Delusions of influence and passivity feelings are seen in states of automatism, convictions of active and passive mind reading, sensations of electrical currents, or of hypnotic influence. Their content varies as widely as do the life experiences of the individual; on the one hand related frequently to the type of mystical craving and credulity which moves people to consult spiritualists, and ouija boards, or seek outlets in theosophy and occultism. Often with their specific content determined in this way, they become linked in the depressive states with the persecutory ideas: the patient projects the aggressiveness onto his enemies, feels himself as the passive victim of their plans and supernatural devices. The sensations of electrical influence, however, are almost uniformly, poorly appreciated, erotic sensations and are about equally frequent in elations and depressions. The ambivalence of power expressed in the patient's belief that he can exert as well as feel influence, send as well as receive messages, etc., occurs oftener in the excitements, is seldom fixed or rigid in content, and appears rather in keeping with the push and exuberance of the elation.

Hallucinations appear in 20 cases of the series, always associated with other evidences of projection. The character of their content is found to be fairly, consistently different in the elations and the depressions. In the latter they are met always with delusions of reference, and frequently also with persecutory notions, and are consistently accusatory or condemnatory in substance, thus representing one part in the projections of the self-accusations of the individual. In the elations, however, hallucinations appear frequently detached and topical (sometimes with symbolistic value) probably in relation, on the one hand to the general distractability, or on the other hand to a fairly extensive fabric of fantasy, especially in the dreamy elations where there is little over-activity and the productiveness lends itself to imaginative creations rather than active excitement.

The delusions of body distortion-appearing as complaints that the eyes are queer, that the hands are claws, or the stomach and intestines closed up, are relatively infrequent and occur almost exclusively (there was one exception) in the depressions. Most of them seem to be "complex determined," in that they relate to subjects of individual sensitiveness. Here the belief that the eyes are queer based on a masturbation-fear-of-insanity complex

was strikingly prominent. The feelings of brain change, sometimes similarly determined, are sometimes also apparently related to the general depressive retardation and feeling that the thoughts come slowly. Another small group of cases might be classed with the depressive hypochondriasis-in which the physical complaints are crystallized into convictions of definite, and frequently vividly described lesions, which bear the brunt of the depression and replace a sense of being out of gear and harmony with the surroundings.

Incongruities of behavior-startling antics which the patient performs quite in contrast to his prevailing mood-appear on the surface as unmotivated inexplicable stunts; such things as a sudden sliding onto the floor, crowing like a rooster, clownish somersaulting, etc., appear appallingly queer on the surface, although in many instances the connections and associations can be determined by an examination of the individual's ruminations and subjects of pre-occupation. In the elations the antics play a rôle similar to the hallucinatory experiences, a symbolistic attitudinizing of some dramatic value, the patient's inconstant participation in his own fantasies. The other type of behavior antics occurs usually in states of tension during depressions, where the tension is exteriorized in oddities which represent the individual's conflicts not infrequently with pre-existent fear of insanity and a certain willingness to live up to its realization. In the accompanying case the patient was seldom in good enough contact to discuss or state freely the content of her psychotic behavior, which was, however, sufficiently suggestive to be worthy of examination.

Lillian G. was 45 years old at the time of admission in May, 1915; a widow who conducted a boarding house. There was little known of the patient's earlier life. She was said to have been a healthy, not especially moody, responsive, normal woman. She married at 30, and had one child. Her husband died after five years; and she then began conducting a boarding house. A few months before admission she suffered pain in the back, at first thought to be due to floating kidney, but in January, 1915, recognized as a tuberculosis of the spine. Immediately after learning this, she became greatly depressed, at night would feel she was dying, slept little and became very tense. In April, she cried a great deal and had periods of agitation in which she rocked back and forth in bed. On admission she was tearful, frankly depressed, but pre-occupied and somewhat irritable if questioned. Her orientation and memory were unimpaired. Most of the time she was dreamy and inaccessible, but this behavior was punctuated

by short periods when she would neigh like a horse, then pant and blow her lips. She accused another patient of reading her letters, but otherwise made few spontaneous statements. She remained with us only five weeks, during which she continued markedly depressed, had ideas of reference— thought visitors read her mail, that "everything was being published in the paper "; that the victrola was saying things about her. She had auditory and visual hallucinations, always of a depressive persecutory nature; that she heard people telling her daughter she had sinned; she saw her daughter outside crying for her; heard devils laugh, and saw her daughter's face. From time to time she neighed like a horse. Once she looked at her hands and said she thought they might have become cat claws. At another time she threw her wedding ring into the toilet. So far the picture appears fragmentary, a bizarre and incongruous assortment. But the underlying moving factors, the real content of the behavior, was made more explicable, when on a few occasions the patient spoke of being punished in hell for her sins her cousin, a prostitute, had lived with her since her husband's death. She herself had had illicit relations only on one occasion, had become pregnant and induced an abortion. She felt that this, if known, would damn her daughter, that people might doubt her marriage and think her daughter a bastard. She threw away her wedding ring "because it did not have her initials on it and might have belonged to anyone." She felt that in the next world she must be further punished, that she might even be turned into a cat, but she never explained the horse neighing. Evidently the tuberculosis focused her fears of death, and accumulated her selfaccusations and contritions which then became projected.

:

To summarize in general review the content of the schizophrenic characteristics in cases showing dominantly an affective reaction, I would emphasize: (1) The prominence in depressions of the symptom constellation of ideas of reference with delusions of persecution and condemnatory hallucinations; (2) an analogous projection of the affect in the varied and dramatic hallucinations; the symbolistic attitudinizing, and the somewhat egotistical and constantly changing ideas of reference of the elation; (3) the determination of the content of the distortions of body sense and of the odd, fixed antic behavior by the underlying conflicts and personal difficulties.

FOOD, SERVICE AND CONSERVATION IN A

PROVINCIAL HOSPITAL.*

BY J. C. MITCHELL, M. D.,

Superintendent Hospital for Insane, Brockville, Ont.

The problem of satisfying the hunger of the inmates of a provincial or state hospital at a moderate expense, and with a menu nutritive, varied and palatable, cannot be overestimated. Since the prices of all food products have advanced to such a height during the past two years (owing to the demands made on us by the great war for freedom in which we are all so zealously engaged), this question has become a very vital one.

During the past seven years those having to do with this question in our hospital, have made a greater effort than ever before to vary the monotony of the meals. "Variety is the spice of life," and this is notably so in feeding the large number we have in our various hospitals. A large number of our patients are so advanced in dementia that the quality or kind of food does not appear to make much difference to them. Many of them are gluttonous and will eat not only the portion allotted to them but that belonging to their neighbors if they can lay hands on it. "Ne'er looks to heaven amidst his gorgeous feast, But with besotted base ingratitude

Crams, and blasphemes his feeder."

We always have, however, a large number to whom the kind and quality of foods is very essential. We all notice in going through our wards, when we have some special change in the quality of the meal, how pleased the better class of patients are. A good and satisfying meal that appeals to them makes such a difference in their attitude, they are so much better natured, so much kinder with each other than they are when they have a meal that is insufficient, poor in quality or served in such a way that it arouses a feeling of resentment. Food, no matter how plain in quality if well cooked, seasoned, and properly served appeals to our senses in such a way that it makes a great difference to our daily lives. It must be ample in quantity and bulk, and served with fruit and

* Read at the seventy-fourth annual meeting of the American MedicoPsychological Association, Chicago, June 4-7, 1918.

vegetables. If properly cooked and tastefully served it becomes a very valuable therapeutic agent in our type of hospitalspatients are so much more accessible and respond so much better to treatment.

As carefully as we have looked into this subject, and as much time and thought as we have given to its consideration, we are not able to satisfy ourselves that we are doing the best we can for our patients.

For many years the diet in our hospital was extremely monotonous. Breakfast consisted of porridge, bread and butter and tea. Dinner-boiled beef (with the exception of Friday when fish was furnished for most of the patients), potatoes, one or more vegetables and boiled rice or a pudding. Supper-bread, butter and tea with stewed figs, prunes or syrup and cheese on Sunday evening. On Thanksgiving Day we served pork, and on Christmas Day fowl and an elaborate dinner, and plenty of eggs for all at Easter. These were about all the changes given during the year. In 1911 this diet was varied a good deal by furnishing an occasional soup, and pork in some form for dinner once a week. We raised our own pigs, and our fat cattle were purchased for us, and they were butchered and prepared at our own institution. Fish for Friday was so difficult to procure fresh in summer that we began the use of canned salmon. This we found worked so well that we have kept it up ever since. We have found it to be cheaper and more palatable and we serve it in different waysoccasionally cold but usually heated and served with white sauce.

In 1914 our Department (the provincial secretary's) in the Ontario Government instituted a plan to be followed in all our hospitals by which we were to adhere to the basic dietary ration table, as prepared for the New York state hospitals. The plan issued to us embraced not only the patients but the officers and employees. We still follow this ration table but have made some changes as we found the bread was not sufficient to satisfy our people. We issue to patients a daily bread ration of 14 to 15 ounces, meat 4 ounces, beans 1 ounces, butter 1 ounces, rolled oats I ounce, sugar 1 ounces, cheese 1 ounces, tea ounce and potatoes 7 ounces. We find this ration works out very satisfactorily. We have a large blackboard, placed in a prominent part of the central kitchen, which gives at a glance the number of