas the true criterion of insane delusion is its relation to and dependence on a morbidly involved brain. The human mind has been a prey to delusion, disease founded, or misinterpreted illusions or hallucinations, of one sort or another, since human life began, especially to hysterical and religious delusions.* The asylums do not show more of delusive *The recent wild whirlwind of Wall Street stock speculation caught many emotionally exalted victims, some of them brain diseased, others the victims of psychic contagion. Extreme inadequately founded optimism in business may be delusion of physiological brain exaltation or it may be, as it often is the forerunner of paresis as much so as that opposite psychic state pessimism is as we see it displayed in fits of the blues and melancholia. It is oftentimes disease founded, as the extreme pessimism of hebephrenia in its most morbid forms. Optic, auditory, gustatory and special tactile impression have given rise to illusion and hallucination in minds both sane and insane. The delusions of dipsomania and inebriety are not greater than those of erotomania, dipsomania and the illusory and hallucinatory delusions of the pudic nerve area, peripheral and spino-cerebral, in the same. This nerve and its marvelous ramifications and connections, influencing and influenced, in the economy of man and woman who have made and moved the world. It has been the doing and undoing of either sex in manifold instances and many wonderful ways. Because of its mysterious influences the wisest of men from Solomon down have marvelled at the "ways of a man with a maid." Normal delusions proceeding from pudic nerve impression reconcile individuals to live together who would oftentimes and otherwise be personally abhorrent. ccxlvii mental self-deception among the insane than we see among the world that we call rational, outside of those abodes of minds gone wrong from disease of brain-too wrong to live with the rest of the world in normal harmonious relations. The diseaseengendered, delusion founded, religious, and other movements of the intellectual world nearly equal those rationally established. The insane, deluded, have a justification and extenuation for their delusions of speech and conduct, in overmastering disease, which the sane world has not. Carlyle's criticism, "mostly fools," was a just judgment upon much of the unbalanced reasoning of mankind. It is the implication of the deluded mind with a brain, primarily or secondarily, organically or functionally, involved in disease, that brings the delusion within the domain of psychiatry. It is the coexistence of brain disease, the delusion being the natural product of the diseased brain, that constitutes insanity. Insanity is a disease, expressing itself in certain symptoms of mental derangement, due to disordered brain, among which are illusions, hallucinations and delusions, changes of character without adequate external cause, usually prolonged, but sometimes brief, constituting departures from the natural habits of thought, feeling or action of the individual, in which plainly defined or formulatable delusion may not even be discerned; delusive states shown in conduct; alterations in the ego (morbid egoism) or individually, etc., but all dependent on disease, all the offspring of disease, thus perverting the mind through involvement of its organ, the brain. Febrile delusion is a temporarily typical insane state of mind. If temporarily recoverable from, under effective psychic impression, we call it only delirium. If persistent, and the patient cannot be aroused from it, we call it insanity, as in long continued traumatic delirium, the post-typhoid persisting delirium, grave or typhomania, etc. Mahomet's vision and auditory hallucinations have been clearly traced to epileptic involvement of the brain, quite an adequate morbid cause of mind perversion, as every cerebro psychopathologist knows, and the visions of Constantine's cross in the heavens and the auditory hallucination " In Hoc Signo Vinces," went into history with the greatest epoch since the days of Christ and the early apostles of the Christian religion. It founded Constantinople and gave rise indirectly to the wars that followed it with the "unspeakable Turk." Mahomet's delusion had a disease basis; Constantine's has not been so proven. Delusion is not per se insanity. If it were, the world would not be regarded as sane. In proof are the delusional features of Swedenborgianism, Mesmerism or hypnotism, Dowieism, Mormonism, Second Adventism, Amishism, Christian Science, sacred and royal touch, witchcraft, obsession, necromancy, hoodooism, high potency Hahnemannianism, Perkins' metallic tractorism and all the delusions of religion and otherwise, of the prolifically hallucinated orient; the Alchemists dream of metallic transmutation, the fountain of perpetual youth, of which Ponce De Leon dreamed, the gold dust followers of Columbus, the Geo. Law's South Sea Island bubble, and the delusions of the stock exchange of to-day, yesterday and always, are proof that delusion is not insanity, though much insanity follows in its wake and many insanities are the offspring of delusion. Insane enthusiasts and enthusiastic paranoiacs often originate delusions, religious, social and political, and sane men and women become their deluded followers. Extreme credulity is not insanity, nor is the wildest imagination of faith, unless it is disease-engendered credulity-for while disease-engendered delusion of a certain kind, in which the ego is peculiarly and prominently manifested (egoistic delusion) often characterizes mental derangement, insanity of doubt, timidity and uncertainty of belief are likewise especially prominent as features of this disease; folie du doute, folie du toucher, the depressing, selfdeprecating, convicting delusions and delusional states of melancholia and the delusion of disease possessed, or hypochondria, of which the hopeful and delusional feelings of phthisical insanity and the exalted delirium of grandeur of paresis are in marked contrast. Time, place, education, stage of civilization, the age of the world, hereditary endowment, rearing in childhood, and from childhood, parental teaching, habits, manners, customs, associates; in short all environment and disease involving the brain in structure, function or circulation, all enter into the adjudication of the question of insanity. The question of insanity cannot be generalized. It is to be especially determined like any other case by diagnosis of disease involving the brain so as to cause symptoms of mental disharmony with environment or natural character of the individual under consideration. If there be no disease basis involving the brain and disordering the mind, it is not insanity and not within the physician's province for adjudication. The question to be settled in the case of Miss Brush and all similar cases, was not whether she had delusions and was, in consequence, insane, but whether she had brain-disease-engendered delusion and did not consequently display her normal mind in her will; her last testament being the product of her mental disease. If disease of brain distorts the mentality so as to destroy or pervert natural and normal will in a testamentary document, so that the party is self betrayed, self-misrepresented or self-wronged by his disease of brain and mind, then the will ought not to stand, whether delusion be shown or not, for delusion per se is not the crucial test of insanity, though a certain delusive state of mind caused by disease usually is, and I believe invariably exists. To be insanely deluded one must be dominated by an overmastering disease so distorting the mind as to make its acts unnatural and out of harmony with the natural mental character and will. The proof reasonably inferable of delusion may be only in the deed. A large number of the world's people do not accept the dictum of David Hume "that testimony is more likely to be false than that miracles are to be true," and the Christian Science people are among the credulous who seem to believe in the possibility of any kind of modern miracles. The setting of broken bones and the stopping of the fatal hemorrhage by absent treatment of mechanical injuries is believed on testimony by the credulous followers of Mrs. Eddy. It was believed by Miss Brush. It was believed also by Miss Brush that "though her blood were all taken out of her body she could yet be made to live by the power of Christian Science healers." This was of course a delusion contrary to nature and all physiological experience. It probably was an insane delusion, but the disease basis necessary to make it so appears not to have been fully established at the trial. An ignorant but sane person or an extremely credulous, but otherwise intelligent, sane person, superstitiously credulous as to the power of God, through miraculous employment of human spiritual influence, might believe this possible |