w^\ Science HQ 750 . Al B85 Ciltramt itf » m yo 7^^^c^q Pttrcl|n$ti^ from am on before ♦ »■»♦»♦»♦♦»♦♦»♦»♦♦♦♦» -♦ — ♦--»—♦ ♦♦♦♦■♦ Eugenics Record Office BULLETIN No. 5 A STUDY OF HEREDITY OF INSANITY IN THE LIGHT OF THE MEN- DELIAN THEORY BY A. J. ROSANOFF, M.D. AND FLORENCE I. ORR, B. S. KINGS PARK STATE HOSPITAL, KINGS PARK, NEW YORK Reprinted from American Journal of Insanity Vol. LXVIII, No. 2, pp. 221-261, 1911 Cold Spring Harbor, N. Y. October, 1911 ♦ ♦ » — » — ♦ — ♦ — « — ♦ — ♦ — o — ♦ — ♦ — ♦ — ♦ — ♦ — ♦ — ♦ — ♦ — ♦ — « — ♦ — ♦ — « — ♦— » — » » "TSTH^ 3 0 83 0 SI ^ z H s p < H 0, Normal off- spring. ■3 i* o. KR X RRoo RR b. DRX RR 00 DR + RR bi. c. DD X RR* DR d. DRXDRaoDD + 2DR + RR di. e. DD X DRoo DD+ DR /. DD X DDco DD Totals....' 17 75 11 37 216 46 66 284 20 U 61 13 7 34 6 55 335 39 20 92 12 0 206 0 0 1,097 146 14 54 64 84 841^ 1(16 130 0 0 8 7^-4 99 7314 0 0 0 0 351 359 10 85 154 45 21 194 77 0 0 84Vj 130 46 21^ 219% 77 0 678 Some of the data represented in the table require special explanation. Among the offspring which resulted from matings of the first type, RRxRR, ten are recorded as being normal, although 228 A STUDY OF HEREDITY IN INSANITY [Oct. theoretically all should be neuropathic. Of these ten one died at the age of thirty-eight years in an accident, during life suffered from asthma, had a son who died in convulsions; another is described as being easy going, is somewhat odd and possibly abnormal in" make-up, is twenty-nine years of age ; the rest are from eight to twenty-two years of age. In other words, in two of the ten subjects the neuropathic constitution is not positively excluded and the remaining eight have not reached the age of incidence. The matings of the second and fourth types, DRxRR and DRxDR respectively, have been divided into two groups each, as already explained in the preceding section : thus groups b and d in the chart include the matings in which the simplex condition of either or both mates, as the case may be, is definitely ascer- tained, the existence of neuropathic manifestations either in an- cestors or in collateral relatives of the subjects appearing in the pedigrees ; groups fe^ and d^, on the other hand, include the matings in which the simplex condition of either or both mates is assumed to exist on the basis of the character of the offspring. It is perhaps not surprising that groups b^ and rfi are larger than b and d respectively when we consider the great likelihood of a neuropathic taint, derived from an ancestor of a remote genera- tion, being transmitted many times in the shape of a simplex condition, and at the same time the fact that our investigations extended in almost all cases no farther back than the generation of grandparents. As is shown in the table the correspondence between theoretical expectation and actual findings is in some cases exact and in all cases remarkably close. It would seem, then, that the fact of the hereditary transmission of the neuropathic constitution as a reces- sive trait, in accordance with the Mendelian theory, may be regarded as definitely established. The material represented in the table appears elsewhere in this paper in the shape of pedigree charts with detailed references to all neuropathic individuals. Among the subjects who have been counted as neuropathic were, on the one hand, those who were recognized as insane, epileptic, hysterical, or feeble-minded, and on the other hand, those who presented anomalies of conduct or disposition which were even in the conservative judgment of our 191 1 ] A, J. ROSANOFF AND FLORENCE I. ORR 229 lay informants related to the neuropathic conditions. At the same time we have counted as normal all cases of mental or nervous disturbance resulting from arteriosclerotic disease with strokes, paralyses, aphasias, etc. § 4. Dissimilar Heredity. Degrees of Recessiveness. Heretofore we have dealt with the neuropathic constitution as a unit, comparing it with the normal condition. The great variety of neuropathic manifestations and the facts of dissimilar heredity show, however, that the neuropathic constitution in reality con- sists of a series of entities which are distinct, at least from the standpoint of clinical definition, though at the same time evidently in some manner related to each other. The phenomenon of dissimilar heredity has, indeed, in the opinion of some cast a doubt upon the validity of conclusions which are in part based upon the assumption of the existence of an essential relationship between the most diverse clinical neuro- pathic manifestations. It must be admitted that the burden of proof rests upon those who assume that imbecility, epilepsy, de- teriorating psychoses, periodic psychoses, paranoic conditions, involutional psychoses, the slighter psychopathic states, and certain eccentricities are all etiologically related. It is for them to explain why the neuropathic constitution leads in some cases to death from convulsions in early childhood, and in others to but a transi- tory depression at the involutional period, the subject being at least approximately normal during the greater part of his life. It is for them to explain why in some cases there is profound congenital mental defect, in others a dementing process coming on in early adult life, in still others recurrent but non-dementing insanity, and in others again a mere predisposition to mental dis- turbance which for many years remains latent and is brought to light only through the operation of some external cause. Some parts of our material seem to throw some light upon the nature of the relationship which exists between various neuro- pathic manifestations. Thus the pedigree charts of at least four families point to the existence of different degrees of recessive- ness. In other words, certain neuropathic conditions, though clearly recessive as compared with the normal condition, are at the same time dominant over other neuropathic conditions which 230 A STUDY OF HEREDITY IN INSANITY [Oct. are, so to speak, of a more pronounced degree of recessiveness. It appears in a most marked way that recoverable psychoses arc dominant over epilepsy and allied conditions. It seems necessary to assume that the normal development and function of the nervous system is dependent not upon a single unit determiner in the germ plasm, but upon a group of deter- miners, and that the number of units lacking from that group determines the special type of defect to be observed clinically. It may be recalled that a similar assumption has been found neces- sary for the understanding of the inheritance of other Mendelian characters, notably various shades of skin pigmentation." For convenience in presentation conditions of slighter degree of recessiveness, like recoverable psychoses, may be designated by the capital letter R, and those of more pronounced degree of recessiveness, like epilepsy, by the small letter r. In Chart I " we find an instance of the union of a manic-de- pressive subject, of a family heavily tainted with manic-depressive CHART I. L. R, CASE NO. 4215. (£) (^ 7* [1] [t] Cl] 1. Insane before death. 2. " Nervous prostration," in sanitarium four weeks, recovered. -^ 3. Manic-depressive insanity, in State hospital. 4. Manic-depressive insanity, in State hospital. 5. Manic-depressive insanity, in State hospital. 6. Epilepsy, in State hospital. 7. Manic-depressive insanity, in State hospital. insanity, with a mate who is normal but who carries the taint of epilepsy. That mating may be represented by the following formula : RRxDrooDR + Rr. ^'' Davenport. Heredity of Skin Pigment in Man. The American Naturalist, Vol. XLIV, Nov. and Dec, 1910. " In all charts the following symbols have been employed : a square indicates a male subject; a circle indicates a female subject; □ or O = normal subject with normal progeny; 0 or @ = normal subject without progeny; M or ^ = normal subject with neuropathic progeny; ■ or • = neuropathic subject; S or ® = subject died in childhood; [3 or (D^=data unascertained. The type of mating is in each instance indicated by a small letter: a, b, bi, c, d, di, e, as in Table II. I9II] A. J. ROSANOFF AND FLORENCE I. ORR 23I In Other words, the offspring from such a mating may be either normal or manic-depressive, but not epileptic, — and such in fact was the actual result as shown in the chart. In Chart II we find an instance of the union of a normal sub- ject, whose mother suffered from a psychosis described by our CHART U. M. S. CASE NO. 65f'8. (2) (t) d)v* (2)^4 1. Hysterical when a girl; had idea someone was trying to poison her. 2. Epilepsy. 3. Epilepsy. i. Manic-depressive insanity, in State hospital. 5. Very nervous. informant as being in the nature of hysteria, with an epileptic mate whose father was also epileptic. That mating may be rep^- resented by the following formula : DRxrrooDr + Rr. In other words, the offspring from such a mating may be either normal or having a psychosis recoverable in its nature and pos- sibly resembling hysteria, but not epileptic; the chart shows that of the six offspring two died in childhood, two were normal, one had manic-depressive insanity, and one was " very nervous," but none were epileptic. Similarly in Chart III we find a mating which may be repre- sented by the following formula : RRxDrooDR + Rr. Of the four offspring one died in childhood, one was normal, one had manic-depressive insanity, and the remaining one is de- CHART HI. B. S. CASE NO. 7002. A & 0 6 dAf^ a Qv4 [J]A 1. Senile deterioration. 2. Crank. 3. Recurrent melancholia with insomnia; five months in sanitarium. 4. Convulsions in childhood. 5. Convulsions in childhood. 6. Easily excited, nervous temperament. 7. Manic-depressive insanity, in State hospital. 232 A STUDY OF HEREDITY IN INSANITY [Oct scribed as being easily excited and of nervous temperament, but none had convulsions or epilepsy. Finally in Chart IV we have an instance of the union of an epileptic subject, of a family tainted with epilepsy, with a mate who suffered from recurrent attacks of depression with insomnia ; this mating may be represented by the following formula: rrxRRooRr. CHART IV. F. M. S. CASE NO. 8432. ij^^^^.if^ a [t] (j] [t] 1. Alcoholic, died from acute alcoholism. 2. Had feeble-minded, queer, insane daughter. 3. " Money mad," very cruel, very miserly though wealthy, left much of his money to housekeeper. 4. Daughter had fainting spells. 5. Has feeble-minded, queer son. 6. Fainting spells. 7. Recurrent attacks of depression. 8. 22 years old. 9. Recurrent attacks of depression, several suicidal attempts, in State hospital. 10. Manic-depressive insanity. In State hospital. 11. Attack of depression with suicidal tendency; recovery after three months. 12. 20 years old. 13. 15 years old. In Other words, all the offspring from such a mating should be neuropathic, suffering from a recoverable psychosis, but not from fainting spells or any other epileptic manifestation. The chart shows that of the seven offspring which resulted one died in childhood, three were normal being between fifteen and twenty- two years old, — probably below the age of incidence, — and the remaining three suffered from recoverable psychoses, but not from epilepsy. a It is probable that there are many degrees of recessi^^ness, but there is a great deal of evidence to show that degrees of recessive- ness do not account for all varieties of clinical neuropathic mani- festations. § 5. Neuropathic Equivalents. In studying any neuropathic defect one must bear in mind that its clinical manifestations will vary with the personality of the subject and with conditions of environment. It is indeed a 191 1 ] A. J. ROSANOFF AND FLORENCE I. ORR 233 notorious fact that most of the so-called clinical entities are remarkable for the variety of their manifestations. This fact has necessitated the introduction in clinical practice of the conception of neuropathic equivalents. Thus notably in epilepsy it has long been found necessary to bring- together such manifestations as fainting spells, convulsive seizures, psychical attacks, brief ab- sences, spells of automatism, periodic dipsomania, etc. More recently Kraepelin has shown that certain depressions, manias, circular and mixed states are but various phases of the same underlying constitutional disorder analogous to the various equivalents of epilepsy."* And Dreyfus has been able to establish the fact that the anxious depressions of the involutional period are but a special variety of manic-depressive insanity ."^ Similarly, in one immense group, under the general heading of dementia prsecox we now, following Kraepelin, include such widely contrasted conditions as simple hebephrenia, catatonia, and delire chroniqiie a evolution systematiqne — conditions which were long regarded as independent clinical entities. Thus in clinical psychiatry progress has been marked by a simplification of classification through a far-reaching extension of the conception of clinical equivalents. Some of the data furnished by our material seem to indicate the necessity for a still further extension of this conception. It is interesting to note that what we learn in institutional experience to recognize as insanity is a comparatively uncommon group of manifestations of the neuropathic constitution, for of our total of 437 neuropathic subjects (not counting the 21 who died in convulsions in early childhood) only 115, or 26.3 per cent, pre- sented at any time in their lives indications for commitment to sanitariums or hospitals for the insane; moreover, it is obvious, where the facts are known in detail, that in most cases in which such indications have occurred they were in the shape of special reactions to special environmental conditions ; and it seems equally obvious that our definition of the various types of neuropathic constitution must be in terms not of such special reactions, but rather of the more stable and more general underlying psychical traits and tendencies. " Kraepelin, Psychiatrie, 7th ed., Vol. II, p. 558. "^ Dreyfus, Die Melancholic, ein Zustandsbild des ntanisch-depressiven Irreseins, Jena, 1907. 234 A STUDY OF HEREDITY IN INSANITY [Oct. Thus in families of patients suffering from manic-depressive insanity we find not only subjects clearly recognized as insane, but also subjects described as follows: high-strung, excitable; dictatorial, abnormally selfish ; awful temper ; periodic drinker, a demon when drunk; committed suicide; had severe blue spells. In the pedigrees of cases of dementia prsecox we find ancestors and collateral relatives described in the following significant terms : cranky, stubborn ; worries over nothing ; religious crank ; nervous, queer ; restless, has phobias ; suspicious of friends and relatives. And in the families of epileptics we find, besides cases of actual epilepsy or convulsions in infancy, also cases of hemicrania, re- current sick headaches, fainting spells, nervous fidgety make-up, and the like. The limits of the legitimate extension of the conception of equivalents thus seem to be beyond even the widest limits estab- lished by clinical definition. It is not to be assumed, however, that members of the same family necessarily suffer from the same neuropathic defect in the shape of various clinical equivalents, for even brothers and sisters, children of the same parents, may suffer from neuropathic de- fects representing not equivalents but different degrees of re- cessiveness. Theoretically there is, in fact, only one combination of mates of which all neuropathic offspring will necessarily suffer from equivalent defects. The third, fifth, and sixth combinations (RRxDD, DRxDD, and DDxDD) need not be considered at all in this connection as from them no neuropathic offspring will result. But let us consider the remaining three combinations (RRxRR, RRxDR, DRxDR) from which neuropathic off- spring may result. If it is true that neuropathic defects may represent different degrees of recessiveness, as we have endeavored to show in a preceding section, then in the case of any neuropathic subject we have no way of telling whether the inheritance of his defect is homozygous or heterozygous, unless we possess an exceptionally detailed pedigree extending far back to past generations ; in other words, we cannot tell whether he inherits from the two parents defects of the same or of different degrees of recessiveness. Con- tinuing to make use of the symbols R and r to represent, re- 191 1 ] A. J. ROSANOFF AND FLORENCE I. ORR 235 spectively, lesser and more pronounced degrees of recessiveness, a given neuropathic condition may accordingly be represented either by the symbol RR or Rr ; and similarly the condition of a normal subject who represents simplex inheritance, i. e., who inherits the neuropathic taint from one parent, may be repre- sented either by the symbol DR or Dr. It may be readily seen, then, that in the case of either the first or second combination there are possibilities of offspring with more than one type of neuropathic defect, i. e., of defects of different degrees of reces- siveness, as may be shown by the following formulae: 1. RrxRrooRR + 2Rr + rr. Rr X rr 00 Rr -I- rr. 2. RrxDrooDR-f-Dr-f Rr + rr. The neuropathic conditions in the children resulting from such matings would not necessarily be equivalents. But in the case of the fourth type of mating, that of two sim- plex individuals, /. e., two individuals who are normal but carry the taint from their ancestors, the neuropathic offspring which may result would in any instance show defects which are theoret- ical equivalents ; for from every theoretically possible variety of combination only one type of neuropathic offspring can result, as may be shown by the following formulae : DR X DR CO DD + 2DR -f- RR. DRxDrooDD + DR + Dr + Rr. Dr X Dr 00 DD -f- 2Dr + rr. Clinical manifestations will, of course, vary with the personal- ity of the subject, the age at which the disorder makes its appear- ance, the nature of the exciting cause, and other environmental conditions ; but in spite of such variations we are able, in the light of a better knowledge of the mechanism of heredity, to identify neuropathic equivalents at least when they occur in brothers and sisters who are the offspring of the matings of the fourth type. In matings of this type only one-fourth of all the offspring, on the average, exhibit the neuropathic condition; therefore most such families have not more than one neuropathic subject and do not afford an opportunity of comparing neuropathic equiva- lents ; but many large families, or some in which by an unlucky chance more than one neuropathic subject has resulted, do afford 236 A STUDY OF HEREDITY IN INSANITY [Oct. such an opportunity, and thus a new aid for the study of neuro- pathic equivalents becomes available. In our own material the pedigree charts from V to XXIX present instances of matings of the fourth type from each of which two or more neuropathic offspring have resulted. Comparisons of the brothers and sisters in these famihes reveal points of rather peculiar interest. In some instances the manifestations clinically observed were either similar or identical; such instances are to be found in Charts VII, IX, XV, XVI, XVII, XX, XXIII, and XXV. In other instances we find well defined psychoses alongside of cases presenting oddities of conduct or of disposition which are familiar to physicians as types of make-up constituting the char- acteristic soil upon which the psychoses develop." Thus in Chart XV we find a case of dementia prascox, in a brother " nervous hysteria when his sister died, had hallucinations of sight and hearing, was disturbed and had to be restrained," and in a sister "nervous temperament, easily excited, has weak spells." In Chart XXI we find in one case " nervous breakdown early in life, was unable to work, recovered," in a sister " awful temper." In Chart XXVI we find in one case the following note : " insane twice, very disturbed, recovered each time," and in a sister " odd, nervous temperament, easily excited." In Chart XXVIII we find a subject who was " insane a few months before death," in one sister " melancholy disposition, had nervous prostration," and in another sister " nervous temperament, melancholy." Perhaps the most striking finding is that of fainting spells or convulsions in childhood alongside of dementia prsecox; this occurs in Charts V, VI, VIII, XI, and XII. In this connection may be recalled the rather frequent occurrence of seizures of various sorts in dementia prsecox — fainting spells, epileptiform convulsions, muscle spasms, etc. : according to Kraepelin in 18 per cent of all cases." Finally we would point out the occurrence, as neuropathic "Aug. Hoch, Constitutional Factors in the Dementia Prcecox Group, Rev. of Neurol, and Psychiatry, Aug., 1910. — Ed. Reiss, Konstitutionelle Verstimmung und manisch-depressives Irresein, Zeitschr. f. d. gesamte Neurol, u. Psychiatrie, Vol. II, p. 600, 1910. " Kraepelin, Psychiatrie, 7th ed.. Vol. II, p. 188. I9II] A. J. ROSANOFF AND FLORENCE I. ORR 237 equivalents, of conditions which are cHnically altogether dissimi- lar. For instance, in Chart XVII one subject is noted as having been " insane during pregnancy with second child, recovered," and her sister as a " religious recluse, nun in convent in Aus- tralia " : perhaps in this instance the difference between the mar- ried state and celibacy accounts for the difference in manifesta- tions. In Charts XIX and XXVII we find cases of senile dete- rioration related to peculiar psychoses occurring earlier in life ; in one case we find the following note : " When a girl went to Washington, lost her money, could not tell why she went there, was placed in an institution ; says a man has ' witched ' her ; has in her pocket a bottle of gin which she takes ' for blood poison ' " ; — in another case : " Irritable in early years of marriage, had hysterical spells, ill-treated her step-children " ; — and in a third case : " Nervous after sister's death, was too nervous to be in- terviewed or visited by anyone." In Charts XXII and XXIX the following cases are associated as family equivalents with epilepsy : " Moderately alcoholic, ideas of persecution against relatives " ; — " Loquacious, rambling, odd, had severe attacks of depression following childbirth"; — "Subject to spells of severe depres- sion " ; — " Seems to have lost interest in life, when interviewed would say only ' I know nothing more than sister told you ' " ; — " Moderately alcoholic, never settled down to anything but roamed around all his life until he died at the age of 62 years of pneu- monia." It should be pointed out here that in classifying the matings there is always a possibility of error especially in the direction of overlooking neuropathic traits and, owing to misin- formation or misjudgment of our informants, counting one or both mates as normal who should properly be counted as neuro- pathic. Thus in individual instances matings classified as belong- ing to the fourth type (DRx DR) may in reality be of the second type (RRxDR), in which case, as already shown, the neuro- pathic offspring may present defects of different degrees of re- cessiveness and not necessarily equivalents. Errors could be guarded against only with the aid of a large amount of material ; in other words any two dissimilar neuropathic manifestations should not be definitely classed as equivalents unless they are repeatedly met with in brothers and sisters of a large number of families resulting from matings of the fourth type. 238 A STUDY OF HEREDITY IN INSANITY [Oct. CHART V. F. R. CASE NO. ij] 6 6 0 g a ^# Q ' 1. Died insane in State hospital. 2. Hysterical spells for about three years. 3. One daughter insane, in State hospital. 4. Insane, in State hospital, recovered, insane again at 76 years. 5. Died in com-ulsions in childhood. 6. Dementia praeco.^:, catatonic, in State hospital. CHART VI. E. C. CASE NO. 7048. dx4j# i£3~^44 [£]vii!4ii [j] (s) [t](s)[f][£l^iid)(s)[£][£] 1. Nervous temperament, easily excited, moderately alcoholic. 2. Nervous, erratic, excitable. 3. Fainting spells. 4. Nervous temperament, easily excited. 5. Easily excited, moderately alcoholic. 6. Dementia praecox, catatonic, in State hospital. CHART VII. J. C. CASE NO. 2921. tl (s) ti u 6 / 1. Daughter was sister of mercy in Australia; is said to have died of homesickness. 2. Feeble-minded, eccentric, laughs without cause, says " I don't know " in reply to simple questions. 3. Died insane at asylum in Cork. 4. Was insane at asylum in Cork; was discharged improved but is still queer. 5. Dementia praecox, at State hospital. 6. Dementia praecox, at State hospital. CHART Vm. T. H. CASE NO. 6330. m^^ © © [t] a 6 /* * ® ^# 6 v* a (5 1. Nervous temperament, fidgety, has nervous son. 2. Dementia praecox, paranoid, in State hospital. 3. Convulsions following small-pox at the age of 5 years. 4. Died in convulsions at the age of 1 year. I9II] A. J. ROSANOFF AND FLORENCE I. ORR CHART IX. M. O'T. CASE NO. 6115. 239 ^ o .ii [t] (2) a.* [^ (2) a s is (!) <& 1. Very irritable, violent temper. 1. Dementia praecox, in State hospital. 3. Dementia prsecox, in State hospital. CHART X. R. M. CASE NO. 6459. n= ti (i)^4b.li (i) (2) (s) 1. Quick tempered. 2. Became melancholy due to disappointment. 3. Dementia pnecox, "paranoid, in State hospital. aiART XI. F. S. CASE NO. 6492. D^ 1. Dementia prseeox, paranoid, in State hospital. 2. Died of convulsions during teething in childhood. CHART XII. E. H. CASE NO. 01655. .S^ <£) 111 0 (2) [°] ih (£) (^ 1. Fainting spells. 2. Son has dementia praecox, in State hospital. 3. Daughter has fainting spells. 4. Dementia praecox, simple, in State hospital. 240 A STUDY OF HEREDITY IN INSANITY [Oct. W^ CHART XIII. M. H. CASE NO. 6323. S^ 1. Committed suicide by han^ng'. 2. One daughter insane, another eccentric. S. One son mentally defective. 4. Alcoholic. 5. Eccentric, quick-tempered, " crazy John." 6. Eccentric, traveled about alone at night, slept through the day. 7. Alcoholic, left his family. 8. Committed suicide by hangfing. 9. Daughter committed suicide. 10. Nervous temperament, easily upset. 11. Nervous temperament, " fretter," son was insane and recovered. 12. Nervous temperament, son nervous. 13. Very peculiar, eccentric. 14. Epileptic. 15. One son mentally defective. 16. Nervous temperament, queer in spells, eccentric. 17. Eccentric, begs gloves, handkerchiefs, etc., without need. 18. Nervous temperament. 19. Alcoholic, nervous temperament. 20. Nervous. 21. Eccentric, never associated with anyone, lived year round in outside kitchen. 22. Dementia praecox, paranoid, in State hospital. 23. Nervous temperament, easily excited, easily upset; daughter also nervous and excitable. CHART XIV. J. H. CASE NO. 7055. II! ■ u/ v^3--rw^4 6 6 6 d 6 1. Senile deterioration. 2. Very alcoholic, died at age of 40 years of " paralysis." 3. Violent temper, ideas of persecution against friends. 4. Was nervous following the birth of first child, recovered. 5. Very nervous temperament. 6. Nervous breakdown several times. 7. Dementia praecox, catatonic, in State hospital. 8. Nervous temperament. 9. Nervous temperament. CHART XV. F. E. CASE NO. 7183. WMmWWW^ (e)'/4s4 Q^ii fi Szii 1. Nervous, little things bothered her, worried a great deal; her daughter was nervous and melancholy. 2. Son had convulsions in childhood. 3. Excitable, nervous, worries. 4. Nervous temperament; easily excited; has "weak spells." 5. Daughter had convulsions in childhood. 6. Dementia praecox, paranoid, in State hospital. 7. Had " nervous hysteria " when his sister died; had hallucinations of sight and hearing; was disturbed and had to be restrained. ipllj A. J. ROSANOFF AND FLORENCE I. ORR CHART XVI. H. M. CASE NO. 6672. 1. Dementia praecox, hebephrenic, in State hospital. 2. Dementia praecox, simple, in State hospital. 241 CHART XVII. D. H. CASE NO. 6699. fO .*lll|t][tl[tl6vll(t)[iltl*f* d (b Q/* 111 1. Violent temper, screamed when she got angry, flighty, " if anj'thing ails her it goes to her head." 2. Insane. 3. Alcoholic. 4. Epilepsy; daughter nervous. 5. One daughter had nervous prostration following childbirth and died; another daughter is nervous. 6. Nervous, eccentric. 7. Is nervous, has fainting spells, suffers from neuralgia, had nervous prostration at meno- pause; one child died ha convulsions. 8. Nervous. 9. Dementia praecox, in State hospital. 10. Died in convulsions in childhood. CHART XLVI. C. R. S. CASE NO. 17242. 6 ^,4m ihMrM^ m 1. Nervous and queer. 2. Two sons were insane; one had melancholy spells, was in an asylum, committed suicide; another is still in an asylum. 3. Very irritable and eccentric, had spells when he was violent and ill-treated his wife, was by some considered insane. 4. " Nervous." 5. Has feeble-minded, nervous son. 6. Was insane, committed suicide. 7. Nervous, irritable, very eccentric, religious crank. 8. Spells of eccentricity, " out of her mind at times." 9. Epileptic, alcoholic, criminal, in State hospital. 10. Dementia praecox, paranoid, in State hospital. 11. Died in convulsions in infancy. 252 A STUDY OF HEREDITY IN INSANITY [Oct. CHART XLVII. C. R. S.'S STEP-BROTHERS AND STEP-SISTERS. CASE NO. 17242. ■1, r III b.liv# (b [±1 1. Nervous, irritable, very eccentric, religrious crank; C. R. S.'s father. 2. Has fainting spells, flta of craziness at monthly periods, tears her hair, etc. 3. Irresponsible criminal, committed theft several times, not well-balanced, degenerate, moderate drinker. 4. Nervous, has fainting spells, " nervous prostration." CHART XLVni. O. D. CASE NO. 58!>4, (°) yep g 1. Nervous, " not right," ideas of jealousy, " subject to fits of unreasonable anger, turned guests out of the house." 2. Eccentric, irritable. 3. Has very nervous daughter. 4. Has nervous son. 5. Very eccentric in dress and manners; one daughter has fainting spells; another is " out of her mind by spells." 8. Dementia prsecox, paranoid, in State hospital. CHART XLIX. H. N. CASE NO. 3962. ^^10 <£) ^ 1. Was insane for eight years before he died. 2. Nervous. 3. Nervous, insomnia, neuralgia. 4. Dementia praecox, in State hospital. CHART L. M. E. S. CASE NO. 4455. /■tO fii^ (& I 1. Had feeble-minded child. 2. Insane for one year following injury to spine, was in eanitarium, recovered without trace of organic trouble. 3. Nervous temperament. 4. Paranoic condition, in State hospital. CHART LVin. C. L. C. CASE NO. 6381. 1. Eccentric, feeble-minded, epileptic. 2. Insane epileptic, in State hospital four years. 3. Insane epileptic, in State hospital. CHART LIX. E. A. CASE NO. 6429. .S 6 6 i^.^ 1. Feeble-minded. 2. Queer, never saw neighbors, stayed in the house, kept doors and windows locked. 3. Dementia praecox, in State hospital. CHART LX. A. W. CASE NO. 6172. o0 LJ /zWi oW /vwH fMl 1. Very alcoholic, cranky, stubborn, convulsions. 2. Daughter nervous, " worries over nothing." 3. Highly nervous temperament, " crosses bridges before he comes to them." 4. Nervous temperament, moderately alcoholic. 5. Highly nervous temperament, irritable nature, worries over little things. 6. Fainting spells. 7. Shiftless, alcoholic, periodic sprees. 8. Children have epilepsy and fainting spells. 9. Religious crank, alcoholic. 10. Inferior make-up, possibly epileptic. 11. Worries over things; blue spells; " way up then way down." 12. Highly nervous temperament, " worries over things which never happen," alcoholic. 13. Dementia prsecox, inferior make-up, in State hospital. 14. Very alcoholic. 15. Formerly very alcoholic; had a convulsion at the age of 21 years. 256 A STUDY OF HEREDITY IN INSANITY [Oct. CHART LXI. F. M. CASE NO. 7277. 6 6 [ti d) (t]^i [t] [t] (2) 6 [£] 1. Periodic drinker, " a demon when drunk." 2. Rambler. 3. Delusional psychosis at menopause lasting nine years. 4. Recurrent delusional psychosis allied to manic-depressive insanity, in State hospital. CHART LXII. M. C. CASE NO. 6868. 9 9 /e>W t/^k /^W 1. High-tempered, excitable, impulsive. 2. High-strung, excitable, alcoholic. 3. Alcoholic, daughter high-strung. 4. Extremely nervous, eccentric. 5. Daughter has nervous temperament, fidgety, easilv excited. 6. High-strung, periodically alcoholic. 7. Had nervous prostration eleven years ago, lasted two years, never fully recovered. 8. Alcoholic, wanderer. 9. High-strung, nervous temperament. 10. Very excitable, high-strung. 11. Constitutional inferiority, in State hospital. 12. Fidgety, cannot keep still. CHART LXIII. E. McG. CASE NO. 7180. ' 6AM^ ^ ^ m 0 d 1. Had very alcoholic son who was found dead. 2. Son had neuralgia. 3. Fainting spells. 4. Fainting spells. 5. Child died in convulsions. 6. Died in convulsions in infancy. 7. Died in convulsions in infancy. 8. Dementia praecox, paranoid, in State hospital. 9. Fainting spells; child died in convulsions in infancy, other children normal. 191 1 J A. J. ROSANOFF AND FLORENCE I. ORR 257 CHART LXIV. S. W. CASE NO. 6965. d a (i) (t) a"~1^4 6 >.^ \si <£>fik (s)1m d'/i 1. Epilepsy. 2. Insane for a time, recovered. 3. Epileptic imbecile. 4. Imbecile. 5. Melancholia in early married life, recovered. 6. Insane five years, was in State hospital, recovered. 7. Insomnia, neuralgia. 8. Daughter had spells of excitement. 9. Feeble-minded. 10. Dementia praecox, catatonic, in State hospitaL 11. Died of marasmus, had one convulsion. CHART LXV. E. K. CASE NO. 6529. .nl :¥m:^ 1. '* Ignorant, queer." 2. Insane, was in sanitarium, committed suicide. 3. Eccentric, violent temper, ideas of persecution against neighbors and relatives. 4. Eccentric, not well-balanced. 5. Alcoholic, lazy, indolent. 6. Dementia praecox, paranoid, in State hospital. 7. Violent temper, queer, extreme dolichocephaly. 8. Defective, cranial malformation. 9. Inferior, " slow." CHART LXVI. C. VAN C. CASE NO. 6470. 3-^i 1. Some children queer. 2. Eccentric, very suspicious. 3. One daughter insane, another eccentric. 4. Nervous, irritable, quick-tempered; suffers from neuralgia. 5. Very eccentric, suspected wife of trying to poison him, later suspected others as well. 6. Insomnia for two years during menopause, extremely nervous. 7. Nervous, quick-tempered; has insane son. 8. Very irritable, nervous, quick-tempered. 9. Very irritable, nervous, quick-tempered. 10. 17 years old. 11. Constitutional inferiority, in State hospital. 258 A STUDY OF HEREDITY IX INSANITY [Oct. CHABT LXVIL A. H. CASE KO. fleCo. S- ^- =- " 4. F - 5. . - -J in cbildhcod. 6. I . ^ - ; -iL CHAET LXVm. J. M<«. CASE XO. TVn. M=0 D=0 ^ 6 © 0.a.BtQ ©^□-'^ .irS~a7i"©~sTii 1. Tim ftv foor or five years ioUiwing motiej Iobbbs, died in hospital 3. Eccentric cnnk, h^k-stumg. 4. CTie daugfater insane. 5. yrfvuus UiJuiptuJiuaiL, fid^cfty. 3. XavooB tea&peiameiic, eaaly excited; one dangbter is neivuus, imagines thinga; sod nerraos, eaalj irritated, p^odic drinker. 7. XerrooB, eai^ij excited, easily fri^tened, periodicaUy alcokdic. S. Paj tiMttifaenia 'with impnlsee and fears, in State hospital. 9. Hernias, has fhftktnc spdb, easily excited. CEAKT T.TTT. T. H. CASE XO. ®31. iS [^ (£) EJ D [£] &=# tn 6 i(bM \^ ^ [STiTi~S~© L yerroGJ, eniGti-iiial, " tot discai: ": 'l^'. in i::i;k c: nielmtfaolia, sat in ccmer. would not eat, smelled peculiar c-dcrs, now -ell. 2. Child ^'a'^ coimilsi-ciDs "' from teething " and died. 3. Child died in ccrrralsicns in infencr. 4. Paiodic alcoholic; daughter had conTulsiocs in infancy. i. Denaitia prscox, paranoid, in Siate boepitaL fi. ConTuLsioBS in infancy: son naroos and had cne conTnlaioa in infancy. CHABT T.XT. J. I> CASE XO. TiSl. H\ u ® 1. Senile deinesr:^. 2. Doo^iter ?ari Trignfr- 3. Ferfile-ffifnrifd. 4. Tvo attaito of atatoua Iveakdown, was melandoly, recovered. Sl Alcoholic 6. Demeatia prasooz, paranoid, in State bcepitaL I9II] A. J. R05AN0FF AXD FLORENCE I. ORR 259 CHART LXH. W. G. CASE KO. S83. 1. Eccentric, prcbablj- in^TW. 2. Very alcoholic. 3. EcceiiTrie, miserlv, sedusiTe, lired in filth, probably ^-naanB 4. Insane, in State hospitaL 5. Eccentric, Terr alcoholic. 6. Dementia prsecox, paranoid, in State ho^itaL 7. Miserlr, " like her mother," had spwlls of veiling, insane. CHART LXXn. P. S. E. CASE NO. 6r&4. 1. Had spells of depresion ai 25 and 41 yeais respectively, would not talk, reeorered ekdk time. 2. Depressed, hvpochondriacal. 3. Always worried abont his health, imagined he had heart trouble. 4. Alcoholic, " has had every disease." 5. Imbecility with maniacal attacks, in State hospitaL CHART T.TVrn. A. J. G. CASE KO. 6511. Q/ii 1-14^ (^6 zd B~5) [t] n Ei.# (I) © n L Insane twice, in State hcKpital, recovered each time. 2. Daughter had convulsions in childhood; later had " nervoiis coH^tse " dne to overwork at school, was in sanitarium two weeks. 3. Dementia precox, in State hospital. § 7. Conclusions. I. The neuropathic constitution is transmitted from generation to generation in the manner of a trait which is, in the Mendehan sense, recessive to the normal condition. Rules of theoretical expectation are accordingly as follows : a. Both parents being neuropathic, all children will be neuro- pathic. b. One parent being normal, but with the neuropathic taint from one grandparent, and the other parent being neuropathic. 26o A STUDY OF HEREDITY IN INSANITY [Oct. half the children will be neuropathic and half will be normal but capable of transmitting the neuropathic make-up to their progeny. c. One parent being normal and of pure normal ancestry and the other parent being neuropathic, all the children will be normal but capable of transmitting the neuropathic make-up to their progeny. d. Both parents being normal, but each with the neuropathic taint from one grandparent, one-fourth of the children will be normal and not capable of transmitting the neuropathic make-up to their progeny, one-half will be normal but capable of trans- mitting the neuropathic make-up, and the remaining one-fourth will be neuropathic. e. Both parents being normal, one of pure normal ancestry and the other with the neuropathic taint from one grandparent, all the children will be normal, half of them will be capable, and half not capable of transmitting the neuropathic make-up to their progeny. f. Both parents being normal and of pure normal ancestry, ail the children will be normal and not capable of transmitting the neuropathic make-up to their progeny. 2. Various clinical neuropathic manifestations bear to one an- other the relationship of traits of various degrees of recessive- ness; in a most marked way recoverable psychoses, though re- cessive as compared with the normal condition, are dominant over epilepsy and allied disorders. 3. Various other clinical neuropathic manifestations bear to one another the relationship of neuropathic equivalents ; that is to say, they are conditions of the same degree of recessiveness vary-^ ing in their clinical manifestations with the personality of the subject, environmental conditions, etc. 4. All the neuropathic children which result from a mating of the fourth type (both parents normal, but each with the neuro- pathic taint from one grandparent) can have theoretically only equivalent defects and not defects of different degrees of re- cessiveness. 5. Among the actual results from such matings the following have been met with : a. Brothers and sisters suffering from clinically identical neuro- pathic manifestations. 191 1 ] A. J. ROSANOFF AND FLORENCE I. ORR 26l b. Psychosis in one subject and peculiar or abnormal disposi- tion, but no actual psychosis, in brothers or sisters. c. Psychosis in one subject and isolated but clinically related symptoms in brothers or sisters ; we find with particular frequency dementia praecox = fainting spells or convulsions in childhood. d. Psychoses clinically not known to be related : senile dete- rioration = peculiar hysteriform psychoses. 6. Neuropathic conditions show only in about one-fourth of the cases indications for commitment to sanitariums or public institutions. The total incidence or neuropathic conditions may be roughly estimated as aflfecting between 1.5 and 2 per cent of the general population. 7. It is further estimated that about 30 per cent of the general population, without being actually neuropathic, carry the neuro- pathic taint from their ancestors and are capable under certain conditions of transmitting the neuropathic make-up to their progeny. Acknowledgments. Many persons have assisted us in various ways in collecting data for our study. We are indebted above all to our informants who have confided to us most intimate family secrets for a purely altruistic purpose. We owe a large debt of gratitude to Dr. William Austin Macy, the superintendent of this hospital, whose unfailing sympathy with the spirit of scientific research has made possible the present study.- And we are also indebted to Dr. Charles B. Davenport, of the Carnegie Institution of Washington, for some suggestions, a good deal of general advice, and actual assistance. J American Breeders' Association— Eugenics Section DAVID STARR JORDAN, Chairman. C. B. DAVENPORT, Secretary The Eugenics Record Office Cold Spring Harbor, Long Island, N. Y. ESTABLISHED in October, 1910, this office aims to fill the need of a clearing house for data concerning "blood lines" and family traits in America. It is accumulating and studying records of mental and physical characteristics of human families to the end that the people may be better advised as to fit and unfit matings. It issues blank schedules (sent on application) for the use of those who wish to preserve a record of their family histories. The Eugenics Section and its Record Office are a development from the former committee on Eugenics, comprising well-known students of heredity and humanists; among others Alexander Graham Bell, Washington, D. C.; Luther Burbank, Santa Rosa, Gal.; W. E. Gastle, Harvard University; G. R. Hen- derson, University of Ghicago ; Adolf Meyer, Johns Hopkins University ; J. Arthur Thomson, University of Aberdeen; H. J. Webber, Gornell University; Frederick A. Woods, Harvard Medical School. The work of the Record Office is aided by the advice of a number of technical committees. Its superinten- dent is H. H. Laughlin, Gold Spring Harbor, N. Y., to whom correspondence may be addressed. PUBLICATIONS Bulletin No. 1. Heredity of Feeblemindedness. H. H. Goddard, April, 1911. 10 cents. Bulletin No. 2. The Study of Human Heredity. C. B. Daven- port, H. H. Laughlin, David F. Weeks, E. R. Johnstone, Henry H. Goddard, May, 1911. 10 cents. Bulletin No. 3. Preliminary Report of a Study of Heredity in Insanity in the Light of the Mendelian Laws. Gertrude L. Cannon and A. J. RosanofF, May, 1911. 10 cents. Bulletin No. 4. A First Study of Inheritance in Epilepsy. C. B. Davenport and David F. Weeks, Nov., 1911. 15 cents. BALTIllOKE, UD., V. a. A. Date Due H-hii^ // / S/rJxV V I^y/ir'Z L. B. CAT. NO. 1137 WELLESLEY COLLEGE LIBRARY 3 5002 03401 6183 Science HQ 750 . Al B85 5 Rosanoff, Aaron Joshua, 1878-1943. A study of heredity of insanity in the light of _ J. \ ,