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The journal of mental science. 

London : Longman, Green, Longman & Roberts, 1859-1962. 

http://hdl.handle.net/2027/nj p.32101074924497 


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THE JOURNAL 

% «• 

OF 

MENTAL SCIENCE. 


EDITORS: 

John R. Lord, M.B. Thomas Drapes, M.B. 

Assistant Editors: 

Henry Devine, M.D. G. Douglas McRae, M.D. 

VOL. LXIII. 



J. & A. CHURCHILL. 

7, GREAT MARLBOROUGH STREET 

MDCCCCXVII. 


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" In adopting our title of the Journal of Mental Science, published by authority 
of the Medico-Psychological Association, we profess that we cultivate in our pages 
mental science of a particular kind, namely, such mental science as appertains 
to medical men who are engaged in the treatment of the insane. But it has 
been objected that the term mental science is inapplicable, and that the term 
mental physiology or mental pathology, or psychology, or psychiatry (a term 
much affected by our German brethren), would have been more correct and ap¬ 
propriate ; and that, moreover, we do not deal in mental science, which is pro¬ 
perly the sphere of the aspiring metaphysical intellect. If mental science is 
strictly synonymous with metaphysics, these objections are certainly valid ; for 
although we do not eschew metaphysical discussion, the aim of this Journal is 
certainly bent upon more attainable objects than the pursuit of those recondite 
inquiries which have occupied the most ambitious intellects from the time of 
Plato to the present, with so much labour and so little result. But while we 
admit that metaphysics may be called one department of mental science, we main¬ 
tain that mental physiology and mental pathology are also mental science under 
a different aspect. While metaphysics may be called speculative mental science, \ 

mental physiology and pathology, with their vast range of inquiry into insanity, 
education, crime, and all things which tend to preserve mental health, or to pro¬ 
duce mental disease, are not less questions of mental science in its practical, that 
is in its sociological point of view. If it were not unjust to high mathematics , 
to compare it in any way with abstruse metaphysics, it would illustrate our 
meaning to say that our practical mental science would fairly bear the same rela¬ 
tion to the mental science of the metaphysicians as applied mathematics bears to 
the pure science. In both instances the aim of the pure science is the attainment 
of abstract truth; its utility, however, frequently going no further than to serve 
as a gymnasium for the intellect. In both instances the mixed science aims at, 
and, to a certain extent, attains immediate practical results of the greatest utility 
to the welfare of mankind ; we therefore maintain that our Journal is not inaptly 
called the Journal of Mental Science, although the science may only attempt to 
deal with sociological and medical inquiries, relating either to the preservation of 
the health of the mind or to the amelioration or cure of its diseases; and although 
not soaring to the height of abstruse metaphysics, we only aim at such meta¬ 
physical knowledge as may be available to our purposes, as the mechanician uses 
the formularies of mathematics. This is our view of the kind of mental science 
which physicians engaged in the grave responsibility of caring for the ,mental 
health of their fellow-men may, in all modesty, pretend to cultivate; and while 
we cannot doubt that all additions to our certain knowledge in the speculative 
department of the science will be great gain, the necessities of duty and of danger 
must ever compel us to pursue that knowledge which is to be obtained in the 
practical departments of science with the earnestness of real workmen. The cap¬ 
tain of a ship would be none the worse for being well acquainted with the higher 
branches of astronomical science, but it is the practical part of that science as it 
is applicable to navigation which he is compelled to study.”— Sir J. C. Bucknill, 

M.D., F.R.S. 


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MED 


CO 

OF 


PSYCHOLOGICAL ASSOCIATION 
GREAT BRITAIN AND IRELAND. 


THE COUNCIL AND OFFICERS. 1916-17. 

president. —DAVID GEORGE THOMSON, M.D. 

PKK 81 UKNT ELECT.— JOHN KEAY, M.D. 
ex-president.— JAMES CHAMBERS, M.A., M.D. 
treasurer.— H. HAYES NEWINGTON, E.R.C.P. 

EDITORS OP JOURNAL / J0HN K. LORD, M.B. 

EDITORS OP JOURNAL. ^ DJaApE g M jj 

DIVISIONAL SECRETARY PoR SOUTH-EASTERN DIVISION 

J. NOEL SERGEANT, M.B. 

DIVISIONAL SECRETARY POR SOUTH-WESTERN DIVISION. 

G. N. BARTLETT, M.B. 

DIVISIONAL SECRETARY POR NORTHERN AND MIDLAND DIVISION 

T. S. ADAIR, M.D. 

DIVISIONAL SECRETARY POR SCOTTISH DIVISION 

KOBT. B. CAMPBELL, M.D., F.R.C.P. 

DIVISIONAL SECRETARY POR IRISH DIVISION 

RICHARD R. LEEPER, E.K.C.S. 

GENERAL SECRETARY.— M. ABDY COLLINS, M.D. 

R. H. STEEN, M.D., M.R.C.P. (Acting Hon. Gen. Sec.). 

CHAIRMAN OP PARLIAMENTARY COMMITTEE. 

H. WoLSELEY-LEWIS, M.D., F.R.C.S. 

SECRETARY OF PARLIAMENTARY COMMITTEE. 

R. H. CULE, M.D., M.R.C.P. 

(both appointed by Parliamentary Committee, but with seats on Council). 

SECRETARY OP EDUCATIONAL COMMITTEE. 

J. G. PORTER PHILLIPS, M.D., M.R.C.P. 

(appointed b> Educational Committee, but with seat on Council). 
registrar.— ALFRED MILLER, M.B. 


representative. 

R. ARMSTRONG-JONES 
H.J. NORMAN Ls.E. D!v. 


f. Div. 


T. E. K. STANSFIELD 
W. H. B. STODDART 
NORMAN LAVERS 
G. STEVENS POPE J s vv 

J. R. GILMOUR |„ ... 

D. HUNTER jN.&M.Div 

JAMES ORR / o 

C. C. EASTERBRO0K \ Scotland. 


MEMHEHS OF COUNCIL. 

REPRESENTATIVE 

M. J. NOLAN 
F. E. RAINSFORD 


| Ireland. 


nominated. 

GEOFFREY CLARKE 

w. k dawson 

R. EAGER 
H. J. MACKENZIE 
G. M. ROBERTSON 
J. G. SOUTAR 


[The above form the Council.] 


AUDITORS 


) R. PERCY SMITH, M.D., F.R.C.P. 

■ ( Maurice ckaig, m.a., m.d., f.r.c.p. 

EXAMINERS. 


ENGLAND 


f R. H. COLE. M.D., M.R.C.P. 

■U. U. PuR 1'ER-PHILLIPS, M.D., B.S., M.R.C.P.Lond., 
v M.P.U. 

TR. DUDS BROWN, M.D., Ch.B., F.R.C.P.Edin., Dipl. 


Scotland ^ Psych., D.P.H 


IRELAND 


JAMES H. MACDONALD, M.B., ChB., F.R.F.P.S.Glasg. 
C T. ADRIAN GREENE, LK.C.S.&P.l. 
i F. E. RAINSFORD, M.D , B.A.Dubl., L.R.C.P.I., 
( L.BC.P.&S.E. 

Examiners for the Nursing Certificate of the Association : 

K. P. TAYLOR, M.D., B S. ; R. B. CAMPBELL, M.D., 

3 » F.KC.P.E.; J. REDING ION, F.R.C.S., L.R.C.P I. 

. ; DAVID ORR, M.D., C.M.Edin 
.S. A P.Edin., Dipl. Psyfcb. 


j, x. > r.xiL.r.ji.; j. lua, r .« 

J. MACKENZIE M.B., C.M. ; 
ypr GEUlftiE DUNLOP ROBERTSON, L.R.C.S 


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11 


PARLIAMENTARY COMMITTEE. 


T. S. ADAIR. 

ROBERT ARMSTRONG-JONES. 

H. T. S. AVELINE. 

FLETCHER BEACH. 

E. H. BERESFORI). 

JAMES V. BLACHFORD. 

DAVID BOWER. 

LEWIS C. BRUCE. 

R. B. CAMPBELL. 

JAMES CHAMBERS. 

R. H. COLE (Secretary). 

M. A. COLLINS (ex officio). 

J. O’C. DONELAN. 

THOS. DRAPES. 

J. R. GILMOUR. 

W.GRAHAM. 

P. T. HUGHES. 

D. HUNTER. 

THEO. B. HYSLOP. 

N. T. KERR. 

R. L. LANGDON-DOWN. 

R. R. LEEPER. 

J. R. LORD. 

P. W. MACDONALD. 


T. W. McDOWALL. 

W. F. MEN'/.l ES. • 

CHAS. A. MEUCIER. 

JOHN MILLS. 

W. F. NEL1S. 

H. HAYES NEWINGTON. 

M. J. NOLAN. 

JAMES ORR. 

BEDFORD PIERCE. 

HENRY RAYNER. 

G. M. ROBERTSON. 

SIR GEO. II SAVAGE. 

G. £. SHUTTI.EWORTH. 

R. PERCY SMITH. 

J. G. SOUTAR. 

J. BEVERIDGE SPENCE. 

T. E. K. STANSFIELD. 

R. II. STEEN. 

KOTHSAY C. STEWART. 
DAVID G. THOMSON. 

T. SEYMOUR TUKE. 

ERNEST WHITE 

H. WOLSELEY-LEW1S (Chair¬ 
man.) 


EDUCATIONAL 

T. S. ADAIR. 

3. R. ARMSTRONG-JONES. 

H. T. S. AVELINE. 

FLETCHER BEACH. 

J. V. BLACHFORD. 

1. J. S. BOLTON. 

R. DODS BROWN ( ex-officio). 

LEWIS C. BRUCE. 

R. B. CAMPBELL. 

22. JAMES CHAMBERS. 

18. R. H. COLE. 

M. A. COLLINS (ex officio). 

2. MAURICE CRAIG. 

H. DEVINE. 

J. FRANCIS DIXON. 

10. J. O’C. DONELAN. 

THOS. DRAPES. 

J. R. GILMOUR. 

11. W. GRAHAM. 

T. ADRIAN GREENE (ex-officio). 

17. B. HART. 

16. P. T. HUGHES. 

12. JOHN KEAY. 

N. T. KERR. 

R. R. LEEPER. 

13. J. H. MACDONALD. 

P. W. MACDONALD. 

1. THOS. W. McDOWALL. 

H. J. MACKENZIE (ex officio). 

15. W.TUACH MACKENZIE. 

21. E. D. MACNAMARA. 

8. R. MACPHA1L. 

LIBRARY 

FLETCHER BEACH. 

HELEN BOYLE. 

M. A. COLLINS (ex officio). 

HENRY DEVINE. 

BERNARD HART. 

THEO. B. HYSLOP. 


COMMITTEE. 

W. F. MENZIES. 

C. A. MERCIER. 

JAMES MIDDLEMASS. 

ALFRED MILLER (ex officio). 

W. F. NEL1S. 

H. HAYES NEWINGTON. 
MICHAEL J. NOLAN. 

DAVID ORR. 

JAMES ORR. 

5. L. R. OSWALD. 

23. J. G. PORTER PHILLIPS (6>ry.) 
BEDFORD PIERCE. 

F. E. RA1NSFORD (ex officio). 

J. REDINGTON (ex officio.) 

14. WILLIAM REID (Aberdeen). 

G. D. ROBERTSON (exofficio). 

6. GEORGE M. ROBERTSON. 

R. G. ROWS. 

20. W r . SCOWCROFT. 

G. E. SHUTTLEWORTH. 

R. PERCY SMITH. 

J. G. SOUTAR. 

J. BEVERIDGE SPENCE. 

T. E. K. STANSFIELD. * 

7. ROBERT H. STEEN. 

8. W. H. B. STOOD ART. 
FREDERIC R. P. TAYLOR. 
DAVID G. THOMSON. 

9. T. SEYMOUR TUKE. 

19. W. R. VINCENT. 

24. J.K. WILL 

H. WOLSELEY-LEWIS. 

COMMITTEE. 

E. MAPOTHER. 

HENRY KAYNER. 

R. H. STEEN i Secretary). 

W. H. B. STODDART. 

DAVID G. THOMSON (ex officio). 


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Ill 


RESEARCH COMMITTEE. 


T. STEWART A DA IK. 

J. SHAW BOLTON. 

J. CHAMBERS. 

M. A. COLLIN8 ( ex-officio ). 
H. DEVINE. 

T. DRAKES. 

E. GOODAI.L. 

JOHN KEAY. 

J. K. LORD. 


II. HAYES NEWINGTON. 
DAVID ORR. 

FOKD ROBERTSON. 

It. G. HOWS. 

R. PERCY SMITH. 

R. U. STEEN. 

I). G. THOMSON ( ex-officio ). 
W. J. TOLLOCH. 


lectures at:—(1) University of Leeds, (2) Guy's Hospital; (3) St. Bartholomew s 
Hospital; (4) University of Durham; (6) University of Glasgow; (61 University of 
Edinburgh and Medical College for \\ omen, Edinburgh; (7) King's College Hospital; 
(8) St. Thomas’s Hospital; (9) St'. George's Hospital; (10) University of Dublin and 
National University of Ireland ; (11) Queen's University of Belfast; (12) Lecturer at 
School of Medicine, Royal Colleges and Medical College for Women, Edinburgh; 
(13) St. Mungo's College, Glasgow; (14) Aberdeen University; (15) St. Andrew's 
University and Dundee University ; (10) Birmingham University; (17) University 
College, London ; (18) St. Mary’s Hospital, London; (19) University of Sheffield; 
(20) Victoria University, Manchester; (21) Charing Cross Hospital; (22) Middlesex 
Hospital; (23) Roya Free Hospital; (24) London Hospital. 


LIST OF CHAIRMEN. 

1841. Dr. Blake, Nottingham. 

1842. Dr. do Vitre, Lancaster. 

1843. Dr. Conolly, Hanwell. 

1844. I)r. Thurnam, York Retreat. 

1847. Dr. Wintle, Warneford House, Oxford. 

1851. l)r. Conolly, Hanwell. 

1852. Dr. Wintle, Warneford House. 


LIST OF PRESIDENTS. 

1854. A. J. Sutherland, M.D., St. Luke’s Hospital, Loudon. 

1855. J. Thurnam, M.D., Wilts County Asylum. 

1856. J. Hitchinan, M.D., Derby Couuty Asylum. 

1857. Forbes Winslow, M.D., Sussex House, Hammersmith. 

1858. John Conolly, M.l)., County Asylum, Hanwell. 

1859. Sir Charles Hastings, D.C.L. 

1860. J. C. Bucknill, M.D., Devon Comity Asylum. 

1861. Joseph Lalor, M.D., Richmond Asylum, Dublin. 

1862. John Kirkinan, M.l)., Suffolk County Asylum. 

1863. David Skae, M.D., Royal Edinburgh Asylum. 

1864. Henry Munro, M.D., Brook House, Clapton. 

1865. Wm. Wood, M.D., Kensington House. 

1866. W. A. F. Browne, M.D., Commissioner in Lunacy for Scotland. 

1867. C. A. Lockhart Robertson, M.D., Haywards Heath Asylum. 

1868. W. H. O. Sankey, M.l)., Sandy well Park, Cheltenham. 

1869. T. Laycock, M.l)., Edinburgh. 

1370. Robert Boyd, M.l)., County Asylum, Wells. 

1871. Henry Maudsley, M.l)., The Lawn, Hanwell. 

1872. Sir James Coxe. M.l)., Commissioner in Lunacy for Scotland. 

1873. Harrington Tnke, M.D., Manor House, Chiswick. 

1874. T. L. Rogers, M.l)., Comity A*ylmn, Rainhill. 

1875. J. F. Duncan, M.D., Dublin. 

1876. W. H. Parsev, M.D., Warwick County Asylum. 

1877. G. Fielding Hlamlford, M.l)., Loudon. 

1878. Sir J. Crichton-Browne, M.l)., Lord Chancellor’s Visitor. 

1879. J. A. Lush, M.D., Fisherton House, Salisbury. 

1880. G. W. .Mould, M.K.C.S., Royal Asylum, Cbeadle. 

1881. D. Hack Tuke, M.D., London. 

1882. Sir W. T. Gairdner, M.D., Glasgow. 

1883. W. Orange, M.D., State Criminal Luuatic Asylum, Broadmoor. 


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IV 


1884. Henry Rayuer, M.D., County Asylum', Hamvell. 

1885. J. A. Eamei, M.D., District Asylum, Cork. 

1886. Sir Geo. H. Savage, M.D., Bethlem Royal Hospital. 

1887. Sir Fred. Needlmin, M.D., Burnwood House, Gloucester. 

1888. Sir T. S. Clouston, M.D., Royal Edinburgh Asylum. 

1889. H. Hayes Newington, F.R.C.P., Ticehurst, Sussex. 

1890. David Yellowlees, M.D., Gartnavel Asylum, Glasgow. 

1891. E. B. Whitcoiube, M.R.C.S., City Asylum, Birmingham. 

1892. Robert Baker, M.D., The Retreat, York. 

1893. J. Murray Lindsay, M.D., County Asylum, Derby. 

1894. Conolly Norman, F.R.C.P.I., Richmond Asylum, Dublin. 

1895. David Nicolson, C.B...M.D., State Criminal Lunatic Asylum, Broadmoor. 

1896. William Julius Mickle, M.D., Grove Hall Asylum, Bow. 

1897. Thomas W. McDowall, M.D., Morpeth, Northumberland. 

1898. A. R. Urquhart, M.D., James Murray’s Royal Asylum, Perth. 

1899. J. B. Spence, M.D., llurntwood Asylum, nr. Lichfield, Staffordshire. 

1900. Fletcher Beach, M.B., 79, Wimpole Street, W. 

1901. Oscar T. Woods, M.D., District Asylum, Cork, Ireland. 

1902. J. Wiglcsworth, M.D., F.R.C.P., Rainhill Asylum, near Liverpool. 

1903. Ernest W. White, M.B., M.R.C. P., City of London Asylum, Dartford,Kent. 

1904. R. Percy Smith, M.D., F.R.C.P., 36, Queen Anne Street, Cavendish 

Square, London, W. 

1905. T. Outterson Wood, M.D., F.R.C.P., 40, Margaret Street, Cavendish 

Square, Loudon, W. 

1906. Robert Armstroug-Joues, M.D.Lond., B.S., F.R.C.P., F.R.C.S.Eng., 

Claybury Asylum, Woodford Bridge, Essex. 

1907. P. W. MacDonald, M.D., County Asylum, Dorchester. 

1908. Chas. A.Mercier, M.D., F.R.C.P., F.R.C.S.,34, Wimpole Street. London, W. 

1909. W. Bevau-Lewis, M.Sc., L.R.C.P., late Medical Director, West Riding 

Asylum, Wakefield; Elsinore, Dyke Road Avenue, Brighton. 

1910. John Macpherson, M.D., F.R.C.P.Edin., Commissioner in Lunacy, 8, 

Darnaway Street, Edinburgh. 

1911. Wm. R. Dawson, B.A., M.D., F.R.C.P.I., D.P.H., Inspector of Lunatic 

Asylums, Dublin Castje, Dublin. 

1912. J. Greig Soutar, M.B., Barnwood House, Gloucester. 

1913. James Chambers, M.D., M.Ch., The Priory, Roehamplon, S.W. 
1914-1916. David G. Thomson, M.D., C.M.Edin., County Asylum, Thorpe, 

Norfolk. 


1896. 

1881. 

1907. 

1900. 


1900. 


1881. 

1902. 

1887. 

1909. 

1912. 

1902. 


1876. 


HONORARY MEMBERS. 

Allbutt, Sir T. Clifford, K.C.B., M.D., D.Sc., LL.D., F.R.C.P., F.R.S., 
Regius Professor of Physic.Univ. Camb.,St. Radegund’s, Cambridge. 

Beuedikt, Prof. M., Franciskaner Platz 5, Vienna. 

Bianchi, Prof. Leonardo, Manicomio Provincials di Napoli. Musee N. 3, 
Naples, Italy. ( Corr. Mem., 1896.) 

Blumer, G. Alder, M.D., L.R.C.P.Edin., Butler Hospital, Providence, 
U.S.A. (Ord. Mem., 1890.) 

Bresler, Johannes, M.D., Ouerartzt, Luben fin Schlesien, Germany. 
(Corr. Mem. 1896.) 

Brosius, Dr., 

Brush, Edward N., M.D., Sheppard and Enoch. Pratt Hospital, Towson, 
Maryland, U.S.A. 

Chapin, John B., M.D., Canandaigua, N.Y., U.S.A. 

Collins, Sir William J., D.L., M.D., M.S., B.Sc.Lond., F.R.C.S.Eng., 
1, Albert Teriace, Regent’s Park, N.W. 

Cousidine, Thomas Ivory, F.R.C.S.I., L.R.C.P.I., Inspector of Lunatic 
Asylum^, Ireland, Office of Lunatic Asylums, Dublin Castle, Dublin. 

Couplund. Sidney, M.D., F.R.C.P.Lond., Commissioner of the Board of 
Control, 16, Queen Anne Street, Cavendish Square, London, W. 

Crichton-Browne, Sir J., M.D.Edin.,. LL.D., D.Sc., F.K.S., Lord 
Cnaucellor’e Visitor, Royal Courts of Justice, Strand, W.C., 
and 46, Huns Place, S.W. (Pbmidbnt, 1678.) 


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Honorary and Corresponding Members. v 

1911. Donkin, Sir Horatio Bryan, M.A., M.D.Oxon., F.R.C.P.Lond. (Medical 

Adviser to Prison Commissioner* and Director of Convict Prisons), 
28. Hyde Park Street. \V. 

1879. Echeverria, M. G., M.I). 

1895. Perrier, Sir David, M.A., M.D., LL.D., F.R.C.P., F.R.S., 34, Cavendish 

Square, London. 

1872. Fraser, John, M.B., C.M., F.R.C.P.E., Formerly Commissioner in 
Lunacy, 54, Great Kiug Street, Edinburgh. 

1909. Kraepelin, Dr. Emil, Professor of Psychiatry, The University, Munich. 
1887. Lentz, Dr., Asile d'Altenes, Tournai, Belgique. 

1910. Mncphersou, John, M.D., F.R.C.P.Edin., Commissioner in Lunacy, 8 , 

Darnaway Street, Edinburgh. (President, 1910-11.) (Ordinary 
Member'from 1886.) 

1898. Magnun, V., M.D., Asile de Ste. Anne, Paris. 

1912. Maudslev, Henry, LL.D.Edin., (Hon.), M.D.Lond., F.R.C.P.Lond., 

Heatbbourne, Bushey Heath, Herts. (President, 1871.) (Formerly 
Editor, Journal of Mental Science.) 

1911. Mocli, Prof. Dr. Karl, Director, Herzberge Asylum, Berlin. 

1897. Morel, M. Jules. M.D., 60. Boulevard Leopold, Ghent, Belgium. 

1889. Needham, Sir Frederick, M.D.St. And., M.R.C.P.Edin., M.R.C.S.Eng., 
Commissioner of the Board of Control, 19, Campden Hill Square, 
Kensington, W. (President, 1887.) 

1909. Obersteiner, Dr. Heinrich, Professor of Neurology, The University, Vienna. 
1881. Peeters, M., M.D., Gheel, Belgium. 

1900. Ititti, Ant.. 68, Boulevard Kxehnans, Paris. (Corr. Mem., 1890.) 

1887. Scliiile. Heinrich, M.D., Illenau, Baden, Germany. 

1911. Seinelaigne, Rene, M.D.Paris, Secretaire des Stances de la Society 
Medico-Psycliologique de Paris, 16, Avenue de Madrid, Neuilly, 
Seine, France. (Corresponding Member from 1893.) 

1881. Tainburini, A., M.D., Reggio-Emilia, Italy. 

1901. Toulouse, Dr. Edouard, Directeur du Laboratoire de Psychologie experi¬ 

mental k l’Ecole de* llautes Etudes Paris et M6decin eu chef de 
l’Asile de Villejuif, Seine, France. 

1910. Trevor, Arthur Hill, B.A.Oxou., of the Inner Temple, Barrister at La>v, 

Commissioner of the Board of Control, 4, Albemarle Street, London, W. 

CORRESPONDING MEMBERS. 

1904. Bierao, Caetano, 48, Rua Formosa, Lisbonne, Portugal. 

1911. Boedeker, Prof. Dr. Justus Karl Edmund, Privat Docent and Director, 

Fichhenhof Asylum, Schlactensee, Berlin. 

1897. Buschan, I)r. G., Stettin, Germany. 

1904. Caroleli, Wilfrid, Manicomia de Sta. Crur, St. Andreo de Palamar, 
Barcelona, Spain. 

1896, Cowan, F. M., M.I)., 107, Perponcher Strnat, The Hague, Holland. 

1902. Estense, Benedetto Giovanni Selvat ico, M.D., 116. Piazza Porta Pia, Rome. 
1911. Falkenberg, Dr. Wilhelm, Oberarzt, Irrenanstalt, Herzberge, Berlin. 
1907. Ferrari, Giulio Cesare, M.D., Director of the Manicomio Provinciale, 

Imola, Bologna, Italy. 

1911. Friedlander, Prof. Dr. Adolf Albrecht, Director of the Ilohe Mark Klinik, 
nr. Frankfort. 

1904. Koenig, William Julius, Deputy Superintendent, Dalldorf Asylum, Berlin 

1880. Korufeld, Dr. Hermann, Fr. Schlesien, Han’ptpostluyerstr., Breslau. 

1889. Kownlowsky, Professor Paul, Khnrkoff, Russia. 

1895. Lindell, Emil Wilhelm, M.I)., Sweden. 

1901. Matiheimer-Gommes, Dr., 32, Rue de 1’Arcade, Paris. 

1909. Moreira, Dr. Julien, M.D.Bahia, Professor and Director of the National 
Manicomium of Rio de Janeiro ( Editor of the Brazilian Archives of 
Psychiatry , etc.). 

1886. Parant, M. Victor, M.I)., Toulouse. 

1909. Pilcz, Dr. Alexander (Professor of Psychiatry in the University of 
Vienna), Superintendent Landessanatorium fur Nerveu uud Geistes- 
kranke Steinhof, Vienna. 

1890. Rfgis, Dr. B., 54, Rue Huguerie, Bordeaux. 

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VI 


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MEMBERS OF THE ASSOCIATION. 

Alphabetical List of Members of the Association on December 31 st, 1915, with 
the pear in which they joined. The Asterisk means Members who joined 
between 1841 and 1855. 

1900. Abbott, Henry Kingsmill, B.A., M.D.Dub., D.P.H.Irel., Medical Superin¬ 
tendent, Hants County Asylum, Fareham. 

1891. Adair, Thomas Stewart, M.D., C.M.Edin., F.R.M.S., Medical Superin¬ 
tendent, Storthes Hall Asylum, Kirkburton, near Huddersfield. 
(Hon. Sec. N. and M. Division since 1908.) 

1910. Adam, George Henry, M.K.C.S., L.E.C.P.Lond., Manager and Medical 
Superintendent, West Mailing Place, Kent. 

1913. Adams, John Barfield, L.R.C.P.&S.Edin., M.P.C., 119, Redland Hoad, 
Bristol. 

1868. Adams, Josiah O., M.D.Durh., F.R.C.S.Eng., J.P., 117, Cazenove Hoad, 

Stamford Hill, N. 

1886. Agar, S. Hollingsworth, jun., B.A.Cantab., M.R.C.S.Eng., L.S.A., Hurst 
House, Henley-in-Arden. 

1869. Aldridge, Clias., M.D., C.M.Abcr., L.E.C.P.Lond., Bellevue House, 

Plympton, Devon. 

1905. Alexander, Edward Henry, M.B., C.M.Edin., M.R.C.S., L.R.C.P.Loud., 
M.P.C., Physician Superintendent, Ashbourne Hall Asylum, Dunedin, 
New Zealand. 

1899. Alexander, Hugh de Maine, M.D., C.M.Edin., Medical Superintendent, 
Aberdeen City District Asylum, Kingseat, Newmachar, Aberdeen. 
1899. Allmaun, Dorah Elizabeth, M.B., B.Ch.R.U.I., Assistant Medical Officer, 
District Asylum, Armagh. 

1908. Anderson, James Richard Sumner, M.B., Ch.H.Glas., Senior Assistant 

Medical Officer, Cumberland and Westmorland Asylum, Garlands, 
Carlisle. 

1898. Anderson. John Sewell, M.R.C.S., L.R.C.P.Loud., Senior Assistant 
Medical Officer, Hull City Asylum, Willerby,near Hull. 

1912. fAnnaudale, James Scott, M.B., Ch.B.Edin., Second Assistant Physician, 
District Asvlum, Murtlilv, Perth ; R.A.M.C. 

1912. Apthorp, Frederick William, M.R.C.S.Eng., L.H.C.P.Edin., M.P.C., 

Senior Medical Officer, St. George’s Retreat, Ravensworth, Burgess 
Hill. 

1904. fArchdale, Mervyn Alex., M.B., B.S.Durh., (Medical Superintendent, East 

Riding Asylum, Beverley, Yorks) ; Capt. R.A.M.C., T.F., No. 16, 
General Hospital, British Expeditionary Force. 

1905. Arclulall, Mervyn Thomas, L.R.C.P.&S.Edin., L.S.A.Lond., Brynn-y- 

Neuadd Hall, Llanfairfechan, N. Wales. 

1882. fArmstrong-Jones, Robert, M.D.Lond., B.S., F.R.C.P., F.R.C.S.Eng., 
9. Bramhum Gardens, S.W. (and PHU Dinas, Carnarvon, North 
Wales; Hon. Major R.A.M.C. (Gen. Secretary from 1897 to 1906.) 
(President 1900-7.) 

1910. fAuden, G. A., M.A., M.D., B.C., D.P.H.Cantab., M.li.C.P.Lond., F.S.A. 

(Medical Superintendent, Educational Offices, Edmund Street, 
Birmingham); Captain R.A.M.C. ( T.) on active service. 

1891. Aveline, Henry T. S„ M.D.Durh., M.R.C.S., L.lt.C.P.Lond., M.P.C., 
Medical Superintendent, County Asylum, Cotford, near Taunton, 
Somerset. (Hon. Sec. for S.W. Division, 1905-11.) 

1903. Bailey, William Henry, M.D.Lond.. M.R.C.S.Eng., L.S.A., D.P.H.Lond., 
Featherstone Hall, Southall, Midd. 

1894. Baily, Percy J„ M.B., C.M.Edin., Medical Superintendent, London County 
Asylum, Hanwell, W. 

1909. fBain, John, M.A., M.B., B.Cli.Glasg.; Lt. R.A.M.C. (address nncom- 

munieated). 

1913. fBuinbridge, Charles Frederick, M.B., Ch.B.Edin., Surg, R.N.R, 

Assistant Medical Officer, Devon County Asylum, Exeter. 


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Members of the Association. vii 

• 1906. Baird, Harvey, M.D., Ch.B.Edin., I’eritean, Winchelsen, Susiei. 

1878. Baker, H. Morton, M.B., C.M.Bdin.,7, Belsize Square, London, N.W. 
1888. Baker, John, M.D., C.M.Aberd., Medical Superintendent, State Asylum, 

Broadmoor, Berks. 

1916. fBallard, E. T. ( 13, Lyndhurst Load, Hove, Sussex) ; Capt. R.A.M.C. (T.) 
1904. Barham, Guy Foster, M.A., M.l)., B.C.Cantab., M.B.C.S., L.R.C.P.Lond., 

• Senior Assistant Medical Officer, Loudon County Asylum. Long- 
Grove, Epsom, and Visiting Surgeon, County of London War Hospital, 
Epsom. 

1913. +Bsrkley, James Morgan, M.B., Ch.B.Kdin. (Senior Medical Officer, 
Bracthridge Asylum, Lincolnshire); Lieut. R.A.M.C. 

1910. Bartlett, George Norton, M.B., B.S.Lond., M.R.C.S., L.R.C.P.Lond., 
Medical Superintendent, City Asylum, Exeter. 

1901. tBaskin, ,1. Lougheed, M. I). Brtix., L.R.C.P.&S.Edin., L.R.F.P.AS.Glas., 

Capt. R.A.M.C. (address uncouimunicated). 

1902. Baugh, Leonard D. H.. M.B., Ch.B.Edin., The Plcasaunce, York. 

1874. Beach, Fletcher, M.B., F.R.C.P.Loud., formerly Medical Superintendent, 

Dnrenth Aeylum, DartJ'ord ; Cane Hill, Coulsdon, Surrey. ( Secre - 
tary Parliamentary Committee, 1896-1906. General Secretary, 
1889-1896. President, 1900.) 

1892. Beadles, Cecil F., M.R.C.S., L.R.C.P.Loud., The Clergy House, Englefisld 
Green, Surrey. 

1902. Tleale-Browne, Thomas Richard, M.R.C.S.Eng., L.R.C.P.Lond., c/o 
P.M.O. Lagos, Nigeria, West Africa. 

1913. Bedford, Percy William Page, M.B., Ch.B.Edin., County Asylum, Lan¬ 

caster. 

1909. tBeeley, Arthur, M.Sc.Leeds, M.l)., B.S.Lond., M.R.C.S., L.R.C.P.Loud., 
D.P.H.Camb. ( Aeeietant Medical Officer, E. Sueeejt Educational 
Committee), Windybank, Kingston Road, Lewes; R.A.M.C. 

1914. fRenuett, James Wodderspoon, M.R.C.S., L.R.C.P.Lond. (Marsden, llkley, 

Yorks); Capt. R.A.M.C., 10th Batt., Duke of Wellington W.R.R. 
1912. Benson, Henry Porter D’Arcv, M.l)., C.M.Edin., M.R.C.P., F.R.C.S. 

Edin., Medical Superintendent, Farnham House, Fimtlas, Dublin. 
1914. fBensou, John Robinson, F.li.C.S.Eug., L.R.C.P.Lond., Resident Physi¬ 
cian and Proprietor, Fiddiugtoii House, Market Laviugton, Wilts. 

1899. Beresford, Kdwyn H., M.R.C.S., L.R.C.P.Lond., Medical Superintendent, 

Tooting Bee Asylum, Tooting, S.W. 

1912. Berncastlc, Herliert Si., M .R.C.S.Eng., L.R.C.P.Lond., Assistant Medical, 

Officer, Croydon Mental Hospital, Warlingham. Surrey. 

1879. Bevan-Lowis, William, M.Sc.Leeds, M.R.C.S., L.R.C.P.Lond., Elsinore, 

Dyke ltoad Av-nue, Brighton. (President, 1909-10.) 

1894. flilachford, James Vincent, M.D., B.S.Durb., M.R.C.S., L.R.C.P.Lond., 
M.P.C. (City Asylum, Fishponds, Bristol); Lt.-Col. R.A.M.C., 
Beaufort War Hospital, Bristol. 

1913. Black, Robert Sinclair, M.A.Edin., M.D., C.M.Aberd., D.P.H., M.P.C., 

Medical Supt., Pietermaritzburg Mental Hospital, Natal, South 
Africa. 

1898. Blair, David, M.A., M.D., C.M.Gla«g., County Asylum, Lancaster. 

1897. Blandford, Joseph John Guthrie, B.A., D.P.H.Camb., M.R.C.S., L.R.C.P. 
Loud.; Barnhill Asylum. Lancashire. 

1908. ■f’Blandy, Gurth Swinnerton, M.D., Ch.B.Edin. (Assistant Medical Officer, 
Middlesex County Asylum, Napsbury, Herts) ; Capt. R.A.M.C. (T,) 
1904. Bodvel-lloberts, Hugh Frank, M.A.Cantab., M.R.C.S., L.R.C.P.Lond., 
L.S.A., Middlesex Countv Asylum, Napsbury, near St. Albans, Herts. 

1900. Bolton, Joseph Shaw, M.D., B.S., D.Sc., F.R.C.P.Lond., Medical Super¬ 

intendent, West Riding Asvlnm, Wakefield. 

1892. Bond, Charles Hubert, I).Sc., M.D., C.M.Edin., M.R.C.P.Lond., M.P.C., 
Commissioner of the Board of Control, 66, Victoria Street, S.W. 
(Hon. General Secretary, 1906-12.) 

1877. Bower, D.ivid, M.D., C.M.Alter., Springfield House, Bedford. (Chairman 
Parliamentary Committee, 1907-1910.) 

1877. Bowes, John Ireland, M.R.C.S.Eng., L.S.A. (address uncommunicated). 


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Members of the Association. 

Bowie*, Alfred, M.R.C.S.* L.R.C.P.Lond.. 10, South Cliff, Eastbourne. 
Boycott, Arthur N., M. D.Loud., M.R.C.S., L.It.C.P.Lond., Medical 
Superintendent, Herts County Asylum, Hill End, St. Albans, Herts. 
{Hon. Sec. for S.-E. Division. 1900-05.) 

Boyle, A. Helen A., M.D.Brux., L.R.C.P.&S.Edin., 9, The Drive, Hove, 
Brighton. 

Boys, A. H., L.R.C.P.Ediu., M.R.C.S.Eng., L.S.A.Lond., The White 
House, St. Albans. 

Braine-Hiirtneil, George M. P., M.R.C.S., L.R.C.P.Lond., Medical 
Superintendent, County and City Asylum, Powiek, VVorcester. 
Brander, John, M.B., C.B.Ediu., Assistant Medical Officer, London 
County Asylum, Bexley, Kent. 

1905. fBrown, Harry Egerton, M.D., Ch.B.Gla°g., M.P.C. (Mental Hospital, 
Fort Beaufort, Cape Province, S. Africa) Major, 8. A. Medical 
Corps. 

1908. fBrown, RobertCunynglinm, M.D., B.S.Durh. (General Board of Lunacy, 
25, Palmerston Place, Edinburgh); Major, R.A.M.C., Administrator, 
Springburn and Woodside Central Hospital, Glasgow. 

1908. Brown, It. Dods, M.D., Ch.B., F.R.C.P., Dipl. Psych., D.P.H.Edin., 
Physician Superintendent, James Murray’s Royal Asylum, Perth. 

1912. fBrown, William, M.l)., C.M.Glas., M.P.C., District Medical Officer 

• Adviser in Lunacy to Bristol Magistrates (1. Manor Road, Fish¬ 
ponds, Bristol) ; Capt. R.A.M.C.,!'., 2nd Southern General Hospital, 
South mead, Bristol. 

1916. Brown, William, M.A., M.B., B.Ch.Oxon., D.Sc.Lond., Reader in 
Psychology iu the University of London (King’s College), (King's 
College, Strand, W.C.). Capt. R.A.M.C., Alexandria (17th General 
Hospital), Magnuil, and theMaudsley Hospital, Denmark Hill. S.E. 

1893. f Bruce, Lewis C., M.D., F.R.C.P.Edin., M.P.C. (Medical Superintendent, 

District Asylum, Druid Park, Murthly, N.B.) ; Scottish Horse 
Brigade, Mediterranean Expeditionary Force. ( Co-Editor of 
Journal 1911-1916; Hon. Sec. for Scottish Division, 1901-1907.) 

1913. fBrunton, George Llewellyn, M.D., Ch.B.Edin. (North Riding Asylum, 

Clifton, York); temp.Lt., S.A.M.C., 2nd Cavalry Field Ambulance, 
British Expeditionary Force, France. 

1912. fBuchanan, William Murdoch, M.B., Ch.B.Glas., Kirklands Asylum, 

Bothwell, Lanarkshire. Temp. Lieut. R.A.M.C. 

1892. Bullen, Frederick St. John, M.R.C.S.Eng., L.S.A.Lond., 3, Richmond 
Park Road. Clifton, Bristol. 

1908. Bullraore, Charles Cecil, J.P., L.R.C.P.&S.Edin., L.ILF.P.&S.Glas., 

Medical Superintendent, Flower House, Catford. 

1911. Buss, Howard Deeimus, B.A., B.Sc.France, M.D.Brux.ACape, M.R.C.S., 
L.R.C.P., L.M.S.S.A.Lond., Assistant Medical Officer, Fort 
Beaufort Asylum, Cape Colony. 

1910. fCahir, Jobit P., M.B., B.Ch.R.U.I., 198, Camberwell New Road, Camber¬ 
well, S.E.; Lieut. R.A.M.C. 

1891. Caldecott, Charles, M.B., B.S.Lond., M.R.C.S., L.R.C.P.Lond., Medical 
Superintendent, Earlswood Asylum, Redhill, Surrey. 

1889. Callcott, James T., M.D., B.S.Durh., M.R.C.S.Eng., Medical Superin¬ 
tendent, Borough Asylum, Newcastle-on-Tyne. 

1913. fCameron, John Allan Munro, M.B., Ch.B.Glas. (Pathologist, Scalehor 

Park Asylum, Burley -in- Wharfedale, Yorks); R.A.M.C., British 
Expeditionary Force. 

1894. Campbell, Alfred Walter, M.D., C.M.Edin., M.P.C., Macquarie Chambers, 

183, Macquarie Street, Sydney. New South Wales. 

1909. fCampbell, Donald Graham, M.B., C.M.Edin., Major R.A.M C. (T.) on 

active service. 

1914. fCampbell, Finlay Stewart, M.D., C.M.Glas., Capt. R.A.M.C., c/o Messrs 

Thomson and Campbell, 113, West Regent, Street, Glasgow. 

1880. Campbell, Patrick E., M.B., C.M.Edin., Medical Superintendent, Metro¬ 
politan Asylum, Caterham, Surrey. 


viii 

1900. 

1896. 

1898. 

1883. 

1891. 

1911. 


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Members of the Association. ix 

1897. Campbell, Robert Brown, M.D., C.M., F.R.C.P.E., Medical Superin¬ 
tendent, Stirliug District Asylum, Larbert. ( Sscretary for Scottish 
Division from 1910.) 

1905. Carre, Henry, L.R C.P.&S.Irel., Woodilee Asylum, Lenzie, Glasgow. 

1891. Carswell, John, L.R.C.P.Edin., L.R. F.P.&S. G lung., 43, Moray Place, 

Edinburgh ; Commissioner-General, Board of Control, Scotland. 
1874. Cassidy, 1). M., M.D., C.M.McGill Coll., Montreal, D.Sc. (Public 
Health) F.U.C.S.Edin., Medical Superintendent, County Asylum, 
Lancaster; R.A.M.C. 

1888. Chambers, James, M.A., M.D.U.U.I., M.P.C., The Priory, Rochampton. 

{Co-Editor of Journal 1905-1914, Assistant Editor 1900-05.) 
(1’hksident, 1913-14.) 

1911. fChambers, Walter Duncanou, M.A., M.D.. Ch.B.Edin., M.P.C., Capt. 

R. A.M.C. , Iniiiskillings (address uncomuiuuicated). 

1865. Chapman, Thomas Algernon, M.D.tilas., L.R.C.S.Ediu., F.Z.S., Betula, 
Rcigate. 

1915. CUuyne, Alfred William Harper, M.B., Ch.B.Alter., Assistant Medical 
Officer, Royal Asylum, Aberdeen. 

1917. Chisholm, Percy, L.ll.C.P. A S.Hdin., Assistant Medical Officer, Stirling 
District Asylum, Larbert. 

1907. Chislett, Charles G. A., M.B., Ch.B.Glasg., Medical Superintendent, 
Stoueyetts, Chryston, Lanark. 

1880. Christie, J. W. Stirling, L.R.C.P.&S.Edin., Medical Superintendent, 
Countv Asylum, Stafford. 

1878. Clapham, YVm. Crochley S.. M.l)., F.K.C.P.Ed., M.R.C.S.Eng., F.S.S., The 
Five Gables, Mayfield, Sussex, {lion. Sec. N. and M. Division, 
1897-1901.) 

1907. fClarke, Geoffrey, M.D.Lond. (Senior Assistant Medical Officer, London 
County Asylum, Banstead, Sutton, Surrey); Lieut. R.A.M.C., 
No. 24 General Hospital, British Expeditionary Force. 

1910. FClarke, James Kiliau P„ M.B., B.Ch.R.U.I., D.P.H., High Street, 
Oakham; R.A.M.C. 

1907. Clarkson, Robert Durward, B.Sc., M.D., C.M.Edin., F.R.C.P.Edin. 

(Medical Officer, Scottish National Institute for the Education of 
Imbecile Children), The Park, Larbert, Stirling. 

1892. Cole, Robert Henry, M.D.Lond , M.R.C.P.Lond., 25, Upper Berkeley 

Street, W. (Secretary of Parliamentary Committse since 1912.) 
1900. Cole, Sydney John, M.A., M.l)., B.Ch.Oxon., Medical Superintendent, 
Wilts County Asylum, Devizes. 

1906. Collier, Walter Edgar, M.R.C.S., L.R.C.P.Lond., Assistant Medical 

Officer, Kent County Asylum, Maidstone. 

1903. fCollins, Michael Abdy, M.D., B.S.Lond:, M.R.C.S., L.R.C.P.Lond. 

(Me dical Superintendent, Ewell Colony, Epsom, Surrey) {Son. 
General Secretary since 1912.); Capt. R.A.M.C., British Expedi¬ 
tionary Force. 

1910. Conlon, Thomas Peter, L.R.C.P.&S.Irel., Resident Medical Superin¬ 
tendent, District Asylum, Monaghan. 

1914. tConollv, Victor Lindley, M.B., B.Ch.Belfast (Assistant Medical Officer 
Colney Hatch Asylum, N ); Lieut. R.A.M.C. 

1878. Cooke, Edward Marriott, M.D.Lond., M.R.C.S.Eng.. Commissioner in 
Lunacy; Acting Chairman Board of Control, 69, Onslow Square, 

S. W. 

1910. Coombes, Percival Charles, M.R.C.S., L.R.C.P.Lond., Medical Superin¬ 
tendent, Surrey Countv Asylum, Netherne. 

1905. Cooper, K. D„ L.R.C.P.&S.Edin., L.R.F.P.&S.Glu*., c/o Leopold & Co. 
Apollo, Bunder, Bombay. 

1903. Cormac, Harry Dove, M.B., B.8.Madras, Medical Superintendent, 
Cheshire County Asylum. Macclesfield. 

1891. Corner, Harry, M.D.Lond., M.R.C.S., L.R.C.P.Lond., M.P.C.,37, Harley 
Street, W. 

1905, Cotter, James, L.R.C.P.&S.E., L.R.F.P.&S.Glas., Down District Asylum, 
Downpatrick. 


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Digitized by 


x Member# of the Association. 

1897. Cotton, William, M.A.. M.D.Ediu., D.P.H.Cantab., M.P.C. (c/o D. N. 

Cotton, Esq., 9, St. David Street, Edinburgh); Capt. R.A.M.C., 
20, General Hospital, B.E.F., France. 

1910. Coupland, William Henry, L.R.C.S AP.Edin., Senior Assistant Medical 

Officer, 1, Sen View, South Road, Lancaster. 

1913. Court, E. Percy, M.R.C.S.. L.R.C.P.Lond., Severalla Asylum, Colchester. 
1893. Cowen, Thomas Philip, M.D., B.S. M.R.C.S., L.R.C.P.Lond., Medical 

Superintendent, County Asylum, Rainhill, Lancashire. 

1911. Cox, Donald Maxwell, M.R.C.S., L.R.C.P.Lond., The Hall, Headcorn, 

Kent. 

1893. Craig. Maurice, M.A., M.D., H.C.Cantab., F.Il.C.P.Lond., M.P.C., 87, 

Harley Street, W. (Hon. Secretary of Educational Committee, 
1905--8; Chairman of Educational Committee since 1912.) 

1897. Cribb, Harry Gifford, M.R.C.S., L.R.C.P.Lond., Medical Superintendent, 
Winterton Asylum, Ferryhill, Durham. 

1911. Criehlow, Charles Adolphus, M.B., Ch.B.Glas. Roxburgh District 
Asylum, Melrose. 

1914. fCrookshank, Francis Graham, M.D., M.R.C.P.Lond. (c/o 25, Duke 

Street, Piccadilly, W.) ; Capt. B.A.M.C. 

1904. Cross, Harold Robert, L.S.A.Lond., F.R.G.S., Storthes Hall Asylum 

Kirkburton, near Huddersfield. 

1915. Crostlnvaite, Frederick Douglas, M.B., Ch.B.Edin., D.P.H.Cantab., 

Assistant Physician, Pretoria Mental Hospital, South Africa. 

1914. Cruickshank, J., M.D., Ch.B.Glas., Pathologist, Crichton Royal Hospital, 

Dumfries. 

1907. Daniel, Alfred Wilson. B.A., M.D., B.C.Cantab., M.R.C.S., L.R.C.P.Lond., 

Senior Assistant Medical Officer, London County Asylum, Hauwell, W. 
1896. Davidson, Andrew, M.D., C.M.Aber., M.P.C., Wyoming, Macqunrie 
Street, Sydn'ey, N.S.W. 

1914. Davies, Laura Katherine, M.B., Ch.B.Edin., Pathologist and Assistant 

Medical Officer,’ Edinburgh City Asylum, Rangour, Dechmont, 
Linlithgowshire. 

1891. fDavis, Arthur N., L.R.C.P.AS.Edin. (Medical Superintendent, County 
Asylum, Exmiuster, Devon); Lieut. B.A.M.C., T.F. 

1894. f Dawson, William R., B.A..M.D.,B.Ch.Dubl., F.R.C.P.I., D.P.H., Inspector 

of Lunatics in Ireland, Claremont, Burlington Road, Dublin. (Hon. 
Sec. to Irish Division, 1902-11 ; Phksidbnt, 1911-12.) Major 
B.A.M.C. 

1901. De Steiger, AdMe, M.D.Lond., County Asylum, Breutwood, Essex. 

1905. Devine, Henry, M.D., B.S., M.R.C.P.Lond., M.R.C.S.Eng., M.P.C., 

Medical Superintendent, The Asylum, Milton, Portsmouth. 

1904. Devon, James, L.R.C.P.AS.Edin., 1, North Park Terracs, Hillhead, 

Glasgow. 

1903. Dickson, Thomas Graeme, L.R.C.P. ft S.Edin., Medical Superintendent, 
Wye House Asylum, Buxton, Derbyshire. 

1915. Dillon. Frederick, M.B., Ch.B.Edin., (Clinical Assistant, West End 

Hospital for Nervous Diseases, Assistant Medical Officer, Northum¬ 
berland House, Green Lanes, Finsbury Park, N.); Lieut. R.A.M.C. 
on active service, Craigenhall, Falkirk, N.B. 

1909. f Dillon, Katbleep, L R.C.P.&S. I., Assistant Medical Officer, District 
Asylum, Mullingar. 

1905. fDixon, J. Francis, M.A., M.D., B.Ch.Dubl., M.P.C. (Medical Super¬ 

intendent, Borough Mental Hospital, Humberstone, Leicester); 
Major B.A.M.C., British Expeditionary Force. 

1879. Dodds, William J., M.D., C.M., D.Sc.Edin., Glencoila, Rellahoutton, 
Glasgow. 

1908. Donald, Robert, M.D., Ch.B.Glas., 3, Gilmour Street, Paisley. 

1889. fDonaldson, William Ireland, B.A., M.D., B.Ch.Dubl., Medical Super¬ 
intendent (County of London Manor Asylum, Epsom, Surrey). 
Lt.-Col. R.A.M.C. O.C. Manor County of London War Hospital, 
Epsom. 


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XI 


Members of the Association. 

1892. Donelau, John O’Conor, L.R.C.P.&S.I., M.P.C., St. Dymphna’s, North 
Circular Road, Dublin (Med. Supt., Richmond Asylum, Dublin). 
1890. Douglas, William, M.D.R.U.I., M.R.C.S'Eng., P.R.O.S., Rrandfold, 
Cloudburst, Kent. 

1905. Dove, Augustus Charles, M.l)., B.S.Durh., M.R.C.S.Eng., “ llrightsidc,” 

Crouch End Hill, N. 

1897. Dove, Emily Louisa, M.H.Lond., 11, Jenner House, Hunter Street, 
Brunswick Square, W.C. 

1903. Dow, William Alex., M.D., B.S.Durh., M.R.C.S., L.R.C.P.Lond., D.P.H., 
H.M. Prison, Lewes. 

1910. Downey, Michael Henry, M.B., Ch.B.Melb., L.lt.C.P. & S.Edin., 

L.R.F.P.&S. Glasg., Assistant Medical Officer, Parkside Asylum, 
Adelaide, South Australia. 

1884. Drapes, Thomas, M.B.Dubl., L.R.C.S.I., Medical Superintendent, District 
Asylum, Enuiscorthy, Ireland. (Pkksidhnt-k lbct, 1910-11; Co- 
Editor of Journal tinea 1912.) 

1916. Drummond, William Blackley, M.B., C.M.Edin., F.R.C.P., Medical 
Superintendent, Baldovan Institution, Dundee. 

1907. Dryden, A. Mitchell, M.B., Ch.B.Edin., Senior A.M.O., Woodilee Mental 
Hospital, Lenzie. 

1902. Dudgeon, Herbert Win., M.D., B.S.Durh., M.R.C.S., L.R.C.P.Lond., 

Mi-dical Superintendent, Khanka Government Asylum, Egypt. 

1899. Dudley, Francis, L.R.C.P.A.S.I., Senior Assistant Medical Officer, 
County Asylum, Bodmin, Cornwall. 

1915. Duff, Thomas, L.R.C.P., L.lt.C.S.Edin., L.R.F.P.&S.Glasg., Colliugton 
Rise, Bexhill-on-Sea. 

1903. Duuston, John Thomas, M.D., B.S.Lond., Medical Superintendent, West 

Koppies Asylum, Pretoria, South Africa. 

1911. Dykes, Percy Armstrong, M.R.C.S., L.R.C.P.Lond., Senior Assistant 

Medical Officer, Fulbonrno Asylum, Cambridge. 

1899. Eades, Albert I., L.lt.C.P. A S.I., Medical Superintendent, North Riding 
Asylum, Clifton, Yorks. 

1906. fEager, Richard, M.D., Ch.B.Abcr., M.P.C. (Assistant Medical Officer, 

Devon County Asylum, Exminster); Major R.A.M.C.,T.F., 2/1 
Wessex Field Ambulance, 55th Division, British Expeditionary Force. 
1873. Eager, Wilson, M.R.C.S., L.lt.C.P., L.S.A.Lond., St. Aubyn’s, Wood- 
bridge, Suffolk. 

1881. Earle, Leslie M., M.l)., C.M.Edin., 108, Gloucester Terrace, Hyde Park 
W. 

1891. Earls, James Henry, M.D., M.Ch.R.U.I., D.P.H., L.S.A.Lond., M.P.C., 
Barrister-at-Law, Fenstanton, Christchurch Road, Streuthum Hill, 
S.W. 

1907. East, Win. Norwood, M.D.Lond., M.R.C.S., L.R.C.P.Lond., M.P.C., H.M. 

Prison, Manchester; also 171, Cheetliam Hill Road, Manchester. 
1895. Easterbrook, Charles C., M.A..M.D., F.lt.C.P.Ed., M.P.C., J.P., Physician 
Superintendent, Crichton liovul Institution, Dumfries. 

1914. fEder. M.D., B.Sc.Lond., M.R.C.S., L.R.C.P.Lond. (Medical Officer, 
Deptford School Clinic), 7, Welbeck Street, W.; Lieut. R.A.M.C. 
1895. Edgeriey, Samuel, M.A., M.l)., C.M.Edin., M.P.C., Medical Superinten¬ 
dent, West Riding Asylum, Menston, nr. Leeds. 

1897. Edwards, Francis Henry, M.D.Brux., M.R.C.P.Lond., M.R.C.S.Eng., 
Medical Superintendent,Cumberwell House, S.E. 

1901. fElgee, Samuel Charles, L.lt.C.P.AS.l. (Colney Hatch Asylum,. New 
Southgate). The Manor (County of London) War Hospital, 
Epsom ; Major R.A.M.C. 

1889. Elkins, Frank Ashby, M.l)., C.M.Edin., M.P.C., Medical Superintendent, 

Metropolitan Asylum, Leavesden, Herts. 

1912. Ellerton, John Frederick Heise, M.D.Brux., M.R.C.S.Eng., L.R.C.P. 

Edin., Rotherwood, Leamington Spa. 

1890. Ellis, William Gilmore, M.D.Brux., M.R.C.S.Eng., L.S.A.Lond., J.P., 

Principal Civil Medical Officer, Singapore, Straits Settlements. 


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xii Members of the Association. 

1908. Ellison, Arthur, M.R.C.S., L.R.C.P.Eng,, Deputy Medical Officer, H.M. 

Prison, Leeds, 120, Domestic Street, Holbeck. Leeds. 

1899. Ellison, F. C., B.A., M.D., B.Ch.Dub., Resident Medical Superintendent, 
District Asylum, Castlebar. 

1911. fEinslie, Isabella Galloway, M.D., Ch.B.Edin., West House, Royal Asylum, 
Morningside, Edinburgh. 

1911. English, Ada, M.B., B.Ch.R.U.I., Assistant Medical Officer, District 
Asylum, Balliuasloe. 

1901. Erskine, Win. J. A., M.D., C.M.Edin., Medical Superintendent, County 
Asylum, Whitecroft, Newcroft, 1. of W. 

1895. Eurich, Frederick Wilhelm, M.D., C.M.Edin., 8, Moruiugton Villas, 
Mnninghnm Lane, Bradford. 

1894. Eustace, Henry Marcus, B.A., M.D., B.Ch.Dubl., M.P.C., Medical 
Superintendent, Hampstead and Highfield Private Asylum, 
Glasnevin, Dublin. 

1909. Eustace, William Neilson, L.R.C.S.AF.Irel., Lisronagh, Glasnevin, co. 

Dublin. 

1909. Evans, George, M.R.Lond., Senior Assistant Medical Officer, Severalls 
Asylum, Colchester. 

1891. Ewan, John Alfred, M.A. St. And., M.D., C.M.Edin., M.P.C., Greyuess, 
Sleaford, Lines. 

1884. Ewart, C. T., M.D., C.M.Aberd., Senior Assistant Medical Officer, 
Claybury Asylum, Woodford Bridge, Essex. 

1914. Ewing, Cecil Wilmot, L.R.C.P.I.& L.R.C.S.I., Second Assistant Medical 
Officer, Chartham Asylum, near Canterbury. 

1907. Exley, John, L.R.C.P.I., M.R.C.S.Eng.; Medical Officer, H.M. Prison; 
Grove House, New Wortley, Leeds. 


1894. Furquharson, William F., M.D., C.M.Edin., M.P.C., Medical Superin¬ 
tendent, Counties Asylum, Garlands, Carlisle. 

1907. fEarries, John Stothart, L.R.C.P.AS.Edin., L.R.F.P.&S.Glas., R.N.R., 

communications to Yrthington, Carlisle. 

1903. fFennell, Cliarles Henry, M.A.. M.D.Oxon, M.R.C.P.Loud., Reform Club, 
Pall Mall, S.W.; Lieut. R.A.M.C. 

1908. Fenton, Henry Felix, M.B., Ch.B.Edin., Assistant Medical Officer, 

County and City Asylum, Powick, Worcester. 

1907. Ferguson, J. J. Hurrower, M.B., Ch.B.Edin., Senior Assistant Medical 

Officer, Fife and Kinross Asylum, Cupar, Fife. 

1897. Fielding, James, M.D., Viet. Univ., Canada, .M.R.C.S.Eng., L.R.C.P. 
Edit)., 18, The Crescent, Norwich. 

1906. Fielding, Saville James, M.B., B.S.Durh., Medical Superintendent, 
Bethel Hospital, Norwich. 

1873. Finch, John E. M., M.A., M.D.Cantab., M.R.C.S.Eng.. L.S.A.Lond., 
Holtndale, Stoneygate, Leicester. 

1889. Finlay, David, M.D., C.M.Glasg., Medical Superintendent, County 
Asylum, Bridgend. Glamorgan. 

1906. Firth, Arthur Harcus, M.A., M.D., B.Ch.Edin., Deputy Medical Super¬ 
intendent, Barnsley Hall, Bromsgrove, Worcestershire. 

1903. Fitzgerald, Alexis, L.R.C.P. <fc S.I., District Asylum, Waterford. 

1888. Fitz-Gerald, Gerald C., B. A., M. I)., B.C.Cantab., M.P.C., Medical Superin¬ 
tendent, Kent County Asylum, Cliartlmm, nr. Canterbury. 

1908. Fitzgerald, James Francis, LR.C.P.AS.Irel., Assistant Medical Officer, 

District Asylum, Clonmel, co. Tipperary, Ireland. 

1904. Fleming, Wilfrid Louis Reiui, M.R.C.S., L.R.C.P.Loud., Suffolk House, 

Pirbright, Surrey. 

1894. Fleury, Eleonora Lilian, M.D., B.Ch.R.U.I., Assistant Medical Officer, 
Richmond Asylum, Dublin. 

1908. fFlyuu, Thos. Aloysios, L.R.C.P.&S.L, (County Asylum, Thorpe, 
4 Norwich); R.A.M.C. 

1902. Forde, Michael J., M.D., B.Ch.R.U.I., Assistant Medical Officer, Rich¬ 
mond Asylum, Dublin. 


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Members of the Association. xiii 

1911. Forrester, Archibald Thomas William, M.D., B.S., M.R.C.S., L.R.C.P. 

Lond., Senior Assistant, Medical Oflieer, Leicester and Rutland 
Counties Asylum, Narborough. 

1916. fForsyth, Charles Wesley, M.H.Lond., M.R.C.S., L.R.C.P. (Assistant 
Medical Officer, Kesteven County Asylum, Sleaford, Lines.); Temp. 
Lieut. R.A.M.C. 

1913. tForward, Ernest Lionel, M.Il.C.S., L.R.C.P.Lond. (Assistant Medical 
Officer, The Coppice, Nottingham); Capt. R.A.M.C., 2/2 East 
Lancs. Field Ambulance. 

1913. Fothergill, Claude Francis, B.A., M.B., II.C.Cantab., M.R.C.S., L.R.C.P. 
Lond.; lleusol, Chorley Wood, Herts. 

1912. Fox, Charles J., M.R.C.S., L.R.C.P.Lond., The Moat House, Alnechurch 

Birmingham. 

1881. Fraser, Donald, M.D., C.M.Ghtsg., F.R.F.P.S., 13, Royal Terrace 
West, Glasgow. 

1901. fFrench, Louis Alexander, M.R.C.S., L.R.C.P.Lond., “ Locksley,” Willing- 

don, Eastbourne; Major R.A.M.C. 

1902. Fuller, Lawrence Otway, M.R.C.S.Eng., L.R.C.P.Lond., Medical Super¬ 

intendent, Threu Counties’ Asylum, Arlesey, Beds. 


1914. fGage, John Munro, L.R.C.P.&S.I., M.P.C. (Earlswood, Redhill, Surrey) ; 
Temp. Capt. R.A.M.C. 

1906. Gane, Edward Palmer Steward, M.D.Durh., M.R.C.8., L.R.C.P.Lond., 
City Asylum, Willerby, Hull. 

1912. Garry, John William, M.B., B.Ch., N.U.I., Assistant Medical Officer 
Ennis District Asylum, Ireland. 

1912. Gavin, Lawrence, M.B., Ch.B.Edin,, L.R.C.P.&S.Edin., L.R.F.P.&S. 
Glasg., Superintendent, Mullingar District Asylum, lrelaud. 

1896. Geddes, John W., M.B., C.M.Ediu., Medical Superintendent, Mental 

Hospital, Middlesbrough, Yorks. 

1892. Gemmel, James Francis, M.B.Glasg., Medical Superintendent, County 
Asylum, Whittiugham, Preston. 

1914. Gettings,Harold Salter, L.R.C.P. & S.Edin.,L.R.F.P.&S.G., D.P.H.Birm., 
Chasetown, nr. Walsall. 

1899. Gilfillan, Samuel James, M.A., M.B., C.M.Ediu., Medical Superin¬ 
tendent, London County Asylum, Coluey Hatch. 

1912. Gill, Eustace Stanley Hayes, M.B., Ch.B.Liverp., Shaftesbury House, 
Formby, Liverpool. 

1889. Gill, Stanley A., B.A.Dubl., M.D.Durh., M.R.C.P.Lond., M.R.C.S.Eng., 
Shaftesbury House, Formby, Liverpool. 

1904. fGillespie, Daniel; M.D. B.Ch.R.U.l., Dipl. Psych. (Wadsley Asylum, 
near Sheffield); Maj. R.A.M.C., Wharncliffe War Hospital, Middle- 
wood Road, Sheffield. 

1897. Gilmour, John Rutherford, M.B., C.M., F.R.C.P.Edin., M.P.C., Medical 

Superintendent, West Riding Asylum, Scalebor Park, Burley-in- 
Wharfedale, Yorks. 

1906. Gilmour, Richard Withers, M.B., B.S.Durh., M.R.C.S., L.R.C.P.Lond., 
Homewood House, West Meon, Hants. 

1878. Glendinning, James, M.D.Glasg., L.R.C.S.Edin. Hill Crest, Lansdowu 
Roan, Abergavenny. 

1897. Good, Thomas Saxty, M.R.C.S.Eng., L.R.C.P.Lond., Medical Superin¬ 
tendent, County Asylum, Littleuiore, Oxford. 

1889. fGoodall, Euwin, M.D., B.S., F. K.C.P.Lopd., M.P.C. (Medical Superin- 
tenueut. City Asylum, Cardiff); Lt.-Col. R.A.M.C., The Welsh 
Metropolitan War Hospital, Whitchurch, nr. Cardiff. 

1899. fGordon, James Leslie, M.D., C.M.Aberd. (Medical Superintendent, 
Fountain Temporary Asylum, looting Grove, Touting Graveuoy, 
S.VY.) ; Temp. Lieut. M*A.M C. 

1906. Gordon-Munn, John Gordon, M.D.Kdin., F.R.S.E., Heigham Hall, 
Morwich. 


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iiv Members of the Association. 

1901. fGostwyck, C. H. G-, M.B., Cli.B., F.R.C.P.Edin., M.P.C., l)ipl. Psycb.j 
(Stirling District Asylum, Lurbert); Lt., R.A.&l.C. on active 
service. 

1912. fGraham, Gilbert Malise, M.B., Ch.B.Edin., R.N., H.M.S. “ Emperor of 
India.” 

1914. fGraham, Norman Bell, B.A., R.U.I., M.B., B.Ch.Belfast, (Assistant 

Medical Officer, District Asylum, Belfust) ; Capt. R.A.M.C., 24, 
Ocean Buildings, Belfast. 

1894. Graham, Samuel, L.R.C.P.Lond., Resident Medical Superintendent 
District Asylum, Antrim. 

1887. Graham, William, M.D.R.U.I., L.R.C.S.Edin., Medical Superintendent, 
District Lunatic Asylum, Belfast. 

1908. Graham, William S., M.B., B.Ch.R.U.I., Assistant Medical Officer, 

Somerset and Bath Asylum, near Taunton. 

1915. Graves, T. Chivers, M.B., B.S., B.Sc.Lond., F.R.C.S.Eng., Mpdical Super¬ 

intendent, City and County Asylum, Burghill, Hereford. 

1916. Gray, Cyril, L.R.C.P.&.S.Edin., Gateshead Borough Asylum, Stannington, 

Ncwcastle-on-Tyne. 

1909. Greene, Thomas Adrian, L.R.C.S.&P.Irel., J.P., Medical Superintendent, 

District Asylum, Carlow. 

1886. Greenlees, T. Duncan, M.D., C.M.Edin., F.R.S.E., Rostrevor, Kirtleton 
Avenue, Weymouth. 

1912. fGreeson, Clarence Edward, M.D.,Ch.B.Aberd., Surgeon, R.N., c/o Messrs. 
Holt A Co., 3, Whitehall Place, S.W. 

1915. Griffith, Alfred Hume, M.D.Ediu., D.P.H.Camb., Medical Superinten¬ 
dent, Lingfield Epileptic School Colony, The Homestead, Lingfield, 
Surrey. 

1915. Grigsby, Hamilton Marie, L.R.C.P.&S.Edin., 79, Victoria Hoad North, 

Southsea. 

1901. Grills, Galbraith Hamilton, M.D., B.Ch.R.U.1., Dipl. Psych., Medical 
Superintendent, County Asylum, Chester. 

1916. Grimbly, Alan F., B.A., M.B.Uuiv.Dnbl. (Assistant Medical Officer, St. 

Edmoudsbury, Lucan, Ireland) ; Lieut. R.A.M.C. (T.R .). 

1900. Grove, Ernest George, M.R.C.S., L.R.C.P.Lond., Bootham Park, 
York. 

1894. Gwynn, Charles Henry, M.D., C.M.Edin., M.R.C.S.Eng., co-Licensee, 
St. Mary’s House, Whitchurch, Salop. 


1894. Halsted, Harold Cecil, M.D.Durh., M.R.C.S., L.R.C.P.Lond.. Manor 
Road, Selsey, Sussex. 

1901. Harding, William, M.D.Edin., M.R.C.P.Lond., Medical Superintendent, 
Northampton County Asylum, Berry Wood, Northampton. 

1899. Harmer, W. A., L.S A., Resident Superintendent and Licensee, Redlands 
Private Asylum, Tonbridge, Kent. 

1904. fHarper-Smith, George Hast.ie, B.A.Cantab., M.R.C.S., L.R.C.P.Lond., 

(Senior Assistant Medical Officer, Brighton County Borough 
Asylum, Ha\wards Heath), May Cottage, Loughton, Essex; 
Capt. R.A M.C. (T.). 

1898. Harris-Liston, L.,M.D.Brux.,M.R.C.S.,L.R.C.P.Lond., L.S.A., Middleton 
Hall, Middleton St. George, Co. Durham. 

1905. Hart, Bernard, M. D.Lond., M.R.C.S.Eng., 29 b, Wimpole Street, and 

Northumberland House, Finsbury Park, N. 

1886. fHarvey, Bagenal Crosbie, L.R.C.P.&.S.Edin., L.A.H.Dubl., Resident 
Mi'dical Superintendent, District Asylum, Clonmel, Ireland. 

1892. Haslett, William John H., M.R.C.S., L.R.C.P.Lond., M.P.C., Resident 
Medical Superintendent, Hailiford House, Upper Hulliford, Shep- 
perton. 

1891. Havelock, John G., M.D., C.M.Edin., Little Stodham, Li*s, Hants. 

1890. Huy, J. F. S„ M.B., C.M.Aberd., Inspector-General of Asylums for New 
Zealand, Government Buildings, Wellington, New Zealand. 


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tv 


Members of the Association. 

1900. Haynes, Horace E., M.K.C.S.Eng., L.S.A., J.P., Littleton Hall, Brent* 
wood, Essex. 

1895. Hearder, Frederic I*., M.D., C.M.Kdin., Medical Superintendent, York¬ 
shire Inebriate Reformatory, Whixley, near York. 

1911. fHeffernan, Capt. P., B.A., M.B., B.Ch.C.U.I., Locock’s Gardens, 

Kilpauh, Madras. 

1916. fHenderson, David Kennedy, M.D.Edin., (Senior Assistant Physician, 
Royal Asylum, Gartnavel, Glasgow) ; Temp. Lieut. R.A.M.C., c/o 
John Henderson and .Sons, Solicitors, Dumfries; Scotland. 

1905. Henderson, George, M.A., M.B., Ch.B.Edin., 26, Commercial Road, 
Peckham, S.E. 

190G. Herbert, Thomas, M.R.C.S., L.R.C.P.Lond., York City Asylum, Fulford, 
York. 

1877. Hetherington, Charles E., B.A., M.B., M.Ch.Dubl., Medical Superin¬ 
tendent, District Asylum, Londonderry, Ireland. 

1877. Hewson, It. \\\, L.R.C.P.&S.Edin., Medical Superintendent, Coton Hill, 
Stafford. 

1914. Hewson, R. \V. Dale, L.R.C.P.&S.Edin., L.R.F.P.&S.Glns., Coton Hill 
Hospital, Stafford. 

1912. Higson, William Davis, M.B., Ch.B.Liverp., D.P.H., Deputy Medical 

Officer, H.M. Prison, Brixtou; 7, Clovelly Gardens, Upper Tills* 
Hill, S.W. 

1882. Hill, II. Gardiner, M.R.C.S.Eng., L.S.A., l’entillic, Leopold Road, 
Wimbledon Ptrk, S.W. 

1914. fHills, Harold William, B.S., M.B., B.Sc.Lond., M.R.C.S., L.R.C.P.Lopd.; 
Capt. R.A.M.C., Lord Derby War Hospital, Warrington. 

1907. fHine, T. Guy Macaulay, M.A., M.D., B.C.Cantab., 37, Hertford Street, 

Mayfair, W.; Temp. Capt. R.A.M.C. 

1909. Hodgson, Harold West, M.R.C.S., L.R.C.P.Lond., Assistant Medical 
Officer, Several Is Asylum, Colchester. 

1908. Hogg, Archibald. M.B., Ch.B.Glus., 64, High Street, Paisley, N.B. 

1900. Hollander, Bernard, M.D.Freib., M.R.C.S., L.R.C.P.Lond, 67, Wimpole 

Street, W. 

1912. Holyoak, Walter L., M.I)., B.S.Lond., 45, Welbeek Street, W. 

1903. Hopkins, Charles Leighton, B.A., M.B., B.C.Cantab., Medical Superin¬ 

tendent, York City Asylum, Fulford, York. 

1894. Hotchkis, Robert D., M.A.Glasg., M.D., B.S.Dtirh., M.R.C.S., L.R.C.P. 

Loud., M.P.C., Renfrew District Asylum, Dvkebar, PaiBlev N.B. 
1912. Hughes, Frank Percival, M.B., B.S.Lond., M.R.C.S., L.R.C.P.Lond.,The 
Grove, Pinner, Middlesex. 

1900. Hughes, Percy T., M.B., C.M.Edin., D.P.H., Medical Superintendent, 
Worcestershire County Asylum, Barnesley Hall, Bromsgrove. 

1904. Hughes, William Stanley, M.B., B.S.Lond., M.R.C.S., L.R.C.P.Lond., 

Medical Superintendent,Shropshire Comity Asylum, Bictou Heath 
Shrewsbury. 

1897. Hunter, David, M.A., M.B., B.C.Cautab., L.S.A., Medical Superintendent, 
The Coppice, Nottingham. (Secretary Jor S.E. Dirition, 1910- 

1913.) 

1909. fHunter, Douglas William, M.B., Ch.B.Glasg., Assistant Medical Officer 

10, Halltield Road. Bradford; Capt. R.A.il.C. 

1912. fHunter, George Yeates Cobb, Colonel, I.M.S., M.K.C.S., L.R.C.P.Lond., 
M.P.C., c/oMessrs. Grindlav & Co., 54, Parliament Street, S.W. 
1904. Hunter, Percy Douglas, M.R.C.S., L.R.C.P.Lond., Three Counties 
Asylum, Arle>ey, Beds. 

1882. f Hyslop, James Col. D.S.O., M B., C.M.Edin., Medical Superintendent 
The Huts, Pietermaritzburg, Natal. 

1888. Hyslop, Theo. B„ M.D.. C.M.Edin., M.R.C.P.E., L.R.C.S.E., F.R.S.E., 
M.P.C., 5, Portland Place, Loudon, W. 


1915. Ingall, Frank Ernest, F.R.C.S.Eng., L.R.C.P.Lond., D.P.H., Tue Biook 
Villa, Liverpool. 


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Digitized by 


xvi Members of the Association. 

1908. Inglis, J. P. Park., M.B., Cli.B.Edin., Assistant Medical Officer, 
Caterham Asylum, Caterham, Surrey. 

1906. Irwiu, Peter Joseph. L.R.C.P.&S.I., Assistant Medical Officer, District 
Asylum, Limerick. 


1914. fjames, George William Blomtield, M.B., B.S.Lond., 2, Cbarnwood 
Street, Derby; R.A.M.C. 

1908. Jeffrey, Geo. Rutherford, M.D., Cb.B.Glas., K.R.C.P.E., M.P.C., 
Medical Superintendent, Bootham Park, York. 

1910. f Johnson, Cecil Webb-, D.S.O., M.B., Ch.B.Vict. (“ Cricklewood,” East 
Slieeu, S. W); Capt. (Temp. Major) R.A.M.C. * 10th Middlesex 
Regiment, Fort William, Calcutta, India. 

1893. Johnston, Gerald Herbert, L.R.C.P.&S.Edin., L.R.F.P.&S.Glas., Brooke 
House, Upper Clapton, N. 

1905. Johnston, Thomas Leonard, L.lLC.P.&S.Edin., L.R. F.P&.S.Glas., Medical 
Superintendent, Brace bridge Asylum, Lincoln. 

1912. Johnstone, Emma May, L.R.C.P.&S.Edin., L.R.F.P.&S.Qlas., M.P.C. 
Dipl. Psycli., Holloway Sanatorium, Virginia Water, Surrey. 

1878. Johnstone, J. Carlyle, M.D., C.M.GIas., Medical Superintendent, Rox¬ 
burgh District Asylum, Melrose. 

1903. Johnstone, lhomas, M.l)., C.M.Edin., M.ll.C.P.Lond., Anuandale 
Harrogate. 

1880. fJones, D. Johnston, M.D., C.M.Edin.; Temp. Major R.A.M.C. 


1879. Kay, Walter S., M.D., C.M.Edin., M.R.C.S.Eng., The Grove, Starbech, 
Harrogate. 

1886. fKeuy, John, M.D., C.M.Glasg., F.ll.C.P.Edin. (Medical Superintendent, 
Bangoitr Village, Uphall, Linlithgowshire); Lt.-Col., R.A.M.C. 
Edinburgh War Hospital, Bangour. 

1909. fKeith, William Brooks, M.B., Ch.B.Aberd., M.P.C., Capt., R.A.M.C., T., 
81st Field Ambulance, 27th Division. * 

1908. Kelly, Richard, M.D., B.Ch.Dub., Assistant Medical Officer, Stortbes 
Hall Asylum, Kirkburtou, near Huddersfield. 

1907. Keene, George Henry, M.D., The Asylum, Goodmayes, Ilford, Essex. 
1899. Kennedy, Hugh T. J., L.R.C.P.&S.L, Assistant Medical Officer, District 
Asylum, Enniscorthy, Co. Wexford. 

1897. Kerr, Hugh, M.A., M.D.Glasg., Medical Superintendent, Bucks County 
Asylum, Stone, Aylesbury, Bucks. 

1902. Kerr, Neil Thomson, M.B., C.M.Ed., Medical^uperintendent, Lanark 

District Asylum, Hartwood, Shotts, N.B. 

1893. Kershaw, Herbert Warren, M.R.C.S.Eng., L.R.C.P.Lond., Diusdale Park 
near Darlington. 

1897. fKidd, Harold Andrew, M.R.C.S.Eng., L.R.C.P.Lond. (Medical Superin¬ 
tendent, West Sussex Asylum, Chichester); Lt.-Col. R.A.M.C., 
Grayiingwell Wav Hospital, Chichester. 

1916. Kilgurriff, Joseph O’Loughlin, A.B., M.B., B.Ch., B A.O.Uuiv., Dublin 
As-isiant Medical Officer, County Asylum, Prcstwich, Lancs. 

1903. King, Frank Raymond, B.A.Cantab., M.R.C.S.Eng., L.R.C.P.Lond., 

Medical superintendent, Pecknam House, Peckham, S.E. 

1902. King-Turner, A. C., M.B.,C.M.Edin., The Retreat, Fairford, Gloucester¬ 

shire. 

1916. Kirwau, Richard R., M.B., B.Ch. R.U.I., Assistant Medical Offic er > 
West Riding Asylum, Men-ton, Leeds. 

1915. Kitson, Frederick Hubert. M B., Ch.B.Leeds. Assistant Medical Officer, 
West Killing Asylum, Wakefield. 

1903. Kough, Edward Fitzadam, B.A., M.B., B.Ch.Dubl., Seuior Assistant 

Medical Officer, County Asylum, Gloucester. 


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Members of the Association. xrii 

1898. Labey, Julius, M.R.C.S., L.R.C.P., L.S.A.Lond., Medical Superin¬ 
tendent, Public Asylum, Jersey. 

1902. Langdon-Down, Perrival L., M.A., M.B., B.C.Cantab., Dixland, Hampton 
Wick, Middlesex. 

1896. Langdon-Down. Reginald L.. M.A., M.B., B.C.Cantab., M.R.C.P.Lond., 
Normansfield, Hampton Wick. 

1914. fLadell, R. O. Macdonald, M.B., Cb.B.Vict. (Shafton House, Holbeck, 
Leeds) ; Lieut. R.A M.C., 1 /5th Norfolk Regiment. 

1909. fLaurie, James, M.H., Ch.M.tilasg. ( Medical Officer, Smithston Asylum) 
(Red House, Ardgowan Street, Greenock); Capt. R.A.M.C., T.F., 
3rd Scottish Hospital. 

1902. Laval, Evariste, M.B.,C.M.Edin., The Guildhall, Westminster, S.W. 

1898. Lavers, Norman, M.D.Brux., M.R.C.S., L.R.C.P.Lond., Medical Super¬ 

intendent, Bailbrook Honse, Bath. 

1892. Lawless, George Robert, F.R.C.S.I., L.R.C.P.I., Medical Superintendent, 
District Asylum, Armagh. 

1870. Lawrence, Alexander, M.A., M.D., C.M.Aberd., 26, Hough Green, 
Chester. 

1883. Layton, Henry A., M.R.C.S.Eng., L.R.C.I’.Edin., 26, Kimbolton Road, 
Bedford. 

1916. Leech, H. Brougham, M.D., B.Ch.Dublin, Assistant Medical Officer, 
County Asylum, Hatton, Warwick. 

1909. Leech, John Frederick Wolseley, M.D., B.Cb.Dubl., County Asylum. 
Devizes, Wilts. 

1899. Leeper, Richard R., F.R.C.S.L, L.R.C.P.I., M.P.C., Medical Super¬ 

intendent, St. Patrick's Hospital, Dublin. (Hon. Sec. to the Irish 
Ditision from 1911.) 

1883. Legge, Richard J., M.D., R.U.I., L.R.C.S.Edin., “ Comeragh,” Leek- 

lmmpton Road, Cheltenham. 

1906. fLeggett, William, B.A., M.D., B.Cb.Dubl. (Assistant Medical Officer, 
Royal Asylum, Sunrtyside, Montrose) ; Temp. Lieut. R.A.M.C. 
1916- Lewis, Edward, L.R.C.P., L.R.C.S.Edin., L.F.P.S.Glasg., Cwirlai, Ty- 
Croas, Anglesey. 

1914. Lindsay, David George, L.R.C.P.AS.Edin., Senior Assistant Medical 
Officer, Dundee District Asylum, West GreCn, Dundee. 

1908. Littlejohn, Edward Salteine, M.R.C.S., L.R.C.P.Lond., Senior Assistant 
Medical Officer, London County Asylum, Cane Hill, Surrey. 

1916. Lloyd, Brindley Richard, M.B., B.S.Lond., D.P.H.Lond., Assistant 
Medical Officer, Peckham House, S.E. 

1903. Logan, Thomas Stratford, L.R.C.P.AS.Edin., L.R.F.P.AS.Gla*., D.P.H., 

Stone Asylum, Aylesbury, Bucks. 

1898. fLord, John R.,M.B.,C.M.Edin. (Medical Superintendent, Horton Asylum, 
Epsom); Lieut.-Colonel R.A.M.C., Horton County of London War 
Hospital, Epsom, Surrey. (Co-Editor oj Journal since 1911; 
Assistant Editor of Journal, 1900-11.) 

1906. fLowry, James Arthur, M.D., B.Ch., R.U.I., R.A.M.C., Medical Super¬ 
intendent, Surrey County Asylum, Brookwood. 

1904. Lyall, C. H. Gibson, L.R.C.P.AS.Edin., Leicester Borough Asylum, 

Leicester. 

1872. Lyle, Thomas, M.D., C.M.Glaag., 34, Jesmond Road, Newcastle-on-Tyne. 

1906. fMacartbur, John, M.R.C.S., L.R.C.P.Lond. (Assistant Medical Officer, 
Colney Hatch Asylum, London, N.); R-A.M.C., Mediterranean 
Expeditionary Force. 

1880 MacBryan, Henry C., L.R.C.P. A S. Edin., Kingsdown House, Box, Wilts. 

1900. McClintock, John, L.R.C.P.AS.Edin., Resident Medical Superintendent, 

Grove House, All Stretton, Church Stretton, Salop. 

1901. MacDonald, James H., M.B., Ch.R., F.R.F.P.AS.Glasg., Govan District 

Asylum, Hawkhead, Paisley, N.B. 

1884. MacDonald, P. W., M.D., C.M.Aberd. (late Medical Superintendent, 

note retired), Grasmere, Spa Road, Weymouth. (First Hon. See. 
S.W. Division 1894 to 1905.) (Phksidbnt, 1907-8.) 

b 


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xviii Members of the Association. 

1011. fMacDon&ld, Ranald, M.D., Ch.B.Ediu. (London County Asylum, Bexley, 
. Kent); Lieut. E.A.M.C. 

1005. MacDonald, William Fraser, M.B., Ch.B.Ediu., M.P.C., 96, Polworth 
Terrace, Edinburgh. 

1905. McDougall, Alan, M.D., Ch.B.Vict., M.R.C.S., L.R.C.P.Lond., Medical 

Director, The David Lewis Colony, Saudle Bridge, near Alderley 
Edge, Cheshire. 

1911. McDougall, William, M.A., M.B., B.C.Cantab., M.Sc.Vict., Foxcombe 
Hill, Oxford. 

1906. fMcDowall, Colin Francis Frederick, M.D., B.S.Durh. (Ticehnrst House 

Ticehurst) ; Cnyt. R.A.M.C., Military Hospital, Maghull, Liverpool. 
1870. MeDowall, Thomas W., M.D.Edin., L.R.C.S.E., Medical Superintendent, 
Northumberland County Asylum, Morpeth. (President, 1897-8.) 

1893. Macevoy, Henry John, B.A.(Douai), M.D., B.Sc.Loud., M.R.C.S.Eng., 

L. R.C.P.Lond., M.P.C., 19, Mowbray Road, Brondesbury, London, 
N.W. 

1895. Macfarlane, Neil M., M.D., C.M.Aber., Medical Superintendent, Govern¬ 

ment Hospital, Thlotae Heights, Leribe, Basutoland, South Africa. 

1902. McGregor, John, M.B., Ch.B.Ediu., Senior Assistant Medical Officer, 

County Asylum, Bridgend, Glam. 

1914. fMackny, Magnus Ross, M.D., Ch.B.Ediu., Capt. E.A.M.C..T.F., British 
Expeditionary Force, France. 

1916, McKenna, Edward Joseph, M.B., B.Ch., R.U.I., Assistant Medical 

Officer, Carlow District Asylum. 

1911. Mackenzie, John Cosserat, M.B., Ch.B.Edin., County Mental Hospital, 
Burntwood, near Lichfield. 

1891. Mackenzie, Henry J., M.B., C.M.Edin., M.P.C., Assistant Medical Officer, 
The Retreat, York. 

1903. Mackenzie, Theodore Charles, M.D., Ch.B., F.R.C.P.Edin., M.P.C., 

Medical Superintendent, District Asvlum, Inverness. 

1014. Macleod, Jan R., L.R.C.P.&S.Edin., L.R.F.P.&S.Glasg., 7, Mayfield 
Gardens, Edinburgh. 

1917. MeMaster, Albert Victor, B.A., M.R.C.S.Eng., Senior Assistant Medical 

Officer, Fife and Kinross District Asylum, Cupar. 

1904. Macnamara, Eric Darners, M.A.Camb., M.D., B.C., F.R.C.P.Lond., 87, 

Harley Street, W. 

1898. Macunughton, George W. F., M.D., F.R.C.S.Edin., M.R.C.P.Lond., 

M. P.C., 33, Lower Bel grave Street, Eaton Square, London, S.W. 

1914. fMacneill, Celia Mary Colquhoun. M.B., Ch.B.Edin. (Pathologist, North- 

field, Pre>toupans); Leith War Hospital, Seafield, Leith. 

1910. fMacPhail, Hector Duncan, M.A., M.D., Ch.B.Edin. (Assistant Medical 
Officer, City Asylum, Gosfortli, Newcastle - on - Tyne) ; Major 
E.A.M.C., Northumberland War Hospital, Newcastle. 

1882. Macphail, S. Rutherford, M.D., C.M.Edin., Derby Borough Asylum, 
Itowditch, Derby. 

1896. Macpherson, Charles, M.D.Glas., L.R.C.P.AS., D.P.H.Edin., Deputy 

Commissioner in Lunacy, 25, Palmerston Place, Edinburgh. 

1901. McRae, G. Douglas, M.D., C.M.Edin., F.R.C.P.Ed., Medical Super- 

intendent, District Asylum, Ayr, N.B. 

1902. fMacrae, Kenneth Duncan Cameron, M.B., Ch.B.Edin. (Bangour Village, 

Dechmont, Linlithgowshire) ; Lieut. R.A.M.C., M.E.F. 

1894. Me William, Alexander, M.A., M.B., C.M.Aber., Waterval, Odiham, 

Winch field, Hants. 

1915. Manifold, Robert Fenton, M.B., D.Ch.Dub., Senior Assistant Medical 

Officer, Denbigh Asylum, North Wales. 

1908. fMapother, Edward, M.D.. B.S.Lond., F.R.C.S.Eng. (Assistant Medical 
Officer, London County Asylum, Long-Grove, Epsom); Lieut. 
E.A.M.C. 

1903. Marnun. John, B.A., M.B., B.Ch.Dub]., Seuior Assistant Medical 

Officer, Second County Asylum, Gloucester. 

1806. fMarr, Hamilton C., M.D., C.M., F.R.F.P AS.Glasg., M.P.C., Commis¬ 
sioner in Lunacy (10, Succoth Avenue, Euinburgh); (Hon. Sec. 
Scottish Division, 1907-iyiO.); E.A.M.C. 


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XIX 


Members of the Association. 

1913. fMurshall, Robert, M.B., Ch.B.Glas. (Assistant Medical Officer, Gartloch 

Mental Hospital, Gnrtcosh, N.B.) ; Lieut. R.A.M.C., 19th General 
Hospital, British Expeditionary Force. 

1905. Marshall. Robert Mactiub, M.D., Ch.B.Glasg., M.P.C., 2, Clifton Place, 
Glasgow. 

1908. Martin, Henrv Cooke, M.B., Ch.B.Edin., Assistant Medical Officer 
Newport Borough Asylum, Caerleou. 

189C. fMartin, James Charles, L.R.C.S. Sc P.I., J.P., Assistant Medical Officer 
District Asylum, Letterkenny, Donegal; Temp. Lieut. R.A.M.C. 
1908. Martin, James Ernest, M.B., B.S.Lond., M.R.C.S., L.R.C.P.Loud., 
Assistant Medical Officer, London County Asylum, Long-Grove 
Epsom. 

1907. Martin, Mary Edith. L.R.C.P.AS.Edin., L.R.F.P.&S.Glas., L.S.A.Lond., 
M.P.C.Lond., Bailbrook House, Bath. 

1914. fMartin, Samuel Edgar, M.B., B.Ch.Edin., Barrister-at-Law (Senior 

Assistant Medical Officer, St. Andrew’s Hospital, Northampton) ; 
Lieut. R.A.M.C., British Mediterranean Expeditionary Force. 

1911. fMartin, William Lewis, M.A., B.Sc., M.B., C.M.Edin., D.P.H., M.P.C n 
Dipl, l’sych. (Certifying Physician in Lunacy, Edinburgh Parish 
Council), 56, Bruntstield Place, Edinburgh; Major R.A.M.C. ( T.) 

1911. fMathieson, James Moir, M.B., Cb.B.Aber. (Assistant Medical Officer, 

Wadsley Asylum, Sheffield); Major R.A.M.C., The Wharncliffe 
War Hospital, Sheffield. 

1904. fMay, George Francis, M.D., C.M.McGill, L.S.A. (Winterton Asylum, 
Ferry hill, Durham); Lieut. R.A.M.C. 

1912. Melvills, William Spence, M.B., Ch.B.Glas., Woodilee Mental Hospital, 

Lenzie, Glasgow. 

1890. Menzies, William K., M.D.,B.Sc.Edin., M.R.C.P.Lond., Medical Superin¬ 

tendent, Stafford County Asylum, Cheddleton, near Leek. 

1891. Mercier, Charles A., M.D.Lond., F.K.C.P., F.R.C.S.Eng., late Lecturer 

on Insanity, Westminster Hospital; Moorcroft, Parkstone, Dorset. 
( Secretary Educational Committee, 1893-1905. Chairman do. from 
1905-12.) (President, 1908-9.) 

1877. Merson, John, M.A., M.D., C.M.Aber., Medical Superintendent, Borough 
Asylum, Hull. 

1871. Mickle, William Julius, M.I)., F.R.C.P.Lond., 69, Linden Gardens, Bays- 
water, W. (President, 1896-7.) 

1893. Middlemass, James, M.A., M.I)., C.M., B.Sc.Edin., F.R.C.P., M.P.C., 
Medical Superintendent, Borough Asylum, Ryhope, Sunderland. 

1910. fMiddlemiss, James Ernest, M.R.C.S.Eng., L.R.C.P.Loud.; 131, North 

Street, Leeds; Lieut. R.A.M.C. 

1883. f Miles, George E., M.R.C.S., L.R.C.P.Lond., Lieut.-Col., R.A.M.C., 
D Block, Royal Victoria Hospital, Netley, Hants; British Empire 
Club, St. James’ Square, S.W. 

1887. Miller, Alfred, M.B., B.Ch.Dubl., Medical Superintendent, Hatton 
Asylum, Warwick. ( Registrar since 1902.) 

1912. fMiller, Richard, M.B., B.Ch.Dubl., Medical Superintendent, Naval Hos¬ 

pital, Great Yarmouth ; Fleet-Surgeon R.N. 

1893. Mills, John, M.B., B.Ch., Dipl. Ment. Dis., R.U.I., Medical Superinten¬ 
dent, District Asylum, Hallinasloe, Ireland. 

1913. Milner, Ernest Arthur, M.B., C.M.Edin., Assistant Medical Officer, Royal 

Albert Institution, Lancaster. 

1911. Moll, Jan. Marius, Doe. in Arts and Med, Utrecht Univ., L.M.S.S.A. 

Lond., M.P.C., 9, Anstey’s Buildings, Kirkstrest, Johannesburg, 
South Africa. 

1913. Molvneux, Benjamin Arthur, B.A., M.D., B.Ch.Dubl., St. Helens 
House, St. Helens, Hastings. 

1910. fMonnington, Richard Caldicott, M.D., Ch.B., D.P.H.Edin. (Darsnth 
Industrial Colony, Dartford, Kent) ; c/o Rev. T. P. Monuington 
Lowick Green, Ulverston, Lancs.; Capt. R.A.M.C. 


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XX 


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Members of the Association. 

1915. Monrad-Krohn, G. H., M.B., B.S., M.R.C.P.Lond., M.R.C.S.Eng., 

Assistant Medical Officer, Bethlem Royal Hospital, Lambeth, S.E. 
1914. fMontgomery, Edwin, F.R.C.S.I., L.R.C.P.I. Dipl. Psych. Munch., 
• (Prestwiuh Asylnm, Lancs.) ; Lieut. R.A.M.C., 77th Field 

Ambulance, British Expeditionary Force. 

1885. Moore, Edw. E., M.D., B.Ch.Dubl., M.P.C., Medical Superintendent, 
District Asylum, Letterkenny, Ireland. 

1899. Moore, Win. D., M.D., M.Ch.R.U.I.. Medical Superintendent, Holloway 
Sanatorium, Virginia Water, Surrey. 

1914. fMorres, Frederick, M.R.C.S.Eng., L.R.C.P.Lond. (Assistant Medical 
Officer, Cane Hill Asylnm, Coulsdou, Surrey); R.A.M.C., Lord 
Warden Hotel, Dover. 

1896. Morton, W. B., M.D.Lond., M.R.C.S., L.R.C.P.Lond., Assistant Medical 
Officer, Wonford House, Exeter. 

1896. Mott, F. W„ M.D., B.S., F.R.C.P.Loud., LL.D.Edin., F.R.S., 25, 
Nottingham Place, Marylebone, W. 

1896. Mould, Gilbert E., M.R.C.S., L.R.C.P.Lond., The Grange, Rotherham, 

Yorks. 

1897. Mould, Philip G., M.R.C.S.Eng., L.R.C.P.Lond., Overdale, Whitefield, 

Manchester. 

1914. fMoyes, John Murray, M.B.,'Ch.B.Edin., D.P.M.Leeds, Crichton Royal 
Institution, Dumfries; R.A.M.C. 

1907. Mules, Bertha Mary, M.D.. B.S.Durh., Court Hall, Kenton, S. Devon. 
1911. fMuncaster, Anna Lilian, M.B., B.Ch.Ediu. (County Asylum, Chester); 

home address, 8, Craylockhail Terrace, Edinburgh; at present 
serving with Serbian Red Cross Society. 

1893. Murdoch, James William Aitken, M.B., C.M.Glasg., Medical Superin¬ 
tendent, Berks County Asylum, Wallingford. 

1916. Murray, Jessie M., M.B., B.S.Durham, 14, Endsleigh Street, Tavistock 

Square, London, W.C. 

1909. Myers, Charles Samuel, M.A., D.Sc., M.D., B.C.Cantab., M.R.C.S., 

L.R.C.P.Lond., Great Shelford, Cambridgeshire. 

1903. fNavarra, Norman, M.R.C.S., L.R.C.P.Lond. (City of London Mental 
Hospital, near Dartford, Kent) ; Temp. Lieut. R.A.M.C. 

1910. Neill, Alexander W., M.D., Ch.B.Edin., Warneford Mental Hospital, 

Oxford. 

1903. Nelis, William F.,M.D.Durh.,L.R.C.P.Edin.,L.R.F.P.&S.Glasg.,Medical 
Superintendent, Newport Borough Asylum, Caerleon, Mon. 

1873. Newington, H. Hayes, F.R.C.P.Edin., M.R.C.S.Eng., The Gables, Tice- 
hurst, Sussex. (Chairman Parliamentary Committee, 1896-1904.) 
(President, 1889.) ( Treasurer since 1894.) 

1869. Nicolson, David, C.B., M.D., C.M.Aber., M.R.C.P.Edin., F.S.A.Seot., 
201, Royal Courts of Justice, Strand, W.C. (President, 1895-6.) 
1888. Nolan, Michael J., L.R.C.P.&S.l., M.P.C., Medical Superintendent, 
District Asylum, Downpatrick. 

1913. Nolan, James Noel Green, M.B., B.Ch., A.B.Dub., The Hospital, Hel- 

lingly Asylum, Sussex. 

1909. +Nornian, Hubert James, M.B., Ch.B., D.P.H.Edin. (Assistant Medical 
Officer, Camberwell House Asylum, S.E.) ; Napsbury War Hos¬ 
pital, St. Albans; Captain R.A.M.C. 

1885. Oaksliott, James A., M.D., M.Ch.R.U.I., Medical Superintendent, 

District Asylum, Waterford, Ireland. 

1916. O’Carroll, Joseph, M.D., F.ll.C.P., Physician Richmond and Whitworth 
Hospitals; Lord Chancellor’s Medical Visitor in Lunacy; 43, 
Merrion Square, Dublin. 

1903. O’Doherty, Patrick, B.A., M.B., B.Ch.R.U.I., District Asylum, 
Omagh. 

1914. O’Flynn, Dominick Thomas, L.R.C.P. A S.I., Assistant Medical Officer 

London Couuty Asylum, Hanwell, Middlesex. 


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Members of the Association. xxi 

1001. Ogilvy, David, B.A., M.D., H.Ch.Dub., Medical Superintendent, London 
County Asylum, Long Grove, Kpsom, Surrey. 

1911. fOliver, Norman H., Capt. R.A.M.C., Special Hospital for Officers, Latch- 
mere, Hum Common, Surrey. 

1892. O’Marn, Francis, L.R.C.P.AS.I., District Asylum, Ennis, Ireland. 

1902. Orr, David, M.I)., C.M.Edin., M.P.C., Pathologist, County Asylum 
Prestwicb, Lancs. 

1910. Orr, James H. C., M.D., Cli.B.Kdin., Rosslynlee Asylum, Midlothian. 

1899. Osburne, Cecil A. P., F. R.C.S., L.R.C.P.Kdin., The Grove, Old C'atton 
Norwich. 

1914. Osburne, John C., M.B., B.Ch.Dubl., Assistant Medical Officer, Lindvilie 
Cork. 

1890. Oswald, Landel It., M.B., C.M.Glasg., M.P.C., Physician Superin¬ 
tendent, Royal Asylum, Gartnaval, Glasgow. 

1916. fOverbeck-Wright, Alexander William, M.D., Ch.R., M.P.C., D.P.H. 

Major f.M.S. Superintendent, Lunatic Asylum, Airra, U. P., India 
(at present on military duty); Lecturer on Mental Diseases. King 
George’s Hospital, Lucknow, and Agra Medical School, Agra. 
Addrett c/o Messrs. King, King & Co., Bombay. 


1905. f P»me, Frederick, M.D.Brux., M.R.C.S., L.R.C.P.Lond., Clay bury Asylum, 
Woodford Bridge, Essex; R.A.M.C. 

1898. -Parker, William Arnot, M.B., C.M.Glasg., M.P.C., Medical Super- 
intendent, Gartloch Asylum, Gartcosh, N.B. 

1898. Pasmore, Edwin Stephen, M.D., M.R.C.P.Lond., Chelsham House, 

Cbelsham, Surrey. 

1916. fPatch, Charles James Lodge, L.R.C.P.AS.Ediu., Assistant Medical 
Officer, Renfrew District Asylum, Dvkehar, Paisley; Capt. 
R.A.M.C. 

1899. Patrick, John, M.B., Ch.B., R.U.I., Medical Superintendent, Tyrone 

Asylum, Omagh, Ireland. 

1892. Patterson, Arthur Edward, M.D., C.M.Aher., M.P.C., Senior Assistant 

Medical Officer, City of London Asylum, Hartford. 

1907. Peachell, George Ernest, M.D., B.S.Loud.,- M.R.C.S., L.R.C.P.Lond., 

M.P.C., Medical Superintendent, Dorset County Asylum, Herrison, 
Dorchester. 

1910. fPearn, Oscar Phillips Napier, M.R.C.S., L.R.C. P., L.S.A.Loud., (Assis¬ 

tant Medical Officer, London County Asylum, Horton, Epsom) ; 
Capt. R.A.M.C., Lord Derby’s War Hospital, Warrington, Lancs. 
1915. fPennant, Dyfrig Huws, D.S.O., M.R.C.S., L.R.C.P.Lond., 21, Bovinton 
Street, Koath Park, Cardiff; Capt. R.A.M.C. 

1913. Penny, Robert Augustus Greenwood, M.R.C.S., L.R.C.P.Lond., Devon 
County Asylum, Exminster. 

1893. Perceval, Frank, M.R.C.S., L.R.C.P.Lond., Medical Superintendent, 

County Asylum, Prestwicli, Manchester, Lancashire. 

1911. Perdrau, Jean Rene, M.B., B.S., M.K.C.S., L.R.C.P.Lond., Senior 

Assistant Medical Officer and Pathologist, Dorset County Asylum, 
Dorchester. 

1911. fPetrie, Alfred Alexander Webster, M.D., B.S.Lond., Ch.B., F.R.C.S. 

Edin. (Assistant Medical Officer, Epileptic Colony, Epsom); Lt: 
R.A.M.C. 

1878. Philipps, Sutherland Rees, M.D., C.M.Q.U.I., F.R.G.S., The Beacon 
Exminster. 

1875. Philipson, Sir George Hare, M.A., M.D.Cantab., D.C.L., LL.D., F.R.C.P. 
Loud.. 7, Eldon Square, Newcastle-ou-Tvne. 

1908. Phillips, John George Porter, M.D., B.S.Lond., M.R.C.S., M.R.C.P.Lond., 

M.P.C., Resident Physician and Superintendent, Bethlern Royal 
Hospital, Lambeth, S.E. (Secretary of Educational Committee 
eince 1912.) 

1910. fPhillips, John Robert Parry, M.R.C.S., L.R.C.P.Lond. (Assistant Medical 
Officer, City Asylum, Bristol) ; Maj. R.A.M.C., Beaufort War Hos¬ 
pital, Bristol. 


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xxii Members of the Association.. 

1906. Phillips, Nathaniel Richard, M.D.Brnx., M.Il.C.S., L.Il.C.P.Lond., Assis¬ 
tant Medical Officer, County Asylum, Abergavenny, Monmouthshire. 
1905. Phillips, Norman Routh, M.D.Brux., M.li.C.S., L.R.C.P.Lond., 67, 
Billing Uoaii, Northampton. 

1891. Pierce, Bedford, M.D., F.R.C.P.Lond., Medical Superintendent, The 
Retreat, York. {Hon. Secretary N. and M. Division 1900-8.) 

1888. Pieterseu, J. F. G., M.R.C.S., L.R.C.P.Lond., Ashwood House, Kingswin- 

ford, near Dudley, Stafford. 

1896. Planck, Charles, M.A.Camb., M.R.C.S., L.R.C.P.Lond., Medical Super¬ 
intendent, Brighton County and Borough Asylum, Haywards Heath. 

1912. fPlummer, Edgar Curnow, M.R.C.S., L.R.C.P.Lond. (Medical Superin¬ 

tendent, Laverstock House, Salisbury); Capt. R.A.M.C., British 
Expeditionary Force. 

1889. Pope, George Stevens, L.R.C.P.AS.Edin., L.R.F.P.&S.Glasg., Medical 

Superintendent, Somerset and Bath Asylum, “ Westfield,” near 
Wells, Somerset. 

1913. Potts, William A„ M.A.Camb., M.D.Edin.&Birm., M.R.C.S., L.R.C.P. 

Lond., Medical Officer to the Birmingham Committee for the Care 
of the Feeble-minded , 118, Hagley Road, Birmingham. 

1876. Powell, Evan, M.li.C.S.Eng., L.S.A., Medical Superintendent, City 
Lunatic Asylum, Nottingham. 

1910. Powell, James Karquharson, M.li.C.S., L.R.C.P., D.P.H.Lond., M.P.C., 
Assistant Medical Officer, The Asylum, Caterbam, Surrey. 

1916. Power, Patrick William, L.R.C.P., L.R.C.S., Senior Assistant Medical 
Officer, County Asylum, Chester. 

1908. Prentice, Reginald Wickham, L.M.S.S.A.Lond., Beauworth Manor, 
Alresford, Hants. 

1901. Pugh, Robert, M.D., Ch.B.Edin., Medical Superintendent, Brecon and 
Radnor Asylum, Talgarth, S. Wales. 

1904. fRace, John Percy, M.R.C.S., L.R.C.P., L.S.A.Lond., Journals and 
notices to Winterton Asylum, Ferryhill, Durham (Wheatley Hill, 
Doncaster); Capt. R.AM.C. 

1899. llainsford, F. E.. M.D., B.A.Dubl., L.ll.C.P.L, L.R.C.P.&S.E., Resident 
Physician, Stewart Institute, Palmerston, co. Dublin. 

1894. fRambaut, Daniel F., M.A., M.D., B.Ch.Dub. (St. Andrews, Northampton); 

Lieut. R.A.M.C., 40th Casualty Clearing Station, British Medi¬ 
terranean Expeditionary Force. 

1910. fRaukine, Surg. Roger Aiken, R.N., M.B., B.S., M.R.C.S.,L.R.C.P.Lond., 

M.P.C. 

1889. fRaw, Nathan, M.D., B.S.Durh., L.S.Sc., F.lt.C.S.Edin., M.R.C.P.Lond., 
M.P.C. (66, Rodney Street, Liverpool) ; Lt.-Col. R.A.M.C., Liverpool 
Merchants’ Hospital, A.P.O.S. 11, British Expeditionary Force, 
France. 

1893. Rawes, William, M.D.Dnrh., F.R.C.S.Eng., Medical Superintendent, St. 

Luke’s Hospital, Old Street, London, E.C. 

1870. Rayner, Henry, M.D.Aberd., M.R.C.P.Edin.', Upper Terrace House, 
Hampstead, N.W. (President, 1884.) {General Secretary, 
1887-89.) {Co-Editor of Journal 1895-1911.) 

1913. fRead, Charles Stanford, M.B.Lond., M.li.C.S., L.R.C.P.Lond. (Assistant 
Medical Officer, Fisherton House, Salisbury) ; Lieut. R.A.M.C., 
Royal Victoria Hospital, Netlev. 

1903. Read, George F., L.R.C.S.&P.Edin., Hospital for the Insane, New 
Norfolk, Tasmania. 

1899. Redington, John, F.R.C.S.&L.R.C.P.I., Portrune Asylum, Donnbate, 
Co. Dublin. 

1911. fReeve, Ernest Frederick, M.B., B.S.Lond., M.R.C.S., L.R.C.P.Lond., 

(Senior Assistant Medical Officer, County Asylum, Rainhill, Lancs.) ; 
Lieut. R.A M.C. 

1911. fReid, Daniel McKinley, M.D., Ch.B.Glasg. (Royal Asylum, Gartnaval, 
Glasgow); Lt., R.A.M.C. 

1910. fReid, William, M.A.St. And., M.B., Ch.B.Edin. (Senior Assistant Medical 
Officer, Bnrntwood Asylum, Lichfield) ; Capt. R.A.M.C. 


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Members of the Association. xxiii 

1887. Reid, William, M.I)., C.M.Aberd., Physician -Superintendent, Royal 
Asylum, Aberdeen. 

1886. Revington, George T., M.A.. M.D., B.Ch.Dubl., M.P.C., Medical Superin¬ 

tendent, Central Criminal As\lum, Dundrum, Ireland. 

1899. Rice, David, M.D.Brux., M.Ii.C.'S., L.R.C.P.Lond., D.P.H., Medical 
Superintendent, City Asylum, Hillesdon, Norwich. 

1897. Richard, William J., M.A., M.B., Ch.M.Glasg., Medical Officer, Govan 
Parochial Asylum, Merry flats, Govan. 

1899. Richards, John, M.B., C.M.Kdin., F.R.C.S.E., Medical Superintendent, 

Joint Counties Asylum, Carmarthen. 

1911. Robert-*, Henry Howard, M.D., Cb.B.Ediu., D.P.H.Glasg., Ennerdale, 
Haddington, Scotland. 

1914. f Roberts, Ernest • Theophilus, M.D., C.M.Kdin., D.P.H.Camb., M.P.C. 

(129, Bath Street, Glasgow); Hawkstone, Cambuslang, Glaggow ; 
Capt. R.A.M.C. 

1903. fRoberts, Norclill'e, M.D., B.S.Durh., (Senior Assistant Medical Officer, 
Horton Asylum, Kpsom, Surrey) ; Major R.A.M.C., Horton County 
of Loudon War Hospital, Epsom. 

1887. Robertson, Geo. M„ M.D., C.M., F. R.C.P.E*lin., M.P.C., Physieian-Super- 

intendeut, Royal Asylum, Morningside, Edinburgh. 

1908. Robertson, George Dunlop, L.R.C.S.AP.Edin., Dipl. Psych., Assistant 
Medical Officer, District Asylum, Hartwood, Lanark. 

1916. Robertson, Jane I., M.B., Ch.B.Giaig., Gartnaval Asylum, Glasgow. 

1895. Robert sou, William Ford, M.D., C.M.Ediu., GO, Northumberland Street, 
Edinburgh. 

1900. Robinson, Harry A., M.D., Ch.B.Vict., 140, Edge Lane, Liverpool. 

1911. fRobson, Capt. Hubert Alan Hir.it, I.M.S., M.R.C.S., L.R.C.P.Lond., 

Punjauh Asylum, India. 

1914. fRodger, Murdoch Mnun, M.I)., Ch.B.Glas., The Rowans, Bothwell, 
Scotland; Lieut. R.A.M.C. 

1908. fRodgers, Frederick Millar, M.D., Ch.B.Vict., D.P.H. (Senior Medical 
Officer, County Asylum, Winwick, Lancs.); Temp. Major, R.A.M.C., 
Lord Derby’s War Hospitxl, Winwick. 

1908. Rolleston, Charles Frank, B.A., M.B., Ch.B.Dub., Assistant Medical 
Officer, County of London Manor Asylum, Epsom. 

1895. Rolleston, Lancelot W., M.B., B.S.Durh., (Medical Superintendent, Mid¬ 
dlesex County Asylum); Lieut.Col, R.A.M.C., Napsbnry War 
Hospital, Napsbnry, near St. Albans. 

1888. Ross, Chisholm, M.D.Syd., M.B., C.M.Kdin., 151, Macquari* Street, 

Sydney, New South Wales. 

1913. Ross, Derind Maxwell, M.B.,Cb.B.Ediu..Morningside Asylum, Edinburgh. 
1910. fRoss, Donald, M.B , Cb.B.Ediu., Argyll and Bute Asylum, Lochgilphead; 
Temp. Lieut. R.A.M.C. 

1905. Ross, Sheila Margaret, M.D., Ch.B.Edin., 83a, Friar Gate, Derby. 
1899. Rotherham, Arthur, M.A., M.B., 1J.C.Cantab., Commissioner under 

Meut. Defec. Act, Board of Control, 66, Victoria Street, West¬ 
minster, S.W. 

1906. Rowan, Marriott Logan, B.A., M.D.R.U.I., Medical Superintendent, 

Derby Couuty Asylum. Mickleover, 

1883. Rowland, E. D., M.B., C.M.Kdin., I.S.O. (attached R.A.M.C.),’ll, Main 
Street, Ge -rge Town, Detnerara, British Guiana. 

1902. fltows, Richard Gundry, M.D.Loud., M.R_C.S., L.R.C.P.Lond. (Patho¬ 
logist, County Asylum, Lancaster), Major R.A.M.C., British Red 
Cross Military Hospital, Mnghull, Liverpool. 

1877. Russell, Arthur P., M.B., C.M., M.R.C.P.Edin., The Lawn, Lincoln. 

1912. fliussell, John Ivison, M.B., Ch.B.Glasg. (Jeanfteld, 18, Woodend Drive, 

Jordan Hill, Glasgow; Temp. Capt. R.A.M.C. 

1916. Russell, William, M.B., Ch.B.Edin., Dip.Psych.Edin., D.T.M.Kdin., 
Assistant Pnysician, Pretoria Mental Hospital, S. Africa. 

1912. + Rutherford, Cecil, M.B., B.Ch.Dubl. (Assistant Medical Officer. Holloway 
Sanatorium, Virginia Water, Surrey); Temp. Capt. R.A.M.C., No. 
16 Standard Hospital, Mediterranean Expeditionary Force. 


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Members of the Association. 

1907. Rutherford, Henry Richard Charles, F.R.C.S.I., L.R.C.P.I., D.P.H., St. 
Patrick’s Hospital, James’s St., Dublin. 

1696. Rutherford, James Mair, M.B., C.M.,F.R.C.P.Edin., M.P.C., Rrislington 
House, Bristol. 

1913. fRyan, Ernest Noel, B.A., M.D., B.Ch.Dub., E.A.M.C., 6th London 
Field Ambulance (T.). 


1902. Sail, Ernest Frederick, M.R.C.S., L.R.C.P.Loud., Medical Superinten¬ 
dent, Borough Asylum, Canterbury. 

1908. Samuels, William Frederick, L.M.&L.S.Dubl., Medical Superintendent 

Central Asylum,Tangong, Rambutan,Perak,Federated Malay States. 
1894. Sankey, Edward H. O., M.A., M.B., B.C.Cantab., Resident Medical 
Licensee, Boreatton Park Licensed House, Baschurch, Salop. 

Sankey, R. H. Heurtley, M.R.C.S.Eug., 3, Marston Ferry Road, Oxford. 
1873. Savage, Sir Geo. H., M.D., F.R'.C.P.Lond., 26, Devonshire Place, W. 

( Late Editor of Journal.) (Pebsidknt, 1886.) 

1906. fScanlan, John J.,L.R.C.P.4S.Edin., L.R.F.P.&S.Glasg.,D.P.H. (1 Castle 
Court, Cornhill, E.C.) ; Capt. E.A.M.C., 5th London Field 
Ambulance, 47th (London) Division, British Expeditionary Force. 
1896. Scott, James, M.B., C.M.Edin.. 98, Baron’s Court Rond, West Keusing- 
ton, W. 

1915. Scott, James McAlpine, M.D., Ch.B.Glasg., Junior Assistant Medical 
Officer, Stirling District Asylum, Larbert. 

1889. Scowcroft, Walter, M.R.C.S., L.R.C.P.I., Medical Superintendent, Royal 
Lunatic Hospital, Cheadle, near Manchester. 

1911. Scroope, Geoffrey, M.B., B.Ch.Dub., Assistant Medical Officer, Central 

Asylum, Dundrum. 

1880. Seccombe, George S., M.R.C.S., L.R.C.P.Loud., c/o Messrs. H. S. King 
and Co., 65, Cornhill, E.C. 

1912. Sergeant, John Noel, M.B., B.S.Lond., M.R.C.S., L.R.C.P.Lond., Medical 

Superintendent, Newlands House, Tooting Bee Common, S.W. 

(Secretary South-Eastern Division from 1913.) 

1882. Seward, William J., M.B.Lond., M.R.C.S.Eug., 15, Chandos Avenue, 
Oakleigh Park, N. 

1913. fShand, George Ernest. M.D., Ch.B.Aberdeen ; (Senior Assistant Medical 

Officer,City Mental Hospital, Winson Green, Birmingham); Journals 
to Capt., R.A.M.C., No. 6 Clearing Hospital, British Expeditionary 
Force. 

1901. fShaw, B. Henry, M.B., B.Ch.R.U.I. (Assistant Medical Officer, County ■ 
Asylum, Stafford) ; E.A.M.C. 

1909. fShaw, William Samuel J., M.B., B.Ch.R.U.I., Major I.M.S., Superin¬ 

tendent, North Veravola, Poona, India. 

1905. Shaw, Charles John, M.D., Ch.B., F.R.C.P.E., Medical Superintendent, 
Royal Asylum, Montrose. 

1915. fShaw, Hugh Kirkland, M.B„ Ch.B.Edin. (Assistant Medical Officer, 
Stirling District Asylum, Larbert) ; Surgeon E.N. 

1904. Shaw, Patrick, L.R.C.P.&S.Edin., Senior Medical Officer (Hospital for 
the Insane, Kew, Victoria, Australia) ; “ Lingerwood,” Wills Street, 
Kew, Victoriu, Australia. On active service. 

1909. Shepherd, George Ferguson, F.R.C.S., L.R.C.P.Irel., D.P.H., 9, Ogle 
Terrace, South Shields. 

1900. Shera, John E. P., M.D.Brux., L.R.C.P.&S.Irel., Somerset County Asylum, 
Wells, Somerset. 

1912. Sheridan, Gerald Brinsley, M.B., B.Ch.R.U.I., Assistant Medical 
Officer, Portrane Asylum, Donubate, Co. Dublin. 

1914. Sherlock, Edward Burball, M.D., B.Sc., D.P.H.Lond., Medical Superin¬ 

tendent, Daren th Industrial Colony, Dartford. 

1914. fShield, Hubert, M.B., B.S.Durh. (Assistant Medical Officer, Gateshead 
Borough Asylum,Stannington, Newcastle-on-Tyne); Capt., E.A.M. C. 

( T.), 1st Nottingham Field Ambulance, British Expeditionary Force, 
France. 


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Members of the Association. 

1877. Shuttlewortli, George E., B.A.Lend., M.D.Heidelb., M.K.C.8. and L.S.A 
Load., 25, New Cavendish Street; 8, Lancaster Place, Hampstead, 
N.W. 

1901. fSimpson, Alexander, M.A., M.D., C.M.Aber. (Medical Superintendent, 
County Asylum, Winwick, Newton-le-Willows, Lancashire); Lt.-Col., 
R.A.M.C., Lord Derby War Hospital, Warrington. 

1905. Simpson, Edward Swan, M.D., Cb.B.Edin., East Riding Asylum, 
Beverley, Yorks. 

1888. Sinclair, Eric, M.D., C.M.Glusg., Inspector-General of Insane, Richmond 
Terrace, Demaiu, Sydney, N.S.W. 

1891. Skeen, James Humphry, M.B., Ch.M.Aber., M.P.C., Medical Super¬ 
intendent, Fife and Kinross District Asylum, Cupar, N.B. 

1900. Skinner, Ernest W., M.D., C.M.Kdiu., J.P., Mouutstield, Rye, Sussex. 
1914. Slaney, Chas. Newuham, M.R.C.S., L.R.C.P.Lond., The Elms, Parkhurst, 

l.W. 

1901. Slater, George N. O., M.D.Lond., M.R.C.S., L.R.C.P.Lond., Assistant 

Medical Officer, Essex County Asylum, Brentwood. 

1897. Smalley, Sir Herbert, M.D.Durh., M.R.C.S., L.R.C.P.Lond., Prison Com¬ 
mission, Home Office, Whitehall. S.W. 

1914. Smith, Charles Kilman, M.B., Cb.B.Aberd., Assistant Medical Officer, 
Borough Asylum, Portsmouth. 

1910. tSmith, Gay ton Warwick, M.D.Lond., B.S.Durh., D.P.H. Cantab., 

M.R.C.S., L.R.C.P.Lond., Assistant Medical Officer, Holloway 
Sanatorium, Virginia Water, Surrey; Capt. R.A.M.C. 

1905. Smith, George William, M.B., Cb.B.Edin., Brisliugton House, near 

Bristol. 

1907; Smith, Henry Watson, M.D., Cb.B.Aberd., Medical Superintendent, 
Lebanon Hospital for the Insane, Asfurujeh, near Heyrout, 
Syria. 

1899. Smith, John G., M.D., C.M.Kdiu., Herts County Asylum, Hill End, St. 
Albans, Herts. 

1885. Smith, R. Percy, M.D., B.S., F.R.C.P.Lond., M.P.C.. 36. Queen 

Anne Street, Cavendish Square, W. ( General Secretary, 1896-7. 
Chairman Educational Committee, 1899-1903.) (Pbhbidiht, 
1904-5.) 

1913. Smith, Thomas Cyril, M.B., B.Ch.Editi., County Asylum, Gloucester. 

1911. Smith, Thomas Waddelow, F.R.C.S., L.R.C.P.Lond., M.P.C., Assistant 

Medical Officer, City Asylum, Mapperley Hill, Nottingham. 

1884. Smith, W. Beattie, F.R.C.S.Edin., L.R.C.P.Edin., 4, Collins Street, 
Melbourne, Victoria. 

1914. Smith, Walter H., B.A., M.D., B.Ch.Dub., Senior Assistant Medical 

Officer, County Asylum, Shrewsbury. 

1901. Smyth, Robt. B., M.A., M.B., Ch.B.Dubl., Medical Superintendent, 
County Asylum, Gloucester. 

1899. Smyth, Walter S., M.B., B.Cb.R.U.I., Assistant Medical Officer, County 
Asylum, Antrim. 

1913. Somerville, Henry, B.Sc., M.R.C.S., L.R.C.P.Lond., F.C.S., Harrold, 
Sharnbrook, Bedfordshire. 

1886. Soutar, James Greig, M.B., C.M.Edin., M.P.C., Medical Superintendent, 

Barn wood House, Gloucester. (Pkbsident, 1912-13.) 

1906. Spark, Percy Charles, M.R.C.S., L.R.C.P.Lond., Medical Superintendent, 

London County Asylum, Banstead, Surrey. 

1875. Spence, J. Beveridge, M.D., M.C.Q.U.I., Medical Superintendent, Burnt- 
wood Asylum, near Lichfield. ( Firet Regietrar, 1892-1899; 

Chairman Parliamentary Committee, 1910-12.) (Pbbsidhnt, 
1899-1900.) 

1913. Spensley, Frank Oswold, M.R.C.S., L.R.C.P.Lond., Senior Medical 
Officer, Darenth Asylum, Hartford, Kent. * 

1891. Stansfield, T. E. K., M.B., C.M.Edin., Medical Superintendent, Loudon 
County Asylum, Bexley, Kent. ■ 




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1901. Starkey, William, M.B., B.Ch.R.U.I., Medical Superintendent, Borough 
Asylum, Blackadon, lvybridge, S. Devon. 

1907. fSteele, Patrick, M.D., Cli.B., M.lt.C.P.Rdin. (Assistant Medical Officer, 

District Asylum, Dundee); St. Colmer, Inverness; Lt. R.A.M.C. 

1898. Steen, Robert H., M.D.Lond., M.R.C.P.Lond., Medical Superintendent, 

City of London Asy lum, Stone. Hartford. (Hon. Sec. S.E. Division, 
1905-10; Acting lion. Oen. Sec. since 1915.) 

1914. Stephens, Harold Freize, M.R.C.S.Lond., L.R.C.P.Eng., 9, Belmont 
Avenue, Palmer’s Green, Loudon, N. 

1914. fStevenson, George Henderson, M.B., Cli.B.Edin., D.P.H.Lond. (Joyce 

Green Hospital, Hartford, Kent); It.A.M.C. 

1912. fStevenson, William Eduard, M.B., B.S.Durh.; Lieut. 19tli Battalion 

Royal Welsh Fusiliers, Winncell Down Camp, Winchester. 

1909. fSteward, Sidney John, M.D., D.S.O., B.C.Cantab., M.R.C.S., L.R.C.P. 

Lond. (Assistant Medical Officer, Langton Lodge, Farncombe, 
Surrey) ; Capt., R.A.M.C., T.R. 

1915. Stewart, A. H. L., M.R.C.S., 72. Wimpole Street, W. 

1868. Stewart, James, B.A.Belf., F.R.C.P.Ed., L.R.C.S.I., 204, Gloucester 
Terrace, Paddington, W. 

1913. fStewart, Ronald, M.B., Ch.B.Glasg. (Gartlock Asylum, Gartcosh, 

Glasgow) ; Capt. R.A.M.C., No. 38 Hospital, Mediterranean Expe¬ 
ditionary Force. 

1887. Stewart, Rothsay C., M.R.C.S.Eng., L.S.A.Lond., Medical Superinten¬ 
dent, County Asylum, Narborough, near Leicester. 

1914. fStewart, Roy M.. M.B., Cli.B.Edin. (Assistant Medical Officer, County 

Asylum, Prestwich) ; Capt. R.A.M.C., Mediterranean Expedi¬ 
tionary Force, c/o G.P.O. 

1905. Stilwell, Henry Francis, L.R.C.P.&S.E., HayeB Park, Hayes, Middlesex. 

1899. Stilwell, Reginald J., M.R.C.S., L.R.C.P.Lond., Moorcrolt House, Hil¬ 

lingdon, Middlesex. 

1897. Stoddart, William Henry Butter, M.D., B.S., F.R.C.P.Lond., M.R.C.S. 

Eng., M.P.C., Harcourt House, Cavendish Square, W. {Hon. Sec. 
Educational Committee, 1908-1912.) 

1909. fStokes, Frederick Ernest, M.B., Ch.B.Glasg., D.P.H.Cantab. (Assistant 
Medical Officer, Borough Asylum, Portsmouth); Major, R.A.M.C. 
(T.), 2/3 Wessex Field Ambulance. 

1905. Strathearn, John, M.D., Ch.B.Glasg., F.R.C.S.E., 23, Magdnlen Yard 
Road, Dundee. 

1903. Stratton, Percy Haughton, M.R.C.S., L.R.C.P.Lond., 10, Hanover 
Square, W. 

1885. Street, C. T., M.R.C.S., L.R.C.P.Lond,, Hnydock Lodge, Ashton, 

Newton-le-Willows, Lancashire. 

1909. fStuart, Fiederick J., M.R.C.S., L.R.C.P.Lond. (Senior Assistant Medical 

Officer, Northampton County Asylum, Berrywood); Major R.A.M C., 
War Hospital, Dunston, Northampton. 

1900. Sturrock, James Prain, M.A.St.And., M.D., C.M.Edin., 25, Palmerstou 

Place, Edinburgh. 

1886. Sufferu, Alex. C., M.D., M.Ch.R.U.I. (Medical Superintendent, Rubery 

Hill Asylum,near Bromsgrove, Worcestershire); Lt.-Col. R..A.M.C., 
1st Birmingham War Hospital, Rubery Hill, Worcestershire. 

1894. Sullivan, William C., M.D., B.Ch.R.U.I., Rampton Criminal Lunatic 
Asylum, Retford, Notts. 

1910. fSutherland, Joseph Roderick, M.B., Ch.B.Glasg., M.R.C.S., L.R.C.P. 

Loud., D.P.H., County Sanatorium, Stonehouse, Lanarkshire. 

1908. Swift, Eric W. 1)., M.B.Lond., Medical Superintendent, Government 

Asylum, Bloemfontein. 

1908. Tattersall, John, M.D.Lond., M.R.C.S., M.R.C.P.Lond., Assistant 
Medical Officer, London County Asylum, Hauwell, W. 

1910. Taylor, Arthur Loudoun, B.Sc., M.B., Ch.B., M.R.C.P.Ediu., 30, 
Hnrtington Place, Edinburgh. 


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1897. Taylor, Frederic Kyott Percival, M.D., B.S.Lond., M.R.C.S., L.R.C.P. 

Loud., Medical Superintendent, East Sussex Asylum, Hellingly. 
1908. Thomas, Joseph I)., B.A., M.B., 15.C.Cantab., Northwnods House, Winter¬ 
bourne, Bristol. 

1911. fThomas, William Rees, M I)., B.S.Lond., M.R.C.S., M.lt.C.P.Lond., 
M.P.C. (Mosside, Maghull, nenr Liverpool); Cant. R.J.M.C. British 
Red Cross War Hospital, Maghull, near Liverpool. 

1880. fThomson, David G., M.D., C.M.Edin. (Medical Superintendent, County 

Asylum, Thorpe, Norfolk); Lieut.-Col. R.J.M.C., Norfolk .War 
Hospital, Thorpe, Norwich. (PuKStDBNT, 1914-16.) 

1903.. Thomson, Herbert Campbell, M.D., F.R.C.P. Loud., Assist. Physician 
Middlesex Hospital, 34, Queen Anne Street, W. 

1905. fTidbury, Robert, M.l)., M.Ch. R.U.l. (Heathlands, Poxliall Road, Ipswich); 

Lieut. R.J.M.C. 

1901. Tighe, Johu V’. G. B., M.B., 15.Ch.R.U.L, Medical Superintendent, 
Gateshead Mental Hospital, Stannington, Northumberland. 

1914. fTisdall, C. J., M.B., Ch.B. (Crichton Royal Institution, Dumfries); 

R.J.M.C. 

1903. Topham, J. Arthur, B.A.Cantab., M.R.C.S., L.R.C.P.Lond., County 

Asylum, Cbarthaui, Kent. 

1896. Townsend, Arthur A. I)., M.D., B.Ch.Birui., M.R.C.S., L.R.C.P.Lond., 
Assistant Medical Officer, Hospital for Insane, Barnwood House, 
Gloucester. 

1904. Treadwell, Oliver Fereira Naylor, M.R.C.S.Eng., L.S.A’.Lond., 102, 

Belgravia Rood, S.W. 

1903. fTredgold, Alfred F., M.R.C.S., L.R.C.P.Lond. (6, Dapdune Crescent, 
Guildford, Surrey) ; Major, R.J.M.C., Mediterranean Expeditionary 
Force. 

1908. Tuach-MacKcnzie, William, M.l)., Ch.B.Aberd., Medical Superintendent, 

Royal and District Asylums, Dundee. 

1881. Tuke, Charles Molesworth, M.R.C.S.Eng., Chiswick House, Chiswick. 

1888. Tuke, John Batty, M.D., C.M., F.R.C.P.Edin., Resident Physician, 

New Saughton Hall, Poitou, Midlothian. 

1885. Tuke, T. Seymour, M.A., M.B., B.Ch.Oxon., M.R.C.S.Eng., Chiswick 
House, Chiswick, W. 

1915. Tulluch, William John, M.D.St. Andrews, Director Western Asylums 

Research Institute, 10, Claython Road, Glasgow. 

1906. ffurnbull, Peter Mortimer, M.B., B.Ch.Aberd., Tooting Bee Asylum, 

Tooting, S.W.; Temp. Lieut. R.J.M.C. 

1909. Turnbull. Robert Cyril, M.D.Lond., M.R.C.S., L.R.C.P.Lond., Medical 

Superintendent, Essex County Asylum, Colchester. 

1889. Turner, Alfred, M.D., C.M.Edin., Plyinpton House, Plyinpton, S. Devon. 
1906. Turner, Frank Douglas, M.B.Lond., M.R.C.S., L.R.C.P.Lond., Medical 

Officer, Royal Eastern Counties Institution, Colchester. 

1890. Turner, John, M.K., C.M.Aberd., Medical Superintendent, Essex County 

Asylum, Brentwood. 


1917. Vevers, Oswald Henry, M.R.C.S., L.R.C.P.Lond., late Junior Assistant 
Medical Officer, Nottingham City Asylum; Norton Vicarage, 
Worcester. 

1904. Vincent, George A., M.B.,B.Cli.Edin.,Assistant Medical Superintendent, 
St. Ann’s Asylum, Port of Spain, Trinidad. B.W.I. 

1894. fVincent, William James N., M.B., B.S.Dnrh., M.R.C.S., L.R.C.P.Lond. 

(Medical Superintendent. Wadslev Asylum, near Sheffield); Lt.-Col. 
R.J.M.C., Wharncliffe War Hospital, Sheffield. 

1914. Vining, Charles Wilfred, M.D., B.S.Lond., M.lt.C.P.Lond., D.P.H., 
M.P.C., Assistant Physician, Leeds General Infirmary, 40, Park 
Square, Leeds. 




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PRINCETON UNIVERSITY 



xxviii Members of the Association. 

1913. fWalford, Harold R. S., M.R.C.S., L.R.C.P.Lotid. (Assistant Medical 

Officer, Kent County Asylum, Banning Heath, Maidstone); Lieut. 

R.A.M.C. 

1914. Walker, Robert Clive, M.B., Cb.B.Edin., West Riding Asylum, Menston, 

near Leeds. 

1908. Wallace, John Andrew Leslie, M.D., Ch.B.Edin., M.P.C., The Hospital, 
Gladesville, Sydney, N.S.W. 

1912. Wallace, Vivian, L.R.C.P. 4. S.I., Assistant Medical Officer, Mullingar 

District Asylum, Mullingar. 

1889. Warnock, John, M.D., C.M., B.Sc.Edin., Medical Superintendent, 
Abbasiyeh Asylum, nr. Cairo, Egypt. 

1895. Waterston, Jane Elizabeth, M.D.Brux., L.K.C.P.I.,L.R.C.S.Edin.,M.P.C., 
85, Parliament Street, Box 78, Cape Town, South Africa. 

1902. Watson, Frederick, M.B., C.M.Edin., Elm Lodge, Clay Hill, Enfield. 
1891 Watson, George A., M.B., C.M.Edin., M.P.C., Lyons House, Rainhill, 

Liverpool. 

1908. Watson,H. Ferguson,M.D..Ch.B.Glas.,L.R.C.P.&S.E.,L.R.F.P.&S.Gla.., 
D.P.H., Northcote, Edinburgh Road, Perth. 

1885. Watson, William Riddell, L.R.C.S. & P.Ediu., 6, Queen’s Mansions, 
Brook Green, London, W. 

1911. fWebber, Leonard Mortis, M.R.C.S., L.R.C.P.Lond. (Assistant Medical 
Officer, Netherne, Mersljham, Surrey); Temp. Lieut. R.A.M.C. 

1911. fWhite, Edward Barton C., M.R.C.S., L.R.C.P.Lond. (Senior Assistant 

Medical Officer, Cardiff City Mental Hospital, Whitchnrch) ; Major, 
R.A.M.C., Welsh Metropolitan War Hospital, Whitchurch. 

1884. fWhite, Ernest William, M.B.Lond., M.R.C.P.Lond. (Betley House, nr. 

Shrewsbury). {Hon. Sec. South-Eaetern Divirion, 1897-1900.) 
{Chairman Parliamentary Committee, 1904-7.) (PRESIDENT 
1903-4.); Temp. Major R.A.M.C. 

1905. fWhittington, Richard, M.A., M.D.Oxon., M.R.C.S., L.R.C.P.Lond., 
(Downford, Montpelier Road, Brighton); Major, R.A.M.C.,T.F., 
2nd East General Hospital, Brighton. 

1889. Whitwell, James Richard, M.B., C.M.Edin., Medical Superintendent, 
Suffolk County Asylum, Melton Woodbridga. 

1903. Wigan, Charles Arthur, M.I).Durh., M.R.C.S.Eng., L.S.A.Lond., Deep- 

dene, Portishead, Somerset. 

1883. Wigleswortb, Joseph, M.D., F.R.C.P.Lond., Springfield House, Wins- 
combe, Somerset. (Pbesident, 1902-3.) 

1913. fWilkins, William Douglas, M.B., Ch.B.Vict., M.R.C.S., L.R.C.P. 

Lond. (County Mental Hospital, Cheddlcton, Leek, Staff.); 
Capt. R.A.M.C. 

1900. fWilkinson, H. B., M.R.C.S., L.R.C.P.Lond. (Assistant Medical Officer 
Plymouth Borough Asylum, Blackadon, ivybridge, South Devon); 
Lieut. R.A.M.C. 

1887. Will, John Kennedy, M.A., M.D., C.M.Aberd., M.P.C., Bethnal House, 
Cambridge Road, N.E. 

1914. Williams, Charles, L.R.C.P.AS.Edin., L.S.A.Lond., Assistant Medical 

Officer, The Warneford, Oxford. 

1907. tWilliams, Charles E. C., M.A., M.D., B.Ch.Dubl.; Greystones, Carnford 
Cliffs, Bournemouth; Capt. R.A.M.C., No. 12 General Hospital, 
British Expeditionary Force, France. 

1905. Williams, David John, M.R.C.S., L.R.C.P.Lond., Medical Superintendent, 
The Asylum, Kingston, Jamaica. 

1915. fWilliams, Gwilym Ambrose, L.R.C.P.Lond., M.R.C.S.Eng. (Pathologist 

and Assistant Medical Officer. East Sussex County Asylum, 
Hellingly); R.A.M.C., 27th General Hospital, Mediterranean 

Expeditionary Force. 

1916. Wilson, Marguerite, M.B., Ch.B.Glasg., Assistant Medical Officer, The 

Retreat, York. 

1912. Wilson, Samuel Alexander Kinneir, M.A., M.D., B.Sc.Edin., M.R.C.P. 

Lond., Registrar, National Hospital, Queen’s Squars, 14, Harley 
Street, W. 


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XXIX 


Members of the Association. 

1897. Winder, W. H., M.R.C.S., L.R.C.P.Lond., D.P.H.Cantab., Deputy 
Medical Officer, H.M. Convict Prison, Aylesbury. 

1875. Winslow, Henry Forbes, M.D.Lond., M.K.C.P.Lond., M.R.C.S.Eng., 
164, Marine Parade, Brighton. 

1899. Wolseley-Lewis, Herbert, M.D.Brux., F.R.C.S.Eug., L.R.C.P.Lond., 

Medical Superintendent, Kent County Asylum, Harming Heath, 
Maidstone. (Secretary Parliamentary Committee, 1907-12. Chair¬ 
man tine* 1912.) 

1869. Wood. T. Outtersou, M.D.Durh., M.R.C.l’.Lond., F.R.C.P., F.R.C.S. 

Edin., 7, Abbey Crescent, Torquay. (Pbbsiubnt, 1906-6.) 

1912. fWoods, James Cowan, M.B., H.S.Lund., M.R.C.S., L.R.C.P.Lond., 
(10, Palace Green, Kensington, W.); Temp. Major R.A.M.C. 

1885. fWoods, J. F., M.D.Durh., M.R.C.S.Eng. (7, Harley Street, Cavendish 
Square, W.) ; Capt. R.A.M.C. 

1912. Wootton, John Charles, M.R.C.S.Eng., L.R.C.P.Lond., Haydock Lodge, 
Newton-le-Willows, Lancs. 

1900. fWortli, Reginald, M.B., H.S.Durb., M.R.C.S., L.R.C.P.Lond. (Medical 

Superintendent, Middlesex Asylum, Tooting, S. W.); Maj. R.A.M.C. 

1862. Yellowlees, David, LL.D.Glas., M.D.Edin., F.R.F.P.AS.Glasg., 6, Albert 
Gate, Do wan Hill, Glasgow. (I'uksidbnt, 1890.) 

1914. fYellowlees, Henry, M.B., Ch.B.Glas., 6, Albert Gate, Dowan Hill, 
Glasgow; Lt., R.A.M.C., 26th British General Hospital, British 
Expeditionary Force. 

1910. Younger, Edward George, M.D.Brux., M.R.C.P., M.R.C.S., L-S.A.Lond., 
D.P.H., Physician to the Finsbury Dispensary, 2, Mecklenburgh 
Square, W.C. 

Ohdinxby Mbmbkrs . 636 

Honobiby Mbmbbbs . 32 

COBBBSPOKDINe MBMBBBB . 18 

Total. 685 

t Serving with H.M. Forces. 

Member* are particularly requested to tend change* of addreee, etc., to The 
Acting Honorary General Secretary, 11, Chandoi Street, Cavendish 
Square, London, W., and in duplicate to the Printers of the Journal, 
Messrs. Adlard 8f Son if West Newman, Ltd., 23, Bartholomew Close, 
London, E.C. 


OBITUARY. 

Members. 


1908. Brown, Ralph, M.B., B.S.Lond., M.R.C.S., L.R.C.P.Lond., Bethlem 
Royal Hospital, S.E. 

1894. Fitzgerald, Charles E., M.D., M.Ch.Dubl., F.R.C.S.I., Surgeon-Oculist 
to the King in Ireland, President of the Royal College of Physicians 
of Ireland, 27, Upper Merriou Street, Dublin. 

1903. fHanbury, Langton Fuller, M.R.C.S., L.R.C.P.Lond. (Medical Super¬ 
intendent, West Ham Borough Asylum, Ilford, Essex). Sportsman’s 
Battalion, Royal Fusiliers. (Missing, reported killed in action.) 

1898. Hine, George T„ F.R.I.B.A., 35, Parliament Street, London, S.W. 

1881. Hughes, C. H„ M.I)., St. Louis. Missouri, United States. 

1899. Kirwan, James St. L., B.A., M.B., B.CIi., R.U.I., Medical Superintendent, 

District Asylum, Ballinasloe, Ireland. 

1899. Macartney, William H. C., L.R.C.P.AS.I., Riverhead Honse, Ssvenoaks. 
1911. fMoon, George Bassett, L.R.C.P. A S.Edin., L.R.F.P.AS.Glas., (Assis¬ 
tant Medical Officer, Surrey County Asylum, Netherne); Surgeon 
R.N. (killed in action). 

1868. Orange, William, C.B., M.D.Heidlb., F.R.C.P.Lond., M.R.C.S.Eng., 
11, Marina Court, Bexhill-on-Sea. (Pbbbidknt, 1883.) 

1877. Turnbull, Adam Robert, M.B., C.M.Edin., Corsewell, Colinton, Mid¬ 
lothian. (Hon. Secretary for Scottish Division, 1894-1901.) 
(Pbbbldbbt-Elbct, 1909-10.) 


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PRINCETON UNIVERSITY* 



XXX 


Lilt of thoss who havs passed the Examination for the Certificate of Efficiency 
in Psychological Medicine, entitling them to append M.P.C. (Med.-Psych. ' 


Certif.) to their nauiee. 

Adam*, J. Barfield. 

Adamson, Robert O. 

Adkins, Percy, R. 

Ainley, Fred Shaw. 

Ainslie, William. 

Alcock, B. J. 

Alexander, Edward H. 
Anderson, A. W. 

Anderson, Bruce Arnold. 
Anderson, John. * 

Andriezen, W. 

Apthorp, P. W. 

Armour, E. F. 

Attegalle, J. W. S. 

Aveline, H. T. S. 

Ballantyne, Harold S. 

Barbour, William. 

Barker, Alfred James Qlanville. 
Bash ford, Ernest Francis. 
Bazalgette, S. 

Begg, William. 

Belbeu, F. 

Bird, James Brown. 

Blachford, J. Vincent. 

Black, E. J. 

Black, Robert S. 

Black, Victor. 

Blackwood, John. 

Blandford, Henry E. 

7 Bond, C. Hubert. 

Bond, R. St. G. S. 

Bowlan, Marcus M. 

Boyd, James Baton. 

13 Boyd, William 
Bradley, J. T. 

Brisiowe, Hubert Carpenter. 
Brodie, Robert C. 

Brough, C. 

Brown, William. 

Browne, Hy. E. 

Bruce, John. 

Bruce, Lewis C. 

Brush, S. C. 

Bulloch, William. 

Calvert, William Dobree. 
Cameron, James. 

Campbell, Alex Keith. 
Campbell, Allred W. 

Campbell, Peter. 

Carmichael, W. J. 

Carruthei s, Samuel W. 

Carter, Arthur W. 

Chambers, James. 

Chambers, W. D. 

Chapman, H. C. 

Christie, William. 

Clarke, Robert H. 

Clayton, Frank Herbert A. 
Clayton, Thomas M. 

Clinch, Thomas Aldous. 

Coles, Richard A. 

Collie, Frank Lang. 

Collier, Joseph Henry 

Digitized by Google 


Conolly, Richard M. 

Conry, John. 

Cook, William Stewart. 

Cooper, Alfred J. S. 

Cope, George Patrick. 

Corner, Harry. 

Cotton, William. 

Couper, Sinclair. 

Cowan, John J. 

Cowie, C. G. 

Cowie, George. 

Cowper, John. 

Cox, Walter H. 

8 Craig, M. 

Cram, John. 

Crills, G. H. 

Cross, Edward John. 

Cruickshank, George. 

Cullen, George M. 

Cunningham, James F. 

Dalgetty, Arthur B. 

Davidson, Andrew. 

Davidson, William. 

6 Dawson, W. R. 

De Silva, W. H. 

11 Devine, H. 

Distin, Howard. 

Dixon, J. F. 

Donald, Wm. D. D. 

Donaldson, It. L. S. 

Donelan, James O’Conor. 

Douglas, A. R. 

Downey, Augustine. 

Drummond, Russell J. 

Eager, Richard. 

Earnes, Henry Martyn. 

Earls, James H. 

East, W. Norwood. 

Easterbrook, Charles C. 

Eden, Richard A. S. 

Edgerley, S. 

Edwards, Alex. H. 

Elkins, Frank A. 

Ellis, Clarence J. 

English, Edgar. 

Eustace, J. N. 

Eustace, Henry Marcus. 

Evans, P. C. 

Ewan, John A. 

Ezard, Ed. W. 

Falconer, A. R. 

Falconer, James F. 

Farquharson, Wm. Fredk. 

Feunings, A. A. 

Ferguson, Robert. 

Findlay, G. Landsborough. 

Fitzgerald, Gerald. 

Fleck, David. 

Fortune, J. 

Fox, F. G. T. 

Fraser, Donald Allan. 

Fraser, Thomas. 

Fredorick, Herbert John. 

Original from. 

PRINCETON UNIVERSITY 



XXXI 


<Hg«, J. M. 

Gandin. Francis NmI. 

Guwn, Ernest K. 

Gominell, William. 

Genney. Fred. S. 

Gibb, H. J. 

Gibson, Tbomas. 

Giles, A. B. 

Gill, J. Macdonald. 

Gilinour, John R. 

Goldie, E. M. 

Goldschmidt, Oscar Bernard. 
Goodall, Edwin. 

Gostwyck, C. H. G. 

Graham. Dd. James. 

Graham, F. B. 

Grainger, Thomas. 

Grant, J. Wemyss. 

Grant, Lacklan. 

Gray, Alex. C. E. 

Gray, Theodore G. 

Griffiths, Edward H. 

Haldane, J. R. 

Hall, Harry Baker. 

Halsted, H. C. 

Haslam, W. A. 

Haslett, William John Handfleld. 
Hassell, Gray. 

Hector, William. 

Henderson, Jane B. 

Henderson, P. J. 

Hennan, George. 

Hewat, Matthew L. 

Hewitt, D. Walker. 

Hicks, John A., jun. 

Hitchiugs. Robert. 

Holmes, William. 

Horton, James Heury. 

Hotclikis, R. D. 

Howden, Robert. 

Hughes, Robert. 

Hunter, G. T. C. 

Hutciiinson, P. J. 

2 Hyslop, Thos. B. 

Ingram, Peter R. 


Jeffery, G. R. 
Jaganuadhan, Annie W. 
JohnstoD, John M. 
Johnstone, Emma M. 
Keith, W. Brooks 
Kelly. Francis. 

Kelso, Alexander. 

Kelson, W. H. 

Ker, Claude B. 

Kerr, Alexander L. 

Keyt, Frederick. 

King, David Bartv. 

King, Frederick Truby. 
Laing, C. A. Barclay. 
Laing, J. H. W. 

Law, Thomas Bryden. 
Leeper. Richard R. 

Leslie, R. Murray. 

Livesay, Arthur W. Bligh. 
Livingstone, John. 

Lloyd, R. H. 

Lothian, Norman V. C. 
Low. Alexander. 


Digitized by 


;ow Alexander. 

Google 


McAllum, Stewart. 

Macdonald, David. 

Macdonald, G. B. Douglas. 

Macdonald, John. 

Macdonald, W. F. 

Macevoy, Henry John. 

McGregor, George. 

Maclnnes, Ian Lamont. 

Mackenzie, Henry J. 

Mackenzie, John Cumming. 

Mackenzie, T. C. 

Mackenzie, William H. 

Mackenzie, William L. 

Mackie, George. 

McLean, H. J. 

Macmillan, John. 

5 Macnaughton, Geo. W. F. 

Macneice, J. G. 

Macpherson, John. 

Maevean, Donald A. 

M album ah, Sreeuagula. 

Mai r, Hamilton C. 

Marsh, Ernest L. 

Marshall, R. M. 

Martin, A. A. 

Martin, A. J. 

Martin, M. E. 

Martin, Win. Lewis. 

Masson, James. 

McDowall, Colin. 

Meikle, T. Gordon. 

Melville, Henry B. 

Middlemass, James. 

Miller, R. 

Miller, R. H. 

Mitchell, Alexander. 

Mitchell, Charles. 

Moffett, Elizabeth J. 

Moll. J. M. 

Monrad Krohn, G. H. 

Monteith, Janies. 

Moore, Edward Erakine. 

1 Mortimer, John Desmond Ernest 
Munro, M. 

Murison, Cecil C. 

Murison, T. D. 

Myers, J. W. 

Nair, Charles R. 

Nairn, Robert. 

Neil, James. 

Nixon, John Clarke. 

Nolan, J. N. G. 

Nolan, Michael James. 

Norton, Everitt E. 

Oldersliaw, G. F. 

Orr, David. 

Orr, Janies. 

Orr, J. Fraser. 

Oswald, Landrl R. 

Overbeck-Wright, A. W. 

Owen, Corhet W. 

Paget, A. J. M. 

Parker, William A. 

Parry, Charles P. 

Patterson, Arthur Edward. 

Patton, Walter S. 

Paul, William Moncrief. 

Peachell, G. E. 

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PRINCETON UNIVERSITY 



xxxn 


Digitized by 


Pearce, Francis H. 

Pearce, Walter. 

Penfold, William James. 

PerdrHU, J. A. 

Philip, James Farquhar. 

Philip, William Marshall. 
12Phillips, J. G. Porter. 

Phillips. J. R. P. 

Pieris, William C. 

Pilkington, Frederick W. 

Pitcairn, John James. 

Porter, Charles. 

Powell. James F. 

Price, Arthur. 

Pring, Horace Reginald. 

Rainy, Harry, M.A. 

Ralph, Richard M. 

Rankine, R. A. 

Rannie, James. 

4 Raw, Nathan. 

, Reid. Matthew A. 

Renton, Robert* 

Rice, P. J. 

Rigden, Alan. 

Ritchie, Thomas Morton. 

Rivers, W. H. R. 

Roberts, Ernest T. 

Robertson, G. D. 

5 Robertson, G. M. 

Robson, Francis Wm. Hope. 

Rorie, George A. 

Rose, Andrew. 

Ross, D. Maxwell. 

Ross, Donald. 

Rowand, Andrew. 

Rudall, James Ferdinand. 

Rust, JameB. 

Rust, Montague. 
lORuthert'ord, J. M. 

Sawyer, Jas. E. H. 

Scanlon, M. P. 

Scott, F. Riddle. 

Scott, George Brebner. 

Scott, J. Walter. 

Scott, William T. 

Seuwright, H. G. 

Sheen, Alfred W. 

Simpson, John. 

Simpson, Samuel. 

Skae, F. M. T. 

Skeen, George. 

Skeen, James H. 

Slater, William Arnison. 

Slattery, J. B. 

Smith, Percy. 

1 To whom the Gaskell 

2 To whom the Gaskell 

3 To whom the Gaskell 

4 To whom the Gaskell 

5 To whom the Gaskell 

6 To whom the Gaskell 
.7 To whom the Gaskell 

8 To whom the Gaskell 

9 To whom the Gaskell 

10 To whom the Gaskell 

11 To whom the Gaskell 

12 To whom the Gaskell 

13 To whom the Gaskell 
To whom the Gaskell 


Go gf6 


Smith, T. Waddelow 
Smith, William Maule. 

Smyth, William Johnson. 

Snowball, Thomas. 

Soutar, James G. 

Sproat, J. H. 

Stanley, John Douglas. 

Staveley, William Henry Charles. 

Steel, John. 

Stephen, George. 

Stewart, William Day. 

Stoddart, John. 

9 Stoddart, William Hy. B. 

Strangman, Lucia. 

Strong, D. R. T. 

Stuart, William James. 

Symes, G. D. 

Taylor, W. J. 

14Thomas, W. Rees. 

Thompson, A. D. 

Thompson, George Matthew. 

Thomson, A. M. 

Thomson, Eric. 

Thomson, George Felix. 

Thomson, James H. 

Thorpe, Arnold E. 

Trotter, Robert Samuel. 

Turner, W. A. 

Umney, W. F. 

Vining, C. W. 

Walker, Janies. 

Wallace, J. A. L. 

Wallace, W. T. 

Warde, Wilfred B. 

Waters, John. 

Waterston, Jane Elizabeth. 

Watson, George A. 

Welsh, David A. 

Wffut T 'I' 

White, Hill Wilson. 

Whitwell, Robert R. H. 

Wickham, Gilbert Henry. 

Will, John Kennedy. 

Williams, D. J. 

Williamson, A. Maxwell. 

4 Wilson, G. R. 

Wilson, James. . 

Wilson, John T. 

Wilson, Robert. 

Wood, David Janies. 

Yeates, Thomas. 

Yeoman, John B. 

Young, D. P. 

Younger, Henry J. 

Zimmer, Carl Raymond. 

Prize (1887) was awarded. 

Prize (1889) was awarded. 

Prize (1890) was awarded. 

Prize (1892) was awarded. 

Prize (1895) was awarded. 

Prize (1896) was awarded. 

Prize (1897) was awarded. 

Prize‘(1900) was awarded. 

Prize (1901) was awarded. 

Prize (1906) was awarded. 

Prize (1909) was awarded. 

Prize (1911) was awarded. 

Prize (1912) was awarded. 

Prize (1913) was awarded. 

PRINCETON UNIVERSITY 



THE 

JOURNAL OF MENTAL SCIENCE 


[Published by Authority of the Medico-Psychological Association 
of Great Britain and Ireland .] 


No. 260 [ m ‘ n w 0 ."T] JANUARY, 1917. Vol. LXIII 


Part I.—Original Articles. 


Optimism and Pessimism. By Henry Maudsley, M.D. 

When two persons meet together to discuss some enter¬ 
prise or future event, or other speculative matter, without 
coming to an agreement, they may separate by one thinking 
or calling the other an optimist and the other thinking or 
calling his opponent a pessimist. Thereby they settle the 
matter temporarily, although of course they leave it undecided 
and agree only to differ. What they really settle is that two 
congenitally different temperaments necessarily view the subject 
from two different aspects and conclude accordingly. They do 
not stay to enquire which is the true view, the one being 
inclined by his temperament to look on the dark side of things 
and see the evils, hates, strifes, sufferings, failures and follies 
in the world, the other inclined by his temperament to look on 
their bright side and accordingly see the good, love, joys, and 
successes in it. Why, indeed, should they stop to enquire?' 
Every mind in the world necessarily construes it in terms of 
itself, and therefore feels and thinks its individual world—- 
the mind of the fool a different world from that of the sage, 
the mind of the sinner from that of the saint, the mind of the 
Andaman Islander from that of the Anglo-Saxon, the mind 
of the particular person from that of his neighbour. There 
must naturally be one common world in the necessarily common 

LXIII. ft 


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OPTIMISM AND PESSIMISM, 


2 


[Jan, 


notion of a like-structured species, but there are as many 
particular worlds as there are persons in it. 

The question which is the true view of life on earth is too 
large and abstruse a question to be profitably discussed here. 
Truth is a pleasant abstraction, a visionary and ever-receding 
ideal of beauty to be pursued ; the particular truth changing 
from day to day in a changing world. No truth can ever be 
whole and complete ; must always be one face only, partial 
and incomplete at the best ; absolute truth almost as absurd a 
fancy as would be the truth of a precocious infant in its mother’s 
womb, were it able there to speculate concerning things in the 
world. Seldom therefore does one generation fail to criticize 
and amend, perhaps to condemn, the truth of a previous 
generation and t» count itself superior in depth and height of 
intellect ; mounted on the shoulders of its predecessor, it 
necessarily sees farther. Yet its truth-culture is sure to be 
criticized and modified by a succeeding generation, which will 
then in turn vaunt its superiority. 

Here by the way it is curious to observe how apt some 
eminent scientific thinkers, having renounced all faith in God, 
miracles, and immortality, are to glorify their eager pursuit of 
truth and mightily to magnify their arduous labours; as if 
truth were a fixed constant, a sacred entity, which they were 
destined to seize and hold someday. Having discarded belief 
in supernatural truth from on high and miraculous interposition 
on earth below, they suffuse their vision of truth with a 
aacred halo belonging to the beliefs which they have expressly 
abandoned. Hallowing it unconscioasly with the silent emotion 
•f their Christian birth and upbringing in a religious atmo¬ 
sphere, they forget that it is not a fixed abstract something 
which they can ever grasp, but a succession of small approxi¬ 
mations, which are so many additions to knowledge by the 
slowly made adaptations they painfully make to surrounding 
nature and call discoveries of its secrets. Moreover, they 
easily overlook the fact that it is not the capture but the 
pursuit which is the joy—the active effort which shares and 
gladly feels life’s essential motion—and that they would be 
desolate after each little capture could they not start afresh on 
a new and enthusiastic chase. So true is the saying of the 
French philosopher—Si je tenais la veritd dans la main, j’ouvrais 
la main afin de poursuivre la verity. 


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Is there any century of human existence which mankind 
would seriously wish to be repeated ? Not even probably the 
present century, the recent unforeseen explosions of which have 
given such a rude shock to its native optimism. Amazing, 
confounding, almost appalling, yet strict effects of natural law 
which ought rightly to have been foreseen by a generation of 
beings proud of their intelligent superiority over all past beings. 
That events so momentous were not in the least anticipated 
but befell suddenly as an entirely unsuspected catastrophe is 
positive and pathetic proof of a stolid blindness to the forces 
then silently and steadily working, and of a foolish self- 
complacent optimism. An optimism which after recovery 
from the collapse of its first rude shock happily springs up 
instantly afresh to see in the present cataclysm the hope and 
promise of a forthcoming moral regeneration and righteous 
elevation of humanity, if not on a great part of the earth, at 
any rate in happy England. In the piously optimistic mind 
faith, being “ the evidence of things unseen,” is sustained and 
fortified by the disappointments and disasters of things seen. 

That exultant optimism springs up afresh in the human 
breast is evidence of an alert and active vitality in a people as 
well as in a single person. In both it is the effect of life instant 
and insistent to assert an*! increase itself ; consciously expressed 
in hope, which, though it springs eternal in the human breast 
and is never satisfied, being unlimited, serves at least to lead by 
a pleasant path to the end of life ; many times, too, persists in 
the last stage of actual dying. 

The pessimistic temperament, on the other hand, is notably 
prone to melancholy, and sometimes to fits of deep melancholic 
dejection. Its lower lust of a slower life is shown by its less 
vivacity and promptness to respond instantly to impressions in 
its relation with the external world, its duller inclination to try 
new adaptations to its physical and social environment. The 
truth is that many of these adaptations, being really transient 
and futile, are wisely disregarded ; and for that reason it gains a 
deeper insight into and truer hold of the substance beneath 
the superficial show. It feels and thinks less vividly, but in 
the end more deeply, less superficially but more solidly. 

The optimist, it is true, ceases not theoretically to proclaim 
the vanity of mortal life, the sorrow, care, and toil of the brief 
life which is here his portion, the joy of the morning when life 


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springs up green and flourishes like the grass, and in the even¬ 
ing is cut down and withers, but utterly ignores the theory in 
practice, and lives on as if he would live for ever, though he 
knows he may not live for a day. By his immanent vital lust 
repugning the thought of its discontinuance he is compelled to 
cherish the hope and nurse the theory of an immortal and tear¬ 
less life elsewhere. He can then, as he does, give “ hearty 
thanks ” to Almighty God “that it hath pleased Thee to deliver 
this our brother (or sister) from the miseries of this sinfut 
world,” to beseech Him soon to complete the number of His 
Elect and end a sinful world’s sufferings. Such the blissful 
compensation which he fondly expects for the prolonged 
martyrdom of his abortive life on earth. 

The pessimist, on the other hand, who feels no such vivid 
assurance of immortal life, and is perhaps subject to dejected 
fits of melancholy, may be wholly void of any expectation or 
wish to live for ever anywhere ; nay, sometimes thinks his life 
of such little worth that he voluntarily ends it. His experi¬ 
ence of what life is and his knowledge of what it always has 
been from its beginning up to its present height convert joy 
of life into mere stoical endurance of it. He is perhaps called 
d hypochondriac, which in a literal sense he is, for the several 
organs of his manifold visceral system, the multiplex under¬ 
lying functions of which are the base and supply of his emo¬ 
tions, are comparatively sluggish and inert, except when 
temporarily animated by some physical agent or the stimulus 
of lively social intercourse. 

The plain truth is that he observes sincerely, thinks fully, 
and feels deeply, unlike in that respect the optimist who, exul¬ 
tant in the immediate joy of living, cares not to learn or think 
on the dismal history of human life through the ages. Giving 
no heed to the story of what .man has been (which is the use 
and value of history) the optimist necessarily lacks in conse¬ 
quence the profitable instruction which, by adequate knowledge 
of the past, he might obtain concerning what man ought to 
strive to be in the future. Would any person, rightly instructed 
and intelligent enough to reflect sincerely and fully on the 
course of nature and human nature, past and present, be con¬ 
tent to be responsible for it, the pessimist gloomily asks him¬ 
self? Were the choice and power miraculously given him to 
determine and direct a future which should be anything like 


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the past, would he not be pessimistic enough to commit suicide 
rather than accept the awful responsibility and exercise the 
awful power ? To the unreflecting optimist pessimistic reflec¬ 
tions of that kind seem to mark an inferior quality of being; 
he regards the person who makes them as something of a 

pathological phenomenon," and himself as the embodiment of 
sound and superior life, lusting to live and joying to live in 
whatever situation its lot is cast. However squalid his circum¬ 
stances and mean his occupation, he is not merely content but 
pleased to live, and seldom voluntarily ends his life. Plainly 
he is a practical optimist; for he is sure his life is worth living, 
and his deeds worth doing to keep it alive, though these be 
only to sweep a crossing or to clean out a sewer. 

How entirely dependent a bright outlook on life is on the 
state of individual vitality is clearly demonstrated by the de¬ 
pressing effect of vital injury or sickness on the estimate of its 
value. In that case the optimist becomes for a time a pessi¬ 
mist, desiring little, hoping less ; sees the world and its events 
in a quite different aspect, not because it is changed in the 
least but because the grievous change is in him. The bodily 
hurt to life repaired, his optimism revives afresh ; once more 
he looks on the bright side of things, and pursues his aspiring 
-aims with jubilant hope and assiduous effort. The life which 
he felt to be little worth when he was sick and dispirited he 
feels to be well worth living now that he is convalescent and 
himself again ; the desire to live the first sign of convalescence. 
That is the natural and normal effect on the individual nature 
■of a vitality inspired by the infused life of nature, and enthused 
by the vision of immortal value, whether that vision be fact or 
fancy. A sane outlook on things has superseded the morbid 
outlook of unsound vitality, and is accordingly concluded to be 
the right view, whatever doubt a deep-reaching and too curiously 
inquiring reason may insinuate. Yet when his vital feeling 
sinks low and gradually approaches extinction in the darken¬ 
ing change and decay of old age he may think differently. 1 

1 Here may he given a true story told to the writer by a friend of John Bright 
from whom he had it. On a certain occasion, after a rather contemptuous comme nt 
by Palmerston on a speech by Bright in the House of Commons, Disraeli, meet¬ 
ing Bright in the lobby, said to him : " Why not, Mr. Bright, join our party; th*y 
■will never do anything for you?” "Ah,” replied Bright, "you come into the 
House, Mr. Disraeli, for one purpose,I for quite another." “ Yes,” answered Disraeli, 
" I regard it as the finest arena in Europe.” Yet Disraeli, when triumphs were 
over and he was near his end, recognized and owned what phantoms his exploits 
bad been.— (Lift of Lord Beaconsf.eld.) 


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Life in fact realizes its nothingness only when it has no time 
left to tell it. 

“ Life is a landing on a silent shore 
Where billows never roll nor tem pests roar, 

Ere well we feel the friendly stroke, ’tis o’er.” 

Notably, furthermore, does some momentous event in indi¬ 
vidual life, pleasing or painful, in like manner change the 
whole aspect of things for the time, raising or lowering vital 
interest in them. 

The progress of human life to maturity and its subsequent 
decline is a succession of individual changes by insensible- 
gradations ; in reality therefore a chain of different selves. At 
twenty-five or thirty-five years of age the person is visibly 
more intensely and largely optimistic than he is at threescore 
or, should he live so long, at fourscore years when, so far from 
being joyous, “ his strength then is but labour and sorrow, so 
soon passeth it away ” : an addition every day to life when he 
ascends, a subtraction from it every day when he descends. 
Too plain it is then that “Verily, every man living is altogether 
vanity.” 

That such changed view of life’s worth is owing to lowered 
vitality of the organism is obvious enough. What that vital: 
reduction signifies physically is not yet known ; must remain 
obscure until scientific enquiry has discovered what are the 
intimate physical conditions of the structure of living tissue 
and of nerve-tissue in particular : why, for instance, a poison 
and a despair should similarly disorder and reduce life. All 
that can be said at present is that one person is so constituted 
as to react quickly and superficially to impressions, another 
person more slowly and deeply ; not otherwise in fact than as 
coal of one kind of structure flames quickly and brightly when 
lighted, giving out less heat, and coal of a different structure,, 
less easily lighted, burns deeply with a dull red glow, giving 
out more heat but less cheerful light. The temporary elation 
of spirit, again, which alcoholic stimulation in one form or 
another physico-chemically produces is after all the effect and 
explanation of the universal craving by stimulated life for an 
ideal gratification which real life denies it. Natural or artificial, 
the ideal ever pursued is never attained. 

Life consists essentially in motion ; is a physical pheno- 


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menon, and its manifestations in mind simply physical pheno¬ 
mena which take effect in the nervous system. As Claude 
Bernard emphatically said, there is no more a “ vital principle ” 
than there is “ mineral principle ”—that is to say, “ an entity- 
distinct from the phenomena themselves.” In the restless 
child, even in the infant fumbling with its toes, life’s nature is 
most clearly shown by the perpetual need of activity. In 
manhood, again, idleness becomes a burden ; relief then to be 
found only in active work. As the Chinese proverb puts it : 
“The dog confined to its kennel, which cannot spend itself in 
the chase, barks at its own fleas.” To every sound organism 
effort is a pure and simple joy ; it is fundamentally to feel 
life’s motion. By the sweat of his face to gain his bread, 
until man returns to the earth whence he was taken, was the 
happy edict of the lost Eden. Great intellects have often been 
compelled, or have wisely willed, to apply themselves to some 
practical, even mechanical, work which has been a wholesome 
diversion and benefit. Thereby they kept themselves in 
contact with realities and dissipated the mists and defects of 
a too exclusive thinking on their own thoughts : Milton to the 
instruction of pupils and Latin Secretary’s work, Shakespeare 
to the active management of the theatre and occasional acting 
in it ; Spinoza to the grinding and polishing of telescope 
glasses,- Montesquieu to gardening, No quiet joy equals that 
of soft repose after labour, no physical ease probably that of 
the last stage of actual dying. Life being thus essentially 
motion, the infinite number and multiplex motional complexi¬ 
ties of the various organs and tissues coordinated and unified 
in the whole human organism, naturally and necessarily express 
themselves consciously in eager mental activity and an opti¬ 
mistic feeling of life. 

Of the two opposite views of life on earth pessimism is alike 
the stern conclusion of thinking reason and the pious con¬ 
fession of reverent religion. “ Man that is born of a woman 
hath but a short time to live, and is full of misery. He cometh 
up and is cut down, like a flower ; he fleeth as it were a 
shadow, and never continueth in one stay.” Optimism, on the 
other hand, is the practical expression of unthinking feeling, 
minding not its theoretical depreciation of mortal life, exulting 
on its direct joy of life. Nor can the pessimist who has neither 
hope nor wish for an immortal life somewhere in an undefined 


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and undefinable Heaven—even though he be then so com¬ 
pletely transformed as to be quite a new self gloriously infused 
with heavenly thoughts, and blessedly oblivious of or indifferent 
to what he was and did on earth—always gratify himself 
with the substituted thought, so heartening to some persons 
and enthusiastically uttered by them in sentimental prose or 
poetry, that he shall live for ever in the life and worship of an 
ever progressive humanity. He cannot bring himself really to 
feel and believe that its future progress is indisputably certain 
and stable, or shall ever be worth the labour, pains and 
sufferings which it has cost through the myriads of years 
required to make man the being that he is ; or, furthermore, 
that it is in the Universal Plan to bestow on him the perfect 
happiness which it is apparently assumed shall then go along 
with the increasing perfection and might not really be a blessing. 
He counts such vision of a new and perfect human future the 
illusion of an unwarranted optimism, eager and instant to have 
the Paradise of a Golden Age to come in lieu of a Golden Age 
past. Exultant life has notably always needed and at the 
opportune season created the fit fictions to inspire and spur its 
efforts to increase mentally by new and useful adaptations, 
abandoning them one after another in the everlasting flux of 
things when they were effete and no longer useful ; such fictions 
manifestly the natural and necessary means of the successive 
steps of its progression. Had it not seasonably made them, it 
must have lost its instinctive impulse to live and increase. 
What reasonable ground then is there to believe that an 
unlimited future progress, with a proportionately increasing 
happiness, may not likewise be only a useful fiction to animate 
human effort, and encourage patient endurance in its sorrowful 
pilgrimage through a “ vale of tears ” ? Hope has ever been the 
animating pulse of conscious life, that pulse fundamentally 
vital—sun-derived naturally or infused supernaturally. 

The really important question is whether the optimistic view 
of unlimited human perfectibility, which inspires the emotional 
outpours of those who picture it in imagination, is justified by 
the history of the human past, in which the archaeologist now 
discovers conclusive evidence that many civilizations have in 
turn sprung up, each flourished for its season and then vanished 
in oblivion. Iu his interesting Presidential Address to th 
Pritish Association at Newcastle (1916) Sir Arthur Evan" 


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informs us that “ the polychrome masterpieces ” on the ceilings 
of the inner vaults of the Altamira Cave supply evidence not 
only of a high level of artistic attainment in South Western 
Europe some ten thousand years earlier than the most ancient 
monuments of Egypt or Chaldiea, but conclusively indicated 
the use of artificial illumination of a high order. Cretan archi¬ 
tecture, again, by its combination of usefulness, beauty, ami 
sanitation, far excelled the similar works of Egyptian and 
Babylonian builders. Much the same, too, as now were the 
robes, the gloves, the mannerisms and gestures of the ladies, as 
seen in the frescoes. Justly, then, may the pessimist, thus con¬ 
fronted with the plain and positive evidence of the successive 
rises and falls of civilizations through the ages, ask for some¬ 
thing more definite and certain than a vague hope or optimistic 
vision of human perfectibility. 

Confident reliance on feeling is the optimist’s support and 
comfort; he feels sure that what he wishes to be shall be, 
however long and tedious the process in the destined procession 
of events. A keen vital vivacity expressing itself instantly in 
consciousness, not caring to reach deeply below it, naturally 
repugns the notion of life’s discontinuance or serious reduction 
while the sun continues to be the source and life of nature. 
Yet it is seldom satisfied with the promise of an eternal life in 
ever progressive life of humanity on earth. Life in being, ever 
craving the continuance and increase of its being, mostly needs 
and uses the theory of an immortal life of sinless felicity to 
supplement its mortal life of misery in a sinful world. There¬ 
upon, converting the theory into a creed, it defies and despises, 
as the way of a creed is, all assaults of reason. 

The momentous question, when all is said, between optimist 
and pessimist is a deeper question than it is generally thought 
right to raise and consider. It is whether a Divine Creator and 
infinitely loving Ruler of the Universe, who hath made and 
loveth all his creatures, great and small, purposes with Provi¬ 
dential benevolence to establish an ultimate and universal reign 
of righteousness on earth—a Kingdom of Heaven here some 
day when, as Isaiah optimistically prophesied, the lion shall lie 
down with the lamb, men beat their swords into ploughshares, 
the little child thrust its hand unharmed into the cockatrice’s 
den. Is that a true theory rightly to be cherished as a creed ? 
Or is it just the ever-springing illusion of human optimism, 


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only that and nothing more ? Sincere, adequate, and un¬ 
biassed contemplation of the procession of events on earth from 
their first known beginnings to their present far from satisfac¬ 
tory state forces' the brooding pessimist at least to suspect,, 
sometimes openly to declare, that it is not true, but just a theory 
of egotistic human wish, actually and visibly contradicted by ex¬ 
perience of what has hitherto been and still is in the procession 
of events. Nevertheless, a fiction useful and necessary now and 
hereafter to lure, incite, and sustain progress, as past fictions 
have been in their season. True experience undeniably is of 
an unlimited and incomprehensible Universe which proceeds 
on its fated way, without haste and without rest, by course of 
fixed law to an end utterly beyond the very limited compass 
of human comprehension ; a rigorously inexorable course in 
which human life is the smallest fraction and nowise the end, 
but it necessarily construes in terms of its minutely fractional 
self. “ The universe,” says Hume, “ so far from demonstrating 
the existence of an omnipotent, wise, and loving father, rather 
suggests a blind nature impregnated by a great vivifying 
principle and pouring forth from her lap, without discernment 
or parental care, her maimed and abortive children." Immen¬ 
sities, eternities, omnipotences, absolutenesses, and like sound¬ 
ing phrases are vague, substanceless words which, uttering the 
emotional outpourings of the awestruck creature, have that 
value ; at bottom the particular value and valuation of the self- 
valuing person. Be this personal value what it may, they are 
at any rate the collective expression of an awful emotion which, 
l>eing a fundamental fact of human psychology, the very basis 
of religion in the procession of events, have their significance, 
whether eternal and supernatural, or not. 

That they are supernaturally derived is the solemn conviction 
of feeling which is aptly and devoutly expressed in the well- 
known lines of Pope— 

“ Father of all in every age, 

In every clime adored, 

By saint, by savage, and by sage, 

Jehovah, Jove, or Lord. 

Thou great First Cause, least understood, 

Who all my sense confined 
To know but this, that Thou art good, 

And that myself am blind.” 


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Yet in matter of fact man’s confined sense cannot possibly 
make him know a Great First Cause, and that it is good. To 
pure knowledge the positive facts of experience plainly demon¬ 
strate that many things on earth are not what he thinks good. 
Personal ecstasy of emotion straightway translates itself into 
knowledge, and the preconceived idea of a good God inevitably 
then finds all things good—even validates the consoling belief 
that God has sent the present war to punish a perverse and 
unbelieving generation for its sins, and to bring it to repentance 
and a righteous resolution to know and do His ways, which is 
the express teaching of theology. That God sent the war may 
be deemed undeniable, but that an all-wise, all-loving Omni¬ 
potence, “ whose eye views all things at one view,” deliberately 
chose and decreed such horrors of slaughterous devastation, 
rapes, rapines, and murders as the proper means to create a 
humbler spirit, and enforce a more servile adulation and 
adoration is nowise so evident and universally indisputable as 
it is to the specially trained theological mind. 

Persons of that habit of mind, without minding closely what 
they say, complacently ascribe to God’s sending the abominable 
deeds for which mankind are solely responsible, as they once 
used to ascribe to the Devil the instigation of man’s evil thoughts 
and deeds, satisfied thus to thrust the actual responsibility off 
themselves, and justify by faith a final pious optimism. 
The nation at war then goes on to flatter and praise 
itself that in its ravages and slaughters it is fighting 
bravely and gloriously for the right and justice—always in 
each case of its specially projected God. “ II est parfaitement 
vrai que les hommes se pillent et s’egorgent, mais c’est toujours 
en faisant 1’tHoge de 1’equite et de la douceur ” (Voltaire). All 
which at bottom proceeds from the inveterate anthropomorphic 
habit of making Omniscience think in their ways of thinking, 
and Omnipotence act in their ways of doing. 

Sacred Scripture is nowise consistent in its optimism, most 
consistent indeed in its pessimism ; for it contains often 
reiterated utterances of mournful pessimistic feeling, and 
agreeably postulates immortal life as compensation for the 
miseries of this mortal life: But can it possibly be that man 
hath no profit of his labour which he taketh under the sun ? 
Yes, is the sorrowful answer ; “ I have seen all the work that 
is done under the sun ; and behold all is vanity and vexation 


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of spirit. For that which befalleth the sons of men befalleth 
beasts, as the one dieth so dieth the other ; yea they have all 
one breath.” 

The truth is that optimistic and pessimistic feelings have 
been expressed in all ages and in all climes—notably by 
writers of eminent intellect in ancient Greece and Rome, 
superlatively by that supreme optimist Plato, more soberly by 
Aristotle, piously by Augustine, Aquinas, and other schoolmen 
(whose ingenious and elaborate attempts to affect a reconcilia¬ 
tion of the painful facts of actual life with ideal fancies and 
Christian dogmas exhibit such marvellously subtle sleight of 
thought and subtle argumentative skill); most pessimistically by 
Brahminism and Buddhism, which last is unqualified pessimism. 
Jansenism versus Jesuitism, again,—especially in the person 
of Pascal—was virtually pessimism versus optimism. Yet the 
conclusion of the whole matter is that no conclusion has been 
reached. Arguments and attempted reconciliations have gone 
on vainly as before, not a step forward has been made, and 
writers now pass and repass the same barren ground in futile 
and endless reiterations to solve the same insoluble problem. 
Doomed, moreover, to remain insoluble so long as mankind, 
cherishing the monstrous belief that the Universe was created 
and works for their benefit, endeavour to construe it in terms 
of their very partial feelings and thoughts, which can have no 
intelligible relation with a whole Universe. To think otherwise 
is nothing else than to make the human relative into the 
absolute. 

Optimistic feeling is loth to admit, nay stubborn to reject, 
such limitation. It infuses into its wants and wishes, even 
believes to achieve in its apocalyptic ecstasies, an actual 
communion with a Divine Reality, which needs no argument 
to prove it. The really important question therefore is what 
is the value of that sublime and self-proving intuition with 
which the particular person is gifted, whatever his quality of 
mind and whatever his expressed character in life ; an intuition 
which no one else can test, and is thought to need no other 
proof than his inspired personal conviction. Is the ecstatic 
feeling of mental transport by him undeniable certainty of its 
value, as he in prodigal admiration of his transported self 
confidently declares ? Or is it not, when soberly viewed by 
impartial observation, and weighed by cool reason, perchance 

I 


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something of the nature of a distracted tract of thought in his 
mental organization, which is then severed for the occasion 
and exercise from all life of relation and, thus severed, pleased 
to count the joy of its spasmodic utterance a communion or 
union with the Divine ? Is it truly the ineffable yet absolutely 
indisputable relation which it is fondly or fatuously assumed 
to be? As the history of a person is the express revelation of 
his character, the dispassionate observer may justly insist on 
his right and duty to consider and weigh strictly the particular 
life-value, as disclosed in deeds, up to the blissful moment of 
the impassioned transport. That value may not probably 
prove to have been great; commonly indeed prove to have 
been quite the reverse. 

Furthermore, it ought to be remembered that the transcen¬ 
dental rapture notably sometimes rises to such a pitch as to 
produce actual “ voices ” of communication, as in Theresa’s case, 
sensible and practical a person as she was in her—strictly kept 
apart—worldly affairs.and sternly contemptuous of the hysterical 
outbursts of her neurotic nuns. Such audible communications 
are not generally thought to have real value; they are regarded 
as incidental hallucinations of the mental exaltation ; much 
like the vision which Luther had of the Devil when he impetu¬ 
ously flung his inkstand at the spectre, and pretty certainly 
would not have done had it been the real Devil in person. 

Moreover, in weighing justly the abstract value of these trans¬ 
cendental raptures it is proper to take strict account of certain 
concrete and rightly relevant physical facts which are apt to 
be overlooked. It is well known that a dose of opium will in a 
fitly sensitive brain, like that of De Quincey, produce a similar 
subtilized feeling of absorption into the infinite, lengthening 
time into eternity, expanding space into infinity, melting indi¬ 
viduality into universality. The person, too, who is being put 
under an anaesthetic, before actual loss of consciousness, some¬ 
times feels himself or herself to be wonderfully transported into 
a realm of spirit, as he or she imagines, and mysteriously 
absorbed for the moment into the infinite reality, or otherwise 
volatilized into an unspeakable intuition of it. Mind, entirely 
severed for the time from its normal life of relation which is its 
substantial life, then struggles in vain to formulate its mysterious 
experience in thought ; the physical stimulated and disordered 
federal organization with its answering feeling of special exal- 


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tation then rendered incapable of orderly sequence of thought 
and feeling ; full rational life temporarily suspended, an exclu¬ 
sive spiritual life sublimed. It is- the custom to speak as if 
such suspension of one tract of thought by another in that case 
Avere actively inhibited, which no doubt it proximately is ; but 
the more correct statement might be that, the motion of one 
train of thought is diverted on to another line of thought, 
thereby automatically inhibiting by physically transferring the 
first motion. 

What is the real value of the transcendental rapture which the 
ecstatic person experiences remains yet undetermined and no- 
Avise indisputable. Has it in fact the value which he or she, 
however meanly endowed, imagines it to have? If that were 
so, it would follow that the right aim to pursue and the duty to 
•do might be for everybody to take a fit dose of opium or like- 
acting drug, or to put himself under an anaesthetic from time to 
time in order to achieve the beatific vision of a spiritual in¬ 
tuition. Not too frequently, be it understood, for such impru¬ 
dent repetition might undoubtedly issue in a fixed and lasting 
mental alienation—in positive insanity instead of sanity of 
sense and thought. 

Of the two lights available for human guidance in the 
gloomy vale of tears, toils and fears is the faith the greater and 
reason the lesser light ? That is the still disputed and unre¬ 
solved question, which the optimist will continue to answer 
confidently by the inspiration of feeling, the pessimist less con¬ 
fidently and more soberly, after his doubting fashion, by the 
dry light of reason. 

Meanwhile, what is certain is that no greater waste of 
ingenuity can well be conceived than the laboured and futile 
attempts which have been made (especially in Germany) to 
compute arithmetically whether the sum of happiness or of 
misery is the greater on earth. That they are pretty evenly 
balanced is proved by the continuance of the dispute, and that 
mankind has continued to go on living may be accepted as 
evidence that they have felt life to be worth living. “ La 
question du bien et du mal demeure un chaos ind6brouillable 
pour ceux qui cherchent de bonne foi; c’est un jeu d'esprit pour 
ceux qui disputent ; ils sont des formats qui jouent avec leurs 
chaines” (Voltaire). For the present, at any rate, life likes to 
live, and for a long time to come, propelled by the outside 



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forces immanent in its nature, will continue to live ; not other¬ 
wise in fact than as lighted coal burns until the sunbeams con¬ 
solidated in its structure are resolved, released, and spent. 

The truth is that the literature'of all countries in all climes 
is full of lamentations that the miseries of life are as numerous 
-as, or more numerous than, its happinesses ; that pleasure 
always brings pains in its train ; that one joy is counterbalanced 
by many griefs ; that pleasures are superficial and pains deep ; 
that happiness and unhappiness are naturally and inevitably 
■connected ; and the like utterances of woe. All which pessi¬ 
misms, though sorrowfully admitted to be true, moral and 
philosophical reflection has now sedulously set itself, with 
utmost and unceasing effort, to counteract by demonstrating 
that the rightly-disciplined and well-governed mind can deal 
with and subdue to its use and benefit whatever ill befalls ; the 
strong will then be well fortified not to suffer long, nor in any 
■case to suffer wrong. 

The right-thinking mind is thus taught that fortune neither 
■does it good nor ill, itself ever the sole cause of its own happy 
■or unhappy condition ; the benefits of fortune to one wh» 
■knows how to make good use of them, the evils to him wh» 
■misuses them. As the Oriental proverb says, every grief 
contains some instruction ; tears are the dew of the soul. 
Happiness thus lies in the individual, not in the things them¬ 
selves ; each person in the same circumstances visibly making 
bis own good or ill. If good fortune makes men joyful, bad 
fortune should make them wise ; for it is wisdom alone which 
in the end can procure the quiet and stable happiness which 
abides. Ail sensual pleasure is vivid but brief, that tranquil 
■harmony of being sure and lasting. 

Such and such like are the thousand moral and philosophical 
reflections which have over and over again been reiterated t* 
prove to man that he never has been, nor is now, the unhappy 
being which he has superficially thought and proclaimed him¬ 
self to be, nor need now, if properly instructed, think himself 
to be. A true reflective optimism will surely demonstrate 
that life, rightly considered and rationally governed, is not 
•only well worth living but capable of incalculable improve¬ 
ment, when its moral and intellectual faculties are duly de¬ 
veloped. It may be so in the long long time to come, but the 
pity is that for the present, and probably for a long time t» 


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16 NOTES ON MENTAL DEFECT IN CRIMINALS, [Jan.,. 

come, the millions of men who cannot realize the sublime 
truth are likely vastly to exceed in number the few wise men 
who have preached and still preach the consoling doctrine. 
Fine principles and precepts have never been wanting; the 
difficulty has always been, still is, and probably ever shall be, 
to apply them effectively in practice. 

But why gloomily doubt, or, worse still, despair, says opti¬ 
mism, seeing that a right use of reason cannot fail to demon¬ 
strate that man is not the unhappy creature of a pessimistic 
morbid fancy, nor the miserable sinner which he has professed 
himself to be. Pessimism the while looks on in brooding 
inarticulate silence, admiring the optimistic aspiration but 
unapt to join heartily in the reasoning. Nay, in its extremest 
outcome it may dimly feel an unconscious sympathy with the 
pessimistic Indian utterance (bitter fruit of several vanished 
civilizations) that it is better to be sitting down than to be 
standing up, better to be lying down than to be sitting up,, 
better than all to be lying dead. Which is, after all, the con¬ 
clusion of religion when it gives hearty thanks for deliverance 
of a brother (or sister) from “ the miseries of this sinful world.” - 
Optimism, having definitely abolished the fiction of Hell, still 
clings by vital impulse of nature to its indefinite and indefinable 
vision of Heaven, or, failing that, to an indefinite perfectibility 
of humanity on earth. Being withal the fundamental expres¬ 
sion of insistent and exultant life, it is the essential condition 
of human progress on earth. 


Notes on Mental Defect in Criminals. By Sir Bryan 
Donkin, M.D. Oxon., F.R.C.P. 

I. In pursuance of the intention, signified in my “ Notes on 
the Mental Deficiency Act” in the Journal for July, 1916, to 
consider, as practically as may be, the subject of mental defect 
as a factor in the production of crime, I find it desirable to 
make some introductory remarks concerning the recently in¬ 
creasing literature of what is known as “ Criminology.” This 
term may be properly applied to investigations undertaken 
with a view to giving such an account of criminal conduct 
and criminal men as may assist in the formation of practical 
measures towards the prevention of the one and the appropriate 


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treatment of the other. Most of the more modern discussions 
on crime and criminals have either directly or indirectly been 
occasioned by the efforts of persons concerned in some way 
with prison administration, or otherwise specially conversant 
with convicted criminals, who strive to discover just principles 
on which to base their practice. But the growing bulk of 
doctrine and debate on the causation of crime, the genesis and 
treatment of the criminal, the meaning of “ responsibility,” and 
even the State’s “ right ” to “ punish ” offenders at all, consists 
to a great extent of definitely formulated theories largely based 
on preconceived assumptions regardless of fact, and often 
mutually contradictory. This occasions much difficulty to those 
who aim at any clear understanding of the subject; and the 
difficulty is increased by the frequently indefinite and equivocal 
use of the words “ crime,” “ criminal,” and “ punishment,” which 
denote the very subjects of discussion. Thus the handling of 
the whole matter becomes widely diffused, leaving no firm 
ground on which to rest any useful conclusion. Sundry kinds 
of topics, sociological, ethical, psychological, and biological, be¬ 
come involved in the dispute, and the student may even be 
landed and left in the midst of such perennial controversies 
as those about the “ freedom of the will,” and the nature, 
and even existence, of the relation between mind and matter. 

Among the disputed questions which contribute to the above- 
mentioned difficulties of attaining a clear grasp of our subject, 
that of whether the criminal, convicted or unconvicted, is mainly 
“ bom ” or mainly “ made ” as such, is probably the most im¬ 
portant at the present time, and most relevant to the topic of 
this article. I have been long convinced from my experience 
that this question is a vain one as regards criminals, as it is, 
indeed, in many other matters appertaining to human qualities 
and conduct. There is, however, much discussion as to whether, 
or how far, criminals are the product of “ Nature” or “Nurture"; 
“ Heredity ” or “ Acquirement ” ; “ Constitution ” or “ Environ¬ 
ment ” : all these oft-quoted, and, as commonly used, virtually 
synonymous pairs of terms being generally employed with no 
less indefiniteness than indifference, and the term “ Inheritance ” 
being constantly confused with “ Reproduction.” I hold the 
view, and have been greatly influenced in arriving at it by the 
writings of Dr. Archdall Reid, that, especially with regard to 
human qualities, the very posing of this question, current and 

LXIIL 2 


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1 8 NOTES ON MENTAL DEFECT IN CRIMINALS [Jan., 


popular though it is among biologists and others who are in- 
, terested in such subjects, leads to irrelevant and unnecessary 
disputes in many and varied fields ; and that it lies at the root 
of great confusion in much that is written under the name of 
criminological science on the causes of criminality. I shall 
refer specially to this subject in a later section, and give here 
but a few illustrations of what I have just said. ‘ 

It is remarkable that the conclusions of practical penologists 
are often closely similar while their assumed premisses are 
widely diverse; and it is probable that many grounds of literary 
dispute would vanish on the attainment of greater precision in 
the meaning of the chief terms employed. Much of the motley 
productions treating of crime and criminals which appear in 
books, magazines, lectures, plays, novels, and newspapers, is 
borrowed, without criticism or care, and with no knowledge 
of the subject, from what are believed to be “ scientific ” 
authorities, and this has its effects on the general public, and 
even on some criminals. Some writers preach that crime is 
caused wholly by circumstances and independently of the 
natural qualities of the man who commits it, or that it is the 
result of a vicious social system which necessitates and explains 
it and renders punishment unjust. Others regard criminality 
as a malady of the criminal, transmitted almost inevitably from 
generation to generation. And many, from both of these 
extreme groups, either imply or state definitely that the actual 
criminal is not responsible for his crime. It is also argued 
and not seldom, that when punishment does not prevent the 
habitual repetition of crime, the criminal is, therefore, not 
responsible. 

Not long ago a prisoner, pronounced after examination not 
to be insane, pleaded in a law-court that all men were irrespon¬ 
sible, because they were unable to help doing what they did. 
He thus voiced accurately and carried to its logical extent the 
doctrine of the born criminal. The complement of this doctrine 
of the criminal’s destiny to crime is that of the equally natural 
and effortless production of law-abiding and non-criminal men ; 
but those who hold this doctrine, as well as others who give 
Httle or no place to the force of circumstances in the process of 
criminal production, do not appear to recognise this evident 
corollary to their argument 

In an interview with a fairly intelligent convict, clearly well 


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versed in the modern literature of so-called criminology, he 
informed me with the assurance of a Hyde Park lecturer that, 
his long course of misconduct was due to the M inheritance of 
his constitution from a drunken father ” ; and, on another 
■occasion, an habitual offender said that as society manufactured 
criminals it ought not to blame him, but to answer for him. 
As one more instance of the prevalent and superficial talk and 
writing about crime and criminals that greatly impresses a wide 
public—this kind of literature having a good sale—I note that 
a popular writer of fiction, in a book about prisons, argues that 
" imprisonment as a punishment has failed,” but that when he 
is contending that the judicial punishment by flogging failed to 
put down the crime of “ garrotting,” he backs his argument by 
the statement that crime was stayed “ by the ordinary law with 
its ordinary punishments " ! 

So we see that authors of crime as well as of books on crime 
may hold discordant opinions about the origin of crime, but 
yet may make truce in jointly decrying the illogicality and 
injustice of punishing the criminal. 

It must not be forgotten that many writers on . crime ftiake 
definite claims that their special teaching is “ scientific,” and 
that some deny that any method of inquiry other than their 
own is scientific at all. This attitude is calculated to have a 
considerable influence on serious inquirers, social workers, and 
legislators, who make no pretence to first-hand study of the 
subject, but are naturally eager, especially when a measure of 
legislation is in the air, to find some expert authority on which 
they may found their opinions and actions. At the present 
•day writers on crime, however materially they may differ in 
principle, and whether they write with knowledge or without 
it, are usually acclaimed in the daily press and elsewhere as 
scientific authorities. The over-ready absorption of new and 
abundant literature on this subject is very observable in the 
United States of America. Take, for instance, the frequently 
indefinite and equivocal use of the term “ heredity,” and also 
the widespread application to the study of crime and human 
characters generally of the special doctrines taught by the 
Mendelian or Mutationist school of biologists. But these faults 
are by no means confined to American literature. The follow¬ 
ing magisterial utterance of Prof. Bateson, the acknowledged 
leader of the above-named school, is in itself a striking instance 


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NOTES ON MENTAL DEFECT IN CRIMINALS, [Jan.,. 


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of positive and plausible statements likely to make a deep 
impression on unwary readers and students. “ Genetic know¬ 
ledge ” (by which term is clearly meant the special knowledge * 
claimed by this school) “ must certainly lead to new conceptions 
of justice, and it is by no means impossible that in the light of 
such knowledge public opinion will welcome measures likely to 
do more for the extinction of the criminal and degenerate than 
has been accomplished by ages of penal enactment.” 

Most members of the fairly intelligent public hold very strong 
views about “ heredity ” : but few can formulate their views or 
explain them to others. Hence much loose and meaningless 
talk about “ inherited criminality,” and the constant use and 
abuse of the term “ degeneracy,” so useful to those who are 
content to substitute undefined words for definite things. Not 
many years ago an Act was passed by the Legislature of the 
State of Indiana, with a view to “prevent the procreation of 
confirmed criminals, imbeciles, idiots, and rapists.” The Bill 
had been previously referred to the “ Committee of State 
Medicine, Health, and Vital Statistics,” as well as to the 
“ Committee of Benevolent and Scientific Institutions.” The 
preamble of this Act began: “ Whereas heredity plays an 
important part in the transmission of crime. . . ; and its 

object was to legalise serious and drastic action, based on these 
crude, ill-worded, and ill-considered statements, vitiated by 
undefined and nebulous terms, and further confused by “ cross 
divisions.” On the other hand, in all countries views of an 
extremely opposite kind are held by many; the question ot 
the existence of inborn capacities or defects being neglected or 
negatived, the causes of, crime referred wholly to external 
influences, and the doctrine of reforming the criminal by religious, 
or moral means persistently and well-nigh exclusively upheld. 
These mutually antagonistic, as well as many intermediate, 
doctrines are to be found everywhere. It is, however, the so- 
called modern or, as it is often called, the “ scientific ” theory of 
criminality that specially concerns our subject—the relation of 
“ mental defect ” to crime. This theory first became generally 
popularised by the teaching of the Lombrosian or anthropolo¬ 
gical school that criminals are racial degenerates, or biological 
reversions to the childish or to the savage state; that criminality 
is “ hereditary,” “ innate,” or " constitutional ”; and that criminals 
must, as a class, be regarded as generally irresponsible and 


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2 I 

incapable of reform. Out of the interest aroused by this now 
greatly discredited teaching there have sprung, as we have seen, 
many different attempts to establish the study of crime and 
punishment as far as possible on a foundation of observed and 
accredited fact. 

In closing these introductory remarks, I must revert for a 
moment to the frankly “ deterministic ” doctrine, held by some, 
of the actual irresponsibility of law-breakers generally. It seems 
surely sufficient for all practical people and thinkers, whatever 
their ulterior philosophies may be, to cast this doctrine aside 
without compunction, and to regard lawbreakers, speaking 
generally, as “ responsible,” or rightly liable to punishment or 
coercion of some legal kind and degree. Even if the view that 
no ill-doer or antisocial member of a community can help ill- 
doing—a view which entails, as we have seen, the inference 
that well-doing is similarly conditional—should be held by 
some in moments of bemused study, human social existence 
will still proceed on the assumption of the old notion of responsi¬ 
bility. The dispute about free-will concerns the matter in hand 
no more than the actual conduct of some men depends on any 
opinions they may have on the nature and relation of mind and 
matter, or on Realism and Idealism, or even on Causation. In 
practical life men assume a general ability to choose their lines of 
action; and also the reality of themselves and other men, and of 
the external world at large ; and most people when they think 
about causation regard it as meaning something more than a 
simple sequence of sense impressions. They still act on these 
assumptions or beliefs as if they were true, however tenaciously 
they may adhere, when in their studies, to doctrines that conflict 
with most that they say and do every day. The postulatesof the 
practical freedom of human action and of the reality of the ex¬ 
ternal world underlie all the words and ways of men, all their acti¬ 
vities and projects, and all their notions of praise and blame. The 
thinking “determinist” will not quarrel with this statement, nor 
need the most thoughtful student of crime and criminals trouble 
himself about the question which occasions it. Practically the 
strictest idealist, in his ordinary actions, is at one with Samuel 
Johnson who “ refuted ” Berkeley by kicking at a stone, and 
so is the “mechanistic ” psychologist who, in his daily life says 
in effect : “ I know my will is free, and there’s an end on’t.” 

II. In considering the relation of mental defect to crime and 


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criminals, it is necessary to be as clear as possible on the mean¬ 
ing we give to the terms crime, criminal, and mental defect. 
All these terms are frequently used in different senses, and not 
seldom in more than one sense indifferently. In this article,. 
“ crime ” means an offence against law ; and “ criminal ” means 
one who is known to have committed such an offence, whether 
or no he has been sentenced or convicted. In the more popular 
sense, the name “ criminal,” which seems to denote generally 
those who commit wilfully such “wrong,” or “evil,” or “wicked”" 
acts as are generally condemned by the community, would 
exclude sundry convicted lawbreakers, and include many known, 
offenders against society who are not legally chargeable. 

As regards the term mental defect as employed here in 
relation to crime, it must be premised that I attribute to it the 
technical sense as explained in my “ Notes” on this subject in 
the Journal of July, 1916, i.e., the sense which has been adopted 
by the Mental Deficiency Act; not the wider and correct sense 
which should include also what is usually known as “ acquired 
insanity,” or “ unsoundness of mind,” i.e. such disorder of the 
mind and brain as occurs frequently in persons whose conduct 
and history previous to the attack negatives any likelihood of 
congenital incapacity. Recognised “ insanity ” in relation to 
crime is a topic which, although important and closely germane 
to our subject, will not be discussed here. “ Mental defect,” 
for our purpose, will mean such a degree of defect, not usually 
counted as insanity, but nevertheless clearly recognisable by 
observation and inquiry, whatever its origin may be. Cases of 
this kind may be grouped under one of the practical designa¬ 
tions of “ feeble-minded ” or of “ moral imbeciles ” that now find 
place in the Mental Deficiency Act. It is not necessary for the 
purpose of practical recognition to enter into an inquiry con¬ 
cerning the nature and origin of this kind of defect, but, for 
certain reasons, some further reference to this question must 
necessarily be made later. Here it may be said that most 
practical observers and students in the field of mental patho¬ 
logy, however they may differ on this matter, do undoubtedly 
recognise the frequent occurrence, in many kinds of convicted 
prisoners, of this defect. It is marked by aberrant conduct 
which points to plainly inferior function not only in the intel¬ 
lectual sphere, but also in the other so-called “ faculties ” of the 
mind ; and the defects indicated maybe manifested in different 


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23 


proportions. These cases are certainly more common among 
convicts than in the general population ; and, whatever their 
nature be deemed to be, there is a general consensus of opinion 
that the characters manifested point to imperfect cerebral de¬ 
velopment as the predominant element in their causation. It 
is this prominent manifestation of defect which demands notice 
as carrying with it a claim for its subject to be credited with at 
least attenuated responsibility, or a modified liability to punish¬ 
ment, and, therefore, to be specially treated. I am very far 
from saying or implying that anything like the majority of con¬ 
victed prisoners belong to the class of which I have just 
sketched the main characteristics ; but I hold that the class is 
an important one and is rightly differentiated and recognised, 
even if only for practical objects, quite apart from the question 
©f any essential difference in origin there may be between the 
criminal cases it includes and those recognised, on the one 
hand, as “ insane,” or regarded, on the other hand, as merely 
the subjects of an inferior degree of normal intelligence. 

This mentally defective class which I have described includes 
criminals of many kinds. Their defect is manifest apart from 
their criminal acts. They are apparently unable to acquire 
the complex characters that are essential to social life, and are 
actually possessed by the large majority of men. These, 
according to their individual surroundings and the multiform in¬ 
fluences acting on them, as on all men, tend to follow the path 
of least resistance, which is, more often than not, the path 
of anti-social action. While saying this, as I have elsewhere 
said it some six years ago in opposing the popular doctrine of 
a naturally hereditary criminal character or quality, I would 
repeat the gist of my statements then made that lawbreaking or 
“ criminality ” is no unity ; that there are no special qualities, 
physical or mental, common to all criminals ; and that the only 
important link between the study of crime and that of biological 
heredity is the fact that a considerably larger -minority of 
persons with clearly appreciable mental defect, apparently of 
congenital nature, is found among convicted criminals than in 
the population at large. 

The study of criminals has, indeed, long convinced me that 
all men are potential lawbreakers, and that without the 
traditional (not biological) heritage of moral or social experience, 
human society would be dissolved. Some of the statements 


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24 NOTES ON MENTAL DEFECT IN CRIMINALS, [Jan., 

that I refer to, and others which occurred in the Harveian 
Oration delivered by me in 1910 at the College of Physicians, 
were quoted by Prof. Karl Pearson from a daily newspaper 
extract and promptly attacked by him in that newspaper, partly, 
if not mainly, from the point of view of the exclusively bio¬ 
metrical method of dealing with biological subjects. The phrase 
I used that “ criminality is no unity ” was specially condemned 
from this standpoint; for the biometrical method of studying 
criminals necessitates the assumption that criminality, or the 
tendency to commit crime, is a unity for statistical purposes. 
This is made evident in a remarkable and elaborate report by 
Dr. Charles Goring, entitled The English Convict—a Statistical 
Study, which appeared as an official publication in 1913. In 
this work, to which I shall presently refer again, the existence 
of a “ criminal diathesis,” common to all men, and of a compo¬ 
site nature consisting of several independent items or qualities, 
seems to have been assumed as a unity in handling the problem 
of crime statistically ; this “ diathesis ” being held to be specially 
prominent in persons who tend to be convicted of crime and to 
come into prison. One important element of this “ diathesis ” 
is said to be inferior intelligence, and another to be “ wilful anti¬ 
social proclivities ” ; and the conclusion is ultimately drawn that 
in the make-up of the convicted criminal or lawbreaker there is 
little, if anything, of importance to be found in accounting for 
the genesis of criminals other than naturally inherited or con¬ 
stitutional qualities ; or in other words, that crime is due to 
inherited tendency : that criminality is to be explained by the 
fact of its “ heredity ” alone. 

These considerations, involving the question of the relative 
extent of the parts played by “ heredity ” and “ environment ” 
in the production of criminals, necessitate some further reference 
to that other question already mentioned in the first part of 
this article : i. e. whether biological characters generally, and 
especially human mental characters, can properly be divided, 
in respect of their origin, into the two classes which it is usual 
to describe severally as “ inborn ” and “ acquired ” : whether, 
indeed, this question can be justly put at all in regard to 
most of the especially human characters which we study as 
such. In connection with this question it is commonly assumed 
that all characters are referrible either to a natural, inborn, 
origin, or to agencies acting from without, such as use and 


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•experience, or “ education ” in the widest sense, t. e., all the 
influences exerted on each individual human being by the 
impressions he receives from intercourse with his fellows and 
from everything that happens to him in his various surroundings. 
It is also now implied generally, though often not stated 
explicitly, that inborn characters are not only transmissible, 
but are more or less inevitably produced, while those called 
41 acquired ” are referrible to influences incident on the individual 
organism subsequent to the fertilisation of the ovum from whence 
it springs, and are not transmissible. Seeing that man is 
mainly differentiated from the lower animals by his remarkable 
•educability, his immensely greater capacity for learning, or 
making acquirements, it is clear that the question under con¬ 
sideration is of peculiarly great importance. It is, of course, 
far outside the scope of this article to dwell at any length on 
this subject, and I touch on it only on account of its bearing 
on the special matter in hand. The confusion that has resulted 
from the failure to recognise that most of the human concrete 
characters that we choose to study, or that can be studied, are 
referrible for their origin both to an inborn capacity for develop¬ 
ing them, and to some external stimulus appropriate for their 
development, and that many inborn capacities may never be 
developed for want of such stimulus, has been fully and clearly 
set forth in the writings of Dr. Archdall Reid, especially in his 
book on the Laws of Heredity , and in a more recent paper on 
“ Biological Terms.” Inheritance, as Dr. Reid insists, is not 
synonymous with Reproduction. There is inheritance without 
reproduction : inheritance of potentialities which never become 
actual. But there cannot be reproduction without inheritance. 
The individual inherits the parental nature. He may, or may 
not, according to circumstances, reproduce the parental charac¬ 
ters, but he will reproduce them in conditions similar to those 
in which his parents produced them. The more closely 
similar the conditions the more certain will be the reproduction; 
so certain, indeed, in many cases, as to seem inevitable. 
Characters thus reproduced are commonly called “ inherited ” 
or transmitted ; and are frequently opposed to “ acquired ” 
characters that are held to be not transmitted or inherited : and 
sameness of reproduction is taken to mean sameness of inheri¬ 
tance, no account being taken of the conditions or stimuli to 
’which such reproduction may have been a response. 


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NOTES ON MENTAL DEFECT IN CRIMINALS, [Jan.* 


In connection with this question of the part played by- 
heredity in the production of human characters, and also with 
that of the relation of mental defect to criminality, it is to be 
noted that the two diverse schools to which we have already 
made brief reference as treating biological problems by means 
of exclusivelyexperimental and biometrical methods respectively, 
appear to be at one in placing a sharp dividing line between 
“ inborn ” and “ acquired ” characters, and also in employing 
the terms “ inheritance ” and “ reproduction ” as synonymous. 
Moreover the characters, or qualities, that these schools investi¬ 
gate are thus found by them to be “ inherited ” or “ inborn.”" 
A reproduced quality means, in fact, for them a purely inborn 
and transmitted quality. It is not necessary to comment 
further on the views of certain adherents of the “ Mendelian 
or “ Mutational ” School ; for I am not aware that a serious 
study of criminalsTias ever been made by any member of this 
group of biologists, which, as is well-known, teaches a definite 
doctrine on the mode of heredity. The Biometrical School has* 
on the contrary, made several elaborate investigations into 
various biological and social questions, and, as regards heredity, 
draws its conclusions from large numbers of observations- 
gathered and statistically studied, without necessitating any 
further assumption than that sameness of reproduction in the 
oase of a given quality implies sameness of inheritance. Little 
cr no account is made of the fact that the human being is very 
specially and to a very large extent a bundle of acquirements, 
produced by the action of innumerable influences or stimuli 
on an organism endowed with infinite capacities for making 
acquirements. It is thus ignored that man’s characters or 
qualities are both inborn and acquired, and are largely the 
product of the action of use and experience, or “ education,” on 
the various capacities for development inherent in his organism. 
The Statistical Study of the English Convict} by Dr. 
Charles Goring, to which I have already referred, is the most 
extensive treatise on the subject of crime and criminals in the 
English or, probably, any language, containing much valuable 
information and detailed demonstration of the errors of the so- 
called anthropological school of criminology in promulgating the 
doctrine of the “ born criminal” recognisable by definite traits 

* Tht English Convict: A Statistical Study, by Dr. Charles Goring, M.D., 
B.Sc.Lond., Deputy Medical Officer, H.M. Prison, Parkhurst. London : published' 
by H.M. Stationer* Office. 


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that differentiate him from the mass of humanity. It is, however, 
the author’s further positive conclusions, arrived at by means of 
the biometrical method of handling his vast material, that are 
really relevant to the matter before us, and cannot be overlooked 
in any discussion of the relation of crime to M mental defect.” - 
For Dr. Goring’s final conclusions involve, or largely rest upon, 
the conception that qualities or characters generally are either 
** inherited ” or “ acquired ”—either of a constitutional, natural 
origin, or produced by the force of circumstances ; and that in 
studying such a character, for instance, as criminality, or the 
“ criminal diathesis,” it is possible to “ disentangle the influences, 
of heredity from a complication of environmental influences.” 
This, as well as his account of the items or ingredients which 
constitute his conception of the “ criminal diathesis," tend to 
illustrate the unfitness of applying solely biometrical methods 
to all branches of biological research. 

The purpose of Dr. Goring’s work, as stated by him, is “ to 
clear from the ground all that remains of the old criminology 

. . and to found a new knowledge of the criminal upon 

facts scientifically acquired, and upon inferences scientifically 
verified." After an extensive and minute biometrical investi¬ 
gation, occupying a large section of the work, he concludes that 
there is no such thing as a physical or “ anthropological ” type 
of criminal men. In this important section, which may be 
termed the destructive part of his work, and is based largely on 
an immense number of accurate measurements, Dr. Goring has 
ably achieved the final demolition of a doctrine which, owing to 
its novelty and superficial plausibility, was much in vogue 
among criminologists for several years. 

With regard to what may be termed the constructive part of 
his work, the author, still using the biometrical method in a 
multiform series of investigations regarding the physique, age,, 
vital statistics, health, mentality, fertility, etc., etc., of criminals, 
arrives at the following conclusions among others : First, “ that 
there is a physical, mental, and moral type of normal person 
who tends to be convicted of crime, i.e., that, on the average, 
the criminal of English prisons is markedly differentiated by 
defective physique, as measured by stature and body weight; by' 
defective mental capacity, as measured by general intelligence ; 
and by increased possession of wilful anti-social proclivities , 1 as 

* The italics here and elsewhere are mine. 


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NOTES ON MENTAL DEFECT IN CRIMINALS, [Jan., 


measured, apart from intelligence, by length of sentence to 
imprisonment.” Second, “ that relatively to the origin in the 
constitution of the malefactor, and especially in his mentally 
defective constitution, crime is only to a trifling extent (if to any) 
the product of social inequalities, of adverse environment, or 
of any other manifestation of what may be comprehensively termed 
the force of circumstances 

In respect of Dr. Goring's conclusion, based on the numerous 
and detailed observations that he has tabulated and summarised, 
that those convicted of crime are differentiated by inferior 
stature and by defective intelligence from the non-criminal 
population, it is clear that he has drawn a just inference from 
the facts before him. It is moreover an inference to which, I 
think, no one of much experience who had made no such special 
investigation would be disinclined to give endorsement. It 
must, however, be remembered that in another place it is stated 
by Dr. Goring that convicts “ are selected by a physical and a 
mental constitution which are independent of each other—the 
one significant physical association with criminality is a 
generally defective physique ; and the one vital mental consti¬ 
tutional factor in the aetiology of crime is defective intelligence.” 
Even if this comprehensive conclusion about convicts undiffer¬ 
entiated by grouping them according to the kinds of crime 
committed is taken as established, it is clear from Dr. Goring’s 
statements that the above-mentioned inferiorities are more 
observable in some groups than in others. The most defective 
convicts as regards intelligence are those who commit murder, 
arson, theft, or burglary, and these form the large majority of 
offenders ; less defective are those who commit crimes of 
violence other than murder; receivers of stolen goods and 
coiners are more intelligent than thieves ; and forgers, embezz¬ 
lers, and fraudulent persons generally are practically absent 
from the records of “ mental defect.” I would remark here 
that among the predominantly large numbers of convicted 
offenders who commit theft of various kinds the signs of mental 
defect are not prominent enough in the great majority of them 
to justify or suggest their classification and treatment as 
** mental defectives ”; and that Dr. Goring, in attributing 
marked mental inferiority to the “ type of normal person who 
tends to be convicted of crime ” uses the term “ mental defect ” 
in a far wider sense than is usual, including within it the lower 


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29 


grades of a normal scale of intelligence reaching from the 
highest to the lowest. Again, in describing the type of persons 
who tend to commit crime, Dr. Goring, while stating with 
emphasis that the factors constituting this type are independent 
of one another, adds to the factors of physical and mental 
inferiority a third factor which he terms “ wilful anti-social pro¬ 
clivity,” and thus composes and completes the “ criminal dia¬ 
thesis ” which, though present, as he assumes, in all normal 
persons, exists in the greatest degree in such persons as com¬ 
mit crime. This is, according to Dr. Goring, “ the physical, 
mental, and moral type of normal persons who come into 
prison.” All these differentiae which mark off the criminal from 
the non-criminal come within the normal scale of human 
characters, and Dr. Goring attributes not so much the criminals’ 
crime, as their detection and conviction for crime, to the defects 
of which they are the subjects. “ The thief,” he says, speak¬ 
ing of course generally, “ who is caught thieving has a smaller 
head and narrower forehead than the man who arrests him, but 
this is the case not because he is more criminal, but because, of 
the two, he is more manifestly inferior in stature.” 

The stress laid on the third and equally independent factor 
of “ wilful anti-social proclivity ” is not, as it seems to me, 
intelligible unless it be admitted that without its introduction 
as a factor in the criminal diathesis the intellectually and 
physically superior convict who, though in a small minority 
among criminals generally, is by no means numerically rare, 
would fail to find a place under that generalised type of men 
with high potentiality for crime which has been arrived at by 
Dr. Goring. In speaking of the constitution of this type he 
states that there is “ another bond of association , though less 
close , between conviction for crime and wilful anti-social proclivi¬ 
ties or moral defectiveness .” This statement, he says, is demon¬ 
strated by the fact that it is the most intelligent recidivists who 
are guilty of the most serious offences. The marks of the 
type of men prone to crime, be it noted, are “physical,” 
“ mental ”—(this term being used by Dr. Goring in reference 
to the factor of intelligence)—and “ moral ” ; and, as we shall 
see presently, all these marks are held to be constitutional in 
origin. Even assuming, for the sake of argument, that no 
question need arise regarding the exclusively constitutional 
nature of the factor of mental defect, as employed in this 


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context by Dr. Goring, it seems that the special and inde¬ 
pendent entity of “ moral ” defect is introduced into the picture 
of the triple constitution of the criminal without justification. 
It seems, indeed, in considering from a practical point of view 
this conception of a “ criminal diathesis ” which is common to 
all men, but bulks largely among criminals, that although the 
.great majority of criminals may be of less intellectual ability 
or even capacity, and of inferior physical development as com¬ 
pared with the average of non-criminals, we shall not gain any 
further light on the genesis of the criminal by stating that he 
is specially prone to commit anti-social acts wilfully. We see 
plenty of short criminals who are intelligent, and tall ones who 
are stupid ; and plenty of intelligent and habitual criminals 
with good physique ; and so far even a demonstration of the 
large majority of criminals being of both inferior physique and 
intelligence would not help us much in the study and treat¬ 
ment of individual criminals. But when the conception of the 
“ criminal diathesis ” includes further such a “ constitutional ” 
factor as an inborn criminal propensity—for this is what 
“ anti-social proclivity ” comes to—it seems so artificially 
strained as to become tautological, and of no practical or even 
speculative value to the student of the criminal’s genesis, 
especially when we remember that all its component elements 
are stated to be independent of one another. 

What really matters most here is the question whether Dr. 
Goring has established his contention that the characters which 
he attributes to the make-up of the criminal are so pre¬ 
dominantly, if not entirely, inborn or produced by heredity, as 
he represents them to be ; and, incidentally, whether any con¬ 
clusion of value bearing on the genesis of the criminal is likely 
to be attained by the statistical method he has employed. 

One of Dr. Goring’s important conclusions regarding the 
genesis of the criminal is that the “criminal diathesis,” revealed 
by the tendency to be convicted and imprisoned for crime, is 
inherited at much the same rate as are other physical and 
mental qualities and pathological conditions in man. A further 
conclusion, based on a statistical inquiry which failed to find 
any “ significant relationship ” between certain conditions, such 
as illiteracy, parental neglect, lack of employment, etc., is, as we 
have seen, that “ crime is only to a trifling extent, if to any, 
the product of the environment or the force of circumstances.’’ 


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3 1 


This second conclusion serves to establish the former provisional 
conclusion that hereditary influence is the only important 
factor in the genesis of the criminal. By these steps it is 
sought to prove that every factor which contributes to the 
“ criminal diathesis ” is a “ heritable quality ” ; and that the 
production of the “ diathesis ” is uninfluenced in any consider¬ 
able degree by the action of any other force than that of 
heredity. 

I have already said nearly enough to show why I think that 
the final conclusions we have been considering are erroneous. 
There can be no doubt whatever that the commission of 
criminal or anti-social acts, like any other quality exhibited by 
human beings, must necessarily involve dependence on heredity. 
The existence of any quality or character implies this : and all 
-arguments adduced to prove this statement are really superfluous. 
From a study of Dr. Goring’s work it might well be inferred 
by readers that no inquirer into the subject of crime and 
criminal had ever recognised the patent and necessary factor 
of inborn capacities of all grades in the production of every¬ 
thing that can be called a " character ” in every living being. 
This is accepted knowledge : no longer an hypothesis in want 
of verification. But that the human being, criminal or non¬ 
criminal, is the creature of his inborn capacities alone has not 
Been proved. Even if, for the sake of argument, the complete 
validity of the methods employed and of some of the sub¬ 
ordinate conclusions arrived at in this study of the English 
convict be assumed, including even that of the denial of any 
“ significant correlation ” between crime and the particular 
-environmental conditions investigated by Dr. Goring, it cannot 
possibly be held that any significant proportion of the innumer¬ 
able influences that act on all men from infancy to age, for 
good or for ill, and contribute so largely to the make-up of 
■each of us, have been eliminated, or could be eliminated by 
such an inquiry as we have been considering. The totality of 
the complex environment which moulds the characters of men 
—“ physical,” “ mental,” “ moral,” or “ intellectual ”—and either 
encourages or stunts the development of their natural or inborn 
capacities, cannot be analysed or reduced to such items as can 
be established or eliminated or reasonably dealt with by 
statistical handling, It is not possible to “ disentangle ” the 
various factors that contribute to the production of a criminal 


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NOTES ON MENTAL DEFECTS IN CRIMINALS, [Jan. 


except in cases that may be marked by patent incapacities to 
acquire such characters as are possessed by the average man 
and are fundamentally necessary to social life. Nor is it 
possible to assess in any case with precision the proportionate 
influence of the two undeniably necessary factors of “ heredity ” 
and “ environment ” in the development of a criminal man. 

It is far from my intention to use any argument from 
“ consequences ” against the chief position maintained in Dr. 
Goring’s work ; such an argument is only too common in 
controversy on this subject. It may, however, be fairly noted 
that one apparent consequence of this position seems to be 
largely irreconcilable with some admissions made towards the 
end of this work. If it be true, as Dr. Goring has proved, that 
lawbreakers in the mass are notably less intelligent than law- 
abiders, and further, if it were true that their inferior intelligence 
is due solely to inborn incapacity, it must follow that there 
would be little, if any, reason for making efforts to reform law¬ 
breakers. Being, ex hypothesi, incapable by nature, and not in 
any recognisable degree by the force of cicrumstances, of duly 
acquiring elementary social qualities, they will in all probability 
continue their misconduct if not permanently coerced by force. 
Their “ criminal diathesis ” is predominant. Yet Dr. Goring 
says at the conclusion of his work : “ We know that to make a 
law-abiding citizen two things are needed, capacity and 
training.” 

I venture to think that most of us, including Dr. Goring, 
would agree, even in default of a demonstrative experiment, 
that most children and young persons, from whatever stock, 
untainted by any noticeable degree of congenital or “ inherited ” 
inferiority of body, “ mind,” or “ morals ” they might have 
sprung, could have their normal criminal diathesis so influenced 
by neglect or positive training as to be actually and easily 
produced as even habitual “ criminals ” of various kinds. A law- 
abiding man, merely as such, is surely a complex of many 
characters or qualities, and needs accounting for as much as the 
lawbreakers. It is certain that most of the qualities that make 
him what he is require much aid from the action of his “en¬ 
vironment ” on his inborn capacities before these qualities can 
be produced or developed. It is equally certain that a man 
who lacks due capabilities to respond to his social environment 
will be a social offender or a lawbreaker. And doubtless there 


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BY SIR BRYAN DONKIN, M.D. 


33 


are many grades between those who possess such capacities in 
a high degree and those who greatly lack them. Human 
beings generally, whether actual criminals, average persons, 
geniuses, or saints, are, to a very special degree, as compared 
with other animals, the products of their environment as well 
as of heredity, *>., of inborn capacities ; but not of the one 
without the other. 

To revert now, shortly, to the practical aspect of “ mental 
defect ” in its relation to crime, and to the treatment of the 
criminal, I hold that, true as it may be that the intelligence as 
tested by observation of the majority of criminals is inferior to 
that of the non-criminal population, yet the majority of crimi¬ 
nals, guilty of many kinds of offence, manifest no such defect 
on the score of intelligence as would suggest to an experienced 
observer that they should be regarded or treated as practically 
irresponsible. I believe that the large majority of criminals 
convicted of most kinds of crime could not with any plausi¬ 
bility be dealt with either as being the subjects of defective 
intellectual capacity, or even of M mental deficiency ” in the 
full and proper sense of that term. But I hold, on the other 
hand, as I have explicitly stated above, that there is a very 
notable minority of criminals of many kinds whose degree of 
mental defect, not only, or always, of generally defective intelli¬ 
gence, is so great and manifest, that for practical purposes they 
should be regarded and treated more or less similarly to the 
insane. They exhibit by their conduct, apart from the crime 
for which they have been convicted, highly probable evidence 
of their being the subjects of such defect of mind and brain as 
to render it fairly certain that the defect is congenital, and has 
but a very subordinate dependence on the “ force of circum¬ 
stances.” Many of these cases bear a close resemblance to 
others occurring among non-criminals, and in all social grades. 
It is in cases of this latter kind where inquiry into family 
histories is more readily made; and this not infrequently 
results in the discovery of further similar cases in near relatives. 
These cases should in my judgment be regarded as the subjects 
of inborn organic defect in a very predominant degree. I do 
not, of course, intend to make any implication that the far less 
salient cases of mental defect, which characterise so many other 
criminals, are not similarly referrible to organic defect, although 
of a less degree. It is certainly widely admitted now that in 
LXili. 3 


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NOTES ON MENTAL DEFECT IN CRIMINALS, [Jan., 


order to study most fruitfully both psychology and mental 
pathology, we must think, as far as our knowledge permits, in 
terms of the organic functions on which mental activities de¬ 
pend. I am thus unable to separate, so sharply as Dr. Goring 
seems to do, the subjects of the greater degrees of mental de¬ 
fect that we have been considering from the subjects of “ in¬ 
sanity." He, apparently, regards the subjects of mental defect 
■as “normal,” but the insane as abnormal, or the subjects ot 
disease. 

III. In conclusion, I append, in view of its relevancy to much 
that has been said above, a brief account of a criminal case 
which I mentioned at the end- of my “ Notes on the Mental 
Deficiency Act ” in the July number of this Journal for 1916. 

A young man, not many years over twenty, was convicted 
of wilful murder. The plea of insanity failed, and the evidence 
as to fact was unquestionably conclusive. He was sentenced 
to death, but the sentence was afterwards commuted to penal 
servitude for life. He had been seen by two experts, and 
was pronounced as insane by the one, but not so by the 
other. I had a long interview with him several weeks after he 
■came into prison, having then no knowledge of his case other 
than what I had gathered from a brief newspaper report. I 
spoke to him on other subjects as well as on his crime and 
conviction, and he talked very freely and quite consecutively on 
all. He appeared content and cheerful, and told me, in reply 
to a question, that he was not shocked by his sentence, or in 
any way disturbed, except by the annoyance and disgrace that 
would be felt by his relatives, who were well-known people. 
He denied that he was guilty of the charge of murder, attri¬ 
buting the crime to another ;' but said that he consented to the 
plea of mental disorder which his legal advisers set up because 
be thought that this would be the best course. I formed the 
■opinion that the grade of his general intelligence was by no- 
means very low: certainly not lower than that of many 
thoughtless and flighty persons who exist in all ranks of life, 
And are able to look after their own interests fairly well as 
far as mere intelligence goes ; and I deemed him, at the time of 
my interview with him, uncertifiable as a “ lunatic ” from the 
legal standpoint I observed nothing special about him, during 
this interview, but his attitude of indifference to his condition. 


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19*7] BY SIR BRYAN DONKIN, M.D. 35 

He had received at least a fair superficial education, as I inferred 
■mainly from his speech and manner. 

His conduct in prison was reported to be good, and I may 
add here that it continues to be so. From further information 
T learned that his parents were very wealthy, and that he had 
apparently been indulged from his childhood in all his desires. 
He had early shown but little regard for the feelings of others, 
was cruel to animals, and was reckless of causing danger to 
himself or any one else. There was, indeed, evidence of many 
other aberrations of conduct pointing to notable mental defect 
that I cannot now specify. 

My general inference was, in accordance with that of Dr. 
Murray, the Medical Officer, that this case fitted in with 
precision to that practically useful group of “ mentally defective ” 
persons which finds a place in the Mental Deficiency Act under 
the well-known but by no means faultless title of “ moral 
imbeciles ”; and that this criminal is no more and no less 
•rightly considered as irresponsible, wholly or partly, than many 
u lunatics ” or persons of unsound mind who are more or less 
readily certified as such by alienists. I believe, however, that 
if he were sent to a lunatic asylum under the ordinary certi¬ 
ficate he would in all likelihood be soon discharged as “ sane ” 
or “ recovered,” for he would perhaps show no aberration of 
conduct or any other indications of insanity while under the 
restrictions of an institution for detaining insane persons, any 
more than he does in prison. It seems also improbable that 
he would be accepted by the Board of Control as a proper 
subject for treatment in a State Institution for “ Mental Defec¬ 
tives ” not certifiable either as “ persons of unsound mind ” or 
as “idiots”; although in theuntechnical senses of these words, 
he is as certainly the one as he is not the other, and is, I think, 
with equal certainty a person highly “ dangerous ” to the 
community. But he could not be called “ violent,” in spite of 
his having committed a premeditated murder. My view that 
such a case as this is properly certifiable under the Mental 
Deficiency Act as a “ Moral Imbecile ” is based on the grounds 
not only of the circumstances of his crime but also of his 
attitude towards his own case, and of the history of his general 
conduct before he committed the crime. I regard him as not 
•fully responsible for the murder he committed, and perma¬ 
nently unfit for free life. 


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36 


EPILEPSY : A METABOLIC DISEASE, 


[Jan.„ 


Epilepsy : A Metabolic Disease. By Guy P. U. Prior, 

^ M.R.C.S., L.R.C.P., Medical Superintendent ; and S. 
Evan Jones, M.B., Medical Officer, The Mental Hospital, 
Rydalmere, N.S.W. 

GOWERS states that the morbid state causing epilepsy 
« consists in some trifling alteration in the chemical constitu¬ 
tion of the grey matter of the brain on which the instability 

spoken of depends.” (i) 

Munson says : “ I believe that the epileptogenous change 
affects the chemical structure of the cell. Function is the 
result of change in the chemical structure of the cell, brought 
about by the laws governing chemical action. Disease being 
a change or failure of normal function, it follows that disease 
is the result of interference with the normal chemical processes 
of the cell” (2). 

We have for twelve months been making observations upon 
the more easily detected chemical changes in the blood and 
urine, to throw if possible some light upon the changes of 
which Gowers, Munson, and other authorities speak. 

We first made records upon the calcium contents of the 
blood and urine, in a number of epileptic patients. This we 
did by the methods taught by Dr. Blair Bell, (3), and it is due 
to a chance reference to his work that we have been able to 
undertake and develop these investigations. We found marked 
changes from the normal, and had some successes in treating 
patients with salts of calcium. We published these earlier 
observations in the Australian Medical Journal of March 4th, 
1016 Since then we have extended our investigations and 
made’ observations upon the alkalinity, coagulability, and 
leucocytes of the blood ; upon the changes in the amount of 
phosphates and chlorides excreted in the urine, and also upon 
the blood-pressure of epileptics. We have treated a number of 
patients with calcium and with the extracts of various ductless 

gla h d is upon the records of the last six months of our work ' 
that we now write. At first we took weekly observations 
upon a number of patients, but have found since then that to 
be of any value the observations must be made daily, as such 
changes as are shown before or after a fit can only with 
certainty be obtained this way. 


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1917 -] BY GUY Pi U. PRIOR AND S. EVAN JONES. 


37 


First, with regard to the calcium excreted in the urine. In 
our paper before referred to, we pointed out that epileptics, as 
compared with others, excreted in the urine less calcium (7). 

Since then we have made 730 records of the calcium 
excretion of nineteen patients, and of these 395 showed less 
than half the normal amount, 165 were from half of to below 
normal; fifty-one\vere normal ; eighty were between normal 
■and twice normal ; and on twenty-nine occasions the excretion 
was more than twice the normal amount. The amount 
excreted varies greatly with the individual patient, some 
patients seldom excreting more than a trace, others excreting 
■as a rule a normal amount or more. We have found changes 
in the excretion both before and after a fit or series of fits. In 
the case of eight patients daily observations were made extend¬ 
ing from thirty to 112 days. 


Average Daily Excretion in Grams Per Cent. 


Case. 

Grams per cent. 

Period in days. 

Fits. 

34 

. -0014 

30 

5 

33 

•004 

38 

5 

11 

. ’009 

80 ' . 

29 

29 

'oi 

30 

6 

3 

. 'oir 

I 12 

197 

8 

. "018 

80 

22 

6 

. '016 

112 

40 

26 

■026 

30 

22 


Taking the normal average percentage excretion of calcium 
-as 0‘2 grm., the above table shows that with the exception of 
one case the excretion was low, and in the Cases 33 and 34, 
markedly so. The amount of calcium excreted does not 
-appear to bear any relationship to the number of fits. 

During the period under review the patients had thirty 
serial attacks, besides occasional isolated convulsions. 

In twenty-six instances there was an increased calcium 
•excretion preceding the onset of the convulsions. 

In twenty-seven instances there was a diminution following 
the increase. In twenty-six cases the diminution was followed 
by a secondary rise. The preliminary rise occurred from the 
fifth day to the day immediately preceding the series. The 
rise varied considerably, averaging r6 of the normal. In cases 
■which had been showing a continued low excretion the rise did 
not always exceed the normal, but was nevertheless high for 
the particular case. 


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38 EPILEPSV : A METABOLIC DISEASE, [Jan.*. 

A rise is often seen in the calcium excretion without a fit 
occurring ; associated with those observations changes in the 
calcium blood index and coagulability that we have noticed 
to precede a fit have not taken place. After a series there is 
a fall in the excretion, which during a series lasting several 
days usually remains high. 

Table showing Relationship of Preliminary Rise to Commencement op 

Series. 

No. of days before series .5.4. 3.2.1 

No. of instances in which 

rise was noted . . 3 . 6 . 10 . 6 . 1 (total 26). 

The preliminary fall was observed as shown by the following, 
table: 

No. of days before series . 3 . 2 . 1 . 1st day of series. 

No of cases . . ..2. 12. 9. 4 

The average excretion during this phase was 0*23 of normal* 
i e. 0 0046 grm. per cent. 

The secondary rise occurred thus : 

Days before series . 2 . r . 1st . 2nd . 3rd day of series. 

No. of instances .2.10.8 . 6 . . r 

The average secondary rise was ri of normal, i. e. 0022 grm. 
per cent. 

The Phosphorus Excretion. 

It was thought that changes which occurred in the calcium 
excretion might influence the output of phosphorus in the 
urine. Accordingly daily examinations were made on several 
patients over periods from one to three months. 

The results of our observations showed a distinct contrast 
between the male and female patients. 

In four women, whose urine was examined in each case 
daily for one month, the excretion of phosphorus was found ta 
be remarkably uniform, being in all of them below normal, 
and with very little variation, and showing no relationship to 
epileptic attacks. 

The males, however, all showed an irregular excretion with 
a wide range. One of these had numerous fits daily, so we 
were unable to draw any conclusions, but three patients were 


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1917 -] BV GUY P. U. PRIOR AND S. EVAN JONES. 39 

subject to serial outbreaks, and they all presented similar 
variations in the phosphorus excretion. 

During the period under consideration these three men had 
twenty-one serial attacks. On fifteen occasions the phosphorus 
excretion fell to a minimum on the second and first day 
before the commencement of a series, and in a similar number 
of instances there was a rise succeeding the series. 

We observed also that an injection of calcium iodide was 
followed by, in many cases, a great output of phosphorus. 
There appears then to be ground for thinking that coincident 
with the increased excretion of calcium before a series, there is 
a retention of phosphorus. 


Chlorine. 

The excretion of chlorine was found to be irregular in the 
men, but less variable in the women. Beyond an occasional 
fall preceding a series we were unable to detect any special 
relationship to the epileptic attacks. 

Calcium Blood Index. 

We have examined the calcium blood index also, according 
to the directions given by Dr. Blair Bell (3 and 4). By his 
method blood is prepared, and the calcium crystals counted on 
a haemocytometer ; he impresses the fact that there are diurnal 
variations, and advises that the blood be taken at the same 
time every day. He gives the normal as being from 0 8 to 
l*o crystal per square. During the time under review we have 
had estimations of the calcium blood index of eighteen patients, 
whose urine was also examined. We have grouped the results 
as follows : 

Calcium blood '4 and lower . '4 to -6 . ‘6 to 8 . '8 and higher. 

40 . 178 . 119 . 70 

It will be seen that the index in most cases is subnormal, viz. 
337 times out of 407. 

Whereas in the matter of calcium excretion each patient 
tends to have his individual peculiarity as to high or low 
amount daily excreted, this is not to the same extent notice¬ 
able in the blood index, but the variations of each patient are 
greater. There is apparently no constant change in the 
calcium blood index before a fit. The amount sometimes is 


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40 EPILEPSY : A METABOLIC DISEASE, [Jan., 

high, but usually there is more variation in the count at the 
time a fit is going to take place than at other times, and more 
often than not there is from a few hours to two or three days 
before a fit a high blood-index together with a high excretion, 
accompanied with changes in the alkalinity and coagulability 
of which we will speak later. Towards the end of, and imme¬ 
diately subsequent to a series, there is always a high though 
variable calcium blood-index, which falls a day or two after its 
• termination. In conditions of status epilepticus a high blood- 
index is found reaching from i to 1*5. We have not found the 
blood-index to have any constant relationship to the urinary 
excretion, to the alkalinity, or the coagulability, though often the 
index has been found to be highest when the coagulation-time 
was shortest, but to this there are many exceptions, though often 
before a series, and always during status, both are high 
together. 

Coagulation . 

We have examined the coagulation-time of the blood by 
means of drawing some into a capillary tube, transferring it 
to a glass slide and noting the time it takes to draw out 
fibrin threads, and using our own blood as a control. 

Turner says that in epilepsy there is an increased tendency 
for the blood to clot, that this is more marked before and 
during a fit, and that after a fit the time may be lengthened (5). 
Pesta found diminished coagulation-time in 37 cases out of 
45, and that the diminution was in proportion to the number 
of fits. Perugia found in 36 cases all to be of lowered coagul¬ 
ability, which could be rendered normal by giving calcium 
salts (5). We have made 464 examinations as to the coagul¬ 
ability of the blood ; 416 of these were made upon 18 of the 
patients on whom we were making daily or weekly observa¬ 
tions ; 48 were made upon other epileptics. These and all 
our examinations have been made about the same time each 
day ; the relationship of an examination to a fit or a series of 
fits is by chance. Of the casual 48, the coagulation of 35 was 
shortened, of 7 normal, and of 6 lengthened. We find that as 
a rule before a fit, and more markedly so before a series, there 
is a shortening in the coagulation-time; if the patient’s 
coagulation is usually short this becomes shorter. During a 
series the coagulation-time is short, but after a series approaches 


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41 


the normal, and often becomes lengthened. We have also 
noticed, in some cases, that during those months when the 
fits have been fewest, the coagulation-time has been longest. 

In Case 29, upon whom observations were made for 5 
months, only in 1 month did she show any lengthening of the 
coagulation time. This she did in 3 examinations out of 4 ; 
the fourth was approaching the normal. In this month she 
-only had one fit, whilst in the other 4 months the fits were 
from 5 to 13. During these months 33 examinations were 
made, 6 times the coagulation-time was normal, and 28 times 
shortened. 

Case 34, on whom 23 observations were made in 1 month, 
showed only twice a lengthening of the coagulation-time ; one 
of these occasions was about 2 hours after having a fit. In 
the same patient an observation was obtained about 2 hours 
before a fit, when the coagulation-time was only J of normal. 

Case 18, upon whom 54 examinations were made in 
months, shows less tendency to shortening of coagulation-time 
than most epileptics, it having been short or normal 24 times 
out of the 54 examinations. Two days before the commence¬ 
ment of a series his coagulation time shortens, remains short 
until the end of a series, then rises, and remains normal for 16 
■days, during which time he is free from fits, when again the 
-diminution of the coagulation-time, with an increase in the 
calcium urinary excretion and a fall in the alkalinity of 
the blood, indicate the probability of another series occurring. 
After this next series of 6 fits in 4 days the coagulation-time 
remains subnormal for 4 days, when he has 3 more fits, and 
the coagulation-time again becomes plus. 

In case 36, 17 observations were made in 4 months. In 
the 4 months when she was receiving pituitary gland, her 
coagulation-time was decidedly lengthened in 3 examinations 
■out of 4 ; during the month in which this happened she had 
but 1 fit. During the other 3 months she received no treat¬ 
ment, and had 10, 6, and 4 fits respectively. In these months 
the coagulation-time was shortened in 10 examinations out of 
13. In the month in which the 10 fits occurred the coagula¬ 
tion-time was decidedly shortened in all four examinations. 

In all cases of status epilepticus we have found the 
coagulation-time more markedly shortened than at other 
times. 


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[Jan.,. 


Alkalinity. 

We have examined the alkalinity of the blood by Boycott 
and Chisolm’s method. To do this a series of small tubes 
are prepared containing quantities of N/1,000 sulphuric acid,, 
rising by o'1 c.c. from O'O to 1*2 c.c.; the volume in each 
being made up to 2 c.c. with distilled water. About 0 02 c.c.. 
of blood is then added to each tube, the contents well mixed,, 
and the tubes placed in a water bath for one hour. With 
normal human blood, a coarse flocculent precipitate makes its 
appearance, when the tubes containing 07 to 0‘9 of acid are 
reached. The appearance of this precipitate is considered to 
indicate the neutralisation point (8). 

Charon and Brich have studied the relationship of epileptic 
convulsions to the normal variations in the alkalinity of the 
blood. They found the seizures to stand in inverse relation to 
the degree, and that the minimum frequency of the attacks 
corresponded with the maximum blood alkalinity (5). Pugh 
reports interparoxysmal alkalinity lower than the average, a 
sudden fall immediately before a fit, and a further fall after. 
He ascribes this as being due to acid toxines, absorbed from 
the intestinal tract (5). 

We have made 290 examinations as to the alkalinity of the 
blood, and all but 3 2 of these have been on the same 18 
patients as the other observations. Of these 290 examina¬ 
tions made on 50 patients, only 15 times have we met with 
a degree equal to what Boycott and Chisolm give as normal ; 
and of these 15, 13 were made on different occasions with the 
blood of the same patient, making only 3 patients that gave a 
normal degree of alkalinity. The rest were subnormal, many 
giving a very low degree of alkalinity. With slight variations, 
many patients seem to run their own degree of alkalinity, 
which makes larger variations at the time of epileptic attacks. 
We have found that, as a rule, there is a fall of blood alkalinity 
before a fit, and after an attack, a rise, to what might be called 
the patient’s own normal, or above. This rise we have observed 
a few hours after a fit; the pre-fit fall may take place a few 
hours before, or there may be an irregular and falling alkalinity' 
some days before the fit occurs. During a series the alkalinity 
continues to fall or remains low. 

In case 32 nine observations on the alkalinity' were made 


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in two months, the neutralising point varying from 0 4 to o - 6 ; 
being, on two occasions, 0 6, shortly after a fit had occurred. 

Case 6 had 10 fits in two series. Before the first series 
alkalinity fell from 4 5 to 4, remained low, and at the end of 
the series reached 3, then rose, and fell again before the next 
series. 


Leucocytes. 

In the case of the same patients as those on whom we have 
made the other observations we have made 395 leucocyte 
counts, and in 183 of these we have made differential counts. 

Turner states that the leucocytes in epileptics are 20 percent. 
below, and under bromides they approach the normal. Lewis 
Bruce has observed a hyperleucocytosis after a serial outburst 
or attacks of status (5). 

We have found that Blair Bell’s (3) method of preparing 
blood for calcium crystals is also an excellent way of showing 
leucocytes, and that we could easily make a differential count 
on the same slide as we counted the blood crystals. We have 
divided the results into four classes, those 

Below 7,000. Between 7,000 and 10,000. Between 10,000 and 16,000. Over 16,000. 

88 108 132 42 

We have found that patients have their own peculiarities as 
to leucocytes, some seldom giving counts above 5,000 or 6,000, 
others seldom below 12,000 or 14,000, and one patient has 
shown an individual peculiarity in his differential count, having 
small lymphocytes increased out of proportion to the poly¬ 
morphonuclear leucocytes. 

We have found that as a rule before a series, and at times 
before an isolated fit, there is a fall in the number of leucocytes 
often to as low as 4,000 or 5,000, and that during a series the 
number will gradually rise, and that after a series the count will 
often be 19,000, or 20,000 or more. 

In one case of status, on a day in which the patient had 77 
fits, two days before her death the leucocyte count totalled 
over 70,000. During an hysterical attack which in one of 
our patients often replaces a fit, we have noted a leucocytosis 
of over 20,000. In several cases in which the leucocytes have 
for one month been consistently higher than during another, 
we have observed that during the month of high count 


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there have been fewer fits, also that during a free 
interval the leucocyte count is higher than at the time of 
taking fits. As to the differential count we have found, with 
the exception already mentioned, the relationship between 
the large, small, and polymorphonuclear to be about normal, 
and that in the post-epileptic rise, the increase in number is 
almost entirely in the polymorphonuclear leucocytes, when of 
necessity they become increased out of proportion to the 
others. 


Blood-Pressure . 

We have made 258 examinations on the systolic blood- 
pressure by means of Tycos’ sphygmomanometer. Of these 
examinations 134 have been made on 64 male patients and 
124 on 51 female patients. The pressure has been taken both 
in the recumbent and standing positions on each examination. 
The patients are of all ages from 20 to 70 years, the majority 
being between 30 and 50 years of age. 

The results are as follows : 

Male patients: 

Standing: 


Below 100 mm. Hg. 

100-120 

. 120-130 . 

136-150 . 

150-170 . 

Over 170 mm. Hg. 

7 

Recumbent: 

56 

35 

24 

11 

I 

7 

Female patients: 
Standing: 

45 

' 37 

32 

8 

4 

32 

Recumbent : 

5 i 

18 

9 

10 

4 

2 3 

59 

15 

iS 

7 

2 


Of the male patients, on 62 occasions the pressure in the 
lying position exceeded that in the standing position. On 22 
examinations the pressure when standing and lying was equal. 
Of the female patients on 56 occasions the recumbent pressure 
exceeded that of the standing, and on 17 examinations the 
pressure in the two positions was equal. 

The significance of the fact that more than half the blood- 
pressures taken by us were equal or higher in the recumbent 
position than when standing we do not understand. Ludlum 
and Carson White in an instructive article mention this varia¬ 
tion of blood-pressure as occurring in some cases of dementia 


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praecox, giving certain Abderhalden reactions, and the results 
they obtained by giving the underactive gland (16). 


Calcium. 

Calcium salts have for some time been considered of use in 
the treatment of epilepsy, and many cases have from time to 
time been reported that have greatly improved on calcium ; 
others have reported that no good but harm results from its 
use. As far as we are aware no concise account of the use 
of this drug in epilepsy has been written, nor any clear reasons 
for or against it advanced. The best summary of its employ¬ 
ment we have seen is contained in an Editorial Review of 
Epilepsia. Here it states : “ Sabbatani concluded that calcium 
in the cortex exercises inhibitory influence, and that its diminu¬ 
tion may bring about convulsive phenomena ” (6). The same 
review quotes Donath’s conclusions : “ That calcium plays no 
important part in epilepsy or tetany.” These conclusions he 
bases on 9 cases treated for 124 days. Sir J. Barr says that 
in epilepsy all soluble calcium salts do good, and advises that 
decalcifying agents such as acids and fruits be avoided (9). 
Blair Bell states that hystero-epilepsy is due to depletion of 
lime salts from the tissues, and that calcium lactate may cure 
this condition (1 o). 

We have for the last twelve months treated 20 male and 1 o 
female cases with calcium, either alone or combined with 
bromides, and during the last six months have added one or 
mote extracts of the ductless glands. All except two of our 
patients are insane epileptics of many years standing ; the 
class of case of which Turner says—“ that in confirmed 
epileptics, with frequently recurring fits, little if any benefit is 
to be derived from treatment, whether medical or dietetic ”(5). 

Of these 30 cases none were any the worse for receiving 
calcium. Donath records that he had to stop treatment in one 
of his cases on account of increasing fits (6). Five of our cases, 
all male, are neither better nor worse. Thirteen have had their 
average number of fits reduced by half or more than half, the 
other twelve have shown a lesser reduction. In several in 
whom the fits are not much reduced in number they are less 
severe, and the after-effects are much less ; many are mentally 
brighter and are capable of more work. Two who had not 


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worked for years have taken to doing so since being treated 
with calcium. Their outlook is brighter, and they have more 
interest in life. 

Glands. 

Having had some success with treating these patients with 
calcium we then added to the treatment the extracts of various 
ductless glands, doing so in the first instance because of their 
influence upon calcium metabolism. We have used extracts 
from the thymus, thyroid, parathyroid, suprarenal, and pituitary 
glands. All these have appeared to be of use in some cases ; 
all with the exception of thymus have apparently done harm 
in other cases. The indications for any special gland extract 
in any given case are at present vague and indefinite. The 
influence, which the secretion of these glands have upon calcium 
metabolism is said to be as follows : 

Thymus—removal of this gland increases the calcium 
■excretion (11). It is said to be engaged in hindering the 
formation and neutralising the excess of acids in the organism ; 
its enucleation leads to acid excess. A puppy without a 
thymus lacks intelligence (12). 

Suprarenals—removal leads to retention of lime in blood 
and tissues and prevents excretion of calcium (9). 

Pituitary extract causes increase of calcium in the blood (13). 
Thyroid and ovarian diminish the free and fixed lime in the 
blood and tissues and thus lessen viscosity. If the thyroid is 
removed the calcium index rises. 

Parathyroids control the distribution of calcium ; if the 
secretion is deficient the tissues lose calcium (14). 

If the thyroid and parathyroid are removed in cats the 
animals have convulsions (11). 

Of these glands we have found the thymus to be of most 
use and the only one from which harm may not occasionally 
result. We used thymus as it is the gland that undergoes 
definite change at the time that the commencement of epilepsy 
is commonest. We looked upon the hypertrophy and persis¬ 
tence of this gland, which is often found in epileptics, as a 
compensatory one, and thought that its secretion might be 
needed more in these patients than in normal people. The 
blood of epileptics is less alkaline than that of others, and the 
thymus is credited with neutralising acid excess (12). Myers 


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1917 ] by GUY r - u - I’RIOR AND S. EVAN JONES. 

states that in acid intoxication the calcium content of the 
blood is increased, probably at the cost of the tissues. He 
also says that oxalic acid poisoning is relieved by calcium, 
•owing to its replacing the calcium withdrawn by the oxalic 
acid (15). 

We have been partly guided by the blood-pressure as to 
which gland to give (16). 

Turner says that epilepsy commences most commonly during 
the time of the greatest activity of the thymus, and that thymus 
<jiven to epileptics aggravates the disease (5). 

The female patients have on the whole made more improve¬ 
ment on the calcium treatment than the men. Some have 
been more regular in their menstrual periods while on this drug 
than they were formerly. Blair Bell says that menstruation is 
dependent upon a certain supply of calcium, and if this is 
■deficient the function will not take place. He also says that if 
•a patient suffering from amenorrhea due to debility be given 
■calcium the function will become reestablished (11). We have 
treated two cases of primary dementia, both of whom had 
-amenorrhea for over three years, as he advises. The first case 
menstruated within a month of the commencement of the 
treatment, and has now done so regularly for over twelve 
months. The physical improvement in this patient was beyond 
•expectations, she having put on two stones in weight and 
maintained it. The other case did not respond so readily, but 
.after taking calcium for three months, and when also taking 
pituitary gland, the menses reappeared. We suggest, therefore, 
that the irregularity of the katamenia which occurs in epileptics, 
may be another expression of the same disturbance of the 
■calcium metabolism which is responsible for the epileptic 
phenomena. 

Injections of Calcium Iodide. 

We have used intramuscular injections in cases of serial 
•epilepsy. It has been pointed out that calcium is a nervine 
sedative, and that it lowers the excitability of the cortex to 
faradic stimulation. It has also been shown by Ringer that 
<alcium salts control the excitability of muscle, which points to 
the fact that muscle and nerve are less irritable when plentifully 
supplied with calcium. Although at the time of a serial attack 
the coagulation time is shortened, and the calcium blood index 


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EPILEPSY : A METABOLIC DISEASE, 


[Jan. 


is generally raised, vve have thought that this may have resulted 
from depriving the nerve tissue of calcium, rendering it more 
irritable, and that by adding calcium to the system this irrit¬ 
ability might be lessened. We have treated 60 serial attacks 
in 13 different patients with the following results: 

One injection : 

No. of fits after injection o . 1.2.3 

Times . . . . 21 . 14 . 2 . 4 

Twice a second injection was given, the patient not having 
responded to the first; each time there were two fits after this 
second injection. Twelve times there was apparently no 
improvement, the series being as long or longer than the 
patient’s usual average. These injections were given to 
patients who habitually have their fits in series. Of course it 
is impossible to say that some of these patients might have had 
no more fits, without receiving an injection ; it is certain from 
their former habits that the majority would have had. One 
patient who becomes extremely dull and is only semi-conscious 
after a few fits, becomes quite conscious and almost bright 
within half an hour of receiving calcium in this way. The 
calcium iodide is prepared according to the directions given by 
Sir J. Barr, t. e. it is made up in a solution of glucose in salt 
solution (17). 

We inject as much as iogr.; no harmful effect has resulted, 
except that in two ca$es abscesses have occurred. We were 
then using solutions of 4 gr. to the c.c., which is probably too 
strong. Before and since we have used solutions of half this 
strength. 

Cases Illustrating the Treatment. 

A lad, aet. 21, had convulsions at the first dentition ; from 
the age of 2 to 11 years he had about one fit yearly. From 
the age of 1 5 he had been getting worse. For six months 
before admission he averaged 77 fits a month. Most of these 
attacks were not ordinary convulsive attacks, but he would 
lose consciousness, run round in a circle from right to left, 
micturate, and then lie down. He was given a mixture of 
bromide and calcium every four hours. For the next nine 
months he averaged less than one fit a month, these being all 
of the ordinary major type. He then left the Hospital, and is 


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now, three years after admission, reported to have about one 
fit in three months. 

Case 3.—Before comingunder our care, he had for many 
months averaged 120 fits a month, although being treated 
with bromides. He is a man, jet. 26, and has been an 
epileptic since the age of 20. Most of his attacks were what 
his friends aptly describe as “ squealing fits." He would lose 
consciousness for a few seconds, would scream loudly, and if 
not held would fall. We have treated this patient for six 
months. For the first month he was given calcium chloride 
four-hourly, and thymus gland 5 gr. every morning, and the 
number of attacks dropped to 90. For the second month he 
was given in addition potassium bromide, 30 gr., every four 
hours ; in this month the fits increased to 118. For the last 
four months suprarenal gland has replaced the thymus and 
1 o gr. of bromide been added to each dose. The number of fits 
during these four months has been 21, 4, 2, and o respec¬ 
tively. In spite of the large dose of bromide that he has been 
taking, he has put on weight, is lively and good-natured, and 
works daily on the farm. Before treatment his coagulation¬ 
time was on most examinations lengthened. 

Case 4.—A lad, aet. 20, has been treated by us for eight 
months. Before admission he is stated by his father to have 
averaged one fit every night. This we did not verify, but 
commenced treating him shortly after admission. He was 
given thymus gland, 10 gr., and a mixture of bromide and 
calcium. During the next seven months he had no fit; during 
the eighth he had 9, which followed upon the reduction of his 
bromide from 15 gr. to 10 gr. per dose. 

Thymus in this case seems to have undoubtedly done good. 
It was given as the fits commenced about puberty. 

Case 2.—A man of little intelligence and an eater of all 
sorts of rubbish, with an especial liking for grass. For six 
months before treatment he averaged 41 fits a month, with a 
maximum of 64 and a minimum of 25. All this time he was 
receiving bromides. For eight months he was given calcium 
and bromide ; the fits during these months ranged from 18 to 
6, giving an average of 13. For one month he had in addition 
suprarenal gland, 5 gr., every morning ; this month he had 
10 attacks. For another two months thymus replaced the 
suprarenal ; during these two months he averaged 19 fits a 

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50 EPILErSY: A METABOLIC DISEASE, [Jan, 

month. In the course of twelve months treatment he has not 
in any month reached half his former average. 

CASE 25.—A dull imbecile, an epileptic since infancy, for 
six months previous to treatment averaged 10 fits a month. 
For ten months she received calcium lactate, 10 gr, and 
potass, bromide, 15 gr, every four hours. In three of these 
ten months she had no fits (which had never been recorded of 
her previously) the monthly average for the whole period being 
3'8. Having a low blood-pressure, she was for three months 
given pituitary gland, 2 4 gr. daily, in addition to the calcium 
and bromide. For these months she averaged 6 fits a month, 
the pituitary gland seemingly having increased the number of 
fits. This patient has made considerable mental improvement. 
She formerly was too dull to converse or to have any interests ; 
she is now a working patient and fairly bright. 

Case 28, set. 35, an epileptic since 12 years of age. She 
was dull and lethargic, and her fits are associated with a 
periodic cyanotic condition of her fingers and toes. For the 
six months previous to treatment her attacks averaged 1S 
monthly, ranging from 16 to 21. For two months she was 
given calcium lactate alone, for which months her fits averaged 
12. For two months bromide, 1 5 gr, was added to each dose 
of calcium, for which time the monthly average of fits rose to 
15. As she on all examinations had a moderately high blood- 
pressure, she was for three months given thymus gland daily, 
as well as the calcium and bromide, the resulting average of 
fits being seven a month. For four months she received 
thyroid gland three days alternately with the thymus, the 
monthly average of fits rising to 10. Since taking thymus 
and calcium the attacks of cyanosis, which formerly were very 
frequent, have almost disappeared. This patient improved 
with calcium alone, but made a more decided improvement 
when taking thymus in addition. There was a slight increase 
in the number of fits with thyroid gland, but when taking this 
gland she becomes mentally much brighter. 

Case 23.—A woman, aet. 66, an epileptic since the age of 
34 years. This is a case of alcoholic origin, and arose at the 
time she ceased to menstruate. For six months previous to 
treatment she had averaged 21 fits a month, with a range of 
from 13 to 29. For four months she received calcium and 
suprarenal gland, with a resulting average of 13 fits a month. 


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showing a maximum of 17 and a minimum of 5. For one 
month 5 gr. thyroid replaced the suprarenal, with the result 
that this month she had 34 fits, the most ever credited to her 
in any one month. This patient improved with calcium and 
suprarenal gland and without bromide. Thyroid gland with 
her increased the number of fits. 

Case 31.—A boy, a:t. 19, an dpileptic since infancy. For 
the twelve months .previous to treatment he averaged 6 fits a 
month, ranging from 1 to 8. His epileptic attacks are 
associated with sexual instability, as before a fit he practises 
onanism freely. For three months he has taken thymus, 5 gr. 
daily. During the first month of treatment he had no fit, in 
the second 4, and in the third 1. The patient states that since 
taking thymus his genital organs have caused him less tempta¬ 
tion, and to this he attributes the diminution in the number 
of fits. 

Pathogenesis of Epilepsy. 

Various writers have assigned numerous causes for the 
recurrent explosive attacks which characterise epilepsy. These 
may be classified as 

(1) Toxic. 

(2) Vascular. 

(3) Infective. 

The supporters of the toxic theory do not agree as to the 
nature of the toxin. Krainsky says ammonium carbammate, 
Haig uric acid, whilst others support a non-specific intoxication 
due to some failure of the digestive functions. 

Experiment in our hands failed to justify the supposition 
that there is a specific toxin in epilepsy. Krainsky by sub¬ 
cutaneous injections into rabbits of blood taken from epileptic 
patients in conditions of status produced convulsions and death 
of the animal in 4 or 5 days. His results are quoted by 
many authors, but as far as we have been able to ascertain 
have not been repeated. We have injected 3 guinea-pigs with 
2 c.c. of blood, aud 3 with 2 c.c. of cerebro-spinal fluid, taken 
from three patients suffering from status epilepticus, and beyond 
a slight malaise the animals showed no ill-effects. 

That the agent responsible for the convulsions is a non¬ 
specific toxin hardly needs refuting. There are too many 


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[Jan.,. 


cases of intestinal toxaemia which do not exhibit symptoms of 
epilepsy. Russell’s vasomotor explanation (i8)has not been 
supported by pressure records made by Munson (22). 

J. Turner (5) has observed intravascular coagula in the 
central nervous system, and offers them as the cause of the 
attack, postulating, however, as do many supporters of the toxic 
theory, a brain hereditarily and structurally predisposed to 
irritability and convulsions, which seems to be begging the 
question. 

Bra, and more recently an American writer, have claimed to 
have isolated specific organisms from the blood of epileptics. 
The trend of modern opinion, however, is in favour of the bio¬ 
chemical theory, as expressed in the quotations at the head of 
the article. 

The analogy of reflex action may usefully be applied to 
reactions of the organism of a higher order. It may be stated 
that motor actions occur in response to conditions which arise 
in the environment, using the term to include endogenous as 
well as exogenous states. It follows then that every motor 
action is preceded by an afferent impulse, w'hich in the case of 
voluntary action may enter consciousness, whilst in the case of 
the vascular and intestinal musculature the reaction is outside 
the field of consciousness. The environmental condition may 
not be immediate in point of time but may remain, or rather 
the conception of it, as a motive to action. Ordinarily, then, 
a motor action is elicited by the excitation of appropriate 
cortical motor cells by some higher centre, and the action is 
adequate to the purpose. This adequacy depends on inhibitory 
and possibly facilitatory mechanisms in the cortex which 
confine the impulse to its proper channel. The complex and 
intimate nature of the interrelations of the cortical cells by 
association paths explains the importance of the inhibitory 
functions, which have been attributed to cells of the second and 
third layers. 

In epilepsy degenerative changes have been described in 
these layers, and Southard has advanced an explanation of the 
epileptogenous discharges, suggesting that removal of inhibitory 
control permits an uninterrupted excitation ofthemotorcells(i9). 
Whether or not inhibitory functions are localised in these cells, 
it seems certain that their activities are manifested at the 
synapses. 


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53 


The Epileptogenous Discharge . 

The outstanding features of the epileptic crises, the disturb¬ 
ance of consciousness and convulsive attacks, indicate that we 
must look to the central nervous system for the rationale of 
their causation. 

The convulsions mean simultaneous activity of the cortical 
motor cells, and necessarily an abeyance of inhibition. We 
suggest that the fundamental pathological change is an altera¬ 
tion of the chemical or physical state of the synapses depriving 
them of selective or inhibitory activities. In this connection 
it is instructive to consider certain diseases in which there are 
specific nerve toxins, e. g., rabies, tetanus, and strychnine 
poisoning. In these a sensory stimulus precipitates a con¬ 
vulsive attack. 

“ Reflex epilepsy,” and cases exhibiting epileptogenous 
zones, are analogous to these, and the relation between a 
sensory stimulus and the occurrence of an epileptic seizure is 
well known. In one of our cases the first convulsive attack 
/oilowed a fright from an alarum clock ; in another, a patient 
«t. 33, the first fit occurred while having a cold shower. A 
third patient, to whom we were giving injections of calcium 
iodide, always became extremely suspicious and irritable after 
a fit, and resisted strongly when an injection was being given, 
with the result that he invariably had another fit. In the first 
two cases there was a sensory impression, in the last an 
•emotional state, which normally produce physiological reactions, 
4 . e., movement expressing fear or surprise, shivering and move¬ 
ment of resistance respectively, by excitation of appropriate 
cortical motor cells. The exciting stimulus in these patients 
was, however, distributed widely through the motor areas, with 
the result that convulsions occurred. 

The disturbance of consciousness is explicable on the same 
supposition that the originating stimulus is uncontrolled by 
the inhibitory mechanism. Lugaro states, " the fundamental 
character of the phenomenon of consciousness is distinc¬ 
tion” (20),clearness of consciousness is proportional to the 
restriction of its field. 

The “ Law of Avalanche ” of Ramon y Cajal is an expres¬ 
sion of the complexity of neuronic associations in afferent 
paths (20). We suggest, therefore, that consciousness is 


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54 


EPILEPSY : A METABOLIC DISEASE, 


[Jan., 


swamped by an overflow of the ascending impulse to numerous 
cortical areas, the process being comparable to the loss of con¬ 
sciousness that may occur with the reception of a severe 
sensory impression. 

Evidence of Metabolic Disturbance in Epilepsy. 

\ 

Munson (2) has reviewed the evidence of disturbance of 
metabolism in epilepsy, and finds the results of different authors 
somewhat discordant Much work has been done on the 
urinary constituents, particularly after convulsive seizures, when 
one might expect the results to be invalidated by the presence 
of katabolic products. A reduced alkalinity of the blood has 
been established, as also a shortened coagulation-time. 

We carried our observations over long periods, and were 
enabled to follow the daily changes. 

Our conclusions may be summarised thus : 

Calcium : The calcium index of the blood is low in epileptics, 
with tendency to rise after a serial attack. 

The excretion of calcium in the urine is low, but shows a 
a rise some days before a series. 

The coagulation-time is shortened, with a further shortening 
before a series, and a lengthening after. 

The alkalinity of the blood is low in epileptics, and there is 
a fail before a fit. 

Phosphorus excretion we have observed in some cases to be 
low before a series. 

The Importance of Calcium in Metabolism. 

In recent years the importance of calcium in the ecotiomy 
of the body has been fully recognised. Its presence is neces¬ 
sary for the coagulation of the blood and muscle, for the action 
of rennin, and Ringer demonstrated its influence on the con¬ 
tractility of cardiac muscle. 

Sabbatani showed that calcium salts lowered, while sodium 
oxalate enhanced, the excitability of the cortex (6), and Roncorini 
demonstrated the inhibitory influence of calcium salts, and 
opposite influence of neutral sodium phosphate (6). 

The association of the menstrual period and the puerperium 
with increase in the number and severity of epileptic seizures 
is well known. In this connection it is interesting to note that 


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I 9 I 7 -] BY GUY P. U. PRIOR AND S. EVAN JONES. 


55 


Blair Bell found the menstrual fluid to contain a considerable 
amount of calcium. The onset of lactation involves a drain 
by way of the milk. Good results have been obtained in the 
treatment of epileptics with calcium. We have been able to 
cut short serial attacks by subcutaneous injections of calcium 
iodide and by intravenous injections of calcium chloride. 
Ballantyne has treated cases of eclampsia with intravenous 
and rectal injections of calcium chloride with good results (23). 
There is reason to suppose, as indicated by experiments 
referred to above, that between calcium and sodium salts there 
is a physiological antagonism ; if this is so, the beneficial 
results of salt-free diet and calcium treatment in epileptics arc 
explicable by a substitution of calcium for sodium, with the 
effect of reducing cortical irritability. 

The organs responsible for the disturbance of < calcium 
metabolism may possibly be found in the ductless glands. 
Marked changes do occur in these tissues, the most frequent 
being persistence and enlargement of the thymus, the signifi¬ 
cance of which we think has been underestimated. 

Sir W. Gowers says that more than 25 per cent, of 
epileptics have their fits between the ages of 12 and 16 
years (21), the period of puberty, when retrograde changes 
occur in the thymus. 

We think that the periodic crises of epilepsy represent an 
exaggerated psychomotor reaction, there being an afferent 
impulse which excites a wide area of the cortex and causes 
unconsciousness and an uninhibited motor excitation, the 
abeyance of inhibition being the consequence of deficient 
resistance or refractivity at the synapses, and due probably to 
disordered calcium metabolism. 

References. 

(1) Allbutt's Mediant , vol. viii. 

(2) Munson, J. F.—“ Is Epilepsy a Disease of Metabolism?” Epilepsy 
and Epileptics, 1906. 

(3) Bell, W. Blair.—■'* Estimation of Calcium Metabolism," Brit. 
Med. Jovrn., vol. ii, 1912, p. 698. 

(4) Bell, W. Blair.—"General Calcium Metabolism,” Brit. Med. 
jfourn., vol. i, 1909, p. 5x7. 

(5) Turner, W. A.— Epilepsy , 1907. 

(6) "Editorial Review of Epilepsia,” Brit. Mei.Jbum., vol. i, 19x0, 
p. 281. 

(7) The Medical Journal of Australia, March, 1916. 


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THE ORIGIN OF MENTAL POWER, [Jan., 

(8) Martindale and Westcott.— Extra Pharmacopoeia , vol. ii, 1915. 

(9) Barr, Sir. J.—“ Lime Salts in Health and Disease,” Brit. Med 
yourn., vol. ii, 1910, p. 829. 

(10) Bell, W. Blair and Hick.—“Observations in Physiology of 
Female Genital Organs,” Brit. Med. yourn., vol. i, 1909, p. 517. 

(11) Bell, W. Blair.—“General Functions of Ductless Glands in the 
Female,” Lancet, April, 1911. 

(12) Thursfield, H.—“ Status Lymphaticus,” Clin, yourn., June 16th, 
1916. 

(13) Bell, W. Blair.—“Use of Hermones in Obstetrics,” The Prac¬ 
titioner, February, 1915. 

(14) Herty, A. F.—“The Parathyroid Glands,” The Practitioner, 
February, 1915 

(15) Meyer, Hans.—“Action of Lime Salts,” Brit. Med. yourn., 
vol. ii, 1910, p. 1594. 

(16) Ludlum and Carson White.—“Thymus and Pituitary ii> 
Dementia Prsecox," Am. yourn. Insan., April, 1915. 

(17) Barr, Sir J.—“ Role of Lime Salts as Therapeutic Agents," Brit. 
Med. yourn., vol. ii, 1912, p. 695. 

(18) Russell, A. E.—“The ./Etiology of Epilepsy,” Epilepsy and 
Epileptics, 1906. 

(19) Southard.—“ Histopathology of Epilepsy,” Epilepsy and Epi¬ 
leptics , vol, V. 

(20) Lugaro.— Modern Problems in Psychiatry, p. 103. 

(21) Gowers, Sir W.— Epilepsy. 

(22) Munson, J. F.—“ Heart’s Action Preceding Epileptic Seizures,” 
Epilepsy, 1907. 

(23) Ballantyne, J. W.— Brit. Med. yourn., vol. ii, 1912, p. 1122. 


The Origin of Mental Power. By Casper L. Redfield, 

Chicago. 

The ordinary biological teaching is to the effect that the 
inheritance of the child is not affected by the education of the 
parent. That dictum is not based upon a direct investigation 
of the matter itself, nor is it based upon an investigation of 
anything which is related to human intelligence. The dictum 
is nothing but an unwarranted deduction from observations on 
the colours of animals, and some experiments on amputating 
the tails of mice. 

Men have been educated more or less regularly in our 
schools for several generations; horses have been educated on 
the race track ; and hunting dogs have been educated in the 
field. The education in these cases has been both mental and 
physical, and an investigation of the thing itself tells a very 
different story from that told by the biologists. That story 


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says very plainly that improvement in mental and physical 
powers from generation to generation comes directly as the 
result of educating each generation in succession. It also says 
that whenever education in any generation falls below a certain 
minimum amount, then the next generation will decline in its 
inherited powers of that particular characteristic which lacked 
education. 

To understand this matter it is necessary to consider what 
education is, and the fact that there is no royal road to learning. 
An education is obtained by hard work continued a long time, 
-and the effect produced upon the organs of intelligence does 
not precede that work. A young man has not done hard 
work for a long time. Only an older man has done that, and 
to investigate the effect upon offspring of educating the parent 
it is necessary to consider the differences between the children 
of young parents and the children of old parents. 

What a person inherits he may transmit to his children. 
That is a matter which is not disputed by anyone. If a child 
may inherit improved mental powers by reason of the father’s 
-education, then the father may profit by the education of the 
grandfather, and may pass along his inheritance to the son. 
By the same process of reasoning we may carry this matter to 
the great-grandparents and other ancestors. An investigation 
which did not extend beyond the immediate father would be 
superficial. What is needed is investigation extending over 
from two to four generations of progenitors for the purpose of 
-getting some accurate conception of what has occurred in the 
production of men of different mental qualities. 

Setting aside those men who have become prominent in the 
world because of some official position, it may be said that a 
great man is one who inherited great mental power. We have 
had many such great men, and to produce them the circum¬ 
stances of their production must have been advantageous. If 
it is advantageous to educate the parents, the grandparents, and 
the great-grandparents, then these great men must have come 
from such educated ancestors. Remembering that only older 
persons have acquired much effects from long continued educa- 
• lion, we have, in the age of parents at the time of reproducing, 
a very definite test of this matter. If the effects of education 
are transmitted from father to son, then great men must come 
from parents, grandparents, and great-grandparents who were 


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THE ORIGIN OF MENTAL POWER, 


[Jan., 

above the average age of parents when the average child is 
born. If we can find cases of great men who were sons of 
young parents, and those parents were themselves the offspring 
of young parents, then great intellectual power can be produced 
-in some other way than by educating the parents first and 
having them reproduce afterwards. 

In the northern part of the United States, the British Isles, 
and the northern part of Europe generally, the average father 
is about 32 years of age when the average child is born. He 
is somewhat younger in other parts of the world, but we may- 
take that 32-year old father as being the standard father. In 
individual cases these 32-year-old fathers will differ widely in 
their mental development which comes from different degrees 
of education, still we can conceive an average for those different 
fathers. We cannot put down in figures an indication of 
those different degrees of mental activity, but we can put down 
in figures the ages of fathers at the births of their children, 
and those ages arc themselves indexes of mental development. 

A list was made of several hundred eminent men—men 
whose names are recorded in our encyclopedias because of their 
intellectual achievements. Their ancestries were then inves¬ 
tigated, and it was learned how old their fathers were when 
they were born, and how old the grandparents were when the 
parents were born. In some cases the facts were learned for 
great-grandparents and even earlier progenitors. The age of 
the father is called the “ birthrank " of the child, and in the 
pedigrees of these intellectually eminent men were found 860 
birthranks. The average age of these 860 persons was not 32 
years. It was more than 40 years. The eminent men of the 
world were not produced by standard parentage. They were 
produced by abnormally old parentage, and that old parentage 
means educated parents, grandparents, and great-grandparents.. 

In a pedigree extended three generations there are fourteen 
progenitors, and among so many it is always possible to find 
one or more persons who. were young when their children were 
produced. Consequently, there were some young fathers in 
these pedigrees, and such young father might be at any point 
in a pedigree. But nothing was found to indicate that mental 
greatness can be produced by a succession of young parents. 

Having got these 860 birthranks, a table was made showing 
how they were distributed, that is, how many cases there were 


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BY CASPER L. REDFIELD. 


59 


•f fathers under 25, how many of fathers from 25 to 29, how 
many of fathers from 30 to 34, and so on. Also, a similar 
table was made showing the normal or ordinary distribution of 
births as they occur in an average community. A comparison 
between these two tables gave some very definite information 
as to the effect of age in parents on the mental ability of 
offspring. 

From this comparison we learn that if the son of a man 
less than 25 has one chance in a million, or any other number, 
of reaching a certain grade of eminence, then the son of a 
man between 25 and 29 would have 2'3 5 chances of reaching 
the same grade of eminence. The son of a man between 30- 
and 34 would have 3'55 chances; the son of a man between 
35 and 39 would have 5^42 chances ; and so on. Each 
increase in the age of the father at birth of the son increases- 
the son’s chances of becoming eminent. When the fathers are 
€0 years of age and over the chances of eminence become more 
than fifty times as great as they are when the fathers are less 
than 25. 



RHative chiuic** of iiecomin* etninoot, m mewnml by Me oi father at birth ef 
»on. from 'Tireit Men." by Redfleld. 


Eminent men are not all equally eminent. Some are merely 
famous for some exploit, while others, less famous, are much 
greater when measured by their intellectual achievements. In 
an alphabetical arrangement men of all kinds will be distributed 
indiscriminately through the list, but when we group our 
eminent men by the ages of their fathers, that indiscriminate 
arrangement no longer exists. Those men who became 
eminent because of inherited opportunities, or because of some 
spectacular achievement, gravitate toward that end of the scale 
represented by the younger fathers ; while those who became 



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THE ORIGIN OF MENTAL POWER. 


6o 


[Jan., 


eminent by reason of pure intellectual power gravitate toward 
the end of the scale represented by the older fathers. The 
years which the father lives before his son is conceived have an 
important bearing upon that son’s mental powers. The older 
the father the better the son. 

Those years constitute a definite and precise fact which 
anyone can verify for himself from encyclopedias and biographies 
to be found in ordinary libraries. They are not explainable 
on the germ-plasm theory, the mutation theory, the selection 
theory, or on any other theory advanced by biologists to 
explain the processes of evolution. They are explainable on 
the inheritance of the effects of education in previous genera¬ 
tions, and they are not explainable on anything else. 

Our eminent men form one end of the human scale. Ignor¬ 
ing idiots and the insane, our subnormal and feeble-minded men 
form the other end. The same test may be applied at this 
other end, and from that test we can get further information 
which is just as definite and precise. There are many family 
groups noted for subnormal and feeble-minded members, and 
some of these groups have been traced back to their origin 
in some one person or some single couple. When we put 
these cases to the test we find that they originate in children 
produced by uneducated parents who were usually several years 
less than twenty when those children were born. We see 
further that these subnormal families are maintained in their 
subnormality by continuous generations of young and uneducated 
parents. When some branch of a subnormal family has 
education forced upon it, and that education is accompanied by 
reproduction in the later lives of the educated persons, then 
that branch rises from subnormality to normality. 

It is not necessary to sterilise, segregate, or transport the 
subnormal in any effort to improve the race. Such efforts are 
futile. All that is necessary to do is to force education upon 
individuals to whatever extent such forcing is possible, and 
then prevent them from marrying until after they have reached 
their majority. Two generations of that proceeding will raise 
the subnormal stock to normality. 

. It is not possible to improve the human race by simply 
selecting superior individuals for reproducing purposes, and 
then leaving them to reproduce in the ordinary way. That 
idea is based on a misconception, and a superficial consideration 


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1917-] PSYCHOANALYSIS, A NEW PSYCHOSIS. 6 1 

of what has occurred in the breeding of domestic animals. We 
select cattle for their beef, and sheep for their wool, but the 
superior human being is not principally beef and hair. Human 
intelligence is a matter of power, and power stands on a very 
different footing from those exterior characteristics of form and 
colour which breeders consider in making selections for 
improvement. 

An athlete and a race-horse gain in strength by training and 
a man gains in mental power by study. Both of these men 
work. It is by work that we develop the mental and physical 
power of the individual, and it is by the amount of work per 
generation before reproducing that we can develop the powers 
of the race. When that work increases the race advances, and 
when it decreases the race decays. 


Psychoanalysis, a New Psychosis. Une Psychose Nouvelle ; 
La Psychoanalyse. Mercure de France , September ist, 
1916 . By Yves DELAGE, Directeur de la Station 
Biologique de Roscoff. Translated by T. DRAPES. By 
kind permission of the Author. 

[The following article from the pen of the eminent biologist, 
M. Yves Delage, was brought under the Editors’ notice through 
the kindness of Sir Bryan Donkin. The vein of irony and 
caustic humour, more or less scathing, which runs through it 
will, no doubt, be distasteful to those who have accepted in 
their totality the theories of the Freudian school, but it is as 
well that the teaching of that school should be presented for the 
nonce from a different standpoint from that adopted by its 
whole-souled adherents. And while it may perhaps offer some 
rather “ strong meat ” for our readers’ consumption, and while, 
in particular, the interviews so graphically described may seem 
too out-spoken and realistic for some ultra-sensitive British 
minds, it can hardly be questioned that they are, unfortunately, 
true to fact; and it might be a blunder on the part of psychia¬ 
trists who cannot bring themselves to admit the soundness of 
the principles of Freudism to content themselves with the 
adoption of a merely passive attitude towards them, and, 
ostrich-like, to shut their eyes to an aspect of a movement which 
is spreading with more or less rapidity in our own and other 


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PSYCHOANALYSIS, A NLVV PSYCHOSIS, 


[Jan*, 


countries outside Germany, and which in the view of many sober 
thinkers is, in much of its theory, scientifically unsound, and at 
least capable of becoming demoralizing in practice; and if, 
through a no doubt pardonable repugnance to anything savour¬ 
ing of prurience or salacity, they were to allow themselves to 
drift into the opposite extreme of a too meticulous and hardly 
justifiable prudery. 

An able criticism of Psychoanalysis, by Dr. Mercier, has 
appeared in a recent number of the British Medical Journal , to 
which the present article, though as regards the original ante¬ 
cedent in publication, may be considered a not inappropriate 
supplement. 

It may be mentioned that M. Yves Delage has lately been 
made the recipient of a very high honour in this country, 
having been presented with the Darwin Medal by the Royal 
Society.—E drs.] 

In the event of a contagious malady making its appearance 
in any country it is the duty of the medical man who first has 
cognisance of the evil to raise a cry of alarm, so as to ensure 
the adoption without delay of the necessary prophylactic 
measures. 

To sound this note of alarm is the object of this article. 

This new affection, which threatens to invade France, had 
its birth in Austria, at Vienna, some twenty years ago. Its 
progress, at first very slow, soon became rapid, and the spread 
of the evil generally now knows no pause. The Germanic 
nationalities were actually the first to be reached ; then German 
Switzerland was invaded, and Holland ; from these it passed 
with a bound to America, where it found a soil favourable to 
its cultivation. Outside these countries Europe has been 
slightly contaminated only amongst the Scandinavian peoples ; 
the Slavs have been barely touched ; the Latin nations have 
up to this proved almost refractory, but some sporadic cases 
warrant the belief that it would be imprudent to allow our¬ 
selves to be lulled to sleep under a delusive sense of security. 

No less remarkable than its geographical distribution is the 
incidence of the malady as regards age, sex, classes of society, 
and the professions. Children and individuals who are subject 
to other forms of mental alienation enjoy a complete immunity ; 
the ignorant or badly educated classes, who live by manual 


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r>Y YVKS DELAGE. 


63 


labour, and those who follow commercial and industrial pursuits 
■do not furnish a single example. It is a malady rigorously 
limited to intellectuals. Among these artists, savants devoted 
to the exact sciences or to physico-chemical studies are generally 
exempt ; literary people are not wholly impervious to attack ; 
but it is above all among psychologists and medical men, and 
more especially among psychiatrists, that the evil perpetrates 
its ravages to a really disquieting extent. The members of the 
clerical profession arc suspect, particularly when they are seated 
•at the Tribunal of Penitence. Women are frequently victims, 
but in their case the disease assumes a special form, not always 
benign, in which the crises coincide with such happenings as 
when the husband returns from his club, the daughter from her 
lectures, or the servant from her marketing. 

The ailment' with which we are here dealing has certain 
characteristics peculiar to infectious disorders : contagiousness, 
incubation, and intensification by passing successively from one 
subject to another. It is not, however, a germ disease, or its' 
microbe is of a most subtle nature, for it is capable of trans¬ 
mission without contact of any kind, by word of mouth, and by 
reading works emanating from the pens of affected subjects. 

It is a malady without any apparent lesion of the central 
nervous system, a purely psychical affection ; in a word, a 
psychosis. Its name, coined by the very persons who are its 
victims, is Psychoanalysis. 

Psychoanalysis, defined in the most general terms, is an 
affection in consequence of which the unfortunates who are 
attacked by it become incapable of accepting just for what they 
are the most insignificant gestures, the very simplest acts, the 
most banal words of persons with whom they have intercourse ; 
in everything there must be discovered some profoundly hidden 
meaning. The detection of this pretended hidden meaning 
becomes for the patient a veritable obsession. 

If this were all, jt would be difficult to understand the wide 
diffusion and the contagiousness of such a disorder, which 
would seem to have no other basis than the satisfaction of an 
inordinate desire. Now, to fathom a mystery when the object 
of the mystery is commonplace would not be a very attractive 
pursuit. But the matter is explained by means of a complica¬ 
tion which is introduced, and, after the manner of microbic 
associations, sets itself to steer the malady in a particular 


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64 PSYCHOANALYSIS, A NEW PSYCHOSIS, [Jan., 

direction; tkis complication, consists in a psychical blindness 
with respect to every factor which is not of a sexual nature, 
whence ensues an irresistible tendency to seek in the sexual 
factor the sole, universal, and omnipotent cause of all human 
actions. We have spoken of microbic associations ; the com¬ 
parison is justified ; psychoanalysis, such as it reveals itself 
to-day, results from the association of the psychosis above 
defined with erotomania. The psychoanalyist is a police- 
magistrate, a compound of an inquisitor and an erotomaniac ; 
and it is because he finds in psychoanalysis the satisfaction of 
his erotic mania that he loves his complaint, as the dipsomaniac, 
the cocain- and morphino-maniacs love their poison. Failure 
to note this feature would leave the diffusion of the malady an 
inexplicable phenomenon. 

Psychoanalysts do not attempt to conceal this side of their 
intellectual equipment ; but they succeed, or think they’ succeed, 
in giving it an almost decent aspect by clothing it in a scientific 
disguise. 

Like all madmen, the psychoanalyst lives in an imaginary 
world, which it is necessary for us to recognise in order to 
understand what goes on within him; and this leads us to 
present a very summary account of the theory in general, such 
as it has been elaborated by its originator, Dr. Freud, and by 
his disciples. 

This theory is characterised by certain significant terms 
which form, as it were, the labels of its content. These terms 
are : Pansexualism and Libido , the Unconscious and the Censure , 
and, above all, Complexes , omnipotent factors equally as regards 
the manifestations of normal activity and in the somatic and 
psychic symptoms of psychopaths. We shall explain all this 
as if we accepted it as current coin. 

The infant at birth has in him only the accumulated instincts 
of the race, acquired during the course of its phylogenetic 
evolution. Now, these instincts are almost exclusively of a 
sexual nature, and the child frankly abandons himself to them, 
in his unconsciousness of what is good and what is evil. All 
the sensory perceptions which little by little go to form his 
individual psychical organisation come under the dominating 
influence of this mental orientation. Thus it is that he is, first 
and foremost, under the sway of impulses from within, an 
unrestrained onanist and, by reaction on his entourage, an 


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66 PSYCHOANALYSIS, A NEW PSYCHOSIS, [Jam, 

another, which strive without ceasing to externalise themselves, 
to give direction to our thoughts, to guide our judgments, to 
determine our conduct, and, unknown to ourselves, to govern 
our most trivial actions. 

Of all these factors there are some, such as heredity, personal 
acquirements the result of sensory impressions, of chance inci¬ 
dents of the affective life, of education, of instigations from 
outside, which guard, with reference to the others which are 
mixed up in diverse nameless resultants, an individuality, a 
personality, and become predominant; it is these to which 
Freud and hrs disciples apply the term Complexes. 

As the result of the frequency of incestuous impulses the 
CEdipus complex occupies a prominent place. 

These complexes (Onanism, Narcissism, Sadism, Masochism, 
incest, homosexuality, etc.) are incessantly attempting to 
externalise themselves, but the Censor is on the watch, and 
repels them into the Unconscious. 

In the case of some degenerates they prove more than a 
match for the Censor, they pass in spite of him and reveail 
themselves in their true form ; this is sexual perversion. But, 
as regards all the others, which are incapable of mastering the 
Censor, they strive to outwit his vigilance by assuming a cloak 
of disguise. In a normal individual the disguise is sufficiently 
clever to permit of the Complexes exteriorising themselves 
under a form agreeable to social conventions. It is in this way 
that the most odious Complexes reveal themselves outwardly 
under quite respectable forms : literary and artistic productions, 
works of charity, filial piety, sport, religion with its attendant 
crowd of prayers and mortifications, and systems of philosophy. 

A normal man is he in whom these, as it were, decent 
manifestations are sufficient to diminish the internal pressure of 
the Complexes. 

Another outcome is the dream where, under a less disguised 
form, the Complexes can disclose themselves without any great 
•detriment. 

Between these two extremes, sexual perversion and the 
normal state, is an intermediate condition, where the violent 
struggle of the Complexes against the Censor reveals itself by 
somatic or psychical symptoms of a morbid nature. This is 
what occurs in the case of psycho-neuropaths. All those 
subjects who are affected with phobias or hysteria or dementia 


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PSYCHOANALYSIS, A NEW PSYCHOSIS, 


[Jan.,. . 


not prepared to perpetrate in their efforts to square the very 
simplest and clearest facts with their preposterous notions. 

You have not hit it off. These men are the sincere and 
unhappy victims of a lamentable misapprehension ; they have 
applied to the human individual the psychology of inhabitants 
of the moon, such as some shrewd Cyrano on returning from a 
pretended voyage to our satellite might have imagined, in order 
to make it as different as possible from terrestrial realities. 

The avowed object of psychoanalysts is, on the one hand, to 
unravel the profound causes of the infinitely varied forms which 
the activity of the normal man assumes; on the other, to 
unearth the Complexes, which are the causes of the symptoms 
from which psycho-neuropaths suffer. But the secret, often, I 
have no doubt, unconscious end, which they could unravel by a 
relatively easy process of psychoanalysis, if they were to apply 
in their own case the same methods of investigation, is, to use 
a vulgar expression, to scratch themselves where they feel the 
itching—in other words, to give satisfaction to their secret 
erotomania. For, since they welter to the full in Pansexualism, 
psychoanalysts know beforehand what they will find at the end 
of their interrogations, namely, some sexual impulse more or 
less unavowable. Moreover, their constant preoccupation is to- 
thrust into the intimate life of everyone an indiscreet look, like 
that of an observer who, from the depths of a dark passage, 
with his eye glued to a hole in the wall, regales himself on 
the scenes enacted in a brothel. 

All these features do not fail to give a colouring to the 
bodily and mental constitution of subjects affected with psy¬ 
choanalysis. We recognise them at the first glance; they 
assume an air of profundity, observe the most minute details, 
their eye follows the slightest gestures, the lines in their brow 
testify to incessant activity of thought. They are indiscreet, 
and put ridiculous questions, apropos of nothing, which set 
men’s backs up, cause honest women to blush, and the frivolous 
ones to laugh, 

• In order to give some precision to our statements let us 
observe the psychoanalyst in his consulting room. A lackey in 
livery ushers in a client. It is a young woman whose pretty face 
is in contrast with a look of suffering, and her cool summer 
costume with a fur collar in which her neck is muffled up. In 
a very husky voice she describes her case. 


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“ Ah ! doctor! I don’t know what is the matter with my 
throat It is just like a handful of sand at times, at others like 
a bunch of needles. I find it impossible to swallow my saliva, 
and you notice my voice, a real calamity for me, who am an 
actress. Along with that, my head is heavy, so heavy ; and I 
haven’t the least appetite.” 

“ Only that! ” says the doctor, with an absent air. 

“ And what more do you want; is that not enough ? How¬ 
ever, I may add that at times I suffer anguish from the feeling 
■of a ball which rises from the pit of my stomach.” 

“ Ah ! a feeling of anguish, a ball ; this is getting interesting. 
Anything else ?” 

" Besides this I have gloomy thoughts. If I did not control 
myself I should cry all day long.” 

" Now we have it. These are neuropathic symptoms which 
onlighten me, madam, as to the real nature of the malady from 
which you are suffering. And these dark thoughts. I must be 
insistent on this point. What is the nature of them ? ” 

“ Oh ! nothing, nothing particular. I let myself be worried 
about the little common annoyances of daily life which, under 
■ordinary circumstances, would leave me quite indifferent.” 

“ And these little worries do not point in any particular 
direction ? ” 

“ Oh ! not at all, sir. Merely domestic matters ; visits to be 
made, precedence at the theatre, everything of the most 
commonplace description.” 

*• Not quite that, perhaps. We will come back to it by and 
by. Do you suffer from nightmare ? ” 

" Oh ! yes, doctor, certainly, for I always awake in a state of 
agitation. I dream absurd things. Fortunately after a few 
minutes all that goes out of my memory, and vanishes in smoke.” 

" See now, make an effort ; it would be of the greatest 
interest.” 

“ Impossible,” she says ; “ after collecting my thoughts for a 
few minutes I recall nothing.” 

“ Look here, I insist, what did you dream about last night? ” 
And with an instinctive movement he readjusts his necktie, 
which had got disarranged. 

“ Ah! the movement you have just made recalls it at once. 
But it is something so absurd and stupid it would not be of the 
slightest interest to relate it.” 


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“ I see that causes you some embarrassment; it is all the 
more necessary for you to tell it without any reticence." 

“ Oh! if you wish; it does not embarrass me in the least. 
It’s idiotic, that’s all." 

“ You dreamt, then . . . . ” 

“ I dreamt that my brother made an attempt to thrust his 
cravat down my throat, and that hurt me greatly, tore my 
throat, and impeded my breathing so much that I awoke. I 
had slept with my mouth open, and my throat was so dry and 
painful that I could not swallow my saliva, nor recover my 
breath." 

“ Cravat ? Cravat ? That’s a symbol, 

but of what ? I must consult my precious note-book in which 
I have jotted down the precepts of the Master.” 

He takes off the table a little book, and turns over the leaves. 

“ Let me consult the table. Corpse. . . . Crater. 

Ah ! there is cravat, page 18 . I must refer to page 18 ." 

He turns over the leaves, again, and reads in a low voice r 
“ Symbolic expression for the male organ. Stems, canes, trunks 
of trees, umbrellas, files, boughs, serpents, cravats, hats, etc.” 1 

“ Ah! cravat counts, then, among the symbols of the male 
organ. I was sure I would be able to recall it. So all is now 
quite clear, for the pharynx, a canal-shaped cavity, lined with 
mucous membrane, has more claims than are really needed to 
represent the female organ. This woman is, without her 
knowing it, obsessed by a desire for incestuous relations with her 
brother. To bring into her consciousness the knowledge of 
this desire is, in accordance with the method of the Master, the 
only means of combating it, and of driving away with it the 
neuropathic manifestations from which this patient is suffering. 
Let us pursue our examination. And this brother of yours, 
madam, do you experience any peculiar feelings with regard to- 
him?” 

“ Oh, doctor ! we adore each other, and the greatest grief of 
my whole life was our having to separate two years ago, when- 
he left for the front. Only think, we were reared together, we 
passed our earliest infancy in the same cradle, for—did I tell 
you ?—we are twins, and we were both so small that it was only 
when we were four years old that we each had our own little 
bed" 

1 Word for word from tex‘-boo!c. 


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“ Ah! really! (aside) every dream being, according to the 
Master, the fulfilment of an infantile wish, it is to this period of 
life that I must direct my inquiries, in order to find out, if pos¬ 
sible, traces of the complex which is at present tormenting this 
lady.” 

(Aloud.) “ And, madam, do you remember if from this 
period of early infancy you felt yourself drawn towards him by 
a particularly ardent attraction ? Does this dream, in which 
he made you swallow his cravat, correspond to any manoeuvre, 
any game of your early childhood ? ” 

“ I don’t understand you, sir.” 

“ In other words, what part did this necktie play in your 
thoughts, in your mutual relations ? ” 

“ But, doctor,” cried the lady, with a great outburst of 
laughter, “ what are you talking to me about ? He had no 
necktie.” 

“No necktie ! No necktie ! Are you quite sure of that ? 
Such an anomaly is not without example in the annals of 
science ; .it is, however, a highly exceptional occurrence.” 

“ What do you mean ? ” 

“ See, now, give me your confidence, and tell me the whole 
truth without any reservation. Under what conditions 
. . . by what .... indiscreet .... ex¬ 
ploration, or by what chance circumstance did you come to 
make this strange avowal that he was devoid of a necktie ? ” 
(Aside.) “ Now, has he gone mad ? ” (Aloud) “ Really 
doctor, I don’t in the least understand what you are saying to 
me. Does one put a cravat on a baby ? ” 

( Thumping his forehead.) “ Pardon, madam, my absent- 
mindedness. Without being aware of it, I have allowed myself 
to be drawn into making use of language which is intelligible 
to the initiated alone. Cravat is here, as in your dream, the 
symbolic representative of an object of quite another kind, of 
such a nature that if it were to come into your consciousness 
in other than symbolic form, and disguised, it would appear to 
you positively shocking. It is in order to prevent your being 
thus shocked that it assumes this innocent disguise, without 
which the moral Censor who keeps guard at the gates of your 
consciousness would not allow it to pass. But it is not without 
protest that it accepts the disguise imposed upon it. Hence, 
in the depths of your Unconscious life there arises a terrible 


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conflict, which reveals itself in these neuropathic symptoms 
which you have described : the sombre mood, the distress and 
the constriction of the throat. It is only when we have suc¬ 
ceeded in stripping it of its disguise, and bringing it to light 
under a form which would be certain to scandalise you, that we 
shall be able to triumph over the painful affections of which 
you complain. But that will be the business of another inter¬ 
view. Till then closely observe, study, and keep in your 
memory your dreams, and all those ideas, of whatever kind they 
may be, which they may awaken in your mind, and, though 
they may appear difficult to you to tell, you will confide them 
to me without reserve.” (Taking up his memorandum book.) 
“ I am entering you for Wednesday, at 3 o’clock.” 

“ Doctor, all this may be very deep, but, meanwhile, I have 
that constant feeling in my throat of masses of sand and 
bunches of needles." 

“ That is of no consequence, madam ; suck some jujubes, and 
come back here on Wednesday.” 

The visitor leaves the room ; the doctor touches his bell, and 
the servant introduces a new client. 

It is a small spare man, very brown, very animated, and very 
agitated. He explains with much volubility that he suffers 
from nocturnal insomnia, while during the day he can hardly 
keep awake. 

“ It is a common enough symptom in many psychopaths, sir ; 
let us come to particulars.” 

“ To tell the truth, doctor, I have but little doubt as to the 
cause of my trouble, but 1 have not the power to resist it. I 
have to be in my office every day from 9 o’clock till 5, and I 
have an objection to bring, as some of my colleagues do, a small 
cold lunch, or to go and tipple with them at a neighbouring bar. 
So I eat nothing in the middle of the day, but in the evening 
I make up for it, and in the company of some good friends have 
a very hearty meal at a restaurant near the markets, which 
suffices me for the twenty-four hours. Then we smoke a 
quantity of cigars and drink a number of cups of coffee. Would 
that not be a sufficient cause for the fitful kind of sleep I suffer 
from ? ” 

“ Many doctors, sir, would say yes ; but that would be only 
a shallow judgment on their part, based on mere contingencies. 
We must pierce to the depth of things, and discover the hidden 


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causes of what I unhesitatingly connect with a psychopathy. 
Insomnia is always the effect of a discordance of ideas which 
are—what shall I say—painful, not to be avowed, trying to 
emerge from subconsciousness, and which consciousness 
represses, because it would be ashamed to acknowledge them. 
They are the spectres of thoughts which we must investigate 
together, and which I hope to ferret out with your kind help. 

“ Let us see, now ; be frank with me and confiding, and 
conceal nothing. In your past childhood, I mean in the whole 
course of your early infancy, were there not some incidents, 
some secret emotions, the renewal of which, even the mere 
recollection of them, is painful to you ? ” 

“ Painful to me? No, not at all ; nothing of the kind.” 

u Look now ; search closely. Try and call up some of your 
remote recollections, and don’t allow yourself- to be stopped 
through a fear of having to tell some rather shocking things. 
Did you not experience towards your mother feelings of a very 
special kind, and a quite inexplicable feeling of hatred towards 
your father ? ” 

“ No, not at all. I scarcely knew my father, who died when 
I was quite a youngster ; and as to my mother, she treated me 
as a worthless young scamp, and I can assure you there was no 
•exaggeration in that.” 

Nothing to be got from this line of inquiry ; let us try 
another procedure. 

“ Lie down on the couch. Close your eyes, conjure up the 
recollections of your early childhood, and the moment I say 
Speak,’ you will say in a loud voice the first word that occurs 
to your mind, whatever it be. That’s all right. Now, atten¬ 
tion. Give your mind to what you are doing, and don’t wriggle 
in that way like a cut worm !” 

The Client (muttering under his breath : “ Like a cut worm 
. . . like a cut worm. . . .” 

The Doctor (his eyes fixed on the chronometer): “ Speak.” 

The Client, at once : “ Asticot.” 

The Doctor: “ Reaction-time f of a second ; good. This 
word should symbolise a Complex which is seething at the very 
threshold of consciousness. But what is the meaning of it ? ” 

He seizes his head with his hands, and repeats . “ Asticot! 
Asticot? . . . That tells me nothing. Let me consult 

the note-book : Aba . . . Aca . . *. Aero . . 


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[Jan.,. 

Arbalist . . . Asparagus . . . Astrolabe . . 

Asticot is not there. What’s to be done ? ” (in an undertone ), 
“ Spirit of Pansexualism, Goddess Libido, come to my aid, 
fertilize my sterile brain." 

A pause. 

Then, suddenly, his eye flashes with a penetrating gleam, and 
he cries : “ Eureka ! Zounds ! It’s as clear as water from a 
well! ” 

“A . . . s, the first and last letters of the word anus, 

the vile instrument of unspeakable forms of indulgence ! This 
suppression of two essential letters was a disguise, upon my 
word cleverly enough discovered by the sexual Complex, but not 
clever enough to escape my lynx-eyed vigilance. And anus in 
Latin means also . . . 

“ You have studied Latin, sir?” 

“ Yes, sir, I was very good at it." 

“ . . . Means also an old woman. As to ticot, here the 

censor has not been too malicious—it’s a very simple matter, 
an anagram. Its ordinary form should be tioc. From tioc 
to ticot is but a step. Certainly, it is the very proof we are in 
search of. This man is tormented by a doubly immoral idea 
of sodomic intercourse with the person of a venerable old 
woman. How splendid to communicate to the Master this- 
important discovery! 

“Is there any old lady between whom and yourself there is- 
a sympathetic relationship, and who, so to speak, fills your 
thoughts ? ” 

“ Yes, doctor, my mother, to whom with pious affection I 
consecrate all my Sundays.” 

“ And what age may she be ? ” 

“ Seventy-one years of age." 

The Doctor (sotto voce) : “ Now we have it ; it is the CEdipus 
complex in its full splendour. 

“ Well, sir, I am enlightened.” 

“ Ah ! And what is it that has enlightened you? ” 

“ This word, having for you a quite commonplace meaning, 
has opened to me the gates of your subconsciousness. I can 
now rivet my attention on this, and I see . . . Ah! with¬ 

out doubting you in the least degree, your full clear conscious¬ 
ness remaining pure ... I see byit thatyou are tormented 
by certain pangs which are the true cause of your insomnia." 


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“ And these pangs ? ” 

“ It is difficult to speak about them . . . you know 

your Greek classics, sir ? ” 

“ Oh, yes, to some extent." 

“ You have read the tragedies of Sophocles, CEdipus Colo- 
neus, CEdipus Rex ?" 

“Yes, certainly.” 

“ Well, these pangs are of the same kind as those which 
overwhelmed the ill-fated spouse of his mother, Jocasta." 

“ And, good God, doctor! what relation do you see?” . . . 

“ And, moreover, the incestuous relations of CEdipus while 
criminal as regards their object, were correct in their nature, 
whilst you, poor unfortunate . . .” 

The Client ( sitting bolt upright , with a scared expression ) : 

“ Come now, doctor, what do you mean by that, and to whom 
do you refer? Which of the two of us has gone off his head ? ” 

“ Be calm, my friend, be calm. Which kind of women have 
you a liking for, blondes or brunettes ?" 

“ Now what the deuce are you driving at by such a 
question ? ” 

“Be calm, my friend, and answer without trying to fathom 
my object.” 

“Well, if you must know, brunettes. I have a repugnance 
to blondes. Blondes—they have a savour of the rabbit” 

“ Your mother’s hair . , ." 

“ Is white, sir.” 

“ I know ; but when she was young was she fair or dark ? ” 

“ Fair, sir ; very blonde.” 

“ A bit doubtful this; it must be the disguise a contrario 
imposed by the Censor. This liking for brunettes is a taste 
inspired by the moral Censor in this unfortunate, in order more 
surely to conceal from him the impulses which, from the depths 
of his subconsciousness, are trying to emerge into the light of 
day. The more intense the impulse—and its intensity is revealed 
to us here by the shortness of the reaction-time—the cleverer 
is the disguise, and the more implacable the conflict between 
the combatants within the closed field of the nervous system of 
the patient. 

“Come and see me again, my friend. I have no hope of 
effecting your cure in a single interview ; this can only result 
from a complete confession by yourself, making a clean breast 


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GASTRIC DISTURBANCE IN THE SOLDIER, [Jan* 


of it, of the secret impulses which are the cause of your malady, 
I am entering you on my list for Tuesday next at three o’clock.” 

{Exit.) 

And now, to those who may be tempted to see in the fore¬ 
going merely an amusing skit, written without any regard for 
justice and truth, our reply is to refer them to the works of 
Freud and his school ; if they wish to escape a task of such 
magnitude, they will find in a work of Regis and Hesnard, 
Psycho-analysis of Neuroses and Psychoses , a very elaborate 
account of these theories, accompanied by authentic examples 
which will make their hair stand on end. If that seems still 
too Ipng, they will find, under the signature of the writer of this 
article, a more concise r/sutn/ in the volume of VAnnee Biolo- 
£ique devoted to the literature of 1914. They will see that we 
have not exceeded the limits of just criticism, and that the 
apparent exaggerations in this satire are, even as regards 
details, in exact correspondence with the enormities of the 
theory. 


Functional Gastric Disturbance in the Soldier. By 
Colin McDowall, M.D., Capt. (Temp.), R.A.M.C., 
Military Hospital, Maghull. 

Functional disturbances of the digestive system are 
common accompaniments of neurasthenia. I shall avoid all 
attempt to classify them, and confine myself to describing 
certain cases in some detail with a view to bringing out the 
points of practical importance in causation and therapy. 

The men who are returning from this war are in many 
instances suffering from neurasthenia. No system of the body 
has escaped, and so it is not surprising that symptoms of 
alimentary tract disturbance are frequently met with. 

From our earliest days we are led to attach importance to 
the digestive tract. Common expressions of everyday life 
relate to the abnormalities of digestion, “ sick of it all,” “ sick 
of life,” “ fed up,” the latter a particularly pet expression of the 
soldier. 

Anorexia arising from a mental state is not unusual. Its 
simple form exists in the young lady who becomes thin because 


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191 7 -] 

it is fashionable. When it is no longer fashionable she may 
find she cannot eat; she has developed primary mental anorexia. 
The secondary form of the trouble arises when the patient is 
unable to resume a normal diet after a period of special diet 
carried out as a means of treatment for organic disease. 

No. 88, single, aet. 25, no abnormality found in the family 
history, passed standard I at school, at the outbreak of war 
was only earning 12s. a week in a public-house in London. 
When a boy he was treated in a hospital for one month for 
“sickness.” He enlisted and was sent to the Dardanelles in 
July, 1915. There he developed dysentery and “ gastritis," but 
stated that before this “ his nerves got bad.” There was 
diarrhoea and fever, and he was sick every day. He was treated 
in Alexandria, and ultimately recovered sufficiently to leave for 
England. The vomiting did not stop, however, occurring every 
day frequently. He could not walk, he thinks “ his nerves 
caused a lot of it.” Added to this there was trouble with his 
bladder, his urine used to dribble away in the day-time, and he 
was also wet at night. After arrival in England he was treated 
at a hospital, but the vomiting did not leave him, anorexia 
also was marked. Ever since leaving the Dardanelles he had 
lived on milk and custard. He was always kept in bed as his 
legs were weak. When admitted to the Moss Side Hospital 
an examination was made at once. The fact that his legs were 
not as feeble as he thought was demonstrated to him. He was 
aided to make use of his legs, and expressed surprise on finding 
that his powers of locomotion were not so bad. He was a 
simple-minded man, but undoubtedly was impressed by the 
success of his walking, and was comforted at the same time by 
being told that the outlook was all very favourable. He was 
put on a light diet and quickly went on to ordinary food. He 
was not sick once in hospital, and became an active worker in 
the ward, later going route marches of five miles with other 
patients. Two months after treatment began he went back to 
duty in good health. His weight had risen from 9 st. to 
9 st. 7 lb. 

In this man we have a gastric phobia making itself evident as 
the sequel of organic trouble, and the occurrence may have been 
assisted by the memory of the sickness he suffered from as a boy. 

The anorexic condition developed in the way it might be 
expected to do. All solid food was naturally cut off while the 


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active symptoms of dysentery were present. But when the 
dysentery was cured this depressed, weak-minded man lacked 
the initiative to tackle food which he considered would be less 
readily digested. He could keep down very little of anything, 
and the most easily swallowed was the least disturbing. There 
is shown in this case a certain amount of qualitative inhibition 
for food, but I regard this rather as the result of circumstances 
than a psychopathy. He was drawn along the path by the 
regime of a hospital; a small amount of individual attention 
would have obviated much if not all of the subsequent state. 
Bed treatment was the worst thing that could have been done 
for him. As long as he was treated as an invalid he remained 
an invalid. He at once responded when more rational surround¬ 
ings were supplied, and a demonstration was given that the 
condition was not as grave as he feared. 

A philosopher has said that all he tried to do was to make 
his listeners think for themselves. A neurasthenic is always 
critical, but also usually reasonable, and it is often productive 
of much good to make his thoughts run along new lines. 

Another but pointed example of an elective anorexia is that 
of a soldier who had been in nine hospitals when he came under 
my care. He was well nourished, but complained that any 
food made him sick, he could not retain milk, beef-tea acted as 
an irritant, and so he had lived for some months always troubled 
with his stomach. He was allowed to choose his own diet, 
and his selection was a plate of potatoes well buttered. This 
dish could be kept down fairly w'ell. Now it would be difficult 
to think of a more stubborn form of nourishment for a pre¬ 
sumably delicate gastric organ to digest. This fact was pointed 
out, and notwithstanding the long illness a good result has been 
obtained. 

Vomiting is a usual symptom in neurasthenia. In some 
patients it forms an insignificant part in their symptomatology, 
in others it is the chief or only trouble. Emotion, arising 
directly from incidents, or indirectly as the result of a mental 
process, has a disturbing effect upon the whole of the alimentary 
tract and commonly causes vomiting. What it is that draws 
the patient’s attention to his stomach varies in different cases. 
Occasionally a direct agent is responsible for attracting the 
patient’s attention to his stomach. One man was wounded in 
the upper part of his abdomen, another had a number of teeth 


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1917.] 


79 


knocked out, in another the sickness accompanying dysentery 
•continued. 

First perhaps it would be well to name the symptoms 
commonly found to be associated with neuropathic vomiting. 
The sickness is not preceded by pain of any kind; it follows 
food frequently, but as frequently is separated from food by some 
hour£ It rifay occur at night with the patient lying quietly in 
bed, it commonly accompanies such positions of the body as 
necessitate bending and stooping, as seen in scrubbing the floor. 
Railway and motor travelling bring it on. There is little or no 
warning given that vomiting is to take place. There may be 
retching, and this produces some tenderness of the strained 
abdominal muscles. Water-brash is the stimulant to vomiting 
in some cases. Rumblings in the abdomen, a feeling as if the 
abdominal contents are swaying backwards and forwards, has 
been described to me in some cases. Loss of the pharyngeal 
reflex is a not infrequent sign. I have not found tenderness, super¬ 
ficial or deep, at all a constant symptom; iq fact what the patients 
are suffering from is causeless vomiting—without a cause, how¬ 
ever, only so far true in that we do not know it after a physical 
examination. These cases that I will read to you, and which 
form the subjects of these charts, will illustrate my meaning. 

No. 72, a N.C.O., set. 28, enlisted at 18, was making from 
30s. to £2 a week at 15. He was claimed out of the Army after 
two years, worked again at his former occupation, and made 
iibout 50s. a week. Became engaged to a girl and walked out 
with her for a year, but broke off the engagement and re-enlisted 
as the result of seeing her drunk. Underwent an operation for 
haemorrhoids four years ago. When the war broke out he was 
abroad, landed in France, and was then in splendid health, 
weighing 11 st. 7 lb. with his boots on. Was shot through the 
upper part of the stomach and left arm on March nth, 1915. 
The bullet was removed at Boulogne. Gastric irritability followed 
the chloroform and continued some days, meanwhile he had 
rectal feeding. Later he came to an English hospital, and 
4 ‘ was not so bad.” The vomiting nearly stopped. His arm had 
been in plaster all this time; he was sent to a convalescent 
home and took ordinary food because he wanted to get home. 
He was sick every day, however. Was sent to another hospital 
to undergo surgical treatment for his arm, and was there two 
months, throughout the whole of which time he vomited all 


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nourishment, “even a drink of tea.” When in the last hospital 
he had great pain in the wound, and could not sleep at nights 
without a sedative. The abdominal wound, though of con¬ 
siderable length, was always a healthy one. The bowels were 
obstinately constipated, and required enemata to relieve them. 
On admission to the Moss Side Military Hospital, Maghull, he 
was sick after all food, and existed on soda-water and milk. 
He was depressed, and very anxious about his own condition. 
The corrugations of the forehead showed the amount of mental 
strain he was undergoing. There was a good deal of tremor 
of head, arms, and legs, while the bowels continued to be very 
inactive. He was intensely irritable, and required the greatest 
care in handling. In the early part of his stay at Moss Side, 
while not under my care, an incident occurred which greatly 
aggravated his condition. I have said how he had lost his fiancee 
as the result of her drinking habits, and had in consequence 
come to regard alcohol as one of the roots of evil of his life. 
He was in a condition to appreciate sympathy, and this was 
shown to him by a nurse. The suspicion arose, however, that 
another patient was using his soda-water to dilute whisky, and 
added to this was the knowledge that this patient was known 
to have paid attention to his favourite nurse, and that they had 
been photographed together. These details may appear trifling, 
but it is by detail, and by detail correctly used, that these cases 
unravel themselves. The patient was much upset by all this, 
and was transferred from such an irritating environment to 
another ward, and ultimately to my own. His weight at this 
time was 8 st. My conversations with him were directed to 
get a full history, and many facts were obtained, but only those 
of interest are recorded. A sister committed suicide by poison¬ 
ing some years ago. Dreams relating to this event are of fre¬ 
quent occurrence. Treatment was directed to pointing out 
how that it was his own thoughts were causing him to be sick. 
For some days after there was no sickness. One day, however, 
he received the Gazette of his own regiment, and in it read of 
the deaths of his old comrades. He was sick twice that day, 
and his bowels began to give him more trouble. Subsequently 
he continued to have a certain amount of daily vomiting, which 
became accentuated upon my absence for a few days’ leave. 
When I returned I found him in bed, his legs drawn up, and 
he complained of great abdominal pain, which he attributed to 


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1917 ] BY COLIN MCDOWALL, M.D. 8 I 

constipation. He thought the anal outlet was becoming oc¬ 
cluded. He had vomited twelve times in four days, and had 
had sleepless nights. My interview with him was at 9 p.m., 
and as he had besought me for morphia, I explained to him 
what I considered was the cause of his trouble, and sent up 
some harmless pink medicine. He had a good night, and for 
the next fortnight vomited only occasionally. The chief break¬ 
down in this period was three attacks of vomiting in one day 
following a letter from his mother asking him to come nearer 
home. Again 1 explained how he was allowing his emotions- 
to assert themselves abnormally. Attention was given to- 
regulating his bowels. A period of partial remission from sick¬ 
ness followed, until one day vomiting took place three times. 
The cause on this occasion was a rebuff from the nurse to whom 
he was attracted. Nineteen days passed, during which time he 
was sick only twelve times. The next breakdown was heralded 
by a suggestion from a superior medical officer that he should 
go before a discharging board. The patient was a keen soldier* 
an ambitious man, and anxious to go back to the front. I had 
never suggested discharge to him, aiming as one should at the 
best result. The suggestion of discharge was disquieting, and 
though it referred to his wounds, he thought also of the stomach 
condition. However, following my explanation, he continued 
to make an effort, and was so far successful that in the next 
fortnight he was only sick twice. For the next month he made 
good progress, and only .was affected on rare occasions, but 
broke down again, and upon inquiry it was found he had been 
dreaming of a “ padded cell ”—an asylum. This dream was 
the result of a visit to a picture palace in which the popular 
idea of a lunatic and a padded room were depicted in a life-like 
manner. A few weeks again passed in which nothing of interest 
happened until one night vomiting took place seven times. 
That day news had been received that an old friend, the man 
in fact who had taught him his trade, had been sent to an 
asylum. How very strongly this idea of the fear of the develop¬ 
ment ot insanity in himself influenced him is here brought out. 
The patient was always extremely irritable, as I have said. The 
strict army discipline to which he had been subject for years 
made him always an easier person for an officer to deal with 
than anyone else. There were constant disagreements with 
patients and nurses. He himself felt, like many others who’ 
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82 GASTRIC DISTURBANCE IN THE SOLDIER, [Jan., 

have been through the fighting, that he was not the same man; 
he knew his personality had undergone a change. He thought 
of his sister and the mode of her death. A tactless remark was 
made to him in one of his hospitals that he was behaving like 
a lunatic. He never forgot that remark. It was not meant to 
be taken literally, but in his weakened and irritable nervous 
state he had not the power of proper discrimination, and so the 
remark was brooded over. Later he had another night of 
vomiting. Here the cause was on the surface, his favourite 
nurse, on my suggestion, had been removed to another ward, 
as the patient had had more trouble with her. Clearly he was 
becoming attached to her, and I told him my belief, and that 
the sooner he recognised that his attentions were not desired 
the better for himself. 

What do we know of this man ? He was a keen soldier, a 
clean living, steady man, much attached to his home and 
widowed mother, very fond of the sister he lost in such a 
tragic way, fearful lest a similar fate should overtake him. An 
emotional man always, he tells how he used to cry when the 
songs of his native land were sung. What are the crises of his 
life ? The dead sister, the girl he gave up because she drank, 
the war and tbe wounds he received, the operation for piles and 
the previous constipation. They all come out in his illness. 
He seeks for someone else to replace his girl; he becomes 
attracted by a nurse, she, however, pays attention to another 
man, a man whom be knows to be a married man, and also one 
he suspects of taking his soda-water to dilute some spirit. He 
ihforms the nurse of all this, only to be not believed. 

Sex then is one of his mental irritants. Another is the dread 
of an asylum. He reacted as the result of news of the certi¬ 
fication of an old friend ; the same result followed the cinema 
performance; and dreams of his sister’s death produce an 
emotional display. In addition the war and his wounds are 
factors, and lastly constipation gave him cause for anxiety. 
The case as a piece of analysis is complex, as many of these 
cases are. 

Many incidents, not forgotten but repressed, go to form the 
cause of his illness. Their memory produces a violent emotional 
disturbance, and the patient shows his emotion by vomiting. 

Now I should like to give an example in which a patient's 
emotions were centred round his domestic life and friends, and 


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T9 «7-] BY COLIN MCDOWALL, M.D. 83 

how the man showed his sympathy towards his home circle by 
rejecting his stomach contents. 

No 69, a private, married, aet. 32, a reservist called up at the 
outbreak of the war. He went through Mons, the Marne, the 
Aisne, and was blown up by a shell at Ypres in the beginning 
of November, 1914. He lost his speech but recovered it in 
time to be home for Christmas. The face was injured by the 
explosion, and a number of teeth were lost. There was no 
sickness in France, but vomiting began in his first English 
Hospital. He, however, was sent home on leave, and while at 
home was sick at every meal. Even before leaving hospital 
"* the least thing used to make him sick.” I asked was it 
always food or his thoughts that affected him, and he said: 
41 You are quite correct, sir, you know how I have always been 
with thinking.” He came under my care towards the end of 
June, 1915, and was then suffering from a very hesitating 
speech. He was of good colour, and sweated excessively. 
The hands were warm, not cyanosed, and the general condition 
was good. He was tremulous and very emotional. The eyes 
became suffused with tears very readily, and in conversation 
one had to go carefully always on account of his irritability. 
He was much attached to his wife and family. His home 
before the war was a good one, but he had been worried on 
account of difficulty in making both ends meet. Vomiting 
occurred after most meals, and frequently also at night. He 
never got to sleep till late, he lay awake thinking. One of his 
children was seriously ill, and ultimately it died. During this 
time the sickness was worse, “ he was thinking all the time.” 
There never had been any pain or tenderness in the stomach. 
While in hospital it was pointed out to him how it was that his 
vomiting was produced. The charts of other patients were 
demonstrated to him. He was urged to make an effort to 
restrain his emotions. In addition what common sense 
suggested was done: his teeth were replaced by a denture. 
Very slowly he began to get the upper hand of his emotions, 
and to a corresponding degree the sickness improved. The 
patient’s weight during the last six months of his stay in 
hospital was always within a pound or two of twelve stone. 
An occupation which carried with it a good deal of variety was 
supplied, and gradually the vomiting became less and less, 
.until he became practically immune from this trouble. Finally 


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GASTRIC DISTURBANCE IN THE SOLDIER, [Jan.,. 


it was decided that he should appear before a medical board 
with a view to discharge. On the day of the board he was 
sick, although for some weeks he had been well, and again a 
fortnight later when sent for to sign discharge papers he 
vomited on the way to the office. He was one of the nicest 
men I have had under my care, thoughtful, unselfish, and- 
pathetically attached to his family and regimental associates. 
He says how he always took things too much to heart. When 
his “ mate ” the soldier who had shared his dangers in France 
who had been with him in the same trench and in two successive 
hospitals, was discharged, he showed his emotion by tears and! 
vomiting. 

As the cases really describe themselves and are of chief 
interest, I will pass on to another example of emotional 
vomiting. 

No. 78, private, set. 26, married. Patient’s ears are asym¬ 
metrical. His father is an alcoholic, who has been certifiably 
insane for some years. His wife died of phthisis in July, 1914. 
There is one child, who lives with the patient’s mother. 
Nothing could be worse than the home, the insane drunken 
father, the old mother trying to look after an unhealthy child 
and helpless husband. Two years before the war broke out he 
worked as an unloader at a goods station, where a sack weighing 
1 cwt. fell on him, and he became as a result nervous and tremu¬ 
lous. He enlisted at the outbreak of war but could not pass 
the class firing on account of tremor of the arms. Being anxious 
to go to the front, he volunteered, and was sent out. On the 
second night near the trenches someone dropped a box of bombs 
near the ammunition of a bombing party. There was an explo¬ 
sion, and in the darkness no one knew what was wrong, and 
some panic arose. After a month in France he was wounded 
in the hand and sent home. He w r as nervous, tremulous, and 
sweated a good deal, and had lost his appetite. The wound 
healed, but the tremor persisted, and so the patient came under 
my care. In December, while in hospital, he began being sick. 
This occurred usually in the mornings after food. There was 
no pain, but he had a curious sensation in the left iliac fossa. 
He used to be sick every day, and gradually became worse, 
vomiting daily two or three times. The hospital was quite 
close to his old home, and he made frequent visits. It was 
never a happy home even before the war—now that the wife was 
dead, the mother old and feeble, the child ill, and the father 


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19!?•] BY COLIN MCDOWALL, M.D. ?5 

always shouting for drink, it was hardly the place to cheer a 
neurasthenic patient. As he used to walk down to the station 
after lunch to catch the train he vomited once always, often 
more frequently. One day in the ward he was sick three times. 
He had hadewords with the nurse regarding some ward work. 
He says how he has always been ready for tears and quarrels, 
but never happy till he had made friends again. I tried to 
explain to him how the vomiting was produced. 1 told him he 
was quite a useless man for the army, and his first duty was to 
improve sufficiently to go back to his old work. He still 
vomited nearly every day, and usually after lunch on the way 
4o visit his home. One night he vomited at 2 a.m., as he had 
been lying thinking in bed, worrying about a matter of dis¬ 
cipline. After two months of treatment he had made progress, 
but was still worried owing to the continued illness of his child. 
To remove this trouble the child was got into a home. For 
twenty days following this piece of palliative treatment he was 
not sick. His breakdown occurred at home in the evening. 
His father “ had been at it again,” apparently cursing the army 
and all in it. Again there followed a period of eight days’ 
freedom from sickness, until one morning he heard he was not 
for the discharging board. He was sick on the spot.' Three 
days later I saw him, and assured him that he was to be dis¬ 
charged, and although in these days he had been sick at least 
twice, he continued well for the next month. The next attack 
of vomiting was at a football match. He was in a rather rough 
-crowd, the men in front were drunk and arguing, and it “ got 
on his nerves.” In reviewing the case the first thing that 
strikes one is that it should never have been a part of my duty 
to look after this man. He was quite unfitted for a soldier’s 
work. The tremor resulting from the accident when unloading 
sacks had never worn off. His stomach responded to his emo¬ 
tions in a very definite way. I suspect this man vomited more 
frequently than admitted, but even so much vomiting as he 
confessed to shows clearly the physical following the emotional 
disturbance. There is no definite factor which would predis¬ 
pose the occurrence of the vomiting. The first gastric disturb¬ 
ance took place when he was in a ward in which he was 
associated with many other neurasthenic subjects, and possibly 
the symptoms of a companion gastropath may have acted as 
a stimulant for the onset of his own disorder. 


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86 GASTRIC DISTURBANCE IN THE SOLDIER, [Jan. 

In many of the neuropathic conditions of the stomach one- 
finds that the symptoms are of a mixed type. An active and 
passive inhibition may be present in addition to an elective 
anorexia. The following example shows this well. 

No. 87, aet. 30, single, a N.C.O. Enlisted at 18. His 
childhood had been a very rough one, the poker and the belt 
were frequently in evidence. In 1911 the patient was the 
subject of dysentery, and had afterwards a difficulty in keep¬ 
ing down food. Vomiting took place two or three times- 
daily for a few days, and was then followed by a short period 
of immunity. This state of affairs lasted for about two years. 
When the vomiting first began he was in India, and was about 
to be discharged as a time-expired man. Three months before 
his time was up the vomiting stopped, but came on again on 
the voyage to Southampton. The vomiting persisted during 
civilian life, and had occurred a few days before war was. 
declared. He was well at the dep6t, but the sickness recurred 
when on the march in France early in August, 1914. He was. 
in some stiff fighting, but could keep no food down at all. 
Some malted milk tablets were the only form of nourishment 
retained. Ultimately this man was invalided home in November, 
1914, on account of the continued sickness. After some 
hospital experience and three months at the depot he was sent 
out to France again. Though vomiting daily he concealed the 
fact. A quick return to England was the result. Since the 
end of December, 1915, the history is one of successive hospitals. 
When admitted to the Moss Side Hospital he was pale, unhealthy 
looking and weighed 9 st. 5 lb. He had already experienced 
many forms of treatment in different hospitals, and so it was 
thought best to allow him to settle down before any definite 
line of treatment was adopted. Fourteen days passed in which 
sickness followed every meal. The patient then asked for some 
medicine to counteract water-brash. His request was complied 
with, but there was no appreciable alteration in the vomiting. 
Now that the diagnosis was clear, and the fact of medicine 
being useless demonstrated to him, treatment along the lines of 
explanation and persuasion was begun. For a week there was 
little or no effect. One day, however, the patient remarked 
that he had kept his tea down, and that the vomitings, though 
still frequent, were less in amount. He was encouraged to 
make further effort and instructed in the fact that the 


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1 9 r 7-1 


BY COLIN MCDOWALL, M.D. 


«7 

vomiting was emotional and also partially habitual. A fort¬ 
night after actual treatment had begun he was sick only once 
during twenty-four hours. The bodily weight had gone up 
half a stone. A few days of further progress followed, when a 
further demonstration was given by the patient of the r 6 le that 
emotion was taking in the causation of his symptoms. The 
patient witnessed a fight between two soldiers and was 
immediately sick. A few days later there was a state of 
immunity for three days. At the time of writing he has not 
been sick for over a week, and the bodily weight t 3 io st. 3 lb. 

This example is a good one as showing the results that cart 
be obtained by this method of treatment, even after the 
symptoms appear to be chronic. 

I have not met with any cases of neurotic vomiting in which 
the symptoms were such as to endanger life, but here is one in 
which danger to life certainly might have been possible. This 
man would vomit over a hundred times in three days. He was 
at. 19 years, and the fact that he was acting sergeant shows 
his degree of intelligence. The patient’s father vomited after 
food for five years, but was cured by an operation. When the 
war broke out this man enlisted early, and was sent out to 
France in August, 1915. He was employed at a Brigade 
Headquarters as a clerk. Working hours frequently extended 
to sixteen or eighteen a day. Sleep was disturbed and much 
curtailed. He had an attack of diarrhoea and vomiting about 
Christmas time, and although the diarrhoea stopped, the 
vomiting persisted. This condition remained unchanged in 
spite of treatment in the various hospitals. Eventually the 
patient came under my care. His weight was 8 st. 5 lb 
Vomiting was constant after all meals, and would take place 
as often as seventy times a day. During twelve hours a good- 
sized chamber would be half filled with froth and liquid mixed 
with semi-digested food. When the sickness first began, and 
during the earlier months, the material was ejected in a violent 
manner. Recently there has been little or no effort, and the 
condition is more closely allied to rumination than true 
vomiting. The pharyngeal reflex was not absent, but as 
sweating was present it was thought that this might be a 
suitable case for treatment with atropine. The result was not 
encouraging. The patient was singularly free from disturbing 
mental elements, and except that he had a brother of sixteen 


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■88 GASTRIC DISTURBANCE IN THE SOLDIER. [Jan., 

in France, he did not worry about anything. Showing how his 
father’s illness must have had some suggestive influence upon 
the cause of his illness, the patient more than once asked if an 
operation would cure him. It was explained to him that his 
father’s illness was quite unlike his own. The patient knew 
that his father had had a pyloric stenosis. He would give as a 
supposed proof of disease of his stomach the fact that the milk 
h$ vomited was all “curdled in little lumps.” Ignorance of 
simple physiological facts, therefore, acted in maintaining the 
continuance of his functional condition. The real cause no 
doubt was the enormous responsibility thrown upon a man of 
so few years. Like many others he had given a false enlistment 
age. The patient began to understand the cause of his trouble, 
and the vomitings became less in amount. He also gained half 
a stone in weight. The number of times he vomits is but a 
tenth of what it was, and with a little patience I look for a 
good result. 

One can give many more examples of this class of case, but I 
think enough have been cited to show what effect emotion has 
upon the gastric processes. The exact mechanism of the 
production of the symptoms is not clear. How much is due to 
vagal stimulation is uncertain. The vagus can influence not 
only the secretions but the state of motility of the stomach 
muscle. Vagal stimulation performed experimentally can 
produce turbulent gastric peristalsis which may readily change 
into retrograde peristalsis, and vomiting occur. 

The great practical point is that the vomiting is the result of 
emotional stress, and that the method of treatment to be adopted 
should be the removal or control of the offending emotional tone. 
This can be done by understanding your patient, giving him 
true insight into the production of his symptoms, removing 
any worrying element, and gradually restoring to the individual 
that self-confidence which has been lost. Tactful interrogation, 
perseverance, sympathy and the common-sense application of 
accumulated facts are all embraced in the term therapy. It is 
quite incorrect to think that it is necessary to wade through a 
morass of filth before correct treatment can be applied. Each 
case must be dealt with individually and on its own merits. 


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* 9 1 7-3 INFECTIOUS BY BACILLUS OF INFLUENZA. 8$ 

•Chronic Infections by the Bacillus of Influenza and their 
Importance as Causes of Nervous Disorders. ( J ) By 
W. Ford Robertson, M.D., Pathologist to the Scottish 
Asylums. 

The bacillus of influenza was discovered and accurately 
■described by Pfeiffer in 1892. Its etiological relationship to 
the disease is now beyond serious dispute. It is a compara¬ 
tively minute bacillus, Gram-negative, and devoid of capsule or 
spores. The chief seat of infection is the respiratory tract. 
The bacillus requires very special conditions for its artificial 
culture. The bacteriological text-books prescribe the use of 
fresh blood smears, and generally state that the organism can 
be grown along with other bacteria—that is to say, in symbiosis 
with them. In the laboratory of the Scottish Asylums it was 
-ascertained that the bacillus of influenza has the remarkable 
property of being stimulated to growth by mere proximity to 
other bacteria, and thus the alternate drill method has come to 
be a routine of the laboratory whenever this bacillus has to be 
subcultured. 

With acute influenza, occurring in epidemics, we are all 
iamiliar. As is well known, various nervous symptoms may 
occur, both during the febrile stage and at a later period. In 
the febrile stage there may be delirium, intense headache, and 
various forms of neuralgia. As sequelae of the acute attack 
■there may occur especially neuritis, neurasthenia, and mental 
•depression. 

An important fact, not generally known, but now clearly 
established by extensive observations, is that an acute attack 
by the bacillus of influenza stimulates other infections of which 
the person attacked happens to be the subject. Thus, catarrh 
of the respiratory tract occurring in the course of influenza is 
mainly dependent, not upon the action of the bacillus of influ¬ 
enza, but upon that of other pathogenic organisms that have 
been present, as active or as latent infections, previous to the 
attack, such as Micrococcus catarrhalis, the pneumococcus, Strep¬ 
tococcus angiuosus, and Streptococcus pyogenes. An acute quinsy 
occurring in the course of influenza can be shown to be essen¬ 
tially due to streptococci : and influenzal pneumonias appear 
-always to be dependent on the action of the pneumococcus, 
•Streptococcus pyogeius, or otherbacterium of high virulence, which. 


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19 1 7 ] BY w * FORD ROBERTSON, M.D. * gi 

investigation can determine the exact nature of the bacteria! 
attack. There are, however, certain forms of long standing 
illness in which we can at least suspect chronic infection by the 
bacillus of influenza. The general features are : 

(1) More or less constant watery discharge from the nose, 
which, however, may be slight. 

(2) The patient is repeatedly “ catching cold." He has 
recurrent attacks of naso-pharyngeal catarrh and bronchitis. 

(3) In some persons these attacks may occasionally be so 
severe as to be accompanied by rise of temperature, headache, 
malaise, drowsiness, and joint and muscular pains, as in acute 
influenza. 

(4) The nervous symptoms include asthma, mental depres¬ 
sion, neurasthenic phenomena, sleeplessness, headache, and 
what are described by the patients as “ gripping sensations " in 
the head, and neuralgic or rheumatic pains. 

A type of case that is exceptional, but by no means rare, is- 
one in which the toxines of the influenza bacillus especially 
affect the heart, either through its muscles or its nervous appa¬ 
ratus. As a cardiac poison the toxines of the bacillus of 
influenza are certainly of the utmost importance. 

It must always be borne in mind that the bacillus of influenza, 
when acting as a chronic infecting agent, never occurs alone : it 
is always accompanied by other pathogenic bacteria, such as 
Micrococcus catarrhalis, the pneumococcus, Streptococcus pyogenes f 
and Streptococcus anginosus, which have their influence upon the 
clinical picture. 

Therapeutic immunisation with sensitised vaccines is almost 
uniformly successful in eradicating the infection and relieving 
the symptoms, but it is generally necessary to treat in a similar 
way one or more accompanying infections. 

The proof that these chronic infections by the bacillus of 
influenza are a cause of the various symptoms that have been 
mentioned lies solely in the observation of numerous clear cases 
in which specific therapeutic immunisation has been attended 
by definite focal reactions and followed by recovery. 

In the course of the past two years I have observed twenty- 
two cases of chronic infection by the bacillus of influenza. The 
general symptoms have been those already described. Several 
of the cases presented interesting and instructive special features; 
and I shall briefly mention some of them. 


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92 INFECTIONS BY BACILLUS OF INFLUENZA. [Jan., 

Nine of the cases suffered from well-marked mental depres¬ 
sion ; in eight there was bronchial asthma. 

A man of middle age had suffered for several years from 
symptoms of a neurasthenic character accompanied by two 
special symptoms, a gripping sensation in the head and giddi¬ 
ness when walking. Bacteriological investigation of the case 
showed that he had a chronic infection of the nasopharynx and 
gums by the bacillus of influenza. There were complications 
in the form especially of Pyorrhoea alveolaris , and these had to 
be treated as well as the bacillary infection, the importance of 
which, however, was not open to question. Under therapeutic 
immunisation the symptoms almost entirely disappeared. 

A naval officer had for several months suffered from depres¬ 
sion, unfitness for work, slight recurrent colds to which he did 
not himself attach any importance, and from pains in various 
parts of his body, which he and his doctor regarded as rheumatic. 
I found that there was an influenza bacillus infection of the 
nasopharynx and gums, accompanied by a Micrococcus catarrhalis 
infection. Under therapeutic immunisation every symptom 
•disappeared, and the patient is now perfectly well. 

Another case illustrates the debilitating action of a chronic 
infection of this kind. The patient is a doctor who suffered for 
several years from recurrent attacks of nasopharyngeal catarrh, 
generally slight, but occasionally severe. He remained thin 
and the cause of his thinness was never clear, although he was 
.known to have a Bacillus coli infection of his ascending colon. 
It was ascertained that he had a chronic infection by the 
bacillus of influenza, and for this he was treated by therapeutic 
immunisation. The catarrhal symptoms rapidly disappeared, 
his health improved in every respect, and he has put on exactly 
two stones in weight since April, when treatment was begun. 

Two cases illustrated the powerful action that the influenza 
loxines may exercise upon the heart. One of these patients 
was a doctor who suffered from chronic bronchitis and heart 
weakness, associated with attacks of palpitation. Chronic 
infection by the bacillus of influenza had never been suspected. 
The administration of the usual small initial dose of an auto¬ 
genous influenza bacillus vaccine was followed by an extra¬ 
ordinary focal reaction in the form of a severe and prolonged 
-attack of palpitation and very rapid action of the heart, which 
•was regarded as confirming the view that the bacillary toxines 


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1917 ] GREY AND WHITE MATTER IN BRAINS. 9£ 

were an important element in the causation of the cardiac dis¬ 
order. Unfortunately, this patient died from a suddenly de¬ 
veloping intercurrent malady. 

In the second case of this kind marked improvement took 
place under therapeutic immunisation. 

In four of the cases the patients were insane. In two of 
these the symptoms were those of depression and stupor, in one 
mania, and in the fourth dementia, insomnia, and constant 
restlessness. 

It is impossible to say if in these cases of insanity the 
influenza bacillus infection is the cause of the malady, for the 
effects of therapeutic immunisation have not yet been ascer¬ 
tained. The exact importance of infections of this kind in 
relation to insanity can be estimated only on the evidence of a 
long series of cases. To direct attention to the occurrence of 
this form of chronic infection, in the hope of being afforded 
opportunities of investigating probable cases, is one of the main 
objects of this paper. 

At the present moment the matter stands thus : Chronic 
infection by the bacillus of influenza is a fairly common cause 
of ill-health, although as yet hardly recognised ; the nervous 
symptoms that occur in some of the cases among the general 
population are so severe that it seems probable that, in persons 
with a hereditary predisposition to insanity, grave mental dis¬ 
turbances may easily be induced. 

(') Paper read at meeting of Scottish Division of the Medico-Psychological 
Association held in Edinburgh on November 17 th, 1916 . 


The Relative Amounts of Grey and White Matter in 
some Normal and Pathological Brains. (Preliminary 
Communication.^) By John Cruickshank, M.D., 
Crichton Royal Institution, Dumfries, Temporary Lieu¬ 
tenant, R.A.M.C. 

The marked complexity of the convolutions of the brain or 
man, as compared with the lower animals, has suggested to 
numerous writers that the higher intellectual and other mental 
faculties characteristic of the human subject are in more or less 
direct relationship to the amount of grey matter in the brain. 
Attempts have therefore been made to measure the amount of 
grey matter in the brains of persons of very different degrees ot 


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94 


GREY AND WHITE MATTER IN BRAINS, [Jan., 


intelligence and mental development. Owing to the highly 
complicated nature of the convolutions of the human brain, the 
method of estimation by direct dissection of the grey matter 
from the underlying white matter has not been adopted except 
in the case of a very few brains, most workers having approached 
the subject by indirect methods. Some observers have directed 
their attention to the measurement of the surface area of the 
grey matter, others to the determination of the absolute amount 
of cortex. Danilewsky, as a result of observations upon the 
specific gravity of the brain and of the grey and white matter, 
has calculated that the cortex forms 30 per cent, of the total 
brain weight. Donaldson, on the other hand, has estimated 
the grey matter of the hemisphere as forming 50 per cent, of 
the whole. 

In the work of which this paper is a brief summary, an 
attempt has been made to measure by direct dissection the 
relative amounts of grey and white matter in a small series of 
normal brains, and to compare the results with the findings in 
brains of cases of mental disease which at post-mortem exami¬ 
nation exhibited varying degrees of atrophy. The procedure 
was as follows : The membranes having been carefully stripped, 
the pons-medulla and cerebellum were removed by cutting 
through the mid-brain as close to the hemispheres as possible. 
The hemispheres were then separated by mesial section, and the 
fluid expressed from the ventricles. One hemisphere was then 
laid on its mesial surface and divided into five portions, named 
for convenience in reference, the frontal, precentral, postcentral, 
occipital, and temporal portions. • Each portion, which weighed 
approximately 100 grm., was then cut into slices about one- 
tenth of an inch in thickness, one slice only being cut at a time, 
the rest of the piece, along with the other parts ©f the brain not 
actually under examination at the time, being kept in a closed 
vessel in the ice-chest in order to prevent drying and decom¬ 
position. Each slice as it was obtained was laid on a glass 
plate and cut into smaller portions, and by a combination of 
cutting and scraping with a sharp scalpel the grey matter was 
separated from the white. It was found that considerable 
practice was necessary before a reliable separation of the two 
layers could be made, and the results obtained from the earlier 
specimens of brain had to be discarded. The work was 
exceedingly laborious, as, even with the help of an assistant. 


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BV JOHN CRU1CKSHANK, M.D. 


95 


«ach of the five portions of the hemisphere took from four to 
six hours for complete separation. As each slice was completed 
the separated material was placed under cover. It was found 
that the fresh unfixed brain gave the best results, as the differ- 
-ence in consistency of the softer grey and firmer white matter 
in the fresh brain was a very material aid in the separation. 
The necessity, which the use of the unfixed brain imposed, 
■of carrying the dissection through in the shortest possible time 
increased the arduous nature ot the work. The difficulty of 
-separation was greatest at the occipital and frontal poles, owing 
to the small size of the convolutions and the degree of infolding 
■of the surface. The precentral and postcentral portions were 
on the other hand comparatively easy, the proportion of white 
matter in these regions being large and the convolutions much 
-wider. The dissection of the grey matter of the basal nuclei 
presented the greatest difficulty. The grey matter of the basal 
nuclei, averaging about 20 grm., was not reckoned as cortical 
grey matter, and is not included in the following results. 

In the tables are given the main results with the series of 
five normal and eleven pathological brains investigated. The 
figures represent the amounts and percentages of matter in one 
hemisphere only. Table I shows the results when the normal 
And the pathological brains respectively are arranged according 
to the amount of grey matter in the members of each group. 
It will be seen that in the normal brains the weight of grey 
matter varied from 327 grm. to 253 grm., and the white matter 
from 237 grm. to 196 grm., the variations in weight correspond¬ 
ing mainly to the size of the brain. The weight of grey 
matter, expressed as percentage of the total grey and white, 
varied from 57*9 per cent, to 53 per cent. It is to be noted that, 
generally speaking, in the normal series the greater the amount 
■of grey matter the greater was the amount of white matter. In 
the pathological series, the grey matter varied from 289 grm. 
to 218 grm., and the white matter from 259 grm. to 149 grm. 
The percentage of grey matter varied from 64 per cent, to 526 
per cent. 

Table II shows the results when the brains, normal and 
pathological, are arranged in three series or columns, in the 
order respectively of (A) their amounts of grey matter, (B) 
their amounts of white matter, and (C) their percentages of grey 
matter. In column A it is to be noted that the normal brains 


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GRF.Y AND WHITE MATTER IN BRAINS, 


[Jan.,. 


are distributed at various levels throughout the series, namely* 
two at the top, one in the middle, and two near the bottom. 
That is to say, the absolute amount of grey matter in the hemi¬ 
sphere is not a distinctive feature of the normal brains. In 
column B, however, the normal brains are all in the upper half 
of the column. The normal brains, in fact, differ from the 
pathological brains, with one marked exception, in having 
absolutely greater amounts of white matter. This is expressed 
differently in column C, in which it is shown that the patho¬ 
logical brains, owing to the loss of white matter, have a per¬ 
centage of grey matter, in proportion to the total grey and 
white, greater than in the case of the normal brains. The 
patholological brains, with one exception (Mr. R—), showed 
varying degrees of atrophy, and the results of the work have 
shown that the greater the degree of atrophy of the brains, the 
greater is the diminution in the amount of white matter. In 
Mr. R—’s case—a voluntary boarder, who suffered from melan¬ 
cholia of a few years’ duration—the brain was large and 
apparently healthy, no trace of atrophy being visible. Micro¬ 
scopically, this brain was practically indistinguishable from a 
normal brain, and in the tables it will be noted that it falls 
among the group of normal brains. 

While the figures in the tables give the weights of material 
actually obtained after separation, it is to be remarked that a 
certain loss of tissue, particularly of grey matter, occurred during 
the process of separation. The total loss of matter per hemi¬ 
sphere amounted on the average to about 30 grm., of which it 
is estimated that about 20 grm. consisted of grey matter. 

The conclusious which have been drawn from these results are 
that the atrophy of the brain which is so common a feature at 
autopsy in chronic cases of insanity, is due more to the loss of 
the underlying white than to the loss of the superficial grey 
matter, notwithstanding the well-known morbid histological 
changes in the latter. This relatively greater loss of the white 
matter of the brain in chronic insanity is quite in keeping with 
our present knowledge of the neuron, when we remember such 
facts as the association of the myelination of nerve fibres with 
the acquisition of higher neural and mental function in the 
process of development, and the essentially nutritive rdle of the 
body and nucleus of the nerve cell. Further, the figures which 
have been obtained for the weight of the grey and the white 


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BY JOHN CRUICKSIIANK, M.D. 


97 


Table I .—Showing in a Cerebral Hemisphere of each of the 
Normal and Pathological Brains, (i) the Amount of Grey 
Matter, (2) the Amount of White Matter, and (3) the Per¬ 
centage of Grey Matter. 


Brain. 

0) 

Grey matter 
(gramme*). 

( 1 ) 

White matter 
(gramme*). 

( 3 ) 

Grey matter 
(percentage). 

Normal, No. 8 . 

327 

237 

57'9 

„ No. 7 

290 

227 

560 

„ No. to . 

275 

227 

547 

„ No. 6 

254 

223 

530 

„ No. 9 

253 

196 

563 

Pathological, Mr. R. 

289 

259 

526 

,, Mrs. T. . 

288 

205 

62'4 

„ Mr. L. 

287 

161 

640 

„ Miss T. . 

286 

173 

58-2 

,, Mrs. D. . 

282 

'63 

63 ‘4 

„ Miss B. . 

268 

*73 

607 

„ Mrs. B. . 

262 

*49 

63 7 

„ Mr. C. 

261 

*73 

6*5 

„ Mrs. A. . 

261 

*74 

599 

„ Mr. F. . 

235 

*77 

57 * 

„ Mrs. F. . 

218 

163 

57‘2 


Table II .—Showing the Brains, Normal and Pathological, 
arranged in three series, in the order respectively of their 
(A) Amounts of Grey Matter, (B) Amounts of White Matter , 
and (C) Percentages of Grey Matter. 


-- 

A. 


B. 



C. 



Grey 

Brain. 

White 



Grey 

Brain. 

matter 

(grammes). 

matter 

(grammes). 

Brain. 

(Per¬ 

centage). 

Normal, No. 8 

327 

Mr. R. 

259 

Mr. L. 


640 

„ No. 7 

29O 

Normal, No. 8 

237 

Mrs. B. 

. • 

63 7 

Mr. R. . 

289 

m No 7 

227 

Mrs. D. 

• • 

63 4 

Mrs. T. . 

288 

„ No. 10 

227 

Mrs. T. 

• • 

624 

Mr. L. . 

287 

„ No. 6 

223 

Mr. C. 

• • 

615 

Miss T. . 

286 

Mrs. T. . 

205 

Miss B. 

* • 

60 7 

Mrs. D. . 

282 

Normal, No. 9 

196 

Mrs. A. 

a . 

59 9 

Normal, No. io 

275 

Mr. F. . 

*77 

Miss T. 

• • 

582 

Miss B. . 

268 

Mrs. A. . 

*74 

Normal, 

No. 8 

579 

Mrs. B. . 

262 

Miss T. . . 

*73 

Mrs. F. 

• • 

57'2 

Mr. C. . 

261 

Miss B. . 

*73 

Mr. F. 

• • 

57 * 

Mrs. A. . 

261 

Mr. C. . 

*73 

Normal, 

»» 

No. 0 

563 

Normal, No. 6 

254 

Mrs. D. . . 

163 

No. 7 

560 

» No. 9 

253 

Mrs. F. . 

163 

II 

No. 10 

547 

Mr. F. . 

235 

Mr. L. 

161 

M 

No. 6 

530 

Mrs. F. . 

218 * 

Mrs. B. . 

*49 

Mr. R. 

• • 

526 


LXIII. 


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98 THE WATER CONTENT OF SOME BRAINS, [Jan., 

matter in the different parts of the brain, and which are not 
published here, have shown that the loss of white matter is 
greatest in the occipital, temporal, and frontal lobes, and that 
the white matter of the precentral and postcentral regions suffers 
to a less degree. In this short communication it has only been 
possible to give the most striking results. A paper with fuller 
particulars regarding the age and sex of the patients from whom 
the pathological material was obtained, the nature and duration 
of the mental illness, and other details, will be published later. 

(') Read at a meeting of the Scottish Division of the Medico-Psychological 
Association of Great Britain and Ireland at Edinburgh, on November 17th, 1916. 


The Water Content of Some Normal and Pathological 
Brains (Preliminary Communication) 1 . By John 
CRUICKSHANK, M.D., Crichton Royal Institution, Dum¬ 
fries, Temporary Lieutenant, R.A.M.C. 

In the preceding paper it has been shown that the general 
or local atrophy of the brain occurring in chronic insanity is 
very largely due to loss of white matter. It seemed to be of 
interest to determine what chemical changes accompanied this 
shrinkage in the size of the brain. As a preliminary to an 
examination of the complex substances of which brain matter 
is composed, it was necessary to investigate the proportion of 
water to solids, as the figures obtained in this way are of the 
highest importance in regard to the interpretation of the results 
obtained by chemical methods. The examination of the 
various portions of brain tissue for the amount of water was 
therefore proceeded with as a routine measure. The whole of 
the grey or of the white matter, as the case might be, from 
•each of the five portions, obtained as described in the preceding 
paper, was spread on glass plates in as thin a layer as possible 
.and carefully weighed. The plates were then placed in a 
Hearson electric drying oven, the temperature of which was 
maintained at about 90° C. A current of dry hot air was 
passed into the oven from a fan attached to a small motor. 
After fifteen to twenty hours’ exposure the plates were 
removed from the oven, and the solid material which remained 
was carefully and completely scraped off. It was then allowed 
to cool to room temperature and weighed. The material was 


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BY JOHN CRUICKSIIANK, M.D. 


99 


returned to the oven for some hours, again removed and allowed 
to cool. This procedure was continued until the material 
attained a constant weight at room temperature. The percentage 
of water in each sample was then calculated. 

The following Tables show that the grey matter contains 
toughly i o per cent, more water than the white, not only in the 

Table I .—Showing the Percentages of Water in the White and 
the Grey Matter of the Different Portions of the Cerebral 
Hemispheres of Normal and of Pathological Brains. 


Brain. 

Frontal. 

Precentral. 

Postcentral. 

Occipital. 

Temporal. 

White. 

Grey. 

White. 

Grey. 

White. 

Grey. 

White. 

Grey. 

White. 

Grey. 

Norm 

25 

73 '1 

82-8 

7 f 6 

81-4 

71 "2 

79-6 

708 

8*7 

729 

8ri 

II 

26 

707 

815 

■JO'2 

81 5 

705 

815 

698 

807 

73'° 

82-3 

II 

28 

720 

81'4 

7 , '4 

8ri 

708 

8ii 

7 1 *3 

8o - 4 

73'5 

81'6 

ft 

3 ° 

730 

83-2 

J2’\ 

8;yo 

716 

823 

72-8 

817 

75‘9 

8 .T 5 

II 

34 

73'5 

846 

75 ' 2 

837 

724 

83'3 

7 2 '3 

82-5 

74'5 

836 

Path. 

l6 

72’ 1 

82‘4 

74'5 

8 i '5 

— 

— 

7 2 '9 

8o‘9 

— 

— 

II 

17 

749 

827 

73'4 

8i - 9 

729 

818 

76-2 

81‘9 

74-0 

834 

ft 

19 

777 

83'4 

760 

82-1 

75'4 

« 3 ' 4 

75 '* 

827 

78-5 

836 

ft 

20 

712 

826 

70 - o 

8i‘9 


— 

71-9 

799 

— 

— 

ii 

21 

77'5 

85-8 

759 

85-6 

— 

— 

77'5 

85-6 

— 

— 

M 

22 

72’ 1 

8ro 

70-0 

825 

7ro 

8o'2 

7 2 '3 

8i - 9 

7 i '4 

78-9 

ft 

24 

73'4 

83-2 

72-1 

l? 3 'o 

70 - o 

8o‘4 

717 

8o-8 

73 ' 2 

80-4 

ft 

27. 

742 

» 3'9 

71 - 8 

824 

737 

82*1 

73 '° 

82-5 

75 'o 

84'1 

It 

29 

7 r8 

82 7 

7 ,- 4 

82-6 

699 

8 i - 4 

717 

82'1 

71-2 

825 

I* 

31 

694 

82*2 

(jg'o 

817 

70-5 

805 

675 

8o'2 

7>'5 

8f2 

ft 

32 

74 '» 

84-9 

y&i 

863 

73'4 

85'3 

73'5 

84-8 

7**5 

871 

If 

33 

79 ' 2 

85-6 

76-9 

82‘0 

75 ' 2 

82'4 

7 < 5'5 

82-8 

8o'o 

838 

ft 

35 

75 'o 

842 

73'6 

847 

73'5 

84'2 

73 ' 2 

829 

76-5 

833 

ft 

3<> 

75'9 

83-6 

75 ' 2 

81 '5 

74'4 

809 

74-2 

8r8 

74'9 

836 

If 

37 

76*1 

862 

75' 2 

838 

75 ° 

83-2 

717 

85-2 

760 

850 

II 

3 » 

74'9 

86-8 

yv2 

85-1 

69^2 

837 

72-9 

836 

75 '° 

847 


Table II .—Showing the Average Percentages of Water in the 
White and the Grey Matter of the Different Portions of the 
Cerebral Hemispheres of Normal and of Pathological Brains. 


Brain. 


White matter. 



Grey matter. 


Fron¬ 

tal. 

Pre¬ 

central. 

Post¬ 

central. 

Occip¬ 

ital. 

Tem¬ 

poral. 

Fron¬ 

tal. 

- 

Pre- 

central. 

Post- 

central. 

Occip¬ 

ital. 

Tem¬ 

poral. 

| Normal . 

1 Patholo- 

724 

7 2 '5 

714 

7 r 4 

73'9 

827 

82 7 

81-s 

8 i '4 

824 

gfcal . 

74'3 

73 ' 2 

72'6 

73 ' 2 

74‘5 

838 

83-0 

822 

82-4 

83-1 

Difference 

1‘9 

o-r 

1'2 

r8 

0'6 

n 

0-3 

07 

ro 

07 

1 


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CLINICAL NOTES AND CASES. 


[Jan,,. 


case of normal brains, as has been observed by others, but also 
in the pathological and atrophic brains. From Table I it will 
be seen that in the series of five normal and sixteen pathological 
brains examined, there is considerable variation in the amount 
of water not only in different brains but also, though to lesser 
extent, in different portions of the same brain. In the case of 
the pathological brains the amount of water is, in the majority 
of cases, greater than in the corresponding portions of the 
normal brains. This is most evident in the case of brains 19, 
2i, 33, and 37. In Table II are given the average percentages 
of water in the grey and the white matter of the different 
portions of the cerebral hemispheres of the brains in the two 
series. The pathological series shows the greater water content 
in both grey and white matter in all the portions. Further, 
the increase in the amount of water in the pathological series 
is greatest in the white matter of the frontal and occipital 
regions. The grey matter of these regions also shows a marked 
increase in water. 

It was found that the more marked the degree of atrophy of 
the brain the greater was the amount of water in the brain 
tissue. The amount of water was always increased in brains 
which showed marked atheroma of the basal or other arteries. 

(') Read at a meeting of the Scottish Division of the Medico-Psychological 
Association of Great Britain and Ireland at Edinburgh on November 17th, 1916. 


Clinical Notes and Cases. 

Crime in Dementia Prcecox. By RALni M. Toledo, 
Assistant Physician, Government Lunatic Asylum, Malta. 

Crimes connected with dementia paralytica and dementia of 
senility are relatively common, and many text-books speak of 
“ medico-legal periods ” in describing these diseases. 

Having followed the progress of cases admitted in the 
Criminal Section of our asylum during the last few years, I 
desire to put on record several of these which serve to illustrate 
the relationship between “ criminal acts ” and those peculiar 
“ psychical states," characterised by a rapid impoverishment of 
the entire mental life, which Kraepelin included under the name 
of “ Dementia Praecox." 

The “ crimes ” of violence in the cases under review were all 


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■1917.] CLINICAL NOTES AND CASES. 101 

committed in the “ predemented stage ” of the disease, very 
often under the influence of a “ fleeting delusion,” and the 
reasons alleged by the patients always " silly and changeable.” 

Case i. —Man, set. 30, shot dead his wife at 3 p.m. in a crowded 
street He tried to run away. He accused his wife of adultery, but 
failed to bring forward “ proofs.” During his period of detention he 
told the police that he “ heard voices ” gossiping about his late wife’s 
character. The judges appointed experts to report on his mental state. 
He was declared insane and sent to our asylum. 

His mental condition deteriorated rapidly, and he is now a dement 
with the characteristic signs and symptoms of the paranoid form of 
dementia prrecox, and subject very often to impulses of a very dangerous 
character. 

Cask 2.—Lad, aet. 20. Charged with having dangerously wounded 
with a knife a friend of his, as the latter had refused to return to him 
•(for just reasons) a toy worth 1 \d. The accused was examined by 
experts by order of the magistrate and declared insane. 

The jury, curiously enough, found the prisoner “ responsible,” and 
the judge had to “convict him.” After serving a year in prison he was 
released, but had to be certified insane six days after he left the prison, 
as he fiercely assaulted his mother. 

He is a typical case of hebephrenic dementia, silly in his way of 
thinking and acting, and at times exhibiting impulses of a dangerous 
-character. 

Case 3.—Man, a?t. 30. Convicted for having wounded his wife. 
After a few months stay in prison he was sent to our asylum as insane. 
On admission he complained of hearing people at night gossiping about 
his wife’s character, and of his inability to satisfy her sexual desires. 

He is at present a typical case of praecox, fond of neologisms and 
-stereotypies, and worried by auditory hallucinations. 

Case 4. —Man, aet. 29. Convicted in Alexandria, Egypt, for having 
wounded with a revolver an intimate friend. Certified insane after 
eight months’ stay in gaol, and sent to the Malta Asylum. His mental 
-condition rapidly deteriorated, and he is now a dement with character¬ 
istic catatonic attitudes. Has dangerous impulses. 

The following two cases may serve to illustrate the changes 
•of the moral faculties that very often precede the demented 
stage of the disease. They are both characterised by a sort of 
abnormal suggestibility on the part of the would-be dements. 

Case i. —Lad, net. 19. Labourer, of a very good character. Con¬ 
tracted quite unexpectedly a friendship with persons of suspicious 
character. Convicted soon after for circulating counterfeit coins manu¬ 
factured by his new friends. 

After a few months’ stay in prison he commenced to complain of 
■“ impairment of vision ” and to refuse to leave his cell, stating that he 

was unable to walk alone.” 

Exhibited resistiveness and wetted his bed. He was at first looked 


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REVIEW. 


[Jan.,. . 


upon as lazy and also as a malingerer. The examination of the patient 
by Dr. Xuerets, our Chief Physician, squared matters at once, and the 
“poor dement” was sent to us for care and treatment. He is now 
destructive, of wet habits, exhibits stereotypies, and at times impulses of 
a dangerous nature. 

Case 2.—Man, set. 26. A mechanic, described as a good father and 
husband. Contracted friendship with a man notorious for his bad 
character. Convicted with him for frauds. 

After a few months’ stay in prison he changed his humour, com¬ 
plained very often of headache, and called the doctor several times, 
thinking that he was dying of “ typhoid.” Refused food, believing it 
was poisoned. He was transferred “ under observation ” to our 
asylum. 

On admission he was hallucinated, passed sleepless nights hearing 
the voices of his wife and child, and answering “ hostile voices ” 
coming out from the walls of his cell. 

He is now a dement, very dangerous, wet in his habits, troubled very 
often by “ voices,” and destructive of clothes. 

Remarks .—The crimes in the cases quoted above should not„ 
I think, be taken as the outcome of mere impulses. 

Impulsive acts of a dangerous or harmless character form a 
prominent symptom in all the forms of dementia praecox. 

They are, of course, unpremeditated, motiveless, and very 
seldom accompanied by signs of emotion. Their occasional 
appearance breaks, so to say, the monotony in the patient’s, 
stereotyped and much circumscribed life. 

On the other hand, the “ crimes ” referred to by me in the 
first four cases cited seem to have been the ultimate result of 
a faulty process of reasoning, and there was in all a certain 
amount of premeditation. 

In the latter two cases the offenders had exhibited such a 
degree of malice as to make the prison officers suspect that the 
prisoners were feigning insanity. 


Part II.—Review. 


Organic to Human: Psychological and Sociological. By Henry 
Maudsley, M.D. London: Macmillan & Co., Ltd. Price 12s. 

When in years to come the progress of scientific thought in the 
nineteenth century has to be described, there should—and there- 
probably will—be found an honourable position in the roll of fame 
for Dr. Maudsley. To many whose worship is given to false but 
specious gods, this may appear hyperbolical and fulsome eulogy. 
Time will show. At present we are still too devoted to mysticism and 


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REVIEW. 


IOJ 


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to metaphysical disquisition, with their apparent profundity and real 
shallowness, to be able to do anything like justice to those who give 
their time and energy to recording facts and drawing warrantable 
inferences therefrom. We are so accustomed to explaining the known 
by the unknown that we resent any attempt at a reversal of the process 
almost as an insult to our intelligence. In the old days the doubter 
would have been racked, stoned, or burnt for daring to suggest such a 
change. Probably he would be now did power remain with those 
whose cherished illusions are attacked. We have, however, fortunately 
arrived at a stage in our history when we not only have freedom of 
thought—and this we must have had ever since we had thoughts at all 
—but when we also have a very wide range of freedom in expressing 
them. That such liberty at times degenerates into license is a regrettable 
but inevitable concomitant. Yet, while it permits the enunciation of 
those trivial and puerile platitudes which, when the pill of nonsense is 
skilfully gilded with verbiage, pass for philosophical profundities, it also 
allows the utterance of opinions which, being opposed to popular senti¬ 
ment, would formerly have entailed persecution upon those who pub¬ 
lished them, or which would have been suppressed by others who, like 
Erasmus, have no desire for the martyr’s death. Dr. Maudsley, had he 
lived in the good old persecuting days, would scarcely have survived 
the publication of the Physiology and Pathology of Mind. Probably the 
title alone would have caused the powers to invoke the assistance of the 
common hangman. Probably also the author would have been roasted 
on a funeral pyre of the first edition ! Certainly he would not have 
been able to state, as he does of the present volume, that it was written 
“to employ the writer in work which might occupy the time and ease 
the burden of the dreary decline from three to four score years.” We 
should have keenly to regret these volumes in which he has rendered 
more precise and scientific the philosophical ideas of Hobbes, Locke, 
Descartes, Condillac, Cabanis, Spencer, and others. He has had the 
advantage not only of being able to avail himself of the work of those 
eminent thinkers, but also of having been able from his study of dis¬ 
ordered mental processes to consider psychological problems from a 
point of view which was not familiar to them. In this latest volume, as 
in those which have preceded it, use is frequently made of this special 
knowledge to elucidate matters which might otherwise remain obscure. 

Any work which deals with such subjects as ethics, psychology, and 
sociology from a biological point of view must, at the present time, 
necessarily be iconoclastic. The breaking of popular idols is, when not 
actually fraught with danger, certainly a thankless task. Dr. Maudsley 
has not been deterred by any consideration of this kind. As one reads- 
his trenchant criticisms of many vague theories and baseless specula¬ 
tions which pass for axioms, Nietzsche’s phrase of “philosophising with 
a hammer ” recurs as an appropriate description of the process. The 
blows are not, however, given in the crude manner which such a phrase 
implies. His hand has not lost its cunning any more than its force. 
There is no hint of that decrepitude which the words of the preface 
might lead us to infer, 'l'he style is as vivid as ever, the reasoning as. 
cogent, and the criticism as keen. 

In former times anyone who formulated his doubts as to everything. 


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REVIEW. 


[Jan., 

being for the best in matters philosophical or theological was branded 
with some opprobious epithet. Dr. Maudsley has well earned that of 
“ materialist,” and frequently enough has it been bestowed upon him. 
But, as formerly, those upon whom such appellations are bestowed are 
apt to look upon them as titles of honour rather than of obloquy; for 
the implication is, almost invariably, that the recipient has had courage 
sufficient to champion an unpopular cause. At a time like the present, 
when national upheaval has given rise to a recrudescence of emotion¬ 
alism and mysticism, it is more than ever necessary that every effort 
should be made by those who, like Dr. Maudsley, can dispassionately 
point out the basis of actions, a basis which is, to so many others, 
obscured by the dust of conflict or lost to view in the clouds of preju¬ 
dice. 

In this book Dr. Maudsley ranges over a wider field than he has done 
heretofore. He applies the biological, evolutional method to social 
organisation as well as to psychology. He has previously carried to a 
logical conclusion the application of the evolutionary theory to mental 
development, and he has made it sufficiently clear that mind is merely 
the name which we use to describe the functioning of highly-developed 
nervous reflexes. Here again he repeats, when dealing with one 
portion of brain function, that “ subtile physico-chemical sympathies and 
synergies of motions and rhythms are constantly at work in the bodily 
unison beneath consciousness ; it is not it which excites them but they 
which excite it when consciousness supervenes.” The non-realisation 
of this most important fact—for the stage has been reached when it 
might well be accepted as such—or the negation of it by those who 
hold that mind is something separated from body, dwelling like 
Mahomet’s coffin ’twixt earth and heaven—either one or the other of 
these errors has led to the promulgation of theologies which are incon¬ 
sistent where they are not incredible, of ethical codes which are impos¬ 
sible of observance now—and probably ever will be so, of social schemes 
which are utopian and unrealisable, and of psychological systems which 
are obscure or unintelligible. It may be said that many of these 
matters are outside the province of the psychologist ; and his intrusion 
into such domains is impertinent if he has confined his search for know¬ 
ledge—like the fakir—chiefly to the umbilical region or, in more elegant 
phrase, to introspection. Dr. Maudsley makes it clear that the days 
are past when such methods as these can be looked upon as the ulti¬ 
mate resort in acquiring information. “The introspective ego, be it 
ever so acute, expert and free, is tied down by material bonds.” It is, 
however, too much to ask of the generality of those who designate 
themselves psychologists—a term which includes at the present time all 
sorts of odd people, such as thought-readers, crystal-gazers, spiritualists, 
and, as Dr. Mercier would add, psycho-analysts—that they should apply 
themselves to the study of nerve-structure and function before launching 
out into windy disquisitions on the Mind. “ Psychology must come 
down from the misty region of abstractions and base itself firmly on 
facts.” That is a hard saying for those who find it so much easier to 
learn a number of words—with capital letters—or to coin new ones, 
and then give them forth with a pontifical air. Yet, as Dr. Maudsley 
says to the metaphysician, “ a full and exact study of bodily structure 


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and function before he rises to his abstract syntheses would be a right 
addition to his reasoning or reckoning (which all reasoning fundamen¬ 
tally is), in no case a disadvantage, and might be unexpectedly instruc¬ 
tive and gratifying.” To this must be added a study of the influence of 
environment, in the widest acceptation of the term, in moulding the 
plastic organisation ; for it is by “adaptive working experience and its 
consequent physical structuralisation in the brain—the literal instruc¬ 
tion or in-formation—that is, of cerebral plexuses of structure and 
function,” that, ontogenetically and phylogenetically, memories are 
incorporated and skill gained. 

I^ack of this understanding of the organic basis of personality has 
been the cause of failure of schemes for the rapid amelioration of social 
conditions by revolutionary or anarchical methods. The state is an 
aggregation of individuals whose potentiality for improvement may be— 
and usually is—low. It is they who must be educated, not an abstract 
conception called the State. Positive harm may be done if this fact is 
lost sight of; the “abrupt imposition of a rigid social system” may 
cause “serious and irreparable damage to a mature national organisa¬ 
tion.” For the individual, it is not sufficient to endeavour to inculcate 
morality by means of precepts, however admirable. “ Not instruction 
acutely to think only but also to feel and do rightly ” ; and the ability to 
assimilate moral precepts is no criterion of social righteousness. Some 
of those who have uttered the most commendable moral maxims have 
been among the most infamous members of the community, if good 
conduct is taken as an earnest of indwelling virtue. The perfectibility 
of the human race is, too, possibly a delusion. In any case, if it is 
eventually to be brought about, long ages must elapse before it can 
become a fact. That being so, it is of little use to expect mankind 
as at present constituted to be able to conform to the impracticable 
schemes of idealists and of visionaries. It is necessary to guard against 
the extravagant imaginations of the moralist as well as against the 
-spiritual debauches of the mystic. 

These are some of the topics dealt with by Dr. Maudsley ; and this 
is but an inefficient sketch even of a portion of what he has written. 
It is, however, difficult to compress into a small space a reliable sum¬ 
mary of so comprehensive a book. Withal, the charm of the style 
cannot be conveyed at second-hand. It is hoped, however, that 
sufficient has been said to indicate its value, and also the advisability of 
speedily becoming more intimately acquainted with its contents. More 
especially may it be commended to those who are too apt to scorn the 
base ascents from which they originated, and who, with their heads in a 
misty atmosphere of speculation and hypothesis, fail to see whither 
their feet are tending. 

I)r. Maudsley in the writing of this book has indeed controverted 
the saying of Montaigne that “ He who commits his decrepit age to the 
press is a fool if he thinks to squeeze out anything thence that does not 
represent him deformed with dotage and stupidity”: nor lias his 
understanding grown “ costive and thick.” May he yet continue in 
health and strength, and with ability still further to confute that dictum ! 

Hubert J. Norman, 


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Epitome of Current Literature. 


i. Neurology. 

The Bio-chemistry of the Brain. {La Biochemica del Cercello.) Dr. 

Giacomo Pighini. 

This is a review by Georges Bohn in the Revue Philosophique »• 
September, 1916, of a book in which Dr. Giacomo Pighini has 
published five lectures which he delivered at the Clinical Institute of 
Milan. 

Dr. Pighini, says the writer, is certainly correct when he declares that 
the facts so laboriously established by histologists are subject to 
criticism, and that the deductions which they have drawn from thesfr 
facts from the points of view of the physiology, psychology, and patho¬ 
logy of the brain are marred by a fundamental error : they are based on. 
the interpretation of images which are for the most part artificial. 
Thus the famous “corpuscles of Nissl ” do not correspond to any real 
structure. 

Dr. Pighini attaches more importance to the study of the chemical 
constituents of the nervous substance of the brain. Among the most 
important and characteristic of these constituents are the lipoids, or 
the “ noble fats ” as they have been called; the cholesterines, the 
non-saturated and the saturated phosphorus compounds ; to each of 
which belong certain particular properties for the working of the brain. 
Cholesterine has the property of neutralising a great number of toxins p 
the non-saturated phosphorus compounds have a great affinity for 
oxygen, hence they play an important rdle in the internal respiration 
of the tissues; further, they retain in solution many organic and inor¬ 
ganic substances, and contribute thus to the regulation of exchanges in 
the substance of the nervous tissues; as to the saturated phosphorus 
compounds, they are the stable elements of the brain. 

The study of the comparative chemistry of the brains of men and of 
various superior animals shows that these brains differ chemically 
among themselves, and that the connections between the different con¬ 
stituent substances present values almost constant in the same species. 
That animal and vegetable species differ chemically the one from the 
other, is a truth that every biologist now considers as evident. There 
are also variations according to the stage of development and age, and 
this has been verified in the case of the brain. These researches ought 
to be pursued further, as well as those relative to the topographical 
distribution of different chemical substances in the healthy and diseased 
brain. For the moment, there are encouraging facts; for example, it 
has been observed that in the brain of paralytics the proportion of 
cephalin is reduced by a third or more. 

Dr. Pighini devotes the whole of one lecture to the subject of the 
neutralisation of toxins by the brain, and one reads this chapter with 
great interest. One fact will show how the subject is treated. When 
one injects a guinea-pig, either into the carotid or directly into the brain, 
with an emulsion of tubercle bacilli, in a little time one finds no trace 
of it; in contact with the cerebral substance, as one can prove in 


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vitro , the bacilli become granular, lose their staining properties, and 
dissolve. But this bacteriolysis sets free the toxins of the microbe of 
tuberculosis; these are fixed by the nervous substances, and, instead of 
being neutralised as other toxins, they are, on the contrary, made more 
active to the point of almost certainly killing the organism ; hence the 
thundering progress of certain cerebral and spinal tuberculoses. 

Another remarkable property of the cerebral lipoids, at least of the 
non-saturated phosphorus compounds, is that of disengaging in burning, 
a great number of calorics ; hence much energy is developed at little 
expense. It has been remarked that during a prolonged fast, when all 
the other organs and tissues are considerably reduced in weight and 
volume, that the brain is little changed. The explanation appears to be- 
that in the brain, which contains substances endowed with great thermo¬ 
genic value, the combustion of very small quantities of these substances, 
is sufficient to produce the energy necessary for the working of the mind. 
It is not astonishing, in these conditions, that the respiratory exchanges 
of the brain, either in excitement or repose, are less than those of other 
organs; between the states of waking and sleeping the differences are 
almost insensible ; after intense mental Work the exchanges remain the 
same. Paul Bert compared the quantities of oxygen absorbed and of 
carbonic acid set free per 100 grm. of various tissues, and found the 
figures less for the nervous tissues. Batelli and Stern have repeated the 
experiment with modern technique, and have entirely confirmed the 
results. It is, however, interesting to note that though it respires feebly, 
the brain shows itself very little able to resist asphyxia. 

The author then proceeds to examine the various theories relative to 
narcosis and sleep. But up till now chemical explanations of these 
phenomena have been unsatisfactory, and this is said to be the most 
feeble part of Dr. Pighini’s book. 

In conclusion the reviewer observes that in spite of the rather one¬ 
sided manner in which Dr. Pighini has treated his subject, the perusal 
of his lectures may be profitable to both psychologists and philosophers. 

J. Barfield Adams. 


2. Physiological Psychology. 

Suggestion as a Fact and as a Hypothesis [La suggestion comme fait et 
comme hypotliese\ (Revue Fhilosophique^ September , 1916.) E. 

Boirac. 

The labours of the School of Nancy, says the writer of this article^ 
have definitively established the important role played by suggestion in 
the greater part of parapsychic phenomena. That suggestion is a fact 
is no longer to be disputed, but it is perhaps necessary to understand 
more clearly the nature and conditions of this fact; to determine in 
what cases suggestion manifestly intervenes without any possible doubt 
of its presence, and in what cases its presence is merely supposed as a 
more or less likely explanation or interpretation of phenomena ; that is 
to say, in what cases suggestion is a proved fact, and in what cases it is 
simply a hypothesis of which the proof remains to be established. 

The word suggestion is capable of being understood in various senses. 
According to its ordinary acceptation, there is suggestion each time » 


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person evokes—generally by a word—in the mind of another person 
an idea which would not have occurred to the latter in the ordinary 
-course of thought, and which is an idea capable of exercising some 
influence on the sentiments or conduct of the thinker. But in its 
special acceptation, tht* word suggestion implies the notion of an 
involuntary or automatic obedience of the person to the idea which has 
been suggested to him. 

The term hypnotic suggestion is often applied to the special accepta¬ 
tion of the word to distinguish it from the ordinary meaning. The 
ordinary condition of suggestion, that is to say, in which the person 
(subject) may normally resist, or in which he obeys either in virtue of 
•a consent, more or less the result of reflection, or as the effect of 
credulity or natural docility, is produced in the state of waking, when 
the person is fully conscious and has complete use of all his faculties. 
The special condition, on the contrary, in which a person cannot 
resist, even when he has the desire to do so, is produced during a 
state of hypnosis, or during a state of apparent waking more or less 
analogous to hypnosis. Hence, suggestion, so understood, is a function 
of hypnotism, which may be defined, at least partially, as “a state 
which develops a special suggestibility absolutely automatic and irre¬ 
sistible.” The name hypnotism shows that we conceive the condition 
-as “a state of torpor or cerebral stupor in which the greater part of the 
superior functions are suspended, or struck with inhibition,” whilst there 
is produced an exceptional activity of the cerebro-spinal axis. 

However, there is another conception of hypnotic suggestion, that • 
•of the School of Nancy, which is altogether different from the above. 
This is the formula of the School: “ Suggestion is the act by which an 
idea is introduced into the brain and accepted by it.” From a strictly 
physiological point of view there are no ideas in the brain, but only 
cells, fibres, etc. The word brain has been used improperly in 
place of the word mind; and the definition, given above, is purely 
psychological. 

The analyses of suggestion made by the School of Nancy are always 
•confined to the sphere of psychology. They are concerned with belief, 
persuasion, expectant attention, imagination, etc., all terms belonging 
exclusively to states of consciousness. 

The methods habitually employed by the School of Nancy to produce 
suggestion are, or pretend to be, purely mental. No doubt they tell us 
that they look more or less fixedly at the patient, that they make light 
touches on his forehead, eyelids, etc., but all these gestures have, they 
believe, no importance; they have simply the object of fixing the 
attention and striking the imagination of the patient. The true agent, 
the only one which is really efficacious, is the word of the operator 
■which insinuates or imposes the idea, and suggestion is finally realised 
when the mind believes. 

One must remember that the masters of the School of Nancy are not 
-savants making disinterested experiments in a laboratory; they are 
doctors operating in clinics with the intention of curing patients. The 
patients come to them knowing that they are going to be treated by 
suggestion, and are already convinced, or nearly so, of the efficacy of 
4 he treatment, and are impressed by the mysterious power which they 



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attribute to the person who is about to apply it. One understands that 
under these conditions, employing, or believing that they employ, only 
the force of persuasion, the School of Nancy honestly believes that no 
other force exists ; but it is wise to look elsewhere, and in doing so one 
may find perhaps that the formula of the School is too narrow to enclose 
all the observed facts. 

Many operators maintain that they obtain the hypnotic state, generally 
accompanied by an abnormal suggestibility, by methods purely physical, 
without the intervention of any idea. Thus Braid provoked hypnosis 
by prolonged gazing at a brilliant point, independently of all suggestion. 
Other men have employed the same method with success. Further, the 
hypnotising of animals is very difficult to explain by the theory of 
suggestion. When one hypnotises a cock by holding its beak fixed for 
some minutes on a white line, it is playing with words to say that that 
is suggestion, that is to say, the effect produced by an idea, as though 
the cock understood that one wished it to sleep, and persuaded itself, 
ipso facto , that it was impossible for it not to sleep. 

It appears to us more probable that hypnotism is a particular state of 
the nervous system, narrowly related, no doubt, to suggestion, but which 
cannot be entirely ascribed to it. This state resembles sleep, and the 
School of Nancy maintains that hypnotic sleep does not differ from 
ordinary sleep, but is sleep produced by suggestion. However, in 
ordinary sleep, the sleeper does not hear anyone who speaks to him, or 
if he hears, he awakes ; his tactile sensibility may be a little attenuated, 
but it exists, and if he be roughly touched, he awakes. How does 
it happen then that in hypnotic sleep the subject hears his hypnotiser, 
answers him, obeys all his suggestions, and yet continues to sleep ? 
How is it that the subject often presents a complete insensibility, so 
that one can touch, pinch or prick him without his appearing to feel 
anything? And how does it come about that he awakes only at the 
command of his hypnotiser, and that being awake he has, as a general 
rule, no recollection of what happened during his sleep ? 

It may, of course, be said that the difference between hypnotic sleep 
and ordinary sleep is in reality the effect of suggestion. If the hyp¬ 
notised subject continues to hear his hypnotiser, to reply to him, to 
obey him, it is because the latter has suggested it to the former before 
putting him to sleep, or that the subject has suggested it to himself. If 
he remembers nothing when he awakes, it is because this amnesia has 
been suggested to him. Unfortunately these assertions are contra¬ 
dicted by facts. The operators of the School of Nancy may, indeed, 
suggest to their subjects that they must continue to hear and to reply 
while they are asleep, and that they must remember nothing when they 
awake. But the great majority of operators make no suggestion of any 
sort to their subjects, not even, at least not verbally or explicitly, that 
of going to sleep. They look fixedly into the eyes of the subject, make 
some passes, and wait for the result. It is true that the fixed gaze and 
the passes may be considered as suggesting sleep, but the sleep thus 
suggested can only be that of which the subject has already the i(fca, 
namely, ordinary sleep. Hence, it is necessary to conclude that all the 
modifications and additions made to ordinary sleep result from sugges¬ 
tions altogether independent of the action of the operator. Is it the 


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subject who suggests them to himself ? That means that there exists 
a traditional type of hypnotic sleep known beforehand to the subject, 
who sends himself to sleep under the suggestion of this type, and not 
under that of ordinary sleep. 

To explain how this type was formed, and how it imposed itself on 
all the subjects, it would be necessary to search for its origin in the first 
experiments of animal magnetism, for the somnambulists of the disciples 
of Mesmer. Ue Puysdgur and others presented already—before the 
hypnotised subjects of Charcot—all the characteristics of general anaes¬ 
thesia, consecutive amnesia, etc. The first authentic case of somnam¬ 
bulism described by the magnetisers, was, it appears, that of Victor 
Vielet, who went to sleep spontaneously under the influence of the 
passes made by De Puys^gur, and who from the beginning, to the 
great surprise of the operator, presented all the symptoms of hypnotic 
sleep. 

The writer says that it has frequently happened that he has operated 
on subjects who were ignorant of everything about hypnotism, and who 
under the influence of passes, hands placed upon the shoulder-blades, 
etc., went off at once into a profound sleep with anaesthesia, amnesia, 
etc. On the other hand, he has frequently operated on subjects who 
knew all about hypnotism, and were very anxious to be hypnotised, but 
who were refractory to all attempts at hypnotism or suggestion. How 
can one explain this difference between different individuals in the 
manner in which they react to hypnotic or suggestive manoeuvres? 
Some would find the explanation in auto-suggestion. If such a subject, 
they would say, in spite of his desire to be sent to sleep, and in spite of 
the complaisance with which he lends himself to the attempts of the 
hypnotiser, remains rebellious to all suggestions, it is, no doubt, because 
he has suggested to himself that he will not go to sleep. But by such a 
method of reasoning one can explain or prove all that one wishes with¬ 
out the expense of observation or experiment. 

Suggestion, we are told, owes its power to the natural suggestibility 
of the brain, or rather of the human mind ; it is the normal consequence 
of the natural credulity and docility of the entire human species To 
go more deeply into the subject, it is a consequence of that psycho¬ 
logical law, by virtue of which every idea tends to affirm itself and to 
realise itself, unless it be prevented from doing so by the equal tendency 
of another and contradictory idea. This law appears to have been 
first enunciated by Spinoza, and to have been repeated by Herbart, 
Dugald Stewart, Taine, Fouill^e, and others. 

However, this law, which renders suggestions possible, renders auto¬ 
suggestions equally possible, and these must in many circumstances 
be in opposition to those. Every human being is under the influence 
of auto-suggestions on many points, such as habits, education, ex¬ 
periences made during past life, etc., which may constitute counter- 
suggestions to a suggestion coming from a stranger. Among these 
auto-suggestions may be included faith in the evidence of our own 
senses and memory, and in the constancy of the order of nature. 

If a suggestion coming from without does not contradict or offend 
any of these fundamental auto-suggestions, it has a chance of being 
accepted by us, and of obtaining our belief, consent, and even 


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•obedience. So we may call such a suggestion by the name of plausible 
suggestion. 

There are suggestions which may be called paradoxical, as, for example, 
when a person wishes to make us believe that it is night when it is 
midday, or that we cannot move our legs and arms simply because he 
-says so. Such a suggestion would arouse in us an immediate and 
•energetic counter-suggestion resulting from our fundamental auto¬ 
suggestions. In the case of a hypnotised subject, the spring of the 
normal counter-suggestions does not work, the fundamental auto¬ 
suggestions seem to be paralysed, and the subject believes blindly the 
most unlikely and impossible things. 

The problem of hypnotic suggestion is to know precisely why this 
suggestion does not meet with the natural opposition, and it is very 
-clear that the reason is not in the suggestion itself. All happens as 
'though an unknown influence created a momentary void in the mind in 
such a way as to allow the suggested idea free play to develop itself 
without impediment. This unknown influence, without which sugges¬ 
tion cannot succeed, is what Durand de Gros called hypotaxia , and 
•which is more generally designated by the name of hypnotism. 

It appears to the writer that the mistake that the School of Nancy 
and others make is to explain concrete facts by abstract terms, such as 
suggestion and suggestibility. Here is a man, whom I can cause to 
•have the most unlikely hallucinations, whose limbs I can paralyse by 
<he mere exercise of my will. What is the cause of these extraordinary 
■effects? Oh! it is very simple. It is all caused by suggestion. But 
this suggestion, how do you explain it? Whence comes its power? 
Oh ! that also is very simple. It is the consequence of suggestibility, 
which is a natural property of the human brain. So the Schoolmen 
believed that they explained the reason why opium caused sleep by 
•saying that opium had a sleep-producing virtue. 

Suggestibility is not a fact subsisting by itself, an absolute fact; it 
is an effect depending on causes yet unknown. We are sufficiently 
acquainted with the laws of psychological life to know that this life has, 
at least in part, its conditions in the organism, especially in the nervous 
system. The cause of any modification of psychological life must be 
sought for in some modification of the nervous system. The hypnotic 
state, it has been shown above, is not universal, that is to say, it is not 
the normal condition of the human mind, and its cause must be sought 
for in some modification of the nervous system. 

There is a priori no reason to suppose that this modification, which 
is of a physical or physiological nature, can be produced by suggestion, 
which is psychological. On the other hand, it has been abundantly 
proved that by manoeuvres purely physical, such as prolonged fixation, 
passes, etc., the hypnotic state can be produced in a great many 
■subjects, and may prepare them to submit to the effects of suggestion. 

It is then false that hypnotism can be brought about by suggestion, 
'because the success of suggestion, in the great majority ot cases, 
requires the preliminary condition of hypnotism. 

A hypothesis may be used in two different ways, theoretical oc 
experimental, according as one employs it to explain facts already 
known, or to experiment in order to discover new facts or to prove a 


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new law. Suggestion may play this double role in parapsychical 
sciences, and we ought to consider it turn by turn as a theoretical 
hypothesis and as an experimental hypothesis. 

It is especially as a theoretical hypothesis that suggestion has been 
used by the School of Nancy. There it is employed to explain the 
various hypnotic phenomena and their different particularities. The 
partisans of this School make constant use of suggestion in their 
practice. But this practical use is simply an operative proceeding and 
not an experimental hypothesis. Knowing that suggestion produces 
certain effects, it is quite natural to employ it when one wishes to 
produce them; but there is no experimental hypothesis in the matter 
unless one tries to obtain by suggestion some effects, with respect to 
which one is ignorant as to whether it is really capable of producing, 
them. 

What is the value of suggestion as a principle of explanation of the 
phenomena of hypnotism ? The exclusive partisans of suggestion tell 
us that it is the key to all these phenomena. To such an assertion there 
are three objections. 

(1) In researches so difficult and so little advanced, the pretention 
of explaining all by a single principle is not very scientific. The most 
urgent need is to observe the growing number of facts under the most 
rigorous conditions of certainty and exactitude, and by submitting them 
to every possible scientific method of examination to try to discover 
their laws. It is true that a hypothesis is necessary in such a research, 
but it must be an experimental hypothesis, which has for its object not 
the explaining of facts and connections already known, but the discover¬ 
ing of new facts and new connections, and which besides, far from being 
sufficient in itself, has its only raison d’etre in the experiments which it 
gives rise to and controls. On the contrary, a theoretical hypothesis, 
that which has for its object the coordination and explanation of 
acquired results, is placed in the last term of the operations of the 
method, not in the course of a science which is in process of making, 
but only when it is at the end of its researches. And surely no one can 
assert that the science of parapsychic phenomena has arrived yet at that 
stage! 

(2) Every attempt to account for an assemblage of facts as numerous 

and varied as these with which we are dealing, meets with the difficulty 
of the plurality or interchangeability of causes. The exclusive partisans 
of suggestion reason in fact as though the same phenomenon were 
always produced by the same cause. Stuart Mill says : “ It is not true 
that the same phenomenon is always produced by the same cause; the 
effect sometimes comes from A, sometimes from B. . . . Many 

causes may produce a mechanical movement, many causes may produce 
certain kinds of sensations, many causes may produce death. A given 
effect may really be produced by a certain cause, but it may be perfectly 
capable of being produced without it.” So, although suggestion does 
in fact produce certain parapsychic phenomena, as somnambulism, for 
example, yet it does not follow ipso facto that these phenomena cannot 
be produced by another cause altogether. 

(3) A principle of explanation is the most satisfactory when it is the . 
most clear, that is to say, when it contains the least part possible of the 


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unknown. Now the analysis of suggestion which has been made 
above, either as a fact or as an operative proceeding, has shown us 
that there are few facts more obscure and where the part played by the 
unknown is more considerable. To explain such or such a parapsychical 
fact by suggestion is in many cases to explain obscurum per obscurum, if 
not per obscurius. 

All these objections, which appear to us to be very strong if they are 
applied to suggestion as a theoretical hypothesis, would singularly lose 
their strength if they were applied to suggestion as an experimental 
hypothesis, for in the latter case it concerns no longer an explanation 
which is given as complete and definitive of a whole order of pheno¬ 
mena, but as a simple provisional interpretation of a particular pheno¬ 
menon or of a particular group of phenomena, an interpretation which, 
even if erroneous, carries with it its own corrective, since it envelops in 
itself the project and the plan of an experiment by which it may be 
immediately confirmed or contradicted. 

J. Barfield Adams. 


r 

The Three Laws of Psychical Activity \Las Tres Leyes de la Actividad 
Psiquica\ (Revista de Filosofia, July, 1916.) Bunge, C. O., 
Professor in the University of Buenos Aires. 

We know the existence of the world and we discern the qualities of 
things by applying our senses to the exterior, and the exterior produces 
sensations in our interior by the functions of our nervous system. Our 
mind, coordinating the experiences of memory, transforms the sensations 
into perceptions. 

If in a lonely road we see a man in the distance, our visual organs 
rapidly reflect his image, and this image causes in our optic nerves an 
instantaneous and involuntary sensation ; the optic nerves transmit the 
sensation to the cerebral centres by an operation likewise instantaneous 
and involuntary, and these centres correlate the sensation of the man 
whom we see with our latent memories of other men whom we have 
seen ; then we possess his perception. When we look at this man, who 
is an unknown, we link his image by a mental operation equally spon¬ 
taneous with that of many other men whose generic qualities we 
know, and we estimate his differential marks, his face, his conditions, 
his classification ; these elements constitute ideas. 

We all know what is a sensation, a perception, an idea; but in 
common and even in scientific language these words are too vague to 
signify a series of psycho-physiological phenomena, more or less alike 
more or less different, as are emotions, desires, sentiments, passions, 
etc. This is because the mechanism of the mind is unconscious in 
the beginning of its movements, and hence it appears subtle, fugitive, 
and complicated. Each primary sensation is accompanied by its 
perception and its idea; but this idea subdivides itself into a series of 
new perceptions and images, and these in their turn give rise to new 
ideas. 

Passions, sentiments, desires, emotions, can always decompose them¬ 
selves into a vast assembly of sensations^ perceptions, and ideas. So, 
when we recognise as a mortal enemy the man who comes towards us 

LXIII. 8 


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at the hour of twilight in a solitary road, the primary sensation transforms 
itself ipso facto into a series of secondary and tertiary sensations, each 
time more and more complicated. We look instinctively to see if the 
man is armed; we inspect his weapons and his strength ; we feel the 
emotion of fear and the passion of hate; we call to mind similar cases 
in order to prepare the better for defence or attack. 

If the wayfarer coming towards us is unknown, our mental opera¬ 
tions may be arranged as follows : 

(1) Primary sensation. —Reflection of the image on the retina. 

(2) Primary perception. —Transmission of the image by the optic 
nerves to the cerebrum. 

(3) Primary idea. —Representation, description, and classification of 
the image. 

If we recognise in the wayfarer our mortal enemy, the scheme is 
more complicated. The primary sensation and the primary perception 
are the same. But the recognition of the image introduces a new 
element into the primary idea, and gives rise to secondary, tertiary, and 
other sensations such as fear, hate, etc., as indicated above. 

English psychologists have formulated two fundamental laws of the 
mind : the law of association by resemblance, and the law of association 
by contiguity. 

An idea being evoked or provoked, we immediately proceed to 
classify and fix it in a determined place in our mind by means of other 
relative ideas, alike or identical. One would say that the human mind 
was a well-arranged library, divided into a logical series of shelves for 
ideas. An idea being produced, we proceed to search for the depart¬ 
ment in which similar ideas are to be found, and when we have 
discovered it, we associate it with them. Such is the law of association 
by resemblance. 

Intelligence, when it reasons, does not proceed by leaps and bounds ; 
on the contrary, it follows a gradual process. This may be seen very 
easily in any example of reasoning, If we go out into the street and 
find there a tumult of armed men who are vociferating loudly, we 
imagine that a revolution has broken out. How do we arrive at this 
conclusion ? By a large and graduated series of associated ideas and 
judgments. We think that generally armed multitudes do not go 
vociferating about the streets ; that this implies an abnormal state of 
things; that a revolution is an abnormal state of things in which men 
rebel against the constituted powers ; that these rebellions break out at 
times in noisy manifestations of a few armed men ; that the police 
always suppress street disorders ; that if they have not suppiessed this 
one, it must be because they have not been able to do so ; that if they 
have not been able to do so, it is because it is great and powerful; that 
if it is great and powerful, it is not a mere noisy faction but a multitude 
which has risen against the powers that be, in short, that it is a 
revolution. So by an uninterrupted continuation of rapid judgments 
we arrive at our conclusion. Such is precisely the law of association 
by contiguity. 

The laws of association by resemblance and by contiguity embrace ' 
the two most frequent phases of mental operations, but not all the life 
of the mind in its many manifestations. Following another and more 


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PHYSIOLOGICAL PSYCHOLOGY. 


1 1 5 

general principle, the writer endeavours here to explain its laws, which 
may be reduced to three : (i) The dynamic law of the mind. (2) The 
static law of the mind. (3) The stato-dynamic law of judgment. 

(1) The dynamic law of the mind. —Psychical life manifests itself by 
an ascending activity, from the most simple to the most complex, from 
the primary sensation to the primary perception, from this to the 
primary idea, and thence to the secondary, tertiary and other sensations, 
perceptions and ideas. 

This is the primary law of the working of our nervous system. Our 
senses are impressed by exterior phenomena, and transmit their impres¬ 
sions to the cerebral centres, from sensation to perception, from percep¬ 
tion to the idea, and from the idea taken from the exterior to other 
interior sensations, perceptions, and ideas. 

It is to be observed that Spencer applies the term “strong im¬ 
pressions” to the sensations, perceptions, and ideas which emanate 
directly from reality, and the term “ weak impressions ” to the secondary, 
tertiary, and other sensations, perceptions, and ideas. These do not 
appear to the writer of this article to be appropriate designations, 
because the intensity of a sensation, of a perception, or of an idea, does 
not always depend on the immediate reality. The interior memory, 
which a lover retains of the object of his passion, is always a stronger 
impression than those which he takes directly or in reality of the other 
women who pass before his retina. Hence, the ascending movement 
of the dynamics of the mind is not ascending in intensity, but in 
quality, that is to say, in complexity. 

(2) The static law of the mind. —Every psychical operation leaves a 
double trace on the mind : a recollection, and a facility for repeating 
the operation of verification. 

This law is so evident that at any moment we can observe it in our¬ 
selves or others. The existence of memory constitutes the base of our 
concepts. We take no notice of a sensation, perception, or idea unless 
we differentiate and correlate it with previous ones. Every mental 
movement engraves a latent image on our mind, which at any moment 
experience can place in relief. 

Again, “ function makes the organ.” From this biological principle 
follows the corollary; the development of faculties depends on their 
exercise. We are born mentally feeble, but with faculties which exer¬ 
cise will strengthen. The physical and psychical functions of our 
organism grow more and more robust by activity and exercise. The 
individual adapts his faculties to his needs, and his needs regulate the 
exercise of his faculties. The more suitable and continued the exer¬ 
cise, the greater is the development of the faculties. Various 
physiological theories explain the phenomenon of intellectual speciali¬ 
sation, the principle of them all being that the greater activity of 
any cerebral region corresponds to the greater irrigation of blood. 

(3) The stato-dynamic law of judgment. —The ascending dynamic 
operation being realised, the new sensations, perceptions, and ideas 
combine with the traces of old sensations, perceptions, and ideas, and 
in virtue of this fcombination reasoning is produced, principally by 
means of three operations : association, contiguity, and simplification. 

Thinking is the conscious operation of the mind. A new idea having- 


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[Jail., 


been acquired by the dynamic law, it is combined with ancient ideas 
by the static law. But how far has the activity of the mind advanced ? 
At what results has intelligence arrived ? First, it associates congruous, 
correlative, concomitant, or similar ideas ; afterwards, it arranges a 
gradual and continuous series of premises. These operations constitute 
what are called the laws of association by resemblance and contiguity. 
Does the mind stop here, or does it pursue these operations to infinity? 
Here intervenes, however, a third process, simplification, which, 
according to the writer, psychologists have not sufficiently defined. 
When hundreds of ideas are floating in our mind, our intelligence by an 
instinctive operation searches for solutions, that is to say, clears 
unnecessary ideas out of the way, solves equations, sums up, multiplies, 
divides, induces, deduces, analyses, draws conclusions ; in short, sim¬ 
plifies. To abstract, to discuss, to deduce, to induce, to conclude, 
merely implies a simplification of various and complicated elements. 

J. Barfield Adams. 


Reflections on Psychological Introspection [.Reflexiones sobre la Intro- 
speccion Psicologica\ (Revista de Filosofia , July, 1916.) Dr. 
Rodolfo Rivarola. 

The mechanic, says the author, attending to the movements of a 
machine in motion, does not stop to examine the theories and laws of 
mechanics, or their evolution ; in the same way the scientist utilises 
his mental mechanism without studying the origin or evolution of the 
ideas with which he formulates his conclusions and his laws. If, how¬ 
ever, he turns his observation inwards, it is as though someone else were 
examining him, or he himself were examining another person, inducing 
and discovering by means of gestures, words, or any other manifesta¬ 
tions or signs, the series of ideas, sentiments, and realised impulses 
which constitute the complexity of the mind. 

When I think of another observing or inducing, I think of myself 
observing or inducing; otherwise I should know nothing either of his 
observations or of his inductions. 

If a clever artist or novelist paints or describes a sunset, I can 
compare his observations and experiences with those which I possess 
of sunsets which I have seen and admired in nature. A man blind 
from birth could comprehend absolutely nothing of the picture nor of 
the description. A man who had lost his sight at an age sufficiently 
advanced for him to have preserved the memory of colour could 
understand the spectacle as described by words as well as one who was 
in full possession of the sense of vision. 

Under our observation and reflection fall two orders of phenomena, 
the one material, the other mental, which require different methods of 
investigation and description. However much we may wish to reduce 
Nature to an organic unity, it is certain, particularly when dealing with 
matter and its manifestations, or with the reduction of matter to energy 
or any other phenomenon, that we speak of ourselves, as standing apart 
from Nature, as though we were standing in a balcony, and were 
looking down on Nature defiling past us in the street. This is called 
the objective method The scientist can say I and Nature, the observer 


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PHYSIOLOGICAL PSYCHOLOGY. 


II 7 

and the observed, and he describes the observed in a duality which 
he cannot in any way avoid. One might say that there is in this an 
insuperable logical inconvenience. Let us see, however, if the position 
be not susceptible of some elucidation. 

Human thought has always followed two currents of ideas. 

(1) That what exists has been created, therefore that a Creator 
pre-exists, exists, and will always exist whether his creation continues or 
disappears. 

(2) That what exists is the perpetual transformation of a substance 
without beginning or end: forms change; uncreated substance is 
eternal. 

On the first is founded religion, the religious sentiment, etc. On 
the second is founded the scientific and intellectual interpretation of 
phenomena which believes like the first that it possesses the truth with 
a conviction which does not yield in intensity to the most extreme 
conviction of a religious believer. That which admits of two exis¬ 
tences, Creator and created, spirit and matter, is dualism ; that which 
admits of the unity of substance and of the infinite evolution of forms, 
is monism. 

There is an analogy between dualism aud the objective method which 
is frequently feared and repudiated by dualists. The independence of 
the observer and the observed is as much dualistic as the separate 
existences of the Creator and the created. However, it is precisely in 
monism that one meets with the greatest use of the objective method. 
To do away with this apparent contradiction it is necessary to remember 
that monism, if it affirms the unity of substance, affirms at the same time 
the plurality of forms. Substance cannot be studied directly, but only 
by aspects, forms, or phenomena. So arises the possibility that in 
relation to determined aspects, and only in relation to them, is possible 
the organisation of knowledge by the objective method. It is with 
reference to these aspects that we speak of the exterior world, that 
is, of the world which we are able tp observe as different to 
ourselves. 

There are, however, other aspects of nature which the most rigorous 
monism cannot study unless on a base essentially subjective. These 
are the phenomena of the interior world, that is to say, the series of 
aspects of nature which we understand only because they are within 
us, and which we designate commonly by the name of spirit, mind, soul, 
consciousness, will, and action. To attempt to explain these aspects 
by the objective method appears to be as great a mistake as to endeavour 
to explain the aspects referred to above by the subjective method. To 
try to obtain an explanation of the cosmos solely by reflective medita¬ 
tion appears to be a process as much exposed to error as to endeavour to 
obtain an explanation of thought by means of the microscope. 

One is accustomed to call natural sciences those which are concerned 
with the organising of the knowledge of the exterior world, and mental 
sciences those which are concerned with the interior world of man. 
Generally there is no difficulty in recognising the natural sciences, that 
is to say, those which can be cultivated objectively. Others occupy an 
ambiguous position, having been considered as natural sciences, and 
studied as such without altogether being so. Psychology occupies such 


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a position. If by psychology we understand the study of the phenomena 
of consciousness, it is a study of something which is in the observer 
himself. It is because he possesses consciousness that he i? able to 
observe. The idea of consciousness has not been derived from any 
outside explanation or experience. If the organism capable of con¬ 
sciousness had not pre-existed in the observer, and if he had not met 
with the idea of consciousness in himself, he would not have searched 
for it in others. Yet in the examination of organisms—whose move¬ 
ments and functions appear to us to be connected with consciousness— 
we proceed objectively in all the experiments by which we prove the 
phenomenon of consciousness. Thus we search for the relation 
between an object, the knowledge of which comes to us by our senses, 
and a conception, the knowledge of which appears in the perception, 
and the consecutive analyses of the perception by which we acquire 
ideas. 

The majority of the works on mental science have to submit or 
appear to submit themselves to the method, purely objective, of the 
natural sciences. The psychologist’s material, however, which is nearest 
to his hand, is in himself at every hour of the day and night when he is 
awake, and even in the time which immediately precedes or follows 
sleep. It is his own consciousness which distinguishes him from the 
other human and non-human beings, and the other natural and artificial 
things which surround him. But it is difficult to find among the 
classical psychologists, those, that is to say, of the official science, who 
are regulated peremptorily by the laws of imitation and of the School, 
one who gives an examination of himself, a balance and inventory of 
his own mentality, or a description of his own sensibility and of his own 
will. Tiie introspective method, which appeals in each one to the testi¬ 
mony of his own consciousness to prove that it conforms with the con¬ 
sciousness of others, is more or less condemned. It has only been 
loyally utilised by literary men, philosophers, or savants who have written 
of themselves in memoirs, autobiographies, novels, poetry, confessions, 
or recollections, without any intention of making psychology, much less 
of making scientific psychology. Meanwhile, the manuals and treatises 
on psychology goon explaining the soul and its faculties, the mind and 
its phenomena, always objectively as though they were describing a bone 
or a stone. 

If we talk of the things of inside in the same way as we talk of the 
things of outside, it is necessary to prove that we have the same right, 
and the same security or reason of certitude. Can we count, weigh, and 
measure the elements of ideas, sentiments, and actions in the same way 
that we count, weigh, and measure the bones of a skeleton ? 

One may believe that every investigator or expositor of mental science 
speaks of himself, when he appears to speak in objective language of 
things foreign to his own personality, as though he were not treating of 
his own ideas and judgments, of passions which he felt, or compre¬ 
hended because he had felt them, and of impulses and actions executed 
or impeded by the order or illusion of his own will. But one must 
admit also that the obligation of objectising perceptions, ideas, 
memories, imaginations, sentiments, and volition as exterior things, 
takes away from the observer, or at any rate from the reader the security 


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1917 .] CLINICAL NEUROLOGY AND PSYCHIATRY. II9 

of a real fact of observation. If the psychical fact the most directly 
observable, and the only one of which one can speak with great 
security, be that of one’s own consciousness, the language of the 
greatest sincerity will be that of one’s own person. It was thus that 
Descartes spoke in his Discours de la Mithodc. 

J. Barfield Adams. 


3. Clinical Neurology and Psychiatry. 

Some Neuroses of the IVar. (Bristol Medico-Chirurgical Journal, July 
1916.) Clarke, J. Michell. 

A neurosis, according to Gould, is an abnormal nervous action or 
an affection of the nerves or nerve-centres of a functional nature. Dr. 
Michell Clarke excludes all cases which exhibit any one or more of the 
definite clinical signs which are usually associated with structural 
change in the central nervous system. He admits, however, that present 
conceptions of what constitutes functional, as contrasted with organic, 
lesions may require modification. Several observers have noted that 
organic lesions of the nervous system may be produced without evidence 
of external injury. Usually there will be found structural changes in 
these cases. 

It is, however, possible that minute multiple lesions, especially if 
widespread, may through a massed effect give rise to symptoms or signs 
not recognisable by present clinical methods of investigation as due to 
an organic lesion, but rather to those of functional disturbance or 
neurosis. These shade indefinably into cases with undoubted signs of 
structural change. 

As the neuroses of war are partly due to the same causes as those 
occurring in civil life, and partly to other special causes, some of them 
will be familiar while others present unfamiliar or special features. 
Hysteria, for example, exhibits the ordinary manifestations, namely, 
monoplegias, paraplegias, and hemiplegias, with or without sensory dis¬ 
orders and muscular contractures, affections of the special senses, such 
as deafness or amaurosis, and of special nervous mechanisms such as 
of speech, and of anorexia or vomiting. Most of them are quickly 
cured by the accepted methods, and cases of recent origin are more 
amenable to treatment than those of long standing. Hysterical paraly¬ 
sis in a limb may be caused by a wound which may be superficial or 
deep, slight or severe. Most commonly the paralysis is distal to the 
injury or does not extend further centrally than the position of the 
wound. Anaesthesia is usually present and is of the glove or sleeve, 
stocking or sock distribution. The upper limit of the anaesthesia is 
transverse to the long axis of the limb, as a rule is sharply defined, and 
the boundaries of the loss of the different forms of Sensation are coter¬ 
minous. All forms of sensation may be lost together, but those to light, 
touch, and pain are more frequently affected than those to heat or cold. 
Sensation to either heat or cold may be preserved and the others lost, 
or cold felt as warm. Attention to the distribution and characters of the 
anaesthesia rarely leaves any doubt as to its true nature. The affected 
limb is often cold, bluish-red, and sometimes slightly cedematous. 

The cause need not be a wound. These troubles may, as in civil 


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practice, occur after any injury. Hysterica) contractures of the limbs 
without paralysis are not so common. Hysterical paralysis and anaes¬ 
thesia may complicate paralysis due to an organic lesion. Lapse of 
time aids in clearing up the diagnosis, for the functional disorder tends 
to pass off. Even in hysterical paralysis of long standing there may be 
wasting of the muscles ; it is of slight degree and affects the muscles of 
the whole limb. The electrical reactions are retained. 

Aphonia may be present; there is a tendency to relapse, and it is 
difficult to bring about a permanent cure. There may be dumbness 
with or without deafness from shell-shock. In most cases the cause 
was the shock of a shell-explosion, with or without burial, sometimes 
producing loss of consciousness for varying periods, sometimes not, but 
in either case leaving the patient in a dull, dazed, or stuporous state, 
from which he emerged to find himself dumb and often deaf as well. 
In most cases hearing returned before speech. Recovery took place in 
some quite suddenly ; in others gradually, with ability to pronounce a 
few words in a stuttering manner at first. Patients were aided by means 
of demonstrating to them the physiological movements of the lips and 
tongue in speaking. Some of them exhibited the eagerness to write 
what they cannot say, as seen in the classical type of this affection, but 
others were dull and apathetic. Simlarly with those suffering from 
deafness without obvious lesion the patients did not make the efforts to 
hear that a deaf person does. 

Hysterical vomiting occasionally occurred. It was cured by keeping 
the patients strictly on milk until vomiting had ceased for some time. 
Hysterical convulsions occurred in only one case. He had not suffered 
from epilepsy. There was a history of a slight wound, and a subsequent 
fall on the head from a height of 6 ft. 

In other cases the hysterical features were accompanied by more or 
fewer evidences of a state of general nervous shock. These neuroses 
present symptoms or groups of symptoms not familiar in civil practice 
before the war. The causes are numerous—anxiety, overstrain, want of 
sleep, wounds, concussion from high explosives, noise, horrible sights,- 
and fear. The most potent are the concussions caused by high explo¬ 
sives and burial in the dtbris produced by a bursting shell. The longer 
the patient was buried the greater the effect. In the majority of these 
cases of neurosis there is a history of mental or nervous disease in the 
patient’s family. Occasionally the breakdown occurred only after the 
system had been weakened by some debilitating disease. 

The chief symptoms noted are exhaustion or prostration, both bodily 
and mental, apathy even to the extent of an absence of the desire to 
recover, pronounced fatigability. There is often wasting or disturbance 
of nutrition, with or without anorexia. Depression, with loss of self- 
confidence, is present in the early stages. It is often associated with 
fears of permanent paralysis or ill-health. Tremors of the limbs are 
common. Patients are extremely sensitive to noises. Cerebration is 
slow. Memory is defective; in the more severe cases even for remote 
events. Affections of the special senses are common soon after the 
accident, but seldom persist long. Definite nystagmus is rare ; nystag¬ 
moid movements are not infrequent. Insomnia is at first the rule, and 
sleep is disturbed by terrifying dreams. In some of these cases there is 


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a more defined loss of power, either hemiplegic or paraplegic. As a 
rule there is at first more or less general loss of power of all the muscles 
of limbs and trunk. In all cases electrical reactions were normal; the 
results in the hemiparetic cases were good. Treatment by rest, good 
feeding, massage, passive movements, and exercises. The leg in all 
cases recovered before the arm. 

Incoordination is present in some cases. The deep reflexes are 
usually exaggerated. Sphincters unaffected. 

Considering the cases as a whole, Dr. Michell Clarke concludes that 
the pathological changes must he widely distributed through the nervous 
system. “The disturbance affects the highest cortical levels, the 
middle levels with the subconscious mechanisms for everyday activities, 
the motor centres in the cord with their issue in the final common path, 
and the muscles themselves, and often also the afferent paths and the 
receptive apparatus for localisation and the components of deep sensi¬ 
bility.” There is possibly a block in the passage of nervous impulses 
from one neuron to another, and this may be due to an alteration in 
the constitution of the terminal ramifications of the axones and the 
dendrites. The disorder of voluntary movement may be explained by 
an overaction of the cerebellum, or by the want of counteraction of the 
cerebellum owing to the impulses from the cerebrum being in 
abeyance. 

Cases of conscious simulation of nervous disorders have been con¬ 
spicuous by their absence : the influence of fear is not so great nor so 
lasting as might have been anticipated. In a few cases, however, the 
fear of returning to the front does retard recovery : where, therefore, 
there is no prospect of his return to active service the patient should 
be so informed. 

Hubert J. Norman. 

Compression of the Carotids in Epilepsy and Hysteria (Nouvehe Icono- 
graphie dp la Salpetrilre, 1916-/, No. 1.) C. Tsiminaskis. 

This is a clinical study of the effect of compression of the carotids in 
cases of epilepsy and hysteria from the point of view of diagnosis, 
pathogenesis, and the mode of production of the seizures in these 
maladies, following on the lines suggested by Binswanger. 

The exogenous or endogenous irritants which are the presumed 
cause of epilepsy doubtless give rise to instantaneous functional altera¬ 
tions in the seat of the disease, and it is these functional alterations 
that determine the fit. Is it possible to cause these alterations experi¬ 
mentally, and thus provoke a seizure ? In man we can produce a 
hyperaemia, or a partial anaemia o£ the brain. It is not possible for 
anatomical reasons to occasion a complete anaemia, for we can only 
limit the supply of that part of the brain supplied by the carotids. The 
artificial production of hyperaemia in the subjects of idiopathic epilepsy 
did not give rise to fits, if, however, anaemia is induced we get positive 
results. In every case in which it is possible to compress the carotids 
(/. e. where the subject is not too fat, or suffering from arterio sclerosis) 
compression gives rise to loss of consciousness in about thirty seconds. 
In healthy people (non-epileptic) consciousness is regained as soon a^ 


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122 EPITOME. [Jan., 

the compression is relaxed. In epileptics, however, unconsciousness 
occurs more rapidly and is followed by a fit, which is of the same type 
as that occurring normally in each subject. This holds good for fits of 
the Jacksonian type as well as ordinary epilepsy. The post-epileptic 
state also was that normal to each person. Out of 116 cases experi¬ 
mented on, failure to induce fits only occurred in nine, and these 
were cases in which fits usually took place at very long intervals (three 
months to one-and-a-half years). Similar investigation was made in 
forty two cases of hysteria. They were subjected to compression of 
the carotids on their first examination only, and suggestion was carefully 
avoided. In every case typical seizures resulted. The author believes 
that his method may have important bearing on the diagnosis in cases 
of doubtful epilepsy, nocturnal or masked cases, and that further 
experiments on these lines may yield information as to the cause, and 
possibly the cure, of this group of diseases. W. Starkey. 


4 . Treatment of Insanity. 

Treatment by Suggestion. (Dublin Journ. of Med. Sci., Aprils 1915.) 

Smyly, Cecil P. 

Dr. Smyly believes in the efficacy of treatment by suggestion, but 
deprecates the use of such a method in cases to which it is unsuited. 
At the same time he criticises the attitude of those who are “ firmly 
convinced that the practice of mental therapeutics is closely allied with 
that of black magic.” Experiments In the use of suggestion are as 
necessary as they are in other scientific matters, but such tricks as 
“ persuading a person to eat a candle, in the belief that it is a banana,” 
are quite unjustifiable. 

Individuals differ in suggestibility as they differ, for example, in the 
accommodative power of their urethra : and barm may be done in both 
instances by the ignorant or unskilful person who uses the bougie or 
who makes the wrong suggestion. It is as reasonable to impugn the 
utility of bougies because evil results in the one instance as it is to 
depreciate the value of suggestive therapeutics because the procedure 
is wrongly used or applied to unsuitable cases in the other. 

.It is the patient’s own mind which brings about curative results, and 
not the substitution of the will of someone else. He must allow his 
attention to be directed it. a certain direction or to be deflected from 
one upon which it has been unduly concentrated. For this a certain 
degree of passivity is essential : resistance renders the method in¬ 
applicable. The attention may be concentrated upon one group of 
ideas so closely that others, though really perceived, are not heeded, 
and thus, for example, analgesia may be produced. It is essential, 
however, that the condition which is giving rise to the painful stimuli 
should not be neglected. Suggestion cannot directly affect a cause 
which exists outside the brain. There are, however, maladies which 
are due to the excessive attention which is paid to normal stimuli. If 
the attention can be diverted by means of suggestion a cure will result 
in these cases. 

Dr. Smyly has used hypnotism and suggestion successfully in 
instances where it was desired to produce anaesthesia for surgical 


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purposes ; for insomnia ; for abdominal pain ; for constipation ; and for 
other conditions. In the treatment of mental symptoms, such as 
“ phobias, obsessions, etc.,” he records only one complete cure and one 
case improved out of six. 

It is essential that a correct diagnosis should be made before any 
attempt is made to treat a case by means of suggestion : otherwise 
almost all the symptoms may be removed, while the cause is absolutely 
unaffected, and being unnoticed may escape proper treatment. On the 
other hand, suggestion may be of great assistance to other methods of 
treatment, such as, in giving the patient confidence to undergo an 
operation. Even in acute medical conditions it may tide him over the 
crisis, or persuade him to give himself a fair chance in a chronic 
malady, and in inoperable malignant disease suggestion may be able to 
render his last days at least more endurable. But, as the author says 
in conclusion, “ to claim that hypnotism, Eddyism, or faith-healing 
can cure such cases is as foolish as it is unscientific, and can lead only 
to disappointment or disaster. Hubert J. Norman. 

Dial as a Hypnotic Remedy. {La medication hvpnotique par le Dial. 

Le Progres Medical , April 5//1, 1916.) 

In August, 1915, Le Pro»rls Medical drew the attention of thera¬ 
peutists to this then new hypnotic. Since that article appeared a 
number of practitioners have made trial of this drug, and have com¬ 
municated their results to the journal, which gives a summary of these 
in a short leader. 

Dial (diallylbarbituric acid) is closely related to veronal (diethyl- 
barbituric acid), but differs somewhat in its effects. It is much more 
active, or at least posse'ses the same potency in a much smaller dose ; 
it is more rapidly absorbed and eliminated; it is without action on the 
kidneys, and causes no irritation of the alimentary canal. 

Experiments on dogs and rabbits have shown that an identical 
narcotic effect with that of a given dose of veronal is obtained with one- 
fifth the quantity of dial. These experiments have demonstrated the 
complete disintegration of this product in the course of metabolism, 
with the absence of any evidence of accumulation, even during prolonged 
administration. The average dose is between and 3 gr. (o‘io and 
0 20 grm.). From observations that have been communicated it has 
been found that it is possible to obtain sedative effects with a much 
smaller dose, J gr- (0 05 grm.), and that in psychoses and states of 
extreme excitement 4|-6gr. (o^o-o^o grm.) are sometimes successful. 
* gr. is the sedative dose in simple nervous agitation, and may be 
repeated three times a day. i-J-gr. is the hypnotic dose in nervous 
insomnia of moderate intensity. It should be given at bedtime in the 
case ot patients who are sleepless in the beginning of the night, and 
on waking when the insomnia is in the middle of the night or towards 
morning : but in the latter case it is indispensable that the patient 
should be allowed to sleep a little later in the forenoon, otherwise, if 
wakened prematurely, he might suffer from vertigo or headache. The 
same dose of i| gr. is also a suitable one in nervous agitation complicated 
with anxiety, but it may have to be repeated three times a day. 2^-3 gr., 


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given in a single dose at bedtime, should be administered in cases of 
obstinate insomnia; this is also the dose in grave conditions of nervous 
agitation, when, if necessary, it may be repeated twice during the day 
Finally, 4^ gr. may be given in states of maniacal agitation, and 
especially in psycho-motor excitement, in neuroses with phobies, and in 
melancholic anxiety: it is also the dose which it will be most often 
necessary to employ in alcoholic delirium, and for the cure of 
morphinomania. Should secondary symptoms arise it is an indication 
for suspension of the treatment for some days. It may then be 
resnmed without unpleasant results if the state of the heart is satis¬ 
factory. 

As regards the value of dial in epilepsy, there have been too few 
trials of it to justify the expression of a definite opinion at present. In 
one case the attacks completely disappeared from the time treatment 
was commenced, to return on its cessation, and disappearing again 
when it was resumed. It would appear, then, to be capable of rendering 
real service in the treatment of this affection, and fresh trials are to be 
encouraged where dial, associated perhaps with codeine, bromides, 
chloral, or belladonna, may be expected to play either a principal or 
an accessory part. 

Dial is manufactured in the Ciba laboratory, at St. Flons (Rhone), 
the proprietors of which kindly offer to place samples at the disposal of 
members of the medical profession. T. Drapes. 


5. Sociology. 

Disease and Domesticity. (Glasgow Medical Journal, August, 1916.) 

Craig , James. 

No crisis in life brings out the best in human nature more markedly 
than serious illness in the household. Individual sacrifices are made 
one to another without a thought of personal comfort or personal right. 
There is a reverse side to this picture, but the occasions on which it is 
shown are few. 

Many domestic worries result from undue irritability in individuals 
who are really suffering from bodily diseases of which they make no 
complaint. A judiciously administered aperient may not only relieve 
an overcharged or irritated bowel, but may also “ minister to a mind 
diseased.” Most of the minor and recurrent forms of mental derange¬ 
ment of an evanescent kind are greatly influenced by attention to bodily 
health in this respect. That many people have come to realise this is 
evidenced by the immense vogue of laxative pills and lotions. Yet the 
disorganisation of bodily structure is too often lost sight of when dis¬ 
orders of conduct are being considered, and the individual is held 
responsible for derelictions which are entirely the result of the tyranny 
of his faulty organisation. Action is deferred in many instances until 
contravention of the law, for example, has occurred ; whereas a wise 
prescience would have brought about intervention at an earlier stage. 
“The ideal of all law should not only be the restraint of the criminal, 
but the restraint of the potentiality for all crime.” Frequently the 
lunatic has to commit some crime before he is dealt with by the law. 


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The drunkard must become a criminal before he can be forcibly put 
under restraint. Many drunkards even boast of their roystering habits. 
Where people have such ideals it is necessary to prevent them by repres¬ 
sive measures from carrying these into force. Such measures must pre¬ 
cede in many instances the inculcation of higher ideals. 

Chronic kidney disease, with alternating skin and mental phases, is 
one of the chief of those conditions which give rise to domestic trouble. 
A kidney toxin which produces scars and sores in the arms and face 
and legs is one which renders “ the spirit irritable, the mind lugubrious, 
and the outlook on life and other human beings suspicious and even 
malicious.” Sufferers from kidney trouble are only too often the victims 
of the quacks. Perhaps they are persuaded to take some form of violent 
exercise, whence results probably a cerebral haemorrhage. “ Every 
man over fifty years of age should get a medical opinion about his heart 
and kidneys before talcing up any violent form of exercise.” Where 
uraemic convulsions do not take place in a patient whose blood is 
charged with toxins, “ some derangement of the intelligence centres ” is 
sure to result. This may take the form of delusions of such a nature 
as to bring about strife in the domestic circle. 

Syphilis affecting the central nervous system is a fertile source of 
trouble. Before the condition is recognised much evil may have arisen. 
It is only later that the cause of much irritability and suspiciousness is 
ascertained. The concealment of syphilitic infection is frequently 
attended by dire results by precluding early and adequate treatment. 

In the study of sociology it is necessary to take into account the part 
played by maladies of all kinds in influencing conduct. Only by so 
doing is it possible to understand the apparently irrational behaviour of 
many members of the community. Cranks, faddists, and peculiar 
people are often only those needing a little medical attention. They, 
and the unduly irritable invalid, do not need coddling and spoiling, but 
frequently more drastic measures of treatment. 

Experience of human nature is often more valuable to the physician 
than recondite knowledge of pathology. The personal factor is an im¬ 
portant element in the cure even of organic diseases- To be able to 
inspire hope in the patient is to have made a step towards cure. Em¬ 
piricism and optimism frequently bring ab.out beneficial results which 
more rational knowledge conjoined with pessimism cannot achieve. 

H. J. Norman. 

A Note on Calumny [Note sur la Calomnie\ (Revue Philosophique 
August. 1916.) Ossip-Lourii. 

The calumniator, says the writer, is neither a liar nor a mythomaniac : 
he is a false interpreter. The suggestion of error, the base of the lie 
and of the myth, is not absent from calumny, but calumny is not, as the 
lie and the myth, the creation of a fiction. It is the disfiguring or 
alteration of the truth. It is a false interpretation, generally voluntary, 
of a quality or of a truth. 

Whilst the lie and the myth are frequently found among children, 
calumny is unknown among them. This is easily explained. 
Children are imaginative and inventive, but they have not yet acquired 


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the faculty of logical interpretation. Thus it will he seen that the 
writer places the calumniator on a higher intellectual level than the 
liar. 

Uncivilised people are familiar with and practise largely the art of 
lying, but they are ignorant of calumny, which, like the use of asphyxi¬ 
ating gas in warfare, is the prerogative of progress. 

Why do people calumniate their fellows ? 

The habit of saying and repeating words and phrases without verifying 
their value or exactitude leads to calumny. The writer, in his work 
Langage et Verbomanic , has pointed out that verbal calumny is allied to 
verbomania. 

Certain miserable people hate all who surpass them, and this hate 
engenders jealousy which ends in calumny. Such people calumniate 
persons who have never done them any harm, and who deserve neither 
their rancour nor their animosity. 

Calumny spreads itself much more rapidly than authentic truth. To 
recognise a truth, it is necessary to search for it, to make an effort to 
discover it; calumny gives itself up at once, it is sufficient to receive 
it, and there is no need to ask whence it comes, or what are its 
credentials. 

Very few people have the habit of going to the bottom of things. 
The number of those who accept an opinion only after having verified it 
is very limited. We are always talking of criticism, but we apply it 
rarely, if ever, to words and judgments which we hear around us. We 
judge our neighbour on the appearances of faults and qualities which 
he does not possess, we give our confidence to those who scarcely 
deserve it, and we suspect people only because others speak ill of 
them. 

“ I am going,” says the writer, “ to give utterance to a paradox (in 
the true sense of the word, vapa 86 £a that which is contrary to con¬ 
vention or to prejudice). I hold that it is nec essary to distiust opinions, 
be they good or bad, which are identic al and unanimous. When three 
persons express an absolutely identical judgment on a subject or an 
object, one may be certain that this judgment has been suggested to 
them, that it is repeated and admitted without control. If it were per¬ 
sonal to each of those who express it, it would at least show shades of 
difference.” 

Returning to the consideration of calumny, let us not forget that 
there are certain men who experience a veritable joy when they succeed 
in diminishing the moral value of someone who is their superior. 

Calumny not only spreads rapidly, but it has a vigorous life. There 
exist at the present day nations still stained by the calumnies cast 
upon them in the Middle Ages. For calumny does not only affect 
individuals; it spares neither groups of men nor nations. 

There are two points to be noted. 

(1) The source of a collective calumny—the calumny which affects 
a group of men or a nation—is very easy to discover, but it is a 
difficult task to find out the source of an individual calumny. How 
can one know when and where a verbal calumny was first cast upon a 
given person ? The victim is very often the last to suspect the injury, 
and he is utterly unable to defend himself from it. One cannot say 


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too much about the suffering of a man of keen emotions who feels that 
the slur of a calumny has fallen upon him. In closely observing 
patients suffering from the delusion of persecution ( perslcutis-persl - 
euteurs), one can prove without difficulty that in many cases the point 
of departure of their idea of persecution was the effect of a calumny, 
of which they were conscious without being, able to prove their 
suspicions. 

(2) An individual calumny has sometimes an accidental character; 
it may be, for example, the product of the great haste in which we 
live, whilst the collective calumny has always a character clearly 
determined and utilitarian. 

Calumny ought to be considered as a symptom of certain varieties of 
moral psychopathy, associated with many perversions of instincts and 
appetites. In all cases it is a morbid phenomenon which denotes a 
trouble of the consciousness or a trouble of the intelligence, and in the 
collective domain a trouble of social vitality. 

As to those who lend a complacent ear to calumnies, it is necessary 
to attribute to them the same moral and intellectual poverty that we 
attribute to those who themselves forge the malicious stones. 

One agrees with the writer when he says that the habit of back-biling 
is found among the mentally unstable. No one will deny that. But 
no one will deny either that the habit makes its appearance quite as 
frequently among the sane. It is found in all classes and among all 
peoples, with the possible exception of children and uncivilised races, 
and there are few men or women who at some time or other have not 
been the victims of false aspersions. 

“ Be thou as chaste as ice, as pure as snow, 

Thou shalt not escape calumny.” 

J. Barfield Adams. 


Anarchism in the Eighteenth Century [Z ’Anarchisme au Dix-huitieme 
Siec/e], (Revue Philosophique , August and September , 1916.) L. 
Proal. 

These articles are extremely interesting. The writer from his judicial 
position has had exceptional opportunities of studying the anarchist at 
first hand, and in elaborating his argument he has drawn freely upon 
his extensive acquaintance with French literature. 

Anarchy, he says, was not born yesterday, it did not burst out 
suddenly ; there is no such thing as spontaneous anarchy. Everything 
has a cause, and the causes of anarchy are many. They are political 
and economic, but they are also literary and philosophical. Anarchy 
is not only the offspring of l'Internationale and la Commune ; it is the 
result of a long work of destruction which has taken place in the minds 
of men. It commenced by making war on religious beliefs, while 
wishing to preserve deism and the doctrine of the spirituality of the 
soul. Then it combated deism and spiritualism as simple theological 
dogmas, wishing only to keep morality natural and independent. Soon 
the obligations and sanctions of morality were despised, and duty was 
replaced by individual right, and by the worship of I, myself. From 
negation to negation one arrives at moral nihilism, and then one passes 
to political nihilism. 


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The Assemblce Constituante made a very complete enumeration of 
the rights of man. It proclaimed the sovereignty of the people, 
individual liberty, equality before the law, equality of taxation, liberty of 
conscience, and of speaking and of writing. The Jacobins found these 
insufficient, and they claimed and exercised the right of regicide and of 
insurrection. Then came the Fouriferistes and others who demanded 
the right of free love and adultery. The Socialists of 1848 completed 
the list by adding the right to work and to public assistance. Anarchy 
of to-day is a negation of all duties to society and the family, and 
a claiming of all rights. It has even added others to the above list, 
claiming the right to idleness, theft, assassination, abortion, and 
sabotage. 

The right to abortion is advocated in an article which appeared in 
the number of La Guerre Sociale for December 28th, 1910. In this article 
the journalist complains of the prosecution of those accused of 
abortion, and reproaches the doctors for lending their aid to justice, 
when the most part of them practise abortion themselves. “ There is 
not a doctor,” the anarchist writer says, “ who does not practise it 
occasionally, unless he be tainted by cowardice or religious pre¬ 
judices.” Abortion is only dangerous, he adds, because it is practised 
by unskilful hands; “suppress the article of the penal code which 
forbids it to doctors and midwives under the penalty of hard labour, 
and it will no longer present more danger than the extraction of a 
tooth. Do you find it dangerous even when practised by specialists ? 
Then be logical, and cease to prosecute the neo-malthusians who teach 
the practical means of avoiding an undesired pregnancy.” 

Statesmen and historians have spread abroad the idea that progress 
can only be accomplished by force, and the masses of workmen imagine 
consequently that a new revolution is the best means of bettering their 
conditions. Some writers have made history, which ought to be for the 
people a school of morality and justice, a school of immorality and 
injustice, of violence and anarchy. Some historians have excused the 
revolutionary crimes, and have favoured their imitation. Believing 
only in force, and admitting only the right to happiness, the anarchists 
expect the triumph of their ideas only from a violent revolution. Like 
the terrorists of ’93 and the apologists of revolutionary crimes, they 
think that the progress of humanity cannot be accomplished by peaceful 
evolution, and that a violent revolution is necessary and legitimate. 
“ All that favours the triumph of revolution is legitimate,” said 
Bakounine,” “all that hinders it is immoral and criminal.” The word 
“ revolution ” is a magic word which inflames the imagination of the 
anarchists. Caserio stabbed President Carnot with the cry of “ Vive 
la revolution! ” 

Is there not also the spirit of anarchy in a great number of the 
romantic writers who glorify passion and the revolt against society? 
The right of free love and adultery is claimed in their novels as well as 
in the brochures of the anarchists. Extracts from the writings of George 
Sand are cited in an anarchist pamphlet, entitled The Immorality of 
Marriage. 

But it is especially, in the eighteenth century that one must look for 
the philosophical origins of anarchy. Tocqueville, writing under the 


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second Empire, came to the conclusion that no one any longer read the 
works of the philosophers of the eighteenth century. “ What French¬ 
man,'’ he asks, “would think today 01 writing the books of Diderot or 
Helvetius? Who would read them ? The incomplete experience, which 
we have acquired during sixty years of public life, has been sufficient to 
disgust us with this dangerous literature.” But the theorists of anarchy 
and the militant anarchists have not ceased to read the philosophers of 
the eighteenth century, and to be inspired by them. In the prosecution 
of Babeuf and his accomplices, who were true anarchists, one of them, 
Germain, said: “ By the reading of Mably, of Rousseau, and of Diderot, 

I sharpened my courage against the oppressors of humanity.” And he 
sharpened his knife also. 

To-day in their books, pamphlets, and newspapers, the theorists of 
anarchy invoke without ceasing the authority of Diderot, Helvetius, 
Rousseau, Volney, and Condorcet. It is from the writings of these 
authorities that they draw their arguments for attacking social institu¬ 
tions ; they turn against contemporary society the violent criticisms 
which were addressed to the society of the Artcien Regime. From the 
writings of the eighteenth century they sort out the good and the evil, 
leaving the good, and choosing the evil. They take care not to borrow 
from Rousseau his moral and religious beliefs, his admiration for the 
gospel, from Montesquieu his spirit ot wisdom and of moderation, from 
Voltaire, Diderot, Helvetius, and Condorcet their respect for civilisation, 
for property, and for the family. But they borrow from Rousseau the 
hate for the great and the rich, the hate of all social inequalities, from 
Voltaire, Diderot, and Helvdtius the hate of Christianity and the priests, 
from Mably, Condorcet, Volney, and Diderot the dream of an ideal 
society, where all men would enjoy a happiness without bounds in 
following the laws of Nature. 

Anarchy is not only an unchaining of anti social passions ; it is also 
an overflowing of sophisms. Anti social passions do not suffice to make 
the anarchist; they are accompanied by false reasonings, intellectual 
insanities, chimerical dreams, which have tainted the moral sense, and 
lighted up revolt. When the magistrates examine a man accused of 
anarchy, it is very rare for them not to find in his answers reminiscences 
of revolutionary readings, and even entire phrases borrowed from the 
works ot the philosophers of the eighteenth century. 

“ Having had occasion,” says the writer of these articles, “ in my 
magisterial career to examine and judge a certain number of anarchists, 

I have been stiuck by their enthusiasm for the philosophers of the 
eighteenth century, whom they consider as their masters. I can 
show how such and such a prisoner has been lea to crime by reading 
such and such a philosopher. Revolutionary sophisms slip easily from 
well-made minds, from well-balanced brains, but ihey penetrate easily 
into the minds of degenerates and half-fools, who are already drawn by 
their morbid temperaments towards false ideas and a revolt against 
society.” 

The philosophers make the laws responsible for all, for ignorance, 
misery, and crime. “ What is the crime,” asks Condorcet, “ of which 
one cannot show, the origin, the first cause, in legislation, in institu¬ 
tions ? ” Helvetius is persuaded that “ it is only by good laws that one 
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130 EPITOME. [Jan., 

can form virtuous men.” Assuredly, there is much truth in these 
maxims. The tax on salt, for example, was the cause of smuggling. 
In the eighteenth century the edicts and other fiscal and revenue laws 
depraved men, and the philosophers were right in saying so. The 
cahiers of the Eta/s Giniraux tell the same tale; in those of Nancy, in 
particular, the people complain justly that the excess of penalties has 
altered the character of the population. 

But the philosophers have not only criticised the fiscal, revenue, 
feudal, civil, and criminal laws which oppressed civil and religious 
liberty, but they also professed revolutionary doctrines, in which the 
anarchists of to-day search for incitements and justifications. Rousseau 
writes: “ It is clear that it is necessary to put to the account of estab¬ 
lished property, and consequently to that of society, the assassinations, 
poisonings, highway robberies, and even the punishments of these 
crimes.” “ I believe,” says Diderot, “ that no one will deny that where 
no property exists, there will be none of these pernicious conse¬ 
quences.” 

In making public happiness and morality depend only on good laws, 
and misery and crime on bad laws, the philosophers have weakened the 
sentiment of personal responsibility, and have excited sentiments of 
revolt against society. “ Society,” says Holbach in his Systhne de la 
Nature , “ is a cruel stepmother for the people, who revenge themselves 
by theft and assassinations.” These anathemas are repeated by the 
anarchists, who call themselves the victims of society. “ I have even 
heard workmen,” says the writer of these articles, “ reproach society for 
dividing riches unequally, because they could not live according to 
their desires.” 

“ Society,” said the anarchist Leauthier at the Cour d'Assises, “ has 
the duty of assuring me of my existence. As it does not do so, it is 
culpable towards me, and I have determined to revenge myself by 
striking the first bourgeois whom I meet.” 

The president of the Assises having said to another anarchist 
prisoner : “You assassinate in order to satisfy your passions ; what do 
you think society may expect from a man who manifests such senti¬ 
ments?” “ It is I,” replied the prisoner, “who expect something from 
society; it ought to support me, and it is not extraordinary that one 
employs every means for being happy, when society abandons the 
citizens.” 

One would hardly believe to what an extent contemporary anarchists 
are impregnated with the ideas of Diderot. It is not, however, the 
learned precursor of Lamarck and Darwin whom they wish to glorify, 
but the revolutionary, who set up the theory of anarchy before Proud¬ 
hon, and even employed the word for the first time. “ And this 
anarchy 01 Calabria pleases you ? ” he says. “ I appeal to it from 
experience, and I wager that their barbarism is less vicious than our 
urbanity.” 

Diderot is one of the favourite authors of the anarchists. In Paris, 
some years ago, they wished to make a manifestation at the tomb of 
Ravachol, and when they were prevented from doing so, they com¬ 
pensated themselves by making a demonstration at the foot of the 
sutue of Diderot. The anarchist, Vaillant, who threw a bomb in 


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the Chambre des Deputts , invoked the authority of Diderot in his 
defence. 

The anarchist doctrine is connected directly with the writings of the 
sensual philosophers of the eighteenth century. Helvetius derived the 
idea of right from the desire of happiness, Holbach from utility, Destutt 
de Tracy from need, Volney from the instinct of conservation. 
Caserio, the assassin of President Carnot, asked for Les Ruines and 
La Loi Naturelle of Volney to read in his prison. £tievant, another 
anarchist, sentenced by the Cour d’Assises of Versailles, cited in his 
defence La Loi Naturelle of Volney, and the writings of Rousseau. 

Anarchists are enthusiastic materialists and atheists. In addressing 
himself to the jury, Vaillant told them that they were only atoms lost 
in matter, that human history is only a perpetual play of cosmic 
forces for ever renewing and transforming themselves. Emile Henry 
made confession of materialistic and atheistic faith before La Cour de 
la Seine. “ We are materialists and atheists,” said Bakounine, “ and we 
glory in it.” 

As religion is a conservative force which teaches obedience to laws 
and authorities, the anarchists wish to destroy it. Proudhon, whom 
Kropotkine calls “ the immortal father of anarchy,” had already pro¬ 
posed to suppress Christianity. “ The Revolution does not make 
covenants with the Divinity,” he said. “ L'ennemi est la.” 

The hostility of Proudhon against Christianity did not arise from the 
same causes as those of other socialists and anarchists, Fourier and 
Saint-Simon for example. Fourier reproached Christianity for being the 
enemy of voluptuousness. Saint-Simon was indignant that Christian 
morality should teach exclusive love, a union for ever indissoluble. 
Proudhon, on the contrary, has written some beautiful pages against 
divorce and free union. He believed in the doctrine of the family, 
and he could not listen with patience to George Sand’s theories of free 
love. 

It is from the writings of Helve'tius, Holbach, Diderot, and Voltaire, 
that the anarchists have borrowed the idea that religion was invented 
by the priests, and that it is utilised by governments to teach obedience 
to the people. Caserio speaks of religion with contempt, seeing in it 
only an instrument of domination. In his pamphlet, La Peste Religieuse, 
the anarchist, Most, considers priests as the gendarmes of despotism, 
and he reproaches them with protecting the strong box of the bourge - is 
by making ihe claims of the people sleep by preaching hope in a better 
world, and confidence in Providence. 

Together witn the hate of religion and priests, and the hate of laws 
and governments, the anarchists draw the hate of wealth and society 
from the writings of Helvetius, Diderot, Mably, and Rousseau. ‘‘The 
nation,” says Helvetius, “is divided between oppressors and oppressed, 
between roubers and those who are robbed.” Brissot, who played an 
important part during the Revolution, wrote in his Recherches Philo- 
sophiques sur la Proprieti et sur le Vol: “ The robber is me rich man. 
Exclusive property is a thelt Irom Nature. It breaks the equilibrium 
which Nature has put in all its woiks. Equality being banished, one 
sees the odious distinctions of rich and poor appear.” 

During the Revolution, Babeuf thought that the moment had come 


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I 32 EPITOME. [Jan., 

for those who had been robbed to make the robbers, that is to say, the 
rich, restore the stolen goods. Thus, by a chain of sophisms, which 
reaches back to the eighteenth century, the contemporary theorists of 
anarchy and their disciples have arrived at excusing theft by calling it 
restitution. At the Cour diAssises the writer has heard an anarchist, 
accused of theft, excuse himself by saying : “ I am not a robber, I am a 
restitutiounaire.” 

The writer then proceeds to a close examination of the works of the 
eighteenth century philosophers, particularly of those of Rousseau 
and Voltaire, pointing out their errors, and the unfortunate influence 
which these errors have had on the development of modern anarchist 
theories. 

In concluding his second and last article, the writer says : “Theonly- 
great philosopher of the eighteenth century who has had a solely 
beneficial influence, in spite of some errors of detail, is Montesquieu, 
because he has always examined political, religious, and social questions 
without passion, without party spirit, with a penetrating comprehension 
of all the aspects of these very complex problems, drawing his principles 
from experience and from the nature of things, proposing the reformation 
of abuses with prudence, endeavouring to make everyone love his duties' 
and his country. He left to others the declamations and diatribes 
against laws, governments, and social institutions. So I have never 
heard a theoretical anarchist or the author of an anarchist crime invoke 
the authority of Montesquieu and seek for an explanation of his theory 
or of his crime in the writings of that philosopher.” 

J. Barfield Adams. 

Spanish Ethics: Problems of Contemporary Morals [Etica Espaiiola, 
problemas de Moral contempordnea\. Andri, Eloy Luis. 

This book is reviewed by J. Peres in the Revue Philosophique , Sep¬ 
tember, 1916. 

In this work the author presents us with a not very flattering picture 
of the present moral state of Spain, and advocates certain methods for 
the regeneration of the country. It is with a sententious and highly- 
coloured verve, which reminds one of the style of Seneca—a style always 
to be found among the moralists of the Peninsula—that the author tells 
his rosary of the present evils of Spanish social life, where theological 
virtues are travestied by the dogmatism 01 ignorance, by parasitism and 
ambition. The ascetic sobriety —a veritable marasmus—which charac¬ 
terises the people, is the child of misery and discouraging inequalities, 
and proceeds in great part from an endemic laziness, tincture'1 with 
ignorance and pride, besetting sins of the Spaniards. The natural riches 
of the country are exploited by cosmopolitan finance, the intillectual 
life rests on a borrowed culture, the whole^constituting “ une civilisation 
achetee toute faiteP 

The author attributes some of these conditions to the geographical 
situation of the country on the borders of two civilisations and two con¬ 
tinents, turn by turn invader and invaded. Hence the du <listn of the 
dominant castes and of the masses translates itself into two orders of 
tendencies—sometimes separated and sometimes mixed—in the Spanish 


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character, historic optimism joined to a pessimist contempt for present 
realities. The past imperialism of the nation is condensed in the indi¬ 
vidual into an individualism prompt to revolt, but held in check by an 
excess of authority, and on which the eccentric geographical position 
is not without its influence, as has happened in the case of English 
individualism, otherwise very different. The contemplative disposition 
of mind, indifferent to the aspects of Nature, which characterises the 
peoples of the Peninsula, turns among some towards things of the 
other world, among others to the uncertain gains of gambling and 
the lottery. 

This individualism, to a certain extent savage, remains, according 
to the author, the most indisputable characteristic of the race, of which 
the chef-d'ceuvre of Cervantes has synthetised the eternal motives in the 
greedy pragmatism of Sancho and the ascetic idealism of Quixote, “ the 
one taking something from all, the other imposing on all his manner of 
living.” 

The author sees in this state of barbarism, in this national laziness, a 
reserve of latent energies. How are these latent energies to be 
aroused? Not by Europeanisation, not by Africanisation, neither by 
French democratisation, nor by German aristocratisation. The task 
will be to humanise the race by returning to the land. Culture, in the 
literal sense of the word, implies a love for the food-giving territory 
made fertile by man. The rich soil until now is of more value than the 
man who has not known how to make the best of it. But the national 
spirit has also its latent wealth. Here, also, things must be searched 
for at the bottom. It is to the old autochthonous foundation of the 
race, covered by Roman, Visigoth. Germanic, and Arab layers, that the 
appeal must be made. Where is this autochthon to be found ? Without 
doubt in the unchangeable type of the labourer, the servant of the land. 
In him is the possible element of renovation, when he is no longer 
weakened by privations. This element may also be found in the 
children, for they are nearer to Nature ; in them atavisms are more 
powerful, and they are less under the sway of exotic influences. 
Here the idea of regeneration by education appears. The author seems 
to think that even history, on condition that it is not only a museum of 
dead biography, but a storehouse of latent life, might be used as a 
means of teaching Spain to recognise the better traits of her true 
personality. 

But the regeneration of the country does not only signify the passing 
from a warlike and ecclesiastic regime to an industrial regime. The idea 
is combined in the thought of the author with that of a return to Nature, 
and even a return to the origins of things, that being understood in the 
sense of a preponderance of young elements. 

Spain must elaborate, according to her hedonism and idealism, a 
doctrine of humanity which will aid her in fulfilling her destiny. For 
such an evolution even her eccentric geographical position is favourable 
—a position “ at the point of convergence of the mental and economic 
currents which connect Europe, Africa, and the New World.” 

J. Barfield Adams. 


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134 EPITOME. [Jan., 

A Man, Supposed to be Possessed of an Evil Eye, Murdered to Free a 
Family from his Malignant Influence \Il “Jettatorc ” massacrato 
per liberare la famiglia\ (Archivio di Antropologia Criminate, 
Psichiatria e Medicina Legale, February, 1916). 

Superstition dies hard. The notion that an individual can be 
endowed with the power of injuring another merely by looking at him 
still lingers in the mental lumber-rooms of many people. I have even 
detected the idea in the ill-natured gossip—an excellent pabulum for 
the cultivation of such germs—of persons who had received more than 
a smattering of education. When fear, with its well known disturbing 
influence on the logical processes of the mind, has so taken possession 
of men and women, who believe in such a superstition, that they are 
the victims of terrifying hallucinations, one cannot be surprised at a 
tragic ending to the drama in which they play their parts. This is 
illustrated by the facts which were revealed in a criminal trial in Italy 
last year. 

Toso Giuseppe, tet. 38, a day labourer, had been allowed by the 
farmer to sleep in the hayloft of a dairy farm in Magliano-Alfieri for 
about two years. One afternoon, Signora Riva, the farmer’s wife, uneasy 
at not seeing Toso at his usual work, went to search for him in the 
hayloft, access to which was obtained from the courtyard by means of 
a ladder. She found the labourer dead, lying stretched out in a normal 
position in the place where lie usually slept. A rapid examination of 
the body made by Signora Riva and some persons who had come in 
answer to her cries of alarm, showed that the straw around was soaked 
with blood which had flowed from wounds inflicted by some sharp 
instrument. At the autopsy it was found that there were six wounds 
in the region of the left clavicle and on both sides of the neck, the 
deepest of which had severed the jugular vein, the carotid, and the 
vagus, and had caused the htemorrhage which was the immediate and 
only cause of death. 

The next day the carabinieri arrested Coscia Virginio di Battista, on 
suspicion of having committed the murder. Coscia was a peasant, 
set. 43, born at Castagnito Alba, and living at Magliano-Alfieri. He 
was married, and was the father of six children, and for some time he 
had gone about lamenting the malignant and occult influence which Toso 
exercised on the health and interests of his family. For this reason he 
had conceived a strong resentment against Toso, which he had given 
vent to with great lamentations before the mayor and the rector of the 
place. 

Coscia is fact confessed that he had killed Toso in order to liberate 
his wife and family from the malignant arts of the “ jettatore.” 

“ I was convinced,” declared Coscia in his examination, “and I am 
so still, that Toso exercised a malignant influence on my family ever 
since the day when he met and spoke to my daughter, Maria. We 
had no longer any peace in the house. All, except my eldest son, 
Battista, complained of the frightful visions with which they were 
terrified.” 

The examining authorities insisted on the probability of an accom¬ 
plice, particularly when they observed that at merely hearing the name 
of Toso, Coscia’s wife gave signs of strange hallucinations 


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“ The crime was committed by me alone,” insisted Coscia. “ No one 
lent me aid or assistance. I was induced by no one to kill the wicked 
man. My wife, although she has often lamented with me the baneful 
influence which Toso exercised upon our family, which since last Easter 
has lived in a frightful condition, never suggested that I should injure 
him. On the contrary, if she had known that I could allow myself to 
commit any acts of violence, she would have dissuaded me.” 

However, Coscia sought to lessen his own responsibility by asserting 
that he had killed Toso in self-defence. 

“ I had gone to the hayloft,” he said, “ to conjure him to have pity 
on us, and to spare us from his malignant influence. He advanced on 
me, and seized me by the neck. Then, with a reaping-hook, with 
which I was armed, I defended myself. I wounded him in order to set 
myself free. Afterwards, ignorant of the consequences of the blow. I 
descended from the hayloft, returned to my house, and without washing 
the reaping-hook I hung it up on the usual nail.” 

But this version of the affair—^he aggression on the part of Toso, and 
the defence on the part of Coscia—appeared unlikely when one con¬ 
sidered that the body lay in a position of repose in the accustomed 
sleeping-place, and that the nature of the wounds, which seemed to 
have been produced by firm and decided blows, indicated a deter¬ 
mined resolution. 

To complete the moral picture of Coscia—a man who had always 
conducted himself well, and had never before been in trouble with the 
police—and that of his wife, who had a preponderating influence over 
the diseased imagination of her husband, it will not be useless to 
observe that they had both gone with their daughter to the Rector of 
Canale to obtain a blessing to conjure away the malignant influence of 
Toso. Also, when once a sensible priest refused to reinforce Coscia’s 
superstition by a new benediction, the latter went to complain angrily 
to the Bishop of Alba, and begged him to recall the reluctant ecclesiastic 
to his duty. 

As to Toso, he was generally described as an amiable man, who con¬ 
ducted himself quietly, and was absolutely averse to malignant practices, 
of which, besides, he would never have been able to see the object, and 
which existed only in the fancy of ignorant people, who were obsessed 
by an unjustifiable terror. 

“Once,” said Coscia, “he touched the arm of one of my children, 
and immediately the arm became diseased. The doctors could not 
understand the case. I carried the child to the seventh son of a seventh 
son, who said that it was a disease caused by a sorcerer. Another 
time Toso frightened another of my children, who could not raise its 
arm when it returned to the house. I took it to be blessed by a 
priest, and this time the malignant influence ceased. I went to the 
Mayor and to other persons in authority, but they could do nothing 
to reduce this man to impotence, and my house became a perfect 
hell.” 

“ Why,” asked the President, “ did Toso persecute you ? ” 

“ I don’t know, and I never knew,” replied Coscia. “ But of six 
children, he looked on four of them and ruined them.” 

And Coscia continued to narrate how it was the holy Sabbath when 


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[Jan, 


Toso touched the arm of the child Maria, and that then the ‘ jtitatura ’ 
entered into her. 

“ All my other children were in a state of terror,” he continued. 
“They always saw before them the figure of Toso in the act of catching 
hold of them. On the 3rd of January last, I found my wife and children 
at home all complaining of the terrifying visions of Toso—visions which 
they could not drive away, and then I decided to put a stop with the 
reaping-hook to this malignant influence. In the dead of night I 
went to the hayloft, where the ‘ jettatore ’ was sleeping, and I killed 
him.” 

“ Is it true what you said in your previous evidence,” asked the Presi¬ 
dent, “ that Toso had caught hold of you, and wished to throw you 
down from the hayloft ? ” 

“ I don’t know. I had lost my head,” replied the prisoner, without 
any longer insisting on the hypothesis of provocation. 

But he insisted energetically in his declaration of having committed 
the crime alone, without the aid of his wife or of anyone else, and 
without any light. The latter circumstance, however, experiment 
clearly showed to have been impossible, because Coscia could not have 
found his way in the dark hayloft to the corner where his victim was 
sleeping, neither could he have avoided a trap-door, which he did not 
know was open. 

Several witnesses deposed that Coscia was in the habit of uttering 
words of vague menace against someone, but that he had never been 
known to injure even the hair of anyone. 

A grave digger deposed that having blamed Toso one day for digging 
a grave badly, the ‘ jettatore ’ told him to be careful, because he would 
meet with a misfortune, and when the grave-digger returned home, he 
found his daughter almost blind. 

“ Now that the sorcerer is dead, all will feel themselves safe,” con¬ 
cluded the grave-digger. 

The wife of Coscia was convinced that if Toso had not died, every¬ 
thing would have gone to ruin under his influence; now, on the other 
hand, everything went well, nothing was broken, and nobody was ill. 

The trial closed with a characteristic declaration by the prisoner. 

“ What do you say about it ? ” asked the President. “ Does every¬ 
thing go better in your house now ? ” 

“ Yes, I prefer my life now to what it was last year,” replied Coscia. 
And he went away in the custody of the carabinieri. 

J. Barfield Adams. 


6. Historical. 

Philosophical Culture in Theocratic Spain. \La Cultura Filosofica en la 
Espaha Teocratica ]. (Revista de Filosoja, July , 1916.) Dr. Josl 
Ingenieros. 

The expulsion of the Moors has been the cause commonly assigned 
for the mental decadence of Spain during the succeeding centuries. 
Possibly too much importance has been attached to this event. For 
many years before their expulsion from the Peninsula the Moors them¬ 
selves were in a state of decadence. Politically they were in a state of 


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anarchy. The brave days of Abd-er-Rahman III and those of Almanxor 
were but memories of the past. The golden age of the Schools of 
Cordova had closed. The architects, who had built unrivalled mosques 
and palaces, and the gardeners, who had laid out paradise and pleasance, 
had passed away, and their cunning had died with them. And what 
was more, the West could no longer borrow from the East the oil to 
feed the dying lamp of knowledge. Learning was expiring in Egypt, 
in Damascus, and in Baghdad. Persia produced no new Abu Ali Ibn 
Sina. A veritable blight had fallen upon Islam. 

Still, the Moors were not utterly exhausted, and there were yet 
possibilities in a nation which had produced thinkers like Averroes and 
Mainidnides, surgeons like Albucasis and Avenzoar, and builders like 
those who reared Es-Zahra and the Alhambra. The wholesale expulsion 
of such a people must have impoverished the country. 

With this modified opinion Dr. Ingenieros appears to agree. The 
violent expulsion of the Arab and Jewish populations, h*e says, had a 
good deal to do with the material and cultural ruin of Spain. But he 
points out other and possibly greater causes. Among the minor sinister 
influences were the hegemony of Castile, with the consequent suppression 
of the healthy rivalry between the different peoples of the Peninsula— 
the ethnology of Spain is much more complicated than is generally 
supposed ; the decay of the ancient universities, though here the 
expulsion of the Arabs and Jews played its part, for the population of 
these university cities had been largely Arab and Jew ; the “ invention ” 
Of Madrid, a city without memories or traditions. But the cause of 
the mental decadence of Spain, which in Dr. Ingenieros’ opinion 
eclipsed all others, was the restriction of philosophical culture to 
theology and its handmaiden, Scholasticism. There is no exaggeration, 
he says, in the words of Emilio Castelar, that “ Spain committed suicide 
to save Catholicism.” Dr. Ingenieros does not touch upon the point, 
but there would seem to be something in the air or soil of Spain which 
is favourable to the growth of orthodoxy. In the palmy days of the 
Caliphate of Cordova the Andalusians were the most orthodox of 
Mohammedans, as in later years the Spaniards were the most orthodox 
of Catholics. . ' 

It is a long story that the learned author of this article has to tell of 
the struggles which went on for three centuries between theology, 
always victorious, and humanistic science, always suppressed. At first 
free thought or rather free enquiry, the child of the Renaissance, which 
flourished in the rest of Europe, though not welcomed, was not 
absolutely refused an entrance into Spain, for Charles V possessed a 
more liberal mind than his successors. .The doctrines of Erasmus 
filtered into the Peninsula, and it looked for the moment as though 
brighter days were dawning for philosophy. But with the death of 
the Emperor, and the accession of his gloomy-minded son, Philip II, a 
reaction commenced, and a darkness like that of the Middle Ages 
closed over the country. But, if I may be pardoned for slightly 
altering the metaphor, this midnight sky was not wanting in stars of 
every magnitude. Dr. Ingenieros’ paper is laden with names of writers, 
some of whom would have been no disgrace to the most intellectual 
nation. Two of these names stand out in bold relief; they are those 


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[Jan., 


of Francisco Suarez and Luis Vives, the protagonists of the Spanish 
struggle between Scholasticism and Free Enquiry. 

Francisco Suarez (1548-1617) was born at Granada, and studied 
at Salamanca. From the time that he entered the Society of the 
Jesuits, he cultivated theology and philosophy. He taught in Segovia, 
Salamanca, and other centres of Spanish learning, and also in Rome. 
He died at Lisbon. He consecrated his whole life to study, and was 
a man of immense erudition, being familiar with the writings of the 
Greek, Alexandrian, and Arab philosophers, and particularly with those 
of the great doctors of Scholasticism. He was the greatest theologian 
of the Jesuit Order. But it is not only as a theologian that one must 
regard Sudrez. He was also a philosopher. “There is no room for 
doubting,” says Dr. Ingenieros, “ the systematic value of his philos¬ 
ophical work, or the considerable influence exercised by it on Catholic 
metaphysics.” Heerebord calls him the “Popeof metaphysicians.” His 
great work, Disputationes Metaphysical , has been regarded as the 
breviary of Tomist Scholasticism during three centuries. 

Luis Vives (1491-1540) represents the antithesis of Suarez in Spanish 
philosophical culture during the sixteenth century. Vives, who was 
descended from a French family long settled in Catalonia, was born at 
Valencia. At first he studied in his native city, but under such 
second-rate masters that he determined to seek better instructors in 
Europe, and he hastened to put this determination into execution after 
having been present at certain Autos de Fe where women were burnt 
alive. In 1509 he arrived in Paris, where he.studied for three years. 
His studies at the great French university being finished, he did not 
venture to return to Spain, where the Inquisition was busy suppressing 
all original and scientific thought. He proceeded to Bruges. In 1516 
he made the acquaintance of Erasmus. The friendship of the two 
men grew apace, and “ the master of Rotterdam could never have met 
with a better disciple.” In 1519 Luis Vives was nominated to a pro¬ 
fessorship in a college attached to the University of Louvain, then much 
frequented by illustrious followers of Erasmus, and from that time 
he identified himself definitely with the Humanistic movement. In 
1523 he taught in Oxford. Later he returned to Bruges, where 
he died. 

The Valencian doctor shares with Erasmus the glory of the human¬ 
istic movement in philosophy. Of the many books which he wrote, 
some of which figured in the Index of the Holy Office soon after they 
were published, De Anima et Vita is the most interesting. It was a pro¬ 
found, original, and scientific work, and exercised a well-deserved influ¬ 
ence on human thought during the sixteenth and seventeenth centuries. 
In place of studying like the schoolmen the essence of the soul, Vives 
applied himself to studying the manifestations of psychical life from a 
point of view purely empiric and functional. He considered the 
manifestations of the soul as a result of organic life, and the superior 
psychical functions appeared to him to depend on inferior biological 
functions. He assigned to the cerebrum the function of knowing, 
although at his time one could not have had a very clear idea of the 
structure and physiology of the brain. Lange considers Luis Vives 
to have been the precursor of modern empiric psychologists. De Anima 


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139 


et Vita preserves even in our day an actual value, though it may be 
purely historic. 

One of the most singular and atypical figures of Spanish Protestantism 
was Miguel Servet (Servetus). He was born at Villaneuve, in Aragon, 
in 1509, and died at Geneva in 1553, being burnt alive by the orders 
of Calvin, who thus imitated the Holy Office in the name of the new 
Protestant fanaticism, and proved that persecution and bigotry are 
not the prerogatives of any particular religious sect. Miguel Servet 
was learned both in medical science and in theology, which he studied 
at Toulouse. He shares with Harvey the honour of having dis¬ 
covered the circulation of the blood. No other Spanish Protestant 
equalled him in profundity of thought. He held that ideas are the 
only intermediaries between the Divinity and the perceptible world, 
and neoplatonic influences may be traced even in his theological 
writings. 

The empiric psychology, which characterised the De Anivia tt Vita of 
Luis, Vives, reappeared in the work of the celebrated physician, Juan 
Huarte de San Juan, entitled Examtn de Ingenios para la Sciencias. He 
renewed the idea of the physiological and cerebral base of the under¬ 
standing. He considered temperament as the base of character, deduc¬ 
ing from that the inequality of human genius with relation to the 
different kinds of intellectual culture. He examined the influences of 
the organism on the temperament, and those of the environment on the 
individual character. His conclusions have especially a practical and 
pedagogic.value; he considered that the mental characteristics of indi¬ 
viduals should be recognised early, in order that each should dedicate 
himself to the studies most conformed to his natural bent. He classi¬ 
fied the sciences in accordance with the mental faculties which are 
required to cultivate them; sciences of memory, sciences of under¬ 
standing, and sciences of imagination. Francis Bacon repeats this 
classification, and it is very probable that he was acquainted with 
Huarte’s book, which was widely circulated. Huarte’s work has been 
compared with Les Caracteres of La Bruyfere, but though it lacks the 
descriptive and worldly interest of the latter, it surpasses it in scientific 
fundamentals. 

In 1554, the physician, Gomez Pereira, published his Antoniana 
Margarita. Among other questions he treats of the souls of men and 
animals: he distinguishes the sensitive from the intellectual soul, 
subordinating the one to the other. He denies understanding to 
animals, although without considering them as machines, as Descartes 
does. Unfortunately, in many parts of his work one cannot appre¬ 
ciate his opinions on account of the mistaken nomenclature which he 
employs. 

Gradually the Spanish mental renaissance was stifled by the Inquisi¬ 
tion. Humanistic philosophers were forced to be silent or to emigrate. 
Scholasticism reigned supreme in the world of intellect. “ The fatal 
mania of thought was cured in Spain, and not a single sporadic case 
occurred before the middle of the eighteenth century.” This does not 
mean that during all this time there were no illustrious geniuses and 
profound thinkers in the Peninsula. The earlier part of this period was 
the golden age of Spanish literature, which Lope de Vega, Cervantes, 


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EPITOME. 


[Jan., 


and Calderon raised to the highest point of fame. But the Inquisition 
prevented writers from cultivating lofty didactic and speculative thought, 
and turned their intellectual activities to work which was purely literary. 
If during those long years philosophy survived in Spain it is necessary 
to seek it on the stage and in the novel, where one finds faithful 
pictures of the contemporary mind. The social condition of the people 
is also admirably painted in the Spanish novel with its roguish humour, 
which Dr. Ingenieros looks upon as the most original creation of the 
intellect of the Peninsula. 

In the middle of the seventeenth century, mysticism found expression 
in the Guia Espiritual of Miguel de Molinos, in which is revealed a 
doctrine of the annihilation of the passions and of the will which 
resembles that of the Nirvana of the Buddhists. 

Omitting that of Molinos, only three other names raise themselves 
above the dull mediocrity of the seventeenth century. They are those 
of the learned Quevedo, the prudent Saavedra Fajardo, and the cautious 
moralist, Gracian. 

The intellectual twilight of the Peninsula was already darkening into 
night at the death of Carlos II. Scholasticism, growing feeble in the 
seventeenth century, became even more weak, if it were possible, in the 
eighteenth. The Catholic dictatorship stifled the thought even of the 
theologians themselves. Then, until the reign of Carlos III, the shadow 
of night grew deeper, and theocratic Spain sank into a profound sleep. 

J. Barfield Adams. 

The Revival of Spanish Philosophical Culture [La Renovacion de la 
Cultura Filosofica Espahola ]. (Revista de Filosofia,/uly, 1916.) 

Dr. Josi Ingenieros. 

In his second article Dr. Ingenieros takes up the story of Spanish 
thought from the reign of Carlos III, and carries it on to the present 
day. 

During the latter half of the eighteenth century the influence of the 
French Encyclopaedists made itself felt in Spain. In the reign of 
Carlos Ilia group of writers appeared, which was called the Aragonese 
party—the antithesis of the Castilian—some of the more conspicuous 
members of which were considered to be so much under the influence 
of French ideas that they earned for themselves the epithet of “ Ajran- 
cesados.” Letters and science awoke. For the moment it seemed as 
though another golden age of literature were about to dawn. “ A Vives 
only was wanted,” says the writer, “an Encyclopaedic Vives, more 
modern, more Spanish than the other, who would live, teach, and write 
in Spain and for the Spaniards.” 

Some of these writers turned to sociology, others to political economy 
and other sciences. Among their names are a few of more than passing 
interest, such as Mayans y Ciscar, the ethnologist, Masdeu, the 
historian, and Hervas y Panduro, the illustrious philologist. 

But the commencement of the reign of Carlos IV (1788-1808) was 
the signal for a new decadence, and matters were quickly complicated 
by the loss of national liberty and the separation of the American 
Colonies. Further, the wall raised to - prevent the penetration of 


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I4t 


European culture was consolidated by the crisis of 1808-14, and the 
circumstances of the French invasion converted the patriotic cause 
into one which was anti-French and anti-European. 

The Cortes of Cddiz (1812) had abolished the Holy Office, but the 
restoration of Fernando VII (1814) was also the restoration of that 
opprobrious tribunal. Then the Spanish Renaissance died again, and 
was buried by religious fanaticism. The same malignant power, which 
four centuries before had closed the crusades by the expulsion of Arab 
and Jewish civilisation, which later had opposed the Inquisition to the 
awaking of Humanism and Free Enquiry, came again to stop up every 
crevice by which the new lights of the continuators of the Encyclo¬ 
paedia—the ideologists—might have entered from France. 

This reactionary system was prolonged, with slight oscillations, during 
the regency of Maria Cristina, during the reign of Isabel II, and only 
came to an end with the revolution of 1866 which expelled the last- 
named monarch. 

One can easily understand that under such conditions no philosophy 
could flourish in the Peninsula. However, in spite of the Scholasticism 
and erudite traditionalism, which monopolised the seats of learning, 
various currents of modern thought made their appearance. Openly 
scientific and naturalistic in character, they looked for the moral and 
intellectual regeneration of Spain by means of the introduction of 
foreign doctrines. After 1850 these partisans of modern thought showed 
signs of greater activity. They undertook numerous translations of 
Descartes, Kant, Leibnitz, Hegel, and above all of Krause. This last- 
named author, who occupies a secondary rank among the philosophers 
of his own country and of his century, took a high position in Spain. 
This he owed not to the intrinsic value of his doctrines, but to the 
ethico-politico-pedagogic sense that they acquired in the hands of his 
Spanish disciples. These, apostles rather than philosophers, thought 
they could best accomplish the social regeneration of Spain by the 
diffusion of public instruction and severe ethical precepts which should 
bridle the abuses of political and religious power. 

Gradually other manifestations of Positivist liberalism, successively 
represented by Comte in France, Spencer in England, Ardigo in Italy, 
and Ostwald in Germany made themselves felt in the Peninsula. 

One of the most interesting parts of Dr. Ingenieros’ paper is that 
which he devotes to the consideration of the revival of philosophical 
studies in Catalonia. During the nineteenth century and at the present 
day various Catalan writers have conquered and are conquering a firm 
position for themselves in the domain ot renaissant philosophy. Posi¬ 
tivism finds itself represented by Gener, biological pragmatism by 
D’Ors, biological nietzscheism by Ruix, psychological biology by Tun 6 , 
and physical naturalism by Comas Sola. 'They may differ among them¬ 
selves on many points, but all agree in considering scientific culture as 
the necessary foundation of philosophical speculation. This appears 
to be the best augury for the future development of philosophical 
studies in Catalonia. The traditional theological current of thought, 
notwithstanding the renown of the great Catalan Scholastic, Jaime 
Balmes, has less signification in this province than in the rest of 
Spain. 


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[Jan-, 

One of the Catalan writers mentioned above, R. Turrd, of the 
Municipal Laboratory of Barcelona, has recently (1914) published a 
volume on the origins of knowledge, Los Origines del Conocimiento , in 
which he studies the natural formation of knowledge in accordance 
with the principles of biological psychology. In the course of nutritive 
assimilation, he says, the organism acquires a “trophic experience,” 
which is the point of departure of “ sensorial experience,” the base of 
knowledge and of human logic. On the subject of which it treats, 
says Dr. Ingenieros, “there is no work in modern Spanish literature 
which can compare with Turro’s : even in European philosophical 
literature his work deserves to rank with the most systematic produc¬ 
tions on account of its rigorous and excellent method. One com¬ 
prehends without difficulty that the author has commenced the study 
of philosophy only after a severe discipline acquired during many years 
spent in laboratory work, and one observes in his book the benefits of 
this fundamental advantage.” 

In the particular domain of aesthetics the works of Prof. Jose Jordan 
de Urries deserve to be mentioned. In these works he treats of experi¬ 
mental aesthetics, converting into a psychological science what was 
before only a speculative study. 

The revival of science in Catalonia has nowhere produced more 
brilliant results than in the work of the faculty of medicine of the 
University of Barcelona. In connection with this school, one may 
mention the work of the celebrated bacteriologist, Jaime Ferran, the 
labours of the hygienist, R. Rodriguez Mendez, the physiological studies 
of Augusto Pi Suiier, and the publications on histology and neurology 
of Prof. Carlos Calleja. 

Mental pathology, abandoned in Spain by official education, shines in 
Catalonia with greater brilliancy than in any other region of the Penin¬ 
sula. The admirable Instituto Pedro Mala of Reus immortalises the 
name of the true creator of Spanish mental pathology. It is directed 
by the eminent Prof. K. Rodriguez Mendez and the illustrious alienist, 
Arturo Galceran Granes, who is the president of La Sociedad de 
Psiquidtna y Neurologia of Barcelona. 

After Pedro Mata there are two Catalans who are the most conspicu¬ 
ous representatives of the classical struggle between the old super¬ 
stitious psychiatry and the new scientific psychiatry. Madness, con¬ 
sidered as a malignant possession of the soul by mysterious, invisible 
influences, came little by little to be looked upon as a functional disturb¬ 
ance ol the cerebrum, which pathological anatomy leads us to under¬ 
stand better and better every day. These two currents of thought were 
represented in the revival of Catalan culture by Pi y Molist, the admir¬ 
able student of Cervantes, who analysed the beauties ot Don Quixote, 
and by Gine y Partagas, whose learned works and lectures introduced 
modern scientific criticism into mental pathology. For the first, accord¬ 
ing to his beliefs, madness was a total or partial disintegration of the 
soul ; for the second, according to his experience, mental diseases 
depended upon structural and chemical alterations of the cerebrum. In 
the last years, the laboratory and clinical experience have pronounced 
for Gin6 y Partagas, preparing thus a naturalistic conception of the 
functions of the mind. To-day, all psychologists take the facts of 


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biology as the foundation of their studies. Philosophers, who do not 
ignore science, affirm that biological psychology is the axis of morality, 
logic, and aesthetics, studies which were formerly looked upon as 
branches of speculative philosophy. 

The key-note of Dr. Ingenieros’former paper was despair; that of 
this one is hope. “ The last generation of the nineteenth century,” he 
says, “ witnessed the desastre of 1896, and the end of the colonial power 
of Spain. This crisis gave rise to a particular sociological literature, 
the orientation of which was European and antitraditional. Books 
appeared, different in origin and in critical value, which gave hope of a 
renovation of Spanish ethics, opposing the virtues of work and the dic¬ 
tates of the sciences to the two traditional cankers of the Spanish 
character—laziness and routine. These, and these only, have caused 
the poverty and ignorance of Spain.” 

It will be observed that the writer’s conclusions are not very different 
from those of Eloy Luis Andre, a notice of whose work Etica Espaiiola, 
appears in this number of the Journal. 

Dr. Ingenieros concludes his paper thus: “At the same time that 
civilisation suppressed the conditions that give rise to the roguish novel, 
Spanish culture separated itself from theological scholasticism and 
approximated itself to the natural sciences. This evolution, slow but 
inevitable, permits one to hope that Spain will rise to the philosophical 
level of the other countries of Europe; and that in time she will think 
again in the thought of the world, with her own strength and accents, as 
in the centuries of Isidoro, Averroes, Maimonides, and Lulio.” 

J. Barfield Adams. 


Part IV—Notes and News. 


THE MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREAT BRITAIN 

AND IRELAND. 

The Ordinary Quarterly Meeting of the Association was held at the Medical 
Society’s Rooms, Chandos Street, London, W., on Tuesday, November 21st, 1916, 
Licut.-Colonel David G. Thomson, M.D., President, in the chair. 

There were present: Sir G. H. Savage, M.D., and Drs. T. S. Adair, R. 
Armstrong-Jones, H. S. Aveline, D. Bower. J. Chambers, R. H. Cole, M. Craig, 
T. Drapes, T. Duff, J. H. Earls, C. F. Fothergill, H. E. Haynes,T. B. Hyslop, 
C. F. McDowall, H. J. Mackenzie, A. Miller, W. T. Nelis, H. Hayes Newington, 
J. G. Porter Phillips, D. F. Rambaut, J. N. Sergeant, G. E. Shuttleworth, R. P. 
Smith, J. G. Soutar, T. E. K. Stansfield, J. Stewart, R. C. Stewart, W. R. Watson, 
H. Wolseley-Lewis, and R H. Steen (Acting Hon. General Secretary). 

Present at the Council Meeting : Lieut.-Colonel D. G. Thomson, M.D. (Presi¬ 
dent), in the chair, Drs. T. S. Adair, R. Armstrong-Jones, James Chambers, 
R. H. Cole, T. Drapes, H. J. Mackenzie, A. A. Miller, H. H. Newington, J. G. 
Porter Phillips, J. N. Sergeant, G. E. Shuttleworth, J. G. Soutar, T. E. K. Stans¬ 
field, T. S. Tuke, H. Wolseley-Lewis, and R. H. Steen (Acting Hon. General 
Secretary). 

The following sent communications expressing regret at their inability to be 
present: Drs. G. D. McRae, C. C. Easterbrook, Bedford Pierce, John Mills, 
J. R. Gilmour, G. E Peachell, P. W. MacDonald, Capt. G. W. James, R. B. 
Campbell, Lieut.-Col. Keay, G. N. Bartlett, Norman Lavers, James M. Rutherford, 
H. Devine, and F. R. P. Taylor. 

The Pbesident said the first business of the meeting was to deal with the 


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minutes of'the May meeting. As these had already been published in the Journal 
for July, he presumed that members would be willing to take them as read. 

Agreed. 

The President said that before proceeding to the agenda paper, he wished to 
ask those present to pass a vote of condolence with the mother and other relatives 
of a distinguished member of the specialty who had just died. He alluded to 
Dr. Ralph Brown, M.D., Lond., B.S., etc. Members might have noted an obituary 
notice concerning him in the British Medical Journal of a week or two ago. 
Though young, he had had a distinguished career. He was Assistant-Physician at 
Bethlem and Bridewell Hospitals, and his qualities were well borne testimony 
to in Dr. Porter Phillips’ memoir to which he had just alluded. Dr. Brown 
was about to obtain a commission in the R.A.M.C., but he was attacked with 
typhoid fever, and had the disease so severely that he succumbed to it. Pie was 
sure the deceased’s relatives would appreciate a vote of condolence from the 
Association. 

The resolution was accepted by members rising in their places. 

With regard to the business arising from tne previous Council meeting, he 
wished to say that the interests of the Association were being closely watched by 
the Council, particularly in regard to a Bill for the State Registration of Nurses, 
for which a Special Committee had been appointed. 

Another matter which had been receiving the attention of the Council, through 
a separate Sub-Committee, was the question of the formation of over-seas 
branches of the Association. The senior members of the Association would 
remember that this subject was taken up very strongly as far back as 1891, but, 
for various reasons, it never materialised. It was now being taken up again. 
There were certain difficulties arising in the Colonies with regard to the examina¬ 
tion of mental nurses, and other matters, which would be very much facilitated by 
the formation of such brandhes.as also would the main interests of the specialty 
and the Association. The Secretary, Dr. Steen, desired him to say he would be 
glad to know the names of any Colonial members who were likely to be interested 
in the matter. 

The ballot was then taken for the election of Oswald Henry Vevers, M.R.C.S., 
L.R.C.P., late Junior Assistant Medical Officer, Nottingham City Asylum, Norton 
Vicarage, Worcester. 

The President nominated Dr. Haynes and Dr. Mackenzie as scrutineers. 

Dr. Vevers was duly elected. 

Paper. 

“ Functional Gastric Disturbance in the Soldier," by Colin McDowall, M.D., 
Capt., R.A.M.C. (Temporary).—(See p. 76). 

Dr. R. H. Steen expressed his appreciation of the paper, and said he hoped 
others would follow him in a discussion upon it. He would not like Captain 
McDowall to go away without knowing how much his contribution was valued. 
He had put excellent work into it, and its preparation must have occupied a 
great amount of time. 

What at once struck one about the cases described was the presence of here¬ 
ditary predisposition. Practically all the cases had a relative who had been 
in an asylum or who had suffered from nervous disease. Another thought which 
came to nim while listening to the paper was, that in reading psycho-pathology 
one was as a rule given very few actual cases, but treated to a-vast amount 
of pyschology. But with regard to the paper just read one could congratulate the 
author on presenting plenty of clinical material fuliy described. 

With regard to the emotions, these exerted a very strong influence on bodily con¬ 
ditions. This was specially shown in the book which Cannon had written, in which 
he paid special attention to the influence of the emotions on the stomach, intestines, 
and adrenal glands. One could easily understand an emotional event causing sick¬ 
ness. With regard to the patients who were sick after hearing distressing news he, 
Dr. Steen, could understand vomiting following these emotional incidents, but he 
would like to ascertain the views of the author as to why the vomiting persisted 
for days and weeks. The author made use of the term “ repressed emotions,’’ 
and lie would feel obliged if, in his reply, Captain McDowall would explain further 
what he meant by it. He presumed he meant emotions which had not had their 


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ordinary outlet. Therefore he supposed the theory of the treatment would be 
that if one talked to the patient, and discussed with him the whole situation, 
encouraging the telling of the whole story, this resulted in the repressed emotions 
having at least a partial outlet. One knew how, in ordinary life, if one had a 
secret trouble, or something which was causing anxiety, it was a great relief to be 
able to tell someone else about it. And he would like to know from Dr. 
McDowall exactly what he did in those cases ; did he take the patient in a room 
by himself, or was somebody else present P Also, what was the actual method of 
procedure, and how did he start P Did the author first obtain the history, and 
then ask the patient for his confidence ? He certainly would like to congratu¬ 
late Dr. McDowall on his excellent results, for practically all the cases had 
made good recoveries. 

Dr. Robert Armstrong-Jones wished to congratulate Dr. McDowall on his 
paper, as he also certainly congratulated Dr. Steen on his remarks in opening the 
discussion; these were extremely practical and to the point. 

He thought that if the author had done one thing in this contribution, he had 
supported William James' theory that in such cases as were narrated the emotion 
was not the cause of the vomiting, but the vomiting produced the emotion ; and 
in the illustrative cases, when the vomiting ceased, the emotion appeared to have 
passed away. Some said we were emotional because we cried: others that we 
cried because we were emotional. There certainly seemed much to be said in 
favour of the ideas of William James. 

He would be glad to hear from Captain McDowall whether his patients had any 
elevation of temperature at about the period of vomiting, as that was a very 
important factor. At a military hospital, where he attended several times a week, 
he had seen many cases of shell-shock. On the previous day he saw one in the 
person of a South African, who had a neurotic history, and was troubled with the 
same kind of vomiting as the cases under discussion. Associated with the vomiting 
was a frequent elevation of temperature, which, in one instance, went up to 
iot° F. 

While he was a dresser at St. Bartholomew’s Hospital, he remembered Sir 
Anthony Bowlby experimenting with some of the children there in reference to 
the emotion of fear. For instance, he took the temperature of a child just before 
an arm or a leg wound was dressed, and in nearly all of them he found the 
temperature was elevated one or two degrees. 

What he had very frequently noticed in neurasthenics was the exercise of the 
imitative faculty. One of the most frequent results of neurasthenia in soldiers 
appeared to be a tremor of some kind—a jerky or rapid tremor ; and it was fatat 
for their recovery to send them to wards in which were patients subject to con¬ 
vulsions, because they would copy them. 

He would like to know how Captain McDowall acted with regard to his cases 
eventually. Were they fit for service again, or not? That was the question 
most often put to him—could such and such men be sent back again ? A typical 
case was the following: A boy, a Canadian, had shell-shock, following which he 
was aphonic for three weeks. He regained his voice, and was sent back to the 
Front on September 30th. On October 2nd he was again suffering from 
shell-shock and aphonia, and he was again in a military hospital. These 
seemed to be feeble people to send back again, and it was desirable that som<> 
conclusions should be arrived at as to what to do with them. When once a 
man had had real shell-shock, he seemed to be poor material to send to the Front 
again. He could quote many more cases, but he would be content with expressing 
his appreciation of the contribution and Dr. Steen's comments. 

Dr. J. Noel Sergeant said the question of the relation of shock to gastro¬ 
intestinal disturbance interested him very much, because he had always been 
susceptible to the latter. When, in his younger days, he played football, he 
always had to visit the lavatory before a match, and he related an incident in 
British Columbia in which he underwent a thrilling experience, with a similar 
sequel. Even addressing an assembly produced warning qualms. He could* 
therefore, readily believe that the more serious forms of shocks could cause 
gastro-intestinal disturbance, and that it might become chronic. The disturbance 
was probably due to the fact that instead of the patient realising that the vomiting 
was due to the shock, he, in many instances, attributed it to something else, such 

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as grave organic disease or derangement. It was quite dear for the uninformed 
to attribute the condition to a mysterious disease of the bowels. Cases of the 
kind described continued to vomit when the cause had been withdrawn because 
they transposed cause and effect, and regarded the vomiting as the disease: it 
really acted as an irritant, and was responsible for the continuance of the vomiting. 
To convince such patients that the vomiting was due to the shock, and that no 
other factors were present, was equivalent to removing the irritant, and this paper 
was of particular interest to him as tending to confirm that interpretation. 

Dr. Fothergill said he also had seen a certain number of soldiers suffering 
from emotional vomiting. He agreed that the proper course was to go fully into 
the history of the case when the patient was first seen, and let him see that an 
interest was being taken in his condition. But when organic disease could clearly 
be eliminated, patients should be stiffly treated in reference to the vomiting. If 
they were declared to be able to take only a milk diet, the plan was to feed straight 
away on full diet, and if that was vomited, have another meal of like dimensions 
ready to be taken in its place. By that course of procedure many of these cases 
were cured of their vomiting at the start. One such man had been for weeks on 
ordinary milk diet, varied with occasional milk-puddings, and he vomited 
persistently when anything else was given him. He was in.the habit of talking a 
good deal about his condition. He, the speaker, put him upon full diet: he 
vomited it, and a second full meal was brought for him. He never vomited again. 
He had done that in a number of neurasthenic cases, and the results were remark¬ 
ably good. One case, that of a lady, had been operated upon by Mr. Rowlands 
for gall-stones. After the operation she persistently vomited whatever was given 
to her. With Mr. Rowlands’ consent, he started her off on full diet. This she 
vomited, and a similar meal was at once given to her. She never vomited after the 
second meal. 

He had never seen a rise of temperature in these people. With regard to the 
condition of patients who had recovered from shell-shock, he did not think they 
were the kind of people to send back into the Army, because the strains and stresses 
incidental thereto would be almost certain to break them down again, in one way 
or another. 

Dr. Drapes said he thought the main point to be elicited from the paper was, 
that all the patients whose cases were described were of the neurotic class, and 
therefore their vomiting should be regarded as of the hysterical order. Civil 
practitioners were, of course, familiar with the occurrence of that phenomenon in 
persons who had never been subjected to shocks in the sense in which they were 
met with in military life, but whose vomiting arose from purely emotional causes 
when there was no organic disease present. Lately he attended a young man who 
had been vomiting, said he had a weak stomach, and was labouring under a strong 
apprehension that he was going to die. He was a robust looking young fellow, 
and when Dr. Drapes first saw him he was lying in bed. Asked what was the 
matter with him, he said he could not eat anything, and he was evidently very 
frightened; in fact, he burst out crying, as in a similar case referred to by Sir 
George Savage in his paper contributed to the annual meeting. The fact was 
found to be that some of the Sinn Fein rioters—of which Enniscorthy was a hot¬ 
bed—threatened to do something to him because he was a loyal man. He had a 
brother in the Army, and the rioters were down upon him for that reason. He 
told the young man that that was now over, and that he should dismiss the idea 
from his mind. He assured him there was nothing whatever the matter with him, 
and that he ought to get up and start at work again. In two or three days he was 
all right, and he was back at work in a week. The giving of good solid meals 
had a good deal of the power of suggestion in it, and would be likely to be effective' 
when the patient was convinced that he was able to take more than a milk diet. 

Dr. Armstrong-Jones had raised the question whether, in these cases, the 
emotion produced the vomiting, or whether the physical symptoms caused the 
emotion. The argument that the vomiting produced the emotion he could not 
feel was sound : it was much more likely to be the other way round. If, what Dr. 
Armstrong-Jones said was true, that the vomiting produced the emotion, the cure 
of the vomiting should have a like effect on the emotion. Dr. McDowall, acting 
on an exactly opposite principle, endeavoured to remove the morbid emotional 
state, and was rewarded by the cure of the vomiting. Probably some members 


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would have read the April number of the Journal, in which was a contribution from 
Dr. Salmon of Florence, in which the author urged the very interesting theory of 
hysteria that it was due to a hyperaesthetic condition of the cenaesthetic centres. 
The cases now related seemed to indicate that that impression was the right one. 
When a vivid impression was made on those centres, such as by the shocks of 
war, they became more easily susceptible, and senstive to stimuli from other parts 
of the brain. This hypersensitiveness might be permanent, and cause many 
hysterical symptoms. This would explain the point raised by Dr. Steen as to the 
persistence of the vomiting after the cause had ceased to operate. The cases quite 
bore out Dr. Salmon's theory, and would make fine material for the psycho¬ 
analyst. Incidentally, also, they showed the value, in neurotic conditions, of a 
good talk. 

The Pkksidf.nt said that before asking Captain McDowall to reply to the 
various remarks he would like to add his tribute to the chorus of thanks, and say 
how interested he was to hear the account of his cases. 

There were one or two points on which he \^ould be glad to receive a little more 
enlightenment, particularly that mentioned by Dr. Armstrong-Jones, as to how, 
when the men recovered from this condition, the medical boards were induced to 
discharge them as unfit for further military service. He, the President, had seen 
many of those cases, though probably not so many as previous speakers had. 
Some 12,000 sick and wounded men had passed through his hospital, yet he could 
count upon the fingers of one hand the cases he had had of neurasthenic or 
hysterical vomiting. There were, of course, many shell-shock cases, and cases of 
outbreaks of acute mental disturbance, but vomiting in those states he had found 
to be very rare. From that chair he mentioned, about six months ago, the case of 
a man who had vomiting of the hysterical type; whenever anything unusual 
occurred in the ward he vomited ; the provocation needed to bring on an attack 
was very small. He assumed that the cases which were seen by Captain McDowell 
were selected cases, those which were sent to his special hospital. (Captain 
McDowall : Yes.) The treatment which the author carried out—interrogation 
and getting at the personal history—revealed an industry and a patience which he 
^id not think was very common. Most were, perhaps, inclined to take such 
measures as Dr. Fothergill referred to, making the patient eat a good meal, and if 
that were vomited, having another ready to be eaten. Both claimed success for 
their methods. Certainly the idea expressed by Dr. Fothergill was much the 
simpler to carry out. 

As an administrative officer, what he was chiefly interested in was how discharge 
was obtained from the Army for the cases when they recovered. 

Captain McDowall, in reply, said that when the patient was talked to and his 
history obtained in the first instance, no one but the patient and himself was 
present in the room. The notes when obtained were locked up, and he never 
discussed the cases with anyone else. The patient was made to understand that 
the notes were not communicated to anyone else. That was a great help. 

They were dealing with all sorts of cases, and it was a method of psycho-analysis 
and common sense. There was no groping for filth; if there was filth in the 
history of the case, it had to be removed. Some element of sex came into every¬ 
body's life, but in these cases, if it did not happen to be in obtrusive evidence, he 
did not look for it nor emphasise it. 

Dr. Armstrong-Jones said the vomiting was the cause of the emotion, but his 
own idea was that the emotion was'the cause of the vomiting. Recently, a little 
girl came running into a drawing-room while he was there —she was expecting her 
father back from the Front—exclaiming “Oh, mother, 1 am going to be sick!” 
There it was clearly a case of emotional disturbance causing the vomiting. 

He had not found a rise of temperature in any of his cases. They were not all 
what would strictly be called shell-shock cases. One or two had never been 
exposed to shell fire. 

He agreed that there was a lot of imitation about thesse cases, though he did not 
think it was intentional. These cases were sent to them after they had become 
more or less chronic; some had been nine or twelve mouths in different hospitals. 

With regard to the question whether such cases w«re fit to return to the Front, 
and the further question how their discharge from the Army was secured, some 
36 per cent, of those discharged during the last two months had been returned to 

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full duty; they were put upon home service for a time, and later were returned to 
the Front. .Many, however, would never be able'to go back to the Front. He 
had not previously had any war experience, but he believed there was no more 
troublesome person to be dealt with than the vomiting hysteric, nor a more trouble¬ 
some person to keep right. The man whom he mentioned as having been dis¬ 
charged from the Army had been sent back to the Front, but a few days later he 
was returned, and went to a provincial hospital, from which he was sent to him, 
the speaker. He vomited four times a day for nearly two years. His case was 
fully discussed, and it was felt that he was only a case for discharge from the 
Army. 

The personal question was an important one; the patients must be dealt with 
as individuals. As to whether some of these men would be any good if sent back, 
certainly they would. They kept touch with their patients when they went out. 
One of them recently received the D.C.M. 

He was able to confirm Dr. Sergeant’s personal experiences from cases he had 
had. A boy recently told him that he always had diarrhoea after a Rugby match. 
Urinating was quite a common concomitant of examinations. 

Dr. Fothergill talked about the need for firmness in these cases. Of course 
there must be firmness of treatment: but if a man were returned to the Front 
simply after having got him to take solid food, he did not think there had been a 
cure, because the cause had not been removed. 

Dr. Drapes’ instance, and the way he dealt with it, showed he was carrying out 
psycho-analysis and common sense, and that was what he himself claimed to do. 


IRISH DIVISION. 

The Autumn Meeting of the Irish Division was held at the Royal College 
of Physicians, Dublin, on Thursday, November 2nd, 1916. 

The following Members were present: Major Dawson, Drs. Drapes, Rainford, 
Mills, J. 0 . C. Donelan, Irwin, H. Eustace, Rutherford, Redington, Leeper (Hon. 
Sec.). 

Dr. Drapes having been moved to the Chair, letters of apology for unavoidable 
absence were read from Dr. Hetherington, Londonderry, and Dr. Nolan, Down¬ 
patrick. Letters were received from the representatives of other members stating 
that they were prevented from attending owing to their military duties. 

Before the business of the Meeting was proceeded with, the Hon. Sec. drew 
the Chairman’s attention to the loss which the Division has sustained since its last 
meeting by the deaths of Dr. Charles Fitzgerald, late President of the College of 
Physjcians, and Dr. Kirwan, Superintendent of Ballinasloe Asylum. Resolutions 
of sympathy with their families were proposed by Dr. Rainsford, seconded by Dr. 
Mills, and passed in silence, the members standing in their places, and the Hon. 
Sec. was directed to forward these resolutions to their respective families. Dr. 
H. Eustace, in the absence of his brother Dr. W. Eustace, who w'as prevented 
from attending by illness, kindly proceeded to introduce the discussion upon 

The General Paralysis of the Insane, with especial Reference to Recent Modes 
of Treating this Disease,” which stood in his brother’s name on the agenda 
paper. 

Ok. Eustace’s Introduction ok Discussion. 

It is with very considerable trepidation that I venture to present a paper in 
accordance with the wording on the agenda, via., " The General Paralysis of the 
Inane, with Especial Reference to Recent Modes of Treating the Disease.” 

My difficulty lies in the fact that 1 have only nursed cases of this disease, and I 
have never had an opportunity to adopt any of the modern lines of treatment by 
the new arsenical compounds, etc. 

However, I have emulated the industrious mole, and by burrowing in the works 
of some savants 1 have raised a trifling mound, which may possibly interest you, 
-and will, 1 hope, produce a discussion^ 

In 1894 Fourier wrote on Les A factions Parasyphilitiques, including locomotor 
-ataxia, dementia paralytica, certain types of epilepsy, and (Osier adds) arterio¬ 
sclerosis. Fournier held that these affections are not exclusively and necessarily 
caused by syphilis, and that they are not influenced by specific treatment. About 


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the same time Drummond boldly stated that all eases of general paralysis of the 
insane and aneurism were due to syphilis; and 1 think it is now almost universally 
admitted that syphilis is a necessary antecedent of general paralysis of the insane. 

Certainly when we meet with a difficult case for diagnosis we become very 
positive when we receive a report from the laboratory to the effect that the blood 
of the previously dubious case gives a positive Wassermann. Moreover, Noguchi 
and others have demonstrated the spirochtete in brains of persons dying of general 
•paralysis of the insane. 

Perhaps the greatest difficulty still exists in determining whether a case is one 
of general paralysis of the insane or cerebellar tumour, as both may give a positive 
Wassermann, and the "titubating gait” may be simulated in general paralysis of 
the insane ; but, of course, if the tumour is in the middle lobe and rapidly growing 
very distinctive, symptoms soon appear. 

Here are some conundrums which have puzzled all of us, and have recently been 
•embodied by Pierce, and 1 wish here to acknowledge my great indebtedness »o 
him for many striking articles in The Medical Annual : 

(1) How is it that careful treatment by mercury during the acutestagcof syphilis 
■does not prevent general paralysis of the insane developing later?” 

The cynic will reply that the administration of Hg. has not been sufficiently 
prolonged in these cases, and that it should be given systematically for a year at 
least. 

(2) " Why are ordinary tertiary symptoms of syphilis rare in general paralysis 
•of the insane ? ” 

We have one case at present under our care, ” E. T—,” who has tertiary skin 
lesions on his scalp and extremities, which lesions appear to improve a little under 
Donovan and Fowler solutions, but they never completely heal up. He is the 
only case of general paralysis of the insane presenting tertiary lesions of syphilis 
that I have seen. 

Marie and [.evaditi were impressed with the number of cases presenting very 
mild primary symptoms of syphilis who afterwards became paralytic, and also by 
the absence of tertiary syphilitic lesions met with in general paralysis of the insane. 
They proceeded to experiment on rabbits and apes. Blood from a general 
paralytic was injected into the scrotum of a rabbit, and in one case cutaneous 
lesions containing spiroch.xtes were produced. The effects of this virus on rabbits 
were compared with those of Truffi’s viius, and the following differences were 
noted : 

(a) The incubation period was longer in rase of the virus of general paralysis 
•of the insane. 

( b ) The lesions were more superficial, scaly, and not indurated. 

(c) The treponema showed a preference for the superficial layers of fhe skin. 
If, says Pierce, " it is demonstrated that the primary lesion is a specific super¬ 
ficial cutaneous lesion it shows that general paralysis may be transmitted by 
contact much more easily than ordinary syphilis, the special organism of which is 
-said to lie in the deeper layer of the skin.” 

If these experiments are confirmed they will clear up many of the problems 
connected with general paralysis, and they naturally raise the question whether 
the treponema of general paralysis is biologically the same as that found in 
syphilis. 

They suggest that general paralysis is due to a special variety of the Treponema 
pallidum possessing special affinity for the nervous system. 

(3) The third conundrum is how to explain "remissions” in general paralysis. 
Mott points out that the multiplication of spirochretes leads to the production of 
toxins which cause the menir.go-encephalitis, and subsequent necrosis of nervous 

-elements. 

No doubt, he says, anti-bodies are produced to which may be attributed the 
remarkable remissions of general paralysis. 

I now approach, " oculis defictis,” the recent modes of treatment of general 
paralysis. 

When salvarsan was first exploited the wife of one of our general paralytics 
■sent me a cutting from a Scotch newspaper headed " Universal Cure for Insanity! *' 
A few days afterwards I received another from the same source with the heading 
-amended to *' Cure for General Paralysis ” I Naturally 1 wrote to the distinguished 


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doctor, whose report had fulminated the brain-pan of the editor of the daily 
newspaper, asking him to kindly give me some details of the successful treatment 
of general paralysis by salvarsan. The following day he replied that he could 
only say “that some cases of general paralysis had appeared to benefit by its 
administration.’* 

He had no reason to thank his editorial friend, and he might well exclaim 
“ Stands Sauchiehall Street where it did ” ! 

As regards treatment, Mott states that neither mercury nor antimony'can pass 
from the blood into thecerebro-spinal fluid, and he doubts whether the introduction 
of salvarsan serum by lumbar puncture will be found of value. 

Erlich himself suggested that the molecule of salvarsan is probably too large to 
pass through endothelial membranes. 

Myerson reports on 7 cases treated by salvarsanised serum. In 4 cases there 
was some clinical improvement. In the remaining 3 there was no improvement. 

Marie and Levaditi report on 12 cases of general paralysis treated intra- 
meningeally with “salvarsanised serum." A rabbit is injected intravenously with 
salvarsan ; an hour later the blood is withdrawn and the serum decanted. The 
skull of the general paralytic is trephined in the anterior temporal region on each 
side, and 5 c.c. of the serum introduced beneath the dura. The serum is injected 
slowly on both sides and directed at first forwards and afterwards towards the 
parietal region. 

What the authors call severe reaction then set in within a few hours—fever, 
vomiting, partial convulsions, and katatonic states. 

However, they cheerfully remark that these symptoms quickly cleared up, and 
decided improvement followed. In all 12 cases there was marked benefit, but 
they clearly state that it is too early to say if the improvement is permanent. 

In the Lancet of January 24th, 1914, Dr. W. d’Este Emery records good results 
in 3 cases, 1 of general paralysis of the insane and 2 of tabes, by following the 
method of Swift, who injects the curative material directly into the cerebro-spinal 
fluid by lumbar puncture. 

The curative material, in Swift’s opinion, consists < 5 f anti-bodies which circulate 
in the blood after an injection of salvarsan. He gives an injection of that drug 
or neo-salvarsan, waits for an hour, bleeds the patient, allows the blood to clot, 
collects the serum, and injects it, after heating it to 6o° C. to destroy the com¬ 
plement, and diluting it with normal saline solution, into the spinal canal. 

Emery’s criticism on this theory is that it seems quite impossible for large 
amounts of antibodies to be developed in so short a time. 

1 may be allowed to add a few words on treatment in “ congestive attacks." 

(1) We have found that “hexamine"or “ urotropine,” as it was first called, 
seems to help in warding off these attacks. 

It is of course largely used as a genito-urinary antiseptic, and it is excreted as 
formaldehyde by the kidneys, but it is also found in the cerebro-spinal fluid. 

Eruckar ( Practitioner , April, 1916), points out that this drug is of no use when 
the urine is alkaline, and as the cerebro-spinal fluid is alkaline it cannot exert any 
antiseptic action there, and consequently its ameliorative action in general 
paralysis of the insane is “ wrop in mystery.” 

(2) The inunction of mercurial ointment with the administration of calomel 
sublingually appeared to save the life of a case, G. P—, under our care, who lay 
unconscious or semi-conscious for a week. 

This man was the exception to the rule I have laid down that general paralysis 
of the insane cases are not benefited by antisyphilitic treatment. 

(3) In another case, A. P—,a congestive attack started with an alarming hyper¬ 
pyrexia, 108° F. I put him in a sitsbath and poured cold water over him. His 
temperature fell to 102° F. He regained consciousness, and lived for 11 years 
afterwards. 

The late Dr. Courtenay always held that this was not a case of general paralysis 
of the insane at all, but he did not suggest any alternative diagnosis. 

In the May number of The Practitioner of this year McGrigor reports on no less 
than 2,000 cases of ordinary syphilis, and he has had very good results by the 
intravenous injection of concentrated solutions of the following arsenical prepara¬ 
tions, via., salvarsan, neosalvarsan, kharsivan and neo-kharsivan. They are all 
scar healers, as Erlich originally claimed for his “606." 


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Undoubtedly the treatment of syphilis has progressed greatly, but the treatment 
of general paralysis of the insane by salvarsan and neosaivarsan either intra¬ 
venously or intrathecally has not met with any measure of success. 

The toxicity of salvarsan is well known, and some authorities think that it is 
impossible on account of this toxicity to give a sufficiently large dose to kill the 
spirochaetes in general paralysis of the insane. 

However, Mott states that in one case in which very large doses of salvarsan 
were administered, the spirochetes found in the brain post-mortem were exception¬ 
ally numerous. 

Salvarsan to be fatal to the spirochetes must come in contact with them, and 
it is very doubtful if it can pass through the choroid plexus into the cerebro¬ 
spinal fluid. I fear we cannot place much reliance on the new methods attempted 
in the treatment of general paralysis of the insane. 

Some of these methods (as described earlier in this paper) approach the heroic, 
but they are certainly justifiable in dealing with an otherwise inexorably fatal 
disease. 

In conclusion, it seems to me that prophylaxis is the only hope, believing as I 
■do that syphilis is a necessary antecedent of general paralysis of the insane. The 
public are now becoming painfully aware of the horrible ravages of syphilis— 
especially awful when transmitted to innocent women and children—and in our 
lifetime the public will demand compulsory notification and compulsory treatment 
of syphilitics. 

The resulting diminution in the number of cases of syphilis will show a corre- 
-sponding fall in the number of general paralysis of the insane. 

The Chairman said they had all listened with great interest to the valuable 
■communication of Dr. Eustace introducing the discussion. He felt sure that the 
many points raised by Dr. Eustace as regards the causation and treatment of the 
disease would be of great interest to all present. 

A lengthy discussion then followed upon all of the points referred to in the 
consideration of the causation, progress, and treatment of general paralysis by 
salvarsan and salvarsanised serum. It was the general feeling that much disappoint¬ 
ment was felt that the results of these modern treatments was not more satis¬ 
factory. Salvarsan did more harm that good in many cases, and at most seemed 
only to render the acute symptoms more easily managed, but failed to markedly 
influence the degenerative tendency of the disease. 

Dr. Redington mentioned treatment by injection in 6 cases by a drug known . 
as “arsesittin ”; of these 6 cases 4 died; in the other 2 cases no marked 
amelioration recurred. 

Dr. Rainsford spoke of his experience of urotropine, which was favourable, and 
this drug appeared by the experience of all the Members who had used H as a 
valuable remedy in preventing secondary infective toxaemias thereby lessening the 
number of seizures, and generally improving the condition of general paralytics in 
the later stages of the disease. 

Major Dawson spoke of the danger of administering salvarsan in advanced 
cases of the disease. From the work done he was led to hope that in the future 
a cure might yet be found for this hitherto intractable malady. Ordinary mercurial 
treatment was both useless and injurious. It was remarkable how few general 
paralytics were found in Irish Asylums. In Limerick there had not been a case 
for nine years, and Dr. Drapes and others present had almost a similar experience. 
There seems little or no doubt that this is wholly due to the fact that in most 
Irish Asylums (those for City populations excepted, such as Dublin, Belfast, ami 
Cork), the large majority of the patients belong to the agt icultural class, amongst 
whom syphilis is a comparatively rare disease. 

Others having discussed the many points of interest, the Chairman said they 
^11 owed a debt of gratitude to Dr. Eustace for introducing so ably the discussion 
which was so freely engaged in. It Was to be hoped that with the recent endeavour 
of the nation to stamp out or control the spread of venereal disease a diminution 
by the number of cases of general paralysis would occur, and as the treatment 
of this disease by even the most modern methods had proved disappointing the 
hope for the future lay in prophylaxis. 

It was decided to hold the Spring Meeting of the Division at the Richmond 
Asylum, by the kind invitation of Dr. J. O’C. Donelan. 


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152 NOTES AND NEWS. [Jan.,. 

Dr. J. O'C. Donelan kindly promised to read a short paper on his "Experiences 
of a War Hospital " at this meeting. 

A6 the discussion at the present meeting had been so interesting and instructive, 
it was decided that at the next Autumn Meeting of the Division the subject of 
“The Alimentary System in Connection with Insanity " should be considered by 
the Members. 

This terminated the proceedings. 


SCOTTISH DIVISION. 

A Meeting of the Scottish Division of the Medico-Psychological Association 
was held in the Royal College of Physicians, Queen Street, on Friday, November 
17th, 1916. 

Present: Drs. Easterbrook, Hotchkis, Carlyle Johnstone, Kerr, T. C. Mackenzie, 
G. M. Robertson, Ford Robertson, Maxwell Ross, and R. B. Campbell, Divisional 
Secretary. 

Dr. G. M. Robertson occupied the chair. • 

Before taking up the ordinary business of the meeting the Chairman referred to 
the recent resignation of Dr. R. B. Mitchell from the Medical Superintendentship 
of the Midlothian and Peebles District Asylum, and he considered that such an 
event should not pass without the Division recognising the long and valuable 
services which Dr. Mitchell had rendered in the interests of lunacy, and at the 
same time expressing the hope that he would be long spared to enjoy his well- 
earned retirement. Dr. Carlyle Johnstone, in kindly terms of appreciation, asso¬ 
ciated himself with the Chairman’s remarks. It was unanimously resolved that the- 
Secretary be instructed to send an excerpt of the Minutes to Dr. Mitchell. 

The Ceiaikman stated that since coming to the meeting he had heard of Dr. 
Turnbull’s serious illness, and the members present expressed their great regret 
to hear such grave news regarding him. 

The minutes of the last divisional meeting were read and approved, and the- 
Chairman was authorised to sign them. 

Apologies were intimated from Lieut.-Col. Thomson, President of the Asso¬ 
ciation, Drs. Yellowlees, Oswald, McRae, Alexander, Ferguson Watson, and 
Crichlow. 

The Business Committee was appointed, consisting of the nominated member, 
and the two representative members of the Council, along with Drs. Carlyle 
Johnstone, Maxwell Ross, and the Divisional Secretary. 

Drs. C. C. Easterbrook and L. R. Oswald were nominated by the- Division for 
the position of representative members of Council, and Dr. R. B. Campbell 
was nominated for the position of Divisional Secretary. 

The following two candidates after ballot were admitted to membership of the 
Association : 

(1) Albert Victor McMaster, B.A., M.R.C.S.Eng., Senior Assistant Medical 
Officer, Fife and Kinross District Asylum. (Proposed by Drs. Ross, Skeen, and 
Campbell) 

(2) Percy Chisholm, L.R.C.P. & S. Edin., Assistant Medical Officer, Stirling 
District Asylum, Larbert. (Proposed by Drs. Campbell, Clarkson, and Keay.) 

Dr. Eastkkbkook, in the absence of Dr. Cruickshank, read interesting com¬ 
munications by him on : 

(«) The Relative Amounts of Grey and White Matter in some Normal and 
Pathological Brains. 

(2) The Water Content of some Normal and Pathological Brains. 

Dr. Foro Robertson read a most instructive and interesting paper on "Chronic 
fnfectioas by the Bacillus of Influenza, and their Importance as Causes of Nervous 
Disorders.'* 

Dr. Maxwell Ross reported an interesting case of “ Cyst in the Third Ven¬ 
tricle.'* 1 

A vote of thanks to the Chairman for presiding concluded the business of the 
meeting. 

No dinner was held after the meeting. 


1 A 4 i the papers read at the meeting are published in the current issue of the 
journal. 


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NORTHERN AND MIDLAND DIVISION. 

The Autumn Meeting 0/ the Northern and Midland Division was held at the 
kind invitation of Lieut.-Col. Vincent, at the Wharncliffe War Hospital, Sheffield, 
on Thursday, October 26th, 1916. Col. Vincent presided. 

The following twenty-two members were present : Drs. M. A. Archdale, J. S' 
Bolton, A. I. Eades, S. Edgerley, J. A. Ewan, J. W. Geddes, D. Gillespie, R. W. D. 
Hewson, C. L. Hopkins, W. S. Kay, H. J. Mackenzie, H. D. MacPhail, S. R. 
Macphail, J. M. Mathieson, G. E. Mould, P. G. Mould, B. Pierce, W. Starkey, 
R. C. Stewart, J. B. Tighe, W. J. N. Vincent, T. S. Adair {Hon. Stc.), also a 
number of visitors, amongst whom were many of the officers of the Hospital. 

A number of apologies for non-attendance were received. 

(1) The minutes of the last meeting were read and confirmed. 

(2) Drs. McDowall, Pierce, and Street were unanimously elected to form the 
Divisional Committee for the next twelve months. 

(3) Col. Vincent then gave a short sketch of the formation of the War Hospital 
He pointed out what led up to the Asylum being taken over, and described 
generally the numerous and varied alterations that were necessitated, such as the 
conversion of rooms into operating theatres and rooms for X-ray work—the light¬ 
ing of single rooms by gas, etc., increased bath accommodation, and the introduc¬ 
tion of special baths for treatment. He described how the existing Asylum staff 
had been incorporated into the new work, and the numbers of staff, nursing and 
military, that were then required to work the hospital. After some general remarks, 
on the arrangements for feeding, etc., he mentioned that they had a school of arts 
and crafts for painting, wood carving, etc., that entertainments were frequently 
given, and that a committee of ladies looked after comforts for the soldiers. 

(4) Major Mathieson then read an interesting paper in which he brought 
forward a brief resume of some of the work done in connection with “nervous 
breakdowns occurring in soldiers on active service.” He considered it very difficult 
to state any one definite cause for these breakdowns, but he thought one writer 
summed it up neatly in saying they were “ the nervous effects of intense emotional 
strain involving the risk of death.” The aetiological factors might be divided into 
three classes—psychical, physical, and chemical—of which the first is by far the 
most important. In the histories he had obtained, heredity appeared to play an 
important rMe as a predisposing agent. The chief physical causes were hard work, 
trauma, and wounds. The inhalation of gases, such as C.O., formed the main 
chemical cause. The symptomatology was found to be " extraordinarily varied 
and variable.” ‘ After briefly reviewing the symptoms as they affected the various 
systems of the body, he mentioned that one fairly common symptom noted and 
incidentally a most troublesome one, was persistent vomiting after and even during 
meals—this condition might go on for many months. The prognosis tended to 
be in the direction of a slow recovery hampered by the continuance of the war. 
The treatment adopted was that of building up the general condition by means of 
“ graduated exercises, tonics, Faradic baths, and massage,”coupled with encourage¬ 
ment and sympathy and a removal of the inducing causes. Isolation of the cases, 
he considered, was certainly contra-indicated ; they tended to improve more 
quickly when a number of similar cases were together. 

Several members spoke on the subject afterwards. 

(5) In the forenoon batches of the members were shown round the wards, etc., 
by the medical and surgical staff, and many cases of very great interest were 
pointed out. Special attention should be called to the dayrooms, which had been 
converted into operating theatres, and the very complete manner in which they 
had been equipped ; and to a most interesting and valuable demonstration in the 
X-ray department, where the methods used for locating the exact position of a 
bullet or otherforeign body were shown, and a large number of stereoscopic plates 
exhibiting bullets, etc., in siitl. 

A most interesting and enjoyable meeting was brought to a close with a hearty- 
vote of thanks to Col. Vincent for his kindness and hospitality, and to the 
Hospital Staff for the trouble they had taken to make the Visit so pleasant and 
instructive. 


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SOUTH-EASTERN DIVISION. 

The Autumn Meeting of the South-Eastern Division of the Medico- 
Psychological Association was held at n, Chandos Street, at 2 p.m. on Wednes¬ 
day, October 4th, 1916. 

The following members were present: Sir George Savage, Drs. Armstrong- 
Jones, Fletcher Beach, D. Bower, P. E. Campbell, I. Duff, J. H. Earls, A. H. 
Griffith, E. S. Pasmore, G. E. Shuttieworth, R. H. Steen, and J. Noel Sergeant 
(Hon. Divisional Secretary). 

Dr. David Bower took the Chair. 

The minutes of the last meeting were taken as read and confirmed. 

The Spring Meeting was fixed for Wednesday, April 4th, 1917, at 11, Chandos 
Street, London, W. 

Dr. Shuttieworth read his paper on " Sdguin and his Works” (printed in the 
October number of the Journal of Mental Science), and an interesting discussion 
followed in which various members took part, including Sir George Savage and 
Drs. Armstrong Jones, Fletcher Beach, D. Bower, A. H. Griffith, and R. H. Stfeen. 

A hearty vote of thanks to Dr. Shuttieworth was carried by acclamation, and 
the meeting then terminated. 


SOUTH-WESTERN DIVISION. 

Annual Meeting, 1916. 

The Annual Meeting of the above Division was held, by the kind permission 
of Dr. MacBryan, at 17, Belmont, Bath, on Friday, October 27th, 1916. 

The following members were present : Drs. Aveline, Baker, Good, Norman 
Lavers, Nelis, Rutherford, and G. N. Bartlett, Hon. Div. Secretary. 

Dr. Nelis was voted to the Chair. 

Letters of apology for non-attendance were received from Dr. Macdonald and 
Dr. MacBryan. 

The Minutes of the last Meeting were read and confirmed. 

Dr. Norman Lavers (present member) and Dr. Aveline were nominated repre¬ 
sentative members of Council. 

The place of the Spring Meeting (April 27th, 1917), was left in the hands of 
the Hon. Secretary, the hope being expressed that a visit to a war hospital in the 
Division could be arranged. 

The members present alluded to the inclusion of a son of Dr. MacBryan in the 
Roll of Honour, and requested the Hon. Secretary to convey to him their deep 
sympathies in his bereavement. 

A discussion on the recently circularised proposals as to the treatment of patients 
from the Services followed. The opinion of the meeting was to the effect that 
(1) Service patients should be defined for practical purposes as patients accepted 
subject to an agreement with, and paid for by, the War Pensions Statutory 
Committee, with the proviso that they shall be treated under the same general 
rujes and regulations as at present apply to private patients, (2) that the rate of 
maintenance should be a fixed sum over and above the ordinary pauper rate in 
force at the time being, the amount to be settled by each asylum. 


WATERFORD DISTRICT ASYLUM. 

Savage Attack on the Medical Superintendent. 

It was with great regret that we heard of the brutal assault which was made on 
our colleague, Dr. Oakshott, which might have had fatal results. The whole occur¬ 
rence was most mysterious, and, so far, inexplicable. Dr. Oakshott enjoys a well- 
deserved popularity in Waterford City.and neighbourhood, and it is difficult to 
even conjecture what motive, except that of mere robbery, which is hardly sufficient 
to explain all the circumstances,could have actuated the perpetrators of the crime, 
neither of whom, unfortunately, has as yet been identified, and although the police 
are said to have strong suspicions with respect to a certain individual, there is not 
sufficient evidence to warrant an arrest. 

Dr. Oakshott is still (end of December) feeling the effects of the outrage, which 


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occasioned severe bruising of various parts of his body, his hands especially being 
badly hurt, and had evidently been trampled on when he was on the ground, and 
his injuries, of course, involved a considerable amount of shock. We offer hi-m and 
bis family our sincere sympathy, and at the same time our congratulations that he 
has (as we hope) escaped any permanent disablement. 

The following account is taken from the Waterford Standard : 

“ Shortly after nine o’clock on Sunday night, November 5th, Dr. J. A. Oakshott, 
Resident Medical Superintendent of the Waterford District Lunatic Asylum, was 
the victim of a dastardly attack and robbery within the grounds of the institution. 
The cowardly deed was committed within only about twenty yards of the male 
•hospital and about one hundred yards from the doctor’s own residence. From the 
information available it appears that Dr. Oakshott, after having completed his 
round of inspection, was leaving the male hospital on his way home when he was 
waylaid by two unknown men. The night was bright and moonlit, but the mis¬ 
creants took advantage of the shade of a rustic arch and some shrubbery to hide 
their presence. The onset was so sudden and unexpected that the doctor had not 
time even to call for help, which was only a few yards away, before he was over¬ 
powered and almost strangled. After knocking the doctor down the assailants 
polled a small canvas bag with a running string at the opening over his head, and 
by this means gagged and almost choked him. They then bound his legs and 
•arms with a rope, dragged the doctor into the shrubbery, and robbed him of any 
valuables he had in his possession at the time. In addition to robbing the money 
they found in the doctor’s pockets, they took the ring off his finger and also a gold 
presentation watch with the owner’s name inscribed on it. In the struggle Dr. 
Oakshott lost consciousness, and his assailants made good their escape. 

•‘About half an hour afterwards, near ten o’clock, Miss Minnie O’Gorman, 
daughter of Mr. Edward O’Gorman, the land steward, happened to be walking 
•along the path where the robbery took place. Dr. Oakshott had by this time 
regained consciousness, and hearing some noise in the shrubbery Miss O’Gorro.in 
went across the path to investigate, and she found Dr. Oakshott lying on the 
ground, bound and gagged. She at once ran for Dr. Fitzgerald, the assistant 
resident medical officer, who despatched a messenger immediately to District 
Inspector Maxwell and released Dr. Oakshott from his unfortunate predicament. 
Dr. Oakshott, who is at present confined to bed, stated that he was unable to 
identify the two men who attacked him. The police are actively investigating the 
occurrence, but so far no arrests have been made. They found on the ground 
. Dr. Oakshott's glasses broken, his keys, pencil case, lamp which he was carrying 
at the time, and his cap. All the circumstances point to the fact that the robbery 
was premeditated, and access to the institution grounds must have been gained at 
the rear of the building through the farm.” 

The Asylum Committee at their meeting on November 13th, passed a resolution 
of regret at the occurrence, and expressed their horror at, and condemnation of, 
the act, which the Bishop of the Diocese characterised as "an outrage on Chris¬ 
tianity and Christian feeling, and opposed to the fundamental laws of humanity.” 

EXAMINATION FOR NURSING CERTIFICATE. 

List of Successful Candidates. 

Final, November, 1916. 

Brentwood Asylum, Essex. —I. McFarlane, D. M. Wilson. 

Maidstone Asylum. —K. Augur, E. Sutton. 

Stafford Asylum.-^-E. Bill, J. Bradbury, M. Budd, G. Davis, F.. Spencer. 

West Sussex Asylum. —T. S. Jefferis, N. B. Tobin, C. K. Weaver. 

Menston Asylum, Yorks. —E. Acton, A. Baguley, S. Buttler, M. Cochrane, F. 
'Glover,* K. Gould,* R. E. Marsh, A. Nolan, M. Scanlan. 

Derby Borough Asylum. — O. E. Coulson, E. Rains. 

, Hull City Asylum. —A. M. Turnill. 

Leicester Borough Asylum. —A. Binge, A. F. Dale, M. Kennelly, E. M. Mulvaney. 

Norwich City Asylum. —E. A. Holliday, H. E. Thompson. 

Portsmouth Borough Asylum .— B. Couzens, C. A. Craddock, C. F. Guyatt, M. A. 
•Guyatt, E. M. Roome. 


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Sunderland Borough Asylum. —O. M. Hingley, M. A. Yare. 

Bethlem Royal Hospital. —I. Sayburn, 

Camberwell House. —E. W. Waller.* 

Fountain's Temporary Asylum. —C. M. Parker. 

St. Andrew's Hospital. —I. P. Bullock, G. W. Panter, I. E. Parker, M. Raban,* 
E. C. Sample,* J. A. Thompson. 

St. Luke's Hospital. —E. J. Green, C. McDonagh, K. S. E. Stevens. 

The Retreat, York. —J. M. Dagg, J. Haslam, A. Horne, G. Huitson, J. Huitson. 
Royal Asylum, Aberdeen. — A. Clark,* E. Glashan, A. Harcus, C. Jack, M. C. 
Pirie, M. F. Roy. M. Watson. 

District Asylum, Aberdeen. —H. Johnstone, C. S. McKellar, A. Robertson, M. A. 
Robertson, H. G. Shepherd. 

District Asylum, Edinburgh. —H. A. Murden, M. M. Tennant. 

Craig House, Edinburgh. —C. Davidson, C. A. J. Kirkness, A. Mackintosh, M. 
Thomson. ■- 

Royal Asylum, Edinburgh. —J. Ewing, J. C. Forsyth, M. McGuire. 

Gartloch Asylum. —E. E. Blyth, M. Macdonald, J. S. Scott. 

Woodilec Asylum. —J. Livingstone, A. F. Smith. 

Crichton Royal, Dumfries. —H. Baker, J. A. S. McLeod. 

Inverness Asylum. —D. C. Macdonald. 
l^anark Asylum. —A. Smith. 

Melrose Asylum. — S. H. Thomason, J. Thomson. 

Montrose Royal Asylum. —C. Johnson. 

Perth District Asylum. —F. B. A.Cuthbert. 

Smithston Poorhouse and Asylum, Glasgow. —A. Campbell,* A. B. McLaren. 
Stirling District Asylum. —j. McLeod, C. Melville.* 

Larbert Institution. —J. Murray. 

Portrane Asylum. —J. Watkins. 

Richmond Asylum, Dublin. —J. Gleeson, W. Hogan, S. Sally. 

Warwick County Asylum. —B. Clarke, C. Edwards, E. Falkiner, W. HiU, S. 
Judge, M. Jordan, F. Lancaster, A. M. Lowe, F. Riley. 


Pkkliminarv, November, 1916. 

Severatls Asylum, Essex. —F. A. Bourne. 

Maidstone Asylum, Kent. — E. Birch, A. Cahill, J. Cahill, B. M. Copeland, A. H. 
Gale, M. M, Garrahan, H. A. Griffiths, G. V. Hammond, G. A. Hooton, V. 
Maudsley, B. A. O'Donnell, L. G. Sutton, M. Webb, E. Williams. 

Stafford Asylum. —M. Chatterly, J. Woodfin. 

Cheddleton Asylum, Staffs. —B. G. Glynn, M. E. Murphy, A. W. Sunderland. 
Menston Asylum, Yorks. — E. 1 . Butcher, F. Davies, M. Hart, H. Lockey, A. 
McDonald, A. Redfern, M. H. Turnill, B. Wade. 

Bethlem Royal Hospital. —E. M. Pentney. 

Coton Hill Asylum, Staffs. —A. Price. 

The Retreat, York. —N. G. M. Brown, M. S. Carney, B. A. Drew, J. M. Hollis, 
A, F. Howells, L. Hutchings, D. Thurston, A. Walton, W. A. Willey, M. F. 
Wllmot. 

St. Andrew's Hospital, Northampton. —C. Millard. 

Middleton Hall. —J. Bailey, M. Chesher, S. Kirkbright, B. M. Temple. 
Fenstanton — L. M. Worsley. 

Hill End Asylum, St. Albans. —M. J. Digham. 

Borough Asylum, Derby. —D. J. Froggatt, A. E. Grainger, M. J. Gutteridge, P. 
Macken. 

City Asylum, Norwich. —E. E. Collins, W. W. Money, M. E. Palgrare, F. M. 
Paftner, E. E. H. Seago, N. B. Tillett. 

Royal Asylum, Aberdeen. —M. H. Riddoch, I. Walker, F. Watson. 

Royal Asylum, Edinburgh. —M. Brown, L. Cheyne, M. Daly, M. Dower, M. W. 
Fleming, B. E. Fleming, M. Girvan, A. Glenn, H. Johnston, E. Mutter, I. M. 
Nicholson, J. M. Watt, J. Williamson. 

Craig House. Edinburgh. —J. A. Flett, M. B. MacGregor, M. M. Maclean, G. 
McHaffie, C. F. McLoughlin, E. Morrison, E. G. Robertson. 

District Asylum, Edinburgh. —R. Brownlie. 


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Gartloch Asylum. —E. Crossan, M. B. Donley, M. Findlay, M. S. Laing, M. 
Macphail, K. A. McKinnon. J. Milne. 

Woodiiee Asylum. — M. Dodds, A. M. Foster, A. Kelly, J. Mackechnie, A. 
Mackintosh, A. M. Ross. 

Inverness Asylum. —C. C. Galbraith, J. S. Fraser, A. Macklennan, A. McKenzie. 
J. C. Stickle. 

Lanark District Asylum. — A. Chilles, C. M. Cruickshank, J. Inglis, S. Prentice, 
J. Stratton, E. White. 

lusrbert Institution. —C. Byden, E. A. Johnston, A. J. Lindsay, M, C. Moffat. 
Melrose Asylum. —I. Clark, B. Leslie, J. H. Smith, T. Steenson. 

Royal Asylum, Montrose. —E. H. McD. Baillie, J. Burke, I. J. Ferrier, M. Ful- 
lerton, M. J. Hamilton, M. S. Logan, H. M. Mason, M. MacKay, C. A. McDonald. 

S. Smith, M. Sutherland. 

James Murray's Royal Asylum, Perth. —M. Cameron, A. Kennedy, M. Mitchell. 
M. Pirie, E. F. Scott. 

Richmond Asylum, Dublin. —P. Hall, M. Glennon, E. McCadden, H. Nugent. 
Portrane Asylum. —E. Kelly, J. Rudkins. 

Warwick County Asylum. —K. Aitken, E. Canning, E. Newbrook, F. Ward. 


Examination for Nursing Certificate, November, 1916. 

Final Examination. 

List of Questions. 

1. A patient, whilst out with a walking party, falls and fractures his thigh. 
What symptoms might he exhibit, and what steps would you, as nurse in charge, 
take to deal with the emergency ? 

2. How would you render first aid to cases of—(a) Fainting, (b) Bleeding 
from a varicose vein in the leg. (r) Choking at dinner? 

3. What are the chief symptoms of heart disease, and what special points 
should a nurse attend to in nursing a case of heart disease V 

4. How would you deal with a case under your care in which sleeplessness was 
a prominent symptom ? 

(5) What are the usual mental and physical causes of refusing food in insanity ? 
Describe the methods of forcible feeding usually adopted, and suggest a suitable 
dietary for a patient who persistently refuses food. 

6. What signs would lead you to expect that an epileptic patient was going to- 
have a fit ? What precautions would you take to prevent the risk of injury: 
(«) During a fit. (b) In the intervals between the attacks P 

7. Describe a case of senile insanity which has been under your own observation. 
What are the chief risks met with in such a case ? 

8 . To what accidents are patients suffering from general paralysis specially 
liable, and what precautions should be taken to prevent their occurrence f 

V 


Preliminary Examination, November, 1916. 

List of Questions. 

1. What is the position of the liver? What are its functions and what are the- 
uses of the bile in digestion ? 

2. Why is ventilation of a bedroom necessary ? State what means you would 
take to ensure that it is properly carried out. 

3. What precautions are taken in asylums to guard against scalds or burns ? 
Should such an accident occur, how is the injury treated ? 

4. Name and give the position of the principal arteries in the body. 

5. How would you Tender first aid to a case of fractured tibia ? 

6 . State the functions of each of the various organs in the skin. 

7. What structures go to the make-up and efficient working of a moveable joint 
of the body ? 

„ f Where does the lymph in the thoracic duct come from ? 

\ What are the functions of lymphatic glands ? 


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OBITUARY. 

Adam Robert Turnbull, M B., C.M.(Edin.). 

It is with great regret that we record the death, at Colinton, on November 17th, 
in his 63rd year, of Dr. Adam Robert Turnbull, late Medical Superintendent of the 
Fife and Kinross District Asylum. 

Dr. Turnbull had a conspicuously brilliant course as a student of medicine at • 
the University of Edinburgh. He took a high place in all his classes, gained 
eleven medals with over 90 per cent, of the marks attainable, graduated, in 1875, 
as M.B. and C.M. with first-class honours, and was awarded the Ettles Scholarship 
as the most distinguished student of his year. His fellow-students showed their 
appreciation of his talents and character by electing him Senior President of the 
Royal Medical Society. 

The subsequent career of a "distinguished student” is always an interesting 
subject for speculation on the part of his friends and contemporaries; but their 
prognostications are more often wrong than right. With such natural endow¬ 
ments as Turnbull possessed, and so many prizes won in the intellectual Campus 
Martius, it might have been expected that he would have found his avocation in 
the prosecution of scientific studies and made a name for himself in the literature 
of medicine. But his mind was not mainly scientific ; he read little when he no 
longer was required to read, and he wrote less. He was a singularly level-headed 
man, cautious and judicial, but not bookish. Essentially practical, he delighted in 
all forms of bodily activity and was never idle : diligent in business and diligent 
in play, whatever his hands found to do he did with all his might, for he was per¬ 
suaded that whatever he was doing was the one thing worth being done. Accident 
directed his footsteps into one of the by-ways of medical practice, and fixed the 
-course of his life in a calling for which, as time proved, he was peculiarly fitted. 

It is one of the anomalies of the profession of medicine that those physicians who 
are entrusted with the control of the most delicate and important of all the bodily 
organs, and have for their cure that faculty which proclaims a man a man, must 
not look for any popular acclamation of their humane labours. The fame of their 
good works does not extend beyond the little circle of their associates ; their 
smallest failures are visited with a prompt parochial reprehension ; if they acquire 
a reputation, it is for eccentricity; and the best they can hope for is a sort of 
notoriety, helped by advertisement. It was not in Turnbull to advertise, and he 
never sought applause; but, in the cure and treatment of the insane, he found the 
proper field for the exercise of his gifts, his common sense, his happy pragmatist- 
philosophy, and his conscientiousness : and the practice of these contained for him 
its own reward. 

After a period spent as Resident Physician in the Royal Infirmary, he was 
appointed, in 1876, Assistant Physician at the Royal Edinburgh Asylum, Morning- 
side, under the late Sir Thomas Clouston. Here he remained for five years, an 
■example to everyone of industry, readiness to learn, courtesy, and goodness of 
heart. There never was an "Assistant” more popular than Turnbull, “little 
Turnbull ” as he was called with a unanimous affection ; he was loved by all who 
came in touch with him, patients and officials alike. The most exacting of patients’ 
kinsfolk, the most critical of parish functionaries, were disarmed by his genial 
smile, his ready assumption of all blame, his innocent cajolery, the honesty of his 
desire to righten wrongs. He entered into all the affairs and interests of the 
-establishment with an equal enthusiasm, and played his many parts on the strange 
and crowded stage of asylum life as if the success of the tragi-comedy depended 
■on his efforts. Whether he was presiding over a meeting of the patients’ literary 
and debating society, or occupying the chairman's seat at a curling supper, or 
acting as master of ceremonies at the weekly dances ; whether he yras disseminating 
cheerfulness and physic for the mind in his frequent visits to the wards, or bringing 
a case-book up to date, neglected of a less scrupulous colleague, or bowing his 
head,.in seeming consciousness of guilt, under the righteous wrath of “ the chief,” 
and taking upon himself the sins of others ; whether, with all the glee of youth 
and the earnestness of age, he threw or " sooped ” the curling stone, or smote the 
-cricket ball, or made good play with his racquet, he seemed always to be in his 


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element, and he always “ played the game." Always and everywhere he found 
something to do, something to enjoy, some one to serve, some one to play the first 
fiddle while he delightedly played the second. He rejoiced in all sports and 
pastimes, and was good at most, but cricket was his favourite. The present 
scribe can see him now, in his mind’s eye, as, crouching behind the stumps, in 
gioves and pads that always looked a size too large, he " kept ’’ wickets as seriously 
as if he were keeping a frontier fort, and reduced the record of byes to zero ; or, 
armed with a bat whose proportions almost exceeded his own, swiping ball after 
ball into the remotest bushes of the demesne, while a deprecatory smile approached 
his ears as his score surely approached the half-century. 

He was so modest, so tender of the feelings of others, so absolutely devoid of 
“ side," so respectful of all opinions, however absurd, so deferential to his manifest 
inferiors, that strangers sometimes doubted his sincerity, and the unrighteous 
sometimes took advantage of his abnegation. It only needed a more intimate 
acquaintance to prove the genuineness of this self-effacement, and to show that 
behind that apparent weakness there was a firmness and determination which, in 
matters of principle or where injustice was threatened to others, it was not wise to 
cross. Those who knew him best knew how sensitive he was and how easily 
wounded in spirit, but he never resented a wrong to himself; there was no animosity 
in his soul, and it was impossible for him to harbour malice. “ The gentlest man 
lever met" was the verdict of one who had been associated with him only in 
business. If he had an enemy, and he had not more than one, it was himself, and 
he was too often the victim of his own depreciation ; but, excessive as it was, his 
modesty was as sincere as his kindness, as blameless as his geniality and the child¬ 
like joy that he took in all whplesome and innocent doings. 

After five years of an active and profitable apprenticeship under the most 
stimulating of chiefs, Turnbull was appointed, in 1881, Superintendent of the Fife 
and Kinross District Asylum at Springfield, in succession to Dr. Brown. Spring- 
field was at that time in a transition stage. With the great increase in the 
population of the district it was rapidly being transformed from a quiet little 
country asylum for 300 patients into one of the largest and busiest institutions for 
the insane in Scotland. Able predecessors had laid the foundations well, but they 
were too narrow for the great works that it was now necessary to construct. With 
his usual earnestness and unwearying industry, and in his usual quiet and 
unassuming manner, Turnbull set about the business in hand, and when, at last, he 
was compelled by bodily weakness to abandon his cherished post, it was to leave 
a hospital for sufferers in the mind second to none in the country, and renowned 
beyond these shores. Springfield under his care came to be regarded as the 
model of Scottish District Asylums, and visitors from other lands were directed 
thither as to the place where Scottish lunacy administration was to be seen at its 
best. All his energies were devoted to the betterment of the insane, all good old 
methods to that end he retained and strengthened, and all better new ones he 
consistently adopted, in spite of difficulties and discouragement. At Springfield 
the insane were deprived of none of those liberties and social pleasures which they 
could be trusted to enjoy without detriment to themselves or others; there it was 
not considered necessary to place a man in an asylum merely because his mental 
condition differed from the normal; there hospital treatment was provided for the 
insane sick as elsewhere for the sane ; the poor “ lunatic" was nursed by trained 
women with as much care and as much efficiency as a Royal Infirmary could 
supply, and asylum attendants were taught that their calling was as worthy of 
honour as that of any other class of nurses. Either as a begetter or as a con¬ 
firmer of beneficent reforms, Turnbull's name will always be associated with the 
introduction of hospital methods in the treatment of mental disorders, with the 
training and education of asylum nurses, and with the extension of the “ boarding- 
out ” system. Of greater value and greater effect, perhaps, than any of these was 
his personal attitude towards his patients. He recognised that the insane were to 
be treated as individuals and not as types or in classes, as human beings each with 
his own feelings to be considered, his opinions to be respected, his separate soul, as 
much as that of any sane man, to be saved. His patients learned to look upon 
him as their friend, their counsellor, their own private physician, and in his 
ministering to minds diseased it may confidently be averred that this intimate 
relation, this personal sympathy and consideration effected as many cures as could 


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have been brought about by more " scientific ” methods or by all the resources of 
the laboratory, and gave more comfort where they did not cure. 

Turnbull held his appointment in Fife for thirty-four years, mostly happy years, 
for it was his disposition to be happy. He had his troubles and his deprivations, 
it is true, like other men—even Springfield was not heaven—and he met with not 
a few rebuffs and undeserved affronts; but nothing could ruffle the native serenity 
and sweetness of his temper, his patient continuance in well-doing overcame all 
obstacles, and the malicious found it a poor sport to attack a man who would not 
■defend himself. For several years he acted as Secretary to the Scottish Division 
of the Medico-Psychological Association of Great Britain and Ireland, an office 
which involved the expenditure of considerable time and energy, but he could 
always find time and had the will to do something more. In 1910 that Associa¬ 
tion conferred upon him the greatest honour at its disposal by electing him 
President; but, greatly to the regret of all the members, ill-health prevented him 
from undertaking the duties. 

A man of remarkably sound mind, Turnbull had always enjoyed the blessing of 
sound health. He continued to play cricket as long as he could get down to the 
ball, and then he took to the gun, and shooting became the chief occupation of 
his holidays, many of which he spent near his native hills in Northumberland. 
But, as he drew near his sixtieth year, his health suddenly failed, and it was found 
that he was suffering from a painful and incurable malady for which little relief 
could be obtained. Ho had suffered long before he asked for medical assistance, 
and he stuck to his post long after it was plain to his friends that he was unfit for 
active duty. The visiting Commissioner discovered him going about his work as 
usual, with all his wonted cheerfulness and thoroughness, at a time when any other 
man would have been lying helplessly in bed. Repeated surgical operations were 
performed upon him, his holidays were spent in nursing homes, he was seldom free 
from torturing pains, and never from discomfort; but he was never heard to 
murmur or complain, and with each small return of strength he went back to his 
work at the asylum. When the present writer visited him during his periods of 
sickness. Turnbull’s hopefulness and self-forgetfulness were such as to put the 
ordinary man to shame. He was reluctant to speak of his sufferings, though he 
seemed to think that he owed his friends an apology for being ill, and he would, 
as soon as was polite, begin to talk of the concerns of other persons, whose light 
afflictions he honestly thought were heavier than his. 

When at last, in February, 1915, he felt that he could carry on no longer, his 
good and faithful service was recognised in uncommonly appreciative terms in the 
official records and the public prints, and he bore away with him into his retire¬ 
ment the affection and the esteem of the whole local community. It had been his 
desire to spend his declining years among the foothills of the Cheviots, under 
whose shadow he was born ; but his precarious condition and the necessity of his 
remaining within reach of his medical advisers prevented the fulfilment of this 
wish, and he very contentedly chose instead to make his new home at Colinton, 
where in a short space of time he was already making new friends. On sunny 
days he was still to be seen from time to time in Princes Street, little changed in 
outward appearance, save for his grey hairs, not at all changed in his old-fashioned 
courtesy, his youthful outlook on life, his happy submission to whatever might 
befall. 

He lived only for a year and nine months to enjoy his pensioned leisure. Death 
came suddenly and mercifully to him in the end. A haemorrhage in the brain 
deprived him of consciousness, and, though he lingered for some days, his sufferings 
were over and, we may believe, his spirit was at rest. 

No one who knew Adam Robert Turnbull will find anything of exaggeration in 
these lines (written by one who knew him intimately for nearly forty years); those 
who knew him best well know how inadequate is this tribute to the memory of a 
blameless soul, the gentlest of creatures, the kindest of men,and one of the bravest. 

j.C.j. 


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Ralph Drown, M.D.Lond., B.S., M.R.C.S.Eng., L.R.C. P.Lond., 

Senior Assistant Physician and Deputy Medical Superintendent, Bethlem and 

Bridewell Royal Hospitals. 

Dr. Ralph Brown was one of a large family of sons, all serving their country ; 
•he had volunteered for a commission in the K.A.M.C., and the formalities for the 
granting of this had not quite been completed when his untimely death occurred 
from a severe attack of typhoid fever. Early in the war his youngest brother was 
taken prisoner; shortly after another was killed in Flanders, and this bereavement 
-affected him very deeply. 

Ralph Brown was educated at Sherborne School, and entered University 
‘College, London, in 1899, where he became Prosector of Anatomy, and later 
gained a gold medal in materia medica and therapeutics. Owing to the fact that 
the hospital was in the process of being rebuilt, he decided to carry out his clinical 
■work elsewhere, and in 1903 gained the scholarship for third year students at 
Westminster Hospital. His career there was one of uninterrupted success. He 
-took the conjoint diploma in 1906, and graduated M B., B.S. at the University of 
London in 1908, and held in turn the posts of Resident Obstetric Assistant and 
Junior and Senior House Physician. He then became House Physician to 
Bethlem Royal Hospital, and decided to specialise in psychological medicine. 
He was then appointed Resident Medical Officer to Moorcroft As-ylum, Hilling- 
■don, but in 1911 he returned to Bethlem as Junior Assistant Physician. With 
<his appointment he became Assistant Medical Officer to King Edward Schools, 
London and Willey. The latter work always filled him with pleasure and happi¬ 
ness, and often in his few spare hours of leisure he would visit the children and 
participate in their pastimes. He at one time held the post of Clinical Assistant 
to the West End Hospital for Diseases of the Nervous System. He was a member 
of the Medico-Psychological Association of Great Britain and Ireland, and a 
Fellow of the Royal Society of Medicine. He was also co-editor of the Asylum 
Workers' News. In 1913 he took the M.D. in Psychology and Mental Diseases, 
-and in 1914 was appointed Senior Assistant Physician to Bethlem Royal Hospital, 
which post he held to the day of his untimely death. 

Although of a quiet and retiring disposition, he possessed a keen sense of 
bumour, and his kindness of heart, his sympathetic manner, and his happy way 
■of giving hopeful assurance to distressed patients will always be gratefully remem¬ 
bered by those who came in contact with him. So abundantly had he fulfilled the 
promise of his earlier years that the future must have held much success in store 
for him, and his death will not only prove a sad blow to his numerous friends, 
but a loss to psychological medicine. A memorial service was conducted by the 
Rev. E. G. O’Donoghue in the Hospital Chapel on October ioth.and attended by 
many colleagues and friends. 


The Death of ThGodule Ribot. 

Members of the Medico-Psychological Association will learn with regret that 
“Th^odnle Ribot, the veteran editor of l.a Revue Philosophique, is dead. 

"Those who for nearly half a century," says Gaston Rageot in his article in 
L‘Illustration (pp. 23-30, December, 1916)—an article written with the loving 
sympathy so characteristic of a French writer, and from which most of the par¬ 
ticulars mentioned in this brief notice arc borrowed—“ have been accustomed to 
•see Theodule Ribot at Le College de France, at the,offices of La Revue Philo¬ 
sophique, or merely as he walked along La Rue des Ecoles, will preserve in their 
memories the image of that little spare man, of late somewhat worn with age, 
with his broad forehead, his straight chin, his amiable and keen expression, his 
whole face illumined with life, with intellectual finesse, and with kindly grace." 

Ribot all his life protested against being called a philosopher. He claimed only 
to be a savant, whose speciality was the study of what took place, very often, 
unknown to onrsehres, in our own consciousness. 

In hie psychological work he drew nearer to the physicians and the alienists 
than to the philosophers, believing that for moral as well as physical science the 
•study of disease was not less useful than that of health. 

He was a voluminous writer, and some of his books had an immense circulation. 


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The number of editions reached by L'Attention, Les Maladies de la Mrmotre, and 
Les Maladies de Volonte were as great as those of the most popular novels. 

“ Is not loving one's fellows the best way of knowing them ?" asks Gaston- 
Rageot. “ That was Th<?odule Ribot’s method." 


THE LIBRARY. 

Members of the Association are reminded that the Library at 11, Chandos. 
Street, W., is open daily for reading and for the purpose of borrowing books. 
Books may also be borrowed by post, provided that at the time of application 
threepence in stamps is forwarded to defray the cost of postage. Arrangements, 
have been made with Messrs. Lewis to enable the Association to obtain books from 
the lending library belonging to that firm should any desired book not be in the- 
Library. In addition, the Committee is willing to purchase copies of such books 
as will be of interest to members. Certain medical periodicals are circulated 
among such members as intimate their desire to be included in the list. 

The following gifts have been received, and the Committee desire to thank the 
donor: 

Dr. William A. White.— Bulletins 2, 3, 4 and 5 of the Government Hospital 
for the Insane, Washington, D.C. 

The following books have been purchased for the Library : 

Instincts of the Herd in Peace and War, by W. Trotter. 

Bodily Changes in Pain, Hunger, Fear, and Rage, by Walter B. Cannon. 

Members reducing their private libraries are requested to bear in mind the 
library of the Association. 

Applications for books should be addressed to the Resident Librarian, Medico- 
Psychological Association, 11, Chandos Street, Cavendish Square, W. 

Other communications should be addressed to the undersigned at the City of 
London Mental Hospital, Dartford, Kent. 

R. H. Stf.kn, 

Hon. Secretary, Library Committee. 


APPOINTMENT. 

White, Ernest W., M.B.Lond., M.R.C.P., Emeritus Professor of Psychological 
Medicine, King’s College, London, appointed Hon. Consultant in Mental Diseases 
in the Western Command with the temporary honorary rank of Major, Royal 
Army Medical Corps. 


NOTICES BY THE REGISTRAR. 

Dates of Nursing Examinations. 

Preliminary .... Monday, May 7th, 1917. 

Final.Monday, May 14th, 1917. 

Schedules must reach the Registrar not less than four weeks prior to the date of 
Examination. For further particulars apply to Registrar, Dr. Alfred Miller, 
Hatton Asylum, Warwick. 


NOTICES OF MEETINGS. 

Quarterly Meetings: Thursday, February 15th, 1917; Tuesday, May 15th, 1917. 
The Divisional Meetings are proposed as follows: 

South-Eastern Division. —Wednesday, April 4th, 1917. 

South-Western Division. —April 27th, 1917. 

Northern and Midland Division. —April 26th, 1917, at the County Asylum,' 
Macclesfield. 

Scottish Division. —March 16th, 1917. 

Irish Division. —April 5th, 1917; July 5th, 1917. 


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NOTICE TO CONTRIBUTORS. 

N.B. —The Editors will be glad to receive contributions of interest, clinical 
records, etc., from any members who can find time to write (whether these have 
been read at meetings or not) for publication in the Journal. They will also feel 
obliged if contributors will send in their papers at as early a date in each quarter 
as possible. 

Writers are requested kindly to bear in mind that, according to Lix(n) of the 
Articles of Association, " all papers read at the Annual, General, or Divisional 
Meetings of the Association shall be the property of the Association, unless the 
author shall have previously obtained the written consent of the Editors to the 
contrary.” 

Papers read at Association Meetings should, therefore, not be published in other 
Journals without such sanction having been previously granted.', 


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THE 

JOURNAL OF MENTAL SCIENCE 


[Published by Authority of the Medico-Psychological Association 
of Great Britain and Ireland .] 

No. 261 [ S, N W 0 , " ,, ‘] APRIL, 1917. Vol. LXIII. 

Part I.—Original Articles. 

Zola's Studies in Mental Disease. By J. Barfield 
Adams, L.R.C.P., L.R.C.S., M.P.C. 

As a rule novelists have not been very successful in their 
delineation of mad people. They usually overdo it ; their 
maniacs are too maniacal.and their melancholics too melancholy. 
Even when descriptions of milder cases of mental disorder have 
been attempted, as in those of Miss Flite in Bleak House , or 
Mr. F’s aunt in Little Dorrit, they have not been altogether 
satisfactory. Neither have the dramatists been more fortunate. 
One of the first plays that I ever saw on a London stage was 
a dramatised version of Jane Eyre , and the character of Bertha, 
the mad woman, as featured by the actress, was a very terrible 
exhibition. It is only fair to say, however, that in several 
modern French plays, where a person of unsound mind has 
been included in the dramatis persona , the character has been 
a fairly natural study of the disease. 

In Emile Zola’s Rougon-Macquart series of novels with the 
enormous number of characters which crowd their pages— 
characters which represent people in almost every grade of 
society, and people of almost every type of mind —it is to be 
expected that we should meet with some who are insane. 
Zola studied human beings as a naturalist, as a scientist, and 
consequently his pictures not only of health but also of disease 
are drawn with a truth which is rarely found in the works of 

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ZOLA’S STUDIES IN MENTAL DISEASE, 


[April, 


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other novelists. His characters are not manikins, they are 
flesh and blood. In his analysis of the mind he does not 
forget the body. In his psychology he fully recognises the 
part played by cenaesthesia. One of his characters, Pierre 
Sandoz, in whom one cannot help thinking Zola portrays 
himself, says, speaking of a novel he is writing, that it is his 
object “ to study man as he is, not as a metaphysical marionette, 
but as a physiological man, determined by his environment, 
and acting under the play of all his organs.” “Is it not a 
farce,” he asks, “ this continued and exclusive study of the 
functions of the brain, under the pretext that the brain is the 
noble organ ? Thought is the product of the entire body. 
What becomes of the nobleness of the brain when the stomach 
is sick ? ” 

If such a method of studying and portraying normal human 
beings is of importance, it is ten times more so in studying and 
portraying those in whom the mental equilibrium is disturbed. 
It is this that gives almost a scientific value to Zola’s studies 
in insanity. 

Our author’s pictures of mental disease are as interesting, if 
not more so, to the general practitioner as to th6 alienist. The 
insane characters in the Rougon-Macquart novels are rarely 
seen in the asylum ; we are introduced to them, for the most 
part, in the midst of their everyday surroundings, often with 
their relatives about them. The general practitioner has one 
great advantage over the specialist; he can, if he will, study the 
insane in their natural habitat as the hunter or the traveller 
studies wild animals. While the alienist, on the other hand, 
studies his cases under abnormal conditions as a naturalist 
studies wild animals in a menagerie. One cannot exaggerate 
the importance of environment. If the normal being reacts to 
his surroundings, does not the abnormal do so also ? And, 
further, the general practitioner has the opportunity of studying 
at first hand the relatives of his patient. He can sometimes 
note the mental or nervous condition, not necessarily diseased, 
of the mother, a matter often of primary importance. His 
observation of the behaviour of an aunt or sister may throw a 
flood of light upon the family history of the case, for trifling 
mental flaws, mere eccentricities, in spite of a woman’s superior 
powers of dissimulation, more readily reveal themselves in the 
female than in the male, and such eccentricities may hint at 


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ZOLA’S STUDIES IN. MENTAL DISEASE, 


[April. 


series, we meet with two . cases of insanity which, although 
described with abundance of detail, are very inferior to the 
finished studies of disease which are found in the later novels. 
The cases are those of Francois Mouret and his wife, Marthe. 

Francois Mouret .—Family history: Father committed suicide. 
Mother was mentally unstable, and died of phthisis. Maternal 
grandmother was insane. The patient had three children : the 
eldest was sane, the second suffered from attacks of delirious 
insanity, and the third was an imbecile. 

Until middle life Francis Mouret showed no symptoms of 
insanity. He was a successful tradesman, and was able to 
retire from business with a comfortable income by the time he 
was forty years of age. When he is first introduced to us, we 
see that he is a commonplace, well-to-do bourgeois, a petit rentier ; 
with all the virtues and all the little foibles of his class. He is 
fond of his wife and children, and proud of his house and 
garden. He has a mania for tidiness—the tidiness of a precise 
old maid. He is perhaps a trifle near in money matters, but 
not more so than a careful man would be whose income was 
limited. He is a bit of a gossip, is fond of company, and of 
jokes—when he is not the victim of them—and although he 
professes to have given up business, he is not above dealing in 
oil wine, or any other commodity, when he sees the chance of 
making a little money. 

Retired business men are the keenest of politicians, and 
Francois Mouret was no exception to the rule. He was a 
republican—the time of the story was the days of the Second 
Empire—and an anticlericalist. In a few years he acquired so 
much influence among the working-men of Plassans that he was 
feared by the opposite party. 

But there were indications that at the bottom this masterful, 
little man, this keen politician, this would-be leader of men, was 
as weak as a child, and there was, moreover, his bad family 
history to be reckoned with. The hour of stress came with the 
entrance of Abb£ Faujas into his life. This priest—the character 
is drawn with bold strokes, but is a little wanting in colour— 
came to Plassans with the mission of converting the city to 
Imperialism, and in carrying out his plans he incidentally 
acquired an immense influence over Mouret’s weak-minded wife, 
who fell in love with him. 

It was the lighting-up of jealousy in Francois Mouret’s breast 


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which revealed the innate weakness of the man. At the first 
suspicion a strong man would have kicked the priest—Faujas 
lodged with the Mourets—out of the house. Francois did 
nothing of the kind. On the contrary, at first he defended the 
ecclesiastic when the neighbours criticised his conduct, much on 
the principle that a small boy speaks well of a bully, of whom 
he stands in hourly dread, hoping by so doing to gain his 
favour. But Mouret found an outlet for his jealousy in his 
treatment of his wife. He overwhelmed her with sarcasms, and 
as a further indication of his displeasure he cut down household 
expenses to a minimum. 

As time went on, the fear which Mouret had conceived of 
Faujas not only increased as far as the priest was concerned, 
but extended by degrees to his wife and maidservant, until at 
last he seemed to live in abject dread of those about him. His 
character also altered day by day. He who had been so genial, 
so fond of the society of his fellows, became morose and 
taciturn. He left off going to his club, and he was no longer to 
be seen chatting with his friends in the cool of the day beneath 
the great plane-trees on the Cours de Sauvarre. 

There were physical changes in the man. In a few months 
his hair turned grey. He grew thin, and stooped. There were 
alterations also in the sphere of the emotions. Mouret’s feelings 
became blunted. Only one affection seemed left to him, and 
that was his love for his poor imbecile daughter, which love 
lingered to the end. 

The process of mental deterioration continued. The busy 
man—formerly busy to enthusiasm even about trifles—grew idle. 
Nothing interested him. He attended to nothing, and went 
about the house and garden gaping as though he were tired of 
life. He submitted to insults, he interfered with no one, and he 
hardly spoke. Finally, he took refuge in an almost empty 
room on the first floor, where he sat for hours doing nothing, 
as was proved by the dust which accumulated on the table. 

In describing these changes Zola has indicated with no little 
skill that two passions, hatred and fear, continued to smoulder 
in the wretched man’s mind. The hatred was the natural con¬ 
sequence of jealousy—of jealousy which could not find relief in 
action. In Mouret’s case it was held in check by his unreason¬ 
able dread of Abb£ Faujas. It seemed as though the priest 
exercised mesmeric influence over him. But the fear was 


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probably only the result of primary weakness of character. It 
was an acknowledgment of another’s strength. 

As the story proceeds, it is seen that Faujas and his political 
friends took full advantage of Mouret’s mental condition. 
They feared that his influence with the working men of Plassans 
would mar their plans, and they resolved to shut him up in an 
asylum. The man was harmless enough, but his enemies 
exaggerated his case,and when exaggerations failed they invented 
histories. They said that he ill-treated his wife, that it was 
dangerous for him to be at large, etc., etc. 

After Franqois Mouret was shut up in the asylum he became 
maniacal. Probably his case might be described as one of 
maniacal-depressive insanity, the melancholic phase occurring 
while he was at home, the phase of excitement after his 
internment. 

Nothing shows so clearly the advance in Zola’s power of 
describing disease as a comparison of the maniac in La Conquite 
de Plassans and the sufferer from delirium tremens in 
L’Assominoir; the one is melodrama, the othfer is a finished 
clinical picture. 

It was a necessary part of the mechanism ot the story that 
Mouret should escape from the asylum, and by he connivance 
of an attendant he does so. Naturally he returns home—the 
asylum at Tulettes was not many miles from Plassans—and in 
the account which he gives of the thoughts which pass through 
the madman’s brain and of his behaviour during the night walk 
the novelist rises to a high point of psychological description. 
Mouret is not in the dream-like condition of an alcoholic. He 
recognises familiar objects, and has some idea of time. When 
he sees the signs of a coming storm he regrets not having 
brought his overcoat and umbrella, and he takes shelter when 
the rain comes down in torrents. But for all that he is living 
in the past, in the days when he and his wife loved one another. 
He is going home. The hour is late, and he fears that the 
dinner will be cold. 

It is nearly midnight when he arrives at his house. The 
doors are locked and the windows are dark. Everyone appears 
to have gone to bed. Mouret knocks. No one comes to the door. 
He calls to his wife. There is no answer. The madman goes 
round to the garden and enters the house by the cellar door. 
There have been great changes in his home since hewas last there. 


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He cannot understand them. Suddenly he hears the voices of 
people talking upstairs. Like a flash the idea of Faujas and 
all that is connected with that idea comes back to Mouret’s 
mind. The dread, which was so characteristic a feature of the 
depressive stage of his disease, has disappeared. There is 
nothing now to hold in check the impulse cf vengeance 
which possesses him. He finds means of setting fire to the 
house and destroys both himself and his enemy in the con¬ 
flagration. 

Marthe Mouret .—Family history good, with the exception 
that her paternal grandmother, Adelaide, was insane. Marthe 
and her husband, Francois Mouret, were first cousins, and 
resembled each other to a remarkable degree. They also bore 
a marked physical likeness to their insane grandmother. 

During her childhood Marthe appears to have been very 
delicate, and to have suffered from attacks of vertigo, strange 
ideas, and mental confusion. When she was about twenty 
years of age she probably passed through a mild attack of 
melancholia with delusions, one being that her head had been 
opened and her brain removed. After her marriage she became 
stronger. The quiet life of a shopkeeper’s wife at Marseilles 
suited her. “ I passed there fifteen years,” she said, speaking 
of her past, “ which have taught me to be happy in my own 
home surrounded by my children.” 

Her life, after she and her husband retired to Plassans, was 
tranquil enough, but there were signs that even before the 
arrival of Abbd Faujas she was becoming restless. Her 
husband’s petty meanness and rough jokes irritated her. Her 
household duties and the care of her children no longer sufficed. 
She was conscious of a vague, unsatisfied desire. She longed 
for she knew not what. Yet she could not stand excitement. 
“ I cannot read a novel,” she tells us, “ without having frightful 
headaches, and for nights afterwards all the characters dance in 
my brain. Needlework is the only thing which never fatigues 
me. I remain at home to avoid the noise of outside, the 
gossip, the nonsense, which fatigues me.” She was haunted by 
the dread of the approach of some catastrophe, and especially 
by the fear that she herself would become mad. 

Soon after Abb£ Faujas came to lodge in her house Marthe 
fell under his influence. The mental changes which resulted 
were at first slow and almost imperceptible, but soon they became 


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more manifest. The priest read the woman’s mind as though 
it were an open book. To satisfy her vague longings he offered 
her the consolations of religion. She seized the proffered com¬ 
fort with eagerness, and, carried away by her enthusiasm, she 
passed through religion to mysticism. She had periods of 
ecstacy which were marked by hallucinations of sight and 
hearing. Gradually a new passion revealed itself in the midst 
of these excited emotions. The woman became enamoured of 
the priest. At first Madame Mouret was scarcely conscious of 
the nature of the feeling. She hardly distinguished it from her 
religion. In the end it became religion itself. 

It is only fair to say that Abbe Faujas did nothing to arouse 
this love for himself. Indeed he repulsed it. He was a hard 
man who cared nothing for women. One might say that he 
hated them as unmitigated nuisances—nuisances both in religion 
and in politics. He was perfectly satisfied with the influence 
he had acquired over the mind of Francois Mouret’s wife, which 
was necessary for the success of his mission in Plassans. He 
did not want her love, which only hampered his designs. 

It is unnecessary to unravel the tangled skein of mysticism 
and eroticism which the novelist exhibits to us as present in the 
mind of Marthe Mouret. The condition is by no means un¬ 
common, and usually manifests itself at times of physiological 
stress—at or after puberty in both sexes, and about the climac¬ 
teric in females, though unmarried women seem liable to it 
more or less at all ages. This form of mysticism differs from 
common-sense religion, either of the Roman Catholic or Pro¬ 
testant variety, by its utter want of altruism. These patients 
are supremely selfish, and are a perfect nuisance in their own 
homes—points which Zola brings out very clearly in his sketch 
of the character of Madame Mouret. 

As time went on the patient developed cataleptic and 
hysterical symptoms. Sometimes, in a state of unconsciousness 
or semi-unconsciousness, she would throw herself on the floor or 
against the walls or furniture of the room, bruising herself 
severely. After recovering from these attacks she appeared at 
first to have no recollection of what had occurred. But this 
amnesia was only temporary, for there is no doubt that later on 
she remembered what had taken place. 

In comparing the cases of Marthe Mouret and her husband 
one observes a curious difference in the effect of the mental 


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disturbance on the character. In the man’s case, he, who had 
been strong and masterful, became chicken-hearted, and gave up 
all initiative in life ; in that of the woman, she, who had been 
weak and yielding, and to a certain extent a down-trodden 
household drudge, became self-assertive and bullying. 

Madame Mouret was naturally plump, and after she had 
passed her fortieth year she grew stout. But as the mental 
malady from which she was suffering developed itself, she 
became rapidly thin. Presently she began to cough, and other 
symptoms of tubercular disease of the lungs manifested them¬ 
selves. It was during this period of wasting that her passion 
for the priest revealed itself in its true character. Excessive 
eroticism is not uncommon among the phthisical. Madame 
Mouret’s love for her family was long since dead, and now her 
modesty died also. The brutal way in which Abb <5 Faujas 
repulsed her seemed to crush the life out of the woman. She 
became a physical and mental wreck, and a little later died of 
phthisis. 

The following four cases form a group by themselves. 
Although in each the nature of the psychic disturbance is 
different, yet they are linked together by the fact that the 
symptoms of mental alienation first showed themselves in 
adolescence or early manhood. 

The first case is that of Silv&re Mouret. His family history 
is the same as that of his brother Francois, and need not be 
repeated. Silvere was a delicate child. After his father’s 
suicide, which occurred at Marseilles, he was brought to 
Plassans. At first he was pushed from pillar to post, but finally 
he went to live with his grandmother, Adelaide, in a tumble¬ 
down cottage on the outskirts of the city. This was probably 
the boy’s physical salvation, for the wild, outdoor life suited him, 
and he grew up strong and healthy. He was a serious lad, and 
was never happier than when he was acquiring information. He 
received a smattering of education at a school attached to a 
neighbouring monastery, and later on he was apprenticed to a 
wheelwright, who took a fancy to the boy. He became a clever 
workman, but his thirst for general knowledge knew no bounds. 
On one occasion he borrowed a work on geometry, and he spent 
, weeks without a guide trying to understand the simplest 
problems. He bought second-hand books on all sorts of 
subjects, and studied them during the night by the light of a 


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ZOLA’S STUDIES IN MENTAL DISEASE, 


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miserable lamp. A self-taught man is only too likely to get on 
the wrong track. Nothing, says Zola, is so bad for the mind as. 
such a method of instruction. Silvere “ became one of those 
learned workmen who can hardly sign their names, and who 
speak of algebra as a person of their acquaintance.” More often • 
than not these crumbs of knowledge give an absolutely false 
idea of great truths. 

At this time (1840-48) Europe was seething with revolution. 
Every man was a politician, especially in France. Ever y cabaret 
throughout the land was the meeting-place of a club of revo¬ 
lutionary amateurs, where the wildest and most impossible 
schemes of reform were bandied from mouth to mouth. Silvere 
seized all these ideas with avidity. At once generous and 
ignorant, he was fascinated by the crude notions of humanitarian 
Utopias and of universal happiness which he heard propounded 
all around him. He passed his nights in reading political 
pamphlets and abstruse dissertations on social economy, works 
which often he did not even succeed in understanding, but which 
he studied with the strange love which demi-savants have for 
difficult literature. About this time he came under the influence 
of his uncle, Antoine Macquart, a lazy drunkard, whose constant 
topic of conversation was the approaching golden age when no 
one would any longer be obliged to work. 

Macquart induced his nephew to become initiated into the 
secret society of the Montagnards, a powerful association which 
at that period extended like a network throughout the south of 
France. From that time Silvere devoted his leisure to furbish¬ 
ing an old musket which he found in his grandmother’s cottage, 
and to dreaming the dreams of the Illuminati. His reveries 
were of gigantic epics, of Homeric struggles, from which the 
defenders of liberty came forth as conquerors amid the acclama¬ 
tions of the whole world. 

But his enthusiasm was, to say the least of it, unhealthy. 
“ He found himself,” says the novelist, “ predisposed to the love 
of Utopia by certain hereditary influences: in his case the 
nervous troubles of his grandmother turned to chronic enthu¬ 
siasm, with Hans to all that was grandiose and impossible. His. 
solitary infancy and his imperfect education had singularly 
developed these tendencies of his nature.” 

In the end Silvere died a martyr to his visionary republi¬ 
canism. 


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This case occurs in the first novel of the series, and Zola was 
more intent upon the charming romance, which he weaves about 
the loves of Silvere and Miette, than in psychological studies. 
But he has given a sketch, faint, no doubt, but of which the 
outlines are distinctly visible, of a mental condition which is not 
uncommon among the young, even among those who are in 
superior social circumstances and are better educated than 
Silvere Mouret. It is natural enough for a healthy and generous 
lad, when he is brought face to face for the first time with the 
ugly realities of life, to enter heart and soul into any plan which 
appears to work for the improvement of the condition of the 
poor and down-trodden, and the healthier the boy the more 
vigorously and enthusiastically will he enter into the business. 
But there is such a thing as unhealthy enthusiasm, a weedy sort 
of overgrowth, specimens of which may be found among the 
juvenile professors of milk-and-water Communism, Christian 
Socialism, and the like. The family history of such cases 
frequently reveals hereditary tendencies to mental disease, and 
the personal history is not always satisfactory from a moral 
point of view. Upon analysis, the vaunted altruism of these 
young men will be found to be only a thin veneer covering a 
thick bed of egoism and pride. One singular characteristic of 
such individuals is their fondness for ostentatious self-abase¬ 
ment. It is astonishing what satisfaction they find in doing 
some trifling and unnecessary act of menial labour. I remember 
a youth, physically overgrown, mentally backward, and with a 
very bad family history, who, though he iived in a luxurious 
home, yet considered that blacking his own boots was an act of 
righteousness. It will usually be observed that the enthusiasm 
grows more and more feeble as such an individual arrives at 
maturity. The veneer of generosity melts away, and the innate 
selfishness stands revealed in all its ugliness. In after-life such 
a man is never a success. If he be wealthy, or have’ much 
family influence, he may be pitchforked into a high position, but 
he is no ornament to it, and sinks rather than rises in the social 
scale. Often, as years go on, he exhibits signs of feeble¬ 
mindedness in one form or another. He may be the victim of 
some phobia or obsession, or of some group of symptoms which 
may be labelled neurasthenia, hypochondria, or even hysteria, at 
the discretion of his medical attendant. 

The second of this group of four cases is that of Serge 


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Mouret. He was the younger son of Francois and Marthe 
Mouret, and it is unnecessary to add further particulars of his 
family history. 

As a child, Serge was quiet and amiable. He did well at 
school, being exceedingly industrious. Very early in life his 
thoughts appear to have turned towards religion, or, rather, 
mysticism, and when he became a man he entered the priest¬ 
hood. Physically he was never robust. 

During his career as a theological student his industry and 
devotion were remarkable, but his health does not appear to 
have been good. Frequently he suffered from hallucinations. 
Sometimes it seemed to him that the high, vaulted roofs of 
the halls of the seminary echoed with angelic voices ; some¬ 
times he felt himself touched by unseen, gentle hands ; at 
other times he smelt a heavenly perfume which long after¬ 
wards, it appeared to him, continued to cling to his garments. 
He was on several occasions confined to his bed with slight 
attacks of fever, accompanied with great physical prostration, 
and one of these attacks was complicated with delirium. 

For some days before his ordination, during the ceremony, 
and for some time after, the nervous tension was so great that 
the young man appears to have lived in a dream. 

After his ordination Serge was placed in charge of the 
parish church of Artaud, a village some leagues distant from 
Plassans. It was a desolate country, such as one meets with 
here and there in Provence. The landscape was shut in by a 
wall of yellow hills, fringed and flecked with patches of black 
pine-woods. The land was terribly barren ; everywhere the 
bare rock cropped up. The vines, dry as thistles, pushed out 
from between the stones. In places, where attempts at culti¬ 
vation had been made, one saw red fields marked with lines ol 
grey olives or miserable almond-trees, and far away the eye 
rested on the pale green of a square plot of wheat, a tender 
note in that scene of arid desolation. The peasants were 
suited to the soil they cultivated. They were brutalised by 
ignorance and poverty. 

Here, in a presbytery in almost as ruinous a condition as 
the church itself, Serge Mouret lived with his half-witted sister 
and a rough but not ill-natured housekeeper. The young 
priest, filled with the enthusiasm of his mystic creed, did his 
best. Assisted by a boy, as mischievous as a Paris gamin , he 


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served the altar daily, even when the church was empty, and 
the sparrows flew in and out through the broken windows. 
He tried to teach the rudiments of religion to the village 
children, and he endeavoured to instil morality into peasants 
sunk in sensuality and drunkenness. But what success could 
such a man, a seminarist utterly ignorant of life, expect among 
such people ? 

One day, after having said mass in the empty church, and 
having partaken of such a meagre breakfast that he was almost 
fasting, Serge Mouret walked some leagues across the arid 
country in the mid-day heat of the sun of Provence. It is 
possible that on that occasion he suffered from a slight sun¬ 
stroke, which may have been a contributory factor in his 
subsequent illness. The errand of mercy on which he had 
set out w'as a failure ; an unexpected visit, which he had paid 
in the course of his journey, had disturbed him mentally, and 
he returned to the presbytery tired and dispirited a long time 
after the usual dinner-hour. 

In the evening the girls of the village came to dress the 
church, and particularly the chapel of the Virgin, with garlands, 
for the morrow was the first of May. After they had gone 
away Serge Mouret remained for a long time kneeling in 
devotion before the altar. When at last he rose to his feet 
he became suddenly conscious of the deathly coldness of the 
church. He shivered, and his teeth chattered. When he 
reached his bed-chamber he felt so cold that he lit the fire. 
The whole house was wrapped in silence, but there was a 
buzzing in his ears, which finished by becoming what seemed 
to him to be the sound of whispering voices. These voices 
increased a feeling of anxiety, of which he had been dimly 
conscious during the day. It became a presentiment of some 
unknown trouble, and, true to his usual mode of thought, the 
young priest sought its origin in some sin which unwittingly 
he might have committed. He sank into a dreamlike con¬ 
dition. All his old life at the seminary passed vividly before 
him. He lived it over again. Presently he came to himself. 
He was shivering no longer. He was burning with fever. 
He went to the window, and opened it, that he might refresh 
himself with the coolness of the night air. The moon had 
risen, and all the plain of Artaud was spread before him, more 
tragic in the pale moonlight than by day. He tried to 


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remember when he had first felt ill, but he could not think 
clearly. The events of the day just past were as dreamlike, and 
even more distant than his life in the seminary. His face was 
covered with sweat. Again he was shivering, and yet he felt 
as though he were on fire. Seeking a refuge from his distress, 
he threw himself on his knees before a statuette of the 
Immaculate Conception, clasping his hands and crying : “ Holy 
Virgin, pray for me ! ” 

He shivered again, his teeth chattered, and, overcome by 
fever, he fell fainting on the floor of his bed-chamber. 

The fever and delirium lasted some weeks. The patient’s 
uncle, Dr. Pascal Rougon, of Plassans, attended him during his 
illness. I have made a study of the character of this clever, 
but eccentric physician, in a recent paper ( 1 ), and I am certainly 
not surprised that the treatment he adopted in a case of brain 
fever was as eccentric as himself. It was successful as far as 
the patient was concerned, but it was disastrous for the nurse. 
But that belongs to the story, and has nothing to do with the 
medical aspect of the case. 

When he first came to himself, Serge Mouret felt as though 
his head were empty. He was in a strange room, but he was 
not in a condition to notice the unfamiliar surroundings. His 
eyes wandered aimlessly from corner to corner. 

“I have been dreaming. I am dreaming always,” he 
murmured with an air of weariness. “ I hear bells, and it is 
that which fatigues me.” 

He remembered something about his delirium. 

“ I feel as though I had arrived after a long voyage,” he 
said, always with the same air of weariness. “ But I don’t 
know where I am. I don’t even know where I set out from. 
I had a fever—ah ! yes, I remember. It was always that 
nightmare of crawling along an interminable subterranean 
passage. The stones fell Trom the roof of the passage, and 
I was walled in. I was seized with a rage to force my way 
through. I worked with my head, my hands, and my feet. 
I was desperate.” 

The nurse gently put her hand on his lips to make him 
keep .silence. “No,” he said, “ it does not fatigue me to talk. 
I am only whispering. I am thinking aloud, and you can 
hear me. But it was droll that in the subterranean passage 
I never had the least idea of going back. All I cared about 


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was to force my way forward through all obstacles, even if it 
took me a thousand years. My knees were bleeding. I had 
struck my forehead against the rock, and I was conscious 01 
the agony of working with all my strength to arrive as soon 
as possible. To arrive where ? I don’t know. I don’t know.” 

The next day was wet. The fever returned, and towards 
■evening the patient became delirious. It was again the night¬ 
mare of the subterranean passage. The weather seemed to 
influence the disease, for the nurse observed that Serge was 
better on fine days and worse on wet ones. 

The convalescence was tedious. The patient had the mental 
■and bodily weakness of an infant. He had to learn again to 
walk, almost to speak. For hours he would play with a comb, 
or some such object, as a child plays with a toy. Although 
Serge remembered something of his delirium, he recollected 
nothing of his life before the commencement of his illness. 
It was an absolute blank. His memory appeared to be 
grievously injured. As time went on, the delusions of his 
•delirium faded away, and he could no longer call to mind 
even the events of the early days of his convalescence. Both 
doctor and nurse feared that the case would end in dementia. 
Day by day the patient gained in bodily strength, but there was 
no mental improvement. 

The cure came about suddenly. Serge had been nursed 
back to health in a lonely country house some miles away 
from Artaud. One day, after he had regained the full vigour 
of his body and to a certain extent that of his mind, he 
climbed to the top of some rising ground, and saw in the 
distance the village, the church, and his own home. His whole 
body shook with excitement. He remembered. The past 
came back to him. 

But it is questionable whether the cure was complete. 
After his illness, Serge was a changed man. The keen edge 
■of his intellect was blunted. At least, on one occasion, there 
was a return of fever with slight delirium, and at times he was 
subject to hallucinations of sight and hearing, and even of 
touch. 

Some years later, Serge Mouret left Artaud, and became 
curi of Saint-Eutrope, a better living, both from a pecuniary 
and social point of view, for it was in the district which pro¬ 
duced the best wine of the neighbourhood, and consequently 


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the peasants were better off. Here he lived in great humility. 
His reputation for sanctity extended far and wide, and he 
might have risen to a high position in the Church. But he 
refused all advancement, and when we last heard of him he 
was showing signs of commencing phthisis. 

The third case is that of Lazare Chanteau. Family history : 
Father, a good-tempered, sluggish man, a martyr to gout. 
Paternal grandfather started life as a working carpenter at 
Caen. Later, he became a timber merchant on a large scale. 
He was always trying to improve his business by venturesome 
schemes, some of which were successful, but the majority were 
failures, and when he died his firm was in a very bad way. 
Mother was the daughter of a ruined yeoman-farmer. Before 
her marriage she was a school-mistress. She was a strong 
minded, ambitious woman. She died of heart disease in 
middle life. 

Lazare’s boyhood does not appear to have been remarkable. 
To a certain extent he was the victim of his mother’s ambition. 
She made him work very hard at school, where he possibly 
over-taxed his powers. At the age of eighteen he passed his 
baccalauriat. At this period he was well-grown. He had a 
large forehead, and a normal growth of hair on his face. He 
cared little for physical comforts, was absent-minded, and given 
to day-dreaming, and had a young man’s contempt for money. 

Madame Chanteau wished Lazare to study law, but the 
young man had no predilection for anything but music. At 
the lycte he had been taught the violin, and his master, who 
predicted a glorious futureTor his pupil, had given him private 
lessons in harmony and counterpoint. As soon as he left 
school, Lazare, full of the idea of being a musical genius* 
commenced writing a symphony, which, however, he never 
finished. 

A little later he grew tired of music, and determined to 
become a doctor. He went to Paris to study medicine. His 
enthusiasm for the art of healing increased to a white heat, 
and he dreamed of becoming the most celebrated physician of 
his age. It is to be noted that he always thought of himself 
as being in the first rank. Presently, his enthusiasm for 
medicine died down. He grew idle, failed to pass his examina¬ 
tion, and blamed his teachers, not himself, for his want of 
success. 


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Tired of medicine, Lazare entered the laboratory of a 
celebrated chemist. Here he conceived the idea of extracting 
bromides and iodides on a great scale from seaweed—making 
a gigantic business of it. He set about it immediately, for 
any delay in putting his plans into execution was veritable 
torture. But the affair proved a failure, and the young man’s 
love for chemistry became speedily exhausted. And so it 
went on. Lazare went in for music again, and gave it up. 
Then he conceived the notion of building a defence against 
the encroachments of the sea, which was gradually washing 
away the shore near his home. This failed. He thought of 
emigrating, of starting a newspaper, of going in for literature, 
finance, politics, etc., etc. One thing is to be noted, that he 
grew more quickly tired of his projects as he grew older— 
he became more quickly mentally fatigued. 

Lazare was as changeable in his affections as in his ambitions. 
He became engaged to his cousin, Pauline, a good-looking, 
sensible young woman, and, after a few months of violent love, 
he threw her over, and married a silly girl, who was utterly 
unfitted to be his wife. The poor young fellow was, as Zola 
puts it, “ toujours en quite d?un bonheur qui avortait .’’ 

Although always disappointed in him, yet Lazare’s mother 
never lost the idea that her son was a genius. Again and 
again she provided him with means, not always by honourable 
methods, to put into execution his ill-digested plans. How 
often is the mother the evil genius of such unfortunates ! Still, 
Madame Chanteau was not altogether blind to the condition 
of her son. More than once the thought crossed her mind 
that he was like his grandfather, the carpenter, who changed 
his business, and nearly ruined all by his hair-brained schemes. 

So far there was nothing very extraordinary in Lazare’s case 
He was only one of that multitude of young men who labour 
under the curse of Reuben : “ Unstable as water, thou shalt not 
excel.” But there was a greater flaw yet in his mental make¬ 
up. He was obsessed by the fear of death. 

One of the peculiar charms of Zola’s novels is the skill 
with which he makes Nature sympathise with the moods of his 
human characters. When he first draws our attention to this 
mental affliction of Lazare Chanteau, the background is painted 
in harmony with the melancholy of the sufferer. The young 
man and his cousin, Pauline, are returning from a long walk 

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along the sea-shore. Twilight is deepening into night, and the 
stars are appearing in ever-increasing numbers in the darkening 
sky. Pauline stood still for a few minutes looking upwards. 

“ How beautiful the stars are,” she remarked gravely. “ You 
have taught me that each one is a sun, and that there are 
millions and millions of them.” 

“ I don’t like to look at them,” said Lazare in a voice choked 
with emotion. “ It makes me afraid." 

It was night now, and the sky, almost completely black 
from the zenith to the immense horizon, glittered with innumer¬ 
able, twinkling points of light. The tide was coming in with 
a low, wailing sound like that of the lamentation of a distant 
crowd weeping in misery. 

Pauline stood gazing in silent admiration at the brilliant 
vault of heaven. Suddenly, mingled with the plaintive moaning 
of the sea, she heard the sound of sobbing close beside her. 

“ What is the matter ? ” she asked, turning to Lazare. 
41 Are you ill ? ” 

The young man did not answer. He had covered his face 
with his hands so that he should not see. When he had 
mastered his emotion and could speak, he stammered : “ Oh! 
that I must die one day, must die one day ! ” 

As in the case of obsessions generally, the date when this 
one originated is uncertain. It was hardly noticeable before 
Lazare was twenty years of age, but soon afterwards it began 
to make his life miserable. He could hardly lay his head at 
night upon the pillow without the idea of death presenting 
itself to his mind. Insomnia developed itself—insomnia made 
horrible by the lugubrious images which passed before his 
fancy. Worn out by fatigue he would fall asleep, only to 
wake with a start, stammering in the darkness, with clasped 
hands and eyes full of horror: “ My God ! my God! ” 
When he was fully awake he was ashamed of this fright. 
He was a professed atheist, a pessimist, a disciple of Schopen¬ 
hauer, and he found it the act of an imbecile thus to appeal 
to a God whom he denied: It was the heredity of human 
feebleness crying for help. 

Even in the daytime a chance word or thought, an unexpected 
occurrence, or a paragraph in a newspaper would conjure up in 
his mind the horrible fear of death. 

It is to be remarked that Lazare lost this dread at the actual 


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Approach of the King of Terrors. His cousin, Pauline, whom 
at that time he loved with all the strength of his ill-balanced 
mind, was seized with a grave disease, and for some days her 
life hung by a thread, and Lazare was himself astonished at the 
calmness with which hie faced the idea of death. He trembled, 
it was true, at the thought of losing his sweetheart, his dear 
companion, but this was another sort of fear, totally different 
from that which possessed him when he had contemplated the 
notion of his own annihilation in days gone by. 

But the respite was short. Pauline recovered, and hardly 
was her convalescence established before Lazare fell again under 
the power of his obsession. One night he awoke with a start, 
and with eyes dilated with horror. The fear of death had 
reappeared in his sleep, in a dream probably. “ My God ! my 
God ! must I die one day ? ” he cried in abject terror. 

The man was ashamed of his affliction, and tried to conceal 
it from those around him. But he nursed it privately in a 
thousand little ways. It was not every night or day that the 
dread overpowered him. Sometimes two or even three nights 
passed without his being disturbed, and he got into the habit 
■of noting down the dates on an almanac. 

Gradually the fear of death, which, though certain, might 
not occur until some date more or less distant, took the form 
of the dread of immediately to be expected dissolution. 
Obsessed with this new phase of the disease, Lazare could not 
go out of a room, nor close a book, nor make use of any 
object, without believing that it was the last time he would do 
so. Thus he contracted the habit of continually saying adieu 
to the things about him. Little by little these morbid ideas 
gave rise to others. Unconscious probably of its origin, he 
became possessed with the notion that by performing certain 
actions he might delay the advent of the inevitable. Ideas 
of symmetry intruded themselves into his mania. He felt 
himself compelled to take three steps to the right, and then 
three to the left, without any apparent object. He must touch 
the furniture on both sides of the chimney-piece or door, and 
he must touch each article an equal number of times. He 
even appeared to attach a superstitious idea of value to certain 
numbers. For example, five or seven touches, distributed in a 
particular fashion, would prevent the adieu from being final; 
•or, in other words, would ward off for the moment the approach 


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of death. “ In spite of his intelligence and of his denial of the 
supernatural, he practised this imbecile religion with the docility 
of a brute. Tt was the revenge of the nervous derangement 
of the pessimist and the positivist, who declared that he 
believed only in facts and experience.” 

The man became a nuisance to his friends. 

“ What are you wasting your time about ? ” cried Pauline to 
him on one occasion. “Threetimes already you have returned 
to that cupboard to touch that key. What do you do it for ?• 
What a maniac you-will be when you are eighty ! ” 

Occasionally his fear of death crystallised into a morbid 
dread of some special malady, or of some particular form of 
accident. His mother died of heart disease, and he became 
convinced that he would die of the same complaint. He was 
always observing his own symptoms—generally imaginary— 
with the anxiety of a hypochondriac. “ His two years of 
medical study had not demonstrated to him the equality of all 
diseases in the presence of death.” On the contrary, his 
superficial knowledge of medicine only aggravated his terror of 
the malady in question. Later, he was seized with a dread 
of fire. He was living in Paris at the time, and his aparte- 
ment being on the third floor, he moved down to the first, in 
order that he might escape more easily in case of fire breaking 
out in the building. 

Physically, as time went on, there was little to be noted in 
Lazare’s case. He stooped somewhat, and seemed older than 
his years. Sometimes a slight trembling of the muscles of 
his face was observed—a trembling which, in moments 
of agitation, communicated itself to the muscles generally 
of his whole body. He was exceedingly sensitive to per¬ 
fumes. I have noticed an increased olfactory sensibility in 
several cases of obsession which have come under my observa¬ 
tion. Lazare had one child, and Zola remarks how quickly,, 
when they played together, both father and son became 
fatigued. 

Gradually the man became listless and idle. His ambition 
seemed dead, or if some phantastic project flitted for a moment 
across his mind, it had no longer the power to raise even a 
flicker of enthusiasm. When we last hear of him, he is leading 
an aimless life on his wife’s money. 

The fourth and last of this group of cases is that of Claude 


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Lantier. His family history was bad. Brother, a sexual 
pervert. Mother, a drunkard. Maternal grandfather and 
grandmother, both drunkards. Maternal great-grandmother, 
insane. Claude had one child, who died of hydrocephalus in 
his ninth year. 

Claude Lantier was the eldest child of his parents, his 
father being eighteen years of age, and his mother little over 
fourteen when he was born. He was a native of Plassans in 
Provence, but was taken at an early age to Paris. He was one 
of those gifted children who, as soon as they can hold a pencil, 
•can draw, and draw well. Some of Claude’s child-sketches 
were brought to the notice of a wealthy old gentleman, an 
amateur authority on Art, who, enraptured at the idea of 
playing the part of Maecenas, adopted the boy, and took him 
back to Plassans to be educated. 

At school Claude Lantier did not distinguish himself, but 
he appears to have escaped the moral infection which is not 
unknown even in scholastic establishments of the present day, 
and his boy friends were those who, like himself, were, or 
thought they were, budding literary or artistic geniuses. The 
pleasure of these lads was to escape from the dull school-room 
and spend long days exploring the wild neighbourhood of 
Plassans. It was in these expeditions that Claude learned to 
love the beauties of Nature, changing with the ever-changing 
sunshine ; that he acquired that feeling for atmosphere, which, 
in spite of all their defects, became the charm of his mature 
works. One of his companions, who afterwards became a dis¬ 
tinguished novelist, had always a book in his pocket, and was 
accustomed to read aloud while Claude worked at his sketches. 
Thus, at the age of fourteen, these boys fell under the influence 
of Victor Hugo, and of that writer’s ideas, his vast pictures, his 
“ eternal battles of antitheses.” Later, Alfred Musset came 
to fascinate them “ with his passion and his tears. A more 
human world revealed itself, which conquered them by pity, by 
the eternal cry of misery which they must henceforth hear 
rising frOm everything.” 

One can quite imagine what sort of a young man Claude 
Lantier was when he went to Paris to study Art in earnest. 
He had learned all. that he knew from Nature herself, and he 
rebelled against the drudgery of the school. After six months’ 
work, his master told him he would never be able to do any- 


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thing, and Claude left the atelier in disgust. He went then to 
study the nude in a free studio, where, having paid his twenty 
francs to the massier, he could work after the dictates of his 
own fancy, and where he was not bothered by the stereotyped 
advice of a fossilised pedagogue. Here his time was not 
altogether thrown away. In after years, hanging on the walls 
of his own studio, were to be seen studies which he had made 
at that period. They were admirable pieces of work, painted 
with the breadth of a master. There was a girl’s foot, for 
example, exquisite in its delicacy and truth. There was 
especially the torso of a woman with flesh like satin, living, 
palpitating, with the suggestion of the blood which flowed 
beneath the skin. 

Art in France, at the time when Zola introduces Claude 
Lantier upon his stage, was in more than its usual state of flux 
and change. The Academicism of David, and later that of 
Ingres, though it still lingered in influential quarters, had to a 
great extent been swept away by the rising tide of Romanticism, 
which found its noblest expression in the work of Delacroix. 
But Romanticism, before even it could completely gain the 
ascendant, found itself involved in a struggle with the artists of 
the Barbizon School, men like Millet, Rousseau, Corot and 
others, men to whom Realism, work done in the open air, was 
everything. The students, the radicals of the artistic world, 
the rising generation in short, embraced the creed of plein air 
with enthusiasm. To no one did it appeal more strongly than 
to Claude Lantier, brought up as he had been in the vivid 
sunshine of Provence. Even in Paris he was always obsessed 
with the beauties of changing light—dawn, sunrise, the 
splendours of noon and sunset, and the soft tones of twilight. 
But he carried Realism too far. He became an unbridled 
Impressionist. Some of his sketches were terrifying, the colour 
crude and violent, and the shadows indicated by great strokes 
of the brush. However, glaring as his faults were, he soon 
found himself at the head of a small band of enthusiastic 
followers, who hailed him as the coming Master. 

In his study of Claude Lantier Zola has presented us with 
the portrait of a genius who fails. A man's failure may be 
looked at from two points of view : the purely objective, that 
is to say, the value of his work, or, if you will, the value that 
the world puts upon his work; and the subjective or psycho- 


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logical, that is to say, the mental defects or deficiencies which 
are the real causes of his want of success. 

In the case of Claude, his objective failure, his failure as an 
artist, was primarily due to his lack of a sense of proportion. 
His composition was lamentable. He was an artist. His 
technique was admirable, and he had an exquisite feeling for 
colour. Taken piecemeal, certain portions, morceaux, of his 
pictures were excellent. A group of figures, a clump of trees, 
the sunlight as it filtered through the leaves, or fell upon the 
water, the painting of living flesh, or even of drapery, were 
charming. But, taken as a whole, his canvases were more 
thdn disappointing. Possibly, in addition to faulty com¬ 
position there may have been something wrong with the 
perspective, though the novelist does not lay stress on this 
point. It was the quality of his work in detail which pleased 
his admirers, who were not only inexperienced students, but even 
celebrated artists. This may be partly accounted for by the 
fact that it is the creative faculty, the workman’s faculty, which 
most fully appreciates detail, while it is the critical faculty 
which, though not underestimating detail, gives the proper 
value to the ensemble. Zola has further emphasised the point 
that it was only portions of Claude Lantier’s work which were 
really valuable by remarking that it was his first sketches, his 
studies, not his finished pictures, that were readily bought by 
picture-dealers, men who are usually keenly alive to the value 
of the wares in which they trade. 

The psychological causes of Claude’s failure were more com¬ 
plex. He was a man of great ideas, and they were not only 
vast, but they were happy. Had his ideas been realised, his 
pictures would have been masterpieces. But they were not 
realised. It seemed as though, in spite of his mastery of 
technique, his hands could not fully work out the conceptions 
of his brain. One might say that he suffered from a form of 
motor apraxia. Probably, to a certain extent, this is the case 
with every artist. 

When Claude conceived the idea of a picture he threw himself 
heart and soul into his preliminary studies, which were admirable 
in their way, and then with his enthusiasm at a white heat he 
attacked the canvas. He worked all day from dawn to sunset, 
and the result of his work was a sketch which was a master¬ 
piece—a sketch in which every stroke of the brush was a 


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stroke of genius. Then came the inevitable. In working 
together the details of his picture he spoiled his sketch. It 
was the irony, as Zola calls it, of a clever man who himself 
brings misfortune on his handiwork. His faulty composition 
marred everything. There was no coherence, and what was 
worse, fascinated by the beauty of an after-thought, he intro¬ 
duced some object which had no connection with the subject 
of his picture. 

It is not to be supposed, however, that Claude was blind to 
the fact that there were faults in his work ; on the contrary, he 
was often painfully ali.ve to it. His critical sense was suffi¬ 
ciently developed to warn him that something was wrong, but 
it .was not keen enough to point out the error ; a condition 
which was intensified by his defective artistic education. From 
this it resulted that, in spite of his vanity, and in spite of his 
belief in himself, at times he was plunged into crises of doubt, 
which were veritable hours of torture. 

It is Zola’s habit, when he wishes to bring into stronger 
light a mental trait, to place the character in which he is 
depicting it beside other personages, some of the very opposite 
mentality, others in whom the same trait is seen from a 
different standpoint, or is modified by varying circumstances. 
Thus, in order to throw into higher relief Claude Lantier’s 
affliction of doubt, he shows us, first, a sculptor who turns out 
sometimes excellent work, sometimes monstrosities, but who 
believes that everything touched by his hand is a masterpiece, 
and who never for a second doubts the excellence of his own 
genius ; then, a celebrated painter who, having gained fame by 
his first picture, lives ever after in dread lest his later produc¬ 
tions should fall below his own high-water mark. 

Step by step, as the story proceeds, Zola traces the decadence 
of an artist and a man in the case of Claude Lantier. The 
novelist is true to life when he shows that mental deterioration, 
while it destroys the good qualities, accentuates the bad, as a 
wasting disease mars the beauty of the human form and leaves 
only the ugliness of the skeleton. At first the declension was 
slow and almost imperceptible. Claude passed through a 
period which was marked by laziness and day-dreaming. He 
commenced half a hundred pictures, but finished none. Before 
he had half painted one his mind was busy with ideas for 
another, and consequently both were failures. His temper, 


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which had always been bad, grew worse. His outbursts of 
'passion became more and more violent and more frequent. 
Whatever love he may have once had for wife and child grew 
cold ; he neglected them both. 

As time went on, it became evident that Claude’s hand was 
losing its cunning. His technique no longer redeemed, or at 
least softened, his errors of composition. His pictures became 
so bad that those who formerly admired his work turned from 
them with pain. Here Zola paints a feature of mental 
deterioration with considerable skill. In progressive forms 
of psychic disorder the fading of the critical sense in its 
various manifestations is commonly observed. However, in 
the early stages of disease it is not altogether lost, but may 
be aroused, and even aroused to the point of great suffering, 
by acute emotion. The novelist tells us that as each picture 
rejected by the Salon came back to Claude, he saw their 
defects, saw them too late, and in a fury cut the canvases to 
pieces. The pictures were so bad—one, a painting of his child 
after death, must have been a terrible affair—that the artist, in 
his days of comparative health, even with his originally mal- 
developed critical faculty, could never for a moment have 
thought of exhibiting them. Hut his failing mind saw no 
fault in them, and he sent them in. Then, stung by the pain 
of rejection, his dying powers of discernment revived, and he 
saw in all their nakedness his errors of execution. His new 
•crises of doubt were terrible. Sometimes he was sunk in pro¬ 
found despair, sometimes his vanity, the last of human passions 
to disappear, buoyed him up. His mind was a battle-field, 
- strewn with hundreds of dead ambitions, on which struggled 
his belief in himself, already wounded unto death, and his 
growing consciousness of his inability to realise his conceptions. 

As his mental deterioration proceeded, Claude developed a 
sort of superstition, a religious belief in the importance of the 
medium in which he painted. He would have nothing to do with 
oil, which he spoke of as a personal enemy. In the place of it 
he used secret preparations, solutions of amber, of resin, etc., etc. 
He became fastidious about his palette knife and the shape 
and texture of his brushes. He invented a theory of com¬ 
plimentary colours which would have astonished Chevreul, and 
which was fatal to his own originality of notation, so clear, and 
so vibrating with sunshine. 


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I90 ZOLA’S STUDIES IN MENTAL DISEASE, [April,. 

Later, the poor fellow became the victim of delusions of 
suspicion. He began to suspect his friends, particularly those 
who had fallen away from him since the deterioration in his- 
painting. The expression of his face altered. His wife saw 
something in his eyes which frightened her. Sometimes she 
saw him in the attitude of listening, as though he heard a voice 
which was calling to him. She began to be haunted with the 
idea that her husband was going mad. 

One night, when he was dining with some friends, he actually 
overheard his former admirers depreciating him in no measured 
terms. It was a mortal blow. All his suspicions were con¬ 
firmed. After his return home he went out again, telling his. 
wife he was going for a walk. His manner during the evening 
had been so strange that the poor woman, fearful of his in¬ 
tention, followed him at a distance. He walked down to a 
bridge over the Seine, and remained for some time leaning on 
the parapet. The scene before him was fraught with painful 
memories, for he had used it as a background for one of his 
fatal pictures, the one in which he struggled more than any 
other against his failing powers. Once and again he made a 
movement as though he were about to throw himself into the 
river, but if he were tempted to commit suicide, for the time he 
conquered the impulse. When at last he turned to go home, 
his wife hurried before him, and was in bed by the time he 
arrived. He appeared to have recovered liimsq^f completely. 
He talked with calmness, and was more affectionate than he 
had been for a long time. When his wife awoke in the 
morning she missed him from her side. She was seized with a 
horrible presentiment, which was only too terribly realised when 
she hurried into the studio. Claude had hung himself in front 
of a picture on which he had laboured for years, striving to 
create a masterpiece, and always failing in the execution. 

Cases of alcoholism are numerous in the Rougon-Macquart 
novels. One of them, which we meet with in L'Assommoir, is 
described with considerable detail. It is that of Coupeau, the 
husband of Gervaise Macquart. His father met with a fatal 
accident when he was drunk, but with that exception Coupeau’s. 
family history appears to have been good, for all his blood 
relations mentioned by the novelist were healthy and temperate,, 
and probably his case may be regarded as one of acquired 
alcoholism. 


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Coupeau was a plumber by trade, and when he first steps 
upon Zola’s stage he is a hard-working man, leading a respect¬ 
able life, and expressing sentiments on the drink question 
which would have done credit to the president of a Total 
Abstinence Society. For some years after his marriage Coupeau 
lived happily and soberly with his wife, who bore him one 
child, of whom he was passionately fond. One day he fell from 
the roof of a lofty building on which he was working and broke 
his thigh. It was six months before the man was about again, 
and then it was observed that a marked change had come over 
him. Possibly he had contracted lazy habits during his con¬ 
valescence ; possibly also the shock of the accident produced 
cerebral changes which resulted in weakened self-control. The 
formerly industrious man was in no hurry to go back to his 
employment, but was content to live on the earnings of his wife, 
who had set up as a laundress, and by skill and hard work had 
acquired an extensive business. 

Little by little Coupeau contracted the habit of loafing about 
and drinking. He did hardly any work, and on several occasions 
came home drunk. 

Zola traces the mental and physical decadence of a drunkard 
with a realistic pencil. At first, when the man is three parts 
drunk, his brain seethes with big and happy ideas ; later, he 
becomes quickly fuddled. In the early stages something of his 
good nature remains, but he is very obstinate, and resists his 
friends when they try to get him to go home quietly, and his 
wife when she endeavours to put him to bed. He becomes very 
emotional. A trifle moves him to tears, and his sobs mingle 
with his hiccoughs. Later, his temper suffers. When he is 
drunk he would kill his father or mother in his anger, and when 
he becomes sober he has forgotten all about it. Gradually he 
loses all pride and ideas of respectability, and his habits become 
unclean and beastly. He loses even the sense of shame. 

In his description of the case Zola lays stress on one mental 
change, namely, that hard drinking destroys the passion of 
jealousy, which is, I think, unusual. He says : “ There are 
some husbands very jealous at twenty years of age, whom at 
thirty drink renders very complacent on the chapter of conjugal 
fidelity.” I have, on the contrary, frequently noticed that 
drunkards are exceedingly jealous, even when they have not the 
slightest grounds for their suspicions. 


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One of the first physical symptoms that Coupeau complained 
of was a form of neuralgia of the scalp, which troubled him in 
the morning when he had slept off his drunkenness. Later, 
when he became a confirmed alcoholic, he suffered from in¬ 
tolerable itching and tickling sensations, prickings, particularly 
of the hands and feet, and a strange feeling as though icy cold 
water were running down his back. Early in the case he 
suffered from dyspeptic symptoms. In the morning after a 
drunken bout his tongue was furred, and he had the well-known 
taste of copper in his mouth. He grew thin. The expression 
of his face changed, and he had a shifty look in his eyes. He 
complained of attacks of giddiness, and the trembling of his 
hands, as time went on, became so great that he could not carry 
a glass to his lips without spilling its • contents. But these 
symptoms were always cured by a stiff dose of alcohol, which 
also relieved his profuse expectoration. Age came on apace. 
He became deaf in one ear, and his sight became defective at a 
comparatively early age. 

The downfall of Coupeau was not one unbroken descent. 
There were pauses, when the man seemed for the time to 
recover himself. Once he got a job at Etampes, and was 
absent from Paris for three months. Away from his com¬ 
panions—companions count for a lot in the temptations of a 
drunkard—he gave up drink, worked hard, and appeared to be 
cured by the country air. He returned to Paris “ fresh as a 
rose, and with four hundred francs in his pocket, with which he 
payed two terms of rent which was owing.” But the improve¬ 
ment was only temporary. In a short time the man had 
resumed his old habits. 

One evening he returned home wet to the skin. In the 
night he was attacked with cough and fever, “ his sides beating 
like a broken pair of bellows.” In the morning the doctor who 
was called in diagnosed pneumonia. Coupeau was taken to the 
hospital. The next day the lung symptoms had disappeared, 
and the patient was transferred to another ward suffering from 
an attack of delirium tremens. When he was cured he promised 
reformation, and for eight days was reasonable. But what says 
the proverb ? “ The dog is turned to his own vomit again ; 

and the sow that was washed to her wallowing in the mire.” 

In three years Coupeau is said to have had seven attacks of 
delirium tremens. This, however, is not very remarkable. I 


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attended a patient for at least twelve such attacks in the same 
period of time. In the end Coupeau died of this disease. 
Zola has painted the final scenes in vivid colours. His descrip¬ 
tion of the restlessness, the eternal going to and fro, the 
trembling of the limbs, the raised temperature, the profuse 
sweat, the hallucinations of sight and hearing, and withal, the 
dreamlike condition of the patient, is true to life. 

In his terrible novel of L’Assommoir Zola preaches one of 
the most powerful sermons against the sin of drunkenness that 
it is possible to read, and he drives the lesson home with all 
his unrivalled powers of description. He hesitates at nothing, 
however ghastly, however disgusting, that will enforce the 
moral of his story. In the lurid picture of Coupeau’s down¬ 
fall he shows us a man, who has not only ruined himself by 
vice, but has dragged down with him his wife and child, 
killing the one and throwing the other on the street. 

In the Rougon-Macquart series of novels there occurs a case 
of impulsive insanity, which has been worked out with con¬ 
siderable skill. It is one of homicidal impulse complicated 
with sexual perversion. The story is too long to be given in 
full, but it possesses several points of special interest which 
may be briefly referred to. 

The family history was bad, and remarkable for the number 
of alcoholics occurring in the ancestry. The sufferer was 
Jacques, the younger brother of Claude Lantier, and it will be 
remembered that in the latter’s case the mother and both the 
grandparents were drunkards. Zola blames, and probably 
correctly, this alcoholic heredity for Jacques’ peculiar mental 
flaw. He says : “ He paid for the others, the fathers and 
grandfathers, who had drunk, the generations of drunkards 
from whom he derived his tainted blood, his slow poisoning, his 
savageness which made him as one of the wolves which eat 
women in the depths of the forest.” In the case of the 
sufferer himself alcohol aggravated the disease, or lit it up 
when it was quiescent. Jacques rarely drank. Often he 
refused even a petit verre , having remarked that the least drop 
of eau-de-vie rendered him mad. 

The disease made its appearance early, soon after the age 
of puberty. Jacques was sixteen years old when he was first 
seized with the overpowering desire to kill. Impulsive in¬ 
sanity often appears early in life. The cases of suicide which 


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occur among young boys and girls, particularly in Germany, 
the country par excellence for the manifestation of mental 
disease—suicides which are either motiveless, or for which the 
assigned motives are either trivial or senseless—are probably of 
this nature. Pyromaniacs are frequently adolescents. Some 
years ago I had under observation a boy of twelve who, 
among other acts of incendiarism, set fire to a hayrick simply 
for the pleasure it gave him to see things burn. 

In describing the crisis of the attack in the case of Jacques 
Lantier, Zola points out the annihilation, or rather the inhibi¬ 
tion, of the sufferer’s own will. It was as though another will 
had taken possession of his body. His hands did not belong 
to him. He no longer belonged to himself. He obeyed his 
muscles like a mad beast. 

Linked to this inhibition of his own will is the dreamlike 
condition in which the sufferer lives. It is of the nature of 
somnambulism. Zola brings this out very graphically in his 
description of Jacques’ journey through the streets of Paris 
intent on the murder of some woman, friend or stranger, 
no matter who she be. It is a veritable case of Jack, the 
Ripper. Jacques does not lose his way, but as he walks on 
he forgets the connecting links in his perambulations. Chance 
prevents the satisfying of the horrible craving which appears 
to become weakened and finally extinguished by sheer physical 
fatigue. Instinct brings the man back to his lodging as it 
brings a sick dog back to its kennel. Then occurs a profound 
sleep, a sleep that reminds one of that which sometimes follows 
post-epileptic mania. Jacques awakes with the sensations of one 
recovering from a fainting fit. He remembers an engagement 
which he had made before the oncome of the crisis of his 
disease, but of the crisis itself, of his long walk through the 
streets of Paris, of his thirst for blood, he has only the vaguest 
recollection. 

In the novel Jacques only commits one murder, but, as that 
crime is the point to which the whole story has been gradually 
working up, we are provided with ample details of the mental 
condition of the murderer both before and after the deed. 
The murder was unpremeditated, and it was only the oppor¬ 
tunity, that is to say, the alluring presence of the victim and 
the proximity of the fatal weapon, which awoke the insane 
impulse in Jacques’ mind. The phrase “beside himself’* 


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accurately describes the man’s mental condition immediately 
before committing the crime. One can hardly say he thought. 
He was living in a dream of undefined horror. All he was 
conscious of was the object of his temptation and his own 
overwhelming thirst for blood. He hardly breathed. A noise 
like the clamour of a crowd thundered in his ears, and pre^ 
vented him from hearing. In the intoxication, which had 
invaded his whole being, his hands seemed no longer to belong 
to him. But hardly had the fatal blow been struck than a 
change came over him. He was conscious of an immense 
feeling of relief, of joy, almost of pride. 

One knows that when a man suffering from post-epileptic 
mania commits a crime, he often shows great skill in making 
his escape from the scene, and in covering up his tracks. The 
same ability may be observed in the conduct of the victim of 
impulsive insanity under similar circumstances. Full use is 
made of this feature of the disease in the story of Jacques Lantier. 

Zola lays "great stress on the absence of remorse in impulsive 
homicide, and in the concluding portion of the novel he again 
points out the amnesia or semi-amnesia which occurs after the 
crisis of the disease. After the murder, Jacques resumed his 
every-day life. He discussed the affair with calmness when it 
happened to be mentioned in his presence. As far as he was 
concerned, the crime might have been committed by another 
individual altogether. Even in giving evidence at the trial of 
two men wrongly charged with the murder, Jacques was per¬ 
fectly tranquil. “ This cross-examination, which ought to have 
troubled him profoundly, left him in an absolute lucidity of 
mind, as though the affair in no way concerned him. He gave 
his evidence as a stranger, as an innocent man ; since committing 
the crime not a fear had disturbed him, he did not even think 
of such a thing. With memory abolished, his organs in a 
state of equilibrium, his health perfect, he stood there in the 
witness-box, with neither remorse, nor scruples, with only an 
absolute unconsciousness of his crime.” 

Among the many degenerates who play their parts in Zola’s 
great tragi-comedy, it is natural that we should find a few 
imbeciles. The rdles assigned to them are not, of course, 
important, but, allowing for perspective, their characters are as 
real and life-like as those of the heroes and heroines of the 
various dramas. 


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As in the case of those whom we meet in the world, Zola’s 
imbeciles differ greatly in mental endowments. One of the 
most intelligent, and at the same time the least vicious, is 
D^sir^e Mouret. Her family history is the same as that of her 
brother, Serge Mouret. The case appears to have been one of 
congenital imbecility. When the girl is first brought under our 
notice she is fourteen years of age, tall and strong, but mentally 
a child of five. She was apparently incapable of learning any¬ 
thing. If one attempted to teach her to sew, she had headaches 
and giddiness. All she cared about were birds and animals, and 
the insects and other creeping things she found in the garden. 
Her laugh was that of an infant, and she was easily moved to tears. 

During the next three years there was no improvement. She 
cared nothing about her clothes, or about personal cleanliness. 
It was dangerous to leave a box of matches within her reach* 
for she was as fond of playing with them as a little child would 
be. She showed herself affectionate to those who were kind to 
her, but her love had no depth. 

About this time she was sent from her home, where she was 
neglected by everyone, to the country to live with her old nurse. 
Here she was well fed and cared for, and allowed to amuse 
herself all day long in the poultry yard. A year or two later 
she went to live with her brother, Serge Mouret, the parish 
priest of Artaud. These changes were beneficial. D£sir6e 
became happy and contented, and although there was little real 
mental improvement, physically her development left nothing to 
be wished for. The picture which the novelist draws of her in 
her twenty-second year might be that of the antique statue of a 
young goddess. She had a fresh, fair, and rosy complexion, a 
graceful figure, and well-formed limbs. But her brain was 
empty, and she had no serious thoughts of any kind. In short* 
she was a magnificent animal—an animal endowed with the 
gift of laughing, for her sonorous laughter resounded from 
morning to night in the house, in the garden, and especially in 
the poultry yard, where she reigned supreme. “ Without 
doubt,” says Zola, “ it was her feebleness of mind which made 
her love animals so much. She was only at ease in their 
company. She understood their language better than that of 
men, and she cared for their wants with maternal tenderness.” 
One might say that her maternal instinct found expression in 
her care for animals. 


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f 


But her love for animals was as shallow' as her affection for 
her human friends. She could wring the neck of a fowl or 
chop off the head of a goose, when the birds were wanted for 
table, with perfect sangfroid , and she stood by perfectly 
unmoved while the butcher killed a favourite pig. Possibly in 
this may be seen something analogous to the love of cruelty 
which one observes in certain degenerates. 

Zola tells us no more about the girl, and one is left to 
speculate as to what became of her in later years. 

The case of Charles Saccard is very different. His family 
his tor)' was fairly good, for w'e have to go back four generations 
to find a case of insanity among his ancestors. But probably 
there was a more immediate cause for his imbecility. He was 
the illegitimate child of a young maidservant, who subsequently, 
however, had healthy children by a strong and healthy husband. 
Charles’ father was the dissipated and feeble Maxime Saccard, 
who w'as little more than seventeen years old at the time of the 
procreation of his son, and who, there is reason to suppose, was 
even then a syphilitic, for he died comparatively young of 
locomotor ataxia. 

At the age of fifteen Charles Saccard had the appearance of 
a boy of eleven or twelve, but intellectually he was only a child 
of five. He was very handsome, and bore an extraordinary 
likeness to his ancestress, Adelaide. With his long, fair, and 
silky hair, and his large, expressionless eyes, he reminded one 
of those rois faineants who terminate a royal race. “ He had 
neither heart nor brain,” says the novelist, “ and was nothing 
better than a vicious little dog, w'hich rubs itself caressingly 
against people’s legs.” 

And he was vicious. In spite of his tender age and his 
poverty of intellect, hereditary vice already revealed itself in the 
boy. Once the experiment was made of sending him to school, 
but he learned nothing, and in six months was expelled on 
account of his disgusting practices. 

He was physically very delicate, and suffered from haemo¬ 
philia. He bled at the slightest scratch, and the haemorrhage 
was with difficulty controlled. Before he had completed his 
sixteenth year he died of profuse epistaxis. 

Another of Zola’s imbeciles is the foundling, Marjolin. The 
child was discovered one morning in a vegetable market, half 
hidden in a heap of cabbages. He appeared to be between two 

LXIII. 13 


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i 9 8 ZOLA’S STUDIES IN MENTAL DISEASE, [April, 

and three years of age. He was fat and healthy, but not very 
precocious, for he could only lisp a few words. The women of 
the Halles adopted him. He was a handsome little fellow, 
with auburn hair, and so plump and ruddy that he might have 
found a corner in one of Rubens’ pictures. It was no use 
sending him to school ; if you did so, he only fell ill. So he 
was allowed to run wild in the great markets, every nook and 
corner of which were soon well known to him. 

Marjolin grew up strong and healthy, but was always very 
backward. At the age of eighteen physically he was already 
a man, but he had no intelligence. He lived, as Zola expresses 
it, only by his senses, one of which, namely that of smell, was 
remarkably developed. Like many other victims of mental 
infirmity he was abnormally sensual, being as lecherous as a 
buck rabbit. In spite of his apparent amiability, at the 
bottom he was horribly cruel, and nothing gave him greater 
pleasure than to inflict pain, or to see it inflicted on birds 
or animals. 

When he was about twenty years of age Marjolin met with a 
severe injury to his head. There was concussion of the brain 
undoubtedly ; possibly there was fracture of the skull—the 
details given by the novelist are not very clear.. When he left 
the hospital he was as fat and robust as before, but he was far 
more of an idiot. He laughed at nothing in particular. He 
stammered and lisped, and many words he was not able to 
pronounce properly. He was as obedient as a sheep. When 
anyone asked him a question, he would repeat the speaker’s 
last word monotonously in a sing-song voice. And so, little 
better than a brute beast, the poor youth passes from the 
scene. 

As is well known, some idiots and imbeciles are fairly good- 
looking. But they are rare; the majority are ugly, and often 
deformed and repulsive in appearance. It will have been 
observed that the three which have been selected from Zola’s 
novels are described as being remarkably handsome. This is 
due, I think, to the idiosyncrasy of the novelist. Zola was 
peculiarly susceptible to physical beauty. He worshipped the 
charm of form and colour as revealed in the human figure. It 
is exceedingly fare to meet with an ugly person in his novels, 
and when one does so, it is generally obvious, I think, that the 
ugliness is employed to throw into higher relief the beauty «f 


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the other characters which happen to be on the stage at the 
same time. Consequently the writer could not refrain, there 
being no reason to make them repulsive, from clothing even 
miserable idiots with physical attractions. 

Apart from his studies in actual insanity, in his delineation 
of normal character Zola has made ample use of the symptoms 
of mental disturbance which are found among the sane. In 
several places he has shown the effect of fatigue and of starva¬ 
tion on the mind. In others he has described the delirium of 
sickness and of approaching death. In his novels are to be 
found examples of delusions, illusions, and hallucinations, par¬ 
ticularly of the latter, probably because they lend themselves 
more than the others to dramatic treatment. He points out 
with great justness the part played by fatigue, either physical or 
emotional, in the production of the phenomenon of halluci¬ 
nation. In one of his most realistic descriptions he employs a 
hallucination, in the production of which both fatigue and 
expectancy are factors, to heighten the tone of the picture. A 
railway-train is rushing through a terrible snowstorm, and the 
engine-driver, worn out by the long journey, is straining his 
eyes as he endeavours to make out the expected signals in the 
dazzling whiteness. Again and again he imagines that he sees 
the red glare which should warn him of danger in the distance. 
His hands tremble as he grips the lever. But before his 
muscles can contract, the illusion fades away, and he realises 
that he is deceived. 

Zola’s great charm is his mastery of colour, and consequently 
his power of describing the concrete, but most of his readers 
will, I think, admit that he also takes a place in the front rank 
of psychological novelists. 

(*) " Dr. Pascal Rougon: Zola’s Studj of a Savant,’* Edin. Med. Jourti., 
January, 1917. 


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200 


DREAMS AND THEIR INTERPRETATION, 


[April, 


Dreams and their Interpretation , with Special Applica¬ 
tion to Freudism. By Sir Robert Armstrong-Jones, 
M.D., F.R.C.P., F.R.C.S., Lecturer in Psychological 
Medicine to St. Bartholomew’s Hospital, and Consulting 
Physician in Mental Diseases to Military Forces in 
London, late Resident Physician and Superintendent of 
the London County Asylum, Claybury. (By arrangement 
with the Editor of the Practitioner ). 

IT may seem out of place, whilst we are face to face with so 
grim a reality as a war for our very existence, and a war which 
has so deeply affected the life of every individual in this 
country as well as within the Empire, that we should be dis¬ 
cussing the realms of dream-land ; but we may claim that the 
“ Bowmen,” in the early days of the war, laid particular 
emphasis upon dreams—for to these of our brave warriors 
appeared the “ Angel of the Mons,” and the “ unconscious 
mind ” has been drawn, in literature at any rate, into the 
tragedies of the war. 

In regard to mental diseases there has been witnessed, among 
our soldiers during this war, a marked dissociation of the elements 
of the mind, and the influence of the emotions upon conduct has 
been more than confirmed. The attention has been engrossed, 
and the mind has acted automatically and unconsciously 
without the direction of the will. Sir William Hamilton 
stated that consciousness cannot exist independently of some 
peculiar modification of mind, but some modification of mind 
(meaning the unconscious) is possible without actual con¬ 
sciousness. This field of the unconscious mind is not, as is 
claimed for it, the recent discovery of Freudian psychologists. 
Consciously and “ unconsciously ” the feeling of all medical 
men has been how best to win the war, and the Director- 
General of the Royal Army Medical Corps has been supported 
in his work with unspeakable patriotism by the whole medical 
profession ; there has been a general undefined feeling that life 
should be preserved, grief assuaged, and suffering relieved, and 
an analysis of this “ unconscious ” feeling has been a favourite 
study among those who endeavour “ to heal the mind.” As an 
instrument in this analysis the study of dreams has been 
regarded as of utility to unravel its mysteries. It is claimed 
that the interpretation of dreams may help to bring out of 


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tht “ unconscious mind ” what is perplexing and hidden, and 
may thus help to restore the balance in the unstable and the 
neurasthenic who have suffered so extensively from mental 
shock of various kinds. The laboratory of the mind is open 
to all, but it must be especially attractive to students of mental 
conditions who take more than an academic interest in the 
subject. We are, therefore, justified in seeking for explanations 
of facts such as dreams which are within the experience of all. 

The subject of dreams has interested mankind since the 
early days of primitive culture, and long before the dawn of 
history. Many and varied have been the speculations in 
regard to them, and the philosophers of antiquity entertained 
great diversities of opinion as to their cause and meaning. 
Dreams may be said to have a world of their own, and to have 
only obscure links of connection with any other facts in human 
experience. The savage regarded the dream-world as similar to, 
only more remote than, the one he dwelt in. When he fell 
asleep his second self left his body for unfamiliar haunts, where 
he met the second self of his dead ancestors. Socrates 
believed in the divine origin of dreams. Lucretius accounted 
for them on the principle that ideas or thoughts were material 
things which could be detached from each other, and be made 
to strike upon the mind. Porphyry ascribed dreams to the 
influence of a good demon, who warned the dreamer of the 
evils the bad demon was preparing for him. Baxter, in his 
work upon the soul, attributed dreams to the agency of good 
spirits which descended from their proper sphere, and con¬ 
descended to weave midnight visions for poor mortals. As 
sleep has something awe-inspiring and inexplicable, so dreams, 
viewed from the waking state, have no less strange or perplexing 
a reality. 

Dreams have been defined as “ conscious processes during 
sleep,” a definition which implies a self-contradiction, for con¬ 
scious processes deny sleep, and normal sleep is attended with 
unconsciousness ; but this unconsciousness may indeed be slight, 
yet it is not infrequently profound and even complete. During 
deep sleep the senses are unaffected by external, and even by 
internal impressions, yet it has been asserted that the mind is 
never at rest during sleep, and that there is always some 
dreaming. Dreams have also been defined as thoughts, or a 
series of thoughts, experienced in sleep—*>., a train of ideas 


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202 DREAMS AND THEIR INTERPRETATION, [April, 

presenting themselves to the mind during sleep. To-day, 
according to the followers of Freud, the definition of a dream 
is “ the symbol of an unfulfilled wish,” the meaning of the 
symbol having to be interpreted by an assumed psycho¬ 
analytic “ code ”; and the art of the psycho-analyst lies 
in the interpretation of these symbols. Because of its sym¬ 
bolic function a dream is looked upon to-day as having 
its root firmly fixed in the experience of the waking life, 
whilst its superstructure lies in the unreality of phantasms. 
It may help to understand the terms “ symbol ” and “ symbol¬ 
ism ” if we state that they are only applicable when the dream 
is interpreted, i. e. the dream then becomes the symbol of the 
meaning elicited. The terms themselves apply to the dream 
as recorded or the manifest dream, which is always centralised 
round certain subjects connected with the waking experience, 
and not, as erroneously believed by some, always and invariably 
connected with sexual matters. . This is an injury to the dreamer, 
and an unnecessary contravention of the proprieties, and it is 
against experience to regard all dreams as desires. In other 
words, the dream, according to Freudian interpretation, always 
means the gratification of suppressed sexual desires. 

The history of dreams is a long and ancient record, and 
authorities in the past have offered many explanations as to the 
process and import of dreaming. The Old Testament describes 
many dreams, also their interpretation. We have the beautiful 
dream of Jacob’s ladder, and that of Joseph, which he related to 
his brothers, also the dream of Pharaoh and of Pharaoh’s servant, 
of Solomon’s choice of wisdom, through which he obtained in 
addition riches and honour. The dream of Nebuchadnezzar, 
which, as frequently happens, he himself had forgotten, was 
with Daniel’s help revealed and subsequently interpreted, 
often the quickest way then to royal favour, and in acknow¬ 
ledgment of which the “ King made Daniel a great man.” 
The influence of dreaming upon the conscience is shown by 
the dream of Job, when he affirmed that “ God speaketh once, 
yea twice ; yet man perceiveth it not. In a dream, in a vision 
of the night when deep sleep falleth upon man ; then He 
openeth the ears of men and sealeth their instruction, that 
He may withdraw man from his purpose.” In the New 
Testament there is Joseph’s dream, both before and after 
the birth of the Saviour; the dream of the three wise men, 


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and the dream of Pilate’s wife, which were all quoted as 
messages from the spiritual world. Shakespeare puts into the 
mouth of Mercutio the cause of dreams : “ Which are the idle 
children of a brain, begot of nothing but a fantasy.” ByrOn, 
Milton, Robert Louis Stevenson, who stated that the motives 
for his best romances were inspired by dreams; Coleridge, 
Moore, and John Bunyan have all dwelt upon this attractive 
subject, and Bunyan stated that the whole of the Pilgrim's 
Progress was revealed to him in dreams. Certain races, like 
the North-American Indians, are stated to look upon a dream 
as a sacred event, being the most ordinary way in which the 
gods make known their will to man. In the Journal of a 
voyage to North America, Charlevoix relates how an Indian 
dreamed he had his hand cut off, which occurred the next day. 
The poor still have their dream-books, and they often pay for 
the “ meaning ” of their dreams. 

It -may help to clear our conception of the working of a 
dream if we briefly state how the mind works normally in the 
waking state. All of us are brought up to observe certain 
conventionalities, and to regard with solicitude certain social 
laws and amenities, in consequence of which feelings of undue 
assuredness, aggression, and self-assertiveness are kept under or 
repressed ; and out of regard for social customs certain ten¬ 
dencies or passions are also kept under control, a feeling of 
self-restraint and inhibition being thus exercised. All of us 
who are properly brought up look upon ourselves with a certain 
compulsion in regard to observing the courtesies, ceremonies, and 
conventions of life, and our conduct is formulated accordingly. 
These compulsions eventually become automatic restraints, and 
they tend to keep up the structure and wholesomeness of human 
society. They constitute the feelings of social obligation and of 
personal regard for others, and are based upon certain instincts 
which have emotional representations, such as fear, anger, joy, 
sorrow, love, hate, and disgust. 

When, let us say, an object is presented to one of the senses— 
for instance, to the sense of sight—all the unconscious feelings 
of restraint which have been instilled into us in youth, and 
which in grown-up people act automatically, are applied to the 
object we have in view, and our conduct or reaction towards it 
varies accordingly ; for our unconscious life is always acting in 
numberless and unsuspected ways upon our conscious mental 


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DREAMS AND THEIR INTERPRETATION, [April, 


life. Supposing, for example, that we were watching a lady at 
some social function who was wearing a green carnation : certain 
rays of light from this object impinge upon the rfetina; these 
are conveyed to the brain, and there stimulate a mental picture, 
i.e., the outward form, figure, surrounding circumstances, time 
and place of the person are appreciated as an external object, 
which, when absent, may be reproduced as an image, a picture, or 
idea upon the cerebral cortex, so that, in the absence of the 
object, an impression of the lady can be revived in memory 
upon the mind, the person being “ remembered ” with all her 
attendant associations. The mind recalls the occasion either 
with pleasure, or perhaps with pain, and in idea the whole 
previous scene can be re-enacted, even to the recognition of 
personal charms, gestures, verbal movements, conversation, 
habits and ways ; these are accompanied by their emotional 
reactions. All can be revived as representative images, so that 
the mind is not only able to cognise the object associated with 
a definite feeling, and with all the voluntary movements, but 
the image, or memory picture, may also be revived with all the 
accompaniments belonging to the original presentation. These 
three factors, viz., cognition, feeling, and will, are the invariable 
accompaniments of every mental process, whether an object is 
presented from without, or its picture is experienced from 
within. The same analogy applies to presentations and repre¬ 
sentations referring to the organic sensations. In dreams these 
elements of the mind tend to become dissociated; the will remains 
in abeyance, whilst the cognitive elements may be represented 
alone, or grouped with others which are similar or dissimilar ; the 
feedings may also be represented to the mind, and may either be 
painful or pleasurable. It is the will which refuses to act, and 
it is questionable whether a dream, once initiated, can ever be 
modified by the will, although some persons state that they are 
able to modify a dream, and that they have frequently done so. 

The recollection of these dissociated elements of a dream 
when recalled by the memory is often so weird, so striking and 
so suggestive, that an attempt to interpret their meaning is 
inevitable, and the phenomena of dreams have thus become 
objects of conjecture, of curiosity, as well as of vivid interest. 
In consequence, many persons have endeavoured to read into 
them some hidden meaning, whilst others regard them with 
heedless indifference, considering them to be only a confused 


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and jumbled record of sleep-memories unworthy of serious 
reflection. Possibly the truth in regard to dreams lies between 
these two extremes of undue scepticism and a too facile 
■credence. It is difficult not to suspect a meaning in some 
dreams, as in the dream of Mrs. H—, whose husband went to 
New York on business. She dreamed one night that he was 
sleeping on the tenth floor of a hotel which took fire, and that 
he escaped with difficulty. The next morning, feeling very 
uneasy, she cabled asking how he was, when he replied : “ Quite 
well and safe, but had a narrow escape last night when the 
hotel was burnt down.” 

The following, sent to me by Dr. Leonard Guthrie, relates 
the experience of a credible witness, E. VV. M—, a distinguished 
scientist and F.R.S. In his own words he writes : 

“ When I lived in Canada the following case occurred : An 
Englishman and an American clubbed together to try to reach 
the Klondike goldfield by the overland trail, i.e., by going due 
north from the prairies instead of following the usual course of 
crossing by the Canadian-Pacific Railway to Vancouver, then 
taking steamer up the coast to Seattle, and crossing back over 
the mountains vid White Horse Pass. After the pair had 
passed on their journey what the American judged to be the 
outposts of civilisation, he shot the Englishman while he- lay 
asleep, tried to destroy his body by burning it, rifled his 
baggage, taking everything of value, and returned.. When he 
was questioned as to what had become of his companion, he 
replied that he (the American) had become discouraged, and had 
given up the expedition, but that the Englishman had pushed 
on. But there was an encampment of Indians close to the spot 
where the crime had been committed. 

" The old chief saw two men come north and encamp ; in the 
night he heard a shot, and saw one man go south. 1 le went to 
the camp, saw the body, and informed the nearest post of N.W. 
mounted police. They trailed the murderer, and arrested him 
before he could escape across the U.S. border. He was brought 
to Regina. Meanwhile the brother of the murdered man in 
England had a dream, in which he saw his absent brother lying 
dead and bloody on the ground. He came down next morning 
very depressed, told his dream, and announced his intention of 
going straight out to Canada to see if anything had happened 
to his brother. He arrived out as the trial of the murderer was 


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progressing. He identified several articles in the possession of 
the murderer as the property of his late brother. The murderer 
was hanged at Regina.” 

Another dream of a prophetic nature, and relating to the 
assassination of Perceval, is recorded in the Book of Days, i, 
p. 617. I am further indebted to Dr. Guthrie for calling my 
attention to it. It was the dream of Mr. John Williams, of 
Scorrier House, near Redruth, in Cornwall. He died in 1841, 
and was described in the Gentleman s Magazine as a man of the 
highest integrity. On the night after the assassination, when 
the facts could not have been known to him by any ordinary 
means, he dreamt that he was in the Lobby of the House of 
Commons, although he had never been there in his life. He 
saw a small man enter dressed in a blue coat and a white 
waistcoat. Immediately after him entered another man in a 
brown coat with yellow buttons. The latter drew out a pistol 
and shot the former, wh.o instantly fell, blood pouring from a 
wound a little below the left breast. In his dream Mr. Williams, 
heard the report of the pistol, saw the blood flow out and stain 
the waistcoat, and he noticed the colour of the victim’s face 
change. He further saw the murderer seized and observed his 
countenance. When asking in the dream who hyad been shot, 
he was told—“The Chancellor.” Perceval was Prime Minister 
and Chancellor of the Exchequer at the time. Mr. Williams then 
awoke and mentioned the matter to his wife, who made light of it. 
At her suggestion he went to sleep again, but dreamt the same 
dream a second time, and then a third. After this, between 1 
and 2 a.m., he got up and dressed. In the forenoon of the next 
day he went to Falmouth, and related his dream again to Mr. 
Tucker, of Tremanton Castle, and his wife. Mr. Tucker replied 
that the description was like the Chancellor of the Exchequer, 
Perceval—although Mr. Williams had never seen Perceval nor 
had anything to do with him. Just then the news of the 
assassination reached Truro, which was seven miles away. Six 
weeks after the event Mr. Williams went to London and to the 
House of Commons. He recognised the Lobby, the exact spot 
where Perceval fell, and the dress of both men in the dream 
corresponded precisely with those actually worn at the time. 
The extraordinary thing about this dream was that a minute^ 
account of it was published in the Times, another was given to 
Dr. Abercrombie, whilst Mr. Williams’ grandson communicated 


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19 1 7-] BY SIR ROBERT ARMSTRONG-JONES, M.D. 

an account drawn up from his grandfather’s words. All these 
agreed in every detail with the first narrative of the dream 
recorded by Mr. Williams. 

Whether we regard dreams as in any way prophetic or not, 
as stated by Andrew Lang, it is remarkable, when we consider 
the enormous number of dreams, that there are not more than 
occasional coincidences. The successes only are noted, whilst 
the failures as to prophecy have been forgotten. It was 
probably through the effort to elicit some meaning from dream 
phenomena that the idea of a soul first arose, and that this soul 
could exist apart from the body and survive its dissolution. 
The phenomena of dreams, or “ visions ” as they were called, 
suggested, as stated, excursions of the soul into some distant 
regions, which it explored, and reported what it had experienced 
to the waking soul, so that if the dream were of the dead, the 
soul was believed to have travelled to the regions of the dead, 
and, if of the living, that the soul had wandered into the society 
of other living souls, and had some message of importance to 
convey to the dreamer, if only it could be properly and ade¬ 
quately interpreted or explained. Thus they were “ symbols ” 
of some message to be imparted by a supernatural being, *>., if 
the dream could be properly solved. This “ symbolical ” view 
has been revived to-day, although the symbols are erroneously 
interpreted to be those of sexual disturbances. The interpreter 
of dream'messages, or the “seer” as he was called in ancient 
times, was, naturally, a sacred person, who came to be regarded 
with considerable importance, if not with prophetic awe and as 
of divine origin. Thus arose the magician, or the “ wise man,” 
whose survival was formerly represented by uncultured and 
irresponsible fortune-tellers, but who are to-day represented 
by competent and able psychologists, who, by methodically 
arranging and sorting the spontaneously uttered thoughts of a 
person who submits to examination, or by comparing the verbal 
association of a series of responses, ascertain the workings of 
the unconscious mind which lies beneath the manifest dream. 
According to the teachings of certain psychologists, all thoughts 
and actions are assumed to be coloured by, if, indeed, they do 
not directly arise out of, the unconscious mind. 

The careful study of the mental life, normal and morbid, has 
been the work of modern science, which has elucidated and 
solved many of the dream combinations—together with other 


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208 dreams and their INTERPRETATION, [April, 

products of the imagination—by the acceptance of that intimate 
union which exists between mind and body. Upon the close 
relationship between mind and body, it has been found that the 
chaotic play' of images in dreams is able to throw much light 
upon normal mental processes, and upon the laws which are 
observable in the working of the mind during the waking state ; 
hence the appropriateness of studying dreams in this new light, 
and the justification of a claim for those who study dreams 
to-day, truly to be called “ interpreters,” for they investigate 
upon the solid and substantial ground of science, the intimate 
and fundamental activities of the human mind in health and 
disease, without the need of resorting to supernatural agencies 
which had to be invoked in former days. 

The interpretation of dreams by the psycho-analytic method 
is based upon the theory that in the hidden mentalities or 
“ unconsciousnesses ” of our minds are found the explanation, 
perhaps the secret, at any rate the quite sufficient interpretation, 
of many abnormal mental occurrences and divergent mental 
states, such as dreams, lapses of memory, absent-mindedness, 
obsessions, delusions, and all kinds of intrusions and domi¬ 
nations of semi-repressed thoughts. 

It is hardly necessary to state that dreaming is not confined 
or limited to human beings. We are familiar with the appear¬ 
ance of dogs which jump and bark in their sleep, more especially 
after active excursions, or following upon hunting expeditions ; 
those who keep canaries have doubtless heard their unexpected 
pipings whilst asleep on their perches. 

In order to understand the nature of dreams it may be 
desirable to consider the physiology of sleep, and although the 
exact cause of sleep is not definitely known, the concomitants 
of sleep are familiar. We know, for instance, that in sleep all 
the normal activities of the organism are appreciably lowered, 
and it is not certain that sleep itself is not a state of debility, 
for there is a lowering of the pulse-rate and of the blood- 
pressure, there is also a slowing down of respiration. There is, 
probably in addition,'a state of venous engorgement, permitting 
the products of fatigue to pass by osmosis into the blood-stream 
or into the lymph-channels during this engorgement, which is 
favoured by the supine position of the body when at rest, thus 
giving a better supply of blood to the head, and so predisposing 
the brain to dreaming. Yet we do not know the inner state of 


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209 


the organ of mind, i.e., the intimate structure of the cells in the 
brain cortex during sleep, nor their relation and dependence 
upon the ductless glands, in particular the pituitary, as has been 
pointed out during hibernation. In regard to the nerve-cells, 
therefore, conjecture must take the place of certainty. The 
brain cortex, normally, is composed of innumerable cells and 
fibres, the latter forming the connecting links and threads 
between the cells, their function being to convey sense-impres¬ 
sions from without the body, and then to convey these trans¬ 
formed impressions outwards for the control and proper working 
of the various organs in the body. 

In an average brain the cells or neurons are computed to 
number 9,000 millions, so a thought, or an idea, or a purpose 
initiated in one cell, or a group of cells, is immediately linked 
up with thoughts from scores or hundreds of others by means 
of these fine connecting fibres. It is believed (Lupine) that the 
fine fibres—which are called dendrites, from their tree-like 
appearance—undergo a retraction during sleep, leading to a 
partial separation of their terminations, thus leaving a space, so 
to speak, which cuts off nerve-currents and thus induces sleep. 
This being a theory only, it has naturally evoked another and 
an opposite explanation of sleep, vis., that sleep accompanies a 
greater and more extensive prolongation outwards of the fine 
nerve-processes of the cells (Lugaro), which then touch each 
other more closely and intimately, thus diffusing rather than 
concentrating nerve-energy, the effect of such a diffusion being 
to lower nerve-potential, and so to bring about a general loss of 
nerve-energy and thus to favour sleep. The whole nervous 
system presumably participates in this lowering activity of the 
circulatory and other systems during sleep, yet it is not ascer¬ 
tained whether this lowering is sufficient to interrupt the 
continuity of the unconscious as well as of the conscious life. 

Dreaming, as is well known, can be induced by such agents 
as opium, alcohol, and tobacco, and this would favour the view 
that dreaming was a morbid process. It is certainly a process 
which more often occurs just before or just after the actual state 
of sleep, and for that reason these dreams are called “ hypna¬ 
gogic.” It is general experience that there are more clear as 
well as more fantastic images just before going to sleep, or 
just before being thoroughly awakened, than occur during 
profound sleep. It is doubtless also within the experience of 


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everyone that the vivid scenes of the day are more clearly 
impressed upon the mind during the intermediate state between 
sleeping and waking than during sleep. Indeed, there is much 
in the basis of observed facts to justify the opinion that dreams 
occur just before the sleeper awakens, and as he is in the act of 
entering into consciousness, that they are a part and parcel of 
the awakening, and merely furnish -the material from which 
the dream is subsequently elaborated, the elaboration only 
occurring after consciousness has been established. Children 
often dream before going to sleep of events which occurred the 
previous day. The Daisy Chain , by Charlotte Yonge, when read 
to a little girl, caused dreams of carriage accidents, and “ Peter 
Pan ” caused dreams of flying to the Never Never Land in the 
case of a clever, impressionable child. Freud asserts that sexual 
traumata begin early, even in intra-uterine life, and that fear 
begins during the process of the passing of the child through 
the pelvis of the mother, and the memory of this “ birth fear ” is 
of “ unconditioned omnipotence ” in after life ! 

The materials of which dreams are made are chiefly memories 
of past experiences, although they are often modified by the 
influence of temperament and environment. Most dreams are 
buried in the unconscious mind, which is partly the reason that 
they can be so rarely remembered fully after waking; this is 
certainly the case with children. It is believed that the age of 
greatest dreaming, as well as that of the most vivid dreams, is 
between twenty and twenty-five years. Women sleep more 
lightly, and dream more than men do ; it is certain, at any rate, 
that more women than men relate their dreams, and women 
who are accustomed to dream sleep longer. The majority of 
dreams occur after 6 a.m., although many occur before four 
o’clock. The time during which a dream is enacted is wonder¬ 
fully short; a few seconds of time in a dream would be 
equivalent to days in the waking state, and many dreams may 
be recorded in support of this statement. The precipitation of 
images in a dream is so great, and the attention so lacking in 
precision, that there is nothing to regulate them in time. An 
analysis of dreams points out that the great majority, 60 per 
cent, of them, relate to sight—thus the ancients were correct in 
describing them as “ visions ”—whilst only 5 per cent, relate to 
the sense of hearing; 3 per cent, have reference to taste, and 
only 1 5 per cent, to smell. In drftms the two senses, taste 


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and smell, which are the oldest, most primitive, fixed, and 
-organised of the senses, frequently attach themselves to sight 
and hearing, which, nevertheless, are easier disturbed because 
more highly evolutionised, the objects to which taste and smell 
relate being thus visualised or heard. 

The faculties of the mind, to borrow an abstraction, “ go to 
sleep,” as it were, in certain orders. We know that we feel 
fatigue so far as our “judgment” is concerned sooner than we 
do in regard to our sensory life, we hear sounds during a light 
sleep and are sensitive to rays of light or to the sense of touch, 
but because the power of forming a judgment is affected early 
in sleep there are imperfect associations and images ; phantasies 
and dreams arise, which are the common experience of all. 
Some power of association and some power of judgment are 
left in light sleep, but the lessened power of these two “ facul¬ 
ties” in dreams reveals the unrestrained, incongruous, and 
disorderly pictures left on the mind. 

It has often been pointed out that insanity and dreams are 
allied so closely that insanity has been described as a “ waking 
dream,” and a dream as a “ sleeping insanity.” The insane, like 
dreamers, are under the domination and control of illusions and 
hallucinations, but they adhere to their dreams or delusions, and 
no appeal to the senses, to reason, or to the judgment can 
reconstruct their mind ; whilst dreamers, so long as they remain 
in the dream state, continue to experience their insanity, a 
reference to a fixed objective standard being impossible during 
sleep, so that the mind, for the time being, remains unsound. 
Here, however, the similitude ends, for, upon an appeal to the 
senses and to reason, the dreamer awakes, whereas the insane 
person continues in his unreason. It has been stated that 
dreams may be followed by insanity, and my experience 
confirms this, although it is doubtful if a dream can ever be the 
actual cause of insanity, both being probably the product of an 
already existing mental weakness. A lady under my care, 
C. W—, dreamt she had, during the night, cut her husband’s 
throat and thrown his body out of the window. She grieved, 
worried, and became so distressed at her imagined murderous 
conduct towards her innocent partner that her mind became 
deranged, and she lapsed temporarily into acute insanity. A 
man, C. V—, used to dream that he had destroyed St. Bar¬ 
tholomew’s Church, and was so alarmed at the notion he could 


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be guilty of such sacrilege that he feared going to sleep, and ho 
also became insane. Another man, H. K—, after the last air 
raid, dreamt that his room was being “ bombed ’’; in his dream 
he saw the explosion, smelt the asphyxiating gas, heard the 
crackling of the fire, and from that moment his mind seemed to 
give way. But it is quite open to argument whether in each 
case the dream was not the first symptom of the mental break¬ 
down caused by fear. It may not always be easy to separate 
hallucinations from dreams, but it is a fact that insane persons 
dream more often than do the sane, and the continued presence 
of hallucinations in them, together with the natural wish to 
explain hallucinations by some plausible but erroneous factor, 
causes the insane mind to be one which is readily responsive to 
slight stimuli. It certainly explains why the insane are light 
sleepers, and are more frequently disturbed by imagined causes 
than the sane. The rays of the moon penetrating between the 
folds of a curtain or along the margins of a window-blind not 
only disturb sleep by the light they shed, but the rays may also 
suggest the figures of persons sent to watch them, or to 
endanger their lives, hence the wakefulness and dreams of the 
insane ; and the general belief is true that these frequently 
experience exacerbations of their illness during a full moon. It 
is a fact, known to physicians, that many of our wounded 
soldiers home from the trenches suffer from dreams of a fearful 
and horrifying kind, due to the memory of constant explosions, 
and of the awful effects of exploding shells upon human life. 
These dreams are accompanied with all the physical symptoms 
of fear; there is present a lowering of the surface temperature, 
there is also the blanched face, the anxious expression, and the 
perspiring skin. 

Dreams are closely related to the condition described as 
somnambulism, which is one of intense abstraction, and nearer 
to wakefulness than is the dream state. The sleep-walker is 
guided by the motive which actuated his waking moments, and 
he sometimes executes performances with a degree of perfection 
which is not even possible to one in perfect possession of his 
senses. I have known a nurse get up in the middle of the 
night, collect all the patients’ day attire, and arrange the 
clothing for about forty patients at the foot of each bed, after 
which she proceeded to collect all plants and flowers from an 
adjoining bath-room and place them in the ward, as in the day- 


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1917-] BY SIR ROBERT ARMSTRONG-JONES, M.D. 2 1 J, 

time. She then retired to rest, but upon awakening she had 
forgotten all the details of the sleep-w alking incident. 

The state described as “ abstraction ” or “ reverie ” is also 
related to the dream state. In this the attention is so fixed 
and concentrated upon a train of ideas that, although the eyes 
are open and sounds are heard, yet no impression is made 
upon them by external objects. In the condition described as 
“ ecstasy ” figures and landscapes may be seen as real; the 
former are most often seen by religious devotees and sojourners 
in the cloister. Blake, the artist, was able to concentrate his 
attention upon his dreams so as to remove all distraction. 
He could paint pictures without sitters, who were so real to his 
imagination that he could carry on conversations with them 
whilst painting their portraits. Among persons whom he thus 
painted were King Edward I and Queen Catherine of Arragon. 

Another state of mental abstraction is the pleasant and 
extravagant kind called “Castle-building in Spain”; a con¬ 
dition in which imaginary scenes of an agreeable form are 
constructed and indulged in for the enjoyment or satisfaction 
anticipated. “ Day-dreaming ” is another state which is an 
entertainment that has probably been practised on occasion by 
each of my audience. “ Trance,” “ lethargy,” and “ catalepsy ”— 
when the mind is concentrated upon an absorbing but narrow 
range of ideas—are also related to dreams, and so is the 
“ hypnotic ” and other states of partial consciousness, but they 
cannot be entered into here. 

We have referred to the “ unconscious mind ” ; the phrase is 
so frequently met with that it is used in various senses. 
Carpenter used it in reference to certain psychical states which 
he described as “ unconscious cerebration,” during which acts 
were performed without the knowledge of the cognitive self; 
one forgets, for instance, a line of poetry, but remembers it 
later when one has ceased, consciously, to think of it. In 
the course of conversation one may forget a word, and having 
“ waited and seen ” the word recurs later without effort, 
perhaps, when the attention is engaged elsewhere. This tends 
to show that there are unconscious mental operations going on 
of whose nature we are ignorant, but the thoughts are there 
in the unconscious mind all the same, and they seem to be inter¬ 
posed between conscious ideas, and to be dug up, as it were, 
with them. Possibly every conscious idea arises out of and 

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dies away into an unconscious mental state, and, according to 
some, there are three degrees or kinds of thought; firstly, 
thoughts of which we are conscious, and which, when given 
attention to, are raised into what is called the “ focus ” of con¬ 
sciousness ; secondly, thoughts which are in the rest of the field 
of consciousness, which are present, but unnoticed owing to 
inattention ; for instance, in the theatre we are intent upon the 
evolution of dramatic situations, but are inattentive to the 
audience or oblivious to the staging. The third depth whence 
thoughts emerge is the unconscious area which could not attract 
attention until their position had been raised into the full and 
clear focus of attention by some association or suggestion. 

It is preferable, I think, to limit the term “subconsciousness” 
to the second of these states in which there is still present 
a certain limited sensitiveness left to ordinary sense-impression, 
whilst the “ unconscious ” state represents the third, i.e., the 
primitive mind, so to speak, out of which conscious thoughts 
and intellectual processes rise and grow. The motive force 
of our acts is believed by some to take its origin in the uncon¬ 
scious mind, whilst the directive and controlling force is in the 
upper conscious levels which thus regulate the lower. 

The technical analysis of dreams assumes that there is a 
dynamic trend of “ desire ” in the unconscious mind which is 
ever seeking for the gratification of personal feelings, passions, 
and sentiments, as against the controlled thoughts of the 
conscious mind. Psychologists who urge this trend or tendency 
in the unconscious mind assert that it is kept back and 
restrained by some imagined power called the “ endo-psychic 
censor ”—a wide-awake critic guarding the dream, and for which 
there is not the slightest justification—a purely fictitious and arti¬ 
ficial ego which is continually struggling to repress the natural 
impulses and thoughts not acceptable to consciousness, this 
41 censor ” exercising a guardianship over sleep, even the deepest 
sleep. These psychologists describe the unconscious mind as an 
under-world of painful memories and wishes always seeking to 
obtrude themselves, and always in health being more or less 
successfully kept under “ like steam in a kettle ” by the artificial 
censor. Surely it is not in accord with experience that we can 
forget unpleasant and horrible scenes or thoughts. They are not 
thrust into an unconscious territory. Personal experience knows 
they are always before one, and it is impossible to “ forget ” 


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215 


-although we can “ forgive ” them, nor are these always related to 
sexual matters. When the passions emerge in the conflict 
they become the “ latent ” cause of dreams, obsessions, and 
longings ; if dreams be the result, then the dream as remembered 
or recorded is the “ manifest ” dream, and the interpreter imme¬ 
diately attempts to elicit the latent wish of which the manifest 
dream is the symbol. By this analysis a clue is furnished to 
the real aim and personality of the dreamer. 

Dreams are thus regarded as the resultant of a conflict 
between the censor and the repressed idea, the dream being 
the “ compromise,” and only to be solved by a code, for which an 
array of symbolism has been invented to serve as a key for its 
interpretation. If the dream be of the sea, for instance, then, 
according to the followers of Freud who have initiated this sex 
meaning, it stands as a symbol for " life,” as, in their own 
words, “ life needs the mightiest symbol, because existence 
depends upon the mighty and profound procreative force.” If 
the dream be of an old house, then it is interpreted to be “ th* 
abode of life,” and, to use the Freudian expression of the 
dream analysts, “ we find it necessary to predicate a creative, 
myth-making tendency in the structure of the mind by means 
of which the currents of life beneath all thought become 
articulate.” 

The following from an able series of lectures recently 
delivered : “ Breast-sucking is of sexual import,” “ constipation 
is a pleasurable experience,” and the desire to retain faeces is 
sublimated into the desire to retain money, and faeces 
symbolises money! 

The psycho-analyst always finds what he is looking for, and 
there is not a single object in the universe for which some 
sexual significance cannot be discovered, even the Zeppelins in 
the sky have a phallic symbol. 

According to Freud, the child when born is a poly-morphic 
pervert and a universal criminal, and the dominating emotional 
factor is incestuous love, the CEdipus complex, and that the 
sublimation and criminal tendency give rise to the surgeon ! 

This sexual theory is over-emphasised, and the Freudians 
who urge sex as the basic origin of all dreams, of all obsessions, 
and of all longings, impulses, and neuroses are “ sex-intoxi¬ 
cated,” they read into dreams the fantasies of their own 
auto-suggestions. In life’s reality surely there are other primary 


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216 dreams and their interpretation, [April, 

and original instincts as well as sex, of which fear, self-pre¬ 
servation, anger, and hunger, and the many relations of the 
individual to the community are the most common examples. 
Deluded ideas about food, digestion, warmth, electricity, voices, 
and enemies are far more common in asylums than sex- 
delusions. All these run deep in the unconscious mind, and 
each has suffered far more repression than sex? It is against 
human experience that all dreams are desires, and it is repulsive 
that all dreams should be interpreted as relating to sex, and 
such an explanation has brought these conclusions of what have 
been called “ chimney-sweeping investigations ” into deserved 
disrepute. In the analysis of dreams, the method adopted for 
exploring the unconscious mind depends upon inferences 
drawn from what has been described as free or spontaneous 
association, “ word association,” and reaction time. 

The latter has been much used in America as an auxiliary 
for the detection of crime by means of an instrument of 
extremely delicate mechanism, such as Hipp’s chronometer, the 
examination revealing a shortened reaction period to word 
association if the accused be innocent, whilst the reaction period 
is longer if the accused be guilty, for he is endeavouring to 
keep back thoughts suggested to the mind in connection with 
the words presented. 

What is the association of dreams with crime? I have 
questioned insane criminals about their dreams in connection 
with specific crimes, and although there is always some reserve 
about admitting revelations in connection with criminal acts, I 
find that they dream much as do other people. In this class 
there is a considerable difficulty in proving their hidden 
personal secrets, and in overcoming the resistance of the so- 
called “ censor.” In these cases the conscious and the uncon¬ 
scious cannot be easily brought together, and a clue as to their 
desires, impulses, or wishes is extremely difficult to ascertain. 
Moreover, this class is not an easy one to investigate, many of 
the criminal classes being mentally defective, although some are 
only morally so, especially as regards prudential considerations, 
for they cannot postpone present pleasure for future good. 
They are easily tempted and easily yield, and they have a 
diminished emotional as well as intellectual endowment. The 
“ criminal type ” is impulsive, and though they may not be 
insane, they have often a psychopathic inheritance and ten- 


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«iencies. Their psycho-anthropological characters may be sum¬ 
marised as egotistic and anti-social, and they are not easy 
material for the psychological analyst. The discovery of crime 
through a dream, when the dreamer has by his own dream 
given himself away, is unknown to me in real life, and this is 
supported by the extensive experience of Dr. W. C. Sullivan. 
Dr. Leonard Guthrie reminds me of the story of the murder of 
Maria Martin by Corder in 1827, when dreams led to the 
discovery of the victim’s body. As he also points out, there are 
numerous instances of murders having been discovered and 
avenged by the appearance of the murdered person’s ghost. 
Shakespeare presents two instances in “Hamlet” and “Macbeth.” 
“ The Bells,” in which Irving represented the Jew, Polonais, 
exemplifies a drama in which the murderer is being continually 
haunted by the dream sound of the sleigh-bells, .and in " Tom ” 
Hood’s “ Dream of Eugene Aram,” “ the unknown facts of 
guilty acts are seen in dreams from God.” The usher, Eugene 
Aram, dreamed of the murder he had committed, and which he 
related long afterwards to the boy—“ the horrid thing pursues 
my soul, it stands before me now ”; “ that very night two 
stern-faced men set out from Lynn, and Eugene Aram walked 
between with gyves upon his wrists.” The suggestion here 
made connects the dream with the murderer’s arrest. Hack 
Tuke relates a remarkable instance of a man dreaming that he 
had performed an act which rendered him liable to legal 
consequences, and for which he had been arrested. On awaking 
he was greatly relieved to find it was only a dream, but in the 
course of two or three days he committed the act in an insane 
condition of mind. He was arrested and brought before the 
court for trial, but was released to the care of his friends. 
There is no record of psycho-analysis assisting in or leading to 
the detection of crime, not even crimes relating to sex, for 
which the Freudians seem to have a peculiar predilection. 

It will be admitted that a most puzzling terminology has 
arisen from the efforts made by this new school of medical 
psychologists to analyse dreams. If the dreamer fails to recog¬ 
nise the new and strange scenes in which the manifest dream is 
located, this is owing to its “ dramatisation,” and if the characters 
are unrecognisable there is “ distortion.” Should the chief char¬ 
acters be given a subordinate position there is a “ displacement,” 
but not infrequently there occurs a fusion of the characters, which 


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218 DREAMS AND THEIR INTERPRETATION, [April, 

is “ condensation.” When the ideas in a dream become detached 
from their usual association, and are “ converted ” into some 
other psychic sphere, then they are being “ sublimated ” into 
some obsession or delusion. Hysteria, for instance, is the 
“ conversion ” of a “ repressed ” idea into some motor and 
Sensory discharge, and .if only the idea can be disclosed to the 
sufferer and by him disregarded, the result is claimed as a cure 
obtained by a “cathartic”—a word which is meant to signify 
suggestion, auto-hypnosis, or, as more recently hinted by 
Dr. Wm. Brown, “auto-gnosis.” These terms, “depression,” 
“ displacement,” “ condensation,” “ transference,” “ intro- ” and 
“ pro-jection,” “ intro- " and “ con-version,” “ sublimation,” “ de¬ 
termination,” “ exteriorisation,” etc., a jumbled vocabulary of 
metaphysical abstractions. 

I have quoted the above to show the complicated vocabulary 
invented by some psychologists to explain dreams, which, as 
Bergson points out, are only states of “ relaxed consciousness.” 
In the waking state we are always adapting ourselves to our 
needs, but in sleep we have ceased to select and choose. The 
mind in its relaxed state brings together memory associations 
which were formerly packed away in the “storehouse of the 
unconscious mind,” the reason fills up the gaps, and a confused 
impression results which is the material of dreams. 

As is well known, the brain cortex is restored and refreshed 
only during sleep, and it is a comfort to know that we dream 
most of events to which no attention has been paid ; were it 
not so, our sleep would be disturbed and pre-occupied by events 
that are of importance, and which have been our greatest 
concern during the day, so that our waking life would be 
prolonged as a permanent dream into the sleeping life, and 
the necessary restoration and nutrition of the brain would be 
impossible. 

It is most welcome that the revival of interest in dreams 
should have awakened the psychologist, the physiologist, and 
the philosopher; but one realises that progress must be at the 
expense of some long-held views or traditions. Unfortunately 
in this instance—if progress can be claimed—it is at the 
expense of some cherished proprieties, and I venture to think 
there has been an unnecessary pandering to the lower instincts 
of innocent men and women on the part of those who describe 
themselves as psycho-analysts. I believe that in the full 


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219 


pursuit of this craft, which is on a par with mysticism, occultism, 
cubism, futurism, etc., there has been a distinct over-stepping of 
the decencies of sex on the part of some who have worked 
upon these investigations. The foreign teachers, who have been 
responsible for employing the “ sex-mad methods ” and the 
craze for new excitement, have, so far 4s this country is con¬ 
cerned, already received the recognition of a posthumous notice 
of their labours, and it would not be incorrect to state that 
among psychiatrists—in this country at any rate, thanks mainly 
to Dr. Mercier—Freudism is dead. 

Discussion. 

Sir George Savage said he felt particularly interested in this subject: he had 
written a book upon Dreams and their Meaning and had read many books on 
the topic- He was himself a perpetual dreamer, and therefore he could speak 
somewhat authoritatively in several directions. x 

First, there should come the definition of a dream, and that Sir Armstrong- 
Jones had not given in his paper. The best definition that he knew of—and it 
was important to consider this definition—was “ mental action taking place during 
sleep which is more or less recognised on waking." On that the question of 
whether a dog is dreaming when it jumped or barked in its sleep could not be 
verified, seeing that we had no means of knowing whether the dog on waking had 
any recognition that a mental process had been in operation. In regard to what 
Sir Armstrong-Jones said about mental action always going on, one wanted a 
definition of mental action. The brain certainly always had blood circulating 
through it, and so was in a condition to react at any time, hence there was always 
present the potentiality of mental action. 

Another question also which he considered important was the length, or rather 
the brevity, of dreams. He was in a position to say it was possible to haVe quite a 
king and detailed dream in a second. On more than one occasion he had been 
in a position to actually ascertain how long a dream occupied. On one occasion, 
of several, he was benighted in the Alps, and there was only One change of posi¬ 
tion he could obtain, namely, by lodging one foot upon a ledge opposite to where 
he sat. As soon as he lost consciousness in falling to sleep, his foot came down 
from its resting-place. Many times the foot was put up, and fell down immedi¬ 
ately, gravitation would not permit of it resting there for more than a second or 
two. During one of these very brief periods he had a detailed dream, the character 
of which it was unnecessary to relate: the dream seemed to have occupied half an 
hour. On another occasion, while at his cottage in the country, he said he must 
go and change into dinner clothes. It was then 25 minutes past the hour, and he 
decided to sleep until the half-hour. At 27 minutes past the hour he had awakened 
and started relating a long dream which he had just had. There could be no 
doubt about it, as the clock was in front of him. He therefore affirmed that dreams 
coold be almost instantaneous. 

There also arose the question of the interruption of dreams from outside, by the 
censor, as one might say. One recognised that the cause of dreams, or the 
character of their association, might be something physical. He did not doubt 
that, in a certain number of cases, a sexual or urinary trouble or excitement might 
cause a person to wake up, hence the immediate precedence of that dream might 
have such a quality ; but that all dreams were associated with sexual functions he 
did not believe. In passing, he said he wished he had been the father of the 
epigram which the author attributed to him about insanity being the state of 
“dreaming awake." It originated with Hughlings Jackson, but he (Sir George) 
had repeated it so often that he had now been credited with its origination. 

The large question of the prophetic aspect of dreams, on which Sir Robert 


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DREAMS AND THEIR INTERPRETATION. [April* 


touched, he must leave on one side. He did not know whether the author 
referred to that most interesting book on Dreams and their Meanings by that 
universal essayist Sir Horace Hutchinson, who seemed able to write on anything, 
from dreams to golf. 

One felt there was a great deal in the sub-conscious mind, a subject on which 
one might speak in the absence of Dr. Mercier. In his teaching days he used to 
employ a simile. One saw a big excavation on the site of what was going to be 
a house. When the house was completed, the kitchen would be underground, and 
would be invisible. In our lives, in early years, the kitchens of our mind were 
filled up. He did not doubt that a person’s experience had a great deal to do with 
his dreams. One of Horace Hutchinson's brilliant suggestions was that dreams 
were associated with either personal, parental, or ancestral experience; that, in 
fact, when one was flying in one’s dreams it was merely the reminiscence of one's 
arboreal or simian ancestors. 

Dr. Rothsay Stewart said he would like to make a few remarks, as the sub¬ 
ject of dreams had interested him for many years. Some years ago he was 
discussing the subject with a friend, and they both tried to arrive at some explana¬ 
tion of dreams. After working at the matter for some time, they produced 
certain theories. After a little practice he (the speaker) found he could relate 
every dream he experienced to some event which had previously occurred in his 
experience, and not more than a day or two before the dream; it may have been 
in relation to something he had recently read. The theory which he and his friend 
propounded they found very workable. It assumed a submental stimulus. He 
never dreamed of anything which had been occupying his waking thoughts for any 
considerable time, and the reason probably was that those cells were already 
exhausted by the concentration bestowed on them. But during the day the atten¬ 
tion might have been momentarily attracted to some object, or some book, and 
that might well be projected into the dream. The reason dreams were so incon¬ 
gruous was that the mind was unconscious during sleep, and the inhibitory power 
present during consciousness was in abeyance. An actual occurrence started the 
dream, but there was no necessary coherency. He believed his theory would be 
found workable by others, if they would try to remember events in actual life 
which had a bearing on the subject of the dream. He quite agreed that the sub- 
mental stimulus causing a dream acted just before the awakening. 

Colonel Sprinothorpe said it had been his misfortune to have to deal with 
some hundreds of shell-shock cases ; and as a result of that experience he felt no 
doubt that in 99 per cent .—if not, indeed, 100 per cent .—of the cases the exciting 
cause was fright. So far as he was able to see, the sexual element had nothing what¬ 
ever to do with it, though he questioned the patients a good deal. He was one of 
those who considered that Freud had made, in this matter, an unutterable mistake ; 
his conclusion was practically an insult to humanity. There were many other 
things connected with these states of dreaming. Still, if people of predominantly 
sexual type were selected, there was no doubt that in them the sexual element 
would be the chief one. Having for many years made a careful study of his own 
dreams, he agreed with those who said they must be almost instantaneous. When 
he contrasted his dreams of earlier years with those he had now, he found that the 
present ones were much more regulated and orthodox: the persons dreamt about 
behaved themselves a good deal better than did those in earlier years, when his 
habits were not so fixed and his cerebrum was more easily upset. With regard 
to the cases of shell-shock, he would like to know whether Sir Robert Armstrong- 
Jones did not consider that what, for the present, must be called the mental 
element in cases of shell-shock was much more important than what had to be 
termed the material. His own view was that terror and fright of the men at the 
time was a far and away greater cause of their condition than was any molecular 
concussion or the trinitro-toluin or other explosive used. 

Dr. Stewart said that in his long life he had had varied experiences; had 
travelled a good deal in the latitudes of science, and discussed many things 
which were nearly allied to psychological medicine. To-day he had listened with 
great interest to the speeches not only of Sir Robert Armstrong-Jones, but also of 
those who followed him, because he had never travelled in the regions they had 
cultivated and become acquainted with, though he had been a naval officer, and 
had been in charge of insane patients, and therefore had had many opportunities of 


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191 7 ] BY SIR ROBERT ARMSTRONG-JONES, M.D. 

collecting facts. Not until recently did it occur to him how much knowledge 
•light be gained concerning the mind by questioning those who were worried by 
their dreams. The facts he had been collecting during the last two or three years 
led him to confirm the view of those who (did not believe dreams invariably had a 
-sexual basis. 

Apparently, from what had been said, even an elaborate dream occupied only a 
very short space of time—a few seconds. He would be very glad, if opportunity 
occurred in the future, to examine that point more fully. Certainly what he had 
heard to-day had spurred him to greater interest. 

Dr. Soutak remarked that much of the interest had gone out of this discussion 
because, so far, no one had taken up a defence of the Freudian idea. Those at this 
meeting appeared to be agreed that the Freudian explanation of dreams was one 
which could be ignored, as there was no substantiality about it. British alienists, 
at all events, did not proceed to examine everything in the light of preconceived 
ideas. It would be easy for anyone with any ingenuity to discover a sexual basis 
for anything, for the expression of any thought. It had been said by one of the 
participants in the discussion that the sexual idea did not prevail in the dreamer. 
The great desirability, he submitted, was that it should not prevail in the mind of 
the investigator. However the matter might be regarded, he thought that in this 
assembly, which was fairly representative of the Association, it might be con¬ 
sidered that the sexual interpretation of dreams was not accepted : to his mind 
such an interpretation was quite contrary to all experience. He did not know 
anything about the sub-conscious or the sub-mental mind ; all he knew was that in 
certain conditions we were conscious of what was in our minds. Dreams occurred 
at the moment when the unconscious was merging into the conscious, a stage at 
which there was not a full operation of discrimination and judgment, as in the 
fully awakened condition. Hence the dreams remembered were fragments. The 
transition from the conscious to the unconscious and vice vtrsA was gradual, and 
it was easy to see why the remembered picture was incongruous and srrappy. 

One point of particular interest raised in Sir Robert Armstrong-Jones’ paper was 
that in which he mentioned dreams appearing to precede conditions of acute 
mental disorder. That he (the speaker) had frequently seen. On the other hand, 
it was exceedingly interesting to find that in not a few instances one found that 
the first indication of improvement in the patient was an alteration in the character 
of his dreams. He had frequently noticed, in melancholic cases, that when they 
began to be happy in their dreams, an alteration for the better had set in in their 
brain state, and that when this occurred the mental trouble would probably be 
recovered from. Again and again he had pointed out to patients that if they were 
able to dream happily, they would also be able to think happily afterwards. 

He would not further detain the meeting except to once more congratulate 
British alienists on the fact that they did not think it necessary to believe that 
sexuality and immorality and a generally pernicious state of mind was at the 
foundation of human action. 

Dr. Alice Johnson considered that one thing which Freud lost sight of was 
that the mind was a reservoir of the beautiful .things-of this world; beautiful 
scenery, good books, anything one could think of. Most people dreamed about 
things of beauty, and these beautiful dreams could not be attributed to sex. 

Dr. Helen Boyle said she had greatly enjoyed the paper, but, as Dr. Soutar 
said, it was a pity there had not been more divergent viewsexpressed. All speakers 
were so heartily in favour of the views expressed that there was not enough opposi¬ 
tion to make it pugnacious. 

One of the points she would allude to was that of forgetting painful things. She 
was not inclined to accept Sir Armstrong-Jones’ idea that we could not forget 
painful things. She considered that the normal tendency of the human mind was 
to forget and be glad to forget painful events ; ordinary people forgot those things 
with a rapidity which was phenomenal, and that was a wise, natural, and sensible 
method to pursue. It was seen in the case of children, and all through life, until 
the tendency to bury painful things became quite normal. That was her chief 
objection to the new treatment of cases, for by it one did exactly the opposite of 
Nature's way. It was a vogue. All through the history of medicine it had turned 
•Out that, owing to deficient knowledge, we had pursued measures which Nature 
iaught were wrong, so that a fresh start had to be made along the lines Nature 


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DREAMS AND THEIR INTERPRETATION, 


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pointed out. The careful analysing which brought into prominence matters which 
troubled the mind seemed to be reversing the natural tendency to bury those 
troubles as deeply as possible. The method of psycho-analysis did, in some cases 
which had resisted other means, seem to enable the trouble to be buried deeper 
than had been previously possible, and to that extent it had proved beneficial. 
But in those cases she attributed it to the suggestion rather than what it had been 
ascribed to. 

She considered that the present investigation of mental attitudes and purely 
mental ideas as the causation of nervous and mental disease was a very important 
one indeed, and in that respect thanks were due to the psycho-analysts for what 
they had done. She believed that the profession had been getting very materialistic 
about it, and a reversion might yet be seen in that—it was usually noticed in 
medicine that there were oscillations of opinion—but there was a tendency to^ 
regard everything as due to toxins, or to some sort of disease-germ, forgetting the 
fact that, as far as human knowledge went at present, we had no explanation for 
many cases which, humanly speaking, appeared to be entirely due to mental atti¬ 
tudes. She herself knew what mental attitudes meant. In the middle of a 
dinner-party she was suddenly told she would be called upon to speak at the end 
of it. The result of that intimation was that she was unable to consume any more 
dinner ; if she attempted to do so, she felt that she would probably be sick. That 
was purely a mental condition, her physical condition had not changed in the 
least. Many nervous and mental troubles and anxieties, and some paralyses, were 
due, as far as could be seen, to mental causes, and hence should be treated by 
mental therapeutics. 

She regarded the opening paper as most important and valuable. 

Dr. Boycott said that, so far, the analogy of opium in the production of dreams 
had not been mentioned. There could be no question that those who for sleepless¬ 
ness or after operations on account of acute pain, had opium, had most vivid 
dreams. When speaking of the cause of dreams being purely mental, that 
definite cause should be borne in mind. What he mentioned was entirely anala- 
gous to a dream,though not an actual dream. Another point was, that conditions 
of mind which resembled dreams were frequently met with in insane people, 
especially epileptics. A short time ago, he saw an epileptic subject suddenly run 
amuck, his behaviour being the most violent possible, so that a considerable number 
of people were necessary to hold him. He came round in a short time, and pre¬ 
sently he (the speaker) asked the man what had been the matter, and the reply 
was that he thought a railway engine had come into the ward and he was trying 
to get out of the way of it. That man was an advanded epileptic, and was constantly 
having fits; it was that condition which probably caused him to have that dream, 
as it could be called. An analogous condition was that of night-terrors in children, 
a condition often attributable to a physical cause, such as intestinal worms or other 
form of bowel irritation. The actual form of these children’s dreams was pro¬ 
bably determined by something they had seen, and they awakened in the condition 
described by Sir Robert Armstrong-Jones, perspiring freely, and much terrified. 

Miss Beatkice Edgell (University of London) said she had been very interested 
in Sir Robert Armstrong-Jones' paper. On such a question as this psychologists 
lopked to this Society for a very strong lead, not only in regard to psycho-analysis, 
but also the Freudian doctrine generally. She was not herself in a position to look 
at the matter from the medical point of view ; but one could not study the mental 
life and be interested in mental processes without having brought before one the 
whole theory of sub-consciousness. It had always seemed to her that the way i«. 
which one needed to approach that, psychologically, was to ask oneself what facts 
there were in conscious life which could be confirmed in one’s own experience and 
in that of others, facts which demanded for their explanation any theory of sub¬ 
conscious phenomena, which we did not know and could not be conscious of. It 
was quite legitimate to use it in that way as an explanatory hypothesis; and if the 
Freudian doctrine had caused people to attend more to this question of the validity 
of such, a hypothesis it would have done good. But she did not think people 
should run away, as they seemed to, with the idea that Freud was the real originator 
of the theory of sub-consciousness. But where one seemed to find that theory 
went to the bad was when the method was perverted, or inverted, as it was in 
Freud’s doctrine of dreams, and in many of the other doctrines too; for the 


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attempt was made to explain not by referring the conscious to the sub-conscious, 
but reversing it. People did not take facts as they found them and try to 
explain them, but took the facts of dream-life and tried to make them fit the 
prearranged explanation. And from psychological quarters one came across a 
collection of facts which one could neither refute nor confirm ; and discussion 
was hopeless when it came to the use of such terms as sublimation, transfer¬ 
ence, repression, and the rest. Nothing seemed to carry any conviction with it, 
because it was impossible to prove what was wrong in the method. 

She would be very interested to hear what was the attitude of the medical men 
present on the subject. 

Dr. R. H. Steen said he would not like the discussion to close without rising 
to thank Sir Robert Armstrong-Jones personally for reading this most interesting 
paper, and for coming forward at a time when he (the speaker) was in a hopeless 
position in regard to finding a contribution for this meeting's discussion. There 
was to have been another paper read, but the author of that had been detained in 
France by his military duties, and in those circumstances Sir Robert very kindly 
came forward with his paper. 

At the risk of incurring the censure of Dr. Soutar, he would like to say that he 
did not think the meeting had been quite fair to Prof. Freud. All the discus¬ 
sion on Freud's theory of the interpretation of dreams had been by way of 
emphasis of the Professor’s sexual view; but he wished to point out to members 
that Freud did not regard all dreams as of a sexual nature. Indeed, the first 
dream Freud gave in full, that of Irma, had nothing to do with sex. He thought 
it unfair to emphasise so much one point in the psychology of that great man. 

He would wish to point to some good features in Freud's Psychology of 
Dreams. The first was the author’s enormous industry. Ernest Jones had related 
that before Freud commenced to write his book he analysed a thousand dieams 
of his own, and Dr. Jones, said that fifty of his followers did the same thing, so 
that there was an immense mass of material to go upon—namely, fifty or sixty 
thousand dreams. So, even if the conclusions were wrong, the author tried to get 
at the truth. 

A second thing which Freud had done was to show that dreams were not mean¬ 
ingless. He doubted whether people, until the time Freud wrote his work, could 
find a meaning in dreams; and certainly Freud had thrown a great deal of light 
on the whole subject. He had shown that there were two parts in a dream : the 
manifest content, and the latent content. 

With regard to repression,the opener alluded to "the censor,” but he was sorry 
he did not also mention any of the works of the Zurich school. A large book had 
been written by one of the members of that school, Jung, and it contained no 
mention of the word “ censor.” The Zurich school founded their theories on 
those of Freud, but went beyond them. It was not easy to state clearly what 
they meant, but an example might be useful. This was taken from The Dream 
Problem, by Maeder, a member of the Zurich school. A young man dreamed that 
he was in a tunnel, that there was an opening in it, through which he looked. At 
the other end he saw a valley, and in that valley a man ploughing a field. Freud's 
interpretation of the dream was characteristic, and rather disgusting. But 
Maeder's interpretation of it was that the young man felt the need for re-birth, 
almost the Biblical equivalent of being “ born again,” and that if he were com¬ 
pletely cured he saw a useful life’s work in front of him. Those of the Zurich 
school said that a dream had a prospective value, and that it had not altogether a 
retrospective or regressive significance, which was the feature which Freud laid 
most stress on. It seemed to be a very beautiful idea, and he thought more might 
be heard of it in the future. 

With reference to a dream being regarded as the fulfilment of a wish, most 
children, he believed, dreamed, and their dreams were generally the representa¬ 
tions of the fulfilment of wishes. A female patient of his recently, when asked 
whether she dreamed at night, replied that she dreamed every night. Asked as to 
the subject of her dreams, she answered, “ I dream I am at home again.” Surely 
that would be considered as a dream which was fulfilling a wish. 

He had felt that he would like to say those few words in favour of Freud, and 
so state the other side, though he was not himself a Freudian, for in twenty years’ 
time he believed much of what that Professor had advanced would have been shed 


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224 DREAMS AND THEIR INTERPRETATION, [April, 

and not heard of again. Still, there were features about his contentions which 
would well repay reading about and studying, as it was possible they might be 
useful in the treatment of their patients. And he would not like it to go forth 
from this meeting that British alienists were not studying the question. 

Dr. Monrad-Krohn hoped, as a non-British alienist, that he might be permitted 
a few remarks. He wished to express his admiration of Sir Robert Armstrong* 
Jones’ paper, and his objective standpoint towards the theories of the Freudian 
school. He (the speaker) could not look upon Freudism with so much righteous 
indignation as some of the speakers in the discussion had done. If it was 
possible to cure a patient by digging out his sexual complex, one was entitled to 
employ that means. Freud had underlined stronger than anybody else the fact 
that there were more determining factors in the mind than we were conscious of. 
Having said that, however, he hastened to add that he was not aware of ever 
having seen any proof that the eradication of the sexual complex had done a 
patient any good. He had read much about Freudism, both the teaching of Freud 
himself and that of the Zurich school; and, to his mind, it only amounted to a 
heaping-up of new terms. It was a great pleasure to hear Sir Robert Armstrong- 
Jones mention a selection of the terms which had been introduced. It was necessary 
to remember that to invent a new term was not to explain the Freudian symbols. 
All the speakers had agreed that dreams were dependent on everyone’s personal 
experience, and no two persons had the same experience, if only because the 
circumstances in which they had lived varied so greatly. How, in the face of that, 
could Freudism claim a general value for the different experiences ? His remarks 
applied not so much to Freud himself as to his pupils, some of whom, he was told, 
contemplated the working out of a dictionary. But how could they claim a general 
value for all these things ? The whole Freudian school had given psychologists 
a stimulus to investigate the sub-conscions mind, and to investigate dreams, but 
after having been given that stimulus, he feared the subject was left more confused 
than before. 

The President said he felt the hour was now too late for him to attempt to 
even summarise the discussion, and he would not detain the meeting by expressing 
his own views on the subject. Sitting there, as an onlooker, he gathered that 
most of what had been said of Freudism could equally be said of anything, how¬ 
ever bad. 

Sir Robert Armstrong-Jones, in replying on the discussion, said he knew 
that Sir George Savage had had some vivid dreams, and his descriptions of them 
were well known to-members of the Association. He had also been glad to hear 
Dr. Lepinska, and he felt much indebted to that lady for having come. 

He had also been much interested in Dr. Soutar’s remarks about the changed 
character of dreams in convalescence; he would bear the point in mind. 

It was also a pleasure to hear Dr. Springthorpe, of Australia, who had had a 
most valuable experience of cases of shell-shock, which condition had been 
divided into four or five types. There was the type which might be caused by the 
autonomic condition fear, connected, more or less, with the disturbance of the 
sympathetic. Several explanations had been given in regard to this shell-shock. 
One was the absolutely destructive molecular change brought about by trinitro- 
toluin, a pressure of about 7,000 kilo, tb the square c.m., yet some of the sufferers 
from this condition were not hot. A man at Mametz Wood did not see the gun 
which went off close to him ; it imparted a terrific shock to the air in his vicinity. 
The man managed afterwards to crawl a few feet, and then had to be carried, and 
he had not walked since. He had no wound, but the cerebro-spinal system was 
delicately suspended in a bag of fluid, and in it there must be profound molecular 
concussion. His sympathies went out to the shell-shock cases; he felt that they 
deserved well of their country. A certain number of men constituted very ready 
material to fall down, because they were of the neurotic type, and in such cases 
one found there was a history of insanity, or of epilepsy, or some singularity or 
oddity or tendency in the family. 

There was also a purely functional condition ; as Dr. Helen Boyd said, the pro¬ 
fession must change their position, and think of mind as a definite entity. When 
one exerted one’s will, one knew it was a something, though it might not be 
material. Some psychologists would not admit there was anything existing which 
could not be proved. He understood Dr. Boyle to say that it was not right to 


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draw an analogy between the conscious and the sub-conscious, or vice-versd, 
because they were two separate things, and not comparable with each other. 
Secondly, there was actual molecular shock in the shell-shock cases; and 
thirdly, hypo-thyroidisra. Some of the brains of shell-shock cases had been 
examined, and the changes found in the nervous system were remarkable. 

He commended to members the researches of Cannon in the Harvard Uni-, 
versity. He put cats into cages, and got dogs to bark at and worry them; then 
he examined the blood, and found the adrenals increased their secretion ; 
the blood-pressure went up, glycogen was released, and in that way energy was 
supplied to the muscles ready for waging the imminent combat. One might ask 
why, with that view, one found a man who had great fear was collapsed. It was 
necessary to carry the point a little further. When injuries had been received 
through fear, it became evident that it was not to the advantage of the organism 
to show combat, the only advantage was to show concealment, and so the organism 
collapsed, and at that time adrenalism had had its innings. Dr. William Brown 
had shown that in fright the pressure of the blood and the pulse-rate came down. 
He had been asked by Major Newton Pitt to see a case in which goitre had 
developed, and Dr. Helen Boyle's experience supported the view that goitre might 
occur almost spontaneously, in which case one found hyper-thyroidism. He 
would like to know whether Dr. Springthorpe would regard fright as the cause of 
the adrenalism. There was a case of an officer, now in Queen Alexandra 
Hospital, who was seventeen months in the trenches. Then he was shot in the 
thigh, and had been in bed seven months, and had undergone nine operations. 
Though he had been a brave commanding officer, he now wept like a baby, 
declaring he could not help it. He had never previously felt fear, and the 
speaker thought the best explanation was that the nerve potential had gone down, 
the battery was now exhausted. That seemed to be the condition of many 
of these cases. 

Dr. Helen Boyle succeeded in burying painful things. She was, he considered, 
a super-optimist. He (Sir Robert) had never succeeded in doing so, hence the 
question of temperament came in. He felt he had a right to speak of Dr. Boyle 
in the way he did, because he had the privilege of working with her at Claybury 
Asylum for five years. 

In conclusion, Sir Robert expressed the thanks and gratitude which he felt on 
hearing the President’? cordial reference to the honour which had been conferred 
upon him. He had very warm feelings towards the Association, with which he 
had been so long connected, and which contained so many of his friends. And 
the honour was not simply a personal recognition of himself, but of those with 
whom he had so cordially worked. 


Remarks upon the Vegetative Nervous System and 
the Internal Secretions. {}) By Frederic J. Farnell, 
M.D., Butler Hospital, Providence, R.I. 

It will not be my desire to enter upon a full discussion of 
internal secretions ; still it will be touched upon sufficiently in 
an attempt to link some disorders of nervous origin with a 
condition clearly defined by Eppinger and Hess as vagotonia. 

As in all other special fields of medicine nervous and mental 
traits follow certain tendencies among certain types of people, 
or even among certain communities, and these tendencies are 
usually shaped by causes more or less inherent for those 
people ; of this all are aware. That there is plenty of clinical 


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evidence to warrant such a justification has been pointed out, 
as a factor in mental disorders, by Meyer, Hoch, and others, 
who have clearly defined types of personality as quite charac¬ 
teristic in certain mental disturbances. 

When one considers the cause of a nervous disorder one 
must distinguish the case of a person in the best of health 
suddenly developing a nervous disturbance from one in which 
a lingering constitutional weakness becomes exaggerated by an 
intercurrent affection. It is to these tendencies which deal 
with the fundamental aetiological relationship of a great 
majority of nervous states that these remarks will refer. 

One cannot help while reviewing the study of vagotonia 
but recognise Sir Grainger Stewart’s classification of constitu¬ 
tions and diathesis as falling closely within the group of 
so-called vagotonics. His classification was somewhat as 
follows : 

(1 ) A nervous constitution , generally with a fair complexion, 
bright eyes, frequent changes in colour and facial expression, 
bones and muscles not strong or vigorous, the heart and nerves 
excitable and unstable. 

(2) The lymphatic constitution , with great head, irregular 
fleshy face, slow weak pulse, large hands and feet, and so 
forth. 

(3) The sanguine constitution , fair hair, blue eyes, easily 
flushing face, strong but excitable heart, yet no nervous states. 

(4) The bilious constitution , with a tendency to obesity, 
dyspepsia, variable intestinal phenomena, usually diarrhoea, 
urinary disorders, etc. 

How often one comes across a mixture of “ lymphatic," 
44 nervous,” and 44 bilious ” constitutions, yielding very plainly 
the 44 vagotonic disposition ” as described by Eppinger and 
Hess. These people appear for advice because of some rather 
slight ailment, 44 indigestion,” 44 constipation,” or a fear that 
high blood-pressure is making itself manifest. They might 
enumerate many symptoms heretofore called 44 neurasthenic,” 
and they are looked upon as individuals with nerves, and little 
attention is paid to them. 

Their symptoms are usually spasmodic and episodic. Their 
faces flush easily, and one often hears them refer to the periods 
of paleness and blotchiness of their face and neck. Their 
extremities become cyanotic, with palmar sweating, and occa- 


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sional complaints of regional areas of sweating. They com¬ 
plain of eructations of gas, regurgitation of food, and a tendency 
to vomit. Bloating and “ a feeling of pressure ” are of frequent 
occurrence. There is intestinal fermentation, rectal pressure 
and deficient bowel movement. This, through absorption of 
-cleavage products in intestines, causes headaches, feelings of 
pressure, insomnia, and vertigo. Gross circulatory manifesta¬ 
tions appear such as cardiac palpation, intermittent irregular 
pulse, variations in blood pressure, pulsations of the abdominal 
vessels. 

The emotional life of these individuals is a most important 
factor in enhancing visceral symptoms, and undoubtedly has 
led many investigators to lay emphasis on the mental state, 
such as Freud in his “ anxiety neuroses ” and others. These 
patients have a weak affective tone, and do not respond or 
adjust themselves to the difficulties of everyday life. When 
these unavoidable experiences occur one must expect a pro¬ 
found visceral reaction, the type depending upon the system 
least sensitised. That these individuals do not wish to be 
called “ nervous ” all are aware, for it is an insult to their pride, 
and carries with it an assumption of “ mental weakness.” They 
carry the old idea that with mental and nervous disturbances 
the imagination is warped, and since the distress and disturb¬ 
ance are real to them their disorder must be organic and ncn- 
oervous. Whether a pain is imaginary or real it matters not, 
for both must be handled carefully. What the layman calls 
■“ nervousness ” is often only a slight excess of normal, and very 
far from the state of pathological nervousness. There can be 
little doubt but that what has been termed “neurasthenia” has 
now fallen into the same category as “ uric acid diathesis,” 
blood-pressure disease, auto-intoxication, all having become 
obsolete, and it now behoves the clinician to dig deeper in 
search for causes and mechanisms.' 

It might be advisable at this point to refer briefly to the 
visceral nervous system. Eppinger has called that system 
which supplies the smooth muscles, cardiac muscle, and 
glandular tissues the vegetative system, because through it the 
normal continuation of life and the vital functions are pre¬ 
served. The “ sympathetic nervous system ” is that portion 
of the vegetative system represented by the gangliated^cord on 
«ither side of the spinal column, with its ganglia and communi- 


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eating fibres, which might be termed the “ thoracic autonomic." 
The vegetative proper is divided into midbrain, whose segments 
pass by way of the oculomotor nerve pathways ; the bulbar 
which through the facial, glossopharyngeal, and vagus supplies 
the glands, vaso-dilators of the head, heart, bronchi, oesophagus, 
stomach, intestines, and pancreas ; and the sacral which 
supplies the descending colon, sigmoid, bladder, and genitals. 

Concerning these different divisions, the mid-brain, bulbar, 
and sacral are similar in that they are entirely local in their 
supply ; whereas the sympathetic or “ thoracic autonomic ” 
not only has its local distribution, but also it sends segments 
to the same structures as the other system, thus causing the 
vegetative system to be innervated by both autonomic and 
sympathetic fibres, and the sympathetic or thoracic autonomic 
is innervated by only one system. This is of great importance 
in differentiating disorders, and will be referred to in relations 
to glandular upsets. As examples of autonomic structure 
having a double supply one may mention the salivary glands, 
stomach glands, intestinal muscle-coats, heart, and blood-vessels. 
Those having a single or sympathetic, smooth muscle of skin, 
blood-vessels of intestines, and internal generative organs. As 
an example of the antagonistic action of the two systems one 
may instance the external genitals. As an example of double 
innervation of similar stimulating effect, the salivary glands, 
in those nerves having a vegetative activity the efferent and 
afferent fibres are interrupted in their course from the cortico¬ 
spinal system by preganglionic and postganglionic segments, 
with a variation in location from the sympathetic cord to the 
submucosa of the intestines. This latter nerve supply has 
been called by Langley the “enteric nervous ” system governing 
the entire tract from the esophagus to the rectum. He mentions 
the fact that the character of their connections to the autonomic 
system and their control of the gastro-enteric tract is little 
known, but that they seem to have an action independent of 
the central nervous system. This has been proven by Cannon 
in his experiments, and he concludes that when this canal 
is entirely separated from the central nervous system it has a 
remarkable power of developing an independent tonic state, 
that is, it soon recovers its tone. This shows that it supplies 
the resiliency that causes the state of tension when the canal 
was filled. This tension is the occasion for the contraction of 


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viscera which are walled with smooth muscle holding a nerve 
plexus. That this tonicity is fundamental is accounted for in 
the failure of efferent motility in atonic states. It is an 
observation that tonic contraction and rhythmic peristalsis 
disappear in asthenia and exhaustive states. It agrees with 
these observations that anxiety, morbid fear, worry, mental 
distress, and kindred disorders stop gastro-enteric movements 
and abolish the tonus of the alimentary canal. 

There is considerable difference of opinion as to the make 
up of the afferent nerves of the vegetative system. Som. 
investigators believe the afferent nerves contain somatic fibres, 
and yet, if so, why should there be a difference in their 
functional activity? It is well known that when pain is 
experienced in the viscera it is usually due to a mechanical 
cause, and its action upon the body is, as Head terms it, reflex. 
This has been shown by Sherrington to be due to an elevation 
in the threshold of the excitability of the arc in the viscera. 
This difference is also extended centrally in that autonomic 
afferent fibres have no central connection, whereas somatic 
fibres have a connection in the brain cortex. Crile has 
attempted to disconnect this somatic system from the brain 
cortex by the application of what he calls the “ principle of 
anoci-association,” and believes that by so doing he has lessened 
his post-operative mortality. 

Notwithstanding the fact that there is no evident connection 
between the autonomic system and the brain cortex, there 
must be some interrelation somewhere. The functions of the 
sweat-glands, the gastro-intestinal tract, and the blood-vessels 
are probably not in direct relation to the brain cortex, yet 
there is no doubt but that they are under the influence of the 
emotions, and through the sympathetic system. Anger, fear, 
and shame are expressed by pallor, blushing, sweating, and 
crying. These impulses must pass by the basal ganglia. 
Lesions of the caudate and lenticular nuclei, as seen in 
sclerosis of tne basal ganglia and in lenticular degeneration, 
cause as the most prominent symptoms emotional variations, 
and in several cases reported (Mills, Oppenheim, Farnell), the 
cerebral lesions were confined to these ganglia. 

It would seem only proper at this moment to refer briefly 
to the anxiety neuroses. Freud, in his monograph upon the 
psychoneuroses, states in relation to the merging of the nervous 

LXIII. 15 


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230 VEGETATIVE NERVOUS SYSTEM, [April, 

symptoms into the peculiar affective state of anxiety having as 
its cause psychic inadequacy for the subjugation of sexual 
excitement, that the psyche merges into the affect of fear when 
it perceives itself unable to adjust an externally approaching 
danger, while it merges into a neurosis of anxiety when it 
finds itself unable to equalise .the endogenously originated 
sexual excitement. The psyche therefore behaves by, as it 
were, projecting this excitement externally. The affect and 
the neurosis corresponding to it stand in close relationship to 
each other. The first is in relation to an exogenous, and the 
latter in relation to an analogous endogenous excitement. The 
affect is a rapidly passing state ; the neurosis is chronic 
because the exogenous excitement acts like a stroke happening 
but once, while the endogenous acts like a constant force. The 
nervous system reacts in the neurosis against an inner source 
of excitement just as it does in the corresponding affect 
against an analogous external one. The many variations in 
the form of anxiety as it affects the body viscera are quite a 
constant and important factor in these neuroses, and it might 
r.ot be inadvisable to divide this disorder into two groups, the 
one in which the anxiety neurosis portrays as its dominant 
factor psychical excitement, and the other the form in which 
the visceral disorders predominate. In the farmer the symptoms 
are relieved by psychological analysis, there being little dis¬ 
turbance in the vegetative system proper, whereas in the latter 
one might place the primary cause as a constitutional disposi¬ 
tion to vagotonia, and consider that consciousness or uncon¬ 
sciousness produce their effect by the inherent weakness of 
that system. May this not be one of the reasons why Freud’s 
theory has not been fully accepted, and in these latter types 
pharmaceutical preparations have produced the required results ? 

In the old disorder grouped as hypochondria and the con¬ 
dition known as cenaesthesia, both being examples of states in 
which consciousness is acquainted with the harmonious action 
of the various visceral organs, it might be difficult to decide 
the exact relation of the disorder to the vegetative nervous 
system, but there are sufficient reasons to believe that the path 
of psychic attention passes through the sympathetic system. 

The exact location of these higher brain centres is still a 
matter of dispute, and yet there is evidence that it has a close 
■connection with the chromaffin system. 


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The most essential parts of the chromaffin system are the 
nervous or posterior lobe of the hypophysis, the sympathetic 
ganglia and paraganglia of Kahn, and the nervous elements in 
the adrenals. This specialised nervous tissue has also been 
found embedded in the kidney, and even carried down with the 
■ovaries and testicles in their development and descent. 

Functionally this system produces in the granules of these 
cells adrenalin. Exception has been taken to recognising the 
adrenals as internal secretory organs because (Kahn) the 
chromaffin cells do not conform to the type of epithelial cells 
nor their grouping to glandular structure, yet from a physio¬ 
logical viewpoint the internal secretory conclusion is justified. 
What can be the significance of this intimate association 
between the glandular and nervous elements? 

The production of adrenalin in these cells is now an undis¬ 
puted fact. It enters the blood-stream viA the vein directly. 
This product acts upon certain tissues, and increases the 
activity of metaholism. These certain tissues upon which 
adrenalin acts are those which possess only a sympathetic 
innervation with the point of election a portion of the cell in 
the neighbourhood of the nerve-ending, although it is generally 
recognised as having its action upon the nerve-ending. 

One must not conclude from these remarks that this is the 
only function of adrenalin. The tone of the sympathetic 
•nervous system bears a close relation to the tension of the 
muscle-coats of the heart and vessels, and it has its influence 
upon the body metabolism, especially in relation to carbo¬ 
hydrates, as well as metabolic processes modifying the albumin 
and salt-content in the blood. 

An important action to be kept in mind regarding adrenalin 
is that where the nerve influenced is one of stimulation the 
adrenalin acts as one of stimulation, and where one of inhibition 
it is inhibitory in action. As an example of the inhibitory 
effect of adrenalin upon a process of metabolism undoubtedly 
taking place through the vegetative nervous system is its influ¬ 
ence upon the pancreas and the pancreatic secretions. This 
glandular physiological relationship shows itself in other 
glandular derangements. Eppinger and Falta have concluded 
that the adrenal system plus the thyroid act as a balancing 
mechanism to the antagonistic activity of the pancreas and 
parathyroids. And yet the thyroid promotes and probably 


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232 VEGETATIVE NERVOUS SYSTEM, [April, 

acts as a regulator of the adrenal system. If adrenalin limits 
the internal secretory function of the pancreas and one stimulates 
the autonomic nerve (the vagus), one would expect to reach at 
some point a balance and adjust the disturbance. Such has 
turned out not to be the case, as it is now proven that stimula¬ 
tion of the sympathetic far outweighs that of the autonomic. 
This naturally would cause one to consider the action of thfr 
remaining glands of this system, the thyroid and parathyroid. 
The thyroid working in conjunction with the adrenals would 
increase the pancreatic disability, but it must be remembered 
that the thyroid serves a double function, being furnished with 
both bulbo-autonomic and sympathetic nerves. Having created 
a disturbance of metabolism in one organ (gland) of sympa¬ 
thetic innervation, one might expect the sympathetic stimula¬ 
tion of another gland (the thyroid). Notwithstanding these 
deepening suppositions one must look upon the thyroid as a 
“ pace-maker,” and hence its double innervation as a means of 
protection, and one frequently called into play, due to the fact 
that it contains probably two internal secretory mechanisms. 

To illustrate these inter-reactions and decidedly complicated 
mechanism a case will be cited briefly. 

H. C—, a boy, jet. 15, whose family present little of patho¬ 
logical importance except that a brother is a cretin. The 
patient was born at full term, labour was difficult, and delivery 
instrumental. He was recognised as a fine baby and weighed 
12 lb. There was nothing abnormal noticed about him ; he 
walked at 14 months, and began to talk at about same time. He 
had no convulsions in infancy. He appeared to develop 
normally until 4 years of age, when he suddenly stopped 
growing, physically and mentally. He did not grow fat. He 
would not play, was cranky and irritable as well as stubborn ; 
wanted to be by himself. Complained of headaches and some¬ 
thing (a numbness) in his legs. He wet the bed regularly. 
He was sick in his stomach, bowels were always costive 
requiring stiff cathartics. He talked in his sleep, and had 
night-mare. Had dreamy spells in which he rolled his eyes, 
and looked dopy in the morning. At the age of 5 years he 
was diagnosed as a case of cretinism. He was placed on 
thyroid gland but immediately, even in small doses, it caused 
sickness, nausea, general uneasiness, and flushing of face. The 
drug was therefore only given at intervals. The next five 


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233 


years showed extremely slow development. When seen four 
and a half years ago by the writer he was in much the same 
condition as described, and was thought to be a case of pan¬ 
creatic infantilism, as described by Herter, although the stools 
were negative. At all events he was given 1 5 gr. of pancreatin 
three times a day, and soon showed a clearing of symptoms ; 
his gastro-enteric system improved, he ceased wetting the bed, 
and he soon gained 1 5 lb. in weight. He continued to improve 
in appearance, his conduct was better, he played and entered 
into boyish pranks, but made slow progress in school. About 
half a year ago he developed terrific frontal headaches, periodical 
blanching, and pallor of the skin of face, syncopal attacks with 
evidence of poor peripheral circulation, weakness, and great 
fatigue. There was practically no disorder of gastro-intestinal 
tract. His pulse was 60, compressible, of low tension, and 
irregular. Blood-pressure was 65. His skin was rough and 
dry and pigmented. X-ray of skull showed normal sella 
turcica, while that of chest evinced a very small heart and a 
shadow over the region of the thymus. His height was 3 ft. 7^ in. 
and weight 69 lb. Are we not now dealing with an adrenal 
disorder ? Is it possible that we are dealing with the con¬ 
dition of status lymphaticus in which the inter-activities of the 
chromaffin system have laid bare their individual symptom 
complex ? Therapeutic measures have adjusted the trouble¬ 
some symptoms, and for four months the patient has taken in 
addition to pancreatin 3 gr. of suprarenal extract, and his 
cardio-vascular disturbance has been relieved. His headaches 
ceased. His blood-pressure rose 15 mm. He has grown 1 $ in. 
Where a year ago his testes were undescended they are now in 
the scrotum. 

It is noteworthy that in the out-cropping of symptom- 
complexes in this case there was throughout an inhibition of 
the sympathetic, and no definite stimulation of the autonomic. 

This is quite contrary to some observers who have noted 
symptoms of vagotonia in lymphatism due to the inferiority of 
the adrenal system. 

To a much less degree than the foregoing one sees frequently 
cases of apparent hypoplasias of the lymphatic system developing 
at an early age epileptoid states, and presenting isolated 
symptoms of vagotonia. It has been a custom at our school 
clinic to place such children upon thyroid and pancreatin. 


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Results have been forthcoming in many cases. Calcium 
metabolism in relation to epilepsy and its allied states has been 
a source of investigation for some time past. Its relation to 
tetany and tetanoid convulsions is now fully accepted, as well 
as being a parathyroid disorder. The parathyroids are anta¬ 
gonistic in their action to the thyroid. Thyroid and pan- 
creatin feeding evidently does something. It cannot be doubted 
that it is a probable occurrence for an organ to send out chemical 
stimuli causing stimulation in one case and inhibition in another. 
The end results will also differ probably by influencing the 
internal secretion of another organ. 

Healey and Anderson, as well as the writer, have observed 
in juvenile court cases the existence of status lymphaticus, a 
constitutional inferiority with an accompanying mental 
inferiority. How many of these abnormal or antisocial 
traits may bear close relation to internal secretory disorders is 
difficult to say ; such as stealing money to buy sweets indicat¬ 
ing a high sugar tolerance ? 

The next group of disorders, also polyglandular in type, 
evince a mechanism passing through both the sympathetic 
and autonomic nervous systems. * This disturbance is hyper¬ 
thyroidism, which probably includes not only the thyroid 
itself but also the ovary or testes and the pituitary body. It 
should be again noted that both nervous systems were 
mentioned as being involved. Allow me to repeat a statement 
made previously in reference to the chromaffin system, “ this 
specialised tissue has even been carried down with the ovaries or 
the testes in their development and descent.” Is it possible 
that in those individuals who develop hyper-thyroidism, with 
complete disorganisation of the interactivities of that glandular 
chain, there is this specialised tissue in the generative organs 
also? This fact might be cleared up by the histo-pathologist. 
Or^ is it a disorder passing wholly through the nervous 
mechanism. It is such problems as these that may lead one 
towards the recognition of a chemical or bio-chemical basis for 
nerve excitation, as well as, or in addition to, the present 
recognition of a physical basis. 

Hyper-thyroidism is a symptom of hypersensibility of the 
sympathetic system or an irritability of the autonomic system; 
It seems difficult to attribute all the symptoms one sees in 
hyper-thyroidism to one axiological cause. From the view point 


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that the function of the nervous system is for the control and co¬ 
ordination of the many and various body activities, one may 
accept the statement that there may be conditions under which 
this nervous system can stimulate one or more activities to excess 
at or about the same time. The question will then arise as to 
whether these pathological conditions do not arise from the 
interaction of causes representing the want of a balance between 
an excessive amount of material thrown out and a lesser amount 
of material upon which to act. 

That the clinical picture of hyper-thyroidism may vary 
greatly during the course of the disease process seems to bear 
•ut the statements just enumerated to a fair degree. For 
example, a female, aet. 37, single, whose family history was 
negative. Her previous history presented nothing remarkable 
except that she was always active, happy, not easily upset, had 
plenty of friends, home conditions the best, etc. The symptom- 
complex as presented upon the initial examination was as 
follows: moderate exophthalmus, von Grafe’s sign marked, 
profuse perspiration, flushing of the face, cardiac palpitation, 
increase in gastric acidity, dyspnoea. These symptoms are 
what Eppinger and Hess group under the heading of vagotonic. 
At the end of a few weeks of treatment many of these 
symptoms were relieved, but there developed a very marked 
degree of tachycardia, her hair fell out in large quantities, and 
in the course of time she had several attacks of fever. Not¬ 
withstanding these symptoms there was progressive gain in 
strength and weight. Eppinger and Hess place elevation of 
temperature in the group of sympathicotonias. Can this be 
rather an attempt at harmonising antagonistic activities which 
bear k close relation to the functioning of the tissue ; a central 
control, through the sympathetic system, maybe, rather than 
an irritability of the sympathetic occasioned by the thyroid 
secretion ? 

Some investigators have attempted to show that the 
symptom-complexes of hyper-thyroidism are constantly parallel 
b» all stages of development and regression, with similar stages 
in development and regression in the secreting cells of the 
gland ; the hyperactivity being due to a toxic compound con¬ 
taining 60 per cent, iodine which is attached in either an alpha 
or beta position, the former being toxic and the latter non- 
toxic. From glands removed during the various stages of the 


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disease the amount of iodine obtained varied with the stage 
from a little less than normal to 1 in 20, or 1 in 15 less than 
normal. This cannot be interpreted as a reduced production 
(iodine compounds (KI) have caused symptoms of hyperthy¬ 
roidism) but as a greatly increased effusion of the substance 
into the blood stream. Therefore the clinical picture would 
vary according to the amount given out, the length of time 
during which the intoxication occurred, and the constitution of 
the patient. 

If one goes a little further and divides the course of the 
disease into three stages (for one is bound to meet cases in 
various stages, or even in a mixture of stages), (1) the stage of 
autonomic irritability, (2) the stages of sympathetic irritability, 
(3) the effects of a disordered vegetative function, it is the 
writer’s feeling that both Eppinger and Hess’s and Wilson and 
Kendell’s versions can be accepted. Eppinger and Hess have 
noted clinical cases which they have terjned “ Basedowoid con¬ 
ditions, which have yielded quickly to atropine. These cases 
might have been merely “ vagotonics.” Kendell has grouped 
these cases as “ non-hyperplastic toxic goitres,” a condition in 
which the iodine content is diffused in a lessened amount. 

This shows to better advantage in typical Graves’ disease, 
a disorder which reacts poorly to atropine in many cases, 
especially so when the tachycardia and the increased metabolic 
changes are taking place. It is these cases, termed by the 
Mayo Clinic as “ hyperplastic toxic goitres,” that the diffusi- 
bility of the iodine is at its greatest, and which, in the writer’s 
small series of cases, have reacted quickly to cytotoxic serum, 
an antiserum low in the iodine content. Experiments have 
shown conclusively that iodothyroidin and atropine are not 
antagonistic. 

The third division is that series of cases which have been 
relieved (through rest, bromides, etc.) of those symptoms of 
vegetative irritability, and show secondary glandular disorders 
with slow, but gradual, metabolic changes. It has been the 
custom to feed these patients with nucleo-proteid and adrenal 
gland with good results. 

Falta and Eppinger assume a polyvalency of the thyroid 
secretion, and regard typical Graves’ disease as an outcome of 
a simultaneous, though probably independent, stimulation of 
both the sympathetic and autonomic nervous systems. Biedel, 


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237 


however, suggests that this secretion might be due to a primary 
affection of the sympathetic nerve, or the nervous areas in 
which it takes its origin. 

This brings us back to the exciting factor in this neurogenic 
hypothesis ; most writers place emotional disturbances first, 
and many cases might be cited in which emotion was at the 
root of this disorder, again evincing a connection with higher 
nerve centres. 

In line with these conceptions attempts have been made to 
connect certain mental states and psychic disorders with over¬ 
irritability of the vegetative nervous system. Such a connection 
has been assumed to exist in depressive states at puberty and 
the menopause, in traumatic neuroses, in the self-accusatory 
and depreciative types of dementia praecox. As all are aware, 
these disorders are maladjustments towards the environment— 
worry, which is a conflict between hope and fear, conduct dis¬ 
orders, sexual or what not, religious or ethical problems. 
Sherrington has said : “ Evironment drives the brain, and the 
brain drives the various organs of the body.” Can it not be 
that this system, the vegetative nervous system, plays a most 
important part in adjustment, and acts as the most essential 
stimulator into action ? Attached to this reactibility is its 
power to influence and direct functional conditions, not evident 
under ordinary conditions, but aroused when given the chance 
—constitutional tendencies, disorders of personality, suscepti¬ 
bility. 

To quote from Hibbin : “ Synoptic man is one who sees the 
verities of life in their true relations, properly co-ordinated 
and sub-ordinated, and who in particular pursuits, however 
absorbing, does not ignore the unity of the whole, nor overlook 
the universal aspect of even the commonplaces of life.” 

(') Presented before Boston Society of Neurology and Psychiatry, March 20th, 
1916. 


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Renfrew District Asylum as a War Hospital for Mental 
Invalids ; Some Contrasts in Administration. With 
an Analysis of Cases admitted during the First Year. 
By Major R. D. Hotchkis, R.A.M.C. (Temp.) Officer ia 
Charge, Dykebar War Hospital, Paisley. 

First Part. 

I PURPOSE giving first of all a short description of the steps 
taken in connection with the conversion of this institution into 
a war hospital, and of the necessary additions to the staff. No 
structural alterations were required to the buildings, as they 
were to be used only for mental cases, and the changes there¬ 
fore required were very slight in comparison to what, for 
example, took place at Bangour or at other asylums. Most of 
you will have read the minute and vivid description by the 
President of our Association, Lieut.-Col. Thomson, when the 
Norfolk County Asylum was converted into a war hospital for 
the sick and wounded, but the radical changes described there 
in the buildings and amongst the staff were quite unnecessary 
at Dykebar, as it was taken over as a going concern. Con¬ 
sequently we were able to admit soldier patients almost at once 
when the others had been removed. It happened by good luck 
that the new nurses’ home had just been completed, otherwise 
it would have been impossible to have accommodated all the 
female staff. With the exception of four orderlies who are- 
billeted with the married orderlies, and tradesmen, all the others 
are housed in the institution. The daily routine in the insti¬ 
tution is much the same as you are all accustomed to, except 
that there is here a certain liveliness, as the majority of the 
patients are young, strong, active men, and a march out here is. 
quite a different thing to the slow and decrepit walking parties 
formerly in vogue, and in the farm and garden there is dis¬ 
played energy never seen before. Work, and especially outside 
work, is encouraged, but of course there is always a certain 
proportion who cannot be persuaded to do anything. 

The first intimation, in the form of a request to the District 
Board made through the General Board of Control for Scotland, 
that Dykebar was wanted as a war hospital for mental diseases 
was given in November, 1915, and after this request had been 
unanimously agreed to by the District Board, certain financial 


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questions had to be settled, the details of which I need not 
enter into. 

I had then personally to set about and try to learn the 
details of the administration of a military hospital, and naturally 
turned first to the Edinburgh War Hospital at Bangour, as 1 
had in former years great help from Lieut.-Col. Keay, when 
Dykebar was first opened, the two institutions being built on the 
villa system. During my visit there Col. Keay kindly explained 
everything himself, and I take this opportunity of acknowledging 
the help I received, not only then but afterwards, when the 
heads of the different departments at Bangour came through to 
Dykebar and helped to give us a start. 1 came away from 
Bangour with my head crammed with figures and my pockets 
bulging with Army Forms. 

I next visited the Moss-side Military Hospital at Maghull, 
which then contained both neurotic and insane cases, but now I 
believe is only used for the former. I then went to the 
Napsbury War Hospital for mental diseases, which is the 
hospital part, though quite a separate building of the Middlesex 
County Asylum, near St. Albans. At both of these hospitals I 
learned a very great deal, and I take this opportunity of acknow¬ 
ledging the courtesy of the commanding officers. 

At the same time there had to be carried through the 
transfer of the parochial patients to other institutions, which 
involved a considerable amount of work, both to the General 
Board of Control and to the staff here, and also, I am afraid, to 
some of my audience to whom they were sent. The more 
serious cases were transferred to the nearest asylums, namely, 
Hawkhead and Riccartsbar, and the new cases from the county 
are being sent either to Smithston or Riccartsbar, which was the 
arrangement before Dykebar was built. By the end of the first 
week of January, 1916, all the patients had been cleared out, 
with the exception of twenty-five men who were retained for 
farm and other outside work, and who are accommodated in the 
reception block, which is a small building quite separate from 
the others. The two classes of patients are thus kept separate, 
though as a matter of fact in outside work the two often 
fraternise, but the soldier always assumes command. The 
transfer of the patients was carried out without a hitch, due to 
the excellent work of the Transport Section of the Red Cross 
Society, and to the providing by the military authorities of an 


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240 WAR HOSPITAL FOR MENTAL INVALIDS, [April, 

ambulance train when parties of about one hundred had to be 
transferred. 

The visits which Miss Macallum, the Matron, and I paid to 
the other military hospitals enabled us to fix approximately the 
number of staff required in the various departments, and 
especially gave us an idea of the kind of cases which we would 
have, and how they differed, if at all, from the ordinary patients. 
We had to remember that all the cases admitted would be 
recent, and that the institution would be filled, not, as formerly, 
with a much larger proportion of chronic to acute, but with 
cases whose illness was of recent date, and that many of there 
would be therefore very acute, and also that the turnover would 
be much greater. 

1 will now describe shortly the increase and organisation of 
the staff in the different departments to meet the new conditions. 

Kitchen .—Instead of one cook and one kitchenmaid, a super¬ 
intendent and assistant superintendent and six kitchenmaids 
were engaged. We were fortunate in securing as superintendent 
a lady with first-class qualifications and previous experience in 
a military hospital. As the patients are encouraged to work in 
every department there are, as a rule, about six working regularly 
in the kitchen. Owing to the fact that the military scale of 
diet is more generous than under ordinary circumstances some 
additions had to be made to the cooking apparatus of the 
kitchen. 

Laundry .—The laundry had just been enlarged, so no diffi¬ 
culty has been experienced. Owing to the extra work, seven 
extra laundrymaids were engaged to replace the female patients, 
and in addition there are as a rule about nine or ten soldier 
patients who work there. 

Store .—There is not much change, except that certain articles 
of food, as meat, bread and flour are sent from the Army Stores 
Department at Greenock, the other provisions being obtained 
under contract as formerly. The ordinary books required by the 
General Board of Control have still to be kept, but the method 
of ordering stores, sending back empties, etc., have to be done 
according to army regulations. The accounts are paid by the 
Finance Committee of the District Board, who, to meet expen¬ 
diture, have to send a requisition to the Command Paymaster 
each month for what is necessary. The accounts have to be 
approved of by the General Board of Control. 


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BY MAJOR R. D. HOTCHKIS, R.A.M.C. 


241 


Pack store .—The pack store is a most important part of a 
military hospital. On admission the clothes of the patients are 
all cleaned if necessary, mended, and carefully put away, any 
deficiencies being made up from the pack store, as everything 
that a soldier requires in the way of clothing has to be kept 
there—for example, the hospital clothing, service clothing, and 
civilian clothing for discharged soldiers—and in the inventory a 
complete history of every article has to be kept with scrupulous 
exactness. Rigid rules and forms hedge in all that has to do 
with army clothing, and the disappearance in transit or other¬ 
wise of any garment or accessory is the prelude to an endless 
correspondence. In this hospital the gallery of the ordinary 
store is used as the pack store, and in addition three or four 
hundred racks were put up in the tailor’s shop for the patients’ 
clothing on admission. 

Office .—This corresponds to a regimental orderly room. 
Under former conditions one clerkess did the work comfortably, 
now it takes the full time of four, and they sometimes have to 
work late and on Sundays. Army forms and methods are very 
complicated, and they give one an idea of the vastness of the 
organisation controlled by the War Office. When I first had 
to study them I felt like going back to school without the 
elasticity of youth. 

Nursing staff .—The Matron, as has always been the case in 
this institution, is over the whole of the nursing staff, both 
orderlies and nurses. The kitchen and laundry departments 
are also under her. There was no head attendant to be made 
sergeant-major, and though it was prophesied that a sergeant- 
major for purposes of discipline amongst the orderlies, was a 
necessity, the present system works admirably. There are 
three assistant matrons, two on day and one on night duty. 

The orderlies are composed of three classes according to 
their engagement. 

(1st) The former attendants, eleven in number, all of whom 
' have been enlisted in the R.A.M.C., the charge attendants 
having been made sergeants and the second charges corporals. 

(2nd) Orderlies, twelve in number, engaged by me on behalf 
of the District Board for the duration of the war and paid by 
that body. They also are enlisted into the R.A.M.C., and are 
mostly men over military age or unfit for active service, and 
amongst them are some experienced asylum attendants. They 


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242 WAR HOSPITAL FOR MENTAL INVALIDS, 

do not contribute to the Superannuation Act, and they could 
be added to at any time if suitable candidates present them¬ 
selves. 

(3rd) Regular R.A.M.C. men, two sergeants, two corporals, 
two lance-corporals, and twenty-one privates, who were sent 
from various units, and who could be recalled at any moment. 
They have the ordinary army pay and allowances and also get 
6 d. per day extra as mental attendants if found satisfactory. 

As regards female nurses, of whom there are twenty-one, 
the difficulty at first was to know how many wards could be 
staffed entirely by them. The present arrangement is that the 
East hospital, which is divided into two adjoining wards with 
a total of forty-nine beds, has been put in charge of nurses 
both by night and day, though an orderly is always there 
during the day for bathing and shaving the patients, etc. 
There are a certain number of cases requiring treatment in bed 
in this ward, and the cases include most varieties of mental 
disease, many of them being in a convalescent stage, but still 
requiring a certain amount of observation. 

One of the villas consisting of seventy-five beds is also under 
nurses, and the cases there, are patients not yet ready to be 
discharged, but who can be allowed a certain amount of liberty. 
I am quite satisfied with the work done by the nurses in these 
two buildings. 

At the beginning, in addition to the two mentioned, another 
villa was staffed by nurses, but the patients sent there were 
more difficult to manage and it did not work so well. Ultimately 
the charge nurse married one of the patients on his discharge, 
and as discipline was somewhat relaxed the villa was placed 
under orderlies. There are no nurses in the north wing of the 
west hospital as most of the very acute cases are there, but 
there are two nurses in the south wing. One of the villas is 
also without nurses, but all the others have either one or two, 
and their duties are chiefly connected with the kitchen and 
dining-hall, and they take entire charge of the food. In doing 
this they have the assistance of several patients for whom they 
are responsible. The night staff consists of one assistant 
matron who is responsible for every part of the institution, 
three nurses, one charge orderly with the rank of sergeant, and 
ten orderlies. 

Medical staff .—My duties as superintendent remain as before. 


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243 


■except that the clerical work is far more than in a civil mental 
hospital. 

There was some difficulty at first in obtaining a medical 
.staff, but thanks to the exertions of Dr. John Macpherson, one 
of the Commissioners, the services were secured of Dr., now 
■Capt. Buchanan, the Medical Superintendent of Kirklands 
Asylum. There are also on the staff Capt. A. Ninian Bruce, 
Lecturer on Neurology at the University of Edinburgh, and 
Dr. Dawson, Medical Superintendent of Ponoka Asylum, 
Alberta, Canada. The Pathological Department is in charge 
of Capt. Bannerman. 


Second Part. 

In this second part of the paper I intend to be very brief, and 
itry to give an analysis of the cases admitted here during one 
year. 

At the outset I am met with the difficulty of classification, 
for here the personal equation is bound to come in, and it is 
not possible to follow one which will meet with the approval of 
-everybody. 

According to an Army Council instruction, the patients who 
ought to be sent here are those who in civil life could be 
certified as insane, but no certificates arc necessary, and in 
actual practice it was found impossible to adhere strictly to this 
ruling. There is no difference in the admission and discharge 
of patients into this hospital from any other military hospital. 
The majority of the patients come from “ D ” Block, Netley, 
where they are first sent from overseas, and where, as a rule, 
they remain for a week or a fortnight, or longer if there is no 
urgent need for beds, and then they are distributed to the 
-various mental hospitals according as there are vacancies, and 
.also according to their mental condition. 

942 cases were admitted from January 24th, 1916, to 
January 31st, 1917, and of these 1 I I were non-expeditionary, 
and were sent here according to official instructions, first for 
diagnosis, and then for final disposal. This leaves 831 cases 
who had served with one or other of the expeditionary forces in 
France, the various campaigns in the Mediterranean, in Meso¬ 
potamia, and in East Africa, and as these cases are naturally 
much the more interesting I propose to confine my remarks to 


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244 WAR HOSPITAL FOR MENTAL INVALIDS, [April, 

them. In this class there are included 5 German prisoners of 
war. 

In the analysis of the cases now to be given the order 
taken is mostly according to the numbers admitted in each 
group. 

Manic-depressive .—188 cases, 21 per cent. This class is 
naturally a large one, and includes all those cases which would 
formerly have been called mania or melancholia. There are 
also included 7 cases of stupor. One of the characteristics was 
that a great many had had previous attacks, and in view of this 
it has been our custom to discharge such from the army, and 
not send them back to duty, or even to a labour battalion. In 
31 excitement was the most prominent symptom, and in 133 
depression. 17 were of the mixed type. The comparative 
smallness of the number of excited cases may be accounted for 
by the fact that a considerable proportion which, by some, would 
have been put into this class, have been included in the Con- 
fusional group, as the symptoms of confusion and disorientation 
were much more prominent and constant than the excitement. 
Considering this group as a whole there is nothing to dis¬ 
tinguish the cases from those found in a civil mental hospital, 
except that—and this, of course, refers more or less to all 
groups—their delusions and hallucinations, and consequently 
their conduct, are coloured by their experiences in the field. 

Alcoholic insanity. —152 cases, 18 per cent. This group 
includes all the varieties of symptoms found in this form of 
mental disease, and in all the cases a reliable history of chronic 
alcoholism or bouts of drinking was obtained, and care was 
taken to exclude cases of mental deficiency in which the 
tendency to alcoholism was one of the symptoms. There were 
many cases of delirium tremens, the most common history being 
that the patients had been home on leave from the Front, and 
had been having, as they put it, “ a high old time,” but on 
returning to France they showed more susceptibility to the 
horrors of war, and often, after a few days, had to be sent 
back suffering from very well-marked delirium tremens. There 
seem to be two types of this class according‘to their history— 
one who broke down as soon as the supply of alcohol was cut 
off on going aboard the leave boat, the other who showed no 
signs till again in the firing zone. Those in this latter class 
were affected by shell fire, etc., in a way not previously felt by 


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them, and they rapidly became nervous, sleepless, and developed 
hallucinations. 

In sharp contrast to these cases of delirium tremens were the 
chronic delusional cases, many of whom were comparatively 
elderly men who had been stationed at the base and thus had 
more opportunity for drinking. Between these two classes were 
those who showed various symptoms, as confusion, depression, 
subacute excitement, and, in practically all cases, hallucinations. 
The history of many of these cases suggested that though 
alcoholism was a prominent feature in predisposing to a mental 
breakdown, of still greater importance was the strain and stress 
of the campaign, and had it not been for this the breakdown 
would either never have occurred, or would have been post¬ 
poned. Of the cases of cut throats admitted here, of whom 
there were 45, 18 were alcoholics. 

Mental deficiency .—151 cases, 18 per cent. This is a large 
class, and includes all degrees of weak-mindedness, from the 
high to the medium grade. It has always been a wonder to me 
how some of them passed the recruiting officers, but the yorst 
types got in during the first rush of recruits under the voluntary 
system. For practical purposes they are divided into two 
classes—the vicious or moral imbeciles, and the ordinary 
defectives. 

Of the first class there were 37, most of whom were habitual 
criminals and could not have been certified as insane, and were 
sent to Dykebar because they were giving trouble at other 
hospitals. The rest, namely 114, were simple defectives, but 
most of them had been able to earn their own livelihood. They 
apparently learned their drill in a passable way, but when 
exposed to the searching test of actual fighting they gave way 
under the strain, and became not only useless, but often 
positively dangerous to their comrades : for example, in several 
cases while' in the trenches comrades had to be told off to see 
that they did not load their rifles, as they would have been 
more dangerous to their own regiment than the foe. Another 
man, when on sentry duty, on being asked by his officer what 
he would do if the enemy appeared, replied that he would 
present arms and say, “ Pass friend, all is well.” Needless to 
say, he was soon sent down the line. Many of these cases had 
an added confusional element, which cleared up rapidly under 
appropriate treatment. A few suffered from attacks of acute 
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246 WAR HOSPITAL FOR MENTAL INVALIDS. [April, 

excitement or depression, and they took longer to get well than 
the confusional cases. They all ultimately recovered from their 
acute attacks. 

Confusional insanity .—134 cases, 16 per cent. Of these 
27 were of the acute type, that is, the signs of confusion were 
very intense and were often accompanied by considerable 
excitement. In the others confusion of a varying intensity was 
the most marked mental symptom. There was in many of the 
cases in addition a hypersensitiveness to their environment 
and consequent irritability, with the result that they often got 
into trouble. In all these cases the reflexes were increased and 
general muscular tremors were often present. Twenty-two of 
the cases exhibited hysterical symptoms, as fits, anaesthesia, 
paresis, aphonia, etc. The vast majority of these cases 
occurred on active service, the chief factors being exposure to 
high-explosive shell fire, the fact of being buried, and in some 
cases of all their comrades being killed, wounds, recent attacks 
of enteric, dysentery, and malaria. In the majority of cases 
their appearance, etc., suggested either a neuropathic or psycho¬ 
pathic disposition and in these cases in which a history was 
obtained of their life previous to enlistment, and of their 
family, this was confirmed. 

Dementia prcecox .— 118 cases, 14 per cent. Of these 11 
were of the catatonic and 14 of the paranoid forms, the 
remaining 93 being cases of simple dementia praecox. The 
above numbers are probably too low as the diagnosis was not 
made until the patients had been here for some time, and there 
are a number of cases recently admitted who were classed 
provisionally under manic-depressive insanity, but who will 
probably ultimately prove to be cases of dementia praecox. 
The interesting question in connection with these cases is, had 
there been no war how many would have carried on without a 
mental breakdown ? This is a question almost impossible to 
answer, but the history of some of these cases shows that a 
very slight stress was sufficient to develop their illness, and that 
the first symptoms manifested themselves shortly after leaving 
this country and before they had actually beer in the fighting 
line. 

Paranoia .—44 cases, 5 per cent. From the history of many 
of these cases, the delusions had evidently been present before 
enlistment, and the strain of the campaign apparently accentuated 


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247 


them, and affected the conduct of the patients to such an 
extent that they had to be sent home. Many of the cases 
were between the ages of 3 5 and 40, and some over the latter 
age, but it is worth while noting that though insane for years 
they were able not only to carry on in civil life, but were 
capable for some time of undergoing the discipline of ordinary 
military service, and the hardships of actual fighting. 

General paralysis. —22 cases, 2 per cent. In the cases, about 
12 in number, where a complete examination was made of the 
blood and cerebro-spinal fluid, the Wassermann reaction in both 
fluids was found to be positive, and in the cerebro-spinal fluid the 
globulin tests and Lange’s colloidal gold test were positive, 
and a lymphocytosis of varying amount was found to be present. 

Clinically all the cases were of the ordinary type, and two 
had marked tabetic symptoms. 

An interesting point is whether the stress of the campaign, 
as would have been expected, accelerated the progress of the 
•disease, and regarding this there have been here two cases 
which are of interest. One who had an attack of melancholia 
which almost necessitated his discharge from the army, but who 
apparently recovered and afterwards did nine months of hard 
active service before he was invalided home. On admission 
here the signs of general paralysis were distinct, but not 
advanced. The other case—a reservist—was invalided out 
of the army some months after the outbreak of war for mania 
and epilepsy, which in view of his later history were undoubtedly 
signs of general paralysis. A few weeks later he re-enlisted 
and did nine months trench fighting in France before he was 
sent home on account of delusional symptoms. On admission 
here he was in an advanced stage. One or two other cases 
tend to confirm the view that in many cases at any rate the 
strain of active service does not very materially affect the 
progress of the disease. 

As regards the effect of the campaign as an exciting cause, 
the data at my disposal, especially as regards the condition of 
the patients before and on enlistment are insufficient to justify 
any positive opinion. 

Organic Brain Conditions other than General Paralysis. 

Five cases: (1) Tuberculous meningitis; (2) Hemiplegia; 
{3) Gross destruction of brain tissue due to a kick from a 


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mule in left parietal region ; (4) Cerebral abscess in the left 
temporo-sphenoidal lobe following gunshot wound ; (5) Syphi¬ 
litic meningitis. 

It is noteworthy how very few cases have been admitted 
here with mental symptoms associated with head injury. 

Epileptics .—7 cases. With one exception, which was a case 
of traumatic epilepsy', all the cases had suffered from epileptic 
fits before enlistment, but of course this fact had been concealed. 
They were not, however, discharged from the army when it 
became known, and it was only' when marked mental sy'mptoms 
made their appearance that they were invalided. The mental 
symptoms were chiefly confusion, and 3 of them had at¬ 
tempted suicide, but had no recollection of the fact. One case 
was exceedingly irritable and dangerous, and ultimately' had to 
be sent to an asylum, but the other 6, after a period of rest, 
were able to be sent home. 

Secondary dementia .—7 cases. These were cases who were 
transferred from other hospitals where they had been for many 
months, and dementia was established before being transferred 
here. 

Not insane .—4 cases. All of them had given trouble at 
other hospitals, and were promptly diagnosed as mental and 
sent to Dykebar. Their residence here was, however, very 
short. One was a malingerer, in appearance a degenerate and 
alcoholic, who, on being apprehended for desertion, pretended 
that he could not speak, and was sent here as a case of mental 
stupor. He was anaesthetised with ether three times, and each 
time was wakened during the stage of excitement when he was 
shouting. As soon as he realised that he was speaking he 
again became silent. A few days later, on being again prepared 
for a further dose of ether, he suddenly spoke and said that he 
had recovered. He was returned to his unit as a malingerer. 

Mental instability .—In official returns the names of diseases 
must follow strictly the nomenclature drawn up by' the Royal 
College of Physicians of London, and not only' the name but 
the number opposite the disease must also be given. In 
February', 1916, the names of certain mental disabilities not 
included in the official nomenclature were authorised by the 
War Office to be used only in the special hospitals for mental 
disease, and amongst them is the term “ mental instability.” 
This term has not been introduced in the above analysis, but it 


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is extensively used here when patients are invalided from the 
army ; for example, cases who have recovered, but whose past 
histories show one or more previous attacks and who therefore 
should return to civil life, are described in invaliding documents 
as suffering from mental instability. It is a term which has 
supplied a distinct want. 

Discharges .—Any conclusions based on the discharges for the 
year must necessarily be premature, and it will not be till the 
final reckoning, when all the patients have left, that reliable 
deductions can be made. The present figures, however, are not 
without some interest, and may be summarised as follows : 

During the year 500 expeditionary cases were discharged. 

Of those, 1 39, or 16 per cent, of the total admissions, were sent 
to asylums ; 1 5 5, or 18 per cent., returned to duty ; 40, or 4 per 
tent., were discharged as recovered, and 111, or 13 per cent ., as 
relieved to the care of their friends ; 5 as recovered and 37 as 
relieved were transferred to other hospitals for further treatment 
•of their bodily condition ; I I died, and 2 escaped. 

When Dykebar was first opened 60 cases were sent from the ♦ 
Moss-side Military Hospital at Maghull, and as that hospital 
was in future only to admit non-certifiable cases, those sent 
here were cases who had been under treatment for not less than 
six months, and some of them had beep there for over one year. 
Their chronic nature was emphasised by the fact that of the 60 
only 2 became well enough to return to duty, while 39, or 63 
per cent., had to be sent to asylums. The others, with the 
exception of 6, were discharged as relieved. If, however, these 
were deducted from the total admissions—and I think it quite 
a legitimate deduction—our percentages would be as follows : 

20 to duty, 13 to asylums, 12 as relieved to the care of their 
friends, and 4 as relieved to other hospitals. 

In conclusion, it gives me pleasure to acknowledge the help 
I have received from Capt. Buchanan in this second part of the 
paper. It is in reality a joint production. 


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CLINICAL NOTES AND CASES. 


[April 


Clinical Notes and Cases. 

A Case of Cerebral Tumour , with Tumour of Skull. 

» By John Tattersall, M.D., B.S.Lond., M.R.C.I\ 
Lond., Medical Officer, Hanwell Asylum. 

The case I here record presents many features of interest,, 
not so much from a psychological point of view as on account 
of the absence of local physical signs considering the size and 
position of tumour. 

Other points of interest are the duration of the tumour of 
the brain, and the presence of a tumour of the skull over the 
position of the cerebral tumour. 

History of case. —Male, age on admission 25. Three years before 
admission, whilst doing his milk-round, he was knocked down by a 
runaway horse. He was stunned, but did not lose consciousness, and 
he continued on his round. After a few days sight began to fail and 
eventually he became blind. In the same month he was taken into a 
London hospital—where no operative proceedings were done. He was 
discharged, and was subsequently admitted into another London 
hospital, and again nothing was done. Apparently this was due to the 
absence of localising signs. He states that at the first London hospital 
he was told he had optic neuritis. Two years after this he was admitted 
into an asylum, and a month afterwards transferred to this asylum. He 
states that headaches and vomiting started seven years before admission, 
but his statements were considered unreliable. 

Examination on Admission. 

Mentally. —He had had delusions, which were not present on admis¬ 
sion. He was generally simple and childish, and his memory was very 
defective as regards dates and events. 

There was mild elation, and in this state he remained until his 
death. 

His physical condition was excellent. 

Nervous condition. —He complained of weakness of left arm and leg, 
but there was no definite evidence of this. His grasp was excellent, 
and there was no spasticity, no marked knee-jerk, no ankle clonus, and 
no extensor response. Gait showed tendency to walk to the right— 
same side as the tumour. 

Ocular condition. —He was blind, and ophthalmic examination showed 
double optic atrophy secondary to optic neuritis. Nystagmus was 
present on turning eyes to right. There was conjugate deviation of 
eyes to right, and he also held his head to the right. Hearing was 
excellent. Knee-jerks were present, but before his death the left knee- 
jerk disappeared. Cranial nerves were normal. 


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There was no anaesthesia to touch, pain, or heat. Sphincters were 
normal. 

Wassermann’s reaction to the blood was negative. 

Course of case .—During his stay in the asylum he had the general 
signs of tumour, namely, optic neuritis, headache, and vomiting; but 
the latter two symptoms were never very marked till near the end. He 
used to take a keen interest in the various entertainments, and in fact 
used to join in the dances. Just over a year after admission a slight 
swelling was noticed on the right side of the skull, but the patient stated 
that it was nothing, and that he had been hit there. The swelling 
gradually got larger until it was the size as shown in photograph. 

Three years after admission here he was taken as in-patient into 
St. Mary’s Hospital, and while there was allowed home for Christmas 
for a few days. On the day after his return he died suddenly. 

Post-mortem Notes. 

Extract .—Bony tumour present on skull chiefly in temporal region. 

Skuil .—On the fight side extending beyond the limits of the temporal 
bone for some distance from the base half way to vertex the bone 
presented a very unusual appearance. There was a somewhat flattened 
fusiform osseous plaque consisting of cancellous growth of bone from 
both surfaces, not adherent to dura mater. On the external surface it 
infiltrated the various tissues. 

Brain .—There was some hydrocephalus on left side. The dura 
mater was adherent over a small area in right parietal region. 

Right cerebral hemisphere showed an extremely necrotic growth, 
3$ in. in length, situated in midpart of hemisphere, thus sparing frontal 
and occipital lobes ; fusiform in shape and its centre occupying the 
whole width of the hemisphere, encroaching on the lateral ventricles. 

Microscopically, the tumour showed endothelioma. 

The points of interest in this case are the duration of the 
growth, which was ten years. The absence of localising signs, 
which was remarkable considering the great size of tumour and 
its position just below the parietal cortex. All the fibres of 
the corona radiata must have been cut off, yet there was no 
direct evidence of monoplegia or hemiplegia. 

Conjugate deviation of the eyes to the right which was 
present should have suggested the side of the lesion, that is, a 
right-sided lesion, because in the case of a destructive lesion of 
the right cortex or right subcortical region the patient looks 
towards the right, that is, towards the lesion. 

Most of the signs which were present, however, suggested a 
cerebellar lesion. 

The tumour of skull was not adherent to the dura mater, 
but the dura mater was adherent to the brain over a small area. 
The tumour of skull and tumour of brain were not in direct 


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contact, but microscopically they showed the same growth, 
namely, endothelioma, which is a most unusual condition. 

I am indebted to the Medical Superintendent, Dr. Baily, for 
permission to publish this case. Also I am indebted to 
Dr. Spilsbury and Dr. Kettle, of St. Mary’s Hospital, London, 
for the pathological notes. 

Skiagram No. i shows the tumour from the right. Side view. 

Skiagram No. 2 shows the tumour on the right, being a front view. 

Photographs show the tumour on the right, with conjugate deviation 
of the eyes to right, and patient holding head to the right. 


Notes on a Case of Cyst in the Third Ventricle. By D. 

Maxwell ROSS, M.B., Ch.B., Royal Asylum, Edinburgh. 

Cerebral tumours do not occur with great frequency in 
asylum practice ; for example, in going through the register 
of deaths of the Royal Edinburgh Asylum for a period of 
fifty-eight years, I only found fifty-five cases in which cerebral 
tumour was mentioned in the death certificate. When they 
do occur they are always of interest to us, and the case at 
present under consideration is especially so, owing to its 
uncommon site and character. 

The patient, a single woman, set. 55, with no known hereditary 
predisposition, was admitted to the hospital on July 25th, 1916. Her 
illness appears to have had as its starting-point an episode which 
occurred when she was in South Arrica some three or four years ago. 
She formed an attachment with a married man of such a character that 
a quarrel with his wife took place. After this she developed symptoms 
apparently of a hysterical type for which she was under treatment for 
some time before she was brought home two years ago. 

During the two years between her return to this country and her 
admission to hospital her symptoms, though they varied from time to 
time in degree, did not present any material change in character. 
Physically she had difficulty in walking and in writing. The former 
varied very much; sometimes she would manage to walk one or two 
hundred yards well and with little assistance, while at other times she 
could not walk at all without support from her nurse. The latter 
became progressively worse, till finally she could not write at all. In 
addition she had incontinence of urine, and on a few occasions attacks 
which were considered purely syncopal; no doctor ever saw her in 
one of these, but after her death we were told that a nurse had once 
remarked that she thought them of cerebral origin. 

Mentally she suffered from a general impairment, and an indifference 
associated with an amnesia of apparently a retrograde type. On the 
impairment was implanted a slight euphoria which left her placid and 


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JOURNAL OF MENTAL SCIENCE, APRIL, 1017. 



No. 1. 







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Ad lard & Sen West .Vesvmait, Lt 










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253 


^cheerful even in the most unpleasing circumstances; in fact, as her 
nurse said, “ Nothing upset her.” 

On admission she was found to be cheerful, without being exalted, 
quite delighted with her new surroundings, but showing her mental 
torpor by utter lack of curiosity in them. Her memory was defective 
but, owing to her indifference and utterly careless answers to questions, 
it was difficult to estimate the degree of defect both of memory and of 
general intellectuality. To many of the questions which she at first 
answered incorrectly and foolishly she would, if pressed, subsequently 
give quite a correct reply. 

The physical examination was negative except for the findings in the 
nervous system, and here, although she made no difficulties, and, 
indeed, was rather amused by the whole business, it was often unsatis¬ 
factory owing to her utter carelessness in her responses and want of 
interest in what was being done. 

As there were no obvious ocular symptoms whatsoever, no ophthal¬ 
moscopic examination was made—a fact we afterwards much regretted. 

The tongue was protruded in the middle line and showed slight 
fibrillary tremors, there were no tremors of the outstretched hands, and 
she grasped without difficulty objects held before her. On applying 
the finger to nose test a very slight tendency to intention tremor was 
observed on both sides, but especially on the left. 

The lower limbs were moved freely as she lay in bed, and the various 
co-ordination tests, though performed with some uncertainty, were on 
the whole quite well done. When an attempt was made to stand she 
swayed and had to be supported on both sides, and on attempting to 
walk she presented a marked degree of cerebellar ataxia. 

There was little weakness in the upper limbs, but some was noted 
in the lower, particularly in the adductor group of muscles. 

The localisation of light touch and appreciation of the head and 
point of a pin were correct and reasonably prompt everywhere except 
in the lower two-thirds of both legs and the feet, especially the left, 
where there was some inaccuracy and retardation of her responses. 

Of the organic reflexes only the urinary was affected. The abdominal 
reflexes were brisk, as were also the tendon responses in both arms 
and legs, the knee and ankle-jerks being somewhat increased especially 
on the left side. The plantar reflexes were repeatedly examined before 
admission, and only once were thought to be extensor. After admission 
they were found at first to be extensor, at a later date flexor, and again 
a few days later extensor. 

The picture was a difficult one to interpret, and the only 
definite conclusion arrived at was that the symptoms were due 
to an organic intracranial lesion, and not functional. With this 
view Dr. Edwin Bramwell, who saw her in consultation, 
concurred. 

There was no change in her condition till August 29th, 
when she had a fainting attack, which, judging by the nurse’s 
description, was of a purely syncopal character. After this she 


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2 54 CLINICAL NOTES AND CASES. [April-, 

was put to bed and at once improved in general appearance. 
On September 4th she looked remarkably well, but said in the 
evening that she felt confustfd and, to use her own words, that 
“ things did not fit together properly in her head.” At 7 o’clock, 
next morning she was found dead in bed, lying on her back 
in a natural and peaceful attitude. She had been last seen at 
4 a.m. by the patrol nurse, who stated that she appeared quite- 
as usual. 

A post-mortem was performed, the only finding of interest 
in it, apart from the examination of the brain, being some fatty 
infiltration of the heart. On removing the calvarium, the dura 
appeared a little congested but nowhere adherent. There was 
distinct excess of cerebro-spinal fluid, and a little congestion 
of the pia. 

There was no basal arterio-sclerosis and no abnormality of 
the sella turcica. The brain itself weighed 42 oz., it was 
of normal softness, and no nodules or areas of hardening could 
be felt. 

Dr. Ford Robertson very kindly undertook the thorough 
examination of the specimen, and on cutting serial horizontal 
sections found a cyst situated in the anterior part of the third 
ventricle, and arising apparently as a simple retention cyst 
from the connective tissue of the velum interpositum. It was 
oval in shape and its surface smooth. The wall was thin but 
tough, and evidently composed of dense fibrous tissue. There 
was one large cyst with a group of small loculi at the anterior 
pole, and the contents were of a transparent firm gelatinous 
consistency. In size it measured -fo of an inch in breadth, f irv 
depth, and antero-posteriorly. 

The neighbouring tissues had been softened and pressed 
aside. The centre of the body of the corpus callosum showed 
a distinct area of softening, the body and adjacent portion of 
the anterior pillars of the fornix had practically disappeared, 
while the foramina of Munro were gone, but were represented 
by the anterior ends of the choroid plexuses of the lateral 
ventricle, which curved forwards and downwards on the sides 
of the anterior portion of the cyst. Thus, there was unusually 
free communication between the third and lateral ventricles. 

No other gross lesions were found, and microscopic examina¬ 
tion of sections from the ascending frontal convolutions on 
both, sides showed no distinct abnormalities. 


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The most interesting paper on tumours of the third ventricle 
is that of Weisenburg who, in 1910, collected from the 
literature a series of thirty cases, and, as a result of his analysis 
of them, describes a fairly typical symptom-complex. He says 
that there are present, firstly, the characteristic signs of 
increased intracranial pressure—headache, vomiting, giddiness, 
and optic neuritis.: and, secondly, almost constantly cerebellar 
ataxia associated with a paresis without a definite paralysis, 
but usually with spasticity, the tendon reflexes being commonly 
increased, though they may be normal or diminished. 

There is, he says, a general impression that mental symptoms 
are characteristic of neoplasms in this region, and he describes 
these symptoms as consisting of drowsiness, apathy, dull 
mentality, and often greater impairment. In the majority of 
his own cases these were the symptoms present, but in addition 
three were at one time diagnosed as cases of general paralysis, 
one presented the mental symptoms of KbrsakofTs syndrome, 
one of mania but with drowsiness and suicidal tendencies* one 
was normal, and in five the mental state was not noted. He 
concludes that there are no really specific mental symptoms, 
and that the presence of those which do occur is due to com¬ 
pression of the cortex against the skull, this compression being 
caused by internal hydrocephalus. . 

If the case at present under consideration be analysed, it 
will be seen that in the secondary physical symptoms and in 
the mental symptoms it corresponds reasonably closely to 
those described by Weisenburg, but it is unusual in that there 
were none of the general physical symptoms of increased intra¬ 
cranial pressure, and that in spite of the absence of these, the 
mental symptoms, which he attributed not to the local lesion at 
all but to practically the same cause as the general physical 
ones, were well marked. 

The mental symptoms of brain tumours consist in the first 
place in a general enfeeblement, which Ballet well describes as 
a return to childishness, but without the vivacity and curiosity 
of the child, and to which he applies the special term 
“ puerilism.” It may exist alone, or be accompanied by depres¬ 
sive or expansive emotional states. In addition there may be 
episodes of confusion, of hallucinosis, of delusion, of automatism, 
and there are cases in which the symptoms resemble those of 
general paralysis, while others present the picture of hysterical 


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256 CLINICAL NOTES AND CASES. [April, 

and neurasthenic states, and are correspondingly difficult of 
diagnosis. 

According to Byrom Bramwell mental symptoms have little 
localising value in brain tumours, although they are most 
frequently to be observed in those of the frontal lobe, and may 
be of some assistance in such cases. Ballet, on the other 
hand, thinks that a careful study of them may be of consider¬ 
able value. According to him they occur in the great 
majority of cases and form early symptoms which, however, 
often pass unnoticed, or are masked by the more striking 
physical ones. 

In our case increased intracranial pressure, the one great 
cause of symptoms, was apparently absent, and also, owing to 
the nature of the lesion, one could exclude the second supposed 
cause of mental symptoms, namely, the action of toxins 
secreted by the growth. The question, therefore, arises 
whether the mental changes can be entirely explained by 
the mere destructive contact pressure of the cyst on the 
surrounding tissues. By its position it caused pressure on 
the optic thalamus, destruction of the anterior fornix, pres¬ 
sure, and a definite area of softening in the body of the 
corpus callosum. 

In tumours of the corpus callosum Francis noted apathy as 
specially characteristic ; Dercum described as mental symptoms 
somnolence, confusion, fatigue, and marked general mental loss, 
while Starr says there is a disturbance of intelligence chiefly in 
the form of dementia, but often comparable to hysteria. 
Ballet, describing the matter more fully, believes mental 
symptoms occupy a considerable and constant place, that they 
occur early, and consist of a clouding, torpor, indifference, 
confusipn, and amnesia. There is also difficulty in associating 
ideas and a chaos of thought. He quotes Seglas and Lande 
as stating that confused, hallucinated, melancholy, or excited 
states may occur, but are commonly associated with tumours of 
the posterior part of the organ. 

If the symptoms presented by our case be compared with 
those just described, it is clear that the lesion of the corpus 
callosum which actually did exist would be, of itself, sufficient 
to cause the mental state which was present. 

Indeed, Ballet’s description of a characteristic trouble in 
associating ideas and a chaos of thought recalled very forcibly 



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the remark made by the patient a few hours before her death 
that “ things did not fit properly together in her head.” 

The case proved during life a puzzling one ; the physical 
symptoms were not of a definite focal character, and the mental, 
though characteristic of organic brain disease, were, in the 
absence of any of the signs of increased intracranial pressure, 
difficult to explain. Indeed, the whole picture, and most 
notably the mental symptoms, suggested a diagnosis of 
disseminated sclerosis. From this point of view it is interesting 
to note that Cooke is quoted by Starr as having pointed out 
that tumour of the optic thalamus may cause a tremor quite 
similar to that of multiple sclerosis, and in our case, though 
there was no actual lesion of the thalamus, it was subject to 
direct pressure by the cyst. 

Taking into regard the description given of the reported 
cases of tumour of the third ventricle this one, except for the 
fact that the classic symptoms resulting from increased intra¬ 
cranial pressure were absent, falls readily into line with its 
fellows in presenting a symptom complex which is fairly 
characteristic of the site of the lesion. 

Apart from this, it is of interest because of its unusual 
pathological character, and because it may be cited as a case 
refuting the views of Weisenburg and others that the mental 
symptoms are always due to a general pressure on the whole 
cortex, or to the action of toxines secreted by the neoplasm, 
and not to the direct action of the lesion on the surrounding 
nervous tissues. 

In conclusion, I wish to thank Dr. G. M. Robertson, Physician 
Superintendent of the Royal Edinburgh Mental Hospital, for 
his kind permission to report this case. 


Referencks. 

Weisenburg.—“ Tumours of the Third Ventricle,” Brain, October, 
1910. 

Ballet .—Traitc de Pathologic Mentale. 

Starr.—“ Focal Diseases of the Brain : Tumours,” Dercum’s “Text¬ 
book of Nervous Disease.’’ 

Bramwell.—“Intracranial Tumours ” ; Albutt’s “ System of Medicine.” 
Dercum.—“ Clinical Manual of Mental Disease.” 


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A Case of Systematised Delirium of Persecution with 
Psycho-sensory Hallucinations. By R. M. Toledo, 
M.D., Assistant Physician, Government Lunatic Asylum, 
Malta. 

Cases of systematised delirium of persecution (Tardive para¬ 
noia) are common. The case however forming the subject of 
this paper is particularly interesting on account of the nature of 
the “ persecution ” and of the “ persecutors ” referred to by the 
patient. 

As it is well known, the chronic delirium of persecution 
appears rather late in life (at age 35—45). 

There, is a stage of prodromata of a hypochondriacal char¬ 
acter called by the authors “ Stage of apprehensiveness or 
incubation period.” 

A second stage, referred to by Magnan as the period of 
“ insane misinterpretations.” 

A third stage of “ delirium proper ” (stereotyped delirium), 
with or without hallucinations. These hallucinations may be 
sensory or simply psychical (Baillarger’s pseudo-hallucina¬ 
tions). 

A fourth stage called the metabolic stage, in which “ ideas of 
pride,” with a sort of pseudo-scientific delirium, supervene. 

A terminal stage of dementia. This is rare in “ true 
paranoia ”; with advancing age, however, the stereotyped 
delirium loses much of its brightness and organisation. 


History of the Case. 

The patient is a gentleman, set 38, liberally educated and of fine 
physique, without any somatic stigmata of degeneration except that his 
temporal arteries are already tortuous and thickened. No history of 
syphilis. The patient was a little given to the abuse of alcohol, and he 
suffered once from biliary colic. 

At the age of 36, he noticed that he was getting gradually mentally 
and physically fatigued, and unable to cope with his work as broker in 
the cotton business in Egypt. He became sleepless, dull and irritable, 
lost weight, and complained much of abnormal “ internal ’* sensations. 
A doctor told him that he had neurasthenia, and recommended him to 
proceed to Europe for change. 

Just before leaving for Naples he “ heard ” an Arab calling him 
“ Kelb ” (“ Dog ” in Arabic). The patient admits that he was a little 
upset, the more so that, at that moment, he felt some very funny sensa¬ 
tions in his inside. A stay of a few weeks in a sanatorium for “ nervous 


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1917-] CLINICAL NOTES AND CASES. 259 

diseases” in Italy “cured ” him, as he says, and he was able to return 
home and to resume work. 

After a lapse of a few months of “ good health ” he felt dull again, and 
he could not explain why his friends “avoided” him, and his relatives 
“ worried ” him. The Arabs called him “ bad names ” and he felt now 
as if “something was crawling in his abdomen,” and a sort of gnawing 
pain. People in the street looked angrily at him, and others would say 
•‘poor fellow.” He read medical books to pass the time as he says, 
including a book on “ Embryology.” 

One night he felt a feminine voice saying something “ in his abdo¬ 
men,” the next night a “ masculine ” one, and then on succeeding 
nights “ laughters, shrieks, and regular dialogues.” “ Teeth ” bit his 
-organs and gnawed his ribs. 

These sensations put the patient (as he says) on the right track, and 
soon after he found out that he was the victim of an uniqne phenomenon. 

It is thus that the patient explains his morbid sensations and 
hallucinations. 

“On my conception, three ovules were impregnated, and under 
normal conditions my mother would have given birth to triplets. • She 
gave, however, birth to me alone, and by a sort of an embryonic 
aberration (patient’s own words) the two other fecundated ovules 
developed into two ape like beings living parasitically in my inside. 
One of them is a male being and the other a female one. They hate 
me, and they have been the source of all my internal sufferings 
and troubles for the last two years. They insult passers-by, by words 
and sounds, causing people to look angrily at me, as they believe that 
I am addressing them. Others pity me as a ‘ madman.’ ” 

Labouring under this delusional idea, which naturally left 
the patient without a moment’s peace, he tried to get rid of 
these two ape-like living beings by asking hundreds of 
surgeons, in his own country and abroad, to operate on him. 

A surgeon, thinking he might benefit the patient, incised 
the skin (under chloroform) on both sides of the abdomen, 
and sutured the wounds. He then tried to persuade the 
patient that he had explored his abdomen, but found nothing. 
The patient thinks now that the surgeon is an “ ally ” of his 
two internal enemies for “ political reasons.” 

The patient believes that by means of “ special nerve- 
organs ” these two parasites have learned all the languages 
(four) which he studied, and alleges that, in every town he 
visits, he must patiently assist at dialogues between his “ inside 
couple ” and “ invisible people,” the subjects being “ diplomatic 
questions of the highest importance.” He complains that he 
was even deprived of his sexual energies, which his “ would-be 
brother and sister ” had turned to their sole advantage. 

He has strong suspicions that an “ offspring ” was born to 


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them lately, and that this would soon start, like the parent's, to 
“ suck his blood ” and “ gnaw his ribs.” 

The patient is quite sensible on matters having no relation 
to this morbid idea of his, and one would not think that he 
was speaking to a mentally-afflicted person were it not that 
occasionally he starts giving blows on his abdomen to keep (as- 
he says) his enemies quiet, alleging that they do hate him 
speaking to anybody, and they try to disturb him by “ shrieks, 
laughters, and running about.” 

The patient refers to magnetic waves not yet known to 
Marconi, originating in the ape’s body, and flashing out in the 
atmosphere via the patient’s head, causing him agonising head¬ 
ache, and all sorts of suffering to humanity. He told the 
writer that he has spent so far £1,700 in visiting cities in 
search of a surgeon who would undertake the task of releasing 
him from his enemies. He has visited Malta for such purpose 
and has written to the authorities describing his case as one 
requiring an “ urgent ” abdominal operation. 

He hopes to visit America, if Europe fails to help him in 
overpowering these two members of an atavistic race. 

Unfortunately this poor patient, who is much in need of care 
in a mental hospital, has been left at large, as his relatives 
consider him as a “ neurasthenic.” 


Part II.—Reviews. 


Herbert Spencer. By Hugh Elliot. “ Makers of the Nineteenth 
Century Series.” Pp. 330. Demy Svo. London : Constable & Co., 
Ltd., 1917. Price 6 s. net. 

Mr. Hugh Elliot, to whom was entrusted the account of Herbert 
Spencer in the Dictionary of National Biography , has here re-written 
that account in a freer and much enlarged shape, and from a more 
mature, critical, and yet discriminating standpoint. He tells us how, 
when on active service in the Boer War, he read through the whole of 
Spencer’s works on the South African veldt. He became a dogmatic 
disciple. In the years that followed, as a. student of biology, he was 
able to see that many of Spencer’s facts and theories would not bear 
examination, while, as a student of English politics, he realised that 
Spencer’s doctrines seemed hopeless. His discipleship tended to 
apathy. But, during the present war, he has again read Spencer’s works 
through. In the light of the war and of that reading he has reached a 
fresh and more judicial outlook. He sees that there was much that was 


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26 I 

extreme in Spencer’s social and political doctrines, much, indeed, that 
Spencer himself would have modified had he lived later ; he sees, also, 
that there is much in Spencer’s scientific doctrines that can no longer 
be maintained, and need not be maintained, if, like Spencer himself, we 
reject authority. Yet, when all deductions are made, he finds that 
Spencer’s greatness as a thinker and value as a teacher remain un¬ 
impaired, being, indeed, especially necessary for our guidance in the 
critical times we are now passing through. 

The book consists of thirteen chapters, in which Spencer’s life and 
character are first dealt with, then the philosophic and social writings in 
general; seven chapters are devoted to Sociology, Ethics, Metaphysics 
and Religion, Evolution, Biology, Psychology, and Education ; a con¬ 
cluding chapter sums up the author’s estimate of Spencer’s place in 
English thought, and an Appendix contains a Bibliography and a 
Chronological Table. 

In sketching Spencer’s life-history, Mr. Elliot attaches due weight to 
the paternal heredity. Spencer was, indeed, the true son of his father, 
the Derby schoolmaster, a highly developed example of a special type 
of Englishman, of aggressive independence, much ability and originality, 
unbending discipline, keenly interested in science and politics, and 
with severe religious opinions, which drew him from Methodism to the 
Quakers. It was precisely the temperament which, with genius super- 
added, produced the synthetic philosopher of evolution. There were, 
however, other elements. Mr. Elliot is inclined to attach no signifi¬ 
cance to the maternal heredity, as the mother was of “ very ordinary 
character ” ; Spencer himself, who considered that she had always been 
under-valued, was inclined to think otherwise. The interesting fact 
about her is that she was of Huguenot descent. It is difficult not to 
believe that this heredity was significant. The Huguenot element 
came in to reinforce the paternal rebelliousness to authority. It is 
possible one may even go further. The Huguenot element in English 
men of genius has often been found potent even in minute doses. 
Bearing other cases in mind, one may well find in this French strain an 
explanation, not only of Spencer’s relentless and un-English logical 
consistency, but of the charm of his literary style, which came to him by 
nature and without deliberate cultivation. Mr. Elliot seems scarcely to 
do justice to the qualities of Spencer’s style. No doubt this is not easy 
for one who works through the whole series of great volumes, since the 
larger part of them, written down or dictated during the prolonged 
decay of Spencer’s vitality, display a very monotonous manner. But in 
the earlier and better written volumes, notably in First Principles and 
The Study of Sociology, we have to recognise that Spencer shows himself 
incomparably the finest artist of the highly distinguished group of 
writers in philosophy and science with which he was associated. And 
it is to be noted that his style is invariably the embodiment of his 
thought, never its mere ornament, and he is a fine artist simply because 
he is a fine thinker. Certainly this quality contributed mightily to the 
immense diffusion of his work throughout the world. 

The chapters devoted to summarising the synthetic philosophy are 
necessarily very condensed and often bald, though always very clear. 
While attaching the greatest value to Spencer’s social doctrines, 
LX I II. 17 


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Mr. Elliot regards The Principles of Psychology as the most important 
division of the work. He frankly admits and points out its defects and 
deficiencies. Yet when all deductions are made, the magnitude and 
brilliince of its conceptions remain unimpaired ; they are all the more 
remarkable when we remember that Spencer had no acquaintance with 
the work of his predecessors, and very little with that of his con¬ 
temporaries. It is unquestionably, Mr. Elliot declares, an epoch- 
making book, and if only Spencer had based its evolutionary doctrine 
on natural selection rather than on the inheritance of acquired 
characters, it would probably have been the most remarkable philosophic 
production of its century. As it is, it remains of the first importance, 
“ and even now is far better worth reading than the great majority of 
text-books which have been produced since.” 

Mr. Elliot’s monograph reflects the activity of a vigorous, alert, and 
searching mind, keenly interested in the problems of science and 
society. He writes fluently, sometimes, it would seem, with an eager 
speed, which once or twice causes the thread of the argument to be 
momentarily lost, but on the whole the reader is glad to keep up with 
so vivid and accomplished a guide. Some of us have alrpost forgotten, 
and others never knew, how much Herbert Spencer stood for thirty 
years ago. This book will perform a valuable function by showing that, 
even in the crisis of to-day, we may still derive light and support and 
inspiration from one of the greatest of English thinkers. 

Havelock Ellis. 


A Study in the Philosophy of Bergson. By Gustavus Watts Cunning- . 
ham,A.M., Ph.D New York and London: Longmans, Green & Co. 

The attitude that the author of this book assumes towards Bergson 
is that of the candid friend : he admires the philosopher, but he is not 
blind to his faults. Like many other people, he finds that the work 
of the brilliant Frenchman bristles with contradictions, and he attempts, 
one cannot say very successfully, to reconcile some of them. 

In the preface the author warns us against any misconception of the 
object of the book. It is a critique, he says, and not a summary. 

44 Consequently the writer ”—the professor has a penchant for speaking 
in the third person—“has not hesitated to pass by many interesting 
phases of Bergson’s thought and to confine his attention to what he 
regards as his author’s basic doctrine.” It is only fair to say that within 
the limits thus marked out the writer strictly coniines himself. He argues 
closely, keeps his point well in view, and rarely allows himself to wander 
•down even the most alluring of by-paths. 

The chief subjects dealt with in the book are Bergson’s views on 
Intuition and Intelligence, and on the problem of Duration. 

To Prof. Cunningham it appears that Bergson’s distinction between 
or separation of Intuition and Intelligence is more apparent than real, 
and he quotes largely from the philosopher’s writings in support of his 
argument. It is questionable, however, if he has succeeded in proving 
his point. The most essential plank in Bergson’s platform is that 
Intelligence is only capable of understanding things material and 
spatial, that is to say, that Intelligence is only capable of comprehending 


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•matter. It cannot “ deal with time and motion except on condition 
of first eliminating the essential and qualitative element of time— 
duration, and of motion—mobility.” The idea seems to be that 
Intelligence, in order to examine anything, .seizes it and holds it 
motionless and inert. Consequently there is need of another power— 
Intuition—to be able to understand reality, duration, and motion. 
This the professor admits to be Bergson’s explicit view, but he finds 
•another and implicit view in the French philosopher’s writings, in which 
the relationship between Intelligence and Intuition is conceived “not 
as that of antagonism, but rather as that of subsumption.” “ Intuition 
involves intellectual activity and transcends it, if at all, only as a more 
comprehensive and concrete form of the same sort of knowledge.” The 
writer does not appear to see the importance of the words “if at all,’’ 
or if he does see it, he lays no stress upon it. 

What Prof. Cunningham calls Bergson’s explicit and implicit views 
are only two of the contradictory points of the philosopher’s doctrine, 
though perhaps they are the most glaring, and his efforts at reconciling 
them—and one grows weary of what is little better than reiteration— 
only emphasise the contradiction. 

The part of the book, which is devoted to the consideration of the 
problem of Duration, is the most successful, partly because the author 
is more dogmatic than he is elsewhere, and has no hesitation in pointing 
out what appears to him to be a fallacy. 

From the consideration of Bergson’s doctrine of Duration a theory of 
Creative Finalism is evolved, which the author elaborates with great 
■detail in the sixth chapter. 

The last chapter with its general summary of the subjects discussed 
in the volume is probably the best. 

The style of the book is rather rugged, and occasionally jars on the 
ear, and the author has an irritating habit of commencing not only 
sentences but even paragraphs with the conjunction, and. 

Although the book is not a very important addition to the literature 
which has grown up around Bergson’s philosophy, it has one merit, and 
that is that it makes one think. J. Barfield Adams. 


The Dream Problem. By Dr. A. E. Maeder. Authorised Translation 
by Drs. Frank Mead Hallock and Smith Ely Jelliffe. 
“ Nervous and Mental Disease Monograph Series, No. 22.” 

The members of the Zurich School of psychoanalysts differ in many 
important respects from the orthodox Freudians. They give all due 
credit to Freud for what he has done and acknowledge that much of 
their inspiration has been derived from him, but they claim to have 
made advances. The Viennese school looks to the past the Zurich 
school to the future. The former tries by analysis to find out the 
cause of the disease, the latter to discover what is the aim of the 
disease. In this small monograph the same principle is applied to 
the study of dreams. The author says that “ the axiom of the dream 
as a wish fulfilment is too indefinite and especially too one-sided, for 
it actually fails to embrace the important teleological side of the 
unconscious function.” Maeder, moveover, thinks that sufficient attention 


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has not been paid to the manifest dream content. “ I place great 
importance on the choice of the pictures and expressions in the manifest 
dream content, since the dream renders an autosymbolic presentation 
of the psychological situation of the unconscious. An energetic, 
purposeful, and well-adapted conduct in the dream, points to a mature 
and successful adjustment of the dreamer towards the matter in hand. 
For instance, in a dream there occurred the violent ejection from a 
church of a talkative, vain, and uncongenial traveller, whereby is pictured 
the serious efforts of the dreamer to overcome the characteristics of his 
own ego as caricatured in the travelling man.” 

Several dreams and their interpretation in the manner of Freud and 
in that of the author are given at length as examples. The interpretation 
of Freud indicates the fulfilment of a wish, the expression of the pleasure- 
principle. The interpretation of Maeder describes the adjustment to 
reality, and he thinks that the analyst of the future should attach most 
importance to the latter. R. H. Steen. 


Dmvnward Paths : A n Inquiry into the Causes which Contribute to the 

Making of the Prostitute. With a Foreword by A. Maude Royden. 

Pp. 200. London : Bell & Sons, 1916. Price 2 s. 6 d. net. 

The problem of prostitution is again arousing interest among us, and 
this little book will be found a valuable contribution to the study of 
that problem. It is remarkable as being perhaps the first sociological 
investigation in this field made in England by women, medical and 
others (who remain anonymous), and it is probably to that fact that 
we must attribute its freshness of outlook, notably its intelligent and 
sympathetic appreciation of the difficulties which tempt women into 
“ downward paths.” The authors, as Miss Royden puts it, “ are not 
Pharisees writing about Publicans, but human beings seeking to under¬ 
stand and enter into fellowship with the outcasts of their sex” ; in this 
endeavour they have adopted an attitude of “ intellectual detachment,” 
not deciding beforehand what their investigation was to discover. 
The same point of view is brought out still more clearly in the first 
chapter where we are told that the prostitute is here approached not 
as a plague to be avoided or a lost soul to be saved, but as “ a disaster 
to be prevented.” In working for the decrease of prostitution they 
believe it is necessary to face deliberately “ the drastic rearrangement 
of cherished social institutions," for, as they believe, they have here 
shown that “ prostitution is not so much an institution in itself as the 
rubbish-heap necessitated by the way in which other much respected 
institutions are built.” In carrying out their investigation in this 
admirably broad and philosophic spirit, the writers are mainly concerned 
with the motives which lead women to take up prostitution. 

The material dealt with may be regarded as not extensive nor 
completely representative, since a large number of the cases came into 
the hands of social workers and are to be regarded as unsuccessful 
prostitutes. The total number dealt with is 830, but concerning a 
considerable proportion of these the information obtained was defective. 
Thus of only 370 were the home conditions in which the prostitutes 
were reared definitely ascertained, about one-half coming from bad 


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homes, and only one-fourth from good homes ; considerable importance 
is attached to bad housing and overcrowding as a predisposing factor of 
prostitution. “ Deliberate choice is found to be the cause in a large 
proportion of cases; when vanity, love of pleasure, adventurousness, 
laziness, fondness for sweets, are added to strong sexual inclinations, 
40 per cent., among 669 cases “ owe their position to their own tastes and 
temperament.” As more than half of these girls were under eighteen at 
the time of their first lapse, and sixteen was by far the most dangerous 
age, the authors rightly regard the period of adolescence as of great 
importance. The chapter in which the special needs and perils of girls 
in this stage are sensibly and sympathetically discussed is perhaps the 
best in the book. As regards specific sexual desire, sixteen was found 
to be the age at which it is most common, then eighteen; after that it 
is not prominent except among married woman and widows ; the pro¬ 
portion of cases in which there is strong sexual appetite after the habit 
of prostitution is established is estimated as, at most, one-sixth. Gain 
rarely appears as a motive before the age of twenty ; it is very seldom 
the cause of the first step. It is also to be remembered that this “ first 
step” only in a very small proportion of cases ever leads to prostitution. 
The classes which regard pre-marital unchastity with shame “ form a 
much smaller part of the English nation than they realise.” It is also 
to be remembered that seduction is a far less important factor than 
was once commonly asserted. Heartless cases of fraud do certainly 
occur, but more often the girl is as responsible as the man, and of 
ten girls who definitely stated they were seduced under promise of 
marriage seven were feeble-minded ; “ consciously or unconsciously 
women are indeed often the tempters, and when once within the zone 
of temptation it may be doubted whether women are the weaker sex.” 

The authors are quite alive to the influence of the hereditary factors 
of prostitution. Thus they point out that even the fact that a girl has 
relatives who are willing to act as procurers towards her, as found in 
many of the cases, is itself often a sign that she comes of a corrupt 
stock. A chapter is devoted to the feeble-minded. Two classes are 
recognised as almost inevitably destined to prostitution: (1) Those 
unable to resist their own strong inner impulses; and (2) those who 
have no strong impulses of their own, but are unable to resist external 
influences; numerous cases are described belonging to each group.' 
The authors do not, however, consider that it is possible to estimate 
the proportion of the feeble-minded among prostitutes, partly because 
the more successful and capable rarely come under investigation, and 
partly because many investigators regard any unconventional manifesta¬ 
tion of sex in an unmarried woman as in itself “ moral imbecility.” It 
would appear from the statistical tables that the authors are inclined to 
regard 255 of their cases as “ mentally deficient.” 

A chapter is devoted to the economic factor of prostitution, and the 
reasons why domestic service produces so many prostitutes (nearly 300, 
or more than a third of the cases here studied) are well discussed. 

The authors are critical of any simple and summary methods of 
remedying prostitution. Thus they state that it is futile to suppose that 
prostitution would he checked by exterminating the procurer; “ were 
every procurer flogged to death the vast majority of their victims would 


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still fall, perhaps a little more clumsily for lack of their intermediary 
offices, into prostitution.” Nor have they too much faith in an excessive 
care of girls and the destruction of their responsibility; “ life is made 
up of risks, and perhaps none is greater than the risk of too carefully 
seeking to avoid all.” But they are firmly convinced that many of the 
factors that make the prostitute, and probably her customer alsd, are 
definitely remediable. Such are a housing system which encourages 
the pollution of children in their homes, an educational system which 
denies the girl all knowledge that might equip her for the struggle 
between her deepest instincts and the outside world, an industrial 
system which condemns her to monotonous toil during an excessive 
period, without adequately nourishing food or leisure for mental 
development, or even healthy amusement, and a social tradition of the 
subservience of women to men which still further accentuates the 
tendency of the weak to drift into temptation. Nothing is said of any 
measures to combat the production of feeble-mindedness. 

At the end will be found a bibliography which is, however, unworthy 
of so excellent a book, being loosely and carelessly compiled, and full 
of all sorts of errors, even of spelling both as regards proper names 
(Sawyer for Sanger, Kirsch for Kisch, Minod for Monod, etc.), and 
French and German words. Havklock. Ellis. 


Epitome of Current Literature. 


i. Psychology. 

Intuition. {Psychol. Rev., November, 1916.) Dearborn, G. 

1 

The concept of “ intuition ” is very frequently and popularly spoken 
of, and is especially attributed to women. The author believes that 
the time has now come when we should subject it to scientific analysis. 
That it is more often a feminine than a masculine characteristic he is 
prepared to believe, and he considers that, in the light of recent trends 
in psychology, intuition takes on a new and important interest. 

There are at least four more or less distinct concepts labelled 
intuition: ('i) The immediate knowledge of unlearned primary truth, 
an eighteenth century philosophical doctrine now chiefly of historic 
interest only; (2) the metaphysical usage of Bergson as instinct become 
disinterested; (3) the inexact use of the word as a foreboding of the 
future; and (4) the concept for which the author himself stands, as 
insight passing into foresight, or, in other words, an immediate know¬ 
ledge of or insight into ejective, objective, and subjective processes 
and situations. 

This involves at least four different kinds of psycho-physical event: 

(1) An affect, sometimes ill-realised, as to the intuited situation; 

(2) a process of comparison and inference, usually not consciously 


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appreciated; (3) a comprehension of the intuition, often acute and 
wise; (4) an instinct to trust the impression thus received. 

Beneath the surface a number of processes are involved : (1) more 
or less sensory perception, (2) emotional mechanism, largely neural, 
(3) awareness of the emotional aroma, (4) conscious appreciation of 
its significance, (5) the attempt to understand that significance, leading 
to (6) comparisons, (7) judgment based on the comparisons, (8) more 
or less unconscious inference, (9) integration of the affect and the 
reasoning process, resulting in (10) tendency to understand the factors 
of the situation in relation to experiences of life, (11) unconscious 
belief in the rightness of this process, leading to (12) self-confidence, 
and (13) conscious realisation of a useful fact often more valuable than 
the results of laboured and extensive mental toil. 

The affect or emotion concerned may be one of many, and the 
author has elsewhere enumerated some eighty which may thus serve. 
Sympathy often quickens intelligence, but “ the dynamism of hate is 
at least equal to that of love ”; always there is some vital interest at 
work, The process of comparison and inference is characterised by 
being quick, accurate, and subconscious. The “ situation ” compre¬ 
hended by the intuition may be defined as “any appreciable relation¬ 
ship whatever, ejective, objective, or subjective, so long as not 
irrational.” In practice intuition is most often used to learn the 
probable behaviour and character of some other person; that is why 
women become so expert in intuition when desiring to protect them¬ 
selves against the strenuous and aggressive male. An important factor 
is the affective instinct to trust the intuition. As a rule men do 
not .avc this instinct, but are on their guard against their intuitions 
as often hopelessly wrong ; in women, especially very feminine women, 
it is strongly marked, and their intuitions are highly adaptive to the 
situation. 

The author regards it as demonstrable that the entire intuitional 
process, except its product, is in the highest degree intelligent and at 
the same time subconscious. In this way intuition and its compre¬ 
hension of a total situation is a real criterion of intelligence. It stands 
for a high degree of that safeguarding of the individual which mind is 
specially meant to serve; obtuseness stands for abnormality and 
lowness of human grade. In this respect, and especially in its 
derangement or its lack, intuition has not received in test-systems 
the attention it deserves. In his own experimental psychological work 
Dearborn has often realised the mental significance of defective 
intuition. Intuition may, indeed, he argues, fairly be regarded as 
a criterion of sanity. As an individual the deranged man’s conduct 
may be satisfactory, his nutrition may be satisfactory; even the mental 
aspects of his organism may possess all the requisites of proper function. 
But he is out of tune with the social consciousness around him. In 
relation to this out-of-tuneness, this fundamental disharmony with 
social values, there is no more accurate or concise concept than 
intuition. Intuition “suggests directly that appreciation of the basal 
life-relationships, causal, rational, social, as well as psychologically 
personal, on which alone our whole important concept of abnormality 
has any modicum of meaning." Havelock Ellis. 


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A Transformation of Fear [Swr une Transformation de la Peur\. {Rev. 

Phil., October, 1916.) Ribot, Th. 

. This paper bears witness to the mental vitality, up to the end, of its 
distinguished author, the editor of the Revue Philosophique, and the 
most prominent representative of French psychology, whose death has 
lately been announced. 

The emotion in question is that of the sublime. Since Lessing and 
Burke this has usually been bracketed with the beautiful, and regarded 
as an aesthetic sentiment. Ribot himself so formerly regarded it. In 
the present paper he seeks to show that it is nothing of the kind. 

Starting from an essay of Grant Allen’s on the Origin of the Sublime, 
which he regards as fairly correct, Ribot points out that all the great 
groups of phenomena which have in the past impressed men as 
sublime have through all their transformations permanently retained the 
idea of a superior force which subjugates. Always there is the notion 
of a limitless force, exciting in consciousness the reaction which is the 
feeling of the sublime. He briefly summarises the principal classes of 
the sublime according to the perceptions, images, or ideas which arouse 
it : (1) limitless space ; (2) infinite time ; (3) gigantic mass, as of 
mountains or pyramids ; (4) the violent forces of Nature or of man ; and 
(5), most imposing of all, the sublime inculcated by religious beliefs, 
from animistic fetichism onwards. Although these causes of sublimity 
are so widely unlike, the underlying emotion is in all cases fear. 

Psychologically analysed, however, the sentiment of the sublime is a 
ocmplex state, in accordance with the general rule that a simple and 
primitive emotion passes through many processes in its higher evolution, 
whether by arrest or excess of development, or a synthesis of homo¬ 
geneous states, or by combination. The last process, which leads to the 
appearance of a state apparently altogether unlike the constituent 
elements, is specially important. This occurs in the case of the 
sublime, contrary and even contradictory elements being united: (1) 
the consciousness of exterior power weighing upon us; (2) a resulting 
weakening and depression of personality ; (3) an unstable secondary 
feeling of exaltation due to a kind of participation in the phenomenon 
witnessed ; there are also other factors of a more negative character. 
The external attitude reveals a fixed gaze, expressing admiration and 
respect (which is the beginning of fear), or silence, an attitude quite 
different from that which accompanies the feeling of the beautiful. 

The feeling of the sublime is thus an emotion combined of two 
fundamental elements—an affective element of fear, and an intellectual 
element involving the idea of a force imposed upon us. There is 
nothing aesthetic in it. Havelock Ellis. 


2. Physiological Psychology. 

J’ure Tactile-motor Consciousness [La Conscience Tactile-motrice Pure]. 
{Revue Philosophique, July, 1916.) Ribot, Th. 

It is always with a feeling of regret that we read some of the last 
words of a writer who has recently passed away, and the regret is the 
more poignant when the writer was such a man as the learned, kindly 
Breton, Th^odule-Armand Ribot. “ The style is the man.” The chie f 


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-characteristics of the man Ribot were his unselfishness and his un¬ 
feigned love for his fellows,, and these characteristics found outward 
expression in his sympathy and courtesy. Courtesy was the keynote, the 
tone of his writings. He handled everything with a touch of velvet. 
But this gentleness was not a sign of weakness. Under the velvet glove 
was the strong, though kindly, hand. Possibly it was this innate 
courtesy which gave to his language its exquisite melody. In spite of 
the gravity of the subjects dealt with, and the closeness of the reasoning, 
Ribot’s works have all the charm of poetry. No philosopher was ever 
so endowed as he with the power of translating the rhythm of thought 
into the rhythm of words. 

Ribot opens the article, which is now before us, by saying that at the 
side of the psychology of the intellectual and emotional states, a third, 
which may be named the psychology of movements, has recently taken 
an important place. Its general characters and essential points may be 
set forth in a few words. Physiologically—and this implies all the rest 
—it attributes to the motor centres the preponderance in cerebral 
activity. Psychologically, the principal role of movements is to co¬ 
ordinate, unify and systematise the facts of experience. The movements 
are the regulators. By different attitudes of mind, notably by attention, 
they favour the work of intelligence of which the natural object is 
action. But the writer cautions us against allowing motor psychology to 
pass beyond the proper limits of its sphere. 

The writer then proceeds to the real subject of his article, which is 
the study of the psychology of motion in the case of individuals who 
are both deaf and blind from birth. 

It is important, he says, to observe that the expression “ deaf and 
blind from birth ” is applied to those who have been afflicted with their 
infirmity before the age of three years at latest—that is to say, at an age 
when visual and auditory recollections are too feeble to remain in the 
memory. To be exact, it is also necessary to remark that so-called 
congenital deafness and blindness are sometimes consecutive to diseases 
of early infancy, such as scarlatina, measles, meningitis, etc., which leave 
cerebral scars, and that consequently complete assimilation to (com¬ 
parison with) a norma! brain is impossible. 

Unless they possess the sense of smell, which is often lacking, these 
patients can only make the acquaintance of the exterior world by tactile 
and kinaesthetic sensations. In order to understand the constitution of 
this strange form of consciousness, it is necessary at first to make an 
inventory of the materials of which it is composed, and then to deter¬ 
mine the processes of mental elaboration—associating, reflecting, co¬ 
ordinating, etc. 

Let us commence with the deaf-mute. The mental weakness of one 
who is deaf and dumb from birth is well known. Inaccessible to the 
perception of language, he cannot, as other children, try to imitate 
spoken words, and reproduce them after many attempts, and thus 
acquire an instrument for analysing thought. However, it is wrong to 
pretend that, left to themselves, deaf-mutes cannot rise above the level 
of sensorial consciousness. Cases in evidence of the ability to do so 
have been reported. It is well known that deaf-mutes invent gestures 
-which are understood by those about them. It is to be remarked that 


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their syntax resembles that of primitive idioms. For example, the 
phrase, “ After having run, I slept,” is translated by four gestures, which 
mean running, myself, finished, sleeping. 

In default of language, the deaf-mute has two processes for analysing, 
his thoughts and translating them to the outside world : the language of 
the fingers, which becomes with exercise almost as rapid as speech ; and 
the method of learning to speak by imitation of the movements of the 
lips and of the organs of phonation. This latter method produces a 
harsh, mechanical voice, which may be compared to that of an 
automaton. 

Simple noises are for the deaf-mute only vibrations, but he dis¬ 
tinguishes their shades and origins with great subtlety. Thus, Laura 
Bridgman recognised her companions by their footsteps. 

As to musical sounds, such a patient distinguishes the different 
instruments by the nature of their vibrations. He can appreciate the 
pitch of sounds, the rhythm, the time, and the value of notes. 

Let us now examine congenital blindness. 

Sight is the sense of colour and of distance (in which the writer 
probably includes form). For the blind, the first function is irrevocably 
lost; the second he replaces as well as he can by direct contact and by 
movements. By movements of different parts of his body, as the neck, 
hands, arms, and legs, he creates for himself spatial determinations, 
such as direction, position, etc. ; for great distances be walks, and time 
gives him the measure of space. 

It is important to remark that while visual apprehension is synthetic, 
tactile-motor apprehension is analytic. A blind man only recognises an 
object after having felt all its parts with care. However, in the case of 
a familiar object he has no need of this lengthy proceeding ; he acts as 
a man gifted with sight. The touch of the back of a chair evokes the 
recognition of the whole chair by restitution ad integrum of all its parts. 
This proceeding is equivalent to pure representation ; a part represents 
the whole, or is in place of the whole, or replaces it. The last case is 
equivalent to abstraction. 

A less known endowment of the blind is the “ sense of spaces,” or the 
“frontal sense”—a fact introduced for the first time into psychology, 
the writer believes, by \V. James. It consists in the perception at a 
distance of about two yards of an obstacle, such as a wall or a tree. 
This sense differs according to the condition of the patient, fatigue, and 
atmospheric variations. Vuilberg believes that this sense exists als» 
among those endowed with vision, but that they are ignorant of it 
because they have no need of using it, having something better at their 
disposal. This sense, which is situated in the forehead and the temples, 
appears to be allied to hearing; it disappears if the nose and ears be 
stopped up. 

It is often said that man is especially a seeing animal, on account of 
the preponderance of visual perceptions and. representations in daily life 
and in the metaphors of language. Among the blind from birth this 
preponderance is transferred to the tactile-motor information of the 
hand, which is for them singularly suggestive. The importance of the 
hand in the intellectual development of man was recognised very early ; 
it was remarked upon in ancient times by the Greek philosophers. 


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Proofs abound of the richness of the information acquired by the hand, 
which is not only an organ of action, but also an instrument of 
conjecture and psychological divination. 

To sum up, the form of consciousness which we are studying (that is 
to say, of the blind) is spatial, and as such is constituted especially by 
motor activity. 

The writer then proceeds to study the case of those who are both 
deaf and blind from birth. 

With some exceptions, those who are deaf and blind from birth have 
no sense of smell, but those who have preserved this sense make good 
use of it. They even rival dogs in the keenness of their scent. 

Such afflicted persons are conscious of atmospheric changes, as heat, 
cold, dryness, damp, and electric tension. Many of them recognise the 
approach of a storm, and are able to point out exactly its precursory 
signs. They have also the vital sensations resulting from the work 
which goes on in the organism. They have appetites, instincts, senti¬ 
ments, emotions, and passions, and even varieties of character. 

With these materials how can a man deaf and blind from birth 
develop himself by the work of mental elaboration which is proper to 
him ? One cannot give a satisfactory reply to this question. As to 
those who are only deaf, or only blind, there are abundant facts to in¬ 
terpret their psychology. But, when the two infirmities are conjoined, 
the conditions change. One may, however, try to indicate the main 
features of mental elaboration by studying the few cases which have 
been carefully observed. 

The deaf and blind can abstract and generalise. (The case of 
abstraction by the blind has been alluded to above.) By the natural 
tendency of the human mind towards simplification and the least effort, 
they substitute for the whole a portion of the object presented or 
represented. This tactile-motor abstraction is sufficient for the operations 
of the mind. The employment of signs permits them to think by 
concepts; but these for the most part, notably the moral ideas, virtue, 
vice, justice, etc., of which the origin is instinctive and affective, appear 
to be less the fruit of their personal reflection than the gift of their 
education. 

Is the idea of God innate ? The religious character of (deaf and 
dumb, and blind) asylums, Catholic or Protestant, naturally gives rise to 
this question. Laura Bridgman appears to have had a vague idea of 
some superior spirit, equivalent in some way to that which is met with 
in primitive religious beliefs. 

The idea of death appears to have been gained by touching a corpse, 
by the horror caused by the cold and rigidity, and by the indignation 
felt at learning that one was oneself destined to the same fate. 

The notion of extent is easily constructed. The blind man, says 
Villey, does not move in a void, as the seeing are inclined to believe. 
He has in his mind a topographical map, which represents the places in 
which he walks, the position of things, and their form and distance. 

The conception of duration appears to have been forgotten by most 
observers. F. Thomas, who almost alone has studied it, says that to his 
deaf and blind patient the future appeared as a long walk—an indefinite 
series of movements of the feet. For the rest, duration is determined 


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by the order and succession of the occupations of the day. This notion 
has a double origin: external and internal sensations, particularly vital 
rhythms. 

It is difficult to study the faculty of invention, the creative imagina¬ 
tion, among such patients. In what concerned practical life, Laura 
Bridgman is represented to us as industrious. It is said fhat “she did 
work of different sorts, which she sold to her visitors in order to provide 
herself with a little pocket-money.” This is very vague. Was it 
invention or imitation ? 

For these patients the field of aesthetics is very limited. For the blind 
from birth the world of colours does not exist, but he has a very rich 
and fine perception and representation of forms. For the deaf-mute the 
world of vocal and musical sounds does not exist. For him, then, there 
is one art suppressed—music, and one might add eloquence. There are 
deaf people who, because they can distinguish musical instruments by 
their vibrations, fancy that they can represent an orchestra to them¬ 
selves. Strange idea of music ! 

It is impossible for us to determine what a brain which, beyond vital 
. sensations and affective states, can only perceive tactile-motor phe¬ 
nomena, would be capable of doing by itself alone, without the clever¬ 
ness and devotion of its teachers—if it had not been, so to speak, 
created a second time, if it had not received from its instructors the gift 
of civilisation. Among such patients, in addition to an organic 
deficiency, there is a social deficiency, because they are not adapted to 
a normal human environment. 

Let us imagine a number of people deaf and blind from birth shut up 
in an enclosure, as the lepers were in the Middle Ages, and having no 
communication with the rest of humanity except what was necessary to 
provide them with means of existence. What would they do? It is 
probable that by means of touch and reciprocal movements they would 
be able to establish some sort of acquaintanceship between themselves, 
some bond, some sentiment of sympathy or of aversion, but it is most 
likely that in spite of their human brains the mental level of this 
assembly would remain below that of societies of superior animals. 

But it is useless to build a psychological romance on a fantastic 
hypothesis. Our object is to discover what the human mind, doubly 
handicapped, but furnished with artificial-methods and with the assist¬ 
ance of others, can know by the single means of its pure tactile-motor 
activity. 

How can one explain the extraordinary development of the modes of 
perception which exist among these patients? One replies, by the 
substitution of sense. Practically, this reply is incontestable and 
sufficient, but it does not teach us the operating cause of this trans¬ 
formation by which the hand becomes the eye, and the fingers “ the 
antennae” of language. This operating cause is a property of living 
beings—adaptation. Since the enunciation of the doctrine of trans¬ 
formation, the importance of this factor as a cause of spontaneous or 
provoked variations has become very great in biology. Better than that 
of Darwin the position adopted by Lamarck, and especially by the Neo- 
Ijtmarckians, can aid us to understand the genesis of “substitutions.” 
The primurn movens is a physiological or psychological need, instinct, or 


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desire—whichever term one prefers. It is not necessary that the effort 
be conscious or subconscious; an unconscious thrust is sufficient, and 
it does many things in vital development. Thus, a variation is con¬ 
stituted. “ Substitution ” is nothing else than variation. 

There can be psychological variations as well as physiological. For 
instance, attention under its utilitarian form is a principle of fixation. 
This may be illustrated by examples. The “ sense of spaces,” the 
“ frontal sense,” mentioned above, exists among many people who do 
not know that they possess it. They could by attention cultivate it, but 
they do not trouble to do so, having at their disposal more practical 
instruments of perception. For sounds, we can, as the deaf, perceive 
them otherwise than by the ears, that is to say, by the feeling of 
vibrations. With some perseverance, in this case also we could create 
an adaptation. But what would be the good of it ? 

Every individual has at his disposal a capital of energy variable 
according to his constitution and the actual conditions of the moment. 
To him who can neither see nor hear, there remains a part of his capital 
which has not been expended by his eyes and ears, and which, being 
turned towards other functions and utilised in other ways, permits of 
new adaptations. 

Taken in its entirety, the case of the deaf and blind from birth gives 
rise to many other problems ; but the writer’s design was to restrict 
himself to a study of pure motor psychology, to penetrate into the 
consciousness, where—with very few exceptions—all is reduced to per¬ 
ceptions of movements, to images of movements, and to combinations 
of movements. 

Stanley Hall, in his interesting study of the case of Laura Bridgman 
(Mind, 1879), makes a remark which the writer says he borrows, 
because it is the resume and logical conclusion of his article : he sees in 
this direct perception of oscillations, as such, a very important fact, the 
most general characteristic of the physical world entering thus directly 
rto the consciousness. J. Barfield Adams. 

The Automatic Meriting of Children from Two to Six Years, Indicative 
of Organic Derivation of Writing in General. [ The Psychological 
Review , November, 1914]. A. Wyczolkowska. 

From the study of the automatic handwriting of children, the writer 
has been able to discover the existence of five different stages in the 
evolution of the writing. These are as follows : 1. (a) Incoherent lines 
produced with obvious timidity and clumsiness in moving the hand ^ 
(b) automatic and unattentive scribbling or chaos of straight and 
concentric lines, limited only by the edge of the paper (2-2£ years). 
2. Circular, perpendicular, and horizontal waving lines, with small 
amplitude but very long phases (2^-3 years). 3. Continuous curves 
with high amplitude, and a notable diminution of phases, with much 
attention brought into the writing exhibit (3-5 years). 4. More or less 
isolated zig zag, with unconscious limitation of letters and symbols of 
the writing in various languages. 5. Conscious imitation of printed or 
cursive writing of adults, mixed with the previous graphic elucubrations. 

From the examination of a number of children the writer concludes 


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EPITOME. 


[April, 

that these stages are invariable, and that it becomes possible to guess 
the age of a child of normal development from a specimen of its hand¬ 
writing. In one case in which a child of four years could only produce 
straight, horizontal lines, the teacher stated that retardation was apparent 
in every other direction. Thus every stage of graphical evolution in a 
child is connected with the corresponding age, in accordance with the 
degree of general development. 

The writer concludes that every child is subject to a graphico 
automatic evolution which to a certain degree helps it to the acquisition 
of trained writing, and extending these views to writing in general, she 
contends that the graphical faculty must have been in the remote past 
the direct cause and source of the impulse which had for its aim the 
beginning of writing in general. 

A further analysis of the various elements in the automatic writing 
of children, and a comparison of the elements with those found in the 
symbols of oriental and modern languages, leads to the conclusion that 
it is essential to recognise in these graphical elements the organic basis 
from which cultural writing has evolved. H. Devine. 


3. Clinical Neurology and Psychiatry. 

The Works of a Paranoiic Artist [/ Lavori di un Pittore Paranoico\ 

(Archivio di Antropologia Criminate Psichiatria e Medicina Legale , 
March-April, 1916.) Sacerdote , Dr. Anselmo. 

In this paper the writer studies the paintings and sketches of Lorenzo 
Pedrone with the. object of pointing out the effect of mental disease on 
the work of an artist. The brief biography which prefaces the article 
is from the pen of Prof. Giacinto Pacchiotti, who in his time was a 
physician of great reputation in Turin. 

Lorenzo Pedrone was born at Alessandria in 1815. His father, who • 
was not well off, obtained a situation in Turin, and Lorenzo was taken 
as an infant to that city. In due time the boy was sent to a public 
school, and appears to have received an excellent education. He was 
passionately fond of painting, and in 1831 became a pupil at the Reale 
Accademia Albertina di Belle Arti. Here he was considered one of the 
best students. However, his father wished him to study for the 
profession of land surveyor. For a time Lorenzo obeyed, but in the end 
the attractions of art overcame those of geometry. 

A correct and elegant draughtsman, a water-colourist justly esteemed 
by all, he found protectors among his former professors, and patrons 
among the nobility and the richer tradespeople of Turin, who sent their 
children to him to be taught drawing. Later, he was entrusted with the 
task of designing the new uniforms for the Sardinian army, created by 
King Carlo Alberto after he ascended the throne. This work was 
carried out by Pedrone in a very masterly manner. 

The remainder of the man’s life appears to have been a failure. 
Little by little he sank in the social scale. He became irritable, and 
envious of everyone. Desperate, without work, without money, he 
sought momentary comfort in alcoholic excitement. He fled from 
everybody, he hated everybody, he suspected everybody. The writer 


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•of the article considers the case to have been one of paranoia, aggra¬ 
vated by alcoholism. 

Lorenzo Pedrone died in 1865 in his fiftieth year. One morning his 
body was found in a ditch near the city poorhouse, half buried in mud, 
-and with the clothing soaked with rain. Death was probably due to 
natural causes, as there does not appear to have been any suspicion of 
either suicide or murder. 

In the possession of Prof. Pacchiotti was an album containing all the 
•designs and water-colour drawings executed by Lorenzo Pedrone during 
the last years of his life, when poor, feeble, humiliated, almost a beggar, 
maddened by alcohol, living in a bare garret, without suitable light, 
•often without proper paper, without models, whom he could not afford 
to pay, often without colours, using rough paper which had served to 
■wrap up cheese, often with only pen and ink, he designed at fancy what 
his intellect, powerful still, though darkening with disease, dictated 
•to him. 

This album is preserved to-day in the Museo Civico at Turin. The 
-writer gives a list, with a full description of each subject, of sixty-three 
of the water-colour drawings contained in the album, and he illustrates 
his article with seven reproductions of the pictures. The subjects of 
many of these water-colour drawings are poverty, misery, death, murder, 
fraud, and other crimes. 

In these pictures the writer considers there are two points which 
should arrest our attention: first, that their conception reflects a state 
of delirium ; second, the sincerity with which the artist has given form 
to the morbid ideas of his imagination. It is this sincerity, he thinks, 
-which sharply differentiates these water-colour drawings of Lorenzo 
Pedrone from the works of the greater number of painters of miserable 
and repulsive things, or of objects suggestive of death—the so-called 

artisti macabri .” Whatever be the perfection of execution, of tech¬ 
nique, or of colour in the paintings of these last mentioned artists, they 
are artificial, and lack force of conception. He likens the work of the 
artisti macabri to a landscape painted from imagination ; that of 
Pedrone to a scene painted from Nature. The one may be far superior 
to the other in technique, but it lacks the sense of life. When one 
thinks of the mural paintings in the Campo Santo at Pisa, one does not 
-altogether agree with Dr. Sacerdote. 

The writer then proceeds to examine in detail the pictures with which 
be illustrates his paper. One represents a dead body lying in an open 
field, and almost entirely covered with snow. The feet—the anatomy 
is fairly good—emerge from the drift, and are bare, save for a little 
snow which lies on the toes and in the hollows between them. The 
composition of the picture and the management of light and shade are 
good. The long grass struggling through the snow in the foreground, 
the clump of leafless trees, laden with snow, on the right, the pollard 
willows in the background, and the birds hovering over the corpse, are 
indicated successfully. 

Another drawing shows us an old woman, who is dozing over a fire, 
suddenly startled by the grinning face of a devil appearing in the midst 
■of the flames. The composition of this picture is not bad, but the 
technique is decidedly so, though the artist has succeeded in conveying 


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276 EPITOME. [April* 

the idea of terror into the attitude of the woman’s figure. In this 
work the writer sees a faithful representation of one of Pedrone’s own 
terrifying and demoniacal hallucinations. 

In a third drawing we see Macbeth listening to the witches. The 
main figure is stiff and awkward, but the idea of listening is well 
indicated, though with a certain amount of conventionality. The writer 
admits that this picture is less significant than some of the others, 
because its inspiration does not come from Pedrone himself, but he sees 
in it the imagination of one who suffers from hallucinations of hearing, 
of one who is tortured by “ voices.” 

The best picture of the series represents a maniac behind the bars of 
his cell. The drawing is excellent. The face expresses acute delirium. 
As the writer says, no one could mistake the man for a sane prisoner 
craving for liberty. Prof. Pacchiotti informs us that this picture is the 
portrait of an insane patient actually seen by Pedrone. 

Then follows a ghastly representation of a gravedigger sitting at a 
table in his cottage, gnawing a human bone. The physiognomy of the 
man is at once stupid and ferocious. The pose of the figure is natural, 
and the anatomy and foreshortening of the limbs are fairly good. The 
table at which the man is seated is badly drawn and out of perspective, 
but the drawing of the worn steps of the staircase in the foreground,, 
and of a barrow on the right is good. Through an open door in the 
background one catches sight of the graves in a cemetery. The light 
and shade are badly managed, and the artist has failed to give the idea 
of depth. Taken as a whole the picture is very faulty. 

The next sketch represents Death carrying away a coffin in a two¬ 
wheeled cart. The anatomy of the galloping horse is fairly good. The 
figure of Death is indistinct, but the writer thinks that the artist has 
succeeded in indicating indifference (in the attitude, I suppose) and 
irony in the fact that the figure is smoking a short pipe. The snow- 
covered landscape is well drawn. On the whole the picture is good, 
and the writer thinks it is of importance as demonstrating the persistence 
of the idea of death in the artist’s mind. 

The last reproduction of the water-colour sketches represents a 
murder, and is very bad both in technique and composition. 

The last of the series of prints which illustrate the article is the 
reproduction of a portrait of Prof. Pacchiotti by Lorenzo Pedrone. 
The portrait was painted before the decadence of the artist’s powers, and 
is reproduced to give a specimen of his better work. It is certainly 
good. The expression is natural, and the modelling is excellent. 

The writer points out that front the point of view of technique the 
water-colour drawings in Pedrone’s album are very imperfect, but that 
this imperfection is partly due to the deficiency of means—paper, 
colours, etc.—during the artist’s days of poverty, and partly to physical 
and psychical alterations in his condition. The portrait of Pacchiotti 
gives us an idea of the excellence of his work in his earlier, happier, 
and healthier days, and thus serves as a standard by which we can 
measure the extent of his decadence. “ When then we see,” says the 
writer, “ that technically the work of Pedrone went from bad to worse, 
and that the artist reconciled himself to considering as finished these 
little pictures (the water-colour drawings in the album), which most 


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certainly he would have repudiated in earlier times, we may conclude 
that the level of his aesthetic criticism had become lowered.” Here it 
seems that the writer assumes a little too much. No evidence has been 
produced that Pedrone did consider a sketch made on a scrap of rough 
paper, which had just been wrapped about a piece of cheese, as a finished 
picture. At the same time, if he had done so, one quite agrees that 
such a blunting of the aesthetic sense would be natural in the case of a 
paranoiic and alcoholic artist, and would be due to the failing of the 
power of auto-criticism. 

The writer passes on to the consideration of another matter. It is 
natural that the productions of a paranoiic artist, who suffers from 
hallucinations, should be representations of these hallucinations. We 
concede the point, but not the converse, namely, that the painter of 
every weird and eerie picture is a paranoiic. And the writer himself is 
more than half inclined to agree with us. If we walk, he says, through 
galleries filled with the works of painters and sculptors of every degree 
of fame and of every form of culture, we are impressed with the fact 
that a large number of the subjects of the works of art represent death, 
hell, devils, witches, and every form of human sadness and vice. Are 
we then to conclude that all the artists, who produced these works, 
were suffering from paranoia or some other form of mental disease? 
The writer might have narrowed the scope of his question, and emphasised 
the answer, if instead of visiting the great public galleries, he had gone 
to the Campo Santo at Pisa, previously referred to, where the true artisti 
macabri reign supreme. The subjects of the mural paintings which he 
would have seen there are weird enough in all conscience—“The 
Dance of Death,” “ The Triumph of Death.” But were the painters of 
these many figures—some strange and grotesque, and others of exquisite 
beauty—all insane ? Was Orcagna a paranoiic? 

Max Nordau affirms that “Art is a slight, initial deviation from 
perfect health.” The affirmation is open to discussion. 

The writer considers that to form a psychological valuation of any 
work of Art it is necessary to have a perfect acquaintance with all the 
conditions of the artist’s time, place, and surroundings, his artistic 
education, the obstacles he has surmounted, and the troubles and joys 
which he has met with on his way; in short, a minute and anecdoted 
biography, gathered together and explained by anthropological criticism. 
So one could determine—without employing the hypothesis of an 
abnormal psychical activity—the origin of the inspiration of many 
works of art on sad and repulsive subjects. It will be generally found 
that the choice of such subjects is due to religious or superstitious 
conceptions, occasionally to a transitory state of the artist’s mind. 

All through the latter part of the article one sees that the writer is 
trying to free himself from the influence of Lombroso. But he cannot 
do so entirely, and his oscillations are amusing. Because some geniuses 
are diseased, it does not follow that disease is the cause of genius. 
Disease modifies the brilliancy of genius in precisely the same way as it 
modifies the stolidity of the average man. 

It will, I think, be admitted that if is more difficult to read the mind 
of an artist in his paintings than that of an author or a musician in 
their respective works. It may be easy to perceive Fra Angelico’s 

LXIII. 18 


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saintly mind in his heavenly scenes and angels’ faces. But what about 
that old rascal, Fra Filippo Lippi? Do not his saints and madonnas 
also speak of beatitude and innocence? Yet I must confess, and in so 
doing 1 weaken my argument, that I remember a little angel who looks 
out of the corner of one of his pictures—it hangs, I think, in the 
Uffizi Gallery at Florence—whose face wears an expression of sheer 
naughtiness. 

With regard to the works of Lorenzo Pedrone, and the indications 
which they give, or are supposed to give, of the mental condition of the 
artist, the writer would probably have strengthened his argument if he 
had given us some idea of the chronology of the water-colour sketches. 
If the picture of the maniac behind the bars of his cell were among the 
lirst of the series, and that of the old woman frightened by the apparition 
of the devil among the last, one would appreciate much more readily 

the decadence of the painter’s skill. J. Barfield Adams. 

• 

A Question of Epileptic Dementia with Recovery. ( Journ . Ner. and 
Ment. Dis., December , 1916.) Thom., D.A. 

The patient, who was admitted to a Massachusetts State Hospital at 
the age of 37, had had one convulsion during teething, and during 
early life was sensitive, easily offended, quick tempered, and inclined to 
seclusion—revealing general traits of the epileptic temperament—before, 
at the age of 20, attacks of petit mal occurred, passing three years later 
into grand mal convulsions of serious type. For a period of thirteen 
years he had convulsions almost daily. He became mentally confused 
most of the time, and had fixed ideas of persecution by his family. 
For the first two years after admission to the asylum he was able to do 
work involving a certain amount of ability and intelligence. But, on the 
whole, during the first seven years there was a slow progressive mental 
deterioration, and at the end of the fourth year he already showed 
symptoms of dementia, inability to do any kind of work, loss of 
orientation, apprehension, and apperception, complete clouding of con¬ 
sciousness, failure of memory for both recent and remote events, un¬ 
clean habits, and inability to feed himself, while there were occasional 
outbursts of impulsive violence. This phase lasted for three years. Then, 
after a series of convulsions of unusual severity—sixty-nine in twenty-four 
hours—the patient became comatose, death seemed imminent, and the 
iast rites of the Church were administered. Next day the convulsions and 
the general condition began to improve. Three weeks later he was up 
and about, gaining flesh, free from fits, showing much mental improve¬ 
ment, tidy in his habits, and able to dress himself. Three months later 
he had his last epileptic seizure. In the three following years up to the 
present there has been continuous physical and mental improvement, 
although the original epileptic personality remains pronounced ; he is 
irritable, impulsive, fault-finding, and hyper-religious. Even in these 
respects, however, there is a continuous improvement. He works at 
gardening faithfully and intelligently, is an excellent penman, shows 
unimpaired memory, bordering indeed on hyper-amnesia in its reten¬ 
tiveness, can discuss general questions intelligently and politely, and 
possesses quite normal powers of attention and concentration. 


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The author criticises Bolton’s and Turner’s definitions of dementia, 
•diagnoses the case as epileptic dementia (on Tuke’s definition) with fair 
recovery, and concludes : “ It seems that it is time to settle the question 
of the permanency of dementia, and, if we are to consider it due to 
irreparable cortical changes, to refrain from using it in the acute con- 
fusional states which go on to recovery. That is, separate in a clinical 
way the functional from the organic. The present case is an excellent 
■example where such a distinction would be of value.” 

Havelock Ellis. 

Prophylaxis and Therapy of Moral Diseases \Profilassi e Terapia delle 
Malattie Morali\ (Archivio di Antropologia Criminal* Psichiatria 
e Mediciha Legale , July-August, 1916.) Ratio, Dr. L. 

This paper is very disappointing. Carried away by his reverence for 
Osare Lombroso, the writer drifts hopelessly away from his subject. A 
firm believer in the “criminal type” (il tipo del delinquente-nato), he is 
■vexed with Carrara and Ottolenghi for the attitude which they have 
assumed towards this pet invention of the master, and he is almost 
-angry with a certain English commission which, after mature examina¬ 
tion, denied its existence altogether. 

This commission was composed of English physicians and anthro¬ 
pologists who carried out an inquiry in English prisons on more than 
3,000 prisoners, who were examined anthropologically, photographed, 
and weighed and measured with mathematical precision and an identity 
of method. 

From these examinations were collected ninety-six data on the facts 
of the life and person of each prisoner. These data were more than 
•sufficient for a conclusive study of the physique of the delinquent, and 
•the conclusion arrived at by the English commissioners was that no 
physical characteristics exist by which the criminal (as such) can be 
^recognised by bodily examination, and that there are no special 
stigmata by which the various classes of criminals—from assassins o 
thieves—can be distinguished from the most honest of citizens. 

But the English Commission, says the writer, puffed up by success, 
(permitted itself to draw an arbitrary induction from these collected 
data, namely, that there does not exist any moral stigmata, beyond a 
•certain natural stupidity which appears as a constant coefficient of 
crime. Hence it was concluded that the delinquent is neither a creature 
sui generis, nor abnormal, but simply an “ unusual ” specimen of 
“ normal huma'nity.” The difference between the delinquent and the 
honest man is therefore not a question of physical strength, height, 
weight, or mental capacity, but of moral weakness in the face of criminal 
temptation. Such moral weakness is not due to morbid or unnatural 
-conditions, nor to atavism, but to the fact that the individual follows 
the line of least resistance. I doubt whether at this point Dr. Ratto 
has quite caught the ideas embodied in the English Commissioners’ 
conclusions. Surely, every man who follows the line of least resistance 
is not a criminal, nor a potential criminal! 

Then an extraordinary position is taken up by the writer. He professes 
<to believe that the English Commissioners were influenced in their 


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conclusions by a desire to preserve intact the theological dogma of free 
will. Anthropometria and biometria, he exclaims, will never prove 
anything for or against the doctrine of free will ! Certainly, one agrees 
with him. 

With much that the learned writer says in the concluding paragraphs 
of his paper concerning the influence exercised by Lombroso directly 
and indirectly on the amelioration of the lot of the criminal one is 
thoroughly in accord. The debt that anthropology, sociology, philan¬ 
thropy, and legislation owe to the great Italian criminologist is enormous. 
Even the debt that literature owes to him is very great, for all those who 
have read his works will readily admit that he is one of the most charming 
of writers. But many of his theories have not stood the test of time. 
He had the fatal habit of not pausing to verify his facts. He was ever 
too ready to take them second-hand. For example, in theorising as 
to the relationship between genius and epilepsy he accepted with child¬ 
like faith the anecdotes related by that dear old gossip, Moreau de 
Tours, who in gathering them together exercised as much discretion and 
historical criticism as that employed by monkish chroniclers in the 
Middle Ages. J. Barfield Adams. 


4. Sociology. 

Medico-legal Aspects of Mental Deficiency. ( Medico-legal fount., May, 
1916.) Gordon, Alfred. 

The author, who is Neurologist to Mount Sinai Hospital, Phila¬ 
delphia, here deals with the responsibility for illegal acts committed by 
individuals who, though not insane in a strict sense, are different from 
normal individuals in power of reasoning, as well as by sentiments, 
tastes, sympathies, etc. There is a long scale of such psychic deviations, 
beginning with mental monstrosities, and ending with slight mental 
feebleness. • Idiocy and imbecility are here excluded. The large group 
of mental feebleness is one step higher than the imbecile, and its study 
is of much greater importance, from a sociological and legal standpoint, 
than that of idiocy and imbecility. The varieties and sub-varieties are 
many, and the transitions imperceptible. This is the most important 
chapter in the study of mental deficiency, for the number of these 
individuals is legion, and we are constantly meeting them, on school 
benches and in practical life. Their influence is frequently injurious to 
the community. 

The author regards insufficient intelligence as primary in these cases, 
and moral obtuseness as secondary. Intelligence exerts enormous 
influence in moulding moral personality. Obtuse moral consciousness 
thus appears as a chief characteristic of the feeble-minded (apart from 
idiocy or imbecility). Through lack of judgment and of will the 
character is weak, unstable, lacking resistance, and an easy prey of 
passions. Most of the symptoms gravitate round the ego. The chief 
characteristics are egotism, envy, jealousy, defiance, doubt, anger, 
hatred, and impulsive manifestations, such manifestations being the 
expression of lack of control of ideas over passions. 

The application of any legal test of “ right and wrong ” is unjust and 
scientifically inaccurate in these cases. We are dealing with quantitative 


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deficiencies inherent to the individual, with an inaptitude to acquire 
knowledge and to perform complex mental operations, and particularly 
with an inherent deficiency of inhibitory power. Such individuals may 
be aware the act they commit is wrong and punishable, and yet by 
nature of their mental inferiority they are not totally accountable. The 
test of right and wrong is bound to be disastrous so far as the adminis¬ 
tration of justice is concerned. The responsibility must be regarded as 
'limited. 

Penal legislation must be combined with legal medicine to constitute 
a sound criminology. By the union of the two sciences narrow 
conceptions of liberty and responsibility will be destroyed and progress 
assured. A broader and less technical attitude is necessary. The 
degree of responsibility must be established in accordance with the 
essential features of the mental status of the particular individual. The 
author views with satisfaction the extent to which the conception of 
■limited responsibility is gaining ground in the penal codes or projects of 
Norway, Switzerland, Russia, Germany, Austria, Japan, and Siam. 

Havelock Ellis. 


5. Asylum Reports for 1915. 

Some English County and Borough Asylums. 

Carmarthen. —Ill-fortune seems to have dogged the steps of this 
authority. After many years of worse than inconvenience from con¬ 
flict of views on the part of the contributing County Councils and after 
much animadversion on the part of the lunacy authorities a satisfactory 
rearrangement was come to, and the way was clear for the provision of 
fresh accommodation to meet pressing need to provide more and better 
accommodation for the inmates. Then came the war and all progress 
was stayed by the Government. Urgent representations were made 
successfully, and the contract was allowed for the laundry work to 
proceed. But the Committee could not obtain the necessary authority 
to equip this addition. The Committee had in hand certain monies 
wherewith to make alterations or repairs on some newly acquired 
property, but the application of these monies was vetoed also by the 
Government. Further, the Committee has had to receive some Cardiff 
patients, and the asylum, which was provided for 600 patients, was 
overburdened to the extent of more than 167 inmates, or 25 per cent. 
in excess. Nevertheless, the patients are not found to be seriously 
prejudiced by the overcrowding. This is by no means an uncommon 
experience and speaks well for the skill with which difficulties have been 
overcome. The recovery ratio on direct admissions was 39’ r. 

Dorsetshire .—The report chronicles the retirement of Dr. MacDonald 
after thirty-three years of work here. The Committee acknowledge his 
services in handsome terms, most deservedly so in our opinion. Among 
several important changes worked by him the provision of complete and 
independent accommodation for private patients standsout pre-eminently. 
From the professional point of view little can be said beyond that while 
the recovery rate on direct rate paid patients was 32'75, that for the 


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private cases was 4186, while the death-rates were respectively 12 33, 
and 10 63 on the average residence. The average residence numbers 
were 665 rate-paid and 254 private cases. Of course before any useful 
conclusion can be arrived at from these bald figures, many other relevant 
facts would have to be enumerated. In congratulating Dr. Peachell on 
his succession to the honourable position of medical superintendent of 
this institution, we venture to suggest to him that he might confer a 
considerable obligation if he at some future time worked out some- 
comparisons of the factors and results of the two classes of admissions. 
Given the general direction of environment and treatment by one brain,, 
the study of such factors as eaily resort to treatment, the classification 
of mental disease, the aetiology, condition of physical health, and so 
forth could hardly fail to be-fruitful. There can be little doubt as to the 
financial results of admitting private patients. We find that the latter 
brought ^, 23,631 into the asylum chest surpassing by ,£2,500 the returns- 
of all classes of rate-paid patients. We note, too, that no less a sum 
than ,£10,471 was transferred from the maintenance account to the 
building and other accounts. The average payment for the private 
patients was just under ^90 per caput. 

Essex County, Brentwood .—By far the most important portion of 
this report is that which deals with the clinico-pathological and patho¬ 
logical work carried on by Dr. Turner on the lines described by us last 
year. We again wish to emphasise the immense value of the exhaustive 
and minute observations recorded by him. We have nothing of the 
kind in this country. It is impossible to do more than to refer to one 
or two points, but the whole report is worth the most careful considera¬ 
tion by pathologists, those engaged in general work as well as those 
attached to mental hospitals. The accumulation of this careful observa¬ 
tion will found a sure basis for advance in pathological science. 

In one case of general paralysis the protein reaction and the Wasser- 
mann reaction of the cerebro-spinal fluid were negative; there was a 
slight lymphocytosis, and the blood gave a positive Wassermann 
reaction. This man, who it is evident from the blood-test had been 
infected with syphilis, had grandiose ideas and other symptoms sugges¬ 
tive of general paralysis, died, but histologically there was no evidence 
of this disease. 

The lesions of the brain in general paralysis are in many cases extremely 
localised. In one male this year (No. 25,656), in which'pieces of tissue from the 
prefrontal, the right paracentral, the left conjoined ascending frontal and ascending 
parietal, and the cerebellum were examined, the only one of these regions which 
showed the characteristic change was the prefrontal, and here the changes were- 
of a very marked degree of intensity. In one of the women (No. 24,691), from 
whom similar parts were examined, it was also only in the prefrontal that the lesions, 
were found. 

One male case (No. 25,558) presented very anomalous symptoms, and was not 
diagnosed during life : a man, ret. 54, admitted with a history of alcoholic excess. 
The certificate stated that he was vacant and lost and incapable of intelligent 
conversation. He had been a potman, then a milk carrier, and two months before 
his admission was engaged as a gardener but found to be useless, as all he seemed 
able to do was to sleep. If handed flower pots he dropped them, and he would 
go to sleep whilst taking his breakfast. When admitted here he walked into the 
ward, undressed himself, got into bed, and promptly went to sleep. After a few 
days he became restless and resistive, and died within four months of coming here. 


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He presented none of the usual mental symptoms, and very few of the physical 
associated with general paralysis. If he had lived in tropical climates one might 
have suspected him to be suffering from sleeping-sickness, a disease due to a 
trypanosome infection, in which the anatomical picture in the brain is almost 
precisely the same as in general paralysis. 

It will surprise many to read that in 24 per cent, of 87 males and 29 per 
cent, of 156 females the foramen ovale was found to be patent. This 
condition was most common in general paralytics, below the average in 
imbeciles. Among the male dementia praecox cases, nine in number, 
it was not found, but in 28 females it occurred 8 times. No suggestion 
is made. In three wortien and two men where the foramen was patent 
the age was approaching or upwards of eighty at the time of death. 

In regard to the suprarenals the following is reported of a female 
case : 

The right gland as the seat of hcemorrhage .—This last was a case of hebephrenic 
dementia prsecox, set. 18 (No. 25,496), who died rather suddenly and unexpectedly, 
and at the autopsy no visible pathological lesion was discovered except a haemor¬ 
rhage into the right suprarenal, which was slightly enlarged and firm, and looked, 
when cut across, Like a piece of damson cheese. No lipoid was to be seen in the 
cortical cells, and no difference in appearance between them and the medullary. 
On microspical examination of the gland all the medullary veins were found to be 
either blocked or partially blocked by laminated clot, enclosing in its meshes only 
very few leucocytes. The gland-cells were necrosed and shrunken, and everywhere 
between them was an extravasation of red blood-cells, as also in the connective 
tissues surrounding the gland. In the cerebellum there was a very marked hyaline 
degeneration of the arteries with thickening, almost or quite in places obstructing 
the lumen ; but elsewhere, that is to say in those regions examined (cerebral 
cortex, three regions—liver and kidney), no structural alteration of the vessels was 
noted, but the hepatic veins showed abundant laminatal intravascular clot. 

One is tempted to assume that in this case the clotting was brought about by the 
entrance of adrenalin into the veins, which would cause a rise of blood-pressure 
that might lead to rupture of the capillaries. 

The systolic pressure of this girl on admission a few months before was normal, 
but no record was taken just before her death. Anyhow, the above appears to be 
a feasable explanation of the rupture in her case, and as haemorrhage into the 
suprarenal is stated to be a cause of sudden death, it was returned as the immediate 
cause of her death. 

Glamorganshire. —Dr. Finlay, in his xtiological tables, of which every 
one in the statistical scheme is kept up to the full, cannot trace 
any striking alteration from the records of former years. So far war and 
its horrors seems to have left no mark on the production of insanity. 
He points to some increase in alcoholism as a factor among the 
female admissions. We note that if the war has not led to increase 
of insanity, it has not brought about any decrease among the men by the 
fact that so many of the male population have been taken away to the 
Colours. 

London County .—Of the many reports received this year that of 
the London County Asylum Committee shows the most marked war- 
shrinkage. Instead of a portly volume it does not even amount to a 
pamphlet; but consists of five pages only. Nevertheless it contains 
matter of interest. We are glad to see an undertaking to bring up 
information when more normal conditions exist, for it would be an 
immense loss to asylum science if later on there should be any consider¬ 
able gap in the statistical work of a body like this, work valuable from 


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consistence and enterprise, with much light thrown on it by the 
analytical powers of Mr. Keene. 

The first point we note is an appreciable decrease in the insane 
population of the area. This decrease does not apply only to the 
asylum, but also to the patients in the Metropolitan Asylum Board’s 
institutions, and even to lunatics in workhouses or with friends. The 
total decrease in the year 1915-16 amounted to 950, of which 637 
related to the asylum, and when this is contrasted with the 26-year 
average increase of 458 (415 in the asylum) it is evident that impor¬ 
tant changes have been at work, which the ordinary accidents and 
happenings will not suffice to explain. Of course the mere closing, for 
war purposes, of such a large asylum as Horton would tend to decrease 
the available space for cases which were not urgently acute. But if 
this were an important factor, operating on the relative population of 
asylums, the Metropolitan Asylum Board’s asylums would respond by 
showing increase, whereas, as said, there is a marked decrease. The 
number of admissions, discharges, and deaths are not stated. The 
relations of these factors to each other would, no doubt, suggest 
the method in which the decrease was brought about, but would not, 
of course, give the real reason. 

The principal facts relating to the use of Horton as a war hospital— 
the expenses of which are chargeable to the Government—are as follows : 

Between May 20th, 1915, and March 31st, 1916, 7,734 sick and 
wounded soldiers have been admitted, of whom 5,997 have been dis¬ 
charged and 1697 remain. The asylum buildings proved most adaptable, 
and have made an admirable general hospital. The nursing has been 
mainly done by females, but such as were left of the male staff of 
the asylum became porters and assistants. The maintenance of 
the patients cost ^127,000, and this, of course, was paid by the 
Government. 

The Maudsley Hospital filled the covetous eyes of the military 
authorities, and was taken over by them, as well as the house, which 
had been secured for the nursing staff. At first, by the desire of the 
same authorities, the building of the pathological section was postponed, 
but they changed their mind again, and it is in their possession. Of 
course the consent of Dr. Maudsley was asked before the hospital was 
handed over, and he generously accorded it. We must, however, all feel 
much sympathy with him in the great disappointment entailed by delay, 
in the complete evolution of his great idea. 

Metropolitan Asylu?ns Board .—The report of this authority has, as 
might have been expected, shrunk to very small proportions, having 
shed most of its highly detailed statements. But it contains the sub¬ 
joined note about Darenth, which conveys some idea of how the bene¬ 
ficent training has been carried on. Not the least interesting item is 
that which shows how, by reason of training, the school has even con¬ 
tributed recruits for the army. 

The success of the workshops is the more remarkable, since a very 
large proportion of the training-staff joined the Colours. 

" The industrial work done by these patients in the workshops provided for the 
purpose was valued at £17,939. In addition, articles to the value of £<ya were 
made by the children in the schools section. Most of the goods were used in the 


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several institutions. Among the classes of work on which patients were employed 
were printing, bookbinding, and paper-bag making, brush and basket making, 
shoemaking and tailoring, mat and rug making, and toy making. On this aspect 
of the work the following remarks by the Medical Superintendent of Darenth 
Industrial Colony are worth recording : 

"With the opening of the extensions of the workshops at the male side it 
became practicable to undertake the manufacture of toys, and this has been 
carried on during the war with marked success. It provides a new type of 
work, at once interesting and lucrative, which has been taken up with 
enthusiasm by the patients, and it is already making demands on our resources 
in the way of floor space and power which cannot be fully met. Since the toys 
are almost entirely made from waste materials, it is very desirable that supplies 
of these from the Board's institutions generally should be forwarded to 
Darenth, where a use can be found for such articles as boxes, tubs, tea chests, 
felled trees or large branches of trees, old American cloth, off-cuts of tapestry 
or cretonne, old leather belting, cotton reels, wall-paper pattern books, 
feathers, condemned skin mats, brooms, and brushes. About 3,000 toys, 
which were sold for a sum approximating to £160, were disposed of in this 
first year of working. Taking all the industries for adults into consideration, 
the working of the past three years is shown in the following table : 


Year. 

» 9*3 • 

I9J4 . 

> 9*5 • 

“ The fall in the proportion of profit suggests that the prices credited to the 
colony for articles made should be revised in the light of the general increase 
in market values. If this were done the figures representing the turnover 
would be even more satisfactory. 

" 23. During the year 73 cases were discharged from Darenth Industrial Colony 
to the care of the guardians, and 31 from Bridge Industrial Home. Of these, 23 
«ntered the army. The total number of discharges during the previous year was 
46 only. This increase, says the Medical Superintendent of Darenth, 

is an expression of the alteration which has been caused in the economic 
position by the war. Among the patients at Darenth are many who are close 
to the vague boundary line which separates unsoundness of mind from what is 
regarded as a normal mental state. With the existing demand for labour 
places can be found for workers who hitherto have been unable to hold their 
own, while in the case of certain of these the control and guidance necessary 
to make good their defects of will and initiative can be provided by military 
service. Present-day conditions have enabled several of the inmates to become 
self-supporting, while the deficit in labour at other institutions of the Board 
has to some extent been made good by the transfer from Darenth of working 
patients." 

Wiltshire. —At Devizes Dr. Cole reports a marked decrease in direct 
admissions. A large number of Bristol patients transferred under the 
War Office scheme led to much overcrowding. However, in spite of 
that, the recovery ratio was increased and the death ratio decreased. 
The decrease in the direct admissions was shown in the females as well 
as the males. Wiltshire is in the peculiar position of containing in its 
-area the great war camps on Salisbury Plain. From these, two out- 
county soldiers and two civil strangers (connected with the camp) and 
four Wiltshire soldiers were among the direct admissions. Dr. Cole 
points out that possibly other Wiltshire military cases may have been 
«ent elsewhere, but is firmly of the opinion that the occurrence of 
Wiltshire lunacy had decreased in the year. The recovery rate, as 
between direct recoveries and direct admissions, was 42 per cent. 


Value of goods made 
and disposed of. 

£ s. d. 

. 14,251 o 5 
, 18,439 18 11 

■ 17.939 8 9 


Profit. 

£ J. d. 

2,078 O O 
1,748 8 5 

i ,692 8 5 


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Yorks , West Riding. —Dr. Shaw Bolton has to' record that 552 
patients from Wadsley were transferred to Wakefield, but in spite of 
that tremendous addition after a time there was no very appreciable 
overcrowding, the generous allowance of space in the Acute Hospital 
permitting of arrangements being made to meet the occasion. But he 
records also that a great number of the transferred patients were feeble 
and bedridden. The incidence and fatality of dysentery, and, to a 
small extent, of typhoid fever, was a demonstrable and, indeed, expected 
sequence. In this sense the war may be regarded as an indirect factor 
in the increased death-rate. Dr. Bolton writes on the effect of large 
transfers of patients : 

“ It was possible clearly to show that the increased incidence of 
dysentery during the year 1915 bore no relationship whatever to the 
local overcrowding of the asylum which occurred. It may, indeed, be 
regarded as certain that epidemics or exacerbations of disease occurring 
after extensive transferences of patients are due to the dissemination 
amongst groups of individuals of strains of dysentery and typhoid 
bacilli, which possess for them a pathogenicity higher than that of the 
strains to which they have been accustomed.” 


Some Registered Hospitals. 

Barnwood .—The Committee most liberally made an offer to receive 
some private patients from some public asylums when the latter were 
converted into military hospitals. The conditions of reception were 
that the patients should be mentally, socially, and otherwise similarly- 
treated, and at the same charge, as at the asylums they were leaving. It 
is needless to say that this beneficent offer was accepted with much, 
appreciation. 

Reviewing the difficulties of aetiology, the just appreciation of 
individual factors, Dr. Soutar asks why is it that, if such factors are 
causal factors of insanities, only one individual here and there succumbs^ 
while the many prevail over the factors. He naturally suggests inborn 
tendency to development of mental disorder under stress as the probable 
answer. Then comes the further problem* why is this tendency only 
effective in a very small minority of those to whom it is handed down? 
We can suggest two solutions. First, can we ever assume that precisely 
the same factors can be found acting with exactly the same force in any 
two cases in each of which the hereditary tendency occurs ? The fact 
is that however strong positive evidence there may be of certair* 
aetiology there must be any amount of negative evidence lost to sight. 
We can see with a fair amount of confidence that a certain factor tended 
to cause the breach in sanity, but it is absolutely impossible to ascertain 
the non-transmitted weaknesses and failures which permit the breach. 
These latter go back to the earliest moments of life, and may be 
represented to some extent perhaps in the term environment, but their 
origin cannot be recalled at the time of the breach. Then there are 
the accidents of life—the opportunities, the friendships, the helping 
hands, and so forth which do much to determine the course of life in 
the individual. In this direction we suggest that there can often be 


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found the reason why of two cases having equal evil tendency one is 
taken and the other left. Yet again, are we to assume that among the 
offspring of a given pair the tendencies, whatever they may be, are 
handed down in equal force to each ? Can we believe that the pro- 
creative powers of the parents are at all times constant in the begetting 
of health or unhealth ? With regard to aetiological factors, we must 
recognise that they are individually elusive and untrustworthy, and that 
an aetiological table must not be read as a thing of scientific accuracy, or 
even as approaching that accuracy. But it has a very definite practical 
value in enumerating certain factors which are more or less often found 
in close relation with the occurrence of insanity, and which therefore 
require close watching and strenuous resistance if we desire to arrive at 
the highest mental vitality, whether in the individual or the race. 

The Retreat, York. —Dr. Bedford Pierce, in pursuance of his claim 
that cases of incipient insanity should be admitted into mental hospitals 
without certificates, points to the fact that a large number of shell-shock 
and other forms of mental collapse on active service are being treated 
in special hospitals without certificates, and he hopes that the advantages 
of this will be so clearly demonstrated that before long such facilities 
will be extended. He scores a good point here. 

As an instance of how patients can be got to do work if they are 
allowed to earn a small sum in this manner, he relates that a gentleman 
patient has made a plan of the grounds after a careful survey, and 
further, has made a plan of the estate in which all forest trees are 
numbered to correspond with a list in a tree-book which he has made. 
There are a great variety of trees on the estate, some of which are rare. 


Some Institutions for Idiots. 

Royal Earlswood Institution. —This most deserving establishment is 
undergoing a strenuous time. The subscriptions and legacies have 
been diverted to an alarming extent, notably on account of the many 
cries which have gone up from other bodies for financial help on account 
of the war. It would indeed be disastrous if, after seventy years of 
meritorious pioneer work, its progress were crippled by forgetfulness or 
lack of appreciation. 

Both the Committee and Dr. Caldecott deplore the change of legis¬ 
lation governing the institution, which results in the absorption of an 
enormous amount of time in making returns and' other work. As an 
instance, Dr. Caldecott says that the county magistrates spent six days 
of five hours each in re-certification of the patients, and this has to be 
gone through again this year. The regulations, rules, etc., of the new 
Act are more stringent than those of the Lunacy Acts, and he states 
that >t is more difficult and more expensive to place a poor idiot or an 
imbecile in an institution than it is to place a dangerous lunatic in an 
asylum. 

His colleague, Dr. Stephens, has done excellent service by the scien¬ 
tific work, the results of which are appended. 

The following is a summary of the results obtained : 

(1) The serums of 100 male patients were examined, and the reaction was found 


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to be definitely positive in 12, weakly positive in 16, and doubtfully positive 
in 14. 

(2) The reaction was found to vary with age, being strongest and most frequent 
in patients between 16 and 21 years of age; and stronger and more frequent in 
those below 16 than in those ahove 21. 

(3) In 72 per cent, of Mongols the test was negative. 

(4) Of the three cases of hydrocephalus examined the reaction was negative in 
two, and doubtfully positive in the third. 

(5) Of the four Cretins examined, the reaction was negative in two, definitely 
positive in one, and doubtfully positive in the other. 

(6) A positive reaction was obtained in 4f2 per cent, of epileptics, and in 22 per 
cent, of non-epileptic cases. 

(7) About 30 per cent, of cases of simple amentia were positive. 

The Royal Eastern Counties Institution. —Dr. Turner, in addition to 
worries caused by loss of staff, of difficulty in obtaining provisions and 
other troubles, has had to deal with very serious epidemics among the 
children. Referring to a virulent onset of scarlet fever, he announces 
a fact that is not generally known, viz., that the incubation period of 
scarlet fever is often longer in mental deficients than is found in general 
patients, and appears to extend to twenty-two or twenty-three days. 
Among fifty-two attacked with virulent measles, no less than ten died, 
while in two others fatal, tuberculosis was lighted up. 

The following is an extract from the Report of the Committee: 

“ The Mental Deficiency Act has been in force now for nearly two years, and 
a closer acquaintance with its provisions has unfortunately confirmed the original 
opinion of the Board that the many restrictions and the great mjiltiplicatio.n of 
forms and reports have thrown a heavy burden of work on the institution. The 
supporters of the institution will remember that this Act confers on County 
Councils certain powers enabling them to deal with a number of defectives. The 
Board have followed out the policy outlined in their last report, namely, that of 
placing all beds that owing to lack of subscriptions could not be filled by elected 
patients at the disposal of the' local authorities of the four eastern counties— 
Essex, Suffolk, Norfolk, and Cambridge. The Board have refused all other offers 
made by authorities outside the eastern counties, and they conceive that this 
policy truly fulfils the purposes for which the institution was founded. They 
have endeavoured to allot the vacant beds fairly and in proper proportions to each 
of the four counties." 


Some Scottish Chartered Asylums. 

The Crichton Royal Institution. —A notable feature here is the large 
number of voluntary patients, who constituted about 7 per cent, of the 
residents. But during the year they made up 11 per cent, of the 
admissions and 26 per cent, of the discharges. The Lunacy Law of 
Scotland was wise enough to provide that a voluntary patient requesting 
to leave should give seventy-two hours’ notice. The twenty-four 
hours’ notice required by the English law is all too short in the interests 
of a patient who requires to be taken care of. 

The pathologist, Dr. Cruickshank, has joined the military forces, and 
has been appointed to a mobile laboratory in France. Some of the 
results of work done by him at Dumfries have already appeared in the 
Journal of Mental Science. Fortunately it was found possible to induce 
Dr. Thompson, Professor of Physiology in Trinity College, Dublin, to 
step into the gap, and continue the routine and research work in the 


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laboratory. Beyond that he has undertaken some most important work 
on his own account 

“ Prof. Thompson, with the aid of the excellent equipment of the laboratory, 
has been able to bring to a successful conclusion an important biochemical investi¬ 
gation which he had begun in Dublin, the results of which are to be published 
shortly. A substance named creatine occurs in the muscles of our bodies, the 
use of which is not known, nor do we even know from w'hat it is formed. Prof. 
Thompson has found, however, that when a substance called arginine, which enters 
into the composition of most articles of diet and which is chemically related to 
creatine, is injected into the veins or beneath the skin of animals, it will give rise 
to'an increased formation of creatine. Thus one of the modes of origin at all events 
of cYeatine, the chemical source of which has long puzzled physiologists, has been 
definitely settled. In connection with Prof. Thompson’s important discovery at the 
laboratory, it may not be without interest to recall that the wide-spread attention 
which the subject of creatine formation has evoked during the past few years, particu¬ 
larly amongst American investigators, took origin in a research which was carried 
out by Prof. Folin, now of Harvard University, at the time when he was assistant 
in pathological chemistry in the laboratory of the M'Clean Hospital at Waverley, 
near Boston, Massachussets, one of the leading mental hospitals in America. In 
the routine and research work of the laboratory, both Dr. Cruickshank and 
Prof. Thompson received much useful and willing help from Miss Lockhart, whose 
good work there, as well as in the dispensary, was much appreciated by them and 
by the other members of the medical staff." 

Royal Edinburgh Asylum, Morningside (1915).—Dr. Robertson 
notes a distinct reduction in the influence of alcohol among the 
admissions, and this occurs in both sexes. He thinks that if it is the 
case that separation allowances have led to more drinking among 
women, the drinking must, according to his figures, have been of such 
a nature as does not tend to produce insanity. The following remarks 
on his experience of soldiers’ insanity are of value : 

“ We have admitted during the course of the year about thirty officers and 
soldiers, the great majority of whom had not been to the front. In a small 
number of cases alcoholic excess was assigned as the cause of the insanity. There 
were two types of insanity which, however, stood out prominently among these 
admissions. There was first a considerable number of cases of simple mental 
excitement or mania. It would appear that in these cases the excitement pro¬ 
duced by their new environment and military duties, and the high tension under 
which they lived, had overstepped the normal. They were perfectly lucid in 
intellect, but very exalted in feeling. They over-estimated their own importance, 
bragged of their doings, and talked too much. There was definite loss of self- 
control, and it was owing to childish and foolish conduct that they got into 
difficulties. They gave us a great deal of trouble in the earlier periods of their 
treatment, but they all made good recoveries. They constantly suggested to me 
exaggerated types of Rudyard Kipling's soldiers. 

“ The second group of cases consisted of high-grade mental defectives. These 
men had passed the physical tests when they enlisted, and had answered the few 
questions addressed to them without displaying their mental deficiency. It was 
very soon found, however, that owing to their low level of intelligence they were 
quite unfit to be trained as soldiers or to realise their responsibilities. Had the 
Mental Deficiency Act been in force for some years, no doubt they would all have 
been known to the authorities.” 

Dr. Robertson scores another point in that question about which 
he feels as strongly as does Dr. Bedford Pierce. Adverting to the 
unpleasantness of certifying soldiers who have broken down in the 
war, and to the absence of certification in the Dykebar Military 


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Hospital, he says that there is no essential difference between the 
soldier who breaks down in war and a woman, for instance, who 
suffers from an attack of puerperal insanity. Logically, therefore, the 
freedom of treatment which is accorded to the entrant into a military 
hospital should be accorded to the candidate for the asylum. He 
points out that the Lunacy Law in Scotland enables the doctor to treat 
an unconfirmed case in any private house or lodging, but the only place 
where this beneficent provision cannot be carried into effect is the 
asylum, thoroughly equipped as it is for carrying out the best treatment 
under strict regulations. The rich can secure an advantage which 
the poor cannot do. This proposition focuses the position and 
arguments very thoroughly, and demonstrates the jealous foolishness 
of the upholders of Lunacy Law as it is now written. 

Mortiingsidc (1916).—We have the advantage of receiving an advance 
copy of Dr. Robertson’s report to the Managers for the year just gone. 
We are prompted to anticipate its consideration on account of some 
strong and wholly admirable remarks made by him on spiritualism. 
The fact of its having appeared among the causes of the year’s insanity 
at Morningside suggests to him the need for uttering a warning. He 
reminds “ inquirers into the subject that if they would meet those who 
are hearing messages from spirits every hour of the day, who are seeing 
forms, angelic and human, surrounding them that are invisible to 
ordinary persons, and who are receiving otheY manifestations of an 
equally occult nature, they only require to.go to a mental hospital 
to find them.” He gives an instance of a person who, losing her son, 
resorted to spiritualism in its usual procedure, first hearing of him 
through medium, then getting into touch with him herself, and then 
widening her circle of spiritual acquaintance till she heard God’s voice. 
He asks spiritualists to say “ where in this case does spiritualism end 
and mental disorder begin. Do they overlap ? Do they coexist ? Or 
is there such a state as disordered mental function at all ? Or is it 
that spiritualism was wholly absent in this case ? ” 

In his experience he has found that, in addition to such cases as 
the above, where spiritualism sometimes leads to insanity in the pre¬ 
disposed, more frequently there is a great fascination for spiritualism 
among those who suffer from the simple forms and early stages of 
mental derangement. It is a ready and comforting explanation to them 
of the imaginary voices, etc. In such cases obviously it would be 
>vrong to describe spiritualism as the cause of derangement, even though 
it may be prejudicial to the course of the case. 

Not everyone, however, will probably be prepared to agree with Dr. 
Robertson in thinking that spiritualism “is a difficult subject worthy of 
patient and unbiassed inquiry by competent investigators.” What is the 
measure of competency to undertake the investigation? If it lies in 
power of analysis, inference, deduction, and dispassionate judgment, we 
can but remember that for thousands of years this problem has been 
treated with such psychological elements by many strong brains. With 
what practical results ? Where are there any data on which fertile reason¬ 
ing can find a starting point ? Where is there any settled formula 
founded on proven fact? Where is there anything more convincing 


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than the expression of personal belief? Surely by this time trustworthy 
data, if they existed, should have emerged. Unless there is some sure 
ground whereon to .found intellectual inquiry, there can be no such 
prospect of value in result as will compensate the known dangers, 
•which include not only the asylum aspect, but that of the police court 
as well. These hard days impress on us lessons of economy and 
temperance. Does not spiritualism, in its temptation to meticular 
and wind-beating ratiocination, lead towards wasteful intemperance and 
riot of thought, just as much as the problem of squaring the circle did 
for many a long day ? Brains competent to deal with the elusive im¬ 
material should be able to find more value in the study of the material. 

Royal Glasgow Asylum , Gar/naval .—YVe are indeed glad to see in 
the report of the annual meeting of the contributors that Dr. Yellowlees 
•continues to be impelled by a sense of duty, in spite of increasing age 
and infirmity, to attend and express the thanks of the meeting to his 
■successors in the medical direction of the institution. The key to this 
sense of duty lies in the fact that, as he says, none but an asylum 
physician can fully realise the difficulties that confront the superin¬ 
tendent. On this occasion he could point to the terrible strain cast 
on Dr. Oswald by the absence of sufficient medical assistance and of 
sufficient nursing staff to do the work fully. He says that he himself 
has repeatedly offered to go to Gartnaval to render what help he could. 
We believe that for a considerable time Dr. Oswald has carried on the 
medical work entirely by himself in addition to the duties of superin¬ 
tending. Verily the heavy strain of war does not fall on the com¬ 
batants only. We fear that many asylum doctors bear an almost 
intolerable burden, but they bear it bravely indeed. 

Dr. Oswald adds yet another aspect of the cry that goes out for 
xelaxation of legal formularies : . 

"The legal processes necessary before a patient who does not seek treatment 
voluntarily can be admitted to a mental hospital have done a great deal towards 
■causing the public to avoid an insane person, and to keep up the belief that 
.mental disorders are in some way different from other bodily diseases. 1 am 
convinced that a relaxation of those, with proper safeguards to individual liberty, 
would be a great forward movement, and it should not be beyond the wit of man 
-to devise a scheme which would protect the public, and yet modify the cumbersome 
procedure which attends the admission of patients to mental hospitals.” 

“ The apparent great increase in the number of the insane is one of the most 
attractive subjects for a speaker or writer on insanity, and the sensational have 
drawn lurid pictures depicting the ruin of civilised nations through mental 
deterioration. In my opinion, the improvement that has taken place in the 
-special insitutions devoted to the insane, and in the treatment and care thev 
receive there, is one of the principal causes in the increased recorded numbers. In 
-areas of most advanced social development we find evidences of a better feeling 
in the form of increasing numbers of voluntary admissions, the patients themselves 
and their friends having now the hope of being benefited by treatment, and 
having less reluctance to take advantage of it. In a crusade against mental and 
nervous diseases the Press can be of the greatest assistance in helping to break 
-down the prejudice against mental hospitals, in emphasising the need there exists 
for the early treatment of incipient cases, and in urging the legislature to give 
facilities for the care of advanced cases, without resort having to be had to 
certification. The present tendency on the part of the public to make flippant 
remarks about sufferers from mental illnesses is cruel and heartless, and should 
/he frowned on by all humane people.” 


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In relation to war retiology Dr. Oswald finds other associations than 
direct loss : 

“Indeed, the saddest cases I have seen have been those in whom.not the war 
itself, but the barbarous manner of its conduct by the enemy, and the murder of 
innocent women and children, have produced morbid depression closely allied to 
insanity. The sufferers have usually been women of high and unselfish character, 
who in the perpetration of such deeds by a nation believed to be highly cultured 
and civilised see a negation of God, and a disturbance of their deeply-rooted 
Christian beliefs.” 

He reports a case where pellagra was the cause. This is a rare factor 
in this country, but not altogether unknown. The patient, a female, 
duly recovered. 

% 

Royal Montrose Asylum. —Dr. Shaw, in referring to the cases 
received from Bangour and Dykebar says that they were all more or less 
chronic with a very unfavourable prognosis, and points out that if the 
duration had been shorter and the type more amenable the change from 
one asylum to another might have resulted in more mental improve¬ 
ment. The various changes, no doubt, had to be effected more or less 
hurriedly, and we fear that this point has been lost sight of. We see 
that with the exception of a few weeks Dr. Shaw had to carry on the 
whole of the medical work by himself; this must have been a somewhat 
discouraging commencement to his office of Medical Superintendent. 

Some Scottish District Asylums. 

Fife and Kinross. —We note that Dr. Skeen has succeeded our old 
and valued friend, Dr. Turnbull, whose recent death we have deplored. 
We cannot but think, while congratulating Dr. Skeen on his appoint¬ 
ment, that he will find his work the easier from the conscientious 
methods of his predecessor. We are glad to see that he proposes in 
future years when the whole of the admissions have passed through his 
hands, to find it possible to prepare a table indicating roughly the cases 
recoverable and irrecoverable. This would, he says, be of more value 
statistically than simply to say that the recovery-rate was 3o - s per cent. 
on the admissions when such calculations ought really to be made upon 
the possibly recoverable admitted. Any such table illuminating a 
particular issue must be welcome. 

He dwells on the inconvenience, when estimating the cost of the 
asylum patients, now and henceforth to be caused generally in Scotland 
by the accounts of the District Board, including the cost not only of the 
lunatics chargeable to the district, but also that of the mental defec¬ 
tives. As the accounts now stand, analysis is required to arrive at the 
actual asylum cost, which, he rightly contends, is a very important 
matter. 

He also deals with the vexed question of farm profits. We have 
commented on this subject more than once in these columns some 
years ago. The new methods of book-keeping under the new Act do 
not admit of charging items, such as carting done by the farm for the 
asylum, or, on the other hand, of making a charge for rent. We 
have before expressed the opinion that everything should be charged 
which would be charged by an outside farmer, for the simple reason 


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that really efficient management of the farm (which should make the 
farm a valuable asset) cannot be ensured unless a reasonable comparison 
can be made with the results of neighbours’ farming, which is carried on 
under similar conditions of climate, soil, proximity to market, etc. As 
he says, under the present mode of reckoning, a considerable and 
hitherto uncalculated amount of labour is obtained at practically no cost 
to the farm, but to some extent at the expense of the institution proper. 
The obvious remedy in this matter is to assess and charge the value of 
the labour, not only of the patients, but of those attendants who work 
in charge of them. It is not difficult for the bailiff to make such an 
estimate, especially if he is helped by the Medical Superintendent and 
any of the Committee who have the requisite experience. To complete 
the account, rent, interest on capital, and such matters as hog-wash 
received from the asylum, should be debited to the farm, and all work 
done by the farm for the asylum or other customers should be credited. 
A farm account, additional to the official account, is kept on these lines 
at many asylums, East Sussex, for instance. It has the good effect, at 
all events, of showing an approximately correct statement of the working, 
thus saving wonderment and possible jealousy on the part of neighbours 
at the inflated profits now officially shown. 

Inverness District .—It is very satisfactory to read that one asylum 
working-party was employed for months in straightening out a dangerous 
corner for the County Council, which had proposed to do itself the 
work of considerable magnitude, and was glad to accept the offer of 
help from the asylum. Another party for several weeks gave valuable 
assistance in the erection of a large new workshop for munitions. Dr. 
Mackenzie is rightly proud of the work, which, he says, affords an 
example of the extent to which dilution of labour may be successfully 
and profitably pushed in such times as the present. 


Some Irish District Asylums. 

Belfast .—There is probably much truth in what Dr. Graham says in 
this extract from his report. 

“ Yet the fact is indisputable that insanity, like crime, has lessened during the 
period of the war. It will not do to Say that the vast numbers of men called to 
the colours include some who might otherwise be recognised among our asylum 
population, for the greatest reduction is among women, 119 being admitted in 
1915, as against 154 in 1913. This fact raises some intensely interesting questions 
as to the probable influence the war will exercise upon the mental life of the 
nation, and upon the problem of insanity. This problem is not an isolated one. 
It is implicated in the general economic, sociological, and physical state ot a com¬ 
munity at a given time. Now the present war will have a powerful bearing on 
these factors, and so, will affect deeply the general mental health. To begin with, 
it is evident there is a shifting of the distribution of wealth, so that vast numbers 
who had formerly lived in poverty or at least in mean circumstances, have 
suddenly, owing to the rise in wages, found, themselves in a degree of comfort, 
and even, relatively speaking, of luxury which in time past had not entered their 
wildest dreams of welfare. These people will have gained a higher standard of 
living. With this standard will come a wider range of interests. The curse 
of grinding toil and abject poverty is that the poor toiler is so pre-occupied with the 
task of gaining a precarious livelihood that he has no time or energy left for the 
pursuit of aims worthy of a truly human life. Long, protracted labour means 

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that the mind is stupefied with fatigue-products, and the worker will seek relief in 
some artificial redeemer from dulness and weariness, such as alcohol. But with 
greater leisure, more education, many of the temptations to indulgence in drink 
will vanish.” 

There appears, however, among his admissions a causal factor as fre¬ 
quent as, but far more dread than, alcohol, which affects only 7 per 
cent. Syphilis has exactly the same ratio of causation. Yet even 
within recent years alcohol was a highly prolific agent, whereas syphilis 
was almost unknown as a factor in any part of Ireland. 

Down District. —Dr. Nolan, in referring to the influence of the war 
on the insanity of his district, relates that of the eight soldiers 
admitted under the Army Act not one could be properly referred to 
that factor. So, too, with the civilians. In fifteen cases in which the 
war was assigned as a factor a close investigation of the full histories 
resulted in the disestablishment of the war in favour of quite a number 
of other associated factors. The “ war idea,” he says, has had less 
effect on the coloration of existent insanity of those already under care 
than it would have had were the current illustrated and other news¬ 
papers in the usual free circulation. Other suitable literature has been 
substituted. 

The effect of the war on finance and supplies has been, says Dr. 
Nolan, discounted here to some extent by careful pre-war economy. 
As an instance, the substitution of cocoa for tea at supper, a change 
made some years before with a view to reducing insomnia and nervous 
irritability, effected at the time of initiation a saving of ^150 per 
annum. At the present time the increase in patients and in the cost of 
tea has increased the saving by an additional sum of ^265. 

Enniscorthy. —Dr. Drapes records a considerable reduction in 
population during the year. We note that the admissions (77) are 
well outset by the exits on discharge, recovered or otherwise, or on 
death (100). But he warns his committee that such figures, taken 
alone, are unreliable. In place of them he offers better evidence of 
the trend of insanity. He estimates the average daily residence for 
four periods, constituted by five-year divisions of the last twenty years. 
He finds thereon that the percentage of increase in the said daily 
average residence for the last three five-year periods has been 107, 
9'2, and 5 5 respectively. He draws, correctly we think, hopeful 
conclusions for the future from this dwindling proportion. The length 
of the test-period is more convincing than yearly comparisons. We 
suggest that the same process applied to admissions might furnish 
further highly confirmatory evidence. But we can see that some 
discount might have to be made therefrom on account of the illusory 
alcoholic admissions against which he inveighs very strongly. He 
says that some of these are sane within twenty-fours of admission. 
He complains, further, that when the easy process of shunting a 
drunken person into the asylum is once initiated, it is repeated 
whenever he goes a little beyond the mark. Seventeen per cent, of 
his admissions last year were due to alcohol. 

Dr. Drapes finds that he can assign no causative influence to the 
war. We may say, after looking over many similar reports, that this 


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seems to be the opinion of the vast majority of asylum superintendents. 
But this is only the asylum experience. The true answer to any 
question of the real war-influence can only be given when on its con¬ 
clusion a summation is made of all cases treated, whether in special 
military hospitals or in asylums, and some further cases of an evanescent 
nature may have been treated elsewhere. 

Omagh. —Dr. Patrick, when referring to the vast importance of 
heredity as a causal factor, relates the following interesting particulars. 
During the year there were in residence two mothers and sons, four 
brothers and sisters, seven pairs of sisters, nine cases of brothers, eight 
known cases of cousins, three cases of uncles and aunts with nephews 
or nieces, and one husband and wife. Also, a patient lately discharged 
who had been in the asylum three times, and whose mother is still 
resident therein, married a woman, one of whose sisters died there, 
another sister being still detained as a patient. One wonders whether 
this could be beaten as an instance of disregard of danger. 

Alcohol was assigned as a principal factor in 8 per cent., while syphilis 
only appeared in one case in 102 males. 


Part IV.—Notes and News. 


THE MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREAT BRITAIN 

AND IRELAND. 

The Quarterly Meeting of the Association was held at the Medical Society’s 
Rooms, Chandos Street, W., on Thursday, February 15th, 1917, Lieut.-Colonel 
David G. Thomson, M.D., President, in the chair. 

There were present: Sir G. H. Savage, M.D., Sir Robert Armstrong-Jones, M.D., 
and Drs. F. Beach, D. Bower, A. Helen Boyle, A. N. Boycott, J. Chambers, R. H. 
Cole, M. Craig, H. Devine, E. L. Dove, T. Duff, J. H. Earls, F. H. Edwards, 
C. T. Ewart, C. F. Fothergill, A. H. Griffith, B. Hart, H. E. Haynes, T. B. Hyslop, 
G. H. Johnston, H. C. MacBryan, A. Miller, G. H. Monrad-Krohn, Jessie M. Murray, 
J. G. Porter Phillips, D. F. Rambaut, J. N. Sergeant, G. E. Shuttleworth, J. G. 
Soutar, J. Stewart, R. C. Stewart, J. Tattersall, F. R. P. Taylor, H. Wolseley-Lewis, 
E. W. White, and R. H. Steen (Acting Hon. General Secretary). 

Visitors: A. H. Buchanan, Dr. Wildon Carr, Beatrice Edgell, Miss Fletcher, 
P. C. Maitland, Dr. Lapinska, Mr. Flugel, Thomas Jones, M. Jones, Dr. Alice 
Johnson, Sir Herbert and Lady Sloley, Col. J. W. Springthorpe, Lady Grey 
Wilson. 

Present at the Council Meeting: Lieut.-Colonel D. G. Thomson, M.D. (Presi¬ 
dent) in the chair, Drs. R. H. Cole, A. Miller, J. N. Sergeant, J. G. Soutar, H. 
Wolseley-Lewis, and R. H. Steen (Acting Hon. General Secretary). 

The following sent communications expressing regret at their inability to be 
present: Drs. T. S. Adair, G. N. Bartlett, C. H. Bond, R. Dods Brown, R. B. 
Campbell, T. Drapes, C. C. Easterbrook, J. R. Gilmour, Lieut.-Col. J. Keay, 
Lieut.-Col. H. A. Kidd, G. D. McRae, N. Lavers, H. H. Newington, and T. E. K. 
Stansfield. 

The President said the minutes of the meeting held in November last were 
printed in the Journal of January last, and, unless a proposal was made to the 
contrary, he proposed to ask the meeting to accept them as read. Agreed. 

The President said he had a few announcements to make before the meeting 
proceeded to deal with the subjects on the agenda. 

First, the Association had to lament the death of Dr. Charles H. Hughes, of St. 
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Louis, U.S.A., a distinguished specialist in mental and nervous diseases and an 
Honorary Member of the Association. 

They had also to regret the death of Dr. William Orange, C.B., of Broadmoor, 
a former President of the Association. 

Dr. Adam Robert Turnbull had also died. He was late Medical Superintendent 
of the Fife and Kinross District Asylum and President-elect of the Association, 
but, members would remember, owing to ill-health he was unable to occupy the chair. 

The death had also to be deplored of Dr. Langton Fuller Hanbury, who was 
Medical Superintendent of the West Ham Borough Asylum, Ilford, Essex. He 
joined the Army on November 1st, 1914, as a private in the Sportsmen’s Battalion, 
Royal Fusiliers, and saw service in France. He was reported “ missing” in July, 
1916, after an engagement in Delville Woods. Since that date, however, the War 
Office seemed to have received some further information causing them to officially 
notify Dr. Hanbury as dead. 

He asked the members to pass, in the usual manner, a resolution, which he pro¬ 
posed, that a vote of condolence be sent to the relatives of the deceased members. 

The resolution was carried by members rising in their places. 

The happier duty now devolved upon him of proposing, as the Association’s 
official mouth-piece, that a vote of congratulation from the Association be passed 
concerning the honour which had recently been conferred by His Majesty on their 
fellow-member Honorary Major Robert Armstrong-Jones, who had received a 
Knighthood. 

Another honour was that which had been received by Dr. John Warnock, who 
had been granted the Order of St. Michael and St. George. He, as members were 
aware, was Medical Superintendent of the great Egyptian Asylum at Abbasiyeh, 
where he had done real and very important work for many years. 

The next honour was that of Captain Huws Pennant, who was Assistant Medical 
Officer at Barnwood House Asylum, Gloucester, and who had been awarded the 
Distinguished Service Order. 

Dr. P. M. Turnbull, Senior Assistant Medical Officer at Tooting Bee Asylum, 
Temporary Lieutenant in the R.A.M.C., had been awarded the Military Cross. 

There was no business to report to the general meeting as arising out of the 
Council meeting just terminated. 

Election of Candidates for Membership. 

The President nominated as scrutineers for the ballot Dr. Wolseley Lewis and 
Dr. Boycott. 

The following gentlemen were balloted for and duly elected: 

Bowie, Edgar Ormond, L.A.H.Dub., Dip. Grant Med. College, Bombay, 
L.M.Coombe, Dublin, Lieut., I.M.S. (T.); "Cairntows," Dyserth, Flint¬ 
shire, N. Wales. 

Proposed by Drs. J. R. Gilmour, S. Edgerley, J. O’C. Donelan. 

Munro, Robert, M.B., Ch.B.Aberd., Assist. Med. Officer, Dorset County 
Asylum. 

Proposed by Drs. G. Ernest Peachell, A. E. Patterson, and R. H. Steen. 

Paper. 

S*t Robert Armstrong-Jones, M.D., Hon. Major R.A.M.C., “Dreams and 
•heir Interpretation, with reference to Freudism." (See p. 200.) 

SCOTTISH DIVISION. 

A Meeting of the Scottish Division of the Medico-Psychological Association 
■was held at Dykebar War Hospital, Paisley, on Friday, March 16th, 1917. 

Present: Lieut.-Cols. Thomson and Keay, Major Hotchkis, and Capt. Buchanan, 
R.A.M.C.; Drs. Stewart Campbell, Carre, Carswell, Easterbrook, Kerr, Oswald, 
G. M. Robertson, Jane L. Robertson, Ferguson Watson, Yellowlees, and R. B. 
■Campbell, Divisional Secretary; Lieut.-Col. A. J. Bourke, Capts. R. G. Banner- 
•nan and A. Ninian Bruce, R.A.M.C.; Drs. Ferguson, Dawson, and Anderson 
being present as guests. 

Lieut.-Col. Thomson, R.A.M.C., President of the Association, occupied the chair. 

Before taking up the ordinary business of the meeting, the Chairman referred. 


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appropriate terms, to the loss which the Association and the Asylum Service 
had sustained since last meeting through the death of Dr. A. R. Turnbull. He 
stated that Dr. Turnbull had been Medical Superintendent of Fife District Asylum 
for the long period of thirty-four years, and that he had always taken a very active 
part in the work of the Association, having acted as Divisional Secretary for 
Scotland for several years, and that he was elected President of the Association 
in 1910, but, owing to ill-health, he was unfortunately prevented from undertaking 
the duties. The Chairman also referred to his many fine personal qualities. It 
was unanimously resolved that it be recorded in the Minutes that the members of 
the Scottish Division of the Medico-Psychological Association desire to express 
their deep sense of the loss sustained by the death of Dr. A. R. Turnbull, and 
their sympathy with his relatives in their bereavement. The Secretary was 
instructed to transmit an excerpt of the Minute to his relatives. 

The Chairman also referred to the recent resignation of Dr. Carlyle Johnstone 
from the Medical Superintendentship of Roxburgh District Asylum, Melrose, a 
position which he had occupied for over thirty years, and he considered that such 
an event could not pass without the Division recognising the long and valuable 
services which Dr. Carlyle Johnstone had rendered in the interests of lunacy, and 
at the same time expressing the hope that he might be long spared to enjoy his 
well-earned retirement. It was unanimously resolved that the Secretary be 
instructed to send an excerpt of the Minute to Dr. Carlyle Johnstone. 

The Minutes of the last divisional meeting were read and approved, and the 
Chairman was authorised to sign them. 

Apologies for absence were intimated from Drs. Reid, Fraser, Parker, McRae, 
"T. C. Mackenzie, Alexander, Shaw, Orr, Steele, and Crichlow. 

The Secretary submitted a letter which he had received from Dr. R. B. 
Mitchell, thanking the members of the Division for their good wishes on his 
retirement from the Medical Superintendentship of Midlothian and Peebles District 
Asylum. 1 

Drs. C. C. Easterbrook and L. R. Oswald were unanimously elected repre¬ 
sentative members of Council for the ensuing year, and Dr. R. B. Campbell was 
■elected Divisional Secretary. 

Dr. Hugh de M. Alexander was recommended to the Nominations Committee 
of the Council as an examiner for the Certificate in Psychological Medicine. 

The following candidate, after ballot, was admitted to membership of the 
Association: 

Alexander Ninian Bruce, M.D., D.Sc., F.R.C.P.E., Lecturer on Neurology, 
University of Edinburgh, 8, Ainslie Place, Edinburgh. (Proposed by Drs. 
Hotchkis, Buchanan, and Campbell.) 

Major Hotchkis read an interesting paper describing Dykebar as a War 
Hospital, and he referred to the chief features of the cases of mental disease 
which had been admitted from the Expeditionary Forces during the past year. 
•(A copy of the paper appears in the Journal.) 

The members were afterwards conducted over part of the hospital by Major 
Hotchkis, when some of the most interesting cases were shortly described by 
•Capt. Buchanan. 

The Chairman thanked Major Hotchkis and his staff for the trouble which 
they had taken to make such an interesting and successful meeting, and a vote of 
•thanks to the President for his presence in the chair concluded the business of 
the meeting. 

After the meeting the members were kindly entertained to tea by Major and 
Mrs. Hotchkis. 

No dinner was held after the meeting. 


IRISH DIVISION. 

The Spring Meeting of the Irish Division was held, by the kind invitation 
■of Dr. J. O’C. Donelan, at the Richmond Asylum, Dublin, on Thursday, 
April 5th. 

Members present: Dr. Drapes, Major W. R. Dawson, R.A.M.C., Drs. J. O’C. 
Donelan, Gavin, Mills, Rainsford, Forde, Irwin, Rutherford, Leeper (Hon. Sec.). 


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Dr. Drapes, having been moved to the Chair, the minutes of the previous 
Meeting were read and signed. Letters of apology for unavoidable absence were 
read from Dr. M. I. Nolan, of Downpatrick; Dr. Hetherington, of Londonderry; 
and Dr. Greene, of Carlow; and some others, stating their regret at being pre¬ 
vented from attending. A letter of acknowledgment of the receipt of the resolu¬ 
tion of condolence was received from Mrs. Kirwan, widow of the late Dr. Kirwan,. 
of Ballinasloe Asylum, expressing her thanks for the sympathy of the members 
of the Irish Division in her bereavement. 

The Meeting next proceeded to elect an Hon. Sec. and two Representative 
Members of Council for the ensuing year. 

On a ballot being taken and a scrutineer being appointed, the Chairman 
announced that Dr. Leeper had been unanimously re-elected Hon. Sec. of the- 
Division for the ensuing year, and Drs. Rainsford and Mills were unanimously 
elected Representative Members of the Council. 

It was decided to accept Dr. Mill’s kind invitation to hold the Summer Meeting 
of the Division at Ballinasloe Asylum. 

The following dates were fixed for the meetings of the Division for the ensuing 
year: 

Autumn Meeting, Thursday, November 1st, 1917. 

Spring Meeting, Thursday, April 4th, 1918. 

Summer Meeting, Thursday, July 4th, 1918. 

It was proposed by Dr. Rainsford, and seconded by Dr. J. O’C. Donelan,. 
and passed unanimously, “ that the Irish Division of the Medico-Psychological 
Association desires to place on record their sense of the admirable manner in. 
which Dr. Leeper has discharged the duties of Hon. Sec. of the Division during 
the year.” 

Dr. Leeper thanked the meeting for their most kind and flattering resolution. 
He regretted he was unable to serve them better, but should always do his best to- 
discharge the duties of his office to the best of his ability, and thanked th* 
members of the Division for their kindly support and help in the carrying on of 
the business of the Association. 

On considering the question of the position of Irish Asylum officials under any 
new Irish legislative changes, it was proposed by Major Dawson, and seconded by 
Dr. Rainsford, and passed unanimously, that a Committee be appointed, con¬ 
sisting of Drs. M. J. Nolan, O’Mara, J. O’C. Donelan, Gavin, and the Hon. Sec., 
“ to consider the position of asylum officers as regards pension under a possible 
Home Rule Government, and to draw up a memorandum, expressing their views, to 
be forwarded to the Irish Members on both sides of the House of Commons and 
any other Members of Parliament likely to help.” 

Dr. J. O’C. Donelan next gave a most interesting account of the War Hospital 
work of the Richmond Asylum. 

The hospital was started in June, 1916, and 104 cases have so far been admitted, 
suffering from mental trouble due to three varieties of causation : (1) Patients who- 
would have become insane in all probability in any case, having had previous 
attacks before the war; (2) patients with neurotic constitutions whose resistance 
to stress and war conditions was insufficient to ensure their remaining free from 
mental trouble; (3) patients whose condition was directly due to shell shock and 
stress of war conditions. 

These cases of shell shock were usually merely confusional insanity passing into- 
stupor, often of particular faculties. 

Many interesting cases were recorded, and treatment by hot and cold baths and 
medicinal means were mentioned. 

Dr. Forde, who had had many opportunities of treating these cases, gave the 
meeting the benefit of his experiences. He regarded these cases of shell shock as 
due to a dislocation of the brain-cells. Hot and cold baths given alternately had 
produced good results in some cases of loss of the power of speech. Many cases 
are borderland cases of insanity. There was marked tremulousness of the muscu¬ 
lature and shakings of the body, with profuse perspiration of the skin of the head.. 
He had found a mixture of the bromides, together with antipyrin, and citrate of 
caffeine, gave great relief where headaches existed, and when the mixture was 
discontinued the men begged for its repetition. Fletcher’s syrup of the hydro- 
bromates was useful, and hastened recovery in some oi the cases he had treated. 


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Hallucinations of sight and hearing were sometimes present, but many of the 
■cases were quite conscious of the hallucinations, and realised that they were 
abnormal, and were, therefore, not to be regarded as ordinarily insane patients 
suffering from hallucinatory states. Altogether it appeared that 56 patients out of 
the original 104 had been dealt with at the Richmond Asylum War Hospital. Of 
■these 26 had been sent to other asylums, 12 had been sent home, and the balance 
had been able to resume their occupations. The patients were segregated from 
the other asylum inmates, and not certified insane. 

Dr. Lebper pointed out that so far as he understood the causation of shell shock 
was due to the sudden effect upon the blood vascular system by shell explosion, 
driving the blood of the body towards the nerve centres, and thereby disorganising 
■or injuring them with sudden violence, or interfering with their functions. 

Major W. R. Dawson gave a most interesting account of cases of shell shock 
and cases resulting from war stress. These varied from cases of slight nervous 
disturbance, where men were easily startled by sudden sounds or noises, to the 
most serious breakdowns. 

Cases in which excessive tremor was a cardinal symptom in patients suffering 
from traumatic neurasthenia, loss of speech, and hearing, and sight. Loss of 
sight appeared to be regained quicker than the loss of hearing or speech. It is 
often most difficult to restore the powers of speech. Some had got good results 
from treatment by hypnotism, but this had been found of little use in other hands. 
Major Dawson spoke of the great kindness and attention of Dr. Forde and Dr. 
Dwyer with regard to the wounded soldiers, which was beyond all praise. 

The Chairman said that the members were much indebted to Dr. Donelan 
viot only for the sketch he had kindly given them of the work done amongst the 
war sufferers in the Richmond Asylum, supplemented as it was by Dr. Forde’s 
■careful observations as regards the clinical aspect of some of these cases, but also 
for the very interesting discussion which followed, to which Major Dawson’s large 
and varied experiences as specialist adviser in nervous diseases to the troops in 
Ireland were a most valuable contribution. He had not had much opportunity 
himself of observing cases of shell shock, as, although a few soldiers had been 
admitted into Enniscorthy Asylum during the past two years, some were very 
transient cases due to a bout of drinking: others had had previous attacks, and 
would probably have broken down under any stress, whether they were in the 
army or not. He thought that the military medical experience of the present 
war ought to go far towards finally disposing of the so-called theory of psycho¬ 
physical parallelism, as almost every possible symptom, whether purely somatic, 
nervous, or mental, was found to follow shock to the brain, so that it would be 
■quite impossible to determine where “bodily ” symptoms ended or mental began. 
They all were the results of similar causes, and there was no line of demarcation 
between them. A great many of these cases were, in their symtomatology, very 
much akin to hysteria, and similar treatment to that employed in hysterical cases 
would be likely to prove efficacious. 

A cordial vote of thanks to Dr. J. O'C. Donelan for his hospitality and great 
kindness in entertaining the Division at the Richmond Asylum was passed by 
acclamation. 

This terminated the proceedings. 


SOUTH-WESTERN DIVISION. 

The Spring Meeting of the above Division was held, by the kind permission 
of Dr. MacBryan, at 17, Belmont, Bath, on Friday, April 27th, 1917, at 2.30 p.m. 

The following members were present: Drs. Aveline, Norman Lavers, MacBryan, 
Rutherford, and Bartlett, who acted as Hon. Divisional Secretary. 

Dr. Aveline was voted to the Chair. 

Letters of apology for non-attendance were received from Drs. Macdonald, 
Pope, Soutar, and Starkey. 

The minutes of the last meeting were read and - confirmed. 

Dr. G. N. Bartlett was appointed as Hon. Divisional Secretary, Dr. Aveline 
very kindly expressing his willingness to undertake the duties in the event of the 
former being called for military duty. 


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300 NOTES AND NEWS. [April,. 

Dr. Aveline and Dr. Norman Lavers were elected as Representative Members of 
Council. 

Dr. MacBryan and Dr. Nelis were elected as members of the Committee of 
Management. 

The following dates were fixed for the Autumn and Spring Meetings respec¬ 
tively: October 26th, 1917, and April 26th, 1918, the place of the meeting for the 
former being left in the hands of the Hon. Secretary. 

The members present made a sympathetic allusion to the loss sustained by the 
Division in the recent decease of Dr. F. St. John Bullen, and it was proposed that 
the Hon. Secretary be requested to convey their sympathies to Mrs. Bullen. 

The decease of Dr. Smyth, Medical Superintendent of the County Asylum,. 
Gloucester, was recorded with regret. 

The Hon Secretary was requested to express the thanks of the members to Dr. 
Starkey for his kind invitation to entertain the Division at the Plymouth Borough 
Asylum. 


THE MENTAL AFTER-CARE ASSOCIATION. 

The Annual Meeting of this Association was held, by the kindness of Sir 
Robert Armstrong-Jones, M.D., at 9, Bramham Gardens, Kensington, on 
March 1st, the Lord Mayor presiding. 

Sir Robert Armstrong-Jones, in welcoming the Lord Mayor, said the City of 
London was noted for the more than kind solicitude which it extended to the 
distressed and those who suffered. Whether these were individuals, or families, 
or social groups, or nations, the charity of the Mansion House was so well known 
that no words of elaboration were needed. Judging by the numerous reports in 
the daily Press of the meetings held at that civic centre, the Corporation of 
London realised the supreme importance of sound mental and physical health, 
and that was an asset upon which, especially at the present time, no limitation 
could be placed. As Treasurer of the Crippled Children’s Homes the Lord 
Mayor’s time must be fully occupied, but his heart was large enough and his 
sympathies deep enough to allow him to extend his beneficent help to other 
charities. The greatest pleasure a person could have was the full realisation and 
use of his mental equipment, and to lose that was a very sad event. He was glad 
to know that the nurses engaged in the large mental hospitals had a three years' 
training, and the forty examination papers he had been looking through, the work 
of mental nurses, compared very favourably with that of budding medical students. 

The Lord Mayor said it was in 1912 that he first had the privilege of addressing 
the Association, and it was a great pleasure to him to know that it was receiving 
such unqualified support. He was so impressed years ago with its good work 
that he became a life-subscriber, and he hoped others in the room would do the 
same. When people recovered from physical illness they required rest, change, 
and support; and when convalescent from mental disease surely the need for this 
was even greater. This Association gave that care. Some people who came out 
of asylums found that there was an unwillingness to associate with them, so that 
they felt they had no place to turn to. As there was no other body which carried 
on this very useful work there need be no fear of overlapping. When people 
came from asylums they were cured, but were not mentally strong ; they required 
people to come along and be props to them. He commended the charity to his 
hearers, and felt grateful that he was allowed to participate in a small way in such 
a useful work. 

Dr. Rayner (for Miss Vickers, the Secretary) submitted the annual report, 
which showed that the work of the Association had progressed most satisfactorily 
during the past year, in spite of the war. The number of patients dealt with had 
increased, and encouraging financial support had been forthcoming. The cases 
were very sad, and often specially difficult. That the work was highly appreciated 
was shown by the efforts made by the subjects of help to repay some of their 
indebtedness when their progress enabled them to do so. Special thanks were 
tendered by the Council to Miss Lucy Wills, who had contributed two separate 
^100 gifts. During the year under review applications were made on behalf of 
508 persons (377 women, 131 men), or 33 per cent, more than last year; 984inter- 


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views were held at the office, 630 visits paid, 154 situations found, and 6000 letters 
were written about the cases. A number of typical examples were quoted. The 
Guild of Help had sent some splendid articles of clothing from time to time. An 
account was also given of the work at the affiliated branch at Birmingham. 

Sir William Collins, M.P., proposed the adoption of the report in an 
eloquent speech. He said that Mrs. Tuke's death reminded one of the enormous 
amelioration of the lot of the mentally afflicted which the last century had wit¬ 
nessed. To realise that, one had only to look back upon the satire which Hogarth 
put upon canvas in that memorable picture in the series called "The Rake's 
Progress,” in which he showed at a glance the panorama of London’s intellectual 
refuse and the way in which it was treated in the latter part of the eighteenth 
century. In that new philanthropy reforms had succeeded each other quickly; 
Wilberforce, Howard, Samuel Romilly, and others had that humanitarian spirit 
which flamed to-day, and which found its expression in such an agency as this 
After-care Association. Their own Tuke, of “ The Retreat ” at York—a member 
of that body, not too popular to-day, which was associated with many of the 
greatest reforms in this country, the Quakers—had done very much, as had 
Conolly at Hanwell, to ameliorate the lot of the mentally afflicted. Perhaps at 
the present time our reforms ran more in the direction of doing something more 
for the beginnings and endings of mental affliction ; and this Association stood 
for that most important phase when the mentally afflicted returned again to par¬ 
ticipate in the affairs of the world at large, when they stood so much in need of a 
guide, philosopher, and friend. There was a form of mental alienation which was 
spoken of by experts as agoraphobia : the fear of the market-place, a fear which led 
them to seek in desperation for something or somebody to hold on to. But the 
mentally afflicted had a highly-developed individualism or egoism, though he 
hoped it would not be maintained that highly individualistic persons were neces¬ 
sarily insane. Most people knew the feeling experienced when recovering from 
physical illness, and he imagined this must be so intensified as to raise it to the 
N lh degree in those who were emerging from mental disease and were seeking 
again to pass into publicity. There were still persons who believed that the 
mentally afflicted were demoniacally possessed ; but the work which this Associa¬ 
tion was carrying on appealed to the highest ideals and the most practical bene¬ 
volence. He remembered seeing, in Florence, a picture which impressed him 
greatly, and which seemed to carry a lesson for such occasions as this. The 
mediajval artist endeavoured to put on one small canvas the Mount of Trans¬ 
figuration, and, in the corner of the picture, the epileptic boy who, according to 
the Evangelist, was so faithfully described as gnashing his teeth and pining away. 
Was not the highest idealism needed to minister to the mentally sick ? Some of 
the humblest ministrations were to those who were most to be pitied, and they 
rose to the highest ideals, ideals which transfigured and transformed our lives. 
And if we desired to realise our ideal we could hardly do it better than in 
endeavouring to idealise the work as it lay at our doors, and assist in the common 
kindly work which this Association was endeavouring to do. 

The Right Hon. Sir David Brynm6r Jones, K.C., seconded the resolution. 
With the experience he had had in connection with lunacy he could say that the 
Association demanded almost universal sympathy; for under the existing Lunacy 
Laws it was doing a necessary work. Under the Lunacy Act of 1890, the mere 
fact that a patient was discharged from an asylum was not conclusive as to the 
discharge of an order about his property : that meant that though a patient was 
regaining his freedom it might not yet be expedient for him to resume control 
over his property. This Association was valuably supplementing the Lunacy 
legislation and administration of the country, and though this was not the time 
to ask for money, he hoped assistance for such a worthy object would continue to 
be forthcoming. 

Sir John Jardine, M.P., and Sir Richard Douglas Powell, K.C.V.O., 
having supported the motion, it was carried unanimously. 

The various officers who retire by rotation were re-elected, on the proposition 
of the Rev. Prebendary Swayne, seconded by Miss Evelyn Fox. Miss Fox, 
speaking as a member of the Visiting Committee at one of the large Metropolitan 
asylums, said she could not imagine anything which would be more difficult and 


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make one feel more hopeless than dealing with these cases if one felt there was no 
one who could be appealed to for assistance. Women and girls who were leaving 
the asylums felt it was a turning-point in their lives; and it was distressing to 
think they might be returning to the conditions which had been answerable for 
their breakdown, b'ut which might be prevented by such advice and help as the 
Association could give. She could not speak too highly of the sympathy and 
human understanding which was given to the work by the Secretary, Miss 
Vickers. 

Dr. Nicolson, C.B., supported the resolution and commended the fine work of 
the officials. Now that many families in the country were earning considerably 
more money, some of the relatives of mental patients could perhaps afford an 
enhanced sum if the claims of the Association were brought home to them. The 
Rev. J. C. Mead Allen also spoke, and the resolution was unanimously adopted. 

Sir George Savage proposed a cordial vote of thanks to the Lord Mayor for 
his kindness in presiding. This was seconded by Dr. G. E. Shuttleworth, and 
carried with enthusiasm. 

The Lord Mayor, in acknowledging the compliment, said he took it as a 
tribute to his office rather than to himself. He would be pleased at any time to 
place the Mansion House at the disposal of this and any kindred Society. He 
referred to the fact that his personal acquaintanceship with Sir Robert Armstrong- 
Jones commenced forty years ago, and it was a great personal pleasure to him to 
see that he had been honoured by His Majesty. 

Thanks having been also tendered to Sir Robert and Lady Armstrong-Jones, 
the meeting terminated. 


KNIGHTHOOD FOR DR. ARMSTRONG-JONES. 

It is with sincere pleasure that we offer bur congratulations to Sir Robert 
Armstrong-Jones on his having had recently conferred upon him the honour of 
knighthood, an honour which has been bestowed on him on account of his life-long 
labours in the interests of the insane, of psychiatric science, and, indirectly, of the 
public generally, who are at last beginning, as it were at the eleventh hour, to 
recognise the vast importance of this branch of medicine. 

Dr. Robert Jones, as we knew him for the greater part of his life (he recently 
took the additional surname of his wife’s family) is the eldest of five sons of the 
Rev. Thomas Jones, Eisteddfa, Tremadoc, who at the time of his death was the 
oldest Congregational minister in North Wales. He was educated at a private 
Grammar School at Portmadoc, and at Wrexham, and finally in the University 
College of Wales at Aberystwith. From there he entered St. Bartholomew’s, 
on which occasion there was a record number of entrants, over 150, and while 
•there was pro-sector to the Anatomy Lecturer. Among his fellow students who 
have achieved distinction were Sir Wilmot Herringham, Sir Anthony Bowlby, 
now Chief Surgeon to the Military Forces in France, and Sir William Collins, 
M.P. for Derby, to whom asylum workers are so greatly indebted for his labours 
on their behalf, and between whom and Sir Robert since their student days there 
has always existed a close mutual friendship and regard. 

At “ Bart.’s’’ Dr. Jones was a diligent student, and not merely of medical lore, 
as in his second year he took the Hichen’s Prize for an examination in Butler’s 
Analogy, also the Wix Prize Essay for the Life and Works of Sydenham. He 
completed his medical course by taking the degrees of M.B., M.D., of the London 
University, and, later, of F.R.C.S. and F.R.C.P.E. His first appointment was 
that of Junior Medical Officer of the Earlswood Asylum, of which subsequently 
he was made Superintendent. Finally, he was appointed Superintendent of the 
L.C.C. Asylum at Claybury, which office he filled with honour and distinction for 
nearly twenty-four years. His retirement from active asylum work was the subject 
of a notice in the October issue of the Journal. 

Dr. Jones’ medical work was not limited to his duties within the walls of an 
institution. He became Lecturer on Mental Diseases to Westminster Hospital, 
and later to St. Bartholomew's, and also to the West London Post-Graduate 
College. He has been examiner in Psychology and Mental Diseases for the 
University of London, on which subjects he contributed articles to Clifford 


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1917.] 

Allbutt’s System of Medicine, Quain’s Dictionary, and to several Encyclopaedias. 
He has also written many reviews and articles for English and American journals, 
and published a small text-book on Mental and Sick Nursing, which was dedicated 
by permission to H.R.H. the Princess Christian, and is now out of print. He is 
now Consulting Physician in Mental Diseases to the London Military Command, 
with the honorary rank of Major in the R.A.M.C. For helping to raise the 
standard of nursing in asylums he was elected a Knight of Grace of the Order 
of St. John of Jerusalem in England. He is a Fellow of the Society of 
Antiquaries, and a Magistrate for the County of Essex in which he lived 
whilst at Claybury. For ten years he was Hon. General Secretary of the 
Medico-Psychological Association of which he was elected President in the 
year 1906. He was also President of the Psychological Section of Medicine 
at the annual meeting of the British Medical Association held in Swansea. He 
married the eldest daughter of Sir Owen Roberts, D.L., M.A., D.C.L., B.D., 
the pioneer of technical education in London, and who was High Sheriff of 
Carnarvonshire in 1908. On this interesting occasion Sir William Collins 
acted as best man to Sir Robert. His wife has been his greatest and most 
sympathetic helper in all his social and public work. We wish Sir Robert 
-and Lady Armstrong-Jones every happiness, and continued opportunities for 
usefulness in that sphere of work to which they have for so long devoted 
themselves. 


CORRESPONDENCE. 

The Board of Control, 

66, Victoria Street, S.W. 

February 16 th, 1917. 

Dear Colonel Lord, —1 have recently received from Dr. F. Sano, the late 
President of the “ Soci£te de Medicine Mentale de Belgique,” and Physician-in- 
Chief of the asylum for acute cases at Antwerp, who has been for some time past 
engaged at the Maudsley Hospital, the accompanying letter of appreciation of the 
way in which he and many of his fellow-countrymen and confreres have been 
received in asylums in this country, and also of the way in which persons of 
Belgian nationality have been treated in English and Welsh institutions since the 
outbreak of war. 

The Board of Control are desirous that medical superintendents and assistant 
medical officers of the various institutions in the country should be made acquainted 
with the sentiments expressed in the letter, and accordingly would esteem it a 
favour if you could arrange for this letter, and Dr. Sano’s communication, to 
appear in the next issue of the Journal of Mental Science. 

Yours very truly, 

E. Marriott Cooke, Chairman. 

Lt.-Col. J. R. Lord, R.A.M.C., 

Horton (County of London) War Hospital. 

. London, February 1st, 1917. 

Mr. Chairman, —At this moment, when large numbers of Belgian patients 
leave England for France, the chief object of our visit is to tender our thanks to 
the Board of Control and to the asylums, from whence these patients have 
obtained such unstinted hospitality. 

Undoubtedly the Belgian Government will prove its gratitude to Great Britain 
in many official and consequently more public capacities, but, in the name of the 
Belgian doctors who were appointed to British asylums with the permission of the 
Board of Control, 1 beg leave to state how grateful we are for all that has been 
•done for the Belgian patients, and how much we appreciate the kindness with 
which they have been received, the healthy conditions under which they were 
tended, and the constant attention paid to them by medical superintendents and 
their staffs. 

Our Doctors Deroitte, Maertens, Boulenger, Van de Maele, De Gheldere, 
Deckx, and myself will still remember the time we passed in the British asylums 
and the excellent experiences we have had therein. Dr. Deckx has returned to 


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Antwerp, Dr. De Gheldere has been called to France, Dr. Van de Maele is now on 
military duty, Dr. Deroitte will be attached to the Belgian Army, and I have been 
called for medical examination by the British authorities and may soon be required.. 
These are reasons all the more good for us to take this opportunity to express our 
utmost-admiration for the excellent organisation in which we were at work. 

I have known the asylums of the Continent for nearly twenty-five years, I have 
known the patients and their constant demands for food, clothing, freedom, etc.,, 
but I think there have never been less claims in that direction than these we have 
experienced here for the last two years. 

I have visited patients at Banstead, Claybury, and Colney Hatch, I have seen 
many other institutions for my Research work, and also private homes where 
Belgian patients were being cared for, and I have heard everywhere the same 
admiration expressed, and especially by the families of the patients. 

These few words, Mr. Chairman, are very insufficient, in our opinion, to convey 
all the sincere sentiments which will be preserved by us for the Board of Control 
and the British asylums, but we trust the future will afford many occasions in 
which we can recall with gratitude and all sincerity the friendly help of which our 
countrymen and ourselves have been the recipients in these times of general 
struggle and severe distress. 

I have the honour to be, Mr. Chairman, 

Your obedient servant, 

(Sgd.) F. Sano, M.D., late President of the Socidtd de 

Mddecine Mentale de Belgique. 

To Dr. Marriott Cooke, 

Chairman of the Board of Control, London. 


In connection with Major Sir Robert Armstrong’s paper on “ Dreams” a 
pathetic interest attaches to the following letter received by him from the late Dr. 
Frederick St. John Bullen, of Bristol, shortly before his death. Dr. Bullen was a 
talented member of the Association, whom death has all too soon removed from 
our ranks. He had made a special study of insanity and diseases of the nervous 
system, and had contributed valuable articles on these subjects to various journals 
— Brain, Journal of Mental Science, and others—the last, which appeared in our 
own Journal, being a paper on the “ Interpretation of Dreams according to Freud,” 
which was published in the January number, 1915; and it adds to the pathos of 
his life that he fell a victim to one of those diseases, progressive muscular atrophy, 
with which he had specially familiarised himself. It is a rare example of fortitude 
and utter disregard of self, in the face of rapidly approaching dissolution ; and 
few probably, even of medical men, would have had the courage and self-denial 
which he displayed in calmly and philosophically reviewing his own case, and 
giving his experience for the benefit of his fellows when actually within sight of 
the confines of the great Beyond. 

“ February 3rd, 1917. 

“ Dear Dr. Armstrong-Jones,—I am very interested in your forthcoming 
paper at the Med. Psychol. Meeting on the 15th inst. You may not be averse to 
receiving some clinical matter, even at the eleventh hour. 

“ As a rather neurasthenic subject my earlier dreams were often characterised 
by Fear and impeded Flight. This was so constant as to be typical during child¬ 
hood. This impaired freedom of muscular thought followed me through life 
(except for common and perfect ‘flying’ episodes), and here, in dreams, was but 
an emphasis of waking life, inasmuch as an invincible self-consciousness has 
hindered any attempts at public performances— e. g. playing the violin or piano 
either in solo or concerted works, taking part in discussions, etc. 

“ In dreams relating to performances on certain musical instruments, in which 
I was proficient, the facility of execution was always impaired, although that of 
original improvisation (merely ideal) was increased. The outcome of all this is. 
that, after a considerable degree of paralysis of my right hand (from P.M.A.) had 
been reached, I had two or three dreams in which unwonted freedom of movement 
in right hand appeared, so real that I awoke with the supposition that the condi¬ 
tion had improved. (Reflection on these dreams made me conceive them as .of 
bad omen, for reasons you will at once grasp.) 


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“ Later on, when the muscles of right forearm and upper arm were markedly- 
involved, I had another dream in which a certain feat of violin-bpwing (involving 
those parts) which 1 had never been able to accomplish in health, 'came off’ 
easily. No more dreams concerning muscular movements have occurred till last 
night, when 1 dreamt I was riding a cycle over rough and hilly ground with 
facility. (I need hardly say that both lower limbs are gravely affected now.) 

“ Of course, one could interpret these freed ideal movements by Freud's 
theories ; but to me they signify a freedom of ideas from inertia of muscle- 
representative-movements. 

“One knows that dreams are relative to the person having them; e. g. in some 
increased activity of movement prevails; in my case the reverse has been the rule; 
so that freer ideas of movement (as compared with dreams in health) have come 
about through destruction of motor cells. 

“ It would be interesting to hear what cultivated musicians would have to say 
on this aspect of dreams. 1 hope to be able to read your paper on the earliest 
possible occasion, as a bulbar paresis is rather hastening up the progress of my 
case. 

“ 1 hope you will excuse these slipshod notes, but I can hardly speak or write 
now, and the laborious expression of my ideas hinders their How. Please make 
any use you like of this letter.” 

On March 12th Dr. Bullen, retaining his cheerfulness and dauntless spirit to 
the last, joined the great majority, passing peacefully away. After his death his 
widow, who we need not say has our sineerest sympathy, with great kindness and 
consideration, sent the following extract from further notes regarding his case, which 
he had written laboriously with pencil, and she had with difficulty deciphered : 

“ My dreams were recounted, not so much as bearing on Freudism, as illustrative 
of the freeing of representation of muscular movements by an interruption in the 
ideo-motor arc ; this interruption from cloying effects of projected muscular move¬ 
ments in my case, known to be due to a coarse lesion ; in ordinary dreams probably 
from disordered synapsis. Freud, no doubt, would class these dreams as wish- 
fulfilments, or substitutions to avoid a painful idea, and to procure and prolong 
sleep. For myself, I follow the old. adage, ‘ Dreams go by contrary,’ i.e. dreams, 
like other cerebral automatic states, consist of a succession of images variant in 
whole or part to that image by which provoked, and a procession of such auto¬ 
matisms account for many of the subtle enigmas propounded by Freud. My last 
dream is not without interest. I am addressing a golf-ball, and my drive is 
accompanied by a slow effort-full swing, on which my comment is : ‘ How painful 
an effort; my muscles must be exhausted by influenza.' The ball hhs travelled, 
true to waking life, some 20 yards into a furze bush ! This dream may be 
modified, as compared with others, by the fact that one arm only is completely 
paralysed, and the movement, even if entirely freed from inertia of muscular 
thought, would never have had the liberty of the movements concerned in music ; 
there being aptitude and dexterity in this, and little or none in golf.” 

The clarity of thought and reasoning, and the touch of humour in this passage, 
in one on whom Death had almost already laid his heavy hand, are little short of 
marvellous. It helps us to realise all the more the loss the profession, and our 
speciality in particular, have sustained by the demise of such a gifted personality. 

UNIVERSITY OF LONDON, UNIVERSITY COLLEGE. 

The following notice reached us too late for insertion in the January number. 
Some of the Lectures have, of course, been already delivered. 

Session, 1916-17. 

A course of seven public lectures on " Psychology in Relation to the War ” 
will be given on Wednesdays at 5.30. p.m. as follows : 

Wednesdays, March 7th and 14/A, 1917.—“ The Psychology of the Unconscious 
and the War Neuroses." By E. W. Scripture, Ph.D., M.D., late Professor 
of Experimental Psychology at Yale University. 


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Methods of investigating the unconscious mind; association experiments; 
analysis of dreams; how the unconscious produces myths and legends; the 
conflict between the conscious and the unconscious minds ; the victory of the con¬ 
scious mind necessary for normal life but never quite complete; nervousness, 
neurasthenia, and hysteria the results of partial victory of the unconscious mind; 
neuroses of dissatisfaction, timidity, and fear; the effect of war stress on the 
mind; the psychology of shell shock. 

Wednesday, March, 21^,1917.—“Repressed Instincts and War.” By Ernest 
Jones, M.D., M.R.C.P. 

Psycho-analysis of repressed impulses in the unconscious mind ; their fate and 
indirect manifestations. Possibilities and limitations of “ sublimation ” into 
socially useful channels; frequency of reaction-formations simulating this. Un¬ 
conscious influences (1) facilitating the causation of war and (2) seizing the 
opportunity of war to enable reversion to more primitive standards of morality. 

Wednesdays, May gth and'i 6 th, 1917.—"The Conflict of Motives.” By Prof. 
T. Percy Nunn, M.A., D.Sc.,-London Day Training College. 

(i) The problems, theoretical and practical, suggested by the conflict between 
the " rational ” and “ irrational ” motives in human conduct, although amongst 
the oldest in history, have received no generally accepted solution, and form a 
centre of contemporary psychological discussion. The war has inevitably increased 
the urgency and interest of the debate. A brief critical review of its present 
position (in the writings of McDougall, Bergson, Shand, Myers, Graham Wallas, 
Trotter, Bertrand Russell, and others) leads to the concept of life as expressive 
organisation. 

(ii) This view developed and confronted with outstanding phenomena of indi¬ 
vidual and social life. Special importance of the discoveries associated with 
Freud. The practical consequence in education and social organisation. 

Wednesday, May 23 rd, 1917.—“ Human Emotions in Relation to War.” By C. 
Burt, M.A., Psychologist to the London County Council. 

Wednesday May 30 th, 1917.—“ Psychological Surveys and Educational Recon¬ 
struction.” By C. Burt, M.A., Psychologist to the London County Council. 


Admission free. 
Gower Street. 


No tickets required. Doors open at 5.0 p.m. Entrance: 

Walter W. Seton, M.A., D.Lit., 
Secretary. 


OBITUARY. 

William Orange, C.B., M.D., F.R.C.P., 

Formerly Medical Superintendent, Broadmoor Criminal Lunatic Asylum. 

The following obituary notice appeared in the British Medical Journal of 
January 13th, and merits a place in this Journal, constituting, as it does, a faithful 
record of the late Dr. Orange’s career, and a most fitting tribute by his intimate 
friend to the memory of a distinguished member of the Association. 

Official and Personal: An Appreciation. 

William Orange, whose death on December 31st, 1916, at the age of 83, was 
announced last week, was of Huguenot extraction, an ancestor having settled in 
Derbyshire early in the seventeenth century, not so very long after the massacre 
on St. Bartholomew’s Day in 1572. His father, the Rev. John Orange—a 
man of studious and philanthropic character—was an Independent Baptist minister 
who “ preached the word ” first at Newcastle and afterwards at Torquay, where 
the.subject of this notice was born on October 24th, 1833, and where he showed 
much promise as a youngster at school and gained quite a number of silver medals. 


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When about 15 years of age Orange was apprenticed, as the custom then was, to 
a doctor at Swallowfield, in Berkshire, for the purpose of entering the medical 
profession. He prosecuted his studies at St. Thomas’s Hospital in London, and 
became M.R.C.S. and L.S.A.in 1856. On leaving the medical school he took a 
prolonged tour on the Continent in charge of a gentleman whose health had 
broken down, a trip which enabled him to furnish himself with a passable 
linguistic equipment in French, German, and Italian, which he found very useful in 
after years. After some dispensary practice and a spell of three years’ work as 
Assistant Medical Officer at Tooting he was appointed Deputy Superintendent of 
the Criminal Lunatic Asylum at Broadmoor at its opening in 1862, under his old 
chief Dr. Meyer, who was the first Superintendent. Together they got the place 
into working order, and laid the foundation of much public work in connection 
with this particular department. On Sunday in t866, while kneeling at the 
Communion Service, Dr. Meyer was struck a violent blow on the head by a 
patient with a stone slung in a handkerchief; on his death in 1870 Dr. Orange, 
who then succeeded him, thus writes of him : 

‘‘To the injury which he received from a patient, and to the constant mental 
strain occasioned by the responsibilities of his office, must, 1 believe, be chiefly 
ascribed the loss which the asylum has had to deplore.” 

In 1868 Orange took the degree of M.D. of Heidelberg, and became a Member 
of the Royal College of Physicians of London, of which he was elected a Fellow in 
1878. In 1883-84 he was President of the Medico-Psychological Society of Great 
Britain and Ireland, and in that capacity delivered an admirable address on 
criminal lunacy, pointing out the relations of mental derangement to offences 
against the law of the land, and explaining the efforts that were then being made 
by Parliament and the legal authorities to bring the procedure of the Courts, with 
regard to trials in criminal mental cases, into some sort of uniformity as a 
development of the practical experience of medical men in these cases. 

The Home Office was well advised in promoting Dr. Orange to be head of 
Broadmoor, although such excellent and capable candidates as Dr. Lockhart 
Robertson, Superintendent of the Sussex Asylum, and Dr. Gover, the Medical 
Inspector of Prisons, were being “ run ” for the post. I knew Dr. Orange at this 
time, but I did not become officially connected with Broadmoor until 1876, when I 
was appointed Deputy Superintendent. Since that date it has been my privilege 
to preserve a close and unbroken friendship with him up to his death. 

Orange’s work as Superintendent of Broadmoor, as a pioneer in systematising 
the complicated details of management and treatment of criminal lunatics gene¬ 
rally, and in formulating and adjusting the multitudinous array of questions 
bearing upon insanity in its relation to crime, made him a world-wide authority of 
the highest repute on these and allied subjects. Amongst the many privileges that 
I had as his deputy was that of meeting the many eminent authorities on insanity 
and crime, both British and foreign, who came to seek his counsel and to visit the 
asylum and its inmates. Dr. Motet, a French physician of great eminence and 
experience, wrote to his Government after a visit in 1881 : *‘We have returned 
from Broadmoor satisfied at having found the realisation of an idea that has 
always appeared to us to be right.” And two years later the French Senate 
received the following report: 

“ The delegates of the Commission of the Senate who visited Broadmoor on 
October loth, 1883, were satisfied that, despite the fine exterior appearance, the 
liberality of the accommodation, and the exceptional care bestowed upon the 
dietary, there is no unnecessary extravagance. It is true that one might at first 
sight imagine some extravagance in the personnel of the attendants as regards 
their number, their selection with regard to height and physique, and then- 
admirable appearance; in their bearing, in the taste bestowed upon their private 
dwellings, which form an avenue of charming cottages outside the asylum; but 
one recognises at once that the great importance given to this question of the 
personnel of the attendants affords the explanation, not only of the small number 
of escapes and other casualties at Broadmoor, but also of the unexpected spectacle 
of good order, tranquillity, and perfect discipline which strikes strangers who 
visit it.” 

It was a source of much gratification and encouragement to Dr. Orange to have 
such testimony to the success of his efforts in wearing down the officiously 


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adverse criticisms which were at times levelled against the raison d'etre of Broad¬ 
moor, and the “ extravagance ” which attended the safe and proper treatment and 
management of this special class of asylum inmate. 

In appreciation of his work the Medico-Psychological Society of Paris made him 
a Foreign Associate, and other societies abroad paid him a similar compliment. 

Most of Orange's work as medical adviser to the Home Office in criminal 
mental cases was of necessity confidential. But among the many cases of indi¬ 
viduals sentenced to death for murder in which, with a colleague, he held a 
statutory medical inquiry on behalf of the Home Secretary may be mentioned 
that of Christiana Edmunds (1872) the notorious Brighton poisoner. In this 
complicated and difficult case Dr. Gull and Dr. Orange, after a long examination 
of the prisoner, found sufficient grounds to justify them in certifying her to be 
insane. Another important case was that of the Walthamstow murder in 1883, 
where William Gouldstone took the lives of his five children. Here Drs. Orange 
and Gover found distinct evidence of insanity. In both these cases a considerable 
amount of feeling and of conflict of opinion amongst medical men and the public 
was engendered, the value of the Home Office reference under circumstances of 
the sort was demonstrated, and whatever excitement or irritation may have been 
displayed was allayed. Orange's capacity for making patient and searching 
investigation and of, as it were, penetrating the intimate workings of the mind of 
accused persons, and his wide experience in dealing with cases of the sort, made 
him invaluable in the administration of justice at this angle, where evidence has 
to be weighed in combination with personal examination, and where the issues of 
life and death may be said to be involved. In the case of Lamson, the Wimbledon 
murderer, who was hanged, no insanity could be found. 

In March, 1878, the Rev. Henry J. Dodwell was tried for shooting at the Master 
of the Rolls (Sir George Jessel) and found “guilty but insane,” and sent to Broad¬ 
moor. The Master of the Rolls was not hit on the discharge of the pistol, which 
contained no bullet, but only (as Dodwell himself told me) a wad made up of a 
marginal strip from the Morning Advertiser, upon which he had written “ Un¬ 
faithfulness to the true interests of the Crown of Englind,” Dodwell’s real object 
being to secure a criminal trial at which he might have an opportunity of making 
his grievances public. On June 6th, 1882, Dodwell made a murderous assault 
upon Dr. Orange, and as the mental schemings of such a mind as his are ever of 
interest, I quote the victim’s own account of the circumstances: 

“ A determined assault was made upon me, on June 6th, by one of the inmates, 
who, whilst I was occupied in reading some letters with respect to which he had 
requested my advice, suddenly, and without warning, struck me a violent blow on 
the head with a heavy stone slung in a handkerchief. The perpetrator of this act 
was the same man who fired at the Master of the Rolls four years ago ; and the act 
was prompted by a precisely similar motive on both occasions—namely, in order 
to attract public attention to a conspiracy of which he believed himself the victim. 
He afterwards stated that he had made up his mind to commit an act that would 
lead to a coroner’s inquest more than a year ago, but that no sufficiently favourable 
occasion had then presented itself. Being, however, cool and determined and 
cunning, although labouring under a dangerous delusion, he was, like insane 
persons of this description, able to exercise sufficient self-control to wait until the 
circumstances were such as he deemed favourable to the full accomplishment of the 
object that he had in view.” 

It so happened that some two months previously Dr. Orange had, at the instance 
of the Treasury, given evidence of insanity at the trial of Robert Maclean, who 
fired a pistol at Queen Victoria; and in the course of his examination he stated,as 
a matter of illustration, that some points in the case resembled those in the case of 
"the man who shot at the Master of the Rolls. He maintains he is right and 
always has maintained he is right. He knew beforehand that he would have to go 
through a criminal court, but he is insane and irresponsible This statement was 
read by Dodwell in the newspaper account of the trial, and it proved to be the 
factor in his mind which determined him to wait no longer, but to commit the 
assault on Dr. Orange at the earliest opportunity, which he himself created by 
asking the superintendent to advise him on a family matter of some importance. 

Although he had leave of absence for a year, Orange never recovered from the 
effects of this assault; and the strain of the work made it a great struggle for 


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•him to keep on in his weakened condition, because he felt that his cofidence in his 
own powers had been reduced. This to a man whose leading mental attribute 
had been decision in action was fatal to his amour propre, and led to his retire¬ 
ment on pension four years after the date of the injury. He did no active official 
work after this, except that after prolonged rest he became a member of the 
Council of Supervision of Broadmoor from 1892 till 1904, and was usefully 
■employed. On his retirement Queen Victoria conferred on him the honour of 
the Companionship of the Bath. 

In its issue of June 5th, 1886, the British Medical Journal referred to Dr. Orange 
in the following terms : 

“ His eminently successful administration of this post has been testified to over 
and over again in our columns and elsewhere ; and when we recollect the danger¬ 
ous and intractable character of the lunatics sent to Broadmoor its superintendent 
•cannot be said to hold an office which is either a sinecure or free from constant 
risks of all sorts. Dr. Orange’s management of Broadmoor has been characterised 
by a judiaious firmness, combined with a most kindly consideration for the interests 
of the unfortunate patients who came under his care. He will be greatly missed 
by them ; while, as an evidence of the estimation in which he was held by the 
officers and staff of the establishment, he was, last Monday, presented by them 
with a handsome and substantial silver salver and many expressions of regret at 
bis departure and cordial good wishes for his future. When referred to, as he 
frequently was, in cases of capital offences where the mental condition of the 
offender came into question, his investigations were thorough, his decisions 
clear and sound; and his recommendations were, we believe, invariably carried 
out, and never failed to be satisfactory not only to the authorities but also to the 
general public, in whose estimation he deservedly stood high.” 

And the Lancet of the same date congratulates Dr. Orange upon the successful 
results of his labours in the public service, and of his most efficient administra¬ 
tion of a grave and responsible public trust. Referring to the “ trying duties 
developing upon him as one of the advisers of the Home Office authorities in 
cases where capital crimes had been committed, and where the question of insanity 
arose,” the Lancet went on to say that 

"The general public have .to be especially grateful to Dr. Orange, for, with an 
•exceptional experience on the subject, his scientific penetration, his sound 
judgment, and his shrewd common sense never failed to secure universal approval 
for his decisions on these momentous issues.” 

After much that was in praise of Dr. Orange, the Journal of Mental Science for 
July, 1886,thus speaks: 

" After hard and anxious work, Dr. Orange succeeded in reducing the compli¬ 
cated details of the asylum administration and of questions which thereafter arose 
as to the best methods of dealing with the criminal lunatics of the country to a 
complete system, such as has earned the unqualified praise of visitors from all 
parts of the world.” 

Dr. Orange’s contributions to the medical press contained expressions of 
•opinion which were always practical and well thought out. His article on 
■"Criminal Responsibility,” in Tuke's Dictionary of Psychological Medicine, deals 
■with the rules by which Courts have been and are guided, and the cases cited by 
bim are useful for reference. He concludes by saying: " It must be remembered 
that in a criminal court the term responsibility means liability to legal punish¬ 
ment.” He adds: “ In a general sense, a person may be said to be insane so as 
not to be liable to legal punishment: (l) When his mental condition is such as 
<to render him unfit for penal discipline; or (2) when, in the words of Lord 
Blackburn, disease of the mind was the cause of the crime; or when, in the 
words of Mr. Justice Stephen, the accused ‘was deprived by disease affecting the 
mind of the power of passing a rational judgment on the moral oharacter of 
the act which he meant to do.'” In an address at Reading in 1877, on "The 
Present Relation of Insanity to the Criminal Law of England,” Dr. Orange made 
the following remark, which ought to be borne in mind : “ Moral depravity must 
be carefully distinguished from actual mental disease. The term ' moral insanity 1 
is, I think, better avoided in a criminal court of law” ( British Medical Journal, 
October 20th, 1877). 


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Of an attractive personality, Orange was essentially the official, and he devoted 
himself unsparingly to the work of his life, for which he was well fitted by a good 
physique, a sound judgment, an equable temperament, and a strong will. He 
had many friends, and was himself a staunch friend. He did not, however, readilr 
make friends; his mind was formal in its activities, and a certain mannerism, 
referable, perchance, to his Huguenot (French) descent, together with a searching 
but not unkindly lpok from his clear eye, rather gave strangers the impression 
that they were “ psychologised.” In this way he no doubt did himself less than 
justice, for he was ever sympathetic with those in trouble, and ready to help when 
appealed to. His was a fine intellect which led him to sound decisions by a 
process of rapid intuition ; but he was occasionally apt to spoil the effect by 
harking back and entering into minute details which occupied time, but which had 
the effect of satisfying him, as it were, that he had not failed to form a correct 
judgment at first. 

He read much in scientific and general literature, was well informed, and could 
hold his own in controversy. He took little or no interest in outdoor games. He 
was keen on the asylum farming operations and fond of riding exercise on the 
Bagshot Heath or in the Swinley Forest, while nothing gave him more thorough 
enjoyment than a day with Garth’s hounds. He could play a good rubber of 
whist, and was musical and capable of taking his part in glees and light operettas. 

Orange had as a lifelong friend Dr. Charlton Bastian ; and of close friends he 
had also Henry Weston Eve and Osmund Airy, and other masters at Wellington 
College, which was in the immediate neighbourhood. In this relation I must not 
omit to mention his good friend the late Sir Warwick Morshead, Bt., the Chair¬ 
man of the Council of Supervision, who was Orange’s steadfast collaborator in all 
that was done for the good of Broadmoor and its inmates. 

Two years after he went to Broadmoor Dr. Orange married Miss Florence 
Elizabeth Hart, a lady of much charm and attractiveness. He had, I am told, 
fallen in love with her when she was a child, and married her when she 
was ret. 17. They were an ideally happy and domesticated couple, given to 
hospitality and the cheerful entertainment of friends and neighbours. She died 
three years before him, and they both lie at rest in the cemetery at Bexhill. 
They had five children—four daughters and one son—all well gifted with in¬ 
tellectuality and working capacitiy. The son, Mr. Hugh W. Orange, C.B., C.I.E., 
is the Accountant-General of the Board of Education. 

In conclusion, I am glad to have been afforded the opportunity of writing this 
memoir of a courteous gentleman, a high-minded public official, and, especially to 
me personally, an esteemed friend. Dav. Nicolson. 


Dr. Thomas Seymour Tuke, M.A., M.B., B.Ch.(Oxon.). 

Dr. Tuke, a regular attendant at the meetings of the Association, is another 
victim of the severe winter. 

After a short illness he died of pneumonia. 

He was sixty-one years of age, but his hearty, buoyant nature gave one the 
impression that he was much younger, and, as a consequence, one cannot help 
feeling that he has been prematurely cut off in his prime. 

He was the son of Dr. Harrington Tuke, who was President of the Associa¬ 
tion in 1873, and who for years was a leading consultant in mental diseases. He was 
proprietor of a first-rate private asylum, The Manor House. To this Dr. Seymour 
Tuke, with his brother, succeeded, and later moved to Chiswick House, the 
property of the Duke of Devonshire. Here, associated with his brother, he 
lived and died. 

He was the grandson of Dr. Conolly, who was so well’known all over the world 
as being the introducer of “ non-restraint ” in the treatment of the insane. 

Dr. Maudsley was his uncle, and no one has been a more ardent supporter of 
humane treatment of the insane than Dr. Maudsley. 

It has been remarkable that the name Tuke has always been associated with 
the most humane treatment of sufferers from mental disorders. There was 
Hack Tuke, a descendant of the founder of The Retreat, York, there was Sir J. 


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Batty Tuke, so well known as the owner of the best private asylum in Scotland, 
and M.P. for Edinburgh University. Yet these Tukes all belonged to different 
families, and 1 believe there was one other Tuke, who received mental patients in 
Brighton forty years ago. 

So much for the heredity of Dr. Tuke. 

He was educated first at St. Paul's School, which had the advantage of being 
a public classical school, allowing him to live at home. I know nothing special 
about his school days, but 1 have no doubt that already he had shown his mastery 
over the cricket bat, and he won a Scholarship to Brazenose, Oxford, at a time 
when that college was noted for its athletic powers, and was especially fortunate 
on the river. 

Seymour Tuke took to cricket, and was in his College Eleven, in fact, I believe 
he was captain. He was a Freemason, and belonged to the best social clubs 
in the University. He took his arts degree and formed many life-long friends. 

He was then, as ever, most kindly and genial, a good specimen of the English 
gentleman, with strong English tendencies to out-of-door sports. He entered 
St. George's Hospital, and for a time was also a student at the London Hospital, 
where he was able to have a larger field for study. He did not make any special 
mark at the hospital, but he was very much liked and respected. He took his 
degrees at Oxford, and then settled to his life’s work. At first he was inclined 
to take things in a very easy, leisurely way, but he married the daughter of 
the late Dr. Graily Hewitt, and in earnest set to work with his brother to do the 
very best for the patients under his care. 

Here he was conspicuous, always cheerful, and constantly with the patients, 
ever ready to walk, talk, play cricket, squash rackets, or golf with them. His 
patients became and remained his friends. No one ever carried out the humane 
treatment more consistently than Tuke. He was President of a branch of the 
British Medical Association, and, as 1 have said, he was a regular attendant at 
the local and general meetings of the Medico-Psychological Association and at 
the meetings of the other allied societies. 

He wrote very little, but if he spoke it was always concisely and to the 
point. 

He was conservative in medicine, and hesitated to follow any new lead till he 
had good evidence that there was reasonable hope of gain from it. Thus, at 
first, he objected to the Salvarsan treatment of general paralytics in Chiswick 
House, but later he accepted the trial, but was in the end against the treatment. 
He had some very strong, almost violent, prejudices. He felt that mental diseases 
and their study were a very clear and defined class, and needed very special study, 
and he was angry that gradually the British public were getting impressed that 
all asylums, and particularly all private asylums, were merely places where patients 
were retained and kept out of harm’s way, but were not “treated” medically.' 
He felt that the sending of these patients into ordinary nursing homes, or into 
the houses of lay-people, was placing them under conditions readily leading to 
incurability. 

For the time to cure these disorders is at the start. Time, he felt, was wasted, 
and patients then sent to asylums when the prospect of cure was reduced. 

He was often prophesying that this will sooner or later lead to scandal, or 
rather will lead to the discovery of scandals'which are being carried on in 
“private-care” homes. 

Personally, he felt the difficulty of understanding the working of the unsound 
mind unless personal care and great patience were exercised. And now he has 
passed away, leaving the beautiful house still carried on by the Tuke family, 
where he was loved and respected. 

It is not fair to leave him without referring to other sides of his character. 

He was a fine, all-round sportsman. He used to be a straight rider after the 
wild stag in Devonshire, a good game shot and cricketer, and, in fact, he would 
have been a good golfer, but he felt it would take too much time. 

In the parish he was a recognised power, the Vicar looking upon him as a 
right-hand helper. He was a keen Freemason, and active in Volunteer work. 
He had a deep grief in the death in battle of his only son, who was going into 
medicine, and was an undergraduate at Oxford. But he accepted his loss in a 
most truly reverend way, and he was certainly a fine example of a Christian 


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doctor. Deepest sympathy was extended to his widow and daughter, and the 
expression of this by the immense congregation at Old Chiswick Church. 

He has left a pleasant memory, which will father grow than dwindle with 
time. 


Joseph Tregelles Hingston, M.R.C.S.Eng., L.S.A. 

Dr. J. T. Hingston died within a few months of his 82nd year on February 18th, 
1917. He obtained his Medical Diploma in 1856 and almost immediately adopted 
Lunacy as his special subject, leaving the Middlesex Hospital to become Assistant 
Medical Officer at the North Riding Asylum, York. In 1862 he went to St. 
Andrew’s, Northampton, as Assistant, and from there in 1868 he was appointed 
Medical Superintendent of the Isle of Man Asylum, to remain only a couple of 
years before he returned in 1870 to the North Riding as Chief, which office he 
fulfilled for thirty-five years, retiring in 1905 on the completion of forty-nine years’ 
Asylum service. He was a member of the Medico-Psychological Association 
since 1871, and many will recall with pleasure the General and Divisional meetings 
held at his Asylum. Hingston throughout his lifetime endeared himself to all with 
whom he came in contact, by his innate old-world courtesy and his sympathetic 
nature. He was a fine type of the kindly, good-hearted gentleman whose thought¬ 
fulness and consideration for others went far to alleviate their sufferings and 
trials. 

He recognised the value of personality and moral influence in the treatment of 
the insane, and strongly advocated the importance of the hopeful word, cheerful 
surroundings, interesting employments, and amusements as a help to his patients 
to put aside the toil of disease and to climb the difficult and tedious path of 
recovery which leads to reason. 

Hingston was of a retiring but cheerful disposition, and few outside his intimate 
friends had an opportunity of appreciating his wonderful charm of manner and 
keen sense of humour. On his retirement he went to reside at Leamington. For 
some time previous to his death he lived with his daughter and son-in-law at 
Acocks Green Vicarage, Birmingham. During the last few months of his illness 
he was subject to severe attacks of angina, but, as ever, his thoughts were not 
centred on his own suffering; his fear was that he might be a trouble to those 
around him. 

“ Leave him—still loftier than the world suspects 
Living and dying.” 


Robert Brice Smyth. 

It is with deep regret that we record the sudden death, on February 27th, of 
Dr. R. B. Smyth at the early age of forty-five. 

He came of an old Ulster family, and his father and surviving brother, who 
are also members of the medical profession, are at present in practice in Belfast. 

He was educated at Uppingham and Trinity College, Dublin, and qualified in 
1893, taking the degrees of M.A., M.B., B.Ch., B A.O. In the following year he 
went as Clinical Assistant to St. Luke’s Hospital, and in 1895 he was appointed 
Assistant Medical Officer at the Gloucester County Asylum, becoming Super¬ 
intendent of that institution on the death of Dr. Henley in 1908. 

For eight years he carried out the duties of a difficult position with marked 
ability, and his lovable disposition and attractive personality endeared him to all. 
No undertaking was too great and no detail was too small for his energies and 
attention, and his whole object and aim in life was the welfare, good name, and 
honour of the institution entrusted to his care. 

From the outset he won the entire confidence of his Committee, and his affection 
for his patients and the extraordinary interest he took in their individual welfare 
were, at all times, predominant. 

Dr. Smyth was a keen follower of all kinds of outdoor sport. A steady 
batsman and a good captain he did much for cricket in the Asylum; he also, in 
his younger days, played regularly for the Gloucester City team. He was a good 
game shot and fly fisherman, and his holidays were always spent in these latter 


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pursuits. He was a lover of dogs, and at one time he was a breeder and exhibitor 
of Irish Terriers, and on several occasions was the holder of the Irish Terrier 
Cup. He was a close observer of nature, and in recent years devoted much of 
his spare time, to his garden and his roses. He was a member of the British 
Medical and Medico-Psychological Associations. 

The funeral took place in Belfast, a short memorial service, attended by members 
of the Committee and staff, being held in the Asylum Chapel on the previous 
Thursday. 

He leaves behind many to mourn his loss, and not least important among them 
are those amongst whom he lived for so many years, his colleagues, his staff, and 
patients. 


THE LIBRARY. 

Members of the Association are reminded that the Library at 11, Chandos 
Street, W., is open daily for reading and for the purpose of borrowing books. 
Books may also be borrowed by post, provided that at the time of application 
threepence in stamps is forwarded to defray the cost of postage. Arrangements 
have been made with Messrs. Lewis to enable the Association to obtain books from 
the lending library belonging to that firm should any desired book not be in the 
Library. In addition, the Committee is willing to purchase copies of such books 
as will be of interest to members. Certain medical periodicals are circulated 
among such members as intimate their desire to be included in the list. 

The Library Committee thanks Dr. Maurice Craig for the gift of the third 
edition of his book on Psychological Medicine. 

Members reducing their private libraries are requested to bear in mind the 
library of the Association. 

Applications for books should be addressed to the Resident Librarian, Medico- 
Psychological Association, 11, Chandos Street, Cavendish Square, W. 

Other communications should be addressed to the undersigned at the City of 
London Mental Hospital, Dartford, Kent. 

R. H. Steen, 

Hon. Secretary, Library Committee. 


NOTICES BY THE REGISTRAR. 

Dates of Examination. 

The examinations for Nursing Certificate will be held as follows: 

Preliminary.May 7th. 

Final.May 14th. 

The examination for Certificate in Psychological Medicine will be held in 
London early in July. For particulars, apply to the Registrar, Dr. A. Miller, 
Hatton Asylum, Warwick. 


NOTICE TO CONTRIBUTORS. 

N.B. —The Editors will be glad to receive contributions of interest, clinical 
records, etc., from any members who can find time to write (whether these have 
been read at meetings or not) for publication in the Journal. They will also feel 
obliged if contributors will send in their papers at as early a date in each quarter 
as possible. 

Writers are requested kindly to bear in mind that, according to Lix(a) of the 
Articles of Association, “ all papers read at the Annual, General, or Divisional 
Meetings of the Association shall be the property of the Association, unless the 
author shall have previously obtained the written consent of the Editors to the 
contrary.” 

Papers read at Association Meetings should, therefore, not be published in other 
Journals without such sanction having been previously granted 

LXIII. 20 


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THE 


JOURNAL OF MENTAL SCIENCE 


[Published by Authority of the Medico-Psychological Association 
of Great Britain and Ireland.'] 


No. 262 [« N VST] JULY, 1917. VOL. LXIII. 


Part I.—Original Articles. 


Dr. Hughlings Jackson on Mental Disorders. By Sir 
George Savage, M.D. 

I HAVE long felt that the relationship of Dr. Jackson’s 
teaching in reference to nervous disorders has not been 
sufficiently considered from the psychiatric side. I fear that I 
shall not be able to do justice to the subject, yet I believe it to 
be almost a duty for me to attempt it. 

To begin with, I knew Dr. Jackson during the greater part 
of his professional life, for while I was holding resident appoint¬ 
ments at Guy’s, Dr. Jackson and Dr. H. Gawen Sutton were 
constantly at the hospital, where they were especially following 
the clinical teaching of Gull and the pathological work of 
Wilks. Then followed a few years during which I was away 
from London, but on my return I renewed my friendship with 
Dr. Hughlings Jackson, and not infrequently went round the 
wards of the London Hospital with him. Later still, he would 
come to Bethlem, and go into some of the wards with me. He 
used to say that the study of nervous disorders, particularly 
epilepsy, gave him endless interest, but as for insanity, he dis¬ 
liked it, and, unlike the neurologist of to-day, he would have 
nothing to do with insane patients if he could help it. His 
mind was one which needed order and precision, and the dis¬ 
orders of mind only perplexed him. He could understand 
losses of power and losses of control, but, as they showed them- 

LXIII. 21 


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selves in the wards of Bethlem, they puzzled and upset him. 
At times he seemed to have a real physical dread of the 
patients, and failed to have anything like the human sympathy 
which he had for the epileptics. He looked upon many of the 
insane as rather useless cumberers of the ground. 

Dr. Hughlings Jackson absorbed the writings of Herbert 
Spencer, and all his philosophy depended on the evolutionary 
theory, His name will always be associated with epilepsy, and 
the works of Hitzig and others abroad, and Ferrier in England, 
established his faith in the localisation of functions in the brain. 
As I shall have occasion to point out, the great principle which 
he insisted upon was that nervous, and most mental, symptoms 
were not the direct result of disease of particular parts of the 
nervous system. In fact, he looked upon disease in any part of 
the body as consisting of two very distinct factors : the one 
associated with the putting out of action of the function of the 
organ, the other—and generally the most evident—the effect 
produced by removal of the higher function, thus allowing 
actions which were controlled or directed by the higher function 
to show themselves. It will be seen here how evolution plays 
the part, for Jackson looked upon all the fully-developed func¬ 
tions as having passed through elementary states which, in fact, 
are represented in less developed organisms. We are all aware 
of the stages which man, for instance, passes, from a simple 
cellular existence through forms resembling the reptile or 
amphibian, before passing into the human. This is, of course, 
the extreme example ; but in the education of the body and the 
mind, and the adjustment of the being to its environment 
many steps are taken. With complete development these 
steps are hidden, and it is only by inversion of the process of 
evolution that they are recognised. It is best seen, as Jackson 
has made plain, in the dissolutions of senility. 

Jackson certainly goes very far in his explanations of symp¬ 
toms in this way, but if all his views are not established, they 
are very suggestive. 

The creed may thus be given : mental operations are simply 
the subjective accompaniments of sensori-motor processes. The 
incentives to volition are sensations received through the organs 
of sense, or the revived impressions of such sensations. The 
sensori-motor apparatus of the cortex is re-represented in the 
higher centres. He says they are represented in the pre- 


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frontal region, which he considered to be non-excitable where 
they have the power of controlling and concentrating conscious¬ 
ness in definite directions, and deciding between courses of 
action. 

Here we have plainly the basis on which his work is built. 
The organs of sense in their relation with their environment are 
represented in the brain in various degrees. This representation 
has to be considered in three grades, ranging from the auto¬ 
matic to the reasoned. 

He looked upon the fore-brain as the highest representative 
part, as the part chiefly concerned in cases of mental disorder, 
or rather, in its manifestations, that is, its symptoms. Jackson 
maintained that the right half of the brain is the more auto¬ 
matic, while in the left, is the more organised, automatic acts 
become voluntary. He referred to the ability of some aphasic 
patients to ejaculate certain words, often of the interjectionary 
type, through survival of automatic power of the right brain. 

Hughlings Jackson contributed two articles in the Journal 
of Mental Science in 1875 and 1887. He gave an address 
which was published in the Medical Press and Circular of 
June 13th, 1894, entitled “The Factors of Insanities,” and he 
contributed to the discussion at the Neurological Society on 
“ Imperative Ideas,” which appears in Brain , parts 70 and 71. 

A very complete account of Jackson’s views are given in Tuke’s 
Psychological Dictionary , by James Anderson, under the heading 
of “ Epileptic Insanities.” 

He says there are three doctrines as to the relationship of 
mind to nervous activities. First, that the mind acts through 
the nervous system (through the highest centres first). Here 
an immaterial agency is supposed to produce physical effects. 
Second, the activities of the highest centres and mental states 
are one and the same thing, or are different sides of one thing. 

A third doctrine—“ one which I have adopted ”—is, that 
states of consciousness, synonymously states of mind, are 
utterly different from nervous states of the highest centres. 
The two things occur together. For every mental state there 
is a correlative nervous state. Although the two things occur - 
in parallelism, there is no interference of one with the other. 
Hence we do not say that psychical things are functions of the 
brain, but simply that they occur during the functioning of the 
brain. 


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It seems to me that the third doctrine, that of concomitance, 
is at any rate convenient in the study of mental disease. In a 
sense the whole body is the organ of mind, and Lewis con¬ 
sidered that some degree of consciousness attends activities oi 
even the lowest centres. He had no idea of showing how 
mind is evolved from the body. States of mind arise in 
relation with certain activities of the highest centres. Emotions, 
for example, which arise in connection with activities of the 
periphery, are re-represented in the highest centres. Fear is the 
mental counterpart of certain activities of practically every part 
of the body. These activities—for example, perspiration, urina¬ 
tion, etc.—are represented for ordinary menial purposes. Dr. 
Hughlings Jackson was very fond of the expression “ menial 
purposes ” when referring to the organic functions. 

Next, I wish to consider the relationship of his philosophy to 
mental pathology. He wrote a short article entitled “ Factors 
of Insanities.” It is noteworthy that he prefers the term in the 
plural — insanities, rather than insanity; and he refers to 
Mercier, who, certainly thirty years ago, began to preach the 
difference between unsoundness of mind and so-called insanity. 
Hughlings Jackson seems to agree with Mercier in his general 
contentions. Included in insanities Jackson places a good 
many states of mind that are not generally considered under 
that head. Thus, he considers dreams and dreamy states as 
nearly allied to mental unsoundness, and groups them with the 
insanities. And when, later, we consider epilepsy, we shall find 
that there again he considers the earlier and threatening 
conditions of epilepsy as insanities, and yet as not to be con¬ 
sidered, clinically, as lunacy. I believe it was Hughlings 
Jackson who said that insanity was “dreaming awake,” while 
dreaming was “ insanity asleep.” As to the factors of insanity 
beginning with dreaming, he says—“ Dreaming has long been 
likened to insanity. I suggest several degrees of normal dis¬ 
solution of sleep: (i) Sleepiness, (2) sleep with dreaming, (3) 
slumber with actions (somnambulism), and (4) deep, so-called 
dreamless sleep. At least (2), (3), and (4) ought to be con¬ 
sidered as different depths of dissolution of the highest cerebral 
centres, with, in (2) and (3), and possibly in (4), lower ranges 
of evolution remaining in those centres.” 

In considering Dr. Hughlings Jackson’s philosophy, we have 
to recognise that he was an evolutionist and a follower of 


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Herbert Spencer to the very end ; that he looked upon every 
disorder as associated with a disintegration or dissolution. To 
this I shall have to refer later. 

He proceeds to say that there are four factors in insanities. 
There are different depths of dissolution of the highest cerebral 
centres. There are different persons who have undergone that 
dissolution, and there are different rates with which that disso¬ 
lution is effected. There is the influence of different local 
bodily states and of different external circumstances on the 
persons who have undergone this dissolution. 

The first factor of insanities, then, is the different depths of 
dissolution. Hughlings Jackson points out that in all forms of 
mental disorder there are positive and negative states. First, 
there is the defect produced by disease, and that defect 
liberates, as it were, the lower functions. So that, taking his 
so-called “ hierarchy,” there are the three grades, from what 
might be called the .simplest nervous centre, to the middle 
nervous centre, and to the highest nervous centres ; and if there 
is removal of function of the highest, then the lower centres are 
brought, more or less, into play. And the degree of mental 
disorder is, to a great extent, related to the amount of disso¬ 
lution of the highest centre, so that the control may be but 
slightly removed with comparatively slight disorder, whereas if 
a greater amount of control is removed by the destruction of 
the highest centres, there will be, probably, a greater amount of 
disorder, or over-action, as he has called it, exhibited in the 
next lower centre. He has pointed out how, gradually, re¬ 
duction and reduction may go on, till at last there is what he 
would call both physical and mental paralysis—a true palsy and 
true dementia—which are very near approaches to death. In 
this small book he gives interesting diagrams explaining his 
meanings. 

The second factor in insanities is the person who has under¬ 
gone dissolution. We all recognise the special tendencies of 
some individuals to break down along certain lines, and it 
comes to this—that the second factor, the person who has 
undergone the change, represents the liability to break down, 
which liability may be congenital, or may be acquired. 

The third factor in insanities is the rate at which dissolution 
has been effected. He points out, very clearly, that when the 
changes have been slow and steadily progressive, the defective 


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control is not so marked ; in fact, it is a very gradual process, 
best marked in senility, so that very gradually the defective 
control is shown by defective power of one kind and another. 
If, on the other hand, the dissolution is rapid, as in alcoholic 
poisoning, then there would be, probably, a very marked, 
exaggerated action of the lower centres. In the same way, 
such over-action not infrequently occurs following the profound 
and sudden dissolution occurring in epilepsy. 

The fourth factor* in insanities is the influence of bodily 
states and external circumstances. This, of course, is a very 
wide subject, and is involved in what he gives as a kind of 
addition to his factors, namely, the complication of factors. 
For, as we all recognise, one cause is rarely efficient jn pro¬ 
ducing the malady when it comes before us. 

Although it is necessary, for clearness, to speak of the factors 
seriatim , it is evident enough that each must be thought of in 
association with others. As in different insanities there are 
different depths of dissolution of the highest cerebral centres, as 
the persons who undergo dissolution are different, as dissolution 
is effected at different rates, and as the bodily states and 
external circumstances of different patients are not the same, 
we may say that every case of insanity is a function of 
variables. 

Passing now from the general factors of insanity, I think it 
is most important to consider his views in relationship to 
epilepsy—the subject which will always be associated with his 
name. It is at times somewhat difficult to make quite clear 
what Dr. Hughlings Jackson meant to teach, for his whole 
frame of mind was so careful and exacting that he scarcely 
ever dares to make a definite statement without qualifying it in 
some way ; so that in studying his writings one meets endless 
footnotes and parentheses, which are somewhat confusing. 

The question of epilepsies and insanities has been carefully 
considered, more particularly in reference to Hughlings Jackson’s 
teaching, by the late Dr. James Anderson in Tuke’s Dictionary 
of Psychological Medicine , and I shall not hesitate to quote 
from that. And I think that probably the best way will be to 
give a certain number of dogmas or epigrams direct from 
Jackson’s teaching, as they express in his own Words and 
concisely what he means. 

In his remarks on evolution and dissolution of the nervous 


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system, he says that “ an epileptic fit really is an universal 
symptomatology of the discharges, or symptoms due to dis¬ 
charge, of the highest cerebral centres.” He speaks of the 
different epilepsies, the scale of fits, and he says : “ I continue, 
for the most part, to speak of epilepsy as if there was only 
one clinical entity, but there are really many different epilepsies. 
I mean what would be called varieties of genuine epilepsy, each 
dependent on discharging lesions of some part of the highest 
centres. I also use the term ‘ fits ’ advisedly, because I do not, 
as I should when working clinically, care as an evolutionist, to 
know whether any paroxysm is or is not a case of epilepsy.” 
He speaks of different insanities associated with epilepsy as 
local dissolutions of the highest centres. “ We should not,” he 
says, “ in strictness speak of varieties of insanity, but of insani¬ 
ties, for, obviously, there are different kinds, as well as degrees, 
of insanity ; that is, there are dissolutions beginning in different 
divisions of the highest centres ; melancholia, posterior lobes ; 
general paralysis, anterior lobes, signifying different dissolutions 
of the highest centres. Evolution and dissolution always co¬ 
exist, or occur in alternation.” So that with a varying amount 
of dissolution there is a varying amount of evolution. Perhaps 
there might appear to be some confusion in his use of the word 
“ evolution.” Sometimes I have thought a better term might 
have been found. The mere relaxing of control and allowing 
an exhibition of force to occur is hardly evolution, and yet that 
is the term used by Hughlings Jackson for the result of relaxa¬ 
tion of control. He urges that in post-epileptic insanities the 
dissolution is local in the sense that it preponderates in the 
highest centres of one-half of the brain. The mania following 
a fit is the outcome of activities on the levels of evolution 
remaining, that is, that the mania is due to relaxation of con¬ 
trol. In disease there is rarely, even in senile dissolution, an 
absolutely regular and formal process of decay ; there is not a 
true reversal of the lines of evolution. As he says, in post¬ 
epileptic conditions you may get all varieties associated with 
temporary dissolution, but in various degrees. He remarks : 
“It is only in such dissolutions as those produced by alcohol 
that we can expect anything like uniform dissolution, a simply 
lower level of evolution." Again : “ We have implicitly urged 
that in each case of the insanity, indeed in all nervous diseases, 
we have a problem of evolution, as well as one of dissolution.” 


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322 DR. JACKSON ON MENTAL DISORDERS, [July, 

He refers constantly to “ the hierarchy of nervous centres.” He 
points out clearly that there is a chain, if you like, or hierarchy, 
a developing association of the nervous centres, that is parallel 
to the development of the nervous system as seen in compara¬ 
tive anatomyj He maintains that the whole of the anterior 
lobe is (chiefly) motor, but he admits that the pre-frontal lobes 
are motor is a doctrine still held by few. 

He puts very clearly—following other physiologists—the 
lines of evolution of the nervous system. First: Increasing 
complexity (differentiation), representation of a greater number 
of different movements. Second : Increasing definiteness 
(specialisation), representation of movements for more particular 
duties. Third : Increasing integration, representation of move¬ 
ments of wider ranges of the body in each part of the centres. 
Fourth : The higher the centres the more numerous the inter¬ 
connections of their units (co-operation). Thus—to recapitu¬ 
late—the highest centres are the most complex, most special, 
most integrated sensori-motor complexes with most numerous 
inter-connections. He points out that it must be remembered 
that the development is not always by insensible gradations, 
but in the evolution there may have been occasional stoppages, 
with rebeginnings. 

The doctrine of nervous evolution will not be understood 
unless it can be seen clearly that centres do not represent 
muscles, but movements of muscles. Jackson is constantly 
referring to this point; that in considering symptoms, we have 
to consider the physiological or vital actions much more than 
we have to consider the mere anatomy or the mere pathology. 
He says that psychical states are functions of the brain, the 
highest centres ; they simply occur during the functioning of 
the brain. Thus, in the case of visual perception, arbitrarily 
simplifying the process there is an unbroken physical circuit, 
complete reflex action, from sensori-periphery, and ultimately 
through the highest centres back to the muscular periphery. 
The doptrine of concomitance I have already referred to. And 
in many of his writings he insists on the importance of recog¬ 
nising the independence of nervous action and simple conscious¬ 
ness, the inability of bridging the difference between the one 
and the other. As he says : “ To merely solidify the mind into 
the brain is to make short work of a difficult question.*’ “ Our 
concern, as medical men, is with the body. If there be such a 


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t 9 I 7 j 

thing as disease of the mind, we can do nothing for it.” Nega¬ 
tive and positive symptoms are, for us, only signs of what is not 
going on, or of what is going on wrong in the highest sensori¬ 
motor centres. Brain is to be considered purely as the organ 
of mind. 

In studying the evolution and dissolution of the nervous 
system in relationship to fits, he gives a very full and complete 
analysis of the symptomatology of the slight fits of epilepsy. 
Thus he says : “ There is often a warning crude sensation, a 
stench comes from the nose. Second, there is the emotion of 
fear (I do not mean fear of the fit, but fear which comes by 
itself). This is a very complex psychical state. Third, there 
is sometimes a dreamy state called the intellectual aura There 
is often a stage of defect of consciousness before what we call 
loss of consciousness.” In fact, he looks upon the dreamy state 
as one rather of a defect of consciousness than as absolute loss 
of it. 

Next, there are convulsions—eyes, face, hands, and other 
parts. Then comes pallor of the face, arrest of heart, flow of 
saliva. But there are sometimes, in the slight epileptic 
paroxysms, movements properly so-called, clutching of the 
throat. A slight paroxysm, in many cases, may simply be 
confusion for a short time; defectively conscious. After a 
severe attack, there remains what is called loss of consciousness, 
with the unconsciousness a concerted series of elaborate move¬ 
ments of all parts of the body. This completes his symptoma- 
logical analysis of a fit. 

After the fit, he says, there is often insanity. We make 
three degrees of post-epileptic insanity. And here I may refer 
to what I spoke of earlier, on his use of the term “ insanities," 
for he speaks of the three degrees of dissolution ; the first 
being associated with the petit vial or the aura ; the second 
being associated with the true convulsions ; and the third being 
associated with the profound unconsciousness. It is with the 
second stage, the ordinary epilepsy, that he is chiefly concerned ; 
and he refers to the automatic conditions that may be met with 
there. He frequently refers to the coma of epilepsy as if it 
were to be looked upon as dementia. He says : “ My conten¬ 
tion is from a scientific—I do not say from a clinical—stand¬ 
point is that all these, one, two, three, are insanities. Three is 
temporary acute dementia. Each departure is a departure from 


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DR. JACKSON ON MENTAL DISORDERS, 


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the patient’s normal mental state. This is enough for us 
mental evolutionists. One and two do not approach the clinical 
standard types of insanity necessarily, and thus for the clini¬ 
cian, are not insanities. These degrees of insanity are to be 
compared and contrasted with degrees of physiological insanity 
of sleep. First, sleep with dreams ; next, deeper sleep with 
actions (somnambulism) ; third, so-called dreamless sleep, also 
with degrees of drunkenness. That may be the three degrees 
of post-epileptic insanity compared. 

Now, as to the positive mental symptoms. They make up, 
or are to us, the present signs of the patient’s mentation or 
consciousness, and are the lower homologues of his normal 
mentation or consciousness. We have to try to show how 
sensori-motor activities, activities of the most complex sensori¬ 
motor or nervous arrangements, those of the highest centres, are 
correlative with states of consciousness. To do this, we shall 
accept the artificial analysis of object consciousness into will, 
memory, reason, and emotion, and try to show the anatomy 
and the physical basis of each, that is, what parts of the body 
the physical basis of each represents specifically. And I may 
say here that this attempt of Hughlings Jackson is distinctly 
original. 

The following is an imperfect sketch, among other things, 
ignoring integration. What on the lowest levels are centres for 
simplest movements of the limbs, become evolved in the highest 
centres into the physical basis of volition. What on the lowest 
levels are centres of simple reflex actions of eyes and hands, are 
evolved in the highest centres into the physical basis of visual 
and effectual ideas. What in the lowest levels are centres of 
movement of the tongue, palate, lips, are concerned in eating, 
swallowing, etc., are, in the highest centres, evolved into the 
physical basis of words, symbols serving us during abstract 
reasoning. What on the lowest levels are centres representing 
the circulatory, respiratory, and digestive movements, are evolved 
in the highest centres into the physical basis of emotions. So 
to speak, the lowest level does the menial work, the highest 
level, evolved out of it, becomes, in great degree, independent 
of it, and is the anatomical basis of mind. 

Shortly, I shall refer next to his article on post-epileptic 
states. He points out the difficulties of the subject, the need 
of psychological knowledge to the understanding of it. He 


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says a medical man’s aim should be to deal with what are 
called diseases of the mind—really diseases of the highest 
cerebral centres—as materialistically as possible; but to be 
thoroughly materialistic as to the nervous system we must not 
be thoroughly materialistic at all as to the mind. I fear that 
Dr. Hughlings Jackson might not be quite in accord with some 
of the later Freudian developments. “ The elements of the 
clinical problem are the anatomy, the physiology, and the 
pathology of disease.” In using these terms, he means that 
the simple anatomy is important, the physiology is very much 
more important, and by pathology he refers rather to the dis¬ 
orders of nutrition associated with the nervous system than 
what we actually understand by pathology. In considering 
this matter again, he repeats what he so frequently insists upon 
—the duplex condition of nervous symptomatologies. Some of 
his friends who took a deep interest in his work used to say, in 
a half-cynical way, “ Has Jackson got no further than those two 
questions of positive and negative symptoms ? ” 

The hypothesis in relationship to the duplex condition of the 
nervous system is, that the principle of duality of symptoma¬ 
tology applies, with a very obvious exception, to all nervous 
diseases with negative lesions', insanity included. The negative 
lesion alone is the result of a pathological change, and produces 
negative symptoms ; the other symptoms completing the symp¬ 
tomatology are owing to activity — often over-activity — of 
healthy nervous arrangements,. and are normal physiological 
states. Jackson, in writing on mental disorder, frequently 
speaks of the perfectly normal physiological action of the parts 
that have been relaxed from control ; he says that the same 
relaxing of control does not necessitate any pathological change 
in the parts then acting. 

It may be worth while to recapitulate here what might be 
called his creed. The lowest level, in comparison with the 
highest level, represents impressions and movements of all parts 
of the body, most nearly directly. It is a series of centres— 
properly segments—representing parts of the body in (1) few 
and simplest combinations (little differentiation) ; (2) in most 
general ways (little specialisation) ; (3) in greatest detajl 

(smallest districts of the body, least integration “ for local 
affairs ”) ; (4) the centres on this level have fewest inter¬ 

communications (little co-operation). If we take note only of 


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326 DR. JACKSON ON MENTAL DISORDERS. [July, 

the organic centres on the lowest level, I think it is plain that 
this formula applies closely. The cardiac and respiratory 
centre are most simple : they have few, if any, different move¬ 
ments ; there is, indeed, practically a succession of similar 
movements at equal intervals. Second, these centres have 
little speciality. Obviously they are for most general ends : 
they serve the body as a whole, in essentially the same way at 
all times, from birth to death. Third, that most of the lowest 
centres represent limited regions of the body is plain (pupillary, 
respiratory, cardiac, bladder centres). Fourth, the interconnec¬ 
tions of organic centres are certainly few ; obviously pupillary 
activities, respiration, circulation, digestion, micturition, go on 
with the greatest degree of distinctness from one another. 

The highest level differs from the lowest only in grade of 
Evolution. The centres of this level represent impressions and 
movements of all parts of the body, triply, indirectly, and in 
comparison with the lowest levels, in most complex combina¬ 
tions, in two most specific ways. Third, each represents very 
extensive areas of the body, if not the whole body—great 
integration. Fourthly, these centres have the most numerous 
intercommunications—that is, that this formula applies to the 
highest centres is in agreement with current doctrine. 

It is certain that the organ of mind is (1) concerned with 
the most numerous different things; (2) of high degree of 
speciality ; (3) that every single process is an act of a person, 
and therefore the inference is irresistible that they are, corre- 
latively, activities of the most highly integrated centres—of 
centres each representing all parts of the body as a whole ; and 
(4) that it is, by its most elaborate relations—very complex 
special and highly integrated combinations and impressions— 
that movements in co-existence and sequence are effected. 

It is hardly necessary, after saying that, to refer to his 
remarks on the evolution of the physical basis of consciousness, 
or on the degrees of detachment and degrees of independence 
of the various levels of evolution. 

So much, then, for the nervous and mental disorders asso¬ 
ciated with epilepsy and epileptic conditions. Beyond that, 
Dr. Hughlings Jackson communicated occasional articles on 
fftlated subj'ects. Thus, he communicated an article to Brain 
on “ Imperative Ideas,” and there is something distinctly 
original in this short article. He refers to Dr. Hack Tuke’s 


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address at Leeds, and he says : “ I have suggested that certain 
absurd and persisting delusions are owing to fixation of gro¬ 
tesque fancies and dreams in cases where a morbid change in 
the brain happens suddenly and increases suddenly during 
sleep.” This fixation of idea giving rise to an imperative or 
fixed idea is certainly, I think, original to him. He speaks, 
later, of it in this way : “ We certainly have to account for the 
existence of these quasi-parasitic states in cases where general 
mental power is but little lessened.” He says : “ For my part 
I consider that illusions, delusions, and other positive mental 
symptoms and insanities signify healthy nervous arrangements 
of the highest cerebral centres, called organ of mind. What we 
call an insane man’s illusions are his perceptions ; what we call 
his delusions are his beliefs, and, more generally, his positive 
mental symptoms sample the mentation remaining possible to 
him, a mentation occurring during activities of what is left of 
his highest centres, of what disease has spared. The physical 
condition of these positive mental symptoms is not caused— 
using the word ‘ cause ’ in its strict scientific sense—by disease, 
not caused, that is, by a pathological process. Disease is, I 
submit, answerable only for the co-existing negative mental 
element of insanity.” Here let me remark that, to take one 
kind of mental symptom, an illusion, a positive mental state 
implies a co-existing negative mental state. A man sees a 
black cat where there is only a black felt hat. Not only is 
there for him a black cat, but this for him is a felt hat. Simi¬ 
larly, mutatis mutandis , for other positive mental symptoms 
sampling the positive element of a patient’s insanity. “ As to 
the physical, disease of the highest range of the highest centres, 
producing loss of its function or destroying it, answers to the 
negative mental element in a case of insanity.” He says, in 
reference to the development of fixed or imperative ideas, that 
when disease of the highest range progresses very slowly, there 
may be no obtrusive positive mental symptoms (control slowly 
removed). When it is very rapid, the patient’s mentation (the 
mentation remaining possible to him) diminishes at a great rate 
(control rapidly removed). In a way, he is somewhat in¬ 
consistent in leaving it to be understood that imperative ideas 
may so slowly grow, whereas he has said they might be para¬ 
sitic ideas caused by fixation in sleep. 

I cannot conclude this imperfect notice of Hughlings 


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328 HALLUCINATIONS IN THE SANE, [July, 

Jackson’s work without pointing out the great debt that both 
neurologists and psychiatrists owe to his work. I always feel, 
however, one regret, and that is, that his close, logical mind was 
not associated with fluency of expression, for, as I have already 
said, a great deterrent to those wanting to study Hughlings 
Jackson’s works lies in the difficulty of following them. How¬ 
ever, one has to be thankful that he has left so much, although 
he may have left no single volume as a record. 


References. 

“ Remarks on Evolution and Dissolution of Nervous System,” youm. 
Ment. Set'., April, 1887. 

“ Post-Epileptic States,” ibid., 1889. 

“Remarks on Diagnosis and Treatment of Diseases of the Brain,” 
Brit. Med. youm., 1888. 

“Imperative Ideas,” Brain, 1895. 

Tuke.— Dictionary of Psychological Medicine. 

James Anderson.— Epileptic Insanity. 

“ Factors of Insanity,” Medical Press and Circular, June, 1894. 


Hallucinations in the Sane. By Robert Hunter Steen, 
M.D.Lond., M.R.C.P.Lond., Medical Superintendent, City 
of London Mental Hospital, near Dartford, Kent, and 
Professor of Psychological Medicine, King’s College 
Hospital, London. 

In insanity hallucinations are frequently present. This is 
no recent observation and has been duly noted in the literature 
since the dawn of medicine. Hippocrates, Asclepiadcs, and 
Celsus make mention of them in their writings. 

Burton in the Anatomy of Melancholy ( x ) says : “ If it 
[melancholy] be extream, they think they hear hideous noyses, 
see and talk with black men and converse familiarly with devils, 
and such strange chimeras and visions (Gordonius), or that 
they are possessed by them, that somebody talks to them or 
within them.” 

Different authors give varying percentages of those affected. 
Esquirol says 80 per cent, which is a higher average than most 
observers will allow, still, there is no doubt of the great 


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prevalence of the symptom. Seeing, then, that the insane 
are so prone to hallucinations, is it a fact that all those who 
have hallucinations are insane ? Without giving due thought 
many might be inclined to say “ Yes.” When, however, the 
literature is consulted it is surprising to find how widespread is 
the existence of hallucinations among those whom no one would 
call insane, and it has been a matter of the greatest difficulty to 
keep this paper within moderate limits. Space also has 
demanded the exclusion of a detailed discussion on the fascinat¬ 
ing subject of the theory of hallucinations. This will be 
referred to only in the summary at the conclusion. 

Nevertheless, to present the matter in an orderly fashion 
several headings have been made and, though in a measure 
trespassing upon the province of theory, they must be regarded 
as only provisional. 

Two main divisions are necessary: (a) Hallucinations the 
result of agencies operating upon the brain or nerves, (b) 
Hallucinations of mental origin. 

The following table gives the sub-divisions : 

(a) Hallucinations the result of causes operating upon the 

brain or nerves. 

(1) Toxins. 

(2) Disorders of the brain circulation,^., anaemia, con¬ 

gestion, etc. 

(3) Disease of end-organs. 

(4) After-images. 

(5) Brain diseases of obscure pathology, eg ., epilepsy, 

migraine. 

(b) Hallucinations of mental origin : Those in which so far 

as our present knowledge goes a physical agency is 
unknown. 

(1) Suggestion. 

(2) Hypnotism. 

( 3 ) Crystal gazing, clairvoyance and clairaudience. 

(4) Hysteria. Somnambulism. Multiple Personality. 

(5) Hypnagogic visions. 

(6) Dreams. 

(7) Hallucinations in history. 

(8) Collective hallucinations. 

(9) So-called telepathy. 

(10) Hallucinations the result of a complex. 


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(a) Hallucinations Resulting from Physical Causes. 

(1) Toxins may be introduced from without, i.e., exogenous, 
or produced by the patient, endogenous. 

(a) Exogenous toxins .—Probably the drug which has been 
used more than any other for the purpose of experimentally 
producing hallucinations is cannabis indica. 

Brierre de Boismont ( 2 ) describes a stance at which he was 
present in company with Esquirol and others when several 
men were given a drink supposed to consist principally of 
cannabis indica. One of these, B—, a painter and musician, 
besides other symptoms had the unilateral hallucination of 
hearing music in one ear while he heard ordinary speech in 
the other. Another of those experimented upon saw “ objects 
which had no existence ” ( s ). 

Mescal button is a drug largely used by the Indians of New 
Mexico. The effects produced upon himself are thus described 
by Weir Mitchell ( 4 ). He saw all sorts of beautiful colours 
and then “ a white spear of grey stone grew up to a huge 
height and became a tall richly finished gothic tower of very 
elaborate and definite design, with many rather worn statues 
standing in the doorways or on stone brackets.” He later saw 
an apothecary’s shop. “ On the left wall was pinned by' the 
tail a brown worm of perhaps a hundred feet long. It was 
slowly rotating like a Catherine wheel nor did it seem loathly. 
As it turned, long green and red tentacles fell this way and that.” 

The abuse of opium has also been responsible for hallucina¬ 
tions. Thus De Quincey writes ( 5 ): “In the middle of 1817 
this faculty became increasingly distressing to me ; at night, 
when I lay awake in bed, vast processions moved along con¬ 
tinually in mournful pomp ; friezes of never-ending stories 
drawn from times before CEdipus or Priam, before Tyre, before 
Memphis.” 

Lauder Brunton (°) gives a good example of the influence 
of salicylate of soda. “In the case of an old gentleman who 
was taking salicylate of soda both his friends and I were much 
alarmed by the patient describing processions of people round 
his bed, when, with the exception of a single attendant, no one 
was in the room.” 

The effect of quinine in producing singing in the ears is well 
known. 


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Quite a long list can be made of the different drugs which 
can produce hallucinations: Alcohol, absinthe, ether, stra¬ 
monium, belladonna, hyoscyamus, nitrous oxide, chloroform, 
mercury, lead, and santonin. 

(b) : Endogenous toxins : Toxcemias .—There are numerous 
records of hallucinations occurring in diseases accompanied 
by pyrexia. These have been omitted as the hallucinations 
are only a part of the febrile delirium. 

Gout may cause hallucinations. “ I was called,” says Dr. 
Alderson, “ to Mrs B—, a fine old lady about 80 years of age whom 
I have frequently visited in fits of the gout. She complained 
of an unusual deafness, and great distension in the organs of 
digestion, leading her to expect an attack of gout. From this 
time she had visions. She was visited by several of her friends, 
whom she had not invited ; she told them she was very sorry 
she could not hear them speak, nor keep up conversation with 
them ; she would, therefore, order the card table, and rang the 
bell for that purpose. Upon the entrance of the servant, the 
whole party disappeared. She could not help expressing her 
surprise to her maid that they should all go away so abruptly ; 
but she could scarcely believe her when she told her that there 
had been nobody in the room. She was so ashamed, that she 
suffered for many days and nights together the intrusion of a 
variety of phantoms, and had some of her finest feelings wrought 
upon by the exhibition of friends long lost, and who had come 
to cheat her fancy and revive sensations that time had almost 
obliterated. She determined, however, for a long time, not to 
complain, and contented herself with merely ringing her bell, 
finding she could always get rid of the phantoms by the 
entrance of her maid. It was not till some time after that 
she could bring herself to relate her distresses to me. She was 
all this time convinced of her own rationality, and so were 
those friends who really visited her, for they could never find any 
one circumstance in her conduct and conversation to lead them 
to suspect her in the smallest degree deranged, though unwell. 
This complaint was entirely removed by cataplasms to the feet, 
and gentle purgatives, and terminated a short time afterwards 
in a regular slight fit of the gout. She has remained ever 
since, now somewhat more than a year, in the perfect enjoy¬ 
ment of her health and faculties”( 7 ). 

(2) Disorders of the brain circulation. — Ancemia. — In 

LXIII. 2 2 


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convalescence from acute illnesses when the patient is still 
weak hallucinations may appear. Also in cases of heart 
disease. “ A non-commissioned officer with hypertrophy of the 
left ventricle imagined he saw white phantoms of strange and 
indefinite forms place themselves before him in threatening 
attitudes. Ashamed of his fears, knowing himself that it was 
only a phantasma, dreading above all things the jokes of his 
companions, he dared not confess how much he was under the 
influence of the strange malady which tormented him ” ( 8 ). 

A n example from a case of drowning .—“ A gentleman fell 
accidentally into the water and was nearly drowned. After 
being rescued he continued in a state of apparent death for 
nearly twenty minutes. After his restoration to consciousness 
he thus describe his sensations whilst in the act of drowning. 

‘ They were the most delightful and ecstatic I have ever 
experienced. I was transported to a perfect paradise and 
witnessed scenes that my imagination never had in its most 
active condition depicted to my mind. I heard the most 
exquisite music proceeding from melodious voices and well- 
tuned instruments’” ( 9 ). Instances are on record in which 
apoplexy has been heralded by the appearance of hallucina¬ 
tions. 

(3) Disease of end-organs are often the source of hallucina¬ 
tions. One example will have to suffice on the present 
occasion; 

Mr. Tatham Thompson has recorded a most interesting case 
of a lady who came to him because she saw the head and 
horns of a goat constantly before her. On measuring her 
field of vision with a perimeter he found there was a blind spot 
corresponding to the figure she had described, and this was due 
to the bursting of a blood-vessel in the eye and consequent 
injury to the retina ( 10 ). 

(4) After-images. —Dr. Hack Tuke describes some remark¬ 
able hallucinations which are difficult to place. Perhaps if 
they are called “ after-images ” without too much stress being 
placed on this as their explanation they will fit in here 
better than under any other heading. He records that a 
certain Dr. Lombard had for some years occasionally seen 
images of persons and things which he had been attentively 
regarding, but he took little notice of the circumstance. “ On 
December 3rd, 1862, however, a much more decided visuali- 


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sation occurred. He was then in the Army and stationed 
on the West Shore of Maryland. A military man, his 
daughter, a naval officer, and Dr. Lombard were seated in the 
verandah of a house which stood within a stone’s throw of 
Chesapeake Bay. The girl sat on the second of the steps 
leading down from the verandah. He himself was on the same 
step at the other end, there being about five feet between them, 
and her profile being clearly in view. For no particular 
reason he began to stare at her, at the same time concentrating 
all his attention upon the features. At the expiration of about 
twenty minutes, he turned his eyes towards the bay simply to 
relieve them, when he saw before him the image of the girl 
very distinctly, and also in like manner all the objects that had 
been within the range of his vision. The image began almost 
at once to fade, but he found that by fixing his whole attention 
upon it that he could retain it. To this power I particularly draw 
attention. He next looked over her head towards a wood 
of southern pine trees, and again saw the image. He had 
repeated this experiment four or five times when the girl 
turned her head towards him and asked why he was staring at 
her so. Dr. Lombard described what he had seen, when, to 
his surprise, she laughed, and told him he was only a beginner, 
and that he ought to be able to obtain in twenty seconds what 
had taken as many minutes. She then led him on the 
verandah to a point where the moon shone brightly, and asked the 
naval officer to take note of the time occupied in the experi¬ 
ments. She told Dr. Lombard to keep everything but herself 
out of mind, to look her full in the face, and then to run his 
eyes up and down her figure. In a few seconds she called “ Time ” 
and told him to look towards Chesapeake Bay, directing him 
to regard the image as attentively as he had regarded her 
previously. He then saw the image very distinctly. The time 
was twenty-two seconds. In the course of the same evening 
many more experiments were made. In reply to her father 
and Dr. Lombard she said that she had discovered that she 
possessed this power through a school-fellow two years before, 
'who possessed the same faculty of voluntarily recalling spectral 
images. Dr. Lombard asked her whether this power would 
last any considerable length of time. She said she could only 
answer for two years from her own experience, upon which the 
naval officer spoke up, and said that he could answer for nearly 


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fifty years, having exercised it himself since he was fourteen 
or fifteen years of age ” ( n ). 

(5) Drain diseases of obscure pathology. — Epilepsy. —In the 
aura preceding an epileptic attack halluciaations are frequently 
met with. These may be sparks of light, noises, olfactory or 
gustatory hallucinations or strange sensations. Sometimes the 
hallucination is more definite. Thus the case is recorded of a 
patient who saw the apparition of an old woman in a red 
cloak who approached him, struck him on the head with her 
crutch, and then the fit took place ( 12 ). 

Forbes Winslow ( 13 ) mentions “ the case of a young man, who, 
when his fits came on, thought he saw a carriage drive up at a 
gallop and with great noise containing a little man in a red 
bonnet ; fearing to be ecrase by the carriage, he fell down stiff 
and without consciousness.” 

Migraine is supposed to be closely allied to epilepsy, and the 
visual hallucinations in this disease are well known. 


Division (b).—Hallucinations of Mental Origin. 

The second division includes those cases which are in a 
measure of greater interest to workers in insanity. They are 
those in which our attention is fixed on changes in the mind 
rather than on changes in the brain. 

(1) Suggestion. —Very interesting work in this connection 
has been done by Dr. Seashore. I quote from a review of the 
original article by Havelock Ellis in the Journal of Mental 
Science. 

“ The most striking experiments, however, are those which 
demonstrate the ease with which hallucinations of a definite 
object can be produced. A spheroidal blue bead two or three 
millimetres in diameter was suspended by a fine black silk 
thread in front of a black surface ; by a concealed device 
the bead could be withdrawn and replaced without the 
observer’s notice. The experimenter was seated at a table, 
ostensibly to keep record, but really to manipulate the apparatus. 
A tape line was stretched from the apparatus to a point some 
six metres in front of it. The observer was first shown the 
bead and then required to go to the further end of the tape 
line and walk slowly up towards the apparatus until he could see 
the bead distinctly. When he saw the bead he read off the distance 


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on the tape-line. The observer was put through this experi¬ 
ment ten times, the distance at which the bead was seen varying 
but slightly. 

“ Before the eleventh trial the experimenter pulled a cord 
which slid the bead behind the frame. The observer, not 
knowing this, walked up as usual, and when he came up to or 
a little beyond the point where he expected to see the bead, he 
generally did see it, and read off the distance as before. As a 
rule the eleventh, sixteenth, eighteenth, and twentieth trials 
were made with the bead withdrawn. About two-thirds of the 
persons experimented on were hallucinated. They knew when, 
where, and how to see the bead, and that was sufficient to pro¬ 
ject the mental image into a realistic vision. 

“ Somewhat similar results were obtained in experiments 
on touch, electrical stimulation, sound, taste, and smell, and 
these results are fully illustrated by charts. 

“Dr. Seashore concludes that : (1) Such hallucinations and 
illusions are normal phenomena, which may be reduced to . 
law ; (2) they are due to suggestion ; (3) the main element in 
such suggestion is expectant attention. 

“ It is clear we may rely upon hallucinations and illusion as 
a factor in daily life to a much greater extent than we have 
yet ventured to do. If a scientific observer, as Dr. Seashore 
points out in the bead experiment, sees the bead as real, 
although there is no bead, I do not think we can set any limit 
to what an excited imaginative person may really see under 
circumstances favourable for illusion ”( 14 ). 

Besides hallucinations caused by suggestion, illusions caused 
in a similar manner are not infrequent. For example, in 
reading a book or paper we rarely read each word letter by 
letter, we merely glance at a word or a sentence and divine 
the meaning. This is one reason why the reading of proofs 
is so difficult. Bergson ( 15 ) quotes experiments made by 
Miinsterberg in which a written word was exposed to the 
view of an observer and at the same time a word of different 
significance was spoken in his ear. For example, the written 
word might be “ tumult,” the spoken word “ railroad,” and the 
result would be that the observer stated he saw the word 
“ tunnel.” 

(2) If hallucinations take place in waking suggestion it is 
little wonder that in hypnotism they are produced with ease in 


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336 HALLUCINATIONS TN THE SANE, [July, 

suitable subjects. For example, it is suggested to the hypno¬ 
tised subject that he can hear bells ringing, see lights, etc., and 
these hallucinations appear. A not infrequent experiment is 
to hand the subject a piece of plain paper and to state that 
there is a photograph on it. This is then at once perceived. 
An interesting experiment is that connected with negative 
hallucinations. It is suggested to the subject that someone 
present has left the room. Immediately the person is no 
longer seen. Though I have rapidly passed over the subject 
of hallucinations induced by hypnotism and suggestion, I do 
not wish it to be inferred that it is one of minor importance. 
In any theory of hallucinations these phenomena must occupy 
a prominent position. 

( 3 ) Crystal-gazing and clairaudience. —In crystal-gazing the 
subject gazes at a mirror or glass ball or any bright object, and 
after a time he distinguishes more or less definite pictures. 
“ The first pictures are often simple—a portrait, bust, plant, 
animal, or house. Then they become more complicated—a 
complete moving scene, as in a theatre, a room, a street, a 
public thoroughfare filled with various people, who walk about, 
come in and go out just as in real life” ( lc ). When a sea-shell or 
shell-like body is held to the ear a murmur is heard. In 
certain subjects definite voices are heard, and this is called 
clairaudience. Though I have no personal knowledge of the 
matter, I think that there is no doubt that certain subjects at 
times obtain hallucinations by these means. As an example I 
will quote from the “ Dissociation of a Personality ” by Morton 
Prince (* 7 ). It must first be mentioned that Miss Beauchamp 
is the name given to a lady who spontaneously changed into three 
different personalities : “ When Miss Beauchamp looks into a 
glass globe she does not see the details of her vision as small 
objects reflected in the glass, but after a moment or two the globe 
and her surroundings disappear from her consciousness, and 
she sees before her a scene in which human beings—herself 
perhaps one of them—are enacting parts as in real life. The 
characters are life-size and act as living persons. When she 
sees herself as one of the characters of the vision she experiences 
over again all the emotions and feelings that she observes her 
vision-self experiencing, and these emotions she exhibits, all 
forgetful of her surroundings, to the onlooker.” 

(4) Hysteria. Somnambulism.. Multiple personality .—Janet 


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says that in the somnambulism of grand hysteria “ the unfolding 
of hallucinations is incomparable, and, except in some cases of 
alcoholic delirium, that are a little like hysteria, we shall never 
find in lunacy such abundance and such copiousness in the 
hallucinations of all senses ( 1S ). To give one case as an 
example : “ It is the story of a young girl, aet. 20, called Irene, 
whom despair caused by her mother’s death has made ill. We 
must remember that this woman’s death had been very moving 
and dramatic. The poor woman who had reached the last stage 
of consumption, lived alone with her daughter in a poor garret. 
Death came slowly, with suffocation, blood vomiting, and all 
its frightful procession of symptoms. The girl struggled 
hopelessly against the impossible. She watched her mother 
during sixty nights, working at her sewing machine to earn a 
few pennies necessary to sustain their lives. After her mother’s 
death she tried to revive the corpse, to call the breath back 
again ; then, as she put the limbs upright, the body fell to the 
floor, and it took infinite exertion to lift it again into the bed. 
You may picture to yourself all that frightful scene. Sometime 
after the funeral curious and impressive symptoms began. It 
was one of the most splendid cases of somnambulism I ever 
saw.- 

“ The crises last for hours, and they show a splendid dramatic 
performance ; no actress could rehearse those lugubrious scenes 
with such perfection. The young girl has the singular habit of 
acting again all the events that took place at her mother’s 
death, without forgetting the least detail. Sometimes she only 
speaks, relating all that happened with great volubility, putting 
questions and answers in turn, or asking questions only, and 
seeming to listen for the answer ; sometimes she only sees the 
sight, looking with frightened face and staring on the various 
scenes, and acting according to what she sees. At other times, 
she combines all hallucinations, words, and acts, and seems to 
play a very singular drama. When, in her drama, death has 
taken place, she carries on the same idea, and makes every¬ 
thing ready for her own suicide. She discusses it aloud, seems 
to speak with her mother, to receive advice from her; she 
fancies she will try to be run overby a locomotive. That detail 
is only a recollection of a real event of her life. She fancies 
she is on the way, and stretches herself out on the floor of the 
room, waiting for death, with mingled dread and impatience. 


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She poses, and wears on her face expressions really worthy of 
admiration, which remain fixed during several minutes. The 
train arrives before her staring eyes, she utters a terrible shriek, 
and falls back motionless as if she were dead. She soon 
gets up and begins acting over again one of the preceding 
scenes ” ( 19 ). 

Jung ( 20 ) gives a lengthy description of another somnam¬ 
bulist, S. W—. She once said, “ I do not know if what the 
spirits say and teach me is true, neither do I know if they are 
those by whose names they call themselves, but that my spirits 
exist there is no question. I see them before me, I can touch 
them, I speak to them as loudly and naturally as I am talking. 
They must be real.” Yet, as Jung says, “To everyone who 
did not know her secret, she was a girl of fifteen and a half, in 
no respect unlike a thousand other girls ” ( 21 ). 

Multiple personality is included by Janet as a hysterical 
symptom. Reference has already been made to Morton 
Prince’s case under the heading of crystal-gazing. The 
following is another example of hallucinations in the same 
patient: “ During the course of this study it will be remem¬ 
bered that Sally (one of the personalities) subconsciously 
induced in B. IV. and B. I. (other personalities) time and again 
hallucinations which were visual representations of her own 
subconscious thoughts. Sally thought of a snake and willed 
and straightway B. I. or B. IV. saw a snake. B. IV. had, 
indeed, another hallucination, similar to the one I have just 
described, as the prickings of her conscience. The vision was 
of myself, and upbraided her in language I had previously used 
for disobeying my expressed wishes. The words and vision 
were the expression of Sally’s thoughts. The evidence is con¬ 
clusive that subconscious ideas can excite hallucinations in the 
primary consciousness ” ( ,2 ). This remark by an observer so 
careful and trustworthy as Dr. Prince cannot be left out of 
account in any theory of hallucinations. 

(5) Hypnagogic hallucinations are those which appear just 
before going to sleep and just before fully waking. These are 
most marked in youth, and, as a rule, disappear when adult life 
is reached. Some adults, however, have the power of seeing 
visions of hypnagogic nature. For example, “ Dr. Weir 
Mitchell remarked that from childhood he has been able to 
summon visions before falling asleep, but that once present 


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they cannot be controlled, and change and disappear of them¬ 
selves . . . ” ( 23 ). “ Mr. Greenwood, again, has recorded 

the hypnagogic visions with which he has been familiar 
throughout life. These faces are never seen except when the 
eyelids are closed, and they have an apparent distance of five or 
six feet. Though they seem living enough they look through 
the darkness as if traced in chalk on a black ground ” ( 24 ). 

De Quincey writes : “ I know not whether my reader is 
aware that many children have a power of painting as it were 
upon the darkness all sorts of phantoms ; in some that power 
is simply a mechanical affection of the eye ; others have a volun¬ 
tary or semi-voluntary power to dismiss or summon such 
phantoms ; or, as a child once said to me when I questioned 
him on this matter, ‘ I can tell them to go, and they go, but 
sometimes they come when I don’t tell them to come ’ ” ( 25 ). 

(6) Dreams. —The celebrated Bernheim ( 26 ), of Nancy, says : 
“Y^a v£rit6 est que nous sommes tous hallucinables et hallu- 
cin^s pendant une grande partie de notre existence.” In 
making this statement he was thinking of dreams. Dreams 
may be considered as the best example of hallucinations 
existing in sane people. They occur so invariably in the life 
of every individual as to constitute a normal event. Occasion¬ 
ally one is met with who says he never dreams, but this is so 
exceptional that it is almost justifiable to assume that the 
speaker does dream but forgets his dream. Dreams have now 
so extensive a literature of their own that it is unnecessary to 
further consider them in this paper. 

(7) Hallucinations in historical personages. —History, especially 
religious history, contains numerous examples, but space will 
allow only a few to be given. 

Mohammed was 42 years of age when he first had his reve¬ 
lations. A tradition quoted from Spengel by Ireland ( 27 ) 
says that when “ Mohammed was walking in the defiles and 
valleys about Mecca, every stone and tree greeted him with the 
words, ‘ Hail thee, O messenger of God.’ He looked round to 
the right and to the left, and discovered nothing but trees and 
stones. The prophet heard these cries as long as it pleased 
God that he should be in this condition, then the Angel Gabriel 
appeared and announced to him the message-of God in the 
mountain Hira, in the month of Ramadan.” Ireland appears 
to have believed that he was an epileptic, though he denies 


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340 HALLUCINATIONS IN THE SANE, [July, 

epilepsy in the cases of Caesar and Napoleon. Discussing the 
question of his sanity, Ireland says ( 2S ): “ He evidently 
possessed an intellect of the highest order for managing and 
controlling affairs, and was skilful both in conducting war and 
treating with his adversaries.” “If Mohammed is to be called 
insane his insanity was of a very rare type ” ( 20 ). 

Joan of Arc heard a “ voice ” say : “ Joan, you must lead 
another life and do wonderful actions, for it is you whom the 
King of Heaven has chosen for the succour of France and the 
help and protection of King Charles expelled from his dominion. 
You will put on male attire, and, taking arms, will be the leader 
of war. All things will be ruled by your counsel ”( 30 ). She had 
visions of the Angel Michael, and with him were St. Catherine 
and St. Margaret. 

Martin Luther is stated to have had hallucinations and is 
said to have thrown an ink-pot at the Devil. It is, however, 
doubtful if the story has any foundation in fact. Still, there 
appears to be no doubt that he heard a voice say to him, “ The 
just shall live by faith.” 

With regard to Napoleon. “ In 1806, General Rapp, on his 
return from the siege of Dantzic, having occasion to speak to 
the Emperor, entered his cabinet without being announced. He 
found him in such profound meditation that his entrance was 
not noticed. The General, seeing that he did not move, was 
afraid he might be indisposed, and purposely made a noise. 
Napoleon immediately turned round, and seizing Rapp by the 
arm pointed to the heavens, saying, ‘ Do you see that ? ’ The 
General made no reply ; being interrogated a second time, he 
answered that he perceived nothing. ‘ What! ’ responded the 
Emperor, ‘you did not discover it. It is my star, it is imme¬ 
diately in front of you, most brilliant,’ and becoming gradually 
more excited, he exclaimed : ‘ It has never abandoned me ; I 
behold it on all great occasions ; it commands me to advance, 
and that to me is a sure sign of success ’ ” ( 31 ). 

Ignatius Loyola had visions of the Virgin, and one so 
different in character as George Fox, of the Quakers, heard a 
“ voice.” 

The list of eminent men who are stated to have had hallu¬ 
cinations ^s a long one. It includes : Pythagoras, Socrates, 
Plato, Attila the Hun, Savonarola, Benvenuto Cellini, Hobbes, 
Descartes, Oliver Cromwell, Pascal, John Bunyan, Malebranche, 


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One of my greatest friends, since deceased, told me the 
following story : He was in business and was ordered by his 
firm to go to Persia on a commercial matter. His sister at the 
time was suffering from phthisis and he was naturally unwilling 
to leave home, fearing he might never see her again. He was, 
however, obliged to undertake the journey. One day, as he 
was driving along in bright sunshine in a plain in Persia, he 
distinctly saw his sister’s face. He later found that the time 
he had this vision corresponded with the hour of her death. 
My friend had told this to his father and one other person. 
The latter had laughed at him, and, fearful of mockery, he had 
never repeated it except to myself under seal of secrecy. The 
father, fVho was a clergyman, said he had had similar experi¬ 
ences. I am sure my dead friend would forgive my breaking 
my pledge to him were he alive, as the story is given and 
received in a serious manner. 

A large number of similar cases can easily be found in the 
literature of telepathy, and are probably to be explained as a 
matter of coincidence. This is not the time or place to discuss 
thought transference, but the point I wish to make is that these 
are examples of hallucinations occurring in sane people and are 
instances of the fact that an idea when associated with great 
emotion can produce an hallucination. 

This leads us to the next case. 

(io) Cases of hallucinations due to a complex. —Dr. Coriat 
( 34 ) writes as follows : 

“ Mrs. L—, aet. 46, who was referred to me by Dr. Prince, 
had been troubled for several years by peculiar visual halluci¬ 
nations. She constantly saw coffins before her eyes ; some¬ 
times the coffins were lying near an open grave, sometimes one 
was open and in it she would see a person whom she did not 
recognise. 

“ These hallucinations never left her unless her attention was 
strongly distracted, and then they vanished for only a few 
minutes at a time. They were beyond her control. She was 
unable to make them appear or disappear at will except oh 
some occasions, when they would vanish momentarily when she 
closed the eyes, after which they would appear in their original 
intensity.” On analysing the case it was found that “ about 
four years previously, immediately before the first appearance 
of the hallucinations, she was in a state of worry and exhaustion 


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At this time the sight of dirt disturbed her a great deal, and she 
was constantly cleansing things about the house. When she 
saw dirt the word * grave ’ would flash into her mind, at first as 
a mere idea, then gradually becoming more and more intense 
until it became visualised into the object itself. Finally, the 
word * grave ’ suggested the word ‘ coffin,’ and this, too, in 
turn became visualised into the object.” 

Freud ( 3S ) records the following case : “ As an example I 
shall cite one of my youngest hysterical patients, a boy, ast. 12, 
who was prevented from falling asleep by ‘ green faces with red 
eyes', which terrified him. The source of this manifestation 
was the suppressed, but once conscious, memory of a boy whom 
he had often seen during four years, and who offered him a 
deterring example of many childish bad habits, including 
onanism, which now formed the subject of his own reproach. 
His mother had noticed at the time that the complexion of the 
ill-bred boy was greenish and that he had red {i.e., red-bordered) 
eyes. Hence the terrible vision which constantly served to 
remind him of his mother’s warning that such boys become 
demented, that they are unable to make progress at school, 
and are doomed to an early death. A part of the prediction 
came true in the case of the little patient; he could not 
successfully pursue his high-school studies, and, as appeared 
on examination of his involuntary fancies, he stood in great 
dread of the remainder of the prophecy. However, after a brief 
period of successful treatment his sleep was restored, he lost his 
fears, and finished his scholastic year with an excellent record.” 

In conclusion, it is to be hoped that the title of this paper 
has been justified. It was an easy task to collect a sufficient 
number of hallucinations in the sane. The main difficulty met 
with was to select suitable examples. Those which have been 
recorded here have been taken as types out of scores of similar 
cases which were available. 

It may perhaps be news to some that the English Society 
for Psychical Research in 1894 presented a report on a census 
taken by them with regard to hallucinations in those in good 
health. The question which was put was the following : 

“ Have you ever, when believing yourself to be completely 
awake, had a vivid impression of seeing or being touched by a 
living being or inanimate object, or of hearing a voice ; which 
impression, so far as you could discover, was not due to any 


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344 HALLUCINATIONS IN THE SANE, [July, 

external physical cause?” “ In answer to this question 27,329 
answers in all were received, of which 24,058 were negative, 
and 3,271, or 11’96 per cent., affirmative ; that is to say, 3,271 
persons stated that they had experienced hallucinations ”( 30 ). 

It is possible that some of those who gave affirmative answers 
were insane, but such an eventuality was excluded as far as 
possible. Even if a few such did creep into the figures, the 
large percentage obtained is very surprising.. 

It may now well be asked what are the lessons to be learnt 
from the facts recorded above ? 

To summarise them as concisely as possible they appear to 
be as follows : 

(1) Hallucinations do occur in the sane. I venture to think 
that such cases should be intensively studied, for, if any pro¬ 
gress is to be made in our knowledge of hallucinations, results 
of value are more likely to be obtained in persons whose 
intelligence is neither dimmed nor distorted by insanity. 
Especially worthy of minute inquiry are hallucinations found 
in border-land or hysterical cases. 

(2) There is no reason to believe that an hallucination 
occurring in a sane person differs in any essential respect from 
that which occurs in an insane person. 

(3) If this be granted, then, seeing that hallucinations in the 
sane can be produced by toxins, no doubt hallucinations in 
the insane are also in some cases the result of toxins. In this 
connection it is noteworthy that hallucinations are most fre¬ 
quently met with in the insanities of alcoholic origin. 

(4) It is, however, true that hallucinations can occur inde¬ 
pendently of physical changes such as might be produced by 
toxins or disease of the brain. An idea may be visualised or 
converted into a voice, smell, or other sensory phenomenon. 
The idea may be introduced from without, as in waking- 
suggestion, hypnotism, collective hallucinations, and, perhaps, 
crystal-gazing. Or the idea may arise from within, as in 
some phenomena of crystal-gazing, dreams, somnambulism, 
multiple personality, etc. In the so-called telepathic halluci¬ 
nation of my friend the idea of his dying sister was ever present 
with him, and it is not surprising that her face appeared before 
him. In the hallucinations of the religious ecstatics, eg., Joan 
of Arc, the mind was filled with overwhelming ideas which were 
converted into hallucinations. 


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If all the foregoing be granted, then it does seem probable 
that hallucinations in the insane can, in certain cases at any 
rate, be best studied from the psychological point of view. 
Such a study would make use of psychological terms only. 
The brain and nervous system would not be mentioned in the 
discussion. It is my belief that progress in the future must be 
expected on these lines rather than in approaching the subject 
from the physiological point of view. 

(5) It is a very suggestive fact that hallucinations are met 
with in cases of multiple personality. This of itself does not 
prove anything, but I feel strongly that in every case pre¬ 
senting hallucinations some process of dissociation is at work. 
If this is so, then hallucinations would be expected in cases of 
multiple personality where dissociation is seen in greatest 
extent. A fuller discussion on this must be reserved for 
another occasion. 

References. 

(1) Burton.— Anatomy of Melancholy , p. 265. 

(2) Hallucinations , by A. Brierre de Boismont, translated by Hulme, 
P- 3 M- 

(3) Ibid., p. 318. 

(4) Manaceine, Marie de.— Sleep: Its Physiology, Pathology, Hygiene, 
and Psychology, p. 245, et sequitur. 

(5) De Quincey.— Confessions of an English Opium Eater, p. 251. 

(6) Brunton, Lauder.— Journ. of Ment. Sci., April, 1902, p. 247. 

(7) De Boismont, op. cit., p. 250. 

(8) Ibid., p. 251. 

(9) Winslow, Forbes.— Obscure Diseases of the Brain and Mind, 
p. 422. 

(10) Brunton, Lauder, op. cit., p. 246. 

(11) Brain, vol. xi, 1889, p. 449. 

(12) De Boismont, op. cit., p. 151. 

(13) Winslow, Forbes, op. cit., p. 486. 

(14) foum. of Ment. Sci., April, 1897, p. 409. 

(15) Bergson.— Dreams , translated by Slosson, p. 41. 

(16) Joire, Paul.— Psychical and Supernormal Phenomena, p. 157. 

(17) Prince, Morton.— The Dissociation of a Personality, p. 79. 

(18) Janet.— The Major Symptoms of Hysteria, p. 33. 

(19) Ibid., pp. 29, 30. 

(20) Jung, C. G.— Analytical Psychology, English translation edited 
by Constance E. Long, p. 22. 

(21) Ibid., p. 25. 

(22) Prince, Morton, op. cit., p. 5ro. 

(23) Manaceine, Marie de, op. cit., p. 239. 

(24) Ibid., p. 241. 


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34^ THE PSYCHOLOGY OF FEAR, [July, 

(25) De Quincey, op. cit., p. 251. 

(26) Bernheim.—“ Des Hallucinations Physiologiques et Patho- 
logiques,” Endphale , 1913, vol. i, p. 508. 

(27) Ireland, W. W.— The Blot upon the Brain , p. 40. 

(28) Ibid., p. 46. 

(29) Ibid., p. 48. • . 

(30) Ibid., p. 60. 

(31) De Boismont, op. cit., p. 61. 

(32) Machen, Arthur, The Bowmen. 

( 33 ) Parish.— Hallucinations and Illusions, p. 309. 

( 34 ) Coriat, Isodor H.— The Journal of Abnormal Psychology , 
August-September, 1910, p. 93. 

(35) Freud.— The Interpretation of Dreams , translated by A. A. 
Brill, p. 432. 

(36) Parish, op. cit., p. 83. 


The Psychology of Fear and the Effects of Panic Fear 
in War TimeS}) By Sir Robert Armstrong-Jones, 
M.D., F.R.C.P., R.A.M.C. 

It is an acknowledged fact that in the whole annals of man¬ 
kind the most eventful period of a nation’s psychology is that 
during which its people is passing through the crisis of war, and 
the history of nations, from the earliest dawn of society, pre¬ 
sents continuous records of warlike operations. The present 
war, which has already lasted over two and a half years and 
which is without any immediate prospect of cessation, has 
disturbed the mind and altered the course of life of whole 
continents ; yet all of us are agreed that it should never be 
possible for this “ malady of princes ” to occur again, and it is 
with the view of preventing its recurrence that civilisation 
(which means the united culture of all the Allies as well as of 
the “ benevolent ” neutrals) is now making a final and intense 
effort. 

Having personal knowledge of the mental effects of the war 
upon the civil population, and having more recently, as Con¬ 
sulting Physician in Mental Diseases to the Forces in the 
London Command, some like knowledge as regards the military, 
I propose in the following paper to write on this subject in part 
from my own experience, in part also from that of others, as 
well as to record the effect of panic fear in more remote history. 
Looked upon psychologically, war Is the manifestation of a 
biological law, it is the embodiment in men of a primordial and 


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347 


deep-rooted instinct to be free. The present war is the outcome 
of resistance on the part of a ruthless and tyrannical militarism 
to the innately-organised determination of a people to be free, an 
instinct, as we shall prove, that is associated with the emotions 
of anger and hate as well as of fear. 

The study of the emotions has commanded attention from 
both psychologists and physiologists, who have not only 
endeavoured to describe them, but to investigate their under¬ 
lying physical basis. Such investigations show that the emotion 
of fear is closely related to the influence of the internal secre¬ 
tions. Prof. C. S. Sherrington has recorded experiments in 
which he cut off the nerve supply to the viscera in animals with 
the object of criticising the James-Lange-Sergi view that the 
emotions had primarily a somatic origin. Nevertheless, our 
chief indebtedness in regard to the study of the emotions still 
remains to Darwin and Herbert Spencer, the latter authority 
seeking to classify them upon their development from simple 
sensuous presentations of pain and pleasure ; whilst Darwin 
investigated them through the natural history method, demon¬ 
strating the continuity of human with animal evolution both in 
mental and bodily characters, originating the doctrine that 
human progress and growth had evolved from subhuman ante¬ 
cedents, a view that has done more to unravel the complex 
mentality of man than any other. 

Psychologists to-day all teach that the emotions have a 
physical correlative, and this aspect has been carefully investi¬ 
gated by Pawlow, Elliott, Cannon, and others, more especially 
in regard to the emotion of fear. More and more is it becom¬ 
ing recognised that conduct is influenced by the emotions ; that 
in every emotion there is a cognitive, an active, and an affective 
experience, and that the emotions are the expressions of—or 
according to some are themselves expressed in—characteristic 
instinctive acts. Pawlow has shown the physical effects of fear 
upon the secretion of the digestive juices, and he concluded that 
pleasant aesthetic appeals to taste and smell assist digestion, the 
sight of appetising food making the “ mouth water ” ; whilst 
vexations, anxieties, worries, and fright retard the secretion of 
saliva, as well as of the gastric and pancreatic juices and the 
bile ; and it has been experimentally demonstrated that visceral 
responses through the sympathetic nervous system accompany 
all the strong emotions. During strong emotional excitement, 

LXiii. 23 


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\ 

such as is produced by fear or pain, anger and rage, the move¬ 
ments of the abdominal viscera are inhibited, whilst under the 
influence of opposite or pleasurable sensations they are 
accelerated ; and this is in accordance with the anatomical facts 
that there are two series of fibres to the visceral organs, viz., 
one which accelerates their movements and the other which 
inhibits them, and it has been suggested that a scheme of 
classifying the emotions might be based upon their associated 
physical correlation. Fear, for instance, is expressed physically 
by the inhibition of all visceral movements ; there is also a 
contraction of the blood-vessels, shown by pallor; there is a 
lowering of the surface temperatures, a “ cold-sweat ” pours over 
the body ; the flow of saliva stops, “ my tongue cleaved to the 
roof of my mouth”; the pupils are dilated; the hair stands erect; 
the heart beats rapidly, the respirations are hurried ; there is also 
a trembling and twitching of the muscles, more especially those 
about the lips and face. A young officer, YV—, who had obtained 
the Military Cross for bravery, told me that on one occasion 
when alone and in danger he was overcome by a sudden fear ; 
he said, “ Something within me seemed to pass right away," and 
his body began to tremble ; but by an effort of will this passed 
off; otherwise, his feeling was to get away from where he was. 
Another officer, T—, who had also been decorated for valour, 
said that whilst he was hard at work in charge of a battery he 
realised that his men were falling one after another, and 
suddenly his legs began to shake, his body to tremble, and a 
“ queer feeling ” came over him which he hoped never to experi¬ 
ence again, and he wished to know what this emotion was ? 
In all danger the effect is the same, i.e., protective automatic 
reflexes occur, and the whole effort of the organism is to obtain 
an “ atmosphere,” as Crile has called it, of “ a-noci-association." 
Precisely the same visceral results as are associated with the 
strong emotions occur after the injection of adrenalin or epi- 
nephrin into the blood-stream ; sugar is reflexly liberated from 
the liver into the blood for the use of the muscles, the blood is 
driven from the abdominal viscera i»to the heart, lungs, and 
the central nervous system ; the coagulability of the blood is 
raised, and the arterial pressure is increased. In all the strong 
emotions, experiments have shown a reflex increase of adrenalin 
in the blood, with all the protective responses referred to ; the 
sugar liberated helping in the muscular struggle, which is either 


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to assist combat or to secure flight; a fuller circulation and a 
higher arterial pressure also favour this, whilst the more rapid 
coagulability of the blood is in anticipation of haemorrhage 
during the life and death struggle. The flow of adrenalin 
during a strong emotion not only tends to augment the effect 
of the emotion, but it also helps to sustain and to prolong it, 
which is the very nature of our experience, as during the time 
we are feeling the emotion these diffused bodily changes set up 
by the organic and glandular activities further react upon the 
brain, and these reactions in their turn act as stimuli, encourag¬ 
ing the continued secretion of adrenalin, whilst the emotion 
lasts ; and in this way sustaining the necessary bodily commo¬ 
tion until the emotional wave gradually dies away. In the 
records of shell-shock cases the blood-pressure taken soon after 
the men are seen at the dressing stations is found to be raised, 
whilst there is a lowering of 20 to 40 mm. after a short rest at 
the base hospitals. 

It cannot be too strongly insisted, that the action of the 
central nervous system is of the syndromic variety, the cortex 
being built and activated to a high degree of perfection on this 
unified basis, yet, although human beings are integral organisms, 
the mind through fright, anxiety, disease, or shock, and also in 
pathological states, may become dissociated, and any of its 
elementary constituents may be abnormally presented, and may 
tend to overact in comparison with the others. It is a fact of 
experience that any stress or strain upon one of the elements 
may disintegrate the whole. It would follow from this, in 
regard to restoration, that every factor which contributes to the 
welfare or the improvement of one part may also contribute to 
the improvement of the whole. As to the predominance of 
any one element of the mind we know that in the delirium 
of grandeur, for instance, the ideas are more vividly expressed ; 
they crowd the attention, although unreal ; and they are 
sometimes critically and logically defended against every appeal 
to reason. 

In the delirium of depression ideas of imagined faults, ground¬ 
less apprehensions of sin-committal, of impending suffering and 
ruin, dominate the consciousness. In dissociated emotional or 
affective states some of the primary emotions may hold the 
mind and dominate conduct, and of these fear is probably the 
strongest and the deepest of all. It is one which man has 


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experienced and recognised from his earliest stages, and also 
one which he has tried to avoid and to control, lest it should 
seize his whole personality. The fear of solitude, of being 
without protection, of vast distances or of open spaces ; the 
fear of closed places or of great heights or of darkness—all of 
use to our ancestors—are notable instances of inherited instincts 
that may be revived under stress or through pathological con¬ 
ditions. There are also abnormal disturbances of the will 
power, which acts through an extraordinary large series of 
circuits ; on the one hand, as a sudden un-reflective discharge, 
on the other causing complete inhibition of voluntary effort; 
witness for example, the hesitation of the neurasthenic to cross 
the road, the irresolution of him who drinks, the lack of will 
power to initiate action, or the disregard of prudential con¬ 
siderations which characterise many affections of the will. 
Witness also, the impulsive tendencies of the epileptic, and the 
equally impulsive obsessions of the paranoiac ; above all may 
be seen the inhibition present in some cases of shell-shock, who 
may be deaf and dumb, and who with every apparent effort are 
unable to phonate or even to whisper, but who through some 
sudden emotional stimulus will regain speech, voice, and even, 
when these are lost, hearing and sight. Quite a large number 
of these aphonic cases are met with in the various hospitals, 
who suffer from no wounds, but who have experienced what 
may be described as awe, or the fear of some unknown or 
vaguely contemplated event. C—, a Canadian, could not 
speak and his whisper was at first inaudible, but he could write 
his thoughts and express his reasoned judgment, and he 
corresponded with his family. He heard and understood every¬ 
thing that was said to him, and there was no intellectual defect, 
but he was miserable and he looked frightened and anxious. 
He enlisted at the age of 43, and there was no possible doubt 
of his valour and courageous behaviour. He was in the Somme 
advance, and he had a complete memory of a shell bursting 
near him, and remembered being taken to the dressing station. 
He was shaky, with marked tremor of the hands, and he com¬ 
plained of frontal headache, and he had a foul tongue, with 
marked digestive disturbances. He dreamed terrible dreams 
as many of these men do. After two months he was sent to 
another of the War Hospitals for examination, and he regained 
his voice the same day. This case is typical of many more, 


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and the question arises what is the pathology of this condition ? 
Phonation and articulation according to the evolution theory, 
are a late accomplishment, and are only utilised to express the 
emotions and thoughts. The view taken by Col. C. H. S. 
Myers, R.A.M.C., is expressed under two heads, viz., either 
the blocking up of paths subserving the mechanism of phona¬ 
tion and articulation and producing an apparent paralysis, 
or the blocking up of paths that control and co-ordinate them, 
thus causing an ataxic or clonic or spastic functional condition. 
It is believed by some that the condition may be due to a 
functional paresis of the “ habit" of breathing, i.e., of muscles 
which subserve respiration so far as sound production is con¬ 
cerned, and to be a bilateral cerebral lesion. At any rate, as 
we shall see later, this refractory condition in the psychic 
mechanism may be, and often is, removed suddenly by some 
unexpected stimulus or through the influence of suggestion. 
Captain Farquhar Buzzard refers to the rarity of this condition 
in officers as compared with the men, and he explains this by 
the better education of the officers who are more able to reason 
and to understand, and who are thus less liable to emotional 
shock. A complete temporary blindness, “ struck blind ” as it 
is called, has been noticed. A soldier, E—, who was in India, 
but never in action, suddenly lost his sight and memory. He 
was brought home, but he has no recollection of leaving 
Bombay or anything occurring before that ; but his memory 
of subsequent events is good. He cannot see, he has photo¬ 
phobia and complains of a “ white haze,” there are no naked 
eye or disc changes reported by Captain Lee in charge of him. 
He cannot stand or walk and is “ all of a shake.” Another 
patient, P—, was in the Somme action, he “ got knocked up by 
waggons ” and fell, he states, on his head, after which he could 
not open his eyes. For three hours he was blind and he 
cannot now open his eyes without constantly blinking, and his 
sight is much impaired. There is no inflammation and no 
pain. His mother’s father is in an asylum. B— pitched out 
of an aeroplane and had a false landing. He has had numer¬ 
ous attacks of complete loss of sight. Nothing abnormal is 
seen, but he complains of “ falling about and my eyes are so 
dizzy.” Both these men dreamed terrifying dreams. Captain 
Lee informed me that many of these cases get well on “ bread 
and milk, no smoking and no visitors ! ” I am not able to 


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352 THE PSYCHOLOGY OF FEAR, [July, 

recall any specific instances of the loss of smell and taste— 
apart from delusions. The sense of smell (and with it 
probably taste) is the oldest and most fundamentally established 
of all the senses, and subserving it is the oldest portion of the 
brain, viz., the rhinencephalon which in the lowest vertebrates, 
as in fishes, practically constitutes the whole brain. This 
sense, described as “ the sense to get and to beget,” is therefore 
the oldest and the most organised and the least likely to 
become disordered : whereas the senses of hearing and seeing 
are the most highly developed, and therefore the least organised, 
and are for these reasons the most likely to become disordered 
by psychic shock. The same applies to the emotion of fear. 
It is the oldest as well as the most intense of the emotions ; 
before it all the bodily functions bow ; and it gives rise to the 
greatest amount of mental dissociation when present. 

Another of the conditions essentially associated with fear, 
viz., muscular trembling and ineo-ordination, is very frequently 
met with among shell-shock cases, and this may pass on to 
general convulsive seizures bordering upon epilepsy, as will be 
referred to in the sudden fear brought on by the Silvertown 
explosion in many of those who heard the noise. There is no 
doubt of the fright here, nor of the disturbance of consciousness, 
nor, indeed, of the usual results of fear which dominate the mind 
and draw away all the nerve potential into different efferent 
channels—in this instance into the sensori-motor efferent tracts. 
Consciousness, as we know, is a continuous dynamic process. In 
health there are constant intercurrent stimuli flowing from one 
area of cerebral activity to another, and, as the whole conscious¬ 
ness is a resultant of the total equilibrium of all the conscious 
mechanisms from organic and external receptors, when a dis¬ 
turbing stimulus like fear arises, the co-ordination of all the 
cortical centres is affected, and a discharge is produced, the 
most facile being that of movement through the lower motor 
neurons, because the discharge through movement is the most 
elementary and the oldest and most accustomed form of dis¬ 
charge, and this discharge excites other areas in more distantly 
related centres of the brain. Normally, the cerebral cortex, as 
was maintained by Gowers, is in a state of constant nervous 
tension, ready at any instant to respond to any stimulus, and 
when the discharge is effected the cortex is left in an exhausted 
state precisely like a “ run-down ” accumulator. The form of 


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discharge actually occurring depends upon the temperament of 
the particular individual; at any rate fear is the most powerful 
stimulus that can be applied to effect this discharge. The 
antithesis to fear is hope, which is the anticipation of pleasure, 
and hope has been a great national asset, the vital energy 
imparted in consequence—to the civilian population as well as 
to the military—has been a considerable moral factor in our 
fight for liberty and existence. The psychology of the war has 
brought us into contact with life in a manner that no national 
upheaval ever has before ; the emotions of disgust and anger 
have been more unreservedly expressed than possibly any other 
emotion in connection with the inhuman, barbarous, and 
revolting cruelties imposed by the Huns upon the vanquished ; 
yet the feelings of self-sacrifice, the tender emotions in regard 
to friends, the love of home and of patriotism, and pride in our 
race have all been kindled, and the world of idealism has been 
roused to a degree never before experienced in our time. The 
study of the emotions, therefore, justifies attention, and I agree 
with McDougall that the inherited instincts, with their emo¬ 
tional side, form the basis of our mental life, and that these 
innate tendencies in each of us afford the truest and best solu¬ 
tion of conduct; in fact individual action as well as social life 
depends upon impulses or instincts whose nature has been 
determined through long periods of evolutionary development, 
yet which have become modified through the influence of 
civilisation into organised and complex impulses. The war 
has certainly brought the emotions into greater and clearer 
relief, and it has given us all a much wider psychic experience. 
The teaching of psychologists has been very stimulating to me, 
and I should wish to be permitted to refer briefly and in general 
terms to the views of the emotions and their bodily accompani¬ 
ments. The older psychologists took the various emotions as 
ultimate, and they were enumerated and described accordingly. 
William James has called such a classification the elaboration of 
the obvious ; it was the cataloguing, he says, of so many entities 
which led to no scientific end ; for there are so many synonymous 
terms for the same emotion, and there are so many possible 
combinations of emotional states, that different terms must refer 
to more or less identical states, eg., hatred, antipathy, resentment, 
dislike, aversion, spite, and abhorrence have all the same connota¬ 
tion, although they appear to denote different emotional states. 


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THE PSYCHOLOGY OF FEAR, 


[July, 


It is not surprising, therefore, that such a classification has 
been abandoned, and in place of this James has suggested, with 
much plausibility if not conviction, a “ physical-reflex ” theory 
of the emotions which has given rise to great controversy 
among psychologists. He states that an emotion is the re¬ 
action of the brain consequent upon the excitation of afferent 
nerves ; a number of bodily changes are set up by some exciting 
factor, and as a consequence of the perception of this factor and 
of its mental representation an emotion is the result; the 
emotion, in other words, is the expression of the stimulus, and 
the order of events is, firstly, the perception of some “ exciting 
fact; ” which, secondly, sets up reflexly some bodily disturb¬ 
ance, and thirdly, this commotion is apprehended or realised. 
It is this “apprehension ” that constitutes the emotion. If the 
emotion be regarded as the mental result of material changes, 
i.e.y if the emotion be the consciousness of bodily disturbances, 
there must be, especially in the turmoil and perturbations 
inevitably set up by the antagonism and conflict of sensations, 
an indefinite number of combinations of such perceptions, and the 
number of the emotions experienced must thus be infinite. In 
James’ own words, “ the popular way of thinking about emotions 
is that the mental perception of some facts or series of facts 
excites the mental affection called the emotion, and that this 
latter gives rise to the bodily expression. My theory, he states, 
on the contrary, is that the bodily changes follow directly the 
perception of the exciting fact and that our feeling of the same 
changes, as they occur, is the emotion. Commonsense says, we 
lose our fortune, are sorry and weep ; we meet a bear, are 
frightened and run ; we are insulted by a rival, are angry and 
strike. The hypotheses here to be defended says that this 
order of sequence is incorrect, that the one mental state is not 
immediately induced by the other, that the bodily manifesta¬ 
tions must first be interposed between, and that the more 
rational statement is that we feel sorry because we cry, are 
angry because we strike, afraid because we tremble, and not 
that we cry, strike, or tremble because we are sorry, angry, or 
fearful, as the case may be. Without the bodily state following 
on the perception, the latter would be purely cognitive in form— 
pale, colourless, and destitute of emotional warmth. We might 
then see the bear and judge it best to run, receive the insult 
and deem it right to strike, but we should not actually feel 


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355 


afraid or angry,” *>., the arousal of bodily changes leads to the 
emotion which is their mental interpretation in the domain of 
feeling. 

James enunciated his doctrine in 1884 almost simultaneously 
with Charles Lange, of Copenhagen, and later this was accepted 
by Sergi in Italy. They maintain that the emotion felt is 
either strong or weak, according to the amount of bodily dis¬ 
turbances set up by the exciting stimulus. Many shell-shock 
cases appear to support this theory, for many of them dream 
terrifying dreams of trench warfare and bombs, and in them 
the physical conditions are associated with fear, such as those 
already recorded—tremors, pallor, and a cold perspiring skin ; 
and upon awaking they experience the emotion of fear or 
terror, which, however, quickly subsides when they are reassured 
“ it’s all a dream.” Driver F. M. T—, who had at first no fear 
of shells, developed a terror whilst at the Front of any 
approaching aircraft or high explosives. He used to dream 
when in hospital that aeroplanes overhead were dropping 
bombs on him. The nurses state that he used to wake up in 
sudden frights, and with his personal linen and even under¬ 
bedding saturated ; his body trembled and his pupils became 
dilated. He was only calmed when told no aircraft was near 
and that he was safe. In his case it certainly appeared that 
the bodily disturbances preceded the emotion of fear, but it is 
open to any critic to suggest that some unusual noise or sound 
heard in the ward initiated the mental emotion, and that the 
explanation of this emotion was the dream, the emotion 
bringing about the bodily changes secondarily. Stout and 
others maintain that the first exciting factor is the mental 
disturbance and that this precedes the bodily commotion, 
which depends upon the estimate made by the mind in regard 
to any particular experience. Stout holds that in each of the 
other departments of the mind the order of events is the same ; 
in feeling the physical stimulus is mentally appreciated as a 
sensation before the bodily commotion that results from the 
stimulus, and in the will the purpose aimed at is mentally 
realised before the movement to obtain the desired end can be 
effected. McDougall accepts the view of James with modifica¬ 
tions, for he declares the emotions to be the mental representa¬ 
tion of instinctive bodily tendencies, i.e., the emotions are the 
mental side of the bodily tendencies, innate in the individual, 


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the result of a long evolution, yet modified by development and 
social customs. 

The instincts have long been a debatable ground for contro¬ 
versy, and they have received during recent years much 
attention from workers in the field of comparative psychology, 
notably from H. S. Jennings, the Peckhams, J. Loeb, and Lloyd 
Morgan. It is claimed by some that the instincts are merely 
impulsive movements directed to some serviceable end not 
present in consciousness, and by others that instinct and intel¬ 
ligence have no real distinction. Herbert Spencer urged that 
all movements were originally reflex, and only when these had 
reached a certain degree of complexity in the evolution of the 
race, did consciousness intervene to direct the reflex movements 
to a useful end, and thus purposeful and conscious movements 
evolved from reflex ones. In support of the evolution of intel¬ 
ligence from reflex acts, it is claimed by some psychologists 
that movements originally carried out as an explicit act of 
attention may, in time, become automatic. Witness, for 
instance, the early difficulties of the raw recruit with his drill. 
As a result of attention and habit these movements, when 
frequently practised, become so familiar that they can be carried 
out without thought, and once the first of the series is initiated, 
the rest follow automatically. It is this “automatic” character 
that is induced in all the individual manoeuvres of military 
people at the expense of initiative. It no doubt tends to make 
a good machine a better and a more perfect one, which is an 
advantage, provided there is no lack of initiative on the part of 
the officers to issue directions ; but when the plans that have 
been organised are interrupted, the machine then fails to be 
effective, for no over-drilled individual possesses the initiative 
or the originating capacity to reconstruct new plans. It has 
been the boast of our country that our army is composed of 
individuals who have not been dragooned into secondarily auto¬ 
matic machines, but that there is sufficient initiative left on the 
part of the men to form what we shall later call the “ collective 
mind,” and the collective mind is the one that tends to make 
for the safety of the whole. 

Psychology of Fear. 

Fear is a fundamental instinct, and James says the progress 
from brute to man is characterised by nothing more than a 


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decrease in the frequency of occasions for fear. Shand states 
that there are as many kinds of fear as there are types of 
behaviour initiated by it. 

Fear is best described as the anticipation of pain, or a 
knowledge of danger which results in action. It is also described 
as a vestigial form of our ancestral type of mentation. The 
first fear must follow a preceding pain, and it presupposes a 
previous experience of pain. Fear thus connotes a mental state 
in which the future appears to dominate the present, whilst the 
actual present is a revived experience of the past, this 
experience being a painful one. It is this revival that 
constitutes the emotion of fear. It is fear that urges the 
organism to avoid a previous danger, and therefore fear has a 
definite biological value. The power to experience fear is neces¬ 
sary for self-preservation, and it is met with in early conscious 
life and in animals; the most easily frightened member of the 
herd has the best chance, costeris paribus, of survival. 

The apprehension of an impending danger in fear, that is, 
the feeling that there is a more painful state impending, is a 
very generalised feeling, and it has (as we shall see) a very 
definite bodily accompaniment. It is a very unitary and a 
very unique division of the affective life ; too little of it 
leads to rashness, and too much gives rise to timidity. As 
S. G. Tallentyre has stated, it is not the desperado who is 
“ careless, reckless, fearless, of what’s past, present, and to 
come ” that is brave, and it is not the man who is incapable of 
fear that has the highest form of courage. There are many 
people, like children with fire, that are not afraid, because they 
have never experienced fear, and there are others who are too 
stolid, too obtuse, or too unimaginative to feel fear. Many men 
in the present war, remarkable for daring, were timid and even 
shrinking as children, yet they became renowned for bravery in 
later life. Fear may be readily induced by suggestion, or by 
imitation, as has been seen in shell-shock cases, because there 
are such definite bodily commotions associated with fear, and 
it is certainly questionable whether many of these should be 
treated together, and a wise eclecticism must be exercised in 
arranging for their treatment together in a leper hospital! 
Fear may so stimulate the imagination that the mind may 
create fictitious objects of dread and terror, and it is these that 
have caused bodies of men and crowds of people to act in the 


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presence of danger as if infected. Cries, trembling, sudden 
starts, paralysis, and convulsions all form a part of the somatic 
picture of fear, and these are not infrequently conveyed from 
one to the other. Although danger may be a cause of fear, 
there are many instances of strong and adventurous persons 
who long to meet danger in order to conquer it. Peril in fact 
is an incentive and an inducement to courage. Captain Scott 
undertook to face the terrible Antarctic experiences to which he 
and his party bravely succumbed, because of the knowledge to 
be gained through peril and danger. There is no possible 
doubt that he realised the emotion of fear because he had made 
full preparations to meet it. He knew from his former Arctic 
travels the risks he ran and the dangers he had to face, and in 
spite of fear he dared to risk the voyage. To some natures 
fear becomes a mental tonic, but possibly other emotions, such 
as curiosity and wonder, help to create the motive for action. 
To many of our brave soldiers life without danger would be 
insipid and flat, and a man in perfect health does not trouble 
at the thought of death, partly because the uncertainty of its 
happening creates no fear. It is known that the weaker animals 
fight better when they experience fear and are driven to be at 
bay, and men often fight better when they are rightly afraid 
and have justice on their side. Fear may come on gradually 
or suddenly. The many slow grinding fears of a vague marginal 
subconscious kind are more characteristic of to-day than are 
the sudden isolated instances which occurred in the days of 
primitive man ; but the stress experienced by our officers and 
troops was the origin of frequent instances of fear coming on 
suddenly and without warning ; danger, therefore, more than 
pain, enters into the mind, and when fear is experienced either 
gradually or suddenly it has more power to effect dissociative 
dissolutions than any other emotion. It causes all other 
sensori-motor activities to cease ; the normal inhibitions stop, 
and the normal reinforcements fail ; immobility, irregular 
tremors, and in some cases complete paralysis and collapse are 
seen, and we can thus realise the truth of the phrase, “ para¬ 
lysed with fear.” In the case of movements those that had 
become primarily useful and instinctive may become affected 
through the sudden shock of a strong emotion, and the mind 
becomes conscious of the state of tension brought about by the 
conflict between movements which subserve the emotion (in this 


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case agitation, tremors, etc.) and those which are being con¬ 
sciously initiated by ideas, so that an inability to move, to 
walk, or to stand, occurs. It is interesting to note that most of 
the shell-shock cases are without wounds, and these cases have 
almost all been “ buried,” “ thrust,” or “ blown,” or have been in 
the vicinity of suddenly bursting large shells. Incontinence of 
the bladder and rectum, due to stimulation of the sympathetic 
by a withdrawal of cerebro-spinal inhibition, have been recorded 
as a result of fear. In the slighter degrees of shell-shock motor 
phenomena, as stated, are very common, and in most of them 
the reflex guidance- of movements is lost. Although we can 
rightly boast that our warriors are among the best troops in the 
world, there are instances within the knowledge of each of us 
where men in close proximity to high explosive shells which 
had burst have wandered away confusedly or unconsciously, 
and have lost their speech and memory for weeks or months, 
but under the influence of suggestion some have been able to 
recall fully afterwards the whole incidents. I have notes of 
cases in which Capt. William Brown, R.A.M.C., effected a 
complete restoration of memory through hypnotic suggestion 
practised early after the shock. To indicate the suggestibility 
of these cases I am allowed to mention the case of a patient 
(under the care of Major Tims, R.A.M.C.) who. was out on 
parole one afternoon when he saw a horse fall, and without 
warning he himself also went down suddenly, and had to be 
helped back to the hospital. A sudden unexpected noise, such 
as an overhead train crossing the road, caused the same effect. 
The Silvertown explosion on Januuary 23rd several miles away 
caused several patients in the same hospital to demonstrate the 
physical effects of fear. I consider an element of fear to be 
present in almost all functional nervous cases, and it is present 
to a slight degree normally in all actions directed by desire, 
and even those who read “ papers ” know the conflict that 
occurs between the wish to succeed and the risk of failure ! 
Fear was formerly considered' by our legislators to be the 
essential factor as a deterrent in the punishment of crime, but 
it is now discovered to be a wiser policy to improve the 
environment, and fear has also been abandoned as a deterrent 
in schools, for it was found that flogging lowered intellectual 
efficiency. Mr. Graham Wallas said that if war ceased Alpine 
clubs would have to be increased, as they added the zest of peril 


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360 THE PSYCHOLOGY OF FEAR, [July, 

and danger to life and assisted through fear in initiating 
energy and activity. Like Shand he appears to regard fear as 
the root-force of character. It is said that if the theologians 
are deprived of the use of fear as a moral agent and a deterrent 
from evil they would lose much of their influence for good, but 
Miss Mackenzie has said that the fear of exchanging this world 
for the unknown would lose much of its delightful sense of 
adventure if we knew whence we came or whither we were going. 

I feel most strongly that it is this fear of the unknown which 
is “ unconscious ” that is at the bottom of most, if not all, of our 
shell-shock cases. 

One of the most painful forms of fear is the pavor noc- 
turnus, or the night terrors of children between three and 
eight years of age, and the question has been raised whether 
it be somatic or of so-called idiopathic origin. Among 
soldiers suffering from shell-shock it is not at all uncommon 
in the early stages, when sleep is disturbed by horrible 
dreams of the parapet, of high explosives, and of Hun atroci¬ 
ties. So marked was this the case in one man whom I saw 
that he feared going to sleep—a condition named hypnophobia. 
The phylogeny of sleep suggests that early man may have 
been semi-nocturnal in his habits, and that dreams and pavor 
nocturnus were protective and prevented the long sound sleep 
which must have been a danger to primitive man, as he might 
at any moment need some sudden extrinsic call so as to act 
with promptness and energy. 

The organic sensations enter largely into the emotions, as 
Bain asserts, who was one of the first to teach this, and par¬ 
ticularly is this the case with fear. We now fear in our hearts, 
stomachs, livers, thyroids, and adrenals, the organic sensations ' 
being thus presented to consciousness, and a vulgar Scotch, 
expression of the fear to act is—“ I have no guts for it.” Not 
infrequently there are met cases among soldiers where fear is 
associated with constantly recurring vomiting, and one was 
recently recorded by Dr. Colin McDowall. 

We are.familiar with the classical work of Sir Charles Bell 
upon the expression of the emotions, in which he associates fear • 
with staring, startled eyes, dilated pupils, eyeballs largely un¬ 
covered, eyebrows elevated to the utmost, the convulsive 
opening of the mouth, when the tongue is seen, yet the lips 
conceal the teeth, and the nostril is inflated; these signs of fear 


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passing on to complete collapse and paralysis. He distin¬ 
guishes fear from terror, which, to him, was an exaggerated fear, 
the appearance of Cain after the death of Abel by Metastasio 
being quoted as one of the best representations of these 
emotions in words. Terror and astonishment, in which the 
person is appalled and stupefied, and where he stands rooted 
and motionless, are contrasted with the fugitive, unnerved by 
fear alone, and in the act of flight. Homer thus describes 
horror : “ Terror and consternation at that sound the mind of 
Priam felt; erect his hair, bristled his limbs, and with amaze 
he stood motionless.” The fear of spiders, of snakes, or, as in 
the late Lord Roberts, of cats, are inherited phobias, of which 
about 140 have been described. They are not of the category 
under consideration. 

Relation between Mind and Body. 

It may be desirable in order to explain certain functional 
nervous states to consider briefly the relation between mind 
and body. This has always seemed to be an interesting 
speculative question, but we desire not to be drawn into any 
deep metaphysical discussion over it. Physiologically con¬ 
sidered man only obeys his biological destiny, and physiology 
takes no view of intellect or of intelligent behaviour ; these are 
outside its purview. Dr. F. Buzzard, in a very interesting 
paper recently published in the Lancet (December 30th, 1916), 
cites a case of functional paraplegia as the effect of a separate 
mental entity upon an equally separate body, and he sought 
for an explanation of this condition from the psychological 
aspect. He says these cases are “ what appear to me to be 
essentially disorders of the mind in the present state of our 
knowledge.” The suddenness of onset and the equally sudden 
disappearance of nervous condition certainly negative an organic 
origin, and tend to favour this mental entity. Dr. Buzzard 
states—and this is striking from a neurologist—“ the more I see 
of these cases, the more convinced I am that an- idea—a con¬ 
scious idea—plays some part in the production of all these 
phenomena” ; also, “ hysteria has its source in the mind. It is 
a mental disease.” The experience of many who have the care 
of mental and shell-shock cases upholds this view, and we are 
not prepared to say, with so many psychologists, that mental 
processes consist only of sensations in juxtaposition, or of 


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363 THE PSYCHOLOGY OF FEAR, [July, 

images (which are revived sensation) held in groups by “ asso¬ 
ciation,” and that there is no such thing as mind by itself, 
although, on the other hand, there are no definite proofs of its 
existence. Man is a purposive being, with intelligence and 
volition, and we realise from such complex physiological con¬ 
ditions as binocular vision, as we also know from the experience 
of effort, used in thought or during attention, that there is. some 
kind of independent entity. But, it is replied, if there be an 
independent mind, why should it appear to arise only in con¬ 
nection with cerebral processes, and not in connection with any 
other processes ? All are agreed, however, that mental states 
are associated with the activity of the nervous system, but this 
does not prove that they are “ functions ” of the brain. To 
think of the mind as an epi-phenomenon, a something inert 
lying beside matter, does not explain mental states, and it is 
contrary to experience and to psychological knowledge to 
accept this view. The view that mind is something incidental 
to matter—a “ spark thrown off by the engine,” or “ a mere 
foam thrown up by and floating on a wave ’’—although held by 
some psychologists, is not generally acceptable. This view 
holds that the mind has no reaction on the brain. There is a 
strong conviction in the minds of most persons that there is a 
definite reality in mental activity and in effort, and therefore to 
put the mind on one side as a mere inert series of phenomena, 
or an epi-phenomenon, is not only inadmissible, but is belied by 
the experience of all who have to do with mental cases. It is 
true that some thinkers suggest that the whole universe is 
ranged on the lines of, and through, conscious experience, and 
that, as we know nothing of the ultimate constituents of matter, 
it is not impossible that matter may in the end prove to be of 
a like nature, or even prove to be identical with, the ultimate 
“ stuff ” of consciousness. As to cause and effect between mind 
and body, it is impossible to state conclusively that either factor 
is a cause, for the two things are not comparable, and to try to 
explain as an effect anything that is not commensurate witl 
the cause is inadmissible. It is not possible to explain con¬ 
sciousness or awareness in physical terms, which must be in 
terms of movement. Moreover, the consciousness that arises 
from cerebral processes is not consciousness of the cerebral 
processes themselves, but of something not only quite different, 
but also outside the brain itself, and even our own appreciation 


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of the functions of the cerebral cortex is a reflection. The facts 
as we know them suggest that a physiological process always 
accompanies a psychological change, but to say they are parallel 
is not warranted, for there is no continued “ point-to-point ” 
relation between them, and to suggest “ parallelism ” is to favour 
a mechanistic view, or an interpretation in terms of physical 
analogy. It would be more true to state there was interaction 
between them than to suggest there was a complete parallelism, 
*>., when changes took place in the cortex something else 
occurred which was over and above material change, but true 
correlation was impossible, and “ interaction,” or the vitalistic 
view as opposed to the mechanistic, seems of late to be gaining 
ground over parallelism as an explanation of the relation of 
mind and body. A young Australian soldier suffering from 
shell-shock, and under the care of Col. Hawkins, R.A.M.C., had 
not spoken for several months. One day in Whitehall he 
unexpectedly met his brother, who suddenly greeted him after 
an absence of seven years. The soldier spoke from that hour. 
A company of about twelve soldiers who had recovered from 
shell-shock set off one afternoon to witness a trans-pontine 
melodrama, a part of the plot being the explosion of a stage 
bomb, which was unexpected. Five of the men instantly lost 
the power of walking and had to be carried home, whilst 
another of the party became aphonic and aphasic. Both of 
these examples seem to indicate the power of some entity 
capable of reacting upon the body, and giving rise to functional 
(as opposed to organic) nervous changes. 

Physiology. 

I believe it would be correct to regard the emotions as the 
mental interpretation of physiological adaptations for survival, 
for they are capable of calling up certain powers of the body 
into action which help the individual to live. They are thus 
purposive, their end being to preserve the welfare of the 
organism and to safeguard it against hurt or injury. Upon 
this view the emotions are supplementary reflexes—few of 
them are under the control of the will—by means of which the 
body Is prepared for protective action. In the popular view 
there are usually three ways in which protective action occur* : 
Firstly, external precautions against cold and storm, wind and 

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364 THE PSYCHOLOGY OF FEAR, [July. 

rain, by the adoption of clothing and shelter ; secondly, action 
against pathogenic and other organisms and toxins through the 
chemical defences, which are more or less innate in every indi¬ 
vidual, and thirdly, those adaptive mechanisms through the 
senses which help to guard the body against injury, and with 
these the special instincts of self-preservation through fight and 
combat, or flight and concealment; each of these bodily 
instincts being attended with a mental side signified by the 
term “emotion." In every emotion there are nervous currents 
discharging impulses to the various muscles, the viscera and 
the vital organs, and it is upon the nature of these reactions 
that we are able to observe and to classify the instincts which 
are the bodily accompaniments of the different emotions. 
After what has been said about the relationship between mind 
and body, we may state, without suggesting factors of causa¬ 
tion, that each of the emotions has a bodily accompaniment. 
Indeed the emotions may be regarded not only as having 
associated bodily states, but also as being themselves special 
mechanisms for reinforcing the bodily activities, for in the 
hour of danger the emotions, acting in conjunction with the 
motor mechanism and certain glandular structures, prepare and 
adapt the body for protective action, and when these mechanisms 
have been discharging for long periods continuously, or for a 
short period intensely, a condition of exhaustion must occur, 
and it is this condition that we meet in so many “ shell-shock ” 
cases. 

It has been ascertained that the visceral response is the 
same for all the strong emotions, and there appears to be so 
much physical uniformity and physiological similarity among 
all the emotions, complex and varied as they seem, that funda¬ 
mentally they may all be identical. At any rate their special 
differentiation must be sought for elsewhere than in visceral 
changes, as it is impossible to discriminate between them from 
their visceral associations, which, after all, are only one side of 
the emotions. C. S. Sherrington writes to me saying that his 
experiments of severing the viscera and skeletal muscles from 
brain influences “ tended to show that the suppression of the 
visceral and vascular accompaniments of the emotions of rage, 
disgust, and fear did not suppress the occurrence of the emotions, 
at least not to the extent that we should have expected were 
William James’ view of their source correct," this view being 


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“ that the visceral and vascular reflexes by a retro-pulsion to the 
brain and mind gave rise to the emotions,” or, in other words, that 
the physiological disturbances originated the emotion, or were the 
emotion, and that we are miserable because we cry and not that 
we cry because we are miserable. Sherrington’s experiments 
tended to show that although the autonomic nervous system 
was the organic background of the conscious life, the viscera 
themselves were relatively unimportant in distinguishing between 
the different kinds of emotions, each of which would appear to 
have its own bed or track deeply laid already and ingrained in 
the central nervous system, and each having in connection with 
this track a separate group of co-ordinating neurones. It would 
be true to state that every stimulus, physical and mental, tends 
to awaken (along ancestral tracks in the nervous centres) some 
response, through various associations that may be peculiar to 
the individual. As we know, each group of neurones has its 
own characteristic expression, arid the tendency for these upon 
stimulation is to act suddenly and to call up separate groups 
of voluntary muscles. It is ascertained that a nervous current 
may cause a contraction in a skeletal muscle in the two to three 
thousandth part of a second, whereas a stimulus through the 
autonomic system, acting upon smooth muscle or upon a gland, 
takes several seconds to react. If sufficiently intense the 
stimulus of an emotion overflows into the more diffuse dis¬ 
charges of the autonomic system, thus giving rise to vague 
cardiac, pulmonary, and visceral perturbations with muscular 
tremors, such as we find so often in “ shell-shock ” cases. We 
know that strong emotions of fear, grief, anger, or rage may 
inhibit the flow of saliva, of the gastric, pancreatic, and intes¬ 
tinal juices as well as of the bile ; the normal movements of 
the stomach and intestine also cease, and the same in a minor 
degree is true of the less dominant emotions. In some cases 
of sudden joy or of intense fear the contents of the hollow 
viscera may even be rejected, which shows that the influence of 
a powerful emotion may overwhelm the normal action of the 
autonomic system, and may thus entirely reverse the functions 
of organs innervated by it. 

It has been ascertained experimentally that when the 
emotions of fear and rage are experienced there is an increase 
of adrenalin and sugar in the circulation. The blood of a 
caged cat tormented by a barking dog will show an increased 


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366 THE PSYCHOLOGY OF FEAR, [July, 

percentage of adrenalin (which can be detected when the 
amount present is a dilution of one in a million), and precisely 
the same occurs when the nerves to the gland are stimulated. 
The physiological effect of adrenalin is to restore the organism 
after fatigue and to cause an innervation of all nerves in the 
autonomic system. The effect of increased sugar in the 
blood is to restore and renew muscular activity, and this, when 
present, prepares the organism for a supreme muscular effort. 
The combined effect of adrenalin and sugar is to excite the 
heart, to contract the walls of the smaller blood-vessels, and so 
to raise arterial pressure, to add tone fo the viscera, and to 
release the sugar stored in the liver, and also to activate the 
sweat-glands in anticipation of violent muscular movements. 
The further effect is to dilate the pupil (possibly the ancestral 
instinct for seeing distant objects), all such phenomena being 
physical results that fully and completely characterise the 
emotion of fear, which is thus demonstrated to be a protective 
reflex, inasmuch as these physiological effects are precisely 
those that prepare the body for a strenuous effort, such an 
effort expressing itself in active combat, conflict, or flight, the 
latter being essentially a struggle to be free. 

Of all the emotions, fear is probably the one that most 
frequently rouses the autonomic nervous system into activity, 
and it is through this emotion in particular that nerve-potential 
from the central nervous system overflows into the autonomic 
ganglia and inhibits the functions dependent upon them. 
There is thus during fear a rapid and probably excessive con¬ 
version of potential into kinetic energy, which must be at‘the 
expense of the energy stored away, in part the stored energy 
of the cytoplasm of the neurone, and in part also that of the 
liver cells, the thyroid, and the adrenals. Although we our¬ 
selves realise the marked psychological distinctions between 
the emotions, it is true that in spite of many complexities some 
of the emotions seem readily to pass into others and for this 
reason they have been described as ambivalent. There is much 
for instance that is common between fear and rage. William 
James even says they are the same, for “ we wish to kill 
anything that wishes to kill us,” and he adds that animals 
which fear and flee not infrequently turn to fury and fight. 
McDougall states that to thwart any emotion or instinct is to 
excite the animal to fight and combat, and Graham Wallas 


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1917-] BY SIR ROBERT ARMSTRONG-JONES, M.D. 367 

makes a great point of the transformation of an instinct, by 
what he describes as a “baulked disposition,” in which there is 
the discomfort or pain at not securing the object of one’s desire, 
and the merging of this feeling into the agreeable consciousness 
of being able to react against the cause of pain. It is with the 
view of “ baulking ” fear that popular opinion urges a timid 
person to regain his previous confidence by repeating under 
assured and safe conditions the same act that caused his fear. If a 
boy falls off his horse and is afraid to try again the riding-master 
insists he should ride the next day, otherwise there is a risk that 
his fear may become fixed and he may thus permanently lose 
his “ nerve.” This accords with the experience of shell-shock, 
which only develops some time after the original “ trauma,” and 
unless treated becomes organised. This transformation of 
emotions is well seen in the passing of fear into anger, with the 
result that hatred is engendered. 

It has been asked, if fear be a protective emotion, why is it 
sometimes physiologically depressing or of a paralysing character, 
and why is it sometimes associated with a failure of the circula¬ 
tion and with collapse ; a condition which is incompatible with 
activity or combat ? Why, in other words, do the same 
emotional states pass into two opposite physical states ? The 
answer is, that the deeper and stronger emotions as well as 
severe pain are occasionally depressing because this condition is 
of biological utility to the organism, and it is then that conceal¬ 
ment, and not combat or flight, must be adopted if escape is to 
be effected; for, owing to the injuries received, an effort at flight 
would not be in the interest of survival or protection ; but would, 
on the other hand, only aggravate the damage inflicted. Under 
these circumstances it would not assist an injured animal to 
attempt to escape; collapse alone would favour survival, yet,when 
the need for action becomes necessary, the body can be roused 
to all its defensive and offensive activities, as occurs in the 
automatic pouring of adrenalin into the blood during a strong 
emotional experience, results which follow equally its experi¬ 
mental injection into the blood-stream. 

It has been conclusively shown by G. W. Crile and those 
who collaborated with him, that a strong psychic stimulus 
produces some change in the conductivity of the cerebral arc, 
the effect of which is to lower the threshold of that arc ; for 
instance, the sudden or unexpected strain which has produced 


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368 . THE PSYCHOLOGY OF FEAR, [July, 

shell-shock brings about a condition of lower nervous threshold, 
that is, it creates an increased sensitiveness to impressions, so 
that a condition of marked nervousness is left, and after being 
“ buried ’’ or “ blown up,” or after hearing continuous loud sounds 
and unusual noises, or after a sudden fright, a lower receptivity is 
induced which will cause general bodily perturbation. Possibly 
of all the senses hearing is the most refined and delicate, 
certainly it is the most highly evolutionised in cultured people ; 
and it is the one most frequently dissociated in insanity. Of 
all hallucinations in cases of mental disease the aural forms are 
the most common. This sense depends upon very specific 
receptors, viz., the hair cells, to which the tectorial membrane 
responds ; and there is an intimate association phylogenetically 
between tactile and auditory sensations ; so that any sudden 
stimulation of the specific auditory epithelium is capable of 
reacting in a very general way upon the mental functions, and 
we find shell-shock cases to be very sensitive to any loud or 
unusual sounds. Moreover, the stream of impulses to the 
auditory nerve must also affect its vestibular branch which is 
closely connected with the static sense, and with the control of 
movement. Although the vestibular nerves give rise to no 
sensations, they are nevertheless closely related to the roots of 
the motor-oculi nerves, as well as to other motor centres in the 
brain stem and in the cerebellum. They thus serve to keep up 
the bodily balance and to keep the eyes fixed upon the same 
point in spite of movements of the head and body. All 
auditory impulses must therefore be continuously correlated 
with movements, yet there is no knowledge in consciousness 
that these movements are made or produced. I was greatly 
interested to see in so large a number of the cases shown on 
December I ith last at the Maudsley Hospital such sudden un¬ 
controlled movement, especially when spoken to unexpectedly 
or loudly, and also the frequency with which one meets with 
nystagmus in these cases. We do not sufficiently realise how 
dependent bodily movements guided by habit are upon the audi¬ 
tory sensations, which are certainly the most highly evolutionised 
and the most important of all the avenues into consciousness. 

As has been suggested a lowered nervous threshold is of a 
protective nature, being an adaptive reaction against future 
dangers, because in this way a minor stimulus elicits a major 
effect, but since a low threshold is lavish of nervous energy 


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1917-] BY SIR ROBERT ARMSTRONG-JONES, M.D. 369 

recuperation must be slow, for there is in this condition of 
exhaustion a loss of efficiency. There is, therefore, great 
theoretical support for the treatment of shell-shock cases by 
prolonged rest. Several cases of this nature that have re¬ 
sponded rapidly to treatment have returned in a short time when 
sent out again to the Front only to present the same symptoms 
in an aggravated form, and I am somewhat uncertain about 
their further utility in positions of great responsibility, although 
they may be an asset to the country in other spheres of action. 
P—, after four months at home arrived at the Front on 
September 29th, 1916, but three days afterwards was sent 
back stolid, aphonic and aphasic ; and for several months since 
then he has required special care and treatment, and this case 
is only one example out of many. 

It is now pertinent to enquire what the bodily conditions 
underlying shell-shock may be, and here at the outset I would 
suggest that to attribute their state to “ funk ” or “ fear ” in the 
cowardly sense would be as unfair as it would be untrue. A 
brave officer who was in the trenches for eighteen months, and 
who seemed to lead a charmed life, could not be accused of lack 
of courage when after being wounded and brought to hospital he 
wept without cause, and showed other signs of nerve exhaustion 
whenever spoken to. To state that shell-shock was the result 
of unconscious fright would be more correct than to attribute it 
to want of valour, yet this would not be the whole factor. It 
has been pointed out that the term shell-shock should be applied 
only to those cases in which there is a definite molecular 
nervous system lesion, the functional cases being regarded as 
“ hysterical," but the term hitherto has been applied to all 
nervous states occurring among soldiers. I am personally 
convinced that the great and underlying cause in many shell¬ 
shock cases is to be found in the instinctive and innate sudden 
unreasonable fear of the “ unknown ” which characterises 
certain temperaments, often those of superior minds; certainly 
those whose nervous organisation is highly complex, and it is 
this type of mind that is soonest subjected to dissociation by 
fear. In them above all others does sudden fear, although not 
consciously realised by the individual, weaken and paralyse the 
functions of the body and mind, and in them also is this fear 
of the unknown “ diversified and intellectualised.” It is in this 
class that awe, reverence and wonder are so often associated 


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THE PSYCHOLOGY" OF FEAR, 


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with fear in regard to the unknown, which to them also is 
mysterious, awful, and supernatural ; and it is in this class that 
the description of the mental state—shell-shock—as one of “ un¬ 
conscious affectation ” best applies. There is a record in many 
of these cases of excessive fatigue, intense anxiety, insomnia, 
and irregularity on occasions—inevitable under the circumstances 
—of obtaining proper food. In some there is a lowering of 
the defences of the body through infection, including venereal 
diseases, malaria and fever ; there is in most of them an actual 
record of sudden fright from the effect of high explosive shells 
with physical concussion from the 9- and 12-in. artillery, as 
they themselves describe it, especially the former. All these 
are conditions antecedent to physical exhaustion ; but in over 
30 per cent, of the cases the sufferers are members of neurotic 
families, with a history of some “ nervous breakdown ”—depres¬ 
sion, anxiety, apoplexy, epilepsy, paralysis, or insanity in the 
parents, and most often, I find, in the mother. Shell-shock 
cases have occurred among our men from all parts of the Empire; 
Australia, Canada, South Africa, and New Zealand have all con¬ 
tributed patients of this class who have served with the colours 
in Egypt, Gallipoli, France, and on the high seas, and all present 
symptoms of diminished nervous energy. It is a fact without 
any doubt that the store of potential energy is diminished by 
emotional and physical stimuli, and Crile has demonstrated 
changes iathe neurones of the cerebral cortex, in the cerebellum, 
in the medulla, and in the cord. These neurones show a change 
varying from slight swelling to complete disintegration with 
vacuolation and atrophy of the dendrites, and although the 
living neurone exhibits no Nissl bodies and is of a different 
granular structure from that seen in microscopical laboratory 
preparations, yet these Nissl bodies are a convenient method of 
indicating the amount of destructive changes. These are 
described as hyper-chromatism passing into general decay with 
disintegration of the cyto-plasm, a rupture of the cell membrane 
and a dislocation of the nucleus which first becomes eccentric 
and then disappears. In addition to these changes in the 
nervous system there are changes in the thyroid, the liver, and 
the adrenals. 

Pathological examination in an instructive case at Claybury 
of extreme neurasthenia with mental symptoms showed 
disintegration of the thyroid, with chromatolysis and a dissolu- 


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1917-] BY SIR ROBERT ARMSTRONG-JONES, M.D. 371 

tion of the vagal roots, and microscopic slides of this case have 
been exhibited by the pathologist ; a case that in my opinion 
appears to bear some relation to cases of shell-shock that 1 have 
seen. The sympathetic symptoms of some of the cases examined 
with their rapid pulse, widely dilated pupils, precordial pains, 
disturbed breathing, vague abdominal discomfort and visceral 
perturbations, associated at times with sickness, appear to me 
to indicate a dissociation between the cerebro-spinal and the 
autonomous system of nerves. In some of the cases there has 
undoubtedly been an enlargement of the thyroid with the 
symptoms I have named, and Major Newton Pitt has mentioned 
to me similar cases from his own experience. 

The physiology of the autonomic nervous system, distinctive 
as it is, still remains somewhat obscure. We know that there 
is an antagonism between the actions of the three great series 
of the autonomous ganglia within the body, precisely as there is 
an antagonism between the emotions, that activate them ; the 
pleasurable emotions, for example (referred to in Pawlow’s 
experiments), assist digestion ; whilst those that are painful, as 
are the strong emotions‘of fear, terror, anger, and rage, stop 
digestion. We also know, as Sherrington has shown, that in the 
cerebro-spinal nervous system there is in health a reciprocal 
balance ~of innervation between antagonistic flexor and extensor 
muscles ; so also there exists a reciprocal innervation in the 
functions of the viscera which are controlled by the autonomic 
system. As has been proved, strychnine and certain toxins, 
such a tetanus, can disturb this reciprocal balance of opposed 
skeletal adjustments, and similary the strong emotions are 
potential to disturb the reciprocal action of the autonomic 
system. The functions of the heart, of many of the glands, and of 
some of the visceral muscles are performed automatically 
through their own intrinsic mechanisms; whilst these and 
other organs also receive a further nerve supply, in part— 
through intercalary nerves—from the central nervous system, 
and in part also from the segmentally arranged autonomous 
system ; the latter being in three larger groups of ganglia. 
The first of these, related to the brain, is connected with 
the building up of reserve power ; the third is related to the 
sacral nerves, and is connected with the lower animal functions 
and the reflexes of the bladder and rectum, whilst the middle 
or the thoracico-lumbar, is connected with releasing power for 


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372 THE PSYCHOLOGY OF FEAR, [July, 

action and is antagonistic to the other two. Each of these 
three autonomic ganglia, has its own physiological characteristics, 
and each has its own special reaction to certain drugs, eg, 
adrenalin affects chiefly the thoracico-lumbar ganglion, which is 
nevertheless slow to react to atropin, pilocarpin, or muscarin, 
drugs which are found to have a marked influence upon the 
other two series of sympathetic ganglia. . As the emotions act 
primarily through the cerebro-spinal neurones, and as their 
overflow runs through and flushes the autonomic ganglia, so a 
power is exercised from above to regulate the functions of 
these lower systems, along the nervous mechanism which runs 
down the cord in the intermedio-lateral tract. It is, therefore, 
possible to cause a dissociation of the two systems with conse¬ 
quent un-controlled, un-regulated action of the autonomic group 
and giving rise to the symptoms already named. One of the 
results of high explosives bursting with a sudden pressure of 
about 7,000 kilogrammes to the square centimetre, must 
inevitably be a percussion shock which would be conveyed with 
an intense mechanical force, through the cushion of the cerebro¬ 
spinal fluid upon which the central nervous system is resting, 
or in which it is suspended, and the injury in shell-shock cases 
—apart from its effect on the ears, eyes, and other organs 
—must be a definite molecular physical injury to the brain and 
cord, an injury which is super-added to that caused by the 
sudden emotional strain. Such a strain must be more deeply 
and fully felt, if the noise and mechanical disturbance were 
experienced for some length of time, as is often the case. To 
us at home it is unimaginable and inconceivable what proximity 
to the continued stress of high explosives must mean. We are 
terrified sometimes by the feeble back-firing motor car, or from 
the noise of a burst tyre, and we recoil petulantly and write to 
the Times if a maid whistles for a taxi—because of the strain 
and shock to our nerves ! Let us try and faintly realise the 
terrifying strain that must be endured by our soldiers at the 
front 1 

It accords with the experience of those who have the care of 
shell-shock cases that motor inco-ordination and sympathetic 
disturbances are much more frequent than are sensory abnor¬ 
malities. The delicate neurones of the anterior horns and 
those of the intermedio-lateral tract are also more liable to injury 
and are more likely to receive a definite trauma through per- 


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1 9 1 7-] BY SIR ROBERT ARMSTRONG-JONES, M.D. 373 

cussion than are the neurones of the posterior nerve root 
ganglia. Prof. Macphail, the Lecturer on Anatomy at St 
Bartholomew’s Hospital, further informs me that the protection 
of the spinal root ganglia is more complete against the effects 
of shock situated as they are in the intervertebral spaces and 
sheathed as they also are by dura mater extensions, than are 
the delicate neurones of the motor horns and the intermedio- 
lateral tracts. Moreover, the fine threads and fibril processes 
conveying afferent impulses from the periphery and connected 
with the spinal neurones are better preserved from shock 
within the cord than are the motor horn neurones with their 
network of anastomosing dendrites ; all of which help to explain 
the fact that motor and sympathetic disturbances are more 
common then sensory. 

Dr. H. Maudsley once said that all the symptoms of insanity 
could be witnessed in ihe effects of alcohol upon the brain, 
and I would almost venture to apply the simile to the symptoms 
shown in shell-shock and which may be witnessed in the course 
of general paralysis, caused by a definite injury to the cortex 
through spirochaetosis. The extreme cases of shell-shock are 
without doubt those with definite physical injuries to the 
cerebral neurones, although in the lighter forms there may be 
no appreciable anatomical lesion. How far these are produced 
by purely mental causes it is impossible to state, but to sum¬ 
marise the causes of shell-shock at least five views have been 
advanced : ( a ) Sudden fear, terror, or fright, acting as an 
emotional stimulus ; ( b ) hypothyroidism ; (c) hyperthyroidism ; 
( d) the inhalation of poisonous gases such as carbon monoxide 
or phosgene (carbonyl), causing disintegration of the red blood 
corpuscles and haemorrhages ; and ( e ) an actual molecular 
physical lesion due to sudden and extreme pressure and result¬ 
ing in a dissociation between the cerebro-spinal and the sympa¬ 
thetic systems. As Mr. Ernest Clarke has stated, this pressure 
may be positive or negative, and may cause acute compression 
or decompression, as was seen at St. Bartholomew’s Hospital 
after a Zeppelin raid, when some windows were blown in whilst 
the others were blown out. Mr. Clarke has himself seen an eye 
completely destroyed at the front by being extruded out of 
its socket during the bursting of a shell. I do not wish to 
dogmatise upon the aetiology of shell-shock, and whatever the 
cause may be, the prognosis must depend upon the amount of 


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374 THE PSYCHOLOGY OF FEAR, [July, 

injury received by the neurons. The condition is without 
doubt one of acute exhaustion, and recovery should be complete 
provided the physical changes have not extended to the extru¬ 
sion of the nucleus and to the destruction of the neurone. 

We now come to the unreasonable fear which seizes upon 
one or more in an assemblage of persons, and to this the term 
“ panic ” has been applied. It is an infectious feeling of fear, 
experienced not infrequently when there is no real danger; yet 
an animal or a man seems to be endeavouring to escape from 
some apparent danger. A child is afraid of the dark or a man 
of ghosts. Something which cannot even be in consciousness 
may act as an instinctive stimulus of fear, or something which 
enters into consciousness but has not before been associated 
with fear or danger, such as a sudden noise or some rapid 
movement. The purposive end of all fear is to escape from 
danger, whether the feeling of fear be personal, or relating to 
property, or other objects we care for, and the fear continues, 
unless controlled, until the end is attained. 

Panic, from tt (ivik<>q (Liddell and Scott, p. 1170), has been 
defined as any sudden or unreasonable fear or terror without a 
visible cause, and at Sparta shrines were erected to ^n^'oe 
(fear), Tt'Xwc (laughter), two demons or spirits whose power 
was, nevertheless, not greatly felt in that city (Manual of Greek 
Antiquities , Gardner and Jevons, p. 15^/ seq.). It is recorded 
that the people of Selinus, in Sicily, always ascribed a victory 
to fear ( Greek Votive Offerings, Rouse, p. 96) and that Pan, 
like other gods who dwelt in forests, was greatly dreaded by 
travellers, to whom he sometimes appeared and whom he 
startled with sudden awe and terror. Hence any sudden fright 
without a visible cause was ascribed to Pan, and was called a 
panic fear ( Smith's Classical Dictionary , Pan). 


Panics in Battle and War Time. 

In the earliest records of war, in which opposed armies came 
to actual personal conflict, it was extremely helpful to be able 
to rely upon the emotions of terror, and mysterious and hidden 
influences were frequently summoned to create these and to 
excite panic. We know from the Biblical records of antiquity, 
when war occurred about 1000 B.C. (II Chron. xxiv) between 


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1917-] BY SIR ROBERT ARMSTRONG-JONES, M.D. 375 

Egypt and Assyria, how the effects of plague and panic 
destroyed the army of Sennacherib. 

In the battle of Salamis, B.C. 480, a naval battle fought off 
the coast of Attica, between the Persians under Xerxes and the 
Greeks under Themistocles, Artemisia, the wife of Xerxes, 
behaved with such incredible feats of bravery that he exclaimed 
the men behaved like women but the women acted with the 
courage of men. Yet a panic seized upon Xerxes and his 
troops, for, as Grote says (vol. iv, p. 484), “ and the Greeks 
themselves made ready for a second engagement, but they were 
relieved from this necessity by the pusillanimity of the invading 
monarch, in whom the defeat had occasioned a sudden revulsion 
from contemptuous confidence, not only to rage and disappoint¬ 
ment, but to the extreme of alarm for his own personal safety.” 
Artemisia, yielding to panic, escaped in one of her own vessels, 
sailing under the Greek colours, and in order to deceive her 
pursuers she set fire to one of the Persian ships, so that the 
enemy chase was relinquished. Another later instance of a 
naval battle was at Actium, B.C. 31, between Cleopatra and 
Marc Antony on the one side and Augustus Caesar on the 
other. The fleet of Cleopatra was twice as numerous as that of 
Caesar, but just at the decisive point panic-fear seized upon 
Cleopatra while in no actual or personal danger, and she took 
to flight. The whole Egyptian squadron followed suit, and 
Antony, seeing Cleopatra pursued, yielded the victory to Caesar. 
The effect of this panic proved to be the ruin of Antony and 
Cleopatra, and Egypt from that time became a Roman province. 

At the battle of Marathon, a village in Attica, B.C. 490, an 
epoch-making victory was gained mainly through the intrepid 
valour of the Greeks under Miltiades, led by Aristides and 
Themistocles against the Persian army. The Persians out¬ 
numbered their antagonists by more than ten to one. The aid 
of the god Pan also greatly contributed to victory, for according 
to Herodotus, Pan assisted the Athenians to strike causeless 
fear and terror into the Persian forces, who fled to their ships to 
escape the pursuit of the Athenians. So pleased were the 
Athenians with their god Pan that they dedicated a grotto for 
his worship, and they established the Lycaean festivals to com¬ 
memorate the victory. 

At the battle of Cunaxa, near Babylon, B.C. 401, between the 
rothers Artaxerxes, who led the Persians, and Cyrus, the 


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376 THE PSYCHOLOGY OF FEAR, [July, 

I 

younger, who commanded the Greeks, the Greeks, although 
victorious, lost Cyrus their leader, and this led to the “ retreat of 
the 10,000.” We have it recorded by Xenophon {Anabasis II), 
who was not only present, but who organised and led this 
marvellous retreat (caused by the inutility of the expedition— 
now that Cyrus was dead—to try and replace Cyrus on the throne 
of Persia) that a panic occurred at night during the commence¬ 
ment of the retreat. The whole camp was a scene of clamour, 
dispute, and even of alarm. Early the next morning Clearchus 
ordered them under arms, and, desiring to expose the groundless 
nature of the alarm, caused the herald to proclaim that whoever 
would denounce the person who had let the ass into the camp on 
the preceding night should be rewarded with a talent of silver. 
This seems to have been a standing military jest in order to 
make the soldiers laugh at their past panic. The battle of 
Cunaxa brought the Persian Empire to the brink of destruction, 
and in this battle, probably more than any other, the dominant 
influences of conflicting emotions are seen in their unreasoning 
effects upon conduct, viz., the over-weening ambition of two 
brothers and the retreat of a victorious army. 

A useful psychological stimulus was practised by the Greeks 
as is now done by our more modern warriors. They shouted 
maxims or songs to animate themselves, and their commander had 
to possess a loud voice in order to strike terror into his own troops 
or into the antagonists. Some of us may have experienced the 
help which is obtained by thus diverting trains of thought from 
sombre to gay, as when our spirits are down or our minds are 
preoccupied with serious thoughts we seek other attractions, or 
turn our minds to some diversion. Since the war the theatres 
and cinemas have never declared such dividends, and history 
only repeats itself, for the night before Waterloo we have the 
record of a grand ball, at which our war chiefs were present. 

Following the evolution of Greek warfare came Roman 
methods, and the latter were warriors even from the earliest 
days of the Roman Republic. The Romans appear to have 
been nearly always at war. During the first five hundred years 
they were at war with the different states of Italy, and for the 
next two hundred with other nations. Every Roman citizen 
had to enlist for the public service, and the ages of recruits 
varied between seventeen and forty-six. In order to kindle 
enthusiasm before going into action, the Roman generals 


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377 


harangued their soldiers from a tribunal of earth heaped up 
locally and the trumpets sounded the march, to which the 
soldiers responded “To arms,” the shout being useful for the 
rush to the charge as well as for the purpose of terrifying their 
opponents. Our own brave warriors to-day relate similar 
tactics when clearing the parapet for the forward rush, and the 
Anzacs had the same methods in the Dardanelles. 

Enumeration of War Panics. 

Many of the battles recorded in ancient history demonstrate 
the great part taken by the emotions in war. 

At the battle of Chaeronea, in Bceotia, B.C. 338, when Philip 
of Macedon was victorious over the confederate armies of 
Athens and Thebes, two points of great interest may be men¬ 
tioned : firstly, the infectious courage and the striking valour 
and intrepidity of the young boy warrior Alexander, who after¬ 
wards became Alexander the Great, the master of Europe, Asia, 
and Africa, and who died at thirty-two ; secondly, the effect 
of panic-fear even upon the greatest orator and statesman, 
Demosthenes, who, when he saw the rout of the Athenians, 
threw down his arms and fled with the rest. He was unable to 
practise what he preached, and it is said of him that when, in 
his flight, his robe was accidentally caught in a bramble, he 
imagined some of the enemy had laid hold of him, and he cried 
out, not “ Kamarad,” but its equivalent, “ Spare my life ” ! 

At the battle of Plataea, a town in Bceotia, B.C. 479, when 
the Greeks delivered Greece for ever from Persian invasion, the 
whole Persian army, on the death of their general, Mardonius, 
was seized with panic and took to flight, and it is stated that 
panic either “ flees or it breaks.” No Persian king ever appeared 
with a hostile force beyond the Hellespont after the battle of 
Plataea. 

At the battle of Issus, B.C. 333, a town on the borders of 
Syria, in Silicia, fought between Alexander the Great and 
Darius, King of the Persians, Darius leapt from his chariot in a 
fit of panic, fearing to fall into the hands of the enemy. The 
troops, observing this, also fled and threw down their arms and 
made off. In this battle was decided not only the fall of 
Darius, but also the ruin of his empire. 

At the battle of Pharsalia, in Thessaly, B.C. 48, between 


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378 THE PSYCHOLOGY OF FEAR, [July, 

Pompey the Great and Julius Caesar, Pompey’s great army was 
defeated. The cry of Pompey’s troops was “ Hercules the 
Invincible,” while Caesar’s men called out, “Venus the Vic¬ 
torious.” Pompey, who had adorned the temple of Venus with 
many spoils, feared that Caesar would be aggrandised at his 
expense and he forced the battle, but through a panic-fear that 
Caesar had ordered the enemy’s face should be attacked, and 
seeing the visages of his troops wounded and disfigured, the 
panic ended in a rout, and Pompey’s army fled in great dis¬ 
order. 

Three other and great decisive battles of antiquity may be 
quoted in which the great Carthaginian general was engaged. 
The first was the battle on the margin of Lake Thrasymenus, 
B.C. 217, when the Romans were trapped and terrified by the 
clash of arms and the shouts of Hannibal’s men, and could not 
escape from the enemy or flee on account of the mist. The 
second, the battle of Canna, B.C. 2 16, where the Roman troops 
under zEmilius and Varro, although twice as numerous as the 
Carthaginians, were surrounded and defeated after unparalleled 
bravery ; and the third, the battle of Zama, near Carthage, 
B.C. 202, when Hannibal at the end of the second Punic War, 
was overthrown by Scipio after a struggle lasting over seventeen 
years. The panic, the rout and the confusion caused by 
elephants and horses and war chariots, and the final scene when 
Hannibal attacked the enemy in front and his own troops in 
the rear, presents a picture to us of the terrible destruction o! 
the Carthaginians and the complete desolation of the highest 
seat of learning and culture, as well as of the most prosperous 
commercial city of the ancient world. Standing on the Byrsa, 
or citadel of ancient Carthage, the writer felt that the world 
had lost invaluable treasures, noble buildings and a world- 
famous library through the supremacy of Rome, and that the 
tender emotions had undergone an enormous strain when it was 
contemplated that the home of St. Augustine and the first and 
greatest seat of Christianity in North Africa had been razed to 
the ground, practically nothing remaining of what was once the 
mightiest city in the world. As Lamarck has said the least 
progress cannot be realised without causing panic and pain 
among the people, and in the history of the wars of our own 
country, we have specific instances of the occurrence of panic- 
fear. In Holinshed’s Chronicles of England , Scotland and 


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379 


Ireland. , vol. iii, 1808, pp. 54—5, it is stated that panic seized 
the French army in the Battle of the Spurs, 1513. This was 
fought at Guinsgate, near Terouenne, in the campaign of the 
English under King Henry VIII in person and King 
Maximilian of Flanders. The allies had formed the siege of 
Terouenne and a body of French cavalry came up to relieve 
the town. The allies advanced in order of battle but the 
French seeing them were seized with panic, put spurs to their 
horses and fled without a blow. At the battle of Gravelotte in 
1870, there were no less than three serious panics which 
resulted in the French army being surrounded. 

There are numerous records in Mommsen’s History of Rome 
of similar panics occurring in classical literature, and Macaulay, 
in his “ Lay of the Battle of the Lake Regillus,” a legend of 
ancient Rome, which portrays the panic-fear caused by the 
sudden appearance of Castor and Pollux upon white horses, 
describes the physical effects of fright in his well-known 
stanzas. 


Panic in Time of War and Pestilence. 

As Dr. Leonard Guthrie writes to me, “ panics and orgies of 
every kind occurred in the time of great plagues as well as 
during war and amongst the inhabitants of countries during 
political crises or upon invasion.” Grote, in his History oj 
Greece , vol. iv, p. 276, gives the record of panic in Athens 
during and after the plague, B.C. 430, which occurred during 
the Peloponnesian War. Fifteen years previously a similar 
visitation had been witnessed in Rome. 

The plague in 1499 in our own country caused such a panic 
that Henry VII moved his Court to Calais, and the plague 
which depopulated Oxford in 1506 and described as the 
sweating sickness,” caused the same panic-fear. 

The Plague of London, a description of which by William 
Boghurst, apothecary, in 1665, edited by Dr. Frank Payne in 
1896, gives details of this devastating epidemic, which began 
in 1664 and only ended with the Great Fire in 1666. Out of a 
total population in London of under half a million, one-fifth 
was removed by the pestilence. Pepys gives an account of the 
panic which ensued. He remained, he says, at his official 
residence, the Navy Office, in Seething Lane, as did the Lord 
lxiii. 2 5 


' s 

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380 THE PSYCHOLOGY OF FEAR, [July, 

Mayor at his, and he met “ hardly twenty people from one end 
of Lombard Street to the other and not more than fifty on the 
Exchange.” A week later, Evelyn, coming up from his house 
near Deptford, found the line of streets through the City to St. 
James’ Street nearly empty of people, the shops shut, and many 
coffins at the doors of houses awaiting burial. Nearly all the 
clergy, magistrates, and (sad to relate) every doctor are said to 
have fled along with the richer classes in general. Among the 
doctors who remained were two men eminent for their investi¬ 
gations and research, viz., Glisson (of Glisson’s capsule), and 
Wharton (of Wharton’s duct). As would be the case to-day, 
several high personages of the Court stayed in town to carry on 
the public business and were afterwards presented with silver 
cups by the King. As we know, the educated man is less 
subject to blind panic than the ill-informed, for, as one’s experi¬ 
ence widens, fewer circumstances excite us ; as we build up our 
conceptual system, we gain the mastery over our outer world, 
and the means at our disposal for modifying situations which 
thwart our activities and which give rise to emotions of anger, 
fear, grief, and pain are infinitely increased. Moreover, as we 
gain knowledge the situations which further our tendencies to 
react quickly and impulsively to outward stimulations do not 
excite us as they did through lack of knowledge. When our 
conceptual system, so to speak, was less determinate we acted 
impulsively and suddenly. The educated and experienced 
learn to expect less of the world, and there is the compensation 
that as we continue to learn, our emotions tend to take on 
subtler forms, which do not involve bodily commotion or the 
physical accompaniments of emotions, to the same degree. 

Possibly there is no argument that conveys so much con¬ 
viction to the average mind as the arithmetical argument, 
especially when an appeal is made to the pocket. This is 
possibly the reason why financial crises cause so much fear and 
anxiety. We have many records of commercial panics, so 
often caused by over-speculation, as in the South Sea Bubble, 
and in the crash following John Law’s banking scheme in 
France, both in the year 1720. Since then, in 1879, the City 
of Glasgow Bank failure brought rum upon many families, and 
in 1890 the Baring crisis occurred, when the financial stability 
of the city was saved by the Bank of England, and in this war 
when the present Prime Minister, then the Chancellor of the 


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I 9 I 7 -] BY SIR ROBERT ARMSTRONG-JONES, M.D. 381 

Exchequer, saved the country by his “ moratorium.” Minor 
panics have quite recently occurred among the lesser people 
through the suspension of the Birkbeck and the Penny Banks. 
Ever since the beginning of the war there have been several 
small panics, the last being the depression in industrial securi¬ 
ties on the American Exchange, when Germany made her 
sinister offer of peace. Political crises are always attended 
with some degree of panic-fear. Revolutions, whether in 
empires, kingdoms, or republics are all accompanied by their 
special panics, as we frequently witness in the Republics of 
South America. 

Dealing with the electoral franchise is always a sensitive 
task, and even in Athens when the franchise was restricted 
during the reign of the oligarchy, this gave rise to acute panic 
and terror ; private assassination was practised on such an 
extensive scale that important persons perished by a special and 
secret systematic murder, carried out by unknown hands, and 
so great was the fear that no man dared to demand an inquiry 
into the death of his nearest and dearest relative ; dismay and 
disturbance became general and panic-fear became universal 
(Grote’s History ). The Reign of Terror in France in 1793, 
when Robespierre demanded the death of the King, and when, in 
his triumph he established the Convention, witnessed the sacri¬ 
fice of the lives of hundreds of the most eminent men and loyal 
citizens. The cruelties and the terror and the savage unreason 
during this short administration of which Robespierre was the 
head, terminated in his own destruction and it ended when he 
himself was guillotined. 

In civil life Col. F. N. Maude, in War and the World's Life , 
p. 408, relates how at the crisis of the Fashoda incident, for 
instance, some one in Portsmouth incautiously dropped a 
remark as to what might happen, if war really ensued, to the 
inhabitants of Shanklin and Sandown in the Isle of Wight. 
As Col. Maude says, the facts had been apparent to everyone, 
ever since the batteries for the defence of the Bay were erected, 
but no sooner was the suggestion of danger made than it was 
taken up by the local press, when a complete exodus of ultra- 
nervous residents occurred from these favoured spots. As 
compared with this may be contrasted the behaviour of Ports¬ 
mouth itself with its inhabitants better educated in military and 
naval affairs. A particular group of dwellings placed directly 


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382 THE PSYCHOLOGY OF FEAR, [July, 

behind certain batteries never lost their selling price nor lowered 
their rents, although every shell fired by an enemy and passing 
over the guns of the battery would of necessity find a final billet 
in the drawing-rooms or best bedrooms, yet no one can suggest 
that Portsmouth is not kept sufficiently alive to the possibilities 
of modern warfare. Col. Maude also refers very aptly to the 
“ resultant thought wave ” of Gustave Le Bon, who stated that 
the latent consciousness of what is best for the race generates 
the crowd impulse, and though Maude wrote before the war, he 
very clearly anticipated what has come on since. This “ domi¬ 
nant thought wave ” is the voice of the crowd, and is not often 
possessed or appreciated by the ordinary leaders of men, 
although Napoleon possessed this instinct of quickly appreciating 
national instincts as well as the power to sway the multitude, 
and he had the gift of “ tuning up ” his army to receive the 
“ resultant thought wave ” and to act in the presence of the 
enemy in the name of the national instinct and without panic. 
It is given to few men to seize the “ dominant thought wave ” 
and to impress this upon a people. Oliver Cromwell, Welling¬ 
ton, and Grant, in addition to Napoleon, possessed this gift. 
This “ collective will power ” ip my opinion, based only upon my 
slight reading of history, is the most uncertain and unreliable 
instinct, and it has well deserved the opprobium attached to the 
conscience of a committee which is described as a mathematical 
paradox, “ the result being less than the sum total possessed 
by its individual members.” Rightly has a “ crowd ” or in other 
words a “ fortuitous assemblage of individuals,” earned the 
reputation of being the most cowardly thing conceivable, the 
most unstable unit ; as under the influence of panic, otherwise 
its “ dominant mental state,” men will commit acts of almost 
unimaginable tyranny, cruelty, or poltroonery. Indeed, the 
perpetration of an act of cruelty tends to continue the emotion 
of anger and rage which kindled it, because this perpetration is 
the bodily accompaniment of the emotion ; and-the bodily 
commotion which constitutes the expression of the emotion, 
being continued, tends to prolong the emotional situation. It 
is upon this theory of the irradiation of an emotion by bodily 
changes that panic is increased by flight and grief is intensified 
by sobbing. It is in order to avoid the occurrence of panic 
that a “ crowd ” is disciplined and trained to be cohesive, 
recruits are taught to give attention, to shoulder arms, and to 


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obey at the word of command, and as all military commanders 
insist the behaviour of a “ trained ” crowd is absolutely predict¬ 
able, whereas the conduct of the other is uncertain and may be 
demoralised. It is a mere matter of changing emotions ; and 
this fact is perfectly true, for during the Reign of Terror some 
who were the most odious as well as the most ferocious relapsed 
afterwards into becoming the most innocuous and peaceful ; 
quite unable to explain their temporary aberration. There are, 
therefore, two kinds of crowds, the one organised into a solid 
cohesive whole, and the other whose units remain a mere 
collection of fortuitous and .separate items, ready to form dis¬ 
sociated, uncertain, and disconnected “ will powers.” It was the 
boast of Napoleon about his trained army that it was more 
noted than any other army in the world for extraordinary 
heroism displayed by its individual members under the eyes of 
their comrades. Again and again, surprises were effected ; 
bridges were crossed under fire, although only a couple of beams 
would be left of them and positions would be taken which 
neither the British nor the Russians nor the Austrians believed 
to be assailable by mortal man. Even the psychology of a 
trained army is to some degree a variable factor for some com¬ 
manders, as do the Germans, instil into their battalions the 
dominant thought of cohesion by orders from without and not 
from among the troops themselves, whereas it has been our 
boast and that of the French that when our men are face to 
face with a great difficulty, their resourceful intelligence instinc¬ 
tively sees what should be done and there is thus created at 
the time from among themselves and from within the essential 
and successful “ collective will power.” 

As a“ corrective” to the panic-fear, the so-called “serre files" 
— i.e., non-commissioned officers in rear of the fighting lines— 
had absolute orders in the old Prussian army to drive their 
halberts through the body of any man who attempted to quit 
the ranks and we hear of something similar to this to-day in 
the German lines. It is the knowledge of certain death behind 
them that keeps some of the Germans forward under the stress of 
fearand terror. As Col. Maude with a true insight into psychology 
says, the best method of preventing panic, and of dealing with it 
wben it has occurred, is to present to the imagination an even 
greater danger if the moment of terror is yielded to, and the 
lines tend to falter or break. As all of us know, panic not only 


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384 THE PSYCHOLOGY OF FEAR, [July, 

occurs among men but also in animals, from 'the Gadarene 
swine to the prairie cattle, and this takes place when the “ herd 
instinct,” as Wilfred Trotter calls it, becomes weakened or 
injured. As in men, it is not necessary that each member of a 
crowd should see or scent the danger ; one does this and gives the 
warning note to the rest which rush and follow it. Among 
the civil population there have been many exciting causes of 
fear since the outbreak of the war in August 1914. My 
experience at the London County Asylum at Claybury has been 
territorially to the East of London, and therefore the part first 
traversed by Zeppelins, and I have noted a considerable 
number of patients—both men and women—whose relatives 
and friends assign the cause of mental breakdown to the fear of 
conditions brought about by the war. The sudden shock and 
the fright and terror experienced from Zeppelin raids have con¬ 
tributed their quota of mental breakdown. At any rate during 
the first two years of the war out of over one thousand admissions 
into Claybury, there were received over ninety women and more 
than half this number of men who were suffering from various 
forms of insanity associated, I think, definitely, with the war. 
Of 130 cases at least 21 patients were ascertained to have their 
insanity connected with Zeppelins. The form of insanity 
mostly associated with the Zeppelin raids was of the depressed 
variety, and some of the sufferers were semi-stuporose and rigid, 
as if from fear, and almost all recovered that were of this type. 
In one case the house the patient lived in was burnt down, in 
another a house near to the patient was destroyed by an ex¬ 
plosive bomb, one patient was elderly and without protection, and 
could not face the danger or the noise of which she was most 
apprehensive ; one had lost her mother through the explosion, 
and another fell into a hole made by a bomb whilst returning 
from an adojning theatre, all due to fright. A not infrequently 
assigned cause was the “ enlisting ” of a fianct or of a son or 
husband, but this, of course, was before compulsory service' and it 
is interesting to relate that compulsion put an end to “joining 
the forces ” as an assigned cause. I am convinced that appre¬ 
hension or an anticipated fear, which constitutes worry and 
anxiety, is far more frequently a cause of insanity than a 
sudden shock may be. The one is an enduring stress and the 
neurones do not get a chance of complete restoration as they 
might do in most cases of sudden shock. “ Nervousness about 


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1917 -] BY SIR ROBERT ARMSTRONG-JONES, M.D. 385 

the war ” was an expression much more frequently used as 
causing a mental breakdown than was a “ sudden shock.” 

In addition to panic from disaster on land and in the air, there 
are panics through losses by ship-wreck on lee-shores, and there 
are disasters in the open sea that have their panics and possibly 
some of the worst of these were due to fires at sea. The panic 
that ensued on board the “ Princess Alice,” when so many lives 
were lost in consequence, is an instance of a pleasure steamer 
going down in the Thames with a loss of life of about 700, most 
of whom could have been saved had it not been for the panic- 
fear. The sinking of the “ Titanic ” is an example of the 
opposite mental state, perfect order being maintained, and “ladies 
first ” was the last order which the cool captain and a disci¬ 
plined crew and collected passengers all respected. The sea 
when giving up its dead will have many tragedies of “ courage 
as well as cowardice ” to relate. 

The theatre panics are too well known to need a reference. 
Public authorities realise that theatre audiences are among the 
worst material to yield to panic-fear, and they have insisted 
upon adequate means of escape under penalties. The feelings 
of the audience in a theatre are often so worked up by plays, 
dramas, and tragic performances that panic-fear soon spreads 
beyond any control or direction. Fires in public places, on 
account of the concomitant distress, excite much fear; such 
as occurred in a house at Eton College (after which a sympa¬ 
thetic message was sent by the King and Queen), at Colney 
Hatch Asylum, and the great City fire at Cripplegate in 1898. 

Earthquakes are always accompanied by panic because the 
disturbances are on so vast a scale, and so uncontrollable 
through human agency, that means of relief are inefficient to 
cope with the distress, and instances of these are familiar to all. 
Mrs. Somerville relates how thousands of persons passed the 
night on which an earthquake was predicted in London in their 
carriages and in tents in Hyde Park at the beginning of the 
last century. 

I have been interested to know how far the emotions, especi¬ 
ally those of fear and terror, have been portrayed in art, for 
Lecky states (Rationalism in Europe, p. 250, one of the most 
subtle, and, at the same time, most profoundly just criticisms), 
that it was the custom of the Greeks to enhance the perfection 
of their ideal faces in sculpture by transfusing into them some 


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386 THE PSYCHOLOGY OF FEAR, [July, 

of the higher forms of animal life, and in the origin of the 
emotions and their proper study we must proceed to their earliest 
appearance in animals. It is in the god Pan that the human 
features approach as near as human features can to the charac¬ 
teristics of the brute. Busts of Jupiter manifest a resemblance 
to the lion, and this is one of the distinctive marks of Greek 
sculpture ; the two natures, human and animal, are fused into 
a harmonious whole, quite unlike the Egyptian methods where 
no effort was made to soften this incongruity. On the other 
hand, Mr. Arthur H. Smith, of the British Museum, writes to 
me: “The Greeks were very reticent in the expression of emotion 
and feeling. In the various friezes of combat the scales are small, 
and the treatment of the faces is on conventional lines. The 
exception to this is the great frieze on the altar of Zeus at 
Pergamon.” The original is in Berlin, but I have had access 
to photographs which depict with marvellous expression the 
whole of the emotions of terror, fright, fear, anger, and hate 
upon these colossal figures. 

In the Uffizi at Florence there is the sculptured representa¬ 
tion of the destruction of Niobe’s children, showing all the 
tender emotions as well as those of terror, pity, grief, sympathy, 
appeal, repulsion, fear, and terror, but possibly in the main more 
sorrow than fear. The sculptured Laocoon in the Vatican also 
represents the emotions of fear, pain, and convulsive struggle. 
In this piece of statuary, as Lecky states, are “traces of mental 
anguish exhibited with exquisite skill, and without contorting the 
features or disturbing the prevailing beauty of the whole.” In 
the " Dying Gladiator ” of the Capitoline Museum there is also 
portrayed the last agony of a brave warrior repelling the 
adversary to the last breath. 

Because the facial expression so often reveals the emotions 
better than do spoken words I recently wrote to Mr. C. H. 
Collins Baker, the Director of the National Gallery, asking him 
what pictures in the National Collection in his opinion best 
represented the views of painters upon the Emotion of Fear, 
and he very kindly gave me much assistance. He referred to a 
study called “ Horror,” by Reynolds, painted from himself for 
Mrs. Siddons’ “Tragic Muse." In this picture the eyebrows 
are drawn, the eyelids somewhat contracted, and the face is 
tense, the mouth is open and fixed, as if hissing the “ Hymn of 
Hate.” A picture of the destruction of Niobe’s children by 


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38 / 


Richard Wilson shows almost a complete scale of the sadder 
emotions, fear passing into resignation, complete collapse, and 
paralysis. Some of the figures are in a beseeching and 
suppliant attitude, the others crouching and terrorised, guarding 
themselves with uplifted right arm, and others serene but with 
clenched fists.' Another picture is the “ Plague at Ashdod,” 
by Poussain, representing this city, which belonged to the tribe 
of Judah, and was on the south-east coast of the Mediterranean. 
To the right of the picture are the steps of the great temple of 
Dagon, in which the image of Dagon fell when the Ark of the 
Lord entered. The shattered idol is seen on the ground. It 
was here that the host of Sennacherib was practically wiped 
out, his army of 185,000 Assyrian troops being destroyed in 
one night, through the intervention, we are told, “ of an Angel 
of the Lord.” In the middle of the picture is the dead mother 
and child lying on the ground over whom the father is weeping. 
One figure is a suppliant on the steps of a temple, another is a 
fleeing child, and the others exhibit fear, terror, horror, and 
disgust, whilst another figure is compassionate and pitying. 

In Carracci’s “ Christ bearing the Cross and appearing to 
St. Peter ” there is a mingled representation of awe, surprise, 
and fright, or as Mr. Collins Baker states some emotion between 
fear and amazement. St. Peter is rigid with fear, " petrified ” 
would be an appropriate term ; the eyes are staring, the hair 
rough and bristling, and the face stern and fixed ; the uplifted 
left hand appears to half repel the object of his surprise and 
terror, yet the bent knee indicates an attitude of humility and 
reverence. In the Transfiguration by Duccio are shown the 
central figure self-realised, but with Moses and Elias on each 
side, and the expressions are characteristic of awe, wonder, and 
fright, whilst the surprised disciples are painted underneath with 
expressions of curiosity commingled with deep reverence and 
fear. Lastly, there is a work by Ercole Grandi, dating back to 
the fifteenth century, of the Conversion of St. Paul, with 
Jerusalem in the distance. The apostle in the centre of the 
picture is dismounted from his white horse, but is gazing at the 
vision of the Christ in the skies. He is in an attitude of fright 
or of shock, possibly of resignation and collapse through fear. 
The group round him shows the crowd to be in a panic of awe, 
some of the figures appear to be attempting to escape in bewilder¬ 
ment and others to be in attitudes of amazement and fright. 


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388 THE PSYCHOLOGY OF FEAR. [July, 

Some of the pictures in the Guildhall Collection which I 
visited through the courtesy of Curator Mr. Temple showed 
fear in a marked degree. The murder of David Rizzio, painted 
byOpie, shows Rizzio being murdered in 1566 by the Scottish 
nobles in the Queen’s room at Holyrood at the instigation of 
Darnley, who holds the Queen back. The approval and 
surprise of Lord Douglas, the anger and determination of the 
murderer, the beseeching attitude of Rizzio and the horror of 
the Queen, the fear of Darnley who restrains the Queen from 
intervening are all the portrayal of strong emotions. Another 
picture by Opie, the “Assassination of James I of Scotland” 
is a strong portrayal of the murder of the King in his own 
house at Perth by Sir Robert Graham and his fellow con¬ 
spirators. The horrified and terrified aspect of the Queen with 
wide staring eyes of horror and surprise, the fearful resignation 
of the King, with fixed eye, rigid attitude and the left arm 
stretched out in self-defence; the clinging affection of the 
collapsed Lady in Waiting who had placed her own arm through 
a bolted staple as a bar, to prevent the entrance of the murderers, 
are all pictures of the emotions. The banquet scene in 
“ Macbeth ” by D. Maclise shows Macbeth fearful and pallid, 
the right hand clutching the seat, the left flaccid yet repel¬ 
ling the ghost ; Lady Macbeth, the stronger mind of the 
two, defying the audience and fearless whilst the spirit of 
Banquo is appearing; and, lastly, there is the picture of 
Edward III at the siege of Calais in 1347 after the surrender 
of the city, when the lives of the citizens were spared at the 
express wish of the Queen. The need and want, the suppliant 
attitudes, the kindly doles and help, and on a mild scale some 
of the horrors of war, are shown by the brush of Sir John 
Gilbert; this and another by him “ The Fight for the Standard ” 
picture the vt(Ue of an actual combat which does not occur in 
the warfare of to-day. 

I have carried on this paper to a greater length than was 
anticipated, because of its historical application and the 
reference to the views of artists and sculptors. It only remains 
for me to repeat in conclusion that fear is something more than 
an avoiding reaction or an elementary reflex. It is a protective 
emotion and the most fundamental of the emotions on account 
of its highly self-guarding value, and it is common to man and 
animals. It is of two kinds, one kind may be induced by 


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389 


1917-] MANAGEMENT OF CONFUSIONAL STATES. 

suggestion and imitation, and is then unreasoning and impulsive 
in its effects; this form may, by suggestion—often uncon¬ 
sciously—infect whole groups or assemblies of people or 
crowds ; another kind is in part under the control of the 
reason. During fear the free flow of all other nervous activities 
are interrupted, an adjustment or adaptation which may be 
necessary in order to protect life. As to the locality of fear 
in the brain there is reason to believe that the reasoned fear 
out of which the most courageous and noble deeds of heroism 
arise has a cortical origin, whilst panic-fears are probably 
thalamic in origin or, at any rate, subcortical. The whole 
question is now being studied by a number of eminent and 
thoughtful men in the department of psychology as well as in 
that of medicine, and it is not improbable that a reconstruction 
of views as to the relationship of mind and body is within sight 
from this study. 

(*) Read before the Medical Society of London. 


The Management of Confusional States with Special 
Reference to Pathogenesis By Tom A. Williams, 
M.B., C.M.Edin., Washington, D.C. ; Neurologist to 
Freedmen’s Hospital and Howard University ; Corresp. 
Mem. Soc. de Neurol, de Paris et de Soc. Med. Mentale 
Clin., etc. 

CONFUSION is a hallmark of the effects of toxin upon the 
cerebrum. When very slight, special tests are required to elicit 
it. Interference with neuronal conductivity is the chief patho¬ 
genetic factor. The topical incidence of this is one of the 
determinants of the form taken by the psychosis, whether 
hallucinatory, disorientative, depressive, delusional, or what not. 
Another factor is the state of the body secretions as affected 
by the toxins ; a third factor is the patient’s psychological 
status, as determined by the capacity and the opportunity for 
experience. 

Toxin may be exogenous, whether from living parasites or 
not, or endogenous, as from vascular stasis, malnutrition, 
exhaustion, endocrin disorders, or it may be dynamic, as when 
psychogenetic. 


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390 MANAGEMENT OF CONFUSIONAL STATES, [July, 

Bodily signs are usually present, such as reflex disturbances, 
tremor, circulatory disturbances, and vegetative disorders. 
Headache and insomnia also almost always occur. Of the 
latter, onirical delirium is usually a feature ; it is a kind of 
somnambulism with partial amnesia, often of mystical character. 
The perceptions are feeble, and motor reactivities usually dull. 
That structural changes may occur when the cause of confusion 
is long maintained is manifest upon histological examination of 
the brain. But that these often permit of repair seems to be 
shown by apparently complete recoveries, even after years. 

The management of the patient consists of, firstly : The 
avoidance of adding the toxicosis of the imperfectly elaborated 
protein which is prone to occur even with a moderate diet, 
because of cloudy swelling of hepatic cells induced by the 
causative toxin or by a similarly induced interference with 
renal elimination causing retention of nitrogenous substances. 
Lack of proper adjustment of the diet, especially in the matter 
of carbohydrates, leads to an acidosis which further aggravates 
the toxic state by interfering with proteolysis as well as with 
proper catabolism. The remedy for this is, of course, adequate 
ingestion of carbohydrate substance. The giving of alkalies, 
after all, has only a neutralising effect, although it is necessary 
in some cases. But the assistance to metabolism of the alka¬ 
line salts, especially in the combinations naturally occurring in 
most fruits and many vegetables is invaluable, so that these 
should be copiously added to the diet. Of course, sufficient 
water should be given, but the idea that abundance of water 
will either neutralise or favour excretion of toxins is untenable. 

Violence, distress, or agitation should never be met by nar¬ 
cotics, which merely increase cerebral toxicity. These symptoms 
are quickly mitigated by hydrotherapy until the full effect of 
metabolic improvement from proper diet can show itself upon 
them. 

Some of the cases (.International Clinics ) illustrate both the 
symptomatology and management of confusional states of 
different aetiology. The first of these illustrates a post-infectious 
toxic state in an individual predisposed by sclerotic blood¬ 
vessels, feeble heart, and a lack of constitutional robustness, as 
well as previous over-indulgence in alcohol. The toxic con¬ 
fusion was maintained and aggravated by the ingestion of 
pharmaceuticals and an excess of protein. Recovery was 


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1917.] BY TOM A. WILLIAMS, M.B. 391 

accomplished by means of the afore-mentioned principles after 
several consultants had failed to benefit the patient. 

Post-influenzal confusion, with exhaustion. —In May, 1915, 
a judge, set. 64, after a severe attack of influenza, remained 
very weak, and confused in mind, and began to develop hallu¬ 
cinations and delusions of a vague character. Several consul¬ 
tants were seen without result, and he became weaker and less 
clear mentally. The patient was in a typical condition of 
mental confusion. Deep reflexes were very faint, abdominal 
reflexes were absent ; there was plantar flexion. There was 
no paralysis and no anaesthesia, so far as could be ascertained. 
The optic disc was not cedematous and showed no arterio¬ 
sclerosis, but the superficial vessels had thickened coats, though 
the heart was small, the apex reaching only to the lower border 
of the fourth rib, I in. inside the nipple line. 

Systolic blood-pressure was 102, the diastolic 60. The 
kidney function had been ascertained by Dr. A. Hooe to be 
normal, phthalein appearing in ten minutes to the amount of 
30 per cent, and 34 per cent, in the first and second hour 
respectively. But there was a large quantity of indican and a 
slight trace of albumin. 

The patient was taking the following diet and medication : 
2 a.m., beef-juice ; 3.20, ammonia ; 4, red solution potassium 
iodide; 5.30, grape-fruit juice; 6.15, three tablets, egg, 
whisky, milk ; 7.30, ten drops B.P., adrenalin solution ; 8, ten 
drops solution iodide potassium; 10.20, soft toast, coffee; 
11.15, three tablets caffeine, strychnine, sparteine; 12.30, 
ten drops B.P. solution ; 1.30, beef-tea ; 2.30, ammonia ; 3.30, 
three tablets ; 4, custard, cream ; 4 30, ten drops B.P. ; 4.45, 
ammonia ; 5, ten drops solution ; 7, egg, whisky, milk. 

I considered this a case of acute exhaustion psychosis, partly 
toxic in character. The treatment prescribed was embodied in 
the following report to his physician. 

As the patient is suffering from exhaustion, stimulants are 
contra-indicated, as the tired organ is incapable of further 
response to them ; therefore, I think it wise to omit caffeine, the 
secondary effects of which increase the exhaustion. 

Strychnine should not be further given either, for it merely 
increases the discharge, that is, the exhaustion of energy of 
medullary neurones. 

Sparteine is a nerve-muscle poison, the effect of which in 


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improving cardiac activity cannot be maintained for long 
without greater nutritional capacity than the patient 
possesses. 

I see no advantage in the iodide of potassium. Further¬ 
more, the basic element of this is a strong cardiac depressant. 
Nor should I give the bromides during the effort to build up 
the patient, as they diminish metabolic processes and diminish 
resistance. Ammonia should be kept for emergencies only, as 
its effect is evanescent. 

The regime I prescribed is as follows : 6 a.m., five grains of 
sodium bicarbonate in four ounces of hot water; 6.15, one 
orange : 6.30, breakfast, cereal and milk, one egg, crisp bacon ; 
8.30, massage, consisting of slow, deep pressure without 
friction ; the purpose of this is to increase the vis a tergo of the 
circulation and thus aid the heart by saving its vis a fronte. 
Sleep, if possible. 

On waking, about 9.30, five grains sodium bicarbonate in 
four ounces of water; 10 to 10.30, lunch, one banana, cereal, 
and milk; 12 to 12.30, massage, sleep: 2 to 2.30, dinner, 
meat and potatoes, green vegetables ; 4.30, massage, followed 
by five grains sodium bicarbonate in four ounces water ; 6.30, 
supper, unpolished rice and milk, one banana. Between that 
and midnight, massage again when the patient is awake. For 
midnight lunch, Graham crackers (*. e., bran biscuits) and milk 
are desirable. The quantity of milk at one meal should not 
exceed five ounces. After meals, the patient should be given 
one capsule of “ Phytin,” an organic phosphorus preparation of 
the Society of Chemical Industry of Basle. 

Beef-tea and gelatin should be omitted as containing too 
much excrementitious materials, which are cardiac poisons. 
Coffee and tea should be omitted also. A small piece of 
bread, with or without butter, may be taken with each meal 
if so desired. Water should be the drink, and should be 
given about one hour before each meal, but should not be 
restricted to that time if the patient desires it at any other. 

The adrenal principle should be continued ; and I think it 
is better given as the dried gland, say three tablets a day to 
start with. I think that its effect might be improved by being 
taken along with one tabloid of “ Hormotone.” 

If this diet is found to be too heavy, diminish the quantities 
at the commencement. If the patient suffers from the heat, 


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cool sponging should be beneficial ; and in any case its effect 
upon the innervation of the vascular system is usually most 
beneficial : the water should be used lukewarm. The best 
cereals to give are puffed grains, with an occasional change to 
oatmeal and the brown prepared wheats, such as Ralston’s. If 
the patient should desire any one article of food, let him have it 
occasionally. 

When these measures were carried out, improvement was 
rapid ; so that in four weeks the patient was able to be about, 
and the following term took his place on the bench, and 
remains well at this time. 

A case seen with Dr. Hardin illustrates the fact that old 
age, weak heart, and debility need not denote unfavourable 
outcome. 

The exogenous poisons, such as alcohol, may produce 
a confusional condition which resembles paresis. A case 
of this kind was sent by Dr. Aymer, of Charleston, in 1909, 
because of hallucinations, delusions, and violence, the result of 
eight days of alcoholism. The distinction was very simply 
made by examining the spinal fluid, so that the patient was 
sent home well in two weeks, even although he had shown 
slurring and reduplicated speech, and gross impairment of 
calculating power. Seven years later the patient remained 
well. 

It is true that an occasional case of paresis very rarely has 
as low a lymphocytosis, but never during an acute attack of 
the period simulated by this patient. 

The distinction was similarly made in a case due to morphine 
to which I was called in consequence of an alienist’s diagnosis 
of paresis. This patient’s morphinism was perhaps due to 
marital infelicity, for he is now remarried, and five years later 
remains well. 

(3) The endogenous sources of confusional states are most 
clearly seen in hypopituitarism, as the following case shows : 

Narcolepsy from hypopituitarism .—A clear-out example of the 
confusional state of pituituary insufficiency is that of the girl, 
act. 25, referred by Dr. John Dunlop in 1911, to whom she had 
been sent on account of the pains in the back and dragging 
feeling and tenderness in the legs, in the belief that she had 
sciatica. There were absent-mindedness, severe amnesia, dull, 
heavy headache, which was sometimes bursting, and was 


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located deep and low in the middle of the head. Torpor 
would occur often suddenly, even causing her to fall. The 
mental confusion was most marked in these attacks, in which 
she felt as if intoxicated, singing and speaking absurdities. 
Although there was no vertigo, lines w-ould look blurred when 
reading. 

General and neurological examination was negative, except 
for increased reflexes, hypertrophy and tenderness of the 
subcutaneous fat, the weight having increased from 131 to 
184 lb. in three months. The limbs were irregularly asym¬ 
metrical ; for instance, the left knee was 16 in., and the right 
17^; the thighs respectively were 384- and 38^, and ankles 

and 9 in. in circumference. The femoral veins were congested, 
so was the conjunctiva. A neoplasm around the pituitary was 
diagnosed on account of the situation of the headache, torpor, 
the adiposis. Confirmation was obtained by the finding of 
visual field contractions, and deepening of the Sella turcica, 
as shown by the X ray. 

The treatment of the case consisted of the exposing of the 
pituitary region to radiotherapy, applied from four different 
temporal points, about ten minutes every week. 

Six months later, although the weight had not diminished, 
the headaches had, the visual field had enlarged, the reflexes 
had diminished, and the narcolepsy had ceased. We expected 
to give thyroid gland (3) in order to diminish weight, but the 
patient passed from observation, so we do not know if her 
relief continues, and are unable to supplement the preliminary 
report of the case made in January, 1912, in the Journal 0/ 
the American Medical Association. 

(4) Psychic disturbances, such as a powerful emotion, may . 
cause temporary confusion ; but it is doubtful if this can be 
prolonged in the absence of secondary somatic factors, such as 
impaired metabolism, circulation, and internal secretions (4). 

The case which follows, however, was purely psychic when 
dealt with by me. 

Post-onirical Jixed ideas removed by re-educative psycho¬ 
therapy. —A clerk, aet. 21, was referred by Dr. J. J. Richardson 
for advice and treatment on account of a state of mental con¬ 
fusion, impossibility of concentration on work, extreme depres¬ 
sion of mind, and nocturnal hallucinations. 

After he had given his name and address he began by 


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saying: “ Do you believe in God and Christ ? ” and when I 
asked him what was the matter, he said : “ It is dreadful, awful. 
Where am I, and what is right ? It seems desecration to speak 
of it : if you can’t help me I do not want to speak of it. 
Everything seems blended into one thought : all else is con¬ 
fusion.” I then asked him how the trouble had begun, and 
after much questioning he succeeded with difficulty in revealing 
to me what had transpired. 

During ether narcosis he had felt that the world had reverted 
to nothingness : that in consequence he could not reach God 
and Christ, and longed for death, so that he could escape this 
terrible nothingness. Everything seemed blurred in that one 
thought, which kept recurring in spite of fiis prayers to God. 
“ It seemed a curse to be brought into the world to suffer that 
awful mental pain; it seemed like after-death lasting a million 
years.” 

For the next week or so he had gone about suffering terribly 
seeming as though he would go insane if he could not return to 
God. A lecture on evolution seemed a desecration. He would 
wake at night, having dreamt the experience again, trembling 
with fear of his future. 

Examination showed no physical disturbances. 

Therapeutics. —He was treated by a full, though concise 
explanation of how thought is disordered by the perversion of 
brain chemistry during narcosis (i) ; how the feeling-tone may 
also be thus depressed, and how the distortion of impressions 
during a sad feeling-tone phase resulted in his hallucinatory 
concept of chaotic annihilation. It was explained that this 
concept was based upon morbid percepts caused by the ether, 
and therefore should not prevail over rational explanations of 
common experience and good sense. Many illustrations of 
toxic and mystic thought were related, and comparison drawn 
with his own case (i). He was asked to write out the infer¬ 
ences he drew from the facts presented to him, and he was 
referred to a clergyman for an explanation of his theological 
doubts. This, however, he did not receive, and I had to resume 
treatment without this assistance. 

He made a rapid recovery (2). 

Anxiety causing exhaustion, which produced mental confusion . 
—A woman, set. 35, was referred by Dr. Ada Thomas because 
she became disturbed about some botanical investigation she had 

LXIII. 26 


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conducted successfully, which she could not apparently finally 
formulate, although she had made a preliminary report to the 
satisfaction of superiors. She would keep on starting experi- 
ments, but they did not seem to go right. She felt dazed and 
as if everything was out of joint. The work seemed easy, and 
yet she could not accomplish it. As there was neither insom¬ 
nia nor loss of weight, she felt that her trouble was psycho¬ 
logical. But her reflexes were exaggerated, her hand trembled, 
her eyeballs were prominent, with congested lids, and the 
breath was very foul. However, she persisted that it was 
temperamental, as she had had an attack as a teacher some 
years before, and thinks that she was prone to it as a child. 
She was hyper-conscientious, and had too much ambition for her 
strength. 

Though her blood-pressure was only 128, her diet was 
lacking in succulence, and she had been taking extra milk, but 
without causing constipation. Thinking that improved meta¬ 
bolism might help her, I prescribed a week’s vacation, with golf, a 
more succulent diet, and a mixture of hormones. In a few days 
the blood-pressure fell to 105, diastolic 55, and she “felt like 
doing nothing at all and without mind,” so that the golf was 
stopped and she was put to bed. Whereupon the blood- 
pressure, after five days slowly rose to normal, the reflexes 
diminished, the tissues were firmer, but the pulse-rate mounted 
to over 100, going to 120 sometimes, and slight exophthalmos 
appeared, with the sign of Mcebius. There were no sweats, the 
breath was less foul; she felt clear mentally. Mixed hor¬ 
mones were stopped. She was then given secretogen and 
advised to return to work the next week, which she has accom¬ 
plished satisfactorily since (5). 

Chronic Confusion. 

(5) That a great many cases of chronic mental alienation 
supposed to be idiopathic are in reality toxicogenetic is becom¬ 
ing clear (9). Most significant is the autopsy material of the 
Massachusetts State Hospital, in which every case of 100 care¬ 
fully studied showed kidney lesions (10). 

When confusion becomes chronic, internment is usually 
imposed, often with a diagnosis of dementia praecox, which is 
regarded by R£gis as merely the chronic form of the mental 
confusion of Chaslin. From Kraepelin’s rubric, Rigis (11) 


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excludes cases of constitutional origin, usually the hebephrenics, 
which undergo rapid involution at puberty. The others, he 
maintains, begin with an acute attack of mental confusion due 
to toxin, usually show catatonia, and often end in dementia. 
Otherwise, there is a gradual failure, with delusional formation, 
inversely proportional to the rapidity of the dementia, and, 
finally, a permanent defect. 

The recovery of some of these cases, even after long 
periods, is in harmony with the conception of Rdgis that a 
factor outside the cerebrum itself is at work. This is in no 
way antagonistic to the finding of lesions in the brain itself by 
Southard (6), for we know that toxin can produce neuronal 
damage. A most remarkable recovery of a confusional state 
of seventeen years’ duration was recently reported by a 
Pennsylvania psychiatrist; and I myself (12) have reported 
one of recurrent maniacal confusion of toxic causation, which 
was completely removed when we prevented the auto-toxaemia 
of excessive eating, which at each alternate menstrual period 
produced an acute confusional attack, with rise of temperature, 
leucocytosis as high as 30,000, lasting for ten days or so, and 
leaving the patient quite normal in the intervals. 

(6) It is less well known, however, that an acute mental 
confusion sometimes occurs in consequence of secondary 
syphilis (14). In this there is always found an intense 
congestion of the meninges, and there is consequently an 
abundance of lymphocytes in the cerebro-spinal fluid, which is 
not always the case in chronic endarteritis ; although even 
here some meningitis is the rule and the fluid shows an increase 
of cells (15). 

(7) In this place I do not consider in detail the mild, 
recurrent chronic confusion which is often an accompaniment 
of, and sometimes substitute for, recurrent headache. That it 
is also a toxic phenomenon seems clear from the study of a 
considerable number of cases (17) where successful management 
is based upon a view of their pathogenesis more precise than 
those hitherto set down without adequate thought by most 
authorities. The following is an example : 

Marked confusion due to metabolic migraine resembling petit 
mal (7).—A bacteriologist, aet. 30, was referred to the writer 
in the spring of 1912, by Dr. Paul Johnson, because of 
attacks he called “ bilious ” (but not preceded or accompanied 


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by constipation), which produced headache, preceded by numb¬ 
ness and prickling in the fingers, followed by dizziness, mental 
confusion, and foolish talk of paraphasic type, without loss of 
consciousness. These attacks had occurred every two or three 
months since the age of twenty-two ; they were of very short 
duration ; there were no scotomata, but they were formerly 
accompanied by vomiting. The headache was of the splitting 
kind, lasted all day, and was followed by dulness and slowness of 
thought the day following. The capacity to concentrate his 
thoughts was increasingly impaired, even between the attacks. 
He was at times irritable. He had no bad habits, and, apart 
from these attacks, he was well and strong. He received a 
blow on the left side of the head as a boy, and there was still 
a dent in the left parietal region, upon which side the headache 
more often occurred. He had a large appetite, which he said 
he controlled, but he ate meat thrice a day, although, he said 
sparingly. The blood-pressure was not raised, and reflexes 
and sensibility were normal. 

Treatment and progress .—He was given the low protein 
“ standard ” diet. He wrote the writer the following winter : 
“ Since I have reduced the amount of protein in my diet and, 
increased the quantity of vegetables, I have had no recurrence 
of those spells.” Dr. Johnson informed the writer that he 
remained well to date, over five years later. 

Therapeutic Summary. 

(8) The treatment of confusional states should be easily 
gathered from the foregoing. It should not be a merely 
empirical dietary and effort at elimination, but should ever be 
directed towards combating the aetiological factor of the con¬ 
fusion. Thus, when the kidney is at fault, nitrogenous food 
must be diminished ; so, also, when the liver (8) is disturbed. 
When exhaustion has occurred, nutrition must be ample. 
When the internal secretions are disordered, it is to these that 
attention must be directed (13). When psychological factors 
are at work, they must be met with psychotherapy. Physio¬ 
logical irritability must be counteracted not by depressants or 
narcotics nor by forcible restraint, but by hydrotherapy, fresh 
air, and non-stimulating food. Even in patients violently 
disturbed, the death-rate where narcotics are used is much 
greater than when psysiotherapy is employed alone, e. g. 


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Gregg says, ( in recounting their experience at the Boston 
Psychopathic Hospital : 

“ The result of the eliminative treatment of the delirium with 
relative freedom and hydrotherapy, and a minimum amount of 
medication, far excels in effectiveness the usual treatment by 
restraint and depressant drugs in cases of the symptomatic 
psychoses, including alcoholism. 

“ Every general hospital should be provided with the 
facilities for treating properly cases of delirium. Such facilities 
should include isolation wards where quiet is not essential, and 
continuous bath apparatus for hydrotherapy.” 

Very striking is the difference in the death-rate among fifty 
cases of delirium tremens in five general hospitals, comprising 
ten cases from different hospitals in New York, Philadelphia, • 
Baltimore, and Boston. These were treated by depressants 
and showed a mortality of 26 per cent., while ten cases from 
the Boston Psychopathic Hospital were without mortality, in 
spite of the fact that they were older and more complicated. 

In the acute and grave cases measures may be required 
more drastic than those employed in the cases I have related. 
Such are: rectal irrigations, saline injections, intravenously or 
per rectum ; but these with caution, lest chlorine retention on 
account of renal hypofunction, by causing oedema, should 
aggravate cerebral incompetence ; hyperhydrosis by electric- 
light baths or hot-packs ; or even bleeding or rachiocentesis. 


References. 

(1) See author, “The Origin of Supernatural Explanations, "Journ. 
Abnor. Psychol., 1915, and Med. Record, 1916. 

(a) Compare the cases related in my “Prevention of Suicide,” 
Amer.Journ. Insanity , 1914. 

(3) “The Syndrome of Adrenal Inadequacy," Journ. Amer. Med. 
Assoc., December 9th, 1914. 

(4) See author’s “Psychogenesis and Internal Secretions,” Monti. 
Cyclopad., 1911. 

(5) Regarding psychogenetic disease, see author’s Cleveland lecture 
on “ Treatment of Psychogenetic Disorders.” See also “ Spurious and 
Genuine Psychotherapy,” Illinois Med. Journ., October, 1914, and 
Med. Press and Circ ., January, 1916, and the fourth case in this article. 
See also “ Prevention of Suicide,” Amer. Journ. Insanity. “ Psycho¬ 
genetic Disorders in Childhood,” Journ. Abnorm. Psychol., 191a; 
Wash. Med. Annals, 191a; Amer. Journ. Med. Sci., 1911; Post¬ 
graduate, 1912. “Treatment of Hysteria,” Journ. Amer. Assoc., 


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400 CLINICAL NOTES AND CASES. [July, 

November 9th, 1914. “ The Traumatic Neurosis,” Amtr. Journ. Med. 

Sci 1915, and Journ, Criminal Law, 1916. 

(6) Southard and Canavan.— State Board of Insanity Reports, 1915. 

(7) “ Treatment of Epilepsy in Accordance with Pathogenesis,” Inter¬ 
state Med. Journ., April, 1915; Rev. Neurol, and Psychol., March, 
1915; Med. Record, 1915. 

(8) Soc. de Biol, de Paris , 1903-1906. 

(9) Massachusetts State Hospitals Reports, 1915. 

(10) Ibid. 

(11) Congrh des alienistis , Paris, 1904, and in Pricis de Psychiatric. 

(12) “Concerning Diet in Nervous Disorders,” New York Med. 
Journ., 1912. 

(13) Med. Reoord, 1917. 

(14) Author, International Clinics, 1909, Ser. 20, vol. i. 

(15) See Vincent, Thise de Paris, 1909, and author, Med. Record. 
Path., “ Progress of Tabes and Paresis,” 1909. 

(16) At Detroit Session of Amer. Med. Assoc., June, 1916; Thera¬ 
peutic Gazette, April, 1917. 

(17) Journ. Amer. Med. Assoc., 1916. 

(>) Condensed from paper read before the American Medico-Psychological Asso¬ 
ciation, 1916. Published in full in International Clinics, 1916. 


Clinical Notes and Cases. 

Some Notes on Battle Psycho-neuroses. By E. Fryer 
Ballard, Captain R.A.M.C.(T.), Medical Officer in Charge 
of Mental Observation Wards, Second Eastern General 
Hospital, Brighton. 

There is nothing new in the symptoms comprising the 
syndromes—generically dubbed “ shell-shock ”—arising from 
the circumstances of battle. But to those of us who have had 
large numbers of these cases passing through our hands, new 
ideas have been suggested, or the confirmation of old theories 
brought home. 

It is not proposed to describe symptoms in detail in this paper, 
nor to give statistics as to the percentage of cases showing 
tremors, mutism, or what not—we are all familiar enough with 
the symptoms of hysteria, neurasthenia, etc.—but to study the 
question broadly, if briefly, from the aetiological standpoint. 

First of all it may be said at once that loss of consciousness 
from physical or atmospheric concussion due to “ blowing up ” 
or burial is, in the vast majority of cases, merely the last straw 
in the production of the psycho-neurosis. 


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A considerable number of cases break down without any 
such incident, or, if such occur, subsequently “ carry on,” to 
break down later without a second concussion. Concussion in 
civil life does not result in psycho-neuroses in normal persons. 
It is not the blow on the head nor the loss of consciousness 
that is the root cause of “ shell-shock ” ; this accident simply 
“ knocks out ” the control—that is to say, the “ censor ” is 
thereby broken through. 

Let me hasten to deny the impeachment that the writer is a 
sexual psycho-analyst—a suspicion likely to follow upon the 
use of the term “ censor ” ! One can adhere to the general 
psychological theory involving a belief in the subconscious, 
suppression of emotional complexes, the censor, and sublima¬ 
tion, at the same time entirely denying the universality of 
sexual causes of psycho-neuroses and psychoses. If anything 
has utterly confounded the sexual theories of the Freudians it 
is the study of shell-shock. It must be perfectly patent to the 
most bigoted sexualist that the instinct involved in shell-shock 
affections is that of self-preservation, and not sex. 

The two main syndromes met with in shell-shock are— 

(1) Those of the anxiety neurosis type, manifesting tremors, 
sweats, palpitation, anxiety, somatic apprehension, insomnia, etc. 

(2) Hysteria, comprising dissociations of consciousness, eg., 
delirium, stupor, automatism, amnesia ; and somatic episodes, 
eg. , deafness, dumbness, anesthesia, paralysis, etc. A third 
type of hysterical manifestation is fits. These may be clinically 
“ hysterical,” hystero-epileptic, or typically epileptic. The last 
frequently supervene after a latent period of apparent health in 
shell-shocked soldiers who have sustained no head injury, who 
have no personal or family history of fits, and who show no 
signs of the epileptic temperament. Whatever the clinical 
character of the fits may be, they are hysterical in origin, even 
though they may become chronic as the result of cerebral habit 
after the need for suppression is long past (see below). 

Other symptoms worthy of mention are vertigo—exceedingly 
common, and only very rarely terminating eventually in petit 
mal or fits; it is probably vasomotor and of neurasthenic 
origin; and stammer, without anxiety symptoms, which is 
probably a psychasthenic sign (i.e., a disguised expression of an 
over-excited instinct of self-preservation). 

Vomiting is not common, but when it does occur may be 


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402 CLINICAL NOTES AND CASES. [July, 

very severe. It is always caused by emotional factors—not diet 
—and may be cured by psychical means. 

In the vast majority of cases of shell-shock, both the anxiety 
syndrome and hysterical symptoms manifest themselves during 
their course ; and in a considerable proportion fits have occurred. 
But where a somatic hysterical episode (e.g., dumbness) is 
successfully maintained, the anxiety symptoms (and often signs) 
are absent—that is to say, a man cannot be hysterically deaf 
and dumb, for example, and at the same time acutely anxious, 
agitated, and frightened when fully conscious. The reason for 
this will appear later. 

Two physical signs sometimes seen in agitated cases are 
Romberg’s sign, and “ trombone ” movements of the tongue on 
protrusion. The importance of bearing these signs in mind 
lies, of course, in their usual incidence in general paralysis of 
the insane and tabes. If purely functional (i.e., shell-shock), 
they are accompanied by inco-ordination of other types, tremors, 
and the physical signs of fear generally, and, moreover, by 
mental anxiety and keen power of auto-criticism. So much for 
symptoms. 

Put briefly, the aetiological hypothesis, which seems to cover 
all these facts, is as follows : 

Soldiers under fire, especially shell-fire, being human beings 
with human instincts, are afraid. The instinct of self-preserva¬ 
tion is in arms. If the instinct were allowed expression as 
instinctive action the soldier would run away. He does not do 
so. If he admitted to himself and continually contemplated 
the struggle between his instinct to run away and his duty or 
necessity to remain, he would become agitated and betray the 
physical signs of a fear, which might perhaps conquer. What 
is he to do, then ? He simply does what we all do under 
analogous conditions : he banishes the struggle from his mind 
{i.e., he suppresses it into the subconscious), and as far as 
possible allows the fear some play in a disguised form, such as 
anger, etc. (i.e., he sublimates). Eventually one of two things 
happens. A time comes, if he continues under the same 
conditions, when he can no longer suppress—the censor fails. 
This failure may be brought about by any incident, ranging 
from definite shell-concussion to seeing a pal wounded, or by no 
special incident at all. The result is that the fear-complex 
arises reinforced in full consciousness once more. If he does 



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not re-suppress, all the symptoms and signs of fear occur, and 
he .has agitated neurasthenia or the anxiety neurosis. If he 
struggles to re-suppress and fails he may have fits. 

The second event that may occur is the development of an 
hysterical episode. If he is able to suppress for a prolonged 
period under fire without sufficient sublimation, and nothing 
occurs to break down the censor, or when it is broken down he 
succeeds in re-suppression, then he eventually develops as an 
instinctive compromise some hysterical episode, eg ., dissociation 
of consciousness, dumbness, paralysis, etc. The theory of the 
production of these episodes, which I have endeavoured to 
explain elsewhere, is briefly as follows : 

As the result of continual suppression of the instinct and of 
continual stimuli tending to excite it (possibly also in part as 
the result of constitutional tendency in some cases), the instinct 
enters into a stage of chronic hyperexcitability, which in part 
constitutes the hysterical temperament. This involves, of course, 
an extra liability to hysterical episodes. The over-excited 
instinct results in physiological over-activity of the censor 
(over-suppression), and hence in the cutting off from conscious¬ 
ness not only of the fear complex, but other stimuli afferent to 
consciousness as well, eg., kinaesthetic sensations, ordinary sen¬ 
sations, etc. Thus are somatic episodes, such as paralysis, 
anaesthesia, etc., produced. The fact that the soldier is fairly 
happy, i.e., free from anxiety symptoms, when he has a somatic 
episode, is the result of the instinctive compromise constituted 
by the episode. The fear complex is still suppressed, but the 
instinct finds disguised expression as the episode, achieves its 
ends, and there is then, of course, no conflict. 

Very marked over-action of the censor cuts off afferent 
stimuli to consciousness from wide peripheral areas, and so 
produces the hysterical states of dissociated consciousness. 

The actual site of the somatic episode is in some cases 
probably determined by associative memory, and often cannot 
be accounted for. In other cases its position is easily explained, 
eg., the exceeding commonness of deafness and dumbness is 
due to the over-suppression of the instinctive desires to listen 
and to cry out with fear. 

With regard to prognosis and treatment. Severe types that 
exhibit well-marked symptoms after six months do not recover 
in the Army. A considerable proportion of those who “recover” 


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in hospital break down again at their depots or command depots, 
often with symptoms dissimilar from those they originally 
presented, and not uncommonly with fits (failure of attempts to 
re-suppress). 

Since shell-shock is essentially mental in origin (whatever 
processes of auto-intoxication supervene)—electricity, radiant- 
heat baths and other machinery, are perfectly useless, except as 
vehicles for suggestion. Ten minutes’ conversation daily 
with anxiety types, together with the assurance that they 
will not be sent on active service again for many months, if 
ever, does more good than all the devices of the engineer or 
plumber. 

Of course the proper treatment for shell-shock soldiers (I 
mean severe types) is analogous to that of civilians suffering 
from the same psycho-neurosis arising from other causes, vis., 
after a few weeks in hospital, complete removal from the 
environment, at all events for a time, in which the illness arose. 
These soldiers ought, therefore, to be given not less than three 
months leave, then be sent to a convalescent home, from there 
to a command depot. If they subsequently break down they 
are no use for the field, and never will be. But under this 
regime I am perfectly sure many men now discharged as 
permanently unfit, would have been fit for some category. 

So far as hospital treatment is concerned, in addition to the 
measures outlined above, it is found useful to keep anxiety 
types in bed in the open air in the morning and to allow them 
out walking with their pals (not escorts) in the afternoons. For 
medicine, bromide of ammonium with syr. glycerphos. co. is 
probably as good as anything. Hysterical somatic episodes 
e.g., dumbness, are usually cured without difficulty by hypnotic 
suggestion. What the writer generally does is to tell the 
patient he is going to bring his voice back in a day or two ; to 
refer to his impending cure each day on seeing him. Then in 
a few days the suggestion of cure has become a faith (more or 
less subconscious). The patient is put to bed in a single room, 
given a few drops of chloroform or ether on a mask with the 
suggestion that after he has counted one hundred slowly to 
himself he will sit up and say : “ Oh, I can speak,” and will 
continue to speak. This method usually succeeds at the first 
attempt. Hysterical fits occasionally precede the return of 
speech, so it is well to be on the watch for these. 


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In some cases real partial anaesthesia, that is to say, the attain¬ 
ment of the stage of excitement, is necessary. 

Two words of warning regarding the cure of somatic episodes 
may not be out of place. 

One is that in recent shell-shock cases removal of the episode, 
as one would expect, results in agitated neurasthenia. The 
mental wounds still gape and are not sufficiently healed to 
dispense with the dressing supplied by the episode. As a 
general rule also patients who manifest physical signs of fear 
(though feeling comfortable) as well as a somatic episode, should 
not be cured of the latter until the former disappears, or the 
same result may occur. In these cases the instinct is so over¬ 
excited that it requires some other outlet than the somatic 
episode ; this it finds in tremors, etc. The other point to 
remember is that, when the patient sits up and says : “ Oh, I 
can speak,” and continues to talk as he is told, he may be in a 
hypnotic sleep. One case at this stage I told to keep on 
repeating “ Mary had a little lamb ” so that he should not 
forget that he could talk ! Then I left him thinking all was 
well. Returning to the ward after half an hour, to my suprise 
I found the patient sitting up in bed still repeating that choice 
poem like an automaton, and for aught I know he would still 
be repeating it now, if it had not suddenly dawned upon me 
that he was hypnotised and asleep ! I then woke him up and 
was thankful to hear him vary his remarks by the bewildered 
exclamation : “ Where am I ? ” 


Part II.—Reviews. 


Sixty-fifth Report of the Inspectors of Lunatics {Ireland) tor the year 
ending December 31 st, 1915. 

The times are out of joint, and iflunacy reports are somewhat belated 
just at present we must remember that even they, like many matters 
still, more important, must bow to the stringency of circumstances 
during periods of difficulty and stress such as we are now, and have for 
some time past been, experiencing. Moreoyer, it need not occasion 
surprise if the bulk of such documents is much reduced. The Report 
of the Irish Inspectors is largely curtailed in size, its dimensions being, 
in fact, 60 per cent, less than those of the Report for the previous year. 
This diminution in size is mainly due to the omission of the reports on 
inspections of the individual asylums which have up to this been 


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406 REVIEWS. [July, 

appended, but some of the usual tables have also been omitted, and 
others have been shortened or condensed. This, of course, to some 
extent impairs the value of the Report. 

For the first time since the year 1863—a period of fifty-two years— 
the inspectors are able to record a decrease in the number of patients 
under care, there being a reduction of 77 during the year, and the ratio 
per 100,000 of estimated population, which reached its maximum, 575, 
in 1914, has fallen by 2. The decrease was due in part to fewer admis¬ 
sions, in part to a considerable increase in the number of deaths. The 
admissions into District Asylums show a reduction of 119, whilst in the 
case of Private Asylums there was an increase of 48; the net decrease 
Leing, therefore, 71. The deaths outnumbered those of 1914 by 220, 
whereas the discharges were fewer by 93. It is to be noted that the 
decrease both in the numbers under care and in admissions was confined 
altogether to the male sex, the male admissions having been fewer by 
82, while there was an increase of n in the female admissions. The 
decrease generally of the total number under care was chiefly noticeable 
in the case of workhouse patients where it amounted to 108, while in 
District Asylums there was a small increase of 3, and in Private Asylums 
the numbers were larger by 32. 

While, as insisted on frequently in former reviews, any conclusion 
based on the statistics of a single year, cannot be accepted as more than 
in the nature of a surmise, still these most recent statistics, coupled 
with the fact that, as shown in last year’s review, the rate of increase of 
insanity in Ireland has been steadily reducing during the past fifteen 
years, maybe regarded as distinctly favouring the opinion that the acme 
of increase has been reached and passed, and that we may hope, 
perhaps even expect, that sooner or later an actual decline in the 
amount of lunacy in this country will make itself apparent. The figures 
for many years past altogether tend to substantiate this view, and there 
are none that we know of that would lead us to another conclusion. 
The decrease in the number of admissions is a novel and healthy sign 
of improvement. The higher death-rate, although perhaps regrettable 
from one point of view, may not improbably continue, owing to the 
accumulation of aged people who have reached or gone beyond the 
normal span of existence, and who, but for the care they have received 
in asylums, would have succumbed much earlier under less favourable 
conditions. Should this higher rate of mortality continue it' will, of 
course, be a factor in reducing the aggregate number of insane in 
asylums. The average annual increase during the ten years 1904 to 
1914 was 218, while during the five years from 190910 1914 it was only 
104, or less than one-half. 

The total number of insane in establishments on January, 1st, 1916, 
was 25,103, of whom 21,530 were in District and Auxiliary Asylums. 
The number of insane outside institutions, including those wandering at 
large, was at the last census 4,044, or approximately 14 per cent. of the 
total. The daily average in District Asylums during 1915 was 21,539, 
as compared with 21,469 in 1914, being an increase of 70 patients. 
Only 9 per cent, of the total under care are now accommodated in work- 
houses. With respect to these latter institutions the inspectors give a 
less unfavourable report than they have hitherto been able to do. 


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They express themselves as being on the whole satisfied with the 
clothing and dietary supplied, but the accommodation is not all that 
might be desired, and the sanitary and bathing arrangements anything 
but satisfactory. These are “ with few exceptions still very antiquated, 
the former consisting only of buckets in the dormitories and privies out 
of doors, while portable baths or even tubs are in very general use, and 
in a few instances there is no regular bathing at all.” 

As regards the influence of the war on the admission-rate it is not 
very easy to make anything like an accurate estimate. The number of 
soldiers and sailors admitted into District and Private Asylums was 85, 
of whom 34 only had seen any active service. The inspectors consider 
that these figures are not of any value as indicating the prevalence of 
mental disease amongst Irish soldiers and sailors, owing to the special 
arrangements made by the War Office for dealing with insane soldiers. 
Probably a more reliable index as to the effects of the war is to be found 
in the number of cases in which mental stress was assigned as a factor 
in causation. These amounted to 19 per cent, of the total admissions, 
of which in 13'6 per cent, it was stated to have been the principal 
cause, the ratios for the previous year having been 16 88 and ii \4 
respectively, so that there appears to have been a not inconsiderable 
increase in such cases. A further inquiry was made as to the number 
of cases in which the war was regarded as a direct causative factor, with 
the result that it was found that in only ri9 per cent, did it operate 
either as principal or contributory cause, and in 0^32 per cent, as 
principal. Two-thirds of these cases were first admissions, and the 
majority belonged to the female sex, in fact three-fourths of the total. 
The war, therefore, can hardly be regarded as having been more than 
an insignificant factor in causing an increase of insanity. 

In alcoholic cases there was a slight reduction as compared with 1914, 
those in which alcohol was assigned as a principal cause being io - 68 
per cent, in 1915 and iroi in the preceding year. 

The death-rate was 7’8 per cent, on the daily average, being 09 per 
cent, higher than in 1914. It is satisfactory to note that the mortality 
from phthisis has fallen from 27’2 to 21‘5 per cent, during the last 
twenty-five years, and in 1915 it was only 20'6 as compared with 22^3 
in the previous year. The deaths from general paralysis were only 
32 per cent, of the total. This disease would appear on the whole to 
be rather on the decline. 

The total expenditure on the district and auxiliary asylums for the 
year ending March 31st, 1915, amounted in round numbers to 
^640,000, which gives an average cost per head of ^29 i8j. 6 d. for 
patients in District Asylums, exclusive of the Auxiliary Asylum at 
Youghal, being an increase of 6 s. sod. on that of the previous year, or 
a fraction over x per cent. That there'W-as not a greater rise was due, 
the Inspectors state, to the fact that nearly all the supplies were 
obtained under contracts made before the war broke out. When the 
expenditure for the year 1915-16 comes to be computed it will probably 
show a much larger increase, which will no doubt be found to have 
advanced by leaps and bounds during the most recent financial year 
terminating in March last. i,o« 

In connection with this subject of finance it is a peculiar feature of 


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408 REVIEWS. [July, 

these reports that while the reports from individual asylums have refer¬ 
ence to the general statistics for the previous year ending December 31st 
and to the financial statistics for the period ending March 31st of the 
current year, the Inspector’s Report, although dealing with the general 
statistics for the same period as those from the several asylums, are a 
year behindhand in their tables of finance. A probable explanation 
may be that the more recent accounts have not yet been audited at the 
time when the Inspector’s Report is being written, and that they do 
not wish to touch on unaudited accounts. But such a plea in defence 
of a practice which we venture to think is to be deprecated, can hardly 
be regarded as adequate, unless this method is a statutory regulation. 
For, although the later accounts may not have been audited at the time 
the writing of the reports is undertaken, the audit will have almost 
certainly been made before they are completed, and in the hands of the 
publisher ; and any necessary amendments or alterations in the 
figures could readily be made before publication. This would bring 
these tables as nearly up-to-date as possible. Those which appear in 
the Report under review have reference to an annual period which 
terminated over two years ago on March 31st,- 1915. Some remedy 
ought to be devised for an anomaly of this kind. 

Except for the fact that a large number of the asylums, practically 
one-half, are overcrowded, some greatly so, there is nothing of special 
interest or that requires comment as regards these institutions. 

Christianity and Sex Problems. By Hugh Northcote, M.A. Second 
edition, revised and enlarged. Pp. 478. Philadelphia : F. A. Davis 
and Co. London: Stanley Phillips, 1916. Price 125. 6 d. net. 

Attention was called to this book in the Journal, on its first publica¬ 
tion ten years ago, as a treatise in moral theology, discussing the 
problems of sex from a remarkably enlightened and liberal standpoint of 
Anglican Christianity. In the present thoroughly revised edition the 
author has greatly enlarged the book, nearly doubling it in size, and 
adding six new chapters with numerous appendices. The usefulness of 
the work has thus been greatly increased for all those—from whom the 
medical psychologist can scarcely be excluded—called upon to consider 
sexual problems from the point of view of morality and social hygiene. 
As the author points out in the new Preface, bad casuistry has often 
been condemned, but a sound casuistry remains more than ever 
necessary, and the science of sexual moral theology “ holds a rightful 
place in the scheme of knowledge, and has an important function to 
fulfil in the moral education of mankind.” Even those who are in¬ 
different to moral theology may still find that the author’s fairness of 
mind, his practical acquaintance with difficulties, and his extensive 
knowledge of the most recent scientific literature of sex, render his book 
an interesting introduction to sexual psychology. 

Havelock Ellis. 

Raymond: Or Life and Death. By Sir Oliver Lodge, F.R.S. 

This book consists of three parts : First, what is called the “ Normal 
Portion,” consisting of reminiscences of Raymond Lodge, who was 


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killed near Ypres on September 14th, 1915, set. 26 ; of letters from him 
at the Front, and of letters from officers who had served with him. 
Secondly, what is called the “ Supernormal Portion.” containing the 
evidence which, in Sir Oliver Lodge’s opinion, conclusively proves that 
Raymond has communicated with various people since his death. 
Thirdly , an exposition of Sir Oliver Lodge’s beliefs about life and 
death, including, of course, his views on the relationship of mind to 
matter. 

After reading Raymond I have no doubt of Sir Oliver Lodge’s bona 
fides , for he presents the 'evidence at considerable length, when he would 
have made out a stronger case if he had suppressed most of it. How¬ 
ever, Parts I and II appear to be really introduced as pegs on which to 
hang his own views about the universe, for he says (p. 280): “ Some 
people may prefer the details in Part II; but others who have not the 
patience to read Part II may tolerate the more general considerations 
adduced in Part III—the ‘Life and Death’ portion—which can be 
read without any reference to Raymond or to Parts I and II.” But the 
evidence in Part II should be carefully read, as otherwise some of the 
statements in Part III might give a very false impression. For instance, 
he says (Part III, p. 374): “ But now, if I or any member of my family 
goes anonymously to a genuine medium, giving not the slightest normal 
clue, my son is quickly to the fore, and continues his clear and con¬ 
vincing series of evidences,” whereas it appears to me that no serious 
attempt to avoid giving clues was made in any case. 

Of the sittings with mediums recorded in Raymond, there are only 
nine in which a semblance of anonymity was attempted, and in none of 
these was any real effort made to take all possible precautions against 
fallacy. The mediums were discoveries of a Mrs. Kennedy, and were 
recommended by her to Sir Oliver Lodge, who apparently made no 
independent inquiries about them. All the supposedly anonymous 
sittings of Lady Lodge were held at Mrs. Kennedy’s house, or else were 
arranged by her; and, as she had received many messages through the 
medium's, as well as through her own automatic writing, from her son 
Paul, who was killed in a motor accident in June, 1914, she was a 
convinced spiritualist, and we have no guarantee that she had not been 
talking about her friend Sir Oliver Lodge and his loss. At any rate, 
her presence at the stances was a clue ; and then the fact of Raymond’s 
death had been announced in The Times , so that mediums could easily 
have got some information about him. As for Sir Oliver Lodge’s 
sittings, he admits (Part II, p. 96) that his “own general appearance is 
known, or might be guessed,” and in every instance the medium 
recognised him. Then as regards the three sittings which his sons, 
Alec and Lionel, had with mediums under supposedly anonymous 
conditjons, it is clear that the medium knew who they were. In short, 
the difference between these facts and what is stated in the sentence I 
have quoted may be taken as a key to the whole book, which chiefly 
illustrates Sir Oliver Lodge’s lack of qualification for experimental 
psychology, of which, I take it, psychical research is but a branch. For 
if he had been a trained investigator, he would have taken, among 
others, the following precautions: (1) In every case the sitter would 
have been disguised. For instance, Sir Oliver Lodge himself might 


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410 REVIEWS. [July. 

have shaved off his beard, or got himself “ made up ” by Clarkson. (2) 
The sitting would have been arranged through someone like a solicitor, 
who had no interest in spiritualism, and would have arranged the 
preliminaries as a pure matter of business for a client without giving any 
clue. (3) In no case would a friend of mediums like Mrs. Kennedy 
have been present for fear she might give a clue. (4) In every case, if 
possible, the medium would have been securely blindfolded, so that he 
could not see the effect of his questions on an emotional sitter like Lady 
Lodge. (5) The sitter would have talked as little as possible, have 
never asked leading questions, and have tried not to give the medium 
hints by word or look. 

There are several passages in Raymond in which Sir Oliver Lodge 
inveighs against scientific critics for trying, as he asserts, to limit the 
range of inquiry ; but there is not a word in the whole book about the 
need of adequate training before undertaking psychical research. Appa¬ 
rently he is quite genuinely unaware that scientific critics, so far from 
trying to limit the range of inquiry, are actuated solely by their desire 
that the advance of knowledge shall not be hampered by the publication 
of researches vitiated by the fallacious conditions under which they 
have been carried out. Indeed, Raymond illustrates very well the 
difference between Sir Oliver Lodge and investigators trained for 
biological and psychological research. Whereas he builds his hypo¬ 
theses on evidence obtained under the most fallacious conditions, in 
accordance with his dictum that “ it seems more useful to get results for 
such observation as is possible under the circumstances than not to get 
them at all”—as he said of Eusapia Paladino’s “physical phenomena” 
( Journ. S. P. R., vol. vi, 1894, p. 328), they maintain that, just as we 
are all victims of illusion if, without training, we investigate a conjurer’s 
tricks under his conditions, so it is mere waste of time to investigate 
spiritistic phenomena under mediumistic conditions, which are in¬ 
compatible with real precautions against error. 

Sir Oliver Lodge believes that he has reached his present convictions 
as the result of the cumulative effect of a great deal of scientific 
evidence, no item of which is conclusive by itself; but a perusal of 
Raymond leaves very little doubt in my mind that by sitting with 
mediums under absolutely untrustworthy conditions, he has gradually 
and unconsciously lowered his critical standard, and, like a man who 
compounds a felony, has had to pay a penalty by becoming the dupe of 
his bias. Under the emotional influence of conversation with the 
“ dead ” judgment is easily warped, and the sitter becomes hypnotised 
by phenomena which leave the critical reader of the record quite cold, 
or may even excite his ridicule. As William James said of the difference 
between taking part in a “ Piper ” sitting and reading the record of it 
(Proc. S. P. R., vol. xxiii, p. 32): “ The whole talk gets warmed with 
your own warmth, and takes on the reality of your own part in it: its 
confusions and defects you charge to the imperfect conditions, while 
you credit the successes to the genuineness of the communicating 
spirit. These consequently loom more in our memory and give the key 
to our dramatic interpretation of the phenomenon. But a Sitting that 
thus sounds important at the time may greatly shrink in value on a cold 
re-reading, and if read by a non-participant it may seem thin and 


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412 REVIEWS. [July, 

certain that Mrs. Leonard could never have got any information about 
Raymond’s songs from any of his family, or from Mrs. Kennedy, etc. 
Although, then, I have to admit that I do not know what is the 
explanation, I do not feel impelled to seek a supernormal explanation 
for a single incident like this, considering the conditions under which it 
occurred. Also it is to be noted that again and again other questions 
were answered incorrectly or evaded, although the answers must have 
been known quite well to Raymond when he was alive. 

The content and style of the mediums’ utterances do not suggest a 
supernormal origin, as they are nowhere inconsistent with the culture of 
the medium employed. The spirit talk is so full of stock phrases, and 
so often shocks the expectations and requirements of common sense, 
that it is difficult to take seriously the long-winded descriptions of 
Raymond’s adventures in “Summerland” with his cat and his dog 
“ Curly,” or his visits to other spheres, including, apparently, an inter¬ 
view with the Deity. “ Feda,” however, is sometimes rather amusing, 
as, for instance, in Sir Oliver Lodge’s sitting with Mrs. Leonard on 
December 3rd, 1915, when towards the end he looked at his watch, and 
she said, “ I could talfc for hours; don’t go yet.” Even Sir Oliver 
Lodge realises the worthlessness of some of the evidence when he 
writes (p. 357): “It is true that in the case of some mediums, 
especially when overdone or tired, there are evanescent and absurd 
obtrusions every now and then which cannot be seriously regarded.” 
But this admission gives his whole case away. What may appear 
ludicrous to him does not thereby cease to be interesting as a scientific 
phenomenon ; and there is no test for distinguishing between the sub¬ 
conscious—or conscious—patter of the medium and those utterances 
which he regards as transmitted by a spiritual entity. 

In more than one place Sir Oliver Lodge begs the reader to be willing 
to learn and be guided by facts and not by dogmas; but Part III is full 
of contentious assertions and matter calling for criticism, such as his 
remarks about the nature and honesty of mediums; his argument that 
prevision is consistent with free-will (p. 315); his views on the relation 
of mind to matter (pp. 326-330); his assertions that telepathy is a fact 
(p. 3 I 3)i and that memory exists apart from the bodily mechanism (p. 
328); his belief in psychometry (p. 305), and that possession by spirits 
is the explanation of dissociated personality (pp. 357-8); and his 
verbiage about the ether of space (pp. 318-9), and “ etherial counter¬ 
parts” (p. 336), etc., etc. His views about table-tilting, however, I 
must quote as a final example of the effect which psychical research has 
had on him. On p. 238 we read : “In general we may say, with fair 
security, that no receptivity to physical phenomena exists save through 
sense-organ, nerve, and brain; nor any initiation of physical phenomena 
save through brain, nerve, and muscle ”; and on p. 363—“ Certainly 
the table can only move at the expense of the energy of the medium or 
of people present ”; but on p. 365, where he hints that speaking and 
writing without the aid of any physiological mechanism, as well as 
“ materialisation,” are facts, he writes—“ In these strange and, from one 
point of view, more advanced occurrences, though lower in another 
sense, inert matter appears to be operated on without the direct inter¬ 
vention of physiological mechanism. And yet such mechanism must be 


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in the neighbourhood. I am inclined to think that these weird phe¬ 
nomena, when established, will be found to shade off into those other 
methods which I have been speaking of, and that no complete theory of 
either can be given until more is known about both. This is one of the 
facts which causes me to be undogmatic about the certainty that all move¬ 
ments, even under contact , are initiated in the muscles (The italics are 
mine.) Apparently he believes that a spirit, by utilising potential 
human energy, may directly make a table move in the absence of 
muscular contraction. What a shock Faraday’s spirit would receive, 
could he realise that his experiments on table-tilting were thus ignored ! 

I. L. Tuckett. 


Epitome of Current Literature. 


1. Physiological Psychology. 

The Classification of Dreams [Per la Classificazione dei Sogni], ( Psiche , 
October-December , 1915.) Assagioli , Dr. Roberto. 

The writer offers the following classification of dreams only as a 
preliminary sketch, and not as a complete scheme. The nature, 
structure, and characters of dreams are so diverse and complex that it 
is impossible to classify them conveniently from one point of view. It 
is necessary, therefore, to make as many classifications as there are 
characteristics by which one can, and ought, to distinguish dreams. 

I. Classification of Dreams according to their Origin. 

(a) Dreams in which the action of external sensorial stimuli (visual, 
auditory, tactile, etc.) is recognised. To this category belong also the 
dreams in which is recognised the influence exercised by atmospheric 
conditions, particularly by their sudden changes. 

(b) Dreams in which the action of internal, organic sensorial stimuli 
is recognised—that is to say, the various buzzings and noises in the 
ears, and all the sensations proceeding from the activities of the various 
organs. Such sensations generally remain subconscious during waking 
hours, buried in the general organic sense of well- or ill-being (ccen- 
aesthesia), but during sleep they have a power of exercising an influence 
on dream-activity. 

(c) Dreams in which the action of supernormal stimuli is recognised. 
Being ignorant of the true nature of these stimuli, we can for the 
present only deduce their existence from their effects. 

(d) Dreams of an evidently psychical origin. Many dreams are 
clearly the production of the spontaneous psychical activity of the 
dreamer, without the co-operation of other stimuli. To this ample 
category belong dreams reproducing real events, and the dreams deter 
mined by emotional tendencies and conditions. 

( e ) Dreams with no evident origin. This is a provisional category, 
which we hope with the progress of science will soon become un¬ 
necessary. 


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II. Classification of Dreams according to their Structure and their 

General Characters. 

(A) Dreams which are (a) Clear, and those which are {b) Confused. 
This distinction has a relative value, since the want of clearness may 
depend on the vague remembrance which we have of a dream when we 
wake, and not on its confusion when it is being evolved in the dream* 
consciousness. On the other hand, sometimes we seem to remember 
that the dream appeared to be confused in the dream-consciousness, 
and further, it is legitimate to admit that the fact that some dreams are 
impressed clearly on our memory, whilst others leave only a confused 
trace, depends in part on the greater or less intrinsic clearness of the 
dream itself. 

(£) Dreams are (a) Vivid, or (b) Pallid. This is a distinction similar 
to the preceding, but which does not coincide with it. 

(C) Dreams may be (a) Continued, or (b) Interrupted, or (c) Dis¬ 
connected, according to their development. The disconnected dreams 
have a sudden changing of surroundings and argument, without, how¬ 
ever, there being a true and proper interruption of the dream. These 
dreams deserve to be studied with particular attention, in order to 
discover the reason of such changes. There are facts which show that, 
in some cases at least, the unexpected changes depend on the action of 
external or internal stimuli. 

From a strictly structural point of view, dreams may be divided 
into— 

(Z?) (a) Simple, and (b) Complicated. And into— 

(E) (a) Coherent, and (b) Incoherent. 

(E) Dreams which are recurrent— (a) those which recur on the same 
night, and (b) those which recur on different nights. Not uncommonly 
these dreams have a special signification in the life of the dreamer, and 
deserve to be accurately studied. 


III. Classification according to Intellectual Characters. 

Although it is true that logic is not a strong point in dreams, it is not 
lacking entirely as some have asserted. 

( A) Logical dreams, which in their relation to reality may be divided 
into (a) Probable, ( b) Improbable, and (c) Impossible. In the latter, 
however, the dream remains coherent with its premises. 

( B) Absurd dreams. 

IV. Classification according to Emotional Characters. 

There are two great classes of dreams: those which are developed 
without being accompanied by emotion, and those that are accompanied 
by it. All the emotions and sentiments of waking hours may appear in 
a dream, and it is useless to enumerate them. It is enough to divide 
dreams into (a) Pleasant, and (b) Painful. 


V. Classification according to Active Characters. 

(a) The dreamer is an actor in the dream—usually the chief actor. 
These dreams are generally dramatic, and rich in sensations and 
emotions. 


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# 

(b) The dreamer is a passive spectator of the dream. As in the 
theatre, in some cases the spectator follows the spectacle with keen 
interest and emotional participation, in others with indifference, or in a 
critical attitude. 

(c) The dreamer is an active spectator of the dream. In this class of 
dreams the dreamer has a vague idea that it is he himself who makes 
one or more of the dramatis persona act or speak. Stepanow, who 
pointed out this kind of dream to the writer, gives the following 
example : “ In a train the conductor was enumerating to a traveller the 
stations through which the train would pass. I heard a series of fan¬ 
tastical names, and at the same time I had a vague idea that I myself 
must have invented those silly names. My interest became more and 
more intense, until at last I awoke exhausted.” This type of dream is 
interesting from a psychological point of view, and is connected with 
the problems of dream-consciousness, dissociation, and impersonation. 

VI. Classification according to the Attitude of the Dreamer in the 

Dream. 

(a) The dreamer believes fully in the reality of the scene which is, so 
to speak, unrolled before his eyes, and in which he appears to par¬ 
ticipate. 

(b) The events of the dream cause the dreamer a more or less vivid 
sense of surprise. 

(c) The dreamer occupies a critical position, and makes various 
attempts at interpreting or correcting the elements of the dream, which 
seem to him unlikely, impossible, or absurd. 

(d) The rare cases in which the dreamer is fully conscious of dream¬ 
ing. 

VII. Classification according to the Connection between the Psychical 

Life of the Dream and that of Waking Hours. 

(A) (1) Dreams in which the ideas, sentiments, and moral principles 
are the same as those of the dreamer in waking hours. 

(2) Dreams in which the ideas, sentiments, and moral principles are 
different from those of the dreamer in waking hours. 

( 2 ?) (1) Dreams which do not exercise any sensible influence on the 
mind of the dreamer during waking hours. 

(2) Dreams, the emotional tone of which is prolonged for a certain 
time into the waking hours. 

(3) Dreams which exercise a special action on the personality of the 
dreamer during waking hours. 

(a) Beneficent dreams: These are useful dreams of various types. 
Some (Autognostic dreams) give us valuable information for the know¬ 
ledge of ourselves, revealing latent bad points in our characters, or 
dispositions and capacities of which we were ignorant. Others (Admoni¬ 
tory dreams) put us on our guard against external or internal dangers 
and perils. Others (Elaborating dreams) continue the mental activity 
of waking hours, elaborating ideas, resolving problems, etc. Others, 
again (Creative dreams), in which the fancy creates products which 
can be utilised in artistic work. Finally, certain dreams which 


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416 EPITOME. [July* 

can be classed among the Supernormal dreams (Telepathic and pre¬ 
monitory). 

( 6 ) Maleficent dreams: Some of these (Impressional dreams) are of 
a terrifying and menacing nature, and disturb the neuro-psychical 
equilibrium of the dreamer. Others (Pathogenic dreams) become 
confused with reality, and give rise to phobias, obsessions, deliriums, 
etc. Others, again (Criminal dreams), instigate the dreamer to crime. 

VIII. Classification of Dreams according to their Signification. 

Although we are still a long way from knowing the signification of 
every dream, yet in a great number of them we can establish it with 
sufficient certainty to group them into various categories. 

(A) (1) Dreams, the signification of which is represented in a direct 
manner. 

(2) Dreams, the signification of which is represented under a sym¬ 
bolical form : This distinction was recognised in antiquity, and, indeed, 
in not a few cases the symbolical relation is so evident that there can 
be no doubt of the exactness of the interpretation. But, on the other 
hand, the greatest number are cases in which the symbolism is obscure 
and complex, which renders the interpretation difficult and uncertain. 
In these cases it is necessary to proceed with prudence, and not yield to 
the temptation of manufacturing a quantity of interpretations as in¬ 
genious and seducing as fantastic. 

( 2 ?) (1) Dreams reproducing real events in an exact manner (Mne¬ 
monic dreams). 

(2) Dreams reproducing real events in a more or less altered manner. 

(3) Dreams representing the nature and action of an external or 
internal stimulus (Prodromic and diagnostic dreams). 

(4) Dreams representing the actuality of desire or hope 

(5) Dreams representing the actuality of fear. 

(6) Dreams representing the actual internal or external situation of 
the dreamer. 

(7) Dreams representing attempts at solving problems or actual 
situations, or dreams referring to ethical or religious ideals (Perspective 
or mystical dreams). 

(8) Supernormal dreams : These are relatively rare, but their existence 
has been clearly demonstrated, particularly by the work of the Society 
for Psychical Research. The two principal types of this class of dreams 
are the telepathic and premonitory. These types are mentioned under 
the head of “ Beneficent Dreams ” (Class VII). 

IX. Dreams of a Special Nature (Typical Dreams). 

(1) Agonising dreams: The most common types of these dreams, 
are—those in which one wishes to move and cannot; those in which 
one is pursued; those in which one arrives late for a train or an 
appointment; those in which one desires to complete an action, but is 
impeded by an interminable series of obstacles. 

(2) Erotic dreams. 

(3) Religious dreams. 

(4) Criminal dreams. 


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(5) Dreams of flying. 

(6) Zooscopic dreams : The sight of animals in a dream may happen 
to normal persons, but it is proved that zooscopic dreams are especially 
met with in the cases of neuropathies and alcoholics. 

X. Phenomena connected with Dreams. 

(1) Prehypnic and posthypnic phenomena: By these one designs the 
vivid images which are perceived at the moment of going to sleep or at 
that of waking. These images acquire such vividness that they seem to 
be sensations, and they deserve the name of illusions or pseudo¬ 
hallucinations, because consciousness perceives them with all the 
characteristics of true sensations, although it is known that no real 
object corresponds to them. If one goes a step further, the illusion 
becomes a hallucination; the dreamer believes in the objective reality 
of the images—in other words, he commences to dream. Prehypnic 
phenomena are the germs from which dreams may be evolved. Post¬ 
hypnic phenomena work in the opposite direction. In passing from 
dreaming to waking, one often requires a certain time and a certain 
strength to recognise the hallucinatory nature of the dream-like images. 

(2) “Dreaming with the eyes open ” (Fantasies, Day-dreaming): A 
great many persons, particularly young people, endowed with a rich 
imagination, give themselves up to “ building castles in the air,” to 
constructing veritable romances, in which they are themselves the 
protagonists, and which appease unsatisfied desires and aspirations. 
These day-dreams may assume such emotional and representative 
intensity, and such variety and richness, that they constitute a true 
world apart, and appear more coloured, more vivid, and, to a certain 
extent, more real than the external world. 

(3) Products of artistic inspiration: These products often present 
affinities with dreams, either by the special state of abstraction from 
external reality—of “ introversion ” in which the artist finds himself at 
the moment of their manifestation—or by their subconscious elabora¬ 
tion, and by their involuntary irrefrangibility, or by the nature of their 
contents or signification. 

(4) Ecstatic visions: Ecstacy is a special religious experience, a state 
of mystical consciousness in which visions sometimes, but not always, 
occur. To these visions the visionary attributes an objective or sym¬ 
bolic character according to circumstances. 

(5) Hallucinations: True hallucinations—that is to say, the belief 
that the subjective images are sensations corresponding to real objects 
—constitute a normal and necessary character of dream-consciousness. 
They are, on the other hand, for the waking consciousness exceptional 
and pathological phenomena. 

(6) Morbid dream states: These are met with among psychoneurotics, 
and especially among hysterical people, and are present in the hypnotic 
state, in some forms of somnambulism, and the “ hypnoid,” “ twilight,” 
confusional, and stuporose states. Another form of the dream state is 
found in cases of drunkenness produced by various toxic agents, such 
as alcohol, opium, hashish, etc. 

(7) Delirium in mental diseases: This phenomenon may be con¬ 
sidered from a psychological point of view as a fusion or confusion of 


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418 EPITOME. [July, 

dream-consciousness and waking-consciousness. This is confirmed by 
the fact that sometimes delirium takes origin and sustenance from 
dreams. J. Barfield Adams. 


a. Clinical Neurology and Psychiatry. 

(1) Shock and the Soldier. (.Lancet , April 15M and 22nd, 1916.) 

Smith, G. Elliot. 

(a) Some Neuroses of the War. (Bristol Medico-Chirurgical Journal, 
July, 1916.) Clarke, J. M. 

(3) Mental and Nervous Symptoms following Naval Disasters \Le$ 

Troubles Nerveux et Psychiques Consicutifs aux Catastrophes 
Navales ]. (Revue de Psychiatric, April, 1914.) Hensard, 
M.A. 

(4) The Treatment of Some Common War Neuroses. (Lancet, June gth, 

1917.) Adrian, E. D., and Yealland.L. R. 

The first paper deals with the question of shock from a diagnostic, 
therapeutic, and social point of view. The whole subject of soldiers 
suffering from the protean manifestations of shock involves problems of 
far-reaching importance upon the social welfare of the whole nation 
after the war. The writer finds that ampler provision has been made 
for dealing with this problem in other countries, and he has collected 
the views of French and German authorities as to the various methods 
of dealing with such cases, with the hope that some solution may be 
arrived at for a situation which is becoming increasingly urgent. 

Stress is laid upon the following points : The importance of diagnosis, 
that is, the discovery of a clear relation between the symptoms and the 
history, arrived at only by a sympathetic study of the patient from day 
to day; the necessity for a consideration of the development of the 
symptoms in order that the patient may be prevented from systematising 
his morbid sensations into a delusional scheme; the influence of previous 
emotional events, apart from the actual traumatic moment, upon the 
condition of the patient; and the need for a correct diagnosis to carry 
out a rational form of treatment. 

The writer quotes Gaupp in regard to the question of the treatment 
of shock cases after discharge from hospitals. Any mention of a return 
to the Front produces a return of the nervous troubles. This manifes¬ 
tation must not be regarded as due to malingering, especially as it 
frequently occurs in men of proved courage. Return to the fighting 
line will almost inevitably render the soldier a life-long pensioner on the 
State, though he might be quite usefully employed in some other 
capacity. The solution of the problem would appear to be the 
setting-up of an organisation to place such individuals in positions to 
which they are most fitted, in view of their previous occupations and 
present mental capacity. Such an organisation must be scientific and 
controlled by skilled medical advice. It is useless and often harmful 
to merely detail these convalescents to garrison duty, which may be 
irksome and monotonous, but rather must an effort be made to find the 
right kind of occupation for each individual case. 

The question of treatment is discussed under the headings of re¬ 
education, hypnosis, and isolation; and in conclusion emphasis is 


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19 1 7-] CLINICAL NEUROLOGY AND PSYCHIATRY. 419 

laid upon the necessity for institutions where incipient cases can be 
treated on a rational basis, the possession of which would prevent many 
cases from drifting into definite lunacy, and increasing the inmates of 
institutions for the insane. 

The second paper deals with the clinical aspect of the various 
neuroses met with amongst soldiers in the war. By the term neuroses 
are excluded, for clinical purposes, all cases which present any one or 
more of the definite signs we have learnt to associate with structural 
change in the central nervous system. This definition is merely one of 
convenience, however, and does not prove or assume the absence of 
structural change which may yet be present in the absence of clinical 
signs. 

The neuroses of war will be partly due to the same causes as in civil 
life, and partly to other and special causes. Some cases will thus 
present familiar features, and others special and unfamiliar features. 
This may be made the basis of a preliminary classification. Amongst 
the former are cases of hysteria—monoplegias, paraplegias, hemiplegias, 
affections of the special senses, anorexia, vomiting—which show a free¬ 
dom from symptoms of nervous shock. The second category, presenting 
symptoms not familiar in civil practice before the war, show evidence 
of general nervous shock in addition to other symptoms which may be 
present. The causes of war neuroses are manifold and comprise the 
effects of anxiety, overstrain, of want of sleep, wounds, of the concussion 
of high explosives, perpetual noises, fear, and painful scenes. All cases 
exhibit certain common mental and physical symptoms. The chief 
mental disorders are mental lethargy, lack of interest, often with no 
desire to get better, depression, want of self-confidence, difficulty of 
concentration, confusion, fear, and terrifying dreams. Physical symp¬ 
toms are tremor, amaurosis, deafness, loss of smell or taste, nystagmoid 
movements, paralyses, and anaesthesias. 

Dr. Clarke states that the symptoms as a whole give the impression 
that the pathological condition underlying them is some block in the 
passage of nervous impulses from one neurone to another—a resistance 
in the synapses. 

The third paper is a pre-war contribution based upon cases surviving 
from the explosion of the “Iena” and “Libert^” at Toulon in 1907 
and 1911. Such cases are especially interesting, as they exhibit symp¬ 
toms, in the aetiology of which emotional shock plays an indisputable 
aDd primary rdle. The writer divides his cases into those which exhibit 
minor psychopathic symptoms, and those which manifest the symptoms 
of a grave psychosis. He excludes those cases in which emotion 
appears to play only a secondary role, and those in which the psychosis 
is due to the action of some well-defined agent, such as physical shock, 
asphyxia from gas, surgical shock, etc. 

Among the minor symptoms at the moment of the shock are noted 
a state of semi-somnambulism, automatic mental activity, absorption in 
some trivial occupation, such as an exclusive preoccupation in the 
attempt to save some garment, a strange lucidity and feeling of exalta¬ 
tion, and a period of amnesia. Those who took part in the work of 
rescue and approached the horrors of the accident showed for several 
weeks symptoms of mental unrest, intense obsessive representations of 


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420 EPITOME. [July, 

the scene, terrifying dreams, diffuse anxiety, fatigue, and various minor 
phobias. A collective morbid mental state—fear, tension, etc.—was 
noted for some time afterwards among the civil and military population. 
This was especially marked in a sudden, unmotived panic which 
occurred at the funeral of the victims of the accident. 

As regards the more severe disorders, the cases are divided into two 
categories : (1) Those with a strong predisposition to mental disorders, 
degenerates and constitutional defectives, who exhibited psychoses in 
accordance with their particular predisposition, and those subjects with 
acquired defects who manifested psychoses corresponding to the defect, 
e.g., chronic alcoholics with delirium tremens ; (2) those with only 
slight predisposition, the majority of whom showed the symptoms of 
mental confusion. 

It is this second category, in which the individuals show a minimum 
of predisposition to mental disorder, that the term emotional psychosis is 
most correctly applied. In such cases there is usually a period of 
normal mental equilibrium, followed by a phase of general fatigue, 
nightmares, and retardation. This precedes the state of actual con¬ 
fusion associated with anxiety and excitement. Several illustrative 
cases are given. 

Such a psychosis thus evolves in the same way as a transitory 
psychosis caused by some intoxication. The identity of course and 
symptoms leads the writer to suggest that in these cases the emotion- 
shock can, in certain organisms hitherto healthy, cause certain nutritive 
disturbances, and liberate certain cytotoxins capable of acting on the 
brain and producing a definite mental syndrome. The diminution in 
the secretion of urine and the decrease in chlorides which is observed 
in these cases lends support to this view. The toxins may be primary, 
due to a special disorder of metabolism hitherto unknown, or they may 
be secondary, freed in the organism as a result of emotional inhibition 
of such organs as the liver and kidneys, or possibly consecutive to 
modifications in the innervation of the sympathetic nervous system. 

The last paper describes a method of dealing with the common types 
of hysterical disorder. The method has been applied in 250 cases of 
mutism, deafness, aphonia, monoplegia, paraplegia, hemiplegia, and 
disordered gaits. The chief phenomena underlying the hysterical 
make-up are weakness of will and intellect, hyper-suggestibility, and 
negativism. The patient has a certain fixed idea, the result of auto¬ 
suggestion, and to this his attitude is negativistic, otherwise he is more 
responsive to suggestion than the normal person. The fixed idea can 
be treated by suggestion, but it is doubtful as to how far the soil on 
which this symptom is developed can be improved by treatment, and 
the writers make no claim to do so. 

The principles involved in the treatment are—(1) suggestion, (2) re¬ 
education, (3) discipline. Employed alone these methods are, as a rule, 
not so efficacious as in combination. Hypnotism attempts at cure by 
pure suggestion, but unfortunately patients often show themselves 
intolerant of suggestions relating to their fixed idea while in the som¬ 
nambulic state, and the method has been found slow and uncertain. In 
isolation the method of discipline is in the foreground, but in many 
cases this, again, is often too prolonged and ineffectual. Persuasion— a 


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form of re-education—is also probably more valuable when preceded by 
preliminary suggestive treatment. 

The most reliable method has been found to' consist in brief sugges¬ 
tive treatment, followed by rapid re-education. The suggestion may 
take any form, but it is essential that the patient should be convinced 
that it will produce an immediate recovery. The simplest form is the 
application of the Faradic current, as nearly every layman is willing to 
accept the suggestion that some form of electricity will cure him. 
Before the actual suggestion, the idea should be fostered that the 
physician understands his case and is able to cure him. His attitude 
must be authoritative in every respect. When the suggestion is em¬ 
ployed, at the least sign of recovery re-education is commenced, and, 
before he can collect his thoughts, the patient is hurried along by 
persuasion until the disordered function is completely restored. 

The writers explain their methods more fully under the headings of 
the various hysterical symptoms, and in conclusion they emphasise, as 
the author of the first paper does, the necessity for a thorough survey of 
the case before a decision is made as to what form of service will be 
most advantageous to the patient and the nation. 

H. Devine. 

Mental Regression : Its Conception and Types. ( Psychiat . Bull., October, 
1916.) Wells, F. L. 

The author, who is a Doctor of Philosophy and Psychologist at the 
McLean Hospital of Waverley in Massachusetts, bases his study in 
part on the literature and in part on original cases. “ Regression ” is a 
term that has been differently defined. It is here regarded as a turning 
back to a stage of development which is only normal at a less mature 
period of the individual’s development. It is usually, though by no 
means necessarily, a reversion to the infantile, and its advantage is that 
it involves an economy of energy. It is sometimes termed the 
“ shirking reaction,” and it always detracts, in more or less degree, from 
the individual’s fullness of life, or rather, we should perhaps say, it is 
the sign and result of defective fulness of life. It may be pathological, 
but is not necessarily so, unless it interferes with adaptations, though it 
can never be regarded as normal. The young woman, disappointed in 
love, who goes into a convent, and the old maid who becomes devoted 
to her parrot, are brought forward as typical examples of regression. It 
will be seen that there is some lack of clearness about the conception of 
a “ regression,” which the author fails to dissipate. 

The exercise of the chief functions of life serves fundamental trends, 
and involves some degree of control over the external world. When 
the energy falls away to less fundamental (and usually more infantile) 
trends involving no such control, there is regression. The author dis¬ 
cusses at length the group, now regarded as very large, of auto-erotic, 
or, as he prefers to term them, auto-hedonic, phenomena, of which 
masturbation is the prototype. Masturbation may be said to occur 
“ when orgastic sensations are produced in the genital tract by action 
or mental process of which the individual is aware, and without the 
contactual stimulus of another living creature.” The author regards 


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42 2 EPITOME. [July, 

masturbation as a normal and possibly even useful transitional stage 
between the diffused pleasurable stimulation of infancy and the sexual 
activity proper of adult life ; but when it takes place in adult life it is 
regressive. With this group of phenomena may be associated intro¬ 
version. Such introversion may be said to occur when thought is more 
or less satisfactorily substituted for conduct, and imagination for reality, 
as when a young man, instead of effectively courting his sweetheart, 
day-dreams about her. This is regression. “ The more prominent the 
introversion the deeper the regression.” 

The prime feature in all regression is negation of effort, the return 
towards the child-state. The child needs no effort, because its parents 
care for it. Regression thus becomes a return to protection and domi¬ 
nation, to all those influences which may have father symbols or mother 
symbols, including not only some forms of sexuality but also of religion, 
alike in what may be regarded as its normal shape as in its erotic 
aberrations of Mariolatry, etc. This theme is developed at considerable 
length. After discussing asceticism in this connection, the author 
passes on to masochism in the sphere of erotic reactions, following 
McDougall in grouping together asceticism and masochism under the 
instinct of self-abasement. The tendency of self-abasement is against 
progression and in the direction of regression. The author seems to 
use “ progressional ” as synonymous with “ self-assertive.” He is here 
open to criticism, for there are clearly limits to the “ progressional ” 
character of self-assertion, limits which seem to be overlooked when 
both religion and anti-militarism are regarded as always and necessarily 
regressive. 

It can scarcely be said that this lengthy study—which, as will be seen, 
is mainly on Freudian lines—much advances the subject dealt with, but 
it remains interesting and suggestive. 

Havelock Ellis. 

The Psychiatric Study of Delinquency, (jfourn. Nerv. and Ment. Dis., 
May , 1916.). Adler , Herman. 

There is a tendency to regard delinquency as a manifestation of abnor¬ 
mality, if not disease. But while the attitude of the community is 
changing, and we are more and more coming to look on delinquency as 
comparable to disease and therefore to be treated with sympathy and 
constructive remedies, the law is still -chiefly concerned in searching for 
“ responsibility.” We are apt to blame the law and exalt science. The 
truth of the matter is, says Adler, that medicine in general and psychia¬ 
try in particular, have not yet sufficiently advanced the subject to 
warrant definitions of such precision that law can note them. We still 
have insufficient knowledge to analyse human nature. It will take 
psychologists and neurologists a long time to explain the phenomena, 
just as Ehrlich said it would take a hundred years to explain the pheno¬ 
mena of immunity. With this in mind and using terms simply as 
symbols, as was done by Ehrlich for his side-chain theory, Adler pro¬ 
poses the following classification of “individuals with mental and social 
difficulties”: (1) The group of defect or inadequacy, in which intelli¬ 
gence is below the lowest normal level (the feeble-minded, Kraepelin’s 


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423 


oligophrenias, the end stages of dementia praecox, and the deteriorating 
psychoses ); (a) the group of emotionally unstable (individuals of 
average or better intelligence, but showing inconduct the predominating 
influence of emotion); (3) the group of those with average or better 
intelligence and only secondary emotional disturbance, but with mistaken 
logical thought processes (the egocentric, the cynical, the prejudiced, 
the contentious, etc.). Many cases lie in the borders. A distinction 
must always be based on prolonged observation. The “ behaviouristic 
psychologist ” will place little emphasis on the results of a single exami¬ 
nation but much on the history of the case. Of 100 delinquent cases 
(men aet. 25 to 55) at the Psychopathic Hospital, 35 belonged to the 
first group, 22 to thd second, and 43 to the third. The main difference 
in the careers of these delinquents from those of average normal 
people consists in their apparent inability to learn by experience. 
Adler applies a generalisation of Weigert’s to the effect that the body 
tends to react to injury by an over-production of defences, that is to 
say, the formation of habits and the acquisition of mental control. The 
delinquent must be encouraged to react to injuring conditions by an 
over-production of defences, the threshold of the reaction to be deter¬ 
mined in each individual case. By careful training, based on analysis 
of the individual, it should be possible to influence future conduct. 
Nothing is gained by attempting to increase the intelligence of a mental 
defective or to change the personality of a paranoid individual. But 
much may be accomplished in controlling the emotional instability of 
the other group. What is needed is a system of mental and emotional 
exercises for the formation of habits, a kind of orthopsychics. Such 
training is more hopeful than punishment, for punishment increases the 
delinquent’s intoxication rather than strengthens his defences, and is 
like administering alcohol in delirium tremens. Adler draws an analogy 
from immunisation, the therapy involving a building-up of the defences 
by training and gradually strengthening, but not overwhelming, the 
organism. * Havelock Ellis. 


Korsakow's Psychosis in Association with Malaria. (Lancet, April 2 8 th, 
1917.) Carlill, H. 

Loss of memory occurs as the result of shell-shock, it may be simu¬ 
lated to avoid uncongenial service, and it is a symptom of dementia 
paralytica, concussion, alcoholic psychoses, senility, and epilepsy. The 
form of amnesia described by Korsakow as occurring in alcoholic 
patients with peripheral neuritis has also been found, associated with 
nervous symptoms, in other illnesses, such as typhoid, diabetes, and 
arsenical poisoning. 

The writer here describes the case of a stoker, aet. 45, with the 
characteristic mental symptoms of Korsakow’s psychosis, which he 
regards, in this instance, as malarial in origin. The neuritic symptoms 
were confined to a loss of the ankle-jerks. General paralysis was 
excluded by a negative Wassermann reaction. H. Devine. 


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EPITOME. 


[July, 


Dementia Prczcox associated with Uncinariasis. (The Journal of 
Nervous and Mental Disease.) Bondurant , Dr. Eugene D. 

In the Southern States of America the hookworm has long been 
regarded as a .possible causative factor in the psychoses and other 
nervous disturbances of childhood and early life. It exerts an uniformly 
unfavourable influence over mental development, and contributes 
towards the production of epilepsy, hysteroid states, and confusional 
psychoses, all of which syndromes disappear when the parasites are 
expelled. 

In the case recorded hookworm injection seems to have constituted 
the sole exciting cause of a genuine dementia prsecox. It was that of a 
young girl, set. 16, previously healthy and mentally sound, of above the 
average intelligence. Except that her mother had been “ nervous ” at 
times her family history was alleged to be free from taint of neuro¬ 
degeneracy. 

She spent a summer in the country and went without shoes part of 
the time, and “ had ground-itch terribly.” Soon after she grew pale 
and weak, became listless and indifferent, and mentally dull. On 
returning to school she found her work too hard for her, and that she 
“ could not learn.” During former years she had been bright, intelli¬ 
gent, active, attentive, and near the head of her class, whereas she was 
now dull, apathetic, inattentive, given to dreaming, and at times 
seemed dazed and confused. She grew worried and despondent, and 
cried a good deal. As time passed she grew steadily worse, became 
more apathetic, completely unable to learn anything, or fix her attention 
on her tasks ; got slovenly in habits, talked to herself, and was silly and 
feeble-minded to the last degree. 

She was brought home, when her condition was a fairly typical hebe¬ 
phrenic dementia praecox. She would not converse, would sit immov¬ 
able staring at vacancy; would at times smile or giggle foolishly ; she 
made no complaint and did not seem distressed—merely apathetic, dull, 
and devoid of mental activity. She was entirely indifferent to Her 
personal appearance, would not dress or undress herself, and was 
unclean in her habits. 

Amongst other “physical” symptoms there was a partial anaesthesia 
over entire cutaneous surface. There were no cataleptoid symptoms. 
Examination of faeces showed the presence of hookworm ova in unusual 
numbers. 

After free movement of bowels by calomel and Epsom salts she was 
given ten grains of powdered thymol in a capsule every twenty minutes 
until sixty grains were taken. Two hours later she had a second dose 
of salts. About 1,500 hookworms were expelled. Liberal dietary was 
given, with an iron tonic, and rest in bed for ten days. Improvement 
was immediate, and recovery rapid and complete. Before the ten days' 
rest was finished all symptoms of mental retardation, instability, and 
defect had completely disappeared, and memory, reasoning power, and 
power of attention, as well as the emotional state, were practically 
normal. One month later she returned to school, made up her 
deficiencies, and completed the work of the year with her class, and 
with credit. 


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Three years after the patient had remained perfectly well, there being 
no trace of mental or nervous instability, peculiarity, or defect, to 
suggest the occurrence of a former severe psychic degeneration. 

T. Drapes. 


3 . Sociology. 

Eugenic Factors in Jewish Life. (The American Hebrew , January - 
February , 1917.) Fishierg, M. 

It is well known that the Jews produce a very much larger proportion 
of persons of marked ability than the nations among which they live. 
Thus, although constituting less than one-third per cent, of white 
humanity, about a dozen of those who have received Nobel prizes have 
been Jews, and of the three American men of science who were awarded 
the Nobel prize, one was of Jewish extraction. It is also known that 
there is a very much larger proportion of mental defectives, insane, 
idiots, congenitally deformed, and physically weak or puny individuals 
among the Jews than in any other civilised religious, social, or ethnic 
group. Dr. Maurice Fishberg, of New York, a distinguished authority 
on Jewish anthropology and sociology, author of a comprehensive book 
on The Jews , here attempts to explain these two apparently con¬ 
tradictory facts. The considerations he thus brings forward have an 
important bearing on heredity as well as on eugenics and dysgenics. 

Up to about seventy-five years ago practically all Jews were orthodox 
and intensely religious, following Biblical and rabbinical ordinances in 
matters of matrimony as in everything else. These ordinances were on 
the whole more eugenic than Christian or Mohammedan marriage laws, 
but with important exceptions. Every Jew was bound to marry and 
procreate as early as possible in life—before the age of eighteen—and 
for Jewesses before sixteen, but not before thirteen. Recalcitrants were 
forced to marry. Marriage for money was deprecated ; the bride must 
belong to a worthy family, and above all it was desirable that she 
should be the daughter of a learned man. The mediaeval and late Jews 
were thus apparently great believers in heredity, and their ideals of 
marriage centred in intellect and learning. If the rich could not find 
scholarly husbands for their daughters in their own circles they would 
seek them among the poor. Rich learned castes were thus formed, but 
not wealth, or old stock, was the core of the caste, but intellect. A 
promising boy among the poor was always sought out, educated, and 
well married, and an intellectual aristocracy thus constituted. It is on 
this foundation that the great achievements of the Jewish mind have 
arisen. 

But there is another side to Jewish marriage laws and customs. In 
the first place, while regard was had to the beauty and physical con¬ 
dition of a bride, there was complete indifference to the physical defects 
of the bridegroom, provided he was a scholar. Moreover, although the 
beautiful bride was preferred, every Jew and Jewess, even if a physical 
and mental cripple, was encouraged to marry and to propagate. The 
blind were united with the lame, the insane with the imbecile, etc., and 
a remarkable and far-reaching dysgenic influence was furnished by 
societies to supply these unfortunates with dowries and trousseaux. 


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Such societies still exist, not only in Eastern, but even in Western 
Europe. Thus it is that, beside the excess of superior members in a 
Jewish community, there is also an excess of paupers and defectives, 
with a large number of borderland cases fairly healthy but with sub¬ 
normal energy, so that they are periodically out of employment; as 
they do not become drunkards, and are consequently considered by the 
charitable as “ deserving,” they are encouraged to go on increasing 
their numbers. 

These conditions are changing. The Jews are adopting the customs 
of their non-Jewish neighbours. The number of defectives will thus be 
diminished. The proportion of intellectually superior Jews will also be 
diminished. “Whether the loss thus sustained in the number of 
capable Jews is compensated by the decrease in the number of de¬ 
fectives,” Fishberg concludes, “ depends on the point of view.” 

Havelock Ellis. 


The Madness of an Emperor, or the Aberration of a Nation 1 [Pazzia 
<dImpcratore 0 Aberrazione Nazionale ?] (Rivista di Patologia 

Nervosa e Mentale , Anno xx, fasc. 7, 1915.) Prof. Ernesto 
Lugaro. 

Among the many books and pamphlets which have been published 
on the psychology of the authors of the present war, that is to say, not 
only on the psychology of the two Emperors and that of the chief 
members of their governments, but also on that of the German peoples, 
Prof. Lugaro’s article takes a high rank. It is one of the most powerful 
indictments of the German race which has appeared, but the facts by 
which the arguments are supported, are proved facts, and the conclusion 
is arrived at logically, step by step. 

The writer examines briefly the case of Francis Joseph, “a man of 
intellectual mediocrity, and moral insensibility,” to whom no one has ever 
attributed a generous act, a happy phrase, or a far-seeing thought. 
Possibly during the last few years he was sinking into senile dementia. 

William’s case is considered more in detail. But after making due 
allowance for his atrophied limb, his epileptiform seizures, his vanity— 
oscillating between sheer childishness and the delusions of a para¬ 
noiac—his brutal, blasphemous speeches, his duplicity, the writer only 
sees in the German Emperor “ a docile, though sometimes maladroit, 
instrument in the hands of the German Government.” 

The Professor pushes aside the two Emperors almost contemptuously. 
He proceeds to study the German race, politically, morally, socially. 

He recites the history of the double-dealing policy of Germany from 
the days of Frederick II to those of Bismarck and Bethmann-Hollweg. 
“ It was not only in August, 1914, but for two centuries that Germany 
has sustained the theory that treaties are only to be respected while it 
is convenient to do so.” 

The various systems of German espionage are described in detail. 
Foreign espionage is considered under the heads of military and 
economic, the latter being the more perfidious and unscrupulous. As 
to the domestic espionage, it is so terrible that one cannot believe that 
any but a race of slaves would submit to it. 


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The moral and social conditions of the German people as revealed 
among the officers of the army, the rich industrials, the socialists, and 
the intellectuals, and the parts played by these classes in preparing for 
the present war, are studied with care. In the analysis of the famous 
“ Appeal to Civilised Nations ” every shred of hypocritical respectability 
is torn away, and German intellectuality, such as it is, stands naked 
before the world. 

The history of the growth of the theory of Germany’s hideous system 
of war is traced from the time of Von Clausewitz to the present day. 
The doctrine of this system being admitted, one understands how the 
Germans deny their misdeeds, and assert that no act of useless cruelty 
has been committed by the Kaiser’s troops. Then in a paragraph, 
every sentence of which rises above the last in burning eloquence, 
Lugaro relates the horrible story of the German atrocities during the 
present war—atrocities which are utterly unequalled for devilish cruelty 
in the history of the most barbarian nations. 

In England a great deal has been made of the point that the 
commanders and crews of German submarines who sink unarmed 
merchant ships and leave the sailors and passengers to perish miserably, 
and the German officers and soldiers who murder the wounded, 
massacre the civil population, violate women, and burn down private 
houses unnecessarily, commit these crimes because they are ordered to 
do so, and that consequently they are free from responsibility. Hear 
what Lugaro says: 

“ With all that, although obedience may be in the blood, although it 
may be reinforced by habits acquired in the family, in the school, and 
in life, there are acts of obedience which would not be committed if 
the moral stamp of the man who obeys were not adapted to the 
order which he receives. There are armies—not Gentian—which 
would not obey certain revolting orders. There are soldiers—not 
German—who would allow themselves to be shot rather than murder 
the wounded, rip up women, or mutilate infants. There are officers— 
not German—who would feel themselves dishonoured by transmitting 
certain orders. It is all very well for theorists sitting at a table to 
declare that terrorism is a military necessity, but terrorism could not 
be put into practice if the troops were not adapted to the inhuman 
work.” 

The Professor’s conclusions are obvious : 

“ Even if one cannot recognise perfect normality of mind in the two 
Emperors,” he says, “ one must admit that their abnormalities have a 
negligible value in the face of the great psychological and social 
movements which prepared the present war. The mind of Francis 
Joseph and the arm of William are not worth even as much as the nose 
of Cleopatra.” 

Prof. Lugaro writes me that his article has been translated into 
English by Dr. W. N. Robinson, and published by Routledge & Sons. 
If any one meets with the pamphlet it is worth reading, and will open 
some people’s eyes. J. Barfield Adams. 


LXIII. 


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4. Psychology in Literature. 

Insanity in some of Shakespeare's Female Characters and Feminine 
Psychology \Follia nelle Donne dello Shakespeare e Psicologia 
Femminile\. (II Manicomio, January, 1915.) Prof Fr. Del 
Greco. 

One is sometimes tempted to ask whether foreigners understand 
Shakespeare. We know that with all their boasted study of his plays, 
and their—save the mark !—emendation of his text, the Germans do 
not and never did understand him. The Hamlet that one meets in 
Wilhelm Meister is Goethe’s Hamlet, not Shakespeare’s. Dr. Her¬ 
mann Ulrici reads his own fantastic ideas into the Englishman’s honest 
work. Gervinus is possibly a little more rational, but very little. 

There is no doubt that the Italians understand the English dramatist 
better than other foreigners. This may be due to the fact that directly 
or indirectly Shakespeare wrote under the influence of Italian literature. 
He was acquainted with the works of Boccaccio, Ariosto, and others, 
either in the original or by means of translations. The scenes of many 
of his plays are laid in Italy. Do not the names of Venice, Verona, 
Padua, long before they evoke the recollection of some fact in history, 
call up to our minds the story of Portia and Shylock, the feuds of the 
Montagues and the Capulets, the quarrels of Katherine and Petru- 
chio ? Would it have been possible for the story of Romeo and 
Juliet, with all its colour and its passion, to have been written of 
any but Italian lovers ? Nay, more, would it have been possible for 
it to have been written by any man who was not impregnated with the 
genius, the life, the very perfume of “ the land where lemon-trees do 
bloom ? ” 

Prof. Del Greco is himself conscious of the difficulties that a foreigner 
meets with in interpreting the English poet. 

“ William Shakespeare !” he exclaims. “He is so different to us. 
How can we understand him ? As his dramas unroll themselves, we 
see the most varied human characters moving among the multitudi¬ 
nous vicissitudes of life. They follow a logical course, and the 
logic reveals itself distinctly in every character amid its changing 
fortunes. Certainly, there are apparent disorders, due to the com¬ 
plex, the casual, and the unexpected, which are found in human 
actions.” 

The first of Shakespeare’s heroines, studied by the Professor, is 
Ophelia. She is a charming girl, and in his earlier and happier days 
before the shadow of his father’s murder fell across his path, Hamlet 
made love to her, brought her flowers, and wrote madrigals in her 
honour. Her father, Polonius, and her brother, Laertes, growing 
suspicious of the object of Prince Hamlet’s attentions, forbade her to 
receive him, and Ophelia, though she loved him with all her heart, 
obeyed. 

Strange coincidence! The refusal of Ophelia to receive Hamlet 
occurred about the same time that the story of his father's murder was 
revealed to him. Ophelia’s father and the Queen, Hamlet’s mother, 
believe that the extraordinary conduct assumed by the Prince is due to 
love. To test the case, they arrange a meeting between the girl and 


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the young man in the Palace. At first Hamlet speaks gently. Then he 
perceives that he is being spied upon, and his suspicions fall upon 
Ophelia. His manner changes; he speaks bitterly, cruelly. The poor 
girl suffers intensely; partly because she thinks that she is abandoned, 
but far more because she sees, or at any rate, believes, that her beloved 
Hamlet is mad. 

The poet with happy expressions indicates the development of 
Ophelia’s heart-felt sorrow. 

In the play-scene, Hamlet lies at Ophelia’s feet. But he behaves 
cruelly to her. His whole attention is bent upon the King. What he 
says to the girl is hard and pungent, and is spoken with a sneer upon 
his lips. When she is alone, Ophelia broods over her sorrow, her 
agony, which is a mixture of pity, disillusion, and wounded pride. 

Then comes the decisive event. Hamlet accidentally kills Polonius, 
and Ophelia becomes mad. 

Through a maze of dark events and sad presentiments the poet leads 
us to the culmination of the tragedy. In spite of some opposition, 
Ophelia makes her way into the royal presence. She, the flower of 
modesty, is dissolute in her speech. Her dress is in disorder. 
She sings snatches of songs, which she interrupts with disconnected 
and incoherent phrases. From these phrases, as from the fragments of 
a broken crystal, one can reconstruct a mind, the agony of a mind ; 
they are expressions of a love betrayed, of suspicions, of mental pain, 
all mingled with fleeting images of the secret funeral of her murdered 
father 

The last scene shows u*s the poor, mad girl, crowned with flowers, 
clinging to a willow-tree on the bank of a brook. She slips, loses her 
hold, and falling into the water, is drowned. 

Having thus briefly sketched Ophelia’s case, the Professor proceeds 
to consider it from a medico-psychological point of view : 

“ Is this picture of Ophelia’s madness exact ? ” he asks. “ It is to a 
certain point.” “ From what form of madness was she suffering ? ” 
“ From dementia prajcox.” 

Shade of Kraepelin ! Ophelia suffering from dementia praecox ! 

Young men and young women, proceeds the Professor, of pleasing 
mental constitution, who have previously shown themselves bright and 
intelligent, gradually or suddenly, sink into madness. They are delicate 
plants which quickly wither in the flower of their age at the shock of 
oncoming puberty. Such was the madness of Ophelia. 

But after all, the Professor has some doubt about his diagnosis. 

If this, he goes on to say, had been a picture of true madness, there 
would have been in the language of Ophelia phrases more empty and 
more disconnected. The sphere of the emotions would not have been 
deep and susceptible to suffering, but gentle and colourless. The 
nature, which feels profoundly, does not become mad in this way. 
Certainly, among the prodromes of dementia praecox there are delusions 
of love, mysterious rapes, and vain dreams of ambition. But all from 
the beginning have the impress of an affectivity capable of little resist¬ 
ance. The apathy, so characteristic of this form of disease, is marked 
from the commencement, and gives to the combat of the affections a 
note of superficiality and incoherence. In Ophelia there was a painful 


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superabundance of the affections : there was a feeling of outrage when 
she saw herself suspected and derided. A person predisposed to 
dementia praecox before all this would have been indifferent. Was not 
after all the case of Ophelia one of minor gravity ? Have we not before 
us an episode in a case of simple “ confusione mentale ,” which might have 
been cured ? After all, it was a sad accident, and nothing else, which 
caused the death of the poor girl. The clinical picture does not leave 
that in doubt. 

There is one point that Prof. Del Greco has not mentioned. If 
Ophelia had been suffering from dementia praecox, would she have 
cared a brass farthing about her lover? And Shakespeare certainly 
indicates that she cared a great deal about him. Would she have been 
distressed at the idea that he was mad, at his altered demeanour, his 
rudeness, his untidiness in dress, he, who in her eyes, and in the eyes of 
all the world, had been the very flower of chivalry ? 

The Professor next proceeds to the consideration of the case of Lady 
Macbeth. 

Macbeth has communicated the witches’ prophecy to his wife. The 
old king, Duncan, is their guest that night in their own castle. The 
idea of murdering him springs up in both their minds. Macbeth hesi¬ 
tates, and his ferocious wife with words of pungent sarcasm spurs him 
on to commit the crime. We see Macbeth, through all the unfolding 
of this terrible scene, hesitating, agitated by thoughts of remorse and 
fear—thoughts, in the midst of which glitters a solemn, grandiose 
philosophy. We see the varying phases of the consciousness of Mac¬ 
beth. And beside him stands his strong, violent, and cunning wife. 

Duncan is murdered, and Macbeth is king, and the latter, giving way 
more and more to massacre and slaughter, becomes the victim of frightful 
visions. Lady Macbeth, a clear-sighted and profound dissimulator, 
rules and comforts him. 

At this point, the position of the two characters changes. The savage 
energy of Macbeth rises supreme among all the horrors that surround 
him. Lady Macbeth disappears from the drama. Suddenly, when the 
catastrophe is imminent, when the ruin of the tyrant is approaching, 
Lady Macbeth reappears. A doctor and a maid are beside her. With 
a lamp in her hand, and dressed in white, she moves like a phantom 
across the stage. With broken, feverish words, with a profound sigh, 
with gestures which reproduce the terrible circumstances of the night of 
the assassination of Duncan, she passes from our sight. The tragic 
effect of the scene is extraordinary. 

Is that scene true to nature ? The somnambulism of Lady Macbeth 
is true. It is true also that the words and acts of long ago, buried in 
the memory and the mind, repeat themselves in such a state. It is true 
that there are ferocious women like Lady Macbeth who never experience 
remorse. They are grave neuropathies. They may be sufferers from 
hysteria. Somnambulism is not uncommonly a manifestation of 
hysteria. But this is a feminine malady par excellence. Terrible 
women, such as the one we are considering, have both feminine and 
masculine characteristics. It is common for hysterical criminals to 
poison their victims, and if Lady Macbeth did not poison hers, she 
came very close to it. It was not to make them drunk only that she 


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put drugs into the wine of those who guarded Duncan. However, 
somnambulism is only a morbid episode; it is not a serious disease, 
and it does not cause death, which appears to have taken place suddenly 
after her sleep-walking, in the case of our heroine. 

Then follow some remarks which it would be well if those of us, who 
are fond of searching for evidence of mental disease in the characters 
and actions of personages in fiction and even in ancient and modern 
history, would read, mark, learn, and inwardly digest. 

But it is ridiculous, says Prof. Del Greco, to criticise Shakespeare 
from an alienist’s point of view at the distance of several centuries. 
What was known about psychiatry at that time ? Besides, a poet is not 
compelled to follow the objective-truth of facts and ideas in all their 
minute particulars. He must convey the appearance of truth. That is 
all. He must move the feelings of his audience, and sometimes in 
doing so his genius leads him away from the truth. If Ophelia had 
been drawn as her form of madness demanded that she should be, she 
would have appeared insignificant. Without the terrible somnambulism 
of Lady Macbeth, she would have aroused in our minds only the feelings 
of fear, horror, and repulsion. 

Those modern poets who describe facts in all their crudity, those 
artists who reproduce disease and madness with great fidelity upon the 
stage are imitators, not poets and artists. One cannot help thinking 
that this is going a little too far. Surely, when it is necessary to 
describe disease or madness, fidelity is better than monstrosities which 
offend common sense, or travesties which verge upon the ridiculous. 

The writer then passes on to consider the passion of love as it is 
revealed in Shakespeare’s women ; pure and all-else-forgetting as in the 
case of Juliet, selfish and interrupted by memories of past amorous 
entanglements as in that of Cleopatra. 

Shakespeare, says the Professor, endows his women with great fatality 
of the affections and impulses. He makes them terrible by that, not 
by the mind or the will. They have no power of long-continued 
resistance; they have not the energy of men. Hamlet, Macbeth, 
Othello, in tremendous circumstances only reveal the original dis¬ 
equilibrium of their minds. They are not mad at all. Shakespeare 
has only one study of a madman—old King Lear—and he in the end is 
cured. Ophelia and Lady Macbeth, on the other hand, show grave 
signs of mental disease. 

In spite of charming writing and a wealth of illustration, ranging 
from the female as found among the lowest and most disagreeable forms 
of animal life to Sappho singing her love songs by the shores of the 
^gean Sea, the remainder of the paper, that which deals with the 
psychology of woman, is rather commonplace. The writer tells us 
nothing new. He only presents us with well-known facts arrayed in 
beautiful language. His conclusion practically comes to this: that the 
masculine and feminine minds, even where they seem most to differ, 
are not opposed, but are merely complimentary the one to the other. 

J. Barfield Adams. 


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5. Asylum Reports for 1916. 

The Annual Report for the Year 1916 of the Government Asylums in 
Egypt. 

Yearly we receive this Report and each number impresses one with 
the amount of constructive work which is being carried out in Egypt. 

This year further relief from merely clerical work has been given to 
the Director, Dr. Warnock, by the Central Board taking over many 
details as to payments and general non-medical administration. 
Government has recognised the good work done and conferred on him 
a New Year Honour. 

The Report consists of five parts ; the first contains the general report 
on the whole lunacy division, the second refers to “ M ” special hospital 
for British military cases, Part III is devoted to the parent institution 
and Part IV to the new asylum at Khanka, while an additional part 
provides appendices concerned chiefly with Government instructions. 

The number of beds in the two asylums remains 1,550; the number 
of patients in residence has risen from 2,055 to 2,081, there being an 
excess in residence amounting to 531. The ordinary admissions were 
970, besides 324 British soldiers. 824 Egyptian patients were dis¬ 
charged ; 228 of these recovered, while 575 were sent homj, though not 
recovered, but being harmless they were discharged to make room for 
more acute cases ; 21 were found not insane. This is not satisfactory, 
for such unstable persons tend to relapse or to fall into degenerate or 
criminal ways. 

The number of deaths at the two asylums amounted to 244 ; on the 
average number resident, 11*2 per cent. 

Lists of the various general and administrative works carried out are 
given in detail. 

An irrigation farm was worked at Khanka Asylum and this produced 
vegetables for both asylums, but the land was becoming water-logged, 
so the farming had to be reduced. Seven patients were admitted with 
fractured bones, six with cut throats. Eight patients were received as 
voluntary boarders, and this marks an advance in the understanding 
of the treatment of the insane by the general Egyptian public. 

The European medical staff is reduced to two, Dr. Warnock and Dr. 
Dudgeon, but an officer of the R.A.M.C. was supplied to assist with the 
British military patients. 

Part II .—This is concerned with the returns from the military 
special hospital, called “M.” During the year 324 patients were 
admitted, suffering from the various forms of insanity. Melancholia 
contributed 59, mania only 16, alcoholism 31, and general paralysis 117. 
Epilepsy 23, and adolescent insanity 36. Simple mental weakness is 
represented by 45 cases, and neurasthenia 30. One would have 
expected more than 18 delusional cases, but the general result is much 
as might be expected. Of these patients the Wassermann test was 
applied with a positive result in 35. 

The table giving attributed causes is, like all such tables, imperfect; 
active service, heredity, and epilepsy being credited with the chief part 
in causation. 

Part III .—Including the military patients 1,344 patients were 


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admitted in the year, a larger number than admitted in any asylum in 
the British Empire. 

The patients were employed in making baskets and mats. The usual 
clinical lectures were given to fifth-year students of the Cairo School of 
Medicine. A certain number of Turkish prisoners were admitted. 
Their language being Turkish made it difficult to get into touch with 
them. 

Twenty-five convicted prisoners were sent for report on their mental 
condition, of whom seven men and two women were sent back to 
prison, being sane. Four murders were committed in Egygt by lunatics, 
but none of these had been in the asylum. Seven persons accused of 
grave offences had been in the asylum, and had been returned to the 
care of their friends. 

A series of interesting tables is given, showing the forms of insanity 
and the nature of the offences of 55 male patients. Of the 55 males 
and 4 female patients 12 suffered from pellagrous insanity, 4 from that 
due to hashish. General paralysis was not represented among these 
patients. Murder and attempted murder were common, and these not 
specially associated with any one cause. A table is given of the forms 
of mental disorder met with among the prisoners of war. 

Of admissions, 1,104 were first admissions, while 240 were readmis¬ 
sions. The usual tables as to times of admission, occupations, etc., are 
given, and need not be reproduced here. 

Of 923 admissions 120 men and 59 women were suffering from 
pellagra, 52 from hashish, 192 from mania, 90 from melancholia, and 
69 general paralysis. 

Special tables in reference to pellagra are given, showing the districts 
from which they cgme. Tables giving the nationality and the places of 
residence of the general paralytics are given. Nine per cent, of the male 
admissions were suffering from general paralysis of the insane. 

A considerable number of the patients had an undoubted neurotic 
heredity, and it was certain that a much larger number had that defect, 
but it was hard to get a true history in Egypt, and we know the 
difficulty in England. The death-rate is rather above the English 
standard. Only 15 autopsies were performed, in consequence of the 
pressure of ordinary work. 

The Laboratory examined by Wassermann test 850 specimens, and 
also 521 cases of ankylostoma, beside a few cases of bilharzia, malaria, 
and tuberculosis. 

One table of particular interest gives the statistics of 630 consecutive 
cases to which Wassermann’s test (Meier’s modification) was applied. 
The result was positive in 26‘6 per cent, of men and 30 per cent, of 

women. 

Of general paralysis of the insane, 75*6 percent, men positive and 100 
per cent, females positive. A full list is given of the forms of mental 
disorder and the percentage of positive reaction. This is worth careful 
study. In treatment a large amount of hypnotics was found to be 
necessary, and Dr. Warnock found the wet pack, now discarded in 
England, a useful help. 

Many attempts at suicide by hanging were made, but without success. 

The high seclusion rates and the free use of hypnotics are a direct 


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434 EPITOME. [July, 

result of excessive overcrowding, which Dr. Warnock says is to be re¬ 
gretted. This part is brimful of interest for all connected with asylum work. 

Part IV. —Dr. Dudgeon’s special report is eminently practical. He 
points out the reduction of costs, and of the increase of useful work on 
the land. 

At Khanka there is accommodation for 400 patients, but there are 
700 in residence. 

The medical staff consists of Dr. Dudgeon and three native assis¬ 
tants. It is suggested that at Khanka the country patients should be 
received, while Abassia will take those from towns. Dr. Dudgeon 
regrets that a large number of epileptics and chronic patients have to 
be received, thus reducing the numbers of curable patients who could 
work on the farm. The usual tables are added, including the various 
items of administrative cost. 

The death-rate is rather high, and depends to a great extent on 
general physical decay and diarrhoea of a very intractable kind. No 
mechanical restraint has ever been used in the asylum, and seclusion 
has also not been used this year. Lectures were given by one of the 
Egyptian doctors to the staff, and the results were satisfactory. 

The list of diseases treated is a very long one, and a very large 
number of surgical lesions are reported. 

Scabies, dysentery, and diarrhoea are very common. 

Thirteen of the staff suffered from malaria. 

The electric power is much used for pumping as well as lighting, and 
the water supply was reorganised. 

Drug-producing plants are being grown on the farm to some extent. 
Very full tables of expenses are given. Dr. Dudgeon had for over three 
months to take over the duties of Dr. Warnock, who was on holiday. 
His work, as shown by the reports, gives evidence of his energy and 
determination under local conditions of difficulty and isolation. 

Part V of the Report contains very interesting views of the develop¬ 
ment of the treatment of the insane in a partially organised country. 
Instructions in detail are given as to the removal of lunatics from 
various parts of the country to the asylum, it being made clear that the 
patient is not to travel with the ordinary travellers. In Egypt there are 
now, all over the country, district hospitals under Government control 
with native doctors. In each of these provision is made for the 
reception of local lunatics, but it is pointed out that these hospitals are 
only receiving stations, and that all patients, if markedly insane, must 
be sent at once to the central asylum at Abassia. It was found 
necessary to draw up rules for the temporary treatment of such cases, 
and an admirable and concise code is laid down. The instructions 
would rather amuse English doctors connected with asylums from their 
simplicity, but one can see the necessity for exact directions for the 
local doctors. Instructions are given so that persons who are excitedly 
talking religion or politics should be cared for, but not necessarily 
treated as insane. 

It seems that persons have been rather summarily sent to the asylums 
without certificate or order. Anyway, from the appendices one can 
trace the evolution of a Lunacy Law. 


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Part IV.—Notes and News. 


THE MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREAT BRITAIN 

AND IRELAND. 

The Ordinary Quarterly Meeting of the Association was held at the Medical 
Society’s Rooms, Chandos Street, London, W., on Tuesday, May 15th, 1917, Lieut.- 
Colonel David G. Thomson, M.D., R.A.M.C., President, in the chair. 

There were present: Sir G. H. Savage, Sir Robert Armstrong-Jones, and Drs. 
T, S. Adair, G. F. Barham, Fletcher Beach, D. Bower, P. E. Campbell, J. 
Carswell, James Chambers, R. H. Cole, Maurice Craig, A. C. Dove, T. Drapes, 
T. Duff, R. Eager, J. H. Earls, C. T. Ewart, C. F. Fothergill, A. Hume Griffith, 
W. S. Kay, H. Wolseley-Lewis, H. J. Mackenzie, W. F. Nelis, E. S. Pasmore, 
J. G. Porter Phillips, D. Rambaut, J. Noel Sergeant, G. E. Shuttleworth, R. Percy 
Smith, T. E. K. Stansfield, J. Stewart, J. Tattersall, F. Watson, W. R. Watson, 
and R. H. Steen (Acting Hon. General Secretary). 

Visitor: F. Sano. 

Present at the Council Meeting: Lieut.-Colonel D. G. Thomson, M.D., R.A.M.C. 
(President) in the chair. Sir Robert Armstrong-Jones, and Drs. T. S. Adair, Jas. 
Chambers, R. H. Cole, Thos. Drapes, R. Eager, H. J. Mackenzie, J. G. Porter 
Phillips, J. Noel Sergeant, T. E. K. Stansfield, H. Wolseley-Lewis, and R. H. 
Steen (Acting Hon. General Secretary). 

Visitor : Dr. David Bower. 

The following sent communications expressing regret at their inability to be 
present: Drs. R. Dods Brown, J. R. Gilmour, R. R. Leeper, John Keay, R. B. 
Campbell, C. C. Easterbrook, N. Lavers, P. W. Macdonald, J. D. McRae, M. J. 
Nolan, H. H. Newington, G. N. Bartlett, and J. G. Soutar. 

The minutes of the last meeting, having been printed in the Journal, were taken 
as read, and approved. 

Obituary. 

The President said that before proceeding to the brief agenda, he regretted 
having to report a serious and heavy obituary list since the Association last met. 
No less than five of their well-known colleagues had, since then, departed this life. 
The first was Dr. R. B. Smyth, who was Medical Superintendent of the County 
Asylum, Gloucester. One knew, both from the obituary notices and from other 
knowledge, that Dr. Smyth must have been a Very able and brilliant man. He 
died at the comparatively early age of 45. He was educated at Uppingham School, 
and at Trinity College, Dublin, where he graduated in 1893. In 1894 he became 
Clinical Assistant at St. Luke’s Hospital, and in 1895 was appointed Assistant 
Medical Officer at Gloucester County Asylum, and became Superintendent of that 
institution on the death of Dr. Henley in 1908. There he won the entire confidence 
of his Committee, his affection for his patients and the great interest he took in 
their welfare was always predominant. Dr. Smyth must have been a very keen 
all-round man, not only in his work, but in all forms of sport, athletics, and all 
forms of outdoor recreation; he was a good shot, and an exhibitor of dogs, for 
which he won cups and prizes. The funeral took place at Belfast. He left behind 
many to mourn his loss, not least among them being his colleagues, his staff, and 
his patients. 

Another of the members who had died recently was Dr. William Rawes, who, 
being a London member, was seen at the Association’s meetings more frequently. 
He was Medical Superintendent of St. Luke’s Hospital, City Road. He, too, 
passed away at a comparatively early age, namely, 55. He had been connected 
with St. Luke’s for many years, and his sudden death, from some form of lung 
trouble, took place very shortly after that establishment was closed. 

The next death to be noted was that of Dr. Thomas Seymour Tuke, a very 
constant attender at the meetings of this Association, and well known to most of 
those in the room. He did good work on the Council. His death took place at 
the age of 61, from pneumonia, which followed rapidly upon an apparently simple 
cold. The Lancet, in its obituary notice, said that the deceased member was the 


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son of Dr. Harrington Tuke, who, in the last generation, was a leading consultant 
physician for mental disorders, and was a grandson of the famous Dr. John 
Conolly. Dr. Tuke was educated at St. Paul’s School, and afterwards proceeded 
to Brasenose College, Oxford, and later to St. George’s Hospital. He had a keen 
love for all British games and sport. After his Oxford career and his entry at St. 
George’s, he showed his abilities as a physician, especially in this department of 
the great subject. He was also one of those who protested against the dangers 
which might follow on the existing fashion of placing insane patients in ordinary 
nursing homes, a very important danger to be remembered at this time. Dr. Tuke 
spoke from a full knowledge of his subject, after many years' association with his 
brother at Chiswick House. He was appointed lecturer on mental diseases at St. 
George’s Hospital. His instruction to his students was always of a very practical 
character, and his general advice to them in matters connected with lunacy was 
always of a character which they required in general practice. He did not aim at 
any high philosophical methods, nor methods based upon scientific research; his 
aim was to present them with what would be most useful to them when they would ’ 
come into contact with actual cases. In his death there was removed from among 
them one of the kindest and most sympathetic of men, and one who discharged his 
professional duties with the highest appreciation of their importance and delicacy. 
He married a daughter of the late Dr. Graily Hewitt, a well-known obstetric 
physician, and his wife and daughter survive him. His only son, Second Lieut. 
A. H. S. Tuke, he lost in the war. 

The next name was that of Dr. Murdoch, the Medical Superintendent of Berks 
County Asylum, Moulsford. Dr. Murdoch had a very useful career there, and was 
much thought of by his committee and his patients. He died suddenly, from 
appendicitis, leaving a widow and family. 

The foregoing were all well known to members of the Association, and did 
active work for it, and it was his duty to propose a vote of condolence to the 
relatives on the sad occasions. 

There was yet another name to mention, and it gave him a shock when he heard 
it to-day, because it was the death of a young and promising member of this 
specialty—Captain Blandy, R.A.M.C., Military Cross. He had been Assistant 
Medical Officer, Middlesex County Asylum, Napsbury. He was a former col¬ 
league of the President’s, and he knew what admirable qualities he had, as well as 
a distinct charm. He was doing exceedingly well in his work. He was killed in 
action. 

The resolution of sympathy with the relatives of the deceased was carried by 
members rising in their places. 

Election of New Members. 

The President appointed as scrutineers for the ballot Dr. Pasmore and Dr. 
Mackenxie. 

The following were unanimously elected members : 

Crocket, James, M.D.Edin., D.P.H., Medical Superintendent, Colony of 
Mercy for Epileptics, Consumption Sanatoria of Scotland, Craigielea, 
Bridge of Weir. 

Proposed by Drs. D. Fraser, R. D. Hotchkis, and R. B. Campbell. 

Mackay, Norman Douglas, M.D., B.Sc., D.P.H., Dall-Avon, Aberfeldy, 
Perthshire. 

Proposed by Drs. H. C. Martin, W. F. Nelis, and R. B. Campbell. 

Morris, Bedlington Howel, M.B., B.S.Durham, Inspector-General of Hos¬ 
pitals, South Australia; Pembroke Street, College Park, St. Peter’s, S. 
Australia. 

Proposed by Lieut.-Col. D. G. Thomson, M.D., R.A.M.C., and Drs. H. 

Hayes Newington and R. H. Steen. 

Shaw, John Custance, M.R.C.S.Eng., L.R.C.P.Lond., Medical Superin¬ 
tendent, West Ham Borough Asylum, Goodmayes, Essex. 

Proposed by Drs. John Turner, G. W. Slater, and R. H. Steen. 

The President said he had now to call upon Dr. Steen, who, in the midst of 
his arduous duties as Secretary of the Association, had kindly found time to 
contribute a paper. 


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Paper. 

Dr. R. Hunter Steen : “ Hallucinations in the Sane ” (see p. 328). 

The President said members had listened to Dr. Steen with great pleasure. 
He had dealt with a difficult subject in a very sane, sound, sensible, yet learned 
and methodical manner. This was a subject which had to be so dealt with. 
Before the meeting proceeded to the discussion of the paper, he would like to read 
a letter he had received from Dr. Mercier: 

“ It has been known for a very long time that hallucinations occur in persons 
who are in every respect sane. Many instances are on record. I have myself 
recorded some very striking cases, in particular that of a woman who conversed 
for some time with ghostly visitors, and did not recognise that they were halluci¬ 
nations until she saw the carpet through the hand that was held out to her for 
money. Another case in my own practice was that of a woman who was haunted 
by the spectre of a rat, which under my ministrations gradually shrank to the size 
. of a mouse, then to that of a blackbeetle, finally to the size of a fly, and then 
troubled her no more. There is, of course, the case of the Duke d’Olivarez, which 
has, I daresay, been related by Dr. Steen, and there is another well-known case 
which he may have related, and if so the following passage may be omitted. 

“'My vision,’ said the patient, 'commenced two or three years ago, when I 
found myself embarrassed by the presence of a large cat, which came and dis¬ 
appeared, I could not tell how, but the truth was finally forced upon me, and I was 
compelled to regard it as a bubble of the elements, which had no existence save in 
my deranged visual organs or depraved imagination. I am rather a friend to cats, 
and endured with so much equanimity the presence of my imaginary attendant 
that it had become almost indifferent to me, when in the course of a few months it 
was succeeded by a spectre of a more imposing sort. This was the apparition of 
a gentleman usher in court dress, with bag and sword, tamboured waistcoat and 
chapeau bras, who glided beside me like the ghost of Beau Nash. Neither did this 
freak of my fancy produce much impression upon me. But it had its appointed 
duration. After a few months it was seen no more, but was succeeded by the 
image of death itself—the apparition of a skeleton. Alone or in company, this 
phantom never quits me. In vain I tell myself a hundred times over that it is no 
reality, but merely an image summoned up by the morbid acuteness of my over¬ 
excited imagination and deranged organs of sight. But what avail such reflections, 
when the emblem at once and presage of mortality is before my eyes, and while -I 
feel myself, though in fancy only, the companion of a phantom representing a 
ghastly inhabitant of the grave ? ' 

“That sane persons suffer from hallucinations has long been known to me, and 
has been mentioned in every book on insanity published by me in the last thirty 
years, and in many other of my publications. I cannot sufficiently rejoice that it 
is now to become known to the Association at large. The Association will not 
listen to me, but it cannot surely refuse to listen to its own Secretary, and its 
members now have it on the authority of their own Secretary that hallucinations do 
occur to sane persons. 

“ If this is so, then I ask members of the Association what becomes of the 
doctrine that insanity is unsoundness of min’d, or disorder of mind, or disease of 
the mind ? Are hallucinations normal, or are they abnormal ? Is an hallucination 
a perfectly healthy phenomenon, or is it unhealthy ? Is it in itself, or does it 
indicate, the normal or the abnormal, order or disorder, health or disease P I 
know not what answer Dr. Steen would give to that question, nor do I know what 
answer would be given by Dr. Newington, or by other members of the Association, 
but I know that I, in common with every medical man outside the Association and 
every competent psychologist, and every person capable of forming an opinion and 
not belonging to the Association, considers an hallucination as unhealthy, abnormal, 
disorder, or disease. About this there can be no doubt whatever. 

“ If, then, hallucination is not a sign of perfect health, if it is a manifestation of 
disorder, or disease, or departure from the normal, of what is it a disorder * What 
is it that is disordered ? The body or the mind P No doubt Dr. Stoddart will say 
it is the body. He will scarcely—I suppose, but I do not know—he will scarcely 
say it is in the big toe, or the liver. He will probably say it is in the brain. To 
speak of an hallucination as existing in the brain, or as being a disorder of the brain, 
is a mistake that no one ought to make after he has left the nursery. 


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" So to speak exhibits an utter ignorance of the abyss that separates the 
universe of mind from the universe of matter. All feelings, volitions, desires, 
thoughts, and percepts are in the mind, not in the body. Feeling, volition, 
desiring, thinking, and perceiving are mental operations, not bodily operations. 
And an hallucination is a mistaken percept, an illusory percept, a disorder of the 
process of perception, which is a mental process. 

“ Hallucination, then, is a disorder of a mental process. It is a disorder of 
mind ; and Dr. Steen tells us that it sometimes occurs in the sane. If this is so— 
and I heartily agree with Dr. Steen that it is so—I want to ask Dr. Steen, and Dr. 
Newington, and Dr. Stoddart, and the rest of the Association, how this can be so 
if insanity is disorder of mind ? If insanity is disorder of mind, how is it that 
hallucination, which is admitted by everyone (except, perhaps, certain members of 
this Association) to be disorder of mind, gan occur in the sane? I submit again, 
as 1 have submitted for thirty years, that insanity and disorder of mind are not the 
same thing. I submit, as I have submitted for thirty years, that not only halluci¬ 
nation, but many other disorders of mind, may, and do, occur in the sane. I 
submit, as I have submitted for thirty years, that disorder of mind no more 
necessarily means that the patient is mad than a shivering fit necessarily means 
that the patient has ague. That disorder of mind does occur in insanity 1 do not 
deny, and have never denied ; but that disorder of mind constitutes insanity I say 
is no more true than that shivering constitutes ague. 

“ I do not hope to convince this audience. I have no doubt that this Association 
will continue to consider a lunatic, an idiot, and a person of unsound mind are 
convertible terms, after even the law has ceased so to consider them. But I wish 
to dissociate myself from this opinion. I take this opportunity, as I shall take 
every opportunity, of protesting against it. I should be sorry for the future 
historian of medicine to suppose that I shared an opinion so universally held 
among alienists, so manifestly erroneous, and so utterly inconsistent with the 
existence of hallucinations in the sane.” 

Sir George Savage said the meeting had just heard a most encyclopaedic 
paper, and one which left it open for anyone and everyone to give his experience. 
Naturally, seeing what the subject was, one looked up authorities, and he noticed 
that Dr. Steen had referred, as they all should, to the work of Hack Tuke. That 
authority gave a very short definition of an hallucination : " Hallucinations :—Sen¬ 
sations experienced, although no external objects act upon the periphery of the 
sensory nerves.” There was no doubt it was a normal and an abnormal thing to 
have hallucinations, and there should be a distinct grouping and consideration of 
them. He was rather surprised to find that visual hypnogogic associations were 
prevalent in youth. He himself had them constantly: it was most pleasing for 
him, on going off to sleep, to see figures and faces getting larger and smaller, but 
always of the same type—and he presumed he was not insane. He did not notice 
having heard in the paper any reference to migraine. The hallucinations in that 
condition were very interesting, and were apart from insanity. That hallucinations 
might be life-long, and yet perfectly normal, he could support by what Plato gave 
in the “ Apologia ” of Socrates. Socrates, defending himself, said : " An oracle or 
sign which comes to me in a kind of voice. It first began to come when .1 was 
quite a child "—this would be of interest to Freudians—“ it never commanded me 
to do anything, but sometimes forbids me to do what I am going to do.” In fact, 
Socrates had hallucinations of a sensory type, and probably they were associated 
with his greatness. 

Another thing which had to be considered was, as Dr. Mercier said, that insanity 
and unsoundness of mind were not quite the same. Dr. Mercier considered that his 
insistence on the difference for thirty years was as a voice crying in the wilderness, 
though that was not so. He (Sir George) remembered being asked to see a man 
in a mental hospital—where he had been for some time, and where he had been 
seen by one of the members of the Board of Control. They said this man heard 
" voices,” and had marked hallucinations of hearing, and therefore he could not be 
discharged. After he had seen the man he agreed he had hallucinations of 
hearing. He had a long talk with the man in his room, during which the patient 
asked him whether he had ideas passing through his mind which he did not act 
upon. He replied that he hoped so. He then said, " My ideas appear to me as 
voices, but I know they are voices; they are not imperative to me, and they have 


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no more influence upon my conduct than the ideas which pass through your mind 
have upon your conduct." He (Sir George) therefore insisted that the man was 
sane; he had never acted upon his hallucinations, and probably he never would. 
He was discharged from the asylum, and, as far as he knew, had remained well 
ever since. 

One heard a good deal about the hallucinations of mad people, and it was a 
most interesting list of such which Dr. Steen gave. But it did not include the 
case of St. Paul. That would have brought in religious and enthusiastic ideals and 
ideas. If a man was definitely and earnestly living up to his ideas, they might 
become so real that the senses might reproduce them. 

The paper was interesting in a high degree, and it afforded food for thought. 
He hoped many more members would discuss it. 

Dr. Pasmore said the subject which had been brought forward by Dr. Steen 
w'as, as Sir George Savage said, a very interesting one. It was one which had 
occupied his own attention a great deal, and he thanked Dr. Steen for having 
brought it on for debate. 

Before proceeding to discuss the subject, “ Hallucinations in the Sane," it was 
necessary to have a clear idea of what an hallucination was, also what was meant 
by sanity; a definition of the first would lead to a clear conception of the second. 
He looked up the definition of " hallucination ” in a little text-book published by 
the Society, Handbook for Nursing the Insane, and as that was written and pub¬ 
lished by a committee of the Association, he took it that the definition given in it 
was authoritative. On page 229 the definition given ran : " An hallucination is a 
perception without an external object.” It therefore became necessary to know 
what a perception was, and when that was clear, one would be able to state whether 
such a thing occurred in the sane, or not. He asked his hearers to refresh their 
memories, to follow him, and to trace the origin of a perception as it occurred in 
■the normal evolution of mind. All the elements of our knowledge existed as 
perceptions until they were brought into more definite shape by our imagination, 
memory, and judgment. When any part of the nervous system was affected, we 
got a feeling of which the mind was conscious ; and that feeling would determine 
a sensation. But that had nothing whatever to do with the object producing the 
sensation, nor were we aware that such a thing existed. It was the consciousness 
of this feeling which we possessed. After a time, in the growth of our mind, when 
there were several sensations experienced, these seemed to close around a central 
point, to which they all seemed alike related. This central point we termed self- 
consciousness; it was that inward or instinctive feeling that all the sensational 
impressions we experienced belonged to one subject, that subject being termed 
the self, or the me. After that, and as our sensations developed contempora¬ 
neously with that, we received a consciousness of the external world ; and when we 
had got that, with its polities and its changes, we were able to project inwardly 
from that self-consciousness the feeling of the outward object producing it; and 
that power which the mind had of passing from the inward feeling to the outward 
we termed perception. That perception grew into an idea and became a concep¬ 
tion, and from conceptions we generalised and evolved abstract ideas and generali¬ 
sations, formed judgments, and so on. 

What was an hallucination ? If it was a perception it would be seen that percep¬ 
tions, to a certain extent, covered the whole of our mental life. In the origin of 
the normal growth of mind, our judgment and our reason were built up on some 
actual foundation, the perceptions we got in life, and from these we formed 
our judgments. But an hallucination was formed from no external sensations. An 
hallucination was a condition which one might define as an auto-genetic irritation 
of the brain, giving rise to a pseudo-sense impression. That was the definition 
which he would favour, because it indicated how the hallucination arose ; namely, 
from a persistency of the irritation of the brain. 

If one were to try to classify hallucinations, he would say that one of the best 
methods would be into functional and organic. The excellent paper by Dr. Steen 
gave an enumeration of the conditions under which hallucinations occurred, but 
did not say what an hallucination was, nor its pathology. Recently, in the Journal 
of Experimental Physiology, vol. ix, pp. 355-390, appeared a very interesting 
account of the experiments which Dassert (?), of Bayonne, carried out. He 
painted the brain of a cat with minute doses of strychnine, and they produced 

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hyperasthesia and hyperalgesia. There was a distinct hallucination. Whatever 
part of the brain was painted, an hallucination was produced at the periphery. 
Hence the latest experimental work showed it was possible to produce, by painting 
with dilute strychnine a condition which might be termed an hallucination of 
touch. This hyperalgesia and hyperesthesia was both superficial and deep. 

He would relate four cases which had come into his experience during the last 
few years. One Sunday morning he was called to see a woman who had com¬ 
mitted suicide by throwing herself through a window. One of her children had 
also been killed by her. Her husband was at church. He was sent for, and 
arrived as she was breathing her last. He said to her: " Why did you do this 
thing ? ” She said : “Those voices I have heard for years to-day said I was to be 
burnt, and the children were to be burnt, and I thought it would be better to-kill 
myself by throwing myself through the window.” He questioned the husband 
very carefully, and he said the voices were not very much, but after the first baby 
was born a neighbour said one day that she was not dressing the child well. He 
told her not to pay attention to that. When the second child was born she said 
the neighbours were saying she did not feed it properly. Again he told her not to 
mind what they said. During the ensuing five or six years the woman led an 
absolutely normal life. The husband said he took her to three doctors, who said 
there was nothing the matter with her; she was quite sane. It was only that 
morning she remarked that the neighbours said she was going to be burnt. 

Thesecond case was that of a man'who was a clerk in London. He used to 
hear his fellow-clerks saying—so he thought—"Get up and go and drink some 
water,” and several other things. But one day his brother, who worked in the 
same office, went into the lavatory and found that the man had cut his throat. 
When asked why he did it, he said: “ The men in the office said I was going to 
be burnt ” ; and so he committed suicide. During the six or seven years previously 
the voices he heard merely made casual remarks about things which he did in the 
office, and they did not affect him. 

Case 3 was that of a very celebrated barrister, who heard voices. He practised 
at the Old Bailey and other courts in the country, and he was a most intelligent 
man. He heard voices saying to him, “ Put your coat on properly," or some other 
casual remark. One day he went to stay with a friend. One morning, at 5 o’clock, 
this friend heard a great rattle downstairs. He went down, and found the man 
had got out of bed, gone downstairs, and opened all the windows and doors of the 
house. Asked why he did so, he said : " I heard a lot of bees in the house, and I 
felt I should be stung by them, so I thought I would let the bees out.” 

The last case he would mention was that of a man who was a celebrated 
“ medium” in London ; he was at present under the speaker’s care in the mental 
hospital. He did seances in the drawing-rooms of titled persons, at which a few 
scientific men were present. He had these hallucinations of hearing, and said he 
could get into communication with the spirit world, by which means he made two 
or three thousand pounds. He said he could collect as much as ^50 in one night. 
A time came when the voices told him he was going to be flogged because he was 
an impostor. He said that after he had been carrying on this business for seven 
years, on some nights he did not hear these voices, but he had to pretend he heard 
them, because he had to keep op his reputation as a medium. When he began to 
fail to hear communicated spirits, the voices threatening flogging began to be 
heard. 

Those four cases were very instructive from this point of view: each case went 
on for several years before anything happened, and it would have been noted that 
as long as these hallucinations did not affect the self—the person, the me —as long 
as they were simply casual voices, which had no persecutory influence on the 
person, he was able to go on in his normal life, to carry on his work, and follow 
his ordinary avocations. But the moment these hallucinations became of a 
persecutory character and affected the person's self, then the patient became a 
lunatic. 

He would have preferred the title of Dr. Steen’s paper to have been “ Halluci¬ 
nations in the Apparently Sane.” His reason was that it would be a pernicious 
doctrine to teach that there could occur, with impunity, hallucinations in the sane. 
There were these authentic cases on record, but sooner or later there was serious 
mental trouble. The man he quoted who was a medium might have gone on for 


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fourteen years hearing these voices, and then been carried off with pneumonia, or 
some such disease ; and his case would have been quoted as one in which halluci¬ 
nations persisted for a long time without having produced any untoward result on 
his mentality. His view was that all these people who had definite hallucinations 
collapsed sooner or later: they always reached a danger-point at which sanity 
passed over the border into insanity. The historical cases were those of men in 
great authority and influence, and it was always difficult to certify such men : it 
could be imagined what the difficulty would have been in such a case as 
Napoleon’s. 

In tracing evolutions of mind, it depended on our normal perception, and 
anyone who had an abnormal condition brought about by an hallucination was an 
abnormal person. He was not now referring to functional hallucinations, such as 
crystal-gazing, and the condition of mind produced by opium ; those were tran¬ 
sitory, and soon passed away after the drug or influence had been withdrawn. 
The class of case now being dealt with was that of the persistent central halluci¬ 
nation. 

He was very glad to have had an opportunity of hearing Dr. Steen's paper. 

Dr. Carswell (Glasgow) said the subject dealt with to-day was of intense 
human interest, and had there been a lay audience present, he thought it probable „ 
that there would have been a much fuller discussion, because among the many 
psychological ideas—or perhaps more accurately, pseudo-psychological ideas— 
widely prevalent among communities, that relating to seeing visions or hearing 
voices—for the ordinary folk did not speak of hallucinations—was very widespread 
indeed. He was particularly struck by the omission from the paper of any 
reference to what was a very widely spread idea, in his own part of the Kingdom, 
at any rate, to the effect that it was the frequent experience of both doctors and 
nurses that people about to die said they saw the faces, or the bodily presence, of 
relatives long since dead. It would be very interesting to know from Dr. Steen 
whether, in his most exhaustive investigation into the literature, he had come 
across definite and reliable instances of the kind. Personally, he had never seen 
in the dying evidence of any such manifestation. All, of course, had seen the low, 
exhausting delirium of approaching death, in which pseudo-reminiscences occurred, 
and the patient spoke of persons long since dead as though they were then actually 

f >resent; but he thought those members who had seen that recognised it as short- 
ived and transient—quite a pathological state due to the bodily collapse. 

Reference had often been made, and was made in this paper, to the production 
of hallucinations by the taking of alcohol. He, the speaker, was not quite sure 
that alcohol ever produced an hallucination. That hallucinations were the most 
prominent feature of delirium tremens in alcoholic subjects was beyond dispute, 
but he was one of those who did not believe that alcohol produced delirium 
tremens. That alcohol produced a condition in which toxins were absorbed into 
the system, or in which toxins were caused in the gastro-intestinal tract, and 
delirium tremens resulted, he regarded as the true pathology of delirium tremens. 

If alcohol in itself produced hallucinatory delirium, that would, in some places, be 
seen very frequently : it would, for instance, be very common in some districts of 
Scotland, especially at certain seasons of the year. As Dr. Ireland, in his book on 
idiocy, very properly remarked, in regard to the effect of alcohol in parents as a 
cause of idiocy in their children, that whole villages In Scotland, at certain seasons 
of the year, such as at New Year, or after the return of the men from their fishing, 
went drunk, and they had been in the habit of going drunk at those seasons for 
generations. One would have expected a crop of idiots nine months after such 
drinking bouts, but this was not the case. But alcohol .produced a fine sense of 
enlargement, importance, and expansiveness, and generally put out of focus, in the 
direction favouring those about him, his capacity of judging. For instance, 
ordinary friends became, at such a time, their greatest friends, for both time and 
eternity, and their families were the greatest families that had ever lived, their 
children were the greatest geniuses who had ever been born, and so on. But he 
could not recall a case in which there was a manifestation of a true hallucinatory 
state in the mere condition of alcoholic intoxication. But perhaps their Irish 
friends knew something of that as well: Englishmen, of course, were so free from 
bad habits that they would have had no experience on the point. 

He would like an answer, if possible, to the question he put as to the appearance 


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442 NOTES AND NEWS. [July, 

to the dying person of a relative or other friend long since dead. Was it a popular 
idea based upon a recognised pathological condition in the dying person ? 

Dr. Steen, in reply, expressed the gratitude he felt for the kind reception of his 
paper. 

The meeting had been very pleased to hear from Dr. Mercier, and would have 
been still more glad if he could have been present among them. He was sure the 
Association had always thought most highly, and with the greatest respect, of 
what Dr. Mercier put forward, and, as Sir George Savage said, many members 
agreed with him on the present subject, namely, that insanity and unsoundness of 
mind were not convertible terms. If a man was insane he was mentally unsound, 
but a man might be mentally unsound without being insane. Therefore Dr. 
Mercier’s teaching had not fallen on the dry and stony ground which that authority 
considered it had. 

The lateness of the hour precluded him from making any detailed reply to the 
criticisms of the paper. Sir George Savage's remarks had been most interesting, 
especially with regard to hypnogogic hallucinations. The cases described by Dr. 
Pasmore were of great value, and it was certainly very difficult in borderland cases 
to state the exact period when sanity changed to insanity. Dr. Carswell had 
brought out a very interesting point in that, although popular opinion was strong 
in the belief that the dying experienced hallucinations, the scientific literature was 
almost silent on the matter. He feared he could not quite agree with all Dr. 
Carswell had said about alcohol. 


NORTHERN AND MIDLAND DIVISION. 

The Spring Meeting of the Northern and Midland Division was held at the 
kind invitation of Dr. H. Dove Cormac at the Cheshire County Asylum, Macclesfield, 
on Thursday, April 26th, 1917. 

Dr. Cormac presided. 

The following seven members were present: Drs. H. D. Cormac, R. Eager 
(Western Division), E. G. Grove, A. McDougall, S. R. Macphail, W. F. Menzies, 
T. S. Adair. 

Apologies were received from several members for non-attendance. 

The minutes of the last meeting were read and confirmed. 

On the proposal of Dr. Macphail, seconded by Dr. McDougall, Dr. T. S. Adair 
was re-elected Secretary for the ensuing twelve months. 

Drs. D. Hunter and J. Geddes were elected to represent the Division on the 
Council of the Association. This was proposed by Dr. McDougall and seconded 
by Dr. Macphail. 

The kind invitation of Dr. Cribb to hold the Autumn Meeting, 1917, at the 
Durham County Asylum, and that of Dr. Cowen for the Spring Meeting, 1918, at 
Rainhill Asylum, near Liverpool, were cordially accepted. The dates and details 
were left to the Secretary to arrange. 

As no papers had been obtainable for the meeting, the time was profitably spent 
in a consideration of various matters connected with present-day asylum administra¬ 
tion, particularly the question of rationing the asylum and the use of suitable 
substitutes for bread, potatoes, etc. 

A hearty vote of thanks was accorded to Dr. Cormac for his kindness and 
hospitality. 


ASYLUM WORKERS’ ASSOCIATION. 

Meeting at the Mansion House. 

(, Abridged. Report.) 

The Annual General Meeting of-the Asylum Workers’ Association was 
held at the Mansion House, London, on May 14th, the Rt. Hon. the Lord Mayor 
(Col. Sir Wm. Dunn), Vice-President of the Association, in the chair. There was 
a distinguished company present, including Cardinal Bourne, Bishop Ryle (Dean 
of Westminster), Alderman Sir G. Wyatt Truscott, Bart. (Chairman, City of 
London Mental Hospital), Sir Fredk. Needham, M.D., and Dr. C. Hubert Bond 
(Commissioners of the Board of Control), Sir J. Crichton-Browne, M.D., F.R.S. 


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Hon. Major Sir Robert Armstrong-Jones, M.D., Sir G. H. Savage, M.D., Dr. 
David Nicolson, C.B. (Lord Chancellor’s Visitor), etc., etc. 

The Lord Mayor said : This, 1 believe, is the twenty-first annual meeting of 
your Association. It is the first held in the Mansion House, but I hope it won’t 
be the last, and that my successors in the seat of the Lord Mayor will make a note 
of the subject. (Applause.) The Association has had many distinguished chair¬ 
men, the second of whom, as I understand, was my friend Sir James Crichton- 
Browne. Other friends of mine have been connected with the organisation, 
notably Sir Wm. Collins, who has presided over you. We were very good friends 
in the House of Commons, though we sat on opposite sides. One of the dis¬ 
tinguished gentlemen whom I welcome here to-day is Sir Robert Armstrong- 
Jones, who has been associated with me from boyhood. The interest that 1 have 
taken in the Association is due to his initiative. This organisation is not properly 
appreciated by the general public. VVe busy people have not time to examine 
carefully all the charities brought to our notice. If we had time I do not think 
that some of them would be quite as successful as they are, while others, including 
the Asylum Workers’ Association, would be more prosperous. This organisation 
must be studied before the good work it does can be recognised. It is impossible 
for an outsider to realise the amount of time, patience, care, and anxiety bestowed 
by the nurses and attendants on the patients in asylums. It is not very popular to 
be connected with a lunatic asylum, and perhaps that is why the public do not pay 
as much attention to such institutions as they deserve; but it is very interesting 
and instructive to go into asylums and see the admirable way in which they are 
worked; the self-abnegation and devotion of the staffs in all grades are above 

r raise. The object of the Association is to promote the welfare of these staffs, and 
can honestly recommend it to your kind and serious consideration. Nobody 
knows better than I in my life at the Mansion House what generous and lavish 
contributions to worthy causes are made by the people, but I want to urge 
emphatically that this Association and some others who have done good service 
for years should not be allowed to fall by the wayside while new organisations are 
supported. (Cheers.) 

Dr. G. E. Shuttleworth (Acting Hon. Secretary) announced that Sir John 
Jardine, M.P., President of the Association, could not attend the meeting as he had 
been sent abroad, on the business of the country. He had sent a letter expressing 
his regret at being unable to take part in this meeting. 

Annual Report, 1916. 

In submitting their Annual Report for 1916, the Central Executive Committee 
have the pleasure of recording a year of consistent endeavour to advance the 
objects for which the Association was constituted in 1895, vie., “ the promotion of 
the interests and welfare of asylum nurses and attendants and of others engaged in 
nursing the insane, with a view of improving their status in the nursing world.” 
Experience has since shown the desirability of the scope of the Association being 
extended so as to include within its benefits those engaged in other departments of 
asylum work, and also those engaged in the training and care of mental defectives 
—a class of the afflicted placed by the Mental Deficiency Act of 1913 under the 
supervision of the same central authority as the insane, via., the Board of Control, 
in which has been merged the former Lunacy Commission. 

At the last annual meeting satisfaction was expressed at the patriotic spirit 
shown by the male members of asylum staffs generally in their ready response to 
the call of King and Country for their services in the voluntary Kitchener's 
Armies. It may now be said that under the Military Service Act every available 
man of military age in asylum service has been called up, and consequently, the 
limitation of depletion of sfaffs originally sketched out by the Board of Control as 
essential to be observed in the interests of the insane has been reached, if not 
passed. In some asylums there is at the present time an absolute shortage of male 
attendants ; in others the able-bodied and experienced have had to be replaced by 
older and less capable men, entailing additional responsibility and increased strain 
upon those who remain from the original staff. Though the female staff has, of 
cburse, not been depleted in the same degree, not a few have from patriotic 
motives transferred their services to war work, including assistance in the care and 
nursing of the wounded and invalided soldiers in the fourteen asylums in England 
LXIII. 29 


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and Wales, and the two in Scotland, which have for the period of the war been 
requisitioned as military hospitals. In a considerable number of instances, more¬ 
over, especially in Scotland, experienced women nurses have been put in charge of 
male wards, so that shortage prevails to a considerable extent even amongst the 
female staff of asylums. As one consequence of this state of things it has proved 
increasingly difficult to keep up to its former strength the membership of the 
Association, the temporary substitutes obtained to fill the places of those with¬ 
drawn for military service or war work not considering it worth their while to join 
what they regard as a nursing organisation. Added to this, the spread of trade 
union principles of late years amongst the rank and file in many asylums has 
considerably narrowed the recruiting ground of an Association which, while 
striving to secure for all asylum workers, without distinction of class, improved 
conditions of service, as was proved by the successful efforts to obtain the passing 
of the Superannuation Act of 1909, does not regard material aggrandisement alone 
as the sum and substance of its aspirations. Rather does it seek to promote 
harmonious working amongst all who in various capacities, whether as managers, 
officers, nurses, attendants, or other employees, have set their hands to the 
benevolent task of ‘‘ministering to minds diseased "—a task, indeed, which calls 
for the highest qualities of heart and head, and corresponding consideration not 
only on the part of immediate employers, but of the public at large. One of the 
objects which this Association may claim to have carried out with some degree of 
success is the wider appreciation of the devoted and often self-sacrificing services 
rendered by asylum workers to the most piteously afflicted section of humanity, 
services which are necessarily less obvious to the public eye than those rendered to 
the sick in hospitals, but not one whit less meritorious, or Jess deserving of the 
sympathy of the community. As a means of intercommunication between members 
the journal of the Association —The Asylum News —is published quarterly (in pre¬ 
war times monthly), and a perusal of its contents, to which members largely 
contribute, and patients sometimes send their experiences, would probably dis¬ 
abuse many of the erroneous ideas formed as to the devotion and capacity of 
asylum workers and the actual incidents of asylum life. 

Under the circumstances referred to above, it can hardly be expected that the 
Association should be able to increase its numbers, and the roll of membership 
stands at present as follows: 

Membership, 1916. 

Life.322 

Associates.178 

Ordinary .......... 1,544 

2,044 

Legislation affecting Asylum Workers during 1916. 

Though these troublous times have not been favourable for domestic legislation, 
and all private measures are necessarily hung up for the present, the Central 
Executive Committee have continued to keep a watchful eye on all proposals 
likely to affect the interests of asylum workers. They have reason for congratu¬ 
lating the Association on the passing by Government of the Local Government 
(Emergency Provisions) Act, which (inter alia) provides for the contingencies 
affecting the superannuation allowances of asylum officers and attendants called up 
from their duties for service with the Colours, and in the main gives effect to the 
representations made by our Parliamentary Committee to the Board of Control 
and the Home Office, under the lead of Mr. Morgans, early in the war. Our 
President urged more generous treatment with respect to grants to dependants of 
men with less than ten years’ asylum service, and with regard to the power to re- 
engage pensioned asylum attendants without their pensions being thereby affected, 
but in view of the urgency of the passing of the Bill as it stood, he found it 
impracticable to get these two points included. The diminution of the period of 
service entitling to pension, especially in the case of women, has not been lost 
sight of, and this and other desirable amendments of the Asylum Officers’ Super¬ 
annuation Act will be pressed forward as soon as there is a chance for private Bill 
legislation. 


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The scheme of legislation by the College of Nursing, Ltd., for the State regis¬ 
tration of nurses has also engaged the anxious attention of the Executive Com¬ 
mittee, and in conjunction with the Medico-Psychological Association (who for 
more than a quarter of a century have carried out a complete and uniform scheme 
of training, examination, and registration for asylum nurses, male and female, 
throughout Great Britain and Ireland and some of the Overseas Dominions) they 
have claimed for mental nurses, as a matter of right, equality of privilege with 
nurses trained in ordinary hospital work. The position at present is somewhat 
complicated owing to an amalgamation having been agreed on by the College of 
Nursing and the chartered Royal British Nurses’ Association, which is now 
awaiting the decision of the Privy Council, but whatever may be the upshot, 
trained mental nurses (of both sexes) may rely upon the support of this Associa¬ 
tion to secure their just rights with regard to equitable representation on the body 
controlling registration and other matters affecting their interest, should any 
project of legislation be brought forward. 

Acknowledgments. 

The Executive Committee have again to express to the President, Sir John 
Jardine, Bt., M.P., their grateful sense of his invaluable services to the Association, 
which is enhanced by his consent to be re-nominated as President for 1917-18. 
They desire also to express their gratitude for the many activities of the Ladies’ 
Sub-Committee, who have stimulated interest in the Association by visits to 
asylums, and by valuable contributions to our own journal and the nursing 
papers. 

Renewed acknowledgments are due to Lieut. Farquharson Powell, R.A.M.C., for 
his earnest and useful work as Honorary Secretary and Editor, and to his co¬ 
adjutor in the latter capacity, Lieut. J. P. P. Inglis, R.A.M.C., until they were both 
called up for active service in the autumn, and they have the cordial good wishes 
of the Association for their welfare in their patriotic duties. Dr. Ralph Brown, 
the other Assistant Editor, we grieve to record, was removed by death just prior 
to the date fixed for his joining up, and we have to lament the passing away of a 
young physician of much promise and a good friend of our cause. We have also 
to record, with much regret, the deaths of four Vice-Presidents of the Association 
—Drs. Kirwan, C. S. Morrison, W. Rawes, and T. Seymour Tuke. 

The Committee specially desire that grateful recognition shall be made in this 
Report of the obliging service rendered to the Association by Dr. G. E. Shuttle- 
worth in taking up the Secretarial and Editgrial duties of Dr. Powell during his 
absence at the Front. Dr. Shuttleworth’s unselfish readiness has saved the'Society 
from grave difficulty. No one knows better than he what the Society stands for. 
He is in sympathy with all its interests and in touch with all its friends. He is a 
past-master in stating its problems, marshalling its forces, and finding possible 
ways of advance. He stepped into the breach made by the war, and once more 
proved himself the friend in need, and so the friend indeed- Not only because Dr. 
Shuttleworth saved the Committee from much anxiety (which was the case), but 
also because his action was of such value to the Association in general, the 
Committee ask him to accept their heartfelt thanks. 

It should also be recorded that the Assistant Secretary, Mr. J. B. W. Wilson, 
has nobly supported Dr. Shuttleworth's efforts, and has never spared himself in 
meeting the difficulties of the times. 

To the Rt. Hon. the Lord Mayor, who for some years has been one of our Vice- 
Presidents, deep gratitude is due from the Association for the hospitality so kindly 
afforded for the holding of the Annual Meeting at the Mansion House. 

H. E. Cardinal Bourne, moving the adoption of the Report, said: I suppose 
that in no department of public life has such enormous progress been made as in 
the department of nursing the sick of every kind. There was a time—say a 
hundred years ago—when, had a comparison been set up between what was going- 
on in England and what was taking place in other countries, we might have been 
obliged to admit that our countrymen were far in the rear as regarded the advice 
and the devotion that they were giving to the treatment of the sick. Now, 
however, I suppose we may fairly claim that in no country is more being done for 
the sick of every kind than in England. Things that were unthought of in those 
days are now of common knowledge and acceptance. Sometimes when we travel 


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446 NOTES AND NEWS. [July. 

we see magnificent buildings which were set up years ago for the care of the sick, 
but which in arrangement and site are, according to our present ideas, unsuited for 
their purpose. But for a long time now every possible care has been taken to 
avoid mistakes. There is one element on which all the rest depends, and that is 
personal qualification and personal devotion. Looking into the past ages we have 
to admit that very often the surroundings, appliances, buildings and methods 
which medicine and surgery disposed of were perhaps the very reverse to what we 
should choose to-day, and yet great, successful, and noble work was done owing to 
the self-sacrifice and devotion of the workers. At one period nursing came to be 
regarded as a function not to be undertaken by people of a certain social position 
or of a higher type of education. Those days, I trust, have disappeared altogether. 
The personal element is, after all, the chief good thing in the history and applica¬ 
tion of nursing, and we may claim that to-day, in this country at least, nursing is 
regarded as a function not only not unworthy, but ennobling all those who exercise 
it, whatever their education or social station. Those who are privileged to tend 
the sick can approach the objects of their care with the sense that they are dealing 
with God's creatures made in His own image and likeness, to whom, however 
different from them in some respects, they are united by a common humanity over¬ 
shadowing all differences. Unless they have that double conviction nurses will 
never carry out their holy functions rightly. If this be true of the tending of every 
kind of malady to which the human body may be exposed, it is pre-eminently true 
in the case of those who are called to give their care to the mentally afflicted, for 
there the God-given reason is clouded, and some of the human characteristics are 
overshadowed. It requires, therefore, great faith and high insight to realise the 
factors on which alone successful tending of the sick depends, and those who 
undertake the task need every possible help to make them understand the greatness 
of their vocation. Your Association has a two-fold purpose: in the first place to 
create and maintain a very high standard of duty among you. An Association of 
fellow-workers united by a bond and a purpose such as yours is one of the most 
potent means of keeping up high ideals. The second object of your Association is 
no less important. It is that those who are devoting themselves to the care of 
others, weighed down, perhaps, by the many anxieties peculiar to their position, 
should in other matters at least be free from worry and anxiety as to both the 
present and the future. That is a claim which you may fairly make to all 
interested in such work as you are doing. I wish that your work were better 
known. The balance-sheet of your Association ought to show very much higher 
• figures on the credit side than it does at present. Splendid work is being done 
with a lamentably insufficient income, and I trust that this meeting will be the 
means of helping you to obtain what you need. If your Association is important 
at the present day, it will be still more important in the future. Your Report 
speaks of over-work and over-worry as a condition of the times. Everybody 
knows something of that. Everybody has more to do and more anxieties and 
worries than before the war. We trust that when peace comes these may diminish, 
but the new obligations that will be thrown on public authorities in connection 
with the Mental Deficiency Act will render the work in which you are engaged 
even more important in the future than it is now. I have the greatest possible 
pleasure in commending the Annual Report to your acceptance, and I commend 
your Association, as a most important, most necessary, and most deserving body, 
to all who have the means of assisting it. 

Bishop Rvlk (Dean of Westminster) said: I count it a high privilege to be 
associated with the Cardinal-Archbishop in moving this resolution, and commend¬ 
ing it very warmly to your attention. We have listened with deep interest to his 
words, so full of eloquence and so profound in suggestion, and I am sure that what 
he hits said will be of great help to the Asylum Workers’ Association during the 
coming year. The kind of work in which you are engaged demands a not very 
common combination of science and philanthropy. They are, as it were, moving 
hand in hand on the path of most necessary hygienic progress. But science by 
itself may very easily be accused of lacking warmth of heart, while philanthropy 
by itself may very often be accused of lacking soundness of head, but here you 
have a work which combines reason and generosity. Generosity is not to be com¬ 
mended if it is not steadied and directed by reason, and reason will not always 
commend itself unless it has the warmth and kindliness of real humanity. In view 


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of these considerations I strongly support the work of this Association, because it 
combines the finest science of modern times, devoted to the study of the mentally 
unsound, with the most humane and self-denying work performed by those who 
minister as nurses and attendants to the unhappy patients in asylums. As His 
Eminence has said, you find it most remarkable if you survey the progress of both 
science and humanity in the last hundred years. How great has been the advance 
made by our medical research and in the systematic development of hospital work 
during those two half-centuries I I suppose that if we looked at the fiction 
composed in the earlier half of the last century, and tried to derive from it an 
impression of asylum work, we should not form a very high opinion of either its 
humanity or its science Those days are past, and the eminent men whose names 
you find on the list of Vice-Presidents and other supporters of the Association— 
men like Sir George Savage, Sir James Crichton-Browne, Sir Clifford Allbutt, and 
others—have watched over the improvement in the treatment of the insane, and 
have prompted the kindness and generosity with which this unhappy class behind 
the high walls of their refuges has been treated by the intelligence and thoughtful¬ 
ness of the most noble of professions. I bear my tribute more particularly to the 
nurses and attendants, whp work day by day, week by week, and month by month 
behind those high walls, which seem so forbidding to people who hurry by them in 
motor cars. As you pass you wonder what kind of life, set in sorrow, is being led 
behind the walls. Some of us have had opportunities of seeing it, and the more 
one saw the more he had reason to thank God for the kind patience and self- 
denying sympathy continually shown by the nurses and attendants. There we find 
none of the element of—shall I say advertisement ?—which is perhaps associated 
with some of the splendid work done by our ordinary hospitals. Few people think 
of what is going on in asylums, because, as His Eminence said, a kind of shadow 
lies between it and ordinary society. Nobody likes to be thought of as connected 
with patients in hospitals of that kind. It is a false shame. Nearly every family 
in the country has connections, friends or relatives, who are patients. There is 
nothing to be ashamed.of in that. There is good reason why every family should 
be interested in, and sympathetic with, the work of this Association. It is Im¬ 
possible to say truly that we all are not in some sort of way connected with asylum 
work and have no reason to thank God for it. So I say may God bless the work 
done by the skilful doctors, the faithful nurses, and the whole legion of atten¬ 
dants and servants who are combined in asylums for the mentally unsound and 
defective. 

Alderman Sir George Truscott, Bart., supporting the motion, said that for 
many years he had been associated with the governing body of the City of 
London’s Mental Hospital. From time to time he had to go through the wards, 
and he never did so without being impressed by the splendid work of the staff. 
Everyone connected with asylum work should be dubbed “ honourable.” He 
looked with pride on his connection with it. There was great sympathy between 
those who governed asylums and those who worked in them, but perhaps the 
former were not always aware of what was for the best interest of the people they 
employed, and therefore the Association did good in bringing before them what 
was likely to improve the status of the staff. He was glad to be brought into more 
intimate connection with the Association, and he joined with the Dean of West¬ 
minster in saying—“ God bless this institution.” 

The motion was unanimously agreed to. 

Sir James Crichton-Browne, proposing the re-election of Sir Jno. Jardine as 
President of the Association, said that the organisation was giving of its best to the 
war service of the country. Almost all its sons of military age had joined the 
Army, and many of them had laid down their lives in the good cause. A large 
number of its daughters were tending the sick and wounded in military.hospitals, 
and the rest, under circumstances of unexampled difficulty, remained in asylum 
wards, ministering to those who had been worsted in the never-ending battle of 
life. One result of the war was already discernible, and that was the greatly 
enhanced appreciation of the nursing profession. The hospital nurse would stand 
higher in public esteem than she had ever done before, and he claimed for the 
asylum nurse equally honourable consideration. The work was always arduous ; it 
involved as muclr technical ability as was needed in the ordinary hospital; it 
demanded even more sympathy and kindness, for it was done under profoundly 


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depressing conditions, and the patients were often irresponsive to attentions. 
Asylum nurses and attendants were, as he could testify from life-long knowledge 
of them, faithful to their trust. Under the auspices of this Society progress had 
been made in their status, privileges, and relationships. When German brutality 
was finally beaten down and just punishment meted out to the miscreants, we 
should have to deal with remedial institutions made necessary by the results of the 
war. Among such institutions would be those connected with lunacy administra¬ 
tion. We should not be content to go on erecting in every county huge, costly 
asylum buildings. These buildings, good as they were in some respects, had 
become receptacles more and more of human dibris, because, notwithstanding all 
our discoveries, there had been no improvement in the rate of recovery during the 
last fifty years. Some new departure would therefore be wanted—less red tape 
and more science, less routine and more freedom, less legal, rigidity and more of 
the elasticity of common sense, less patching up and more prevention. It was on 
prevention that hope for the future of lunacy must be founded. The causes must 
be removed. After the war we should perhaps have a Minister of Health, who no 
doubt would turn his attention to lunacy. Measures now in contemplation must 
be efficiently carried out to strike at the root of much of the mental disease and 
degeneracy with which we were afflicted. Segregation of the weak-minded would 
probably be managed to some extent in order to limit the propagation of their 
kind. The extended scheme of education promised by Mr. Fisher—an education 
physical as well as intellectual—would conduce to the force of character and self- 
control which were guarantees of integrity throughout life. Improved feeding of 
the people would to a large extent restrict the ravages of the great white plague, 
tuberculosis, and the great black plague, insanity. Then the widened sense of 
brotherhood which the war had established among all classes of the community 
would give courage and confidence to many who in former days had been 
betrayed into bitterness of spirit and despair. The new facilities that were to be 
given for the treatment and, he hoped, the prevention also of the great hidden 
plague would no doubt reduce that insidious disease which was the terror of the 
asylum worker—general paralysis of the insane. The wave of insanity which the 
war would create would, unfortunately, obscure the position for a time. But when 
that wave had subsided, we should, he believed, see a very substantial, continuous 
reduction in the prevalence of insanity in this country. The report of the. Board 
of Control, just issued, showed that for the first time since the statistics began to 
be issued sixty years ago there was a decrease in the number of notified insane 
persons in this country. That, however, was obviously due to movements of 
population consequent on the war,.and we must not count upon its continuance. 
As for the asylum workers, there would be a greater demand for personal 
consideration. He thought that better days were in store for them, and that the 
value of this Association would be more fully recognised. Finally, he expressed 
the hope that after the war members of the volunteer aid detachments who had 
done such good service among the wounded would enter our asylums and qualify 
to become trained mental nurses. 

Sir R. Armstrong-Jones, who seconded the motion, held that the mere fact of 
meeting at the Mansion House secured public support and encouragement for any 
society, and he therefore rejoiced that the Asylum Workers' Association had 
obtained that privilege. As the Cardinal had said, nursing had made enormous 
strides in the last hundred years. The last great stride was taken during the 
Crimean War, and perhaps we should find that similar progress had been brought 
about by the present conflict. Mental nursing had participated in the improve¬ 
ment. Since the present war began not a single soldier- had been certified as 
insane, but that fact must not make us too optimistic. In 1793 Pinel transformed 
the treatment at the Bicfetre Hospice, Paris, and exactly one hundred years later 
the London County Council opened their great mental hospital at Claybury. It 
was the great Earl Shaftesbury who kindled the modern feeling of sympathetic 
care for the insane, and also for the workers who ministered to them, and it was 
the father of Sir James Crichton-Browne who made the first attempt to educate 
the asylum nurse. He initiated the great ideals which exercised so much influence 
to-day with reference to study and training for asylum nurses. As recently as 
1S76, Dr. (afterwards Sir Thomas) Clouston lamented the unattainableness of the 
ideal asylum nurse, and in 1882, when he (Sir R. Armstrong-Jones) entered the 


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medical service of a London asylum, there was not even a clinical thermometer in 
the institution. All this had now been transformed. Only since the opening of 
Claybury Asylum in 1893 had there been available for the staff scientific technical 
training (such as systematic lectures, bedside demonstrations, technical instruction) 
in any of the London asylums. Now, happily, such training was given every¬ 
where, followed by uniform examinations conducted by the Medico-Psychological 
Association. So satisfactory are the practical results that he might instance that 
during three years at Claybury, with its many feeble, bedridden patients of faulty 
habits, there was not a single case of bed-sore—a record which said much for the 
quality of the nursing. Scientific training of nurses and attendants was not only 
beneficial to the patients: it kindled the interest of the workers, and helped 
to overcome the repugnance which young nurses sometimes felt. That was a most 
important result. With regard to the proposed re-election of Sir John Jardine to 
the Presidency, the Association was very fortunate in securing his services, for he 
was a man of great learning and experienced in affairs, not only M.P., but LL.D., 
and formerly of high judicial rank in India. Personally, Sir John had reason to be 
proud of his three sons at the Front, where one of them had gained the D.S.O. 
and the Military Cross. He realised that for the care of the insane persons of 
high character were needed, and good nurses and attendants could only be 
retained by making their positions as comfortable as possible and providing for 
their future prospects. How depressing their work sometimes was appeared in a 
tragedy at an institution from which he (the speaker) had just come. It was a 
large general hospital, where a soldier, under the influence of delusions, cut his 
throat. Only asylum workers knew, as a rule, what it was to watch over suicidal 
patients night and day. The Bishop of Barking once said at their annual meeting 
—and he was a great ally and friend of theirs—that he thought a sense of humour 
was one of the great essentials of a good mental nurse. It certainly takes the sting 
out of sarcasm, and helps to transform so much of the merciless ridicule one has 
to encounter unperturbed into harmless banter, or possibly into just criticism. But 
the patient is always very quick to read censorious harshness in those about him, • 
and the nurse without good nature, tact and sympathy will never secure attachment 
or elicit the. support of her patients. The meeting had been honoured by the 
presence of the Chairman of the Asylums Committee of the London County 
Council—a gentleman whose friendship and support he cordially acknowledged. 
Mr. Goodrich had done much to raise the level of material comfort among the staff 
in the London County Council Asylums. To secure this for the staff is to make 
their domestic life stable and happy, to establish them permanently in the service, 
to the great advantage and comfort of the patients, who disliked changes in the 
staff as much as a mistress does, and to win for them and their families the respect 
of their neighbours. 

Sir George Savage congratulated the Lord Mayor on the success of the 
meeting. Speaking of himself as a witness from the past, he said that more than . 
fifty years had gone by since he first had to do with the treatment of the insane. 
At Bethlem Hospital in those days it was looked upon as quite proper that a 
nurse should be also a scrubber of floors. He held that however useful scrubbing 
might be, it was better that nurses should be highly educated, and therefore he 
rejoiced at the enormous amount of good done by the Association in raising their 
standard. It was not necessary to dwell at length on the many excellent qualities 
possessed by Sir John Jardine. He was a most competent director of the many 
kinds of work in which the Association was engaged, and therefore his re-accept¬ 
ance of the office of President was a thing to be thankful for. 

The motion was unanimously adopted. 

Sir Frederick Needham, one of the Commissioners of the Board of Control, 
moved the election of the Vice-Presidents and officers, remarking that the Associa¬ 
tion had been most successful in doing good work, and he hoped it would do more. 
Having recently visited a number of large asylums, he had been impressed with the 
opportunity which lay before the Association of promoting the economy of food, 
which the Food Controller was urgently asking for. In some of the asylums 
visited by him the staffs had most loyally co-operated with the authorities to 
reduce the quantity eaten to a point within the limits fixed by the Food Controller. 

In other institutions those limits had not been reached, but there was an approxi¬ 
mation to them. He regretted to say, however, that in a third section of the 


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asylums there was still indisposition to recognise the urgency of the demand for a 
reduced consumption of certain kinds of food. In one of these institutions he was 
present at dinner-time, and he saw a shameless distribution of bread. He under¬ 
stood that the staff had not been quite willing to co-operate with the authorities in 
reducing the rations. He saw great quantities of bread handed out to the patients, 
with the result that after the dinner a very large amount of bread was left on the 
tables, crumbled, broken, and in such a condition that it could not be used for 
human consumption. He spoke about it at the time, and he wrote strongly to the 
Committee on the subject. This Association might use its great influence to 
promote a strong movement for the economising of food in asylums throughout the 
country, and he hoped that the Committee and officers would consider the sugges¬ 
tion. If they acted on it they would add to the good works already standing to the 
credit of the Association. 

Asylum and General Hospital Nurses. 

Dr. Hubert Bond (Commissioner of the Board of Control) seconded the 
motion, remarking that the work of officers of an association of this kind was much 
greater than could be realised by people who had not experienced it. In the 
present instance it must not be forgotten that the Hon. Secretary and Editor (Dr. 
J. Farquharson Powell) was at the Front, and that once again Dr. Shuttleworth 
had come forward in his ever-ready way to fill the vacant place. Referring to 
asylums converted into war hospitals, Dr. Bond said that the War Office had 
gladly taken over, not only the buildings, but the staffs, and it had been a great 
privilege to him to go among them and see what they were doing. As very few 
members of those staffs had received the training of a general hospital, they had 
been obliged to subordinate themselves to new-comers who had gone through such 
training. The patriotism of the old staffs had enabled them to accept the change 
without a murmur, so that in no case had there been trouble. He was glad to see 
in the Association’s Annual Report an allusion to the action of the Executive in 
connection with the proposed State registration of nurses. Here was an oppor¬ 
tunity for reciprocity. Mental nurses required three years' training to earn the 
final certificate of the Medico-Psychological Association, but candidates who had 
had three years' general hospital training were exempted from the preliminary 
examination and from one year’s mental hospital training. It seemed to him that 
two years’ general hospital training should be enough for those who had already 
gone through three years' asylum training. 

Presentation or Medals. 

The Lord Mayor, on behalf of the Association, then presented medals for long 
and meritorious service. 

Dr. R. H. Steen proposed a vote of thanks to the Lord Mayor, which was 
seconded by Dr. Shuttleworth. 

The motion was adopted amid cheers, and the Lord Mayor having remarked that 
it was very pleasant to lend the Mansion House for such a good cause as that of 
the Association, the meeting came to an end. 


HOSTELS FOR HEROES. 

Under this heading an account of a meeting held on April 28th, at 15, Grosvenor 
Gardens, by invitation of Eleanor, Viscountess Gort, in connection with recupera¬ 
tive hostels for nerve-stricken soldiers appeared in the Daily Graphic of April 30th. 
Sir Frederick Milner presided, and amongst those present who addressed the 
meeting was a Dr. White, B.Sc., M.B., who, in the course of her remarks (we 
understand she is a lady member of the profession), according to the report in the 
Daily Graphic, “ protesting against nerve-stricken men being sent to lunatic 
asylums, said that soldiers who had served our country were put, here in England, 
into worse prisons than our prisoners in Germany. After three years of war they 
had been absolutely unable to make any impression on the War Office with regard 
to these men. There were 200 uncertifiable men in one of the blocks of the 
Middlesex County Asylum at Wandsworth. They were not insane. Such men 
needed cheer and employment.” 


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Such statements as these, unjustified as they are by facts, are likely to make a 
very unfavourable impression on the minds of the public, and are not creditable to 
any person who makes them. We thought that this idle tale had been extinguished 
by the report in Truth of February 23rd, 1916, but there appear to be some that still 
give credence to the legend. For this reason we think it well to reproduce the 
articles which appeared in Truth a propos the alleged outrage. 

The first was published in that paper on February 9th : 

" Mad-houses for Soldiers. 

'* Owing to the inadequate manner in which Parliamentary proceedings are 
nowadays reported in the daily press, it will be news to a great many people that 
numbers of invalided soldiers suffering from nervous and mental disorder, but not 
certifiable lunatics, are at present being treated in lunatic asylums. At intervals 
during the latter part of last Session several members of Parliament have been 
agitating against this proceeding by the only means at present available, namely, 
harrying with questions the representatives of the War Office in the House of 
Commons. They have, however, found themselves, as too often happens in such 
cases, up against an official stone wall—a wall more than usually impregnable at 
present owing to the absence of any organised Opposition. In this state of things 
the only remedy lies with public opinion, and fortunately this is one of the rare 
cases in which public opinion can be appealed to and can express itself in 
opposition to the Government without any fear of assisting the enemy. For these 
reasons I draw special attention to the following letter from a correspondent 
thoroughly familiar with all the facts of the case : 

“ ' Sir, —A good deal of attention has been given lately in the medical world to 
a vast number of instances of strange and perplexing nerve-disturbance occurring 
as the result of prolonged stress, exhaustion, sudden shock, or even (it may be) the 
intolerable strain on natural human susceptibilities unstrung by scenes of horror. 
It has been pointed out how varying must be the treatment adapted to these many 
different manifestations. And in the case of officers all kinds of interesting 
methods are resorted to for linking up again with stable normal life the transiently 
shattered threads of consciousness. 

“‘With the rani and file, however, the case is sadly different. The Under¬ 
secretary for War, when questioned on September 30th, 1915, admitted that all that 
is done for ' uncertifiable’ nerve-shaken soldiers of the rank and file is to place 
them in a block of a county asylum, and under the same management as the rest 
of the asylum, which is in use for certified lunatics. 

He acknowledges that these soldiers, being uncertifiable, could not, if they 
were civilians, be legally placed in such a position (see Hansard, September 30th, 
1915). Yet this is the way in which our brave soldiers are treated (who have been 
willing to sacrifice life, limb, and prospects in their country’s cause) when sent 
home to recuperate after the fearful strain through which they have been passing. 
The Director-General promised a year ago that special treatment in hospitals 
should be provided for them, apart from lunacy. But this is how this promise has 
been kept. 

“ ‘ There are numbers of such cases among the wounded, who are every whit as 
much shaken, yet who recover in a short time with rest and sleep and medical care 
in the base hospitals. Why, then, are the unwounded sent to blocks of county 
asylums, where the public know well that all the inmates are certified as insane, 
and naturally conclude that the soldiers are regarded as insane, too ? A taint so 
undeserved and so unnecessary should be removed, and our soldiers of the rank 
and file treated with the same consideration as officers, who are kept free from 
any association with asylums. It is a more serious risk for the men than for 
officers, since they have to depend on their own exertions for their livelihood, and 
(as pointed out by the Murray Commission on Disablement) the existence of such 
a taint may easily prejudice their future chances of employment. 

“‘The Chairman of the Labour Party asked in the House of Commons on 
January 26th, 1916, why the rank and file are exposed to such a risk, and why 
hospital treatment is not provided for those who are uncertifiable. 

“ 1 A sum is paid by the War Office to the asylum authorities in respect of the 
' care and treatment’ of these uncertifiable soldiers, and the arrangement relieves 
the War Office of responsibility. The Lunacy Board of Control may have the best 


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of intentions, but it is not its proper function to deal with the uncertified. When 
once placed under the wing of lunacy authorities these soldiers may readily be 
certified at any moment, without appeal, at the will of the asylum doctor and com¬ 
manding officer. 

“ ‘ It will not look well at the end of the war if many of our soldiers are found 
in asylums, and their families in trouble, and perhaps without support. 

"' Yours faithfully, 

“' Pro Patria.’ 

“ In view of the reference made in the above letter to promises made by the 
Director-General of the Army Medical Department which have not been kept, it 
should be explained that about a year ago a very weighty memorial upon this sub¬ 
ject was addressed to Lord Kitchener by a large body of M.P.’s and medical men. 
The matter was referred to the Director-General of the Army Medical Department, 
who received a deputation of the memorialists, and in what passed subsequently 
Sir Alfred Keogh certainly conveyed the impression that the views expressed in 
the memorial would be carried out. They certainly have not been. No doubt 
officialdom will be ready with plenty of excuses for what has been done, and at 
times like these it is as well to give those who have to deal with unprecedented 
difficulties under emergency conditions credit for a sincere desire to do their best. 
But I am inclined to think that the excuses, when brought out into the light of day, 
will not do, and that the public will decide that the best which officialdom has yet 
been able to do is not good enough, The official mind evidently recognises that it 
is important to save the men whom it is putting into lunatic asylums from future 
stigma as having been under treatment as lunatics. How does it seek to avoid 
this ? By temporarily rechristening an asylum or a block of buildings in an 
asylum ‘ Army Hospital So-and-So.’ Is this good enough ? The plain facts are 
that because they are soldiers who cannot help themselves the men are being put 
into asylums in circumstances where this could not be done if they were civilians. 
This is a very wide stretch of military law and military authority. That it should 
happen in consequence of what the men have already suffered in war will be repug¬ 
nant to the feelings of almost everybody, and the more so because it has not been 
found necessary to extend this method of treatment to officers in the same condition. 
It will take a very strong case to justify what is being done, and the public are 
entitled to know what the justification is. We are not only entitled to know it, 
but bound to find out, for the men concerned are perfectly helpless, and we all have 
an imperative duty to look after them.” 

The second article appeared in the issue of February 23rd: 


" Nerve-shocked Soldiers. 

“ On February 9th a letter signed ‘ Pro Patria ’ was published in Truth severely 
criticising the method which has been adopted for the treatment of soldiers 
suffering from nerve-disturbance in consequence of the shocks of war. The grava¬ 
men of the criticism was that such soldiers are treated in 1 blocks of county 
asylums,’ and that this was being done in violation of a promise given a year ago 
by the Director-General, Army Medical Department, that such 1 special treatment 
in hospitals should be provided, apart from lunacy.’ In reply to this, it was 
suggested that the Editor should see for himself the principal establishment to 
which these observations apply, and judge for himself of the justice of the accusa¬ 
tion. He did so. The establishment in question is the Springfield Military 
Hospital, Beachcroft Road, Upper Tooting. Having visited it and seen every¬ 
thing there was to see material to the charge, under the guidance of Major Worth, 
M.D., R.A.M.C.,the Commanding Officer, the Editor comes to the conclusion that 
the accusation is absurd, and feels it his duty to say so, for the sake of everybody 
concerned, and especially of the men. 

“ The sole foundation for the accusation, so far as the Springfield Hospital is 
concerned, is that the building is situated on land attached to the Wandsworth 
Asylum of the Middlesex County Council, and that the Commanding Officer is 
also the Superintendent of that institution. The asylum stands in its own ground, 
surrounded by a high wall. The hospital was erected on the other side of this 


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wall at some time subsequent to the asylum, as a special institution for imbecile 
children. The War Office has taken over this building, and controls and conducts 
it as an ordinary military hospital. The second in command is a quartermaster of 
the R.A.M.C. He has under him a staff of R.A.M.C. orderlies in uniform, and a 
certain number of female hospital nurses. There is a military sentry on duty at 
the gate, which is at the end of a lane leading from Beachcroft Road to the 
hospital and leading nowhere else. The whole atmosphere of the place is that of 
a military establishment. The hospital itself is, externally and internally, a 
delightful building, in the designing of which the greatest care must have been 
taken, and little expense spared, in order to provide the original inhabitants with a 
beautiful home. In going over it I was chiefly struck with wonder as to what some 
of the ratepayers would say if they knew how much of their money had been spent 
for this purpose. The house stands in a splendid situation on the brow of a slight 
hill, with a broad outlook westward and southward over open fields. It must have 
several acres of ground round it for the use of the patients. Except for the high 
wall on one side, the whole surroundings are as rural as they could be on the out¬ 
skirts of a London suburb. In short, the place is an ideal one for the purpose for 
which it is being used, and the soldiers must be hard indeed to please if they do 
not thoroughly enjoy their residence there. They present no visible sign of not 
doing so. Some of them, poor fellows, can hardly be in the mood for enjoying 
themselves. Two or three were in bed when I passed through the wards, suffering 
more or less painfully. A few others were sitting in wheeled chairs, more or less 
without the use of their legs ; a few others deaf or speechless. But the great 
majority of the 230 inmates were strolling about or sitting in the grounds, or 
lounging in the spacious and comfortable rooms, smoking, reading, or chatting 
with their visitors, who were numerous. In short, they were evidently enjoying 
what Major Worth told me is the first essential of cure, rest, and enjoying it under 
as comfortable conditions as you or I would if we went for a rest-cure to a well- 
equipped country hotel. They are under no more restrictions than their wounded 
fellow-patients in any other military hospital; indeed less, for Major Worth says 
that he believes in letting them as far as possible do what they like, and he 
thought that military discipline in his establishment was rather slack. 

“ In such circumstances I can only say, as said above, that it is absurd to suggest 
that these men are being treated in ‘ blocks of a county asylum,’ or that special 
treatment in hospitals, 1 apart from lunacy,’ has not been provided for them as 
promised. The expression ' a block of a lunatic asylum ’ suggests something 
which bears no relation at all to the circumstances of Springfield Hospital. The 
condition ‘ apart from lunacy ’ is carried out in the spirit as well as in the letter, 
for I repeat that the hospital has in all respects the character and atmosphere of a 
military establishment. The ground of complaint amounts to this, that there is a 
lunatic asylum next door, and that the same medical officer is in charge of both 
houses. The first point is frivolous, and could hardly have been raised if the two 
buildings belonged to separate landlords. The second point, so far from being a 
reasonable cause of complaint, is really the crowning merit of the arrangement, 
because it enables the men to enjoy all the benefit of hospital treatment under the 
immediate eye of a highly qualified and experienced specialist. By all accounts, 
Major Worth is as good a man for this job as could be found in all England, and 
from what I saw I should think the patients are lucky to have him so close at 
hand. 

“ The charges made in the letter published on February 9th referred to more 
than one establishment. As to others than Springfield Hospital I cannot speak 
from personal knowledge ; but I am credibly informed and believe it to be the fact 
that there is only one other where any association with lunacy law treatment can 
possibly be suggested. This is the Maghull Hospital, Liverpool, which was built 
for a lunatic asylum, but was taken over by the War Office for use as a hospital 
for nerve disorders before it was ever occupied as a lunatic asylum. Objection to 
the use of this building in this way seems a degree more absurd than the objection 
to the Springfield Hospital. That being the state of the case, I must withdraw the 
observations made in Truth of February 9th on my correspondent’s letter. So far 
from reproaching Sir Alfred Keogh for not having carried out his promise in 
regard to providing hospital treatment, I think, after seeing Springfield Hospital, 
that he is to be congratulated on finding the chance of carrying it out in such an 


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454 NOTES AND NEWS. [July, 

admirable manner. And if anybody feels any doubt on that point, I recommend 
him before he opens his mouth on the subject to do as I did, and go and see for 
himself.” 

The incident was also commented on in The Hospital of March 4th, 1916, as 
follow^: 


“The Springfield Military Hospital. 

“The Editor of Truth recently gave publicity to an accusation of broken pledges 
directed against the Director-General.of the Army Medical Service (Sir A. Keogh) 
in connection wfth the arrangements for ‘ nerve-shocked ’ soldiers. Having 
availed himself of an invitation to inspect on the spot the Springfield Military 
Hospital, Wandsworth (around which the contention seems to have arisen), he 
very emphatically refutes the whole of the criticism which he formerly printed, 
and incidentally testifies to the efficiency of the Springfield Hospital in a manner 
which must be highly gratifying to the Commandant, Major Worth, who is also 
Superintendent of the neighbouring Wandsworth Asylum, under the Middlesex 
County Council. An enthusiastic description is given of the hospital buildings 
themselves, and of the extensive grounds in which they stand ; while the system of 
treatment as Major Worth administers it is also spoken of in the very highest terms 
of praise. Altogether both the Springfield Hospital and the Army Medical Depart¬ 
ment get a very excellent testimonial over the incident, which may be regarded as 
most satisfactorily closed." 

We must say that it is a matter for surprise that at a meeting held more than a 
year after the occurrence of an incident which received such publicity at the time, 
there was apparently no one in the audience acquainted with the facts, and that 
not the slightest attempt appears to have been made to refute an absolutely 
groundless canard. 


CORRESPONDENCE. 

War Emergency Fund of the Royal Medical Benevolent Fund. 

To the Editors of the Journal of Mental Science. 

Sir, —The time has come to make a further appeal for the War Emergency 
Fund. 

This Fund was instituted last year to afford assistance to members of our pro¬ 
fession who, in consequence of having joined the Army Medical Service, find 
themselves in temporary difficulties. 

Many medical men, when called up, had to leave on very short notice, without 
time to make adequate provision for the continuance and maintenance of their 
practices during their absence. As a result they have had to face a severe fall in 
income even when supplemented by Army pay; while many expenses, such as rent, 
insurance, taxes, family maintenance, and education, could not be reduced. 
Although in a year or two after their return it may be hoped those affected will 
recover their position, still, in the interval help is, and will be, necessary, and it is 
to meet these needs that the War Emergency Fund was established. 

To be effective the grants must be made on a liberal scale, and the fund from 
which they are to be drawn must be a large one. The sum obtained last year was 
about .£4,000. This is quite inadequate, as at least £25,000 will be required if 
even a small proportion of those requiring assistance is to be helped. From the 
wealthier members of the medical profession, it is hoped, substantial sums will be 
received, but everyone should feel it a duty which he owes to his less prosperous 
colleagues to give the most liberal donation he can afford. 

At the same time the appeal is not, and ought not to be, restricted to the medical 
profession. The public, too, may be rightly called upon to bear its share, and to 
show, by liberal contributions, its appreciation of the special services so freely 
rendered by the medical profession to the country. 

The War Emergency Fund is a special department of the Royal Medical 
Benevolent Fund. It is kept separate and distinct from the ordinary operations of 
the general fund, and is under the management of a committee specially appointed 
for the purpose. 


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Communications should be addressed to the Honorary Secretary, War Emer¬ 
gency Fund, ii, Chandos Street, Cavendish Square, W. I, to whom cheques 
should be made payable. 

We are, etc., 

Samuel West, 

President. 

Charters J. Symonds, Colonel A.M.S., 
Honorary Treasurer. 

G. Newton Pitt, Major R.A.M.C.(T.), 

. . Honorary Secretary. 

London, W. I, 

June 8th. 


Cases of Special Distress caused by the War which the Committee have Helped. 

A lieutenant in the R.A.M.C., who had only been in practice a few years, 
volunteered for service, and was killed in action a few days later. He left a widow, 
with two children, aged 3$ and 1 year, without means except the War Office 
pension. The Fund voted £25 for her immediate necessities, and the Officers’ 
Families Fund gave further help. 

A captain in the Territorials was called out, and had to leave his practice in the 
hands of a locum , who proved a failure. There were seven children, aged 2 to 14. 
Financial difficulties arose, and payment of the school fees became impossible. 
Between the Fund and Guild, and the Officers' Families Fund, the necessary fees 
were raised, and sorely needed clothing provided. 

A captain in the Territorials, who was called out when the Army mobilised, and 
had to leave his practice worth £800 at a day’s notice, could not pay the fees for 
his son’s education, who was in his last year at school. The Fund, the Guild, and 
the Professional Classes War Relief Council together raised the necessary money. 

A captain in the Territorials was killed in action, and left a widow, and two 
•children, aged 3 and 4i years. The Fund investigated the case, and referred it to 
the Officers’ Families Fund, who gave her a grant to meet her immediate 
necessities. The Fund also obtained work for the widow, a trained nurse, who 
■was thus enabled to earn her own living. 

A major, R.A.M.C., Territorial, was called out at the beginning of the war and 
was abroad for over two years. He was invalided to England and put on home 
service. His practice was completely lost by his absence. There are three 
children—one in the Navy, one in the Army, and one at school. He had to give 
up his house, as he was in difficulties with rent, taxes, and education. The Fund 
gave ^50, and further help was obtained from other sources.. 

A captain in the R.A.M.C.(T.), with a wife and six children, found the income 
-derived from his practice, left in charge of a locum, and the balance of his Army 
pay insufficient to meet his expenses. He obtained assistance from the Civil 
Liabilities Committee and the Officers' Families Fund, and a grant was made from 
the War Emergency Fund towards the education of the children. 

A practitioner, earning £700 to j£8oo, volunteered for service, leaving his 
practice in the hands of a neighbour, who was not a success. There were two 
•children, aged 7 and 10, and another baby was born shortly after the husband left. 
The wife contracted pneumonia and nearly died. A resident patient had to leave 
the house. Rent and other expenses led to a debt of about £80. This the doctor 
could not meet, and he hurried back from the trenches to save his home from being 
sold up. The Fund voted .£25, the Guild gave ^,'15, the Officers’ Families Fund 
^25, and the Professional Claeses War Relief Council offered further help, with 
the result that he returned to the Front with his immediate anxieties relieved. 


Sir,—W e beg to support the urgent letter of appeal to this Fund which 
appeared in the last week's medical journals. 

This Fund was instituted by the Royal Medical Benevolent Fund last year to 
afford assistance to members of the profession who, in consequence of having 
joined the Army Medical Service, find themselves in temporary difficulties. 


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456 NOTES AND NEWS. [July 

We very strongly commend the claims of this Fund to the generous support of 
both the profession and the public. 

We are, etc., 

Frederick Taylor 

(President, Royal College of Physicians). 
W. Watson Cheyne 

(President, Royal College of Surgeons). 

W. H. Norman, Surgeon-General, R.N. 

(Director-General of the Medical Depart¬ 
ment of the Navy). 

Alfred H. Keogh 

(Director-General, Army Medical 

Service). 

William Osler 

(Regius Professor of Medicine, Univer¬ 
sity of Oxford). 

T. Clifford Allbutt 

(Regius Professor of Physic, University 
of Cambridge). 

John Tweedy 

(Past-President, Royal Medical Benevo¬ 
lent Fund). 

11, Chandos Street, 

Cavendish Square, 

W. I. 

June 1 6th. 


OBITUARY. 

William Rawes, F.R.C.S.Eng., M.D.Durh. 

To the great number of the friends of Dr. Rawes the news of his death came as 
a sudden shock, as few had heard of any severe illness. There is no doubt that the 
closing of St. Luke’s Hospital was in a measure a great sorrow to him, though he 
was looking forward to a well-earned holiday. He told the writer that he felt 
parting from the majority of the patients as old friends, and these same feelings 
were, I know, reciprocated by the patients. 

Dr. Rawes was educated at the London Hpspital. After qualifying in 1885 he 
was appointed House-Physician to Drs. Hughlings Jackson and Stephen Mac¬ 
kenzie, and later to a House-Surgeoncy under Mr. John Couper. A few years 
later he became Assistant Medical Officer at St. Luke’s (July, 1891). He was 
made Medical Superintendent on December 26th, 1898 (upon the retirement of Dr. 
George Mickley), and was still an officer on the date of his death, March 6th, 1917. 
Dr. Rawes attended frequently the meetings of the Association, and on two 
occasions the South-Eastern Division met and were hospitably entertained at St. 
Luke’s. 

A former assistant and intimate friend writes : 

“ He was a man of wide intelligence, great intellectual powers, and of detached 
views. He thought for himself, and refused to take anyone’s views or teaching 
without first examining it closely. Main and broad questions, and practical 
subjects in his work as alienist, were those to which he devoted his mind, but he 
refused to waste his time and intellectual energy on any impractical or futile 
subjects, or those, as a rule, of purely academic interest. His advice in cases of 
mental disease, and also in all medical and surgical cases, was always most 
valuable, as it was not only sound, but enlightening from its practical standpoint. 

"The guiding principles of his life were truth, honesty, and justioe, and these 
endeared him to his friends, his patients, and to all who worked with him, as one 
on whom they could rely, and to whom they could give their best service. He also 
possessed a fine sense of humour, which is essential te success. His principal 
recreations were foreign travel and reading history and travel. At such sport and 
games of skill as he could practice he was good, and enjoyed them. He was a keen 
Mason, and Treasurer of the London Hospital Lodge." 


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457 


Charles Theodore Ewart. 

Clinical psychiatry has lost a devoted as well as an able and interesting per¬ 
sonality by the death of Dr. Ewart. It is unspeakably sad that he should have 
been called away from the work of his life, just as he was happily enjoying the 
climax of his ambition, for which he had long waited and which, when at last 
attained, he maintained with honour and the utmost credit, via. the post of Medical 
Superintendent of the London County Council’s large asylum at Claybury, with 
nearly 3,000 beds, and to which he was temporarily appointed only last September. 
All who knew Ewart respected his loyalty, the love that he had for the work of 
tending the insane, his anxiety for their comfort and welfare, as well as his great 
reserve of perseverance and patience. It is not too much to say that no man was 
ever more respected by the staff nor more loved by his patients for the special 
qualities which make a successful medical officer of a large institution. Those who 
knew Ewart never failed to realise his great tenderness in speech and action, for sym¬ 
pathy was in the nether springs of his nature. He never turned a deaf ear to the 
most trivial complaint, even when made by the most unreasonable of his patients, 
and he readily gave an interview to the most unamenable and perturbing spirit. He 
regarded his patients as his friends and he gave of his best freely to serve their 
interests. The writer knew no medical officer who so readily responded or who 
gave his time so unstintedly to “interviews with friends” in order to reassure 
anxious relatives that the patient was receiving the best curative and remedial 
treatment, and his sincerity always carried confidence and conviction. 

He was gifted with no small amount of that introspective mental analysis which 
characterises so many Scotsmen, and his great delight was in a contemplative 
philosophy which sustained some religious, reflective, or mystical trend. He was 
a man who was capable of doing great things, and he was certainly a man whose 
friends had great expectations from him, for he had initiative original powers and 
an inventive, suggestive mind ; but he possessed the defects of his qualities ; his 
calm, contented disposition, his mysticism (usually associated with a keen intellect), 
and his firm optimism (that all would work well in the end) militated against his 
achieving early success and distinction. Ewart was so full of life—he made all the 
detailed arrangements for his own operation, and planned his summer holidays, 
and even arranged what books to read during his convalescence—that he may be 
said to have been absolutely open and " responsive ” to life. He was the type of 
perfect gentleman; suave, self-resourceful, and self-reliant; sympathetic, and in 
consequence considerate for the welfare of others. 

He possessed a deep feeling of altruism, with a most hopeful temperament; 
he had an imposing and pleasing presence, and these, combined with a refined 
intellect and good manner—he had a loathing contempt for any meanness or 
underhand dealing—made Ewart one of the most popular and charming characters 
whom the writer has met. 

Dr. Ewart was never keen to attend public meetings, even when he had the 
opportunities to be present; he was lost in a self-assertive crowd; he loved so 
much more the personal touch, for he was the quiet scholar and he felt into the 
soul of things. He contributed on occasions to high-class magazines and journals. 
He wrote for the Nineteenth Century, the Westminster and Empire Reviews, 
Quest, Chambers' Journal, and others, and he excelled in magazine articles rather 
than in contributions to medical literature, because he had a passion for a more 
abundant life, and this made him extend his sympathies beyond his own special 
sphere. It was this lure for something more than was apparent in things that 
made him search for the deeper reality which existed and which he was thus led to 
pursue. In spite of this philosophic tendency he was one of the earliest of this 
passing generation to draw practical attention to the value of special industrial 
colonies for those afflicted with epilepsy, and he may be correctly described as the 
originator of the scheme adopted later by the London County Council when the 
Colony for the Insane Epileptic was founded at Epsom. He was the first to insti¬ 
tute the training of nurses in the London asylums upon the basis of a syllabus 
adopted by the St. John Ambulance Association, as a recognition of which he was 
elected an Honorary Life Member of the Association. He took the greatest 
interest in physical drill for mental patients, many of whom in asylums need some 
encouragement to perform muscular movements, especially those of a general, 


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[July, 


orderly, and sustained kind, and he was a firm believpr in the maxim, Mens sana 
in corpore sano. 

He was an ardent naturalist and loved the country with all its pursuits, and he 
was a great “gamester,” being a “ plus” golfer and well known at some of the 
principal links, a keen cricketer and “ Footer ” player, a good opponent at tennis, 
and a useful hockey hand, but owing to a football accident, which brought on a 
strained knee, he was obliged of late years to moderate his favourite bent towards 
athleticism. Dr. Ewart was a well-trained and well-read graduate of the Aberdeen 
University, and was intimately known to some of its most distinguished alumni , 
who were his fellow-students. 

He came of a good family i his father was a Judge of High Court in Jamaica, 
and his mother was a Barclay. He married whilst at Claybury a daughter of the 
late Mr. Abraham. Flint, of Chigwell; she and her young daughter are left to 
mourn the loss of a most devoted father. Last Easter he suffered from an abscess 
of the vermiform appendix, which was successfully treated in a nursing-home in 
London, and on Saturday, June 16th, he was further operated upon in his home at 
Claybury for appendicitis. The writer saw him the day before he died, when the 
wound, owing to complications, was re-opened and the abdomen re-examined. 
He was then calm, composed, and self-reliant, his only thoughts being for others. 
He died from exhaustion and shock four days after the operation, having for a few 
months only reaped the fruits of a too long-deferred promotion. 

His remains were laid to rest, by his own wishes, near to the scenes of his long 
labours, and with every mark of love and respect. ■ 4 fis great wish is probably now 
being realised; he had hoped after death to begin life in a new state with far more 
abundant opportunities for experience, having left behind him the busy strivings of 
a probationary existence. 

It is hard to believe that Ewart has ended all his aims, plans, and activities! He 
Will be tenderly recalled by several present medical superintendents who were his 
colleagues at Claybury—as well as by many matrons—as a loyal, sincere, and 
generously-minded friend, and to the writer and his family his memory will be long 
retained and affectionately cherished. R. A.-J. 


A CORRECTION. 

In the discussion on Sir Robert Armstrong-Jones's paper on “ Dreams,” which 
appeared in the April number of the Journal, Dr. Rothsay Stewart is reported 
(p. 220) to have said—“ it assumed a submental stimulus.” Dr. Stewart writes: 
“ This should be ‘ subminimal stimulus.' The term is borrowed from electricity, 
and the meaning wished to convey was that certain cells in the brain, which had 
received the least stimulus to allow of their acting, would have become active 
during a dream.” We regret that this clerical error should have occurred.— Eds. 


THE LIBRARY. 

Members of the Association are reminded that the Library at 11, Chandos 
Street, W., is open daily for reading and for the purpose of borrowing books. 
Books may also be borrowed by post, provided that at the time of application 
threepence in stamps is forwarded to defray the cost of postage. Arrangements 
have been made with Messrs. Lewis to enable the Association to obtain books from 
the lending library belonging to that firm should any desired book not be in the 
Library. In addition, the Committee is willing to purchase copies of such books 
as will be of interest to members. Certain medical periodicals are circulated 
among such members as intimate their desire to be included in the list. 

Members reducing their private libraries are requested to bear in mind the 
library of the Association. 

Applications for books should be addressed to the Resident Librarian, Medico- 
Psychological Association, 11, Chandos Street, Cavendish Square, W. 

Other communications should be addressed to the undersigned at the City of 
London Mental Hospital, Dartford, Kent. 

' R. H. Steen, 

Hon. Secretary, Library Committee. 


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APPOINTMENT. 

Dunn, Edwin Lindsay, M.B., B.Sch., Trinity College, Dublin, Medical Super¬ 
intendent of the Berkshire Asylum, Wallingford. 


NOTICES BY THE REGISTRAR. 

The examination for Certificate in Psychological Medicine will be held in 
London early in July. For particulars, apply to the Registrar, Dr. A. Millek, 
Hatton Asylum, Warwick. 


NOTICE TO CONTRIBUTORS. 

N.B .—The Editors will be glad to receive contributions of interest, clinical 
records, etc., from any members who can find time to write (whether these have 
been read at meetings or not) for publication in the Journal. They will also feel 
obliged if contributors will send in their papers at as early a date in each quarter 
as possible. 

Writers are requested kindly to bear in mind that, according to Lix(a) of the 
Articles of Association, " all papers read at the Annual, General, or Divisional 
Meetings of the Association shall be the property of the Association, unless the 
author shall have previously obtained the written consent of the Editors to the 
contrary.” • 

Papers read at Association Meetings should, therefore, not be published in other 
Journals without such sanction having been previously granted. 


LXIli. 


30 


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JOURNAL OF MENTAL SCIENCE, OCTOBER, 1917. 


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H. Haves Newington, F.R.C.P.Edin., M.R.C.S.Eng. 
Obiit July 31st, 1917. Treasurer, 1894-1917. 


Portrait by Olive and Katherine Edit Sheringham. 

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462 HERBERT FRANCIS HAYES NEWINGTON. [Oct., 

Sussex family whose home, Pashley, at Ticehurst, is of historic 
interest in having been the residence of Ann Boleyn and her 
father. 

Hayes Newington received his preliminary education at 
Blackheath, and his medical training partly at University 
College, London, and in part at Edinburgh University. He 
qualified as M.R.C.S.England and L.R.C.P.Edinburgh in 1871 
and 1873 respectively, and, taking the Membership of the 
latter in 1878, he was elected a Fellow in 1898. 

His connection with Edinburgh led to his joining the medical 
staff of the Royal Edinburgh Asylum at Morningside, at the 
head of which Dr. David Skae then was, and, on the appoint¬ 
ment of the late Sir Thomas Clouston to the Physician-Super- 
intendentship of that institution in 1873, Hayes Newington 
became the latter’s first Senior Assistant Physician : small 
wonder therefore that, with the stimulus of those two teachers 
and the traditions into which he himself had been born, his 
professional views and aspirations should have been of high 
order. Of fine physique and commanding presence—but the 
latter robbed of all hauteur by a slight stoop and a manner 
transparently sincere and friendly—he was a “ big man ” in 
both body and mind ; and on his return to Ticehurst House, 
and later on as its medical head, the future progress and 
development of this already well-known establishment were in 
eminently sa/e hands. 

To say that Hayes Newington was a many-sided man gives 
but a shadowy indication pf the immensity of his activities and 
the diversity of his interests ; but, many though these were, all 
directly or indirectly had as their goal the improved care and 
treatment of the insane, the welfare of those so engaged, and— 
it is not too much to add—the mental health of the general 
population. It is no easy task either to summarize his work, 
or at all adequately to portray the unique and great place he 
filled in the ranks of those practising the special branch of 
Medicine to which, with untiring energy, he devoted his life; 
probably his ideal biographer would have been his old friend. 
Dr. Urquhart—another member of, alas ! the fast dwindling 
** Old Guard ” of our Association—whose death occurred on the 
same day as his own. At this year’s Annual Meeting it was 
Dr. Hayes Newington who proposed the late Dr. Urquhart as 
an Honorary Member of the Association. There is a touch of 


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pathos in the incident, as a close and almost lifelong friendship 
had existed between the two men. Only six days later both, 
within a few hours of each other, passed beyond the confines 
of this mortal life. In their deaths they were not divided. 

It is, however, safe to assert that, in the home of his 
ancestors, at Ticehurst House, of which he was medical super¬ 
intendent and part-proprietor, he found his life’s work. His 
reign there was marked by many improvements and several 
important additions to the resources of the institution. Never 
for one moment did he, or those associated with him, allow 
private considerations to come before the best interests of the 
patients. A gift of rare insight, with an ability to enter into 
the lives of his charges and to win their fullest confidence, were 
qualities Hayes Newington possessed in remarkable degree; 
and doubtless it was to this intimate knowledge of his patients’ 
cases, to his Jripe judgment, and to his real scholarship in 
psychological medicine that he owed both his success as a 
physician and the readiness with which cases, often giving rise 
to a maximum amount of anxiety, were entrusted to his care. 
He realized the importance of providing for their pleasures and 
recreations, and the zest with which he himself joined in these 
with them was ever an example to the staff under him. A 
good cricketer, a keen golfer, and an enthusiastic musician, he 
utilized these and other accomplishments for the welfare of his 
patients and, rightly, did not think it derogatory to the dignity 
of his position to act as organist, choir-master, and conductor 
of the orchestra of Ticehurst House. If his attitude towards 
innovations in modes of treatment was one of considerable 
caution, he at any rate saw to it that, as regards the methods 
on which his experience had taught him to rely, there should 
be no stint in the means for their thorough application. That 
he was in no wise hostile to modern methods and that he was 
well aware that the march of knowledge in the specialty would 
inevitably carry with it changes in lines of treatment are 
evidenced by his anxious solicitude—known at least to some of 
our members—that, when time with him should be no more, his 
successor should be a man versed in the results of modern 
research and imbued with a desire to apply them. If an 
epitaph to his life-long labours to maintain and enhance the 
best traditions of Ticehurst House be wanted, most truly may 
it be written of him : 


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464 HERBERT FRANCIS HAYES NEWINGTON. [Oct. 

“ Thou cam’st not to thy place by accident, 

It is the very place God meant for thee.” 

But to most of us—among whom and for whom he so 
assiduously toiled for almost half a century—Hayes Newington 
was best known, and will longest be remembered, for the pro¬ 
digious work he did for the Association and in relation to the 
important positions in it which he has filled with such con¬ 
spicuous ability and acceptance. How much those present at 
our meetings owe to him for their creature comforts has probably 
been little realized outside the Association’s permanent officials : 
it is a fact to which he would never permit any reference, but 
which ought not to escape notice here. In catering for the 
social amenities of our gatherings every detail, however trivial, 
was the subject of his scrutiny, and he brought into play here 
the same methods of precision and exercise of system that 
characterized all his work ; if any member at the festive board, 
finding himself cheek-by-jowl with a particular friend, ever gave 
a passing thought as to the happy coincidence by which he 
found himself so placed, he may now know that it was usually 
to the Treasurer’s foresight that he owed his pleasure. All that, 
however, is “ by the way ” and insignificant in comparison with 
the great work he did in furtherance of the prime aims— 
scientific and administrative—of the Association. His connec¬ 
tion therewith dates back to 1873 and it would be of interest 
to know, not how many but how few of its meetings in those 
forty-four years he failed to attend. In 1889 he occupied the 
presidential chair on its vacation by his already-mentioned 
former chief—Sir Thomas Clouston. He served on, or acted as 
Chairman of, almost every Committee that from time to time 
has been set up, and of the Standing Committees. He was 
Chairman of the Parliamentary Committee from 1896 to 1904. 
He was our “ watch-dog ” over proposed legislation, and from 
his high position, both medically and socially, he was often 
able to improve or correct intended enactments. In the anxious 
period immediately prior to the passing of the important Acts 
of 1890 and 1891 and in connection with the Superannuation 
Act of 1909 he was much at Westminster, and rendered 
yeoman service to the real interests of all concerned ; as also he 
did for asylum staffs in relation to the Workmen’s Compen¬ 
sation Act. 

It was, however, in the Treasurer’s seat, in which he followed 


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1917 -] HERBERT FRANCIS HAYES NEWINGTON. 465 

Dr. Paul and which he occupied from 1894 until his death, 
that he was most familiar to us, and where he was the “ power ” 
not only “ behind the throne,” but by the side of successive 
presidents. His faculty of seeing all sides of a question of 
policy or procedure .and his accurate knowledge of the 
minute-book, even for remotely antecedent entries, were 
remarkable. Creative criticism and “ a modest and learned 
ignorance” distinguished his mode of discussion. For these 
reasons, and because of his obvious single-mindedness and 
directness of motive he could, in debate, always arrest and 
sustain attention ; and, where a decision was necessary, rare 
indeed must have been the occasions where his advice was 
not followed. His skill in the more immediate duties of 
the office of Treasurer and his successful management of the 
Association’s finances are too well known to need here more 
than record. His labours in assisting with the preparation 
of the Handbook for Attendants on the Insane —first published 
in 1885—and in connection with the training, examination, 
certification, and registration of mental nurses, male and 
female, are- also common knowledge ; their valuable results 
can never be obliterated. Mention, too, must not be omitted 
of the strenuous manner in which he threw himself into the task 
entrusted to the Statistical Committee, whose work, extending 
through three years, besides effecting other important changes, 
was productive of much saving in labour by homologating to a 
considerable extent the tables published by the Commissioners 
in Lunacy and those recognized by the Association. Assuredly, 
since the death of Dr. Hack Tuke, the most dominant person¬ 
ality at the Council and on the Standing Committees has been 
Hayes Newington ; but his loyalty to his numerous friends 
and the trust he inspired not only made jealousy impossible, 
but made his dominance a source of congratulation. The 
affection and esteem in which he was held by the members was 
marked by their presentation to him, at the Annual Meeting, 
1913, of his portrait in oils by W. W. Ouless, R.A., on the com¬ 
pletion of his fortieth year of membership of the Association. 

Despite this position in our Association, Hayes Newington 
shunned the “ limelight,” and his professional views are to be 
found mostly in the records of scientific discussions. Never¬ 
theless his literary powers were great, and he published not a 
few papers of much value—notably, for example, “ Observa- 


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tions on Stupor” (1874), “ Mental Aspects of Music” (1897), 
and “Plans of a New Asylum for East Sussex” (1900). The 
subject of his presidential address was “ Hospital Treatment 
for Recent and Curable Cases of Insanity.” 

In local government, Hayes Newington gave much valuable, 
though unobtrusive, assistance. At the formation of county 
councils, he was elected for the Ticehurst division, and was, at 
the time of his death, and had been for several years, Alderman 
of the East Sussex County Council. Many of the medical 
features of Hellingly Asylum, which he worked out with the 
Architect (the late Mr. G. T. Hine, F.R.I.B.A.), are the result 
of his prevision, planning, and organisation. He more than 
once declined the honour of a seat on the County Bench. 

Notwithstanding these numerous claims on his time, the 
deep interest he had from early years taken in the affairs of his 
native parish never flagged. At the establishment of parish 
councils he was co-opted Chairman of the Ticehurst Council. 
A great lover of his garden (the dahlia was his favourite flower), 
he did his best to encourage successful results, and was Presi¬ 
dent of the local Horticultural Society. 

For some considerable time his health had not been good, 
and, following the death by a motor accident of his cousin and 
partner (Dr. Alexander Newington), his friends viewed with 
anxiety the additional strain of work thrown upon him, and, 
later, the effects of the war caused further stresses in connection 
with his duties. But no one who was present at the Annual 
Meeting of the Association in the third week of last July and 
listened to his share in the discussion on Dr. Mercier’s paper had 
the least suspicion how near at hand our loss was ; and when 
the end came as it did on the 3 1st of July, it found him, except 
for a few hours’ indisposition, as he himself would have wished 
—in harness and at work. That the affection he bore for his 
native place was returned in full measure by the parishioners 
was strikingly manifest at the funeral which took place at Tice¬ 
hurst ; nor was the solemnity of the occasion diminished by 
the circumstance that throughout the service in the churchyard 
the guns from the Front were plainly audible. 

In 1875 Dr. Hayes Newington married Jane Elizabeth, 
daughter of Prof. Archer (Director of the Edinburgh Museum 
of Arts and Science), and this memoir would be incomplete 
without an allusion to his home and character as a host. If a 


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CHADWICK LECTURE. 


467 


special welcome was reserved for their more intimate friends, none 
could visit “ The Gables ”—the home he built for his family and 
himself at Ticehurst, and where hospitality was proverbial— 
without feeling invigorated and encouraged. In all these 
matters he was ably seconded by his wife, who was ever alert 
to shield him from the strain of his many activities. As well 
as by her he is survived by a son and daughter, the latter of 
whom has given indefatigable assistance in the clerical work of 
the Treasurership. If the end of his life was clouded by 
sorrows, sorrows through the war, it is a source of satisfaction 
to know that they were to some extent mitigated by the 
knowledge of the emphatic manner in which the gallant 
services of his son have been recognised. 

“ Strong towers decay, 

But a great name shall never pass away.” . 


Part I.—Original Articles. 


Chadwick Lecture (April 26th , 1917 ) : Mental Hygiene 
in Shell-shock, during and after the War. (*) By 
F. W. Mott, M.D., LL.D., F.R.S., Major, R.A.M.C.T. 

Mr. President, Ladies and Gentlemen, —A new epoch 
in military and medical science has arisen in consequence of 
the employment of high explosives, combined with prolonged 
trench warfare, in this terrible war. 

The term “ shell-shock ” is applied to a group of varying 
signs and symptoms, indicative of loss of functions and dis^ 
order of functions of the central nervous system, arising from 
sudden or prolonged exposure to forces generated by high 
explosives. The forces producing shell-shock are most com¬ 
monly generated by the explosion of large shells, but also of 
mines, aerial torpedoes, whizz-bangs, trench mortars, bombs, 
and hand-grenades filled with high explosives. 

In a large number of cases, although exhibiting no visible 
injury, shell-shock is accompanied by burial. Again, cerebral 
or spinal concussion may be caused by sand-bags, hurled from 
the parapet or paradoes of the trench, striking the individual 
on the head or spine. The soldier may be concussed by the 


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468 CHADWICK LECTURE, [Oct., 

roof or wall of the dug-out being blown in, or he may be 
driven violently against the wall of the trench or dug-out, or 
blown a long distance, simply by the strength of the explosion. 

One case in point: An engineer officer under my care 
recollected nothing of the circumstances of the shell-shock 
which brought him to hospital, but a brother officer informed 
me that he was blown 40 feet along a road by the explosion 
of one shell, and blown back again by the explosion of another. 
The enemy was “ strafing ” the road by planting shells along it 
at intervals. 

It has been shown that the force generated by 17-in. shells is 
equal to 10,000 kgrm. per square metre, or 1 o tons to the square 
yard. This supports the contention that even death may occur 
as the result of aerial concussion, generated by high explosives, 
without visible injury. I think probably the cause of death in 
such a case would be sudden arrest of the vital centres. (*) 
The stem of the brain, surrounded by the cerebro-spinal fluid, 
is prevented from oscillating by the anterior and posterior roots 
and the ligamentum dentatum. The cerebo-spinal fluid, there¬ 
fore, acts as a water jacket to the spinal cord, and water cushion 
to the base of the brain. A sudden shock of great intensity 
would be transmitted through this incompressible fluid, and, 
seeing that it not only surrounds the central nervous system, 
but fills up the hollow spaces, ventricles, and central canal, and 
all the interstices of the nervous tissues, it follows that a shock 
of sufficient intensity communicated to the fluid would occasion 
commotion of the delicate colloidal structures of the living 
tissues of the brain and spinal cord. Such commotion would 
certainly lead to disordered function, and if severe to loss of 
function. The higher centres are the most likely to be affected ; 
therefore consciousness, memory, sensory perception, and speech 
suffer. If the commotion is sufficient to arrest the functions of 
the vital centres in the medulla, instant death would ensue, 
but it is difficult to determine in many cases whether the force 
was delivered by the hurling of a sand-bag against the head or 
spine, or simply by aerial concussion in a confined space. 

This leads me to call your attention to another important 
factor which may complicate the condition termed “ shell¬ 
shock.” The soldier, while lying partially buried and uncon¬ 
scious, or at any rate helpless, may be exposed to various 
noxious gases, ( 2 ) generated by shells or mines, especially carbon 


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BY F. W. MOTT, M.D. 


469 


monoxide, or oxides of nitrogen, both of which are poisonous 
by reason of the de-oxygenating effects upon the blood. Other 
poisonous gases from shells may produce most injurious and 
and even fatal results ; eg ., cyanogen compounds, phosgene, 
which is chloride of carbonyl and chlorine, etc. Both these 
gases are very deadly in their effects. 

From the point of view of compensation or pension, the 
War Office authorities very properly regard shell-shock as a 
definite injury ; still, from my experience, I have formed the 
opinion that the term “ war neurosis ” would be better for the 
majority of cases now sent back diagnosed as “ shell-shock,” 
because the signs and symptoms of these in no way differ 
from cases of neurasthenia and hysteria, occurring even in soldiers 
who have never been exposed to shell-fire, but have experienced 
the emotional shock of fear, and apprehension of what will 
happen to them, if they are exposed to the terrors of shell-fire 
and trench warfare. 

Another objection to the term “ shell-shock ” is its elasticity, 
rendering it liable to be differently applied by different medical 
officers. I have observed that some medical officers avoid the 
term as far as possible, and I am always suspicious of the soldier 
who, when asked what he is suffering from, glibly informs you 
“ Shell-shock, Sir.” I am apt to believe he is “ shell-shy.” I 
agree with Major Hurst that it would be better if the term 
“ shell-shock ” was more limited in its application, and it should 
not be employed in cases of neurasthenia, hysteria, or fear, 
causing a man to be sent back, although he has only been 
subjected to the experiences of war which every soldier must 
undergo who goes to the Front. The term “shell-shock” 
should, from a scientific point of view, be applied to those 
cases where there is definite evidence of commotion or con¬ 
cussion of the central nervous system. 

Malingering as shell-shock is, I am informed by Capt. 
William Brown, quite common at the Front, and the detection 
of conscious fraud is not easy in many of these cases, owing 
to the fact that a functional neurosis, due to a fixed idea or 
obsession, inhibiting will power, may be mistaken for malinger¬ 
ing. Again, the notion of never recovering tends to become a 
fixed idea, and this fact is of considerable importance in respect 
to the discharge from the Army “ permanently unfit,” and the 
subsequent payment of pension and compensation. It is 


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essential to be sure of your diagnosis that the disease is 
altogether functional, and, being satisfied thereof, to avoid all 
forms of suggestion of non-recovery. 


Mental and Bodily Condition of the Individual at the tune of 

receiving the Shock. 

In considering the effects of shell-shock on the nervous 
system, it is necessary to call attention to a complex of factors 
of extrinsic and intrinsic origin, apart altogether from the 
effects produced by direct material injury to the central 
nervous system by commotion and concussion. I will now 
consider the extrinsic conditions in modern trench warfare, 
which lead in a neuro-potentially sound individual to nervous 
exhaustion, predisposing to shell-shock. It must be obvious 
that through all the sensory avenues, exciting and terrifying 
impressions are continually streaming to the perceptual centres 
in the brain, arousing the primitive emotions and passions, 
and their instinctive reactions. The whole nervous system, 
excited and dominated by feelings of anger, disgust, and 
especially fear, is in a condition of continuous tension ; sleep, 
the sweet unconsciobs quiet of the mind, is impossible or 
unrefreshing, because broken or disturbed by terrifying dreams. 

Living in trenches or dug-outs, exposed to wet, cold and 
often (owing to shelling of the communication trenches) to 
hunger and thirst; dazed or almost stunned by the unceasing 
din of the guns ; disgusted by foul stenches, by the rats and by 
insect tortures of flies, fleas, bugs, and lice, the minor horrors 
of war, when combined with frequent grim and gruesome 
spectacles of comrades suddenly struck down, mangled, wounded 
or dead, the memories of which are constantly recurring, and 
exciting a dread of impending death or of being blown up by 
a mine and buried alive together constitute experiences so 
depressing to the vital resistance of the nervous system that 
a time must come when even the strongest man will succumb, 
and a shell bursting near may produce a sudden loss of 
consciousness, not by concussion or commotion, but by acting 
as the “ last straw ” on an utterly exhausted nervous system,, 
worn out by this stress of trench warfare and want of sleep. 

In considering the effects of shell-shock, it is necessary to 
take into account, the state of the nervous system of the 


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individual at the time of the shock caused by the explosion. 
As I have indicated, a neuro-potentially sound soldier may* 
from the stress of prolonged trench warfare, acquire a neur¬ 
asthenic condition, and it stands to reason that a soldier who is 
already neurasthenic from a previous head injury, or from 
acquirement of a disease, prior to his being sent to the Front, will 
not stand the strain so well as a neuro-potentially sound man. 

Of even greater importance than the extrinsic conditions in 
the causation of military unfitness from exposure to shell-fire* 
are the intrinsic conditions, for if there is an inborn timorous 
or neurotic disposition, or an inborn or acquired neuropathic 
or psychopathic taint, causing a locus viinoris resistentice in the 
central nervous system, it necessarily follows that such an one 
will be unable to stand the terrifying effects of shell-fire and 
the stress of trench warfare. A large number of the cases of 
shock which I see in hospital and which especially require 
treatment by mental hygiene are neuro-potentially unfit. 

They come back after a short experience at the Front, 
suffering with neurasthenia or hysteria, which persists for months 
and even a year or more ; these are temperamentally unfit. 

To take two concrete examples of the importance of the 
personal factor in the consideration of the causation of shell¬ 
shock. Acommercial traveller with one year’straining,three weeks 
in France, and three days in the trenches, was sent home suffering 
with shell-shock; after six months in hospital he is still tremulous 
and hardly able to stand or walk. He has done his best, but 
has cost as much as a cartload of shells. Compare the 
personality of this man with another, who was also admitted 
under my care suffering from spinal concussion, paralysed in 
all four extremities, with loss of control over his bladder and 
bowels. The history he gave was that he was in a dug-out 
when an 8-in. shell burst 2 ft. behind the dug-out; he was 
partially buried, but did not lose consciousness ; when he was 
rescued he was found to be paralysed. Now this man shows 
none of the signs of shell-shock ; he has no terrifying dreams* 
and although the concussion caused a haemorrhage into his 
spinal cord, followed by degeneration of the pyramidal tracts 
(viz., the paths of volitional impulses), nevertheless he is making 
a splendid recovery, and in two months is much less helpless 
than most of the severe functional cases of paraplegia, in which 
the paralysis of the legs is due to a fixed idea that they are 


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472 CHADWICK LECTURE, [Oct., 

unable to walk or stand. He appeared to be insusceptible to 
emotional shock. The case of another man under my care 
however, illustrates remarkably well the effects of emotional 
shock (psychic trauma) in the production of a profound effect 
upon the central nervous system. He was sent out with a 
party to repair barbed wire, when a great shell burst among 
them, blowing him into a shell-hole ; he scrambled out; seeing 
his comrades mangled and dead, he fell down and recollected 
no more of what happened for some weeks. When admitted 
under my care, he presented a picture of abject terror, reminding 
one of the lines in Spenser’s Fairie Queen : 

“ He answered not at all, but adding new fear to his first amazement, 
Staring wide with stony eyes and hollow hue, 

Astonished stood as one who had espyed 
Infernal furies with their chains untyed.” 

As we know, one of the peculiarities of the functional neuroses, 
eg., hysteria, is not only the sudden manner in which an 
emotional shock may cause a loss of function, but likewise the 
sudden manner in which it may be unexpectedly restored by a 
stimulus of the most varied kind, provided there is an element 
of surprise. That is, his attention is for the moment taken off 
its guard. I am referring especially to hysterical mutism and 
aphonia. If the patient is neuro-potentially sound, he will 
recover as a rule from shell-shock by rest of the mind and body 
under healthy conditions without any special treatment. But 
the neurotic, the neuropathic and the psychopathic individual, 
with an inborn or acquired locus mmoris resistentice in the 
central nervous system, is more difficult to treat successfully, 
for when an inborn or acquired predisposition to a neurosis or 
psychosis exists, functional disorders or disabilities of the 
nervous system tend to become organised by habit, and 
eventually firmly installed. 

Before we consider the mental hygiene of shell-shock, it is 
necessary to point out the more important signs and symptoms, 
for although the general principles of treatment are the same, 
special functional disorders and disabilities necessitate special 
methods. 


The Effect of Shell-shock on Consciousness. 

Most of the severe cases have suffered from loss of conscious¬ 
ness, or they have no recollection of what happened after the 


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shell burst and till they were at the clearing station or hospital; 
it does not follow that they were in a state of complete un¬ 
consciousness during that time, for cases have been recorded 
where under hypnotic suggestion they have been able to 
revive in consciousness some of the forgotten events. Again 
the following case rather tends to show that often instead of 
complete unconsciousness loss of power of recollection seems to 
be the effect produced on consciousness by the shock. Several 
cases Of the kind have come under my notice, but I will describe 
one of the most reliable, as it is a history that came from an 
officer. His company dug themselves in in a wood ; he went 
out into the road to see if a convoy was coming when a large 
shell burst near him. It was about 2 a.m. and quite dark ; 
about 4.30 a.m. it was quite light, and he found himself being 
helped off his horse by two women who came out of a farm 
house. He had no recollection of anything that happened 
between the bursting of the shell and this incident. It is 
interesting to know that it is possible for him to have inhaled 
noxious gases, for the single cigarette in a metal case that was 
in his breast pocket was yellow on one side, due, no doubt, to 
picric acid contained in the explosive. 

Many cases have been admitted under my care at the 
Neurological Section of the 4th London, who had not yet 
recovered normal consciousness, and for some days were in a 
dazed, somnolent or even semi-conscious condition. Usually 
these cases came at a time when large convoys were sent from 
the Front owing to a recent engagement. The histories "of cases 
sometimes showed that men absented themselves as a result of 
shell-shock, and, wandering away from the trenches, were found 
in a dazed condition, unable to account for their actions or to 
recollect how they came there. This condition is not unlike a 
fugue or automatic wandering of an epileptic ; and, indeed, in 
some of these cases there was a history of epilepsy or a pre¬ 
disposition to it, but in others no other cause was ascertainable 
than the conditions which induced shell-shock. 

A good many patients say that they can picture in their 
mind’s eye the shell coming; they visualise the death and 
destruction caused, and they can revive in memory the sound 
of the explosion, but a blank of variable duration in their 
recollection of events follows. Many of these patients have not 
really suffered with either cerebral commotion or concussion. 


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474 CHADWICK LECTURE, [Oct., 

and in strict acceptation of the term are not true shell-shock 
cases. Cases of severe concussion or commotion have not only 
an anterograde but also a retrograde amnesia, and these cases 
may sometimes show such a complete loss of memory of any 
event in their past life that they do not know their own name 
or where they live; in fact, their recollection is a blank, as if 
the commotion had obliterated the store house of the mind and 
its contents. .In these cases it is quite probable there has been 
either an additional factor of concussion or burial with gassing. 

Some of the severe cases of amnesia we know were gas 
poisoning complicated by concussion or burial. However, it 
is as well to bear in mind that when a man professes a complete 
loss of memory, otherwise showing no signs or symptoms of 
shock, he may be suspected of malingering. Cases have been 
admitted to hospitals, and diagnosed as shell-shock, because 
they are unable or pretended Uo be unable to recollect their 
names or where they came from, who have never been out of 
the country. I am informed by Capt. William Brown, who 
is neurological expert with the 4th Army, that hypnotism is 
very useful in detecting such malingerers, and the fear of giving 
themselves away has a deterrent effect on this form of 
malingering, whether it be deserting their post or deserting the 
ranks and professing inability to recollect what has happened. 

The drowsy anergic stupor which many of these patients 
suffer from may disappear gradually ; or it may be associated 
with auditory or visual hallucinations of a terrifying nature—day 
dreams of the terrible experiences they have gone through. As 
the mind becomes more conscious of the external world, these 
day dreams are screened off and as a rule are not able to pass 
the threshold of consciousness; but I have had cases where quite 
suddenly and unexpectedly terrifying visual hallucinations have 
induced all the external manifestations of fear, eg., profuse 
sweating, a wild terrified look and attempt to escape by flight, 
and w ? hen prevented from doing so, fear gave place to maniacal 
excitement and desperate struggling to escape. Some of the 
cases are obsessed with a terrifying experience; for example, 
one soldier kept shouting out that he saw “ginger-headed Fritz,” 
it turned out that this was a German sniper of renown. Another 
felt a patch of blood on his cheek, and when a mirror was held 
in front of him and he was shown that there was nothing there, 
he said he felt it was there although he could not see it 


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Asked how it happened, he said that a Prussian Guard had 
stabbed his sergeant in the neck with a saw bayonet, and when 
the Prussian drew it out the blood spattered all over his cheek. 
Now, although as a rule, in most cases these terrifying ex¬ 
periences do not come up into consciousness during the daytime 
when the mind is occupied in reacting to the constant perceptual 
chain of events, yet if the mind is not diverted from introspection, 
these terrifying experiences are always ready to obtrude them¬ 
selves on consciousness, and this is clearly shown by the fact that 
one of the most constant, most serious and disturbing symptoms 
of shell-shock are the terrifying dreams which are seldom, if 
ever, absent, although sometimes they cannot be recollected, but 
in such cases although the patient does not recollect the dream 
he will tell you that he has been awakened in a cold sweat and 
has experienced the feeling of sinking or falling; this may be 
due to relaxation of muscles fn consequence of fear. 


Sleep and Dreams. 

Insomnia, and sleep disturbed by terrifying dreams, afflict 
nearly all cases of shell-shock and war neurosis. I have 
not found any evidence supporting Freud’s views. I have 
questioned a number of officers and men, and have asked them 
to write confidentially their dream recollections. Very seldom 
indeed do they refer to any reminiscences of childhood. They 
almost always tell the same story of dreaming of their recent 
experiences in the trenches. Shakespeare has clearly indicated 
how dreams influence the minds of men, and how they are 
based upon past experiences. Thus, Mercutio, in the description 
of Queen Mab, refers to the soldier’s dream in the following 
lines, which are as true to-day as when Shakespeare wrote 
them : 

“ Sometime she driveth o’er a soldier’s neck, 

And then dreams he of cutting foreign throats, 

Of breaches, ambuscadoes, Spanish blades, 

Of healths five fathom deep ; and then anon 
Drums in his ear, at which he starts and wakes; 

And, being thus frighted, swears a prayer or two, 

And sleeps again.” 

In addition to the revival of experiences of trench warfare, 
of hearing the shells burst and seeing the flash, of parapets 


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476 CHADWICK LECTURE, [Oct.* 

being blown down, of being buried, of charging the enemy* 
soldiers often complain of a falling or sinking feeling ; possibly 
it is to this that Shakespeare refers in the lines, “ Of healths 
five fathom deep.” Often, in their dreams, soldiers are heard to 
cry out; and officers have been heard to give commands to 
their men, and urge them on to battle. 

I have had four or five cases of soldiers who, in their sleep, 
have gone through the pantomime of fighting with the bomb, 
with the bayonet, and with rifle. In consequence of the danger 
of injuring themselves in their unconscious but violent pur¬ 
posive motor activities, it sometimes became necessary to place 
them on a mattress in a padded room. Sometimes soldiers, 
when placed under an anaesthetic, have been known to perform 
the pantomime of habitual acts, as of raising the gun to the 
shoulder, and pulling the trigger. 

The ancients were fully aware of this, thus Lucretius says: 
“ Again the minds of men which pursue great aims under 
great emotion often during sleep pursue and carry on the same 
in like manner, kings take by storm, are taken, join -battle, 
raise a loud cry as if stabbed in the spot.” “ De rerum natura.” 
—Munro. Sometimes the same terrifying dream recurs night 
after night, causing great mental distress. An officer told me 
that he had two dreams based upon two separate experiences 
which constantly recurred ; one was attended the next day 
by a feeling of mental depression, the other by a certain 
degree of exhilaration. The former was the sight of the 
legless body of a Prussian that lay for days in front of their 
dug-out, and which it was impossible, and highly dangerous, as 
they had found to their cost, to move. The latter was his 
escape from a death struggle. He was in a trench, a Prussian, 
threw a bomb at him, which just missed him, and exploded out 
of harm’s way ; he then threw a bomb, and it blew the 
enemy’s head off, just as the Hun was preparing to throw 
another at him. 

When these dreams cease, the patient is getting better. They 
are indicative of terror, which is contemplative fear continued 
and fixed in imagination, and the signs and symptoms these 
patients suffer from are largely due to the continued effect of 
fear on consciousness. It is obvious that this fact is all im¬ 
portant to bear in mind when considering the mental hygiene 
of shell-shock. The principal objective signs and subjective 


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symptoms of shell-shock largely correspond with those of 
paralytic fear. We speak of being paralysed by fear, of giving 
way of the knees, of trembling or quaking with fear, of being 
dumb with fear, of ‘ blue funk.’ 

All these popular expressions regarding the influence of the 
emotion of fear on the human body are based upon actual 
experience, for paralysis, tremors, giving way of the legs, 
mutism, and cold blue hands are among the most constant 
signs of soldiers suffering with shell-shock. 


The Influence of Fear on Phonation and Speech. 

A frequent condition met with is aphonia and mutism or 
inability to speak even in a whisper. This in no way differs 
from hysterical aphonia and mutism. 

It is the conscious mind operating on the centres in the 
brain controlling phonation which causes this affection of 
speech, for mutes often shout in their sleep, and this may be 
the prelude to the recovery of their speech ; one man recovered 
his speech on being told that he had been talking in his sleep 
by a comrade who slept in the next bed ; he was so suprised 
that he said, “ I don’t believe it.” Another man recovered his 
speech when pitched out of a punt on New Year’s Eve ; he 
had been mute for more than six months. This lad could not 
whistle, could not phonate in coughing, could not blow out a 
candle, yet he was heard to shout in his sleep. An X-ray 
examination of his chest showed that the diaphragm hardly 
moved even when he made a great effort; the fear effect on his 
conscious mind had inhibited the respiratory movements 
necessary for phonation and the idea had become firmly 
installed in his mind. Breathing exercises to relax the con¬ 
tracted respiratory muscles may be usefully employed in some 
of these cases, and I have had two lady helpers (Miss Oswald 
and Miss Bush), teachers of elocution and singing, who have 
done excellent service. The latter has organised singing-classes, 
and it is astonishing how helpful these have been in restoring 
phonation and in curing speech defect, such as stammering, 
stuttering, mutism, and aphonia, by spontaneous imitation. 

Mutism with Deafness. 

Mutism is often accompanied by deafness ; sometimes the 
patient recovers his speech and remains deaf. I have had a 

LXIII. 32 


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478 CHADWICK LECTURE, [Oct, 

great number of cases of mutisnfi and mutism with deafness, 
and in only one instance have I been unable by suggestion or 
other means to restore the function. A particularly intractable 
case came to the hospital, who had been deaf and dumb for 
nearly a year ; I tried strong electric shocks, tuning-forks to the 
head, and sudden noises and hypnotism, without any result, but 
Dr. Yelland, of the National Hospital, Queen Square, cured 
this man. I think the imposing array of electrical machines, 
coloured lights, and other strong suggestive influences, were 
partly instrumental in accomplishing what I had failed to do, but 
also I think the knowledge of success in other difficult cases, 
attending Dr. Yelland’s effort, played a very important part in 
curing by strong suggestion this apparently hopeless case. 

To illustrate the value of suggestion in this particular class 
of case, I may select another incident. I told a man, who was 
deaf and dumb, and had been so for some time, that he would 
recover his hearing and speech on a particular day. When I 
visited the ward on the day, I said : “ Sister, does D— speak ? ” 
“ No,” she said ; “but he was heard to speak in his sleep.” I 
saw a way out of my difficulty, for I wrote down: “You 
spoke last night in your sleep; you will certainly recover.” 
Now this man, impelled by dreams, used to go through the 
pantomime of bayoneting Turks in the trenches, of which he 
was quite unconscious in the morning. He fell out of bed 
while doing this, cried out, and awoke, having recovered his 
hearing and speech. Sometimes the men do not want to recover 
the speech too quickly, and speak only in a whisper. When 
I have thought a patient was thus consciously prolonging his 
disability, I have said to the sister aside, but loud enough for 
the patient to hear : “ This man must be kept in bed on No. 1 
diet, and when he can ask loud enough for you to hear, he can 
have a bottle of stout and a mutton chop.” I have had 
several get well the next day by this treatment. 


Hysterical Sensory Dissociatioji. 

The deafness may be partly functional, partly due to injury 
of the drum of the ear, or wax may be damped against the 
drum. Only about 17 per cent, of the cases of deafness are 
really due to, or partly due to ear disease ; the majority of the 
cases are purely functional, and due to dissociation of the 


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sensory perceptive centres of hearing of the brain. They do 
not hear the tuning-fork, although they feel the vibration. 
There is usually dizziness, but there are signs which clearly 
serve to differentiate this functional cortical brain deafness 
from the deafness due to damage of the organ of hearing 
and equilibrium, or the nervous structures in it. 

Sometimes a man is blind, and an examination of the eyes 
shows that there is no injury or cause in them to account for 
the loss of sight. Vision may be lost suddenly and restored 
suddenly ; suggestion plays an all-important part, not only in 
dissociating the visual perceptive structures in the brain from the 
nervous tracts which convey the light stimuli of the blinding 
flash from the eyes, but in restoring the sight by re-associating 
them. Again darkness may by suggestion cause blindness, as 
was shown in the following case. A man suffering with- shell¬ 
shock, crept into a culvert and lost his sight there, so that 
he was unable to find his way out ; a wounded man came in, 
and by their combined efforts they got out; the blind man 
carried or helped to support the wounded man, and the 
wounded man directed the blind man. 

Another interesting case was that of a grenadier who was 
blind, deaf and dumb, and this case like many others I have 
seen, illustrates the fact that, when an individual is deprived of 
the use of one or more of the sensory perceptive centres of the 
brain, the mind is more alert in receiving stimuli arriving by 
the remaining avenues. Thus, this grenadier who was quite 
blind, deaf and dumb, was most sensitive to touch, so that he 
started back when the feeding cup was put to his lips. The 
day after admission he had an hysterical fit, owing to abdominal 
pain, and suddenly recovered his sight. The next day he was 
able to write down his name, regiment, native place, etc., but of 
his experiences in France he knew nothing, although he had 
been out a considerable time. He was very distressed that he 
could not hear or speak. A few days later he had another 
emotional outburst, and thereafter recovered his speech and 
hearing. We subsequently found that he had been blown up 
and buried by a shell, but of this he had no recollection. He 
made a rapid recovery. This was a true case of shell-shock, 
causing a functional neurosis by disassociation due to commotion 
of the brain. 

Here I may say how important it is to ascertain how long 


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a man has been in the front line in estimating how much of 
the functional disorder or disability is due to a pre-war neurotic 
condition. 


The Differential Diagnosis of Shell-shock. 

Shell-shock is a term applied to severe forms of war 
neurosis, usually associated with commotio cerebri or con¬ 
cussion, and not infrequently attended by burial and the 
inhalation of poisonous gases while lying buried or unconscious. 
The shock may be so severe as to cause instant death by arrest 
of the vital centres in the medulla, or complete loss of conscious¬ 
ness may supervene of varying duration. Upon the return of 
consciousness the patient may be unable to recollect past 
experiences for a variable period of time ; there is a retrograde 
amnesia, sometimes so complete as to leave the whole past a 
blank. In severe cases, instead of a complete restoration of 
consciousness, there may result a condition of deep anergic 
stupor, which may in rare instances continue for weeks and 
months ; more frequently there is a dazed, somnolent condition, 
associated with mutism, and a vacant, mindless, apathetic 
expression in the eye and face ; the stuporose state is accom¬ 
panied by an emotional indifference to surroundings. The 
depth of the amnesia is reflected in the expression of eye and 
face, and the malingerer is usually unable to simulate success¬ 
fully the mindless expression, which is associated with a complete 
loss of memory, for he generally overacts that part of the 
business which lies within his conscious power to overact. 

Cases of exhaustion psychosis have been mistaken for dementia 
prrecox ; especially when, associated with the stupor, there have 
been auditory hallucinations, fragmentary delusions, mental con¬ 
fusion, and outbursts of impulsive violence. I have seen patients, 
even thus afflicted with such serious symptoms of mental disorder, 
get well. Consequently, when there is a history of shell-shock, 
or a reasonable belief that the patient has suffered shell-shock, 
it is well to wait before giving a bad prognosis. Two youths, 
under my care for months, suffered from anergic stupor, and 
recovered ; it was curious that when speech returned, their 
language in mode of utterance and modulation of the voice, was 
like that of an infant. When asked how they felt (although in 
hospital at different times), they each gave the answer in the same 
way—“ me bet-tah.” 


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An exhaustion psychosis from shell-shock may be associated 
with a restless, choreiform, motor delirium ; several of these 
patients had suffered in early life from chorea.. Some of the 
patients suffering from psychasthenia are troubled by one or 
other of various phobias; the commonest of which are claustro¬ 
phobia and agoraphobia. All patients with shell-shock complain 
of inability to concentrate their attention, and they are easily 
fatigued by mental or bodily effort; some of them suffer with 
asthenopia ; nearly all complain of headache, occipital, frontal, 
or through the temples. Hyperacusis and being startled by 
noises, is usually present. Tremor of the hands is usual, less 
often of the upper lip and of the legs. The knee jerks are 
exaggerated, otherwise normal. The pupils are equal and 
react normally. 

Of the various types of neurasthenia associated with shell¬ 
shock, the spinal, cardiac, cerebral, and gastric were the most 
common. 

Only a few of the cases relatively suffered with signs and 
symptoms of sexual neurasthenia ; where sexual neurasthenia 
occurred, the cases were usually of men who had not been at 
the Front, or if they had, had not remained there long. 

The symptoms of the spinal type were, generally speaking, 
the result of suggestion ; eg, the patient had received a blow 
on the back, or a superficial wound of the spine, or there was a 
history of burial. In addition to the usual group of neurasthenic 
symptoms, there was pain and tenderness of the spine and 
tremor and giving way of the legs, and not infrequently functional 
paraplegia, or a condition of astasia-abasia (inability to stand 
or walk, although able to move all the joints of the legs while 
lying in bed). The abdominal reflexes are normal; the sphincters 
are unaffected and the plantar reflex is flexor. 

The cardiac form of neurasthenia also is common. Such 
cases have frequently been labelled D.A.H. as a systolic murmur 
has been discovered. The knowledge of this has in many 
cases led to a concentration of the mind on the precordium ; 
they feel pain and discomfort in the region of the heart; they 
suffer with palpitation and breathlessness on exertion ; and in 
some cases there is a non-conducted systolic murmur and 
physical manifestations of dilatation. The heart’s action in 
these cases is rapid, 120—160 (tachycardia); it is accelerated 
by emotion and apprehension, but mental diversion will diminish 


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CHADWICK LECTURE, 


[Oct., 

it. The pulse has sometimes been markedly diminished in 
frequency when I have taken the patient’s mind off himself by 
asking him to pull against me. 

It is of great importance to gain the full confidence of the 
patient by making a thorough examination in these visceral 
neuroses the better to be able to assure them that their organs 
are not diseased, and that the symptoms they are suffering from, 
and which alarm them, are due to nervous exhaustion and 
apprehensive contemplation by the mind of the vital organ. 
As Dejerine truly says : “ Cest la fol qui satire—on qui gutrit'.' 

Treatment of Shell-shock in the Early Stage. 

I am informed by medical officers at the clearing-stations 
that there is an increase of pressure of cerebro-spinal fluid in 
true shell-shock cases, and that sometimes even it is blood¬ 
stained or contains albumin ; also that relief of symptoms 
occurs by withdrawing fluid by lumbar puncture. 

The treatmetit of cases of shell-shock varies to some extent in 
different individuals, according to symptoms and signs, but there 
are some symptoms which are seldom absent in all true cases, 
viz., insomnia and terrifying dreams. I have found the continuous 
Warm bath of great value in the treatment of these cases when 
they come over from France. The water in the baths is kept 
continuously at the temperature of the blood by a special 
mechanism of heat regulation ; the patients are kept in the 
bath for a quarter to three-quarters of an hour, or even longer. 
The effect is most soothing on the nervous symptoms, and one 
can understand how it is so from the fact that the whole of the 
sensory nerves of the skin are acted upon by the warmth; 
the tired muscles are relaxed, and the blood is withdrawn 
from the internal organs, including the brain, to the skin. 
These baths are extremely useful in cases of maniacal excite¬ 
ment. Often the bath, with a drink of warm milk at bed-time, 
suffices without hypnotics' to produce sleep. But if hypnotics 
have to be given, the quantity required is less when combined 
with the baths. The hypnotics I recommend are trional, 
gr. x—gr. xv, preceded by mist, paraldehyde 3u\ or this alone. 
Pot. brom. or chloral, of each 1 5 gr., and either tinct. opii irt xv., 
or tinct. cannat. ind. n\ x. Dial two i-|- gr. tablets. In maniacal 
excitement hyoscin in j\— gr. doses hypodermically. It is 


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better to avoid drugs if possible, but sleep is indispensable. The 
next thing is to attend to the general bodily condition by 
nourishing, digestible, and easily assimilated food ; and lastly, 
very important is attention to the primse viae, by which auto¬ 
intoxication and cerebral congestion can be relieved. A dose 
of calomel and saline in the morning is the usual practice. 
The severe headache from which these patients suffer, requires 
relief by an ice-bag to the head, aspirin, phenacetin, and other 
drugs which relieve neuralgic pains. 

After the patient has recovered from the more serious con¬ 
dition of shock, and the mind is becoming more alert and 
interested in its surroundings, we have to consider how best 
to allay the symptoms, which nearly all suffer from, viz., head¬ 
aches, dizziness, tremors, feeble circulation, and exhaustion, 
readily brought on by mental or bodily effort. As a sedative 
and nerve tonic I usually prescribe dilute hydrobromic acid, 
quinine, and strychnine. I have found pituitrin useful in cases 
of low blood-pressure. When the symptoms point to hysteria, 
bromide and ammoniated tincture of valerian are prescribed. 
If the patient is sufficiently well to sit up, it is better that he 
should do so, at first for a few hours a day, if possible in the 
open air. To severe cases, the noise of gramophones, pianos, 
the click of billiard balls, and even musical instruments, excite 
and aggravate symptoms ; quiet repose in single rooms, such 
as we have at the Maudsley Hospital, is undoubtedly a most 
important and necessary mode of treatment in the early 
stages of severe cases. 

At the same time these patients should not be left alone ; 
quiet and unstimulating diversion of mind should be en¬ 
couraged to avoid introspection and dwelling upon the terrible 
experiences they have gone through. These men are often too 
tired or unable to read on account of inability to concentrate 
attention, and fatigue of the muscle of accommodation and the 
mind may be diverted by simple games, knitting or wool work, 
bead work, basket work, and net-making. 

Mental Hygiene in Later Stages. 

As soon as they are better, patients are encouraged to play 
billiards, cards, and other games, in the winter time especially; 
also there are frequent concerts and popular lectures, all of 


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which serve to divert the mind and produce an atmosphere of 
cure which is very essential. Soldiers will put up with a good 
deal provided they have good and abundant food, and it is 
essential for recovery that there should be no grousing. 

Grumbling and grousing are contagious, and it is always 
well to get rid of a soldier from a ward if he is exciting dis¬ 
content in the others. Discipline is very essential; laxity of 
discipline, over-sympathy and attention by kind well-meaning 
ladies giving social tea-parties, drives, joy-rides, with the fre¬ 
quent exclamation of “ poor dear,” has done much to perpetuate 
functional neuroses in our soldiers. The too-liberal gifts of 
cigarettes has produced a cigarette habit in officers and men, 
which is highly detrimental in these cases of war neurosis, 
■especially in cases of irritable-dilated heart, or in cases of 
cardiac neurasthenia. 

Again, in many cases of functional paralyses, the idea of a 
permanent disability requiring pension for the rest of a man’s 
life may become a fixed idea, owing to wrong diagnosis, over¬ 
sympathy, and misdirected treatment. In many of these cases, 
as I have found, what is required is merely strong suggestion to 
the patient that there is nothing the matter with him except 
the idea that he is paralysed, which has become installed and 
firmly fixed in his mind, by prolonged bed, daily massage, and 
electricity, which has kept suggesting to him that there is an 
organic disease causing his complaint. I have seen many cases 
of inability to stand or walk, who yet could move their legs in 
bed, and by the tests I have described exhibited conditions 
definitely pointing to functional paralysis and not to organic 
disease. Being thus sure of my ground, I have told the patient 
to get up, and I would support him and see that he did not 
fall. I have then engaged his attention by asking him questions 
about himself and his former life while gradually relaxing 
my hold, until he was standing without any support. After a 
little while, I say to him, “ Now, you did not know that you 
have been standing about five minutes without any support.” 
I have often succeeded in making such a patient walk. Men 
have come who have been using crutches for a long time, and 
I have told the sister to take the crutches and put them in the 
museum, for this patient did not want them. 

Sometimes, however, there may be so much trembling and 
shaking in the legs that the man is unable to walk without 


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■support. I induce him to try with sticks, and gradually get to 
•one stick, and then to no stick, thus re-educating the muscles. 
Others come walking like quadrupeds, bending their backs and 
supporting themselves on the sticks : a little good-natured chaff 
and taking away the sticks has cured these. 

Some patients, owing to an injury by a fall caused by an 
exploding shell, have developed a functional paralysis on the 
side of the injury, either arm or leg, or one of these limbs. 

Supposing it is the arm that is so affected, I perform a 
number of associated movements of the two arms together— 
the healthy one and the paralysed—myself assisting the im¬ 
mobile arm, telling the patient at the same time to help me by 
thinking of the same movement. After a little while, he 
may be doing the main part of the movement himself. In 
all these functional paralytic conditions of an hysterical 
nature, a great tonic is to tell the patient that it is not 
at all likely that he will ever be sent back to active service, 
for he would be no use, and that what we want to do is 
to discharge him from the service in such a state that he 
will be fit to resume his previous occupation, or we can put him 
to some work useful to the State, whereby he will not be a 
burden to himself or the community. 

I am quite sure that if this method were adopted early, in 
a large number of cases known by an expert to be tempera¬ 
mentally unfit for military service, a great economic saving 
would be effected. 

Of course, precautions would have to be taken against 
malingerers. I am sure that machines employed by doctors as 
a means of making the functional paralytics move their limbs, 
are wrong in principle and in practice, and I entirely approve 
of the methods adopted by Col. Deane at the Croydon Hospital 
•of restoring function by natural methods, in which the mind 
is exercised. Thus, I had a boy with functional paralysis of 
. the right arm ; boxing and gymnastic exercises soon put him 
quite right. Col. Deane lays especial stress upon the value of 
■associated movements, such as we get with the parallel bars, 
the climbing rope, skipping, football, Indian clubs, and the 
nautical wheel, and the ordinary apparatus of the old-fashioned 
gymnasium. My contention is, that this apparatus can be applied 
to any man who is capable of any movement. The inestimable 
-advantage is, that his mind is projected into his paralysed limb, 


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and all his sound limbs are being exercised at the same time. 
Constant change and adaptation is another advantage, especially" 
when associated with mental occupation in the work. Diver¬ 
sion of the mind by useful occupation, both in the workshop 
and in the garden, have been most successful in restoring 
health and strength to these disabled men. Now, before 
discharging soldiers suffering from these functional neuroses,, 
either as permanently unfit, or under Cl (garrison duty at 
home), C2 (agricultural work), or C3 (sedentary occupation), 
I always tell them that they must show themselves fit to- 
to be discharged, by having so far lost their symptoms that 
when they do return to civil occupation, people should not say, 
“ What are those blessed doctors doing in discharging a poor 
fellow in a condition like this ” ; and before they can leave the 
hospital they must give evidence of being in a fit state. I also 
tell them that I will prescribe for them two hours’ occupation in 
the morning, either in the carpenter’s shop or in the garden. 
This treatment I have been enabled to carry out through the 
generosity and kindly interest of Lady Henry Bentinck, who, 
at her own expense, has built in the grounds at Maudsley 
Hospital a large workshop fitted with every appliance for 
carpentering, cabinet-making, and metal work, and with a first- 
rate instructor. Numbers of officers and men are daily employed 
in this workshop, and almost daily Lady Bentinck comes to 
encourage them by her presence, and to supply any need for the 
successful prosecution of the work. The War Office pays for 
nothing. 

Fortunately the Maudsley Hospital is situated in extensive 
grounds (for London), and the soldiers have, under my direction, 
done much to beautify the waste that followed the building opera¬ 
tions ; they have even made a fountain and flower-beds, which 
the King and Queen admired when they visited, and were 
greatly interested in. I might say here that the soldiers have 
built a poultry-house, and they are now hatching the eggs, in 
which process they take great interest. Since everybody has 
to grow vegetables, I have utilised a large amount of the garden 
for this purpose, but we should have been unable to have done 
this satisfactorily but for the prompt and generous manner in 
which Lady Bentinck purchased the tools required for a gang 
of twenty men, and also supplied the seed potatoes and other 
seeds necessary for cultivation. 


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As soon as the men show that they are fit to undertake work 
of this nature, we feel that they are sufficiently recovered to be 
discharged from the hospital under C2 or C3 ; but very often 
we find they suffer from dizziness or they easily tire, or say 
they suffer from dizziness or tire; in fact they are not an 
energetic crowd, and many of them would prefer to patrol the 
Walworth Road or visit the cinemas. In the carpenter’s shop 
the men receive such remuneration as the sale of the articles 
they make, less the cost, brings in ; orders for handicraft are 
received by the instructor. There are patients, however, who 
cannot stand the noise of the hammering and tapping. 


Agricultural Employment During and After the War. 

We have discharged a number of neurological cases to Ber¬ 
mondsey Military Hospital for auxiliary agricultural employ¬ 
ment, and I have heard that this experiment has been successful. 
There are twenty-five acres of land at that hospital which can be 
utilised for agricultural purposes. The experiment, therefore, 
might be extended with great advantage, for I am convinced 
that occupation in the open air is a very beneficial mode of 
treatment of nervous cases in convalescent stage. It does not, 
however, always seem to be popular with a certain type of case. 
In commencing the treatment of convalescents by manual 
labour, it is essential to regulate carefully the character of the 
labour and the numbers of hours per day, and the work should ■ 
be so arranged and graduated as not to induce more than that 
gentle sense of fatigue that promotes appetite, interest, sleep, 
and the general sense of well-being. Each case, therefore, has 
to be inquired into and the individual encouraged to take 
interest. When a shell-shock case is discharged from the 
Service who by upbringing or inclination has a desire to work 
on the land, means should be provided whereby he can do so. 
The money he earns for his labour should be supplemental to 
the pension money or gratuity. 

In concluding this lecture I feel it my duty to associate with 
the name of Chadwick as a pioneer of sanitary science the name 
of Maudsley as a pioneer of mental hygiene. This great 
philosopher and philanthropist gave a large part of his fortune 
eight years ago to the London County Council to build a 
hospital for the treatment of acute mental diseases, with a view 


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488 MADNESS AND UNSOUNDNESS OF MIND. [Oct., 

of preventing them from becoming chronic and being sent to 
the county asylums. In the recent report of the Asylums 
Committee of the London County Council reference is made to 
the generosity of Dr. Maudsley, who is now over eighty years, 
in permitting the War Office to utilise it for the treatment of 
soldiers suffering from shell-shock and war neuroses, for which 
it is so admirably constructed and equipped. We only hope 
that he may live to see it utilised for the purpose he intended. 
When the King and Queen visited the Maudsley Hospital a few 
months ago they expressed themselves as very pleased with all 
the arrangements for the comfort and treatment of the many 
soldiers who have been sent over from France suffering from 
“ shell-shock.” 

(') Some abridgments and additions have been made, but practically the lecture 
remains as it was given, with the exception of a section on " Diagnosis," which 
would have been unsuited to a lay audience.—( a ) Since this lecture was delivered 
I have had the opportunity of examining the brain of a man who died suddenly 
the day after he had been brought from the clearing station. He had been exposed 
to heavy shell fire; there was no history of gas or burial. There was no visible 
external injury, and Capt. Stokes, who made the post-mortem examination, from 
his findings came to the conclusion that the man had died of shell-shock. Micro¬ 
scopic examination showed no punctate haemorrhages in the white matter which I 
have described as characteristic of gas poisoning, and which I have demonstrated 
as being due to thrombosis or embolism of terminal arterioles or venules. Never¬ 
theless there were ruptured vessels in the medulla oblongata, the pons and the 
corpus callosum, and the condition of the heart and lungs showed that arrest of the 
cerebro-respiratory centres might have been the immediate cause of death. The 
full account of this case and another of death from the explosion of a large amount 
of cordite will be published shortly in the Journal of the Army Medical Service. 
The reader is also referred to a communication read before the Pathological Section 
of the Royal Society of Medicine entitled “ Punctate Haemorrhages of the Brain 
in Gas Poisoning,” Proc. Roy. Soc. Med., vol. x, Pathological Section. 


Madness and Unsoundness of Mind. By Charles A 
Mercier, M.D., F.R.C.P., F.R.C.S/ 1 ) 

It is considerably more than a quarter of a century since 
I first promulgated the doctrine that madness and unsound¬ 
ness of mind are not the same thing ; that madness includes 
more than unsoundness of mind, and that unsoundness of mind 
very often occurs in the sane, and is, indeed, one of the most 
frequent disorders of the sane. This doctrine has always 
seemed to me as manifestly true as the doctrine of natural 
selection, and, like the doctrine of natural selection, needs, it 
appears to me, only to be stated to secure the adhesion of 


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every reasonable mind. In fact, I have found by experience 
that to the immense majority of my acquaintance it does only 
need to be stated to secure their adherence. Nearly everyone 
—everyone outside the membership of this Association—to 
whom I have stated it, without a single exception, has, in fact, 
accepted as self-evident that what matters in influencing our 
judgment of madness or sanity is not what a man thinks or 
feels, but what he says or does ; not his mind, but his conduct. 
Even within this Association the doctrine has many adherents 
among the younger members, for I often receive letters from 
them, telling me how great an assistance it has been to them ; 
so that things are moving, and I trust that before long vve 
shall reach the stage that I predicted in a correspondence in 
the British Medical Journal , when not only will the doctrine 
be universally admitted to be true, but also we shall all declare 
that we never held any other, and that any claim of mine to 
have originated it will be strenuously denied. However, litera 
scripta Vianet. The minute-book of the Educational Committee 
will show that when I urged that conduct, as being the most 
important factor in madness, should be systematically studied, 
I could not secure even a seconder. When I subsequently 
brought the subject forward in this Association I had not one 
supporter. Nor had I when I brought it before the Royal 
Society of Medicine three years ago. In the third edition of 
Dr. Craig’s book on Psychological Medicine , which has just 
appeared, the doctrine is not so much as even mentioned, and 
Dr. Craig says that insanity cannot be defined. This he says 
in face of the fact that at the Royal Society of Medicine I 
showed that there are several different concepts confused under 
the name of insanity, and I carefully defined every one of 
them ; nor has any one of my definitions ever been impugned. 
I venture to assert that if these definitions had emanated 
from a German source they would have been welcomed with 
enthusiasm and received with reverence. 

I am weary of going over the old ground, but I suppose 
I must traverse it once more. I say, therefore, that to regard 
madness as disorder of mind alone, or as equivalent to un¬ 
soundness of mind, is manifestly an imperfect, inadequate, 
lopsided, and inexcusable view to take, and cannot be taken 
except by those who see no difference between mind and 
conduct, between feeling and thinking on the one hand and 


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49O MADNESS AND UNSOUNDNESS OF MIND, [Oct, 

speaking and acting on the other. To them I have no more 
to say. If they cannot now see the difference between thinking 
and speaking, between thinking a man is a fool and calling 
him a fool; if they cannot see the difference between feeling 
and acting, hptween desiring money and stealing money, I 
have no more to say to them. They are beyond the reach 
of any argument of mine, and I must leave them. To my 
mind, and to the minds of very many others both within and 
without the medical profession, to whom I have opened the 
subject, the view of insanity as primarily disorder of conduct 
is the greatest advance that has been made in our contempla¬ 
tion of insanity since it ceased to be regarded as demoniacal 
possession, and came to be looked upon as disorder of mind. 

It is disorder of mind—in part. Disorder of mind enters 
into the concept of insanity, but it is not the whole of the 
concept nor the most important part of the concept Disorder 
of brain-function is another part of the concept, but first and 
foremost comes disorder of conduct ; and for this reason, that 
conduct and disorder of conduct can be directly observed. 
We can see it or hear it. It is made evident to our senses. 
Disorder of brain-function cannot be directly observed. Dis¬ 
order of mind cannot be directly observed. They can neither 
be seen, nor be heard, nor be felt. They are completely hidden 
from observation. In as far as they exist in madness they can 
only be inferred, and inferred from the observation of conduct; 
that is to say, of what a man says and of the way he acts. I 
do not argue this, for again I say that those who cannot see 
it are beyond the reach of argument'. It is, I submit, as plain 
that disorder of conduct enters into the concept of insanity as 
that two and two make four. It is as plain that disorder of 
mind alone does not constitute insanity as that two do not 
make four until we add the other two. 

That, then, is one of the theses that I have been trying for 
twenty-seven years to get this Association to accept, and I 
understand that at length I have been in large measure 
successful ; but there are still some who bow the knee to the 
old Baal of the doctrine that madness is unsoundness of mind 
and unsoundness of mind is madness. 

I assert, on the contrary—and this is the second part of 
my thesis—that there are many disorders of mind that are 
quite compatible with sanity, that often occur in the sane 


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without compromising their sanity in the least, and that no 
one would or could consider insane. At the last meeting of 
the Association Dr. Steen read his paper on “ Hallucinations 
in the Sane.” I pointed out at the time that hallucination is 
disorder of mind ; and if hallucinations may occur in the 
sane, and it is common knowledge that they do, then disorder 
of mind may occur in the sane, and this knocks the bottom 
.out of the doctrine that madness is the same thing as disorder 
of mind. Let me now point out that among the hallucinations 
of hearing, which are common both to the sane and the insane, 
is tinnitus. Tinnitus is not usually considered to be hallucina¬ 
tion, but unquestionably it is so. If the hearing of voices 
when there are no voices to hear, no sound-waves impinging 
on the tympana, is hallucination, then the hearing of musical 
notes or of blowing off steam when there are no musical notes 
or there is no blowing off of steam to hear is equally hallucina¬ 
tion. I say if, for I have taught that it is very doubtful 
whether there is any true hallucination of hearing. Certainly 
in many, and I believe in all, cases of so-called hallucination 
of hearing there are impressions on the auditory nerve coming 
either from without or from within the body ; but these im¬ 
pressions are misinterpreted. In that case they would not be 
hallucinations, but illusions. But what we call them does not 
matter. In any case, they are sensations received and inter¬ 
preted by the mind—by the mind, I repeat—and the erroneous 
imagination or misinterpretation, it does not matter which, is 
disorderly action of the mind. Aurists speak of noises in the 
ears ; but alienists know, or ought to know, better. The noise 
is not in the ears, but in the mind, just as the blue colour of 
the sky is not in the sky, but in the mind. Tinnitus, then, is 
disorder of the mind ; and does tinnitus never occur in the 
sane ? Is this disorder of mind the same thing as madness ? 
If disorder of mind is insanity, then tinnitus is insanity. From 
this conclusion there is no escape. It cannot be denied ; it 
cannot be controverted ; it cannot be disputed. But if reason¬ 
ing that is rigorously exact leads to a conclusion that is mani¬ 
festly absurd, where is the flaw ? What is wrong ? It is the 
premiss from which we started, and this premiss is that dis¬ 
order of mind is madness, and madness is disorder of mind. 

Then if madness is not disorder of mind, or unsoundneSs 
of mind, or disease of mind, what is it ? Disease of brain, 


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you will say, perhaps, but that won’t do. Cerebral tumour 
is disease of brain, but cerebral tumour is not madness, and 
may exist without a discoverable trace of madness. Cerebral 
haemorrhage is disease of brain, but cerebral haemorrhage 
is not madness, and may exist without a discoverable trace of 
madness. It is not proved, and it is not provable, but it may 
be that in every case of madness there is disease of brain, 
and for my part I believe that in every case of madness there 
is disorder of the function, or of some function of the brain ; 
but madness is certainly not the same thing as disorder or 
disease of the brain, for if it were, we could never observe it; 
for we cannot observe disorder or disease of the brain, at any 
rate, without opening the skull ; and we do not open the skull 
in order to recognise insanity. It is not proved, and it is 
not provable, but it may be that in every case of madness 
there is disorder or disease of mind, or unsoundness of mind ; 
but madness is certainly not the same thing as disorder, or 
disease, or unsoundness of mind, for if it were we could never 
observe it, for certainly we cannot observe what is going on in 
the minds of other people. 

On the other hand, it is provable and it is proved that in 
every case of madness there is disorder of conduct. When 
we certify a person as mad, we certify to facts indicating 
insanity that we have ourselves observed, and we certainly 
have not observed disorder of brain or disorder of mind. What 
we have observed is something the patient has said or some¬ 
thing the patient has done ; and what the patient says or does 
is not part of his brain or part of his mind ; it is part of his 
conduct. If there is no disorder, or failure, or defect, or fault 
in anything he says or does, it does not in the least matter 
what the state of his brain is or what the state of his mind is. 
He is not mad, and no one could possibly consider him to be 
mad, and the question of his madness or sanity would never 
arise and would never be inquired into. Whatever the state of 
a person’s mind may be, he is not considered mad if he behaves 
in every respect like a sane person ; and if he behaves as a 
madman, he is mad, whatever the state of his mind may be. 
It is behaviour, it is conduct, that we go by. And behaviour 
can be directly observed. We can see it or hear it. Disorder 
of brain we can neither see nor hear. Disorder of mind we can 
neither see nor hear. Neither of them can be observed. We 


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are to put in our certificates facts observed by ourselves, and 
the only facts we can observe are facts of conduct or behaviour. 
We cannot see or hear the delusion in another person’s mind ; 
all we can see or hear is the expression of it in speech or 
gesture or some other mode of conduct. 

Really, gentlemen, I am ashamed to have to put before you 
such elementary truisms as these. Of the innumerable persons 
outside this Association before whom I have placed them I have 
never found one that did not tumble to them instantly. The 
Royal College of Physicians has officially adopted my views. 
The Royal Commission on the Feeble-minded officially adopted 
my views. The Home Secretary, in framing the Mental Defective 
Bill, officially adopted my views. Parliament, in passing the 
Bill, officially adopted them. How long will this Association 
lag behind ? 

Some views I do not hold are commonly attributed to me 
in this connection. I am sometimes jeered at for holding and 
teaching that conduct is the only disorder in madness ; that 
madness is disorder of conduct, and nothing else. I have 
never said so and never thought so. I am always careful to 
say that madness is primarily disorder of conduct; that is to 
say, that disorder of conduct is the most important ingredient 
in conduct. I am sometimes supposed to hold that in insanity 
there is no disorder of mind at all. Since I deny that mad¬ 
ness is disorder of mind, and nothing else, it is assumed that I 
deny there is any disorder of mind in madness. I have never 
said so and never thought so. The very first time I stated 
my doctrine, seven and twenty years ago, I said : “ No doubt 
disorder of mind is always present in insanity, and salt is 
always present in sea-water ; but salt is not the same thing 
as sea-water and disorder of mind is not the same thing as 
insanity.” Again, it is commonly foisted upon me that since I 
hold madness to be primarily disorder of conduct, therefore I 
hold that all disorder of conduct is madness. I submit that 
my critics have no right to attribute to my mind the muddle 
that exists in their own. I make these protests, well knowing 
that they will be ineffectual now, as they have always been 
ineffectual in the past. My critics make up to me for rejecting 
the doctrine that I do hold by attributing to me other doctrines 
that I do not. 

I shall be curious to discover what the attitude of the 
lxiii. 33 


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members of this Association now is to this doctrine of mine, 
that disorder of conduct is the primary ingredient in insanity. 
Will they scout it as so manifestly absurd as not to be worth 
discussion, as they scouted it when I brought it before the 
Educational Committee ? or, short of this, will they discuss it, 
but discuss it with contempt, and unanimously reject it, as 
they did last time I brought it before the Association ? or 
will they discuss it as a doctrine worth discussion, and be 
divided in opinion over it ? or will they declare that they have 
always known it and agreed with it ; that there is nothing 
new in it, and that I am making a pother about nothing ? 
That is what I hope to gather from the discussion that will 
follow. 

t 

(') Read at the Annual Meeting of the Association, held in London on 
July 25th, 1917. 


Materialism and Spiritualism. By Henry Maudsley 
LL.D.Edin.(Hon.), M.D.Lond., F.R.C.P.Lond. 

Of all the consoling illusions which mankind have harboured 
to irradiate, hearten, seduce and dupe them in their onward way 
to the perfection, universal peace and brotherhood which they 
hope and expect to approach, if not attain—after the devastating 
deluge of this long war for an unknown Divine event is over— 
none is perhaps more wildly irrational than that of a complete 
regeneration of human nature, and the coming of a perfect 
transformation scene on the troubled earth ; for all the world as 
if the method of vital progress which has been since the begin¬ 
ning of life is appointed to come abruptly to a stop, or to be 
reversed; with the optimistic belief, too, that life shall be 
thereby exalted and glorified immeasurably. Could the fatuity 
of egotistic optimism go farther? Was the universe specially 
created to be a stage on which man—equally with other species 
and the rest of animate nature—lives, suffers, decays, and dies, 
might play his transitory part ? Was that the illusive goal 
which at its outset launched it on its transcendental aim and its 
mysterious career, along which it has groaned since in long 
protracted travail? Naturally in that matter the devotees of 


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religion believe the most, hope the most, cry aloud the most; 
otherwise their faith might be rudely shaken. 

Yet the fond opinion is the fixed belief of many persons who 
seldom think what they profess to think when they try to think. 
Holding the traditional age-consecrated opinion, theological and 
metaphysical, grafted in them in infancy, fostered by education, 
enjoined by authority, sanctioned by custom of thought and 
conduct, embodied in the very words of the language they use, 
they are sure that everybody, whether idiot, imbecile, or man of 
genius, is a dual being having a material and a “ spiritual body ” 
—joint corporeal and incorporeal bodies. They think that the 
soul has an existence independent of its temporary bodily 
tenement, which at arly moment it may leave at will without 
thereby suffering harm to itself, nay, in the idiot’s case with 
positive advantage, and that it shall ultimately mount high 
into the boundless blue—they know not how, and know not 
where—to rest in unknown regions of everlasting felicity. The 
peace, happiness, and perfection denied them on earth they are 
sure will be granted there. Why ? Simply and solely because 
they wish and yearn for such a happy issue out of the afflictions 
of their mortal lives. Loving life while it lasts, and longing for 
its continuance, as they needs vitally must, they cannot endure, 
shrink with aversion from, the unwelcome thought that they 
may end when they die and turn to dust. Self-preservation 
and self-love resent and reject the repugnant idea. How, 
indeed, can they do otherwise ? The essential instinct of life 
is to live ; to lose that instinct is gradually to lose life. 

But is that a sure and safe guarantee ? The motive force of 
every conscious activity, that which supplies the impetus, is 
desire, which is itself unlimited, really illusion, one of Nature’s 
pretty ironies ; the inanity of the particular desire being only 
seen and felt when it is gratified. Vanity of vanities is then 
the soberly sad verdict of experience and just reasoning. 

Thence, however, it comes naturally to pass that they are 
eager and pleased to foresee in this greatest, most barbarous 
and destructive of all wars ever waged, waged too exultantly 
with all the accumulated gains through the ages of human 
development, the advent of a new heaven on a new earth. 
Awe-inspiring and mysterious as the order of events may 
appear, they are sure that there is no disorder, but that all 
things shall work well at last for the happy progress of the 


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496 MATERIALISM AND SPIRITUALISM, [Oct., 

human species, which alone of all organic things, though born, 
grown, decaying, and dying like them, is destined not to perish 
everlastingly. 

Given this belief in an immortal soul and a continued progress 
of mankind to perfection on earth, the probability, amounting 
to virtual certainty, is that there will, after the war is over, be a 
furious recrudescence of spiritualism in its various disguises, its 
fantastical” and fanatical forms, its neurotic vagaries. Materialism, 
which it is now the fashion and consolatory belief of the theo¬ 
logical and metaphysical mind to pronounce quite discredited, 
though it persistently raises its bruised head, as it always has 
done, will be utterly scouted as an ignoble, obsolete doctrine; 
always despicable, and never worthy to have been entertained 
by noble spiritual beings, constituted and destined to move 
onwards indefinitely on earth, and upwards eventually to heaven. 
At all cost of thought the incontestable and grossly revolting 
materialism of the present war, which has for a time amazed 
and appalled the minds of the most pious believers in a Divine 
guidance and direction of the progress of mankind to perfection 
and bliss, will be dismissed as a passing anomaly or an in¬ 
superable mystery. 

Is it to be contemplated without dismay that so dire and 
mortifying an exhibition of barbaric fury, with its detestable 
atrocities devised deliberately and methodically practised— 
such a foul eruption of the fund of human nature—should ever 
be seen again on the now blood-deluged Europe ? And that 
by a generation which, having learnt the lesson of a bad and 
sad experience, will assuredly profit by it? Incredible is the 
impious suggestion, it will be said. There shall be an early, if 
not an immediate, regeneration of human nature; Christianity, 
which for nearly two thousand years has not been truly Christian, 
and is now sometimes pronounced bankrupt, shall then be vitally 
Christian ; men shall not learn war any more; nations shall 
with one consent join together in reciprocal services ; live in 
peace, concord, and amity. It is not for frail and erring human 
thought to appreciate or accuse the hidden ways of Omniscience 
and Omnipotence: they are past finding out. 

Nevertheless, judging the future soberly by the past, and the 
constitution of human nature being what it essentially is, the 
exhilarating vision of a vast confederation of humanity stretching 
from pole to pole is not so bright and fair as the sanguine 


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optimist would fain have it be. Had the war, fought as it has 
been, chanced to have been sagaciously predicted, the prediction 
would assuredly have been contemptibly scouted as the outrageous 
blasphemy of a madman, or the impious utterance of a fool. 

The portentous event was nowise fortuitous nor capricious. 
It came to pass as a Divine event with mathematical precision 
from remote, often obscure, yet deeply concatenated causes and 
conditions, in consequence of the constant, stealthy operation of 
immutable, rigorous laws; being at bottom just as strictly 
natural and Divine as the earthquake which ruthlessly over¬ 
whelms a city and a whole eitiful of its inhabitants. Ought 
it not indeed to have been justly foreseen by adequately 
instructed intellect, priding itself on its height of development 
and past conquests, loudly vaunting its present conquests, sure 
of their accelerated increase in time to come? Yet men were 
blind to that which was secretly fermenting, deaf to its menacing 
mutterings, insensible to the thick darkening clouds, until the 
sombre brooding storm burst furiously on them. 

For the optimistic expectation of a regeneration of human 
nature there is no reasonable justification in fact. What visible 
ground of reason, even of well based hope, what shadow of proof 
in history is there to assume and declare that peace, not war, 
is the normal and destined purpose of the race in its struggle 
to advance, increase, and multiply ? A settled optimistic 
faith, it is true, yet optimism is the natural offspring of an 
enthusiastic temperament, which may after all be of small value, 
and is pretty sure for the most part to be individually over¬ 
valued. As long as nations are not constituted alike—-and 
such sameness is not rationally to be looked for—so long will 
their constitutional differences have their special developments, 
these always liable and often likely to come into collisions and 
collusions, and to breed consequent animosities ; whence must 
ensue conflicts of interest and conduct. Self-interest, latent, open, 
or disguised, cannot ever be rooted out of human nature ; its 
fundamental impulse is vitally inherent in all its manifold and 
various activities. It is the essential instinct of vital self¬ 
conservation and increase. 

Life, be it clearly understood, is motion , that its essential 
nature; wherefore vital stagnation necessarily leads to vital 
corruption and decay, at any rate on earth, whatever be the case 
in heaven. Here below unquestionably it is the motion of 


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vital force which inspires and animates feeling as well as thought, 
mind as well as body. 

For that reason mankind naturally and necessarily believe in 
progress, which is something never exactly defined. To define 
the soothing word would be to limit, and the blessing of progress 
is that it is illimitable. They can always go on expecting to 
advance, undismayed and undeterred by checks, interruptions, 
and delays, even by the apparent disorders in the human course. 
Herein there is nothing for astonishment, nothing for regret, 
nothing for despair, no reason even excessively to deplore the 
present devastating war into which nations have madly plunged, 
and are now heart and soul employed in. The mighty waves of 
organic being move irresistibly on, notwithstanding impediments, 
checks,and irregularities, everywhere flooding creek, cranny, cove, 
bay, and estuary; to ebb quietly back afterwards into the vast main. 

Human insight, let it penetrate as far as it can, inevitably 
comes blindly to a stop; that is the fate of its finiteness. 
Omnipotence which has created and permitted evil and sin— 
“ shall there be evil in the city, and the Lord hath not done it ? ”— 
yet omniscient omnipresence into which sin and evil do not enter ! 
That is the perplexing problem by which the thinker is con¬ 
fronted ; one too, that will require all the subtlety of the subtjle 
theological intellect to overcome, should the attempt be frankly 
and seriously made. To call the problem a mystery and leave 
the matter there is a disappointing and disheartening procedure, 
which is inconsistent with a single-minded devotion to truth; it is 
to shirk it rationally. Just and adequate reflection surely teaches 
that no one can know evil without at the same time knowing 
good, nor know good without knowing evil; one word mean¬ 
ingless without the other to give it meaning. Bacon, I think, 
says somewhere that a mixture of discord in music doth ever 
add pleasure. In that case, however, the introduced discord 
must be judiciously timed and ruled ; then it becomes a con¬ 
cordant discord which contributes to the general harmony. If 
that be so, why should not a mixture of evil and good in the 
universe be the concordant discord which adds to the supreme 
harmony of “ the music of the spheres.” 

“ Such harmony is in immortal souls, 

But, whilst this muddy vesture of decay 
Doth grossly close it in, we cannot hear it.” 

After all is said, the fundamental fact remains that man is a 


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part of Nature, contained in it, a portion and partial expression 
of its Divine Omnipotence, derived from and embraced in its 
mighty unity, controlled by its order in its orderly sequence, 
and not perhaps so responsible for his deeds as he is prone 
egotistically to imagine^ 1 ) In the unknowable universe or its 
universal plan is the unsearchable Power, the great Cause of 
Causes, which directs and guides the incalculable course of 
events; and for the infinitesimal fraction of it which man is to 
hazard an exploration of its infinitude (which, truly thought, 
is really a mere negative word), and to justify its ways to his 
understanding is to inflate ambition to its utmost height of 
absurdity : not a less folly than it would be to try to fathom 
the unfathomable. Is it not in fact as supremely ridiculous as it 
would be for a microbe to comprehend the human body which 
it joyfully inhabits ? Man’s conceit of self, his inordinate vanity, 
takes too much upon himself, thinks too much of himself; his 
birth he hails as a benefit and a blessing, his death he fears as 
an evil and a calamity. Self-centred and viewer of things from 
that subjective standpoint, necessarily tinctured as it is with his 
passions, interests, and prejudices, he apprises the world too 
seriously, sees it not clearly and truly; instead of looking on 
it purely objectively as a transitory scene in which his function 
is to play his part well, and thereupon to gratify himself, not 
with the vanity of his personal prowess but with the good work 
which he can persuade himself he has faithfully done. Let him 
think to reap only what he has rightly sown ; in no case will 
he fail to reap what he has sown. 

Haply and happily then may be justified the soothing saying 
that the vox populi is the vox Dei , which, be it so or not, is the 
voice of might and right, if not of what men from their finite 
point of view think and call justice; seeing that things come 
to pass inevitably by necessary laws and cannot be other 
than they are, Nature knowing neither good nor evil, nor sin, 
nor virtue ; moral or immoral be its course according to finite or 
relative notions, the infinite and absolute “ Power above ” will 
surely at last bring the painfully prolonged and confused travail 
of the long-suffering race to an end on earth, when the antici¬ 
pation of its perfection in heaven will no more be needed, yet 
may be devoutly embraced by pious souls. Blessed they then 
in their bliss if desire has not proved to be a delusion. This is a 
thought which, though it concern him not now, may be offered 


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500 MATERIALISM AND SPIRITUALISM. [Oct., 

as a soothing balm to the painful pilgrim in his sore travail of 
toil, suffering, and sorrow through this mortal vale of tears, 

“ and the miseries of this sinful world,” from which he gives 
Almighty God thanks when death mercifully delivers him. ( 3 ) 

What now is the final question to be answered by dispassionate 
and impartial inquiry ? The question is rightly twofold : 
firstly, whether the doctrine of materialism is defunct, as 
spiritualists would fain have it be, and persuade themselves it is, 
or dormant only in a state of suspended animation ; secondly, 
whether the doctrine of spiritualism, when closely scrutinized, 
and made definitely intelligible to clear thinking, differs in 
essence from materialism. Is it not at bottom perhaps a 
difference not of things but of names only ? The rose remains 
what it is though it be called by any other name. 

As regards the doctrine of materialism, the vulgar opinion, 
that also of many persons who think themselves much wiser 
than the vulgar, is that of a lump of coarse and apparently 
passive and inert matter, a clod of clay, of lump of lead, or 
the like; which is an absurdly inadequate and quite false 
notion. They do not realize that matter is made up of mole¬ 
cules, that molecules are made up of innumerable atoms, and 
that in ever}’ atom there are countless electrons or ions ever 
whirling with inconceivable rapidity in the most subtile and 
yet most potent motioqs. They are uninstructed, do not 
observe, take no thought of what is hourly or daily before 
their eyes. Were they thoughtfully to watch the alert, active, 
untiring—yet then comparatively slow and sluggish flight—of 
a fly on a summer’s day, and justly reflect what a source of 
latent energy its activities within the compass of its small body 
imply and signify, they might form a truer notion of what 
materialism at its deepest bottom actually is. For their lack 
of observation and thought they have no excuse and are rightly 
to blame. An appropriately imposed penalty on their thought¬ 
less indolence might be to be tormented on a hot summer’s 
afternoon by the pertinacious persistence of the fly, when they 
would gladly go to sleep, or worse still, when lying prostrate on 
a bed of mortal sickness, though sensible enough to feel the 
irritating annoyance, to be similarly pestered. 

Thus much concerning materialism as it is in its inmost 
reality, not in the ignorant conceit which looks only on the 
surface of things. 


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Next, as regards spiritualism, what does the word mean 
when the reality is closely studied, not the mere name loosely 
used ? Is there no sort of substance in the postulated soul 
begotten on body by body on earth in animal fashion ? Is it 
motion entirely without form and void ? To think on it as 
something real it is surely necessary to grant it some measure 
of substance, be that ethereal only. And if so, how does 
its extremely attenuated fineness—its subtilised, rarefied, and 
perhaps ultragaseous condition—really differ from the exquisite 
fineness of the most subtile material motion ? Spiritualism as a 
living thought, a substantive idea, and materialism in its deepest 
sense at bottom—do they not mean the same thing, signify the 
same reality ? To say so might not offend tender prejudice were 
men not slavishly—or sometimes it is to be feared knavishly— 
to treat names as if they were things. Let them, by way of 
considerate, if not compassionate, trial, deign to condescend to 
lower thought and to acquiesce in the use of the expressions 
spiritualized matter and materialized spirit , and leave the matter 
there. Labyrinths enough there are in which they may find a 
more hopeful and promising prospect of exit. Alike beyond 
comprehension in the end are the infinite beneath and the infinite 
above. True thought ought to teach men that all nature is 
one, nothing in it single ; that is the basic fact. Its fundamental 
unity includes the human soul, whicj), during its mortal exist¬ 
ence, at any rate, is part, portion, and partial expression of it. 
To disrupt this fundamental unity would be to upset the entire 
order of nature, to destroy the value of all human aspiration, 
feeling, and thought, to make a chaos in the mind. 

Certain it is in that case that there would be a gratuitous 
and confounding breach of the continuity of nature in its pro¬ 
gressive development. Its observed course manifestly is, through 
all its multifarious and multitudinous differentiations, to more 
complex and higher unities of organic matter; that is the 
inherent tendency of the ever-aspiring vital force, the conatus 
fiendi of Spinoza, which now as dan vital is hailed as a 
new idea—the very essence of its being. Upwards and 
ever upwards it strives and rises to make separate parts and 
even individual mortals into more complex social unities: 
from the single family to detached and loosely scattered 
wandering families, from them to the tribe, from the tribe to 
the nation, from the nation eventually, it is presumed and 


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502 MATERIALISM AND SPIRITUALISM, [Oct., 

hoped, to universal brotherhood of the various alien races 
differing in race, colour, and creed. How rightly understood 
this progressive evolution of organio evolution unless strict and 
close account be taken of the fundamental invisible material 
energies, ever inconceivably active, deep down beneath all 
mSTnifestations of visible energy ? It is surely lawful and 
right, nothing else than an indispensable condition of fruitful- 
thought, carefully to study and truly apprise the value of the 
infinitesimally minute forces of invisible matter. 

Few are the persons, prescient and precious rarities in the 
world—not two perhaps in two or ten thousand—who have 
sufficiently studied nature and are fully apprised of physical 
causes, or of the effects they must necessarily produce. As 
Spinoza justly insisted—“ No one can understand this dis¬ 
tinctly (the union of body and mind) unless he first adequately 
understand the nature of the human body. He remains in 
that case ignorant how far the powers of nature extend and 
what its capabilities are.” 

Few persons again—happily for them—sufficiently realize 
how great is the tyranny of the particular social system in 
which their lot is cast. Let the reader frankly ask himself if, 
had he chanced to live in Dahomey or other barbarous country, 
he would not have conformed to its savage and sanguinary 
“ customs ” rather than have been put to a cruel death ? 
“ Custom doth make cowards of us all.” 

Furthermore,were he a minister of religion in a particular sect, 
dependent in it on his stipend for a livelihood, would he not, 
in his own interest, repeat its formulas, and conform to its 
doctrines and ceremonies, although all the while perhaps 
thinking them silly? Yes, probably, and thereupon practise 
all the arts of sophistry, subterfuge, and prudent reticence to 
prove to himself that he was doing right. 

Prejudice by selective affinity craves and lays hold of that 
which nourishes and fortifies it. Then it is apt to become a 
vice, which is not unlikely to be deemed a virtue by its owner. 
The person likes to be deceived, likes to deceive himself, and is 
by natural law deceived —vult decipi decipiatur. 

Interweaving here a brief but not unrelated interlude with 
regard to a class of minds not unlikely to start or join in the 
crusades of spiritualistic revivals, it is incumbent not to overlook 
or under-rate the value of the work done by the minor prophets or 


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passionately inspired enthusiasts, whom common opinion prob¬ 
ably looks upon as narrow-minded fanatics, faddists, or fools. 
Yet in time, when groups of them are gradually formed, their 
fiery zeal penetrates and usefully affects the stolid mass of 
indifference, and the flaming zealots are seen not to have been 
merely shrill shriekers, quite futile in their day and generation. 
As matter of fact, they are not so much resented and repelled 
by the average person as is the man of great genius, who lives 
a life apart and aloof from their narrow enthusiasms ; they are 
in congenial sympathy with the apathetic mood of their like- 
minded and like-feeling fellows ; whereas he is not understood, 
seems alien, hostile, remote when he appears, perhaps wholly 
antipathic, and is deemed a social or anti-social, or, at any rate, 
is called unsocial. The existing social environment cannot abide 
him if he will not conformably admire its structure and functions 
and become subservient to them. As he is thus isolated, it is 
prone to excommunicate him, which is literally to cast him out 
of the communion. When he does rarely from time to time 
appear, all the common people join in common consent to 
make common cause against him ; you may know him then, as 
Swift said, by that token. All the dogs join in unison to bark 
at him. He goes where no one has gone before, and where no 
one goes near him for a while. In due season, however, others, 
with slow and stumbling feet, tread in his footsteps. 

Manifestly the problem of the origin of life on earth, among 
other problems which most persons pronounce insoluble, cannot 
be solved so long as men neglect or ignore these fundamental 
energies of matter,ethereal or quasi-ethereal matter. Here, as with 
other mysteries, although silence is imposed by saying that the 
oracle has spoken, it is right to recognize and bear in mind 
that it is those who know least who are always most sure that 
a problem is insoluble and would bar more inquiry. History 
is full of instances of problems which our less instructed ancestors 
in their day thought insoluble, but are now commonplaces of 
knowledge. Silenced by the Roman Inquisition Galileo was 
forced to recant. Pope Gregory excommunicated as blasphemers 
and atheists those who accepted the discovery that the earth 
moved in its orbit round the sun. Descartes even found it 
prudent to leave France and die in a foreign country. There 
is no real difficulty among adequately instructed persons, who 
do not treat words as things, in foreseeing a discovery of the 


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MATERIALISM AND SPIRITUALISM. 


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probable mode of origin of life on earth, where somewhere at 
some time it did naturally emerge from the maze of material 
forces and conditions, and perhaps secretly emerges now. The 
plain trend of advancing scientific research and thought is 
towards that desired achievement. Although man did not 
invent life, he need not despair of finding out how it was 
invented. Nature is not yet barren ; it has many resources, 
will make many experiments and inventions, will effect probably 
new developments, before it fulfils its aspirations and accom¬ 
plishes the will of its destiny. 

Picture it, think of the disastrous spectacle which is presented 
to rational thought by those who, sure that life cannot have origi¬ 
nated naturally, believe that there was once a suddeil breach in 
the continuity of natural law, in order to bring life miraculously 
from above into the world, and what the statement really means. 
Were the law of gravitation suspended for a single instant would 
it fare well with the constitution of the universe? Were the 
laws of thought in the human mind put a stop to for a time— 
laws which after all only reflect more or less clearly and dis¬ 
tinctly so much of external nature as each mind, whatever its 
structure, is constitutionally capacitated to come in contact 
with—what would become of human reason and sensible 
conduct ? 

What, then, is the conclusion of the whole matter? That 
the expected recrudescence of spiritual speculations and ex¬ 
travagances is not fated to kill materialism. It would be a 
pity indeed if they did, seeing that man, whatever his inmost 
composition, is undoubtedly a largely material compound. Let 
him strive to his utmost by all the self-inflicted sufferings and 
penances of a rigorous asceticism, as ascetic fanatics have done 
in cold comfortless cells and dreary deserts, by unwholesome 
gropings into his own overfostered and overstudied feelings, by 
frequent and fervent prayer to eradicate the lusts and affections 
of the flesh, the flesh still remains ; in no case can he deliver 
himself from “ sin, the flesh, and the devil,” any more than he 
can get out of his own skin : his component elements have ever 
retained and must ever retain their properties and functions. 
Indisputable therefore is the truth that the deepest bottom of 
nature is matter ; spiritual theories, be they fanciful and foolish, 
or well founded and wise, being at last emanations from the 
whole bodily self. “Conceived in sin,” as he is taught, he must 


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•suffer its effects. Nothing has the immortal soul during its 
mortal mission on earth ever felt or thought into which the 
body has not vitally entered, and the functions of which it has not 
strictly determined. Severed from the body in heaven it must 
surely be another self, happily oblivious there of its former 
discarded self and its deeds under the sun. When all is said, 
the salvation of an individual soul by constant devotion and 
sole service to - its welfare, now that theological religion is 
becoming social and merging gradually into a religion of 
humanity, is seen to be a selfish and antisocial procedure. 

A final materialistic conclusion which may deserve to be 
pondered is that insensible and most subtile rhythms probably 
pervade and perpetually affect the entire body By them is the 
harmony of its parts and a graceful whole maintained. It 
might indeed be profitable work to try to make practical use 
of their insensible operations in order to maintain the health 
and grace of the body. It is not the body’s visible joints only, 
those of fingers, trunk, and limbs, which ought t© be kept supple 
by fit, regular exercises, but all the insensible rhythms might be 
put into exercise, so far as possible; which is not perhaps so 
utterly impracticable a business as at first sight it appears to be. 
As attention to a disturbing sensation or a positive pain 
notably augments it, so may the infraconscious, insensible 
rhythms affect the particular muscle, organ, or selected part on 
which attention is specially concentrated. - 

The suggestion will not be worthless if it excites reflection 
on the underlying, ceaseless, subtile bodily motions which go on 
below consciousness. Consciousness, let it be emphatically stated, 
is not itself an energy, nowise an imagined entity which does 
work, as commonly said or implied ; it is an index only of the 
underlying energy. The best work of the truly inspired poet, 
artist, writer, person of genius of any kind, is done in secret 
physiological depths, silently implicit ; its silent gestation, its 
actual creative function, is done unconsciously. He may cackle 
with announcing delight, like the hen which has laid an egg, after 
he has produced his egg, but he is not in the least aware how the 
egg was formed. It has now become necessary for the psycho¬ 
logists to make large use of an infraconscious mind, into which 
receptacle they put what they like and draw out what they like 
to do the work which the conscious mind does not do ; they 
may therefore in due time realize that consciousness is not a 


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working entity but an index of the material work silently done 
by the brain. 

(') As Wordsworth taught in the familiar lines, which the mystically ecstasized 
witnesses to a soul are never tired of quoting: 

“The soul that riseth with us, our life’s star, 

Hath had elsewhere its setting, 

And cometh from afar: 

Not in entire forgetfulness, 

Nor yet in utter nakedness, 

But trailing clouds of glory do we come.” 

And similar quotations might be multiplied, e.g., 

“ Soul of the sparrow and the bee, 

The mighty tide of being comes 

Through countless channels, Lord, from Thee. 

It springs to life in grass and flowers, 

• Through every grade of being runs, 

While from creation's lofty towers 
Its glory flames in stars and suns.” 

1 quote from memory, which is not what once it was, but in the main, I believe 
■correctly. 

( 2 ) “ \y e gi ve Thee hearty thanks for that it hath pleased Thee to deliver this 
our brother out of the miseries of this sinful world, etc ."—Burial Service of the 
Church of England. 


The Orientation of Human atid Animal Figures in Art. 

By J. Barfield Adams^ L.R.C.P., L.R.C.S, M.P.C. 

Prolegomena. 

Mlle. Josef a Ioteyko in her learned articles on La 
Thtorie Psycho-Physiologiquc de la Droiteric, which were 
published in the Revue Philosophique , June and July, 1916, 
and of which an epitome appears in this number of the 
Journal, quotes largely from the works of Mlle. V. Kipiani, 
an enthusiastic educational reformer, who advocates a certain 
method of reading and writing, the object of which is the 
avoidance of unnecessary eye-strain. The method, which is 
fully described in the epitome, is not new. It is simply the 
boustrophedon mode of writing employed centuries ago by 
the Ancient Greeks, and abandoned by them for the method 
which is now used by European nations. 

Carried away by her enthusiasm, Mlle. Kipiani has made 
certain statements with regard to the orientation of children’s 
drawings, and of the figures in the pictures of ancient and 
modern artists, which appear upon careful examination to be 
incorrect. 


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1917-] BY J- BARFIELD ADAMS, L.R.C.P. 1 507 

In Mile. Ioteyko’s second article (pp. 69 and 70 of the 
July number of the Revue Philosophique') occur the following 
passages : 

“ Passing to drawing , Mile. V. Kipiani proves that nearly 
all children orient to the left the profiles which they are 
asked to draw. Further, in examining the original pictures 
of numerous painters as well as the reproductions of the 
pictures from all the picture galleries of Europe she proves 
that the majority are only oriented to one side alone (to the 
left). Men, horses, bicycles, aeroplanes, all that moves on 
the earth or in the air, says she, all that is oriented by the 
hand of man, looks, walks, runs, and flies towards the left 
on canvas or on paper. What an error of orientation ! What 
lack of observation, what abnormality of the sense of space ! 

“ What is the cause of this hemiplegic orientation ? The 
principal reason is the movement of writing with the right 
hand which commences on the left, the eyes being carried 
from left to right. This cause, besides, is itself subordinated 
to the laws of the anatomy and physiology of the muscles 
of the hand, which designs with more facility in that direction. 

“It is because we design with the right hand only that 
we orient our pictures and our drawings to the left. It is the 
most easy habit, the most facile, the least reasoned out, and 
that is why it is most general among children. The artist 
frequently changes it, thanks to his virtuosity, and also for 
reasons of convenience, symmetry, and aesthetics ; nevertheless, 
here also, it is the orientation to the left which predominates. 

“It is then permitted to say, concludes Mile. V. Kipiani, 
that the exclusive, so to speak, usage of one hand alone gives 
us only an inexact and fragmentary notion of space ; instead 
of orienting his figures in all possible directions, in accordance 
with the reality which surrounds us, the right-handed draughts¬ 
man gives them a stereotyped direction, always the same. 
These drawings might be called ‘ hemiplegic drawings,’ to 
such an extent has the exclusive use of only one cerebral 
hemisphere made incomplete beings of us. 

“ Examples of left-handed, or ambidextrous artists, who 
orient their personages in the opposite direction, are a 
demonstration of the sound foundation of this opinion. 

“ The orientation of personages among the ancient Greeks 
and Egyptians was by preference to the right. It is the same 


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508 human and animal figures in art, [Oct, 

in the case of the drawings of the Chinese and Japanese. 
Mile. Kipiani attributes this result, among others, to their 
centripetal handwriting. 

“ Mile. Kipiani draws attention to this interesting fact, that 
among the Europeans the principal idea of the picture is 
found on the left side, among the Chinese and Japanese it is 
on the right side that the principal scene unrolls itself, and 
it is from the right side that the personages and objects are 
oriented.” 

I. 

The games, which children play in the streets of a town 
appear to follow a law of periodicity as inexorable as that 
which rules the movements of the planets or the coming of 
the seasons. Marbles, peg-top, and tip-cat enjoy a passing 
vogue and then disappear as regularly as the delicate blossoms 
of springtime give place to the brilliant flowers of summer. 

During the last few weeks, hop-scotch has been the fashion¬ 
able pastime in the streets of Bristol, and, as everybody knows, 
a piece of chalk is convenient, nay, almost necessary, for 
outlining on the road or pavement the geometrical figures 
required by the game. A child, and—dare we say it ?—a 
grown-up person, endowed with an artistic temperament tires 
quickly of watching the skill of his companions. Means and 
opportunity—and artistic genius like sin requires means 
and opportunity to develop itself—of otherwise amusing 
himself are at hand, and with the chalk for his brush and 
the pavement for his canvas the future Royal Academician 
proceeds to exercise his budding talent, while his playmates 
continue to hop after the foot-driven stone. That is why 
it is so rare to come upon a spot, where hop-scotch has 
been played, without finding close to the chalked squares 
and oblongs of the figures of the game a number of rough 
drawings of human beings and other objects. 

One day recently, I found seven profiles chalked upon 
the street pavement. They were, judging by the up-turned 
moustache, intended for portraits of the Kaiser. They were 
not complimentary, neither were they well drawn, but they 
would have delighted the heart of Mile. Kipiani for they were 
all oriented towards the left. 


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1917 ] BY J- BARFIELD ADAMS, L.R.C.P. 509 

/ 

Another day, I saw two little girls, who, tired of playing 
hop-scotch, were drawing on the pavement. They were 
drawing human figures, but not in profile. There was the 
usual full-moon face, with the features more or less successfully 
indicated, the hair standing on end like the periwig of Shock¬ 
headed Peter, and a large, roi^id body, to which attenuated 
limbs were attached at impossible angles. The method of 
drawing adopted by the younger child—she was eight years 
old, I was afterwards told—was curious. She was kneeling 
on the pavement, and as she proceeded with her design, she 
crawled round it in such a way that she always drew the 
chalk towards herself in making each line and curve, 

I asked the children to draw a man sideways, and after 
some explanations, for, as it is well known, children have no 
intuitive idea of drawing profiles, the elder girl, who was 
eleven years of age, began. The figure, which she drew, had 
an enormous nose, and faced to the left. As soon as she 
had finished it, and without pausing to admire her handiwork, 
the young artist commenced a second figure which faced 
towards the right—the two figures looking towards each 
other. When the child was asked why she drew them facing 
different ways, she said: “They were talking together.” It 
is to be observed that the child drew the figure facing to 
the right as readily and as easily as she drew the one facing 
to the left. 

On another occasion, I found a procession of four figures 
chalked on the pavement. Two of the personages, a man 
and a woman, were taller than the others, whose father and 
mother they were probably intended to represent. They were 
all four drawn in profile, and faced towards the right. 

Generally speaking, girls are fonder of drawing on the 
pavement than boys. As to subjects, men are preferred to 
women, and just at present soldiers are preferred to ordinary 
individuals. I have seen the puttee and the outside pocket 
in the skirt of an officer’s tunic indicated not unsuccessfully 
in some of these chalk drawings. Naturally, profiles are 
comparatively rare, but when they are met with, they as 
frequently face to the right as to the left. 

Miss Beatrice M. Sparks, M.A., the head mistress of the 
Colston’s Girls’ Day School, Bristol, very kindly permitted 
the children in the Kindergarten and the first form of the 

LXIII. 34 


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school to draw the figure of a man in profile. The majority 
of the young artists succeeded in their task. 

In the Kindergarten the ages of the children ranged from 
four years and nine months to eight years and seven months. 
From this department thirty-two drawings were sent in. The 
quickest children drew the figure in three minutes, the slowest 
in seven. The greatest possible care was taken to prevent 
the children from copying from one another. All the children 
found profile drawing very difficult. Some of them said they 
had never seen a man sideways. Several of the younger 
artists were so decided on this subject, so “ adamant,” as the 
Kindergarten mistress expressed it, that we were compelled 
to accept full-face studies. One child stood up and tried to 
look at herself sideways, in order, as she said, “ to see what 
my arms do.” Another small person hit upon the ingenious 
idea of drawing first a back view of a man, and then of looking 
sideways along the paper to try if she could obtain a side 
view of her own drawing. 

Twenty-two of the Kindergarten children could write more 
or less well, though some of them had very little control over 
their pencil. Four of the children could only print letters, 
and six could not write at all. No child was left-handed, nor 
had any inclination to draw with the left hand. 

Of the thirty-two drawings sent in, two were failures. 
The first was so confused that it would hardly have done 
credit to a prehistoric artist’s design scratched with a sharpened 
flint on a mammoth’s tusk or a piece of reindeer horn. It 
might almost be called prehistoric, for it was the artist’s first 
day at school, and he was only four years and nine months 
old. The second failure bore more resemblance to an article 
of furniture than to a human being, and so we had to pass it 
over. Eight of the drawings unfortunately were full-faced. 

The profile drawings were twenty-two in number. Three 
faced to the left, and nineteen to the right. In some of the 
drawings it was only possible to make out the orientation of the 
figure by observing the direction of the nose or the feet. But 
a few were remarkably good, both for the correctness of the 
anatomical proportions, and the expression of life and move¬ 
ment. 

In one case—the figure was evidently intended for a soldier, 
was very well drawn, and faced to the right—the Kindergarten 


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5 11 

mistress observed that the child “ continually turned the paper 
round and round so that he could always draw the pencil 
towards himself.” This child’s method of drawing and that 
of the little girl, mentioned above, who crawled around the 
design she was chalking on the pavement, approximate to 
Mile. Kipiani’s idea of centripetal writing. 

In the first form, the ages of the children ranged from 
seven years and three months to ten years and three months. 
Seventeen drawings were sent in. The time allowed for the 
work was ten minutes. All the children in this form could 
write. No child was left-handed, nor had any inclination to 
draw with the left hand. 

Although the form mistress remarked that all the children 
found great difficulty with the face, they all succeeded in 
correctly indicating the profile. Some of the figures were very 
well drawn. In a few cases, the relative proportions of body 
and limbs were, to put it mildly, deceptive. 

In these seventeen drawings, nine of the figures faced 
to the right, and eight to the left. Compared with the 
drawings made by the children in the Kindergarten this 
reveals a considerable proportional increase in the orientation 
of the figure towards the left ; and if Mile. Kipiani had 
stated that such orientation was an acquired habit due to 
education, she might very properly point to this increase in 
confirmation of her theory, seeing that it occurred among 
older children, who could write better, and had been accustomed 
to write during a longer period. But education and acquired 
habits are not included in the premises of her proposition. 
She simply says : “ That nearly all children orient to the 
left the profiles which they are asked to draw.” 

This brings us to another point. There are a large number 
of children, especially those endowed with artistic genius, who 
draw, and sometimes draw well, before they are taught to 
write. How does the movement of the writing with the 
right hand from left to right influence them in the orientation 
of their drawings? The answer, I suppose, would be that the 
influence is phylogenetic : the parents, the ancestors, wrote 
with the right hand from left to right, and consequently the 
children orient their drawings in the opposite direction. (Why 
opposite direction ?) But for how many generations have these 
ancestors been able to write?. Three or four generations back, 


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ioo or 120 years ago, the majority of our ancestors—for, if 
we consider the ever-widening fan of backward genealogy, the 
bluest modern blood must be mingled to a great extent with 
the red stream that coursed through the arteries of lower, 
and lower middle-class progenitors — could do little more 
than sign their name, even if they could do as much as that. 
Go back eight, ten, twelve generations, 200 or 300 years, and 
it was generally a case of “ Bill Stumps, his mark.” Certainly, 
the time for the operation of phylogenetic influences has been 
very short. 

Mais revenoiis a nos rnoutons. The result of the examination 
of the work of the thirty-nine school children, who succeeded in 
drawing a human figure in profile, is that twenty-eight oriented 
the figure to the right, and eleven to the left. The orientation 
of the pavement drawings was more equal. Two little patients 
of mine, one aged six years, who could not write at all, and 
the other eight years, who could write fairly well, both drew 
profile figures facing to the left. 

One cannot draw any positive conclusion from these figures. 
They are too few in number. But they are sufficient to 
challenge Mile. Kipiani’s statement that “ nearly all children 
orient to the left the profiles which they are asked to draw.” 
There is little doubt that children orient their drawings exactly, 
as grown-up artists orient theirs, and that is, as 1 shall pre¬ 
sently show, in accordance with the dictates of their fancy or 
the supposed requirements of the scene they are depicting. 
The child, who, when she had drawn two figures facing one 
another, and consequently oriented in opposite directions, said 
that “ they were talking together,” touched the thing with the 
point of a needle. 

• II. 

Mile. Kipiani states that ‘‘in examining the original pictures 
of numerous painters, as well as the reproductions of the 
pictures from all the picture galleries of Europe, she proves 
that the majority are only oriented to one side alone (to the 
left). Men, horses, bicycles, aeroplanes, all that move on the 
earth or in the air, says she, all that is oriented by the hand of 
man, looks, walks, runs and flies towards the left on canvas 
or on paper.” She adds also that “ among the Europeans the 
principal idea of the picture is found on the left side.” 


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I have no hesitation in saying that these statements are 
incorrect. If one took the trouble to examine every picture 
in all the European galleries, it is quite possible that it would be 
found that there was a bare majority in which the general 
orientation was to the left. But it is quite as possible that a bare 
majority might be oriented to the right. What I assert is, that 
artists orient their figures and the direction of the movement 
of their figures, and place the principal idea of the picture on 
the canvas how and where the working out of their conception 
requires ; and that they are totally uninfluenced by any con¬ 
scious, unconscious, or subconscious tendency to left-handed 
orientation at the bidding of their left cerebral hemisphere or 
of “ the laws of the anatomy and physiology of the muscles 
of the hand which designs with more facility in that direction.” 

I have visited several of the English and Continental picture 
galleries. I cannot, of course, remember the details of all the 
pictures that I saw in those galleries, but those details which I 
do remember, and in which my memory is assisted by repro¬ 
ductions now at hand, fully bear out my assertion. 

In the Mauritshuis at The Hague hangs Rembrandt’s well- 
known “ Lesson in Anatomy.” The principal point of interest 
in the painting, “ the principal idea,” as Mile. Kipiani terms it, 
is the dissected hand and forearm which is to the right of the 
centre of the picture. The face and figure of the dissector, 
Prof. Tulp, is oriented towards the left, whilst the faces of the 
seven other figures in the picture are turned more or less 
directly towards the right. 

From the wall of another room in the same gallery, Paul 
Potter’s famous bull gazes serenely at the spectator. The 
bull’s body is turned towards the left,-while that of its master, 
if the human being in the picture bears that relationship to 
the animal, is turned towards the right. The bull is certainly 
the point of interest, and occupies the centre of the canvas. 

In Jan Steen’s ‘‘Portrait of the Artist and his Family,” four 
of the human figures and the dog look to the right, two look to 
the left, and three face the spectator. In this artist’s pictures 
there are often several points of interest. In this one there 
appear to be two : the child on the old woman’s knee, on the 
left ; and the boy playing the flageolet, on the right. 

Of the many portraits in the Mauritshuis\ I have only two 
reproductions. One is the painting of the Infante Karel 


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514 HUMAN AND ANIMAL FIGURES IN ART, [Oct., 

Balthazer (Don Balthasar Carlos) by Velasquez. This faces 
to the left. The other is a portrait of J. P. Olycan by Franz 
Hals, and it faces towards the right. 

In the Stadhuis at Haarlem, naturally, we see nobody but 
Frans Hals, and we come away remembering no one but him. 
In four of his great Regent pictures, the faces of the figures 
look right and left in about equal proportions. In one, the 
“ Officieren van den St. Joris Doelen , 1639,” the majority of the 
faces—all of them except three—look to the left. In Frans 
Hals’ portrait of Nicolaes van der Meer, the face and figure 
are turned towards the right. In that of Nicolaes’ wife, 
the face and figure are turned towards the left. 

Going on to the Rijksmuseum at Amsterdam, we find that we 
have exchanged one master for another—Frans Hals for 
Rembrandt. It is not that the famous Dutch picture gallery 
is poor in the works of other artists. On the contrary, it is 
exceedingly wealthy in treasures of art, and you are only too 
conscious of it as you walk down the great central gallery— 
the Gallery of Honour—with its eight alcoves, which one 
can only compare to the side chapels of a cathedral. But 
Rembrant Van Rijn is the man whom Amsterdam delighteth 
to honour above all, and you feel that when you see the loving 
care with which they have enshrined his masterpiece, the 
so-called “ Night Watch.” 

You leave behind you the “ Gallery of Honour ” with its 
chattering sightseers and busy students, who chatter also when 
a friend stops beside them to look at their work. You pass 
along a corridor, and ascend a short flight of steps. You 
cannot lose your way, for a hand painted on the wall points 
to the words : “ De Wacht van Nacht ,” “ La Rond de Nuit." 
You open a door and enter a large room. What a change 
from the great, noisy picture gallery ! This is a room of 
silence and subdued light. It is like entering a church, or a 
death chamber. 

On the wall immediately in front of you hangs a picture— 
one picture—“The Night Watch.” The windows are on the 
left, and are draped with black velvet curtains, which can be 
adjusted so that the light may always be suitable for the 
proper appreciation of the painting. There are, perhaps, a 
dozen people in the room. There is no talking. Occasionally, 
one whispers to one’s neighbour—a criticism, an eulogy. For 


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the rest, the silence is only broken by a visitor moving from 
one bench to another that he may see the picture from a 
different point of view, or by someone stepping forward to 
study more closely the technique of the master. 

Truly, Rembrandt’s masterpiece is worthy of the honour paid 
it. But look at it from the point of view of the subject under 
discussion, and you will see that though a few of the figures are 
oriented towards the right, the majority look towards the left 
and, further, that the movement proceeds from the right to the 
left. Was Rembrandt a hemiplegic because of this orientation? 

Perhaps, he redeems his physiological character in “ The 
Syndics of the Cloth Merchants’ Guild.” Here two figures 
are turned towards the right, two towards the left, and two face 
the spectator. But Rembrandt lapses again in his portrait of 
Vrouw Bas. This dear old lady, in her fur-trimmed gown, her 
starched cap, ruffle and cuffs, turns towards the left, although 
she looks you straight in the face. 

In Nicolaes Maes’ picture of an old woman asking a blessing 
over her midday meal, which hangs in the third alcove on the 
left of the “ Gallery of Honour ”—you looked at it before you 
went to see “The Night Watch - ”—the figure occupies the left 
of the painting, and is slightly turned towards the right. The 
light also comes from the left. 

In De Hoogh’s “ The Cellar,” one figure looks towards the 
left, and the other towards the right ; the point of interest 
being slightly to the left of the centre. In Ruisdael’s “ Wind- 
muhle am IVasser,” the windmill and the mass of the picture 
are on the right. One would be inclined to say that the point 
of interest was on the right also. 

Leaving Holland and going to France, we visit the Louvre. 
Do the portraits panelled in the Apollo Gallery all face one 
way ? From the wall of the Salon Carre, Mona Lisa looks 
down on you with her sardonic smile. She is not a whit 
changed since her visit to her native country. She looks 
towards you, but her body is turned towards the left. On 
the opposite wall of the Salon hangs the “ Marriage of 
Cana” by Paul Veronese, with all its beauty of colour and its 
wonderful composition. Do the many figures in those many 
groups follow a fixed line of orientation ? Can you discover 
the hemiplegic touch in that picture ? 

Go a little further on into another room, and look at Greuze’s 


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“Village Bride.” In this picture, seven figures look towards 
the right, and three towards the left. One, the bride herself, 
faces the spectator with downcast eyes. The point of interest 
is to the right of the centre of the canvas. 

In another room you will see Chardin’s “ Le Btntdicitl" 
In this picture, one figure looks to the left, another to the 
right, and a third faces the spectator. In Delacroix’s “Dante 
and Virgil ” most of the figures are oriented towards the left. 
The boatman, who is struggling with his oar, turns his back 
on the spectator. The point of interest, whether it be the two 
poets or those marvellous studies of anatomy, the nude figures 
clinging to the side of the boat, is in the centre of the picture. 

In the Uffici, at Florence, you will see Botticelli’s “ Birth of 
Venus.” Two of the figures look towards the right, one 
towards the left, and the fourth, that of the goddess, faces the 
spectator. In the same gallery is Bernardino Luini’s “ Salome 
and the Head of St. John the Baptist." In this picture, one 
face looks towards the right ; the three others, including that 
of the decapitated head, are turned towards the left. In 
Fra Filippo Lippi’s “ Virgin and Child with two Angels,” also 
in the Uffici , the Madonna looks towards the right, the Christ- 
child and one of the angels towards the left,' and the other 
angel faces the spectator. 

Two of three examples may be added from English galleries. 

In Hogarth’s second scene of “ Marriage a la Mode,” which 
is in the National Gallery, we see that all the human figures, and 
even the bust and statuettes on the mantlepiece, are oriented 
towards the left. Only the dog looks the other way. This 
orientation is serious. I never heard or read that Hogarth 
suffered from hemiplegia. He died rather suddenly—possibly 
from an apoplexy—but death did not allow time for the 
development of paralytic symptoms. 

In Millais’ “ The Order of Release,” which hangs in the 
Tate Gallery, two of the figures look towards the right, and 
two, including the baby which is asleep in its mother’s arms, 
are turned towards the left. The dog, which has its back 
to the spectators, turns its head to the right. 

In Rossetti’s “ Dante’s Dream,” which is in the Walker Art 
Gallery at Liverpool, three of the figures look towards the 
right, while only two, including the dead body of Beatrice, are 
* oriented towards the left. 


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As to Scotland—do you remember Sir Noel Paton’s two 
pictures of the quarrel and reconciliation of Oberon and 
Titania in the Edinburgh Gallery? They are full of life and 
movement, and yet they are “ such stuff as dreams are made 
on.” The colour is marvellous. The iridescence of the 
fairies’ wings is a touch of mannerism perhaps, but very, very 
charming. I have no reproduction of these pictures at hand, 
but I looked at them so often in my student days that I am 
sure I am correct when I say that the elves peep out from 
flower and foliage in every direction, and trip and dance upon 
the sward, hither and thither, as the artist’s fancy willed. 

All the above examples, taken indiscriminately from among 
the better known pictures in British and Continental Galleries, 
support the assertion that artists orient the figures in their 
paintings according to the necessities of the picture, and not 
in obedience to some unconscious impulse which compels the 
almost constant orientation of animate and inanimate objects 
from right to left. 

It may, however, be argued that it was only in the later 
centuries, when artists had acquired complete command of 
their art, when they knew the advantages and limitations 
of tempera, oil, and water colour, when they had studied 
anatomy, and had solved the mysteries of chiaroscuro and 
perspective, that they succeeded in overcoming the influence 
of their left cerebral hemispheres and the muscles of their 
right hands; that in earlier times they oriented their figures 
from right to left with the positional regularity of coaches in 
a railway train which was always moving in one direction. 
Facts do not support this argument. I will deal with pre¬ 
historic and early historic pictorial orientation in a later part of 
this paper. For the moment, let us compare, from this point 
of view, pictures painted in the fourteenth and fifteenth centuries 
with those painted in the nineteenth. 

Giotto, in the fourteenth century, in the fresco of “Joachim 
among the Sheepcotes,” at Padua, orients the figures as he 
thinks necessary. One figure looks towards the right, the 
other two towards the left. The sheep, if those wooden- 
looking things, which seem to have come out of a child’s 
Noah’s ark, are sheep, move from right to left. 

Van Eyck also, in the fifteenth century, orients his figures 
in accordance with the requirements of the picture. In his 


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“ Adoration of the Lamb,” which is or was—for, owing to the 
thievish and destructive habits of the cultured officers and 
men of the Imperial German armies, one cannot say what may 
have happened to the panel since 1914—in the cathedral of 
Ghent, it is seen, that the two groitps of figures on the left of 
the painting look towards the right, and the two on the right 
look towards the left, while the point of interest is exactly in 
the centre. In another picture, “ The Virgin and Child and 
Chancellor Rollin,” by the same artist (it is disputed whether 
the picture be by Hubert or John Van Eyck, but, as far as our 
subject is concerned, the period is the same), which is in the 
Louvre at Paris, one figure looks towards the right, and three, 
including the tiny angel which is holding a crown over the 
Madonna’s head, are oriented towards the left. 

Let us pass on to the nineteenth century. 

In Whistler’s (1834-1903) “The Artist’s Studio,” which is, 
I believe, in a private collection, two figures are oriented 
towards the right, and one, the lady with her back to the 
spectator, towards the left. Of course, in the case of Whistler, 
I do not forget the portrait of his mother, in the Luxembourg 
at Paris, and that of Thomas Carlyle at Glasgow, both of 
which look stolidly towards the left, and—especially the portrait 
of his mother—remind one of silhouettes. 

Two pictures by G. F. Watts (1817—1904) may be men¬ 
tioned : “ Hope,” which is in the Tate Gallery, and in which 
the figure is oriented towards the right ; and “ Love and 
Life,” also in the Tate Gallery, in which the female figure is 
turned towards the right, and the male figure is partially 
oriented towards the left, whilst the movement is from left to 
right. 

It may be further urged that the examples, that I have so 
far brought forward, are too few to be argued from. To meet 
this objection as far as possible, I have made a systematic 
examination of the pictures in the Bristol Art Gallery, the 
only one that the limited time at my disposal has allowed me 
to visit. 

This collection is a modest one, and has not been in existence 
many years. It is, however, fairly representative of modern 
art, and as such will answer the purpose I have in view. It is 
no richer in masterpieces than many other provincial galleries, 
and is perhaps a little overcrowded with local talent ; but, 


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thanks to the generosity and taste of certain wealthy citizens, 
it possesses pictures which rank high as works of art. Among 
these may be mentioned—without prejudice to the claims of 
perhaps twenty others—Didier-Pouget’s “ Heather in Bloom : 
Morning,” with its glorious wealth of colour ; Mondineu’s 
“ Bear-baiting in Gascony,” full of light and dramatic life ; 
and last, but not least, Miss Lucy Kemp-YVelch’s “Timber- 
hauling in the New Forest.” 

It is when one looks at such a picture as the last that one 
feels the absurdity, the falseness of Mile. Kipiani’s estimation 
of the pyschology of an artist. “ What error of orientation ! ” 
cries the scientist. Look at that team of horses struggling up 
the slope, and at the great trunk of the fallen tree dragging 
behind them, and, crushing, as it moves, fern, grass, and 
heather! You can almost hear the voices of the men as they 
urge on the horses, the heavy breathing of the beasts, and the 
dull thud of the timber as it bumps on the uneven ground. 
And mark ! the movement is from left to right. 

“ What lack of observation ! ” Look at the postures of the 
men, the straining muscles of the horses, the stretches of 
fern, the leafy trees, the light and shade. Look more closely. 
Is that not a tiny bit of yellow broom peeping up among 
the green fern and purple heather ? Has the artist lack of 
observation ? Has she failed in execution ? 

“ What abnormality of the sense of space ! ” Good heavens ! 
Look at that valley in the mid-distance, in which the air 
vibrates with subdued sunshine. Look at the wooded hill in 
the background, and, above its crest, at the faint bluish 
suggestion of yet further distance. Has the artist no conception 
of space, of distance, of atmosphere ? 

The three pictures I have mentioned perfectly demonstrate 
an artist’s power of expressing the idea of space. In “ Bear- 
baiting in Gascony,” the painter has represented not much 
more than the half of a circular space, twenty or thirty yards 
in diameter, ringed in by stretches of canvas or sail-cloth, and 
overshadowed by plane-trees. In Miss Kemp-Welch’s picture 
we have a bit of wooded England—a valley half a mile or so 
across. In Didier-Pouget’s “ Pleather in Bloom,” the landscape 
stretches from the hillside, covered with purple heather, across 
the gorge-seamed uplands of Correze, far away, a hundred 
miles away, to the distant Pyrenees. 


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In the Bristol Art Gallery, I examined 170 landscapes, 86 
genre pictures, 22 historical pictures, and 21 portraits—299 in 
all. These were all the pictures in the five large rooms at the 
time of my visits, except a series of small water-colours by 
VV. J. Muller, which were in a bad light, and were consequently 
difficult to study, and a very fine set of engravings from 
Turner’s Liber Studiorum. I did not examine these engravings 
because I wished my conclusions to be drawn from the works 
of the greatest possible number of different artists, and to add 
71 pictures, all by the same man, to the small total of 299 
would, I think, have been unfair. 

In classifying pictures, landscapes give us the least trouble— 
they are landscapes and nothing else. Occasionally, it is true, 
a “ Landscape with Cattle ”—for example, some of H. VV. B. 
Davis’ paintings—will cause us to hesitate. But the hesitation 
is only for a moment, we nearly always put them into the 
genre picture category forthwith. 

When we first look at a landscape, our attention is generally 
arrested by a striking mass of form or colour or both, which 
in most cases appears on one or the other side of the picture. 
Occasionally, such a mass is seen in the centre, or filling lip 
the background. More rarely, a mass occurs on both sides of 
the picture ; the masses balancing one another. For instance, 
in Corot’s “ Souvenir d’ltalie ” two trees with their mass of 
foliage fill up- nearly the whole of the right-hand side of the 
picture. In Constable’s “ Hay Wain ” the trees and the house 
are found on the left. If you look at Millet’s “ Church at 
Greville,” you see that the ecclesiastical building occupies the 
centre of the painting ; and in the same artist’s “ Spring,” the 
wooded hill in the background catches the eye rather than the 
apple-trees in the mid-distance, partly because of its bulk, and 
partly because of the way the light is thrown upon it. Claude 
Lorrain, the great master of classical landscape, had a veritable 
penchant for symmetry. In his “ Queen of Sheba,” the Corinthian 
column, pilaster and architrave on the left are balanced by a 
palace with Doric columns on the right. 

This mass, which first strikes the eye, is not necessarily the 
principal point of interest in the picture. For example, in 
Corot’s “ Souvenir d,' Italic ,” one would probably be inclined to 
say that that delightful glimpse of an Italian town in the left 
mid-distance was the principal point of interest in the landscape, 


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and not the trees and their dense mass of foliage in the right 
foreground. Neither need such a mass be always a portion of 
the darker part of the picture ; it may be bathed in sunshine, 
whether it be the corner of a forest, a stately palace, or merely 
a cloud effect. 

It must be a great temptation for such a poor hemiplegic 
creature, as Mile Kipiani believes an artist to be, to dump down 
this mass on the left-hand side of his canvas. He appears, 
however, bravely to resist the temptation, and to place the 
mass where his artistic sense deems it to be required. 

In 70 of the pictures examined at the Bristol Art Gallery, 
this mass was found to be on the left-hand side. In 51 it 

was on the right-hand side. In 15 paintings, there were two 

masses, one on either side. As these figures show, such marked 
symmetry is rare. It is not very pleasing. Even Claude 
Lorrain’s “ Queen of Sheba ” gives one rather the idea of a 

scene on the stage of a theatre. In 34 pictures, the mass was 

in the centre, the actual figures being as follows : in 2 it was 
in the exact mid-distance centre ; in 4 very slightly to the left, 
and in 3 very slightly to the right of the mid-distance centre ; 
in 3 it was in the centre of the background, and in 2 in the 
centre of the foreground. 

“ Men, horses, bicycles, aeroplanes, all that moves on the earth 
or in the air,” says Mile Kipiani, “ all that is oriented by the 
hand of man, looks, walks, runs and flies towards the left on 
canvas or on paper.” This statement is certainly incorrect. 
Figures of men or animals are not, of course, essential to a 
landscape, and frequently when they appear in a picture, they 
are little more than dots of colour, and it is impossible to make 
out in which direction they look or move. In only 128 of the 
landscapes, which I examined, was I able to distinctly make out 
the orientation of the figures. In 27, they looked or moved 
towards the left. In 7, they were looking backwards, or 
travelling from the foreground towards the background. In 10, 
they were facing the spectator, or advancing forwards from the 
background. In 37, they were looking or moving towards the 
right, and in 47, they appeared to be looking or moving 
in about equal numbers in different directions. Roughly 
speaking, this is what one would have expected from what one 
sees in everyday life. Certainly, the artists have committed 
no error of orientation, nor shown any lack of observation. 


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In a few pictures, principally seascapes, it was possible to 
detect the direction of the wind. In 14, it blew from left to 
right ; in 5, from right to left; and in one, from the background 
forward. 

The study of the direction of light in landscapes is very 
complicated. In 39 of the pictures examined, it came from 
the background forward. In 65, it came from the left side of 
the painting, and 43 from the right. In 14 it came diagonally 
from the left background forwards towards the right foreground. 
In two pictures, one being early morning, the other mid-day, 
it appeared to come from above. In 3, it came forwards 
diagonally from the right background towards the left fore¬ 
ground. In three others, the direction of the light appeared to 
be from the foreground towards the background, and in one from 
the left foreground diagonally towards the right background. 

In genre or subject pictures, as in landscapes, a mass of form 
or colour usually at first arrests the eye. It may consist of a 
group of figures, or a building, or, in the case of interiors, of a 
piece of furniture or an article of domestic use, and it may 
occupy any position in the picture. 

In the genre pictures examined at the Bristol Art Gallery, 
this mass was found to be on the right in 22, and on the left 
in 20. In 24, it was in the centre, in 7, slightly to the right 
of the centre, and in 8, slightly to the left of the centre. In 5, 
a mass appeared on either side of the picture. In this class of 
paintings, it is seen, therefore, that symmetry takes the wooden 
spoon. 

Light in this class of pictures is as important as it is in 
landscapes, though it is not so difficult to study. In 33, it 
came from the left side of the painting, and in 28, from the 
right. In 4, it passed diagonally from the left foreground towards 
the right background, and in 1, from the right foreground 
to the left background. In 9, the light came from the back 
towards the front, and in 4, it passed from the foreground 
towards the back of the scene. In two pictures, the light 
streamed diagonally from the right background towards the 
left foreground, and in two others, in an opposite direction. 
In two cases, the light came from the centre of the picture, in 
one from a fire, and in the other from caydles. In the last 
painting of the series, the light was diffused over the scene 
from a number of Chinese lanterns. 


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“ Mile. Kipiani draws attention to this interesting fact, that 
among the Europeans the principal idea of the picture is found 
on the left side.” “ The principal idea ” is developed in the 
genre class of picture more than any other, except the historical. 
In those examined, the principal point of interest, “ the 
principal idea,” was in the centre in 44 ; in 18, it was slightly 
to the left of the centre ; in 9, it was slightly tq the right of 
the centre ; in 8, it was actually on the left side ; and in 7, it 
was actually on the right. 

In historical pictures, the mass that first arrests attention 
was observed on the left in 10, on the right in 5, in the mid¬ 
distance centre in 4, and once in the centre of the background. 
In two cases, there was a mass on either side of the picture. 

The orientation of the figures in these historical pictures 
was from right to left in 3, and from left to right in 6. In 12, 
the number of figures which looked or moved in opposite 
directions was about equal ; and in one, the figures faced the 
spectator. 

The light in this class of paintings came from the left in 3 
pictures, and from the right in 4. It came from the back¬ 
ground forwards in 5, and passed from the foreground back¬ 
wards in 2. It streamed diagonally from the right foreground 
towards the left background in 2, and in the opposite direction 
also in 2. It came from the right background diagonally 
towards the left foreground in 3, and in the opposite direction 
in 1. 

In these historical pictures, the principal idea was found in 
the centre in 16, slightly to the right of the centre in 3, 
slightly to the left of the centre in 2, and actually on the left 
side of the canvas in 1. 

Of the portraits : the two in profile were turned towards the 
left. Of the three-quarters face, 9 were oriented towards the 
right, and 6 towards the left. Of the full-length portraits, 2 
fairly faced the spectator, and 2 had the body slightly turned 
to the left. 

Portraits in profile do not appear to be popular. Certainly 
they are not at all common. The three-quarters face, sometimes 
approaching closely to the profile, with its greater scope for 
indicating delicacies of light and shade, and for expressing 
likeness, is more generally met with. I have looked over 
some sixty or seventy reproductions of portraits by Romney, 


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524 HUMAN AND ANIMAL FIGURES IN ART, [Oct., 

Gainsborough, Reynolds, Raeburn, Lawrence, Diirer, Van 
Dyck, Holbein and others, and have only found three in 
profile. Two are by Reynolds: “Mrs. Hoare and Child,” 
in the Wallace collection, and “The Duchess of Devonshire 
and Child,” at Chatsworth House. The first looks to the left, 
and the second to the right. The third is the portrait of 
Erasmus by Holbein, now in the Louvre. This face is turned 
towards the left. 

The consideration of the profile brings us to another im¬ 
portant point in. the subject under consideration, namely, the 
orientation of the head on coins, medals and seals. In 
designing these objects, the artist is in no way bound to pay 
attention to “ reasons of convenience, symmetry, and aesthetics.” 
He is not hampered by locality as in landscapes. In short, in 
no other work of art can he allow such free play to the influence 
of his left cerebral hemisphere and the muscles of his right 
hand—if such influence exists—as in die-engraving. 

The results of the examination of a few modern coins is as 
follows : 

The head on a bronze (?) coin of the First French Republic 
looks towards the left ; so does that on a five centime piece of 
the Third Republic (1872). Napoleon III looks in the same 
direction on his coins. In England, George II, Victoria, and 
George V do the same. The head of Vittorio Emanuele II 
on a ten centesimi coin (1863) is oriented towards the left. 
The same orientation is observed on the silver coins of 
Willem II of Holland (1848), and of Queen Wilhelmina 
(1906), and on a one cent coin of the United States (1859). 

On two large copper coins of George III (1797), the head 
looks to the right. On a brass medal, commemorating the 
coronation of William IV and Oueen Adelaide (1831), the 
heads are turned towards the right. Edward VII’s head on a 
penny (1902) looks to the right. Louis Philippe, on a silver 
quarter-franc (1842), also looks to the right. Wilhelm Koenig 
Von Preussen, on a silber groschen (1866), turns towards the 
right. The head of Isabel II of Spain, on a silver two reals 
piece (1857), is oriented towards the right, as is also the case 
with the allegorial head on a silver coin (1895) °f the Con- 
fcederatio Helvetica. And lastly, the head of Willem III of 
Holland, on a silver half-guilden (1863), looks to the right. 

If space allowed, I might lengthen this list indefinitely with 


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525 


the results of the examinations of ancient, mediaeval and 
modern coins, medals and seals, and also of cameos and 
engraved gems. But tfie conclusion would be always the 
same ; namely, that artists in all countries and in all ages 
oriented their work according to the dictates of their fancy, or 
their discretion, or the demands of the customs of the countries 
or periods, and in no way obeyed any physiological- law. 

1 am not a philatelist, and I cannot at this moment refer to 
a large collection of postage stamps. I believe that the heads 
or figures on these stamps are generally oriented to the left. 
But this is not a universal rule, for, on the envelope of an 
Italian letter, which is now lying before me, I see that although 
the king’s head on the five centesimi stamp is turned to the 
left, that on the twenty centesimi one looks towards the right. 

III. 

“ The orientation of personages among the Ancient Greeks 
and Egyptians was by preference to the right. It is the. same 
in the case of the drawings of the Chinese and Japanese. 
Mile. Kipiani attributes this result, among others, to their 
centripetal handwriting.” 

With regard to the Chinese and Japanese, I regret that at 
the present time I have not the opportunity of studying a 
sufficient number of the drawings of artists of those nation¬ 
alities to produce evidence for or against the part of the 
proposition which refers to them. But in that which concerns 
the Ancient Greeks, Egyptians, and several other peoples of 
antiquity, one finds ample material among the remains of 
.the decorative and plastic arts practised by these races to prove 
the correctness or incorrectness of the above statements. 

By the expression “ centripetal handwriting ” (ecriture centri- 
pcte') I presume that Mile. Kipiani means handwriting which is 
written and read from right to left. 

Wallis Budge tells us, in his little book, The Dzvellers by the 
Nile, that “ the arrangement of the hieroglyphics in inscrip¬ 
tions varies, but generally they face to the right, and are read 
from right to left like Arabic, Syriac, Hebrew, etc. Sometimes 
they face to the left, and are read from left to right ; but very 
often they are arranged in perpendicular rows, with carefully 
drawn lines separating each row. Instances have occurred 

LXIII. 35 


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where the characters face in one direction, but are to be read in 
the other.” 

With such a liberty of choice in the orientation of what one 
may call their handwriting, one may assume, in perfect accord¬ 
ance with Mile. Kipiani’s theory, that the Egpytian artists had 
a liberty of choice in the orientation of their drawings. 
Certainly, of this liberty they took full advantage, for they 
oriented their designs, not “ by preference to the right,” but 
either to right or left, and even upwards and downwards, 
exactly as they liked. 

If we examine the hieroglyphics, we find that the symbols, 
which represent animals and human beings, or parts of the 
anatomy of animals or human beings, often (always, in the fac¬ 
similes I have examined) face towards the left recently. Even 
the serpents stand up on end and look to the left. This arrange¬ 
ment of anatomical and zoological symbols seems perfectly 
reasonable if they' are to be read from right to left. It would 
not be surprising if the Ancient Egyptian artists, in sculpturing 
their mural decorations and drawing on papyrus, had always 
oriented their figures towards the left, in continuation of a 
habit which they had acquired from their mode of writing, 
which was largely' ideographic ; and in doing so they' would 
have been much more logical than modern European artists 
would be, if, as Mile. Kipiani would have us believe, they 
alway’s oriented, or at any' rate, had always a secret desire to 
orient, their figures towards the left, because they were 
accustomed to write a phonographic form of handwriting 
which ran in the opposite direction ; that is to say, from left 
to right. 

May I be permitted a digression ? The theorist, whose 
propositions we are considering, appears to have overlooked 
the fact that with most, if not with all, races the art of 
drawing preceded that of writing. The Aztecs, the Ancient 
Egyptians, the early peoples of Crete, and many other primitive 
folk were at first picture writers. Some of them never advanced 
beyond that stage, but others, more capable of culture, by 
the aid of their own mother wit, or by borrowing from others, 
arrived at employing a conventional and stereotyped alphabet 
in writing. The process of evolution can sometimes be traced. 
In the hieroglyphics and in the ancient Cretan script, ideograms 
and phonograms are found side by side. Indeed, phonograms 



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are only ideograms become conventional. Even in early cunei¬ 
form inscriptions there are reminiscences of picture-writing: for 
example, the sign for a gate, or that for a star. I cannot 
remember any race which has invented a form of phonographic 
writing which was not evolved from primitive ideograms. If 
a race adopted phonography without having passed through 
the ideographic stage, it received it as a culture-drift from its 
neighbours. 

The effect of these facts upon the hypothesis under con¬ 
sideration is obvious. 

Returning to the Ancient Egyptians : although they still 
made use of the system of hieroglyphics, with its mixture of 
ideograms and phonograms, yet from early historic times they 
employed two other forms of writing, the hieratic and the 
demotic or enchorial, both of which were phonographic and 
cursive. Possibly these, and not the hieroglyphic, are the 
modes of handwriting to which Mile. Kipiani attributes the 
preference which, she says, the Egyptians had for orienting 
their personages to the right. 

If they had such a preference they have concealed it with 
marvellous skill, for in all their sculptures and paintings, 
whether on the walls of their tombs, on their papyri, or on 
their mummy-cases, they have oriented the figures of men and 
animals precisely as they considered the scenes depicted 
required. To demonstrate this point, it will be perhaps most 
convenient to refer to The Book of the Dead. This ancient 
literary work may be said to be profusely illustrated, and as 
facsimiles of whole chapters of it are to be found in nearly 
every European museum, it may be readily examined. But 
the papyri of The Book of the Dead are very numerous, and it 
is rare to find that the arrangement of the chapters or scenes 
depicted are exactly alike in any two manuscripts, consequently 
the orientation of the figures in other copies may be exactly 
reversed from those I. am about to mention. 

In the scene, which shows us what the Ancient Egyptians 
thought life was like in the Elysian Fields, we see the 
“ cycle of the great gods ” facing towards the right. The 
deceased himself is paddling his boat vigorously towards the 
left. Cows are driven in the same direction. The reaper 
turns towards the left as he reaps the celestial barley or the 
heavenly corn. In another scene, a boat is rowed by six kings 


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528 HUMAN AND ANIMAL FIGURES IN ART, [Oct., 

towards the right. In the Judgment Hall of Osiris, the great 
god gazes towards the right, and the forty-two judges look in 
the same direction. But Thoth, Horus, and Anubis, and a very 
ugly-looking animal all face to the left. 

In order to make our study of the orientation of figures in 
pictorial art as complete as possible, let us glance for a few 
minutes at the mural decorations found in Ancient Babylonia 
and Assyria. But before doing so, it will be interesting to 
consider the mode of writing formerly employed in those 
countries. A pen was not used, but a small iron rod, which 
was triangular at the end. This was pressed on the surface of 
a slab of moist clay, which was held in the left hand, and the 
direction of the wedge-shaped or cuneiform marks was de¬ 
termined by a turn of the right wrist. In this case, if Mile. 
Kipiani’s theory be' accepted, “ the laws of the anatomy and 
physiology” of a different set, or at any rate of an additional 
set, of muscles of the right hand and forearm to those employed 
in mo<fern penmanship must have influenced the orientation of 
the figures designed by the artist, when he put aside his writing 
materials and turned to painting or sculpture. We expect to 
discover evidence of this altered orientation. But strange to 
say, the early Babylonian artist orients his figures in the same 
directions as does his modern European brother, that is to say, 
he orients them according to the requirements of his ideas. 

In the British Museum there is the representation of two 
winged female figures standing before the sacred tree. One 
figure looks to the right, and the other to the left. On the 
well-known cylinder of Adam and Eve in the Garden of Eden, 
Adam—I suppose the gentleman with horns on his head is 
Adam—looks to the left ; Eve, who wears what looks like a 
fashionable hat—no doubt le dernier cri of Ur of the Chaldees 
or some other Babylonian Paris—looks to the right. The 
serpent, which stands on its tail behind the lady, if it be oriented 
at all, is oriented towards the right. 

In Perrot and Chipiez’ magnificent work, many illustrations 
may be found which support this view of the orientation of 
figures in Chaldean art. 

In the case of the Assyrians, we are dealing with a people 
who geographically, historically, in literature and in art were 
closely connected with the Babylonians. They also employed 
the cuneiform mode of writing. On the Assyrian cylinders, as 


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on those of their southern neighbours, the figures of gods, men, 
and genii face right or left as the subject requires. 

Perhaps the finest specimens of Assyrian art are those which 
decorated the royal palaces, such as those brought to light by 
Layard’s excavations in the Nimrud Mound. Here you have 
battle-pieces, diplomatic meetings, hunting scenes, etc. ; and 
you will observe that the orientation of the figures follows no 
rigid rule, but that each man, animal, or vehicle, looks and 
moves in the direction that the scene requires. 

Near the town of Kirmansh&h, on the road from Ramadan 
to Baghdad, in the region where our gallant Anglo-Indian Army 
is now fighting, rises the Rock of Behistun. It is a landmark 
for many miles around. On the smoothest face of this rock, 
and in so lofty a position that it was inaccessible to destructive 
hands—thank heaven ! it was never exposed to the scientific 
iconoclasm of a modern German horde—“ Darius, the great 
king, the king of kings, the king of Persia,” sculptured the 
story of his ancestry, and other little matters. He added an 
illustration to the document, and you may see, carved in the 
living rock, a row of captives, who, roped together by the neck, 
turn towards the left, facing the king—a fine man, head and 
shoulders taller than those about him—and two of his officers, 
who are all three looking towards the right. 

Other illustrations of an artist’s freedom in the orientation 
of his figures might easily be found in Ancient Persia. It 
will be sufficient to mention the famous Lion Frieze at Susa. 
This is formed of glazed tiles of various colours. Looking at 
it, one sees white, yellow, and green lions—the anatomy of the 
animals is more true to nature than the colouring—moving one 
after another from right to left over a ground of turquoise blue. 

Turning to the artistic remains of a people altogether 
different, and probably in a different stage of civilisation to 
the nation which occupied the valleys of the Euphrates and 
the Tigris, and the lands towards the east of these valleys, to 
those of the Hittites, which people Dr. Haddon classes with 
the Alpine races, we find art in a cruder form. The pseudo- 
Sesostris—it is to Herodotus that we owe the idea that this 
figure was that of the Egyptian monarch, carved at a spot that 
was perhaps intended to mark the extremity of his conquests— 
is sculptured on a rock in the pass of Karabel, not far from 
Smyrna. The figure is carved in profile, and, armed with a 


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530 HUMAN AND ANIMAL FIGURES IN ART, [Oct., 

spear, and having a bow slung aross his shoulder, the warrior 
appears to be marching from left to right. Other figures of 
men, also supposed to be Hittites, may be seen at Keller, near 
Aintab. They are moving from right to left. 

Let us leave Asia Minor and go to one of the isles of the 
West. Comparatively recent excavations in Crete have thrown 
new light on ancient history and on ancient art. The frontispiece 
of The Dawn of Mediterranean Civilisation by Angelo Mosso, 
translated by Marion C. Harrison, shows us a portion of a 
painted sarcophagus from Haghia Triada. Three figures 
are there represented, all facing ■'towards the left. On p. 54 
of the same book there is an illustration of a steatite vase, on 
which is the figure of a soldier facing to the right. 

Before considering the art of the Ancient Greeks, important 
for its own sake, and for the fact that Mile. Kipiani has appealed 
to it in confirmation of her theory, I must beg the reader’s 
patience for a moment while we glance at the mural paintings 
and other decorative work of the Ancient Etruscans. 

In Mrs. Hamilton Gray’s Tour to the Sepulchres of Etruria 
in 1839, we find many illustrations of the artistic work of 
this interesting race. The frontispiece of the book gives a 
representation of a procession of souls with good and bad 
genii, which is taken from the wall of the Grotta del Tifone at 
Tarquinia. Two of the figures in the procession face the 
spectator, but all the others are looking towards the left. 

The walls of the Grotta della Querciola were richly 
decorated, and the authoress provides us with some exceedingly 
beautiful specimens of the paintings. There are two pediments 
in which naturally the figures on the right face to the left, and 
those on the left face to the right. On the friezes, there are 
many figures of dancers and players on double flutes. Seven 
of these figures face towards the right, and six towards the 
left. In three of the figures, including one of the musicians, 
the artist has succeeded in conveying the idea that they are 
actually turning in the movement of dancing. Sargent’s “ La 
Carmencita ” is about to dance ; the Ancient Etruscan artist’s 
figures are dancing. The former is the future tense of the 
infinitive, the latter is the present of the indicative. 

On the walls of the Grotta della Querciola, there are also 
hunting scenes. In one, four of the human figures and one of [| 

a horse are oriented towards the right, and one human figure 


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towards the left. In another scene, which represents a boar 
hunt, five of the human figures and all the animals, dogs, horses, 
and the boar itself, are facing towards the left, and two human 
figures towards the right. 

The frontispiece of Dr. Isaac Taylor’s Etruscan Researches 
gives the reproduction of a painting on one of the walls of a 
tomb discovered at Vulci in 1857. The subject of the picture 
is the sacrifice of Trojan prisoners ; and of the ten figures, 
five face towards the right, and five towards the left. The 
woodcut, Dr. Taylor tells us, has been taken from the magnifi¬ 
cent work of Noel des Vergers, L'ti.trurie et les lltrusqucs, 
PI. XXI. 

On p. 1 12 of Dr. Taylor’s book there is reproduced a 
picture, or rather a scene, taken from a bronze mirror now 
in the Berlin Museum. The subject of the illustration is Orestes 
killing Clytemnestra. Two of the figures face towards the 
right, and one towards the left. The scene is very dramatic, 
and the movement is from left to right. Below the principal 
design, apparently filling in the lower curve of the mirror, is 
the recumbent figure of a man, supposed to be Orestes, 
struggling with a serpent or dragon, which is in the act of 
devouring him. The human figure faces towards the right, and 
that of the reptile towards the left. The woodcut is taken 
from Gerhard’s Etruskische Spiegel , PI. CCXXXVIII. 

Mile. Kipiani states that the Ancient Greeks and Ancient 
P'gyptians oriented their personages by preference to the right. 
We have seen that the latter exercised no preference in the 
matter, but followed the necessities of circumstance. The 
Ancient Greeks acted precisely in the same way. 

But from the point of view of the influence of handwriting on 
the orientation of figures in art, the case of the Ancient Greeks 
is peculiarly interesting on account of the changes in the direc¬ 
tion of their writing which occurred in historic times. First, 
they wrote from right to left, as Arabic, Syriac, and Hebrew are 
written, which habit they may have acquired from the Phoeni¬ 
cians, if, though this is now disputed, they received the alphabet 
and the knowledge of writing from that nation. Then, they 
adopted the boustrophedon (f 3 ov^ arntfaj') method—that is to 
say, they wrote first from right to left, and then back again 
from left to right, in the same way as oxen plough furrows in 
a field. Prof. A. H. Sayce informs us that the Hittites 


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5 32 HUMAN AND ANIMAL FIGURES IN ART, [Oct., 

employed the boustrophedon mode of writing, and he suggests 
that the Greeks learned “ to write in such a fashion from 
neighbours who made use of the Hittite script.” 

This boustrophedon method of writing is precisely what 
Mile. Kipiani advocates. She proposes that books should be 
printed in the following way: “ One line should be printed 
in ordinary characters and read from left to right in the 
ordinary fashion ; the following line should be printed ett 
viiroir, and read from right to left, and so on." The object 
of this innovation, or rather, as we have seen above, this 
return to an ancient method, is to save the eyes from the 
unnecessary labour of constantly going uselessly back from the 
end of one line on the right of the page to the beginning of 
the next line on the left. 

But to return to the Ancient Greeks : after a while, for 
some reason or other, they gave up the boustrophedon method, 
and took to writing from left to right as we do at present. 
This new mode of writing is said to have been introduced 
by Pronapides of Athens in the time of Homer. Probably, 
the Greeks borrowed the idea—from whom it is difficult to say, 
for their literary neighbours, including the Etruscans according 
to Dr. Taylor, wrote from right to left. The Greeks were far 
more given to borrowing than to inventing. They were the 
greatest plagiarists that ever lived. It is true, that when they 
got hold of another person’s idea, they improved upon it. 
They borrowed a rough diamond, and they gave back a faceted 
gem. But they borrowed it all the same. Still, in whatever 
way they became acquainted with the idea of writing from 
left to right, they probably had excellent reasons for abandoning 
the boustrophedon method. 

Homer is generally supposed to have been born between 
900 and 1000 years before the Christian era. If then the 
Greeks have employed the method of writing from left to right 
since that period, the works of Greek art, in which we can study 
the orientation of the figures, were created under the same 
cerebral and muscular influences (if any) as those which now 
govern modern artistic work ; and Mile. Kipiani is wrong in 
attributing to their “ centripetal handwriting” the preference 
which, she says, the Ancient Greeks showed for orienting their 
personages to the right. 

But it is unnecessary to lay stress on this point. It is 


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unimportant. The direction of handwriting had no more effect 
on the orientation of the figures in the works of Greek artists 
than it had or has on that of the figures in the works of the 
ancient artists of Egypt, or of those of the great Mesopotamian 
empires, or of the artists of modern Europe. This statement 
can be verified in almost any museum, or by reference to any 
illustrated work on Greek art. I need only give two examples. 

In the Bristol Museum are casts from the East and West 
Pediments of the Temple of Athene at Aegina. The date of 
the building is approximately B.C. 456. The originals of the 
casts are now in the Glyptothek at Munich. The subject of 
the sculptures is a battle between the Greeks and Trojans. In 
the left half of the East Pediment, the three figures, one being 
recumbent, face towards the right. In the right half of the 
same Pediment are two figures, one of which lies prostrate on 
the ground, but both face to the left. In the left half of the 
West Pediment, four figures are oriented to the right, while in 
the right half, three figures turn towards the left. In the 
centre stands the statue of Athenfe which faces the spectator. 
At each end of this pediment is a recumbent figure ; that on the 
left looks towards the left, that on the right towards the right. 

It may be suggested that this orientation and arrangement 
of the figures were due to architectural reasons. It is possible. 

In the Bristol Museum there are also casts from the frieze 
of the Temple of Apollo Epicurios, in Arcadia, about five miles 
from Phigaleia. The temple was discovered in 1812, and the 
date is probably B.C. 430. The originals of the casts are now 
in the British Museum. Here the orientation and arrangement 
of the figures are not affected by architectural considerations. 
The frieze from the west side of the temple represents a 
combat between Centaurs and Lapithae Eleven of the figures 
face to the right, and twelve to the left. The frieze on the 
north side of the temple represents a combat between Greeks 
and Amazons. Nine of the figures face to the right, and four 
to the left. 

Mile. Kipiani for confirmation of her theoryhas appealed to 
the designs of the child artists of the schoolroom, but she has 
not appealed to those of the artists of the childhood of the 
world. Let us see what the latter have to tell us. 

If we examine engravings of the well-known specimens from 
the Dordogne caves, we find : (1) on a piece of reindeer’s horn 


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534 HUMAN AND ANIMAL FIGURES IN ART, [Oct., 

the figure of a fish, which is swimming from right to left; (2) 
on another piece of reindeer’s horn there is the representation 
of the head and chest of an ibex, the orientation of which is 
towards the left ; (3) on a third piece of reindeer’s horn are 
two horses’ heads, which face towards the left, and an eel or a 
serpent or something of the sort, and a human figure, both 
facing towards the right ; (4) a group of reindeer (it is not 
stated on what material these figures were scratched) which 
face to the left ; (5) on a piece of a mammoth’s tusk, the drawing 
of a mammoth which faces towards the left. The engravings, 
from which the above descriptions are taken, are those in Lord 
Avebury’s Pre-Historic Times. 

On October 20th, 1913, a communication was made to 
the Acadimie des Sciences by M. Douville on behalf of Dr. 
Lucien Mayot of the University of Lyon, and M. Jean Pissot 
of Poncin, Ain, concerning certain prehistoric discoveries 
which had been made in the subsoil of the rock-shelter of La 
Colombiere. This rock-shelter is situated on the right bank of 
the River Ain, about twenty mitres above the present level of 
the river, between Poncin and Neuville-sur-Ain. Among'other 
finds were certain pieces of limestone, evidently smoothed and 
prepared for artistic work, on which were scratched, engraved, 
if you will, various designs. 

Reproductions of four of these prehistoric sketches appeared 
in L'Illustration, October 25th, 1913. One represents the 
well-drawn figure of a horse, which faces towards the right. A 
second presents an interlacement of lines, among which it is 
possible to make out the figures of a zebra-like horse, a bison, 
and some animal of the felidae genus. They all face towards 
the right. A third represents the upper part of a human figure 
with an outstretched arm. This figure is also oriented towards 
the right. The fourth represents the head of a mouflon (ovis 
musimon) facing towards the left. The left end of this stone 
has been partially carved into the profile of the animal. 

All these examples demonstrate that the prehistoric artist 
obeyed no fixed and rigid law in the orientation of his figures, 
but followed the dictates of his fancy, or, if he were drawing 
from nature, copied the actual position of the model. 

Conclusion. 

The statement, therefore, that “ all that is oriented by the 


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hand of man, looks, walks, runs and flies towards the left on 
canvas or op paper,” is incorrect. All that is oriented by the 
hand of man, on canvas or on paper, looks, walks, runs and 
flies towards the left or the right as the fancy of the artist 
dictates, or the necessities of the picture require. The corollary 
follows that the statement, that “ it is because we design with 
the right hand only, that we orient our pictures and our 
drawings to the left,” is also incorrect. 

There is neither jot nor tittle of evidence that orienting our 
pictures and our drawings to the left “is the most easy habit, 
the most facile, the least reasoned out.” And, as we have seen 
there are instances whieh give us the right to challenge the 
statement that such a habit “ is most general among children.” 

Undoubtedly, artists change the orientation of the figures in 
their pictures “ thanks to their virtuosity, and also for reasons 
of convenience, symmetry and aesthetics.” But it is absolutely 
incorrect to say that “ it is the orientation to the left which 
predominates” in their work. 

Both Mile. Ioteyko and Mile. Kipiani write as though the 
two hemispheres of the brain were two separate organs—as 
separate as the two kidneys. They write as though there were 
no decussation of the pyramids; as though the Corpus Call®sum, 
the great commissural pathway between the two hemispheres, 
did not exist. They ignore the unity of the nervous system. 
Further, they write as though only one of the cerebral hemi¬ 
spheres, only one of these separate organs, functioned. The 
left hemisphere, according to them, is active ; the right passive. 
Indeed, at times, they seem to regard the right hemisphere as 
being so passive that to all intents and purposes, as far as its 
action on intellectual and somatic economy is concerned, it 
might be non-existent. All this is bad anatomy and bad 
physiology, and consequently the psychology, which is based 
upon it, is bad also. 

There are some scientists who worship Broca’s area with an 
adoration equal to that which was paid to the pineal gland in 
the days of Descartes. 

As far back as 1878, Ferrier showed experimentally in 
monkeys and other animals that the 010-lingual centres had 
a more or less bilateral action. P. Marie and his followers 
have collected many cases of lesions of Broca’s centre without 
aphasia ; and, more important still, cases of aphasia due to 


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[Oct., 


disease of the right cerebral hemisphere in right-handed people 
have been recorded. 

In the elucidation of physiological and psychological 
problems, the evidence of the post-mortem room is as trust¬ 
worthy as that of the experimental physiological laboratory. 

In his work, the artist has to do chiefly with colour and 
form, and it is the latter which is concerned with the orienta¬ 
tion of the figure in drawing. The blind man obtains his 
wonderful idea of form largely from the tactile sensibility of 
both his hands, not his right hand only. Those who are 
endowed with sight, receive their ideas of form principally 
through the medium of.the oculomotor nerves. The briefest 
possible consideration of the central connections of these nerves 
will, I think, demonstrate the impossibility of our conception 
of form being a concern of one hemisphere only. 

The central connections of the third nerve are with the 
anterior portion of the sommsthetic area, and with the cortex 
about the visual area of the occipital lobe of the opposite side 
of the brain. It has probably associations with the cerebellum, 
and with the sensory nuclei of the other cranial nerves. The 
trochlear nerve, a nerve of the greatest importance in the 
estimation of form, has similar central connections. And it is 
necessary, from the point of view of the subject under con¬ 
sideration, to emphasise the fact that it is the only cranial 
nerve the fibres of which undergo a total decussation. The 
sixth nerve has similar central connections to the other 
oculomotor nerves. It also is of the greatest importance in 
the estimation of form, on account of the connection of its 
fibres with the third nerve of the opposite side, and through it 
with the opposite internal rectus muscle. 

How is it possible that the left cerebral hemisphere should 
exercise, as Mile. Kipiani’s theory asserts, such an overwhelming 
influence on the orientation of the figure ; that is to say, on 
the artist’s execution of his conception of form ? 

The whole brain is none too big for the artist. He makes 
use of every centre, every neuron, every association fibre, every 
projection fibre. His sensibility must be acute enough to 
receive the most delicate impressions from the outside world. 
His will must be perfect in all its complexity. The flaw that 
mars a genius is more often in the will than in any other function 
of the mind. The artist fails because he cannot execute his 


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conceptions. It is this that lies at the root of the faulty com¬ 
position of many an otherwise excellent picture. His perception 
must be of the keenest, and his memory of the surest. And, 
above all, he must be gifted with the most subtle powers of 
discrimination. The true artist represents the highest form of 
intelligence. The poet and the musician may equal him in 
intensity, but he far surpasses them in breadth. 

Yet it is after contemplating the work of a man, endowed 
with such powers of conception and execution, that the scientist 
exclaims : “ What an error of orientation ! What lack of 
observation ! What abnormality of the sense of space ! ” 


Psycho-analysis in Relation to Sex. By Havelock Ellis. 

In 1895 an unostentatious book quietly appeared in Leipzig 
and Vienna entitled Studies of Hysteria (Studien iiber Hysterie ), 
written jointly by two authors, Dr. Josef Breuer and Dr. 
Sigmund Freud. There was no public ready to receive the 
book, it attracted little attention, and had a small sale. In 
England and America it remained almost unknown, so that it 
is now a satisfaction to the present writer to recall that almost 
the first full exposition in English of the views set forth in this 
book appeared in the first volume of his own Studies in the 
Psychology of Sex in 1 898. Yet these studies of hysteria, as an 
attentive reader could scarcely fail to realise, turned over a new 
page in medical psychology, and the new page was of fascinating 
interest. A case of hysteria was no longer to be regarded as, 
on the psychic side, almost beneath a physician’s serious 
attention, nor was it to be settled merely by an accurate 
description of the physical symptoms, after the manner of 
Charcot’s school, to which school in the first place Freud himself 
had belonged. It was a mystery to be patiently investigated, 
a mystery to which the key often lay far back and forgotten in 
the patient’s history, and when skilfully used, with knowledge 
and insight, the patient’s medical history acquired not only 
psychological significance but something of the interest of a 
novel. Freud himself clearly recognised this and stated, even 
in this first book, that it was by a representation of psychic 
processes, “ such as we are accustomed to receive from the poet,” 
that he had gained his insight into the nature of hysteria. 


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Priority in the inception of the ideas contained in this book, 
and the treatment based on them, belongs, as Prof. Freud 
has since acknowledged, to the elder writer, Dr. Breuer. After 
acting as the missionary for the conversion of his more famous 
colleague,Breuer disappears from the psycho-analytic scene. He 
was indeed an unconscious if not unwilling missionary in this 
field. He pointed out the road but could not accompany the 
disciple far along it. He signed with Freud the statement in 
the preface that “sexuality plays a leading part in the causation 
of hysteria,” and elsewhere makes the emphatic statement on 
his own account that “ the great majority of serious neuroses in 
women arise from the marriage bed.” But it would appear, 
from what Freud has more recently said, that on this funda¬ 
mental question of sex Breuer never fully shared the revelation; 
as Freud has himself put it, Breuer guided him to an insight 
which he himself never gained. 

The process, so far as the change of attitude towards sex is 
concerned, may deliberately be termed “conversion,” and it is 
that term ( Bekelirung ) which Freud himself applies to it, for we 
may best understand it as of the nature of a religious conversion, 
a changed attitude towards the world and the revelation of a 
mission in life. 

We have to remember that Freud was the pupil of Charcot, 
and under Charcot’s inspiration was preparing to devote himself 
to the physical aspects of nervous disease and to physical treat¬ 
ment, especially electro-therapeutics. Charcot was indifferent 
to the psychic side of his cases and, following the French 
medical tradition and well seconded by his disciples, he regarded 
the recognition of a sex element in the causation of disease as 
degrading. That attitude was the outcome of the whole of 
Charcot’s temperament and habit in approaching disease, as was 
clear at once to anyone who saw him—as I still vividly recall 
him—in his dealings with patients at the Salpetriere. One 
realised that he felt he had a complete mastery of the case and 
that he regarded it as a purely physical problem ; for the patient 
himself, and for any communication that the patient might be 
able to make, he felt evidently an almost contemptuous disdain. 
There could be no attitude more directly opposed to that which 
Freud ultimately reached. But it was in that atmosphere 
Freud was trained to approach nervous disorders. We can well 
believe that, when at length faced by the mysterious Sphinx of 


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sex he had flouted and met with the stern demand why he had 
persecuted her, Freud passed through a deep spiritual upheaval, 
a complete revolution, comparable to that experienced by a still 
greater Jewish apostle of truth in days of old, on the road to 
Damascus. If we are tempted to think, as most of us certainly 
are tempted to think, that the convert has sometimes been 
dazzled by his new vision and drawn by his convictions to 
excess, we may learn to view these results with a more sympa¬ 
thetic tolerance if we understand how, certainly on the basis of 
a favourable soil, they were originally brought about. 

It can scarcely be said that there seems to us much excess 
to-day in this early volume of Studies on Hysteria, although, 
Freud tells us, its unconventional views sufficed to create around 
him a vacant space even in the circle of his friends. Much as 
the Freudian doctrines and formulas have been transformed 
since, not only was the sexual element in the causation of 
hysteria here clearly recognised at the outset, but the chief lines 
of its psychic mechanism were set forth. The doctrine of the 
“ suppression ” of unpleasant, and usually sexual, experiences 
into the unconscious was there, and, Freud has lately declared, 

“ the doctrine of suppression is now the foundation pier on which 
the structure of psycho-analysis rests.” There was also the 
doctrine of “ conversion,” by which an emotional experience 
may be changed into a physical, and usually pathological, 
phenomenon having no conscious or apparent resemblance to 
its emotional cause, which this process, more or less, relieves 
and removes, so that, as Freud expressed it, “ the hysterical 
symptoms are built up at the cost of the remembered emotions 
at the origin the physical pain or disability had been associated, 
in time, with the emotional experience, but the link *had never 
been recognised in consciousness. We see again in this book 
the conception of “ symbolism,” which was afterwards to play r 
so important and so much discussed a part in Freud’s teaching; 
in this first book, however, the symbolism of objects was, as 
F'reud has since acknowledged, overlooked though present, and 
the symbolism revealed was a symbolism of situations, a sexual 
situation being represented by an analogous situation on a 
different and more avowable plane ; it was, therefore, more a 
physiological than a psychic symbolism. In this first book, 
once more, we have the tendency for the sexual exciting cause of 
the disorder to be traceable further and further back towards early 


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life, although there was, as yet, no definite assertion of “infantile 
sexuality,” which was not put forward until 1905. Finally, the 
Freudian method of treatment was in principle here established 
as a method of drawing out and bringing to the surface of 
consciousness a repressed and corroding element, a method by 
Rreuer termed “cathartic,” though Freud himself later termed 
it “ analytic,” probably because he felt unable to accept Breuer’s 
conception of “ a foreign body in consciousness.” No extreme 
position at any point can, indeed, be said to be taken in this 
first book, and it is probable that many to-day who view 
psycho-analysis with horror might peruse the volume with a 
degree of assent they would not have felt when it was published, 
for even the opponents of Freud have now absorbed some of 
the ideas he has flung into modern currents of thought. 

For my own part, it seemed a fascinating book even when it 
was first published, and I read it with sympathy and real 
enlightenment, if perhaps some reserve of judgment. The 
attitude of Charcot towards sex in relation to hysteria was by 
no means universally shared in England. Various physicians 
had stated their belief that the sexual emotions, by no means 
necessarily or usually in their coarser aspects, played an im¬ 
portant part in the causation of hysteria. I had myself, a 
year earlier (in Man and Woman), ventured to express the 
opinion that the part played by the sexual emotions in hysteria 
was under-estimated. So that I was fully prepared for the 
general attitude of the authors of the Studien tiber Hysterie, 
and, indeed, read the book with rare intellectual delight, apart 
from any agreement with its thesis, simply because that thesis 
was presented with a sympathetic intuition and a power of 
skilful artolysis which had never before, even by Janet, been 
expended on the delicate and elusive mechanisms of the dis¬ 
ordered emotions. I still think that there is no simpler or 
more persuasive introduction to Freud’s work than his first 
book. 

Freud was pleased with my recognition of the book, and 
from that time began an exchange of publications and occa¬ 
sionally of letters. He found in my Studies helpful suggestions 
in the development of his own doctrines, suggestions which I 
had not myself been inclined to carry to an extreme or dog¬ 
matic form. In this way he was encouraged by the “ Histories ” 
of normal persons in the third volume of my Studies, as well 


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as by an instructive article published by Sanford Bell in the 
American Journal of Psychology , to follow up the task he had 
already begun of pushing back' the sexual origins of neuroses 
to an ever earlier age, and especially to extend this early origin 
so as to cover not only neurotic but ordinary individuals, an 
extension of pivotal importance, for it led to the Freudian 
doctrine becoming, instead of a mere clue to psychopathology, 
an alleged principle of universal psychological validity. He 
thus finally reached that conception of constitutional “ infantile 
sexuality ” which he regards as so fundamental, and his oppo¬ 
nents as so horrible. He also adopted some of my terminology, 
such as “ auto-erotism ” and “ narcissism.” The first of these 
two terms, however, I may remark, the Freudians have often 
perverted and confused. This was not entirely due to Freud 
himself, who, when in 1905 he first adopted the term, found 
its chief significance in the fairly legitimate sense of a sexual 
impulse which was not directed towards other persons, and 
found its satisfaction in the individual’s own person. But, sub¬ 
sequently, Freudians have often used the term to indicate a 
sexual impulse, which not only found its satisfaction within the 
individual’s own person, but was actually directed towards his 
own person. Now, that is what I . term “ narcissism,” and 
regarded as a subdivision of the great group of auto-erotic 
phenomena. The essential characteristic of an auto-erotic 
manifestation, as I had devised the term, was that the erotic 
impulse arose spontaneously and from within, and was not 
evoked from without in response to the developed normal 
appeal of an attractive external influence. I formed the word 
on the model of such words as “ automobile,” which means 
moving by itself and not, as the Freudians would have it, 
towards itself I regard erotic dreams in sleep and erotic 
reverie in waking life as the typical form of auto-erotism, and 
the term seemed to me a convenient way of grouping together 
a large number of phenomena for which no common name had 
previously existed. That is why I consider that the Freudian 
tendency to limit the term to a single group of manifestations 
is illegitimate and confusing ; it stultifies a useful name for 
which there is no other convenient equivalent. So far as I 
know, indeed, no Freudian has attempted to justify this 
perversion of the term. 

The point is worth mentioning because it indicates a frequent 

LXIII. 36 

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Freudian tendency to looseness in definition. This is to be 
noted, but not altogether to be blamed. Definitions are not so 
essential in the biological sciences as in the mathematical 
sciences. Moreover, the Freudians are at the beginning of 
their science—if science it may be termed—while precisely 
accurate definitions come at the end of an investigation and not 
at the beginning. This looseness of definition has been a part 
of the vital growth, the perpetual shifting new development, 
which has so strikingly marked Freud’s work. 

Freud’s conceptions have indeed grown marvellously. The 
Studien iiber Hysteric have long been left behind. He is 
perpetually remoulding his ideas, as his experience widens and 
his insight becomes more penetrating, introducing new ideas, 
extending them into new fields. From hysteria psycho-analysis 
was applied to other groups of psycho-neurotic disorders, 
first to morbid obsessions and impulsions, then to all sorts of 
psychic disorders, including various forms of insanity, though 
it may be doubted whether it has worked out as well in any of 
them as in hysteria, and in the severe forms of mental disease, 
as Freud himself has pointed out, it is helpless. The applica¬ 
tion of the Freudian idea to the normal child was, as has been 
said, a pivot on which the whole doctrine has turned. It 
involved, first of all, a new elaborate analysis of all that is 
meant by “ sexuality.” The infant, the young child, is, of 
course, not sexual in the limited and Idealised sense which we 
have in mind when we think of sexuality in the adult. In the 
young child, as viewed by Freud, sexuality is generalised, and 
may take on many forms, forms which in later life, if we found 
them associated with a specific underlying sexual impulse, we 
should call perverse. Therefore Freud regards *the child as 
■“ polymorph-perverse,” and, as is indeed well recognised (and 
as my own investigations had repeatedly shown), the sexual 
perversions of later life may largely be regarded as a per¬ 
sistence of, or a return to, the impulses of child life. The 
extreme and pronounced way in which Freud set forth his 
doctrine of infantile sexuality aroused much opposition and 
resentment among many people, who failed to realise that sex in 
early life is a different thing from sex in adult life. Later, 
Freud deprived this objection of its force by a dexterous turn 
of the artist’s hand, which became necessary at the point he 
had reached ; he enlarged the whole conception of sexuality, 



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and “ Libido " for him became practically the manifestation of any 
pleasurable desire. The extension of the Freudian domain to 
cover the normal child necessarily led on to the inclusion of the 
normal adult and all his activities. Freud was greatly helped 
and encouraged here by the application of psycho-analysis 0 
to dreams. We may all, he holds, apply psycho-analysis to 
ourselves, and demonstrate the validity of its princples, by 
studying our dreams. He attaches supreme importance to 
this field of investigation : “ dream interpretation is the founda¬ 
tion stone of psycho-analysis.” His largest and most elaborately 
detailed book is on dreams, Die Traumdeutung. It was 
certainly a legitimate and hopeful field of investigation, though 
there are some of us, some even who have given special 
study to the analysis of dreams^ who doubt whether the great 
and rich field of dream-life can be so entirely squeezed into the 
limits of the Freudian formulas as Freud has asserted, and who 
cannot possibly accept the wild statement that before psycho¬ 
analysis dreams were regarded as “ a purely bodily phenome¬ 
non ” outside psychology. Only one further extension of the 
Freudian conception was possible, and that Freud eventually 
took. Having included individual psychology in his domain, 
he proceeded to incorporate also therein collective psychology, 
so that finally psycho-analysis could be applied to all the 
highest social manifestations of human development. 

A few years ago Freud himself published a schematic out¬ 
line of the various sciences to which psycho-analyses had been 
applied or become applicable (^ : (1) It helps to explain much 
in the science of language. (2) It modifies the hypotheses of 
philosophy and stimulates philosophic activities in new direc¬ 
tions. (3) .It affects biology, not only by, for the first time, 
doing justice to the place of the sexual function in humanity, 
but by acting as a mediator between biology and psychology. 
(4) Pschyo-analysis brings new contributions to our conception 
of evolution, showing that the old axiom that the development 
of the individual repeats the development of the race applies 
also in the psychic sphere, and indicating that infantile psychic 
formations persist in the adult. (5) It also contributes to the 
history of civilisation, not only by helping to explain myths 
and legends, but by illuminating the origin of great human 
institutions as attempts to relieve human needs which cannot 
be directly gratified. (6) In the fine arts it plays a similar 


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544 PSYCHO-ANALYSIS IN RELATION TO SEX, . [Oct, 

part, explaining alike the hidden motives of the artist and 
of his audience in seeking to resolve a conflict which might 
otherwise work out disastrously. (7) It likewise concerns 
sociology, for the forces which cause repression and sup¬ 
pression of the individual are mainly engendered by docility 
to social demands. (8) Psycho-analysis is, further, of the 
greatest importance for the sciences of education by revealing 
the true nature of childhood, and enabling the educator to 
avoid the danger of too violently repressing instincts which 
may seem to the adult vicious and abnormal, but which 
are only rendered dangerous by the adult’s futile attempts to 
crush them, instead of allowing them in due course to be 
sublimated, for “ our highest virtues have arisen as reactive 
sublimations from the foundation of our worst predispositions." 

What is Freud’s vocation ? One is tempted by this enumera¬ 
tion of the fields in which he claims to be working to ask a 
question to which the answer may not be quite obvious. He 
started as a medical psycho-pathologist, but medicine covers now 
only a small part of his field. We cannot even describe him as a 
man of science, for he attaches himself to no particular science 
—even as a psychologist he is too large to be fitted into any 
school—and his activities are individualised, intuitive, and 
conceptual to a degree which removes them from the impersonal 
and objectively verifiable basis of science. He enters the 
philosophic domain, and might by some be termed a meta¬ 
physician ; but - here, again, apart from the fact that, as he 
himself has frequently observed, he has always deliberately 
avoided the study of philosophic literature, he by no means 
lives, as the philosopher is bound to live, in the world of ideas, 
but is primarily absorbed in the active manipulation of human 
nature. His activities are, indeed, above all, plastic and 
creative, and we cannot understand him unless we regard him 
as, above all, an artist. He is indeed an artist who arose in 
science, and to a large extent remains within that sphere, with 
disconcerting results alike to himself and his followers when 
he, or they, attempt to treat his work as a body of objectively 
demonstrable scientific propositions. It has thus happened 
that nearly all the chief and ablest of his early supporters— 
Bleuler, Adler, Jung, and Stekel—have successively left him. 
For in art we are concerned with matters of taste and sympa¬ 
thetic insight, which one person may feel and another not, or 


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human evolution ; abnormally, in neurotic persons, the process 
miscarries, and the help of art is necessary to render the 
process natural. This art is the whole of psycho-analysis. 

Freud traces back the processes with which he deals to roots 
in early childhood, to an infantile disposition with certain 
resultant psychic mechanisms, and that is largely why they are 
lost from ordinary view in the unconscious. The later psychic 
developments are highly important, but they are always obscurely 
connected with more fundamental roots, however concealed, in 
childhood or infancy, even though ultimately they are shaped 
by human imagination into the great figures and conflicts of 
Myth and Religion and Art. 

This infantile source of later psychic processes is, in Freud’s 
view, sexual, though, as already indicated, a dexterous sleight 
of the artist’s hand has later enlarged the conception of sexual 
pleasure by combining it with all pleasure, thus taking away the 
ground from the anti-Freudians’ feet. On infantile “sexuality,” 
and on its significance for all later life, he lays great stress. 
The infant’s sexual life he regards as highly complex. It 
primarily consists in simple tactile pleasures, in thumb-sucking, 
in friction of the various body openings, or of other sensitive 
spots. It develops into a special interest in the activity of the 
excretory functions. Extending to other persons, it tends to 
attach itself in the boy’s case to his mother, in the girl’s case to 
the father,as well as between brothers and sisters, and it also tends 
to ignore the adult distinction of sex; “ You will not be wrong,” 
Freud says, “ in attributing to every child a fragment of homo¬ 
sexual aptitude.” These special attractions may easily become 
special aversions. Fundamentally, however, they are wishes. 
A sexual wish is, in Freud’s view, fundamental. 

In the course of the development, however, the infantile wish, 
as a result of important conflicts, disappears into unconsciousness 
and is replaced in consciousness by some other manifestation. 
This is inevitable, for, as the subject grows older, the moralised 
emotions of shame and disgust, acting as censors, drive the 
infantile “ sexual ” wish out of the conscious field. Fragments, 
indeed, of this infantile state of desire may in some cases persist 
in the form of fixed perversions. Perversions are related to 
neuroses as positive to negative. In the neuroses the same 
original impulses are at work, but they are working from the 
unconscious side, all the intensity of the suppressed emotion 


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becoming transferred to the physical symptom. Disease is thus, 
in Freud’s words, a flight from unsatisfying reality into some¬ 
thing which, though biologically injurious, is not without advan¬ 
tage for the patient, for it is a kind of cloister into which, with 
his transformed infantile longings, thepatient retireswhen deceived 
by the world or no longer able to fight against the world. We 
imagine that we can destroy our childish and primitive impulses 
by some miraculous process and change them into nothing. It 
is not so, says Freud. Nothing is destroyed. We can at the 
most shift our desires into the unconscious, convert them into 
morbid shapes, or sublimate them, and then not entirely, into 
exalted ideal impulses. Spirit is as indestructible as matter; 
that is Freud’s great discovery. Freud’s work is the revelation 
in the spiritual world of that transformation and conservation of 
energy which half a century earlier had been demonstrated in the 
physical world. 

That is an abbreviated description of a state of things which, 
as Freud now views it, is of universal extension, and represents 
a fundamental human process of supreme importance. It is 
only in the rare cases in which it is intensified through occurring 
in abnormal persons that it becomes morbid and demands the 
physician’s attention. The method by which the physician of 
Freud’s school investigates this state of things, by bringing it 
to the light of consciousness and, in so doing, relieving it, is the 
famous method of psycho-analysis. 

At first, when working with Breuer, Freud used hypnotism as 
the vehicle of his method. Me has, however, long since aban¬ 
doned that method as capricious and mystical, while in many cases 
the patients could not be hypnotised at all. He prefers to 
investigate the patient in the normal state by what he terms the 
analytic method. For a doctor to find out what he is ignorant 
of by addressing questions to an equally ignorant patient seems 
unpromising. But Freud remembered that he had seen Bernheim 
show at Nancy that, when a patient appears ignorant of what 
happened to him in a previous hypnotic state, his ignorance is 
•not really absolute but may with skill be overcome. He found 
it was the same with the early emotional experiences which lay 
at the roots of these patients’ neuroses. Freud encourages the 
patient to say everything, however irrelevant or indecorous or 
silly, which comes into his head, while he, as it were, stands by 
and watches these bubbles from the psychic depth, on the look- 


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out for those which furnish a clue to the nature of the process 
beneath. Jung developed a valuable branch of this psycho¬ 
analysis with his method of free association, which consists in 
reading out a string of words to the patient, telling him to say 
at once what each word suggests, and noting down the results, 
in the faith, often verified, that in this way the patient will 
unconsciously give away secrets that are unknown even to 
himself, not merely by the nature of the words that he responds 
with, but by his hesitation in responding at all to certain words. 
This method Freud regards as the psycho-analytic equivalent 
of the chemist’s qualitative analysis. 

As the patient’s real history is thus brought to the surface 
and revealed, slowly and laboriously—and Freud admits that 
the process is extremely slow and laborious—the patient is 
enabled to become conscious of the morbid process, and in so 
doing is greatly assisted in casting it off. In that way the 
psycho-analytic method is, as Breuer terms it, cathartic, and, as 
Freud points out, it is the very reverse of the hypnotic method, 
for w'hile hypnotism seeks to put something into the patient, 
psycho-analysis seeks to take something out, and is, as Freud 
has himself said, analogous to the sculptor’s art. 

This conception of psycho-analysis was a brilliant idea for 
which Freud deserves all credit. It has not, however, been 
pointed out, so far as I am aware, that Freud had a forerunner 
in the idea, though not in its clinical and therapeutical appli¬ 
cations. In 1857 Dr. J. J. Garth Wilkinson, more noted as a 
Swedenborgian mystic and poet than as a physician, published 
a volume of mystic doggerel verse written by what he considered 
“ a new method,” the method of “ impression.” “ A theme is 
chosen or written down,” he stated ; “ as soon as this is done 
the first impression upon the mind which succeeds the act of 
writing the title is the beginning of the evolution of that theme, 
no matter how strange or alien the word or phrase may seem.” 
“ The first mental movement, the first word that comes,” is “ the 
response to the mind’s desire for the unfolding of the subject.” 
It is continued by the same method, and Garth Wilkinson adds,. 
“ I have always found it lead by an infallible instinct into the 
subject.” The method was, as Garth Wilkinson viewed it, a kind 
of exalted laissez-faire , a command to the deepest unconscious in¬ 
stincts to express themselves. Reason and will, he pointed out, 
are left aside ; you trust to “ an influx ” and the faculties of the 


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mind are “directed to ends they know not of.” Garth Wilkinson, 
it must be clearly understood, although he was a physician, used 
this method for religious and literary and never for scientific or 
medical ends ; but it is easy to see that essentially it is the 
method of psycho-analysis applied to oneself, and it is further 
evidence how much Freud’s method is an artist’s method. 

When we survey the Freudian conception of psycho-analysis, 
it is manifest that the core of it is its doctrine of sex impulse 
as appearing in infancy, passing through various phases and 
processes, mostly involving conflict, and ultimately developing 
—except when by miscarriage it takes on morbid shapes— 
into the loftiest cultural shapes that humanity can create. It 
is not only the core of Freudism, it is also the chief point of 
attack for the opponents of Freud. It must be said that 
Freud has never compromised on the matter, and to-day he 
vigorously reproaches Adler and Jung, once his chief lieutenants, 
for seeking to minimise or explain away the sexual core of 
psycho-analysis. It may indeed be said that Freud has even 
gone beyond his own thesis in his emphasis of sex. He is 
quite aware that he uses the term “ sexuality ” in, as he says, 
“ a much wider sense than is usual,” and no one has so well 
shown how different the sexual world of childhood is from that 
of the adult as Freud himself in his study of the sexual theories 
of children ; these theories commonly devised by children to 
explain the mysteries hidden from them are not only different 
from the adult’s facts, they usually leave out entirely all that 
the adult means by sexuality. So that when the ignorant adult 
approaches the sexual feelings of childhood he is apt to make 
the crudest and most lamentable mistakes. Yet Freud himself 
has encouraged this error and exposed his position to quite 
unnecessary attacks by speaking of childish sexual psychology 
in terms of adult physical facts. This is notably the case as 
regards Freud’s introduction of the term “ incest-complex,” and 
by his acceptance as typical in this respect of the altogether adult 
story of CEdipus and Jocasta. Although a very little considera¬ 
tion should have sufficed to show that these adult conceptions 
are on a different plane from the emotions and ideas of children, 
and though Freud had himself shown how totally unlike the 
adult’s are the ideal and undefined sexual visions of the child, 
the leader’s confused mistake has been followed by a sheep-like 
flock of Freudians, who have thereby copiously aided the 


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unnecessary indignation of their opponents. For the truth is 
that, with a different conception of “ infantile sexuality ” on 
each side, the Freudian and the anti-Freudian have each alike 
been fighting, in St. Paul’s words, “ as one that beateth the air.” 

We must at the same time remember that the Freudian 
emphasis on infantile sexuality, however careful and guarded 
the terminology adopted, would still have shocked and repelled 
the average conventional man and woman. In the matter of 
sex we are all a little mediaeval. Hunger and Love, said 
Schiller, are the two great pillars which support the world. It 
shocks us not at all when the importance of the pillar of Hunger 
is emphasised, and even exaggerated, as it may be by the 
political economist. But it is another matter when we find the 
pillar of Love emphasised and even exaggerated. It is only 
the child of genius, trained to deal with facts and to follow 
Nature wheresoever she seems to lead, who is innocent of this 
prejudice and bewildered by the outcries he unwittingly evokes. 
A distinguished thinker, James Hinton, who, like Freud, began 
as a physician and gradually extended his speculations over the 
central facts of life, was such a child of genius worshipping 
and following Nature. “How utterly,” he wrote, “ all feeling 
of impurity, or reasons for special feeling at all, is gone from the 
sexual passion in my mind! It stands before me absolutely as 
the taking of food. I cannot even recall why the feelings of 
special impurity cling about it. It has taken its place in my 
mind absolutely afresh, and as one with all that is most simple 
and natural and pure and good.” ( 2 ) It was in this spirit that 
Freud formulated his theory of “ Libido,” with its infantile 
manifestations and marvellous transformations, serenely pursuing 
his way, while the conventional world was shocked, and even his 
own chief supporters often fell away, Adler depriving “ Libido” 
of its love constituent, and Jung even transforming it into a 
vague metaphysical abstraction. 

There is, however, no need to fall back on this, the funda¬ 
mental justification or condemnation—as we choose to see it— 
of genius. We may preserve our usual wordly attitude and yet 
be able to discern that, when the misapprehension arising from 
bad terminology and extreme statement are put aside, the 
essentials of the Freudian vision of life may still be found 
acceptable. We have refused to face thern, but we have 
obscurely recognised them, and they have even been plainly 


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expressed, especially by poets and novelists. Let us take as 
an example one of the insights of Freud which has most 
aroused antagonism : the emotional relationship between mother 
and son, to which there is a corresponding relationship between 
father and daughter. This is notably a case in which feelings 
which are entirely plain to see have yet not been seen merely 
because people were unwilling to see them. Mothers had been 
suckling their children for untold millions of years before, a 
century ago, Cabanis pointed out the nature of the delicious 
pleasure often—or, it is probable, normally—experienced in 
suckling, and it is not surprising that another century should 
have elapsed before Freud pointed out that this pleasure is 
mutual, although in the infant it can only be termed “ sexual ” 
if we are careful to understand that sexual pleasure at this 
early period is an altogether different thing from what it 
becomes later. It normally remains a different thing even for 
a considerable period, and towards the mother it is permanently 
a different thing, for the son always feels as a child to his 
mother, yet on this basis, which we may regard as physically 
non-sexual and emotionally sexual, the relations of mother and 
son may be, Freud would be inclined to say quite normally* 
comparable to that of lovers. Let us turn to a novel, called 
Comnte tout le Monde , written a few years ago, by Madame 
Lucie Delarue-Mardrus, one of the' best women novelists of 
France to-day. As the title indicates, it is a commonplace 
story, the ordinary story of an ordinary middle-class girl, wife* 
and mother, who experiences the ordinary joys of life and the 
ordinary deceptions. Yet the story is told with such art and 
such insight that, commonplace as it is, and even because it is 
commonplace, we are made to feel that it is a completely 
veracious record. Isabelle, the young Norman lady, who is 
the heroine, has two sons, and the elder, Leon, adores her ; his 
earliest childish letters to her express this adoration : when he 
goes to school at the age of seven he kisses the little cakes his 
mother brings him because they have been in her hands. But 
in a few years’ time he becomes self-conscious and conceals his 
feelings ; he loves to be in his mother’s presence, but he is shy, 
reserved, and awkward, and is apt to get on his mother’s nerves, 
all the more so, as she, on her part, adores her younger son, 
through private emotional associations preferring him to the 
elder boy, who, in secret, writes verses, and addresses a poem to 


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Joan of Arc, whom he sees in vision “beautiful as my mother.” 
While still a school-boy he dies, and only then it is that his 
mother realises the adoration expended upon her, and, too late, 
passionately responds to it. We may, again, turn to a recent 
English writer, “ Anna Wickham,” a mother of sons, who 
writes verse of a notably powerful, sincere, and poignant order. 
In a volume of hers we find the lines : 

“ My little son is my fond lover. 

Sometimes I think that I’ll be scarcely human 
If I can brook his chosen woman ! ” ( 3 ) 

These emotions are experiencd, they are even expressed 
(perhaps especially by women, as the sex of the writers I have 
quoted indicates), but we have put them aside, have carefully 
avoided considering their significance, at the most have ex¬ 
plained them, or ridiculed them, away. So that when at last 
the child of genius appears upon the scene, and sees, and 
realises what he sees, and proclaims it aloud—as the child in 
the fairy tale cried out: “ The Emperor has no clothes on ! ”— 
the world is shocked, though it has only been told what in 
reality it already knew. 

We must not, however, conclude that Freud has herein 
performed an altogether unnecessary task. True, the “incest- 
complex” is a terminological absurdity, since the sexual 
theories of childhood are absolutely unlike those of the adult, 
and the adult’s attitude has no more meaning for the child 
than, it would usually seem, the child’s attitude has for the 
adult. Yet the sexual emotions remain on the psychic side 
the same, however unlike the ideas and the objects aimed at. 
Freud, with his artist’s instincts, sensitive to Nature—for both 
the artist and the scientist are explorers and revealers of 
Nature—has not only been more acutely aware of the 
existence of these .infantile emotions than any before him, but 
he has more accurately investigated them, and he has, more¬ 
over, devised or created a dynamic mechanism into which they 
beautifully fit, to emerge at last, by a process of sublimation, 
in the highest manifestations of the human spirit. 

The domain in which Freud works is largely that which he 
terms the “ unconscious,” the mighty treasure house in which all 
the apparently forgotten experiences of our lives are stored. It 
is a mysterious and gloomy region, admirably adapted for the 


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operation of Freud’s artistic genius. But we may do well to 
remember that it is a vast region and contains many things. 
With his complete sincerity, simplicity, and natural gift of 
divination, Freud has been happily inspired, into whatever 
excesses of exaggeration we may believe he has sometimes 
fallen. But less finely gifted men may not fare so well in the 
Unconscious. They must select among the facts they find, 
and in their selection ordinary psycho-analysts who have not 
the sensitive flair of genius to guide them will be guided by 
the rigid and systematic theory which has them in its clutches. 
This has been pointed out by Poul Bjerre, of Stockholm, not 
an opponent of psycho-analysis, but himself a distinguished 
psycho-analyst, writing in Freud’s own organ. ( 4 ) He is 
especially referring to those who expect to find the “ incest- 
complex ” everywhere, and who accordingly find it. “ Life 
cannot be pressed into a single theory,” he adds, “ however 
impressed it may be by the highest genius, and however com¬ 
prehensive.” If these wise words linger in our minds we shall 
view Freud and his opponents alike with toleration and often 
with sympathy. 

It is not possible here to discuss those notable psycho-analysts 
who were once Freud’s chief disciples and coadjutors and are 
now his rivals or opponents. It is the less necessary since, if 
we are mainly looking at psycho-analysis from the angle of sex, 
it cannot be said that they have added much to what Freud 
has brought forward, though they may sometimes have taken 
much away. They have all done good work. Prof. Bleuler 
was a distinguished psychiatrist before he joined Freud, of 
admirable solidity, judgment, and insight. Stekel is a capable, 
energetic, and industrious worker. C. G. Jung, belonging to 
Zurich, where the first large movement of Freudian appreciation 
began, was an early adherent. He not only devised the asso¬ 
ciative method of exploring concealed psychic states, but 
introduced the term “ complex,” a much used, and, as Freud 
thinks, much-abused if not unnecessary term, though, it must 
be added, Freud employs it himself. Of late years Jung has 
written copiously, and especially a very lengthy essay on the 
“Transformation and Symbols of Libido.” In this luxuriant 
jungle of philosophy and philology Jung wanders with random 
and untrained steps, throwing out brilliant suggestions here and 
there, hazarding the declaration that “ the soul is all Libido,’ 


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and that “ sexuality itself is only a symbol,” conveying the 
general impression of a strayed metaphysician vainly seeking 
for the Absolute. He remains a psycho-analyst, but from 
Freud, who has never fallen into such extravagances, he has 
wandered far. Freud himself, in a contribution to the history 
of the psycho-analytic movement, written with all his transparent 
sincerity and instinctive charm, sums up an account of his former 
disciple’s relation to the movement by saying that Jung has 
furnished the psycho-analytic instrument with a new handle 
and then proceeded to put in a new blade. Alfred Adler is 
entitled to more respectful consideration, and herein I am also 
expressing Freud’s opinion. There is nothing of Jung’s obscurity 
and confusion ; indeed Adler may be said to err in the opposite 
direction by becoming too precise, narrow, and coherent. His 
chief conception is that of the “ impulse of aggression ” and the 
“ masculine protest,” on which he places extreme emphasis. 
This is the impulse by which we seek to fortify our weakest 
side, even that based on bodily defect, so that it developes into 
the dominant aspect of our character. We may often see this 
illustrated by those undeveloped persons who by dint of physical 
culture ultimately come to regard themselves, and, indeed, may 
actually become, superior to the average in physical development 
This conception has proved fruitful, and Adler has succeeded in 
forming a school of co-workers. All these investigators are not 
to be despised. But Freud remains the man who first devised 
the instrument of psycho-analysis as it is now known, and who 
revealed the world in which it operates. 

It must not therewith be concluded that any of the con¬ 
ceptions Freud has so artfully woven will of necessity endure 
permanently. He changes them so often himself that it would 
be foolish to suppose that his successors will not continue the 
same process. In this respect we may compare him with 
Lombroso, another Jew of genius, who also began as a psycho¬ 
pathologist and also gradually extended his conceptions over a 
wide sphere of abnormal and normal life. His theories have 
been proved to be often defective, even his facts will not always 
bear examination ; he himself admitted that of the structure he 
had raised perhaps not one stone would remain upon another. 
Yet he enlarged the human horizon, he discovered new fields 
for fruitful research and new methods for investigating them. 
That was something bigger than either a sound theory or a 


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has to admit that a disproportionately large part of the work 
has consisted in a covering up of our ignorance by means of a 
number of hybrid names based on hypothesis and not on facts. 

It is only necessary to mention a few of the terms that are 
in vogue to-day, which have even got a sort of hall-mark—and 
discuss their value—to see what a number of unnecessary, 
undesirable, and confusing terms we have in this chapter of 
psycho-neurology. Pointing at a few of these terms, one hopes 
also to start a process of “ weeding ” that will rid the present 
atrocious nomenclature of aphasia and allied conditions of all 
unnecessary and confusing terms which now take the place of 
clear clinical terms and descriptions, and make us take things 
for granted which are not proved. 

Although one is firmly convinced that there is a very close 
connection between anatomical and physiological facts, and 
although one already possesses some quite valuable and definite 
knowledge in this respect, it has to be admitted that the rela¬ 
tion between the psychomotor and psychosensory functions 
and their anatomical substrata is yet far from completely 
explored, and, therefore, it cannot be emphasised strongly 
enough that a nomenclature that mixes anatomy and physiology, 
and anticipates knowledge that we have not yet gained, cannot 
be anything but a cause of confusion and a bar against further 
progress of clinical as well as anatomical research on these 
subjects. From this point of view, such terms as “ cortical 
subcortical, and transcortical aphasia ” ought to be completely 
condemned. There can be no doubt that there are consider¬ 
able individual variations in the relation between the different 
“ speech centres ” both in structural and educational respect (*), 
and it is an open question whether these individual differences 
are not the chief determining factors in the making up of 
different variations of the chief forms of aphasia. This 
again, shows how undesirable are these hybrid anatomo- 
physiological terms. 

“ Internal speech ” is another term that has caused much 
confusion. In his introduction to Hughlings Jackson’s writings, 
on aphasia, Head writes : “ One of the greatest obstacles to- 
mutual understanding amongst students of speech has been 
the diverse use of the expression ‘ internal speech ’; ‘ internal 
speech,’ ‘ langage interieur,’ and ‘ innere sprache ’ have not even 
been used consistently in any one language.” One searches irt 


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vain to find what advantage the invention of the term “ internal 
speech ” has for the investigation and understanding of aphasia. 
Personally, one would not hesitate in saying that it is less than 
nothing—a negative value. What clinical evidence have we of the 
hopothetic “ internal speech ? ” Hughlings Jackson believed that 
writing was the key to the understanding of the “ internal 
speech ” ; that may be, but there is no proof of it, and there is 
no proof of the existence even of a process that could be called 
“ internal speech,” which seems to be an unnecessary, and, 
therefore, undesirable synonym for “ thinking.” 

Amnesic aphasia is another term that cannot be defined 
sharply, and it is therefore unnecessary and confusing. Memory 
is a secondary quality of any one nervous function (probably 
based on biochemic processes that are common not only to all 
nerve-cells but probably to all protoplasm). One can remember 
(and consequently also forget) a motor function as well as a 
sensory. One can with equal right call every kind of aphasia 
(motor or sensory) amnesic. The conclusion is that the term 
is superfluous and confusing and should be discarded. 

It seems on the whole highly necessary for the further advance 
of clinical research on these important and complicated subjects 
that a thorough revision of our nomenclature should take place, 
and that clinical terms based on purely clinical facts should be 
standardised, and established, to the exclusion of terms that are 
unnecessary and confusing. 

In the following scheme one has tried to outline a standard 
method for clinical examination of psychomotor and psycho- 
sensory functions and on the base of this one has tried to establish 
a set of purely clinical terms. 

Anyone who has worked for any length of time^on the 
subject of psychomotor and psychosensory disturbances will 
have been struck by the fact that everyone of our clinical tests 
is really a double test consisting of two different components : 

(1) The perception of the sensory stimulus—a psychosensory 
reaction and 

( 2 ) The motor response—a psychomotor reaction. 

When, e.g, one asks a patient of ordinary intelligence how 
old he is and one does not receive an answer, then the reason 
for this may be either that the man does not understand or 
that he cannot speak. Which is the real reason can only be 
determined by other tests. When again one asks a patient to 
lxiii. 37 


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lift up his left arm and he fails to do so, the reason may either 
be that he does not understand or that he is unable to perform 
the movement. 

In other words, the cause of the defect may be either on the 
side of the motor or on the side of the sensory functions involved. 

' When we, to recapitulate, consider the tests that we employ 
for psychomotor and psychosensory disturbances, we find that 
they are all in this way double tests in so far as they comprise a 
sensory and a motor reaction. 

It is, in other words, only through the psychomotor reactions 
that we gain information about the psychosensory processes, and 
the psychosensory functions are, on the other hand, involved in 
all our tests for the psychomotor functions as necessary for the 
transmission of the test stimulus. 

Thus all our tests comprise one psychosensory and one 
psychomotor reaction, and it is only by a combination of tests 
that we can localise the defect to a distinct function ( J ). 

Eg. a man is asked how old he is—no response ; he is asked 
to lift his left arm up—no response ; he is asked to write his 
address—no response. Now one writes to him asking him to 
to say his name—correct response; to lift his left arm— 
correct response; to write his address—correct response. 

From this we are entitled to draw the conclusion that his' 
auditory perception of spoken language is deficient and that this 
is to blame for the lack of response in the three first tests. 

It is now easy to see how one can evolve a complete system 
of tests, and how an absolutely logical and definite nomenclature 
can be established on the basis of this system of investigation. 

It is well to enumerate first the different psychosensory 
and psychomotor functions we are interested in clinically, and, 
for the sake of an easy survey, they are here tabulated : 

Psychosensory functions and their corresponding disturbances : 

1. Auditory perception — disturbance = total auditory 

agnosia. 

(a) Of words ; disturbance = sensory aphasia. 

(£) Of inarticulate sounds ; disturbance = partial 
auditory agnosia. 

2. Visual perception —disturbance = total visual agnosia. 

( a ) Of words ; disturbance = alexia. 

(i b ) Of drawings ; disturbance = (“ asymbolia ”). 

( c ) Of objects ; disturbance = partial visual agnosia. 


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3. Tactile perception ; disturbance = astereognosis, 

4. Olfactory perception. 

5. Gustatory perception. 

The last two are of comparatively little importance in the 
ordinary clincal examination of psychosensory functions, as the 
psychic functions connected with these sensory functions are 
very scanty compared with I, 2, and 3. 

Psychomotor functions. —There are only three ways in which 
man can give expression to his thoughts : 

I. By means of spoken language ; disturbance = motor 
aphasia. 

II. By means of written language; disturbance = agraphia. 

III. By means of mimicry, demonstration, and actions ; 
disturbance = apraxia. 

Consequently, the psychomotor reaction by which the patient 
responds to our different tests can only take one of three 
forms : 

I. Spoken response ; 

II. Written response ; 

III. Practical response (in the shape of actions, demon¬ 
strations and mimicry). 

In order to have a complete system of examination for all 
these functions we have to couple each psychosensory reaction 
with each of the psychomotor reactions. Simple as this may 
appear at first sight, it will be found that the whole system, in 
order to be complete, will comprise a very large number of 
different tests—so many tests, in fact, that one cannot expect 
the whole “ system ” to be employed as a routine examination 
in every neurological case. But when dealing with a case of 
psychosensory or pyschomotor disturbance with a view to 
research, nothing short of the whole complete system of 
different tests is, in the author’s opinion, satisfactory. 

The order and sequence of the different tests can, of course, 
be varied from case to case, and so can the actual carrying .out 
of the individual tests. The main thing is that the whole 
system of tests has been gone through in its completeness. 
To facilitate the orientation of the different combinations of 
psychosensory and psychomotor functions, the following diagram 
may be found useful. 

In order not to make this diagram too complicated the 
olfactory and gustatory forms of perception are left out. 


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560 PSYCHO-SENSORY AND MOTOR DISTURBANCES, [Oct, 

Perhaps it is as well to point out that the diagram is 
not meant in any way to have any anatomical significance. 
Nothing has barred the progress of the research in aphasia 
more than the unwarranted confusion of functions with anato¬ 
mical centres. In all probability, centres proper—in the same 
sense as the centres for different simple movements in the 
motor area—do not exist for these complicated psychosensory 
and psychomotor functions, whose paths necessarily must 
extend over the various parts of the brain. 

As regards the practical carrying out of this system of 
tests, one finds it, of course, advisable to alter the order of the 
tests to suit the different cases. The author has found it 


PSTCHOdaNSOttY FUNCTIONS • 


Psycho motor Functions « 


1 1 . 



practical in most cases to proceed in the following order 
First (I), are all the different tests carried out in which the 
patient responds with spoken language; then (II), those tests 
to which he responds in written language ; and then (III), those 
where his response takes the form of actions, mimicry, or 
demonstrations—“ practical ” response. 

I- Pexception as evidenced by spoken response : 

I. Auditory perception — 

(a) Of words : How old are you ? 

What is your name ? 

What way did you come here ? etc., 
etc. 

(b) Of inarticulate sounds : The patient is asked to 
shut his eyes and tell what he hears : 

Rattling of keys. 

Whistling. 


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* 917 -] 


BY G. H. MONRAD-KROHN, M.D. 561 

Imitation of various animals (dog, 
cat, etc.). 

The patient may also here be asked 
if he can recognise a melody played 

T .. , . on the piano, etc. 

2 . Visual perception — r - 

(a) Of words: (Of course one must make sure 

that the patient has learnt to read)— 

Various questions are put to him in writing: 

“ When were you bom ? ” etc. 

He is let relate, in his own words, the contents 
of some printed matter that has been given him, 

(b) Of pictures : He is shown different pictures, and 

asked to explain them. 

One can also draw a simple sketch for him, 
and note in what stage of the unfinished sketch 
the patient can “ diagnose ” it. 

(c) Of objects : He is shown different objects (pencil, 

cigar, book, etc.), and asked to name them. 

3. Tactile perception : 

The patient is told to shut his eyes, and to name 
objects placed in either of his hands (eg.,coin, pencil, 
key—not keys that rattle, auditory perception). 

4. Olfactory perception : 

To name smells applied to his nostrils. (Compare the 
ordinary neurological test of the first cranial nerve). 

5. Gustatory perception : 

To name tastes of substances applied to his tongue. 
(Compare the ordinary neurological test for taste). 

II. Perception as evidenced by written response. —Here the 
patient is asked to answer in writing to the same or similar 
questions as under I. 

III. Perception as evidenced by ‘ practical ’ response ( actions, 
demonstrations , and mimicry'). 

I. A uditory perception : 

“ Lift your left hand up.” 

“ Button your coat.” Actions of gradu- 

“Take the pencil and draw ated complication 
a house.” f —with object 

“ Beckon to a person ; show and without 
how you would use a key.” object. 

“ Look angry ” (mimicry). 



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5 62 PSYCHO-SENSORY AND MOTOR DISTURBANCES, [Oct. 

2. Visual perception : 

“ Do what I write to you ”—similar to I. 

3. Tactile and visual perception : 

“ How do you use this ? ”—a key, a brush, a 
tape-measure, etc. Strike a match, etc. 

In addition to this system one lets the patient 
Repeat words) Automatic actions without 
Copy writing 1 any psychic content. 
Transcribe printed matter into 
handwritten language 
Read aloud 
Write to dictation 

That in every case the spontaneous language is to be closely 
observed need not be mentioned. It seems also superfluous to 
dwell on the difference between intellectual and emotional 
language (more or less highly associated speech) which is so 
important in regard to spontaneous language, and which has 
been so masterly treated by Hughlings Jackson. 

That in educated persons, who speak several languages, the 
examination should be carried out in two or three languages is 
obvious from a research point of view. 

On account of the variability of so many aphasic patients 
to tests (as already pointed out by Huglings Jackson) one ought 
to examine every patient repeatedly. 

The above system of tests represents nothing radically new, 
and is but an attempt to comprise all these related tests for 
psychomotor and psychosensory disturbances in one logical 
system which allows one to get a complete picture of each case. 

Only when our clinical examination becomes as exact in its 
definition as the anatomical can we hope that a closer co¬ 
operation between the two will lead us to further advance in 
respect of cerebral localisation of these complicated functions. 

By this minute examination one will also in many cases 
obtain a basis from which therapeutic attempts at re-education 
can be made. In this respect it is our object, helped by the 
still intact connections between psychosensory and psychomotor 
functions,to establish anew communication past the disconnection 
discovered—aided in this respect also by our knowledge of the 
natural evolution of language. 

As regards the practical examination and the distinction 
between the different forms of psychomotor and psychosensory 


Semi¬ 

automatic 

actions. 



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563 


disturbances it has to be admitted that the different psychomotor 
and psychosensory functions are interdependent. As on a lower 
level the control of the sensory function is necessary for the 
perfect execution of motor functions, so are psychosensory 
functions necessary for the perfect execution of the psychomotor 
functions. When the deep sensation becomes deficient in tabes 
the affected limbs become ataxic. In the same way, sensory 
aphasia leads to disturbances of speech, paraphasia—the control 
is lacking. 

It has further to be borne in mind that motor aphasia 
is frequently combined with agraphia or apraxia or both. 
(Hughlings Jackson first pointed to the fact that aphasic 
patients often are unable to protrude their tongue when asked 
to do so although they immediately afterwards may be seen to 
lick their lips spontaneously.) 

In fact, cases where a combination of psychomotor and 
psychosensory disturbances co-exist are on careful examination 
found to be more frequent than pure cases of only one psycho¬ 
motor or psychosensory disturbance. On the other hand one 
finds cases where only the co?mection between a psychosensory 
and a psychomotor function is broken. 

In labelling the different cases for purposes of research (and 
also for purposes of treatment by means of re-educatiori) it is 
therefore highly desirable to indicate the “ connections ” inter¬ 
rupted, and in this respect one would propose a nomenclature 
based entirely on our clinical examination, as described above. 

The proposed terms are best understood when represented 
in an analogous diagram to the one referred to in the description 
of the whole system of examination, and it is to be hoped that 
this second diagram will therefore need no explanation. 

In this diagram, d. stands for disconnection when the 
test gives no response; for disturbance when it gives a faulty 
response. 

The above nomenclature may at first sight appear very com¬ 
plicated but one will soon find that it is really not so. It has the 
advantage of expressing exactly what the clinical examination 
has given in terms that are purely clinical— eg., case of sensory 
aphasia with phaso-phasic, phaso-graphic, and phaso-practic 
disconnection and slight lexo-phasic and stereo-phasic dis¬ 
turbance gives at once a complete picture of the clinical aspect 
of the case. In this case the patient gives no spoken response 


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564 PSYCHO-SENSORY AND MOTOR DISTURBANCES. [Oct, 

to perception of spoken language, no written response to per¬ 
ception of spoken language, and no practical response to 
perception of spoken language, whilst his spoken response 
to perception of written language and his spoken response 
to stereognostic perception are faulty. 

The connections not mentioned as disconnected or disturbed 
are taken to be found in good working order. 

A case where there is phaso-phasic, audito-phasic, lexo-phasic, 


Phtchocimobt 4 IH O H OK8 Pstchoboto* ArrwcTKjHm: 



visuo-phasic and stereo-phasic disconnection is, of course, one of 
complete motor aphasia , and it will readily be admitted that 
for such a case this shorter and already well-known name is to 
be preferred, but there are—as already pointecj out—many 
cases that cannot simply be labelled motor aphasia , apraxia , 
alexia , etc., and in these numerous cases the above nomenclature 
is intended to help to a more accurate classification. And for 
the sake of giving any localising value to the anatomical finding 
post mortem a minute clinical examination intra vitam and an 
equally minute record of the examination in standardised terms 
is obviously all important. 

The number of cases of different psychomotor and psycho- 


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A THEORY OF CONDUCT. 


565 


sensory disturbances that any one observer is fated to see and 
study is often not very great—and just for this reason it is all 
the more important that one recognised standard method of 
examining and one recognised standard nomenclature should 
enable the different investigators to compare their cases without 
•confusion. 

This is a condition, sine quA non , for an organised co-operation 
in the further research of psychomotor and psychosensory 
functions, their disturbances and their anatomical localisation. 

What is needed is :— 

Clinical standards in form of 

(1) A standard examination (which will not exclude 

original additions in the examination of individual 
cases), and, based upon this standard examination, 

(2) Standardised clinical terms. —This entails athorough 

reformation of our present nomenclature. 

One has in the above scheme tried to outline a standard for 
the clinical examination and, based upon this, a purely clinical 
nomenclature. It goes without saying that perhaps many will 
find that the above is not the happiest form for either, and 
perhaps others might do it better. 

The author’s chief point has been to raise the questions 
mentioned above. If they are taken up by others and brought 
to a more satisfactory conclusion, the author will still feel that 
he has achieved his object. 

(') Cf. Brain, parts 1 and 2, vol. xxxviii, July, 1915.—( 2 ) Cf. Grassel’s term 
temperament polygonal.”— (*) N.B. No anatomical localisation is meant here. 


A Theory of Conduct. By Alan McDougall, Director of 
The David Lewis Epileptic Colony. 

In the beginning every creature was a patriarch : it was, 
philosophically, not only its individual self, but also all its 
potential progeny. Such a creature’s whole conduct was 
•directed towards the one goal of eternal life on earth. It so 
■happened that in very many cases the creature’s best chance of 
success involved association with other creatures of its kind, or 
«ven of other kinds. From this arose the complication of the 
acquirement of tribal instincts. Tribal instincts were acquired 
■only for patriarchal purposes, though in very many cases they 


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A THEORY OF CONDUCT, 


[Oct., 

proved to be the immediate cause of the creature’s death. A 
further complication arose when certain of the creatures ac¬ 
quired intellect and took to thinking. Philosophically, a living 
thing exists only that it may produce a generation capable of 
producing yet another generation. A generation is important 
only as the cause of its next generation. Intellect often gave 
the creature an immediate advantage over rivals, but it glorified 
the individual self at the expense of the patriarchal self. This 
is recognised in the third chapter of Genesis, where intellect is 
called the serpent, and thinking is called (in Chapter II) the 
tree of the knowledge of good and evil. The statement that 
“ in the day that thou eatest thereof, thou shalt surely die ” 
declares that the race is kept going only by those who do not 
understand how to limit their families. 

The explanation of conduct is made more difficult by the 
fact that it is, in the human race, only during adult life that 
patriarchal appetites are vigorous. During infancy and senility 
the patriarch is feeble, the individual rules. A further difficulty 
is that a normal appetite may be replaced temporarily or 
permanently by an exaggeration or a diminution or an absence 
or a perversion of itself, or by a substitute-appetite. 

Nevertheless, in spite of all the complications that obscure 
the field of vision, it can be seen that conduct is the consequence 
of appetites evolved to procure the creature immortality on 
earth through progeny. Throughout manhood the normal man 
may be regarded as two-fold : he is an individual and he is a 
patriarch. The individual concerns himself only with his own 
personal welfare. The patriarch concerns himself with what 
may happen on earth after the individual with whom he is 
associated dies. The interests of the patriarch and those of 
the individual are often opposite. The creature has often the 
discomfort of being the field of battle between the two interests. 
Normally, that peace which the world cannot give comes only 
with the triumph of the patriarch over the individual. It is not 
everybody who is normal. 

Zeal for the discovery of the abnormal must not outrun dis¬ 
cretion. The substitute-appetite is not necessarily abnormal, 
more often perhaps it acts as a safety valve. Take, say, the 
very young man’s appetite for fame. He has individual 
ambition, he is resolved to make an eternal name for himself. 
A while later he is found to be talking no longer about fame 


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BY ALAN MCDOUGALL. ' 


567 


but about a girl. He may declare the great things his son is 
going to do ; but it is patent that he has lost his earlier intention 
of doing big things himself. The explanation is that the 
appetite for fame (immortality on earth through name) was a 
substitute-appetite ; a ursurper that ruled while the true appetite, 
the appetite to be immortal on earth through progeny, lay 
sleeping. If the environment of the creature is such that the 
true appetite, if it awoke, could not be satisfied, the substitute- 
appetite may persist throughout life without being evidence of 
disease. 

Infancy and old age are much simpler studies than the 
period of adult life. In them the individual rules : the patri¬ 
arch is more or less dormant, or even dead. The Rubayat of 
Omar Khayyam and the Book of Ecclesiastes were both of 
them written by men who, through senile decay, had ceased to 
have patriarchal instincts, and had come to view the order of 
things from the standpoint of the individual. In normal child¬ 
hood the patriarch is not non-existent: but he is the weaker 
partner. The study of senile conduct is complicated by the 
persistence of habit into old age. An old man planted apple 
trees. Was he still patriarchal ? Or did he simply think it a 
pleasing way of occupying his time ? Or had his next 
generation warned him that if he didn’t show himself to be 
worth his keep he’d find himself in the workhouse?. There are 
many other possibilities, any of which may be the whole or 
the partial explanation in a particular case. The fact remains 
that normal infancy and normal senility resemble each other 
and differ from normal manhood by being more under individual 
than patriarchal rule. 

There exists a very interesting set of abnormal people. In 
them throughout infancy, throughout manhood, throughout 
senility, the individual predominates : the patriarch is feeble or 
non-existent. Philosophically, the condition seems to be one 
not of arrested development, but of premature senility. They 
are a peculiar but a numerous people ; they are to be seen 
every day everywhere. Some of them fill high places ; of 
others the lot is humble. Some go to the top of their spheres ; 
others go to jail. Some of them are hailed as great thinkers, 
and are recommended to their more normal and healthier neigh¬ 
bours as guides, philosophers, and friends. 

This theory of conduct is as old as literature. Though 


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568 CLINICAL NOTES AND CASES. [Oct., 

probably not put by them into words, it was taken for granted 
by the authors of the Book of Genesis and by the folks whom 
they made immortal on earth through literature. In the days 
when Jacob said “ I being few,” the unphilosophical separation 
of a man from his progeny had not been made, and God, who 
punished only unto the third and fourth generation and yet 
showed mercy to the creature in thousands, needed no apology 
by doctors of divihity. He was easily understanded of the 
people. 


Clinical Notes and Cases. 


Insanity from the Patient's Point of View. 

After an interval of nearly six years from my recovery, I am describing 
from the patient’s point of view an attack of confusional or stuporose 
insanity which lasted for five months. No notes have previously been 
made of my recollections, but as the period of my lapse from sanity 
stands out in my memory like a well-remembered dream, little difficulty 
is experienced in recalling my ideas and feelings at the time. A selection 
from these is made and they are joined together to form a consecutive 
history, which, indeed, the whole experience seemed as I lived it. 
Unlike a dream, the sense of time and its passage was present. My 
delusions also, were distortions of things presenting themselves to my 
senses and not solely a tangle of ideas subjectively produced, as dreams 
for the most part seem to be. 

At the time of the commencement of the mental illness I was in one 
of our tropical dependencies, where I had been a medical officer for 
over six years. I was in camp with a number of other officials who were 
engaged in administering the affairs of some uncivilised tribes dwelling 
in a mountainous part of the dependency. I appear to have been 
somewhat violent at the onset, and was secured and sent to a European 
station some days’ march away, and then on by train to a sanatorium 
in the hills. After a stay here, where I seem to remember a sort of 
struggle for my sanity and a consciousness that it was disturbed, I was 
removed to an asylum, at a coast town about twelve hours away by rail. 
I was first placed in a room in one part of the institution, and later 
removed to another with a verandah opening on to the garden. 

It is not intended here to account for the cause of my insanity, but 
rather to describe from the point of view of an insane person his outlook 
and notions as to what was happening. I have waited so long before com¬ 
mitting the recollections to writing because they were, naturally, somewhat 
humiliating and painful. The illness has, however, now receded so far 
that it can be calmly considered, especially as the interval has been free 
from relapse, and I have successfully resumed the practice of my pro¬ 
fession. For convenience of narration the recollections that follow are 


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given in the third person, and comments given in the first person within 
brackets. 

At the time when A— first realises that he began to distort the happen¬ 
ings around him, he remembers beginning to distrust the two principal 
officials of those who were encamped with him. One of them he 
imagined to be a Jesuit in disguise, the other a magician. He thought 
they were concocting devilish plots against him, and committed an 
assault upon one of them. He was also under the impression that the 
surrounding native tribes were about to attack the encampment. A— 
therefore loaded his revolver and kept awake for several nights so as to 
be.prepared against attacks. [I think that the assault took place and 
that the revolver was so prepared, also that the insomnia was real, but 
whether the tribes had actually been menacing the camp or not I cannot 
be certain.] A— then remembers a confused journey from the camp 
to the European station, the journey being crowded with manifestations 
of black magic, wrought by his two enemies, the Jesuit and the magician. 
After reaching the station, which A- 1 - recognised, the principal incident 
he remembers was that of walking down a road between two persons 
who each held an arm on either side. A former acquaintance of his 
passed on a bicycle, and A— recollects having rushed up and kicked 
the bicycle, fancying that his conscience required him to do this. 
[Wherein lay the imagined offence of the cyclist I am now not clear.] 
A— next remembers travelling by train to the hill sanatorium with two 
attendants. In the same compartment was a stranger to whom A— 
paid particular attention, thinking him to be another of the officials with 
whom he had lately been in camp. This official he thought also to be 
a Jesuit and to be working against him. Finally, A— walked across 
the compartment and assaulted him. [I fancy this episode was true.] 

A— then arrived at the hospital in the hill station, a place where he 
had previously worked and which he remembered. He also recognised 
the matron, and was at first pleased to see her. The doctor, who was 
a stranger to him, he at first welcomed. He remembers at this stage 
coming to himself'for a short space, and knowing that he was struggling 
against insanity, but found himself compelled to yield to a rush of 
distorted ideas. One of his notions just then was that the hospital was 
full of the insane, whom he had been brought there to treat. 

He also seems to remember being surrounded by a number of persons 
who forcibly fed him with a nasal tube, and being coaxed not to struggle 
by a half-caste nurse. A—, however, stoutly resisted what he imagined 
was a form of torture being inflicted by evil-disposed persons. 

A— apparently began to resent the constant surveillance to which he 
was subjected. He got to dislike the matron, who he thought was 
spiteful, and the doctor he identified with Crippen. [I am told I used 
to address him by this name.] 

In the garden of the hospital there were numerous hollyhocks and 
roses. A— imagined that these blossoms were whispering and beckon¬ 
ing to him, and their agitation by the wind he thought to be their 
endeavour to reach him as he lay in bed. He was at first charmed by 
the fairy-tale world into which he had thus penetrated. He soon 
wearied of it, however, as the flowers could not reach him, and their 
blandishments became monotonous. 


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CLINICAL NOTES AND CASES. 


[Oct, 


A— next imagined himself to be alone in the garden, which had 
become a sort of disc, with a void beyond its edge. He later met 
some of his friends there, but they soon disappeared, and A— began 
to feel lonely. He was under the impression that he had died, and 
that his death had come about by suicide. He seems to have con¬ 
cluded that after death a series of heavens succeeded one another. 
These he figured as a number of discs one above the other, connected 
together by a central stem ; in fact, an arrangement such as the dishes 
seen in certain old flower vases. 

A— began to try and reach the next heaven, whither he thought his 
friends had gone. He could not discover the way to do so except by 
again committing suicide, which might be attained by diving over the 
edge of the disc into the void beyond. Whether he did so or not is not 
clear, but his next recollection is of having succeeded in reaching 
another heaven, where he again met the friends who had preceded him. 
This new abode consisted of a series of dim underground vaults, and 
through these A— wandered disconsolately, seeking a lady with whom 
he had once been in love. He finally came across her, but to his 
disappointment found that she had become black and wore native male 
clothing. Her features also had altered. He was repelled, in spile of 
his feeling that he should remain loyal to her. He began to consult with 
his friends upon some method of escape from their dreary abode. 
During these deliberations, Dr. Crippen appeared on a horse, bearing 
upon the saddle behind him a beautiful girl, with whom he galloped 
away to some place where he could not be followed. He did this a 
number of times, one of his captives being A—’s lady-love, now 
returned to her old self. This excited the intense indignation of A— 
and his friends. 

To reach yet another heaven, A— discovered that he must submit 
himself to a series of tortures at the hands of various vague and wicked 
people. These tortures included the liberation from the skies of heavy 
weights upon his head, and the being tied down upon a table so 
tightly that the circulation was impeded. A number of evil people 
came and went in the execution of these and other tortures. A— 
bore them bravely, and was highly commended for doing so by various 
elderly relatives who seemed to be in the background. When he had 
lain for some time strapped upon the table, a beautiful woman came 
and released him. She appeared to be Eve, and A— consequently 
inferred that he must be Adam. Another supernatural being now 
came on the scene, and intimated to A— that the world had come to 
an end, and that there was a new beginning of things. This grave and 
saintly person proceeded to give A— a choice of how he was to pass 
his existence. A— appears to have chosen a somewhat lascivious 
mode of life, which he a terwards regretted and was ashamed of, for, 
though it was was granted to him, it turned to dust and ashes. 

The next event which emerges was A—’s existence on a wonderful 
vessel, a sort of airship, which lay poised above the world, which had 
come to an end.' On the vessel were a number of celebrated persons, 
with whom A— met in conclave, deciding how to start a new world. 
A— was held in high esteem by these eminent persons, but he seems to 
■have been conscious of being tongue-tied and of little assistance in 


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the discussion. [This sense of mental limitation and of inability to 
carry on a conversation was present continually during my mental 
aberration. It caused me distress, and disinclination for the society of 
my fellows.] 

The next thing remembered was that the huge ship set out for a voyage 
through the universe, travelling over land and sea, as well as under the 
ocean. At first the voyage excited interest, as great tropical forests and 
mountains were skimmed over and various wild animals seen. At one 
point on the journey there was found seated by the road side the lady 
with whom A— had been in love, and whom in a vague way he had 
been searching for in his previous adventures. She was waiting for him 
there, with a crimson cloak around her. The airship stopped, and a 
happy meeting took place. The meeting was too brief, however, for 
A— had to return to the airship, which sped on, leaving the lady by the 
wayside. The airship was on some sort of circular tour, for in due 
course of time it again passed the lady, who was this time multiplied to 
two or more ladies, each exactly alike and clad in crimson cloaks. A— 
again met her (or them) with joy, but this was short-lived, because of 
the interference of a General Officer who appeared on the scene. [A 
military officer had been A—’s rival in real life.] The voyage of the 
strange vessel continued once more, but it came round time and again to 
the place where A—’s lady-love was seated. She increased in numbers, 
each time, until there finally seemed to be waiting for him an endless 
row of ladies in crimson cloaks. This did not appear to A— to be 
humorous but rather the reverse. Another episode A— recollects to 
have occurred during a halt of the vessel. A— with ease and boldness 
dived to the bottom of a deep pond and secured the roots of the lotus 
lily, which had never before been secured by mortal man. These he 
presented to a Jewish girl of very great beauty, but the interview seems 
to have come to an untimely end. 

[The period extending from the time I left the garden, which was 
situated on a disc, up to the point described above, appears to have 
been that spent on the railway journey from the Sanatorium in the hills 
to the Asylum in the coast town, a journey of eighteen hours. My idea 
of being tied down to a table may have had a basis of truth, as it is 
likely that I was unmanageable and required to be fettered. The notion 
of being tortured by having weights dropped on to my head possibly 
arose from the bumps of the train in passing over points, though my 
untrained attendants may have administered me some cuffs. The airship 
would be the train, and the occurrences on the journey the distortions 
of what was seen from the windows. What is described below took 
place at the coast town asylum.] 

A— next found himself in an underground cellar, where he was in 
bed, with a series of military warders looking after him. He was de¬ 
tained there by the power of the “General,” who kept him prisoner. 
Leading into the cellar were two wide dark passages; along these at 
intervals there thundered down towards him express trains, and A— 
was expecting, though with no great concern, to be run over by them. 
Such, however, was A—’s virtue or other power, that the trains invariably 
drew up hissing at the threshold of the cellar. One episode A— 
remembers was throwing his pillow at the lighted lamp and sending it 


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crashing over. [I am not sure whether this is only imaginary or not, and 
why I should have done it. Most occurrences of the kind, which seem 
to have been purely mischievous, were done under the idea that they 
were meritorious. A railway line passed close to the asylum, which 
gave a basis for the delusions about railway engines.] 

Next, A— seems to have been removed to a large room, the walls of 
which appeared to have been covered with trophies. One of his ideas 
here was that the roof threatened to fall in, but A—, by drawing his 
arm across as he lay in bed, and pointing from one corner to another 
diagonally across the roof, was able by his inherent power to keep it tip ; 
constantly the roof threatened to fall in, but as constantly A— was on 
the alert, and by executing this manoeuvre managed to keep it up. Twa 
of the trophies on the walls, one at each end, he thought to be the 
tusks of elephants which had belonged to his grandfather [who had 
been of Jewish nationality and a magnate in India, owning some 
elephants there.] 

These tusks gradually changed into the heads of two old Jewesses. 
One of these became very friendly with A—, and constantly spoke to 
him and gave him advice. By her help he managed to keep the roof 
a fixture, and the danger of its fall became less and less. The other 
old Jewess was an antagonist; she and her party somehow represented 
Cain, while A— seemed to be Abel. 

A— constantly imagined himself to be pre-eminent, and among his 
other gifts felt his capacity for whistling to be distinguished by its 
power and musical quality. He began to hear the far-off whistle 
uttered by some maiden across the world. He whistled in reply, and 
she heard it. He was then thrilled by a love affair conducted by means 
of whistling. Finally, A— and the whistling girl drew together across 
the world and met. But here again intervention came, this time in the 
form of Cain and his old Jewish mother, and this love affair also 
ended abruptly. 

[I was then conducted from the large chamber across a garden to a 
small room on the ground floor with a verandah opening out of it. I 
found myself able to walk over to my new abode. Up to this, I had 
lain in bed, and not been on my legs at all. I had apparently accepted 
this as a matter of course, not finding any necessity to account to 
myself for my lack of activity. Before leaving the large chamber, I 
had come to realise that the “trophies” on the walls were illusions, for 
they were merely the cornice of the ceiling with various stains upon it. 
This small room was the last of my abodes until I regained my 
reason. Though still full of delusions, my mind became more active* 
and I remembered interviewing various old acquaintances who came to 
see me. My delusions gradually tended to concern themselves more 
with what went on around me, and my mind was less occupied with 
figments of the imagination evolved introspectively as I lay stuporose 
upon my bed.] 

One hallucination, and a pleasant one, was that of two rival choirs of 
angels singing divinely in the heavens. One choir was in the Christian 
heaven, and the other in the Aryan one. The two choirs, A— thought* 
sang in rivalry, each trying to allure him and to outdo the other. 

A— was fond of watching the clouds sailing over the sky. To him 


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they represented real forms corresponding to various objects on the 
earth Certain of these he got to know, one especially, which was a 
huge bear He was usually able to distort any clouds he might see 
into the fancied presence there of this animal. 

A— used to see daily various native patients of the institution who 
were employed to work in the garden. Some of these were old and 
withered, and his imagination identified them with the “hooluk” 
monkeys which A— had, when sane, often heard wandering in troops 
through the mountain forests, giving voice together in choruses of loud 
and not unmusical cries. The old natives squatting about in the dust 
he thought were hooluks, and he envied them their freedom and ability 
to spring up into the cool shade and swing themselves away across the 
forest. He envied also their exemption from the necessity of washing 
and personal toilet. [I was periodically lathered and shaved with a 
safety razor by a mixture of persuasion and force. I had also to 
undergo other necessary toilet operations, and felt them a burden. So 
I longed to become a hooluk monkey, as others had apparently grown 
to be in their old age, and to be able to grub about unclothed, untutored, 
and unwashed. Later, however, as I improved, I began to be more 
appreciative of cleanliness and tidiness. I remember that when a 
previous colleague was announced as a visitor, I wished to get dressed 
properly to receive him. I also became more anxious to have baths.] 

To look after him, A— had four European attendants, who were, 
probably, soldiers from a regiment stationed in the same locality; One 
was quite a young fellow, who tried to be kind, but whom A— disliked 
for some reason. The second, was a Cockney, to whom A— had a 
cordial aversion, because the man was of a waggish turn, and had one or 
two nicknames for A— which appeared to him derogatory and indecent. 
They offended his dignity, and he resented the indecency. The third 
was an older man, whom A—got to dislike and be rather afraid of, as he 
was a powerful man, and use to retaliate for occasional assaults by 
hitting back pretty hard. The fourth attendant was one of the few 
people for whom A— seemed to entertain friendly feelings. Both the 
last-mentioned attendants A— imagined to be former friends of his, 
and he was at times somewhat put aback by the change in appearance 
that these friends had undergone, and at their inappropriate remarks 
when he referred to their former experiences together. The Cockney 
attendant, A— challenged to a fight, and they had a few rounds 
together. [When sane, I was by no means pugnacious, not being 
powerful in build nor constitutionally bold. I was surprised to find 
myself become so bold and ready to attack, and to bear deprivation and 
pain. These feelings of boldness and courage afforded me pride and 
pleasure.] 

There were some other European inmates of the institution to be 
seen by day in adjacent verandahs of the building. Where their facial 
appearance at all permitted of it, A— imagined them to be former 
acquaintances of his, or celebrated persons. One he considered was 
Napoleon, another to be Lord Rosebery. There seem to have been 
two or three Napoleons, who appear to have multiplied in the same 
fashion as the lady of the scarlet cloak. A sense of fun, absent up to 
this, seems now to have returned, for A— was tickled by seeing the two 
LXIII. 38 


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Napoleons, exactly alike pacing down the verandah, one closely following 
the other. Other comical incidents, which A— chuckled over, were 
the meetings of Napoleon and Lord Rosebery, who had frequent 
altercations on the subject of Rosebery’s biography, “ Napoleon : The 
Last Phase.” 

The birds that came about the garden seemed to A— to have a sort 
of human personality. He had an idea that each bird had its human 
counterpart or twin, and that certain persons were able to transfer 
themselves to their bird counterparts. The numerous crows that were 
about the place he imagined to be evil and mischievous spirits. One 
of them he identified as an old lady he had known, and was amused 
by her transformation into a mischievous crow, though he had been fond 
of her. 

The groups of native patients who were led about the place seem to 
have puzzled him. On one occasion A— thought that a native who 
passed him whispered, with a meaning look, “I am Napier of Magriala.” 
[This is curious, as this soldier was one of whom I had only the slightest 
knowledge, as one of the heroes of a past generation.] This seemed to 
strengthen the idea that A— was inclined to hold that there was a 
change of colour as well as of body after death. 

On another occasion A— seemed to be reflecting upon his imagined 
ancestors. One of these, a celebrated warrior, suddenly appeared before 
him and shook hands. This red-haired giant seemed to A— to be very 
embarrassed, and to disappear as suddenly as he arrived. [I do not 
think that this incident arose out of any real one, but think that it was 
purely imaginary.] A— often thought he heard the Founder of the 
Christian religion calling from afar with a voice of surpassing power 
and sweetness. 

A— began to weary of his imprisonment in the small room. He at 
times thought himself to be Daniel in the lions’ den, though he did not 
appear to think it necessary to account for the absence of the lions. 
He began to try and puzzle out where he really was, and the reason for 
it. His thoughts began to get more lucid, and he appears to have been 
allowed more freedom in the garden. Suddenly, when walking there, 
the explanation dawned—he had been off his head and was in the 

asylum at R-, a place he had occasionally visited before his insanity. 

After this, his delusions dropped away, and he was shortly after dis¬ 
charged and sent to England. He suffered greatly from depression, 
and was acutely neurasthenic for the next three years, passing through 
a period of great mental distress. This seemed due to the fact that, 
though sane, his full faculties only gradually returned. He was incapable 
■of sustained thought, and had to give up the practice of his profession. 
Memory was very defective, and his natural love for relatives and friends 
seemed to have forsaken him. Life was indeed a burden, but at the 
•end of three years he rapidly mended and got back his interest in life. 
He is now fully recovered, and serving as a regimental M.O. at the 
Front in France. 

My period of insanity may be described as a not unhappy time, 
though there were interludes of weariness and melancholy. Delusions 
of grandeur were constantly present, when I imagined myself as an 
•exceptionally virtuous and gifted man, who was being persecuted for 


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these qualities by my fellow-men. The hostile attitude of my fellows, 
however, caused no fear or unhappiness, as I felt fortitude in opposing 
them and imagined myself as acting a praiseworthy part. I considered 
myself highly attractive to the other sex, and an erotic basis appears to 
have underlain a good many of my imaginings. Hallucinations of 
beautiful music, as detailed above, gave great pleasure. Certain delusions 
about the happenings around me were comical and quaint, and afforded 
interest and amusement. As my delusions dropped away, I lost some 
of them with conscious regret, for they had furnished me with pleasure 
and entertainment, and there seemed to be nothing to take their place. 


A Hypothesis concerning some Manifestations of Insanity. 

It is probable that consideration of the vastly long history of the 
human race and of its evolution from the stage governed chiefly by 
instinct, as one of the lower animals, onwards through the stages of 
primaeval and savage man, to the complex civilisation of later ages, will 
assist in elucidating many of the manifestations of insanity. 

Though man as a reasoning animal is of great antiquity, the anthro¬ 
poid and preceding stages from which he emerged are immensely 
longer. When in insanity the highest mental faculties become confused 
or lost it is not unreasonable to suppose that there is revealed much 
of the mentality of primteval man and the instinctive impulses of the 
lower animals. Just as our bodies are evolved from the lower forms of 
life, and our erect forms and trained members are adaptations of the 
bodies of opr four-footed progenitors, so it cannot but be that our 
minds have a similar derivation from their minds. Our civilised ideas 
are thus the superstructure upon a firm foundation of primaeval 
mentality, which again rests upon the instinct that guides all animal 
life. 

From a purely theoretical standpoint, such a case as one of pro¬ 
gressive dementia might be considered to retrograde gradually through 
the stages of primitive man and of the animal back to a vegetative stage 
with an automatic existence dependent on reflex functions. Too strict a 
comparison of the insanity with savage man is, however, fallacious, as 
savages are not subject to hallucinations. Also, apart from dementia, 
the alteration of the higher mental faculties is a derangement rather 
than a loss, the manifestations of the primitive mind and of the animal 
one in the insane being partially controlled and obscured by the 
available remainder of the civilised faculties. 

In illustration of the opening argument, three prevalent attributes of 
the insane may be considered. These are their superstition and belief 
in magic, their hostility and violence, and their erotic tendencies. 

Magic, or the perverted applications of physical forces, are familiar 
explanations of the insane to account for their own unpleasant sensa 
tions, or for various happenings around them. By the savage, magic 
is called in as an explanation where effect is not preceded by obvious 
cause. By the insane, not even this degree of reasoning is required. 
In my own c ase, magical and supernatural happenings were accepted 
without question to ac< ount for whatever required explanation in my 
surroundings, although, before the insanity, I was the least superstitious 


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576 CLINICAL NOTES AND CASES. [Oct„ 

of men, and, indeed, almost a sceptic as regards religious belief. The 
mind of the child sheds some light upon early mentality, and it is 
notoriously prone to superstitious terrors, and to “ make-believe ” in its 
P la 7- 

The general violence of the insane, and what is part of it, their fear¬ 
lessness, may be considered a manifestation of the more fundamental 
mentality of the animal. The life of the lower animals is one of constant 
physical strife with other species or with their own. They either prey 
upon others or are themselves preyed upon, or, within the same species, 
contend for the possession of food, mates, or resting-places. Thus 
the life of most animals is one of constant watchfulness against attack 
and of escape from sudden danger. Strain of such a nature would be 
unendurable were the nervousness of animals comparable to that of 
men under such trials. It is unlikely, therefore, that the sensation of 
fear or of pain among animals is more than a dull one compared with 
that of man, though they prudently flee at the least suspicion of danger. 
Most animals, though fearful of hereditary enemies, will freely engage 
in a trial of strength with their own kind. 

With these facts in mind, may it not be suggested that the angry 
attitude of so many of the insane is a reversion to the primitive state 
of mind, when a possible antagonist is suspected in all who approach ? 
There is, no doubt, another cause also for the combativeness of the 
insane. Civilised life is largely one of repression. While feelings of 
pleasure and friendship are allowed to have an outlet, those of anger 
and aversion require our constant self-restraint. When the check 
imposed by our reason is loosened, old pent-up animosities find ex¬ 
pression. When an insane person exhibits hostility to any individual 
about him, he has often imagined him to be a former enemy or even a 
friend. In the latter case, old feelings of annoyance, such as may be 
caused even by friends, crushed down at some previous time, arise 
once more to the surface. The kindnesses, on the other hand, done 
by his friend would have found at the time their natural response in 
the expressed gratitude of the recipient. In this way may be explained 
the aversion to relatives with whom an insane person may previously 
have been on good terms. 

By minds in this suspicious and superstitious state, compounded of 
the traits of brute and savage and civilised man, the restraint and 
the personal attentions that are necessary are all misinterpreted and 
objected to. The interference with liberty is resented by all the com¬ 
ponents of the mentality, civilised or other. Forcible feeding is 
looked upon as a personal violence, the act of enemies or demons, 
since its purpose is not understood. Unpleasant medicines are refused, 
just as the feeding of the animals is governed by their palates, the 
human remnant of reason regarding the offer of the unpleasant medi¬ 
cine as an endeavour to administer poison. 

The third common manifestation of insane mentality chosen to 
illustrate the thesis of its recrudescence of primitive mentality is the 
erotic one. This is so important as to have given rise to the theory of 
psycho-analysis, in which the sexual feelings are considered to be the 
basis of the insane state. But, surely, sexuality holds in the minds of 
the insane no more than a position analogous to that held by hostility. 


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The checks which civilisation imposes upon the sexual passions, both 
in their entertainment and indulgence, are strictly comparable to those 
of the angry passions. What was said of the violence of the insane 
person applies largely to his erotic tendencies. With, the civilised 
checks upon sexual thoughts gone, these repressed tendencies become 
manifest. His surroundings are imagined or perverted into being such 
that he may properly indulge these passions, because the people about 
him, perhaps regardless of age or sex, are readily metamorphosed into 
former lovers. 

The lack of a sense of shame and decency is merely the loss of the 
most superficial of civilised feelings, and one that is largely a matter of 
convention among the different races of mankind. 

The vague but ready acceptance of magic by the insane, dealt with 
on a previous page, is associated with a looseness in the recognition of 
the identity of form. Exactness of likeness is not required for accept¬ 
ing any stranger as an old friend, and, indeed, human acquaintances 
may be recognised in animals and birds. Such vagueness of visual 
recognition is common among the lower animals, where a dog will 
bring up a family of kittens substituted for her own, or a hen rear a 
brood of ducklings. The make-believe of children will readily accept 
such changes of shape, and an implicit belief be reposed upon the 
fairy-story accounts of such transformations. 

Yet another characteristic of the insane, which may be described as 
an ancient heritage, is the love and appreciation of music. Creatures 
so far from our line of evolution and relatively so low as the birds are, 
curiously enough, most akin to man in the love of song, and this 
attribute may even be fitly ascribed to certain families of insects. It 
is not matter for surprise, therefore, that this ancient faculty persists 
even in far-gone insanity. 

There may finally be dealt with one or two traits which are not here 
brought in as illustrating the primitive mentality of the insane, but 
because my own experience may shed some light upon them. The 
unsociability of the insane and disinclination for the society of others 
is largely due to their self-absorption. The strange world into which 
they have penetrated puzzles and disturbs them, and the thread 
of their old connections and interests are severed. The insane, there¬ 
fore, are engaged either in a constant endeavour to explain themselves 
to themselves, or are in a world of happenings and imaginings all their 
own. This self-absorption necessarily crowds out an interest in 
others. 

A second characteristic is the suicidal tendency that is so common. 
In my own case, the only time I thought of suicide was apparently 
early in my insanity, when I imagined myself alone in a garden from 
which I could not escape and was melancholy. I imagined I was 
dead, and that the only escape from the surroundings with which I was 
so out of harmony was by undergoing a second death. It is possible 
that the deliberate courting of death by other melancholics may, in 
some cases, be due to a similar belief on their part, namely, that they 
have gone through the portal of death and have entered into a world 
to which they do not belong. They naturally seek, therefore, an exit 
by the door through which they think they have entered, in the hope 


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of reaching a harmony between themselves and their surroundings, the 
conscious lack of which is the prevailing trouble of the insane. 


A Case of Pellagra in Central Asylum. By William F. 
Samuels, Licentiate in Medicine and Surgery, Dublin,. 
Medical Superintendent, Central Lunatic Asylum, Tan- 
jong Rambutan, Federated Malay States. 

For some time past now cases of pellagra have been reported from 
different parts of the world. I attach notes of a case which I believe 
was pellagra which occurred in the F.M.S. Asylum at Tanjong Ram¬ 
butan, F.M.S. 

N.T.S., Chinee. Was transferred from Kuala Lumpur on January 
26th, 1912. He had been admitted there on January 9th, 1912. 
There is no mention of any skin affection at the time of his admission, 
but some months after I noticed pigmentation of the dorsum of his 
feet, front of his ankles, and the backs of his hands. Little notice was 
paid to it, though the pigmentation persisted. 

The next entry as to the state of his skin was in December, 1913, 
when he was admitted to No. 1 (Infirmary Ward) with fever. It was 
then noted that there were “ small ulcers on his hands and legs.” 
These corresponded to the area already noted as having been pig¬ 
mented. They were superficial and clean, and rapidly healed, leaving 
the pigmentation rather more marked and the skin somewhat thickened 
and wrinkled. It now dawned upon me that this might possibly be a 
case of pellagra, but nothing further was noticed till the end of August, 
1914, when he developed a marked erythema at the back of both 
hands and wrists. The skin exfoliated, and the patches then rapidly 
healed, leaving pigmented areas as before. 

In October the same condition was again noted in backs of the 
hands, wrists, and extensor aspect of the forearm. A few days later 
the dorsum of feet and front of ankles were noticed to be in the same 
condition; and shortly after the same appearance was noted on the side of 
nose. He' now developed diarrhoea, but no blood or mucus was passed. 
The skin exfoliated, and a red raw surface was left “like a burn of the 
third degree.” The lips now showed much the same condition, while 
later the tongue became denuded of epithelium, and small superficial 
patches of ulceration appeared on the palate. His appetite, which had 
previously been voracious, now failed. But even before the failure of the 
appetite, when he ate quite enough for two men and craved for more, 
he never was anything but miserably thin. The skin affection gradually 
spread till it reached the elbows and knees, and now, for the first time, 
showed any tendency to attack the flexor aspect. Up to this the 
trouble had been strictly confined to the extensor aspect. From this 
on he gradually went down hill, and died, on November 18th, r9i4, of 
hypostatic pneumonia. 

Mentally, he was a melancholic, but was all through extremely 
peevish. He was continually complaining of ill-treatment, which, on 
investigation, proved to be groundless. He complained that he was 


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brought here under false pretences, being told he was to be made a 
king on arrival; also that “ they ” would not let him sleep, and cut him 
with axes. He never gave an explanation as to who “ they ” were. 
Eventually he ceased to speak of these persecutors, and sank deeper 
and deeper into a condition of melancholic stupor, and was with 
difficulty roused. It is unfortunate that no careful notes were taken of 
the earlier attack, but the possibility of its being pellagra did not dawn 
on me until the end of what was apparently the second, or perhaps 
even the third attack, as the pigmentation was noted before his first 
attack here. 

There are many points in favour ot pellagra in this case. The 
repeated attacks leaving a dry wrinkled pigmented condition of skin 
behind. The distribution of the skin affection, starting as an erythema 
on the back of the hands and dorsum of feet, and its limitation to the 
extensor aspects of the limbs until near the end; the patch appearing 
at the side of the nose; the “bald tongue” and involvement of the 
palate ; the voracious appetite, while the patient all the time remained 
thin; the attacks of diarrhoea; the peevishness and continual com¬ 
plaining, together with the gradually and steadily deepening melancholia. 
These symptoms look extremely like those of a case of pellagra, and, 
while I confess I have never seen one and only go on what I have read, 
and am open to correction, I cannot see what else it could be. I believe 
it to be the first case of pellagra described in the Federated Malay 
States. 

I have to thank Mr. G. Abraham, Assistant-Surgeon, Central Asylum, 
for the care with which he noted the last attack. 


Occasional Notes. 


The College of Nursing , Ltd., ayd the State Registration of 

Nurses. 

Early in 1916 an Association was formed, consisting largely 
of influential laymen and others interested in hospital nursing, 
for the purpose of standardising the education of nurses and 
securing their State registration. Foremost amongst the 
pioneers of the movement we may mention the names of the 
Hon. Arthur Stanley, M.P. (now Sir Arthur Stanley, Gr.C.B.E.), 
well known for his eminent services in connection with the 
organisation of volunteer nurses for war purposes, and Sir E. 
Cooper Perry, M.D., Superintendent of Guy’s Hospital, with 
Sir Henry Burdett, K.C.B., K.C.V.O., (Editor of The Hospital ), 
Miss Swift, R.R.C., Matron-in-Chief of the Volunteer Nursing 
Service, and a number of matrons of general hospitals to which 


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580 OCCASIONAL NOTES. [Oct, 

training schools are attached: As a result a body called The 
College of Nursing was formed, and this was incorporated as a 
limited company, under the Companies Acts, 1908 and 1913, 
on March 27th, 1916. Among its objects were set out the 
promotion of (a) the better education and training of nurses, 
and (b) of the uniformity of curriculum ; (c) the recognition of 
approved nursing schools ; (d) the adoption, if thought fit, of 
the results of examinations held by approved nursing schools as 
sufficient evidence of efficiency ; (e) the granting of certificates 
of proficiency to those who have passed above, and to persons 
who may pass prescribed examinations after training ; (f) the 
granting of certificates of proficiency in any special branch of either 
medical or surgical nursing; (g) the institution and conduct of 
examinations of persons desirous of obtaining certificates of 
proficiency, or of training and proficiency, in nursing; . . . 

and (i) the making and maintenance of a Register of persons to 
whom such certificates of proficiency, etc., have been granted. 
Our space does not permit of further quotation, but when we add 
that the statement of objects uses all the letters of the alphabet 
(save z) for successive paragraphs, our readers will see that the 
aims of the College are fairly comprehensive. 

This scheme having been brought under the notice of the 
Medico-Psychological Association Education Committee, the 
Council approved of the formation of a special committee to 
watch events likely to involve the position and interests of 
mental nurses, and deal with any questions which might affect 
our Association. This special committee (of which Dr. Shuttle- 
worth has acted as Chairman, and Dr. Porter Phillips as 
Secretary) has held meetings from time to time as occasion 
has seemed to require, and, having opened communications with 
the College of Nursing, it was arranged in October 1916 that 
a small deputation of its members should be received by the 
Chairman and the Hon. Secretary of that body. It was pointed 
out by successive speakers that the Medico-Psychological 
Association had elaborated as long ago as 1 890 a scheme for 
the systematic training, examination, and certification of asylum 
nurses (male and female), and that upwards of 12,000 mental 
nurses so qualified were now on the Association’s Register 
The examinations (which were both oral, practical, and in writing) 
had from the first been conducted on a uniform standard both 
by local and central examiners; the course of instruction had 


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originally extended over two years (after probation); since 
1910 the period of training had been extended to three, con¬ 
sisting of scientific and practical courses of lectures, with clinical 
demonstrations, and (in addition to class examinations) a 
Preliminary and a Final Examination. It was suggested that 
as the College of Nursing provided, in the Bill which they had 
drafted, for the registration of mental nurses in a “ supple¬ 
mentary register” attached to the general register of nurses, 
the Council of the College promoting such a Bill would be in a 
better position to deal with mental nurses were some members 
conversant with asylum training added to their numbers. 
This point seemed to appeal to Sir Arthur Stanley, but it has 
since been urged on behalf of the College, which is now seeking 
amalgamation with the Royal British Nurses’ Association and 
a Charter conferring the title of “The.Royal British College of 
Nursing,” that it would suffice were such members to be placed 
on the Provisional Council formed under the Act. It seems, 
however, to us that the Council of a College which puts forward a 
claim to the supervision of all branches of the nursing profession 
is hardly in a position to legislate for the large and important 
section of asylum-trained nurses unless reinforced by expert 
members practically acquainted with the special circumstances 
of this class. 

Space does not permit a criticism of the two competing Bills 
on the State Registration of Nurses which have been prepared 
by the College of Nursing and the Central Committee for the 
State Registration of Nurses respectively. When the time for 
action arrives the Medico-Psychological Association (in con¬ 
junction with the Asylum Workers’ Association, which has been 
loyally co-operating in this matter) will exercise the not 
inconsiderable parliamentary influence they can reckon on to 
secure equitable treatment for mental nurses both male and 
lemale. 


Conduct and Insanity. 

1 

Tantaene animis coelestibus irae ? 

Dr. MERCIER has a grievance against the Association. 
Owing to obstinacy, or obtuseness, or muddle-headedness on 
the part of its leading members and writers, so he leaves us to 


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infer, they have ignored, if they have not actually opposed, his 
views as to the essential nature of insanity ; views which have 
been eagerly accepted by Lawyers, Physicians, Royal Commis¬ 
sions, the Home Secretary, and Parliament, practically by 
everyone in fact “ outside the membership of the Association.” 
With this exception he has “ never found one that did not 
tumble to them instantly.” 

The Association versus Dr. Mercier and everyone outside its 
ranks. Athanasius contra mundum. 

But is it so? We venture to differ from Dr. Mercier on this 
point. Because other writers do not employ exactly the same 
phraseology as he does with respect to the true nature of 
insanity, it does not follow that they are in complete disagree¬ 
ment with him as regards the facts relating to this question, 
that they may not even be in substantial agreement with him 
on essential points. Shorn of dialectics Dr. Mercier’s position 
seems to be this, that insanity is mainly disorder of conduct, 
although in part—as he rather grudgingly admits—disorder of 
mind, and of brain function. What probably the majority of 
alienists would regard as a more accurate description would be 
that insanity is disorder of mind, due to disorder of brain func¬ 
tion, and revealing itself by disorder of conduct. And these 
three ingredients must be considered together in forming a 
correct conception of insanity. Dr. Mercier apparently attributes 
to his (supposed) opponents the view that madness is “ disorder 
of mind alone, or an equivalent to unsoundness of mind.”' 
Does anyone really maintain this standpoint ? Dr. Mercier 
keeps his gaze concentrated on disorder of conduct as being the 
real essence of insanity, and for anyone to urge that disorder 
of mind may be at least an equally important element arouses 
his ire forthwith, and he immediately proceeds to demolish such 
a notion with all the rhetorical ammunition at his disposal (no 
mean amount), and to denounce the upholders of it with bell,, 
book, and candle. 

In argument, and particularly in psychological argument, a 
great deal turns on the exact meaning of terms. Now, there 
are two terms employed by Dr. Mercier which, unless they are 
accurately defined, may involve an ambiguity of meaning. 
These are “madness” and “primary.” If by madness he 
means certifiable insanity—and it is pretty clear that that is the 
meaning in which he uses this term—then probably everybody,. 


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including even the most benighted member of the Association, 
will agree with him that conduct is a highly important item, we 
will grant him the all-important item of this condition for us to 
take into consideration. But, if his contention is—and this is 
apparently the case—that unsoundness of mind is a compara¬ 
tively unimportant ingredient in even certifiable insanity, then, 
probably no one will agree with him. As regards the term 
“ primary,” it may have a chronological meaning, i. e. first in 
order of occurrence ; or it may mean first in order of import¬ 
ance, two totally different significations. If used in the latter 
sense—the sense in which Dr. Mercier apparently L^es it—and 
as a criterion of certifiable insanity , but only under these con¬ 
ditions, then, again, few will disagree with that opinion. But if 
used in the sense of priority in order of sequence, and of first 
importance as regards causation, then it is almost inevitable that 
the large majority of students of insanity will be found to 
dissent from that view. Conduct, Dr. Mercier has himself 
defined as “ action in pursuit of ends.” He says also, “ an act 
is movement . . . done with a purpose” ( Conduct and its 

Disorders , Introduction, pp. xix, xxi). And again, “ Conduct 
is founded . . . upon coherent belief; upon assured con¬ 

viction,” “ Knowledge is of value only as a basis for action ” 
(Psychology , Normal and Morbid , p. 253). Now, end, purpose, 
belief, knowledge, conviction, these all imply mental states ; all 
precede and determine conduct ; they are, in fact, its cause. 
No purposive action, no “conduct” can occur without some 
antecedent mental condition yvhich prompts it. The mental 
condition must, therefore, be regarded as at least of equal 
importance with the acts, the conduct, which are the outcome 
of it. This is just the point where. Dr. Mercier appears to join 
issue with those who differ from him. He seems reluctant to 
assign anything more than an insignificant role to the mental 
conditions underlying and leading to insane acts, which con¬ 
ditions in the eyes of most alienists are just as much an 
essential part of the insanity as the acts themselves. Conduct 
is a symptom of a certain state of mentality. Disorder of con¬ 
duct is a symptom of disorder of piind, and both conjointly 
constitute insanity. They are inseparably linked together, and 
the result cannot occur without the cause. 

To take a concrete instance, which is of not uncommon 
occurrence in human experience. A man has acquired the 


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delusion that another individual has sinister intentions with 
respect to himself. He thinks this person is trying to injure 
him in some way by, let us say, robbing him, drugging him, or 
killing him outright. He may hold this delusion for months, 
even years, and never disclose it by any overt act. Suddenly, 
without any apparent reason, he attacks the object of his 
suspicions and half murders him. If we accept Dr. Mercier’s 
contention, then we must regard this man as “ sane ” (although 
no doubt of unsound mind) up to the moment when he 
makes the assault on his supposed enemy. There was no 
disorder of conduct, therefore the man was not insane. When 
he delivers his first blow, in that instant, but not before, he 
becomes insane. Surely this is not very far from a reductio ad 
absurdum. If Dr. Mercier thinks thus, we are of opinion that 
he will have to bring much stronger arguments than he has yet 
adduced to establish his position. We must agree to differ 
from him. 

But is there really any serious difference between the view 
that Dr. Mercier holds and that held by alienists generally ? 
He insists that disorder of conduct is of primary consequence 
in insanity, but admits that disorder of mind is usually present. 
Others regard disorder of mind as the primary condition, 
primary both in order of sequence and in importance. The 
difference boils down to a mere matter of degree; to which of 
the two things greater weight is to be attached. May we dare 
to suggest that the whole controversy is more or less of the 
nature of a “storm in a teacupi”? And if the Association has 
appeared to ignore Dr. Mercier’s views on this matter, it has not 
been from any want of respect for him as a writer or teacher, 
but simply because they failed to see that any apparent disagree¬ 
ment on their part from these views was of any vital consequence, 
nor of such magnitude or importance as that with which he has 
sought to invest it. 

Dr. Mercier has been, and is still, a distinguished member of 
the Association. He has had conferred on him the highest 
honour which is in its power to bestow, by being elected to fill 
the presidential chair. His works are well known to most of 
us, and read with pleasure and appreciation. On his appear¬ 
ance, unexpected by but few, at the Annual Meeting in July, 
he received a warm and genuine welcome from all the members 
present. Under such circumstances has he nothing but hard 


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words to fling at it? We believe he still retains his old 
affection for the Association—perhaps, hittc illae lachrymae. 
We prefer to regard his upbraidings and reproaches as in the 
nature of a lover’s quarrel, and 

Amantium irae amoris integratio est. 

That is a consummation for which in the present instance 
we devoutly wish. 


Part II—Reviews. 


Manual of Psychiatry. By J. Rogues de Fursac, M.D., Paris, and 
A. J. Rosanoff, M.D., New York. Fourth edition. Revised 
and Enlarged. Pp. xi + 504. London: Chapman & Hall, 1916. 
Price 1 or. 6 d. net. 

The original edition was an American translation of a French work 
with but a few alterations. The fourth edition is now published, and 
owing to the war its preparation has been placed entirely in the hands 
of Dr. Rosanoff. It contains a good deal of new matter, and the book 
is now assuming the character of an American production. The 
dominating influence of Kraepelin’s teaching is conspicuous, but other 
authorities are mentioned without, however, much attention to British 
authors. 

Part I is devoted to General Psychiatry and begins with aetiology. 
When considering the factor of heredity we are glad to note a succinct 
account of the Mendelian theory. The statistics, as regards neuropathic 
inheritance, alcoholism, syphilis, and other causes of insanity, are given 
from admissions to the New York State Hospitals. Psychological 
manifestations are only discussed in so far as they belong to abnormal 
mental states, and embrace three chapters on symptomatology. Hallu¬ 
cinations, co-existing with sound judgment, the author refers to as 
“conscious hallucinations,” which surely is an ambiguous term ? 

Four chapters deal with the Practice of Psychiatry, in which case¬ 
taking, methods of examination, special diagnostic procedures, general 
therapeutic indications and prognosis receive attention. Lumbar 
puncture and the Wassermann reaction and other chemical tests are 
carefully described, as are also the Binet Simon and Association tests. 

The author emphasises the need for after-care of discharged patients. 
But little is said of psycho-analysis, which is described as a difficult, 
time-robbing task. To the question whether insanity is increasing in 
America, Dr. Rosanoff replies in the negative. He gives prominence 
to the subject of the prevention of insanity. He . regards alcoholism as 
equivalent to neuropathic taint, and prostitution as largely associated 
with feeble-mindedness. He arrives at the conclusion that three-quarters 


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[Oct, 


of insanity is due to bad heredity, and that segregation is still the best 
course to pursue. 

Part II is described as Special Psychiatry, under which the separate 
mental disorders are considered. The classification of the clinical 
groups is as follows: (i) Constitutional, (ii) Alcoholic, (iii) Syphilitic, 
(iv) Traumatic, (v) Miscellaneous. 

The article on Dementia Piecox is largely re-written and contains 
Adolf Meyer’s views. In the account given Dementia Paranoides 
seems to be encroaching more and more on Paranoia, and Magnan’s 
Delire Chronique is described under the former category, although still 
regarded by the French as a separate entity. The author gives a full 
description of Psychopaths. The chapter on General Paresis is quite 
up to date. The book contains but two illustrations, and these occur 
in the chapter on Cerebral Arteriosclerosis to explain the blood supply 
of the cortex. 

We heartily commend the book to our readers, who will however, not 
fail to note that it is scarcely as full on the pathological side as it is in 
its clinical aspects. It contains a great deal of useful information 
regarding insanity in America, and will be read with much interest by 
psychiatrists in this country. 


Psychological Medicine: A Manual of Menta^ Dise'ases for Practitioners 
and Students. Third edition. By Maurice Craig, M.A., M.D. 
Cantab., F.R.C.P.Lond. Pp. xii -f- 484. London: J. & A. 
Churchill, 1917. Price 15J. net. 

The third edition of Dr. Craig’s work has recently made its ap¬ 
pearance. It continues to be a popular book for both students and 
practitioners, and it is rightly regarded as one of the best modern text¬ 
books in this country. 

The author’s views are well known, and he has always striven to bring 
Psychiatry into closer line with General Medicine, and has kept abreast 
of all progressive tendencies in this direction. 

The chapter on normal psychology remains somewhat brief, and the 
writer no doubt considers that further reading on the subject should be 
derived from other sources. We notice, however, that there is now 
some reference to instincts which will be appreciated. The anatomy 
of the cerebral cortex is not considered and must be sought elsewhere, 
as well as any discussion on the mechanism of the brain in mental 
processes. 

The chapter on symptomatology contains a good resume of abnormal 
psychology, as well as a description of the bodily accompaniments of 
mental disease. The individual psychoses are fully described, and their 
classification remains as in former editions. 

In the chapter on Idiocy and Imbecility there is now added the 
procedure of the Mental Deficiency Act, which will come into more 
extended operation after the war. 

There is a slight reference to anxiety neurosis in the chapter on 
neurasthenia, but the chief addition to the book is an excellent chapter 
on psychoneuroses occurring in men exposed to shell-shock and strain 
•of war. Dr. Craig here gives us the benefit of his experience of these 


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\ ' 

cases which, unhappily, have become so numerous in the present world 
struggle. The proper treatment of these patients has arrested the 
attention of the profession and laity alike, and has helped to infuse an 
active interest in psychological medicine, from which much practical 
good should ultimately result, especially in regard to the need of fresh 
legislation for the care of incipient insanity. The author points out 
that these shell-shock cases, although mainly regarded as functional, 
yet when seen early sometimes exhibit the physical signs of organic 
disease. He outlines the symptoms that arise as the consequence of 
prolonged fatigue, insomnia, emotional stress and concussion, and indi¬ 
cates how these patients are best dealt with from both the psychological 
and medical standpoints, as well as the special measures that have 
proved of value after the acute stage has subsided. Apparently psycho¬ 
analysis has not proved as useful for these cases as was at first anticipated. 
The author has given an instructive account of these affections, the 
diagnosis of which from more pronounced organic disease, and also from 
simulated disease is a difficulty that is often present. 

The chapters on sleeplessness and on the general treatment of the 
insane are especially worthy of the attention of the practitioner, who will 
find guidance in the correct use of sedatives and other wise counsel. 

The illustrations and coloured plates are beautifully reproduced. 
They are the same as before, and are inserted in the centre of the 
book with a separate letterpress. The book has been carefully revised 
and is more compact than before, although it contains ten additional 
pages. 


An Epitome of Meiital Disorders. By E. Fryer Ballard, M.B., B.S. 
(Lond.), Capt., R.A.M.C.(T.), Medical Officer in Charge of the 
Observation and Mental Block, 2nd Eastern General Hospital 
(T.F.) Brighton. Pp. xv -f 206. London : J. & A. Churchill, 1917. 
Price 6 s. net. 

The writer’s intention has been to provide a concise and practical 
aid to the diagnosis and treatment of the more common varieties of 
mental disorder as met with in general practice and asylums. This he 
has fulfilled with some success from the point of view of the practitioner 
and assistant medical officer. 

A classification adapted from Tanzi is set out at the commencement 
of the book, and then follows a short chapter on the General Causation 
and Treatment of Mental Disorders. The language used is somewhat 
colloquial, and there is no pretence to an exhaustive examination of the 
subject. Part I is headed Common Types of Insanity. The first 
chapter deals with states of excitement, and therein mania, dementia 
precox, acute confusional insanity, general paralysis, delirium tremens, 
alcoholism, epilepsy, gross brain disease, senile cases, and drug cases 
are discussed seriatim with special regard to differential diagnosis. 
The succeeding chapters deal in turn in a similar fashion with states of 
depression, delusional states, states of stupor, and slates of mental 
enfeeblement. 

We recognise that this method will appeal to the medical man who 
is not well versed in the clinical examination of mental cases, but it 


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hardly enables a student to obtain a proper grasp of the individual 
psychoses. An attempt to remedy this aspect is afforded by the com¬ 
pilation of an alphabetical list of forms of insanity with cross references 
to the different scattered pages on which these disorders are discussed. 

For confusional insanity can we not dispense with Meynert’s synonym 
amentia, as this term has come into general use for mental deficiency 
in this country ? 

Part II is concerned with borderline psychoses, shell-shock, com¬ 
bined and atypical psychoses. In his description of hysteria the author 
has adopted some of the modern current theories and makes free use- 
of the word “censure” in place of the old-fashioned “higher control.” 
By means of a little diagram he seeks to explain neurologically what he 
conceives to be the mechanism of the production of hysterical episodes. 
A somewhat complicated diagram is given to illustrate the results of 
shell shock, described in a separate chapter, which contains records 
of some cases under the author's observation. There is a tendency 
to obliterate the line of distinction between fits of a functional nature 
and true epilepsy, and the expression, epileptic fits of hysterical origin,, 
is, we think, to be deprecated. In the last chapter the author describes 
combinations of syndromes and anomalies. It consists largely of a 
consideration of the original temperament on which a psychosis is 
grafted and includes also mixed types. 

Dr. Ballard, who was sometime Assistant Medical Officer at the 
Somerset County Asylum, has written a useful little book, in which also 
is to be found a glossary. 

The volume will be specially welcomed by practitioners who have the 
care of mental patients in our Military Hospitals. 


Wit and its Relation to the Unconscious. By Prof. Sigmund Freud, 
Translated by A. A. Brill, Ph.B., M.D. 

Dr. Brill has stated elsewhere that no one is really qualified to use or 
to judge Freud’s psycho-analytic method unless he has mastered the 
four books:— The Interpretation op Dreams. Three Contributions 
to the Sexual Theory. The Psychopathology of Everyday Life , and 
Wit and its Relation to the Unconscious. To those unacquainted 
with the German language this was impossible, but now', through Dr. 
Brill’s exertion, all these are available to English readers. There has. 
been an abundance of adverse criticism of Freud in English publications, 
but it must be admitted that this has come in the main from those wha 
in their w'ritings give evidence that they have not studied Freud at 
first-hand. They appear to have depended for their information on 
short articles written by followers of Freud. Such articles, not always 
wise or true, are really condensations of larger works, and even with the 
best will in the world it is impossible to epitomise faithfully. However, 
no one will have any valid excuse now, and in future critics will be 
expected to have at least read the works of the author they criticise. 

In the book under consideration the patience and persistence of 
Freud in the investigation of the psychology of so elusive a subject is 
remarkable. The book is divided into three parts: analysis of wit. 


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synthesis of wit, and theories of wit. It is not easy in a short review to 
quote all the interesting details. This is all the more difficult in the 
present instance, as, unless examples are given, the description is un¬ 
intelligible. The book itself is full of examples of wit, some funny, others 
rather feeble, so that it is somewhat surprising to note that Freud when 
he first met a certain joke was moved to loud laughter. This suggests 
the question of idiosyncrasy in regard to wit, a subject not mentioned 
except in relation to wit among Jews, and upon which Freud’s views 
would be of interest. 

A prominent feature of the book is the comparison instituted by the 
author of “ wit and the dream.” Freud says that he has been the sole 
discoverer of the relationships between the two. It follows then that 
unless the reader is familiar with Interpretation of Dreams he will 
have hard work to follow Wit. The processes in wit having a “ far- 
reachmg agreement with the processes of dream-work,” are “condensa¬ 
tion with and without substitutive formation, displacement, representation 
through absurdity, representation through the opposite, and indirect 
representation.” Though there are resemblances between the dream 
and wit there are nevertheless certain differences. For example, wit is 
eminently social, always requiring two people and sometimes three or 
more people. The following lines may be taken as an epitome of a 
large part of the book : “No matter how concealed the dream is still 
a wish, while wit is a developed play. Despite its apparent unreality 
the dream retains its relation to the great interests of life; it seeks to 
supply what is lacking through a regressive detour of hallucinations; and 
it owes its existence solely to the strong need for sleep during the night. 
Wit, on the other hand, seeks to draw a small amount of pleasure from 
the free and unencumbered activities of our psychic apparatus, and later 
to seize this pleasure as an incidental gain. It thus secondarily reaches 
to important functions relative to the outer world. The dream serves 
preponderately to guard from pain while wit serves to acquire pleasure; 
in these two aims all our psychic activities meet.” 

There are interesting chapters which can only be mentioned, e.g., 
the tendencies of wit, and the motives of wit, and wit as a social 
process. The question of the relationships between wit, the comic, and 
humour are discussed in the last chapter, and the author reaches the 
following conclusion : “ It has seemed to us that the pleasure of wit 
originates from an economy of expenditure in inhibition , of the comic from 
an economy of expenditure in thought, and of humour from an economy of 
expenditure in feeling. All three activities of our psychic apparatus 
derive pleasure from economy. They all strive to bring back from the 
psychic activity a pleasure which has really been lost in the development 
of this activity. For the euphoria which we are thus striving to obtain 
is nothing but the state of a bygone time in which we were wont to 
defray our psychic work with slight expenditure. It is the state of our 
childhood in which we did not know the comic, were incapable of wit, 
and did not need humour to make us happy.” 

Enough has been written to indicate the nature of the book. What¬ 
ever his merits or demerits there can be no doubt that Freud is a thinker 
of great independence and originality. His best friends have stated 
that he is not always easy to understand in the original. If this be so 

LXIII. 39 


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one need not be surprised if in a translation the same defect is apparent. 
Bearing this in mind Dr. Brill is to be congratulated on the satisfactory 
completion of a difficult task. 

R. H. Steen. 


Physiology and Psychology of Sex. By S. Herbert, M.D. London : 

Black, 1917. Pp. 136, 8vo. With 49 illustrations. Price 3 s. dd. 

net. 

For some years past a stream of little books on sex, intended for 
popular consumption, has been poured out from the press. Yet it is rare 
indeed to find any that can be viewed with approval. A brief examina¬ 
tion usually shows that they are either unscientific, or cranky, or at 
best, crammed with well-meant but unwise advice. It is, therefore, a 
great satisfaction to find in Dr. Herbert’s book a manual of sex which 
presents the essential facts in a simple, clear, and scientific manner. 
The satisfaction is all the greater since here for the first time in a 
manual of this compass psychology is placed in the same rank with 
physiology. Morality, save incidentally, is excluded, as the author 
contemplates a separate volume on the ethics 01 the sexual life. In 
manner the book is somewhat bald, restrained, and objective ; but in 
dealing with a subject which has often unpleasantly evoked a very 
different manner of writing these qualities are commendable. In 
substance the author presents results which are in accordance with 
the best recent investigation, and his opinions are temperate and sound, 
though in regard to a few debated points there will be a legitimate 
difference of opinion. The book is addressed to “ beginners ” rather 
than to a professional audience, but in this field there are still many 
medical “beginners” who can scarcely fail to find Dr. Herbert’s 
manual illuminating and helpful. 

There are seven chapters, of which four are devoted to psychology. 
After setting forth the general principles of biology, the author deals 
with the physiology of the germ-cells, copulation, pregnancy, paturition, 
etc. Turning to psychology, he discusses sex differences and mating, 
and, finally, the aberrations of sex (auto-erotism, erotic symbolism, 
sexual inversion) and the sexual norm (the problem of continence and 
sexual hygiene). Havelock Ellis. 


The Child and the War. By Cecil Lefson. London : P. S. King 
& Son, 1917. Pp. 68. Price is. net. 

In all the belligerent countries to-day a great increase has occurred in 
juvenile delinquency. In the present pamphlet the causes and remedies 
of this state of things, so far as England is concerned, are studied by 
the Secretary of the Howard Association, who is also a recognised 
authority on the Probation System. 

As regards the facts, the total number of children and y>ung persons 
( i.e ., under 16) charged with punishable offences has increased 34 per 
cent., and at least 12,500 more children came beiore the magistrates 
than in time of peace. The increase was much greater in the second 
than in the first year of the war. By far the greater proportion 


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of the increase is in larcenies and felonies. (As the author remarks, 
“ orchard raiding is ‘ larceny,’ and the urchin who steals a penny pie 
from an itinerant pieman is a ‘felon,’ if, indeed, he is not a highway 
robber out and out.”) Although the offences are often trivial their 
real increase is greater than the alleged increase, as street darkness and 
defective police service favour the offender’s escape. More than two- 
thirds of the offenders worked in groups and gangs, and were, indi¬ 
vidually, fairly harmless. The offenders are nearly all boys. 

In investigating the causes the first place is given to the father’s 
absence; two out of five of the fathers of juvenile delinquents are 
serving in the Army or Navy. In other cases elder brothers who 
exerted a wholesome control are also away. It is estimated, indeed, 
that the great majority of the five million men withdrawn from home 
life exercised some sort of control over children. Moreover, the 
father’s absence has often led to the mother being over-worked, or 
slack, or absent in factory employment. In normal times 50 per cent. 
of juvenile offenders are orphans, and the war has placed a vast 
number of children in the position of orphans, while not supplying 
them with the mitigating conditions which usually exist in the case of 
orphans. There is not only lack of discipline in the home, but also in 
the school. About 1,200 schools have been taken over for hospitals, and 
in some cases a half-time system has been adopted. The teachers are 
often women, unable to enforce discipline. Children can do what they 
like and have much more time on their hands than ever before. Even 
the demand for child labour has increased delinquency. From 150,000 
to 200,000 children have been released from school for work between 
the ages of 11 and 13. it is precisely at this age-period that the 
chief increase in delinquency has occurred. High wages and long 
hours of work for children are in themselves demoralising. Some 
importance is attached to the war-spirit. The child catches the spirit 
of craft, guile, and revenge which fills the prevailing war-talk ; he 
desires to become a hero and to emulate his elders ; a van in a 
darkened street becomes a German convoy and the contents legitimate 
spoils of war. It is impossible to exaggerate the influence of the war 
on the minds of children. On subnormal children this influence 
becomes especially serious. 

When we turn to the question of remedies, we find that magis¬ 
trates are fining delinquents, whipping them, sending them to reformatory 
or industrial schools, or releasing them under the Probation Act. The 
author criticises the uneven and unreasonable way in which these 
measures have often been carried out. Thus the Probation Act pro¬ 
vides for the restitution of thefts, but ignorant magistrates frequently 
fail to realise their duties in this matter, and it happens that a child 
steals ^5, is discharged on probation, and proceeds to enjoy the results 
of his theft without question. The number of Probation Officers is 
also altogether inadequate, and the author recommends that ministers 
of religion and suitable women should be appointed. The reformatory 
schools have all been filled up, often unwisely, children who in normal 
time would have been well behaved being sent for a long term of years 
to consort with others of a much worse type, while defective offenders, 
who most need treatment, are not sent anywhere, not even (through 


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the ignorance of the Court) to the far too few insititutions which are 
prepared to receive them. It is these offenders who present the most 
serious problem. Flogging is deprecated; when applied, it should be 
without delay, and the boy : s headmaster should be authorised to 
administer it. • 

Punishment, however, by itself is, in any case, no real remedy. The 
author wishes to develop the suggestion of Mr. Findlay, Professor of 
Education at Manchester University, for providing wholesome open-air 
activities for children on the outskirts of cities in camps and settle¬ 
ments, with land, garden, farm, workshop, kitchen, and wash-house. 
Children’s clubs with self-government (on the lines of the Little 
Commonwealth) are also advocated. Cinemas should have two houses 
a night, the first house being adapted for children ; in Germany children 
under 17 are forbidden to go to cinemas except such as are specially 
licensed for them, and in Russia only by permission of school authorities. 

These remedies, the author admits, are only palliations, and some 
are not easy to apply under present conditions. The radical remedy 
is too obvious to need stating. Havelock Ellis. 


War-Shock. By M. D. Eder, B.Sc.Lond., M.R.C.S., L.R.C.P.Lond. 

London: William Heinemann. Pp. 154. 

One of the features of the present war is the interest which has been 
taken in the functional disorders which by most writers are included 
under the term shell-shock. 

Dr. Eder’s book, which deals with 100 consecutive cases, will prove 
to be a useful contribution. The author prefers the term “ war-shock 
to “ shell-shock,” and points out that exactly the same symptoms have 
occurred after shrapnel wounds, falls, and without previous injury at 
all, as have followed those produced by high explosives. In many of 
the cases the description is of a sketchy nature. This has been unavoid¬ 
able, and it is unfortunate that the exigencies of military-medical 
service prevented several of the most interesting cases from being fully 
worked out. Dr. Eder does not believe that hereditary predisposition 
is a factor of much importance, 70 per cent, of his cases were free from 
hereditary or personal psycho-neurotic antecedents. With regard to 
treatment he says : “ The treatment par excellence is hypnotic sugges¬ 
tion,” and “ 91‘s per cent, of cases of war-shock were cured by this method 
and 8 5 per cent, improved.” In several cases this treatment was 
assisted by psychological examinations conducted in the manner known 
as psycho-analysis. War-shock or shell-shock appears to vary from 
time to time, and different hospitals seem to admit differing cases, and 
if Dr. Eder had the opportunity of examining a second 100 consecutive 
cases he might possibly find that things had altered. Still, there is no 
doubt that he has produced a most interesting study, and everyone 
whose duty it is to treat such cases should possess this book. 

R. H. Steen. 


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A History of Penal Methods: Criminals , Witches , Lunatics. By 
George Ives, M.A. London: Stanley Paul, 1915. Pp. 409, 
8vo. Price 105 . 6 d. net. 

This interesting work evidently had its origin in a humanitarian 
impulse. We feel that the author is moved less by a coldly severe 
scientific spirit than by a warmly human and generous effort to 
ameliorate the lot of the suffering—a kind of bias of humanity. On 
this bias, however, it is clear that he has laboriously set himself to 
study the historical records as impartially as may be, so that the 
resulting work possesses a value independent of the reader’s own 
particular bias. 

As the title indicates, the author seeks to bring out the fact that in 
the past criminals, witches, and lunatics have been dealt with by what is 
substantially the same method—the method of instinctive revenge against 
anti-social acts and manifested by punishments. We are slowly realising 
that in the case of all these groups, the author argues, punishments 
regarded as remedial measures are merely effete survivals. He con¬ 
cludes, in agreement with the general modern tendency, that we must 
aim at the “scientific sorting out of society’s failures,” according them 
individual treatment as demanded by their various and widely different 
needs ; this will prove to be “ the greatest measure yet undertaken to 
ensure the ultimate but certain elimination of crime.” The author 
holds that a man should not be sent to prison except to be benefited by 
prison, “in the sense that a patient is benefited by a necessary 
operation.” He is opposed to all penal retribution, and would only 
permit the infliction of death in the case of criminals who may be 
assumed to be hopelessly incurable. For the most part he advocates 
settlements for criminals, where they will be treated as patients or semi¬ 
lunatics. With regard to the abnormal, the author considers, we are as 
yet “only on the threshold of justice,” though the path of progress is 
clear. 

Such advocacy of practical measures, however, is but lightly touched, 
and occupies only a small part of the book. The chief interest of the 
work, and the author’s main task, lies in historical research. After an 
interesting and instructive chapter of considerable length on the penal 
methods of the Middle Ages, there follows a chapter on witch trials, and 
then the former treatment of the insane is described. The long 
chapter on banishment is of peculiar interest, and contains vivid and 
detailed pictures of the terrible conditions which prevailed in Australia 
during the transportation period; the realisation that these were in 
existence only a century ago may well serve as a wholesome corrective 
of undue national complacency. The next chapters deal with various 
phases in the evolution of the modern prison system, and are followed 
by a discussion of the classification of crimes. The author is satisfied 
with a broad division into two great groups : crimes of circumstance 
and crimes of impulse. There are, that is to say, the crimes due to 
environment, crimes into which, it is assumed, most people would fall 
if subjected to the same pressure, and crimes due to nervous defect or 
abnormality in the individual. The author believes that, though some 
offences appear to overlap, “ the existence of these two great groups is 


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as exact and positive as any broad and classifying law ever laid down 
by science.” 

The copious foot-note references to the literature constitute a useful 
feature of the volume. The author has evidently expended care on 
these, though he has not escaped falling into numerous minor 
inaccuracies. Havelock Ellis. 


Part III.—Epitome of Current Literature. 


i. Physiological Psychology. 

The Laws of Relative Fatigue. ( Psychol. Rev., March , 1917.) 

Dodge , R. 

The problems of fatigue have recently, for well-known reasons, 
attracted unusual attention. They are, however, ancient problems 
around which a bewildering and contradictory mass of work and 
literature has accumulated. The author, who has for many years been 
working on the subject, here deals (in a Presidential Address to the 
American Psychological Association last year) with one limited aspect 
of these problems: the relativity of fatigue. He is more concerned 
with the scientific than with the practical aspects of the subject, for he 
considers that the extreme practical importance of fatigue has injured 
its proper scientific investigation. For this we must know what mental 
fatigue is, if it exists at all, and how it is conditioned. 

If the word fatigue has any scientific propriety in connection with 
mental life it refers, the author believes, to the metabolic conditions of 
mental action, and not to any predetermined characteristic of its conse¬ 
quences. He regards it as improbable that any of the mental work 
decrements commonly treated as mental fatigue are ever simply con¬ 
ditioned by true fatigue processes in nervous tissue, while, conversely, 
real fatigue may not appear as decrement at all. He invokes the 
physiological fact that nervous tissue has been found quite resistant to 
fatigue, while, on the contrary, hyper-excitability is an almost regular 
phenomenon of extreme mental fatigue. The complete cessation of 
mental processes cannot mean a correspondingly complete fatigue of 
nervous tissue. Again, the traditional differentiae of fatigue fail to 
exclude normal psycho-physical rhythms, of which the most significant 
is sleep. There is no physiological justification for the belief that sleep 
is the daily climax of fatigue, and for some people evening is the best 
time for work. The conditions for sleep are not, however, simple, and 
include habit, the absence of stimuli, probably wide-spread inhibitions, 
and possibly gland-products and vasomotor changes. Restriction of ac¬ 
tivity is more potent than over-exertion. “ Lecturers never go to sleep, the 
audience may.” A third argument against the true fatigue character of 
so-called mental fatigue lies in the means used to induce it. To produce 
nerve-muscle fatigue the same tissue is successively stimulated in the same 
manner. In mental fatigue the greater the complexity of the task, the 
more pronounced the decrement. This is probably due to confusion 
between paths of discharge and not to fatigue of any one path. It is not 


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really fatigue, but merely associative rivalry. A fourth reason may be 
found in the operation of incidental inhibitions, which, when attention 
is concentrated in one field, produces a pseudo-fatigue effect in other 
fields. 

Putting aside irrelevant conceptions of fatigue, is there in mental life a 
real fatigue effect? Dodge believes there is. But it differs from nerve- 
muscle fatigue in two respects: inconstancy of the stimuli, and inter¬ 
action of competing paths. In nerve-muscle fatigue experiments the 
stimulus (usually the faradic current) is more or less simple, constant, and 
regular. In mental fatigue experiments it is necessarily unknown and 
variable, and, still more important, the ever changing inner factors, such 
as personal interest, are unknown. Perhaps true mental fatigue is really 
fatigue of the inner stimuli rather than of the capacity to re-act. Some¬ 
times there are successive changes in the inner stimuli resulting from 
fatigue, though the work is continued. Dodge holds that the first law 
of relative fatigue may be formulated thus : “ Within physiological limits, 
all fatigue decrement in the results of work is relative to the intensity 
of the stimulus.” The adequate adjustment of stimuli is a very real 
problem in practical life, and in the training of both normal and abnormal 
children. Continuous activity under the reinforcement of emotion, or 
even in the educational use of play, may be a source of serious fatigue, 
as Kraepelin holds. Another conspicuous reinforcement is worry. It 
would seem to be no accident that this is so closely connected with 
exhaustive psychoses. 

There is, further, the complication of what Sherrington calls com¬ 
petition. Any afferent impulse in the higher nervous system may 
theoretically activate any efferent path. We thus reach a second 
law of relative fatigue : “ In any complex of competing tendencies the 
relatively greater fatigue of one tendency will tend to eliminate it from 
the competition in favour of the less fatigued tendencies.” 

The longest mental process ends at last. But the causes are many, 
and fatigue is only a single contributory factor, less important than 
intercurrent competing tendencies. That is why in pathogenic nervous 
exhaustion it is a therapeutic measure to strengthen some competing 
interest—to develop some fad, play, interest, or what not. But most 
normal lives are too full of competing interests. Any monotonous work 
leads to an insistent demand for change, just as when, after lying awake 
sometimes, we turn over, not from fatigue, but because in the complex 
of competing tendencies, a little relative fatigue may lead to the entirely 
disproportionate result of a change of the whole body mass. Social 
changes are caused similarly by relative fatigue, a desire to shift the 
pressure. All the phenomena of restlessness are similar. “ They operate 
in work and play, in social and economic activities, in politics and in 
religion. Without this interference in our lives, unwelcome as it often is, 
we must have continued indefinitely in the direction of our first activity, 
with the consequent loss of that vital equilibrium on which the organism 
as a unit of different parts depends for its continued existence. “Relative 
fatigue, then,” the author concludes, “ is not a mere limitation of human 
efficiency. It is not exhaustion, but prevents it. It is a conservation 
of organic equilibrium, as well as a condition of organic development.” 

Havelock Ellis. 


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The Psycho-Physiological Theory of Right-handedness [ Theorie Psycho- 
Physiologique de la Droiterie\ (Revue Philosophique, June and 
July, 1916.) Mile. Ioteyko. 

The writer commences her article by enunciating the doctrine that 
the normal human being is asymmetrical. “In 1903,” she says, “I 
expressed the opinion that the normal man is asymmetrical. The 
principle of the bilateral symmetry of the organism, established until 
recently in biological sciences, is replaced to-day by the idea of asym¬ 
metry, which, far from being an abnormal or pathological phenomenon, 
is, on the contrary, the expression of the natural state. One of the 
halves of the body is more developed than the other from an anatomical 
and physiological point of view. In the case of the right-handed man, 
, it is the right side which is favoured ; in the case of the left-handed 
man, it is the left. Now, each half of the body being dependent on the 
hemisphere of the opposite side, one sees that in the case of the right- 
handed man it is the left brain which is most developed, whilst in the 
case of the left-handed man a greater development of the right brain is 
assumed.” This thesis is supported by references to the works of 
many observers. 

The author then proceeds to consider the various theories which have 
been put forward to explain the origin of right-handedness. They are 
numerous and ingenious, and some of them, particularly those advanced 
on anatomical grounds, deserve far more attention than has been given 
them in the paper. Herber’s theory, which approximates most closely 
to the writer’s, is fully discussed. 

In the statement and explanation of her own hypothesis, Mile. 
Ioteyko is very diffuse. The proposition may be epitomised as follows: 
Among the influences of muscular work, that which it exercises on the 
heart is the most important. Overwork of the heart is often determined 
by physical labour. Death from fatigue, which one observes in excep¬ 
tional cases, is due to stopping of the heart. Fatigue of the heart is 
then the rock to be avoided in muscular movement. It is natural to 
admit that some form of auto-regulatory mechanism must exist in man, 
some mechanism which exercises a protective action with regard to the 
heart. And the writer supposes that it is this defensive action which 
incites man to use by preference in hard work either the right hand 
alone or the two hands at once, but always avoiding the use of the left 
hand alone, because by its situation in the neighbourhood of the heart 
it finds itself in closer connection with that organ than the right hand. 
Finally, muscular work executed by the left hand ought to react more 
violently on the heart than work done by the right, and to prove the 
truth (or otherwise) of this proposition the writer carried out certain 
experiments in the psycho-physiological laboratory of the University of 
Brussels. 

The experiments were made on 32 students (22 males and 10 
females), set. about 20. The work imposed on each arm was as follows: 
The forearm being flexed on the arm, each subject was given a weight 
of 2 50 kgrm. to hold in the hand. The subject, in a standing position, 
had to raise the weight every two seconds above his head to the com¬ 
plete extension of the arm. The men were required to raise the weight 
thirty times, the women twenty. When the subject entered the labora- 


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tory, he remained at rest for several minutes. After this period of 
repose, the rapidity of the pulse was observed and noted down as the 
normal state. The work, mentioned above, having been executed with 
-one hand, the pulse-rate was again observed. Half an hour later, the 
same experiment was performed with the other hand. And later again 
it was carried out by the two hands simultaneously, each hand being 
laden with a weight of 2^50 kgrm. 

Taking the average of all the experiments, which included right- and 
left-handed men and women, the writer considers it was demonstrated 
that the fatiguing work of the left hand produced a more intense effect 
on the heart than the same work performed by the right. In examining 
the results by groups (right- and left-handed, males and females) this 
conclusion was not so clearly demonstrated. It is interesting to observe 
the enormous gain for the heart when one works with both hands 
simultaneously. The mechanical work is doubled, and the cardiac 
beats are not proportionally accelerated. 

Applying her theory to the explanation of the causation of right- 
handedness, Mile. Ioteyko considers that the right hand has developed 
greater strength than the left for the reasons enumerated above (saving 
the heart from overwork and consequent over-fatigue). Right-handed¬ 
ness is then an acquired superiority in phylogenetic development. The 
work of the right hand has reacted on the left hemisphere and produced 
its supremacy, and that not only from a motor point of view, but also 
from that of sensibility, address, and intelligence, because of the connec¬ 
tions existing between the different centres. Thus the difference between 
the two hemispheres, at first physiological, has become psychological in 
the course of time. 

In discussing the subjects of the education of the left-handed, ambi¬ 
dextrous education, etc., the writer refers at length to a system of reform 
of reading and writing proposed by Mile. V. Kipiani. 

In reading, this lady wishes to avoid the fatigue to the eyes in passing 
from the end of one line back to the beginning of the next, which 
requires constant change of accommodation. She thinks that this 
asymmetry of reading, which is performed always from left to right, and 
the abrupt and oblique movements imposed on the eyes at the end of 
each line, are the principal causes of many of the abnormalities of the 
eyes found among readers. 

In order to remedy these inconveniences, Mile. Kipiani proposes 
that books be printed in the following fashion : One line to be printed 
in ordinary characters and read from left to right in the ordinary way ; 
the next line to be printed en miroir (each letter being reversed 
laterally), and read from right to left, and so on. In thiyway continuity 
of seeing will be assured, and the abrupt movements of the eyes will be 
• avoided. 

With regard to penmanship, Mile. Kipiani advocates ambidextrous 
writing. Taking into consideration that the natural movements of the 
two hands are divergent from the middle line of the body, the right 
hand will write on a sheet of paper placed on the right side, and the 
left on one on the left side. In each case, the act of writing is to be 
performed as follows: The first line is to be written in the ordinary 
fashion; the second en miroir; the third in the ordinary way, and so 


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598 EPITOME. [Oct.,. 

on.- The sole difference between the two hands will be that each 
follows its natural slope ; the right will slope from right to left, and the 
left from left to right. 

Mile. Kipiani also makes certain statements with regard to the orien¬ 
tation of children’s drawings and of the figures in the pictures of ancient 
and modern artists. I have examined the correctness of these state¬ 
ments in an article on “ The Orientation of Human and Animal Figures 
in Art,” which appears in the present number of the Journal. 

J. Barfield Adams. 


2 . Clinical Neurology and Psychiatry. 

On the Mentality of those who Commit Suicide [Sulla Mentalita dei 
Suicidi\ [II Manicomio, April , 1916.) Prof. Francesco Del Greco. 

Sadness, or rather melancholy in the common acceptation of the 
word (1 hardly think the word depression quite conveys the writer's 
idea), tedium vita, and impulse, appear to Prof. Del Greco to be the 
most important elements in the mentality of an individual about to 
commit suicide. 

Impulse alone explains some unusual cases of suicide, especially those 
in which prisoners who have failed to prove themselves innocent kill 
themselves, or those in which people destroy themselves in anger, pain, 
or anguish. 

After excluding other causes, such as imitation, suggestion, intense 
love, etc., the author returns to the consideration of sadness and tedium 
vita, which, linked together and overlapping, become a sentiment of 
profound weariness, loneliness, and desolation. The sufferers say them¬ 
selves that life is not worth living, that life has no value. To this 
mental condition the author applies the term vuoto dell ’animo , which 
may be translated as emptiness or loneliness of the mind. The idea, 
as developed in the paper, appears to be that of an intelligent being 
who is, or becomes, conscious of being absolutely alone in infinite 
space. There is something of the sublime in the idea, particularly if 
one accepts Ribot’s theory that fear is an essential element in the notion 
of the sublime. 

Tbe writer points out that the part played in the causation of self- 
destruction by this loneliness of mind is illustrated by the rise and fall 
of the suicide rate as revealed in history, and as found among the 
various states and conditions of mankind. 

Suicide, he says, is less frequent among barbarians than among the 
civilised, less frequent among those living in rural districts than among 
those dwelling in cities, less frequent among Catholics than among 
Protestants. Suicide is a black shadow which follows the culminating 
moments of civilisation. 

The barbarian is altogether ruled by customs, superstitions, and 
moral ideas coming from without himself. With him collectiveness is 
at the maximum ; individualism at the minimum. There is not enough 
autonomy in the barbarian or primitive man for him to torment himself 
about the value of his-own being in the world. The collective aspect 
of the mind dominates him. It is not possible for him to experience 


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that agonising, terrible feeling “of solitude in the midst bf his own 
family and in the midst of his own fellow citizens,” which is seen among 
the insane melancholics and many other civilised men who are disposed 
to commit suiode. 

Reflection may reintegrate or dissolve the collective aspect of the 
mind. The two actions are illustrated in the philosophy of Plato and 
in Stoicism. 

The objective idealism of Plato was in many respects the elevation 
(and development?) of hereditary and traditional convictions by a 
master of thought. It continued through the times of civil decadence 
the “ancient interior compact,” the rules which uncultivated man had 
drawn from customs and religion. And it is to be noted that Platonico- 
Aristotelian teaching formed a constructive and substantial part of 
mediaeval thought, and of Christian and Catholic philosophy. 

In Stoicism, which was the philosophy almost official of the Roman 
Empire, there was a diffused sense of human brotherhood, but there 
was also a formidable and solitary pride. The ego, the individual, stood 
alone on emptiness and nothing. The god of the Stoic was the mind 
of the world. It was an impersonal god. And the Stoic, with all his 
thorny virtues, believed himself to be greater than his god. The Stoic 
was a tower, superb and solitary. What wonder then that in the end, 
weary of his strength and wrestling, he believed himself justified in 
committing suicide and ending it all. 

To the East we owe many cults, superstitions, and beliefs. To the 
East we owe the neoplatonism of Plotinus, and finally Christianity, 
which again linked man by an ideal thread, by a thread of love and of 
communion with another Individuality, divine and all powerful. The 
Christian idea of a God of love and goodness, ready to comfort the 
agonised mind, became a firm and unshakeable point in the midst of a 
suffering world. 

With all this ancient history we find many analogues in modern 
times. From the free examination of Protestantism to the criticism of 
modern philosophy there has been a constant work of “ interior disso¬ 
lution,” a restless, implacable search for supreme moral certitude. This 
certitude is never attained, but always wished for. 

The author sees subjectivism triumphant in all the fields of modern 
science, art, and poetry. This subjectivism culminated in romantic 
philosophy, as developed in the writings of J. J. Rouseau, De Vigny, 
and Chateaubriand, in the Werther of Goethe, in some of the works of 
Victor Hugo, and those of many other authors, where man, the ego, raised 
himself above the world and everything else. It was a solitude imperial, 
but sad, as every solitude is. In this literature human passions are exalted 
to absurdity, and every bond of dependence with the past is broken. 

The author appears to consider subjectivism (in which is included 
the idea of egoism) must in the end lead to loneliness and misery; 
objectivism (which includes the idea of altruism) to happiness and 
contentedness. “ In the work of philosophy, of art, and of science, the 
artist and the thinker find peace. The man of the world finds it in the 
universality of work, in the objectivity of work, whatever the work may 
be, if it be only worthy and directed to the good of all men.” 

J. Barfield Adams. 


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The Crime of Porter Charlton [// Delitto di Porter Charlton\ 
(II Manieomio, April, 1916.) Valtorta , Dr. Dario. 

This study in psychological and forensic medicine is a model ot 
systematic arrangement of facts. Narrative, family history, and bio¬ 
graphy occupy their proper positions in the perspective, and although 
one cannot altogether agree with the writer’s conclusions, one is filled 
with admiration for the minute and careful analysis of the physical and 
mental personality of the criminal. 

The case, which at the time of the trial assumed almost the proportions 
of a cause clllbre, but has, no doubt, been forgotten in the awful turmoil 
of recent events, may be briefly outlined. 

In the spring of 1910, Porter Charlton, an American bank clerk, 
set. 21, married Mary Scott, a divorced woman with a shady past, and 
many years his senior. Charlton obtained a situation in a bank at 
Frankfurt-am-Main. The newly married pair left New York for Genoa 
on April the 16th, 1910, intending to spend some months in Italy on 
account of the husband’s health, he being threatened with phthisis, 
before they went to settle in Germany. During the voyage the w r ife is 
supposed to have had a miscarriage. She was confined to her cabin, 
and was attended to solely by her husband. She suffered from hysteria, 
exhibited a good deal of jealousy, and the pair quarrelled frequently. 
From Genoa they went to Como, and finally settled in the lake-side 
village of Moltrasia, where they spent their time quarrelling and making 
it up, and drinking heavily. Their conjugal life went from bad to 
worse. On the night of June the 5th, 1910, Charlton murdered his 
wife. The next day he carefully packed the dead body into a trunk, 
and sank it in the lake. Then he left Como for Genoa, and took his 
passage back to New York. On his arrival at that city, whither the 
news of the murder had preceded him, he was arrested. He immediately 
confessed the crime, exonerating a Russian of the name of Ispolatoff, 
who appears to have been the only acquaintance made by the unfortunate 
pair during their residence in Italy. Charlton was detained in custody 
in America for three years, while the lawyers and the alienists were 
making up their minds about the case. In the end he was sent back 
to Italy, where he stood his trial on the charge of murder. The jury 
found that he was irresponsible for his actions at the time of committing 
the crime, and he was transferred from the prison at Como to the pro¬ 
vincial asylum, where he came under the care of Dr. Dario Valtorta, the 
writer of the article which we are considering. 

As one reads Dr. Valtorta’s charmingly written paper, one cannot 
help thinking that it contains all the materials for a rattling good novel, 
full of thrills from cover to cover. It would be up-to-date with psycho¬ 
logical studies of characters, passions, and emotions, and it has a tragic 
denouement. The mysterious Russian is a personage full of possibilities. 
For local colouring we have the romantic scenery of Lake Como, moon¬ 
light trips on the water, life h deux in a little Italian villa. There are 
minor characters in abundance, contadini and contadine, tavern-keepers, 
milk-sellers,'washerwomen, etc., etc. 

At first view, we seem to be dealing with a commonplace and sordid 
crime. A silly young man falls madly in love with a fascinating woman, 
many years older than himself, a woman who, from a respectable family 


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point of view, was decidedly impossible. He marries in haste, and 
when the bloom is rubbed off the peach, love quickly takes flight. The 
pair quarrel and drink, and drink and quarrel, and one night, when he 
was probably three parts drunk, the man knocks the woman on the 
head and kills her. 

But there are other points to be considered. Charlton’s family history 
was rather bad. His paternal grandfather was a paranoiac who died of 
chronic alcoholism at the age of 35. His mother died at the age of 39, 
probably of phthisis. A maternal uncle was violent, lazy, and dissolute. 
A female maternal cousin was epileptic. One brother was said to be 
abnormal in character. Another was said to be epileptic. 

Further, Charlton’s personal history was not good. He had had at 
least one epileptiform attack, and he had signs of commencing tubercular 
mischief in one lung. For the rest, as a boy and adolescent he appears 
to have been affectionate, gentle, passionately fond of poetry and music, 
and of an intelligence above the average. He was said to have been 
very abstemious, and even to have shown an intolerance of alcohol. 

As for the woman, Mary Scott, she must have been fascinating. Her 
past history in spite of, or perhaps because of, its shadiness brings that 
out clearly. She was just the sort of woman, if she took the trouble, to 
bewitch men. We are not told much about her personal appearance. 
She was good looking, one supposes, though that is not absolutely 
necessary, for Charlton’s imagination would have made up for all defects, 
and clothed her with the beauty of an angel. But mentally she was an 
understudy of Cleopatra. She was hysterical, jealous, and passionate. 
She was said to suffer from “sexual hyperaesthesia.” Possibly she 
suffered from uterine mischief. She also gave way to excessive drinking. 
Altogether she is painted in very black colours. But one must remember 
that in these cases the victim hardly ever gets fair play. 

Coming to the crime itself, we are told that after Charlton killed the 
woman he threw himself on a bed, and slept a long and profound sleep. 
He woke up to find the body of the dead woman lying on the floor near 
him. Dr. Valtorta draws the ghastly picture with a strong hand. When 
he was first questioned on the point, and in all subsequent examinations, 
Charlton professed to be quite oblivious of the actual details of the 
crime, and of many of the events and of many of his own actions during 
the following day. Dr. Valtorta lays great stress on this amnesia. It 
is, of course, the most important plank in his platform. He cross- 
examined his patient again and again on that point with great patience 
and subtilty. But Charlton stood firm and never budged. 

The conclusion arrived at was that the crime was an impulsive homi¬ 
cide, probably of a post-epileptic nature : the other factors in the case 
being alcoholism in a man intolerant of the drug, auto-intoxication from 
tuberculosis, and nervous exhaustion from sexual excesses. 

Can we accept the above conclusion ? The post-epileptic idea may 
be correct, but it is purely theoretical. The profound sleep after the 
committal of the crime, and the amnesia or semi-amnesia, were quite as 
likely to have been the results of drunkenness as of epilepsy, and the 
evidence of the man’s habits during his residence at Moltrasia points to 
drunkenness. Forgetfulness of events and actions during the day 
following the crime was probably due to the state of terror in which 


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602 EPITOME. [Oct., 

the man then existed. Terror is an emotion which most profoundly 
disorganises mentality. Further, in their many quarrels, the wife had 
frequently charged her husband with the loss of virility. That is a taunt 
that a young man bears very badly. There is no reason to suppose 
that the quarrelling was all on one side, and that the man responded to 
the woman’s violence and abuse only with love and kisses. On the 
contrary, the woman appears to have become afraid of the man. On 
the very night of the murder, she had put on her hat and jacket, packed 
up her portmanteau, and was about to escape from the-house during 
her husband’s absence, when he returned, and forced her to go back. 
A jugc dinstruction would have reconstructed the subsequent scene 
without the aid of psychology. 

It must be remembered that we have the man’s story, but not the 
woman’s. 

Dr. Valtorta’s paper is painstaking, elaborate and learned. But is it 
not after all a clever piece of special pleading ? Stripped of accidental 
circumstances, such as the social position of the murderer, the romantic 
surroundings of the tragedy, the unusual method of disposing of the 
dead body, and the question of extradition, the crime is, as I said 
before, commonplace and sordid. It is sordid. It does not possess 
the faintest trace of that melancholy charm which is sometimes revealed 
in a crime passionnelle. If the murder had been committed in the 
slums of London or New York, possibly the termination of the trial 
would have been different. 

J. Barfield Adams. 


Hystero-traumatism with so-called “ Physiopathic ” Syndrome Cured by 
Re-education [ Hystero-traumatisme avec syndrome dit ‘‘ physio- 
pathique ” gue'ri par la reeducation\ (Le Progres Medical, March 
10th, 191 7.) Per rand. Dr. Jean , Physician to St. Joseph's Hospital, 
Paris. 

Attempts have been made to classify the numerous forms of paralysis 
resulting from wounds in battle. Some are due to direct lesions of 
peripheral nerves and their roots : others are hystero-traumatic' in 
nature. Between these two extreme varieties there is a particular 
clinical type which must be isolated from others—paralysis of reflex 
origin. 

Certain neurologists describe a form of paralysis characterised by 
special trophic, vaso-motor, electric, and reflex troubles in the paralysed 
limb, such phenomena being sufficient in their eyes to prove the organic 
origin of the paralysis, which explains their therapeutic failures. They 
inter from this the uselessness of, even heroic, psycho therapeutic 
measures. This inference would seem to be somewhat premature, as 
observations on a case in point go to prove the contrary. It was that 
of an infantry soldier who, in May, 1915, was wounded in the right 
calf. Healing followed a normal course, and was completed in a few 
weeks. During convalescence he began to walk badly owing to alleged 
pain in the limb, which assumed the position of equinus with con¬ 
tracted Achilles tendon. A surgeon, believing that the lesion was really 
organic, severed the tendon, restoring mobility to the foot, which could 


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1917-] CLINICAL NEUROLOGY AND PSYCHIATRY. 


603 


now be easily placed flat on the ground. He could, however, walk no 
better after the operation, and, although the equine phenomenon could 
no longer be produced, owing to section of the tendon, the legassiimed 
another vicious position, being semi-flexed on t-he thigh, with immobili¬ 
sation of the knee-joint. He could only barely put his foot to the 
ground, and was extremely lame, walking with the help of a crutch. 
Again a surgeon, never suspecting a neuropathic affection in the case of 
a wounded man, did a tenotomy of the flexor tendons of the leg, 
putting it up in a plaster apparatus to maintain extension of the limb. 
The result was satisfactory only to a slight extent, but he walked with¬ 
out a crutch when he was sent to a neurologic centre in December, 
1916. 

He walked with two sticks, the right leg in a position of forced 
extension on the thigh, and flexion was impossible. The first care was 
to seek for evidence of a lesion of the terminal branches of the sciatic, 
and especially of the internal popliteal branch. There was no true 
motor paralysis, but relative weakness of all active movements. All 
passive ones were possible except flexion of the knee. There was no 
sensory trouble ; and all the reflexes were normal, a little stronger 
perhaps on the affected side. Trophic troubles were very marked. 
All the distal part of the leg was oedematous, cyanosed, almost a violet 
tint, very cold as compared with the sound limb. The skin was thin, 
attenuated, and the toes crossed each other to some extent. In the 


whole foot and lower third of the leg there was well-marked muscular 
hyperexcitability. The slightest tap on the muscles brought on violent 
contractions, and even dissociation of movements which are not usually 
independent in action, such as adduction of the great toe, or abduction 
of the little one. In a word, the case presented all the troubles 
attributed to reflex contractures or to the phenomena called “ physio- 
pathic.” 

The mental state was peculiar. A working miner, he weeps at the 
least examination, manifests absolute terror at the slightest touch of his 
affected leg, and tremblingly implores one to cure him. 

I To sum up: here was a wounded patient with a paralysed limb and 
'contraction of the knee, who presented all the signs of the paralyses 
called “ reflex,” who has been subjected to a series of tentative thera¬ 
peutic measures which have failed : a characteristic type. 

As to treatment the patient was brought into our re-education ward,and, 
after having been for a considerable time subjected to fatigue by more 
or less violent physical exercises, the contracture was, as it were, brutally 
overcome. After half an hour of passive movements of flexion and 
extension of the leg, and after showing him how he could bend 
and straighten his limb, he was induced to do this voluntarily. These 
active movements were aided and sometimes provoked by galvanic 
stimulation of painful intensity. In the end he was able to walk slowly, 
while he bent both knees fully, and, after a treatment lasting about two 
and a half hours, he was cured. 

The case was a particularly bad one, for surgical immobilisation had 
caused intra-articular adhesions in the knee which it was necessary to 
rupture. A slight amount of hydrarthrosis followed next morning, 
but a few days later he walked like any normal person. 



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604 EPITOME. [Oct.,. 

This, though a remarkable case, is not a solitary instance of the 
kind, and Dr. Ferrand has published the general result of his researches 
on the subject. The clinical type which has been sought to be created 
does not seem sufficiently differentiated. We need only cite in proof 
the successive denominations which have been given it. The term 
“ reflex contracture ” assumes a condition which very often does not 
exist, for there is flaccidity in many of these paralyses. Moreover, the 
term “ reflex ” implies a pathogenic idea, which is already abandoned 
by the creators of the clinical type. It has been designated a “ physio- 
pathic. disorder,” a term which is not very precise, and has hardly more 
significance than the old term “ functional.” In the minds of the 
authors this term “ physiopathic " would imply the idea of an organic 
lesion, or at least one not functional in character. And the syndrome 
thus created is, in their descriptions, opposed not to an organic, but to 
an hysterical syndrome. In this view Dr. Ferrand cannot share. 

He concludes his article with the following summary : 

(1) Physiopathic symptoms exist, but they do not constitute an inde¬ 
pendent clinical syndrome Many patients presenting these special 
symptoms, separate or combined, are cases of organic affections with 
lesions of peripheral nerves; moreover, direct and not reflex. 

(2) There is but little relation between the reflex lesions described 
by Charcot as occurring in chronic arthritic cases and post-traumatic 
lesions. These latter are, moreover, described by him also amongst 
the hystero-traumatisms. 

(3) The symptoms are not completely new. 

(4) They are to be found to-day in many wounded who do not 
present any organic lesion, but merely ordinary hystero-traumatisms. 

(5) They do not constitute any contra-indication to pyscho-thera- 
peutic treatment, even of an heroic kind, and these patients are cured 
as well as others. In any case, from the fact of a failure of cure it is 
not to be inferred that they are not the subjects of hystero-traumatism ; 
for some succeed where others have failed, of which the patient whose 
case has been recorded is an example. 

(6) From a medical and military point of view, such patients (when 
they have not been attacked with organic affections) should be considered 
and treated as cases of hystero-traumatism. It would be dangerous to 
make them out to be organically diseased or to treat them as such, for 
the contagion of example would make ravages in neurological centres. 

(7) To cure these patients we must employ all the most energetic 
means which the authorities have placed at our disposal, from moral 
suasion to the most painful electric currents. In this way multiple 
successes are achieved, and the Army recuperated with vigorous 
subjects. 

Such are the conclusions to which Dr. Ferrand and his colleagues 
have been led by a practice of eighteen months in one of the most 
important neurological centres in France. T. Drapes. 


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1917-] CLINICAL NEUROLOGY AND PSYCHIATRY. 6o$ 

Premonitory Ailments indicative of Incipient Pulmonary Tuberculosis 
\Propathies rlvllatrices de tuberculose pulmonaire\ {Le Progr'es 
Mldical, May 5 th, 1917.) Raymond, Dr. Paul. 

Although not of direct psychiatrical interest, having regard to the 
fact that phthisis is of such common occurrence in asylums, and 
also to the importance of early diagnosis upon which a favourable result 
so often depends, this paper is of considerable interest from a clinical 
point of view, and not without practical value. 

That such affections as sciatica (neuralgic variety), herpes zoster, 
psoriasis, erythema nodosum, and possibly arthritic disorders, are not 
infrequently prodromata of tuberculosis is probably not very generally 
known. That the detection of pulmonary phthisis injits earliest stages 
is often extremely difficult is admitted by most author ties ; any means, 
therefore, which will aid in its discovery- before the disease becomes 
established becomes of unquestionable value. And Dr. Raymond 
urges the importance of a most careful examination of the lungs in 
any case in which the above-mentioned diseases occur. At the Larrey 
military hospital at Versailles he has had opportunities of observing many 
cases which exemplified the connection between these maladies and 
tuberculosis. None of the patients were sent into hospital on account 
of pulmonary trouble, but with a view to treatment of the more 
obvious affections from which they were suffering. Thus, five cases of 
sciatica were admitted, one of whom was also the subject of psoriasis 
and arthritic troubles, and the point of importance about these cases 
is that the minor affections in most instances manifest themselves long 
(in one case tw r enty-one months) before any pulmonary mischief reveals 
itself. And patients sometimes appear to be in robust health when 
first seen, and then, only some months later, begin to suffer from any 
overt signs of commencing phthisis, such as cough, loss of weight, etc. 
In many of them there was a tubercular family history. Dr. Raymond 
attributes the prodromal maladies to the action of bacillary toxins on 
peripheral nerves, and, through them, on the skin, starting from a 
latent pulmonary tubercular focus. 

Dr. Raymond does not claim to be the first to note the connection 
between phthisis and these prior ailments which he has found to 
be so often the prelude to it. Peter, in the case of sciatica; Leudet, 
Lemonnier, and Flers, in that of zona ; Gauchet, as regards psoriasis ; 
and several writers with respect to erythema nodosum have drawn 
attention to the relationship between these and pulmonary disease. 
But he considers the profession generally does not realise the import¬ 
ance of such connection, and its usefulness as affording an opportunity 
for much earlier treatment of tuberculous patients than would other¬ 
wise be the case. The practical outcome of his researches is to 
emphasise the necessity in every such case, especially if persistent and 
obstinate to treatment, of making a minute and exhaustive examination 
of the lungs for signs of incipient disease, and not to be too ready to 
regard them as distinct autonomous morbid entities. 

The facts already known as regards the development of psoriasis 
over the area of a nerve distribution enable us to understand how this 
may be similar to what occurs in zona, in so far as both may be evi- 
LXIII. 40 


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NOTES AND NEWS. 


[Oct, 


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■dence of a suffering nerve reacting to a bacillary toxin. The relation 
of erythema nodosum to innervation is more difficult to comprehend, 
but the fact of its localisation always in the same areas is a proof of 
the intervention of the nervous system. By its susceptibility to 
microbic poisons, and particularly to those of tuberculosis, the nervous 
system becomes a veritable touchstone, and plays a highly important 
rile in diagnostic procedure. T. Drapes. 

_) _ : __ _ 


Part IV—Notes and News. 


THE MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREAT BRITAIN 

AND IRELAND. 

The Seventy-Sixth Annual Meeting of the Association was held in the 
rooms of the Medical Society of London, on Wednesday, July 25th, 1917, 
Lieut.-Colonel David G. Thomson, M.D., R.A.M.C., President, in the chair. 

There were present-. Sir George H. Savage, Drs. T. Stewart Adair, G. F. 
Barham, A. Helen Boyle, D. Bower, P. E. Campbell, M. Craig, J. Chambers, 
W. H. Coupland, J. F. Dixon, E. L. Dove, T. Drapes, J. H. Earls, R. Eager, 

F. H. Edwards, C. F. Fothergill, A. H. Griffith, H. E. Haynes, G. B. James, 

G. H. Johnston, J. C. Johnstone, J. Keay, N. T. Kerr, N. Lavers, H. Wolseley- 
Lewis, C. Mercier, A. Miller, G. E. Miles, H. H. NeWington, H. J. Norman, 
E. S. Pasmore, H. Rayner, J. N. Sergeant, G. E. Shuttleworth, R. Percy Smith, 
J. G. Soutar, J. B. Spence, T. E- K. Stansfield, James Stewart, R. C. Stewart, 

H. F. Stilwell, R. J. Stilwell, J. Tattersall, J. Turner, E. W. White, and R. H. 
Steen (Acting Hon. General Secretary). 

Visitor-. Dr. J. F. Briscoe. 

Present at the Council Meeting-. Lieut.-Colonel D. G. Thomson, M.D., R.A.M.C. 
{President), in the chair, and Drs. T. S. Adair, J. Chambers, T. Drapes, R. Eager, 
j. Keay, N. Lavers, A. Miller, H. H. Newington, H. J. Norman, J. N. Sergeant, 
J. G. Soutar, T. E. K. Stansfield, H. Wolseley-Lewis, and R. H. Steen (Acting 
Hon. General Secretary). 

The following sent communications expressing regret at their inability to be 
present: Drs. J. R. Gilmour, G. D. McRae, R. R. Leeper, C. C. Easterbrook, 
W. H. B. Stoddart, John Mills, R. B. Campbell, G. N. Bartlett, J. G. Porter 
Phillips, R. L. Oswald, and R. H. Cole. 

Minutes. 

The President said that as the minutes of the last annual meeting had already 
appeared in the Journal, perhaps it would be the wish of the meeting to take 
them as read. 

This was agreed to, and the minutes were signed. 

Election of Officers, Council, and Standing Committees. 

The President nominated Drs. Turner, Adair, Dixon, and Norman as 
scrutineers for the ballot. 

After the ballot had been taken. 

The President declared that the officers who had been nominated had been 
duly elected. 

Election of Auditors. 

The President said Dr. Percy Smith and Dr. Maurice Craig had acted in that 
capacity for the past year, but Dr. Percy Smith wished to be relieved of his 
duties, so that it became necessary to elect another auditor to take his place. He 
understood that Dr. Edwards, of Camberwell House, was willing for his name to 
be put forward to fill the post. Drs. Maurice Craig and Edwards were accordingly 
elected. 


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19 * 70 


NOTES AND NEWS, 


607 


Election op Standing Committees. 

The President proposed the re-election of the whole of the Standing Com- 
mittees, en bloc. It would be open, however, to any member to propose an 
additional name, or to move for the deletion of a name. 

Dr. Steen proposed the addition of Dr. H. J. Norman to the list of members 
on the Education Committee. 

This was agreed to. 

Annual Report op the Council for the Year 1916. 

Dr. Steen read the Report of the Council for the year. 

The number of members—ordinary, honorary, and corresponding—as shown in 
the list of names published in the Journal of Mental Science for January, 1917, 
was 685, as compared with 696 in January, 1916. 

The following table shows the membership for the past past decade: 


Members. 

1907. 

1908. 

1909. 

I9IO. 

1911. 

1913. 

•913- 

■9M. 

19*5- 

1916. 

Ordinary 

Honorary 

Corresponding 

645 

30 

IS 

652 

29 

15 

673 

32 

17 

680 

33 

17 

690 

34 

19 

696 

35 

19 

695 

34 

18 

679 

34 

18 

644 

34 

18 

635 

32 

18 

T otal 

690 

696 

722 

73° 

743 

750 

747 

73i 

696 

685 


The number of new members elected and registered during the year 1916 was 
15, a decrease of 9 on the previous year. The names of 3 members which had 
been removed were restored. The number of members who resigned or whose 
names were removed by the Council under Bye-law 17, owing to arrears of 
subscription, was 19. 

It is with regret that 8 deaths have to be recorded. Among these were 
Dr. Orange, a past president, and Dr. Adam R. Turnbull, a president-elect. 

The result of these changes is that there has been a decrease of 9 in the ordinary 
membership. 

The Association may be congratulated upon the fact that in these times of 
stress the membership has been so well maintained. This record speaks well for 
the numerous members on active service whose loyalty to the Association is most 
gratilying to their colleagues who have remained at home. 

Owing to the war the Annual and all the Quarterly Meetings have been held 
in London and without the usflal social accompaniments. These meetings were 
well attended and valuable papers were read which led to interesting and useful 
discussions. 

The Divisions have also held the usual meetings, which, considering all things 
have been well attended. The Divisional Secretaries are to be congratulated 
upon the success of their endeavours to “ carry on ” during the war. 

Though there has been a lull in legislative measures affecting the specialty 
the Parliamentary Committee has met regularly and carefully watched over the 
interests of the Association. 

The Educational Committee has also met frequently and prepared regulations 
for the training and examining of those who devote themselves to the care and 
nursing of the mentally defective. These regulations follow closely those 
connected with the certificate of proficiency in nursing and attending the insane 
and will be presented for your acceptance this day. 

Special Committees have been appointed by the Council. One of these 
concerned with the College of Nursing and the Bill for the Registration of 
Nurses has been active in safeguarding the welfare of asylum nurses. A second 
Committee has dealt with the question of the formation of over-seas divisions 
of the Association. Though at the present time it is impossible to bring forward 
any schemes in furtherance of this aim much useful information is being collected 
by the Committee. 


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6o8 NOTES AND NEWS. [Oct., 

Letters have been received from members in regard to difficulties met with in 
carrying on their work, and communications have been made to the Government 
offices concerned. 

The Journal has well maintained its high standard, and the Council desires, 
to record its appreciation of the work of Dr. Drapes, on whom the main burden 
has fallen, in that he has so successfully overcome the many troubles which he has 
had to contend with. 

The debt of gratitude which the Association and the Council owe the Treasurer 
has been increased by his continuing to nurse the finances of the Association in 
spite of diathetic and other disabilities.) 

Thanks are due to the Registrar, the Divisional and Committee Secretaries, 
who, though pressed by additional private work, have devoted much time and 
energy to their respective offices. 

The chair at the Annual, Quarterly, and Council Meetings has been taken by 
Lieut.-Colonel D. G. Thomson, who has presided with dignity and courtesy. 

He moved the adoption of the Report. 

The President moved, as an addendum to that Report, the following: “That 
the Council feel bound to accord its warmest thanks to the Acting General 
Secretary, Dr. Steen, for his ceaseless labours in that office.” Members would 
know that all through the year Dr. Steen’s attention had been called to a multitude 
of affairs, which demanded foresight and ready action, in spite of all the cares 
of his professional office in these exacting times. The affairs of.the Association 
had never been more clearly, accurately, and effectually brought before its members. 

The Report of the Council, with this addendum, was then put and carried. 

Treasurer’s Report. 

Dr. Hayes Newington (Hon. Treasurer) submitted his Report. The Auditors 
might have some remarks to make of their own, and, if the meeting would allow 
him, he would say anything which might be necessary after those gentlemen had 
spoken. He would like the Association generally to know that not less than 
one-fourth of its registered members were acting on, or in connection with 
the war, namely, 161 out of 644. That fact would account, to some extent, 
for the difficulties about subscriptions. He could only endorse what the General 
Secretary read about the sense of loyalty shown by these members to the old 
Association. 

The Report was approved. 

Report of the Editors of the Journal. 

In presenting their Report the Editors feel that it is so far satisfactory that 
during, these times of stress, involving, as was inevitable, a large reduction of 
scientific research and literary output connected therewith, sufficient material has 
come into their hands to enable them to keep the Journal fairly up to its normal 
dimensions. This desirable result, however, they feel it will be hardly possible to 
maintain until war conditions no longer exist. The restrictions in force as regards 
paper supplies have become still more stringent of late, and the printers find it 
difficult to obtain sufficient for their requirements. The aggregate number of pages 
in the Journal for 1916 was, in round numbers, 840, giving an average of 210 for 
each issue. The January issue of the current year contained 163 pages, the April 
number 150, and some little time ago we received an intimation from the printers 
that 128 pages will probably have to be the limit in future. The difficulty might 
be met—provided that material is forthcoming—by reducing the size of the print, 
although that would be a matter for regret. It would, however, we trust be only 
necessary as a temporary measure" of relief. As the circulation has notably 
diminished since the commencement of the war, the Editors thought it advisable 
to reduce the number of copies printed from 1125 to 900, thereby effecting a saving 
in cost, and also obviating an accumulation of surplus copies. They trust that 
this step will meet with the approval of the members. 

The total amount of expense connected with the production of the Journal for 
the year 1916 was, as shown in the Treasurer’s Statement, .£578 10s. 11 d., as com¬ 
pared with ^361 10s. 4 d. for the previous year—a difference of £2l^ os. 7 d. This 
increased expenditure was, of course mainly due to the enormous increase in the 


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6lO NOTES AND NEWS. [Oct., 

cost of paper, which has advanced by from 300 to 400 per cent. The cost of 
labour has also risen considerably. The difference between the two years, more¬ 
over, would not be so great but for the fact that, as members no doubt recollect, 
in 1915 the October number, for reasons stated at the time, was limited to a mere 
record of business matters, forming only a small pamphlet, which reduced the cost 
of production for that year by some £$o or £60. This circumstance makes the 
difference appear larger than it would otherwise have been. Probably about £160 
would be more nearly correct. 

The Editors appreciate greatly the kind support they have received from the 
various contributors to the Journal, and they feel they are particularly indebted to 
that veteran and distinguished member of the specialty, Dr. Henry Maudsley, for 
his valuable paper which appeared in the January number of the current year. 
They also gladly acknowledge the help afforded them by the Assistant Editors, 
Dr. McRae and Dr. Devine, especially in the matter of proof reading, which, 
useful and necessary as it is, entails not a little drudgery, and a very considerable 
expenditure of time. They are also indebted to our acting General Secretary for 
practical suggestions which he has been kind enough to give on different occasions. 

The Editors have again to regret the delay in the appearance of the Journal, 
which has been almost entirely due to labour difficulties, these having been, under 
present circumstances, absolutely insurmountable. John R. Lord. 

Thomas Drapes. 

Dr. Drapes read the Report, and moved its adoption. It was agreed to. 

Report x>r Auditors. 

Dr. Percy Smith read the Report as follows: 

We beg to report that we have examined the Treasurer’s accounts for the year 
1916, and seen the vouchers for payments made on behalf of the Association, and 
find them, as usual, in perfect order. 

The outstanding feature in the Association’s expenditure for the year has been 
the increased cost of publication of the Journal, which is inevitable owing to the 
advanced price of paper and labour. 

The income of the Association shows a net decrease of ^91 16s. 2d., which is 
partly due to those members who are on active service abroad and have been 
excused their subscriptions, and partly to diminution in receipts from fees for 
examinations. There is also a diminution in the total membership of the Associa¬ 
tion, as the wastage is not at present made up by the usual number of new members. 

The dividends show an increase of £15 5 s. 2d., which will be more in the future, 
as in 1916 a further £500 was invested in Exchequer Bonds, which have now been 
converted into War Loan Stock, of which the Association now holds ^1500. 

The amount written off for unpaid subscriptions was ^37 15s. o d. as compared 
with .£65 3s. o d. in 1915, but we regret to notice the increased volume of subscrip¬ 
tions remaining unpaid on December 31st, 1916, which amounts to ^312 7s. 6d. 
This, however, may be partly explained by the number of members on service 
abroad who are not receiving the Journal at present. We understand from the 
Treasurer that a considerable proportion of this outstanding amount has been paid 
in the cuijent year. We are impressed by the enormous amount of labour 
entailed on the Treasurer and his assistant by the delay in payment of subscrip¬ 
tions by members. 

The value of the Stocks held by the Association has again had to be written 
down by no less a sum than £331 19s. 3d .; on the other hand, in spite of this, the 
value of Stocks at present held by the Association is ^3065 15s. 6d. as against 
^2897 14s. 9 d. at the end of 1915. 

The Association is especially indebted to the Treasurer for the very able way 
in which he continues to conduct its finances during the present critical times. 
We notice that he has now acted as Treasurer for a period of twenty-three years, 
and his work cannot be too highly appreciated. Although in the past a note of 
recognition has always been accorded to his chief assistant, we feel that the 
time has now come when Miss Newington’s name should be definitely mentioned 
as the one referred to, and to whom the Association owes its best thanks. 

R. Percy Smith. 

Maurice Craig. 

He moved its adoption, and it was agreed to. 


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Annual Report op the Educational Committee, 1916-17. 

Dr. Steen read this Report, as follows: 

This Committee has held four meetings during the year, and although abnormal 
conditions have existed with regard to travelling, the attendances of the members 
have been very fair. 

Two candidates presented themselves for the Professional Certificate Examina¬ 
tion and both were successful. 

After a lapse of four years the Gaskell Prize has again been competed for. 
There were two competitors and the award has been made to Major James Cowan 
Woods, of The Priory, Roehampton, now serving in the R.A.M.C. 

The number of entries for the Nursing Certificate Examinations has been very 
well maintained. 

The Sub-Committee dealing with the framing of the Regulations and Syllabus 
for the Training and Examination of Candidates for the Certificate of Proficiency 
in Nursing and Attending re Mentally Deficient have presented their report. This 
has been accepted and approved by Council. The proofs of the Regulations and 
Syllabus have been received from the printers, and can be obtained from the 
Acting General Secretary. 

The question as to the advisability of electing a Deputy Registrar in Cape 
Colony has been raised, and is now under consideration. 

Maurice Craig, Chairman. 

J. G. Porter Phillips, Hon. Secretary. 

He moved that the Report be adopted, and this was carried. 

Report of the Parliamentary Committee, 1916-17. 

Dr. Wolseley-Lewis read this Report, as follows: 

During the past year your Committee has met on four occasions. 

The following are the chief subjects that have received attention : 

Nurses’ Registration. 

The College of Nursing. 

The proposed Ministry of Health in its relation to Asylums. 

The Central War Committee and the calling up of Army Medical Officers. 

On each of these subjects resolutions have been forwarded to your Council, 
and action has been taken with a view to safeguard the interests of the Asylum 
Service. H. Wolseley-Lewis, Chairman. 

R. H. Cole, Secretary. 

He wished to add to the Report the statement that it had been recognised by 
the Parliamentary Committee that the question of a Ministry of Health was a 
very important one, and the Committee had made a recommendation to the 
Council to-day which had resulted in the decision to form a Special Committee 
to watch this matter and have power to act in whatever way they might deem fit. 
He moved the adoption of the Report. 

This was agreed to. 

Report of the Library Committee. 

Dr. Steen submitted this Report, as follows: 

The Committee have to record, with gratitude, that during the past year, 
gifts to the Library have been made by Drs. M. Craig, B. Hart, T. B. Hyslop, 
P. W. MacDonald, H. Maudsley, W. Rawes, R. H. Steen, and W. A. White 
(Washington). 

The Committee are desirous of increasing the usefulness of the Library, and are 
willing to purchase such new books as any member may suggest to be advisable. 

Certain medical periodicals have been circulated among those members who 
have asked to be placed on the list though owing to the difficulties of transmission 
several American Journals have come at intervals which are less regular than 
in ordinary times. 

The Committee are anxious that more members should take a personal interest 
in the Library, and donations of books dealing with psychiatry will always be 
acceptable. Henry Rayner, Chairman. 

R. H. Steen, Secretary. 

He moved its adoption. Carried. 


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612 notes and NEWS. [Oct, 

The President said there was no report from the Research Committee, nor 
from any Special Committees. 

Motions involving Expenditure of Funds. 

Dr. Steen asked that the approval of the meeting be given to the usual annual 
item of £25 for the Library. This the Association had kindly granted to the 
Library for many years past, and he asked now for its repetition. 

Agreed. 

Dates for the various Meetings for the Year. 

The suggested dates on the agenda were formally approved, namely: Tuesday, 
November 27th, 1917; Thursday, February 21st, 1918; Tuesday, May 21st, 1918; 
July-,19*8. 


Election of Honorary Members. 

The President said his next duty was to bring before the meeting the names 
©f two gentlemen as candidates for the Honorary Membership of the Association: 

Colles, John Mayne, LL.D. (Univ.Dub.)., K.C., J.P., Registrar in Lunacy 
(Supreme Court of Judicature in Ireland), Lunacy Office, Four Courts, 
Dublin. * 

Proposed by Lieut.-Colonel D. G. Thomson, M.D., R.A.M.C., and Drs. 
T. Stewart Adair, Thomas Drapes, James Chambers, Richard R. Leeper, 
and R. H. Steen. 

Urquhart, Alexander Reid, M.D.Aber., LL.D.Aber., F.R.C.P.Edin., late 
Physician Superintendent, James Murray’s Royal Asylum, Perth. 
“Tamachie,” St. John's Road, Meads, Eastbourne. 

Proposed by Lieut.-Colonel D. G. Thomson, M.D., R.A.M.C., and Drs. 
T. Stewart Adair, T. Drapes, J. Chambers, H. H. Newington, and 
R. H. Steen. 

He asked Dr. Drapes to say a few words in support of the proposal concerning 
Dr. Colles. 

Dr. Drapes said he had no idea he would be called upon to say anything with 
respect to Dr. Colles, until a few moments ago. Dr. Colles was an eminent 
member of the Legal profession, and he had always taken the warmest interest 
in the welfare of the insane, no man more so. At the same time, he had won 
the confidence of all the officers of asylums in Ireland, to whom he had always 
shown the greatest kindness and consideration in every possible way. He did 
not think anyone deserved this honour more than did Dr. Colles, and he had great 
pleasure in supporting his candidature. 

The President said he would ask Dr. Hayes Newington to say a few words on 
behalf of his very old friend, Dr. Urquhart. 

Dr. Hayes Newington remarked that he did not think he need say much 
in support of the election of Dr. Urquhart as an Honorary Member of the 
Association; the amount of work he had done justified his election. It was 
scarcely necessary to remind the Association that for many years he was the 
moving spirit of the Journal, and a splendid editor he was, in all ways. He was 
never idle in the affairs of the Association. He was not only a good man for 
proposing measures, he was also active in opposing anything which did not seem 
to him to be quite suitable. In that way he had done much for the honour of 
the Association, and had prevented it proceeding too fast on many occasions. 
If Dr. Urquhart had not earned by his services the honour it was now proposed 
to confer upon him, he would have been fit to be so elected on his own merits, 
as a learned, educated, and experienced member of this specialty. He did not 
know that there was anybody who had so thoroughly replaced Dr. Hack Tuke 
as Dr. Urquhart had; he knew the inside of psychiatric work on the Continent 
as well as he knew the inside of that work in this kingdom, and in that respect 
he did great service to many members of this Association by pointing out what, 
of the best kind, was being done abroad. He, the speaker, therefore, felt no 
hesitation in recommending Dr. Urquhart to the Association’s favour. 

1 he President nominated Dr. Dixon and Dr. Norman as scrutineers. 

The ballot, taken separately, revealed the unanimous election of both gentlemen. 


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The ballot was then taken for the following candidate for Ordinary Membership : 

Dunn, Edwin Lindsay, M.B., B.Ch., Trin. Coll. Dub., Medical Superintendent, 
Berks County Asylum, Wallingford, Berks. 

Proposed by Drs. H. R. Abbott, T. S. Good, and R. H. Steen. 

He was duly elected. 

The meeting then passed to the following item : To consider proposed Regula¬ 
tions and Syllabus for the Training and Examinations of Candidates for the 
■•Certificate of Proficiency in Nursing and Attending on the Mentally Defective.( l ) 
The President called upon Dr. Maurice Craig to explain. 

Dr. Maurice Craig said he had been asked to explain as Chairman of the 
Sub-Committee which was appointed to consider this matter. The question 
was as-to whether the time had not now arrived when there should be a certificate 
granted for nursing mentally defective people, on the same lines as that for 
ordinary mental nursing. The Sub-Committee went into the question, and tried 
to graft the new side of it on to the old. That, however, was found to be 
impossible, because the whole training seemed to be different in the latter part. 
They then decided to take the first, the preliminary part, as it now stood for the 
ordinary certificate. But in regard to the second part, it was found necessary 
to alter it very considerably, so as to meet the conditions in regard to the case 
of the mentally defective, both as to training and the Law. The Sub-Committee 
made as few alterations as possible, and, whenever that could be done, they 
adhered to the same wording. The alterations made were only done in such a 
way as to make the scheme practicable in the various institutions for the mentally 
defective. If the scheme as now presented were adopted by the Association at 
this meeting, it would be necessary to decide which institutions would be approved 
by the Council as training places. That, however, had been the case all the way 
through ; applications from various institutions which asked to be recognised 
under the nursing scheme had constantly been brought before the Council. 
Another matter which came up for consideration was, whether the Association 
was going to deal with the training of the nurses, or whether they were going 
to try and include in it the teachers too, for there were two classes in these 
institutions—teachers and nurses. When this matter was entered into, the 
Sub-Committee at once found itself faced with difficulties if the attempt were 
persevered in to include teachers, as there were other bodies working from that 
side. Therefore, the Sub-Committee, which was largely composed of medical 
superintendents and medical officers of institutions for the mentally defective, 
decided that the only way was to restrict its attention absolutely to the nursing 
side; that the certificate should be granted on those lines, but that teachers 
should be eligible for the certificate if they complied with the rules laid down. 
The proposed certificate for nursing mentally-defective people was practically on 
the same lines as the existing certificate for nursing mental patients. It was 
felt that it was very desirable to pass this through at this meeting, because new 
rules were being brought in with reference to the mental defectives, and if this 
Association did not accomplish something of the kind, other bodies might. Even 
now, it would be some months before a start could be made. The Sub-Committee 
was in agreement with the central Committees of these institutions for the mentally 
-defective, and everything proposed was in accord with the views of the Board 
of Control. Acquiescence on the part of the Association would mean that this 
body would take its due position on the matter, and its function would not be usurped 
by others. He moved that the proposal submitted and circulated, be approved. 

Dr. Percy Smith said some members had not seen a copy of the proposed 
Regulations. Either they should be read in full to the meeting, or each member 
should be furnished with a copy. 

Dr. Maurice Craig replied that the difficulty in regard to supplying each 
member with a copy was one of the supply of paper. He drew attention to the 
paragraph to the effect that a copy could be obtained. 

Dr. Steen reminded Dr. Percy Smith that there were 650 members of the 
Association, and it was thought a better plan to notify that any member desiring 
a copy could be supplied with one. A number of members did write for a copy, 


(*) See Notes and News, p. 630. 

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[Oct.,. 


and it was furnished. Also, a copy was on view at the Association’s Library in the 
building. He thought everything reasonable had been done. 

Dr. Rayner said he supposed the new Regulations would be printed in the next 
issue of the Journal. 

Dr. Steen replied that this would be done if the Association wished it. 

Dr. Wolseley-Lewis said he would be happy to second Dr. Maurice Craig’s 
proposal. He agreed that it was urgent that the proposals should be accepted. 
He had attended one or two meetings of the 9 . A.M.D., and as an opportunity 
had been given to members to become acquainted with this, he thought the 
proposals should be carried through at this meeting. 

Dr. A. Hume Griffith asked whether the case of epileptics was included in 
the proposed Regulations. 

Dr. Maurice Craio replied that only those who came under the Mental 
Deficiency Act would be included. In the case of the certificates for mental 
nursing the Act had to be carefully followed, and the corresponding Act must be 
followed in the Regulations for inentally-defective patients. 

Major Ernest White said he took it that there was no finality about 
this proposed Certificate; that it could come up for revision in twelve months’ 
time, and any regulation changed which had not been found to have worked 
satisfactorily. In introducing regulations for a new certificate it was almost 
impossible to produce perfection at first, a fair period of trial was needed, and if 
after due trial revision was found to be needed, that would be a simple matter. 

Dr. W. H. Coupland said he was a member of the Sub-Committee, and this 
matter was gone into with very great care. He agreed with Dr. Maurice Craig 
that the matter was urgent; it was necessary for this Association to get into 
train some kind of certificate dealing with the mentally defective. They in the 
sphere of treatment of mental defectives had felt very much the need of something 
of the kind, and there was great need for uniformity. The C.A.M.D. was in 
negotiation with the Board of Education to take a certain course, and it was 
necessary for this matter to be dealt with at once, so as to have a clear ground 
of action. It was not known when the Government might decide to alter the 
Mental Deficiency Act—certainly it sadly needed alteration—and it was thought 
there should be a certificate for attendants until such time as action might be 
taken. 

Dr. Dixon said he would like to point out the danger of confusion between 
this certificate and that for nursing the insane—the present Certificate. He 
thought the Certificate for Nursing Mental Defectives should bear a title less 
confusing. 

Dr. Maurice Craig replied that the Sub-Committee had kept closely to the 
Law the whole way through, and the terms of the Act had been used, not the 
Committee’s own. 

The President said he clearly saw the point which Dr. Dixon had in his 
mind; it was that people possessing this certificate might pose as able to nurse 
the certified insane, whereas they might not be so qualified, and did not profess 
such capacity. He asked whether that point was considered in committee, and 
thought if Dr. Dixon had any alternative to suggest, the meeting should hear it. 

Dr. Maurice Craig said that it was decided that the Certificate and badge 
should be quite different ones, nevertheless he thought Dr. Dixon’s point should be 
borne in mind. 

Dr. Dixon said he had only just seen this, so he was scarcely prepared to give 
an alternative. 

Dr. Maurice Craig replied that the objection to the term “Feeble-minded” 
in this place was that it was a definite term under the Act, and it would only 
apply to a certain proportion of the people. That was the difficulty which was 
felt in getting a term at all.' 

The proposed Regulations were then unanimously agreed to. 


* 


Presentation of the Gaskell Prize. 

The President said it now became his duty to present the Gaskell Prize for 
this year. No Divisional Prizes were being awarded, most of the Association's 
younger members being absent on National Service. The winner of the Gaskell. 


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Prize, consisting of a sum of Fifty guineas and a Gold Medal, had been awarded 
to Dr. James Cowan Woods, Major, R.A.M.C., of the Priory, Roehampton. 

He then presented the Prize to Dr. Woods. 

In connection with this Prize, he had to announce that the runner-up sent in a 
contribution of such exceeding merit that the Council had decided to award a 
Second Prize to him, also from the Gaskell Foundation. The winner of this was- 
Dr. Monrad-Krohn, and it would consist of Fifteen guineas, and a silver replica 
of the Medal. 

Thanks to the President. / 

Sir George Savage said that as Senior Past-President of the Association and 
one of the oldest members, he once more had the great pleasure to propose a 
Vote of thanks to the President. It was a record presidency of a record President. 
It was unusual for a president to hold office for so many years, but he had served 
the Association so well during the period of the war; and he (the speaker), was 
more than ever impressed with his self-sacrifice when recently travelling from 
Liverpool Street Station, with its crowds of people, for the President had come 
not once or occasionally, but at every meeting he was present. 

Major Ernest White said he had been invited to second this proposal, and 
he regarded it as peculiarly felicitous, because, of the public asylum superintendents 
who were elected in the Jubilee year, Lieut.-Colonel Thomson and himself were 
the only survivors in England. And when he harked back and thought of the 
Institution with which the President had been so long associated, he remembered 
that, from boyhood, he spent many happy days there with Dr. Thomson's 
predecessor. Dr. Hills. The charms of the old River Yare and the surroundings 
of that happy spot had for him a very great attraction, and that had ever remained 
true. He had again visited the spot in more recent years, and seen the marked 
improvements which had been effected under his master hand, structurally and 
in other ways. There, during the past three years, Lieut.-Colonel Thomson had 
filled one of the most important positions in the hospital world and for the State. 
So that, apart from the work which the President had done for this Association, 
he had done a great work for the State, and, therefore, his fellow members had 
all the more reason to be proud of him. They would wish to congratulate him 
on his three years of strenuous work for the Association, and hoped that the 
fourth year, on which he had now entered, would bring peace to this land, and 
with it the promise of all the good which we had enjoyed in the days gone by. 
All would wish him "God speed I” in his work. 

The vote was carried by acclamation. 

The President said it was not his intention to make a speech, but he desired 
to thank the members very much for their toleration of him for a third year, and 
to express the blessed hope that when peace time came, the Society would elect 
a new President. 

He would now call upon Dr. Mercier, whom all were especially delighted to 
see among them in person. The Council feared they were only going to have his 
spirit, but here he was in body and mind. 

Dr. C. A. Mercier: Mr. President and Gentlemen, I have to apologise to you 
for depriving you of a treat. This paper of mine was to have been read by 
Sir Bryan Donkin, who very kindly, in the event of my unavoidable absence, 
undertook to read it for me. My absence was unavoidable, but, like unavoidable 
things, it has been avoided. I had to come up to town on urgent business 
to-morrow, and I anteponed my visit by one day. The only drawback to these, 
otherwise, pleasant meetings is that, by a kind of convention—I do not know 
that it is a rule—one is not allowed to smoke in this room. But there is no 
prohibition against going to sleep; it is a privilege of which I have often availed 
myself on these occasions, and if any of you desire to do likewise on this hot 
afternoon, pray do not consider my feelings. (See p. 488 for Dr. Mercier’s 
paper on “ Madness and Unsoundness of Mind.”) 

Sir George Savage said he would like, first, to introduce to Dr. Mercier, and 
to show the President an engraving in which he, the speaker, was represented as 
a lecturer at Guy’s Hospital saying “ There is no such thing as insanity.” 

There was a great deal that was interesting in what Dr. Mercier had said in 
his paper. The Association expected an intellectual treat, and it had had it. 
Of course, it was felt that Dr. Mercier wielded a very sharp sword when it came 


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6 l6 NOTES AND NEWS. [Oct., 

to a question of logic. He feared most of the members did not agree with the 
author, because their’s was the practical view, whereas Dr. Mercier’s was rather 
the theoretical. Dr. Mercier was not insane, but undoubtedly he had one 
or two obsessions. The author had quoted himself, and he, Sir George, was 
now going to quote himself. In an article in Clifford Allbutt’s System of Medicine, 
the first paragraph the speaker wrote was “ The following division of this work 
is devoted to the consideration of unsoundness of mind and insanity. As I 
shall point out, these are not the same thing, for there is much unsoundness of 
mind which does not seriously affect the relationship of the individual to his 
circumstances, and which, therefore, cannot be considered insanity.” Maudsley, 
years before, said, “The main business of a man’s life is to adjust his relationships 
to his mind. Such relationships, with human advance, become more and more 
complex, and when specially out of sympathy and out of harmony one becomes 
alien. No necessary brain lesion, however, may be present.” Then came the 
question of the advantage or the disadvantage of a definition. His old teacher, 
Sir William Gull, once said, “Definition? Definition is of the devil; the devil 
himself is only a definition, and the sooner he is done with, the better.” Moxon, 
on the other hand, when asked for his definition of insanity, said, " How can you 
define a negation ? Define sanity if you can, but define a negation, insanity, 
you cannot." 

It would be agreed that the most interesting point was that we were to be 
judged by conduct, and by nothing else. When one thought of what their old 
friend, Hughlings Jackson, wrote on the "Factors of Mind,” one could realise 
that any one of the factors of mind might be disordered and yet such disorder 
might not produce a corresponding disorder of conduct; and as long as there 
was mere disorder of a function which did not interfere with conduct, it must be 
admitted that there was no insanity present. He supposed that a symposium 
on this question would be most satisfactory. For instance, he had recently been 
reading a biography of Swinburne. No one would say Swinburne was insane, 
but who, on the other hand, would say he was of sound mind? He was an 
epileptic, his conduct was very irregular, and yet he was of brilliant intellect. 
He (the speaker) remembered suffering a severe snub from Lord Coleridge. He, 
Sir George, gave evidence about a certain boy who had committed a murder, 
and the characteristic of that boy was that he was asocial, and he was always 
reading books which he did not think much of. And the Judge said, “Like 
Shelley.” And Sir George said, "Well, my Lord.” When the Judge summed 
up, he said, “ Gentlemen of the jury, what can you think of the evidence of an 
expert who even suggests there might be something wrong mentally with 
Shelley?” One felt that there was an enormous amount of disorder in the 
most brilliant people, and he thought Dr. Mercier must often have had the 
" policeman ” idea coming before his mind: “ Is this person one who ought to 
be restrained?” It almost came to this, for one was so constantly asked “Is 
this person certifiable?” and the answer often was “Why? he is neither suicidal 
nor dangerous.” That gave the idea that unless a man was suicidal or dangerous 
he was not insane. He did not think that even Dr. Mercier would go as far 
as that. 

Then there were the other cases, always of extreme interest, in which there 
was a double life or personality. Such cases were not very common, but recently 
he had seen a case in which, twenty-three hours out of the twenty-four, the woman 
led a perfectly normal life. The other life was a post-epileptic condition, epilepsy 
? larvae, in which she performed the most extraordinarily destructive acts. One 
of the causes of the existence of the domestic “ghost” was that all sorts of 
extraordinary things were happening in the house, which no one could explain 
until it was discovered that this woman passed, at about 2.30 in the morning, 
into an unconscious state from which she could not be roused to the normal, and 
in which she did remarkable acts. He warned the friends that in one of these 
states she might attempt to set fire to the house. She did try to do so, and then 
it was considered necessary to treat her as insane. 

He had said enough. They felt, he trusted, that they would not be insane, but 
perfect sanity would be a heaven he would not desire to live in. Loss of higher 
thought and of self-control was bad, but a healthy “ Damn ! ” on the golf-links 
was not altogether out of place. 

Dr. Hayes Newington said he had been interested in Dr. Mercier’s paper, and 


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he had pledged his sanity to accept the invitation and tread on it a bit. The 
author had classed him, the speaker, with two eminent gentlemen, Dr. Craig and 
Dr. Stoddart, but he wished to separate himself from them, as he did not feel 
that he was worthy of such association. The two gentlemen named were proposers 
of definite propositions, whereas he only acted from a negative point of view. He 
did his sane best at first to contradict Dr. Mercier’s definitions, but he was not 
in a position to give a definition of insanity, or even to say what insanity was. 
His position was still a negative one, and he had found a good deal that one might 
question to-day. At the beginning Dr. Mercier stated, as an incontrovertible fact 
that two and two make four. But was that always the case P Not always : two 
whiskeys and two sodas could not be turned into four whiskeys; it must be two 
likes added to two likes to produce four, otherwise they might counteract each 
other. That carried a useful point in connection with this argument of Dr. Mercier’s • 
they were never agreed about their definitions or principles. Dr. Mercier founded 
argument upon the statement that in the certificate insanity or unsoundness of 
mind were regarded as convertible terms; but he would have thought that the 
word “or” between two things meant that a choice was given between them, and 
this wording on the certificate certainly meant that insanity and 'unsoundness of 
mind need not be the same thing. And that was how those in the specialty 
regarded it : they did not talk of insanity if they used the milder term “ unsound 
in mind.” They did not believe certified people were necessarily insane, but 
people were certified because they were, in their view, plus Dr. Mercier’s view 
needing detention. It was not fair to say people were certified on the question of 
their insanity. He did not understand how Dr. Mercier could still stick to his 
proposition that insanity was diseased conduct. The author asked his view 
and he had stated it in the British Medical Journal. He preferred the older 
phraseology, that insanity was a disorder of mind. He thought that if Sir Clifford 
Allbutt had been editing a new System of Medicine, and asked an authority to 
write on zymotic diseases, and that authority commenced by saying measles was 
not a zymotic disease but a disease of spots, the surprise would not have been 
greater than that produced by Dr. Mercier’s contention. But he still thanked 
Dr. Mercier for his paper, which had done a lot of good, and the author always 
brought forward something humorous as well as scientific. 

Dr. James Stewart thought the summary of this discussion might be expressed 
in one or two words. For a number of years those in the specialty had been using 
a negation, namely, the word “ insanity,” a word which, after all, it was impossible 
to define; and, if the word were continued, practitioners would have to give up the 
idea of stating an absolute definition of the term. It was sufficiently clear to those 
who had been acquainted with people whose condition was such as to require that 
they should have special treatment for a special disease that there were so many 
varieties of mental disorder that no definition could be advanced which would 
include a hundredth part of them. Hence he thought it almost a pity that there 
should be apparently such a difference of opinion between such eminent men as 
Dr. Mercier and those he had mentioned upon a matter upon which all alienists 
were, after all, agreed. Alienists were agreed upon the point which Dr. Mercier 
had emphasised so distinctly, that a person declared insane was one who had 
disorder of conduct; but the term was not confined to disorder of conduct, it was 
intended to imply more. When one said that a person was insane, all that one 
wanted to imply was that the mental condition of that person was that he had not 
soundness of mind. Where the line was to be drawn neither he nor anyone else 
could define. But he thought it was wise to adhere to the term " insanitv,” for it 
did not compromise the mental practitioner, nor compel him to give a definition 
within narrow limits as to the extent of the unsoundness. 

Sir Bryan Donkin said he had but few words to offer on this discussion. As 
he had already said to the Secretary, in case he had read the paper to the meeting, 
he agreed with the whole of it, and since Dr. Mercier had finished reading very 
little had passed which he felt called upon to comment on. It occurred to him 
that neither Sir George Savage nor Dr. Hayes Newington quite understood what 
Dr. Mercier meant by “conduct.” For instance, he thought Sir George rather 
implied that Dr. Mercier believed that disorder of conduct and insanity were 
convertible terms. Dr. Mercier did not say that, and he (the speaker) did not 
think any words written or spoken by Dr. Mercier bore the implication that every 


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person displaying disorder of conduct was insane : yet that seemed to be implied 
in what Sir George Savage said. A similar criticism could be applied to what 
was,said by Dr. Newington and Dr. Stewart. Dr. Mercier never said that disorder 
of conduct was insanity; what his contention was, was that disorder of conduct 
-was a necessary element in the conception of insanity, and that without disorder 
of conduct a person could not be pronounced insane. He had read in every text¬ 
book except Dr. Mercier’s that insanity had not been defined. It was not defining 
a condition to make an exhaustive description of every type of insanity, but it was 
surely possible for any person who had thought about insanity to say what he 
meant when he used the term “ insanity,” and that was what Dr. Mercier had in 
mind when he spoke of a definition. It seemed an astonishing thing—unless 
people had been trying to make a joke, as Dr. Maurice Craig was said to have 
attempted—how they could refuse to accept at once what Dr. Mercier had been 
preaching, though not in vain, except to members of this Association. Large 
numbers believed that Dr. Mercier was correct, and that he had brought a definition 
of insanity which was extremely useful in practice. He could quote a considerable 
number of those, particularly those who had been practising in prison service; 
these medical men got to know a good deal about insanity, and he personally 
regarded Dr. Mercier’s work, not only as theoretical, but also as very practical. 

Dr. Newington rejoined that he did not think Sir Bryan Donkin understood 
his (the speaker’s) remarks. What he quarrelled with in Dr. Mercier’s statement 
was that insanity was declared to be, not a disease of mind, but a disease of 
■conduct; it was the double statement, of which he was unable to accept the first 
part. Members of the Association believed that insanity was a disease of mind, 
whatever the person’s conduct was. 

Dr. E. S. Pasmore regarded this paper of Dr. Mercier’s as a most important 
one. He thought the best definition of insanity was that given by Shakespeare : 

" Madness, what is it ? To be nothing else than mad.” Where many had made 
a mistake, he believed, was in forgetting that the first sign of insanity was an 
alteration of conduct; that had been a guiding principle in his practice as an 
alienist. The first sign of mental aberration was not disease of the conduct, but 
^n alteration of the conduct. The line of demarcation had been passed when a 
man was brought of whom it could be said, “This man is insane, and he was not 
insane before.” That had been shown in several cases of which he could quote 
the particulars. There was such a thing as disorder of mind which could not be 
termed insanity, such as those mentioned by Dr. Mercier, in which there was an 
hallucination of hearing. When Dr. Steen read his recent paper on “ Hallucina¬ 
tions in the Sane ” he was very glad to have been present to hear it. On that 
occasion he (Dr. Pasmore) pointed out that a person might have an hallucination 
of hearing, or of sight, or anything else, and yet might lead a perfectly normal life, 
but when that hallucination had to do with the person’s life, then an alteration 
of conduct set in, and the person might be adjudged insane. He reminded the 
meeting of the case he quoted at that last meeting of a man who, with his 
hallucinations of hearing, was courted and made much of by aristocratic London, 
and who made a large fortune Out of his hallucinations. He went on very well 
until he heard, or fancied he heard, people saying things which affected his 
character, calling him a thief and a cheat. When that stage arrived he became 
insane, and the speaker had him under care at the present time. The line of 
demarcation justifying certification was not when a man became suicidal or 
dangerous, because many persons who were neither of those were still very insane 
and quite unable to adapt themselves to their surroundings. He therefore insisted 
on the point that the first indication of insanity was an alteration in conduct. 

Dr. J. F. Briscoe said the present contribution dealt with a very practical point. 
He had been in a police court twice a week and been asked by the Judge, “ What 
is the condition of the mind ? " A man was alleged to be drunk, and the decision 
to be arrived at was whether to send him to the workhouse for fourteen days 
because his conduct had been altered. He was known to have been all right the 
day before, and he was given a dose of Epsom salts, and next day he was all right. 
Recently he was called to say whether a man was certifiable, and his reply was 
that, if he were certifiable, then half the people of Southampton were certifiable. 
The man was running in front of a tram-car and trying to knock the driver off it. 
-As he had done the same before, he certified him, and was written to the next day 


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to know why he had done so. It would be of advantage if this Association would 
set out some definition, not quibble about terms. His teacher used to say every¬ 
body was insane, but some were more so than others. He saw Dr. Mercier’s 
arguments, which were those of an able mind, and he realised Dr. Craig’s attitude 
too, yet conduct was a very important criterion. 

Dr. Noel Sergeant said he had not listened to Dr. Mercier for the twenty-seven 
years which he mentioned in the paper; the present was the first time he had 
heard the view expounded, and he begged to subscribe to it. He considered that 
Dr. Mercier had made out a convincing case. The conduct must be studied, for it 
was upon that that the differentiation between the sane and the insane rested mainly. 
Another means was to differentiate between the insane person and the criminal. 
The attempt to differentiate between the sane and the insane brought in its train 
the corresponding difficulty of defining the difference between the insane person 
and the criminal. 

Dr. J. G. Soutar said this was a very old discussion ; it had been going on ever 
since insanity was written about, and practitioners of the specialty could go on 
quibbling with all their ingenuity in regard to the exact meaning of terms. All 
were agreed when dealing with a person of unsound mind, but they were not able 
to frame in words, in the form of a definition, what they were quite agreed about 
in practice. That had been a difficulty ever since the question of insanity had 
been raised. Sir Bryan Donkin, interpreting—properly, he thought—Dr. Mercier’s 
attitude, said that conduct was the criterion by which the sanity or the insanity of 
a person was to be decided. His (the speaker's) own view did not agree with 
that. Still, he was not concerned with a definition; it was a question of being 
called in to certify certain persons. A person's conduct had been of a certain type, 
and one had to say whether this anti-social conduct was the result of mental 
disorder or whether it was not. In other words, one went beyond the mere 
consideration of his conduct. It was common to find in histories that patients 
adopted, or fell into, certain mental attitudes which tended to certain types of 
conduct; and when the history of these patients was better known it revealed the 
fact that for a long time they had been fighting against that tendency, which was 
the logical outcome of the mental condition. He held that long before a patient 
would even admit in words, and certainly before he committed any anti social act, 
he was subject to a definite mental attitude; and it was the physician's duty to 
ascertain, by little things, the tendency and anticipate its development, so as to 
save the person from the impending evil. Often he was prepared to certify a man 
before he had committed any anti-social act, even before he was prepared to admit 
in words what his mental state was. The alienist viewed the general question 
and considered it as a whole; he did not fix his attention on the person having 
said one wrong word or done one little wrong thing. Given a person of unsound 
mind, it was the alienist's business, not necessarily to certify him, but to take such 
steps as would prevent such person from falling into the committal of an action 
which would be a disaster to himself. The criterion which the meeting had been 
discussing to-day was not the whole matter, it was one of the criteria by which a 
man was adjudged to be of unsound mind. One had only to go to the derivation 
of the word “ madness" to see that it meant rage and nothing else, and unsound¬ 
ness of mind was the state out of which mad acts sprang, and it was the work of the 
alienist to anticipate and treat that state before the mad act was committed. 

Dr. Mercier, in reply, said they were getting on, for on the last occasion he 
brought the subject before the .Association it was laughed out of the room, and 
nobody seemed to have a word to say about it except one of derision and contempt. 
To-day, however, it had been seriously discussed; then fore he had hopes that in 
another twenty-five years the Association might find itself on a level with the 
general state of medical opinion outside this body. Inside the Association, 
however, the opinion on the matter, as far as he could make out, was still very 
nebulous. Unfortunately, his infirmity would not all**w him to reply to the 
speakers in detail, but he would read their criticisms in the Journal, and he hoped 
to reply—perhaps more satisfactorily—in print. 

Dr. Maurice Craig, who was unable to be present at the reading of Dr. 
Mercier’s paper, writes as follows : 

In the first place I wish to express my regret that Dr. Mercier is not satisfied 
with my reference to his work in the chapter on the meaning of the term "In- 


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sanity ” in my book on Psychological Medicine. Had I appreciated the import¬ 
ance he attached to the doctrine, I should most certainly have stated it; the 
omission was not by intent, and, if the book reaches another edition, this over¬ 
sight shall be corrected. Nevertheless, when I come te discuss this doctrine, I 
scarcely know where to begin. I have never said, neither have I ever held, that 
madness and unsoundness of mind are the same thing. I do not know what an 
obsolete term like the former means, but Dr. Mercier tells me that it is “ disorder 
of conduct." On the other hand, he declares that all disorder of conduct is not 
madness. Therefore it must be a disorder of conduct which is associated with 
some other condition, the quality of which renders the so-called state of madness 
diagnosable by Dr. Mercier. He is careful to claim as his interpreters both speech 
and gesture, and what else is left whereby one mind may understand another ? 
Nevertheless, he says that it is not all disorder of speech and gesture which con¬ 
notes so-called madness. The fact is that behind this disorder of conduct stands 
Dr. Mercier’s insight into mind, his wide knowledge and his learning, and 
although in his modesty he relegates these to a secondary postion, in reality it is 
these qualities which make him recognise certain disorders of conduct, and certain 
disorders only, as true insanity. 


IRISH DIVISION. 

The Summer Meeting of the Division was held on Thursday, July 5th, 1917, at 
Ballinasloe Asylum by the kind invitation of Dr. John Mills (Medical Superinten¬ 
dent). On arrival of the early train from Dublin Dr. Mills met attending members 
and motored them to the Asylum. After inspecting the farms and wards of the 
Asylum the visitors were driven to see various places of interest in the neighbour¬ 
hood, including the battlefield of Aughrim, returning to the Asylum for luncheon. 

After luncheon the meeting was held. Members present: Dr. Mills; Dr. Greene. 
Carlow; Dr. English, Dr. Gavin, Mullingar; Dr. Leeper, Hon. Sec. Dr. Mills 
having been moved to the chair, it was decided that owing to the small attendance 
of members routine business alone should be proceeded'with. 

Letters of apology for unavoidable absence were read from the following : Dr. 
Hetherington, Londonderry ; Lieut.-Colone! Dawson, Dr. Considine, Dr. William 
Graham (Belfast), Dr. M. J. Nolan, Dr. L. Graham, Dr. Revington, Dr. Harvey, 
Dr. Lawless, Dr. Martin, Dr. F. C. Ellison, Dr. Drapes, Dr. O'Mara, Dr. Ruther¬ 
ford, Dr. W. Eustace.Dr. E. J. McKenna, Dr. H. M. Eustace. 

It was decided that the reading of a paper by Dr. Mills on an interesting subject 
which was on the agenda should be postponed until the Autumn Meeting owing to 
the small attendance of members. 

Dr. I. Adrian Greene, in a short speech, expressed the regret of those 
present that so few of the members had been able to attend the meeting 
owing to war conditions, and cordially thanked Dr. Mills for his hospitality. He 
said they had all seen that day the many improvements recently made in the 
Asylum, and especially the increased food production by the cultivation of the 
extensive farms they had visited. Dr. Gavin having also spoken, and thanked 
Dr. Mills for his kindness and hospitality and for the pleasant and instructive 
day he had given to his visitors, the proceedings terminated. 


THE MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREAT BRITAIN 

AND IRELAND. 

Regulations for the Training and Examinations of Candidates for the Certificate 
of Proficiency in Nursing and Attending on the Mentally Defective, with 
respect to which some discussion took place at the Annual Meeting (see p. 613). 

These Regulations are practically identical with those in force as regards, 
candidates engaged in nursing the insane, with the exception of a few necessary 
verbal alterations The same is the case with respect to the Syllabus for the 
Preliminary Examination, but in the case of the Final there are some alterations 
and additions. The first three sections on " Diseases and Disorders," “ The 
Nervous System,” and “The Mind,” are practically the same. For the paragraphs 
under the heading in the old Syllabus of “Conduct and its Disorders” the- 
following are substituted: 


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Types of mental disorder: 

(а) Melancholia; Mania; Delirium; Stupor; Dementia; Delusional 
Insanity; Juvenile general paralysis; Insanity with epilepsy; Mental disorders 
arising in childhood and adolescence. 

(б) Mental deficiency : Its nature and forms; Difference between insanity 
and mental deficiency; Development of the normal mind in childhood; 
Deviations therefrom in mental deficiency. 

(The mentally deficient graded as ( a ) Idiots; ( b ) Imbeciles; (c) Feeble* 
minded ; ( d ) Moral imbeciles.) 

( c ) Mentally unbalanced children. 

Mental defects; Congenital and acquired. 

Varieties of mental defects: (1) Genetous; (2) Mongolian; (3) Micro- 
cephalic; (4) Hydrocephalic; (5) Hypertrophic; (6) Eclampsic; (7) Epileptic; 
(8) Paralytic; (9) Traumatic; (10) Inflammatory or post-febrile'; (11) 
Syphilitic; (12) Cretinoid; (13) Idiocy from deprivation of senses. 

Physical abnormalities and sensory defects associated with mental 
deficiency. 

Abnormalities of conduct. 

And the last two paragraphs in the old Syllabus are replaced by the following: 
Management and Training of the Mentally Deficient. 

Observation of rules: Routine; Bearing of nurses towards patients; 
Promises to patients; Threats; Discipline and correction ; Feeding; Cleanli¬ 
ness; Personal habits; Drivelling; Incontinence; Sexual irregularities, etc. 

Training of senses and power of attention. 

Training of muscles: Exercises; Massage and remedial movements; 
Inculcation of self-helpfulness in undressing, dressing, etc.; Cultivation of 
manual and industrial activities. 

Cultivation of speech. 

General principles of education: Simple educational exercises ( e.g. 
building blocks, form and size boards, simple picture puzzles and alphabet 
blocks; stringing beads and exercises in colour discrimination and in 
counting, description of pictures, drawing and elements of writing; String 
work, wool work, knitting and sewing; Inculcation of good temper and 
consideration for others, truthfulness, etc.). 

Vicious and mischievous habits: Impulsiveness; Destructiveness; 
Struggles and the use of force; Safeguards against physical injury; Homicidal 
tendencies; Liberty ; Escape ; Exercise, occupation, and amusement; Report¬ 
ing mental changes ; Interviewing patients’ friends. 

Care and treatment of the mentally deficient in private houses: Increased 
difficulties; Guardianship. 

MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREAT BRITAIN 

AND IRELAND. 

Examination for the Gaskell Prize, July 5th and 6th, 1917. 

Examiners: R. H. Cole, M.D., F.R C.P. 

J. G. Porter Phillips, M.D., M.R.C.P. 

July sth, 1917. 

At 10 a.m. 

Psychology. 

(Four hours allowed.) 

Questions. 

X. What do you understand by the terms “ projection,” “meaning,” "interest,” 

and" conflict ” as used in modern psychology? 

2. Give an account of the current theories of the production of dreams. 

3. Trace the evolution of the social instinct in its relation to mankind. 

4. Describe the James-Lange theory of emotion and any modifications of this 

theory that you know of 

5. What is a complex? and state its rCle in regard to the doctrine of the associa¬ 

tion of ideas. 

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6. Contrast the various affections of memory from both the psychological and 
neurological aspects. 

At 3 p.m. 

Case with Commentary. 

(Two hours allowed.) 

Examine the case allotted to you (30 minutes’ allowed), then return to the 
Examination Room and write an account of the Case, giving also Diagnosis, 
Prognosis, and Treatment in full (90 minutes allowed). 

July 6th, 1917. 

At 10 a.m. 

Mental Diseases. 

Questions. 

1. Discuss the nature and treatment of Chronic Alcoholic Inebriety. 

2. Give an account of the "Tics” with special regard to their aetiology and 

treatment. 

3. Describe the disease known as Katatonia. State your views on the significance 

of its symptomatology. 

4. Define the recognised grades of Mental Deficiency. Give a brief description of 

its various types from the pathological standpoint. 

5. Describe a case of Acute Delirious Mania and its treatment. What is the 

pathology of this disease ? 

6. What are the symptoms and signs in an early case of General Paralysis of the 

Insane? and give the differential diagnosis. 

At 3 p.m. Viva, ^ hour each. 

Examination for the Certificate in Psychological -Medicine. 
Tuesday, July 3rd, 1917. 

Examiners: R. H. Cole, M.D., F.R.C.P. 

I. G. Porter Phillips, M.D., M.R.C.P. 

R. Dods Brown, M.D., F.R.C.P. 

J. H. Macdonald, M.B., Ch.B. 

T. Adrian Greene, L.R.C.S., L.R.C.P. 

F. E. Rainsford, M.D., B.A. 

10 a.m. to 1 p.m. 

Questions. 

1. Describe a case of Systematised Delusional Insanity. Trace the evolution of 

this disease in its psychological aspect. 

2. Give a clinical account of the recognised varieties of Mental Disease associated 

with pathological conditions of the Thyroid Gland. 

3. Describe some laboratory tests used in the diagnosis of General Paralysis. 

4. In what mental affections do Convulsions occur? Describe their characteristics 

and differentiate between them. 

5. Describe briefly some methods for detecting Feigned Insanity. 

6. Discuss the medico-legal and clinical bearings of a case of so-called " Moral 

Insanity.” 

At 2 p.m. 

Half-Hour is allowed for the examination of Case in Ward. Candidates must 
afterwards return to the Examination Room for Viva Voce. 


HONOURS FOR DR. PERCY SMITH. 

We regret that by an oversight our congratulations have not been offered 
before now to Dr. Percy Smith on his having been elected President of the 
Psychiatry Section of the Royal Society of Medicine for last year, which office, 
by the suffrages of his colleagues, he still retains for a second year. And, in 
addition, he has been made President for the current year of the Neurological 


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Section of the same body. It is gratifying to see such proofs of the esteem in 
which such a well known and valued member of the Association is held by a 
■sister society. And if our congratulations to Dr. Smith are rather late in point 
of time, they are none the less cordial and sincere. 


MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREAT BRITAIN AND 

IRELAND. 

At a Special Meeting of the Council held on September 20th at 11, Chandos 
Street, Cavendish Square, London, W., Dr. James Chambers, The Priory, 
Roehampton, S.W., was elected Treasurer of the Association. 


WAR SERVICE HONOURS. 

The names of the following officers of the R.A.M.C. have been brought to the 
notice of the Secretary of State for War for valuable medical services rendered in 
connection with the war : 

Temporary Lieut.-Colonels: E. Goodall, J. Keay, H. A. Kidd, J. R. Lord, A. 
Simpson, D. G. Thomson, W. J. M. Vincent. 

Temporary Majors-. W. R. Dawson, H. C. Marr, F. W. Mott, N. H. Oliver, 
N. Roberts, F. M. Rodgers, R. G. Rows, J. C. Woods, R. Worth. 

Temporary honorary Major E. W. White, M.B., to be temporary honorary 
Lieut.-Colonel. 


EGYPTIAN NEWS. 

Dr. Collins encloses two cuttings from the Egyptian Mail, which are transla¬ 
tions from the native papers, and will, no doubt, be read with interest. 

A Tribute to Dr. Warnock. 

“ A 1 Ahram ” says: 

"The refusal of Dr. Warnock of the post of Director-General of the Public 
Health Department, and his desire to remain in the post he has been occupying 
for the quarter of a century, is a lesson to all officials. 

“ Mental diseases are the most obscure of all maladies, and many of them are 
still not understood; in fact, modern science has been able to define only some of 
them. All these diseases were unknown in Egypt thirty or forty years ago, when 
the patients were constantly tortured either by striking them with the key of a 
saint or by burning their faces to drive the djinn out of the body. 

"Dr. Warnock has organised the lunatic asylum on the modern European 
system, and treated the patients in accordance with the latest discoveries; in fact, 
he treats them as a kind father treats his sons, and those who read his annual 
reports realise his great labours in the service of humanity. 

“ It has been said with much truth that insanity has increased in Egypt, but 
those who say so are not aware that the progress of civilisation leads to the 
increase of these diseases in all countries, while the enlightenment of the public 
makes them produce their patients instead of concealing them, with the object of 
having their malady attended to. 

“ The Department of Mental Diseases has two hospitals—one in Khanka for 
men, placed under Dr. Dudgeon ; and the other for men and women at Abbassia, 
under Dr. Warnock himself. Three years ago a hospital for British soldiers was 
opened and placed under Dr. Warnock also. 

“ The Department of Mental Diseases was at first under the Department of 
Public Health, but six or seven years ago it was detached from that Department, 
and Dr. Warnock has thus become independent of it and placed directly under the 
Ministry of the Interior. All those who have had to do with Dr. Warnock are 
aware that he performs his difficult duties with the greatest conscientiousness. 

“The latest demonstration of Dr. Warnock’s serious services is this expression 
of his preference to remain in his post. Every official is anxious to be promoted 
and to have his pay increased, and although the public thinks that the post of 
Director-General of Public Health is senior to that of the Director of the Mental 
Diseases Department, these words of Dr. Warnock have given his post special 
importance. He means to say that the post which he has occupied for twenty-five 


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624 NOTES AND NEWS. [Oct.* 

years, the patients whom he attends to and whose sufferings he alleviates, and the 
researches his department makes are more to him than an increase of pay or a 
higher-sounding title. The Egyptian nation which honours the memory of Clot 
Bey and Dr. Ruffer will also honour that of its faithful servant, Dr. John Warnock.’ 1 

A Certificate of Insanity. 

Al-Mahrussa says: 

“ I always supposed that licences were given to coachmen, shoeblacks, bar 
proprietors, etc., only, who are allowed to exercise their trade after passing a 
medical examination which at least certified them sane persons. But I have lately 
seen a certificate of madness which allows its holder to do as he likes. 

“The other day I came across Hassan Marei who has to go once a week to the 
lunatic asylum to be examined. The man escaped from the asylum years ago 
wearing a native woman's ‘ iz&r,’ and went to the authorities to whom he said 
that he was not insane, and he was therefore allowed to go about as he pleases. 
But it seems that he still likes to call himself insane, particularly when this 
pretension saves him from his adversaries. He is, therefore, sane with the sane, 
but mad when he considers it in his interest to call himself mad. 

“ I asked him how he came to have a licence for madness, and was told that 
he obtained it from the Court, and produced a judgment rendered by the Muski 
Court in a case of libel of which he was accused, in which the Court said that as 
the defendant, Hassan Marie, was kept in a lunatic asylum for some time and still 
goes there once a week for medical examination, it is likely that he committed the 
act complained of in a moment of madness, and is therefore acquitted. 

“ When I saw the judgment 1 said to myself: how excellent is this madness 
which is so powerful a protection in moments of danger! ” 


EXAMINATION FOR NURSING CERTIFICATE. 

List 0/ Successful Candidates. 

Final Examination, May, 1917. 

Berks County. —Lillian E. Gray, Alfred Stickley, Ruth L. Plumb. 

Carlisle. —Isabella Main. 

Glamorgan. —May E. Thomas, Urania Morris, Margaret J. Davies. 

City of London.^— Mabel John, Marion Johnston, May L. Webb. 

Han-well. —Evelyn E. Plumridge, Esther E. Hankin, Amy M. Brocksopp, Ethel 
E. Gascoyne, Mildred Rust, Mary Russell, Edith Rowell, Mary V. Bennett, Maggie 
Wright, Winifred M. Toms, Irene M. Earp. 

Bexley. —Mary A. Stocker, Katherine Gander, Florence E. Saunders, Edith 
Jones, Mima Robbins. 

Cane Hill. —Sarah M. Sheppard, Eleanor Shepherd, Mary E. Dunn, Helen 
Stearman. 

Colney Hatch. —Elise S. Bell, Annie L. Cooper, Beatrice L. Dawe, Yvonne R. 
Colin. 

Notts County. —Nancy Bush, Kitty Nolan, Violet Wright. 

Bicton, Shrops. —Violet M. Brookes, Hilda Jane Davies. 

Cheddleton. —Winnie D. Butler, Hylda M. Thomas, Katie Farrell, Sarah 
Champion, Laura Johnson. 

Burnt-wood. —Grace D. Perry, Moses Roberts. 

Netherne. —Ellen M. Tye, Beatrice E. Jury, Violet E. Hall, Elsie K. Kilgower. 

Hay-wards Heath. —Ada M. L. Brooshooft, Ellen M. Haysey, Amy E. Cox, 
Alice E. Harbord. 

Napsbury. —Sarah R. Chandler, Muriel Edith Western, Annie B. Urquhart, 
Brigid M. O’Sullivan, Olive Turney, Dorothy Bailey. 

Notts City. —Florence Swinbourne, Martha Robinson. 

West Sussex. —Dorothy M. Hewer, Eliza M. A. Probert, Herbert Long, William 
H. Berry. 

Barnsley Hall. —Nellie Smith, Hilda W. Lucas. 

Winson Green. —Clara R. Newbold. 

Hull City. —Catherine E. Tait, Edward McCormick. 

Sunderland. —Phylisa M. Forster. 


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Bailbrook House. —Florence L. Morris, Emily Trevis. 

Bootham Park. —Lilian Robinson, Maria M. Williams, Seth L. Smith. 

Brislington House. —Alice M. Summerhill. 

Camber-well House. —Elsie L. Palmer, Ellen M. Ashbury, Georgina Creak. 

Coton Hill. —Winifred Keeling, Florence L. Wilson, Florence Cox. 

Fenstanton. —Annie McMahon. 

Holloway Sanatorium. —Ida Richards, Mabel C. Kerr, Olive M. Martin, Mar¬ 
jorie N. Ellis, Catherina Tjebbes. 

Middleton Hall. —Mary H. Bonson, Ellen G. Butters, Priscilla Farley. 

Retreat, Yorks. —Violet S. Huggard, Elizabeth H. Thomson, Amy Skelding. 

St. Andrew's. —Annie Lee. 

Aberdeen Royal. —Jean Young, Elsie H. Cowie, Annie Hay, Dorothy McHardy, 
Helen Forbes. 

Aberdeen District. —Jeannie A. Rennie, Maggie M. Duff, Catherine M. McPetrie. 

Argyle and Bute. —Nellie Creegan, Rebecca F. McGowan. 

Ayr. —Annie R. Dickie, Christina S. Smith, Annie Young, Margaret Y. Chalmers, 
Agnes Wilson, Thomasina Gibson. 

Crichton. —Lewis Falconer, James Kerr, Margaret Wilson, Isabel H. William¬ 
son, Janet J. Gilmour, Janet R. Murray, Annie Nelson, Margaret Brown, Jeannie 
Stewart, Beatrice A. White, Sara L. Murray, Annie W. Smith, Sarah McMillar, 
Elizabeth Edgar, Annabella M. Groat, Margaret J. Player, Marion D. Turner, 
Margaret S. Riddell, Catherine McRury. 

Dundee. —Jeanie Carr, Christina Low, Lizzie Lovie, Patrick Donnelly. 

East Lothian , Haddington. — Marguerite M. L. Cleugh, Helen J. Mackenzie. 

Edinburgh Royal. — Barbara Robertson, Jean Dickson, Jane A. Currie, Ethel 
Waller, Maggie M. McGillivray, Helen McArdle, Edith Bateman. 

Gartnavel. —Mary Daly, Mattie Murdoch, Annie Martin, Rachel W. Stein. 

Gartloch. —Annie Campbell, Elizabeth Bruce, Agnes Rankin, Jane C. Bryan, 
John McDonald, Elizabeth Garrow. 

Woodilee. —Jessie B. Findlay, Violet R. Phillips, Patrick McGlynn. 

Lanark. —Thomas Prentice, Barbara Anderson, Margaret Begley, Dorothy 
Cooper, Mary Singer. 

Melrose. —Donald Campbell, Helen Simpson, Alexander Bruce, Catherine 
McKay. 

Montrose. —Margaret Duncan. 

Renfrew. —Flora McDonald. 

Riccartsbar. —Isabella Duff, Mary C. Douglas. 

Larbert. —Irene K. Lowes, Christina M. Cloonan, Margaret J. Blair, Annie 
Macrae, Annie R. Macdonald, Annie Townshend, Jean Sloan, Janet M. Donnan. 

Monaghan. —Annie Cully, Maggie McCaffrey, Annie Qaly, Michael McManus, 
Charles Coleman, John McEntee. 

Portrane. —John Kinsella, Thomas McDonnell, William Brady, Bridget Murtagh, 
Rose Cartwright, Mary B. Soughley, Mary Croarkin. 

Rich/nond. — Patrick Coogan, Rose Kiernan, Elizabeth Gore, Elizabeth Doyle, 
Christina Fegan, Elizabeth J. Gavin, Kate Cass, Thomas Conroy, Nicholas 
Higgins. 

Hellingly. —Elizabeth H. Willey, Mary Roberts, Isabelle E. Ormonds, Edith A. 
Langley, Ethel E. Duley, Lilian Nugent, Ethel L. Steer, Blanche Beebee, Emma 
L. Stevens, Edith M. Coates. 

Long Grove. —Edith Clarke, Rosa E. Dealey, Annie J. Gould, Louisa M. Pharaoh. 
Agnes Darke. 

Banstead. —Marion E. M. Taylor, Daisy M. Barrack, Evelyn R. Horton, Emily 
R. Hempstead, Rose A. Quinn, Edith Wilkinson, Kate Mills, Dulcibel Jeffery. 

Chester County, Upton. —Edith Diggory, Constance Eleanor Wharan, Ruth 
Williams, George E. Partin. 

Macclesfield. —Nellie O. Watts, Elizabeth Cameron. 

Denbigh. — Ellis Jones. 

Hawkhead. — Isabella Smith. 

Inverness. —Elizabeth B. Bothwell, Mary H. Mackay, J. Maclachlan, Margaret 
A. MacCulloch. 

Mullingar. —Teresa M. Diffley, A. Scanlon, Lizzie Christie, Mary Anne King, 
Daniel Brennan. 


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Banning Heath. —Daisy Wooley. 

Severalls. —Mary Gerrie, Winifred V. Taylor, V. Large. 

Scalebor Park. —Florence Helliwell, Caroline Barley. 

Gateshead Borough. —Agnes Walmsley. 

Warwick County. —May Flaherty, Amelia F. Marshall, Hilda Harris, Clara- 
Genders. 


South African Asylums. 

Valkenberg. — E. F. Ings. 

Bloemfontein. —Lawrance Hartig. 

Pietermaritzburg. —Thomas H. Ellender, Virginia J. Danniell. 

Pretoria. —Irene Ryan, J. Johanssen, E. Shrimpton, A. Parkinson, E. M. 
Saunders, M. Lynn, J. C. Truter, M. Grant. 

Grahamstown. —William Henry Hall, Stephanus Johannes Bosch, Ivy Muriel 
Boardmann. 


Preliminary Examination, May, 1917. 

Berks County. —Jane Gilhenny, Kate Roles, Rose E. Hurle, Henrietta F. Neelyv 
Lillian Mercer, Ethel Price. 

Chester County. — Edith E. Williams, Nellie Griffiths, Margaret Morris, Lucy 
Arrowsmith, Lily E. Robinson, Annie C. Manley, Margaret J. Griffiths, Annie 
Eyton, Minnie Lloyd, Margaret Williams, Sarah J. Partin, Rosaline E. Nowell, 
Ivy Jeffries, Alice Crook. 

Macclesfield —Maie Edwards, Nellie Ashcroft, Annie Peden, Sarah J. Leigh, 
Jeanie Killough, Ethel Howells, Alice E. Belbin, Minnie Pearson, M. Leigh,. 
Mary A. Frost, Emily M. Williams, Edith Beach, Matilda Callaghan, Ruth. 
Dunkerley. 

Cumberland and Westmorland —Marion M. S. Lightbody, Ethel M. Howe, 
Alice Holdsworth, Margaret Macdonald, Flora Gray. 

Denbigh. —Annie Lewis. 

Brentwood , Essex. —Nellie M. Gardner, Mabel S. Brittain, Eva M. Barker,.. 
Miriam Miller. 

Glamorgan. —Gladys M. Phillips, Dorothy Thomas, Gladys A. Lewis, Bridget 
A. Neville, Gwendoline M. Evans, Catherine A. Thomas, Gertrude Jones, Beatrice 
Vile, Elizabeth J. Jones, Gertrude Wilkes, Margaret Davies, Sarah J. Tarr, 
Sarah A. Jones, Muriel Owen, Elsie May Griffiths. 

Barming Heath. —Agnes M. Williams, Alice M. E. Escott, Laura V. Killian, 
Margaret M. Wimsey, Annie Kennedy, Ellen E. Shepherd, M. Temple, Phyllis M. 
Evans, Gladys M. Bishop, Alyce Warren. 

Chartham. —Winifred K. Brazier, Alicia Cullen, Mary Hatton, Amy A. Wellard, 
Mary Angus. 

Kesteven. — Florence M. Wright, Lucy E. Todd, Violet M. Jackson, Violet M. 
Spikings, Sarah K. Reast. 

Notts County. —Lucy E. Jackson. 

City of London. —Elaine Quail, Janie Hosken, Edith M. Allibone. 

Banstead. — Florence M. Marley, Florence E. Smith, Phyllis Stribbling, 
Winifred C. Bright, Jeanie A. F. Fisher, Elizabeth R. Neighbour, Frances C. 
Ollett, Emily Trevorrow, Susan E. Howard, Ida Hill, Florence Ada Davey. 

Cane Hill. —Olive M. Clavey, Lilian M. Corby, Ellen L.' Davies, Rose E. Martin, 
Dilys M. Jones, Caroline Evans, Esther A. Howard, Caroline Sapsford, Olive Jibb,. 
Ellen Edwards, Nellie L. M. Perrey, Mary Connell, Elsie M. Payne, Georgina G. 
Butler, Daisy E. Martin, Eleanor Farrelly. 

Claybury. —Edith E. Woodford, Maud E. Wiese, Elizabeth V. Warner, 
Dorothy E. Slater, Edith M. Simons, Florence D. Shead, Josephine M. Ripley, 
Annie E. Reeve, Olive M. Reade, Maud J. Pateman, Mary L. Pateman, Ada E. 
Parrish, Hannah E. Owen, Lilian E. Mann, Alice McGillicuddy, Nellie R. Love, 
Hilda H. Love, Janet E. Jones, Gretta Hyland, Mary Fennelly, Emily Dilley, 
Elsie Cook, Grace A. Clement, Maud Car, Elsie Blake, Margery C. Barker, 
Frances P. Allton, Edith Anty. 

Colney Hatch. —Margaret K. M. Westcott, Eva M. Childs, Mary E. Magee 


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627 


May Good, Minnie Young, Charlotte E. Rufus, Jessie M. Bingham, Dorothy C. 
Headon, Mary Ducker. 

Hartwell. —Annie E. Newman, Isabella Davies, Louise Scott, Edith S. Newell, 
Dorothy Price, Daisy A. Partridge, S. Cooper, Catherine Hart, Mabel Simpkins, 
Ellen S. Clements, Rose M. Brown, Minnie E. Lelean, Elsie Stebbings. 

Long Grove. —Ruby M. V. Wilson, Maria E. Vant, Alice M. Olley, Rose A. E. 
Message, Grace Banwell, Adolphus W. Sadgrore. 

Shrewsbury. —Ada Howells, Emma Cooper, Clara Jones, Elsie Chilton, Catherine 

A. Hogan. 

Burntwood, Staffs. —Ethel G. Bates. 

Cheddleton. —Mary Connolly, Beatrice M. Farmer, Gladys E. Chaplin, Charity 
E. Rooney, Phoebe Thomas, Mary F. Coyle, Catherine McEllarney, Amy Bierlein, 
Mary E Watters, Esther O’Connor. 

Netherne, Surrey. —Florence Vickery, Alice E. Sparkes. 

Hellingly. —Annie Thomas, Rose Seeley, Winifred M. Williams, Ellen M. 
Vincent, Constance C. Dorey, Ethel J. Gurney, Rose Brett, Margaret Clarkson, 
Rachel Evans, Florence B. E. Christian, Winifred. Johnson, Bertha Miles, 
Elizabeth J. E. Drew, Mary Withey, Edith Francis. 

Haywards Heath. —Ellen H. Smith, Maud E. E. Ashe, Edith Iron, Grace A. 
Lane. 

Worcestershire, Barnsley Hall. —Thomas M. Wincott, Jonas J. Wakeman, 
Frank Walton, Emily K. Newman, Alice E. Blick, Lottie Baker, Annie Bingham, 
Alice Hill, Edith King, Esther A. Taylor, Ellen L. Tomkys. 

Scalebor Park. —Lillian M. Mavin, Agnes A. Binks, Doreen Illingworth, Irene 
Edwards, Annie Sygrove, Edith Barker, Phyllis Lister, Charlotte Priestley. 

Beverley, Yorks. —Minnie E. Proctor, Eva Welburn, Mary E. Ramshaw, Evelyn 

B. Parish. 

Winson Green, Birmingham. —Emma Benton, Edith A. A. Eads. 

Derby Borough. —Marjorie P. Cox, Elizabeth Mason, Florence Pritchett, 
Doris A. Wright. 

Hull City. —Walter Robinson, David Stynes, Jenny Bate, Eveline Brown, 
Emmeline Grayshon, Kate Marr, Lily Neal, Agnes Senior, Alice Stables. 

Notts City —Daisy Branton, Blodwen Davies, Ethel Davies, Mary Halford, 
Edith A. Pearce, Hilda Pearce, Jane Riley, Ethel L. Steele. 

Portsmouth. —Bridie Butler, Beatrice M. Swan, Alice M. Trotman, Kathleen 
Dyer, Dorothy Jolly, Hilda Larkman, Florence M. Webley, Elsie A. Parker, 
Nellie L. Hill, Grace E. Norris, Myrtle Phillips. 

Sunderland. —Mary Grainger, Christina Glassford, Lizzie A. Forde, Christina 
Laws. 

Bailbrook House. — Mary Peddle. 

Bootham Park. —Henry Locke, Margaret Black, Mary Black, May Boyes. 
Brislington House. —Florence A. L. lies, Fanny Joyce, Margaret E. Carr, 
Florence L. Baker. 

Camberwell House. —Dorothy L. Phelps, Dulcie Sybil Steer, Gertrude Hopkins, 
Annie E. Mecham, Amy E. Glisbey, Kathleen N. Sloan, Ida M. Clabburn, 
Myfanwy Roberts, Jessie Webster, Dorothy G. H. Jenkins, Jane E. Prall, Ethel 
E. M. Pepler, Mildred A. M. Palliser, Dorothy W. Phillips, Mary E. Welton. 

Holloway Sanitarium. —Edith M. Telfer, Amy E. K. Davies, Celia J. Orme, 
Muriel Perkins, Winifred M. E. Healey. 

New Saughton Hall. —Elizabeth Mitchell, Alexandra V. Hall, Mary Gerrard, 
Donald Henry. 

York Retreat. —Ada Hutchinson, Ethel B. Davison, Margaret E. Wilmot, Minnie 
M. Swanson, May Brydon, Lizzie Alexander. 

St. Andrew's, Northampton. —Edith A. Moss, Sarah S. J. Buck, May Burt. 
Aberdeen Royal.— Emily W. Glennie, Margaret J. Logie, Agnes Murray, Eliza 
M. Jamieson, Jean R. Matheson, Annie I. E. Gordon, Elizabeth B. Anderson, A. 
G. Cameron. 

Aberdeen District. —Elsie Campbell, Lily J. Reid, Catherine Crichton, Margaret 
Sutherland, Helen M. McLean. 

Argyle and Bute. —Catherine McLeod, Mary Sinclair, Mary Me A. Haggart, 
Mary A. McK. Fletcher, Margaret Watt, Lily Mackay. 

Ayr. —Agnes B. Cowan, Jessie Millar, Jane J. McCulloch, Dorothy Dawe, Jessie 


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L. M. Yates, Janet S. Mackenzie, Agnes S. Mallock, Margaret Mathieson, Elspeth 
G. Kirkwood, Jane F. White, Jane B. McKellar, Agnes B. Haig, Elizabeth 
Summers. 

Banff. —Jeanie M. Burnett, Maggie A. Stewart, Frances M. Sutherland. 

Crichton. —Ellen McCaw, Margaret McCloy, Sarah J. Maclean, May Travers, 
Annie M. Weir, Mary Campbell, Christina MacAskill, Mary B. Munro, Mary Fraser, 
Mary Tait, Charlotte Henderson, Margarett McK. Nicholson, Adelaide McAdam, 
Catherine Macdonald, Elsie D. Potter, Mary MacFadijen, Elizabeth Cairns, 
Margaret H. Smith, Marion Morrison, Janet McCartney, Margaret E. Kennedy, 
Lena E. Weston, Grizel Ellen Brand, Molly Graham, Mary A. W. Starkey, Lizzie 
A. Reid, Jean Quinn, Catherine McCloy, Jean J. Ross, Annie McCuIlen, Isabel 
Campbell, Jessie K. Cameron, Elizabeth Hendry, William F. Farrington, Robert 
Purvis, William B. Henderson, James M. McLaren, John L. Campbell, William 
Scott. 

Dundee. —Margaret H. Ladd, Jean Corbett, Norah Knowles, Laura J. Low. 

Elgin. —Ann B. Strathdee, Lily L. Taylor, James Mackintosh, B. Philip, 
Isabella Hadden. 

East Lothian and District. —Annie Thomason, Elizabeth R. M. Walker, Mary 
Cumming, Marion Farquhar. 

Edinburgh Royal. —Eva H. Dodd, M. Macrae, Margaret Brady, Elizabeth 
Leadbetter, Mary B. Sinclair, Mary Finnigan, Annie D. Macvean, Elizabeth 
Robertson.' 

Gartnavel. —William Inglis, James Cameron, Annie B. Lorimer, Ethel E. 
Fergusson, Catherine Cameron, Catherine T. Robertson, Annie Stewart, Agnes 
McD. Hastie, Molly McCann. 

Gartloch. —Charlotte Rarity, Flora Robertson, Margaret F. Levack, Isabella 
McC. Parker, Mary A. O’Reilly, Margaret Summers, Susan B. Proctor, Morag 
Kennedy, Jessie Macrae Douglas, Christina McLeod, Margaret Dobbie, Janet 
McK. Shennan, Davina D. Robertson. 

Woodilee. —John Welsh, Agnes C. Hamilton, Ellen D. Mann, Georgina H. 
Wilson, Elizabeth A. Reat, Catherine Morgan, Mary F. McIntyre, Mary Macdonald, 
Dorothy Dale, Elizabeth Lithgow, Ann J. McLaughlin, Elizabeth McC. McPhai^ 
Mary S. Stewart, Jessie A. Cook, Anne Macdonald, Helen H. Brown, Janet 
Crombie. 

Ha-wkhead. —Beatrice Andrews, Isabella E. Leslie, Marie Hood, Charlotte 
Fletcher, Julia Mullany, Stewartina C. G. Adams, Elizabeth Ross, Louisa Brady. 

Inverness. —Isabella Macdonald, Kate McGbinity. 

Lanark. —Helen W. Baillie, Sarah Elliot, Annie Knowles, Jean McHardy, Mary 
McHattie, Jessie Macintosh, Annie M. McLaughlin, Mary McLellan, Margaret G. 
Millar, Elizabeth Newall, Catherine O’Connell, Mary Purvis, Elizabeth Singer, 
Catherine Smith, Elizabeth S. Watson. 

Melrose. —Margaret Webster, Elizabeth J. Coulon, William Wilson, Harriet 
Mackenzie. 

Midlothian. —Helen K. C. Tennant, Margaret Macrae, Agnes G. Lemmon, Mary 
Keith, Hughina Findlay. 

Perth. —Johan M. MacDonald, Helen H. Watson. 

Montrose. —Nellie Callaghin, Georgina Fairweather, Margaret Tierney, Wil- 
liamina D. Allan,'Robina C. McKay, Rachel Smith, Alice Smith, Norah Arm¬ 
strong, Robina Stewart. 

Murray. —Elsie D. Muir, Helen S. Brown, Jessie J. Burnett. 

Riccartsbar. —Robert J. Mitchell, James McBain, Jeanie McConachie, Jane 
Alexander. 

Smithston. —Thomas Goldie, Isabella J. Murray, Margaret J. Macleod, William 
Cameron, William B. Cameron, Margaret L. Hamilton, Christy A. McLeod. 

Enniscorthy. —James Byrne. 

Londonderry ■—Cassie Stranie. 

Monaghan. —John Gray, Joseph Wilson, Owen Sheridan, George Jordan, Robert 
Williamson, Thomas A. Maxwell, Teresa M. Ward, Tillie McClelland, Maggie 
Corr, Lillie Duffy. 

Mullingar. —Thomas Commons, Michael Scally, Thomas Murray, John Creamer, 
James Martin, William Flanagan, Lizzie Glennon, Marcella Killian, Margaret 
Prunty, Rose A. Mullen, Nellie Christie. 


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• 1917 -] NOTES AND NEWS. 629 

Portrane. —Mary E. Cardan, Catherine Tighe, Annie E. Rochford, Bina Fahy, 
William Kavanagh, Patrick Healy, John Cartwright. 

Richmond. —Patrick Seery, John Flanagan, Michael Purfield, Elizabeth Doyle. 

St. Patrick's. —Thomas Bohan, Thomas Mullarney, Michael O'Neill, Marguerite 
Finlay, Margaret Hogg, Ida Jordeson, Jane O’Toole, Henrietta Patterson, Rose 
Trout. 

Severalls, Essex. —Ellen A. Davies, Frances M. Bishop, Florence M. Holmes, 
Mary J. Davies. 

Bethlem Royal. —Millicent M. Bennett, Rose A. Huss, Bertha Horwood, Ernest 
A. Virgo. 

Warwick County. —Gertrude Walters, Kate Haines, Elsie Faulkner, Molly 
Kellaghan, Della Everall. 

South A f rican Asylums. 

Valkenberg. —N. J. Smith, Johanna von Mollendorf, C. A. Griffiths, Jacob Blom- 
kamp, M. J. Kroezen. 

Bloemfontein. —R. Robinson, G. M. Wadsworth, A. J. Jacobs, S. Schoeman, 
H. M. M. Luttig, A. H. K. Smit, J. E. Laidler, M. D. Maree, C. P. Kok. 

Pretoria.- —H. Heffman, H. Greef, A. Clausen, J. Page. 

Grahamstown. —Ellen Maud Jones, Alma Magnet Webber, Rachel Maria Johanna 
Joubert, May Reilly. 


OBITUARY. 

Alexander Reid Urquhart, LL.D., M.D.Aberd., F.R.C.P.Edin., 

Formerly Physician-Superintendent of James Murray's Royal Asylum, Perth. 

During the last two years the Scottish Division of the Association has 
suffered the loss of two of its honoured members in Sir Thomas Clouston and 
Dr. Turnbull. We have now to deplore the passing of Dr. Urquhart, of the 
Murray Royal Asylum, Perth. This occurred at Eastbourne on July 31st—the 
same date as that on which there also died his life-long friend, Dr. Hayes 
Newington, of Ticehurst. It is not too much to say that the Medico-Psychological 
Association was deprived on that day of two of its most representative and 
esteemed surviving members in England and in Scotland. 

Dr. Urquhart was a regular and prominent attender of the meetings of the 
Association, he played an impressive and effective part in its deliberations, and he 
engaged actively in many phases of its practical work. He was known personally 
to, and much liked by, very many members of the Association, and the value of the 
services he rendered was recognised by all. In recognition of these facts the last 
distinction conferred upon hini was most appropriately his election as an honorary 
member of the Association. We feel it now to be a duty to record, as a tribute to 
his memory, some impressions of him and his work in the pages of this Journal, in 
the welfare of which he took so affectionate an interest while he was its Joint 
Editor. 

As is so often the case with those who make a deep impression on their fellows, 
Dr. Urquhart’s strong personality was his outstanding feature. He was a big man 
—big in mind and heart, as well as in body. He was also a highly cultured one. 
The range of his interests was exceptionally wide, his industry was great, and he 
had cultivated, apparently with ease, his many mental gifts. He had in the first 
place a very strong love of art in all its aspects; he understood it in no ordinary 
way, and he was proficient in the technique of several branches of it. In the 
special sphere connected with his professional work he applied these artistic 
talents to .the architecture and decoration of buildings connected with the care of 
the insane. The utilitarian details of asylum construction, such as door-handles 
and water-taps, were, however, also at his finger-tips. We believe that no one in 
our profession was his superior in knowledge of these matters, and he contributed 
articles on asylum construction to Hack Tuke’s Dictionary of Psychological 
Medicine. During his period of office as Superintendent, among other structural 
improvements introduced by him, a recreation hall and two new villas were added 
to the asylum, in the designing of which he helped largely. A beautiful little 
chapel with an organ was also designed by him, and built by contributions from 


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630 ‘ NOTES AND NEWS. [Oct*. * 

friends of patients and of the asylum and from his own personal friends. Having 
been born in Elgin, he early took an interest in its cathedral, and later on in 
ecclesiastical architecture in .general. Architecture and music were two powerful 
lodestones to him all his life, and drew him to most of the old chateaux and 
cathedrals ir. France and to the Wagner Festival at Baireuth. He encouraged 
musical and theatrical performances among his patients and staff, and no amateur 
ever made a more acceptable stage-manager. 

Apart from work, books were, however, his greatest interest. He was keenly 
interested in literature, both medical and general, but he was also a lover of books 
themselves. He formed an interesting library, which was housed in most artistic 
surroundings, the designing of which by himself was a labour of love and a 
perpetual joy to him when completed. One of his hobbies was to collect books 
printed in the city of Perth, and his collection of books dealing with insanity was. 
specially complete in volumes now out of print. He prepared the article on 

Medical Literature ” for the Dictionary. 

These qualities and interests which have been described were the means of 
bringing Dr. Urquhart into contact with many people, and as he was eminently 
sociable and loved his fellow man he formed a wide circle of friends, both within 
and without the medical profession. Being of a genial disposition, and gifted with 
a strong sense of humour and the ability to tell a story well, he was always good 
company, whether he was in the privacy of his library with only one or two friends 
or at a public function. His post-prandial oration when President of the Asso¬ 
ciation in Edinburgh was listened to with delight by all who were present. He 
was also prepared to put himself to an extraordinary amount of trouble to help 
friends who came to him for advice and information on subjects in which he was 
interested. He would, for example, provide designs to one for an artistic object of 
some kind, to another supply reasons for and against the belief that Napoleon 
suffered from epilepsy, while a third would receive an outline itinerary for a visit 
abroad, a list of hotels to go to, and numerous introductions to friends on the 
Continent. He had not only hosts of friends in this country, but since the death 
of Dr. Hack Tuke no member of our Association was so well known abroad or had 
so many personal friends among alienists in Europe and America. 

When Dr. Urquhart was a young man he enjoyed the opportunity of travelling 
round the world, and he never lost his interest afterwards in travel or in foreign 
peoples and countries. Almost every year he devoted his holiday to visiting some 
country, where he studied architecture, pictures, books, and music, inspected the 
asylums, and added to his circle of friends. In this way he spent a holiday in 
Vienna, Leipzig, or Paris, or saw what was to be seen in Greece, Spain, or 
Sweden. He had travelled in almost every country in Europe, and in 1897 he 
made a long-desired journey to America, where he made many friends (among 
whom may be specially mentioned Dr. Alder Blumer), and from which he brought 
home many new ideas. He was an honorary member of Belgian, French, Italian, 
Canadian, and American associations connected with the care of the insane. 

» Kindness of heart was a prominent trait of his character, and he managed the 
Murray Asylum and the affairs of its patients and its officials with a fatherly and 
benevolent interest. He believed in bringing patients and officials together socially 
as much as possible, and his ideal was to convert the institution into a home and 
its inmates into a happy family, and he probably attained a higher measure of 
success in this than any other superintendent in Scotland. His benevolent 
instincts and activities were, however, not limited to the interests of the inmates 
of the institution of which he was head. He was an active member of 
charitable institutions in Perth itself, as well as of local antiquarian and literary 
societies. He took a great interest and a leading part in the British Medical 
Association. Whatever he took up, too, he took up keenly, and was never content 
to play a passive part. He loved to be in the heart of all movements, and he was 
consequently never happier than when he was in London. He was essentially a 
town 'and not a country man, and neither shooting, fishing, nor golfing interested 
him at all. It was characteristic of him and indicative of his native gentleness that 
he gave up shooting when a young man because of the painful impression made 
upon him by the sufferings of a wounded animal. 

Such were the qualities of the man who succeeded Dr. Murray Lindsay as 
Superintendent of the Royal Asylum at Perth in the year 1880 at the early age of 


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twenty-eight. Important and varied as the qualifications for a post charged with 
such responsibilities must be, Dr. Urquhart possessed these in a measure seldom 
met with. In Dr. Mercier’s words, “ He was the very model and exemplar of the 
highest class of physician.” He was a master of his profession, and he showed his 
interest in his medical work by returning to a London hospital for the purpose of 
refreshing his knowledge several years after graduation. He was particularly 
interested in the problems connected with heredity, and this was the subject of the 
course of lectures he delivered as Morison Lecturer of the Royal College of 
Physicians of Edinburgh in the year 1907. It had also been the subject of his 
Presidential Address to the Association in 1898. He was recognised as an 
authority -on the Lunacy Laws of Scotland, on which subject he contributed 
articles and was frequently consulted by his medical brethren. It is understood 
that he had laboriously compiled a complete manuscript index of these laws, which 
it is hoped will be carefully preserved. Finally, with regard to administration, he 
introduced many reforms on coming to Perth, and it need only be said of him, to 
indicate his interest in this subject, that he was one of that enterprising quartette 
of Scottish superintendents who compiled the first edition of the Handbook for 
Attendants on the Insane for the Scottish Division, which was afterwards adopted 
by the Medico-Psychological Association. Dr. Urquhart was the last survivor of 
these four collaborators, the others who pre-deceased him being Dr. Campbell 
Clark, Dr. Mclvor Campbell, and Dr. Turnbull. Now that they have all passed 
away it is to be hoped that the Association may soon decide to perpetuate their 
memory in some fitting manner, and record a sense of the obligation it owes them 
for their useful pioneer work. Dr. Urquhart was among the first to recognise the 
desirability of the matron of a medical institution like a modern mental hospital 
being fully trained as a hospital nurse, although he had been anticipated by Dr. 
Campbell Clark at Bothwell and Dr. Maclaren at Larbert in appointments they 
had made. His insistence on this point has met with success, and the principle he 
advocated has been universally accepted in Scotland. In conclusion, it is scarcely 
too much to say of Dr. Urquhart’s knowledge of asylum affairs, medical, legal, and 
administrative, that it was encyclopredic in character. 

Dr. Urquhart’s industry, keenness, and multifarious activities, including that of 
an Editor of this Journal, imposed a severe strain on his constitution. Everything 
he put his hand to he did well, but to effect this he required to labour from 9 a.m. 
till the small hours of the morning in order to overtake his work—much of it a self- 
imposed task. Little wonder, then, that at a comparatively early age this con¬ 
tinuous overwork told upon him. 

On account of ill-health he retired in 1913 from the post he had held with 
honour for thirty-four years. He was then appointed Consulting Physician, and 
was presented by his many friends with his portrait in oils by Mr. Fiddes Watt, 
A.R.S.A. His Alma Mater conferred upon him the degree of LL.D. He was 
succeeded by Dr. Dods Brown, Senior Assistant Physician of the Royal Edinburgh 
Asylum at Morningside. 

As already recorded he died on July 31st, 1917, at the age of sixty-five yeaij, 
and he is survived by his widow, two sons, and three daughters. Both of the sons \ 
are in the Army, the elder being a captain in the R.A.M.C. 

George M. Robertson. 


Dr. Arthur Edward Patterson. 

Dr. Arthur Edward Patterson, Senior Assistant Medical Officer, City of 
London Mental Hospital, passed away after a short illness on August 26th. He 
was the son of the late Major D. A. Patterson, and received his early education in 
Aberdeen, subsequently proceeding to Aberdeen University, where he qualified 
M.B., C.M. in 1885. He obtained the M.D. in 1896. After a short period of 
general practice, he entered upon what was to become his life work as Assistant 
Medical Officer to the Derby Borough Asylum. He was appointed Senior 
Assistant Medical Officer of the City of London Mental Hospital on January 1st, 
1892. A conscientious, painstaking officer he proved himself to be, and his cheery 
manner and true kindness of heart ensured his popularity with the staff and 
endeared him to his patients, who were devoted to him. 


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NOTES AND NEWS. 


[Oct, 

He was a member of the British Medical and Medico-Psychological Associations, 
and published several articles in the medical papers, one of which, “ An Analysis 
of 1,000 Admissions into the City of London Asylum,” appeared in the Journal 
of Mental Science. 

At one time he took a keen interest in Masonry, and was Past Master of the 
Adelphi Ledge No. 1,670. 

The first part of the funeral service took place in the Asylum Chapel on 
August 30th. The Visiting Committee was represented by Sir George Wyatt 
Truscott, Bart. (Chairman) and several other members. 


ROLL OF HONOUR. 

We greatly regret to hear of the death of Lieut. A. N. Oakshott, only son of 
Dr. James Oakshott, Medical Superintendent of the Waterford Asylum, at the 
Front in France. Lieut. Oakshott’s career in the Army was but short, but short as 
it was he had endeared himself by his winning ways to every man in his company 
and to his brother officers, from many of whom his father has received touching 
letters of regret and sympathy. His Major wrote: “He died very gallantly on 
the early morning of September 17th while leading his platoon in an attack on 
the German lines. Death must have been instantaneous, but before he met it he 
had shown an example of courage and determination which was most inspiring 
to his men. He was exceedingly popular in the battalion both among officers and 
men, and his death has been a great loss to us all.” 

We offer Dr. and Mrs. Oakshott our sincerest sympathy in their sore 
bereavement. 


THE LIBRARY. 

The Committee have to thank Dr. E. F. Ballard for presenting to the Library 
his book Epitome of Mental Disorders. 

The following books have been purchased : Spiritualism and Sir Oliver Lodge , 
by Dr. Mercier; Shell Shock and its Lessons, by G. Elliot Smith, M.D. and T. H. 
Pear, B.Sc. 

R. H. Steen, 

. Hon. Sec., Library Committee. 


NOTICE. 

Old Numbers of The Journal of Mental Science. 

The Association has in its possession a number of old copies of the Journal o 
Mental Science. It has been decided to offer these to Asylum authorities for 
Asylum Libraries. Application is to be made to Mr. Bethell, 11, Chandos Street, 
Cavendish Square, London, W.i, and applications will be dealt with in the order of 
receipt. All expenses of carriage must be prepaid. 

R. H. Steen, 

Acting Hon. General Secretary 


APPOINTMENTS. 

Marman, John, B.A., M.B., B.Ch., N.U.I., Medical Superintendent, Count 
Asylum, Gloucester. 

McDowall, Colin F. F., M.D., B.S.Durh., Medical Superintendent of Ticehurst 
House. 

Costello, Christopher, M.B., B.Ch., N.U.I., Assistant Medical Officer, Richmond 
District Asylum, Dublin. 

Ellis, V. C., M.B., B.Ch., N.U.I., Assistant Medical Officer, Richmond District 
Asylum, Dublin. 


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1917 -] NOTES AND NEWS. 63J 

NOTICE TO CONTRIBUTORS. 

N.B. —The Editors will be glad to receive contributions of interest, clinical 
records, etc., from any members who can find time to write (whether these have 
been read at meetings or not) for publication in the Journal. They will also feel 
obliged if contributors will send in their papers at as early a date in each quarter 
as possible. 

Writers are requested kindly to bear in mind that, according to lix(u) of the 
Articles of Association, “ all papers read at the Annual, General, or Divisional 
Meetings of the Association shall be the property of the Association, unless the 
author shall have previously obtained the written consent of the Editors to the 
contrary.” 

Papers read at Association Meetings should, therefore, not be published in other 
Journals without such sanction having been previously granted. 



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INDEX TO VOL. LXIII. 


Part I.—GENERAL INDEX. 

Anarchism in the Eighteenth Century, 127 
Appointments, 162, 459, 632 

Armstrong-Jones, Sir Robert, congratulations on his knighthood, 302 

„ „ „ correspondence with Dr. Frederick St. John Bullen, 

re Dreams and their interpretations, 304 
Art, orientation of human and animal figures in, 506 
Asylum reports for 1915, 281 

it n 11 '9 1 ®, 43 2 t 

„ Workers’ Association, annual report for 1916 and annual meeting, 442 
Auditors, report of the, 610 

Bacillus of influenza, chronic affections by the, and nervous disorders, 89 
Balance sheet, 609 

Barn wood Hospital report for 1915, 286 

Battle psycho-neuroses, some notes on, 400 

Belfast Asylum report for 1915, 293 

Bio-chemistry of the brain, 106 

Blandy, Capt., death of, 436 

Board of Control, correspondence with, 303 

Brain, bio-chemistry of the, 106 

Brains, normal and pathological, relative amounts of grey and white matter in 
some, 93 

Brains, pathological and normal, water contents of some, 98 
Brown, Dr. Ralph, obituary, 161 

Bullen, F. St. John, correspondence with Sir Robert Armstrong-Jones re Dreams 
and their interpretation, 304 

Calumny, note on, 125 

Carmarthen Asylum report for 1915, 281 

Carotids, compression of, the, in epilepsy and hysteria, 121 

Cerebral tumour, with tumour of the skull, case of, 250 

Certificate of proficiency in nursing and attending the mentally defective, dis* 
cussion on, 613 

Chadwick Lecture: on mental hygiene in shell-shock during and after the war, 

467 

Charlton, Porter, the crime of, 600 
Classification of dreams, 413 

Clinical neurology and psychiatry, 119, 274, 418, 598 
„ notes and cases, 100, 250, 400, 568 
College of Nursing, Ltd., and the State Registration of Nurses, 579 
Conduct and insanity, 581 
Conduct, theory of, 565 


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636 


INDEX. 


Confusional states, management of, with special reference to pathogenesis, 

Consciousness, pure tactile-motor, 268 

Contributors, notice to, 163 

Correspondence, 303, 454 

Council, report of, 607 

Crichton Royal Institution, report for 1915, 288 
Crime in dementia prsecox, too 
Criminals, mental defects in, 16 
Cyst in the third ventricle, 252 

Delinquency, psychiatric study of, 422 

Delirium, systematised, of persecution, with psycho-sensory hallucinations, 258 
Dementia, epileptic, with recovery, 278 

„ prxcox associated with uncinariasis, 424 

„ „ crime in, 100 

Dial as a hypnotic remedy, 123 
Disease and domesticity, 124 
Domesticity, disease and, 124 
Dorsetshire County Asylum, report for 191s, 281 
Down District Asylum, report for 1915, 294 

Dreams and their interpretation, with special application to Freudism, with dis¬ 
cussion, 200 

„ classification of, 413 

Edinburgh, Morningside Asylum, reports for 1915 and 1916, 289 
Editors, report of the, 608 

Educational Committee, report of the, 1916-17, 611 

Egypt, annual report for the year 1916 of the Government asylums in, 432 
Election of honorary members, 612 

„ of members, 144, 296, 436, 613 
„ of Officers and Council, 606 
Emperor, madness of a, or the aberration of a nation, 426 
Enniscorthy Asylum, report for 1915, 294 
Epilepsy: a metabolic disease, 36 

„ and hysteria, compression of the carotids in, 121 
Epileptic dementia, with recovery, 278 
Epitome of current literature, 106, 266, 413, 594 
Essex County Asylum (Brentwood), report for 1915, 282 
Ethics, Spanish, problems of contemporary morals, 132 
Eugenic factors in Jewish life, 425 
Evil eye, man supposed to be possessed of an, 134 
Ewart, Dr. Charles Theodore, obituary of, 457 

Examination for nursing certificates : list of successful candidates, 155, 624 

„ for the certificate in nursing and attending the mentally defective 

discussion on, 613 

,, „ „ in nursing and attending the mentally defective- 

regulations, 620 

„ „ „ in psychological medicine, 1917,622 

„ paper for the Gaskell Prize, 1917, 621 

Fatigue, relative, laws of, 594 

Fear, psychology of the effects of panic fear in war time, 346 
„ transformation of, 268 
Fife and Kinross Asylum report for 1915, 292 
Functional gastric disturbance in the soldier, 76 

„ „ „ „ discussion, 144 

Gaskell Prize, examination paper for the, 621 
„ „ presentation of the, 614 

Gastric disturbance, functional, in the soldier, 76 
Glamorganshire County Asylum report for 1915, 283 
Glasgow, Gartnaval Asylum report for 1915, 291 


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INDEX. 


637 


Hallucinations, in the sane, 328 

„ ,, „ discussion on, 437 

„ psycho-sensory, systematised delirium of persecution, with, 258 

Hanbury, Langton Fuller, death of, 296 
Hingtson, Joseph Tregelles, obituary, 312 
Historical, 136 
Honours for war service, 623 
Honorary members, election of, 612 
Hostels for heroes, meeting in support of, 450 
Hughes, Charles H.,death of, 295 
Hypnotic remedy, dial as a, 123 

Hypothesis concerning some manifestations of insanity, 575 

Hypothesis, suggestion as a fact and as a, 107 

Hysteria and epilepsy, compression of the carotids in, 121 

Hystero-traumatism, with so-called " physiopathic ” syndrome cured by re¬ 
education, 602 

Influenza, chronic infections by the bacillus of, and their importance as causes of 
nervous disorders, 89 
Insanity, conduct and, 581 

„ from the patient’s point of view, 568 
„ hypothesis concerning some manifestations of, 575 

„ in some of Shakespeare's female characters and feminine psychology, 428 
„ treatment of, 122 

Internal secretions, vegetative nervous system and the, 225 
Intuition, 266 

Inverness District Asylum report for 1914, 293 

Ireland, sixty-fifth report of the Inspectors of Lunatics for the year ending December 
31st, 1915, 405 

Irish Division meeting, 148, 297, 620 


ackson, Dr. Hughlings, on mental disorders, 316 

ewish life, eugenic factors in, 425 

ournals of Mental Science, old numbers of, 632 

Korsakow’s psychosis in association with malaria, 423 

Laws of relative fatigue, 594 
Library Committee report, 611 

„ notice respecting, 162, 313, 458, 632 
Literature, psychology in, 428 
London County Asylum, report for 1915, 283 

Madhouses for soldiers, 451 
Madness and unsoundness of mind, 488 

„ ,, „ discussion on, 615 

„ of an emperor, or the aberration of a nation, 426 
Malaria, Korsakow's psychosis in association with, 423 
Materialism and spiritualism, 494 
Medico-legal aspects of mental deficiency, 280 

Medico-Psychological Association,examinationpaperfortheGaskcll Prize, 1917,621 
» » » meetings, 143, 295,435,606 

,1 „ „ regulations for the training for the certificate in 

nursing and attending on the mentally de¬ 
fective, 613, 620 

„ „ „ seventy-sixth annual meeting, 606 

r,> ,1 „ special meeting for election of Treasurer, 623 

Meetings, dates of, 162, 612 
Members, election of, 144, 296, 436, 613 
Mental After-Care Association : annual meeting, 300 

„ and nervous symptoms following naval disasters, 418 
„ cases, war hospital for, Renfrew District Asylum, 238 
„ defects in criminals, 16 

LXIII. 42 


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638 INDEX. 

Mental deficiency, medico-legal aspects of, 280 
,, diseases, Zola's studies in, 165 
„ disorders, Dr. Hughlings Jackson on, 315 
11 hygiene in shell-shock, during and after the war, 467 
„ power, origin of, 56 
„ regression : its conception and types, 421 
Mentality of those who commit suicide, 598 

Mentally defective, certificate of proficiency in nursing and attending the, dis-- 
cussion on, 613 

Metropolitan Asylums Board report for 1915, 284 
Mind, unsoundness of, madness and, 488 
Moral diseases, prophylaxis and therapy of, 279 
Montrose Royal Asylum report for 1915, 292 
Murdock, Dr., death of, 436 

Naval disasters, mental and nervous symptoms following, 418 
Nerve-shocked soldiers, 452 

Nervous and mental symptoms following naval disasters, 418 

,, disorders, chronic infections by the bacillus of influenza, as causes of, 89 
„ system, vegetative, and the internal secretions, 225 
Neurology, 106 

„ clinical, psychiatry and, 119, 274, 418, 598 
Neuroses of the war, 119, 418 
„ war, treatment of, 418 
Newington, Dr. H. F. Hayes, obituary, 461 
Northern and Midland Division meetings, 153, 442 
Notes and news, 143, 295, 435, 606 
Notice of meetings, 162, 612 
Notices by the Registrar, 162,313,459 

Obituary.—Blandy, Capt., 436 

Brown, Dr. Ralph, t6t 
Ewart, Dr. C. T., 457 
Murdock, Dr., 436 
Newington, Dr. H. Hayes, 461 
Orange, Dr. W., 306 
Patterson, Dr. A. E., 631 
Rawes, Dr. H., 456 
Ribot, T., 161 
Smyth, Dr. R. B., 312, 435 
Tuke, Dr. T. Seymour, 310, 435 
Turnbull, Dr. A. R., 158 
Urquhart, Dr. A. Q., 629 

Old number of the Journals of Mental Science, 632 
Omagh Asylum report for 1915, 295 
Optimism and pessimism, 1 

Orientation of human and animal figures in art, 506 
Orange, Wm., death of, 296 
„ obituary, 306 

Paranoiic artist, works of a, 274 

Parliamentary Committee, report of the, 1916-17, 611 
Patient’s point of view, insanity from the, 568 
Patterson, Dr. A. E., obituary, 631 
Pellagra, case of, in Central Asylum, 578 
Pessimism and optimism, 1 

Philosophical culture in theocratic Spain, 136, 140 
Physiological psychology, 107, 268, 413, 594 
President, vote of thanks to the, 615 
Prophylaxis and therapy of moral diseases, 279 
Psychiatric study of delinquency, 119, 274, 418, 598 
Psychiatry, clinical neurology and, 418 


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INDEX. 


639 


Psychical activity, three laws of, 113 
Psychoanalysis, a new psychosis, 61 

„ in relation to sex, 537 

Psychological introspection, reflections on, 116 

„ medicine, examination for the certificate in, 622 
Psychology, 266 

„ feminine, 428 

„ in literature, 428 

„ of fear and the effects of panic fear in war time, 346 
„ physiological, 107, 268, 413, 594 

Pyscho-neuroses, Battle, some notes on, 400 
Psycho-physiological theory of right-handedness, 596 
Psycho-sensory and psycho-motor disturbances, 555 
Psychosis, Korsakow's, in association with malaria, 423 

Rawes, Dr. Wm., obituary, 435. 456 
Registrar, notices by the, 162, 313, 459 

Renfrew District Asylum as a war hospital for mental cases, 238 
Report of Council, 607 
Report of the auditors, 610 

,, of the editors of the Journal, 608 
„ of the Educational Committee, 1916-17, 611 
„ of the Library Committee, 611 
„ of the Parliamentary Committee, 1916-17, 611 
„ of the treasurer, 608 

Report: sixty-fifth report of the Inspectors of Lunatics (Ireland) for the year 
ending December 31st, 1915, 405 

Reports: annual report for the year 1916 of the Government asylums in Egypt, 
432 

Reviews, 102, 260, 405, 585 
Ribot, Theodule, obituary, 161 

Right-handedness, psycho-physiological theory of, 596 
Royal Earlswood Institution, report for 1915, 287 

,, Eastern Counties Institution, report for 1915, 288 
„ Medical Benevolent Fund, War Emergency Fund of the, 454 
Roll of honour, 632 

Sane, hallucinations in the, 328 
„ „ „ discussion on, 437 

Scottish Division meetings, 152, 296 
Sex, psycho-analysis in relation to, 537 
Shakespeare’s female characters, insanity in some of, 428 
Shell-shock, mental hygiene in, during and after the war, 467 
Shock and the soldier, 418 

Skull, tumour of the, with cerebral tumour, case of, 250 
Smith, Dr. Percy, honours for, 622 
Smyth, Robert Brice, obituary, 312, 435 
Sociology, 124, 280, 425 

Soldier, functional gastric disturbance in the, 76 
„ shock and the, 418 
Soldiers, madhouses for, 451 
„ nerve-shocked, 452 

South-Eastern Division of the Medico-Psychological Association, meetings, 154 
South-Western Division, 299 
Spain, theocratic, philosophical culture in, 136 
Spanish Ethics: problems of contemporary morals, 132 
„ philosophical culture, revival of, 140 
Spiritualism, materialism and, 494 
Springfield Military Hospital, 454 
Suggestion as a fact and as a hypothesis, 107 
„ treatment by, 122 
Suicide, mentality of those who commit, 598 


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640 


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Treasurer, Dr. James Chambers, elected, 623 
Treasurer's report, 608 

Tuberculosis, incipient pulmonary, premonitory ailments indicative of, 605 

Tuke, Thomas Seymour, obituary, 310, 435 

Tumour, cerebral, with tumour of the skull, case of, 250 

Turnbull, Dr. A. R., obituary, 158, 296 

Uncinariasis, dementia prxcox associated with, 424 
Urquhart, Dr. A. R., obituary of, 629 

Vegetative nervous system, and the internal secretions, 225 
Ventricle, third, cyst in the, 252 

War Emergency Fund of the Royal Medical Benevolent Fund, 454 

„ hospital for mental cases : report of first year at Renfrew District Asylum, 238 
„ neuroses of the, 418 
„ „ treatment of, 418. 

„ service honours, 623 

„ shell-shock and mental hygiene in, during and after the war, 467 
„ some neuroses of the, 119 

„ time, psychology of fear and the effects of in, 346 
Warnock, Dr., a tribute to, 623 

Water content of some normal and pathological brains, 98 
Waterford District Asylum, attack on medical superintendent, 154. 

Wiltshire County Asylum, report for 1915, 285 

Writing, automatic, of children from two to six years, indicative of organic 
derivation of writing in general, 273 

York, the Retreat, report for 1915, 287 
Yorkshire, West Riding Asylum report for 1915, 286 

Zola’s studies in mental diseases, 165 


Part II.—ORIGINAL ARTICLES. 

Adams, J. Barfield, orientation of human and animal figures in art, 506 
„ „ Zola’s studies in mental diseases, 166 

Armstrong-Jones, Sir Robert, dreams and their interpretation, with special applica - 

tion to Freudism, with discussion, 200 
„ „ psychology of fear and the effects of panic fear in 

war time, 346 

Ballard, Capt. E. Fryer, some notes on battle psycho-neuroses, 400 

Cruickshank, John, relative amounts of grey and white matter in some normal and 
pathological brains, 93 

„ „ water content of some normal and pathological brains, 98 

Delage, Yves, psychoanalysis, a new psychosis, une psychose nouvelle, la psycho¬ 
analyse-, translated by T. Drapes, 61 
Donkin, Sir Bryan, notes-on mental defects in criminals, 16 

Ellis, Havelock, psychoanalysis in relation to sex, 537 

Farnell, Frederic J., remarks upon the vegetative nervous system and the internal 
secretions, 225 

Hotchkis, Major R. D., Renfrew District Asylum as a war hospital for mental 
invalids; some contrasts in administration; analysis of cases admitted during 
the first year, 238 

Insanity from the patient’s point of view, 568 


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INDEX. 


641 


Jones, Evan, see Prior, Guy P. U. 

McDougall, Alan, theory of conduct, 565 

McDowall, Capt. Colin, functional gastric disturbance in the soldier, 76 

„ „ „ .. discussion, 144 

Maudsley, Henry, materialism and spiritualism, 494 
„ „ optimism and pessimism, 1 

Mercier, Charles A., madness and unsoundness of mind, 488 

„ „ „ „ .. discussion on, 615 

Monrad-Krohn, G. H., on psycho-sensory and psycho-motor disturbances, 555 
Mott, Major F. W., Chadwick lecture, April 26th, 1917, mental hygiene in shell¬ 
shock during and after war, 467 

Prior, Guy P. U., and Jones, Evan, epilepsy: a metabolic disease, 36 
Redfield, Casper L., origin of mental power, 56 

Robertson, W. Ford, chronic infections by the bacillus of influenza and their im¬ 
portance as causes of nervous disorders, 89 
Ross, D. Maxwell, notes on a case of cyst in the third ventricle, 252 

Samuels, Wm. F., a case of pellagra in Central Asylum, 575 
Savage, Sir George, Dr. Hughlings Jackson on mental disorders, 315 
Steen, Robert Hunter, hallucinations in the sane, 328 

Tattersall, John, case of cerebral tumour with tumour of the skull, 250 
Toleda, R. M., case of systematised delirium of persecution with psycho-sensory 
hallucinations, 258 

„ „ crime in dementia praecox, 100 

Williams, Tom A., management of confusional states, with special reference to 
pathogenesis, 389 * 


PART III.—REVIEWS. 

Ballard, E. Fryer, An Epitome of Mental Disorders, 1917, 587 

Craig, Maurice, Psychological Medicine: A Manual of Mental Diseases for Prac¬ 
titioners and Students, third edition, 1917, 586 

Cunningham, Gustavus Watts, A Study in the Philosophy of Bergson, 262 

De Fursac, J. Roques, Manual of Psychiatry, fourth edition, 1916, 585 

Downward Paths: An Inquiry into the Causes which Contribute to the Making o 
the Prostitute ; with a foreword by A. Maude Royden, 1916, 264 

Eder, M. D., War Shock, 592 

Elliot, Hugh, Herbert Spencer, " Makers of the Nineteenth Century Series,” 1917, 
260 

Freud, Prof. Sigmund, Wit and its Relation to the Unconscious, translated by 
A. A. Brill, 588 

Herbert, S., Physiology and Psychology of Sex, 1917, 590 

Ives, George, History of Penal Methods: Criminals, Witches, Lunatics, 1915, 593 

Leeson, Cecil, The Child and the War, 590 

Lodge, Sir Oliver, Raymond : or Life and Death, 408 

Maeder, A. E., The Dream Problem, translated by Drs. Frank Mead Hallock and 
Smith Ely JeHiffe. Nervous and Mental Disease Monograph Series, No. 22, 
263 

Maudsley, Henry, Organic to Human: Psychological and Sociological, 102 

Northcote, Hugh, Christianity and Sex Problems, 408 

Sixty-fifth Report of the Inspectors of Lunatics (Ireland) for the year ending 
December 31st, 1915, 405 


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642 


INDEX. 


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Part IV.—AUTHORS REFERRED TO IN THE EPITOME. 


Adler, Herman, 422 
Adrian, E. D., 418 
Andrd, Eloy Luis, 132 
Assagioli, Dr. Roberto, 413 

Boirac, E., 107 
Bondurant, Dr. E. D., 424 
Bunge, C. O., 113 

Carlill, H., 423 

Clarke, J. Michell, 119, 418 

Craig, James, 124 

Dearborn, G., 2 66 
Del Greco, Prof. Fr., 428, 
598 

Dodge, R., 594 


Ferrand, Dr. Jean, 602 
Fishberg, M., 425 

Gordon, Alfred, 280 

Hensard, M. A., 418 

Ingenieros, Jos^, 136, 140 
Ioteyko, Mile., 596 

Lugaro, Prof. G., 426 

Ossip-Lourie, 125 

Pighini, Giacomo, 106 
Proal, L., 127 

Ratto, L., 279 


Raymond, Dr. Paul, 605 
Ribot, Th., 268 
Rivarola, Rodolfo, 116 

Sacerdote, Anselmo, 274 
Smith, G. Elliot, 418 
Smyly, C. P., 122 

Thom, D. A., 278 
Tsiminaskis, C., 121 

Valtorta, Dr. Dario, 600 

Wells, F. L., 421 
Wyczolkowska, A., 273 

Yealland, L. R., 418 


ILLUSTRATIONS. 

Photographs to illustrate Dr. Tattersall's paper, 252 
Diagram to illustrate Mr. C. L. Redfieid’s paper, 59 
Tables to illustrate Drs. Prior and Jones’s paper, 37, 38, 39, 44 
Tables to illustrate Dr. Cruickshank’s papers, 97, 99 


ADLARD AND SON AND WEST NEWMAN, LTD., LONDON AND DORKING. 


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lilt ■■ill 111* i i M 

32101 074924497 


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