THE...

sane asylums during the year was 49,622.

INSANITY IN THE UNITED STATES. A special census of the insane confined in institutions in 1910 in continental United States was taken by the Bureau of the Census, Department of Commerce and Labor, and a preliminary comparative summary for 1904 and 1910 was lately issued by Director Durand. The statement was prepared by Dr. J. A. Hill, chief statistician, division of revision and results, who is in charge of the work. The figures are subject to revision later, as there are a few institutions from which complete returns have not been received, but if any changes are made they are not likely to affect materially the totals and rates given herein.

The number of institutions canvassed was 372; the number of insane persons in the institutions January 1, 1910, was 187,454; the number admitted during 1910 was 60,603; and the number discharged in that year was 53,880. At the last special United States census of the insane the population in insane asylums January 1, 1904, numbered 150,151, and the number of persons committed to in

1910, there was an increase of 37,303, or 24.8 per cent., in the number of patients confined in insane asylums; and an increase of 10,981, or 22.1 per cent., in the number annually committed to such asylums. An increase of 37,303 in the population in insane asylums taking place in six years is an annual increase of 6,200.

INCREASE OF INSANE POPULATION.

While the population of the United States increased about 11 per cent. in the interval between 1904 and 1910, the population in insane asylums increased about 25 per cent. The number of insane in asylums per 100,000 population increased from 186.2 in 1904 to 203.8 in 1910. The number of persons annually committed to hospitals for the insane per 100,000 population increased from 61.5 in 1904 to 65.9 in 1910. If these ratios are accepted as representing insanity rates, it would appear that the number of persons becoming insane, in a community comprising 100,000 persons, was greater by 4.4 in 1910 than it was in 1904. It must be remembered, however, that these figures include only the insane who are committed to hospitals. As to the number of cases of insanity not resulting in commitments to hospitals the census has no data. It is entirely possible that the increase in the number of commitments per 100,000 population is not due to any considerable degree to an increased prevalence of insanity, but simply to the extension of this method of caring for the insane. It is a change which might result from an increase in the number of institutions of

this class and from an increasing disposition on the part of the public to resort to such institutions. In this connection it may be noted that the number of institutions for the insane reported by the census increased from 328 in 1904 to 372 in 1910, an increase of about 13 per cent. The average number of inmates per institution increased from 458 in 1904 to 504 in 1910.

The figures compiled by the census afford a striking indication of the prevalence of insanity, if not an exact measure of it. It is somewhat startling to reflect that the 187,454 patients confined in hospitals for the insane make up a population larger than that of the city of Columbus, Ohio.

Kentucky in 1904 had 3,058 insane present in institutions, in 1910, 3,538; 957 were committed in 1904, 1,240 in 1910; 869 were discharged, died or transferred in 1904, in 1910, 1,147. In proportion to the population in Kentucky, there were in 1904, 135.9 per 100,000, and in 1910, 154.5 per 100,000.

This is indeed an alarming prevalence of insanity, but Kentucky is not so very high in the list of 49 states reported, there being 28 states with a larger proportion according to population.

Notes

The Board of Council of Lawrenceburg has elected Dr. J. L. Toll, City Physician, and Dr. G. D. Lillard, City Health Officer.

At the regular meeting of the MedicoChirurgical Society, December 8, Dr.

Baldauf presented a paper entitled, "Blood Cultures in Typhoid Fever."

Dr. J. N. McCormack, Secretary of the State Board of Health, lectured before the Jefferson County School Teachers' Association, December 9, on "Sanitation in Schools."

Dr. W. B. McClure, of Lexington, Treasurer of the Kentucky State Medical Association, while crossing the Louisville & Nashville Railroad tracks in his automobile, was struck by an advancing train and his automobile demolished. Dr. McClure, it is reported, was uninjured,

There was a meeting of the Jefferson County Medical Society on Wednesday night, December 27, at which the election of officers for the coming year was held. The following were elected:

Dr. Edw. Speidel, President; Dr. Herbert Bronner, First Vice-President; Dr. E. L. Henderson, Second Vice-President; Dr. A. C. L. Perceful, Secretary; Dr. C. H. Harris, Treasurer. Executive Committee-Dr. John J. Moren, Chairman; Dr. C. G. Forsee, Dr. W. F. Boggess. There were two members of the Judicial Council elected to take the places of two members whose terms had expired-Dr. F. T. Fort and Dr. H. A. Davidson.

Book Reviews

The Physicians Visiting List (Lindsay & Blakiston's) for 1912.

Philadelphia: P. Blakiston's Son & Co.

This is the sixty-first year of the publication of this excellent visiting list, which is issued in several editions-the Regular, for 50, 75 and 100 patients weekly, in one and two volumes; the Perpetual, the same as the Regular, but without dates, and the Monthly Edition, in which the

patient's name need be written, but once during the month, the entire month's account being kept in but one place.

Calendars for 1912 and 1913; Uterogestation table; Incompatibality: Poisons; Dose table; Quarantine Periods; Asphyxia and Apnea, and Comparison of Thermometers are included in the first pages, and the usual pages for cash, addresses, engagements, obstetrics, etc., are in the body of the book.

It is a very compact, useful and handy book.

Anatomy, A Manual for Students and Practitioners.

By John Forsyth Little, M. D., Assistant Demonstrator of Anatomy, Jefferson Medical College, Philadelphia. Second edition. Revised and enlarged. Illustrated with 75 engravings. Philadelphia and New York: Lea & Febiger, 1911,...

This is one of the excellent Medical Epitome Series, and has reached its second edition. In it no mention has been

made of embryology, histology or applied anatomy. The original book has been revised before by Dr. Henry E. Hale, and now by the present author, Dr. Little. It is a miniature text-book.

Diseases of The Stomach, a Text-Book for Practitioners and Students.

By Max Einhorn, M. D., Professor of Clinical Medicine at the New York Postgraduate Medical School and Hospital, etc. Fifth revised edition. New York: Wm. Wood & Co., 1911.

The chief additions to this edition is the elaboration of the chapter on the X-ray in diagnosis of stomach abnormalities.

This book is very thorough. Its chapter divisions are as follows: Anatomy and Physiology; Methods of Examination; Local Treatment of the Stomach; Organic Diseases with Constant Lesions; Functional Diseases with Variable Lesions; Abnormal Conditions with Reference to the Size, Shape and Position; Nervous Affections and the Condition of the Stomach in Diseases of Other Organs.

The chapters on Methods of Examination and Local Treatment contain many valuable suggestions. The author's clever devices for theses purposes are described in these pages.

The radiographic cineomatograph films are revelations to one who sees them for the first time, and the most original work along these lines has been done by Cole. One of Cole's radiographs is shown on page 42.

Diagnostic and Therapeutic Technic. A Manual of Procedures Employed in Diagnosis and Treatment.

By Albert S. Morrow, A. B., M. D., Adjunct Professor of Surgery in the New York Polyclinic, etc., etc. With 815 illustrations. Philadelphia and London: W. B. Saunders Co., 1911.

The plan of this book is to describe certain general diagnostic and therapeutic methods, and then the measures employed in the diagnosis and treatment of diseases affecting special regions and organs of the body. Only such operative procedures as are required in emergencies or which form a necessary part of some of the measures are described.

The full description in detail of all methods given is commendable, as nothing is left to the reader's imagination.

The following are the chapter headings: General Anesthetics, Local Anesthesia, Sphygmomanometry, Transfusion of Blood, Infusions, Hypodermic Medication, Bier's Hyperemic Treatment, Collection and Preservation of Pathological Material, Exploratory Punctures, Aspirations. Full descriptions follow in the remaining chapters of diagnostic methods. in disorders of the special organs of the body.

The illustrations, mostly original, are specially good, being for the most part line drawings, but showing splendidly instruments and various steps of diagnostic methods.

We commend the book highly.

VOLUME 18

NUMBER 9

Original Contributions

DEAFNESS-ITS CAUSE AND NEWEST TREATMENT.

BY H. E. Cook, M. D.,

Formerly Chief of Clinic, St. Bartholomew's Ear Department; Attending Surgeon New Amsterdam Eye and Ear Hospital; Assistant Surgeon Ear Department, Cornell University Dispensary. NEW YORK, N. Y.

In presenting this subject it is my carnest purpose to impress upon the general profession and the general public the enormous importance of the correct treatment and also the correct preventive method of. treatment of catarrhal deafness.

While credit must be given for the least advance, the general profession will bear me out that aurists as a rule are dismal failures as regards the treatment of chronic deafness. The ear specialist of to-day offers practically nothing to the person suffering from catarrhal deafness, notwithstanding the fact that nineteen out of every twenty cases of ear trouble is chronic catarrhal deafness.

The fact that so little has ever been accomplished by the specialist gives the charlatan a splendid opportunity.

Hearing, which is next to sight in importance, has gained absolutely nothing. as regards beneficial treatment. Cases are being treated exactly the same as was advocated thirty-five years ago and that brings us back to the time of Professor Politzer who introduced the Politzer bag

for the treatment of middle ear deafness. It was and still is in a measure, as far as relates to the present methods employed by aurists, the only real and successful means of treating the ear. Even this. though very meagre in its results and slight in its scope, has accomplished much.

To mention the hundreds of useless instruments that have been thrown on the market and introduced to the public simply for the monetary return would be a waste of valuable time.

The person who reads this article will be one who is sufficiently interested and knows the absolute uselessness of the present methods of treatment and the ineffective instruments that have been imposed upon the public. The laity are disheartened with the various unsuccessful methods used to give them relief. The ear specialists themselves are actually in despair. Any honest specialist, if you demand a frank and decisive statement. will say that he despairs of ever producing any material results in these cases. It is a great misfortune that conditions are allowed to exist which encourage the suffering public in their eagerness to get relief to be so easily imposed upon by the charlatan and irresponsible medical man.

To make my arguments a little clearer I will enter into a little more detail on: What is deafness?

What is the cause of deafness?

What can we do with a patient who has acquired deafness?

We find these conditions in young and old. Most cases start with infancy as a rule.

The young infant may be born with abnormal conditions, which I shall state later. This would predestine the child to catarrhal deafness. The infant may be born with all the organs perfectly normal, but through a series of nasal involvement develop a condition called adenoids, which is practically hypertrophy of lymphoid tissue at the back of the nasal cavity, also enlargement of the mucous membrane lining of the nose. This condition can result even after the most careful attention given by the parents of the child. A diagnosis can be readily made even by the merest tyro on medical subjects. The child would breathe with his mouth open, snore at night, toss and become worried during sleep. Dullness of intellect as well as dullness of hearing and running ears develop. These conditions may or may not accompany or precede scarlet fever, measles and diphtheria. The hard palate (roof of the mouth) will show a very high arch. There will be a broadening at thebase of the nose, producing a condition known later in life as "frog face." In the older child the teacher will notice the child appears listless and inattentive and takes him to be dull of intellect. His speech will be interfered with, giving a nasal twang.

The mechanical effect produced by the adenoids will be to obstruct the orifice of the eustachian tubes, preventing a proper drainage of the fluid of the mucous membrane lining of the middle ear and of the eustachian tubes and at the same time preventing an equality of air pressure in the middle ear which is absolutely essential so the ear drum may remain highly sensitive and responsive to the most mi

nute vibrations, and this is necessary for most acute hearing.

If a condition of adenoids does not exist, but an overgrowth (hypertrophy of the turbinate bones) has existed at any time during youth or childhood, or a spur of the septum, a similar condition of affairs may result, possibly not immediately but gradually, and will simulate a condition that will be produced by adenoids itself.

Granting that this condition of adenoids, hypertrophied turbinates and spurs of the septum, and with the subsequent nasal catarrh which follows, have existed with the child for a year or a number of years or with an adult without their removal by operative measures, the patient will exhibit the following symptoms as regards catarrhal deafness: head noises, such as tinnitus, parecusis, "hearing better in a noise," diplacusis, conversational deafness which the layman associates with deafness and with which the general physician is fully acquainted. In some instances splendid hearing on the telephone but partial loss of conversational hearing. An examination of the ear in these cases will show partial or complete retraction of the ear drum, partial or complete absence of the drum due to suppurative processes, a thickened or thinned drum membrane, contracted or collapsed condition of the eustachian tube, partial fixation of the stapes, etc. Any of these pathological conditions may be present and still the patient may show what is known as excellent bone condition, signifying a perfect or nearly perfect perceptive apparatus (an auditory never undamaged).

What does the aurist do? What can he do? If adenoids are present it is absolutely essential to remove that condition by operative methods. In my opinion there is no operation in the whole