him, possibly even by the tube; the result is usually more or less emaciation and may result in marked malnutrition; similarly the sleep may be seriously interfered with, even though the patient is quiet. The resulting loss of sleep and malnutrition sometimes lead to the death of the patient. On the other hand, the patient may moan and wring his hands in anguish, walking up and down, crying out that he is a sinner and that he wants to die and the like. This is the so-called melancholia agitata. The physical symptoms of importance are sleep disturbances, poor appetite, with emaciation, cyanosis, often a subnormal temperature, low blood pressure, slowed heart action and weakened circulation. The hair may become gray, the skin dry and harsh and indeed any of the signs of senile decay may appear. =Diagnosis and Prognosis.=—These depend partly upon the mental symptoms, partly upon the physical. On the mental side is to be emphasized marked depression, with the relatively clear orientation, resembling the depressed phase of Manic Depressive insanity; also the dominance of the self-accusatory delusions. On the physical side the age period, and the evidence of previous attacks, even though very slight. The prognosis from the study of the mental symptoms depends on the presence or absence of signs of defect, or deterioration, as for example foolish and silly delusions. On the physical side the presence or absence of conditions like kidney or arterial disease; in general, it may be said if the physical findings are negative and the mental symptoms show no deterioration there should be a good outlook, particularly if the condition has not become too chronic. A favorable outlook is always possible if the disease is treated early and the lesions disturbing the activities of the glands and of nutrition and the circulation are corrected and if the other physical findings are negative and signs of deterioration absent. Since this is probably only a sub-group of the Manic Depressive Psychoses, as has been mentioned above, the results obtained under osteopathic treatment are noted under the Manic Depressive group. Remarks by Dr. Hildreth Our experience with this class of cases invariably lead us to the nerve centers which regulate and control the process of nutrition and circulation; it is a matter of keeping up normal equilibrium of all organic life and especially the circulation to the brain. The basis of the treatment therefore is to be found in the nutritive centers, as well as those centers which control the circulation to the brain, the ductless glands, etc. Senile Dementia Senile Dementia may be defined as an abnormal weakening of the mind arising in old age. As the word dementia implies, the intellectual change is quantitative rather than qualitative, the prime characteristic of the disease being mental loss rather than mental perversion.